What is hypnosis? The story of hypnosis started a few hundred years ago. The first record of the use of hypnosis on patients has to be that of Dr Franz Mesmer. He graduated from medical school with honours in 1765. He practiced first in Vienna and later in Paris. Pierre Janet, in his book Psychological Healing, gave the following description of Mesmer’s method of practice. Mesmer used an elaborate apparatus. In the centre of a hall, which was filled with the sound of ceremonial music, he placed a large oak tub, Mesmers famous ‘baquet’. This was filled with water, iron filings, and powdered glass. It had a lid pierced with holes and coming up through the holes were iron rods. The patients, who were completely silent and expected something to happen, would join hands and apply the iron rods to those parts of their bodies afflicted with the ailment. Mesmer, the great magnetizer, in a silken robe of lilac colour, would then appear with a long iron wand in his hand. He would pass slowly in front of his patients, fixing his eyes on them and passing his hands on their bodies or touching them with his magnetic wand. These patients, because of his great name, were expecting something to happen. Some did not feel anything, but some felt uneasy, some went into a trance, and some, especially young women, fell down on the ground and went into convulsion. This was supposed to be therapeutic, and after a few of these ceremonies, and payment of enormous fees, many patients declared that they had been cured of many of their ailments.

Magnets were supposed to be full of supernatural power in those days, and the ceremony provided the suitable environment for most of these patients to go into a trance state. Mesmer knew nothing about hypnosis, nor did he know why some of his patients got better. It was later discovered that patients with hysterical or psychosomatic symptoms would improve if they went through cathartic experiences or acted out some of their buried, unconscious, primitive wishes. We now describe a person in a trance as a person being mesmerized, and mesmerism is somehow equated to hypnotism.

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Pain may arise from injury to our body cells. This is known as organic pain. More accurately it arises from the stimulation of nerve fibres as a result of injury to the body tissues. However, some organs of the body, such as the brain itself, are not supplied with pain nerves, and these organs can be cut or otherwise injured without causing any pain at all. In other instances. due to the complicated anatomical arrangement of the nervous system, the pain is not felt in the diseased part but is felt is some other area.

On the other hand, pain may arise in any part of the body as a result of the operation of psychological mechanisms within the mind, and in the complete absence of any physical disease or injury, This is known as functional pain.

It is important that we do not consider a person suffering from functional pain as imagining that he suffers pain. This is not so. He does suffer pain. Furthermore, functional pain may be very severe, and there is nothing in the quality of functional pain which automatically distinguishes it from organically determined pain. Although we can often tell one kind of pain from the other by the way in which it comes about or by the patient’s reaction to it, we cannot always distinguish the two by the actual nature or severity of the pain.

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Q. What causes these erosions to take place in a healthy person?

A. The basic cause is too much acid and pepsin in the gastric fluid. At all times, a continual battle is going on in the stomach. On one hand, glands in the walls are actively producing acid, which in turn allows production of pepsin, and these two liquids commence digestion of the food. This means it is broken down into its basic component parts which will allow it to be absorbed by the blood stream further down in the intestinal canal. On the other hand, the mucosal lining has to resist the action of these chemicals on itself, for it is also subject to being digested — a case of the body actually devouring itself! Normally, the two remain in a fairly stable equilibrium, and no harm occurs; food is broken down, and the stomach wall remains intact.

Q. Do ulcer patients produce too much acid and pepsin?

A. In most cases, probably all, the answer must be ‘Yes’. Often this is not so with stomach ulcers, but it has been found that in many cases of duodenal ulcer, acid production is three times that of normal. Imagine that hot burning acid being present in three times the normal volume. We have already pointed out the extremely strong burning nature of hydrochloric acid — as every plumber who solders knows — and this may act for hours on the lining of the intestine. No wonder that little craters and holes develop.

In a particular disorder called the Zollinger-Ellison syndrome, acid production is stimulated to incredibly high levels and as much as eight times normal acid production occurs. Little wonder these patients suffer from serious ulcers.

Q. If there is no acid present, does that mean no ulcers?

A. The reverse holds true. Excess acid and there is a high risk of ulcers. No acid, so called achlorhydria, and there is no chance of an ulcer developing.

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As already noted briefly, sciatica can be experienced in a number of ways. Most typically it manifests itself as one or more of the following sensations, with some sufferers having more than one kind of sciatic pain or discomfort:

A pain that sufferers describe as ‘aching’, ’stinging’, or even ‘burning’, this either following a specific course, such as along

the back of the leg, or restricted to one specific area, such as the upper part of the thigh.

A cramping pain, as though the muscles in the affected leg are contracting involuntarily. ‘Cramping’ sciatica is also often marked by spasms.

Less specific – and also usually less severe – pains, including feelings of numbness, or experiencing ‘pins and needles’, these once again being experienced either over a fairly large area or concentrated within a much smaller one.

Because it’s only too easy to mistake some of the pains or feelings of discomfort that arise from ‘mild’ sciatica for something else – for example, pins and needles or cramp may happen because you’ve been sitting too long in the same position, especially if your legs were crossed – it often takes some time before a sufferer comes to the conclusion that his symptoms are due to something specific and are more than merely the kind of odd sensations most of us experience now and then, dismissing them from our mind once they disappear seemingly of their own accord.

For many, however, the onset of sciatica is only too obvious as its pain is so intense that it is virtually crippling during its worst moments. A bad attack of sciatica can be so disabling that even the smallest movement, such as getting in or out of a chair, or even sneezing or coughing, brings on agonising distress. Acute sciatica can usually, but not always, be linked to some recent incident or event that provoked it.

The specific underlying causes of sciatica are examined in the next chapter in which we also look at the ‘greater picture’ of back pain in general.

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Of late, vitamin A has been much in the news as a drug that reduces the incidence of certain cancers. Accordingly, for the sake of fair balance, we felt that our readers should be told about a recent report in the Western Journal of Medicine (137:429).

A young woman visited her doctor because dryness of the eyes made it uncomfortable for her to wear her contacts. She also complained of a sore tongue and gums, cracking of the skin at the corners of the mouth, and generalized itching and dryness of the skin. She also had a continuous headache, felt nauseated, and had frequently vomited during the previous seven days. Devoted to jogging, she nevertheless had had to give it up because of severe pains in her bones.

On being questioned in the hospital, this lady (a health food store employee) admitted taking 25,000 units of vitamin A daily (five times the “recommended daily allowance”) for several months. Tests showed abnormally high vitamin A blood levels that, among other things, had disturbed her liver. All of these signs and symptoms were typical of toxicity due to excess of vitamin A.

Treatment with intravenous fluids normalized this woman’ s blood levels of vitamin A in about a week. Had she taken vitamin A in excess for much longer, however, early death from liver failure would have become inevitable. The lesson, then, is to take only enough vitamin A to avoid deficiency and bolster resistance against cancer, the recommended daily allowance (RDA), but do not take it in excess.

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Symptoms

Sudden abdominal pain; cramping pain; diarrhea; vomiting

Home care

Apply mild heat to the abdomen.

Treat constipation by changing the child’s diet or with a glycerin suppository.

Precautions

-    Do not try to relieve stomach pain by giving a laxative or placing ice on the stomach.

-    If you cannot diagnose the child’s pain as being due to a cause such as constipation, digestive tract upset, or emotional stress, take the child to the doctor.

-    If the stomach pain is accompanied by fever and painful urination, the child should see a doctor.

-    If pain is accompanied by a fever and a cough, see a doctor.

-    If any stomach pain persists or gets worse, consult a doctor.

-    Severe, crampy stomach pain accompanied by blood or mucus in the stool requires a doctor’s attention.

-    Be concerned if the stomach pain causes the child to bend forward while walking.

-    Severe pain that follows injury to the abdomen or lower chest may indicate internal injury and requires a doctor’s attention.

The abdomen contains the stomach, small and large intestines, liver, spleen, pancreas, kidneys, urinary bladder, gall bladder, and organs of reproduction. Disease or injury involving any of these organs can cause abdominal pain and, consequently, a “stomachache” can test the diagnostic ability of a parent or a doctor. Fortunately, almost all stomachaches in children are caused by one of four problems: constipation; acute digestive tract upset (caused by viruses, bacteria, or improper diet); emotional stress; or urinary tract infection.

Other less frequent causes of a stomachache are appendicitis, pneumonia, infectious mononucleosis, and hepatitis.

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Drugs may be absorbed by mouth, by injection, by inhalation, or by contact. They may be well accepted, or they may cause intolerance or allergy. Intolerance is an exaggerated response to a large quantity of a drug, while allergy is sensitivity to the drug regardless of the quantity used.

Allergy to a drug assumes one of these forms:

a.     A local inflammation and itching (for example, at the site of a penicillin injection)

b.     A fixed reaction caused by swelling and itching which appears in the same place each time the drug is used ñ Hives

d.     Anaphylaxis

e.     Serum sickness

Drug allergy is usually less severe in children than in adults; drugs sensitize when first used, but open the door to dangerous reactions later on. A good example of this is anaphylaxis caused by a second injection of penicillin.

Anaphylaxis

This is a dangerous allergic reaction which may occur after an allergy injection, a bee sting, the eating of allergenic foods, an injection of horse serum, or an injection of penicillin. The symptoms may be shock, hives, congestion in the nose, or asthma. To prevent anaphylaxis, a careful history (to avoid a potential allergen) should be taken by the child’s allergist.

A child who has had a slight reaction to penicillin should avoid its use. In case it is imperative to use it, it is much safer to have it taken by mouth than by injection. Furthermore, injections of penicillin are to be given in the arm and not in the buttocks, so that a tourniquet may be placed above the place of the injection to slow down the passing of the injected material into the circulation (in case of a reaction).

The treatment of anaphylaxis consists of:

a.     An injection of adrenalin to relax the spasm of the bronchi and to diminish the secretions of the mucus glands

b.     An intravenous injection of calcium gluconate

ñ     Monitoring of the blood pressure so that another injection of adrenalin can be given if it becomes necessary

d.     Hospitalization

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Luteinising hormone (LH) controls the development and release of the egg from the ovary. Women who have high levels of this hormone in the first half of their menstrual cycle seem to have a greater risk of miscarriage. In addition, women with polycystic ovary syndrome (PCOS) have raised levels of LH.

Progesterone is the hormone which maintains the pregnancy during the first few weeks. After the egg has been released from the ovary, the ruptured follicle then develops into the corpus luteum which produces progesterone. If the egg is not fertilised, after 14 days the corpus luteum withers, progesterone levels fall and a period occurs. If the egg is fertilised and the embryo implants successfully and starts to produce another hormone hCG (human chorionic gonadotrophin) then the corpus luteum gets the message to continue producing progesterone. Without sufficient levels of progesterone, the pregnancy cannot continue, and that is why anti-progesterone drugs are now used to terminate an early pregnancy without the need for an operation.

Because of this obvious link between progesterone and maintaining pregnancy, many doctors give progesterone as injections or pessaries to prevent a miscarriage. But Professor Lesley Regan, in her excellent book Miscarriage, states that ‘Injections of hormone, in the early weeks of a pregnancy at risk, may prolong the miscarriage but they cannot reverse it. Low progesterone levels in early pregnancy are the result rather than the cause of miscarriage.’

After the egg has been fertilised, the womb (endometrium) lining will also stay thick where the embryo will implant and develop. If the womb lining is inadequate, then the embryo will not ‘hold on’ and a miscarriage will occur. It is possible to have good levels of progesterone and yet have a thin womb lining, perhaps because the womb lining is not responding to the levels of progesterone. Other doctors, however, do give progesterone to women with a history of recurrent miscarriages and they have gone on to have a successful pregnancy.

Ultrasound can also be useful for those women with a history of recurrent miscarriages, as it can often pick up an indication of corpus luteum failure before any drop in progesterone level is seen in the blood. This is where the use of progesterone can be beneficial.

There are so many factors that govern the efficient functioning of the cycle that it is not always easy to identify cause and effect. Every part of the cycle is dependent on what went before so we may not be able to ‘fix’ problems in the second half of the cycle without looking at what has gone wrong in the first half. By going back to the basic foundations of health and getting yourself back into balance, you have a much better chance of maintaining a pregnancy without the need for hormones or other drugs.

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Smoking diseases are diseases caused directly or indirectly by smoking tobacco. The best known is lung cancer but this is only the tip of the iceberg, as we shall see.

Smoking is the single greatest cause of death in the UK, and the World Health Organization has said that the control of smoking would do more good than any other single action in preventive medicine. At least 100,000 deaths are attributable to smoking in Britain each year with an average loss of about ten years of life. It accounts for 90 per cent of deaths from lung cancer; 75 per cent of deaths from chronic bronchitis; and 25 per cent of deaths from coronary heart disease in men under 65. The risk of coronary heart disease attributable to smoking is greater in younger men so that a man under 45 who smokes twenty-five or more a day may have a fifteen times greater risk of dying from a heart attack than if he were a non-smoker. Here are some chilling facts:

• Early studies suggested that relative mortality risks among female smokers were less than those of male smokers, but it is now clear that these studies were comparing the death rates of a generation of lifelong male smokers with a generation of women who had taken up smoking much later in life. The smoking characteristics of the two sexes are now becoming more and more alike, and the rates of smoking-related diseases are drawing closer together.

• Women who take the contraceptive pill and who also smoke cigarettes are more likely to have a coronary attack, stroke, and blood clots in the leg veins which may shift to the lung (pulmonary embolus), than are non-smokers who are on the Pill. One study has shown that for women aged 25-34 on the Pill the relative risk of death from circulatory disease was 1.6 for non-smoking Pill takers but 3.4 for smokers; women aged 35-44 the risks were 3.3 and 4.2 respectively, and for women over 45, 4.6 and 7.4. There is also a considerable increased risk for women on the Pill who smoke and who have one or more known risk factors for coronary heart disease.

• The natural menopause occurs on average 2-3 years earlier in smokers.

• Fetal growth and birth weight. Babies born to women who smoke are on average 200 g lighter than babies born to comparable non-smoking mothers. The relationship between maternal smoking and low birth weight is independent of all other risk factors which influence birth weight including maternal size, race, socio-economic status and the sex of the child. Furthermore, the more cigarettes a woman smokes during pregnancy, the greater the probable reduction in birth weight. However, if a woman stops smoking before the twentieth week of pregnancy, her risk of having a low-weight baby will be similar to that of a non-smoker.

• Children whose mothers smoke ten or more cigarettes after the fourth month of pregnancy tend to show poor progress at school, at least up to the age of 16. In both reading and mathematics tests they do less well than other children. This effect is found after allowing for other factors affecting educational level.

• Spontaneous abortion. Tobacco use during pregnancy causes a two-fold increase in the risk of spontaneous abortion (miscarriage).

• Complications of pregnancy. On average, smokers have more complications of pregnancy and labour, which can include bleeding during pregnancy, premature detachment of the placenta and premature rupture of the membranes.

• Perinatal mortality (defined as still-birth or death of an infant within the first week of life) increases in direct relation to the number of cigarettes smoked during pregnancy. In one large study, the perinatal mortality risk increased by 20 per cent for the infants of smokers of less than twenty cigarettes per day and by 35 per cent for smokers of twenty or more a day, compared with that of non-smokers.

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Questions to ask

Some of the questions that you might like to ask your doctor include:

• Does the doctor have a partner who knows about you and can treat you if your own specialist

is unavailable?

• Can the doctor see you immediately if you have an urgent or serious problem?

• Will the doctor personally answer and return phone calls or will those phone calls be taken

and answered by a secretary?

• Are phone calls answered promptly; does your doctor receive messages to contact you when

Requested?

• Can the doctor be contacted out of hours?

• Will the doctor see you out of hours?

• Will the doctor read out to you the results of pathology reports or referrals, etc., or will the

results be given via the doctor’s secretary.

Getting the best from a doctor

To get the best out of your doctor you need to be well-informed and provide honest and accurate information.

In order to be well informed you should read about the menstrual cycle so that you understand how the cycle works, know about hormonal changes and their effect, and understand what endometriosis is. This can be achieved either by yourself or by your doctor suggesting reading material and other sources of information. You can also contact your local women’s health information centre.

It is important to recognize that your doctor is not a mind reader, and that it is up to you to tell her or him what your problems are so that your doctor can get an overall picture of your illness. Identify the major areas of concern for you – infertility, pain control, improvement of lifestyle.

It may be a good idea to keep a diary in which you can record your visits to your doctor and make notes of any side effects of drugs or surgery or other treatments suggested by your doctor and list questions for future visits.

Be honest about symptoms and make sure the information you give is complete, accurate and relevant. It is of no benefit to you to withhold information.

It is important to be able to talk openly to your doctor and to feel that you can discuss your needs and fears.

If you have concerns about the side effects of drug therapy, you should feel comfortable discussing these with your doctor. If you have printed information about drugs or treatment you want to discuss, take this with you to the appointment so that your doctor can comment.

Always report the positive as well as the negative feelings you may be experiencing.

Vital decisions and concerns such as marriage, sexual relationships, careers and children should also be discussed with your doctor since these make up the total picture.

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