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.

*4\124\2*

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.

*212\143\2*

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

*26/99/5*

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.

*101/73/5*

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.

*219/72/5*

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.

*91/41/5*

Poisoning

Over half the fatal poisoning cases amongst elderly people involve drugs and medications. This is not surprising as people receiving a variety of treatments may become confused as to which medicines to take, when, and in what quantities. Gases and vapours are responsible for a third of the deaths by poison amongst the elderly. This usually takes the form of gas poisoning-from faulty gas appliances or as a result of failing to have flues cleaned regularly.

The dangers of water

Whether you are walking near a pool, boating on a lake, cruising down a canal or sailing on the sea, water is a real hazard that demands great respect.

When at the seaside:

•     Don’t bathe when a red or other warning flag is up. It is not clever and could endanger the life of someone else who tries to save you.

•     Keep a close eye on children -never let them play at the water’s edge unattended. Babies and small children can drown in a few centimeters of water before you even know they are in trouble.

•     Ensure that non-swimmers and all children wear approved and properly constructed life jackets if they are on the water.

•     Look before you dive-many people suffer serious illness because they have hit their heads on rocks or dived into inches of water.

•     If you are on the water either in a boat, water skiing or windsurfing, watch out for bathers. Keep well out of the way or fun can turn to tragedy within a few seconds.

•     Beware of poisonous jellyfish. Most jellyfish are harmless but the Portuguese man-of-war (distinguished by its air-filled bladder that stands up like a sail) is poisonous. Never swim behind a Portuguese man-of-war because the tentacles can stretch up to 45 meters (50 yds) and bear poisonous capsules.

•     Listen to the locals when swimming anywhere unfamiliar. With holidays taking people into tropical and sub-tropical waters today some are getting bitten by poisonous fish. Some of these bites can be dangerous so ask if it is safe first.

*80/72/5*

There are other misconceptions which people have about meditation. Some people see meditation as an escape from reality or a selfish preoccupation. It is neither. A normal meditation time is twenty minutes, twice a day. This hardly constitutes an escape from reality, nor can it be regarded as selfish. Everyone needs to have time to themselves. It is not selfish to want time alone, it is natural and normal.

The disorder and agoraphobia mean we cannot contribute as much as we would like to our daily family situation. Practising meditation can mean a major step for our overall recovery. Recovery means we can contribute more, not only to the family but also to ourselves. Wanting to take time out, to help the recovery process, should never be considered selfish.

Taking the time to stop and meditate can be a problem for some people. Meditation is usually practised for two twenty-minute periods each day, although a number of people meditate for only one twenty-minute period each day and still find it beneficial. Other people tell themselves they can spare no time for meditation at all, despite the fact that the disorder may consume them twenty-four hours a day. It is a matter of making a choice in our priorities. It can mean the difference between ongoing anxiety, and our recovery.

Another myth about meditation is the idea that, when meditating, we may be leaving ourselves exposed to other influences. This does not and cannot happen. Even in the deepest phase of meditation we are always in complete control of ourselves. We are always aware of everything within and outside ourselves. When we are asleep we are not consciously aware of anything, yet we will wake up should there be any internal or external threat. In meditation we don’t need to ‘become’ aware because we are consciously aware, and consciously in control, the whole time.

*63\94\8*

Psychotherapy has sometimes been the only treatment people have tried. It can be difficult to see the relevance of psychotherapy to anxiety disorders, but if we have a history of childhood abuse, or undergone some other trauma, psychotherapy is very important. Despite the sense of shame many of us feel over these issues, they do need to be dealt with for our long-term well-being. There are very understanding and caring therapists working in the area of childhood abuse, and the local public hospital or community centre can refer anyone who needs help to these therapists.

Even if there is no major past or present trauma, psychotherapy, in conjunction with other therapies, can be extremely beneficial.

Some of us are frightened of psychotherapy in case we find out we are ‘really bad’ people. This is one of the most common fears associated with psychotherapy, but it has no basis. We have this fear because we have never had a sense of who we are.

Take the risk. We will discover there is nothing ‘bad’ about us. Like everyone else, there will be aspects about ourselves we may not like. Only when we know these aspects can we modify and integrate them.

Psychotherapy means more than just looking at the problems and difficulties of childhood. It is not so much a process of who is to blame, as a process of understanding causes and effects. It looks at how we, as children, responded in certain situations. These responses created our defences, motivations and patterns of behaviour that we unconsciously carried into adulthood, but which may not be appropriate now. When we become aware of these responses, we are then able to change them if we want to.

*45\94\8*