Archives

For Апрель, 2009.

PLEURISY

The pleura are two delicate membranes which surround the lungs. The condition in which they become inflamed, as the result of either a bacterial or a viral infection, is known as pleurisy. It is characterised by sharp or stabbing pains in the chest or shoulder when a breath is taken.

Normally the pleura move smoothly against one another as the lungs expand and contract during breathing. A thin film of fluid lubricates the membranes. When an infection is present, the pleural fluid becomes sticky and the pleura rub against one another. This ‘pleural rub’ can be heard clearly through a stethoscope. Sometimes an excess of pleural fluid is produced, protecting the inflamed membranes from friction. This pleural effusion can be detected when a dull note is produced by tapping the chest wall. A raised temperature and general feeling of unwellness is a further symptom.

Pleurisy is generally a minor illness. However in some cases it may be a sign of a more serious disease such as pneumonia, a blood clot in the lung, lung cancer or tuberculosis. It is therefore imperative that a doctor be consulted before undertaking any form of complementary treatment.

Homeopathic remedies can be used to treat pleurisy. Chest and back compresses can help reduce internal inflammation. Large doses of Vitamin C and Vitamin A may be recommended by a naturopath.

*31\69\2*

ST JOHN’S WORT AT WORK: MERCEDES’ STORY

Mercedes is a social worker in her early fifties who makes a distinction between the two different kinds of emotional suffering that she has experienced in the course of her life. The first type, ‘the remains of a difficult childhood’, took her some time to sort out. But even after being satisfied that she had taken care of the residue of her childhood, she found herself left with ‘a light film of dysthymia, which lasted for years and was probably inherited from my parents, both of whom suffered from depression’. Dysthymia is a condition of chronic, persistent low-grade depression.

As a result of her low mood, Mercedes would procrastinate, putting off unpleasant tasks such as housekeeping or paperwork in favour of activities she greatly preferred, such as knitting, crocheting or playing with her birds and her dogs. Naturally introverted, she would withdraw in social situations, where she always felt as though she was holding back.

Mercedes decided to try St John’s Wort because it was natural and she understood it to cause few side-effects, starting with 300 mg three times a day. It took at least five weeks to notice an effect, and even then it was subtle though palpable. She stopped procrastinating as much and was more outgoing in social situations. Her husband noted the change, remarking that her dark moodiness had lifted and that she now seemed ‘lighter’. She experienced no side-effects whatsoever, plans to continue to take the herbal anti-depressant and is interested in recommending it to several of her clients.

The stories of Matthew and Mercedes illustrate how versatile an anti-depressant St John’s Wort is, capable of bringing someone out of the dark depths of despair, as in Matthew’s case, or of alleviating the milder and more subtle dysthymia which affected Mercedes. The dosages needed by these two individuals were quite different, with Matthew responding to 300 mg per day while Mercedes used the more conventional 900 mg per day dosing schedule. Optimal dosages of other types of anti-depressant medications vary widely and there is no reason to suppose that this will prove to be different for St John’s Wort. The size of the patient is not always a good guide to the best dosage, as these two cases illustrate: Matthew is 6-foot tall and weighs 13 stone, yet required only one-third the dosage used by Mercedes, who is a small woman. Another difference between Matthew and Mercedes is the time scale of the effects of the herbal anti-depressant, from the almost immediate beneficial effects experienced by Matthew to the five-week lag before the treatment kicked in for Mercedes. Such observations indicate why it can be useful to experiment with different dosages for different people and why it is important to persevere for several weeks before declaring a trial of St John’s Wort to be a failure.

*7\75\2*

CASE STUDY: BEHAVIOR PROBLEMS, HEARING LOSS, AND HYPERACTIVITY

David Hart was eight years old when he was brought to me. His problems were obvious: his face was never at peace, but was wracked by spasms; he was continually sniffing, blinking, and squinting. His eyes were red and rimmed by dark circles. Although his grades were average, he had frequent temper tantrums at school and at home.

In addition, David had a hearing problem, which seemed to increase as he grew older. He complained of a ringing in his ears, a condition called tinnitus. This had been unsuccessfully treated with decongestants and antihistamines. Sometimes he complained of having a «bug in his ear.» The slightest noise in class distracted him, since then he could no longer hear the teacher distinctly.

The routine five-day water fast in the Ecology Unit worked wonders: the mouth tic, eye-blinking, and hyperactivity disappeared. So, too, did the bags under the eyes, which are called «allergic shiners,» a frequent sign of food or chemical susceptibility.

When single foods, known not to have been significantly contaminated with chemicals, were returned to David’s diet, some of them brought on attacks of spasms and facial contortions. The worst offenders in his case were wheat, beef, corn, and blueberries, followed by haddock, cherries, peanuts, and potatoes.

Many foods, however, could be eaten without causing any symptoms, such as crab, chicken, pork, lamb, and onion. When some of these acceptable foods were given to David in their commercial, supermarket form, however, they caused grimaces, hyperactivity, eye circles, and gassiness. The boy became progressively more grouchy and twitchy after the second feeding of «normal» food, and this increased with each subsequent feeding. The avoidance of such foods paved the way for David’s recovery, and the last time I spoke to his family, he was greatly improved and doing well in school.

Like Paul Rossi, David was one of those hyperactive children whose problem was actually caused by a highly individualized reaction to the food and chemical environment, and greatly helped by avoiding those items to which he was allergic.

*60\110\2*

THE BASIC CONCEPTS OF ALLERGIES: INDOOR AIR POLLUTION

It may have occurred to the reader that air pollution plays a role in the problem of chemical susceptibility. This is true, but not in the way most people suspect. For while it is true that outdoor, or ambient, air pollution is a significant source of exposure, a far greater threat is posed by the presence of indoor, or domiciliary, air pollution.

Indoor air pollution? The term itself is unfamiliar and strange to most people, who tend to think of air pollution solely in terms of smog. Yet the home itself generates combustion products or is directly exposed to them, and many household products give off noxious fumes.

Indoor air pollution is particularly dangerous because exposure to it is so constant. Outdoor air pollution comes and goes; indoor pollution is ever-present, and thus its effects generally remain well hidden. In this it obviously resembles food allergy: as has been explained, allergy to uncommonly eaten foods is readily detected; the real danger comes from allergy to the ordinary foods which we take for granted.

My involvement with the problem of indoor air pollution dates from my earliest chemical-susceptibility cases. In the case of Nora Barnes, for instance, pine paneling and other pine products were implicated as a source of chronic illness. In Ellen Sanders’ case, natural gas and pesticide spray resulted in asthma, arthritis, and a host of other complaints. Removal of these pollutants has resulted in her enjoying reasonably good health over a twenty-five-year period.

I first discussed the topic of indoor air pollution in a series of articles published in 1961 and then in my book, Human Ecology and Susceptibility to the Chemical Environment (1962). Shortly afterward, the topic became a matter of public debate. In 1962, the government called a conference on air pollution, the first of its kind, in Washington, D.C. As often happens with such conferences, the program and speakers’ list were announced first, and then the public was invited to attend. Out of a three-day program, only one-and-a-half hours were allocated for open discussion. During the discussion, I rose to say how astounded I was that no reference had been made, in three days of speeches, to indoor air pollution as a separate topic. In my clinical experience, I added, indoor air pollution was eight to ten times more important as a source of chronic illness in susceptible people than ambient air pollution. Outdoor air pollution, I told the gathering, tended to be intermittent and variable, while indoor air pollution was constant. This very constancy made it a source of chronic disease. And of the various materials found in the home, the gas kitchen range, I said, was easily the worst offender. This left some of the experts without words, but on the far side of the room a gentleman rose and confirmed what I had said, adding some telling details of his own. He introduced himself as Francis Silver. He was an engineer from West Virginia, and later became a member of the Society for Clinical Ecology. We had never met before, but he and I had come to almost identical conclusions about the danger of indoor air pollution, as the result of very different experience—he as an engineer of buildings and I as a clinician studying the effects of such buildings on individual health.

In the following years, there were two conferences devoted solely to the topic of indoor air pollution. In general, these were productive, and I spoke at both.

Since the early 1950s, the extent of the problem of indoor air pollution has continued to grow larger. At the present time, it represents a major source of chronic illness among susceptible individuals in the United States. This can be best understood by considering the kinds of exposures which most frequently result in such chronic health problems.

*30\110\2*

CHILDREN’S HEALTH: DRAINING EAR

A draining ear occurs when any abnormal discharge or fluid comes out of the ear canal. The only material that normally comes from the ear canal is wax (cerumen). Earwax is ordinarily brown, though it may be beige or even yellowish if mixed with water when bathing, showering, or swimming. Normally, earwax has only a mild odor, contains no blood, and never flows out in large amounts.

Any other material discharging from the ear canal signals a potentially serious condition. It may be a symptom of a middle ear infection; a boil in the ear canal; swimmer’s ear (infection of the ear canal); rupture (break or tear) of the eardrum by injury or infection; a foreign object in the ear canal; tumour of the middle ear (cholesteatoma); or fracture of the base of the skull.

Signs and symptoms

Abnormal discharge from the ear may be thin and watery, bloody, odorous, cheesy, green, yellow, or white.

Home care

Any drainage from the ear canal (except typical earwax) should be considered abnormal. Do not try to treat a draining ear at home. It should be promptly seen by a physician.

While waiting to see the doctor, pain accompanying a draining ear may be temporarily treated with aspirin or paracetamol pain relievers.

Precautions

• A draining ear should be examined by a doctor within 12 to 24 hours.

• Do not pack cotton into a draining ear. Packing the canal may force the discharge back into the middle ear.

• Do not use a cotton swab or any other instrument to remove material still in the canal.

• Do not attempt to wash out a draining ear since the eardrum may be broken or torn.

Medical treatment

Your doctor will gently clean your child’s ear, inspect it, and diagnose the cause. Depending on what is found in the ear canal, treatment may require oral antibiotics, medicated ear drops, removing a foreign body, an X ray of the child’s skull or mastoid bone, or surgery for cholesteatoma (tumour of the middle ear). In the case of a ruptured eardrum, antibiotics may be required for a long time, until the eardrum is healed and hearing returns to normal.

*55/84/5*

MEDICAL TESTING: TAKING INVENTORY OF YOUR HEALTH

Your Forties

Age 40 is when it’s time to step up your tests, generally getting them every other year instead of every three. It’s also time to start tending to your lower half. Your risk for colon cancer rises sharply when you hit your mid-forties, and your risk for prostate cancer increases as well. In addition to the other aforementioned tests, get this test now, suggests Dr. Goldberg. He also notes that race and personal or family history of illness can change the timing and frequency of medical tests.

Rectal exam: Nobody wants one. Every 40-plus man needs one every year, says

Dr. Goldberg. A digital rectal exam (DRE) – in which your doctor inserts a gloved, lubricated finger into your rectum to feel your prostate-is your best line of defense against prostate cancer.

Your Fifties and beyond

Not much changes between 40 and 50, so long as you’re continuing your regular tests about every two years. At age 50, start getting physicals annually and continue getting the DREs you started getting in your forties. Just add a couple more tests, and you’re set for life, says Dr. Goldberg.

Stool sample: During a DRE, the doctor will also take a tiny sample of stool to test for any traces of blood-a sign of cancer growth or development. Like DREs, this should be done every year, says Dr. Coulehan.

Sigmoidoscopy: Your 50th birthday is a good time to start having this test and then get it done every five years thereafter, says Dr. Goldberg. A sigmoidoscope is a thin, flexible, lighted instrument that actually lets the doctor look into your rectum and large intestine for polyps, or growths that might signal cancer. The test takes just a few minutes. And don’t worry. The sigmoidoscope is so thin and flexible, doctors say that although the test is uncomfortable, it is not painful. If you are at higher risk because of family or personal history, your doctor may recommend more inclusive tests such as colonoscopy or a barium enema at an earlier age.

PSA screening: PSA (prostate-specific antigen) screening is a blood test that checks for a compound that is produced exclusively by the prostate gland. Significant increases in this compound can indicate a problem, such as prostate cancer. You should have this test done every year starting at age 50, says Dr. Goldberg, unless you are at high risk because of your family history or if you are an African-American.

*62/36/5*

BREAST SURGERY: STAYING IN HOSPITAL AFTER OPERATION

An operation to remove a lump from the breast will probably last about 20 to 30 minutes; mastectomies may take up to an hour. Therefore you are likely to be away from the ward for no more than 3 to 4 hours. You may feel drowsy and slightly sick as the effects of the general anesthetic wear off. If your mouth is dry, you can take sips of water, but drinking too much immediately after your operation can make any nausea worse. As your digestive system will not be affected by the operation, you will be able to eat as soon as you want to.

Following a mastectomy, you may be returned to the ward with a drip inserted into your arm. This contains a saline solution to replace the fluids that have been lost from your body during the operation, and will be removed after about 24 hours or when you are able to drink freely.

Drainage tubes

One or more small tubes will extend out of the side of the dressing covering your wound, each draining into a plastic bag or bottle, which will probably be placed beside you in the bed. Although the drainage system is cumbersome, you will be able to get up and move around the ward while it is still attached, but do remember to make sure the collecting bag(s) is supported before you do so. It may be taped to the.-side of your body or pinned to your nightdress. The weight of an unsupported bag will pull on the wound, causing discomfort.

During the first day following your operation, fresh blood and fluid will drain into the collecting bag. On the second day, the amount of fluid will probably have reduced substantially, and may be mostly clear, with a small amount of blood. Following a wide lump excision, the single drainage tube may be removed after about 24 hours. Each of the two tubes required after a mastectomy will be taken out when the drainage into them has reduced, which may be anything from 1 to 7 days after your operation.

The wound

Your wound will probably be covered by a clear dressing with an overlying pressure dressing to reduce bruising. The pressure dressing consists of a wad of gauze covered with Elastoplast strapping which is quite tightly applied after wide lump excisions and mastectomies. This will probably be removed after about 24 hours, once a doctor has visited you on the ward to check your wound.

If you do not want to be able to see the wound through the remaining clear adhesive dressing, do ask a nurse to cover it with gauze. You may find the sight of the blood-encrusted wound, the stitches and possibly some bruising upsetting. However, it will improve each day, and it should have healed and begun to look a lot better after a couple of weeks.

The wound may have been stitched with an absorbable material that will dissolve of its own accord in time, and only its ends may be visible. Alternatively, the stitches may be of a nonabsorbable material, possibly with a small white bead attached at each end. Stitches of this type will have to be removed 7 to 14 days after your operation. Many wounds are now stitched with a single continuous stitch, and appear as a single straight line.

The pull of the stitches may cause a feeling of tightness which will improve after a few days.

*41/39/5*

PHYSICAL EXAMINATION FOR ENDOMETRIOSIS

A physical examination usually involves:

• testing a specimen of your urine

• taking your blood pressure

• examining your breasts

• examining your abdomen

• a pelvic examination (sometimes also known as an internal or a vaginal examination).

The purpose of the pelvic examination is to try to determine whether there are any indications that you may have some endometrial implants or cysts present. Sometimes, the pelvic examination will suggest the presence of endometriosis but often nothing abnormal will be found, especially in the early stages of the disease.

Knowing what is involved in a pelvic examination will help to relieve any anxiety that you may have and help you to relax and therefore make the examination more comfortable for you and easier for the doctor. Ask your doctor to explain the procedure to you before she or he begins.

It is best if you empty your bladder just before the examination as a mil bladder will make it difficult for the doctor to perform the examination satisfactorily.

During the pelvic examination you will usually be asked to lay on your back with your legs spread apart, knees bent and feet together.

While the doctor is examining you it will help if you tell him or her when you can feel any pain or discomfort. A pelvic examination may cause a little discomfort but it should not be painful. If the examination does cause pain ask your doctor to stop for a moment to allow the pain to subside while you relax again. After the examination has been completed ask the doctor to describe what he or she felt.

The doctor will begin by examining the external genitalia, which includes the vulva, clitoris and labia, for any signs of inflammation, irritation or infection.

The doctor will then insert an instrument, known as a speculum that holds the sides of the vagina apart to examine the vagina and the cervix. The doctor may also take a Pap smear or a sample of any unusual discharge using a cotton swab or a wooden spatula. Once a thorough examination has been made the doctor will remove the speculum and perform a bimanual pelvic examination.

In the bimanual examination the doctor inserts two gloved fingers into your vagina and places the fingers of the other hand on your lower abdomen in order to feel the outline, shape, size and location of the pelvic organs between his or her hands. The doctor will also feel for any nodules, lumps, growths, enlargements or areas of tenderness.

During the examination the doctor may be able to feel nodules of endometriosis in the Pouch of Douglas, on the utero-sacral ligaments or in the recto-vaginal septum. It may also be possible to feel if the ovaries are enlarged, which may indicate cysts on the ovaries. The doctor will also be able to feel if the uterus is lying in the normal position or if it is stuck in a retroverted position.

Occasionally, the doctor may feel that it is necessary to perform a recto-vaginal examination if you are complaining of symptoms involving the bowel. This examination is similar to a bimanual pelvic examination but the index finger is inserted into the vagina and the middle finger into the rectum. The fingers of the doctor’s other hand are placed over the lower abdomen to help outline the organs and feel for any enlargements or growths.

If a pelvic examination does not indicate anything abnormal and if it was not performed near the time of your period it may be worthwhile having another examination just before, or during, your period when the endometriosis is most active thus making the implants more tender, larger and easier to feel.

*19/41/5*

PREVENTIVE MEDECINE: DISEASE AND THE WESTERN LIFESTYLE

To many, if not most, of us living in the West, the notion that some of the diseases we all take for granted as the major killers are preventable is indeed hard to accept. Strokes, heart disease and cancers between them kill most westerners yet they are relatively uncommon in the non-westernized world. Why should this be, and is it possible that by altering the way we live we could reduce or even abolish these conditions?

At first, the suggestion that it is our western lifestyle that causes many of our major diseases seems quite ridiculous, but the pioneering work of a group of doctors who spent decades in non-westernized parts of the world must make us think again. They noticed that certain non-infective diseases were very much less common in traditional societies than they were in the West. They wondered at first what to call these diseases. ‘Diseases of civilization’ (meaning modern, western civilization) is not quite right because evidence suggests that some of them were around but uncommon in the ancient civilizations of Egypt, Greece, Rome, India and China. Given that the conditions they found to be so common were now mainly seen in communities that had adopted our western, technological way of life, they decided to call them ‘western diseases’.

The first two criticisms that are immediately thrown at such a suggestion are, first, that people in the Third World tend not to live to be old enough to get ‘our’ diseases, and second that their medical systems are so poor that they simply do not diagnose the conditions even when they are present. Neither of these criticisms stands up when examined in depth, and studies which show that migrant populations (originally without western diseases) adopt the diseases of their westernized brothers in their new country, prove without doubt that it is not simply that whole populations in the non-industrialized world are somehow immune to westernized diseases. It is also impressive (if depressing) to watch peoples with traditional lifestyles take on our disease pattern as they adopt our way of life.

So what could possibly be causing these western diseases? Obviously motor-car accidents can only occur where there are motor cars, and pollution from industrial effluent or cigarette smoke is only found where these two abound, but these are not the diseases I mean when I refer to western diseases. The conditions in question are such disorders as: high blood pressure, obesity, diabetes, heart disease, appendicitis, piles, varicose veins, gall-stones, kidney stones and cancer.

Of course, any of many changes in western lifestyle in recent years could account for the frequency of all these conditions today and their virtual absence until the last century in the West and in most of the world today, but because many of them seem to affect the digestive system it makes sense to start looking for clues in the food we eat. Modern technology has radically altered the production and preparation of food and it now seems that food changes are at the heart of many of these ‘new’ western diseases.

*56/72/5*

FEEED YOUR BODY RIGHT: SHE NEVER LEAVES HOME WITHOUT HER BUTTER SPRAY

How can you lose 100 pounds on a 1,200-calorie-a-day diet and still enjoy going out to restaurants?

Carry butter spray and fat-free salad dressing in your purse.

That’s what Alayne Gunto of Moundsville, West Virginia, did when she became determined to whittle her 242-pound figure.

Alayne comes from a family with a history of weight problems. While she tried on and off to slim down, she was never really successful. Then her mother, father, and grandmother all had heart surgery within months of each other. That was the wake-up call Alayne needed. She decided to lose weight because, as she says, «I didn’t want to put my husband and children through that experience.»

Alayne put herself on a strict 1,200-calorie-a-day eating plan. She paid attention to what and how much she ate, something she had never done before. She kept close tabs on her portion sizes by reading food labels and using measuring cups. She started eating breakfast every day but quit her habit of munching on high-fat

snacks. To bolster her resolve, she joined TOPS (Take Off Pounds Sensibly), where she participated in regular weigh-ins.

All of these strategies helped Alayne hold course on her self-styled weight-loss program. But there is one trick in particular that she says has kept her from blowing her calorie and fat budget. «I like to eat out, but I want to know exactly what’s going into my mouth,» she explains. «I don’t want to leave it up to the restaurant to tell me I’m eating low-fat. I don’t necessarily believe their advertising. So I order my salads and baked potatoes plain. I just open my purse and dress them myself.»

Alayne’s strategy worked. Within 15 months of starting her weight-loss program, which included daily walks, she reached her goal weight of 145 pounds. She has maintained this weight for 2 years.

These days, just looking in the mirror is incentive enough for Alayne, a 34-year-old homemaker, to keep her eating and exercise habits on track. And although she admits to occasionally going over her fat and calorie budget, she never goes to a restaurant without her condiments.

WINNING ACTION

Stick with your own low-fat or no-fat condiments. Salad dressing and butter pack a lot of calories for the little room that they take up. Take a tip from Alayne and pack your own when going to restaurants. These travel particularly well: Marzetti’s fat-free salad dressing, available in packets at the supermarket salad counter, and I Can’t Believe It’s Not Butter spray.

*49\89\8*

MYOFASCIAL SYNDROMES

These occur when there is an inflammation of the body’s muscular system. Myofascial pain is a term that refers to the muscles and to the cellophane-like membrane that covers the muscles.

Such conditions are difficult to diagnose as there are no effective examinations or techniques to indicate their presence. The diagnosis is sometimes made only in the absence of neurological or orthopaedic factors.

Myofascial syndromes often mimic conditions such as disc disease and arthritis of the spine. The causes of such syndromes include whiplash, injuries to the neck, excessive exercise, and muscle tension such as typists feel in their shoulders after sitting through a long day.

In these cases, muscles which usually slide freely against one another are pinned down by adhesions caused by a muscular injury. Muscles pulling on the tight areas cause muscle spasm.

Australia has just experienced an epidemic of myofascial-type syndromes in otherwise healthy young individuals who usually complain that the condition is caused by sitting at computer keyboards

for long periods.

In Australia, such conditions are often labelled RSI (repetitive

strain injury).

One of the only ways to diagnose myofascial syndrome is to induce pain as an identifiable trigger point in the back or other muscles. Trigger points are parts of the muscles or ligaments that when pressed with a finger cause severe pain to radiate away from the pressure point.

Although the precise cause of such trigger points is not yet fully understood, it is thought that perhaps restrictive muscle movement causes initial pain. In turn, this restriction is believed to produce muscle spasm that pulls the sensitive covering over a bone to which the muscle is attached.

Treatments Myofascial syndromes are often treated well by physicians using the techniques of TENS therapy and acupuncture. Non-steroidal anti-inflammatory drugs may help relieve inflammation initially and relaxation techniques are often used as a back-up treatment to the physical treatments and appropriate medications.

Temporomandibular joint or TMJ syndrome

*73\37\8*

THE ‘REWARDS’ OF PAIN

Patterns of pain behaviour are very self-destructive.Yet sometimes people discover that there are coincidental, secondary rewards for suffering, such as increased attention, decreased family responsibility and avoidance of sexual activity. Alternatively, the pain can be used to provide a convenient tool which can be used to manipulate others.The attraction of such games may be strong enough to keep pain patients from recovering. They thus find it worth their while to adopt a certain posture and particular movements which may have been prevented, or alleviated, by taking the appropriate prescribed drugs at the recommended level.

Consequently, they may continue the posture, or the limp,or the drugs — even if such habits no longer have credibility. It is all part of the convincing pain games that a small, but important, minority of patients play.

Some pain sufferers may have found that their pain habits elicit sympathy, feelings of concern, or even approval — rewards they are willing to buy at the expense of being in pain. A particular facial expression, a moan, or a particular ‘pained’ look may offer a pleasant pay-off because others usually respond with kind words or efforts to help.

More common is the patient who is extremely hostile to doctors or members of their families who refuse to act sympathetically to gestures of pain. And there’s the type of patient who wants to ‘even the score’ with a spouse not considered sympathetic enough.

*50\37\8*

BRUCE’S MOTORCYCLE ACCIDENT AND GUNSHOT WOUNDS

Bruce was riding his motor bike along the heavily treed banks of a river and failed to see a large tree branch which caught his shoulder. The immediate result was of a tearing pain at the base of his neck followed almost instantaneously by total paralysis of the affected arm. A moment later the motorcycle hit another tree, head-on, causing an immediate loss of consciousness. His paralysed arm was removed and he had been given a number of neurosurgical procedures aimed at controlling his constant almost unbearable pain. Ten years after when he came to the pain clinic he was still suffering constant pain. Fortunately he had an almost miraculous response to TENS therapy and a small dose of Rivotril.

Gunshot wounds

Gunshot wounds, too, fall into the violent trauma category. Damage to peripheral nerves in the arms or legs by such wounds is accompanied by excruciating pain, persisting long after the tissues have healed. These pains may also occur spontaneously for no apparent reason, as in the neuralgia following shingles. The pain has been described by victims as ‘burning’, ‘cramping’ or ‘shooting’. Sometimes the pain is triggered by such an unlikely event as a gentle touch or even a puff of wind! Spontaneous attacks of pain may take minutes or hours to subside. Many occur daily for years after the injury.

*28\37\8*

MYTHS ABOUT PAIN

Many of the problems arising between doctors and patients appear from the perceived and common myths regarding chronic pain: It’s all in your head

To some extent all pain is in your head. Because pain is a purely subjective experience — pain is what you say hurts!

Just ignore that pain and it will go away

Many forms of chronic pain simply cannot be ignored. The person experiencing severe unending pain may be able to use distraction but the pain may well still be an intrusion into every waking moment.

Nobody ever felt as bad as you

Although it is true that no-one else ever felt what you feel, it is likely that there are-others who share similar experiences to yours.

God is punishing you for a past mistake .

It is highly unlikely that the Creator has taken the time to specifically torment you for some past misdemeanour.

You’ve been abusing your body so take the consequences

Unfortunately pain occurs in those who abuse their bodies and also

in those who were previously fit. Chronic pain plays no favourites.

All pain is the same

As mentioned earlier all pain is subjective and is thus different for each one who experiences pain.

You just look too healthy to have chronic pain

Since no-one has yet invented a pain meter what is observed by an outsider can be totally misinterpreted. Until the day an external pain measurement device is invented some patients will appear to casual observers as though they are pain-free.

*6\37\8*

CLASSICAL ALLERGIC DISEASES: HELEN’S STORY

Helen had eczema as a baby and began to have asthma attacks when she was about six. These got a great deal worse when she was eight years old, and on close questioning the doctor discovered that her parents had recently built an aviary inside the conservatory that was attached to their house. Skin-prick tests showed that Helen had a strong reaction to feathers, and when the birds were removed from the house her asthma settled down to its previous level. In the hope of getting rid of it completely, her parents replaced all feather pillows and cushions with foam-filled ones. Although this seemed to help a little, Helen still had asthma attacks once or twice a month. These frequently came on after parties or outings, and the doctor suggested that it might just be excitement

triggering off the attacks. Then her asthma started to become more frequent again, and as the attacks often took place at school, it was interfering with her studies. Helen’s mother began to wonder if foods that Helen only had at parties or at school, during breaks, were responsible. Crisps, squash and other food containing additives were obvious suspects as Helen was not given this sort of food at home. She agreed to go without these foods for a month to see if this had any effect. Within a few days her attacks virtually disappeared and tests with different types of additives showed that artificial colourings and sulphites could bring on an attack within a few hours. As long as she avoids ‘junk food’ Helen is now free from asthma.

*51\180\8*

SYMPHOSAN’S SEVEN INGREDIENTS – 2

Arnica, which may be found anywhere in Switzerland up to a height of about 2800 m (8,500 feet), has been recognised as an aid to healing wounds for thousands of years and is acclaimed as such in the oldest herbal records. Contusions with extravasation of the blood into the adjoining tissues are also cured by means of an extract from the root. Arnica will encourage proper capillary circulation, which makes it an important ingredient that enhances the effectiveness of the other plant remedies.

Besides these six ingredients making up Symphosan, there is yet one more. It is houseleek (Sempervivum tectorum), a plant that used to be found growing on the roofs of old houses in Switzerland, especially on thatched ones. It may not have been a good thing for the roofs, but the householders certainly knew how to take advantage of the fresh plant to treat inflamed eyes, burns, scalds, ulcers or sores and wounds, for which it is a cooling and healing medicine.

All these outstanding herbs are combined to make Symphosan a truly remarkable remedy that should be kept in every medicine chest and rucksack.

*711/28/1*

HOW A GOOD HERBAL REMEDY IS DEVELOPED – ESTABLISHING THE THERAPEUTIC EFFECTS

To establish the effects of a natural plant medicine one must first of all be capable of observing accurately and interpreting correctly. In every age there have been people endowed with intuitive insight which enabled them, by personal experience and observation of others, to determine what plants are most suitable for curing a given condition or illness.

The effect of various substances on the human organism can be observed with greater accuracy after two or three days of fasting. Needless to say, one would only experiment with plants and substances known to be nonpoisonous. After taking one plant or another, it is possible to judge the relative merits – how it affects the bowels, the kidney, the stomach or the appetite, or whether it stimulates the functions of the body in some other way. If the body is in good condition, certain important effects can be easily perceived. In homoeopathy this is the so-called ‘proving’ of remedies on healthy people.

*667/28/1*

THE SKIN – THE EFFECTS OF SUNLIGHT (PHYSICAL APPEARANCE)

With regular exposure to sunlight, the way we look and feel will both improve, giving us a better physical appearance than we had before. It has been found that exposing the skin to sunlight increases, in a manner of speaking, the voltage of the nerve system so that the whole body will experience greater vitality. The skin is like an antenna that absorbs and emits rays. For this reason some people appear to refresh us and others sap our strength; when in the presence of the latter if feels as if all our energy were being drained, tiring us very quickly.

It is interesting to note that sunlight on the skin also heightens the efficiency of our sensory organs. We are able to hear and see better when we let the sun recharge us.

*623/28/1*

VIRUSES; LACTIC ACID PREPARATIONS; COMFREY (WALLWOSAN)

The syndrome observed in the patient matched the symptoms attributed to the cytomegalovirus. However, as I wanted to be absolutely certain I sent the lady to a hospital where the laboratory was headed by a virologist I knew personally. I explained to him that I suspected the cause of her problem to be the cytomegalovirus. He did not think so, however, especially as the symptoms were not so obvious to him that he could confirm my opinion there and then. Nevertheless, he agreed to do a blood test. To his great astonishment what I had suspected proved to be true.

I then asked him what he would recommend to help the patient, and he suggested building up and improving her general condition of health since there was no specific remedy to combat the virus.

Comfrey {Symphytum officinale) is a fine pain-reliever in cases of cancer of the stomach and intestines. For this reason it is usually prescribed for diseases of these organs.

In more recent times research has shown that lactic acid is also beneficial in caring for cancer patients and should be considered for this purpose. Molkosan, sauerkraut juice and vegetable juices taken alternately will improve the patient’s condition and quench his thirst, however great it may be.

*579/28/1*

ARTHRITIS AND GOUT – CELL METABOLISM

The cell’s metabolism is yet another miracle at work, one whose workings scientists rack their brains to puzzle out. Although we do have some knowledge of the internal processes, this represents only a fraction of what actually goes on in the cell. We know, for example, that the cell takes in proteins, sugar and salt solutions together with various minerals and that it releases some substances, in a sense, waste material. But why is it that one kind of cell selects this or that substance for itself, while another kind attracts different substances? In other words, what enables the cells to make this selection? No one has yet been able to discover the answer to this question.

*535/28/1*

SCIENTIFIC EXPLANATIONS: POOR POSTURE

Pain is a significant stress to the body. The adrenal glands are forced to work hard for as long as we are in pain. Back pain, neck pain and headaches are perpetuators of the stressed state. Poor posture places undue strain on the muscles of the back, shoulders and neck making them tight and eventually stiff and sore. The sensory nerves convey this state of agitation from the muscles to the brain creating, or adding to, any agitation that may already exist there. Brain agitation manifests as that stressed-out feeling of being ‘uptight’. Being ‘uptight’ usually means tight neck muscles that are causing the shoulders to hunch up.

The muscles of the neck are attached to the vertebrae of the neck and when they tighten they pull the vertebrae together. In time the vertebrae press tightly enough against each other for the nerves that run between them to become pinched. Pinched nerves that emanate from the neck can cause a host of symptoms in the tissues they serve as well as pain in the neck muscles. Those that run from the neck to head can give rise to headaches and those that serve the face can give rise to involuntary twitches in the facial muscles and puffy bags under the eyes.

Those nerves that run from the neck to the nose can give rise to sinus pains, stuffy nose, runny nose and post-nasal drip. Pinched nerves can mimic the symptoms of allergy. Pinched nerves are one of the reasons allergy type symptoms remain in stressed people who are sticking strictly to their Anti-Candida/Anti-Allergy Program. The other reasons are long-term high levels of stress hormones in the blood which lower the body’s resistance, and neurokinin.

Hard-chargers are prone to bad posture. Being always on the go they tend to sit on the edge of chairs and hunch forward over desks, typewriters and computers. This in time strains the neck, shoulder and back muscles. The head weighs 7-9 kg (15-20 lb) and this perpendicular posture with a forward-bending of the head places great strain on the neck muscles, which keep the head from falling forward, back or sideways.

To get some appreciation of what this does to the neck muscles, imagine what expanding a Bullworker to 9 kg (20 lb) of pressure and holding it for eight hours would do to your arm and chest muscles. If the perpendicular, forward-bending, while perched on the end of the chair, posture is combined with a lot of rushing around and speeding in cars the muscles tighten even more. Working under pressure and taking on too much work gives rise to rushing and speeding.

Poor fluid intake and poor oxygen intake also tighten muscles. The muscles are about 70 per cent water and if these levels drop below 70 per cent the muscle tends to shrink. A shrunken muscle is a tight muscle that does not respond well to any method that is used to relax it, whether it is deep breathing exercises, massage, meditation, heat or Valium. Fully hydrated muscles expand to their normal size and are much easier to relax.

Adequate oxygen is needed to facilitate the metabolic processes of muscular expansion and contraction. Oxygen-deficient muscles (hypoxia) are more prone to fatigue, tightening and pain as any out-of-condition person knows when they suddenly take up a vigorous exercise regime. A lack of vitamins and minerals, especially the B vitamins, calcium, iron, zinc and magnesium, interfere with muscle cell metabolism and predispose muscles to spasm (tight, sustained contraction).

In addition to correct diet, deep breathing exercises, adequate fluid intake and the mental relaxation exercises, close attention must be paid to posture if tight muscles, pain and the allergy-mimicking symptoms they produce are to be overcome. Sit back in chairs. By using the support of the chair back you reduce the strain on the back and neck muscles which no longer have to work hard to keep you upright.

If having to bend forward to do paperwork take the weight of your head on your hand with the elbow supported by a pile of books. If your shoulder and neck muscles are already sore sit with a warm hot water bottle on them for ten minutes at night while relaxing in front of the TV. To thoroughly negate the stresses and strains imposed by the perpendicular forward-bending posture we need to regularly practise the opposite posture, that is, horizontal bending back.

The best way to exercise this posture is by swimming backstroke two to three times per week in warm water. Follow this with a warm shower, never a cold one (heat expands, cold contracts and tight, sore muscles are contracted muscles), with the jets of warm water being trained directly on the tightest, most painful spots. Make sure while swimming that you look at the roof, not the end of the pool. Looking at the end of the pool cranes the neck forward and strains the muscles. Don’t rush, this is a time to relax. Do a length and take a rest. Breathe deeply and slowly during this time then do another length. Do not be competitive about this swimming exercise. This is a time for therapy not a time for goal setting. If you’re not a swimmer then Tai Chi, yogic walking and yoga are just as effective for releasing tight neck, back and shoulder muscles. No head, neck or shoulder stands though if you do yoga.

In addition to straining neck and back muscles the posture of perpendicular forward-bending tends to round the shoulders forward so that chest expansion is restricted. This same posture forces the lower ribs down into the abdomen restricting the action of the diaphragm. Shallow breathing results, giving rise to oxygen deficiency, which tightens muscles, which in turn reduces chest expansion and perpetuates shallow breathing. A vicious circle is born which gets the sufferer more uptight and tired, which aggravates the collapsed state of the perpendicular forward-bending posture. Is it any wonder those who rush get less done, make more mistakes and have to repeat more of their work. The distraction of the pain and the lack of oxygen in their brain greatly affect concentration, comprehension and memory. In the initial stages of your muscle relaxation regimen it pays to consult your osteopath or chiropractor for heat, massage and manipulation of the muscles and vertebrae. This will accelerate your recovery.

*220\18\9*

SCIENTIFIC EXPLANATIONS: THE METABOLISM

The metabolism can be broadly described as the sum total of all the chemical reactions which take place inside all the cells of the body. Perhaps the most important metabolic processes are those which turn the food we eat into energy or into body chemicals such as hormones, enzymes and antibodies. These chemicals are made from protein, fat, carbohydrate, vitamins, minerals and trace elements. If a deficiency exists in any one of these nutrients certain chemicals cannot be made and this will adversely affect the function of the other chemicals, thus producing an imbalance in the metabolism.

Most metabolic imbalances are associated with over-weight which in turn is frequently the result of eating the wrong type of food. Take white bread for example. It is both fattening and capable of causing serious disturbances in the metabolism. It is fattening for two reasons:

1. Because white bread is refined it is quickly digested and therefore rapidly absorbed into the blood as molecules of glucose which arrive in the bloodstream in such large quantities that the blood sugar levels immediately shoot up. To normalise the blood sugar levels the pancreas releases the hormone insulin which removes the glucose from the blood by converting it to fat. Years of eating white flour and sugar can so sensitise the pancreas that it over-reacts and releases too much insulin. This causes the glucose levels to drop too low, causing the metabolic imbalance known as functional hypoglycaemia. This usually happens to those who are vitamin and mineral deficient and/or under stress.

2. Because white bread is refined it lacks the vitamins and minerals required for normal carbohydrate metabolism and, because it cannot be metabolised properly and used by the body as a carbohydrate energy source, most of it must be converted to and stored in the body as fat. Thus, the body has increased in weight but its carbohydrate needs have not been fully satisfied. This usually manifests a desire to eat more carbohydrate and all too often white bread is again the choice.

To be correctly metabolised, any carbohydrate food needs to contain vitamins B3 (niacin), B1 (thiamine), B2 (riboflavin), B6 (pyridoxine), B5 (pantothenic acid) and the minerals phosphorus and magnesium. During the milling process of whole grain flour to its white refined state the magnesium, phosphorus, pyridoxine and pantothenic acid are removed and not replaced. If this white flour (refined carbohydrate) is to be metabolised at all the body must steal these four nutrients from other glands and tissues, thus creating imbalances in the metabolism. It steals phosphorus from bone, thereby impairing its growth and ability to repair and magnesium from heart muscle, predisposing it to spasm and, in time, arrest. Pantothenic acid (B5) is stolen from the nerves and brain, rendering us liable to lowered energy levels and increased irritability, and pyridoxine (B6) is stolen from the white blood cells, particularly the T-lymphocytes (which attack viruses, yeasts, bacteria and cancer cells) causing them to become very weak and lethargic.

Sugar, be it white, brown or raw, requires the same vitamins and minerals to be metabolised and is thus responsible for creating the same metabolic havoc. How much of our processed foods contain white flour and white sugar? Most of it. Even frozen turkeys contain added sugar! Any manufactured food with a word in the list of ingredients on the label ending in -ol, -ole, -one, -os or -ose has sugar in it. You’ll be amazed how many do.

It is the complex interaction between all the vitamins and minerals which maintains a balanced metabolism and a healthy body. Foods picked fresh from the garden have a far greater chance of containing all the necessary nutrients. The foods on the Metabolism-Balancing Program, especially when supplemented by a complete vitamin and mineral formula, ensure that our bodies receive the required nutrients. No vitamin or mineral can work on its own and must be aided and complimented by all the others. For a single vitamin or mineral to be effective it must arrive in the system with all the other vitamins and minerals and at the same time. That’s why you take your vitamin and mineral formula just before the main meal of the day. Unrefined foods ensure a balanced metabolism and are also the foods which arc least (if at all) fattening.

*202\18\9*

THE ANTI- CANDIDA PROGRAM: THE LIST OF DO’S

1. Do study amines and salicylates, moulds and ferments (don’t eat unleavened breads from your baker— bakers use yeast plus sour dough), malt, monosodium glutamate (MSG) and milk (for the appropriate six weeks). Do this before starting the program to make absolutely sure you do not eat any of these foods.

2. Do eat liver at least once, preferably twice, per week. The nutrients in liver can make the difference between average and excellent results. Lamb’s liver is best. Chickens are force fed with chemical pellets, so don’t eat chicken liver.

3. Do wash all fruits and nuts in warm water and soap to remove mould (unshelled nuts don’t need to be washed). Don’t leave them in the water too long. Just in and out for a quick brisk wash then dry them quickly before they go soggy. Rinse off all the soap. Sunflower seeds are grown locally and therefore are fresher than nuts. Only wash them if they smell a bit mouldy.

4. Do chew wholemeal, unleavened bread thoroughly, taking the time to mix it well with saliva. Unleavened bread requires more chewing than ordinary bread as it’s harder to digest.

5. Do cut your freshly baked, unleavened bread up into slices. Wrap them individually in greaseproof paper and keep them in the freezer. Leave them out overnight to thaw. This way they won’t grow mould.

6. Do rinse and wipe clean the blade of any cutting utensil before cutting any food you are going to eat. Black, brown and greeny blue coloured film on the crust of bread or on the surface of vegetables is mould. Wash off before cutting through fruit or vegetables, you will drive the mould in otherwise.

7. Do seek out all mould in the house and remove it. Cracked pipes that leak into brick, concrete and carpet underlay are insidious mould producers. If the house is the slightest bit musty after one to two days of being shut up, there is hidden mould—find it.

8. Do wear a mask if cooking a food you are allergic to as the smell of it can trigger your symptoms. This is applicable to those who are cooking for others who are not on their program.

9. Do drink mineral water with a drop of freshly squeezed lemon or lime juice in it when out socially. If they are available have a Diet Coke or diet lemonade as well. Dry roasted cashews, hazelnuts, almonds and macadamia nuts (the latter three have salicylates) may also be had as a treat or at parties. As a treat at home you may have popcorn. Be careful about salted nuts. If the manufacturers can’t guarantee they haven’t used adulterated salt don’t touch them.

10. Do test all nuts by biting and tasting them before eating them. If nuts are getting old they turn rancid and lose their sweet fresh taste. Rancid nuts can cause enough of an adverse reaction as to mimic your allergy and Candida symptoms. Many patients in the past have erroneously believed they are allergic to nuts because they have eaten rancid nuts. Fresh nuts are more nutritious. However, roasted nuts can be eaten once per week as a treat. No need to wash roasted nuts.

11. Do chew nuts properly. All nuts must be reduced to a puree before they leave your mouth. Bits of nut have sharp edges that can irritate the bowel lining to the point of causing diarrhea. Many patients have erroneously believed they were allergic to nuts because they had diarrhea that showed bits of (unchewed) nut.

12. If it’s a drinks party, get them to make popcorn and the Candida Killer dip with plain Kettle Chips (provided you are past the first four weeks) for you. You can drink diet lemonade or Diet Coke at the party. My experience is that friends are only too willing to help.

13. If you are pregnant do stay on fruit for the duration of the program. This will slow your rate of healing down but that can’t be helped. Stay off milk for the mandatory six weeks of the program and for the whole program if you are proven allergic to it or belong to any of the Asian, African or Mediterranean ethnic groups. Crushed egg shells plus Formula Six and sardines or salmon three to four times per week will give you all the extra calcium you need.

14. Do take a herbal laxative if at first you are a little constipated. Any type is OK and won’t affect your allergies, as laxatives are not absorbed.

15. Do substitute soymilk for cow’s milk as long as the soymilk doesn’t contain malt and other additives. Have only the soymilk shown on the shopping list.

16. On completing the Anti-Candida/Anti-Allergy Program, and successfully containing all your symptoms, do return to the Metabolism-Balancing Program, plus Formula Six, for the rest of your life. Go back onto the Anti-Candida Program once a year for four weeks to give yourself a clean out.

*184\18\9*

THE METABOLISM- BALANCING PROGRAM: IRON AND FLEXIBILITY

If you are very tired, have heavy or extended periods, have mid-cycle bleeding, have had a number of children or have had miscarriages or termination of pregnancy, you will more than likely need an iron boost. I recommend you go on a course of the FAB Co iron tablets available at the health store. (Not for men.)

Take one before breakfast, one before lunch and two with Formula Six just before the evening meal. Do this for four weeks, and if you haven’t picked up in that time, do it for another four weeks. Then stop. Formula Six will do the rest.

The Metabolism-Balancing Program is flexible. Not only can you swap your options around, you can eat them at different times of the day, if you choose. You can have the evening (main) meal for lunch, if you like, and breakfast in the evening! It doesn’t matter what order you eat your meal in, as long as you eat three meals per day, eat what’s on the program and take the supplements before and after the main meal, whenever that is.

The Metabolism-Balancing Program is flexible enough to allow you 5 per cent junk food. That’s 5 per cent of the total weekly food intake, which means no more than five items of junk food per week. You may wish to take this in the form of sweets at a dinner party once per week. Often it creeps in as sugar or white flour in sauces and gravies. Five per cent junk food will do you no harm if you arc following the program seriously and taking your supplements.

Keep frozen foods to a minimum—have them only if fresh foods are not available.

*166\18\9*

STRESS: TAKING TIME OUT

It takes time to adopt new attitudes and for some people a change of attitude doesn’t come easily. Action always speaks louder than words and action can greatly influence the way we think. For this reason, hard-chargers will find it of benefit to set aside specific time to do other things. Write this schedule down, post it on your mirror and rigorously adhere to it. The following checklist is one I suggest as the basis of such a schedule. It will bring balance to your life and in so doing will lower stress levels:

• Take time to work—it is the vehicle of success.

• Take time to rest—it is the foundation of health and vitality.

• Take time to think—it is the source of achievement.

• Take time to play—it is the secret of perpetual youth.

• Take time to read—it is the fount of wisdom.

• Take time to be friendly—it is the road to happiness.

• Take time to love and be loved—it is nourishment for the soul.

• Take time to share—it is too short a life to be selfish.

• Take time to laugh—it is the music of the heart.

• Take time to dream—it is the well of inspiration.

Feelings follow thoughts. The thoughts we choose to think determine the feelings we experience. We are all born with a free will. This enables us to choose the thought we wish to think.

So powerful is human thought it can over-ride the effect that external influences can have on us. Because of this, we have the power to remain minimally distressed through the greatest adversity, if we choose to. Our attitude has the greatest of all influences on our stress levels.

*148\18\9*

EXERCISING AT HOME: EXERCISES THAT DO NOT HELP A BAD BACK

Exercises for the back are chiefly intended to strengthen the muscles. The vertebral joints do not need to be exercised, because the spine is never at rest, even when you are in bed. Stiffness in these joints can be helped by exercise only if it is due to weakness in the muscles and ligaments. This can be helped by gently working the muscles. But when there is pain as a result of a disc prolapse, misaligned facet joints or stress from curvature, exercises can do harm rather than good. An important rule is: if an exercise hurts, stop doing it.

Exercises that do not help a bad back

There are some kinds of exercises which should be positively avoided when you are recovering from back pain, and used with caution at all times:

• Bending forwards from the sitting position is supposed to strengthen the abdominal muscles, but is not advisable where the pressure can push a disc protrusion into the spinal canal;

• Techniques (‘hanging’ in the inverted position) to stretch the spine are given by some instructors to reduce disc protrusion and strengthen back muscles, but uncontrolled traction can increase fibrosis and scarring with further loss of elasticity and increased susceptability to pain in the long term;

• Bending sideways can be beneficial in moderation, but always involves some rotation of each vertebra, so that the exercise needs to be done slowly, carefully and over a short range;

• Rotation has been thought to mobilise stiff joints, but excessive rotation is harmful: since the immobile joints cannot be moved, the capsules and ligaments around the joints will be overstrained;

• Toe touching used to be one of the classic exercises for fitness, but to touch your toes while standing (or while sitting) with legs straight and feet apart is likely to do more harm than good, particularly if you use the opposite hand, so adding a twisting motion;

• Double leg raising, often recommended as an abdominal strengthening exercise, can be positively harmful because it puts considerable strain on the lower back. During this exercise the hip muscles have to do most work and as they are attached to the lower lumbar vertebrae and the pelvis, the abdominal muscles are called upon to stabilise the pelvis while the legs are lifted. The weight of the straight legs makes it too difficult for the abdominal muscles to continue to hold the pelvis, which tilts forward. This causes the lumbar spine to hollow as the spinal joints are pulled forward, putting considerable strain on them;

• Lifting both legs up straight, or sitting up from lying with a straight back are two exercises which should not be carried out, except by someone exceptionally fit and well muscled.

*105\111\2*

UNDERSTANDING BACK TROUBLE: PREVENTING A RECURRENCE-THE CHRONIC SUFFERER

When certain changes have occurred in the structure of the spine, especially if these are the outcome of a degenerative process, there is no way of restoring all the painfree functions of a normal spine.

Sometimes people have to be told that there is nothing more that can be done in the way of medical treatment for their back trouble, and find that treatment by physiotherapists or other therapists does not ease their suffering. They must then learn to live with their faulty spine, since they cannot be given a new one.

Such advice is bound to be depressing, even when accompanied by the assurance that there is no serious organic disease.

Moreover, chronic pain can itself be depressing. Some people in this situation let the rest of their life be dominated by their back; others are more able to meet the challenge and learn to cope by modifying life style, while maximising the painfree range of movement.

Trying anything-Although a patient may have been told that all the normal measures have been tried, there is always a possibility that the verdict may become outdated by new knowledge, improved diagnostic techniques and methods of treatment not previously available.

Some sufferers, therefore, feel that there is always a chance that another surgeon, another doctor, another therapist, may have a way of doing something for them. There are a number of doctors and other therapists in private practice who offer specialist treatment of back pain. They are often exponents of a particular line of therapy.

Other long-term sufferers pin their faith on a succession of non-orthodox treatments which may be providing no more than brief temporary relief. There is probably no harm in this as long as they are seeing a professionally qualified person, even though it is unlikely that one of these treatments will provide a cure, or restore to their spine all its former mobility.

The constant trying out of this treatment or that remedy is likely to set up an endless cycle of hope and disappointment. Miracle cures are mainly anecdotal. There is, moreover, some risk that, for instance, regular manipulation may accelerate osteoarthritis of facet joints, or repetitively overstretch fibrous tissues formed in a previous healing process.

*82\111\2*

PHYSIOTHERAPY: THE TREATMENT

Back pain frequently responds well to physiotherapy, the treatment by physical methods, as an alternative or adjunct to drugs or surgery. The methods include several different therapies, manipulative procedures, therapeutic movement or exercises, treatment with heat, cold and with electrical equipment. The aim is to help restore the function of the body and rehabilitate the patient: it also includes advice and instruction on posture and daily activities.

More than one method of treatment may be tried; each patient’s condition and progress is reassessed regularly, and the treatment altered accordingly. For example, a patient with very acute back pain may initially be given heat treatment and an instant support to wear. This may be followed after a couple of days by traction or gentle mobilisation, and possibly later by controlled manipulation, and the treatment usually includes a regimen of exercises and instruction on how to lift and move safely.

What a patient does when not having treatment plays an important role in recovery; the physiotherapist will, therefore, usually advise what he should do between treatments. Patients who hope and expect that the physiotherapist will work on them to get them better are not pleased to discover that they are, instead, expected to participate actively.

*61\111\2*

UNDERSTANDING BACK TROUBLE: WHERE DOES IT HURT?

The body’s central nervous system consists of the brain and the spinal cord, which is the brain’s extension down the spinal canal. The nerve roots which pass in pairs out of the spinal cord at the level of each vertebra, and at the sacrum, proliferate into an abundant network of nerves, some as long as one metre, reaching to distant parts of the body. They carry information about injury along the spinal cord to the brain, which acts as a control centre, where the information is interpreted in the form of a sensation of pain. The sensory nerves which bring it are able to convey information about the type of injury; thus, the pain of a blow is different from that of a pinprick.

Pain is not sensed in the injured tissues themselves: the experience of pain is registered in the brain. For pain to be felt, there must be, or have been, a nerve supply. Some structures of the body have little, or none: for instance, the nucleus of an intervertebral disc. If it is damaged, no pain will be felt unless part of the disc presses on one of the nerve roots, the dural tube or on a ligament. Therefore the absence of pain does not necessarily mean that there has been no injury.

There can be an interval, sometimes days, between injury and sensation of pain. If you are concentrating hard on something else, you can often override the pain message. Sportsmen, in particular, often fail to realise that they have been hurt, until the game they are playing is over. A severe pain can mask a lesser pain, rather like a strong radio signal suppressing a weaker one. Thus it may not be until the more severe pain has responded to treatment that a secondary pain reveals the presence of a lesser injury

Pain is both a mental and a physical event, and the extent to which it is found endurable depends largely on individual temperament. Some people give way rapidly, and take to their bed, while others grimly remain at their posts, regardless of suffering. There is an intelligent compromise between these extremes: an awareness that pain is, in general, a warning of injury or risk of injury through misuse or malfunction, which should not be neglected.

*38\111\2*

HOW THE DAMAGE IS DONE: THE EFFECTS OF MOVEMENT

Any muscular activity and movement causes some increase in spinal stress. If you stand on the bathroom scales and watch the pointer while you raise your arms, you will see it move up. The force needed to lift the arms is passed down your spine to your feet and (via the scales) to the floor. The same is true of every other activity – pushing, pulling, carrying, getting up, sitting down.

Body movements that are caused by outside forces also cause stress on the spine. Most forms of transport, from horses and bicycles to trains and buses, bounce and jolt the human frame; apart from jolts and jars, most people occasionally stumble or fall. The force of all such vibrations is imparted to and resisted by the spine, but in most cases it suffers no serious injury, because of its capacity for absorbing shocks. It converts the energy into movement by going with the impact instead of resisting it and alters the quality of the applied force, so that it is less likely to cause injury.

The function of converting force into movement is a vital one. Unless some of the applied energy can be quickly converted into movement, it will break bones or cause other injury. In young and supple people, much more movement can be produced than in someone old and stiff, and they can therefore take more punishment than the elderly. As well as being more mobile, the structures in a young spine can bend or change shape more readily in response to loads and muscular tension. This is why the young are better than old people at ‘taking’ forces and reducing them.

Spinal functions also include a safety mechanism: namely, protective backache or. pain. Pain is information and mainly of value in giving warning of postural stress. It is not so effective at preventing injury caused when something proves too heavy to lift or will not move because it is, unexpectedly, stuck – then the pain may come too late.

*16\111\2*