Health and medical information

Unfortunately the art of hypnosis was used a great deal by the stage hypnotists and magicians to entertain audiences. Hypnosis became a magical act and the magicians liked to let the audience believe that they possessed supernatural powers. Because of this the medical profession distanced itself from it, and hypnosis was not used for medical purposes for many years. At the time of Freud and Charcot in Vienna, at the end of the nineteenth century, however, intense interest in the subject was developed. Hypnosis was used on patients, and with good results.

Nowadays hypnosis is used more and more by doctors and psychologists. In 1958, hypnosis was formally accepted as a form of medical treatment by the American Medical Association, and three years later by the British Medical Association. Hypnosis is now no longer a magical act, but a well-respected science. Much research is conducted on hypnosis, and some medical journals are devoted entirely to hypnosis. The International Society of Hypnosis has thousands of members from all over the world, all of whom are doctors, dentists, and psychologists. Its headquarters is situated in the Austin Hospital, Melbourne.

Now back to the top hat magician and the lady. The lady went into a hypnotic state, commonly known as a trance. She was not sleeping; if we carried out an EEG recording on her, the brain waves would not be characteristic of sleep. She was aware of what was happening, but the scope of awareness would have been abnormally small. She was only aware of what the magician (hypnotist) was suggesting to her and was not aware of the presence of the audience. She was still thinking for herself and normally would not accept any suggestion from the hypnotist if it contradicted with her conscience or belief. When she was woken up from the trance, she remembered what happened, and this is generally the case with hypnotized subjects.

Hypnosis is not a magical act, but a special state of awareness, and everyone has the ability to go into this state. We are familiar with the other states of awareness, the conscious state and the unconscious state.

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For descriptive purposes it is often convenient to consider pain as either organic or functional. But like many things in nature this pigeonholing of ideas is not completely valid. It is not quite as simple as that. Thus pain that is caused in the first place by some disease or injury soon produces a psychological reaction. It causes the patient to worry. He may worry a lot, or he may worry a little. The degree to which he worries will depend upon a great number of factors—the nature of Ills personality, and whether he somehow feels bad about his condition, or whether he blames himself for having caused it, or whether he feels that in being sick he has let down his family or others for whom he feels responsible. Psychological factors such as these influence the severity and duration of the pain. This is the psychological overlay that may accompany a pain which is classified as organic in origin in that it was primarily caused by stimulation of nerves by disease or injury. In fact, the psychological overlay may be the major factor in producing the pain in these cases, and it is not uncommon for the psychological overlay to maintain the pain long after any physical cause for the pain has ceased to operate.

This mechanism is often seen very clearly in cases of injury involving compensation. A man is injured at work. He knows that he is entitled to monetary compensation, but he does not know the exact figure until his claim is settled. The injury heals, but the pain persists. Sometimes the pain even gets worse. In spite of this he looks fit and well, but people near to him come to notice that his thoughts keep returning to this question of his claim for compensation. Doctors who examine him can find no cause for his pain, and they are inclined to regard him as malingering. Of course, everyone knows that cases of malingering do occur, but these represent only a small minority. The pain is determined unconsciously by the functional overlay without the patient having any real awareness as to what is happening. When no compensation is concerned patients recover from similar injuries without the same prolongation of the pain. Sceptics point to the fact that the pain clears up miraculously when the claim is settled, but this does not disprove the unconscious cause of the condition.

A man about forty-five years old was referred to me by his local doctor. The patient suffered from definite but mild rheumatoid arthritis. The local doctor was puzzled by the recent increase in the degree of pain suffered by the patient. It was little influenced by pain-killing drugs, and was on the point of ruining the patient’s life.

The patient’s wife was childless. Twenty years ago they had taken a baby girl to live with them. They had brought her up as their own, but the child’s parents had never allowed them to adopt her. The girl was now to be married and the real father had come to take his place at the ceremony. The patient was tense, bitter, resentful, and full of unexpressed hostility. His tension had provided the functional overlay to the organic pain.

A childless woman of fifty had had minor surgery three years previously. She complained of pain in the scar. She had sought help from overseas specialists to no avail. She used the following words to describe her condition: “Feels like a knife or something sharp. Like a metal plate. Conscious of it all the time. It is an inhuman sort of pain. It aches at the base of the incision. Stiff and sore as if bruised.”

She was a shallow society woman without any real sense of values, who for years had tried to escape life in an endless round of parties. Now she was older and no longer beautiful. She saw her friends with their children. The hurt of it all came to her, and she felt it in the scar of the operation.

I did not put these ideas to her. To do so would have been cruel, and would have made her worse by mobilizing her anxiety. It is usually unwise to tell people the cause of their trouble in so many words, much better to let it come indirectly; then they understand and know it to be true. This happened with this woman. She changed during the weeks she was doing the exercises, and it was clear that she achieved some inner acceptance of things in a way that is not uncommon when people come to do the exercises in meditative fashion. At the same time the pain subsided and she was able to resume a more active life.

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Q. So many people we know complain about their ulcers. How common are they in the community?

A. All kinds of statistics have been quoted over the years. Several studies carried out in Britain show that by the age of 55 years, between 6 and 20% of people have suffered from one. At any given time, in Australia, it is believed that between 2 and 4% of the population suffer from them. Many have an ulcer and are unaware of it, or have minimum symptoms. This covers about 25%. About 50% have fairly severe symptoms, but with treatment manage reasonably well, and live a fairly normal life.

The remaining 25% endure severe symptoms often with complications which make life difficult.

Q. Does it affect men more than women?

A. Peptic ulcer seems to trouble men more commonly. In the general world scene, stomach ulcer is 2-3 times more common in men, and duodenal ulcer 3-5 times more common in males, although in Australia, according to some doctors, gastric ulcer is more common in women.

Q. When is the most likely age for these to develop?

A. Peptic ulcers may occur at any time from youth to old age. However, the most common age for duodenal ulcers is around 30 years, and gastric ulcers about 40 years of age.

Q. Are they inherited?

A. Like many disorders, the tendency is believed to be inherited. Just as with heart disease and diabetes, there is an increased risk if the parents suffered with the disorder. One of these days, it may be possible to predetermine if a person will develop ulcers.

At present the researchers are carrying out an intriguing activity called ‘gene mapping’. Here, they are able to locate on the chromosome the extact spot or locus in which a certain disease is inherited. So, by mapping baby’s genes before birth, it may be possible to tell if he is predestined to develop heart disease, cancer, diabetes, peptic ulcers … and some claim that his potential for developing into a criminal may also be told. Others dispute this, but it is definitely in the pipe line.

Q. We often hear the claim that successful businessmen are more prone to develop ulcers. Is this fact or fantasy?

A. The current view is that it is fallacy. Duodenal ulcers seem just as common in any social group. Some British claims say that stomach ulcers are more likely in those of lower social standards.

Q. What is your view?

A. I live and work in an area where there is a lot of industry. I see many of the workers, plus many of the executives of these companies. It often seems that the greater the pressure on a person, mentally speaking, the greater chance he has of developing an ulcer. It may be a figment of my imagination. But I figure that the more mental anxiety and stress the person is subjected to, the greater the number of impulses racing to the acid producing glands of the stomach. And the greater amount of acid pumped out. So, an increased ulcer risk.

Q. Don’t you relate this to your treatment of some people with medical hypnotherapy?

A. As you know, I have also been practising medical hypnotherapy — or relaxation therapy as I prefer to call it — for fifteen years or so. This aims at completely relaxing the system, specially the nervous system and the areas to which the nerves travel.

For many years I have noticed that folk who are tense, anxious and pent up, the very ones with a knot in the stomach, too much acid, tummy upsets, ulcers, are the very ones who seem to respond well to relaxation treatment. I figure out that less tension, less impulses travelling to the acid glands, less acid produced, leads to a reduced risk of stomach upsets and probably a reduced risk of ulcers. Certainly I am not claiming a cure for ulcers, but it appears to help in conjunction with other treatment.

However, this is purely a personal note injected for good measure, for I feel it is relevant. Anxious, stress ridden individuals can often help themselves, of that there is little doubt in my mind.

But, generally speaking, the experts today do not relate ulcers to specific social or economic situations apart from those mentioned.

Q. What about the relationship of ulcers to other conditions. Is this likely?

A. Some time ago it was found that peptic ulcers seemed more common in people with blood group O, and also those with the liver disease called cirrhosis. I might add that cirrhosis, or destruction of the normal liver tissue and its replacement with useless fibrous tissue, is more common in heavy, chronic drinkers.

Ulcers also seem related to some other medical conditions, such as the Zollinger-Ellison syndrome in which a diseased pancreatic gland causes an enormous over-secretion of acid in the stomach. Sometimes a rare disease of the parathyroid glands (which are located in the thyroid gland in the neck) may play a part; Cushing’s syndrome, a disease of the supra-renal glands which sit on top of the kidneys may be associated with a reduced ulcer risk, although if there is too much cortisone-like hormones in the blood stream, this may delay ulcer healing.

Q. What about drugs. Can these upset the lining and cause ulcers to form?

A. The picture is a bit confused, although many doctors believe they play an important part. It has been found that people with ulcers tend to take excessive analgesics such as aspirin products, and smoke more heavily than those with no ulcer. Therefore, the two are often linked, but others claim this does not necessarily say one causes the other. In short, ‘they probably have little effect,’ says one prominent Sydney-based ulcer expert. He also says that ‘there is no convincing evidence that stress or anxiety play any role in the causation and natural history of chronic peptic ulcer, or that any personality type predisposes to peptic ulcer.’

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The human spine – also at times called the spinal column, vertebral column, or just the backbone – is a flexible bony column that extends from the base of the skull to the small of the back. It serves two main purposes:

Working together with various muscles and ‘girdles’ – the latter being encircling or arching arrangements of bones, such as the pelvic and shoulder girdles – the spine provides the support that enables us to stand upright.

It also encloses – and so protects to a large extent – the spinal cord, that portion of the central nervous system whose nerve cells and bundles connect all parts of the body with the brain. Structurally, the spine consists of a number of vertebrae (or

individual bones) that are stacked on top of each other and separated as well as connected by discs of fibrocartilage (the intervertebral discs, which are discussed later in this chapter).

Although adults have 26 vertebrae, new-born babies have 33, nine of those extra ones becoming eventually fused into two separate single bones. An adult spine has five regions, consisting of the following, and starting from the bottom up:

Four fused coccygeal – or tail – vertebrae, which together make up the coccyx.

Five fused sacral vertebrae, which form the sacrum.

Five lumbar – or lower back – vertebrae.

Twelve thoracic (also at times called thoriac) – or chest -vertebrae.Seven cervical – or neck – vertebrae.

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Since liver has the reputation of being an inexpensive but “complete” food, dishes employing it are often recommended for dieters who wish to eat sparingly but well.

Regardless of one’s reason for eating a lot of liver, the danger is the same — it can provide too much vitamin A. Because liver is an animal’s storehouse for vitamin A, we can acquire much more of it than we can handle if we eat a lot of liver nearly every day.

In extreme cases, when hungry explorers have eaten nearly all of the liver of a shark or of a polar bear, both of which contain exceptional amounts of vitamin A (many thousands of times the recommended daily allowance for humans), sudden death from brain swelling has occurred. In the more usual cases, when people have eaten beef or chicken liver several times a week, the illness is much less dramatic.

Typically, Emergency Medicine (17#8:105) reports, the symptoms of milder and more usual cases of vitamin A intoxication include long-lasting headaches and blurring of vision. Victims also sometimes complain of a momentary loss or sudden dimming of vision lasting but a second or two.

Another fairly common symptom is a pulsating swishing or ringing noise in the ears. There may also be nausea and vomiting in some cases, but these symptoms are less common and occur, in addition to the other symptoms mentioned above, only when the blood vitamin A level suddenly rises even further above normal following ingestion of a vitamin tablet.

Proof of this diagnosis is simple and involves simply taking a blood sample and sending it to the laboratory for measurement of the vitamin A level. Since prevention is better than cure, avoid this problem by eating liver only in moderation. For instance, giving a baby a can of ground chicken liver every day might well provide him with too much.

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Signs and symptoms

The diagnosis first involves ruling out appendicitis. If appendicitis can be ruled out, consider other possibilities.

Your child probably is constipated if he or, she has recently had no bowel movement or a hard movement; if the pain is intermittent (crampy) on the left side of the body and follows eating; and if the abdomen is soft but not tender to the touch.

Your child probably has digestive tract upset if he or she has eaten too much or has been exposed to someone who has acute gastroenteritis; if the pain is intermittent and occurs around the upper abdomen or navel; or if diarrhea follows vomiting.

Your child’s stomachache is probably due to emotional stress if he or she is or has been upset and if the pain does not worsen.

If your child’s pain cannot be explained by any of these causes take the child to the doctor.

Your child’s stomachache may be due to urinary tract infection if the child has a fever and frequent, painful urination. The child should see a doctor.

Home care

Treat constipation with a change in diet or a glycerin suppository. Unless it is severe

(acute pain lasting for more than 24 hours), digestive tract upset will go away on its own; however, an anti-nausea medication (ask your doctor for suggestions) can relieve the vomiting, and mild heat applied to the abdomen can relieve the pain. A stomachache due to emotional stress will ease with relief from the stress, but one that arises from a urinary tract infection requires the attention of a physician. If any stomach pain persists or worsens, take your child to your doctor.

Precautions

• Never give a child a laxative or place ice on the abdomen to treat abdominal pain.

• Steady, worsening pain usually is more serious than intermittent, crampy pain. However, severe and regular crampy pain I may indicate a serious problem, particularly if there is also blood or mucus in the child’s stools.

• Abdominal pain that forces a child to bend forward as he or she walks is a cause for concern.

• Abdominal pain combined with fever and a cough suggests pneumonia.

• Severe, worsening abdominal pain that follows an injury to the abdomen or lower chest suggests internal injury and requires a doctor’s attention.

Medical treatment

Your doctor’s first task is to determine the cause of the pain by taking a detailed medical history, performing a complete physical examination, and, in many cases, ordering a series of laboratory tests or X rays. If the diagnosis remains doubtful your doctor may observe your child for a few hours or ask for a consultation with another physician.

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An allergic reaction to an injection of horse serum can produce serum sickness. It occurs in 10 percent of children if only 10 cc. of serum are injected, while the incidence rises to 90 percent if 100 cc. are injected. The symptoms are hives, swelling of the joints, and fever. These may appear immediately after an injection, be delayed, or be accelerated. An immediate reaction appears minutes after an injection; a delayed one appears hours after an injection; an accelerated one appears days after the injection.

If a child has had any one of these reactions, a skin test for the serum that has caused the reaction is unnecessary and dangerous. However, if a previous injection went by without a reaction, a skin test for the serum is necessary before giving it again.

In case a child must take a tetanus shot and he is known to be allergic to horse serum, then a human serum which is rich in the same kind of antibodies has to be given to him instead. This serum is to be injected intramuscularly as one single dose. Although human serum has never caused an allergic reaction, this remains a possibility. To avoid it, active ‘immunization against tetanus with toxoids is mandatory to eliminate the need for any tetanus immune serum.

Special precautions are necessary to immunize an egg-sensitive atopic child against influenza, measles, rubella, and mumps vaccines because these vaccines contain egg. (However, if the child has hives or asthma after eating eggs, then no egg vaccine is to be given to him).

Flu vaccination must be given in three doses—the second one two weeks after the first, and the third two months after the second, starting in September and going into December. The vaccine used has to be free from alum, be polyvalent, contain the Asian flu virus, and be given intracutaneously in one-tenth of the regular dose.

While giving the atopic child any kind of immunization, a pediatrician should have adrenalin on hand for unforeseen reactions.

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These disorders occur when a woman produces antibodies directly against her own cells. The antibodies are thought to cause blood clots in the placenta, preventing the baby getting enough nutrients and blood. Treatment involves drugs that thin the blood, like aspirin and heparin.

An auto-immune condition called systemic lupus erythematosis (SLE) causes chronic inflammation which can affect many systems of the body. One of the world’s leading experts in this disorder is Professor Graham Hughes, Head of the Lupus Arthritis Research Unit at St Thomas’s Hospital in London. His original investigations showed that many lupus sufferers also had a blood clotting syndrome which can be detected through the presence of antiphospholipid antibodies in the blood. Lupus sufferers get pregnant easily but have a high rate of miscarriages. This syndrome has now been called Hughes Syndrome. It is like having ’sticky blood’, which can trigger a miscarriage by causing blood clots to form in the placenta. It is also thought that, these antibodies can directly attack the cells of the placenta, making implantation difficult. Hughes Syndrome can sometimes be found in women who do not have symptoms of SLE but are having recurrent miscarriages.

The two main antiphospholipid antibodies that need to be tested for are lupus anticoagulant and anticardiolipin antibodies. Professor Lesley Regan, of the Recurrent Miscarriage Clinic at St Mary’s Hospital in London, has pioneered this work on antiphospholipid antibodies and miscarriages. She makes it clear that women need to have a number of tests to determine whether they have positive antibodies, as fluctuations can occur. You can also get false positive readings and so she recommends that women should test positive on at least two occasions, with each test performed at least eight weeks apart.

The treatment of choice for ’sticky blood’ is aspirin. This has been a surprise because previous studies have linked taking aspirin in pregnancy with children’s heart disease, brain malformations and cleft palates. Very heavy doses have been blamed for preventing normal growth of the lungs and ‘blue baby syndrome’. The difference is that in this treatment the aspirin dose is low – only 76mg daily. The aspirin is given prior to conception and as soon as the woman finds out she is pregnant she is also given the anticoagulant drug heparin.

Trials at St Mary’s have shown that the combination of aspirin and heparin works more effectively than just aspirin alone. As with any drug treatment, one has to weigh up the benefits against the risks: it has been reported that women taking heparin during pregnancy may have an increased risk of osteoporosis (thinning of the bones) and they will need to be monitored. Further larger studies are needed in order to confirm the miscarriage benefits of aspirin and heparin.

Another possibility, instead of either aspirin or heparin, is to use vitamin E. This vitamin can help thin the blood and prevent clots. Aspirin is often recommended for people who are at risk of heart attacks, in order to keep their blood thin and reduce the possibility of a clot. Yet a study published in the Lancet in 1996 found that taking a daily dose of vitamin E reduced the risk of having a heart attack by an astonishing 75 per cent. The scientists heading this study commented that the results were even more ‘exciting than aspirin’. Unfortunately a number of women are now being given aspirin, as a just in case’ measure, without any of the blood tests showing positive to the blood clotting factor.

The recommended dose of vitamin E should be around 400 IU and you should buy the natural form of this vitamin, d-alpha tocopherol.

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• Breast feeding. Research has shown that smoking cigarettes may contribute to inadequate breast-milk production. Nicotine has also been found in the breast milk of mothers who smoke, although the effect on the baby is not yet fully understood.

• Long-term growth. Studies of long-term growth and development give evidence that children of mothers who smoked in pregnancy may have slight but measurable deficiencies in physical growth and intellectual development up to 11 years of age. Infants of parents who smoke are also more susceptible to chest infections, bronchitis and pneumonia than are the children of non-smokers.

The act of breathing in other people’s smoke has been labelled ‘passive’, ‘involuntary’ or ’second-hand’ smoking. Many non-smokers experience nose, throat and eye irritation from passive smoking; and there is evidence that long-term exposure may be harmful even to normal, healthy adults. Non-smokers dislike the smell of tobacco smoke in their clothes and hair following exposure.

The smoke from the burning end and from the mouthpiece of the cigarette is more irritant than the smoke which is breathed out. Since pipe and cigar smokers tend to inhale less than cigarette smokers, the contribution of their smoke to atmospheric pollution may be greater than that of cigarette smokers.

• Non-smokers who report recent exposure to smoke have been found to have nicotine concentrations in their saliva and urine which overlapped those of smokers who had smoked up to three cigarettes before sampling.

• Carbon monoxide (CO) levels in air heavily contaminated by tobacco smoke can exceed those permitted in industry for an eight-hour exposure. The amount absorbed by the non-smoker increases with the period of exposure.

• Recent research found that non-smokers who worked for twenty years with smokers, but who were not exposed to cigarette smoke at home, had sustained measurable lung damage similar to that in smokers who did not inhale.

A Japanese study has shown that the non-smoking wives of cigarette smokers developed lung cancer at higher rates than non-smoking wives of non-smoking husbands. The study followed up 91,540 non-smoking wives for fourteen years. The lung-cancer mortality rate of those married to men who smoked twenty or more cigarettes a day was twice as high as that of women who were married to non-smokers.

In another study, in Greece, it was found that for non-smoking women the relative risk of lung cancer associated with having a husband who smokes was an estimated 2.4 for women whose husbands smoked less than twenty cigarettes a day and 3.4 for those whose husbands smoked more than this.

Young children can be harmed by passive smoking. Infants under a year in age run twice the risk of developing a serious chest illness if both parents smoke. Also, children of parents who smoke have more upper respiratory infections than do children of non-smokers.

Since the early 1970s the proportion of adult cigarette smokers (over 16) in Great Britain has been decreasing. Between 1972 and 1982 the proportion of adult male smokers fell by over a quarter and that of women by about one fifth. Smokers have been a minority in the adult population since 1976. It has been estimated that there are about 16-17 million adult smokers in the population of Great Britain, and nearly 10 million ex-smokers. Between 1980 and 1982 about one million people gave up smoking.

Since 1978 men have been smoking on average fewer cigarettes per week, although they smoke slightly more now than in 1972.

• Cigarette sales in the UK have been declining steadily since 1974.

• There is a link between cigarette smoking and socio-economic group, showing a continuing trend for more smokers (men and women) in manual than in non-manual groups but in 1982 smokers were, for the first time, a minority in every socio-economic group.

• In England and Wales alone about 95,000 people are killed by smoking each year. It has been estimated that out of 1,000 young men who smoke in the UK, 1 will be murdered, 6 will die in road accidents and 250 will die prematurely as a result of their smoking. Most die from one of the three main diseases associated with cigarette smoking: lung cancer; chronic bronchitis/emphysema; and coronary heart disease. Lung cancer is caused almost entirely by smoking. In 1981 about a third of the total deaths from lung cancer were in people aged under 65. Although deaths from this disease are declining among men, they are rising among women.

• More than two-thirds of all smokers want to give up.

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Improving consultations

Start by writing down any information you need prior to the appointment. Your questions should also be written down and added to during the consultation.

Repeat information back to the doctor to make sure that you have heard and understood everything correctly. Ask for diagrams and illustrations to help you understand the information the doctor provides.

Take a friend or partner or relative along for moral support; it is important that family and friends be informed about your disease.

During the appointment take notes if necessary and ask the doctor to write down any instructions.

Although difficult at times, try to control your emotions when talking to your doctor as this will make it easier to understand the information and take notes.

Realistic expectations

It is reasonable to expect your doctor to ask if you understand vital aspects of your proposed treatment regime and for that information to be expressed in terms that you understand. To achieve this, your doctor first needs to establish your level of knowledge on both the technical and medical aspects of the disease.

It is not reasonable to put doctors on a pedestal and to accept all their advice without question. Let your doctor know what your expectations are – different women will have different needs and expectations.

It is not reasonable to have unrealistic expectations of what your doctor can achieve. For instance, the disease may not always respond to the best treatment available so it would be unfair to get angry with your doctor. Remember, doctors do not have all the answers to endometriosis – or anything else for that matter. They, too, can get frustrated with the lack of ‘cures’.

Making the right decision

Start by evaluating your doctor’s recommendations in the light of your own needs. If you want advice and guidance but also want to make your own decisions about treatment, then let your doctor know.

Trust

No doctor wants to feel that her or his credibility is being challenged but, equally, no woman should ever feel intimidated.

Let your doctor know that you respect her or his opinion but expect open and mutual communication and trust. You should trust your doctor’s level of knowledge just as the doctor should have respect for your judgements.

Confidentiality is also important and you must feel that information is confidential to both you and your doctor.

Your doctor needs to be able to trust that you have followed the treatment plan you both have agreed upon.

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