СИНДРОМ ХРОНИЧЕСКОЙ БОЛИ-CHRONIC PAIN SYNDROME

Wilhelm Reich was a Viennese psychiatrist who was a follower of Sigmund Freud but later broke away to establish his own therapy. Like Freud, Reich believed that frightening and painful experiences and feelings could be repressed by the conscious mind. Reich based his therapy on his belief that repressed feelings could cause physical as well as psychological problems and that these could be released by certain movements. He divided the body into seven zones in which tightening of certain groups of muscles created ‘body armour’. Rigid patterns of behaviour he termed ‘character armour’. He believed that the blockages created by these armours impeded energy flow in the body and could lead to deteriorating health.

Reichian therapy is a form of bodywork in which the therapist helps the patient to become aware of the ways in which posture, muscular tension and breathing patterns reflect emotion. Physical manipulation of the body aims to relax the body armouring.

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There has been a resurgence in the use of stimulant medications, such as Ritalin and Dexedrine, with the increased awareness and recognition of the problem of adult attention deficit disorder (ADD). Since it is not uncommon to find both depression and

ADD in the same person, the question will arise as to the safety of combining stimulants with St John’s Wort. There is no reason not to do so under a doctor’s supervision, using the usual rules of starting low and going slow, as the following two case studies will indicate.

Dick, an economist in his early fifties, was referred to a sleep clinic by his wife, who suspected him of having sleep apnoea because of his snoring. After sleep studies were performed, sleep apnoea was ruled out and instead, he was diagnosed as suffering from narcolepsy, a condition characterized by waking during the night and severe drowsiness during the day. The drowsiness can reach dangerous levels as patients may doze off at the wheel or fall asleep at other inopportune times. Other curious features of this disorder are a tendency to have hallucinations just as one is falling asleep and to collapse while awake, often as part of an emotional response such as laughing. It has been suggested that the dormouse in Alice in Wonderland might have been suffering from narcolepsy, as he was always falling asleep and collapsing into the teapot!

Dick’s symptoms of narcolepsy were effectively treated with the stimulant Ritalin, but after his drowsiness cleared he realized that he was left with aspects of his personality that he was not happy with, particularly shyness and excessive cautiousness. He would hesitate to initiate conversations, to offer his opinions in group meetings or to assert himself in the workplace. In addition, he continued to overeat and gain weight and his sleep disturbances persisted to some degree. Even though he was not actually depressed and was able to experience pleasure in aspects of his life, his psychiatrist thought he might be suffering from a type of depression and prescribed St John’s Wort.

The very day after starting the herb, Dick felt buoyant, which was very surprising to him as he had read that it takes weeks for the herb to exert its effects. He knew that something unusual was going on because he had bicycled into work every day for months and had never before initiated a conversation with one of his fellow bikers. That day he did – and he has been less shy ever since, as well as less self-effacing and more inclined to speak up. Even confrontations which he would have assiduously avoided in the past now no longer seem so daunting. He is contributing more in meetings, feels more engaged and others have noted these changes even more than he has and have pointed them out to him. His psychiatrist has pushed the dosage of St John’s Wort higher in an attempt to get the maximum benefit from it. Best of all, Dick has not noticed any side-effects of the herb whatsoever.

I had occasion to combine St John’s Wort and stimulants in treating Zack, a 17-year-old boy with a long-standing history of both depression and ADD. When he first came to see me he was on one of the older anti-depressants, nortriptyline. Even though he was on a relatively low dosage of the anti-depressant, he noted a distinct decrease in his interest in girls after starting the medication. «I am still interested in them up here,’ he remarked, pointing in the vicinity of his brain, ‘but it doesn’t seem to be connected with down there.’ This was clearly a case for St John’s Wort. In my usual fashion, I gradually added in the herbal anti-depressant while tapering the conventional anti-depressant. On St John’s Wort alone, Zack felt too giddy, impulsive and unconstrained, so I reduced the dosage of St John’s Wort and reintroduced the nortriptyline at an even lower dosage than before. He declared the mix to be perfect. He no longer felt depressed, was no longer impulsive and experienced a welcome return of his interest in girls both emotionally and physically.

Now it was time for Zack to go off to university, and concentration and focus became major problems, as they invariably are for people with ADD. I introduced Dexedrine 5 mg twice a day to the mix, which helped him with his attention and his studies. He reported no problematic side-effects of the combination and is now enjoying university both socially and intellectually.

While this chapter has portrayed the value of St John’s Wort in a variety of conditions that are severe enough to warrant medical attention, the herbal remedy is also being used by countless numbers of people for less major, yet quite disruptive problems of everyday life.

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Хронической болью, по данным Международной ассоциации по изучению боли, принято считать боль, которая продолжается сверх нормального периода заживления и длится не менее 3 мес . В настоящее время хроническую боль рассматривают как самостоятельное заболевание, в основе которого патологический процесс в соматической сфере и первичная или вторичная дисфункция периферической и центральной нервной систем. Неотъемлемым признаком хронической боли является формирование эмоционально-личностных расстройств, она может быть вызвана только дисфункцией в психической сфере, т.е. относиться к идиопатическим или психогенным болям . Психогенная хроническая боль наиболее распространена и наиболее сложна для диагностики и лечения. В соответствии с критериями DSM-IV понятие хронической боли используется для обозначения болевого синдрома, длящегося более 6 мес.

Хронический болевой синдром может наблюдаться в клинической картине любой депрессии. Симптомы депрессии при хроническом болевом синдроме могут быть очевидными или стертыми. Достаточно часто боль является «маской» депрессии и собственно депрессивные симптомы выступают в атипичной форме и скрыты за доминирующей в клинической картине болью. Среди синдромов маскированной депрессии некоторые авторы отдельно выделяют алгическо-сенестопатический синдром. Больные с типичными проявлениями депрессии достаточно быстро оказываются в поле зрения психиатров. Напротив, больные с атипично протекающими, маскированными депрессиями долго и подчас безрезультатно лечатся у врачей общей практики, так как распознать подобную депрессию достаточно сложно.

It may seem surprising to include the automobile as a source of indoor air pollution. Yet, not only does ambient (outdoor) air pollution enter the home, but the automobile itself has become part of the home in parts of the United States. Many houses have been built with the garage incorporated into their structures. This is particularly true in the case of ranch houses. Not uncommonly, the master bedroom is located directly above the garage and is saturated by fumes rising from it.

For the chemically susceptible, this development in modern living can be disastrous. Simply stated, garages should not be incorporated into the basements of homes unless elaborate precautions are taken to prevent fumes and odors from rising and fouling the air of the living quarters. To do this, however, is extremely difficult—in fact, nearly impossible. Even a passageway between a garage and home may allow sufficient fumes to enter the house to cause or perpetuate symptoms. Careless home construction often contributes to this problem.

A similar situation prevails in many apartment houses, where garage fumes get into the elevator shafts and contaminate the living quarters of the buildings. One partial solution to this problem is to let a car cool off completely before putting it into the garage. In this way, engine fumes will be less apt to accumulate and pollute the house.

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Eye allergies are allergic reactions of the eyes. They may affect the conjunctiva (the transparent covering over the whites of the eyes and the insides of the eyelids). They may also affect the skin on the eyelids and around the eyes.

Eye allergies are caused by a wide variety of substances carried to the eyes by the air or by the hands. Seasonal, airborne materials are pollens from trees, grass, weeds and other plants. Non-seasonal airborne materials include house dust, feathers, molds, and animal dander (tiny scales from the skin of an animal). Many irritants may be carried to the eyes by the hands, including nail polish, household cleaning products, materials from stuffed toys, and finger paints.

Signs and symptoms

The whites of the eyes become red and itchy. The eyes water, but no pus is formed. Occasionally, the whites become visibly swollen with clear jelly-like material. The eyelids become swollen and red. The skin of the eyelids may be smooth or rough and scaly. Pouches beneath the eyes may become swollen and bluish and resemble «shiners».

Certain clues can distinguish eye allergies from several other conditions that also cause reddened eyes (conditions such as conjunctivitis, viruses, foreign bodies in the eyes, sties, glaucoma). Eye allergies cause itching and tearing but never cause pain or pus. Swelling of the whites of the eyes is a key sign of an eye allergy.

Home care

Oral antihistamines usually help. With your doctor’s permission, use of eye drops containing phenylephrine or ephedrine brings temporary relief. Applying cold compresses to the eyes may also ease the discomfort. Whenever possible, identifying and avoiding the irritating substance is clearly the best solution.

Precautions

• If there is pus or pain in the eyes, the condition is probably not an allergy.

• If the pupils of the eyes are dilated (enlarged) and slow to respond to light, see your doctor.

• If home treatment is not effective in 24 hours, see your doctor.

• If vision is affected, see your doctor.

Medical treatment

Your doctor will examine the outsides and insides of your child’s eyes. Medicated eye drops are effective but are safe only after a doctor’s examination. Skin tests may be suggested to help identify the substances causing the allergic reaction. Desensitization shots over an extended period are rarely recommended.

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Polyunsaturated fatty acids are more unstable than monounsaturated and saturated fatty acids. This means that they become rancid (oxidized) more easily when exposed to oxygen, light and heat, and have the ability to form trans fatty acids. We are continually told by health authorities that polyunsaturated fats are healthy, and saturated fats are bad for us.

Vegetable oils that have become oxidized act as free radicals in the body. Free radicals can cause damage to our cells and DNA; they age us more quickly and have been linked to the development of heart disease and cancer. Importantly, new research has shown that cholesterol itself is not the problem, but oxidized cholesterol is a bigger risk factor for heart disease. The more free radicals we have in our body, the greater the chance that our cholesterol will become oxidized. This form of cholesterol behaves differently and is more likely to attach itself to our artery walls.

Trans fats have been well researched in recent years, and their effects on our heart are becoming clearer. Some researchers believe they are responsible for the epidemic of heart disease in the 20th Century. Trans fats have an adverse effect on our blood fats because they increase the levels of LDL «bad» cholesterol, and reduce levels of HDL «good» cholesterol. This is a double whammy; their effects on cholesterol levels are considered to be twice as bad as saturated fats. This is very unfortunate because many consumers buy foods that are labeled to be «low fat» or «cholesterol free», and these are the types of foods that are often highest in trans fats! Trans fats are also known to raise triglyceride levels, and interfere with the metabolism of essential fatty acids in the body.

In the Nurse’s Health Study, women who had the greatest amount of trans fats in their diet had a 50% higher risk of heart attack compared to women who consumed the least amount of trans fats.

Because trans fats become incorporated into our cell membranes, they interfere with the action of insulin. They promote insulin resistance and in this way they make you fat, and increase your chances of developing Syndrome X and diabetes. Trans fats also promote the release of inflammatory chemicals called cytokines, contributing to inflammation in the body.

If you do nothing else for your heart, make sure you avoid eating partially hydrogenated vegetable oil, and processed vegetable oil that does not state it is «extra virgin» or «cold pressed». In the USA the trans fat content of all packaged foods will need to be stated on the label by January 2006. There are no such plans in place for Australia yet, so you will have to identify trans fats yourself by looking for the words «partially hydrogenated» or «hydrogenated vegetable oil», «vegetable oil» or «vegetable fat». Check food labels carefully to make sure you avoid these types of fats. Healthier alternatives to use would be extra virgin olive oil, butter, ghee and virgin coconut fat. Healthy spreads for bread include avocado, hummus, tahini, tomato paste or natural nut butter/paste.

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What is it?

A condition in which a woman becomes miserable or frankly depressed after having a baby. It is extremely common, with some surveys showing that eight out of ten women feel low, weepy and depressed, and are easily upset, in the first week or two after a birth. These emotions may or may not be accompanied by a feeling of anxiety around the time of taking the baby home from the hospital-a condition seen more commonly in first-time mothers.

Usually post-natal depression is not sufficiently serious to prevent the sufferer from functioning normally, but is very unpleasant for her. Such a woman typically cries at the slightest provocation, perhaps for no reason at all, feels she can’t cope with the baby, is critical or openly aggressive towards her partner, feels guilty about not loving her baby enough, goes off sex, loses her appetite, can’t sleep, has nightmares, and may have panic attacks.

A1975 study found that of sixty-six women having their first babies 84 per cent experienced post-natal depression of some kind and 77 per cent were anxious. Twenty-four per cent were frankly depressed.

Post-natal depression starts at any time after the birth but the common ‘baby blues’ is experienced in the first few days and lasts only for a couple of days. More severe forms of depression start from 2-3 weeks post-natally, but can first appear as much as six months later.

What causes it?

No one knows for sure but there are several theories:

• Hormonal theories have always been popular because the levels of progesterone rise during pregnancy and then fall very suddenly immediately after the birth. Superficially this appears to be a plausible explanation but it is difficult to see how this sudden fall in hormone level could cause depression weeks or months later. Also, these very same hormones are deemed to be the cause of pregnancy depression in which progesterone levels are high-not low.

It was noticed many years ago that there were certain similarities between premenstrual symptoms and post-natal depression. Dr Katherina Dalton, a pioneer in this field, wondered whether there might not be a connection-possibly a shortage of one of the circulating hormones. Unfortunately, it is not easy to measure hormones post-natally because the levels swing wildly until the menstrual cycle re-establishes itself. Whilst we still have a lot to learn about hormonal abnormalities, several researchers have meanwhile found other abnormalities. One of these is:

Inadequate vitamin B6. This vitamin now has a proven place in the management of premenstrual tension and it has also been tested in the post-natal situation. One researcher gave 100 mg of the vitamin for twenty-eight days to more than 100 women who had already had one baby (thus ruling out first-timers). The results showed that the B6 group had much less depression than did those given a placebo and that the effects were particularly marked in those women who had premenstrual symptoms. Depression has been linked to a shortage of a neurotransmitter called serotonin and vitamin B6 shortage can cause too little of this to be produced in the body. Research in Birmingham (England) has found that the substance from which serotonin is made fails to rise after birth in some women who later become depressed.

Tiredness and sheer exhaustion are often cited as causes of postnatal blues but there is almost certainly more going on than this. Undoubtedly, physical and mental exhaustion are a part of the baby blues in some women but they are unlikely to be a major factor in true post-natal depression.

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Of course, there’s a catch. In this case, two manly traits interfere with spiritual development. First, we are raised to ignore and discount intuition—our inner voice. Second, we are taught to suppress our emotions. On both counts we need to do some unlearning, says Dr. Kurth. Here’s how.

Pause and listen. Don’t listen only to your reasoning mind. Listen to your inner urges, nudges, leanings, voices. And give yourself permission to act on them, says Dr. Kurth.

Also, make time to just put the world on «pause,» Dr. Kurth says. «We get very caught up with all the events of our lives. And in order to have an intimate connection with some transcendent reality, we have to take time to stop and listen.»

Get emotional. «Listen to your emotions and let your emotions and passions inform what you do,» Dr. Kurth says. One definition of enthusiasm is «being infused with the spirit of God,» she says. Often when we are impassioned, we are connecting with our spiritual essence, she says.

Meditate. Okay, break out those orange robes. Nahhh, we’re kidding. The simplest, most basic meditation, says Dr. Kurth, is simply to pause for five minutes and focus attention on nothing but your breathing. Breathe comfortably, deeply, naturally. Don’t force it. Just relax and watch your breathing for a few moments.

Meet Mother Nature. Take quiet walks in natural settings outdoors, says Dr. Kurth. The beauty, vastness, complexity, and seeming omnipresence of nature can be both awe-inspiring and relaxing.

Pray tell. Talking over problems in prayer, turning them over to a higher power, taking decisions into prayerful consideration, is obviously an effort to connect with the Divine. Throughout history many people have found this a helpful spiritual practice, says Dr. Kurth. You might, too.

Make beautiful music. Singing, playing, or listening to inspirational music opens doors to greater spiritual realization, says Dr. Kurth.

Be creative. «Working in any of the creative arts can help one discover and develop his spiritual nature. The key here is work that involves inspiration. Spirit, says Dr. Kurth, comes from the Latin word meaning «breath,» as in «the breath of life.» And the word inspire comes from the words «in spirit.»

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Most of us know people who exhibit what seem to be peculiar eating patterns, from self-professed «chocoholics» to the college student on a macrobiotic diet. Yet these unusual habits seldom represent a true eating disorder. Understanding just what qualifies as an eating disorder begins with basic definitions of the terms.

Anorexia-self-starvation-was first described as a clinical syndrome three hundred years ago. Yet only within the past few decades have eating disorders been widely recognized, not just by the public but by physicians themselves. Even as I write, controversy rages, here and abroad, over the exact nature of these disorders. This debate is more than mere medical hairsplitting; a precise understanding is crucial so that therapy can be developed and applied.

Anorexia and bulimia may appear to be different illnesses with different symptoms. Anorexia is characterized by starvation; bulimia is notorious for its cycle of bingeing and purging. While there are distinctions between the two conditions, it is also true that they have certain features in common.

Both anorexics and bulimics overvalue bodily thinness. The flip side of this attitude, and of equal importance, is an exaggerated fear of fatness. These highly prized but basically unhealthy concepts are constantly reinforced by social pressures and cultural signals.

Both disorders also involve an obsession with food. As the disease progresses, patients get caught up in the rituals of acquiring, preparing, and consuming meals. In time, thoughts of food come to dominate every aspect of their lives, at the expense of family, friends, careers, and, of course, health.

Eating disorders are «spectrum» disorders. Like the spectrum of light in a rainbow, anorexia and bulimia appear in a range of intensities. Think of anorexics as occupying the red end of the spectrum, with bulimics at the violet end. Both «colors» are highly intense but are of different hues. In between are many variations of the illness, each with a distinctive «color,» or pattern of symptoms. There are several types of patients with eating disorders, especially among those with bulimia. The main difference between them may be simply the severity of their symptoms.

Looking at a rainbow, it is difficult to tell exactly where one color ends and another one begins. The colors seem to slide into each other, overlapping at certain critical points.

The same can be said of eating disorders. Women who start off with anorexia find it difficult to maintain constant starvation. So they eat. They then often adopt such measures as self-induced vomiting in order to keep their weight down. Conversely, patients who begin by bingeing and purging may eventually try starvation as their only means of restricting food intake. This passage from one kind of eating strategy to another affects the treatment they require. Anorexic patients, for example, fear that learning how to eat normally may result in urges to binge.

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Sandra Hameroff was having a hard time losing 40 postpregnancy pounds—until she started taking time off from her diet.

Shortly after the birth of her son, Noah, Sandra got serious about shaping up, determined to return to her prepregnancy weight of 100 pounds. She started using her cross-country ski machine four times a week. She also went on a strict diet, allowing herself no more than 1,300 calories a day and denying herself a lot of her favorite foods, especially pizza and french fries. As a result, she found herself on the brink of a full-scale binge more than once.

When a sympathetic friend learned of Sandra’s efforts—and her list of forbidden foods—she made a suggestion: «Why not give yourself a break from your eating program once a week? You’ll tame those cravings before they permanently undo your diet.»

The next Monday through Thursday, Sandra was a model of gastronomic self-control, amazing even herself. Then came Friday, and with it, her old favorites: pizza, ice cream, and a hearty dessert.

As radical as it sounds, indulgence was just what she needed. The next day, Sandra resumed her stricter eating plan with greater enthusiasm. Soon after, her husband got into the act by taking her to dinner on Friday nights, which only served to make her splurges seem even more special. «I looked forward to them,» she says. «They made my diet easier to stick with.»

Four months later, Sandra stepped on a scale and discovered that she had lost all 40 pounds without guilt or giving up the foods that she loved. As a gift to herself, she hired a personal trainer to help her get in the best shape ever. «She brought me to a new level of fitness,» Sandra says.

WINNING ACTION

Give yourself a break. As we all know, dieting is hard work, and temptation is everywhere. Instead of trying to fight the urge to splurge all the time, allow yourself a chance to indulge those fat fantasies every now and then. Just remember that you have to be on the wagon 6 days out of 7.

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Let us look at the so-called ‘store-front window of the pain supermarket’ to see the range of individual treatments, their advantages, disadvantages and factors which would prevent their use as well as their approximate costs and where these treatments can be obtained.

Take for example, Mary, 33, an ex-kindergarten sister, who had exhaustively sought relief for a chronic back pain problem.

‘Mismanagement by the medical profession has made my life miserable with unbearable pain for the past five years!’ was how she angrily described her problem.

Mary had a long history of lower back pain which had involved two operations in which the individual vertebrae or spinal bones were fused together. Despite the operations on her lower back she was dissatisfied about the continuing level of pain and how it was disrupting her life.

She also complained of severe pain in the neck and shoulders. Her misery was made complete by deterioration of the cartilage at the back of both kneecaps known as chondromalacia patellae.

When admitted to hospital, her pain symptoms were related to her long-term orthopaedic problems and what she described as ‘the lousy cards life’s dealt me’.

After her surgery things had gone spectacularly wrong, with numerous post-operative complications including wound infection. When her knees began to fail, she began swimming to relieve the-pain. But the swimming brought on a painful condition of both shoulders — ‘frozen shoulder’.

She was then re-admitted to hospital where she was told that her original fusion operation was a failure. The second fusion operation was carried out in an attempt to correct the pain in her lower back.

This was as unsuccessful as the first operation in relieving her pain and she was then referred to a psychiatrist. Shortly after this she became acutely suicidal with homicidal thoughts towards her child.

Mary was transferred from a private hospital to the in-patient pain programme with a three-month history of depressive symptoms including persistent lowering of mood, tearfulness, difficulty in getting to sleep, waking early, loss of energy, poor appetite, a weight loss of seven kilos and loss of interest in everything, including physical activity. She had also ‘frightened off her treating psychiatrists — so difficult was she to

manage. b

Initially, Mary was very prickly, with a caustic tongue, very difficult to manage and very defensive, suspicious and hostile towards doctors after her past experiences.

After her first week in the pain program she was still difficult but coming around to the viewpoint that she might as well try any last resort to climb out of the depths that she had fallen into due to her chronic pain experience.

The breakthrough for Mary came with one of the main features of the pain program — patients being given the opportunity to experience a number of different techniques including laser acupuncture.

Within the first few sessions she noticed an improvement in her pain levels. She reported that her pain was becoming more and more acceptable and within the four weeks of the pain program she had minimal levels of pain.

Now, instead of depressing everyone, Mary was a general inspiration for new in-patients. On discharge, she was having weekly treatment. After six months, she had progressed to having treatment monthly.

Today she has continued to improve. Her previous constant demands for pain medication and treatment became far less and her relationship with her husband and son are greatly improved.

She is still taking medication but it has fallen to controllable levels. She is very happy with the results of the treatment and has now gone back to being involved in a kindergarten part-time.

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Migraine headaches are classically described as ‘excruciating’. In many cases, these are thought to be an allergic reaction to some types of food such as citrus fruit, cheeses, peanuts and red wine.

Acute migraines are sometimes accompanied by nausea and double vision and are usually described as being ‘a high intensity, throbbing sensation’.

They are normally experienced on one side of the head, usually the same side during each attack. Some experience what is known as ‘prodromal symptoms’. That is, flashing lights, nausea and sometimes tingling in parts of the body before the beginning of the actual head pain.

Commonly these headaches last from one to several hours and respond to sleep and appropriate and early treatment.

Less common variants can last for up to several days at a time. In some sufferers the headache can be experienced on both sides of the head. The headache may be accompanied by severe disturbances of bodily sensation — numbness and tingling — and even paralysis.

Parts of the vision of the affected eye may be lost causing partial vision in the affected patient. In some the nausea can be extreme with nothing able to be held down.

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Knowledge gaps about pain sensation, and its severity, existed until only recently. To a large extent, this was because most of the research was done on experimental animals rather than on actual chronic pain patients. There was thus no deep understanding of the difference between acute and chronic pain. (See Chapter 3 for a more detailed explanation.) There was also an over emphasis on pain’s physical and mechanical causes based on the widespread, but wrong, assumption that pain is purely a sensory experience. The emotional and psychological factors involved in pain were relegated to secondary importance.

Different definitions

Even specialists from different fields of pain management and research define pain in different ways. A recent international conference of pain specialists provided a fascinating range of definitions of the word ‘pain’.

1. Neurophysiologists understand ‘pain’ as being the appropriate response of specific pathways within a nervous system.

2. To experimental psychologists ‘pain’ is a behaviourial response to a stimulus.

3. Neurologists understand that ‘pain’ means the patient has perceived just that experience.

4. Clinical psychologists believe that an individual may complain of pain whether or not a physiological stimulus is identified.

5. Psychiatrists understand that ‘pain’ means a patient is in distress, which is expressed as a disagreeable somatic (body) sensation.

6. Acupuncturists usually define ‘pain’ as a complaint of a disagreeable sensation. The word pain is used to describe a subjective perception of distress. It is not a simple sensation like a primary sensation. Accompanied by a greater emotional response than any of these, pain is complex and subject to individual interpretation.

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T he word pain comes from the Latin word poena or the French word peine. It is important to realise there are many different types of pain. For example:

Jill’s trigeminal neuralgia

Jill had trigeminal neuralgia a lightning-like pain in the face and mouth, which is so severe that it makes some sufferers feel as though they want to kill themselves. ‘My pain feels like someone is jabbing my face with a red-hot electric needle. The worst thing about the pain is that it’s so unpredictable. I never know what’s going to set it off— swallowing, laughing, or talking. Even the smallest thing can set it off. I try to stay home and go out as little as possible.’I don’t use make-up. I don’t wash my face. I don’t even brush my teeth. Sometimes I don’t have any pain for days.Then I find myself starting to worry about when it may start up again.’

Mary’s post-operative pain

‘After surgery to remove the gallstones, I felt miserable. The pain near the incision was sharp. It seemed to spread all over my body. The nurses gave me some pills which took the edge off the pain and by about three days after the operation, the pain was mostly gone.’

Rudl with terminal cancer

‘At first, I didn’t mind the thought of dying, so long as it wasn’t too painful. But, then I began to worry about all those drugs they were giving me. They were making me groggy and confused. I couldn’t think properly or even feel like I was alive. There were times when I didn’t take the pills because I wanted to be alert for whatever was left of my life.’

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Because the mechanism behind true or ‘classical’ allergies is well understood, the potential for treating them with drugs is very good. The preparations used include corticosteroids (sometimes referred to simply as steroids, although they are not the same as the steroid drugs used by athletes) which have a general suppressive effect on inflammation, antihistamines which counteract the effect of the mediator histamine, and bronchodilators for use in asthma.

Although at one time there were serious side-effects associated with many anti-allergy drugs, the modern formulations have overcome most of these problems. The drug treatments now available are both safe and effective.

Before embarking on any other form of treatment, such as an elimination diet, it is important to weigh up the costs and benefits of that treatment as compared with using drugs to combat the symptoms. In cases where the symptoms are relatively mild, it may be better to rely on drugs alone. The decision involves a great many personal considerations, including, for example, the relative importance of food to the person concerned, their perseverance and will-power, and the number of meals that have to be eaten away from home. Nutritional needs also have to be taken into account. It is a decision that can only be made by the individual patient (or by the parents in the case of a small child) in consultation with the doctor concerned.

*62\180\8*

This woodland plant with elegant sword-shaped leaves and delicate white flower bells not only brings joy to our hearts in the spring when we come across it on our walks, but also strengthens and stimulates this organ, albeit that few people are aware of it. As long ago as the Middle Ages, lily of the valley was held in high esteem as a heart medicine. Later, however, when the more potent digitalis, or foxglove, was discovered, lily of the valley fell into disuse. An English doctor, by the name of Withering, found digitalis in the tea mixture of an old woman herbalist who used it to cure dropsy. This happened in the year 1785 and digitalis has been used ever since.

However, in recent times, we are beginning to realise that we have wrongfully neglected lily of the valley and that the plant that produces the most dramatic effect is not necessarily the best one. After many years of using digitalis as a heart medicine we have come to know some of its side effects. For example, we know now that digitalis is cumulative, which means that it remains in the heart muscle for quite some time and so prolonged treatment may seriously damage the heart. Lily of the valley, however, does not pose the same danger, since within four hours the glycoside, the active substance, is broken down by the body, although its medicinal effect continues for much longer.

*721/28/1*

The whole, dried plant can also be made into a powder, which in turn can be used to produce tablets. The advantage of a powder and tablets is the fact that they retain all the plant’s substances, including the ashes. On the negative side, sensitive ingredients are lost in the drying process, although the minerals, oils and resins remain fully effective. Remedies taken in powder and tablet form are ideal for use as laxatives and to stop diarrhoea, as well as to aid the digestion and eliminate worms. Papaya preparations are a good example in this respect.

*677/28/1*

No one likes to have skin blemishes, yet it is not uncommon for young people to have a problem with spots, especially at the age of puberty. A spotty face can even create an inferiority complex if all lotions and creams fail to help. This is another reason why the problem of impure skin should be tackled at the roots. The recommendation to be careful about what one eats and adopt an appropriate diet is not always received with appreciation, but it is necessary, since the trouble is basically the result of ingesting the wrong food.

If you suffer from spots it is of the utmost importance to reduce your intake of fats by half or three-quarters. What is more, take great care to avoid heated fats and oils, animal fats being especially detrimental. Cakes, biscuits, pastries, and all other sweets should be left out of the diet altogether or at least drastically reduced. Eggs, particularly boiled eggs, omelettes and other egg dishes are like poison for impure skin. Only fresh, soft white cheeses such as cottage cheese or quark are digestible, but no other kind of cheese. Raw vegetables, natural brown rice, potatoes boiled in their skins, cottage cheese and horseradish are nutritive and remedial and contain plenty of essential vitamins and minerals. Hot spices tend to make things worse. Some external remedies that have proved very effective are Echinaforce and Molkosan; one day apply Echinaforce to the affected area, the next day use Molkosan, and continue in daily alternation. Apply a little Bioforce Cream to any patches of dry skin. For internal treatment take Violaforce, a tincture made from heartsease (wild pansy), and also Echinaforce.

*633/28/1*

Besides the fruits mentioned in the article, the patient should also eat avocados, papaya, and perhaps bananas – fruits that are available all the year round.

A well-known tennis player came down with AIDS, and was diagnosed as such by the doctors of St Vincent hospital. This same person was completely cured by means of a special diet high in vitamins but low in protein, a protein-free fruit diet. Today he plays tennis with the same verve and vitality as he did before.

There is no doubt the AIDS disease has scared many, above all the young, making them rethink and modify their ethical views, especially their attitudes towards sexual morality. And I appeal whole-heartedly to doctors and dieticians to try everything in their power so that something positive rather than alarming will soon be reported by the media.

Remember, nature is bound to have a way, but it must be sought. And he who seeks can expect to find a solution.

*589/28/1*

Thousands of pages have been written about cancer, yet our critical questions remain practically unanswered. Histologists with their modern ultramicroscopes or electron microscopes have so far not been able to tell us why a healthy cell becomes a cancer cell. It is for this reason that the early diagnosis of cancer is so difficult. Public information and lectures often make cancer appear to be a simple and straightforward problem and, for example, women over forty are encouraged to visit the doctor for a regular check-up. The doctor keeps telling them that there is no reason to be anxious, that everything is in order – and the women lose their fear of cancer. Then, quite suddenly, and in spite of the doctor’s reassurances, a woman notices a hard lump. She rushes to a specialist who asks, with a slight tone of reproach in his voice, ‘Why did you not come to see me sooner?’ When she answers that the family doctor has been checking her regularly for years the specialist is naturally embarrassed and worried. Indeed, cancer is a difficult problem even for a capable physician and his efforts to prolong a patient’s life can often be in vain.

*545/28/1*

No vitamin or mineral acts by itself, it needs to inter-react with other vitamins and minerals before it can be of any nutritional use to the body. This is why vitamins and minerals cannot be considered as therapeutic agents (in the manner of drugs) that cure specific diseases. For instance, vitamin C is not a cure for the common cold. However, it is a principal nutrient in raising the body’s resistance to the cold and ‘flu virus. The white blood cells (T-lymphocytes) cannot absorb vitamin C unless vitamins B12, B6, folic acid, choline and the mineral zinc are also present. Moreover, vitamin C cannot boost the virus-killing power of the white blood cell if it doesn’t have these same nutrients to interact with once inside the T-lymphocyte.

If there is not enough zinc in your diet, your cells actually lose vitamin A even though you may be taking a vitamin A tablet. Vitamin A deficiency leads to improper metabolisation of iron (anaemia) which in turn affects calcium metabolism (reduced bone growth, muscle contraction and the burning of glucose for energy). When iron metabolism is disrupted vitamin B12 metabolism is disrupted, which in turn disrupts folic acid, which in turn disrupts magnesium metabolism and so it goes on and on.

By working together, vitamins and minerals get the metabolism working properly and thus correct metabolic diseases. Vitamins are only of assistance where deficiencies exist. Metabolic diseases are, in the main, the result of vitamin and mineral deficiencies.

In its 1988 report on the nutritional state of Australians the federal Department of Health found that Australian women (in particular) were deficient in zinc, calcium and iron and suggested that more seafood be eaten. My experience is that most people cannot afford the amount of seafood needed to overcome these mineral deficiencies. A complete multi-vitamin and mineral is a much cheaper way of achieving the desired result.

*228\18\9*

Prolonged or excessively shallow breathing causes a build-up of carbon dioxide in the blood. Too much carbon dioxide causes the significant chemical imbalance of the blood called acidosis. Acidosis has far-reaching effects on the metabolism of the body.

As carbon dioxide retention in the blood progresses the degree of metabolic imbalance increases and the symptoms of acidosis become more numerous. The early symptoms are a quickening of the pulse, stomach upsets, heart burn, gas, panic and anxiety attacks, moist warm hands, muscle cramps in neck, shoulder and back, constricted pupils and elevated blood pressure. Severe carbon dioxide retention leads to drowsiness, dizziness, fatigue, confusion, tingling and numbness in arms, legs and hands, and tremors. Hallucination, fainting and coma are the severest symptoms of all. Some people experience sleep disturbances.

Although the blood has special buffer substances to neutralise the carbonic acid (retained carbon dioxide in the blood) and the kidneys are also able to neutralise it, the body still relies heavily on the lungs to blow most of it off. This can only be done if we breathe deeply as most of the carbon dioxide sits in the lower lobes of the lungs.

Drugs, especially morphine, Valium and the barbiturates, will also cause carbon dioxide retention. Deep breathing is imperative for those who are being treated with these drugs.

Those whose shallow breathing is the result of stress also have a build-up of lactic acid in the blood. An excess of lactic acid robs the body of its calcium reserves as calcium is needed to neutralise lactic acid. A deficiency in calcium contributes to anxiety. The deep breathing exercises help to reduce the levels of lactic acid as well and are even more successful at this if the mental relaxation exercises are also practised.

Deep breathing helps to maintain a steady, elevated, metabolic rate which helps keep the body weight normal.

*210\18\9*

Q. Which of the cold pressed vegetable oils is best? Why do we need them?

A. They are all good. Choose an oil that you are not allergic to.

Q. Will I put on weight if I have the oil?

A. Not if you take only the quantities recommended in the programs.

Q. Which is the most stable oil for cooking?

A. Olive oil. But it contains amines and salicylates. Use one of the others if you suspect you are amine or salicylate sensitive.

Q. Is cod liver oil safe to give to children?

A. Most certainly, if you can get them to take it. If not, give them the MaxEPA marine lipid capsules. Not for toddlers though, they may choke on tablets or capsules.

Q. Which is better, butter or margarine?

A. Butter. Margarine has preservatives, colourings and often milk sugar and milk protein. Butter is pure fat.

Q. Will Nystatin and garlic kill Lactobacillus acidophilus?

A. No. Nystatin kills only yeast organisms and garlic is not a broad spectrum killer of bacteria. It only kills unfriendly bacteria. Lactobacillus is a friendly bacterium.

*192\18\9*

Lunch is not to be eaten any later than 1.30 p.m. If it is, you run the risk of hypoglycaemia and will blame the resulting tiredness, lethargy, mood swings, poor concentration, weakness, lightheadedness on the program, suspecting you are allergic to a food,

A 230 mL (8 oz) glass of water or vegetable juice must be sipped with lunch. Glucose cannot be added to the water on the Anti-Candida Program.

If you missed your morning deep breathing exercises then twenty minutes’ yogic walking in the park before lunch is a good substitute and will relax and energise you for the rest of the day.

As with the breakfast menu, the lunch options may be mixed and matched, swapped or changed with other meals. Again keep high and moderate amine and salicylate foods out for the first four weeks—study the lists.

OPTION 1

A home-made garden salad (not from fast food outlet) comprising any variety of garden vegetables that you are not sensitive to. Include 120-240 g (4-8 oz) of lean unprocessed meat (all fat trimmed), seafood or poultry (skin and all fat trimmed off). Eggs may also be had if you are not allergic to them and your cholesterol levels are normal. Nuts and/or sunflower and sesame seeds may be added to give the salad variety and flavour. 90-150 g (3-5 oz) of a carbohydrate food such as boiled, baked or mashed (with oil) potato must be eaten. Cooked brown rice, wholemeal pasta and wholemeal unleavened bread are other acceptable alternatives. No rice cakes.

Home-made chips (French fries) may also be eaten—not if you have high cholesterol though, and not the commercially prepared chips or the little round potato balls served at restaurants and take-away outlets, or bought frozen from the supermarket. These contain chemicals that many people are allergic to. Carbohydrate foods must be eaten at lunch to prevent the blood glucose levels dropping by mid-afternoon (hypoglycaemia). You can have a dressing of cold pressed vegetable oil with lemon juice (no vinegar) and garlic if you like. Add any of the permissible herbs and spices to the dressing. Candida Killer dip may be eaten on the side or over the salad after four weeks.

OPTION 2

Good for lowering cholesterol levels, although suitable for anyone.

A thick bean and lentil stew. Add lecithin granules if your cholesterol is high. One to three slices of wholemeal unleavened bread may be eaten with it (not rice cakes). Have the bread dry or with a thin spread of butter if you are not allergic to milk and your cholesterol levels are normal. Preferably, brush olive oil on the bread.

You may still have this dish if your cholesterol levels are normal as it only lowers high cholesterol levels, it doesn’t lower normal cholesterol levels. A rice bran muffin may be eaten in place of the bread if your cholesterol levels arc high.

OPTION 3

A thick vegetable soup. Include any variety of garden vegetables that you are not sensitive to. Lean meat, fish or poultry may be included in the soup, as may any of the permissible herbs and spices. One to three slices of unleavened wholemeal bread (not rice cakes), with butter (though preferably oil) on it, may be eaten.

Toast the bread (after first four weeks) if you like. If your cholesterol levels are high, a rice bran muffin may be eaten instead of bread, and rice bran may be added to thicken the soup. The soup may still be eaten if your cholesterol levels are normal as it won’t lower them below normal.

OPTION 4

Sandwiches—two slices of bread per sandwich, as thick as you like. Unleavened wholemeal bread (not rice cakes) or muffins may be used for sandwiches. The fillings may include salad with lean meat, fish or poultry. Canned fish (done in brine [salt and water] only) may also be used.

Egg filling is permissible if you are not allergic to egg and your cholesterol levels are normal. Cashew, almond and hazelnut pastes (and butters) and tahini are good fillings. No peanut butter though. You may have a thin spread of butter (if you are not allergic to milk and cholesterol levels are normal), though oil is preferable.

Candida Killer sandwich filling may be used if desired. Savoury Mince may also be used. Have one to three sandwiches, depending on your size, hunger and activity levels.

OPTION 5

Not for hypoglycaemics.

60-120 g (2-4 oz) of raw nuts and/or sunflower and sesame seeds. Two to three fresh fruits (but no melons, grapes or bananas) may be eaten with the nuts and seeds for eight weeks of the twelve week program. For four weeks you are to have the nuts and seeds only.

Have nuts and fruits in accordance with any allergies that you may have. Keep high and moderate amine and salicylate foods out for the first four weeks.

Note: You cannot have this option if you had fruit salad for breakfast.

*174\18\9*

In fairness to cortisone it does have a place in the overall treatment program of allergies. Cortisone creams are very effective at keeping skin rashes and eczema at bay while the programs are taking effect. Keeping the skin quiet during this time keeps stress levels down, the anxiety of looking at an affected skin being a major stress. Such anxiety reduces the efficacy of the programs. The short time that cortisone cream will be needed will not be long enough to damage the skin as the programs speed the rate of skin regeneration. Cortisone puffers allow a good night’s sleep which is imperative for raising the body’s resistance to colds, ‘flu and asthma. Asthma responds quickly to the programs when body resistance is up. The programs lose some of their efficacy when sleep is broken by too many asthma attacks. The short amount of time cortisone puffers will be needed while on the program is not enough to produce significant Candida colonies or tissue damage to the mouth, throat and upper windpipe.

This is a slow process. The time it takes depends on the amount you’re on and the length of time you have been on it. Your doctor will probably reduce it by 1 -2 mg only every two to four weeks. This gives the metabolism the chance to adjust and rebalance itself. My experience is that withdrawal from cortisone tablets is more successful if the patient is on the Metabolism-Balancing Program. If you are on cortisone and showing the early signs of Cushing’s syndrome, don’t panic. Follow the instructions listed in the recommended program. There is a 90 per cent chance you will get better.

If you allow yourself to be on the cortisone drugs (tablets taken orally) for too long you’ll reach the point of no return. You won’t be able to come off them.

*156\18\9*

We all enjoy spending time with friends and loved ones, and in any case, the stimulation of visitors can be beneficial. There will be times when you feel the need for almost constant support and companionship. If you are experiencing a ‘low’ period and feel anxious and vulnerable then the company of a loved one or a good friend is invaluable – how often do we admit in times of stress or crisis (although usually after the event) that ‘I couldn’t have got through it without X’? At other times you may prefer to be alone with your own thoughts or to go out on your own in order to feel more independent. Your needs will vary, and while it may not be possible for family and friends always to be with you when you need them, it is helpful if they can understand when and why you need them most.

If you live alone or your wife/partner works full-time, then you will need to devise ways to ensure you have sufficient company and support. Even if you are generally happy to be alone, it is important that you do not feel isolated and unable to ask for companionship when you need it. Picking up the phone and letting a friend or relative know that you’d appreciate a visit can be hard at first – there may be some sense of admission that you can’t manage on your own, which you find difficult. This is not, of course, the case – often, people are delighted to be asked, and flattered that you have chosen them. It is very important not to let pride stand in your way! If you do usually live alone, it is likely that hospital staff will insist on arrangements to be made for your support and care before you are able to go home after treatments. This is not because they do not trust you to look after yourself, but because side-effects and problems can be unpredictable, and it is in nobody’s interest not to take suitable precautions.

From a practical point of view, you may need more support than usual with everyday tasks which you have always undertaken without a second thought, such as preparing meals or getting around and out of the house. Treatment can have unexpected effects on your physical strength and stamina, and it is important to make sure that back-up is available when you need it. This doesn’t necessarily mean you need someone to look after you full-time, although one option is to ask a relative or friend to stay with you for a time. If this is not feasible or desirable, your district nurse can arrange to visit you at home each day, and Marie Curie or Macmillan nurses can offer more specialist nursing care if you need it. Your GP can visit to check that you are coping with your medications and any side-effects. An occupational therapist can also advise on any special equipment to make managing at home easier for you.

Arrangements for both emotional and practical support may need to be more structured if you live or spend most of your time alone and can’t rely on the presence of a wife or partner. You may have to make a more conscious effort to ensure that you have all the help you need – but this does not mean that you will manage any less effectively.

*57\118\2*

Any step into unknown territory holds fears. Starting college or a new job, moving house and visiting the dentist all cause us a degree of fear either because we don’t know what to expect from the experience and/or because we anticipate that it will be unpleasant. Dealing with cancer is certainly a league ahead in terms of the intensity of our fears, but the root cause is the same: fear of the unknown. There are so many unknown factors involved that our security is profoundly threatened:

Will I be in pain?

What is the treatment like?

Will the treatment hurt?

Will the treatment work?

What does the future hold for me?

How will my family cope?

Will my life ever be ‘normal’ again?

How will I manage to get through this?

Becoming well-informed about your cancer and treatment can help to allay certain fears: the greater your knowledge and understanding of what is happening, the more control you can take and the less uncertainty you will feel about specific aspects of your disease or treatment. However, fear is not a logical emotion and a theoretical understanding will not always prevent you from worrying. It cannot necessarily help you with more general fears – about coping or about the future, for example.

One of the aspects of cancer and its treatment which causes most fear is uncertainty: uncertainty at how effective your treatment is and uncertainty at how much of your cancer will be eradicated. Waiting for the results of X-rays or blood tests, perhaps not hearing anything for several weeks between treatments, can cause great anxiety. You don’t know what to prepare yourself for or what plans to make, you can’t stop thinking about what might or might not happen. Tension is bound to build up, however much you try to take your mind off your cancer.

After the first awful month or six weeks, it was clear that I was responding well to my chemotherapy. Following so much bad news, this was more than we could have hoped for. But there was still a very long way to go and although my tumour markers were moving in the right direction, there was no guarantee that this would continue. We anticipated each hospital visit (weekly at this stage) with a mixture of unvoiced hope and stomach-turning trepidation. Butterflies? Legions of them, all on overtime. If the details were not immediately forthcoming, it took a huge effort of will to ask, ‘What are my tumour markers this week?’ or ‘What did the CT scan show?’

Apart from immediate fears about the possible unpleasantness of treatment, thinking about the future is likely to emerge as your single greatest fear. This can encompass a whole range of ideas, from ‘How will I manage to get through my treatment?’ to ‘Will I ever get better?’ At times when you are feeling physically low, you might wonder if you can bear to undergo any more treatment or how you can possibly tolerate the effects of your cancer any longer. How will you cope if you become physically incapacitated in some way? Who will look after you? How will you manage financially? Do you fear that your family and friends will eventually tire of supporting you and that you will feel a burden to them?

Fighting against cancer shakes the very foundations of your life, and it would be unusual not to experience fears that your life is toppling around you. These thought processes cannot be banished, but you can help to keep them in perspective by sharing them with someone you trust to take you seriously and listen. There may be times when you know your fears are irrational, but you need someone to take the time to talk them through with you. You may not expect solutions to your fears, but sharing them and knowing that someone you like and respect acknowledges and appreciates your worries can make them more bearable.

Just to hear someone say, ‘Of course you’re not being stupid! I can see now how difficult this is for you’ or T hadn’t appreciated until now how cancer takes over your life’ can be enormously helpful and will help you to realize that you don’t have to face your fears alone.

Sometimes a desire to express anxiety can be inhibited by a superstitious worry that voicing fears will somehow make them come true. For example, you are anxious that your treatment might not be as effective as you’d hoped, but you daren’t say so because you don’t want to ‘tempt fate’. We know this cannot happen but it can still make us hold back from saying all we want to. Even sharing this fear can help. Nobody will think you foolish: others are likely to admit to exactly the same worry.

If you spend a lot of time alone, your fears are more likely to become magnified. Similarly, if you are not sleeping well, fears can get out of control in the middle of the night. It would be foolish to pretend that they can be avoided completely, but it is important not to allow them to take over your mind. Sharing your worries will help. It is tempting to be ‘strong’ and keep them to yourself, but the people around you will be aware of your state of mind and will want to help. It is, however, important to remember that there may be occasions when you simply prefer to maintain a ‘stiff upper lip’. There are times when this can be an equally valid coping mechanism.

*45\118\2*

In the early stages, you may feel that you simply don’t know what questions to ask about your cancer and treatment, beyond a general sense of ‘What’s going to happen to me?’ When your doctors ask you, ‘Do you have any questions?’ it can be difficult to know where to begin, and how to put your fears and queries into words without appearing foolish or stupid. Most people are starting from a base of no knowledge at all on the subject of their cancer, so it may be most constructive to begin with some very basic questions, which you can develop as your knowledge builds up. For example:

How do your doctors know that you have cancer?

What type of cancer do you have and how advanced is it?

How does it spread and how will it affect your body and the functioning of your organs?

What type of treatment is proposed?

How long is the treatment likely to take? (weeks? months?)

What is the hoped-for outcome of the treatment (although it is never possible for doctors to give guarantees)? Is a cure or substantial remission a possibility or is the treatment palliative (aiming to alleviate but not to cure)?

How will the progress of your treatment be measured?

Who is the doctor who will be in charge of your treatment? Are there any other doctors you will see on a regular basis?

Where will you receive your treatment? Will you have to stay in hospital?

Asking a few specific questions such as these will often help to prompt further information from your doctor. It is easy otherwise for a consultation to speed by before you feel sufficiently at ease to really start talking. Remember that you don’t have to talk in medical jargon, although you do need to be clear. It’s perfectly acceptable to say, «I have a sharp pain in my stomach’ – you are not expected to be able to perform self-diagnosis. On the other hand, it is helpful if you know the names and doses of any drugs you are taking (for pain relief, anti-nausea, etc), so that your doctor can check on their effectiveness and whether any prescriptions need to be changed. This is less daunting than it sounds, as you will be given a card containing details of your drugs, which should be kept up to date. It is much easier if you can discuss these by name rather than ‘the big pink capsules’ or ‘the little yellow pills’.

The question many people consider the most important – and the most difficult to ask – is on the subject of your future prognosis. In the past, a cancer diagnosis was an almost certain death sentence, and many people still make this association immediately on hearing their diagnosis. However, treatments have progressed tremendously in recent years, and it may be that your cancer can be treated effectively. This depends, of course, on your type of cancer, how advanced it is and how you as an individual respond to treatment. When you ask about your likely prognosis, your doctor may use terms whose meaning is not obvious to you, but which have a specific connotation in this context. These include ‘cure’, ‘remission’ and ‘relapse’.

•    Cure

A cure means that all evidence of your cancer has been eliminated completely and that it will not return. How this is assessed depends on the type of cancer in question. For example, testicular cancer tends to recur within five years, and most often within two or three. So if your initial treatment is successful and a period of five years passes in which no cancer is detected, you should be considered cured. Other cancers recur in different timescales, and your doctor will be able to advise you about this.

•    Remission

Remission means that the symptoms of your cancer have disappeared or lessened, i.e. that the cancer has got smaller. A partial remission means that the cancer has shrunk by at least half. A complete remission means that the evidence of your cancer has disappeared completely and it is no longer detectable. This is not the same as a cure, as the cancer may return in the future. If it does not return within a given timespan, you may be considered cured.

• Relapse/Recurrence

This means that following your treatment, some cancer cells still remained in your body and started to grow into a detectable cancer again. It may be that these remaining cancer cells were undetectable after your initial treatment but have become active again later. This can occur in the months after treatment has ended or may not happen for some years. Your doctors will advise you about the likelihood of a relapse occurring.

You might be eager to know about your chances of achieving a cure or substantial remission, but this may be tempered by a fear of hearing bad news – for example, that only a short period of remission is expected to be achieved by treatment. Your doctors may volunteer information about the anticipated success of your treatment, based both on statistical information and the specific details of your own case.

Another term you will hear doctors refer to is the ‘stage’ of your cancer, which describes the extent, if any, to which it has spread to other parts of your body. There are four stages. Stage I means there is no spread and the cancer is confined to the primary site. Stage IV means that there is extensive spread beyond the primary site. Stages II and III fall between the two extremes.

Some people want to be kept fully informed about the progress of their treatment. You may decide, on the other hand, that you do not wish to be told too much medical detail about your cancer and treatment, especially at first. This is a very personal choice and is entirely your decision. Your doctors should be sensitive to this, although they do need to ensure that you understand what is happening during your treatment and afterwards.

It is worth remembering that while you will be looking for definitive answers to your questions, it may sometimes be difficult for your doctors to provide them. This does not mean that they are avoiding your questions, or that there are gaps in their knowledge. The treatment of cancer holds many uncertainties, and it would be wrong for doctors to be asked to provide guarantees about the future, although it is natural for you – and your family – to seek reassurance. It is useful to find out at an early stage which doctors you will have greatest contact with, so that you know who is likely to have the most knowledge about your case and is therefore in the best position to answer your questions.

In the very early stages, you may feel that you want to know as little about your cancer and treatment as possible and that additional information and knowledge are pointless because they can make no difference to your condition. This is a perfectly understandable reaction as you and your family try to come to terms with your diagnosis. As the initial shock recedes, however, you are likely to find that it is helpful to start learning a little more about your cancer. There are many books and leaflets available, covering a huge range of cancer-related topics. For some basic factual information, your hospital should be able to provide you with booklets produced by the organization BACUP (British Association of Cancer United Patients). These cover both specific cancers and related issues, such as cancer treatments and diet. Books and leaflets have a useful role as you can refer to them when you please.

If you are unclear about information you have received, you should never be afraid to ask your medical team for clarification. Similarly, don’t worry about asking the same questions more than once: when you are under stress, it is sometimes difficult to absorb information as easily as usual and your medical team will understand this.

*33\118\2*

Radiotherapy is often given as an out-patient, if you are well enough to be at home and to travel each day to the hospital.

Planning is a very important part of radiotherapy treatment, to ensure that you receive the appropriate dose of radiation and that it is directed at exactly the right points on your body. Scans and X-rays will help your doctors to plan your treatment as these will assist doctors to establish the exact size and position of your tumour. Ink marks may be made on your skin where the radiation is to be directed, or if you are having radiotherapy to your head or neck region, then a see-through mould of the area may be constructed to keep your head absolutely still, and the ink markings will be made on this mould. The planning stage of your treatment may take some time and is likely to occupy the whole of your first appointment. It is tempting to feel impatient and natural to want to start the treatment as soon as possible. However, precise and careful planning is a vital stage of your treatment and cannot be rushed.

The dose of radiation you are to receive will be calculated precisely. It will then be split up into a number of smaller doses or ‘fractions’ which you will receive over a period of days or weeks, usually on Monday to Friday, with a recovery period at the weekend. The strength and number of doses will be tailored to your specific circumstances – your type of cancer and how advanced it is, and your general state of health must all be taken into consideration.

Various machines may be used to administer radiotherapy, either

from one or more fixed positions or while rotating around your body.

Before you have your treatment, you will be positioned very

carefully by the radiographers so that the radiation is directed at

exactly the right point. You may feel awkward if you have to hold a

slightly uncomfortable position, but the treatment itself is painless

and will take between a few seconds and a few minutes. In fact,

many people are surprised at how quickly the radiation treatment

itself is administered.

*21\118\2*

Your own doctor or oncologist is the best person to answer detailed questions about your specific cancer. However, it can be very difficult to absorb medical information which is given to you verbally when you are feeling vulnerable and possibly very unwell. This section provides some basic details of the more common cancers which affect men, by their site of origin.

It looks first at the male-specific cancers which, by definition, affect only men and cannot affect women. Although they are not necessarily the cancers which affect the largest numbers of men (these are traditionally the lung and bowel cancers), they are the cancers for which men need to have an especial awareness, in the same way that women are especially aware of breast and cervical cancers. The other cancers included in this section are those which are statistically most prevalent amongst the male population. The different cancers are covered in the following order:

prostate cancer

testicular cancer

lung cancer

non-melanoma skin cancers

cancer of the urinary tract – kidney and bladder

cancer of the bowel – colon and rectum

stomach cancer

non-Hodgkin’s lymphoma

leukaemias

Please remember throughout this section that the facts given are necessarily brief and generalized and are intended to provide you with a first step towards understanding more about your cancer. Your doctor and oncologist will be able to give you more detailed information about your cancer and recommend further books or leaflets for you to read in your own time, if you feel this would be helpful. The British Association of Cancer United Patients (BACUP – tel: 0800 181 199 and 0171 613 2121) publishes a series of booklets on different cancers, treatments and related topics. These are available free to people with cancer. Don’t be afraid to ask if you ever feel you need more information.

The mainstream cancer treatments, which are by necessity mentioned here in relation to each of the cancers discussed, are covered in detail in Chapter 3.

A glossary of the more common medical terms which you may encounter is included at the end of the book.

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