MIGRAINE – MIGRAINE HEADACHES

May 15, 2009

Migraine headaches rarely last beyond one day and, if not relieved with drugs, may go once the person goes to sleep. Where the headache persists for days, it is usually initially a migraine which develops into a tension headache and the sufferer has difficulty separating them.

Ergotamine is a drug which constricts the arteries and is the treatment of choice for most vascular headaches. These drugs are often combined with an antihistamine to stop nausea and vomiting.

They must be taken at the onset of the migraine so as to abort an attack.

Ordinary analgesics, even strong ones, are of little use in relieving migraine. The stronger narcotic drugs like morphine and pethidine should be used with extreme caution.

If the attacks are infrequent, taking an ergota-mine preparation to relieve the attack is all that is necessary. More severe or frequent attacks usually require the use of one of the preventive drugs taken on a regular basis, usually for many months.

Some cases resistant to other measures do well with manipulation of the neck, hypnosis or acupuncture.

*504/71/1*

CARPAL TUNNEL SYNDROME – GENERAL INFORMATION

It is common in pregnancy and here it is believed to be due to swelling of the nerve and the overlaying band of ligament as part of the general retention of fluid in the body which may occur in pregnancy.

It may be relieved if the pregnant woman takes a diuretic; a drug that washes fluid and salt from the body. The symptoms are usually relieved following delivery.

Carpal tunnel syndrome causes pain in the hand and fingers, but this pain may spread up the forearm as well.

Pins and needles and numbness may affect the hands and fingers. The fifth finger is never involved because of its different nerve supply.

Patients may be unaware that the little finger is not involved and claim that their symptoms involve the whole hand. But when they are made aware of it and they take particular note, they will find that this finger is spared.

That is a very important point in making the diagnosis. Pressure on the nerve in the neck will usually involve all five digits. Sometimes weakness and inco-ordination of the muscles, particularly those of the thumb, may be part of the problem.

The pain appears to be worse following use of the hand but it also commonly comes on at night and may wake the person in the early hours of the morning. It is usually relieved by hanging the hand down over the side of the bed.

In mild cases the use of one of the antiinflammatory drugs to relieve the inflammatory swelling of the nerve in the tunnel may produce relief. This is often combined with the taking of a diuretic to reduce fluid retention.

If these simple measures do not work, it is worth a trial of applying a plaster of Paris splint to the wrist to be worn only at nights.

Nerve conduction studies will confirm the diagnosis. Where conservative measures fail, operation gives excellent results.

*247/71/1*

YOUR CANCER YOUR LIFE – RIGHT TO HAVE QUESTIONS ANSWERED (DIFFERENT PATIENTS)

May 12, 2009

Remember that, because every patient is different, and because no one can look with certainty into the future, many of the answers can only be educated guesses—what is average or likely. No one can tell you exactly how you will react to a certain treatment or how long you will live. The best anyone can do is tell you what is likely to happen. It is important to know this, and also to know what could happen if you are not an ‘average’ patient, that is both the best and worst that could happen.

Remember you cannot make the best decisions for yourself without this information. Getting it will not be easy. Most of the answers should come from your practitioner. You can ask other practitioners as well as the first one you see. You will find many of the answers in this book. You can go to a library or bookshop and find other books. You can get information from other patients, other hospital staff, friends, or relatives.

Much of this information will not be offered, you will have to ask and often ask more than once. If you find it hard to push for all the information, some of the following will help.

*5/40/1*

SKIN CARE: DANGER ASSOCIATED WITH SOLARIUMS

May 8, 2009

Various advertising brochures present different inaccuracies. There are, however, three fundamental inaccuracies which most of them contain.

The first is the claim made for the enormous benefits of UVA radiation for the body! They reject the ‘blazing and potentially dangerous sun’, only to promote ‘the rich golden tan, which gives you that healthy, confident, affluent look. Who could resist, especially as they say that the radiation which produces a tan is also the major source of vitamin D. In fact the major source of vitamin D is dairy products and fish oils, not sunlight. Moreover such supplementation of vitamin D is hardly necessary in our society: vitamin D deficiency results in rickets, a virtually non-existent condition in developed countries.

The second misleading claim concerns the safety of these units. They maintain that they ‘filter out the potentially harmful part of the UV range’, and use only the ‘beneficial tanning rays’. Some even state that they produce ‘a safe tan, without drying and prematurely ageing the skin’, and further, that such tan is a very effective measure towards the prevention of skin cancer’.

Thirdly, they state that ‘it is not necessary to wear protective goggles’. This, in spite of increasing evidence of cataract formation.

It can be seen, therefore, that tanning for cosmetic purposes is not a harmless procedure. This is equally true whether the tan is developed by lying on sunny beaches or frequenting solariums. The greatest disadvantage of the solarium concept is that it allows people to maintain a tan all the year round. Such people thus have the means of accumulating consistent cellular damage, resulting eventually in tissue breakdown which manifests itself as premature ageing and cancer.

The widespread use of solariums is a public health issue, just as smoking has become. In the United States the Government Department of Health and Human Services, together with the Food and Drug Administration, are very much aware of the danger involved in the indiscriminate use of solariums. As a result, regulations governing their use and their equipment are being enforced. All operators are required to be licensed, and their equipment regularly calibrated and checked. Posters must be prominently displayed, warning of the skin and eye dangers, and referring to the various drugs and diseases which may adversely affect the client using the solarium.

*101\44\4*

THE MENOPAUSE: HOT FLUSHES AND NIGHT SWEATS (PART 2)

Hot flushes and night sweats are, therefore, an obvious case for treatment with hormone replacement therapy, and in fact relief from these distressing symptoms is the commonest reason for women wanting to take it. As the problem is caused by falling levels of oestrogen, the flushes cease when these levels are topped up to their normal level. Once oestrogen therapy is started, the situation can be dramatically improved within a few days, and the flushes have usually ceased completely within a few weeks. If you are still troubled with them after three months of therapy, ask your doctor if he will change your dosage of oestrogen; he should be able to find one eventually that relieves your symptoms without causing unpleasant side-effects. Once things have stabilised, the relief will usually continue for as long as you remain on the therapy. However, they may return if you stop the treatment suddenly, move to a hot climate (if you go abroad on holiday, for example), take a course of antibiotics, or come under additional stress. If this happens, ask your doctor’s advice.

Taking HRT will eliminate night sweats, dramatically improving the quality of your sleep, and with it your level of fatigue and irritability. Sadly, some general practitioners still prescribe tranquillisers and anti-depressants to women who complain of hot flushes and night sweats, and the insomnia and emotional upsets that they cause. This is difficult to justify, as the problem is due to falling oestrogen, and nothing else. Replace the oestrogen with HRT and the flushes and sweats will disappear, and with them the sleep disturbance they cause and its accompanying fatigue, irritability and lack of wellbeing. If you are on tranquillisers or anti-depressants for these particular menopausal problems, talk to your doctor about the possibility of changing to hormone replacement therapy. (If he ‘doesn’t believe in it’, see page 90 for other suggestions.)

Many women feel they want to ‘die of embarrassment’ or ‘disappear into the floor’ when a hot flush strikes them at work or in mixed company. This is largely due to other people’s perception of hot flushes; some men and young women may laugh and make unkind remarks. Perhaps we could bring up our sons in such a way that they become men who will not diminish a female colleague’s self-esteem at work, but will show kindness and sympathy during what is a very uncomfortable few minutes. Once our daughters know more about the menopause and its causes and effects, perhaps they will help to develop a culture that will ensure attitudes have changed by the time their turn comes.

Flushes have been described as ‘something like adolescent acne – an outward sign of natural hormonal changes’. They may be troublesome and embarrassing but (unless you are one of the unfortunate 5 per cent) they do decrease in number and strength, and they will eventually pass as the body adjusts to its lower level of oestrogen. However, just because the menopause is ‘natural’ doesn’t mean you have to put up with its distressing symptoms for months or years, and we are lucky that HRT is now available to relieve them.

*11\42\4*

DRUG TREATMENTS FOR EXCESSIVE BLEEDING

Numerous pharmaceutical treatments have been developed to stop excessive bleeding. Not only do they avoid major surgery which, until quite recently, was the only treatment option for these conditions, they also preserve a woman’s fertility, a factor of increasing importance with current trends to deferral of childbearing until after the age of thirty.

In general, these treatments are best used in the short-term (that is, for no more than a year) because prolonged use tends to result in side-effects. This drug-induced respite from heavy bleeding secures time during which women and their doctors can examine the situation carefully before settling on a strategy. For women approaching menopause, medical treatments may provide just the sort of stopgap needed until their bleeding problems disappear spontaneously.

Drug treatments can shrink tissues that may be responsible for bleeding. According to some doctors this makes subsequent surgery easier; although practitioners whose approach is to cut out or excise the aberrant tissue say it makes the surgical removal of unwanted tissue more difficult because it is less visible in its shrunken form.

The cost of drug approaches compared with surgery depends on the duration of their use, whether their price is subsidised through a national health scheme (such as through the Pharmaceutical Benefits Scheme in Australia) and whether there is a need for regular medical checks or examinations.

*26\198\4*

RECURRENT NIGHTMARES

Some people complain of a recurring dream and seek analysis. They are convinced that there is a hidden important message in the dream and that is why they keep dreaming it night after night. What really happens is that these people keep on thinking about the riddle in their dream day after day and their mind is occupied with these same ideas day after day. Consequently these ideas will appear in the dream night after night.

Nightmares arise from a failure in the dream works. Our primitive driving forces and anxieties are not handled effectively by the dream works, and these express themselves as horrible feelings in our dreams. When we wake up, we are anxious and fearful about the dream we have just had. Nightmares are called ‘dream anxiety attacks’. Recurrent nightmares are recurring bad dreams.

If you wake up from a nightmare, the best thing to do is to say to yourself, ‘Thank God, it is only a dream’, relax, and fall back into sleep. Nightmares, like any other dreams, will be forgotten in the morning. Recurring nightmares happen because you believe that there is some bad message in the dream and, because you keep thinking about it, you remember it. Once it is recalled and repeated in your memory again and again, it will certainly appear in your dream night after night Next time, if you wake up from any nightmare, do not go over it If you cannot stop thinking about it, get out of bed immediately and get back to the real world; do something relaxing like watching the television or reading .the newspaper. Your nightmare will then vanish and will not reoccur. Incidentally, some modern medicines for blood pressure can cause nightmares. It may be wise to check with your doctor if the nightmares persist and if you are taking these medications.

*26\174\4*

THE SELF-MANAGEMENT OF ANXIETY: THE IDEA OF REGRESSION

April 29, 2009

Over the ages the mind of man has evolved from relative simplicity to greater and greater complexity. In a similar way the mind of the infant and child works in a much simpler fashion than that of the mature adult. But we, mature adults of the twentieth century, do not keep our minds constantly working at the full capacity of their state of development.

We often let our minds slip back, as it were, and let them work at a simpler stage of developement—at a more primitive level. This is regression. It happens quite normally in our moments of reverie and when we are in the transition between wakefulness and sleep. It also occurs as a result of fatigue or mental illness or drugs or even alcohol. Essential features of regression are that we are less alert and that the critical faculties of our mind are less active. Regression to this kind of more primitive functioning of the mind is an important part of our relaxing mental exercises.

Let us for a moment consider anxiety from the evolutionary point of view. We have already learned enough about it to realize that it is a very complex state. Fear, on the other hand, is a much simpler emotion. We can see animals expressing fear, but it is hard to imagine that animals experience anxiety as we know it. The emotion with its attendant apprehension is too complex for their state of development. In other words, anxiety is a relatively recently acquired function of the mind—something that our prehuman primitive ancestors did not experience. In regression the mind goes back to a simple, primitive way of functioning in which there is an absence of anxiety. This is seen in our everyday experience. In moments of reverie and complete mental relaxation our mind fills with calm, and there is an absence of any feeling of anxiety.

We have discussed the way in which we learn various patterns of response during our life. Now, if we want to learn a new and better response to a certain situation, it is necessary that we first unlearn the old pattern of response. We cannot simply add some new response to the old pattern, or we should develop some quite incongruous reaction. We cannot learn a new habit without first dropping the old one. In other words, before learning a new pattern of response we must first regress, and go back in our mind to the state before the development of the bad pattern of response. In our relaxing mental exercises we do this. We regress to a state of mind free from anxiety, and we are then free to learn the new pattern of calm and ease of mind.

This is the basic reason why explanation and persuasion are generally quite ineffective in helping those with tension. These are logical measures and work at an intellectual level; and they do not allow for the regression which is so necessary. As a result the patient can see the logic of what is explained to him, and he would like to do what we try to persuade him; but he cannot. He just remains as tense and anxious as ever because the all-important regression has been omitted.

In other relaxing techniques which are successful and in which the idea of regression is not actually mentioned, we can safely assume that regression occurs spontaneously without the patient’s knowledge.

*52\57\2*

SYMPTOMS OF ARTHRITIS

The most common symptom of arthritis is that the joints at first become painful. The pain can have many degrees of intensity and it can come and go. Sometimes it disappears for months, even years, then it returns again. At first the pain could be a feeling of numbness and stiffness. Sometimes a creaking and cracking of the joints is felt. Often the joints become swollen and inflamed. Pain can be dull but also very severe, occurring mostly at night and in the morning.

It is important to understand that these symptoms, although they may seem to be the very first signals of approaching arthritis, are not at all the first symptoms of the onset of the disease. Arthritis is not a local disease of a particular joint but a systemic disorder, a disease which affects the whole body. It could have taken years and years of abuse to bring about the systemic disturbance in bodily functions which eventually leads to a breakdown of the health and the functions of the joints.

*8\176\2*

THE FACTS-THE FIRST SEIZURE AND THE DIAGNOSIS OF EPILEPSY: OTHER CAUSES OF IMPAIRED OXYGEN SUPPLY TO THE BRAIN-VERTIGO

April 28, 2009

Doctors are careful to distinguish true vertigo—a perception of dysequilibrium of the body in its relation to space—from non-specific feelings in the head such as ‘dizziness, or ‘muzziness’ which are so often associated with anxiety and depression. True vertigo is rarely a symptom of a partial seizure in a temporal lobe. Far more common is vertigo due to a disorder of the balancing organ—the labyrinth—lying within the inner ear. The labyrinth may malfunction in an episodic way in both children and adults. In young children the distinction between paroxysmal vertigo and partial seizures may not be easy, as in both the child is frightened, and may either hold on to his mother or fall. The distinction rests on the absence of amnesia or confusion after the attack of benign paroxysmal vertigo, and the presence of abnormal tests of labyrinthine function.

*42\188\2*

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