The word “pain” comes from the Latin word poena which also means punishment. So there is nothing new in the association of these two ideas. The child is educated to a complicated system of values and behaviour which allows him to take his place in society. This is achieved primarily by the process of reward and punishment. Love and physical rewards are given for being good; and hostility and physical punishment for being bad. This is the learning process in its simplest form, and as a means of leading the child to acceptable behaviour it is very effective. However, the constant association of pain with punishment conditions us to lose sight of the biological

purpose of pain as a simple and helpful warning against injury. The child is constantly reminded of this association so that it persists into adult life. If in fact corporal punishment is not inflicted, the threat of it is usually still there, and even if it is not actually threatened it is referred to obliquely, “If you had been properly punished when you were younger, this would not have happened.” This is the child’s ordinary experience, so the two ideas, pain and punishment, become fused together in his mind.

*112\57\2*

Q. What about side effects? We seem to read about adverse conditions occurring from time to time. Are these serious?

A. I suppose every known drug has an adverse side effect on somebody somewhere. It is a fact of life. Why, even most foods can be found to disagree with somebody. Considering that by 1984 around 30 million patients are said to have been treated with cimetidine, the number of adverse side effects is surprisingly small. Certainly researchers will dig up a wide range of symptoms which are claimed to have been produced by cimetidine, but in the total picture, these are very small and probably of little consequence.

The same doctors will also point out that simple, old fashioned aspirin, which has been around for nearly 100 years, may cause allergy reactions, asthma, bleeding from the stomach and bowel, nausea and vomiting, diarrhoea, and many other symptoms. But this does not preclude it from being one of the most valuable and widely prescribed drugs of all time.

If adverse side effects occur, then appropriate steps can be taken at once. On the other hand, if they are minimal, then the benefits of treatment will often outweigh any problems.

Q. Are other drugs in this family available, or is cimetidine the only one?

A. In 1982, another drug called ranitidine became available in Australia. Like cimetidine, it is a product of original research in Britain. It is marginally different, works in a similar manner, is claimed to have certain benefits, as all new drugs claim. Time, however, will show if this is really the case. Some major British trials have indicated that it may be of special benefit in the few cases in which cimetidine therapy fails to work. No drug will be effective 100% of times and a related drug may prove effective, this appears to be the case with ranitidine. Another preparation is a drug called oxmetidine, which is also similar in activity. Yet another named omeprazole has also been developed. How these will compare to the others, time will tell. It has all been succinctly put by a Sydney gastro-enterologist who recently wrote in an Australian medical magazine: “It is difficult to envisage that these drugs will be any safer or more effective than cimetidine in equipotent dosage.”

Q. Can the patient still take other medication with cimetidine if necessary?

A. The most likely medication will be antacids, and this is often taken in the early days along with cimetidine. It does little more than reduce pain. As pain disappears, most will cease using antacids, but they may be taken if desired. Often the decision is left with the patient.

It is pointed out that the doctor will be careful in prescribing other non-ulcer type drugs in the event of high dosage levels being required. Sometimes, in severely ill patients, cimetidine is given by injection, either directly into the blood stream (intravenous) or the muscle (intramuscular injection). This helps it work more rapidly.

In ageing patients, when the liver and kidney are not working as efficiently as in younger days, the drug may further reduce their working efficiency, and drugs such as warfarin, phenytoin, theophylline, which go to the liver also, must be taken with care. Nevertheless, this is the doctor’s concern. He is well aware of these special circumstances in certain patients and will offer the appropriate advice.

*15\61\2*

Just because you’re referred to a surgeon does not necessarily mean that an operation will be performed or even suggested. Surgeons will invariably make their own assessment of what they think is best. Although surgeons as a group do tend to have a bias towards their own speciality, they do also recognise that an operation is not always the best nor only answer. It is not rare for someone who was referred to a surgeon to then later on be referred to yet another specialist because the surgeon concluded that this was a case where less intrusive treatment might work just as well.

If surgery remains indicated, there are numerous possible procedures with an excellent track record. However, it also has to be pointed out that every form of surgery carries its own set of risks.

The decision to undergo an operation should therefore always be weighed up most carefully.

To help you make up your own mind about having an operation if one is offered, The National Back Pain Association suggests a number of questions you should ask your surgeon, these including:

What is my exact diagnosis?

Do I have signs of nerve root compression? And are the symptoms that I have directly related to nerve compression?

What are my chances of good pain relief if I opt for a surgical intervention?

Are there any alternatives to conventional surgery that I could try?

How many of these procedures have you performed? What is your success rate for the surgery you have offered me?

What the NBPA is essentially saying through these suggestions is that any patient should make sure that the problem has been fully and accurately diagnosed, that an operation is likely to yield a good result, and that the surgeon is fully experienced in the intended procedure.

Additionally, the NBPA suggests that “the decision as to whether to have surgery and what type, is difficult, and needs very careful consideration. The only person who can really answer your questions about the effectiveness of surgery for your particular problem is your own surgeon. Ensure that you attend appointments well-prepared with your questions written down and, preferably, with someone else to listen to the response.

A similar message comes from the Agency for Health Care Policy and Research, a part of the Department of Health and Human Services in the USA, which somewhat more bluntly states:

Even having a lot of back pain does not by itself mean you need surgery.

Surgery has been found to be helpful in only 1 in 100 cases of low back problems. In some people, surgery can even cause more problems. This is especially true if your only symptom is back pain.

People with certain nerve problems or conditions such as fractures or dislocations have the best chance of being helped by surgery. In most cases, however, decisions about surgery do not have to be made right away.

Most back surgery can wait for several weeks without making the condition worse.

If surgery is recommended, be sure to ask about the reason for the surgery and about the risks and benefits you might expect.

You may also want to get a second opinion.

*13\124\2*

Although people in good health need only about 50 micrograms of folic acid every day, the need for this important member of the vitamin B complex increases dramatically (seven to 20-fold) during bacterial infections and after loss of blood. Extra folic acid is used whenever new cells are formed in large numbers anywhere in the body.

Thus, when the bone marrow produces many extra white blood cells to fight an infection or forms many new red blood cells to make up for blood lost during surgery or hemorrhage, it suddenly uses much more folic acid than usual. If this increased need is not recognized and met, the patient will be unable to produce all the necessary white cells, red cells, and platelets, or to recover completely from a serious infection, even though transfusions and antibiotics are employed.

A report in Critical Care Medicine (8:500) points out that during a serious illness, the bone marrow uses up its folic acid stores so fast that it becomes deficient in this essential vitamin even though folic acid levels in the blood and other tissues remain normal.

It may not be possible for patients to obtain all the vitamins they need by mouth when they are seriously ill, and to facilitate recovery, daily injections of folic acid (10 milligrams) may be required. Another reason that folic acid in tablet form may not be recommended, the American Family Physician (32#4:290) reports, is that it may cause a deficiency of zinc. If present in the stomach to excess, it is thought, folic acid combines with all of the zinc contained in our food, thus rendering it insoluble and less easily absorbed.

Foods such as peanut butter, beans, nuts, liver, and green leafy vegetables are natural sources of folic acid.

*221\143\2*

Sudden Infant Death Syndrome (SIDS) is a medical mystery. Otherwise known as cot death, it seems SIDS is not a new phenomenon. It was referred to in the Bible (by another name) and was well described in medical journals over 150 years ago. In Australia, about one in every 500 babies dies of SIDS in their first year of life, usually between the first and fifth month.

SIDS is medically defined as the unexpected death of an apparently healthy baby for whom an autopsy fails to identify the cause of death. In other words, it is not known why the baby died. It seems that the baby simply dies within about five minutes, usually while asleep, without any indication of pain or distress.

There are over 100 theories about the possible causes of SIDS. To date none have been proven. One day, through research, we may be able to determine some or all of the causes of SIDS and identify those babies who may be at risk. Statistics reveal that SIDS occurs most often in the winter months, and it affects more boys than girls. The baby has sometimes had a mild respiratory infection and may not have been feeding well in the preceding months. Even though these and other factors are more common in children who die from SIDS, it does not necessarily mean they are the direct cause of SIDS. Many infants die from SIDS with no indication of these factors being present. Also, in cases where these factors are present, most babies do not die. This may sound rather confusing but indicates the current state of knowledge. These factors may however give clues to researchers about further lines of investigation. Despite extensive research there is nothing known as yet that can be done to prevent a baby dying from SIDS.

*208/84/5*

«The job. How can you complain about not having enough to do? It seems too stupid for words. But that’s what it is. Just plain bored. Sounds silly. Instead of just sitting and doing nothing, I get irritable. Irritable with myself. Irritable with the people around me. Irritable with a society that lands me in a job like this. Worse than all that, I bring the irritability home with me to my wife and kids. Snap at them. Then I feel guilty. Then more on edge than ever. »

They laugh about the civil service. Joke about it. But there is often that glimmer of truth in the things we laugh about most readily.

Man. As a species we have survived. We have survived because we have learned to assert ourselves against an inhospitable environment. If we graduate into a changed environment of continuing calm and ease, we are left without the normal challenges of life to which we have become accustomed over countless generations. It demands that we adjust to a new way of living in which our innate assertiveness has no external outlet. We seem to be lost. Our brain is alerted, but there is no outlet for mental or physical activity. And we experience this deprivation as boredom.

Other interests and hobbies are a help. Not much to do at work and our mind can run on enjoying the challenge of our hobby. The same applies when our work is mainly repetitive, requiring little mental effort on our part.

*6/98/5*

Large areas of eczema should be treated with baths. Colloidal baths are used for acute eczema. They may consist of:

Bran: Very hot water is allowed to run into a tub over a cheesecloth bag containing one to three pounds of wheat bran. The tub is filled with water, and the bag is squeezed occasionally to introduce the bran into the water.

Cornstarch: One pound of cornstarch is stirred into a tub full of water.

Oatmeal: Two cups of boiled oatmeal are put into a cheesecloth bag, and then the bag is used as a washcloth on the skin.

Tar baths which are helpful in sub-acute eczema are made with three ounces of a solution of crude coal tar, N.F., put into a full tub of water. Sodium bicarbonate baths are soothing for very irritated and itchy skin. One cup of sodium bicarbonate to a tub of water is used. Magnesium sulfate baths may be used, one cup to a tub of water, for acutely inflamed skin which is oozing.

Failure in the treatment of eczema may be caused by a bacterial or a fungal infection, a concomitant contact dermatitis, seborrhea, an endocrine disturbance, an immunological disorder, a situation of stress, or a drug eruption that takes place at the same time as the eczema.

Tranquilizers are a radical part of the treatment of any form of eczema. Atarax or Vistaril are generally chosen in syrup form to be given by mouth in teaspoonfuls three or four times daily for a period of three to four months.

*36/99/5*

Scientists used to think that adult illnesses (like heart disease, breast cancer, diabetes and obesity) were either the direct result of what we have inherited through our genes or were due to unhealthy living patterns. Current research, however, suggests instead that we are programmed to be susceptible to these illnesses depending on what we were exposed to in the womb. This concept – that the diseases of adult life could be connected to conditions in the womb – is called foetal programming.

The research by Professor David Barker mentioned earlier (which showed the link between our birth weight and the possibility of heart problems) is just one aspect of this programming. It seems that whatever conditions in the womb stunt the baby’s growth also increases their risk of cardiovascular disease. Scientists are now taking this research further by looking at other traits which may be influenced in the womb, such as high cholesterol, obesity, diabetes, breast cancer, mental illness and intelligence.

This new science of foetal programming is even causing a rethink of genetic influences. For instance, it has always been thought that identical twins are more likely to share a similar characteristic because this characteristic was controlled by their genes. But identical twins also share the same conditions in the womb so could other factors be at work?

Recent research, published in the American Journal of Clinical Nutrition, monitored the daughters born to those women who were pregnant during the Dutch famine of 1944 – 45.They found that those women whose mothers were malnourished during the early stages of pregnancy because of the famine had a significantly greater chance of being obese at the age of 50. If the mothers had been starved after the first four months of their pregnancy there was no difference in the Body Mass Index for these daughters, compared with an average cross-section of similar age. The researchers concluded that the obesity developed as a result of permanent changes ‘fixed’ in the womb, rather than as the result of the usual lifestyle factors.

Further findings from this research also suggest that the children of the women who were pregnant during the famine have a greater risk of developing late-onset diabetes.

Professor Barker is suggesting that, because different issues in the foetus have different critical periods of development, the timing of an effect on a woman is crucial. The converse is also true. If we nourish the baby in the womb as healthily as possible we can lessen the risk of the child developing future illnesses.

This does not mean that we have no control over our health as adults. But it may put us more at risk of developing a certain problem like heart disease later on in life, requiring us to be more careful about our diet, exercise etc. But, more importantly, this research shows that certain adult illnesses could be prevented if we concentrated on making the environment in the womb as healthy as possible.

*112/73/5*

What is it?

A condition in which an individual becomes ‘hooked’ on sugar-containing foods so that life without them becomes a misery or virtually impossible. Sugar addiction is worth worrying about because it makes people fat (with all the resultant health risks this entails) and causes tooth decay. It may also, via its action on insulin metabolism, have something to do with the causation of diabetes.

What causes it?

• There is little doubt that most higher animals find sugar a pleasant taste and many of nature’s fruits, and vegetables contain sugars. Although most westerners with their sweet tooth don’t realize it, vegetables such as carrots and onions are very sweet. So it appears that it is natural for us to like sweet-tasting things.

• Upbringing is undoubtedly the prime reason why so many people in the West are sugar addicts. From the very earliest days mothers give their babies dummies filled with sugar solutions or coated in honey to suck to keep them quiet. This sort of habit sets the body’s sugar ‘thermostat’ so high that anything that is not extremely sweet is perceived as less palatable.

• A cultural acceptance of the myth that dietary rewards must involve sugar. The woman who feels low pre-menstrually or the unhappy child on the way home from school both opt for sweet, sugar-containing slugs of confectionary.

Prevention

• The best starting point is total and on-demand breastfeeding. Breast milk contains its own sugars and tastes very sweet. However, these sugars are balanced with other constituents and don’t have the harmful effects that sucrose (table sugar) has. A baby nourished in this way will not crave sugary drinks and sweets.

• Don’t have sugar on the table as your children grow up. Teach them to find sweetness elsewhere-in vegetables or fruits.

• Once you are a sugar eater and want to change your ways, keep a sugar diary for a week or two. It is very difficult to appreciate just how much sugar you actually eat unless you do this. Statistics show that sugar added to food accounts for 25 per cent of all the calories eaten by the average adult. For teenagers this figure can be as high as 50 per cent. Get used to reading labels on foods and steer away from those that are rich in sugar or have anything ending in ose, (maltose, dextrose, sucrose, etc.) on the label.

• Shop more wisely. This will mean buying few or none at all of the following: sweets and chocolates; cream-filled and iced biscuits; cakes and sweet pastries; jams, honey, marmalade and spreads; tinned fruit in syrup; sweetened yoghurts; jellies and ready-made desserts; sweet pickles; fruit sauces; tomato ketchup; and fizzy drinks and squashes containing sugar.

• Ban all sugar and sweets from the house. Feeding your craving is much more difficult if the things are not there to be eaten. In spite of all the publicity about the dangers of sugar consumption, in 1980 in the UK the use of sugars and sweeteners was up 50 per cent from 91 lb a year per person at the turn of the century to 143 lb a year.

*228/72/5*

•     Physical exercise also has beneficial effects on the skin. In one study, twenty older women who exercised regularly on a trampoline were compared with twenty who did not take exercise. The exercisers looked younger, and had fewer wrinkles and better skin colour than the sedentary group. They also had less pronounced bags under the eyes.

Blood pressure creeps up with age in almost all westernized societies. The fact that this is not inevitable is shown by its absence in many traditional-living countries. Reducing salt intake and using relaxation exercises have been found to halt the gradual increase in blood pressure and even to reverse it. Taking plenty of calcium has also been found to help reduce blood pressure.

As we age (after the age of 25) we lose 3-5 per cent of our muscles, glands, connective tissue and internal organs every ten years. The breakdown products are passed out in the urine, and fat takes the place of the once active tissues. So unless you lose this 3-5 percent of your body weight each ten years you will get fattier and less muscular. But this is not an irreversible part of ageing. A study of two champion runners aged 70 and 71 found that they had the same amount of body fat as university students. Just dieting, however, is not enough-you have to exercise to build up lean muscle and other tissues.

•     Exercise can also be an excellent treatment for varicose veins in old age. The author of a leading book on the subject claims that old people with the condition should run, jump, jog and ‘do anything but sit still’. The pumping action of the calf muscles helps improve leg circulation, and it also helps to keep your legs elevated when rested (above heart level if possible).

•     Many elderly people have lost a lot or even all of their teeth and see this as inevitable. It isn’t. Tooth loss in middle and old age is mainly the result of gum disease. This can be totally prevented by regular brushing (from gum to tooth), the use of dental floss and regular visits to the dentist. Vitamins A and Ñ are vital too. Calcium and vitamin D are now known to help prevent the loss of bone from tooth sockets. One researcher supplemented, for a year, the diet of women with very low bone density with 750 mg calcium daily plus vitamins D and C. Within a year he found the rate of bone growth around their teeth roots had roughly doubled.

•     The brain also lives by the principle ‘Use it or lose it’. There is no doubt that you can teach an old dog new tricks. Experiments with rats have shown that those raised in ‘enriched environments’-roomy cages, with other rats and a variety of playthings had heavier, more chemically active brains than did rats raised alone in ‘impoverished’ environments.

Physical exercise can also help. In one study reaction times, short-term memory and reasoning power were all improved in a group of elderly, out-of-shape people when they were put on a four-month walking programme. The walking group improved in six out of eight areas of mental functioning; a group who did weight lifting and push-ups in one; and an idle group in none.

There are various ‘cures’ and ‘preventives’ for old age for which claims have been made over the years but none has yet withstood scientific scrutiny-even ginseng with its well-known pharmacology and the vast scientific literature on its success in other areas. At the moment all such rejuvenation and old age-preventing techniques should be regarded with suspicion.

*89/72/5*