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There is yet another psychological method of coping with pain, and I believe this is the best of all. It is not as complete as psychological dissociation, but it is completely free from the possible dangers which may result from the too facile use of dissociation. In this method we do not try to deny the pain, or make the part concerned numb, or stand apart from the pain. We accept it for what it is—a warning. But we accept it in its pure form without any overlay or embellishment at all. We allow ourselves to experience pure pain, simple and unadorned. When we do this we soon learn that pain—that is, pure pain—really does not hurt at all.

I have warned you several times that your success or failure with this method depends very much on your willingness to go along with me. The idea of pain in pure form not hurting is probably quite new to you. It seems strange. More than that, most likely it seems downright silly. But do not just reject the idea because of this. You have the evidence of my own personal experience and that of many patients. So let yourself go along with me.

The wise use of autosuggestion is very valuable, but the relief of pain by this method is often difficult. For it to be effective we may have to set out deliberately to increase our suggestibility. It is possible that this could have side-effects in the direction of increasing our suggestibility in other areas. These are the problems of the use of autosuggestion in the self-management of pain. Then if we consider dissociation, we see that it is essentially a disintegrating process of the mind, whereas our ultimate goal is complete integration and maturity, which of course is a manifestation of integration. A very significant point about the self-management of pain by feeling pain in its pure form is that it is essentially an integrative process. Therefore the

side-effects of learning the self-management of pain in this fashion are all to the good, and work for greater integration and maturity of the personality.

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Q. Whilst we are talking of liver disorders, who not mention the long-term effects of alcohol on the liver?

A. A good idea, especially as alcohol intake is increasing in Australia and serious liver diseases causing considerable health impairment are also on the upswing.

Q. How much alcohol is needed to produce serious liver damage?

A. It varies, and women are more susceptible to the adverse effects. Severe liver damage may result after ten years (sooner in females), where there has been a daily consumption in excess of 100 g. In practical terms this is roughly equivalent to ten 300 ml (10 oz) glasses of beer, 960 ml (32 oz) of wine or 10 to 13 oz of distilled spirits. About 10 per cent of alcoholics develop cirrhosis, severe liver destruction, but less severe damage is common. All degrees of liver damage occur, from a simple kind called fatty liver, to an acute alcoholic hepatitis, to cirrhosis.

Q. What symptoms take place?

A. In the early stages there may be few if any. A fatty liver tends to enlarge in size. Alcoholic hepatitis may show up as vomiting, diarrhoea, a fever with an enlarged, tender liver, probably felt in the upper left side of the abdomen as it juts down under the ribs. It is much like Hepatitis A. In cirrhosis, it depends on the extent and the capacity of the liver to cope. The liver is enlarged and the surface covered with hard, raised nodules of fibrous tissue indicating the liver cells are destroyed. General health deteriorates, there is fatigue and weight loss. Blood vessels on the skin of the face, arms and trunk appear, the palms become red, body hair decreases, the testes decrease in size and the breasts often develop lumps called gynaecomastia. Fluid may accumulate in the abdominal cavity. Drowsiness occurs.

As greater pressure is exerted on the blood vessels taking blood to the liver, this backs up, and swollen vessels called varices may occur in the oesophagus. These may haemorrhage causing life endangering bleeding. As the brain is gradually affected, mental confusion, slurred speech, shaky hands may occur which may lead on to coma.

Q. This all sounds a gloomy story. Is there treatment?

A. If the patient immediately stops taking alcohol, many cases show an amazing comeback in general health. This is often very difficult and convincing a patient of his health needs, whilst accepted, is often difficult to police. Psychiatric assessment is often necessary. This plus medical treatment under expert guidance can often provide a great deal of help.

Q. What are the current views on drugs and liver damage?

A. Quite apart from alcohol causing destruction of the liver cells, many known drugs if taken in large quantities may similarly produce adverse effects. Many doctor-prescribed drugs, if given in overdose, may cause serious liver disease. The more of the drug that is taken, the greater the degree of liver damage. The range is extensive, including the tetracyclines, corticosteroids, paracetamol (a drug commonly taken in overdose), salicylates, anabolic steroids (often taken by athletes to increase their muscularity), methotrexate (an anti-cancer drug). Many other drugs, in certain individuals, may also damage the liver in certain cases. Fortunately, in view of the enormous amounts of medicinal drugs taken, the adverse liver effects are relatively numerically small.

Q. Is liver cancer common?

A. Cancer which arises primarily in the liver is uncommon, except in some African and Asian countries where Hepatitis B is endemic, and this seems to predispose to it. In western lands, it may follow on from Hepatitis B infection but is much less common.

The liver is a very common site for metastases or secondary cancers which spread there “from another primary source.

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Doctors always know when spring has sprung. They start getting visits from gardeners – both young and old – who, getting back to work in the garden after the winter, have damaged their muscles.

The difficulties arise not just because of the sudden onset of activity in the cold and damp – but also because of the many opportunities that gardening offers for overstretching, bending too far for too long and lifting heavy loads.

Following these suggestions will help reduce the risk:

Before you start, stretch your muscles with a gentle warm-up.

Wear loose clothes and sturdy shoes or boots.

Choose your equipment carefully: lightweight, long-handled tools mean you don’t have to stretch arms and legs to the limit. Hover-mowers need particular care – don’t swing them around from your waist and keep as upright as possible, with the handle close to your body.

Overenthusiastic digging and weeding often cause damage .Don’t take huge spadefuls when you’re digging and keep your back as straight as you can. When weeding, kneel down as close as you

can to the bed. If you’re pulling out a deep-rooted plant, take the

strain on your arms and legs, not your back.

Some additional tips for gardeners from Dr Arthur Grayzel, senior vice-president for medical affairs of the Arthritis Foundation in America. He suggests:

Some people will feel more comfortable by not kneeling on the ground, but instead sitting on a small stool, so further reducing stress on the joints.

Use plant containers that are high off the ground – or small raised garden beds – to reduce stretching and bending.

Don’t work for long periods with a tool that you have to grasp firmly.

Divide your garden in several smaller areas and concentrate on one of these at a time to avoid overdoing things.

Don’t grip heavy loads with your fingers or arms, but carry them in your arms.

Look in your garden centre for tools specially made for people with arthritis – even if you’re not affected by this disease – as equipment designed for the arthritic will also often help prevent back strain.

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This is the name of a helpful technique, in the course of which you use a special sequence of different kinds of breathing so that you ‘ride’ the pain, exactly as though it really were a surf wave. You breathe slow, deep breaths as it begins, take shallower and shallower breaths as the climax builds up, and then breathe more and more deeply again as the pain ebbs away. The secret of success with this breathing technique is to be very relaxed before you begin and then to do everything gently and rhythmically, moving smoothly from one kind of breathing to the next, as you need to. Like relaxation, it takes practice. To start with, I’m going to describe the four different kinds of breathing you can use.

1 Very deep breathing or breathing in first gear-You have already learnt this one. It’s the kind of breath you have been using to help you relax, sucking air in through your nose as you count three slowly and then blowing it out through your mouth as though you are blowing out those three candles, one behind the other. One way to test whether you are breathing really deeply is to put your hands round your waist as you breathe in, with your thumbs round the back pointing towards your spine, with your fingertips touching in front. (Not many women are that skinny, but cheat!) Slide your fingers round until they’re touching tip to tip. Now take your deep breath. You’ll find that as your lungs fill with air right down to your waist they rise and expand, so your fingers are pulled apart, leaving a sizeable gap between them. Each breath should take around seven seconds. This, incidentally, is the sort of refreshing deep breath athletes take after very strenuous exercise. Watch them on television and you’ll see them puffing the air out of their open mouths — blowing out their three candles.

2 Deep breathing or breathing in second gear-This type is almost twice as quick as the first. And once again it’s easiest to do if you breathe in through your nose and out through your mouth. If you are breathing at the right rate you will be expanding just the top half of your lungs. You can feel this happening if you put your hands under your armpits with your fingertips pointing into your armpits and the backs of your fingers resting against your ribs. At each breath, about four seconds each, you will feel your ribs expanding sideways and pushing outwards against your fingers.

3 Shallow breathing or breathing in third gear-If you’ve ever watched a silent film, you’ll have seen breathing like this. The dastardly villain has upset our heroine. She’s terribly agitated, poor thing, black rimmed eyes rolling about all over the place and well-upholstered bosom heaving up and down. Of course it’s all absurdly exaggerated and overdone. When we breathe with our bosoms they are going to rise and fall gently and rhythmically. Put one hand lightly across your bosom and breath in and out through your mouth, gently but quite quickly. This sort of breathing should be twice as fast as breathing in second gear, about two seconds for each breath. You should feel a gentle rise and fall of the air in the top part of your lungs. But no huffing and puffing and no heaving—just take it nice and steady.

4 Very shallow breathing or breathing in fourth gear-You’ll only have to use this sort of breathing during a particularly bad pain and then only for the short time it takes to ride right over the top of it, which will be about ten seconds or so. Lie as still and relaxed as you can and let your breath flutter in and out of your open mouth. Each breath out only lasts long enough for you to say ‘Huff to yourself. If you rest your fingertips lightly in the hollow of your neck, just above your collar bone, you’ll feel the air just lifting your throat.

These are the four different kinds of breathing, each more shallow than the last. You’ll probably need only the first three, but it’s nice to have the fourth in reserve. It’s a good idea to practise the whole sequence once or twice a day for a week or so before you actually need to use it, so that the routine is familiar and comes easily to you. But don’t overdo it. This is an artificial way of breathing, so it’s a trick to be used sparingly and only when it’s really needed. Get a friend to help you and, if necessary, time you through one whole sequence. But if you’re the sort of person who normally works to music, be warned. Background music makes it difficult to find the right rhythm to which to breathe. When you’re ready to begin, start with two very deep breaths. They should take about seven seconds each. Now move into second gear and take four deep breaths. These usually take about four seconds each. Next breathe ‘over the top of the pain’ with seven or eight shallow breaths, which take about two seconds each. Now go back down through the gears again, with four deep breaths and two very deep ones. The whole sequence shouldn’t take more than a minute and a half which, believe it or not, is about the average length of one period pain.

When your next period begins, use all your new resources to make life as easy as you can. Lie in a comfortable relaxed position, use a hot water bottle or two, take aspirins if they work for you, and be ready to breathe through any particularly difficult pain. If you can do all this, you’ll allow the muscles in your womb to get on with the job of squeezing its now useless lining out of your body. Don’t resist it. Stay calm and relaxed, and get with it, as women do when they’re in labour. The quicker the job is done, the sooner your period will be under way, the less pain there will be and the sooner all pain will be over.

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AND TREATMENT

Signs and symptoms

Hypothyroidism. When the thyroid is underactive at birth, it’s not usually apparent for a few weeks. When the condition finally does become apparent, it causes excessive sleepiness, choking while nursing, severe constipation, and noisy breathing. After three to six months it is obvious that the child’s growth rate is retarded. In addition, the child has a protruding tongue; thick, dry skin; and a hoarse cry. When the thyroid becomes underactive later in childhood it slows growth and causes constipation, sleepiness, and thick, dry skin. An underactive thyroid may or may not be associated with goitre (enlargement of the thyroid gland)

Hyperthyroidism. Overactive thyroid usually develops between the ages of ten and 15. Sometimes, however, it may occur in children as young as one or two. An overactive thyroid causes irritability, restlessness, behavior problems, tremors of the hands, increased appetite without weight gain, excessive sweating, and protruding eyeballs. Overactive thyroid is sometimes accompanied by goitre.

Because all symptoms of over- and underactive thyroid can result from other conditions not related to the thyroid, laboratory tests are essential to the diagnosis.

Home care

Home care involves taking your child to your doctor for routine checkups and watching for the symptoms of a thyroid malfunction.

Precautions

• Symptoms of underactive thyroid may occur in older children, especially adolescents, who have normal thyroid function. Only your doctor can determine if the thyroid is malfunctioning.

• A child who has a cyst on the neck should not have it removed until the doctor has determined that the cyst is not actually the thyroid gland in an abnormal position.

Medical treatment

Your doctor will establish the diagnosis on the basis of a physical examination, which includes measuring the child’s blood pressure, and laboratory tests that measure thyroid and pituitary hormone levels in the blood. The doctor may also order a test to determine how well the thyroid absorbs radioactive iodine; this may be necessary to evaluate function and look for tumours of the thyroid.

Treatment of an underactive thyroid involves prescribing synthetic thyroid or thyroid hormones for the child to take by mouth. Treatment of an overactive thyroid involves either medication or surgical removal of part of the thyroid gland.

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Children with diabetes usually grow normally and reach the adult height that would have been expected from the family pattern of growth. On the other hand, insulin is needed for normal growth, and if a child with diabetes is not having enough insulin, he or she may not grow normally. Poor diabetic control and poor nutrition may also lead to impaired growth. Persisting and very poor control of diabetes can lead to such severe impairment of growth that the child may actually appear dwarfed and if this is not corrected, the ultimate adult height may be short. Fortunately, this is now rare and can be readily prevented by good diabetes control.

If a child develops diabetes in early life, the onset of puberty may be delayed for a year or more. If this happens, the growth spurt that occurs during puberty will also be delayed and the child will be growing slowly in his or her early teenage years when most other teenagers are growing rapidly. For a few years, he may be relatively short compared to his friends, but with good control, catch-up growth will occur later.

Occasionally, we see children who have delays in growth or develop puberty later than expected even though diabetic control seems quite satisfactory. We cannot always find an explanation for this, but if it is a concern, other investigations may be needed.

Of course children with diabetes are in all other respects normal children and there will be the same variations in growth and in the timing of the onset and progress of puberty that all children experience. We just have to be sure the child is having adequate nutrition and insulin and that diabetic control is satisfactory. That is one of the reasons why regular medical check ups are helpful in childhood diabetes.

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Everything we do, we do on a background. All that we do in life is done on our personal background and on our cultural background. All that a nation does, in both peace and war, is done on its historical background. The small things we do in life, our relationships of man and woman, are all done on the background of what we are. There are specific things that we can do in the management of stress, but their effectiveness is greatly modified by the background of our way of life.

Every one of us, there is no escape, each of us, is a conglomerate of living material. Over countless generations, by the process of evolution, this living material which is us has developed certain needs and reactions. This is the biological background for what we do in the management of stress. If we keep within this background, the specific things we do will be so much the more effective.

The most important thing that we can do in helping our brain integrate the excess of impulses which it is receiving is to let our mind run quietly for a while. This not only temporarily reduces the overload on our brain, but actually helps our brain to work more effectively. So the evolutionary process has provided us with a need to conduct our life in a way that provides a background which makes it easy for our mind to run quietly for short periods, and so avoid the effects of stress. One problem is that, as we develop an increasingly sophisticated way of life, we tend to ignore our simple biological needs.

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Idealism

“They call me a greenie. That’s OK by me because that’s how I feel about things. They laugh. They say we would hinder progress. If that’s how they see it, that’s their way of looking at things. Different from my way. Seems to separate us, one from the other. Makes us different. Not the same. Not one of them. And tension comes between us. Feel it in all kinds of situations.”

This is life. The idealistic among us become separated from the main stream of humanity. Become an identified minority group within the community. And, as with other minority groups, suffer from the prejudice and alienation of the main mass of society.

If we ourselves have leanings in this direction, what should we do? Modify our idealism to suit the prevailing trends of society? No. Never. Rather we must seek an inner security in ourselves, and so save our idealism from forming a background of stress.

Contraception

“I’m a good Catholic. No, I shouldn’t say that. Put it this way. My friends would say I am a good Catholic. I attend Mass. I go to confession. But I shop about. I try to go to a priest who is modern in his views. Is that cheating? Some times I think it is. Wake at night thinking about it. Should I go to one of the old school, and face the music? Be reminded of Hell and damnation. It’s all about contraception, of course.”

Just another background problem which makes her more likely to become stressed if a major problem should arise.

Church-going

“My wife likes to go to church. That’s OK. I am quite pleased for her to go. But must I go too? If I go, I get irritated by the waste of time. Then my irritation shows up between the two of us. If I don’t go, there comes a distance. It’s as if we were on different planets. People with different interests. The one not understanding the other. And that wonderful feeling of Sundays together just disappears.”

Life is a sequence of giving and taking. And nowhere is it so paramount as in our relationship of man and woman. Such giving has no price attached to it. If there be a price, it is not giving. It is then simply a transaction of the market place. The spin-off, the side effect, comes in our reduction of tension, and its effect on the whole stress situation.

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•     There is nothing one can do about one’s family history of ulcers but if there is a history it makes all the more sense to adopt as many of these preventive measures as possible to try to reduce your chances of developing an ulcer.

•     Stress is definitely a provoking factor in ulcers but not just the classical stress of the business executive. It is probably not the stress itself that is the problem but more how you react to it. Being a doctor is probably one of the more highly stressed occupations yet studies of doctors fail to find an excess of ulcers. Potential ulcer patients are usually highly strung and have been subjected to long periods of anxiety and emotional tension. Even children under such stress can get ulcers. One study of twenty-four teenage and pre-teen ulcer patients found that ten of them had lost or almost lost a close relative or personal friend within the year of the ulcer diagnosis.

Stress produces high gastric-acid levels in everyone but in the very tense and emotional individual who seems to have to ‘work’ hard at everything in life there seems to be a perpetual overproduction of acid. Any signs of upper abdominal pains or heartburn in such people should be taken as a warning sign that an ulcer could be on the way.

Don’t take sedatives and tranquillizers – favour natural methods such as yoga, meditation, relaxation and exercise.

•     Cut out all caffeine-containing drinks and medications. This includes cola drinks.

•     If you need a pain-reliever use soluble aspirin or paracetamol for the odd headache. If you need more serious long-term pain relief for a medical condition talk to your doctor if you have ever had ulcer symptoms or if there are ulcers in the family.

•     For years milk and a bland diet were the mainstay of the treatment and prevention of duodenal ulcers. Today they are considered to be useless and even possibly harmful. There is no evidence that such a bland and unappetizing diet is of any value and it deprives the ulcer patient of valuable vitamins and minerals he or she would otherwise be getting.

Milk neutralizes acid in the stomach for a while but kicks back by increasing acid secretion later by as much as 20 per cent! In one study some men had more than 30 per cent more acid after drinking milk. Other foods high in calcium also increase acid production. These include cheese and other dairy products.

•     Sugar and white flour appear to promote ulcers too. One study of forty-one people with chronic stomach problems (with and without ulcers) found that twenty-eight were better on a reduced carbohydrate diet. A study at the University of Manchester of white and whole-meal bread led the researchers to conclude that ‘The substitution of whole-meal bread for white might be of benefit to patients with duodenal ulcers and non-ulcer dyspepsia.’

•     Historically, ulcer patients have been advised to eat frequent, small meals. Recent research, however, shows that this makes more acid even though the food buffers some of it. The best eating pattern has now been found to be three main meals a day, rich in dietary fibre and low in refined flour and sugar. Something’ late at night is often helpful to soak up acid that could irritate the stomach or duodenum overnight. The best policy is to take antacids at this time.

How you eat could be more important than when. Most nervous, tense individuals (ulcer-type personalities) bolt their food. This is harmful because a substance called urogastrone which is produced by the salivary glands and protects the lining of the intestine is in short supply

•     Smoking should be stopped because it does three harmful things in the context of ulcers. First, it stimulates the stomach to produce more acid; second, it reduces the amount of acid-neutralizing bicarbonate produced the pancreas, and third, it lets liquid parts of a meal out of the stomach ahead of buffering solid parts so that more acidic fluids hit the duodenum than should be the case.

•     Zinc has been shown to be of value in healing duodenal ulcers in humans, and given that it is of proven preventive value in animal experiments it is probably worth trying as a preventive.

•     Various pieces of research suggest that vitamins A and E when taker together offer a degree of protection against ulcers which is greater than any other known preventive. Take 50,000 IU vitamin A and 100 IU vitamin E daily.

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What is it?

A condition in which a child wets the bed at night even though he or she is potty trained. It comes about because the child does not receive sufficient warning stimuli from the bladder to tell him or her that it is time to urinate.

Most children become dry at night when they are 2 or 3 years old but others, especially heavy sleepers, can take much longer. A half of all 2-year-olds are still wet at night; 20 per cent of 3-year-olds; 10 per cent of 5-year-olds and 5 per cent of 11-year-olds. All children become dry eventually unless there is an underlying medical problem.

What causes it?

• Immaturity-the child’s ‘bladder is full’ sensations are not yet well developed and they go

unrecognized.

• Deep sleep.

• Stress. This might be caused by upsets in the family-especially the arrival of a new baby,

parental rows, marital break-ups, moving house, etc. There may also be anxiety over, for

example, going to playgroup, or being left with someone else when both parents go out to

work. Any or all of these can make a previously dry child wet the bed.

• Certain congenital abnormalities of the urinary tract. See your doctor if you suspect this is the

case.

Prevention

•     Keep both the child and his or her room warm. Dress him or her in nightclothes that fit well and are snug-all-in-ones are good.

•     Lift the child out of bed when you go to bed and sit him or her on the lavatory or potty. Some children remain asleep through this but most wake and then go back to sleep at once. A few children obligingly walk to the lavatory when woken.

•     Limit fluid intake during the late afternoon and early evening, but don’t restrict fluids totally. Be guided by common sense.

•     Look for any of the above causes that could be prevented and work on them.

•     Certain electrical gadgets that ring or make other noises to awaken the child as soon as he or she wets a sensitive pad in the bed are available but have not been widely used as either treatment or prevention, and their success rate has not been established.

•     A particular anti-depressant drug has been used for some years but I do not favour its use for young children.

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