Medical Weblog

This state of mind, which is not altogether uncommon, may increase our feeling of pain, but at the same time it helps us to endure it.

But remember that this is a pathological sequence of thought which is engendered by the psychological mechanisms which we have already discussed. If you find yourself thinking along these lines, concentrate on this. Yes, you have done wrong. We all have. And now you are suffering from pain. The pain has a real cause whether it be organic or psychological, and is in no way punishment for past misdeeds.

The Masochistic Embellishment of Pain.-Just as pain can become associated with the idea of punishment, it can also become associated with the feeling of pleasure. This rather complicated psychological reaction has its origin in sexual experience. The man is active. He is vigorous. His movements are forceful and may cause pain. Thus the ideas of sexual pleasure and causing pain may become associated. This is known as sadism. On the other hand, woman is passive. He does it to her, perhaps forcefully; and feelings of sexual pleasure are intermingled with pain. In these circumstances the pain itself may become tinged with pleasure. This is known as masochism. By various complex psychological reactions either man or woman may become sadistic or

masochistic, and the feeling of pleasure in giving or receiving pain may be transferred from sexual experience to the ordinary affairs of everyday life.

However, it is masochism, or the feeling of pleasure involved in experiencing pain, which concerns us in our present discussion. We could find many simple examples of this. When we scratch ourselves perhaps we get a strange feeling of pleasure as we actually injure the skin. There is often a great temptation to pick at the scab on a healing wound. As we pick it, there is a feeling of it hurting, but at the same time there is a pleasurable sensation. People often toy with a little piece of loose skin at the base of a fingernail in much the same way. Many people who discipline themselves very sternly are masochistic. This sometimes applies to those who swim every morning in winter, finding pleasure in the extreme cold. These examples merely serve to show that minor degrees of masochism are accepted as ‘normal behaviour.

Under some circumstances this same psychological mechanism of masochism can become stimulated and applied to pain of either functional or organic origin. In a perverse way the pain becomes tinged with a pleasurable feeling. This helps the sufferer to tolerate his pain, or if the condition is more fully developed he may really grow to enjoy the pain. However much this may help the individual to cope with his pain, we must remember that such a process is a gross perversion of the normal senses, and if allowed to develop to meet some particularly painful situation it is likely to lead to complications in other aspects of life.

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Q. Sometimes the tongue turns a bright red and becomes awfully sore.

A. This is termed glossitis and a red, raw, painful tongue can occur. Often there is no obvious cause. Simple measures usually bring relief but if they do not, within a few days, see the doctor. The physician will check for underlying causes. A sore tongue may be a symptom of another disorder which needs treatment. Regular mouth rinses with warm, salty water every hour or two often bring relief. (One teaspoonful of common salt to a glass of warm water. Rinse and spit out.) Addition of a few drops of mild antiseptics and anaesthetics to the fluid sometimes may give added comfort.

Vitamin C, 1,000 mg 2-3 times a day, and the Vitamin B Complex (e.g., one high potency B complex, mineral tablet or capsule once or twice daily) has its adherents and may assist. See the doctor if these are not quickly successful. Many complaints such as food allergies, dental disorders, anaemias, nutritional disturbances, diabetes, etc., can cause the symptoms.

Q. The lips are an awfully important part of the body. Not only are they readily obvious to anyone who looks at your face but they may become awfully tender. They often become cracked, specially in cold, windy weather. How can people treat and prevent this?

A. It is common for the lips to crack and become tender at the

corners and discharge. Superimposed infection with bacteria and

fungi is common and this prolongs the discomfort.

Simple chapping of the lips is common in cold weather or if

exposed for a period to hot dry or cold winds.

Cleanse the corners of the lips regularly with warm water or a

weak antiseptic solution (such as pink-only Condy’s solution).

Repeat every few hours. Then apply a simple cream. Ordinary

toilet lanoline often helps.

If this is ineffective see the doctor. He may recommend cleansing with liquid paraffin then applying a steroid cream, particularly one containing anti-bacterial and anti-fungal additives, such as Kenacomb or Pimafucort cream.

Vitamin C, Vitamin B complex, and minerals often help. For simple chapping of the lips, either lanoline or any lanoline based lip-stick is good. It usually takes several days to heal. Avoid winds and excessive exposure to the elements. This is important to promote healing and prevent recurrences.

Q. Is it possible for cancer to develop on the lips?

A. Yes. Leukoplakia. As the name implies this is a whitening of the mucous lining of the lips or tongue. It is usually fairly apparent. This needs prompt medical attention. It is a precursor to cancer and there is no simple way of knowing when the cells are becoming cancerous. Never neglect this symptom. Any persisting sore on the lips may be an early cancer. Avoid lip sunburn.

Q. I believe that thrush can infect the mouth, specially in children. What are the symptoms and the treatment?

A. This is a white, patchy discolouration that commonly occurs on the tongue and inside the cheeks of babies and small children. It may occur anywhere in the oral cavity. Surrounding mucous membrane is often red and bleeding occurs if an attempt is made to remove the curd-like patches. It may be painful. It is caused by an organism called Candida albicans, which is present in about one third of normal mouths. It gets out of hand under certain circumstances, such as when receiving broad spectrum antibiotic therapy and in states of malnutrition. But it can also occur for no obvious reason. Very healthy, well cared for babies are often victims. Diagnosis is usually obvious. The old fashioned and hideous looking (but very effective) remedy of painting the inner part of the mouth with gentian violet has now passed. Placing a few drops of Natamycin (1%) suspension into the child’s mouth after each feed is generally successful (Pimafucin suspension). This is usually given by the doctor.

Q. What about ulcers around the lips and gums and on the tongue and inner parts of the cheeks? So many people seem to develop these horrid sores.

A. There are two fairly common types, aphthous ulcers and Vincent’s angina.

Apthous ulcers are shallow yellowish lesions that may occur on the tongue, inner part of the cheek, the lips and gums. They are usually very painful and are surrounded by a red margin. The lymph glands under the jaw usually swell and are tender. Sometimes a fever occurs.

The cause is unknown but nuts, chocolates, citrus and other fruits are often blamed and are avoided during treatment. Bland mouth washes are usually ordered (such as hot, salty water every few hours. Adding Ora-sed may assist). Vitamins are often

advised, such as Vitamin C 1,000 mg with each meal, and the Vitamin B Complex.

See the doctor, as these ulcers may persist for days and weeks making eating, drinking and the use of salty or spiced foods uncomfortable.

The doctor may prescribe lozenges containing hydrocortisone. One of these sucked two or three times daily (placed between the cheek and gum, well back in the oral cavity) can effect a cure in a short period of time (Corlan pellets). These must be used under medical supervision for they are potent preparations. They may be used at the first sign of recurrence.

The anti allergy powder sodium cromoglycate (Intal) applied locally often helps.

Medical hypnotherapy sometimes cures these with one session. This may indicate there is a psychosomatic basis for their occurrence.

Q. What about the other kind you mentioned, the Vincent’s angina?

A. Vincent’s angina is an ulceration of the back part of the throat (the oropharynx). It may be caused by the herpes simplex virus or a spirochaetal infection. Until the advent of metronidazole, 200 mgm tablet 8 hourly for 3-4 days (Flagyl), treatment was usually ineffective. Tinidazole (Fasigyn) is also effective. This may be prescribed by the doctor. Simple mouth rinses, plenty of fluids and simple, easy-to-swallow foods assist in the acute stages.

Q. Are there any other kinds of ulcers that we should know about?

A. Certainly. Breaks in the mucous lining of the lips, mouth and tongue can occur for numerous other reasons. Simple biting is a common cause. This is often seen in adolescents of school age, particularly if emotional conflicts are present. It may be a nervous reflex habit, much like nail-biting and hair-pulling. It can lead to the production of chronically sore and ulcerated areas.

Poor dental hygiene, such as broken teeth, is also a common cause of ulcers and sores in the mouth. Any persisting sore in the oral cavity, on the lips or tongue should be checked out by the physician. Cancer of the tongue, although not common, still may occur and can be a lethal disease if untreated.

In these days of increasing social permissiveness, syphilis is increasing in incidence. Mouth ulcers may be an indication of this disease and it necessitates prompt diagnosis and therapy.

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As with every other ailment, it is naturally better to prevent back pain and sciatica from arising in the first place than having to cope with it afterwards.

Protecting your back from unnecessary or avoidable strain or stress is an important part of overcoming any existing problems as well as preventing possible future ones. Taking sensible precautions will help you cope v. ith your condition in three key ways:

The first and most obvious benefit is that just treating your back more kindly may be enough by itself to stop the back pain or sciatica altogether.

Even when precautionary measures fail to relieve your symptoms totally, these will almost certainly be greatly eased.

And, perhaps most important of all, protecting your back may stop further damage from taking place.

Setting aside difficulties arising from injury, accident or disease, back problems arise in general because one of two scenarios, or a combination of these:

A specific event during which you put your back under greater strain than it can cope, without something giving way – this could be lifting something that was just too heavy for you, or bending down awkwardly, or even perhaps just spending a long time sitting or working in a position that placed extra strain on your back.

An ongoing sequence of events that gradually strained your back, none of these events being harmful enough to cause serious trouble by themselves, but their cumulative effect eventually

adding up to a back that’s become troublesome.

Although at first glance it might appear from the above that precautionary measures to protect your back could be divided into two main groups – those aimed at preventing specific events harming you and those that deal with more general precautions – it’s not that easy to classify them that way because they often overlap to a great extent. For example, while it’s obvious that everyone – even people with no signs of back problems – should be careful and sensible when lifting or picking up anything heavy, this is advice that should be followed at all times, not merely when you think the item you’re lifting is particularly heavy, or when you think your back is getting ready to ‘play up’ once again. It’s a fact that it’s just as possible to strain your back badly when lifting something comparatively light, but doing this incorrectly, than when picking up something heavier.

But it’s not just lifting that puts your back at risk. Says the Osteopathic Information Service: “Many other common activities such as ironing, vacuuming, gardening, making a bed, and driving a car, if carried out incorrectly, can also lead to problems.

“Lifting, however, is particularly hazardous. Most people know the theory but forget to apply it in the heat of the moment. Remember: stand as close as you can; bend at the knees and keep your back straight; try to avoid lifting and twisting at the same time; get some help if you need to lift a heavy piece of furniture. Similarly, it should be a case of all things in moderation when you are stretching. Stand on a firm chair or ladder rather than stretching too far to dust or paint the ceiling and, conversely, kneel rather than bend down to reach low shelves or dust the skirting-boards.

“For many energetic activities – and housework or gardening can fall into this category if you approach them enthusiastically — it is best to work up gradually. Tackle lighter jobs first to warm up and loosen the joints before taking on more demanding bending and stretching tasks.

“As a general rule, use smooth, controlled movements rather than jerky ones and, if you do feel pain at any time, stop. Avoid the temptation to do ‘just that last little bit’. Pain is a vital warning sign and should not be ignored.”

However, it’s not just when you’re active that your back may be at risk. Poor posture or bad seating can equally contribute to making your problems all the worse. And your bed, of course, plays a vital role in keeping you and your spine rested (for more inforrnation about sleeping arrangements

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Migraines are in a class by themselves and are probably the most complicated of all headaches. All sorts of factors seem to accumulate to cause a migraine and an approaching period will only be one of them. Some migraines start when you wake up and get progressively worse through the day. Many make you feel sick. And they all interfere with your vision in one way or another. Bright lights are unbearable. Or you see flashes of light, or stars, or jagged shapes. Or even more alarming, you suddenly find that you’ve lost a patch of vision altogether, or that what you’re looking at has a jagged line breaking across it as though you were watching an image in a broken mirror.

Complete relaxation in a darkened room is often a great help to migraine sufferers. So is gentle fingertip massage. But you need to tackle all the causes of your particular pain if you’re to be cured. And that means checking your diet and your lifestyle. Some migraines seem to be triggered by an allergy to a particular food; cheese, chocolate and alcohol are often the villains, but they’re not the only ones. Other migraines seem to be linked to particular stresses that you’ve been forcing yourself to face. They often start immediately the stress is over, after the exams, for example, or when you stop work, or when you get out of the car after that difficult drive.

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Signs and symptoms

A child with threadworms has few symptoms. The child may complain at night of itching or burning around the anal or genital area. Threadworms can also be a cause of a sudden onset of bedwetting. If the infestation is heavy the child may have abdominal cramps. Threadworms can cause appendicitis (although this is rare), and they can work their way into a girl’s vagina and urethra (the passageway from the bladder to the outside) causing inflammation of the vagina or bladder.

Usually the diagnosis of threadworms is easily made by examining the skin around the anus at night while the child sleeps, or just after waking. Earthworms head back into the anus if disturbed by light, so the search must be done quickly. A threadworm can be mistaken for fluff on the skin; if the fluff moves, it’s a threadworm. Occasionally threadworms may be found in a bowel movement, but this is not a reliable way of making a diagnosis.

Home care

Vermifuges (worm medicines) must be obtained by prescription. When one member of a family has threadworms, all members (except infants and pregnant women) should be treated at the same time.

Precautions

• Suspect that threadworms may be the cause of recurrent inflammation of the vagina or bladder. • If one member of a family has threadworms, launder that person’s underclothes, bed linens, and towels to destroy the worm’s eggs. Also, cut and scrub his or her fingernails to remove any eggs. • Do not mistake fluff or thread for threadworms; look for movement.

• Do not blame household cats and dogs for a child’s having threadworms. These worms live only in humans.

Medical treatment

Your doctor investigates for threadworms using clear tape that will pick up any eggs that are on the skin. The tape is then examined under the microscope. If the test is positive, the doctor will prescribe worm medication for the entire family.

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Arthritis is an inflammation of any joint or joints. Arthritis most often affects joints in the fingers, toes, wrists, ankles, elbows, knees, shoulders, hips, jaw, and spine. Six types of arthritis are common to childhood: rheumatoid arthritis; acute rheumatic fever; infectious arthritis; allergic arthritis; arthritis following a viral infection; and arthritis of rubella.

Rheumatoid arthritis can occur at any age past one year old. So far the cause is unknown. It may affect one or several joints. The joints become swollen, warm, stiff, and mildly to moderately painful, but not usually red. The neck is affected in 50 percent of the cases. Arthritis may appear months before or after other signs of illness, such as fever, irritability, loss of appetite, and a fine pink rash.

Arthritis associated with acute rheumatic fever, usually affects many joints, which become red, swollen, and extremely tender. Other symptoms of general illness (including fever) are also present.

Infectious (purulent) arthritis is an inflammation within a joint caused by various bacterial diseases (including staphylococcal, streptococcal, pneumococcal, and salmonella infections). This type of arthritis most often occurs in infants less than one year old. In older children and adults, it can be caused by puncture wounds near the joints. In this type of arthritis, the joint is tender, swollen, and red. The child usually has a fever.

In allergic arthritis the joints are stiff, swollen, and red, but pain is slight. The disease is caused by an allergic reaction to insect stings, medications, foods, or small particles inhaled from the air. It is generally accompanied by hives.

Post-viral arthritis occurs after an illness caused by a virus. The symptoms are similar to those from other causes of arthritis, especially rheumatoid arthritis. Post-viral arthritis corrects itself without treatment.

Arthritis of rubella occurs as a complication of German measles (rubella) or as a reaction to a rubella vaccine, especially in older children. Arthritis of rubella usually corrects itself without treatment and usually causes no permanent damage.

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The multifactoral causation of illness applies even in psychoneurotic conditions. In these disorders there is often a clear-cut causal relationship between some past event and the present disability. This is the cause. But whether or not the cause actually produces symptoms may depend on the individual’s general level of stress. Furthermore, understanding the psychological causation of the illness may not be enough in itself to relieve the symptoms without some reduction of the general level of stress.

Claustrophobia

«This all happened a few years back, but I remember the story vividly.

‘It’s damn silly. Get the jitters if I go to the toilet and shut the door. The jitters, and can’t do what I came for. All right if I leave the door open. Can’t always do that. Know all about it. Tail gunner with the Lancasters. Thirty missions over Germany. It was at the bad time. They said ten per cent chance of coming through a tour of duty. I know all about that. Get caught in the search lights. God! How did it feel! All the ack-ack in the world firing. Terrible crash. But the old bus kept going. It’s the blast that makes the crash. Fighters on our tail. Gave them what I could. I know all that. Bombs away. Then home at last. Our ‘drome bombed out. Craters miles deep in the runway. Flying around in the dark, trying to find somewhere to get down. I know all about that. Off again in a couple of nights. Up the steps into that little box on the tail of the plane. Chap on the ground slams the door. How did it feel! I know all about that, but I still get the jitters if I close the door of the toilet. »

The psychopathology is painfully obvious to everyone including the patient. This demonstrates a very important point. There is a widespread delusion among people in general, and not a few psychiatrists and psychologists that a knowledge of the cause of nervous symptoms will make them go away. This is simply not true. The relief of the symptoms requires some other factor as well. This may sometimes be provided by the relief of stress in the profound experience of intensive meditation.

«Can’t stand being shut in. Terrible panic. Sweat. Heart thumps. Feel I’m going to faint. If I go anywhere, have to sit by the door. Better if it’s open. Have to sit by the door in church, and on an aisle at the cinema. »

Unlike the tail gunner, she had no idea as to the cause of her claustrophobia. However, when under deep hypnosis, she became very disturbed, crying out, ‘Let me out of here. Let me out.’ It transpired that she had regressed to an incident in childhood when her mother had locked her in the broom cupboard for being naughty.

The interesting point is that this dramatic insight did not give immediate relief to her claustrophobia. Her relief came only slowly over a period of some weeks as the level of her stress was gradually reduced.

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Skin troubles

“It comes and goes. Has done so for years. Just now I am in a bad phase. Skin bad. Inflamed, itchy. And I’m bad too. Irritable, edgy. Not my usual self as when my skin is all right.”

His skin is bad, and he is bad. His brain is receiving a continuous in-put of disturbing impulses, making a background for the development of stress.

In these recurring skin troubles we are often faced with a complicated array of causes. Of course there is the genetic factor. Some people are born with sensitive skins. Then there is the allergic factor. Some are sensitive to different brands of soap or a detergent used in washing underclothes. Or the allergy may be a result of something eaten, and manifested in the skin. And stress. Of course, stress plays a part. In fact many of these recurring skin troubles are precipitated by stress. It often happens that the effects of allergy and stress combine to produce the rash.

Now we come to the main problem. The rash, and particularly the itching, by their disturbing impulses to the brain produce stress. Then the stress further aggravates the skin condition. In this situation some serious meditation will reduce the stress and so help the healing of the skin condition.

Fatigue

“I’m tired. Just tired. Little things are getting on top of me. I can usually cope. Cope well. But now I can’t. Everything is a muddle. Feel at my wits’ end.”

The message of this little book is that we should help our brain through act of mind and by what we do, so that we can cope with adverse circumstances. But of course we all have our limits. And some people have not fully learned the principles of the self-management of stress. So there may come the time when the individual is in fact overwhelmed, and becomes over-fatigued. This may arise through a number of circumstances – a smouldering chronic infection, sleeplessness, conflicts of conscience, or simply the ageing process and, of course, a greater load of mental or physical work than the individual can manage. Fatigue has a direct effect on our brain cells. Disturbing impulses are not so well integrated and the individual comes under stress.

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Travel problems.

For details of motion sickness and how to cope with it see next entry. Tell your doctor before taking travel-sickness pills, if you are taking any other pills.

Most of us go on holiday abroad in an aircraft. A short plane journey presents no health problems at all but a longer one can have ill effects that may mar the start of your holiday.

Here are some tips for long air trips:

•     Drink plenty of non-alcoholic fluid before and during your flight. The air-conditioning in the aircraft is very dehydrating and this, as much as anything else, is what makes people feel bad after a long flight.

•     Get some good sleep before you go as this helps minimize the effects of jet lag.

•     Take things to freshen up in your cabin luggage-you’ll feel a lot better when you arrive.

•     Don’t overeat or over-drink (alcohol)-or you will pay for it for the next couple of days.

•     If possible, don’t plan to do anything too strenuous for the first couple of days after you arrive at your destination. Give your body a chance to get back its balance in the new time zone. Because this can take two days off each end of your holiday it makes sense to travel long distances only for long holidays. It is probably not sensible to go halfway round the world for less than two or three weeks.

Local hazards

Lastly, remember that there could well be local hazards in the area to which you are going. For example, more package tours now go to very exotic places with poisonous plants and fish. Be guided by what the locals do-or don’t do!

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•    There is little doubt that back pain is commoner in ‘sophisticated’ countries. This had led many experts to see backache as a manifestation of the stressful life. This does not mean that all backache is imagined-this is, of course, not so. What it does mean is that given that so many of us are unfit and have weak backs we tend to over-emphasize or to be particularly sensitive to even quite minor back pains. Just as many headaches are undoubtedly manifestations of stress, so too are many back pains. That this is so can be proven by treating certain back pains with tender, loving care and reassurance, with tranquillizers or with hypnotherapy.

•    Poor posture is a preventable cause of back pain. Even sitting is bad for the back. Even if one sits correctly the pressure within the spinal discs is still twice that when standing and the pressure when standing is twice that when lying down.

Try to preserve the natural slope of your backbone as closely as possible. Walk tall, lifting up out of the hips and keeping your head up, your shoulders straight, your tummy pulled in and the lower back hollow. This will not only make your back better but will mean that you carry yourself and your clothes better. Avoid standing on one leg and don’t slouch when sitting.

Start off by strengthening your tummy muscles. These are often weak and flabby. A good exercise is to put your hands behind your neck as you lie flat on the floor and then lean forward to thrust your elbows towards your knees without the legs leaving the ground. Do this gently a few times every day until you can do it 20-30 times easily and without strain. As your tummy muscles strengthen you will find it easier to hold your tummy in. Do this consciously whenever you remember-at the bus stop, while waiting in a queue, and so on.

Get into the habit of walking upright with your tummy held in and you will prevent backache as you never thought possible.

•     Wear low-heeled shoes whenever possible and flat ones for doing any kind of long walk or physical work. Don’t let fashion wreck your back.

•     When lifting heavy weights bend your knees, keep your spine straight and balance the load equally in both hands. Lift things slowly and not jerkily.

•     Avoid standing in one fixed position for more than a few minutes. On long plane journeys try to get an aisle seat and go for walks frequently. Stop the car on a long journey and walk about for 5-10 minutes.

•     Choose firm, back-supporting chairs and car seats. The greatest pressure on the discs of the spine occurs when one is seated in a soft chair. Similarly, choose a firm mattress, ideally one that is a little too hard rather than too soft, especially as all mattresses soften with age. If your mattress is ten years old or more you should get a new one.

Wear proper sports shoes for running and jogging and indeed for any sports. These will absorb most of the shock waves and protect your back. Try to run on grass rather than hard surfaces and run on your toes.

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