Health and medical information

You will then be quite clear in your mind as to what the self-management of pain involves. You will see that there are six general principles and that success requires some attention to each of these. You will also see that the application of each of these principles is easy enough to master if you will just let yourself go along with the idea of it.

Reduction of the General Level of Anxiety-This is the first principle in the self-management of pain. It is essential, as anxiety increases pain. The reduction of anxiety is achieved by our understanding the nature of pain, by our facing up to and resolving conflicts which have been causing anxiety, and by the practice of relaxing mental exercises.

The Avoidance of Psychological Reactions That Increase Pain-This principle means that, whatever happens, we shall not allow ourselves to be overwhelmed by distress which is so easily induced by pain. We shall be realistic if the pain should lead us into guilty thoughts about our past shortcomings. By our attitude of mind we shall halt the feeling of fear which would only make us feel our pain more acutely. In each of these matters we gain further help by the calm engendered by the relaxing mental exercises.

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Q. I suppose everybody has suffered from an infection of the stomach and bowel system.

A. This is undoubted, for via the mouth, germs have direct access to the stomach and intestinal systems. Located on food they are quickly transmitted to the stomach and intestinal system where they multiply and produce irritation of the bowel lining, causing an increased rate of peristalsis (movement) which gives rise to abdominal discomfort, nausea, vomiting, diarrhoea, a fever, perspiration, chills, lack of appetite, general aches all over and headaches. Dehydration and prostration may occur quickly, especially in small children.

Q. Is this the same as food poisoning?

A. The symptoms are similar but in food poisoning germs have actually entered the food, multiplied there and produced their toxins which are then eaten. The body absorbs these and similar symptoms occur. They may be severe but are usually self-limiting.

Q. What is the best treatment?

A. In simple cases, starvation for 24-48 hours is best. Adequate fluids, such as frequent sips of cool water, or lemonade with powdered glucose D (about Vi tsp per half glass); ice blocks or chipped ice. Cool sponges will help brighten the spirits. Gradually resume normal meals but small amounts of non fatty products are best. Fats seem to aggravate the condition. Doctors sometimes prescribe anti-vomiting medication but it is usually unnecessary. Diarrhoea also may benefit from medication such as Lomotil or Imodium but this is for adults only.

Q. Aren’t some cases due to specific organisms?

A. Most of the common causes of gastro, as it is commonly called, are due to viruses, often transmitted by flies. Other types are due to certain identifiable organisms which produce dysentery, such as one named shigella. Symptoms are similar or may be more severe. Fluid replacement is necessary and certain antibiotics are effective. Medical supervision is advisable both for diagnosis and treatment.

A very severe type of bowel disorder is called botulism, rarely seen in Australia. This infects food and may produce serious symptoms which may be life-endangering. They are similar in nature to general bowel infections but may lead on to prostration, weakness and sometimes respiratory failure as the nerves are poisoned. Special anti-toxins are available.

Q. Is it advisable to seek medical help with any bowel disorder?

A. Often symptoms are mild and fairly quickly vanish. However, with any persisting symptoms, especially if associated with considerable fluid loss and abdominal pain, medical attention is essential. This is very important in babies and infants who dehydrate rapidly and may quickly reach an irreversible stage. Many years ago huge numbers died from simple gastric infections.

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Spending 40 or more hours a week sitting down and using equipment that demands repetitive actions can lead to stresses and strains, from continual backache to one of the relatively recently identified repetitive strain injuries.

A good sitting position is vital. Your feet should be flat on the floor (or on a footstool) and your back reasonably straight. If the seat is adjustable, tilting it forward a little may prove more comfortable and can encourage better posture. If the seat isn’t adjustable and the lower back is not supported, roll up a towel or use a small cushion for support. Pull the chair close to the desk to avoid leaning forward and putting strain on your back.

Any equipment you use frequently throughout the day such as files, the telephone and computer, should be easy to reach without overstretching. Constant use of the telephone – particularly if it’s cradled between the ear and shoulder – can result in tension to the neck and shoulder area.

Try to do a number of different work activities during your day, varying your posture every so often to stretch your back and relax your muscles.

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It’s bad enough to have to endure extreme cramping pain every month without being sick as well. It’s a horrid experience and one most sufferers dread, so the vicious circle of

pain-fear-tension-pain is even more extreme for them. If your stomach muscles are tense, your stomach can’t function properly and you’ll feel sick, so the more often you can practise relaxation and the more relaxed you can be the better. If you find that you are breathing more rapidly than usual because you’re worried or frightened, try breathing in second gear for a while. If it works, breathing like this can help you in two ways. For a start, if you are changing your breathing pattern you have to concentrate hard on what you’re doing. This takes your mind off your worries. Secondly, deep breathing like this will calm you down and reduce the feeling of panic you are experiencing. Many women find that as they grow calmer, they don’t feel so sick.

The third thing to do is to treat your stomach with great respect at period time. Try not to overload it. It’s a great temptation to eat really well in the days before your period begins if you know you’re soon going to be feeling too sick to eat. But, as you may have discovered through unpleasant experiences, a full stomach is more likely to make you sick when your period begins than a half empty one. If your period is predictable, eat a light diet for several days before it begins. Avoid heavy meals and alcohol. Cut down on the starchy stuff, like cakes, buns, puddings, biscuits and sweets. Eat fresh fruit and salads, and small portions of the protein foods like meat, fish, eggs and cheese. If you can, try to relax completely immediately after you’ve eaten. Don’t get up and rush straight into the next job as soon as your meal is over, but give your body a calm, relaxed time in which it may begin to start digesting what you have eaten.

Most women who suffer from sickness at this time say once their period has begun it’s best not to eat or drink anything, because the least thing triggers the sickness. But some women find that it helps to sip iced water or raspberry tea, lemon juice or mineral water, or that traditional cure for morning sickness, a cup of hot weak tea and a dry biscuit, nibbled slowly. However, you may find that when you’re completely relaxed and breathing gently, the pain becomes so slight that you don’t feel sick any more. You may even feel that you could eat a normal meal. But you will probably agree that little, light and often is the best idea, at least to begin with.

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Repeated, jerky, spasmodic movements of isolated groups of muscles are called tics. Tics occur in preschool and school age children as a result of undue pressure and emotional stress. They increase when a child is upset or excited and stop temporarily when he or she is diverted or asleep.

Signs and symptoms

Usually, tics involve twitching the mouth, wrinkling the forehead, blinking the eyes, sighing, coughing, or sniffing. The head, shoulders, hands, or arms may jerk uncontrollably. Tics can happen several times a minute or only once or twice a day and they persist for weeks or months.

Tics are usually obvious, but they may have to be distinguished from allergies, which often lead to twitching the nose, blinking the eyes, and coughing. A more serious but rare form of tics is Gilles de la Tourette’s disease. The disease may resemble tics at the outset, but it progresses to violent twitching of the face and arms and sometimes other parts of the body. The spasmodic movements are accompanied by explosive sounds such as a barking cough or indistinct words or unintentional obscenities. Because Gilles de la Tourette’s disease is so unusual and because it is fairly mild to start with and becomes progressively worse, early diagnosis is not possible.

Home care

Do not pay undue attention to tics. You may aggravate or prolong the condition if you react by calling your child’s attention to the tics, demanding that the child stop, nagging, or punishing the child. Your best plan is to identify and then relieve any obvious stressful situation at home, at school, or among your child’s friends.

Precautions

• Ignoring tics requires the cooperation of brothers and sisters, parents, relatives, neighbors, and teachers.

• If tics are the only sign of emotional tension in a child they may be due to the customary stresses of childhood. However, if tics persist for more than a few weeks or occur with other symptoms or patterns of disturbed emotional behavior, they may signal a potentially serious problem. Seek professional advice.

Medical treatment

Your doctor will examine the child carefully to make sure that the tics are not due to a physical illness. The doctor will evaluate stressful situations in your child’s environment, and advise you how to handle them. Your doctor may require consultation with a neurologist (specialist in nervous system disorders) to diagnose and treat Gilles de la Tourette’s disease.

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There are a number of devices to make injections of insulin more convenient. One of these is the insulin pen and this works on the same system as the fountain pen for writing: it is shaped rather like a pen, has an internal reservoir or cartridge of insulin which is replaceable and a needle where the pen would normally have a nib. The needle is replaceable as needed, generally after a few days of use and the insulin cartridges hold between 150 and 250 units.

There are insulin cartridges for both long and fast acting insulins and some insulin mixtures. The first of these pens introduced to the market here was designed by Novo Industries and called the Novopen, and some people use the term to refer to all the available pen systems. There are however other types including Insuject by Nordisk. Moreover there are different pens for long acting and for short acting insulin. Thus, Novo pen I is usually used for Actrapid insulin and Novopen II for Protaphane, Ultratard and Actraphane. Insuject is used for Velosulin and Insuject-X used for Insulatard, Mixtard and Initard.

The original intent of the pens was to allow quick acting insulin to be administered conveniently before each meal. This mimics to some extent the way the pancreas releases insulin when we eat. In addition to these three insulin injections, an injection of long or moderately long acting insulin is given at night, usually before bed. This provides a supply of insulin throughout the night and into the next day.

The pen makes it relatively easy to have insulin at lunch time at school or work by carrying the pen in a pocket or bag. It makes it more convenient to accept invitations for meals away from home and gives more flexibility in timing and insulin dosage. Some people vary their dose of quick acting insulin according to their blood glucose level (more if it is very high) and most people vary the dose according to the degree of exercise they expect to have following the injection. A young person would therefore lower the dose if he was going swimming or had a football match. Some people have a little more quick acting insulin if they are at a social occasion and expect to be eating a bit extra.

The ability to vary the dose in this way depends on doing extra blood glucose estimates at times, especially when getting used to the system.

The pre-mixed insulins make it possible for some people to use the pen for twice daily injections. This does have the advantage of convenience but the disadvantage that it is not possible to vary the portions of the fast and slow acting insulins when they are pre-mixed. The insulin manufacturers may develop systems where the proportions of the insulins can be varied. If this happens, it is likely that the pen systems will largely replace the conventional syringes and bottles of insulin.

One disadvantage of the system is that it is not always possible to check that the full dose has been given. Using the syringe, the dose can be checked when it has been drawn into the syringe and it is obvious when the full dose has been given and the syringe has been emptied. With the pen, it is possible for malfunctioning of the pen or for a blocked needle to occur so that some or even all of the dose is not given properly. It is also possible for a young child to make errors. This can be partly overcome by expelling two to four units of insulin into the air to check that the pen is working before administering the insulin dose beneath the skin.

Some people choose to use the four injections a day pen system for convenience. Others do so to get the best possible control of their diabetes. Most people, when they first develop diabetes, prefer to start with one or two injections a day and feel it is best to become familiar with the syringe before trying the pen system, particularly as it does not necessarily lead to better control. Like all gadgets, they can become lost or broken and it is important to have the conventional syringe as a standby.

Adjustment of insulin dose using the pen system

It usually works out that between a third and a half of the total insulin requirements for the day is given as an injection of slow acting insulin at night. The remainder of the total dose is given as three injections of quick acting insulin before each meal, in about equal proportions. These proportions, and the total amount of insulin for the day, depend upon a person’s total insulin requirements, their pattern of response to insulin and their usual meal and activity habits. They would normally be worked out by your doctor.

After a few days, a pattern of response will probably develop and based on blood tests, dose adjustments can be made.

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Anything that we do to cope with stress operates on the biological background of what we are. In Western countries, two opposing philosophies are becoming apparent. One says, ‘We are only here on earth for a short time, so let us work hard and play hard, and get the most out of it.’ The opposing philosophy says, ‘Life is for living, that’s all that counts, so stay on the dole while you can.’ Both these approaches to life have an effect on our coping with stress.

Work hard, play hard. How does this fit in with our biological heritage? Animals, both grazing animals and hunting animals, work for food for the day, and when this is satisfied, they rest. It is the same with primitive human peoples. In Eastern countries, particularly the Hindu and Buddhist, work has a leisurely quality about it. For the Latin and Greek peoples of the Mediterranean basin, the siesta is an established part of life. Maybe that in our ‘work hard’ ethic we are moving towards a better concept of life. This may be so, but it makes us more vulnerable to stress. This comes about for two reasons. The stream of impulses arriving in our brain is so much the greater, and we deny ourselves those moments of quiet which allow our brain to achieve better integration as happens with those who enjoy their siesta.

The ‘play hard’ part of this philosophy also has a part in our stress. Those who work to the limit – business executives, men who hold down two jobs, women with a family who also work outside the home – these people are on the verge of stress on account of the burden of their work-day life. For them, to play hard is often an escape. A very poor escape from their nervous tension. In these circumstances, playing hard adds to the stream of disturbing impulses and so contributes to further stress.

Work hard and play hard’, as a philosophy of life, is not consistent with our biological heritage and provides a background for the development of stress. What of the opposing philosophy, ‘Life is for living’? We associate this belief with those of the younger generation, who exploit the social services of the country. But this philosophy has spread far beyond those people.

Another group consists of successful businessmen who retire early into a life of golf and idleness in the belief that, after all, life is for living.

Both groups swap the problems of work for the problems of idleness. As biological creatures we are not well conditioned to a life of idleness. In the days before yesterday, primitive man who did not work was soon short of food. He became undernourished, and died without children to survive him. So we have bred into us a need to work. The followers of the ‘life is for living’ doctrine fail to recognize this. They run short of ways of filling in the idle hours. Idleness, instead of being a blessing, soon becomes a problem. In this way their pattern of life forms a background for the easy development of stress.

The background occupation most likely to reduce stress is one which is consistent with our biological heritage. That is, we work, but also have adequate rest.

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“I know what men want. What they need. And I give it freely. Unstintingly. As in the other fields of life, I am enriched in giving. Yet come the times when I wish the calls to give were less frequent, less passively insistent. Yes.

And less assuming about it all. I do not think that everybody would understand what I mean. But I am sure there are some that do.

‘This way, that way, another way, always something new. It’s good. It’s great. Yet I have the feeling that the ultimate may be something very simple. So simple, so complete, that sex has gone from it. Just to be, and nothing more.

‘Yearning. Am I seeking something that does not happen? Something beyond the capacity of man and woman?”

Life changes. We change. Man and woman are different now from what we were a hundred generations ago. In those times sex was pure physiology. Animal lust. Then dawned the time, and sex became the ultimate expression of love as we know it. Now another dawn is breaking. Sex transcended, and expression of love we did not know before.

If the reach of our emotions is not attained, we are unsatisfied. One dissatisfaction adds to another, and lays the foundations for stress when some greater problem arises.

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It is estimated that 200,000 of the 600,000 pregnancies that occur in the UK each year are “unwanted”, although it should be said that many of those who become pregnant in this way come to terms with the pregnancy and so the baby becomes at least to some extent ‘wanted’.

Most people imagine that all such babies result from ‘bad luck’ or contraceptive failure but those who work in the field of psychosexual medicine are convinced that most of the pregnancies in the so-called ‘bad luck’ women can be explained on more convincing grounds.

Human females over the age of the menarche (once they start having periods) can only get pregnant if they have intercourse within a few days of ovulation. Ovulation (the release of an egg from an ovary) occurs 14 days before the onset of a period irrespective of the length of the woman’s menstrual cycle. In a ‘typical’ cycle this means that the woman ovulates on day 15. To be safe from unwanted pregnancies, therefore, she will have to abstain from penis-in-vagina intercourse or use a contraceptive for a few days around this time. As no woman has a completely predictable cycle, however, preventing unwanted pregnancy generally means using some method of contraceptives throughout the menstrual cycle.

There are many different forms of contraception, all of which have their advantages and disadvantages, but all are unsatisfactory in one way or another. It is these unsatisfactory aspects that lead to at least some unwanted pregnancies. Truly satisfactory and acceptable methods would leave less room for poor usage and other practices that lead to ‘failures’.

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What is it?

A collection of pus in the breast, almost always secondary to a blocked duct during lactation.

What causes it?

Most breast abscesses start as a blocked milk duct in lactating women. Milk dams up behind the blockage and causes a tender, often painful, lump in the breast. When the baby feeds, the ‘let-down’ reflex produces more milk, so building up even more pressure in the blocked area. Treatment at this stage cures the condition and the dammed-up milk does not then go on to form an abscess. If nothing is done the local tissues soon become inflamed and the overlying skin is reddened. Inflammatory products get into the bloodstream and the woman has a fever. She may also feel ‘flu-like and achy. This inflammatory condition is called mastitis.

The stagnant milk in the blocked duct can easily become infected with blood-borne bacteria, so forming an abscess. The infection sometimes spreads beyond the affected duct and its gland, causing bacterial mastitis. This involves a larger area of the breast than an abscess alone.

A woman with a breast abscess has a tender lump in her breast, with some degree of inflammation around the lump. The abscess may spontaneously burst and drain its pus either down the duct to the nipple or even into breast tissue and thus to the skin of the breast.

An abscess should be treated as for a blocked duct and also with an antibiotic. It is unlikely that there will be any danger if the baby drinks the milk but some women prefer to feed only from the uninfected breast, especially if pus is draining from the nipple. The pain and other symptoms of an abscess are helped by aspirin and rest.

A condition less commonly seen nowadays is a breast abscess following infectious mastitis due to virulent bacteria entering the breast via the nipple. Modern thinking encourages less handling of babies in hospital by staff and also better hygiene precautions. These measures lower the chances of dangerous ‘hospital’ bacteria gaining access to the mother’s breast.

Prevention

This is based on treating a blocked duct promptly. Immediate and thorough action for a blocked duct prevents almost all abscesses. One major survey found that women only got an abscess if they stopped feeding when they had a blocked duct with mastitis.

•    The general lowering of tension in the breast gives you a chance to unblock the duct. If you have ever had a blocked duct or feel a lumpy area of the breast developing, make sure that your breasts are soft and empty after the baby feeds.

•    If your breast feels lumpy after a feed give the baby more or express the milk by hand or pump. Try to fit in twice as many feeds even if you are already feeding on demand, and don’t be afraid to let the baby suck for as long as he or she wants to. Make sure that your breasts never get over-full. If your baby is sleeping for long periods, either wake him or her to feed or else express some milk, in order to soften the breasts.

•    Always offer the affected breast first to ensure efficient emptying and return to it several times during a feed as milk can be let down many times in one session.

•    Most important-gently massage the lump towards the nipple to try to release the dammed-up milk. You can do this at any time-during a feed or when the baby is not at the breast. If you can, have several hot baths a day and submerge the affected breast under the water to keep it warm. Massage the lump and express the milk into the water.

•    If you can’t get into a bath place a hot water bottle over the area or splash the breast with hot water while leaning over a basin. Massage and heat together work well but be careful not to burn yourself.

•    Unblocking a duct (or ducts) can take several days of perseverance. When the milk is finally unblocked, it may flow freely from the nipple. You will see that it is thicker and looks whiter than your usual milk.

•    Check that your bra is not pressing somewhere and causing the blocked duct. Some nursing bras with a band across the top when the flap is open can exert substantial local pressure. Be careful how you pull down the cup of an ordinary bra-that too can constrict the breast. Some women sleep on their stomach at night and the pressure on their breasts can cause a duct or ducts to block.

•    Change the position in which you feed your baby from feed to feed and even during a feed so that the direction of suction is varied. Babies can suck in such a way as to leave a particular segment of the breast un-emptied at times.

•    If, after 24 hours’ intensive effort as described above, the symptoms are getting worse, see your doctor at once for antibiotics, but continue the treatment as above. Don’t stop feeding.

•    Rest as much as you can.

•    Physical exercise, especially of the top half of the body, can help disperse the painful swelling caused by a blocked duct.

•    Take 1 g vitamin Ñ a day as soon as any painful lump appears, to help combat the infection. If you find you get mastitis frequently your zinc status could be low, so go on to a full dose of zinc as recommended on the container.

•     Some doctors recommend lecithin as an additive to the diet for women who repeatedly get blocked ducts.

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