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The extent of the disabilities people suffer through the disorders mean that we, as a community, lose the many and varied talents of these people. Not only is there a horrific personal cost, there is also an enormous socio-economic cost to the community.

In 1980 the economic cost of panic disorder, calculated in terms of employment losses, disability benefits, financial support and health care costs, was estimated at US $1 billion (Sheehan et al. 1980). A survey in the United Kingdom placed the economic cost of panic disorder, calculated solely on the basis of absenteeism, at £3 billion per year (Phobic Trust NZ 1991).

After speaking with over 12 000 people with an anxiety disorder, I have no doubt in my mind we are the most medically tested group of people in the country. In an effort to find out what is wrong we may see a number of doctors and specialists. We can undergo a range of medical tests including cardiographs, brain scans, testing for ulcers, numerous blood tests, not once but at least twice if not three, four or more times. As our symptoms can be unremitting we may regularly seek professional help either through our doctor or by attending the casualty department of our local public hospital.

Unfortunately this can be to no avail. Without a diagnosis and appropriate treatment many people become so disabled through the disorders they are forced to give up their jobs and rely on social security benefits. Others may refuse a job promotion or may need to take a lower paid position in an effort to cope with their disorder.

The cost to the community through these disorders is still not acknowledged, let alone addressed. Health care costs are soaring, yet many of the costs could be lessened through understanding and relevant treatment. Anxiety disorders and the secondary conditions are treatable. People can recover and resume normal lives. Greater awareness and understanding within the health professions and the general community will lessen both the personal and monetary costs.

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It will be clear from Table 1, that many of the symptoms seen in psychosomatic illness are also features of food intolerance. Indeed, ‘opponents’ of food intolerance would maintain that most supposed food intolerance is psychosomatic illness. But doctors specializing in the treatment of food allergy and intolerance would disagree. They see innumerable patients who have been told that their symptoms are psychosomatic or ‘all in the mind’ by one doctor or another. Yet a high proportion of these patients respond to an elimination diet. They get better when foods are eliminated from the diet – and they stay better, which is the important thing.

A diagnosis of psychosomatic illness or hypochondria is very largely a diagnosis of exclusion – it requires all other possibilities to be excluded first. With many patients suffering vague, multiple symptoms, food intolerance must be regarded as one of those possibilities. Unless steps are taken to ‘eliminate it from the enquiry’ – and that must mean a diagnostic diet – then there is no sound basis for saying that a patient’s symptoms are psychosomatic.

Things are not necessarily done in this order, however, and for good reason. Many of those attending the doctor’s surgery with physical symptoms, such as headache or diarrhoea, actually have serious emotional, sexual or family problems that they want to discuss with the doctor, but find it difficult to start on such sensitive topics. Family doctors are trained in the art of discovering what the patient has really come to see them about. If you have symptoms that you think may be caused by food intolerance you should not feel affronted if the doctor’s initial questions seem rather personal and irrelevant to the aches and pains being suffered. Answering the questions calmly and reasonably will do much to convince the doctor that your problems are not psychosomatic.

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If you have a family history of prostate cancer, get regular checkups and tests for BPH, including a digital exam of your prostate by your physician. The use of a screening test, such as a ptostatic-specific antigen, or PSA, test, is still controversial, and its results are unproven.

Whenever I feel a hard nodule in a patient’s prostate, I refer him to a urologist, even if he has no signs of urinary problems. The urologist will use a sonogram to check for cancer and will take a biopsy—which is a totally safe procedure—if he strongly suspects the presence of cancer. The biopsy is done either in the urologist’s office or in the hospital on an outpatient basis.

If you have an enlarged prostate with no signs of cancer, taking 5 milligrams of Proscar once a day for at least six weeks can help keep your symptoms manageable. Also, your doctor may suggest that you take Hytrin, a mild antihypertensive medication that can have the immediate benefit of reducing the effect an enlarged prostate has on urinary retention. You’ll usually start a regimen of Hytrin with a dosage of 1 milligram each day and slowly build it up to 5. Unlike with intestinal cancer or breast cancer, there’s not much you can do to lower your risk of prostate cancer, such as changing your diet.

A great deal of evidence shows that men who have prostate cancer do extremely well, even when it has spread. The most common therapy uses the hormone estrogen; what’s curious is that a form of cancer that only men get is treated with a female hormone, while breast cancer is typically treated with tamoxifen, a form of male hormone. The side effects of hormone treatment for prostate cancer include a loss of sexual desire and an increase in breast size.

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If your doctor determines that you have diverticulitis, you will need to be hospitalized. In addition, you will not be able to eat solid food or drink liquids for several days, since you will need to rest the bowel to clear up the condition. You will be given intravenous antibiotics and fluids, and a CAT scan will be done with a modified barium enema. This will serve two purposes. First, it will empty out your intestines, which will allow them to rest. Second, the barium will enable your intestines to show up on an X ray so that your doctor can examine the diverticula and determine if the infection is limited to a few diverticular pockets or has spread to form an infectious abscess. When your fever and pain disappear after about five days, you will be able to drink liquids again, and within a few days you will be able to eat solid food.

In most cases, surgery is not necessary to treat diverticulitis; only when an abscess has formed will surgery be considered. And, contrary to popular opinion, diverticulitis is not a preindication of cancer.

To prevent a recurrence of diverticulitis, you will need to exercise regularly and follow a high-fiber, low-fat diet, since a diet that’s high in fat slows the bowel transit time, as does a diet low in fiber, which aggravates the diverticula. The combination of exercise, high fiber, and low fat seems to speed up the bowel transit time and helps to eliminate the problem. You should also avoid eating nuts, seeds, popcorn, and foods with an indigestable hull such as corn.

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Description and Possible Medical Problems

We’ve all been thoroughly trained to believe that any mass that suddenly appears anywhere on the body must be cancer, an attitude that often results in unnecessary visits to the doctor’s office. The good news is that if a mass suddenly appears on your sternum, it’s probably not a serious health problem.

This mass, called a xiphoid process, is actually a small area of the sternum that extends below the rib cage in the center. If you’ve recently lost a large amount of weight, you may suddenly feel a “mass” and think it’s a tumor. However, it’s actually been there all along. Others might become aware of it if they experience a trauma to the chest wall and the xiphoid process becomes bruised or inflamed.

Treatment

If you’ve recently discovered your xiphoid process, you have nothing to worry about. If it is painful, Tylenol or Advil, taken four times a day or as needed, will work just fine.

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If your doctor discovers you have polymyositis, dermatomyositis, or polymyalgia rheumatica, he will probably prescribe the corticosteroid prednisone to help reduce pain and inflammation. Prednisone will also help lessen the skin rash and inflammation that accompany dermatomyositis. Prednisone works by reducing inflammation in the blood vessels and tissues by increasing the body’s tolerance to the inflammation, thus alleviating the symptoms.

The prednisone will be started at a high dose, usually about 40 to 60 milligrams daily. This will then gradually be decreased to a lower dose over a period of several weeks to several months. Side effects include bloating and a “moon face.”

- If your muscles remain weak and achy despite treatment, or they occasionally stiffen up, your doctor may recommend that you schedule regular sessions with a physical therapist to help keep your muscles flexible with range of motion exercises and the use of heat therapy. In any case, it’s a good idea to participate in an exercise program after the initial pain and inflammation subside; regular activity should become part of your life in order to prevent future flare-ups.

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Chains of lymph nodes run along the side of the neck from the ear to the shoulder. Lymph nodes feel like small peas under the skin. If they’re swollen, they may also be painful to the touch, and you may also have flulike symptoms, such as nasal congestion, fatigue, and overall aches and pains. Feel along the line with your fingertips; it is important to know if you have one or more swollen lymph nodes.

If you have swollen, painful glands behind the ear and jawbone accompanied by a high fever and lethargy, you probably have a viral infection. Just a few years ago, if this happened to you, it wouldn’t raise any eyebrows. You’d stay in bed for a few days, be patient, take aspirin, and drink lots of liquid if it was viral, and in a week or so you’d be back to normal. If it has a bacterial origin, then antibiotics would be added.

Today, however, the story is different. If you have what seems to be the flu along with swollen lymph nodes and it doesn’t go away after about a week, you may have chronic fatigue syndrome, which is believed to be caused by the Epstein-Barr virus. However, though many people automatically jump to the conclusion that they have chronic fatigue syndrome, the condition is actually quite rare.

Chronic fatigue syndrome is actually a variation of infectious mononucleosis. Back in high school, mono, or “kissing disease,” was a badge to be worn proudly. Adults who get chronic fatigue syndrome face the possibility that they will have to deal with it for the rest of their lives.

Other symptoms of both mononucleosis and chronic fatigue syndrome include a sore throat, low-grade fever, headache, and, of course, fatigue. The difference between the two diseases is that mononucleosis generally clears up within a few weeks; chronic fatigue syndrome can go on for years.

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If the reactions between the patient and the doctor are to be studied as a way of illuminating the patient’s problem, it is necessary for the doctor to be aware of his or her normal doctoring style. It is then possible to recognize changes from this norm, and to think about what it is in the patient that has provoked that change. Such a way of thinking is very different from the way the doctor has previously been trained where the emphasis was on the collection of accurate information, logical thinking about differential diagnosis and the provision of correct treatment.

Doctors come into seminars hoping to learn how to help people with contraceptive or psychosomatic difficulties. Their thinking is concerned with, ‘Was my action right or wrong?’ or ‘How could I have done better?’ Gradually they learn to think differently, and to wonder, ‘What was it about the patient that made me act in that way?’ Or to put it another way, ‘What sort of doctor was I to that patient?’ Such questions can lead to a re-examination of the patient’s problem, often providing clues to unconscious forces that had not previously been recognized. For instance, a doctor may become much more of a didactic teacher than usual.

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Marital therapists, or couple therapists, work with the couple on the relationship between them. Referral for marital therapy will be more effective when there is agreement between the couple that changes in the relationship are required. Specific training in sexual difficulties is taken by selected therapists who work for Relate Marriage Guidance, or facilities may be available within a psychiatric department. The objective is to establish an emotionally secure relationship which permits normal sexual responses to occur and be enjoyed. The main emphasis is on the nature of the sexual interaction and away from the specific sexual response. It is essential for this therapy that both of the couple are willing to work at the goals set by the therapist. Based on Masters and Johnson’s work (1970), the couple are asked to carry out certain sexual homework assignments while keeping within limits such as the exclusion of genital touching or intercourse in the initial stages. The reaction of the couple to these assignments is then used to examine the interaction between them and to reveal some of the underlying problems. Modern modifications to the original Masters and Johnson techniques include a much more flexible approach using psychotherapeutic methods to identify and reduce the obstacles to the behavioural assignments (Bancroft 1989). Some therapists work as co-therapists, each working with one of a couple and conferring on how best to proceed together. Others work alone treating a couple and their relationship.

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Patients in the older group may have anxieties about whether they should be still sexually active and hide their requests for advice about contraception behind other complaints such as vaginal soreness or period problems in the same way as those just beginning their sexual life. They may need to try out a different doctor from their usual one in the hope that these clues may picked up. The familiarity which is such an asset in general practice may be an obstacle if doctors assume that they know why the patient has attended. A new doctor/patient interaction can allow attention to be paid to covert presentations, and the doctor is less likely to slip into a social interaction, rather than a medical one, as may occur with a well-known patient. Missing thyroid disease or anaemia in a patient seen regularly is a well-known occurrence; less well recognized is the inattention to the unspoken needs of the patient. The woman who attends regularly for her oral contraceptive checks may be unable to bypass the doctor’s routine enquiries to broach the difficulties she is having; the doctor assumes all is well and fails to notice the hesistations or unease. Only by attending another doctor, who does not know why she has come, can she change the focus of the consultation.

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