Hysteria is a condition in which some symptom develops which acts to solve some conflict for the patient. The conflict may be conscious or unconscious, and the symptoms may solve the conflict in some realistic way or may solve it only in some symbolic fashion, but in either case it usually does the patient harm in some other way. Very often the symptom takes the form of paralysis of a limb. For instance, a soldier may be approaching the enemy position. Naturally, he is afraid. He stumbles and falls; and suddenly finds that his leg is paralyzed. He is unable to go on. The hysterical symptom has served as a means of solving the conflict between his desire to do his duty and his desire to save himself. In a similar way pain may be a hysterical symptom.
The boy who has not done his homework suddenly develops a pain in the stomach when he is about to leave for school. It is real pain. He feels it and it hurts him. He cries with it. In fact this is a feature of hysterical pain; the sufferer has to let others know about it. These examples may seem very simple, but they are real; and we must remember that the soldier in fact cannot move his leg, and the child does in fact suffer pain. It is not altogether uncommon for adults to develop a severe headache when the time comes for some task which they do not relish. The circumstances may be such that the headache excuses them from the task; or on the other hand it may provide a ready excuse to themselves or to others for not doing it well.
Q. Now comes the important question of diagnosis. What is the story here?
A. The first essential point is that any person with any of the tell-tale symptoms which indicate a gastrointestinal disorder should seek medical attention. It is fruitless self-medicating, such as throwing down some antacid pills or mixture or powders in the hope that ‘it might go away’. Certainly, if there have been dietetic indiscretions — in short, plain stupidity in one’s eating habits, such as eating the kind of food that history has shown produces a tummy upset, then the penalty is usually patently obvious for anyone to see. Some self-medication for a day or so will often help, and eliminate the grotty stomach. But with ongoing symptoms, attending the doctor is advisable.
Q. What happens when the patient visits the doctor?
A. Usually the physician will take a fairly detailed medical history. He will try and elicit a sequential description of the symptoms suffered, how long they have been present, their intensity, and so forth.
Q. Does he examine the patient?
A. The physical examination follows the history taking routine. The answers to his questions will give him a clue what to seek next. He will concentrate mainly on the abdomen, for this is the spot where symptoms are worst. He will note your reaction to his feelings and proddings (or palpation as the medics say). Always give reliable answers to his queries; it is pointless giving false ones, for the only person to suffer from this is you, the patient. If there is pain with pressure, say so. Do not try and be brave, this is foolish in the business of diagnosis. Often from the history and examination the doctor will have a pretty good idea of the diagnosis.
I might add that these days most doctors will also give the other systems of the body a quick once over — such as checking blood pressure, the heart, the urine, and other systems. Occasionally other disorders may be picked up at the same time, and this is always fruitful.
Q. What comes next?
A. If the physician suspects an ulcer, he will then proceed with the next step to confirm it. Here, there are two options open.
Q. What special examinations are carried out?
A. The first is called a barium meal x-ray of the stomach and duodenum. The second is called an endoscopic examination of the same organs.
These are flexible plates of fibrocartilage that connect any two adjacent vertebrae in the spine, between them accounting for a fifth to a quarter of the length of the spinal column. Each disc has two main parts:
In the centre of the disk is the nucleus pulposus, a gelatinous substance; and
Surrounding the centre is a ring of very strong fibrocartilage -the annulus fibrosus – whose outer edges are made of collagen, making it much stronger than most other ligaments in the body. Apart from connecting the vertebrae in a flexible manner, the
discs also serve as a series of shock absorbers that help protect the spinal cord and the brain from the effects of impact resulting from the body’s movements. For example, were it not for the discs, the impact produced just by walking would send shock waves directly through a more or less rigid spine directly to the brain where damage would eventually result. Two key points to note about intervertebral discs:
The younger you are, the more effective they are as shock absorbers. At birth, the nucleus pulposus is extremely elastic, but as you grow older, this jelly-like centre becomes harder, some of its gelatinous substance having been replaced by cartilage.
Apart from any natural deterioration that accompanies ageing, the discs can also become damaged by accident or disease. One all too common occurrence is a prolapsed intervertebral disc (often simply referred to as PID, or a ‘slipped disc’), a condition in which the pulpy inner material of a disc protrudes through the fibrous outer ring. When this happens the protruding material can exert pressure on adjoining nerve roots and ligaments, and should this pressure affect the roots of the sciatic nerves, then one or more of the typical sciatic pains may follow. As far as what causes a disc to prolapse – incidentally, this word simply means the falling down or slipping out of place of an organ or a part of the body – this is usually the result of one of two scenarios:
As part of the natural wear and tear that marks ageing, the outer ring of a disc will gradually have become weaker and weaker until one day it is so weak that the smallest amount of extra pressure upon it allows part of the gelatinous centre to pass through it. The final precipitating incident that causes a disc’s prolapse may be quite minor – such as an awkward bending or twisting movement, or even a sneeze or a cough – and would not have had any repercussions were the disc’s outer ring not already very weak. In many ways, this can be described as an accident waiting to happen. If a disc is so weak that it prolapses because of a sneeze, then it would have done so sooner or later.
Alternatively, a disc may prolapse because it has been subjected to an unusually great amount of stress, such as can happen during a fall or a road accident. Naturally, the condition of the disc will to some extent dictate whether it prolapses or not in given circumstances, but any disc, no matter how healthy and resilient, can fail when subjected to enough force.
While a prolapsed disc is one of the major causes of sciatica, there are also several others, including:
A disc that’s become distorted or bulges. Without actually prolapsing, an intervertebral disc may just change shape sufficiently, usually because it’s affected by nearby muscles in spasm, so that it’s flattened, part of its squeezed out section creating pressure on the nerves.
Various rheumatic diseases can attack the spinal joints, causing them to swell, so putting pressure on the nerves.
Osteoporosis – a disorder that causes the loss of bony tissue, resulting in bones that are brittle and liable to fracture – can damage the vertebrae, one possible consequence of this damage being pressure upon the nerves.
Ankylosing spondylitis – the first word describes a process of fusion of the bones across a joint space and the second means ‘stiffening’ – is a disorder in which the joints of the spine become inflamed. As the initial inflammation diminishes and healing takes place, extra bone may grow out from the sides of the vertebrae and can fuse these together, leading to a spine that’s stiffened. Sciatica is a common symptom of the early stages of ankylosing spondylitis.
Spinal stenosis. This is a condition in which the spinal canal has become narrowed.
As you can see from the above, the possible root-causes of sciatica are many and varied. While the symptomatic pain is usually due to a fairly straightforward problem that can generally be resolved through some simple remedies and precautions, there is always a possibility that a more serious disorder is responsible. For that reason, it is essential that sciatic pain that persists and fails to respond rapidly to rest and ordinary analgesics be investigated promptly and its cause fully established. Naturally, the way to find out what is causing your sciatica is to consult your doctor
Pyridoxine (vitamin B6), a letter in the Lancet (1:636) suggests, may be like Thalidomide in its ability to cause human birth defects. The letter reports the birth of a child with nearly total absence of the right lower leg, the type of defect seen so often in babies whose mothers, during pregnancy, had taken Thalidomide.
By itself, this report would not be sufficient to incriminate pyridoxine as the cause of birth defects (it could have been a coincidence), but viewed in the context of pyridoxine’s other known side effects, it looks highly suspicious. Given repeatedly in large enough doses, both Thalidomide and pyridoxine, it has been found, cause almost the same type of nerve damage in the limbs, with numbness and tingling in the “stocking and glove” areas, progressing to weakness and instability in walking.
This suggests that pyridoxine and Thalidomide share a common toxic effect on human tissue, and that this is also capable of producing birth defects. Although there is no proof of this, it would be prudent to avoid the current fad of taking supplemental pyridoxine.
The woman whose baby was deformed, incidentally, had been taking one 50 mg tablet of pyridoxine every day.
Signs and symptoms
To pinpoint its cause, recurrent abdominal pain must be associated with other symptoms such as vomiting, diarrhea, constipation, blood or mucus in the stools, fever, and failure to gain weight, painful urination, ingesting inedible substances (pica), or anaemia. Also important is the pattern of the pain – where it is, when it occurs, how long it lasts.
In general, recurrent abdominal pain that is accompanied by no other symptoms or has no set pattern is probably not serious.
If constipation is the cause of the pain, correct it by changing your child’s diet or using a glycerin suppository. If milk seems to be the cause, eliminate milk and milk products from the diet for one or two weeks; then add milk to the diet again and observe the effects. If emotional stress is responsible, try to eliminate the stress. Most important, note and record the pattern of recurrent abdominal pain and any other symptoms that occur before consulting your doctor.
• Recurrent abdominal pain due to emotional stress is real and requires treatment just as much as pain due to an identifiable physical condition.
• Do not try to relieve stomach pain by giving laxatives or placing ice on the stomach.
Your doctor will take a careful history of your child’s recent health and perform a complete physical examination. Frequently the doctor will order urine, stool, and blood tests. If the cause of the pain still is not clear, X rays of the stomach, large and small bowels, and the urinary tract may be required. If X rays provide no clues to the problem your child may be hospitalized for extensive blood tests and an internal abdominal examination.
Skin testing is a very reliable method of determining the kind, as well as the degree, of sensitivity to an inhaled allergen. Intradermal or scratch tests should be performed in three sessions, one session each week, as it is not advisable to perform more than ten of them each time. A possible schedule of testing might look like the one indicated here.
First session Second session Third session
Trees Silk Alternaria
Grasses Feathers Aspergillus
Plantain Dog Hair Penicillium
Ragweed Goat Hair Hormodendron
Tobacco Horse Serum Cottonseed
Pyrethrum Cat Hair Flaxseed
Orris Root Rabbit Hair
The above tests are to be repeated in different dilutions because the intensity of the reaction to each dilution determines the treatment. A very sensitive child classified as AA can tolerate a much smaller quantity of desensitizing material than someone who has been classified as À, Â, Ñ, or D. However, even though testing in different dilutions is a good guide to the strength of the solution to be used in desensitization, it does not indicate the actual amount of discomfort that the allergic child may be suffering.
During skin testing, some highly sensitive children may get hives or shock. If this happens, the doctor should place a tourniquet on the arm above the site of the test (in order to delay the absorption of the testing material) and inject adrenalin in the testing area. This injection may have to be repeated in half an hour.
Skin testing for foods has limited value in the diagnosis of a food allergy. Consequently, many allergists skip these tests altogether. They rely instead on an accurate history and elimination diets. Those who do tests for foods find that intradermal tests are more accurate than scratch tests, but the possibility of severe anaphylactic reactions while testing for shellfish, nuts, and strawberries are possible.
A study published in the British Journal of Cancer showed that men, who smoke, while their partner doesn’t, run the risk of fathering children who develop cancers such as leukemia and brain tumours. The theory is that chemicals in tobacco smoke can damage the DNA in the sperm. Taking this one step further, it’s easy to see that any changes in DNA in the sperm could lead to a possible increase in miscarriage rate. DNA damage cannot be picked up in a normal semen analysis so this problem would not be seen during routine fertility investigations.
Quite apart from the possible increase in abnormalities in babies of women who smoke during pregnancy, there is also an increased risk of miscarriages.
Another study, by Professor Jane Golding of the Royal Hospital for Children in Bristol, highlighted how our own actions can affect the next generation. Jane Golding looked at daughters who didn’t smoke but whose mothers had smoked. The daughters subsequently suffered a significantly increased risk of miscarriages.
It is universally acknowledged that alcohol can alter a man’s sperm count and cause an increase in abnormal sperm. Therefore, it follows that if an abnormal sperm fertilises an egg, nature will try to ‘get rid’ of that embryo because it is working on ‘survival of the fittest’.
Alcohol is a substance that is known to cause mutations. For example, studies have shown that alcohol given to female mice immediately after mating caused severe damage to the chromosomes of one-fifth to one-sixth of the embryos. This resulted in a higher percentage of miscarriages or death shortly after birth. Chromosomal damage is a recognized cause of miscarriage.
Research has also shown a strong relationship between alcohol and miscarriages. A 1977 study found that women who have a drink every day have a risk of miscarriage 2.5 times higher than non-drinkers. In this same study they found that if the woman was a drinker and a smoker her risk of having a miscarriage increased by up to four times.
The conclusion, from a number of the studies on women, is that even moderate alcohol consumption works as a reproductive toxin and as such increases the risk of a miscarriage.
• Find other things to do with your hands that will help you cope with tension. Knitting, ‘worry beads’, playing with a bunch of keys, or whatever, all work.
• Get your family and friends to sponsor you to stop smoking.
• Have a bet with someone as to how long they think you will give up for.
• In the early days of giving up, change your routine so that old trigger-points and situations don’t get at you while your urge to smoke is great.
• Keep busy. Sitting around thinking about smoking and how much you miss it will soon have you longing to go back to it.
• Be prepared for the mood swings as your body gets used to doing without the 100-400 puffs a day it has been accustomed to.
• Don’t kid yourself about how strong-willed you are-keep away from people and situations where you could be put to the test. One small slip and you will have undone all your previous efforts. One day in the distant future you might be able to enjoy the odd cigarette or cigar after a meal but in the early days this is too much to hope for. Complete abstinence is the only way.
• Give yourself a treat every day. Make sure that not all of them are in the form of foods, or you will soon get fat.
Obviously it is best never to start smoking in the first place. Here are some tips on ‘primary’ prevention:
• Breastfeed your children exclusively for at least six months and offer the breast after that whenever they need comforting. Psychiatrists and analysts have found that many smokers are ‘frozen’ at the oral stage of life during which a baby’s main pleasure comes from his or her mouth. If breastfeeding (or bottle-feeding even) goes badly and the baby is left to cry, its oral needs unfulfilled, it is thought that later in life he or she will turn to other forms of oral gratification. Undoubtedly, smoking is the most common of these, though earlier on in life dummy- and thumb-sucking are also widespread. Most normally developed adults don’t seek oral pleasure in this way and don’t respond to stress and anxiety by putting something in their mouths. Some, of course, do and these can be found at any slimming clinic or club.
• Perhaps the best preventive measure adults can take for their children is to ensure that they themselves don’t smoke. This will greatly reduce the likelihood that the children around them will want to smoke.
• Next, it’s worth trying to bring up our children to be able to resist peer pressures to take up the habit. Most young children say they don’t ever want to smoke yet obviously a percentage will be smoking by the age of 15. We should teach children that to take up smoking only because of pressure from their peers is to show that they cannot hold their own against their peers by doing only what they really want to do. They should be encouraged to think of smoking not as tough or glamorous but as an attempt to appear tough or glamorous by those who lack confidence. Such thinking has been shown in tests in California to protect children against drugs and alcohol too.
Another successful ruse is to use older young people to deliver the anti-smoking message in their own style. Play-acting helps in group work and can be fun too. Parents can also get across the message that:
1. You don’t have to be conned by smoking advertising.
2. They wish they had never taken it up because they can’t afford it.
3. They are glad they gave it up and how much better they feel.
4. It is possible to resist smoking just to go along with the crowd.
5. Smoking doesn’t make you ‘cool’.
6. By resisting smoking you will also be able to resist drugs and alcohol.
A study of 526 Californian students, who were encouraged in this way, found that those who were trained to be able to resist the pressures to start the habit began smoking at less than half the rate of those who did not have the training.
Every woman should be aware that a second opinion is her right and she should never be made to feel guilty about wanting one. A second opinion will give you peace of mind so it is essential that you get this from a specialist well-versed in the treatment of endometriosis and one who is well up on the latest research and technology. It is important that the doctor giving the second opinion is not in the same practice as the first doctor.
If you are unable to communicate with your doctor or you are uneasy about your doctor’s attitude, approach and explanations then you should seek a second opinion.
You should also obtain a second opinion if you are unsure about the type of treatment recommended, or if your doctor says there is nothing wrong with you.
If you do not feel that adequate tests and evaluations have been carried out or you wish to consult a doctor who has expertise in one particular aspect of the treatment of endometriosis – such as laser therapy or infertility – then seek a second opinion.
• Have been recommended a hysterectomy.
• Are told by their doctor that nothing further can be done to treat their disease.
• Need reassurance that the treatment suggested by their first doctor is appropriate.
What is it?
Spots, usually a mixture of black-leads, red or purplish spots of various sizes, pustules, scars and pits on he skin. They are mainly found on the face, the back of the neck, the back and the chest, but can be found in the armpits and on the buttocks. The complexion is often greasy and muddy and the individual usually has lank, greasy hair.
Acne is most common during adolescence and most people grow out of it in their twenties.
What causes it?
During adolescence profound hormonal changes are occurring and the oil-producing glands in the skin begin to over-produce their secretions. These secretions often become dammed up in the sebaceous glands and the topmost part of the duct blocks up with oxidized sebum to produce a blackhead. If this is squeezed a worm of sebum appears. Some women have acne or similar types of spots every month pre-menstrually and others have them when they are pregnant but these are easily explained and usually disappear quickly.
Of the specific things thought to cause acne here are just a few:
• Refined foods, especially sweets and chocolates. Having said this, most acne researchers dismiss the effect of diet.
• Caffeine-containing drinks such as tea, coffee and cola.
• Stress. Some people definitely have more spots at times of stress. This may well come about as a result of the increased levels of androgens (male hormones) produced by the adrenal glands during stress.
• Woolly clothing next to the skin.
• Environmental factors are not uncommon in acne. Mechanics, fast-food workers and anyone who works in a greasy atmosphere can develop acne because the atmospheric grease blocks the pores in the skin. Those who work with chlorinated hydrocarbons found in paints, varnishes, mineral oils, pesticides and roofing materials may develop a type of acne called chloracne.
• Iodine and bromide-containing medicines. Iodized table salt contains too little iodine to worry about but some asthma medications and multivitamins contain a lot. Other drugs that cause pimples are steroids, male hormones, lithium and certain anticonvulsants.
• Tar and oil products.
• Infrequent washing. Ordinary oily skin has very little to do with pimples. The oil that reaches the skin is usually not the problem – it is the oil trapped in the hair follicle that produces acne. Antibacterial soaps have been found to be of little value compared with normal soaps.
- Anti Depressants-Sleeping Aid
- Cardio & Blood-Cholesterol
- General health
- Healthy bones Osteoporosis Rheumatic
- Men's Health-Erectile Dysfunction
- Pain Relief-Muscle Relaxers
- Women's Health