Backache is one of those common symptoms from which nearly all of us suffer at some time.

For the majority, it proves to be a minor problem like an occasional headache. For others, it may lead to severe and prolonged pain and disability and result in permanent invalidity.

It may be associated with secondary emotional illness with depression, lack of self-esteem, chronic anxiety and domestic and marital problems. The old idea of many chronic back sufferers being malingerers has, one hopes, almost disappeared.

The spinal column consists of a number of bones, the vertebrae. When looked at from the front, it is straight, but when viewed from the side, it has a number of curves. Because they are arranged like two Ss, one on top of the other, the end result is a functional straight line.

Each vertebra consists of a thick portion of bone, the body, from which two projections come off and meet at the back forming a canal through which the spinal cord passes.

A further projection, the spine, comes off where these join and this is the knob we feel in the centre of our backs. Further projections both upwards and downwards form joints with the vertebra above and below.

*214/71/1*

Wendy’s Story: Wendy, a thirty-one-year-old manager of a Florida boutique, has been married for three years. She has been trying to get pregnant but has encountered many difficulties. Wendy described her crisis: ‘After doing a laparoscopy on me, my doctor told me 1 didn’t have endometriosis. He said I was okay, yet I’m in pain two weeks of every month. I want a baby, but its hard to fed sexy when you feel so bad. Even so, I’ve been pregnant three times in the last two and a half years, but I have miscarried each one. What could be wrong with me?”

Wendy’s plight is one many women with undiagnosed endometriosis understand all too well: pain, infertility, and no adequate explanation tor their symptoms. In the past, it was felt that endometriosis in a more advanced stage prevented pregnancy because cysts and massive adhesions set up a hostile environment for conception. Most recent research into the subject, however, has revealed that a one-to-one correlation between infertility and endometriosis exists at earlier stages, too. (A chapter devoted to this will explicate further.) This research on earlier-stage endometriosis is particularly relevant to Wendy’s case.

A team of doctors at the University of Kentucky Medical Center’s Reproductive Endocrinology Department in Lexington concluded, in their 1985 study, that women with mild endometriosis suffered twice the number of spontaneous abortions, or miscarriage, that women with the disease at a more serious stage suffered. In examining this phenomenon, Michael Vernon, Ph.D., and his colleagues speculated that early or milder endometriotic lesions might be more “metabolically active” and produce prostaglandins, the hormones that have been implicated in the activity of endometriotic tissue. Prostaglandins might be partially responsible for infertility and miscarriage, since they cause uterine and tubal cramping, thus making conception and full-term pregnancy more difficult.

In further testing, they examined various types of implants, from very mild to serious. These implants have, in fact, been classified on a rating system to standardize their description for doctors. Devised by the American Fertility Society this system charts and describes implants by color and degree of growth, and rates them on a scale of severity from I to IV. (See the illustration on page 66.) Implants may be red, reddish brown, dark brown, or black (also known as powder bum). The Kentucky team also discovered that the “mildest” implants produced and synthesized twice the amount of prostaglandin F that implants at an intermediary stage produced, which in turn produced more of the hormone than the powder-bum variety, (In some expertments, powder-burn implants produced no such hormone.) This explains why women with minimal endometriosis sometimes experience more pain than women with massive growths. (Massive growths arc simply easier to identify.)

Wendy’s doctor clearly suspected endometriosis—no doubt this reason for performing a laparoscopy. That he was unable to find any obvious trace of the disease led to his conclusion that she was free of it. My advice to Wendy is to return to her doctor to begin a program of Danocrine to halt endometriotic growth, and to start on a diet high in complex carbohydrates and rich in B vitamins—the vitamins that are important in combating stress and favoring conception.

*38\43\4*

Psoriasis, one of the commonest skin diseases, is also one of the most cosmetically disabling. Although it is very rarely fatal, it produces an immeasurable amount of misery. It affects people mainly at the peak of their working and reproductive lives, and has considerable adverse socio-economic effects on them and their families. The disease has been known for hundreds of years. Many of the diseases referred to in the Bible as leprosy are in fact thought to have been psoriasis.

Psoriasis is a skin condition in which red scaly patches develop on the skin. The areas most commonly affected are the elbows and knees, but the scalp and other areas of the body may also be affected. The main problem with the condition is that it is cosmetically unacceptable, both visually and on account of the scales which are shed from the spots. Fortunately the condition very rarely affects the face, and usually is mainly on areas covered by clothing.

If one parent is affected, it is estimated that there is a 25 per cent chance of immediate members of this family also developing the condition. If two parents are affected, then the likelihood increases to 65 per cent. Fortunately many generations in a family may escape developing the condition.

A number of factors are known to precipitate the onset or appearance of psoriasis. For instance certain infections, such as a streptococcal tonsillitis, are known to be implicated particularly with children. Trauma, due to such things as injuries or sun-burn, may also cause the appearance of psoriasis. It has been suggested that certain hormonal changes such as those occurring with puberty and menopause, may aggravate the condition yet certain other hormonal changes, such as those during pregnancy, may improve the disease. As with many otherconditions. psychological stress can certainly aggravate the disease.

There are various form of psoriasis. There is the acute or Curtate form of the condition, which is usually seen in children and which may be precipitated by tonsillitis.

Then there is the chronic or Plaque form which is the commonest manifestation, and which classically affects the elbows, the knees, the buttocks, and the scalp. In this latter area, it may easily be confused with severe dandruff.

Occasionally psoriasis is confined to the creases or flexures, and sometimes in infancy it occurs as a napkin psoriasis. Here it may be confused with a simple napkin dermatitis or eczema. Nail psoriasis can be most disfiguring. It may affect the nails only or be associated with other forms of psoriasis- Usually it causes lifting of the nail, with or without pitting, and eventually, disintegration. This condition may be misdiagnosed as a fungal infection, from which it must always be separated, as the treatment is very different. Most infrequently, psoriasis takes on a Pustular form, and then is mainly distributed on either the palms or soles, where it has the appearance of an infective process. It is not, however, infective or infectious.

Rarer still, is the exfoliative form of psoriasis, where the entire body skin is shed, and the patient becomes extremely ill. Another of the rare complications of psoriasis is an arthritis, which mainly affects the finger or toe joints, and occasionally the cervical spine, or lower back joints. Psoriasis, however, is not contagious, nor does it affect the blood, or cause cancer.

The basic pathology of psoriasis is related to increased rep rod activity of the cells in the skin and increased production of DNA in the epidermis and dermis. How this comes about is as yet uncertain, although much research work is being done in order to try and elucidate the basic fault, so that hopefully one day it may be corrected. As a result of these abnormalities in the skin there is a marked increase in the rate of cell ‘turnover’. The abnormal cells reproduce approximately ten times more quickly than the normal cells, which results in a build-up of cells which appears as thick scale.

The treatment of such a disfiguring condition is obviously of considerable importance—a society which extols the virtues of physical beauty as much as ours makes people with psoriasis feel very self-conscious. The question is always asked, ‘Can psoriasis be cured?’ Unfortunately it can no more be ‘cured’ than can high blood pressure, schizophrenia, or diabetes. However, and this must be stressed, in most cases it can be completely controlled so that there may be no evidence of the condition at all for long periods of time. Even though the condition may recur, it can once again be brought under complete control.

*66\44\4*

These have been developed on the premise that sweetness without calories would assist fat loss, but the link appears to be tenuous, at best. Because carbohydrate, including sugar, naturally suppresses appetite, the rationale for artificial sweeteners for fat loss is limited for most people. The biggest users of artificial sweeteners are obese people and research suggests that people who use artificial sweeteners do so to express their fat-loss concerns rather than decrease energy intake (i.e. They may make up for the loss of calories somewhere else). There is some concern that artificial sweeteners increase appetite, but a comprehensive look at all the research on sweeteners by Professor Drewnowski shows there is no evidence that sweetener use per se causes increases in food intake by increasing the appetite. The use of artificial sweeteners in conjunction with other dietary strategies may be useful in limiting energy intake and there is no substantive evidence to suggest any ill-health effects from use of sweeteners, in moderation.

*119\186\4*

Most endometriosis sufferers have felt depressed at some stage for one reason or another. Suddenly you have to come to terms with having a chronic illness. There is the constant tiredness and the frustration of feeling lethargic. Sexual relations are put under enormous stress if you suffer pain during intercourse. Pain may also interrupt your lifestyle.

Treatment may not be effective and you worry about what alternatives you may be faced with. So many of your questions seem to go unanswered and at times you really feel as though you are unable to get on with your life.

For those who have fertility problems there is the concern that perhaps you may never have a child. And if you are lucky enough to get pregnant will you miscarry? Will the disease hinder a normal delivery?

Many of us become depressed thinking about the future management of the disease. Will you be faced with more hormone treatment? Will you require more surgery?

*108\83\2*

Diagnosed with endometriosis at the age of 2 7,1 was told that the best treatment was to take the male synthetic hormone, Danazol. I had to take 600 milligrams a day for nine months. I was a little apprehensive about taking Danazol but realised that not all women suffered the side effects that I had read about. I decided that if the Danazol was going to get rid of the terrible period pain I was suffering every month then I was prepared to take the tablets.

Every day whilst on the medication I looked for side effects from the drug. I jumped on the scales every morning to see if I had gained weight. I peered in the mirror to see if I was growing a beard and I inspected my skin to make sure

I wasn’t developing acne.

I was surprised that I actually felt good during the time I took Danazol. For the first time that I could remember my whole life didn’t revolve around my menstrual cycle. No periods and no pain for nine months was sheer bliss. I did develop a few side effects, but the relief I obtained from the pain far outweighed the side effects.

I gained about six kilograms in weight. This gain appeared to be more a body building, muscular weight increase which didn’t bother me. I experienced some nausea and occasional vomiting but it wasn’t a major problem.

The only other side effect I experienced which, unfortunately, has been irreversible was a deepening of my singing voice. My upper range decreased four tones. Luckily, I am not a professional singer but I still get frustrated occasionally at the change. At the end of the Danazol treatment, a laparoscopy revealed no evidence of endometriosis and I subsequently had two children. Seven years later I had another laparoscopy and was again diagnosed as having endometriosis.

This time I took the trial drug Buserelin, one of the GnRH agonists. It was in the form of a nasal spray. I took the drug for six months and during that time had no side effects. I had been told by my doctor that I might experience hot flushes, dry vagina, depression or headaches. Luckily, I didn’t experience any of them. Another laparoscopy at the end of the Buserelin treatment revealed that apart from one endometrial cyst, the endometriosis had disappeared.

Six weeks after this laparoscopy I was back in hospital having the cyst and left ovary removed. Although I was a registered nurse and familiar with hospital environments, I was still nervous at the prospect of major surgery.

I need not have worried — everything went according to the plan my doctor and I had discussed. I had a continuous morphine infusion for the first 24 hours after the operation — it was great, I experienced very little pain. I was up walking around the day after surgery and drinking and eating the day after that.

I was discharged from hospital five days after the operation and was back at part-time work and playing sport six weeks after the surgery.

Three years later I feel great. I still get some ovulation and period pain every month, but nothing like the severe, debilitating pain I experienced before I had treatment.

*50\83\2*

Although someone who is very stressed may need medication on a temporary basis to get them through a particularly sticky patch, this kind of treatment invariably involves its own risks, including those of potential side-effects as well as the danger of becoming dependent on the drugs. Tranquillisers were commonly prescribed – many experts say overprescribed – to combat stress until quite recently, but doctors are nowadays much more aware of the pitfalls of this approach and are instead choosing more and more to help stressed patients by using various ‘relaxation techniques’.

There are many different types of these techniques, all of them sharing the same broad aim, but seeking to reach their goal in varying ways. Three techniques used frequently – and generally most successfully – to reduce stress that may be exacerbating muscular tension in general and back pain in particular are active relaxation, passive relaxation, and breath control, all of which can be used either individually or in any permutation with the other two.

Relaxation techniques produce tangible benefits in two quite distinct but interconnected ways:

1) They can prevent stress and/or tension from reaching such a point where they cause symptoms to appear.

2) When symptoms, such as sciatica, are already present, relaxation can help reduce them.

While it is not within the scope of this book to go into the various relaxation techniques in depth, there are many other books available that give simple step-by-step instructions. To help you make a start, there follows details of three simple methods for promoting relaxation that many people with back difficulties have found especially useful. First, however, a note of caution is in order: while all of these techniques are normally safe for anyone in reasonably good health, it is just possible that they could lead to an adverse effect under some circumstances. Therefore, should you try any of these methods, stop the exercise immediately if you feel at all uneasy at any time. And, to be absolutely safe, ask your doctor for his advice before you try these.

METHOD ONE – ACTIVE RELAXATION

This is probably the single most useful technique for bringing rapid relief from stress and also has the benefit that it is the most easy to learn and apply. Essentially, it consists of promoting mental relaxation through physical relaxation, the latter being attained through first deliberately tensing muscles and then consciously relaxing them.

Here’s a very basic active relaxation programme which you can adapt as you wish to meet your own needs and circumstances:

Select a time of day when you don’t expect to be interrupted. Lie down flat on your back on the floor, placing a light support – a small cushion or a rolled up towel – under your head.

Extend your legs fully, but spread slightly apart. Your arms should be at your sides, but also spread out slightly.

Clear your mind of all other thoughts and concentrate solely on registering the sensations that will be fed back from various parts of your body as you alternatively contract – that is tense up – and then deliberately relax various muscle groups in your body.

Incidentally, never try to relax a muscle without contracting it first – by contracting the muscle first, you’ll learn to recognise the contrast between a muscle that is tense and one that is fully relaxed. To make sure that a muscle is fully contracted, clench or tighten it hard for at least ten seconds before letting it go fully limp and resting loosely wherever/ it is, supported only by gravity.

This ‘tense it up first, then relax it totally’ procedure is carried out in sequence to extend to every major set of muscles in the body, starting with those that are furthest from your head. This is the sequence recommended by experts to attain the maximum amount of overall relaxation in the shortest time:

Begin with your toes, tensing and relaxing each of them in turn. Then on to the feet, one at a time, then the calves, knees, thighs, and buttocks, alternating between your left and right sides until both your legs are totally relaxed.

Next comes the trunk. Start with the lower abdomen, then the upper abdomen, followed by the lower back, the upper back, the chest and finally the shoulders.

Now do the arms, starting once again with the muscles furthest away from your head. First the fingers, each individually of course, followed by the hands, wrists, forearms, and upper arms.

Finally, it’s the turn of the neck and head. Start with the neck, then the throat and lower jaw, finishing with the face. Contract each section of the face separately – that is chin, lips, cheeks, nose, forehead and eyes in turn.

Once all the muscles in your body are fully relaxed, just lie still for ten minutes or so, enjoying the sensation of physical relaxation while keeping your mind clear of worries or problems.

At the end of your allotted time, get up slowly and deliberately, not abruptly as this could cause the unnecessary contraction of muscles you’ve just relaxed.

Although this routine should ideally be performed daily, this may not always be possible. If so, do the exercise as often as you can, preferably at least three times a week. Incidentally, although it may take you twenty minutes or longer to work your way through the various sets of muscles at first, you will soon find that this speeds up immensely after you’ve done it a few times.

METHOD TWO – PASSIVE RELAXATION

This form of relaxation – also called meditative relaxation -addresses itself directly to your mind as you clear it of extraneous thoughts to concentrate on a single relaxing idea or image.

Passive relaxation will usually be most effective when it immediately follows a session of active relaxation, for example, such as the exercise described directly above. There is no specific position you should adopt for passive relaxation, but it’s obviously important that you be at ease and comfortable, and you could either be sitting or lying down, whatever seems most suitable for you.

Start by spending a moment or two relaxing your body and clearing your mind before going on to the meditative process itself with one of the following methods:

Close your eyes, then evoke a mental image of a place where you’d really like to be. The image you imagine can either be that of a real or totally imaginary place. For example, it could be a warm beach, a sunlit meadow, a mountain top, or whatever strikes your personal fancy. Use your mind’s eyes and explore in depth all the pleasing aspects of this peaceful and wonderful place, absorbing and rejoicing in its sights, sounds and smells as you luxuriate and delight in being there. Eventually, bring yourself gradually back to reality, but hold on to the deep sense of inner peace and calm you experienced as you visited your mental paradise.

While in a relaxed state, look at a previously chosen object you find really pleasing, such as a vase full of flowers, a statuette, or a painting. Bring all your senses to bear fully on this object: your eyes noting its every intricate detail; your hands gently exploring its shape, contours and textures; and your mind responding to the beauty of every pleasing pattern it recognises. Spend a few minutes on this mental inventory, then close your eyes and re-create the object in your mind while you think about all its beautiful aspects.

METHOD THREE – BREATH CONTROL

Both of the two relaxation promoting methods described above can be used most successfully with additional exercises in which you exercise conscious control over your breathing. Breath control can not only help you relax even more deeply, but it also revitalises your whole body by providing it with an extra intake of oxygen that ‘recharges’ your whole organism.

Of the many different kinds of breathing exercises, the single most useful one is the Complete Breath, a technique that comes from ancient Hatha Yoga, that part of Yoga discipline concerned with the control of the physical body. An excellent time to use the Complete Breath is while you’re still lying down after completing a relaxation exercise. Here’s what you do:

Bring your legs and feet together so that they nearly touch, leaving your arms lying loosely at your sides.

Very slowly and deliberately, take in a deep breath and while doing so gradually raise your hands upwards to initially make them meet above your head, then move them back further so that they end up lying straight out behind your head with their palms up.

Now exhale slowly and deliberately, fully emptying your lungs, and as you do so bring your arms back to where they were originally along your sides.

Repeat this procedure up to ten times, making certain that each successive cycle proceeds smoothly into the next one. It’s most important not to hurry this exercise, but to concentrate on making each movement as smooth as possible, letting it flow naturally into the one that follows.

The above are, of course, just a few of the many proven relaxation techniques available. Many more are an essential part of the therapies offered by alternative practitioners, details of which can be found in

*55\124\2*

Even more important than experts in alleviating the stresses of everyday life are our family and friends – our everyday supports. Researchers have found that even in rat models of depression, social supports play a crucial role in mediating the effects of stress on the development of depressive-type symptoms. In one model, researchers expose a more submissive rat in a cage to a more dominant one. The dominant rat will attack the submissive one and beat it into a state of submission, which the researchers have suggested is the equivalent of a depressed state. If they then place the injured rat alone in a cage, it will remain in a cowering, submissive posture. This will not occur if the rat is returned to a cage with its litter mates. The presence of these other rats appears to provide relief from the depressive symptoms, which do not persist.

Although it may be novel to consider the importance of social supports in protecting against depression in other species, its value in shoring up the human spirit should come as no surprise. In small communities all over the world there is considerable support from neighbours, friends and family in times of need. A good friend or, better still, circle of friends is one of the best non-pharmacological anti-depressants you can find. Cicero, writing about friendship about 2,000 years ago, observed that a joy is doubled and a sorrow halved when it is shared with a friend.

In our modern industrial society, however, where people move around more frequently and often live in more impersonal settings, the support of family and friends is often lacking. This is reflected in the Beatles’ famous song Eleanor Rigby, where the group sings about all the lonely people and asks where they all belong. Eleanor Rigby who ‘picks up the rice in a church where a wedding has been’, is a symbol for those of us who are detached from a group of supportive people. Where can such people find comfort and support in times of need? Others who fall into this category are those who come from dysfunctional families, which appear to be ever-increasing in prevalence. Often such people feel that they cannot turn to their families in times of need because they will not be understood and accepted for who they are. Such people can find enormous support and comfort by turning to support or recovery groups.

*70\75\2*

(TONIC-CLONIC SEIZURES)

Whether the paroxysmal discharge be primary, or secondarily generalized from a focus in the cortex, consciousness is lost if the seizure discharge involves much of the brain.

Cerebral nerve cells are connected to other nerve cells in the spinal cord. The powerful generalized cortical seizure discharge is therefore linked through this direct transmission system to muscle fibres. Disordered contraction of all muscles is the hallmark of a grand mal seizure.

The first phase of a grand mal seizure is known as the tonic (contraction) phase. At this stage, because of widespread contraction of muscles, the body is rigid, and is incapable of maintaining a normal coordinated posture, so that the person falls to the ground. The respiratory muscles also contract, forcing out the air in the chest, so there may be an involuntary noise—a grunt or a cry—at the onset of the attack. The jaw muscles also contract, and, because the normal associated movements that keep the tongue out of the way are disordered by the seizure discharge, the tongue or inside of the cheek may be bitten.

During the tonic phase there are no coordinated movements of breathing, yet muscular contraction caused by the seizure discharge is vigorous. This combination means that the oxygen in the blood is rapidly used up, and the subject will become a dusky blue colour, the technical name for which is cyanosis. This colour is exaggerated by dilatation of blood vessels in the face by raised pressure within the thorax, due to the strong contraction of chest muscles. Normal movements of swallowing are lost, so that saliva may dribble out between the tightly clenched teeth. The disordered contraction of abdominal and bladder muscles may result in incontinence of urine, though this is by no means invariable. Dilatation of the pupils and sweating often occur.

After one or two minutes of the tonic phase, the seizure passes into the clonic or convulsive phase, with rhythmic movements of limbs and trunk muscles. These gradually cease after a few minutes, and the child or adult lies passively unconscious, often breathing stertorously. Normal colour returns. Consciousness gradually lightens, so that they can be roused, then begin to move around, and then can be helped to their feet and a chair. For several minutes after this, they will be confused and restless. After this they may suffer a headache for the rest of the day, or go to bed and sleep for a couple of hours. They will also be aware of stiff and painful muscles which have contracted forcibly during the seizure.

*9\188\2*

Symptoms: raised, red welts; itching; welts change appearance rapidly.

Home care:     

Use cold water compresses, calamine lotion, and corn flour baths to help relieve itching.

If hives are caused by an allergy, medication prescribed by the doctor can be given to the child when the hives appear.

Precautions:

-    See the doctor if hives appear on the child’s tongue.

-    See the doctor immediately if the child is coughing or has difficulty breathing or swallowing.

-    If the child has hives accompanied by fever, the doctor will order a culture to check for strep throat

-    If an allergic child’s medication doesn’t relieve the hives, call the doctor.

Hives (urticaria) are an allergic reaction of the skin, and about 20 percent of children develop hives once or repeatedly. Hives can involve any area of the skin, and 95 percent of cases are caused by foods, beverages, or medications to which the child is allergic. Among the substances most likely to trigger a reaction are citrus fruits, chocolate, nuts (including peanut butter), tomatoes, berries, spices, sweets, tropical fruits and fruit juices, and artificial food flavorings.

The small proportion of cases of hives not caused by a food or medication allergy’ is caused by one of the following: a substance that the child has touched, such as a plant, ointment, or cosmetic, or the saliva of a dog or cat; an insect bite or sting; overexposure to sunlight or cold temperatures; or something the child has inhaled, for instance, pollen, mold, an insecticide, animal dander, or feathers. One rarely seen form of hives is caused by respiratory or other viruses, by the streptococcus bacterium, or by certain medications. This form of hives is known as erythema multiforme.

*116/84/5*