PAIN AND GUILT: RELIGIOUS ASPECTS OF PAIN AND GUILT

You may say to yourself, “I am not a religious person, so this section does not concern me.” But the idea which I wish to discuss is religious in the widest sense, and applies to us all. It is like this. We have within us a number of very simple, primitive ideas which form a basis of our conduct of life as humans. Our sense of right and wrong is one such idea. The question of the origin of these ideas is beyond our present study, but they are ideas that are common to people of all religions including atheism. The particular idea that concerns us now is the feeling that sin is punished. I have referred to this as a- feeling, because, with many of us, it is vague and

ill-formulated, and is never really thought of in clearly logical terms. In fact, when we come to examine the idea logically, we are inclined to think that it is not sensible, and that we never really held such an idea. But it is there within us just the same. Our wickedness is punished. Wrongdoing brings pain. Then when we suffer pain, we think back, and ask ourselves, “What have I done wrong?” The idea is reflected in the expression which all doctors hear every day, “But what have I done to deserve this? Why should this happen to me?”

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TREATMENT OF ULCERS: DRUGS PREVENTING ACID FORMATION

Q. What is the most widely used form of treatment at present?

A. Just now, probably the most popular form of therapy is the use of a family of drugs called the histamine IT receptor antagonists. The most widely used one is called cimetidine, although the doctor will probably give you a prescription using the trade name, ‘Tagamet’. These are tablets taken orally which act on the acid producing cells of the stomach wall, and prevent acid production. In turn, this inhibits the production of the other important stomach chemical, pepsin. Therefore, with no acid and pepsin present, the cause of the ulcer vanishes, and symptoms vanish as the ulcer gradually heals.

Q. How long does it take for symptoms to disappear?

A. Many patients report that symptoms, especially abdominal pain, disappear within a few days! This seems remarkable, especially with those in whom pain had been intermittently present for months or even years. It may be dramatic.

Q. Does cessation of pain mean the ulcer has healed completely?

A. Certainly not. It means acid production is stemmed, and the pain from acid irritation on the exposed nerves has stopped. It takes at least from four to six weeks for the stomach lining to grow over the ulcer site.

Unfortunately, many patients thinking that pain cessation means ulcer healing, foolishly stop medication. The results are then bad, for often within a few more days, the pain naturally recommences as acid production starts up again. Once the physician has ordered a course of treatment it is imperative that it be taken exactly as prescribed, and for the total number of tablets.

Q. What is the usual dosage?

A. Generally, 400 mg is taken morning and night. Many doctors now find that one single evening dose of 800 mg is preferable. It is easier to remember, and seems to give very satisfactory results. The aim is to keep acid at a low level during the day, and the higher bedtime dose is aimed at keeping it low throughout the night. Remember, nocturnal pain due to acid build up is the hallmark of the ulcer patient — and a very disturbing symptom. This dosage method is different to multiple doses which were originally recommended.

Q. What is the value of this altered dose routine?

A. First of all, doctors have found that the results are often as good or better with this system. Also, by making the tablet swallowing routine less frequent, a strange phenomenon called ‘patient compliance’ is far higher.

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SCIATICA: INVESTIGATIONS AND SURGICAL TREATMENTS

While the vast majority of instances of sciatica and lower back pain will respond to fairly simple treatment within a matter of weeks -or even much more quickly than that – there will always be some that will be more intractable, either not responding at all to just rest and analgesics or responding so little that it becomes evident that other treatments have to be considered. When that happens, a patient will usually be referred by his doctor to a specialist at the out-patient department of his local hospital.

Your initial consultation with a specialist will generally follow a similar pattern than when you first saw your own doctor: a history of the problem will be taken, additional questions will be asked, and there will be a further physical examination, this then probably followed by yet more questions.

At the end of your consultation, your specialist may well ask for various tests or other investigations to be done before making his diagnosis. Depending upon the circumstances, the purpose of these tests may be three-fold:

To specifically identify the cause of your troubles, if that’s not already known; and

To eliminate other disorders which may be marked by similar symptoms; and

In those comparatively rare instances where an operation appears indicated, to help pinpoint exactly what approach is likely to work best. Tests and investigations commonly used include:

X-rays. While radiography is widely used in the diagnosis of many other disorders, its results are unfortunately often disappointing when back problems are being investigated, the difficulty being that many of the subtle changes in the spine that cause pain simply fail to show up clearly enough, especially during their early stages. Additionally, it takes a pretty large dose of radiation to X-ray the spine, and this is something that is best avoided unless truly indicated.

Computerised tomography (or CAT- or CT-scan). Using much smaller doses of X-rays, this scanning method records the different thicknesses of tissues, translating these findings through the intermediary of a computer on to film that provides a cross-sectional image.

Magnetic resonance imaging (or MRI). Producing images rather like those from a CAT-scan, this technique uses very powerful electromagnets instead of X-rays, so making it free of the risks that can accompany radiation.

Myelogram. This is a specialised method of X-ray examination in which radio-opaque contrast medium is injected beforehand into the subarachnoid space in the spinal cord. Although this method is of particular value in recognising tumours of the spinal cord (as well as other conditions in which the cord or nerve roots are compressed), it needs to be accepted that this investigation represents a major intervention in itself and that therefore the patient should be made aware of the risks and side-effects that can be involved.

Blood tests. These can provide information about a wide range of disorders, including many different types of rheumatic diseases.

While all these tests – and several others – are potentially available, it is highly unlikely that all will be requested or that even more than just one or two will be done.

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CONTENTS OF ZINC TABLETS

Though zinc currently has great popularity as a dietary supplement, there is surprising confusion about the strengths of the various types of zinc tablets now being sold. In an attempt to learn exactly how much zinc (as the element) there is in each type of tablet and capsule being marketed in health food stores and drug stores (where they can only repeat what is on the labels), the author called several manufacturers. Confusion was the only consistent finding. Most of them, who are merely repackagers, stated that they had no exact knowledge of the nature of their zinc products since they buy the crystalline powder from a chemical manufacturer.

Perhaps the biggest obstacle to a proper understanding of the problem was their lack of knowledge as to how much water is included, along with the zinc salts (sulfate or gluconate) in the crystalline powders from which the tablets and capsules are made. Eventually, one of the largest manufacturers put some of its research staff to work on the problem and, after about 10 days, came up with a definite answer. They told us that one 220 mg tablet or capsule of zinc gluconate contains 28 mg of zinc and that one 100 mg tablet or capsule of zinc sulfate contains 22.5 mg of zinc.

The Recommended Daily Allowance (RDA) of zinc, according to Goodman and Gilmann’s The Pharmacological Basis of Therapeutics (6th ed., p. 1553), is 15 mg. This amount, approximately, would be provided by one 110 mg tablet of zinc gluconate or by one 50 mg tablet of zinc sulfate. This much, it is believed, should be sufficient to maintain normal persons in a positive balance of zinc. Greater amounts than this, obviously, would be required to repair a deficiency state.

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HOME CARE, PRECAUTIONS AND TREATMENT OF STYES IN CHILDREN

Home care

Place cotton balls or a washcloth soaked in warm water on the eyelids for ten to 20 minutes several times a day. Give aspirin or paracetamol to reduce pain. Apply antibiotic eye drops (available by prescription) several times a day to prevent the formation of additional styes. Do not treat cysts unless they are infected; then, treat them in the same way you would a stye.

Precautions

• The whites of the eyes do not become red as a result of a stye.

• One large or several small recurring styes, or a stye that accompanies such symptoms as fever, headache, loss of appetite, or lethargy, should be seen by a doctor.

• Styes can be contagious. Keep the infected child’s towel and washcloth separate from those used by other family members.

Medical treatment

Your doctor may prescribe antibiotics to treat one large or several small recurring styes. It is rarely necessary to open and drain a stye. The doctor may take a culture of the nose and throat secretions to find out where the bacteria are located. Your doctor may surgically remove an infected cyst. However, cysts often disappear spontaneously in months or years. Your doctor will treat an infected cyst in the same way as a stye.

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STRESS: BACKGROUND PROBLEMS

Incompatible workmates

“It is just that we are different. Not really one of them. And it makes things difficult. It’s there all the time. Ill at ease with them, when there is really no need to be.”

Cultural differences may make it hard. The individual from a disadvantaged home background may feel out of it with the others.

Even differences of interest can have the same effect. If the talk is all horses, or football or golf, and those are not our interests, we are not at home in that milieu, and that feeling of fellowship, which binds workmates, one to the other, eludes us. Our brain is crowded with trivial but disturbing thoughts which form a background on which any major problem, at home or elsewhere, can easily produce stress.

The individual who, by the advent of circumstance or by active endeavour on his own part, has learned something of inner security does not suffer in this way. And this same inner security of the individual allows his companions to be more at ease and more friendly towards him.

The difficult boss

“It’s not that I don’t like him. He is decent enough in his way. But he drives me mad. He has no idea, no idea at all, that I feel like this. He would be terribly shocked to know it. Supervises everything I do. Checks over the simplest things. Feel I could tell him to get on with his business, and leave me to mine. Bottle it up. Then some small thing upsets me at home and I blow up.”

This story is common enough. Maybe you are personally familiar with it. He only needs some real problem in any field of life, and the additional input to his brain will bring him properly under stress.

Some people tolerate discipline and unnecessary supervision without the situation adding in any way to the inflow of disturbing impulses to their brain. Others are psychologically intolerant of such a situation. This occurred in its simplest form among recruits in the armed forces during World War II. Some adjusted easily, some did not. Those who have had little discipline or supervision in their early home life are likely to find it difficult. So also are those who have been brought up strictly in a highly disciplined household. They reach adult life and have the feeling they have left all that behind. The strict boss reactivates their memories of childhood. They feel they are being treated like children, and they have to contain the aggression which the situation arouses.

Unfortunately, the individual’s knowledge of the cause of his reaction is little help in coping with the circumstances in which he is placed.

The cloak that protects us from the chill wind of stress must be tailored to our own individual needs. The first step is to get rid of the tension. And this is not as difficult as you might think. Five or ten minutes effective meditation in the morning will make an extraordinary difference.

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ECZEMA AS SKIN ALLERGIC DISEASE

Hypoallergenic Feeding

The prevention of eczema is achieved partly through hypoallergenic feedings. For example, an atopic baby should be breast fed. If that is impossible, the baby (until eight months of age) has to be fed a hypoallergenic diet that contains no egg, meat, fish, milk, or orange. The one suggested by the author allows everything outlined here.

Juice: Pineapple juice, grape juice, apricot juice, apple juice, Soya milk (15 1/2 oz.) combined with boiled water (151/2 oz.) Fruits: Pineapple, apple, apricot, plum, prune, banana Cereals: Cornmeal, rice, hominy, Post Toasties, puffed rice, barley cereal Meats: Lamb, beef, mutton, lamb chops Vegetables: Fresh or canned asparagus, lettuce, string beans, white potatoes Breads: Ry-Krisp Butter: Substitute salted Crisco Fat: Pure olive oil. Flour: Substitute cornstarch, rice, rye, barley flours Miscellaneous: Karo syrup, unflavored gelatin, hard candy flavored with peppermint or wintergreen – no soft candy. Important: Supplementary synthetic vitamins should be added.

Environmental Control

In order to further provide for the prevention of eczema, the child’s environment must be controlled.

a.     The bedroom of the baby should be free of dust, feathers, fur, animal hair, fuzzy clothing, and silk.

b.     The baby must wear cotton fabrics that have been washed with mild detergents (such as Calgon) and that have been rinsed out thoroughly. Woolen clothing (if unavoidable) should be lined with white cotton cloth.

ñ     The use of regular soap is to be avoided; an alkali-free soap should be used on the baby’s skin. His skin must never be scrubbed, but patted dry with clean towels, and open lesions on the skin should not be picked or scratched.

d.     The baby must avoid excessive exposure to the sun by the use of sun-screening agents.

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FERTILITY AND NUTRITION: EATING WELL

Those who are sceptical about the importance of nutrition in pre-conceptual care argue that there are many cultures where the women are living through famine and yet we see them on the television with babies. They conclude that the lack of nourishment is not affecting their fertility.

However, studies have shown that in fact the babies are not born to the most undernourished women (as they are infertile) but to those whose intake is marginal, and the unfortunate outcome is sick babies. A number of studies have looked at fertility and what happens to babies when food is in short supply. During the short but terrible Dutch famine of 1944-5, right at the end of the Second World War, it was found that the timing of malnutrition was crucial. Women who conceived or were in the early part of their pregnancy when the famine struck had many more babies who died around the time of birth than women who were in the later part of a pregnancy when the food shortages happened.

This finding ties in with those on the effects of alcohol during pregnancy which is more damaging in the first 12 weeks. During the Dutch food shortage half the women of childbearing age lost their periods (i.e. became temporarily infertile). There was also an increase in stillbirths for those babies conceived during the food shortage.

Appallingly, there was also an increase in malformations among the babies born nine months after the Dutch hunger winter. These babies were conceived during the worst of the food shortage, and the impact seemed to continue in those women who conceived four months after the shortage was over. The implication is that they were still suffering the effects of malnutrition. This provides further evidence to support having a Four-Month Preconception Plan, to get the maximum benefit for fertility and the health of the baby.

Nature is extremely clever. At a time of food shortage, when the woman does not even have enough nutrients to nourish itself, it stands to reason that she cannot nourish a baby properly. So, in extreme cases of famine, the body shuts down its reproductive function, in order to avoid risking the baby’s health. The reproductive system is the only system we do not need to survive. In a time of literally life and death, the body channels its resources away from the reproductive system to other areas of greater need. As soon as the food supply is plentiful, periods return and fertility is often restored as soon as the first month, but an epidemic of miscarriages can often then follow.

Poor maternal nutrition during the most sensitive period of the baby’s development may produce lifelong changes in physiology and structure. And the most rapid cell division is taking place before most women know they are pregnant. The brain, heart and other major organs develop in the first month. When the placenta takes over, around the twelfth week of pregnancy, it can extract the nutrients from the mother’s blood for the baby. So, in the later stages of pregnancy, the mother could be nutritionally deficient and yet the baby would not suffer, unless the mother was severely malnourished. In mothers who subsequently gave birth to low birth weight babies, 43 out of 44 nutrients measured in the mothers were significantly below those of mothers whose babies fell in the normal range.

Unfortunately, and astonishingly, the UK ranks alongside Albania as having one of the worst statistics in Europe for producing seriously underweight babies according to the World Health Organization. As many as 7 per cent of babies in England and Wales are classed as ‘low birth weight’, which puts them more at risk of stillbirth, mental handicap, dying within a month, blindness, deafness, cerebral palsy and autism.

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PREVENTION AND HEALTH: SUFFOCATION AND CHOKING

What are they?

Conditions that lead to a blockage of the air passages and death if not handled quickly. Suffocation occurs when something shuts off the mouth and nostrils, and choking when something goes down the windpipe so that the person cannot breathe. It is mostly children who are affected by both of these conditions.

Children usually choke on pieces of food and sweets, but also on foreign bodies such as coins and buttons. The child chokes, coughs and possibly turns blue. Adults usually choke on food.

Causes of suffocation

•     Babies can be suffocated by a pillow in bed.

•     Older children can suffocate by putting polythene or similar bags over their heads while playing.

•     Older children can suffocate when they climb into a disused refrigerator and shut the door.

•     Babies can suffocate by inhaling talcum powder-it clogs their lungs.

Causes of choking

•     A baby can choke on vomit in its cot if it is lying on its back.

•     Babies or young children can choke on a piece of lumpy food when they are just getting used to eating solids. An older child can choke on a piece of food which has ‘gone down the wrong way’.

•     Choking on things other than food is a common occurrence in childhood. Beads, small toys and the like are really dangerous.

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PREVENTION OF UNFITNESS AND DISEASES GENERALLY

Prevention of diseases generally

•    By far the commonest type of illness in old age is iatrogenic-doctor induced. Many old people are on medication that greatly handicaps them in all kinds of physical and psychological ways.

•     Stop smoking cigarettes. However late you stop it reduces your chances of getting lung cancer and improves your breathing, your senses of taste and smell, and your appetite.

•     Control your weight. Eat sensibly to prevent obesity.

•     Keep active and involved with other people.

•     Keep physically fit.

Screening measures that are definitely worth taking.

•     Have your blood pressure taken at least once every two years.

•     If you are a woman, have a mammogram done every year in your fifties.

•     If you are a woman, have a cervical smear done at age 50, 55 and 60.

•     Have a tetanus immunization every ten years and ‘flu immunization every year.

Screening measures that are probably worth taking.

•     Have a stool sample examined yearly for blood so that any colon cancer is picked up     early.

•     Have your hearing and eyesight tested yearly.

•     Look after your feet.

•     Visit your dentist once a year.

•     Treat pressure sores and eczema.

•     Have your blood tested for anaemia every two years.

Screening measures that can be useful but are not of first importance

•     Have your eyes tested for glaucoma.

•     Have a rectal examination once a year for rectal cancer.

•     Undergo screening for depression.

•     Undergo screening for mental functioning generally.

•     Have blood tests for reduced thyroid function every five years.

Screening measures of no proven value

•     Routine electrocardiograms.

•     Routine blood tests.

•     Routine barium enemas or me

•     Routine urine analysis.

Prevention of unfitness

All four aspects of fitness – stamina strength, suppleness and skill-can be improved with advantage in old age. As well as actually being fitter many old people feel so much be when carrying out such a fitness programme. Here are some useful hints.

•     Check with your doctor that you have no physical illness or disability that would make a     fitness programme unsuitable or dangerous.

•     Bear in mind that the dictum ‘use it or lose it’ applies at any age but especially in old age.

•     Continue with a sport or activity that used to give you pleasure when younger, or take up     a new activity. Swimming, yoga, keep-fit, music and movement, and gentle aerobics are     all good, as walking and gardening.

•     Find out about your local leisure centers, adult education classes, and so on.

•     If you get ill or have to go into hospital remember that fitness takes longer to return the     older you are. A few days’ inactivity can take several weeks to overcome.

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