When there is no clear cause for the condition, patients suffering from chronic pain are sometimes referred to a psychiatrist for his opinion. When these patients really unburden themselves they often disclose that they are preoccupied in thinking about some wrong they have done in the past. Over the years they have thought about it a great deal, and in thinking about it in this way, the wrong becomes greatly magnified. They have never told anyone about it. “This is something that I always thought I would bring with me to the grave.” And all the time there has been the thought, “Of course I shall be punished for it.” In the first place the pain may have arisen from some quite trivial cause; but once the pain is there, it soon becomes fixed. Only

half-consciously he thinks, “This is what I have been expecting; I knew it had to come; I am glad it has come at last and I shall get it over.” In a sense he is glad of the pain. By suffering the pain he will ease his conscience of the thing that he has done, and his mind will be at rest again.

On the one hand a patient in this situation wants to get rid of the pain because it hurts him, but on the other hand he wants to keep it, as it expiates his feeling of guilt. The pain lingers on, unrelieved by the various medicines he is given. Expiation never seems complete, so it continues until brought to light and worked through in psychotherapy.

*113\57\2*

Q. What other forms of medication are used?

A. The Histamine ft-receptor antagonists are currently the most widely used drugs for peptic ulcers. Nevertheless, a form of medication called tri-potassium di-citrato bismuthate (colloidal bismuth) is also claimed to produce very good results. It is said to be about as effective as cimetidine, but until recently the only form available was an unpleasant tasting liquid which had a strong ammoniacal odour. It is now available as a chewable tablet and this has improved patient compliance. There is little doubt that if a person does not like his medication, , he often will not take it. He will invariably lie to the doctor and say he is taking the prescribed medication!

Q. Does it have adverse side effects?

A. Every medication has some side effects in someone as we have already pointed out. However, like cimetidine, these are small and fairly unimportant, at least in the known short term. It may stain porcelain teeth fillings, colour the tongue and cause the stools to turn a strange dark grey. It is taken well before meals. Its effect is negated by the presence in the stomach of food, milk or antacids, so it is essential these are not taken at the same time, or indeed probably within an hour or two either way.

*16\61\2*

The operation most commonly used in an effort to permanently cure back troubles caused by one or more discs is spinal fusion. Much more popular in the United States than in this country, this is an operation in which two or more vertebrae are essentially welded together and any troublesome discs between them removed. There are various ways of performing this procedure, but the one used most nowadays involves both anterior and posterior fusion of the vertebrae, the spine being approached from the front (via the abdomen) and then through the back. The damaged disc is then replaced by a bone graft.

Just how good the results of spinal fusion are is still a matter for debate by experts as the operation so far has not been the subject of a properly-controlled trial. Certainly, there are many patients who have benefited greatly from spinal fusion; in other instances, the results have been less favourable. More may be known in a year or two about the true benefits – and risks – of spinal fusion as a trial to compare its results with those achieved through non-surgical rehabilitation programmes is being set up.

Laser disc decompression is an alternative way of dealing with bulging discs that is currently being pioneered in America, but it also remains the subject of some controversy about just how effective and free from long-term side-effects it is.

This method has proven itself useful in dealing with a disc that bulges but where no part of the disc’s soft centre is actually protruding from it, the pressure on the nerves resulting purely from the fact that the disc is larger than it would normally be.

Here’s how this procedure is performed. A silicon optical fibre is temporarily inserted into the disc. Energy from a laser is transmitted into the disc via the fibre and this causes the loss of water and some of the substance that makes up the centre of the disc. As the pressure within the disc is decreased because of the loss of material, it shrinks and pulls the offending bulge off the nerve root, so decreasing or eliminating the pain.

The procedure takes about 15 to 30 minutes, followed by two to three hours in the recovery room. The advantages of this method is that operating time and hospitalisation is kept to a minimum, and that it can be suitable for patients who are surgical risks, for example, those with heart trouble or age-related problems. The proponents of this approach say that there have been no major complications to date and the degree of success is about 80 per cent so far.

*14\124\2*

Since there is now good evidence that deficiency of selenium in our diet encourages the development of cancer, many people are taking supplementary selenium in the form of a tablet every day. One must be careful not to take too much selenium, however, since it can be very toxic if taken in excess.

Morbidity and Mortality Weekly Report (33:157) contains the story of a 57-year-old woman who took one selenium tablet daily and, after 11 days of this dosage, began losing her hair and developed sore fingertips. Continuing with the selenium because, at the time, she did not know that is was causing her problems, she slowly lost all of her hair during the next two months and developed a discharge around her nails, all of which she later lost as well. In addition, she suffered with episodes of nausea and vomiting, a sour-milk breath odor, and increasingly severe fatigue.

Eventually, her doctor found that her selenium blood level was four times higher than normal, and that this, in turn, was due to the selenium tablets being more than 100 times stronger than advertised.

The tablets (now recalled from the market) had been distributed in 15 states coast to coast. Knowing what to look out for, we should be able to quickly recognize selenium overdosage and protect ourselves against this danger.

*222\143\2*

It is not possible to make any definite recommendations about treatment. The following are some suggestions for normal healthy baby care. It is not known for certain whether these will prevent cot death but they do improve the care of normal babies. Before making any changes to the way you care for your baby, please check with your pediatrician or maternal health sister.

• Before becoming pregnant try to be as healthy as possible.

• Ensure good antenatal care.

• Do not use morphine or other hard drugs.

• Avoid maternal smoking during pregnancy as this can contribute to lower birth weight or premature babies who are believed to be more at risk.

• If possible, try to breast feed as this appears to reduce the possibility of respiratory infections.

• Do not give the baby certain antihistamines or “knock out drops” which have a sleep-inducing effect.

• Parents should consult their maternal and child health nurse or doctor as to the best sleeping position for their baby.

• Maintain a warm, even temperature for the baby. In winter, keep the baby’s room heated evenly or have it sleep in your room in order to keep a check on major fluctuations in temperature.

• Maintain a smoke-free environment. Research shows that babies living with smokers are more at risk as they inhale significant levels of carbon monoxide.

• Keep the nose and mouth free from obstructions.

• Ensure your child is immunized at the correct age.

• Try not to take the baby to crowded places during winter and avoid having people with colds handling the baby.

*209/84/5*

“I wish I were back home with my own people. People I can understand. I’m not at home here. They say nasty things. Rude things. Call me “Old bastard”. But they seem to like me. I can’t understand. I’m not a bastard. I hate it. They laugh. It spoils my life. I wish I could go back to my own country.”

Local idiom and local slang are always confusing to the newcomer. His brain cannot integrate conflicting messages. They seem to like him, but still call him a bastard. Far from being a matter of vilification, ‘old bastard’ is a term of endearment in the Australian vernacular.

I remember, some years ago, the cool reception I received when I addressed the head nurse of an American hospital as ‘sister’. In Australian hospitals the word carries strong overtones of respect, while in America it is a term of familiarity.

In matters as simple as this, the misunderstanding can be rectified by simple explanation. But without such explanation, the individual lives in an atmosphere of uncertainty which can form a background for the development of stress.

If we are secure enough in ourselves these misinterpretations lose their ill effect. We can stand by, and assume there was something in the conversation which we did not understand correctly.

*7/98/5*

The poison ivy plant is a vine which climbs on trees, hedges, or stone walls and has a leaf composed of three leaflets, two of which are opposite each other. The leaf is about three inches long, and its edges are either smooth or have notches. The plant is green in summer and turns red in the fall. In May and June it bears small clusters of greenish-white flowers which turn into white berries (not poisonous to eat) the size of a raisin during the fall. Its flowers and fruit clusters may remain on its branches after the leaves have fallen.

The poison sumac plant is a coarse woody shrub (which is known as swamp sumac) that never assumes the vine-like form of poison ivy. Its leaves are divided into from seven to thirteen pairs of leaflets, with a single leaflet at the end of the stem.

Poison oak (otherwise known as oak-leaf ivy) is a low-growing shrub which has slender, upright branches that bear leaflets similar to those of the oak tree and fruits similar to those of the poison ivy plant.

An unseen oil which coats the leaves of all of these plants may stick to the hands, shoes, or clothes of the person who touches them and may remain there for many months (strongly enough to revive the dermatitis). Smoke from a burning poison ivy plant may carry enough of this oil to cause irritation in the nose or eyes of a person standing in the vicinity of the fire.

The symptoms of poison ivy dermatitis are a slight redness in the skin followed by a mild itch which slowly increases in intensity. The redness may turn into tiny watery blisters after a few hours. These may burst, ooze, dribble over the skin, and become infected. The oozing material, however, does not spread the disease to other parts of the body or to other people. The blisters take about two weeks to heal without any medication.

Treatment of poison ivy dermatitis consists of washing the affected skin immediately with soap and water (to stop the oil from reaching the deep layers of the skin). If blisters have already formed, dressings of normal saline should be applied. If the blisters have become infected, the application should be tepid soaks of 1:10 Burrow’s solution. Antihistamines may also be used if local applications fail to bring relief. In severe cases, the only treatment that may help is prednisone taken by mouth.

A child should be taught the following:

a.     To identify poison ivy, poison sumac, and poison oak leaves

b.     That he should immediately wash the area that has touched the plants with soap and water

ñ     That poison ivy dermatitis may occur at any time during the year by contact with twigs of the dormant plant, but that the danger is greatest in spring and summer when the oil of the plant is abundant and lively

d.     That poison ivy dermatitis is not necessarily an allergic disease and that any child may get it

e.     That he may get poison ivy dermatitis by touching clothes or animals that have been contaminated with it, by inhaling the smoke of the burning plant, or by eating the buds of the plant

*37/99/5*

You may be told by your doctor not to drink during the first three months of pregnancy but it is fine after that as long as it’s only one or two glasses now and again. However, unfortunately, we now know that even a little bit can be too much. During the first 12 weeks, the highest rate of cell division takes place and all the major organs are formed, so there is more risk if a toxin like alcohol gets to the baby then. After the third month the baby grows and matures. This period is important because, even though the baby is fully formed, his or her organs cannot function on their own yet. As well as the heart and lungs the brain is also maturing. It is the brain that can be vulnerable to damage after the first 12 weeks.

It has been known for centuries that drinking during pregnancy can cause problems with the health of the baby. In the 1720s ‘gin epidemic’, the Royal College of Physicians stated that parental drinking was a cause of ‘weak, feeble and distempered children’.

Alcohol is classed as a teratogen (an agent or drug that can cause malformation of an embryo or foetus). Professor David Smith from Washington points out that ‘there is no known teratogen yet studied in man which clearly shows a threshold effect where the substance is quite safe to a particular level, beyond which it is teratogenic’. In effect, he is saying that the experts cannot say that one glass a week would be fine but two glasses are not. As the World Health Organization states, ‘no alcohol during pregnancy is the only safe limit’.

By day 36 of pregnancy, the neural tube of the embryo opens and a rudimentary system is formed. If a teratogenic substance like alcohol is drunk at this most crucial time, it can result in various malformations in the newborn (e.g. defective heart and muscular skeletal abnormalities).

Remember that you will be two weeks pregnant before you know you are. You only know that you might be pregnant when your period is late.

However, although the first three months are the most critical, the teratogenic effects of alcohol continue throughout pregnancy, affecting, at the later stages, brain development and function, in particular. Low birth weight and congenital abnormalities have all been linked to the teratogenic effect, with the probability of twice the risk of abnormalities.

The placenta does not act as a barrier. Alcohol is a low molecular substance which is quite capable of crossing the placenta and entering the baby. It does not take a mathematician to work out that, in relative terms, a dose of alcohol must have a much more profound effect on a minute developing embryo than on the much larger mother.

*113/73/5*

• Get into the habit of nibbling on healthy foods in between meal Chew nuts, raw vegetables (you will be surprised how sweet many of these are), seeds, fruit cheese or even hard-boiled eggs This will stop you feeling you have to reach for the sweet thing In the early days of weaning yourself off sugar, it is a good id» to have fruit, for example, in the car.

The trouble with sugar addiction is that, like any other addiction it makes your body produce abnormal physical reactions – in this case a rise in insulin to combat the rise in blood sugar. Unfortunately, a rapid release of insulin produced in too large an amount in a sugar addict causes the blood sugar to fall about an hour later producing the classical effects of hypoglycemia. These are so unpleasant that it often does not take much will power to stop this self-destructive behaviour. Don’t see nibbling in between meals as bad-make it a virtue by nibbling at the right sort of foods. If you are eating healthily at mealtimes you will probably find you need fewer in-between meals snacks anyway. It is far better to eat six bulky, high-fit meals a day than two or three energy-rich, sugary blow-outs.

• Eat more high-fibre foods and complex carbohydrates. Unfortunately, the majority of sugar addicts like these foods least îf all so this could take a few weeks to get used to.

• Take more exercise – in particular, do something physical when you feel you would like to binge on sweets. When you crave sugar get down on the floor and do some push-ups or some other strenuous exercises.

• Use artificial sweeteners if you have to as a crutch while you wean yourself off sugar, but don’t substitute one for the other permanently. A cloud hangs over the safety of all the artificial sweeteners and using them to overcome your addiction simply substitutes one form of sweetener with another. Aim to be off all sweeteners within a couple of months of getting rid of your addiction for sugar.

• Keep well away from confectionary vending machines. They are disastrous for the sugar addict.

• Research has found that the  vitamins, especially nicotinamide, help kill the hunger in sugar addicts. Whole grains, fresh vegetables and wheat-germ are all sources of this vitamin.

• Eat more chromium, manganese and zinc. The trace element chromium is known to be vital in sugar metabolism, and zinc and manganese help stabilize blood sugar. Zinc has a vital role in taste generally and a recent study found that it can help control a sweet tooth. Ten healthy people were fed zinc supplements for fifteen weeks to see how it would affect their senses of sweet, sour and saltiness. The most dramatic finding was that they could all get by with less sugar.

*229/72/5*

What is it?

A potentially lethal venereal disease that affects mainly the homosexual community and those who have received infected blood by transfusions. The letters of the name stand for Auto-Immune Deficiency Syndrome-the condition is so named because it produces a breakdown in the body’s ability to combat infections.

AIDS appears to be a new disease and at the time of writing the total number of cases reported worldwide is less than 12,000. Just why some people who develop AIDS die and others seem to be able to cope with the infection is not known but most people who contract the disease probably do not realize they have it. Only about one in ten of those with the AIDS virus go on to develop a more serious form of the disease.

There is no treatment for AIDS and this makes prevention all the more vital. Gamma interferon, Inter-leukin and bone-marrow transplants have all been tried unsuccessfully.

The first signs of AIDS are night sweats, fevers, rapid weight loss, lethargy and general malaise. Sometimes these symptoms are clear-cut and then disappear. Swelling of the lymph glands and the appearance of skin blotches are signs that the full AIDS condition has developed. Symptoms can take from six months to four years to appear after the initial contact with someone with the virus.

People who have AIDS usually die from pneumonia or skin cancer as a result of the breakdown of the immune system.

What causes it?

AIDS is caused by a virus that was only identified in May 1984. Since then the entire genetic structure of the virus has been discovered but vaccines may take a long time to develop because the AIDS virus, unlike that of certain other viral diseases, appears to be able to live alongside the antibody to it in the blood. The virus is also very changeable (rather like the ‘flu viruses) and this again makes for problems in combating it.

Infection with the virus does not necessarily mean death as was thought until very recently. Having said this, once someone has the disease itself (as opposed to being infected with the virus) at the current state of knowledge death is certain. The disease has only been around for six years or so and it is clear that the incubation period can be this long. There is now concern that carriers of the virus might remain symptom-free for perhaps much longer and then finally develop the disease-all the time passing it on to others unwittingly.

*90/72/5*