Antidepressants Blog

According to circumstances, and according to our own individual personality, at different times we can use various psychological reactions to reduce our pain. We can do what we can to deny it, and use various distractions to forget it. If our personality is such that we can do it, we can

dissociate ourselves from the pain and stand apart from it or even make the painful part numb. We can all practise autosuggestion, and most of us can get some help from it provided we do it in a really relaxed state of mind.

The Practice of Relaxing Mental Exercises-This of course forms the basis of this approach to the management of pain. It allays anxiety, wards off distress, allows the effective use of autosuggestion, and of itself reduces our threshold of pain.

Any system that is successful in the self-management of pain is based on a calm and relaxed state of mind. The system described here is simple and effective, and can be mastered by almost anyone who sets his mind to it.

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Q. What about worms? Are these very common?

A. Indeed they are and I guess nearly every child in Australia has suffered from worms. The most common kind here is the threadworm, also called the pin worm. It commonly affects children of school age, for eggs are readily transmitted on fingers and hands, school implements, toys and play things.

The eggs quickly hatch out in the bowel and adult worms leave the anus to deposit eggs around the anal margin at night. This causes irritation and the desire to scratch, which in turn transmits more eggs to the fingers and under the nails and so they are spread to others, either members of the family or school chums. Apart from irritation there are rarely any severe effects.

Q. What is the best treatment?

A. Ideally the whole family or the whole class or school should be treated at the same time. A variety of medications is used, Mebendazole (Vermox) is very satisfactory. One tablet, or 5 ml of liquid, is all that is required irrespective of age. If the worms recur, which is common, a further dose or two at weekly intervals will again have a beneficial effect. Other worm killers are also used with good effect.

Q. What about other worm infestations. Are these common?

A. In certain under-developed countries they are notoriously common. In Australia, in the main, they are not commonly seen. Round worm (ascariasis) sometimes occurs. There may be no symptoms, although nausea, vomiting and colic may be present. Piperazine citrate is effective treatment. Hookworm, strongyloides and tape worm are occasionally seen.

Q. What about giardiasis? This seems to have suddenly taken off in Australia in recent years.

A. True, and the parasite called giardia lamblia which came here from the Mediterranean area is now very common all around Australia, especially along the eastern seaboard. It usually comes from infected water, maybe swimming pools, is swallowed, multiplies in the duodenum and causes ongoing diarrhoea with frothy stools. The organism may be identified by material taken from the duodenum or from the contaminated stools.

Q. What about treatment?

A. This is excellent. Metronidazole (Flagyl) given three times a day for a week is curative. A simpler method is taking tinidazole (Fasigyn), four tablets of 500 mg as a single dose. These drugs should be taken under medical supervision after the diagnosis has been confirmed.

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Sports injuries are mainly caused by contact with another person, an object, or through overuse of muscles. Obviously, not all such risks can be avoided – you can’t foresee a collision on the pitch or a fall on the track – but they can be minimised.

Getting the body ready for exercise is just as important whether you play sport every day or once a month. It’s particularly important for older people and those not used to exercising. If you are unused to exercise, a visit to your doctor before you start is always a good idea. Gently warm up for five to ten minutes to improve muscle flexibility. Before going on an energetic sporting holiday, such as skiing, start your exercise programme about six weeks beforehand. It’s also important to ease your body back down after activity, first with mild physical exercise, then gentle stretching exercises to help prevent muscle stiffness. Changing into warm clothing stops the body getting chilled.

Clothes and equipment should be chosen with care: shoes must fit properly and be correct for the purpose; clothes should be appropriate, and your racket, bike or clubs should be of the right size for your height and weight.

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Some people suffer from what seems like the reverse of sickness. A swollen bowel is another source of pain and discomfort in a part of your body which is already uncomfortable enough. The same light diet that helps ward off sickness is also useful to prevent constipation. So for you, too, I would recommend light nourishing meals with plenty of fruit and salads, particularly in the week before your period. Many people find that it helps to eat some roughage at breakfast time, wholemeal bread and marmalade, for instance, or some Weetabix or bran sprinkled on your cornflakes.

It also helps if you can drink a glass of warm water as soon as you get up on days when you are constipated. This will often get a sluggish system moving, particularly if you follow it with two cups of hot tea at breakfast. And if you can follow breakfast with a short session when you are completely relaxed, you will be giving your body the best possible chance for it to function normally.

There may still be occasions when you feel so uncomfortable that you need an aperient before you can begin to improve. There was a time when laxatives were handed out every week to reluctant children, who usually didn’t need them. Then people found out that this was a very silly practice, and harmful too, because overdosed children like that grew up into adults whose bowels couldn’t function properly and naturally unless they continued to dose themselves. So dire warnings were issued and we were urged to leave our bodies alone to get on with the job naturally. Nowadays most people use laxatives only occasionally, when they really need them, which is what you will have to do if you should find that a swollen bowel is making your period pain worse. But on most occasions you’ll probably find that extra fluid intake and adherence to a sensible diet will be all that is necessary for relief.

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Symptoms: Sore, red throat; inflamed tonsils, often with spots; fever.

Home care:

Treat as you would treat a cold or sore throat.

Give aspirin or paracetamol for fever and pain

Give the child plenty of fluids.

Precautions

-    Drooling accompanying a sore throat should be brought to the attention of your doctor immediately.

-    Between the ages of three and nine, children often have enlarged tonsils and adenoids; this enlargement is normal and should not be confused with infection.

-    White, cheesy material on the tonsils is normal and does not indicate infection.

-    If a child is eating poorly, the cause is something other than enlarged tonsils.

-    A quinsy sore throat always requires medical treatment.

The tonsils (in the throat) and the adenoids (in the back of the nose) are part of the lymphatic system, and their function is to destroy disease-causing germs. They may become infected with disease-causing germs from a common cold, strep throat, infectious mononucleosis, diphtheria, or tuberculosis.

Signs and symptoms

The child will complain of a sore throat and will have a fever. The throat will appear red and sometimes there are spots on the tonsils. Acute infection of the tonsils is diagnosed from the appearance of the throat and the results of a throat culture or blood count. This enlargement of the tonsils rarely produces symptoms by itself but, in extreme cases, can make it hard for the child to swallow. Enlargement of the adenoids can result in mouth breathing, hearing loss and middle ear infection, snoring, nasal speech, and bad breath. Adenoids can be examined with special instruments or seen on an X ray.

A unique infection of the tonsils is quinsy sore throat (peritonsillar abscess). In quinsy a large abscess forms behind a tonsil, producing intense pain and a high fever (39.4°C or 40°C). The abscess eventually pushes the tonsil across the midline of the throat. The child will have difficulty speaking (“hot potato speech”) and swallowing and will drool.

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‘Complications’ refer to things that can go wrong during the course of diabetes, either as a consequence of diabetes itself or its treatment. Thus, ketoacidosis is a complication of diabetes but hypoglycemia is a complication of insulin treatment. Complications may occur as part of the course of diabetes, but treatment may affect the severity of the complications or when they develop. Some complications, such as social and psychological problems arising in the course of diabetes, may be due partly to diabetes itself and partly to its treatment.

Most people think of impairment of vision, kidney function, blood circulation or nerve function as the principal complications of diabetes. These are sometimes called ‘late complications’ because they occur (if at all) many years after the onset of diabetes.

There is however a number of complications that can occur during the early stages of diabetes. These include hypoglycemia, psychological stress, growth impairment, pregnancy problems and cataracts.

Whereas most of the early complications are correctable and reversible, many of the late complications are not. It is for this reason that complications of later life are the main source of worry for family and friends of the person with diabetes. Prevention of complications is one of the main tasks for physicians caring for diabetes. Young people sometimes don’t seem quite as concerned about the long term affects of diabetes. Perhaps this is because they, very sensibly, think there is no point in worrying about an uncertain future, and perhaps because there are higher priorities in their lives at the moment than becoming too involved with strict diabetic control. It is not usually helpful or fair to threaten young people with the prospects of complications if they do not take better care of their diabetes. It would however be a mistake to suppose that young people don’t care.

It is perhaps important to have some understanding of the risk of complications. We can often recognize their early development and do something to minimize the risks of them progressing to the point where they cause trouble or impair health.

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We feel we must get on in the world. So don’t let us waste our time. Well, what is waste of time?

Sleep is not waste of time. It is a biological necessity. It is the same with rest. What of leisure? We must sleep. We must take a rest. But with leisure there is a matter of choice. We can take it or not as we please.

If we sleep, we sleep. If we take a rest, we rest. But leisure is different in that there are so many ways we can take our leisure.

In matters in which we are able to make a choice, we can either choose well or choose badly. So it is with leisure.

Too much or too little. Too much breeds the feeling of purposelessness. Too little and we deny ourselves those important moments of allowing our mind to run easily. If we do something which is consistent with our biological needs, we call it ‘common sense’. If we apply this kind of wisdom to leisure time, we provide a background which will reduce our vulnerability to stress. The crucial factor is that we should enjoy our leisure in such a way that we have moments in which our brain runs easily in a way that allows it to integrate all the messages it has been receiving.

I am not suggesting that all our leisure should be spent sitting quietly in the garden or in some beautiful park. Nor do I suggest that we should spend most of our leisure lying in the sun on the beach, or sitting with a book by the fire. No. Not that at all. These activities may be useful ways of letting our brain run quietly. But we can still let our brain run quietly while we are actively doing things.

We play games. If we play for the game, for the exercise, the companionship with our fellows, and the fun of it, at the end of the day our brain will be further on the way to coping with the problems that beset us. But if we play the game in highly competitive fashion, at the end of the day we may feel exhilarated from a win, but our stress situation will remain unchanged.

Play, romp, have fun and our stress is reduced. And laugh, particularly if we can laugh at ourselves.

Leisure often involves going out, parties, socializing. A part of this is eating and drinking. We are gregarious animals. Over past generations we learnt the hard way that it was safer to stay in the group. In primitive times, those who wandered off by themselves became the victims of enemies, either human or animal, and did not survive to have children. So the tendency to be gregarious has been bred into us. And this tendency is reflected in the behaviour patterns of our leisure time.

The relaxation of our mind in the friendly company of others does something to help our brain towards the full integration of stimuli, and so works to prevent stress.

In contrast to our gregarious need we have more recently evolved a tendency to have some time by ourselves. This is a much more recent development of human kind, and comes about through our increasing awareness of our own being, and an awareness of our relationship with the world around us. This need is manifested more strongly in the introverted people among us. This is so because their habitual way of dealing with anxiety and nervous tension is to withdraw from the problems around them. So they have the tendency to withdraw into themselves, and this becomes a feature of their leisure activity. In this quiet withdrawal into the self, the introvert gains some inner tranquility in being by himself. He likes to ponder things. Not the problem that is the basis of his stress, but rather the wonder of the natural things around him. His mind runs quietly, and stimuli arising from his problems are better integrated.

A few moments’ daydream may do more to relieve stress than an hour’s discussion of its causes.

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“We are a castle of playing cards. Someone shakes the table and everything collapses. It does not need a storm, just the slightest puff and we are gone.

Put up the interest rate. Just a few points. Gone. That which was steadily balanced falls to pieces.

I’m not a magician. How could I tell they were going up? My whole business. All that I have worked for threatened.”

He is clearly under stress, and the threat to his business is his major problem. In his mind, the only problem. But it so happens that his wife’s father was a successful businessman. She is given to comparing her husband to her father. In fact, her urging him to greater success had provoked him into taking unwise risks. His reaction is, ‘What will she say? What will she think?’ This is the associated problem resulting directly from the major one. If someone could lead her into supporting him instead of criticizing him, he may well be able to cope with the major problem without stress.

And how does she give this support that will allow his mind to run free? No advice. No working it out logically with him. And certainly not, ‘My father would do it this way.’ Reassurance is little help. The real help comes by the wordless expression of support. If she curls up closely in bed that night, nothing need be said.

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What are they?

Varicose veins are knotted, distended, twisted, leg veins in which the valves have ceased to function properly.

Approximately one in four North American women and one in ten North American men suffer from varicose veins, yet they are much less common in Third World countries. One survey found that over the age of 50 in the US 42 per cent of men and 64 per cent of women had them. In a survey of Egyptian women factory workers the figure was 6 per cent.

Not only do varicose veins look unsightly; they produce pain (a dull, aching heaviness); the ankles swell (especially in warm weather); there are painful calf cramps at night; the legs itch or burn; and more serious complications such as shin ulcers, inflammation of the veins, blood clots and bleeding can occur too. More than 100,000 Americans die each year from a blood clot which then lodges in the lung.

Treatment is traditionally with elastic stockings (hose) to apply pressure on the veins, injections of sclerosing agents to seal off the worst veins, and surgery to remove the offending veins. None of these is a very successful or pleasant treatment so once again prevention must be considered.

What causes them?

• Heredity. There is little doubt that varicose veins are more common in the families of those who already have them. Whether this is true heredity or due to an environmental factor (see below) is not yet clear.

• The erect posture of humans, constrictive clothing and repeated pregnancies have been discarded as primary causes of varicose veins because none of the theories stands up to scrutiny when examined in detail in other populations of the world.

• The probable cause of varicose veins is as follows. We in the West eat very little dietary fibre and strain at stool to pass a small number of hard, small ‘sticky’ stools in a seated position on a lavatory. Peoples around the world who have very few varicose veins eat plenty of fibre and pass large-volume, soft and easily evacuated stools in a squatting position.

Research has shown that the pressure produced when straining at stool is transmitted down the leg veins and it is postulated that this repeated downward pressure (against the blood flow) damages the valves in the veins. Normally the valves stop blood pooling in the leg veins under gravity as blood passes upwards against gravity propelled by the pumping action of the calf muscles as we walk. Once the valves have been rendered inoperative blood pools and distends the veins and blood flow becomes sluggish. Blood leaks out into the skin causing unsightly discoloration and other skin changes and the scene is set for the serious, even life-threatening complications listed above. In traditional peoples who squat to open their bowels the angle of the thighs to the abdomen is so acute that it shuts off the major leg veins in the groin, so preventing the pressure produced by straining at stool (which is very low anyway because of their high-fibre diet) from passing down into them.

• Standing for long periods definitely makes varicose veins worse because of the increased gravitational burden. Sitting, it appears, might also make things worse, as does crossing one’s legs when seated.

• Female hormones may well have something to do with the problem. Indeed, something has to explain why it is that women are so much more likely to suffer from the condition than are men. Although they are more constipated than men this alone does not appear to answer all the questions. That a hormonal change during pregnancy could be involved is deduced from the fact that in some women inflamed leg veins are early signs of pregnancy-even before they miss a period. At this stage the fetus cannot possibly be compressing the large veins in the pelvis so perhaps it is the rising levels of the connective-tissue-relaxing hormone (relaxin) that make the vein walls relax too much and leads to varicosities.

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Benign (non-cancerous) breast disease is a family of rather ill-defined conditions which show up as pain and lumpiness in the breast. The pain, tenderness and lumps fluctuate with the phases of the menstrual cycle and tend to get progressively worse until the menopause.

The vast majority of women who have painful, lumpy breasts will not go on to get cancer of the breast. However, the condition is still worrying and wearing on a month-to-month basis. If ever a normally lumpy breast begins to have a well-defined mass, a blood-stained nipple discharge, a turning-in or tethering of the nipples, abnormalities in the overlying skin or glands in the armpit, consult your doctor at once.

No one knows for sure but the prolactin antagonist drug, Bromocriptine, and the female sex hormone antagonist, Danazol, both help cure the condition in some women, so presumably hormones play an important part in the story. Unfortunately, both these drugs are expensive and have side-effects.

Research in many centers over the years has made it possible to piece together a preventive package which can also be curative.

• Stop smoking.

• Reduce the amount of animal fats you eat. The Japanese, who eat lots of fish and very little animal fat, have very little benign breast disease. Also, studies of women with breast disease suggest that there is a disturbance of fatty acid metabolism which can be corrected by reducing the amount of animal fat they eat and increasing the amount of polyunsaturated fats in their diets. Oily fish, such as mackerel, herring and salmon, are especially useful.

• Avoid tea, coffee, cola and other caffeine-containing substances. These all contain various biologically active substances called methylxanthines which have been found to aggravate breast disease.

• Take a dietary supplement containing the following:

Vitamin E, 4-600 IU daily

Vitamin B6, 50-100 mg daily

Vitamin  complex, 25 mg daily

Magnesium, 200 mg daily

Zinc, 10-40 mg daily (especially if your breasts are worse pre-menstrually)

Cold-pressed linseed oil, 1 – 2 tablespoons daily

Evening primrose oil, 4 – 8,500 mg capsules daily

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