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These are two forms of treatment that are used quite commonly by both medical doctors as well as by alternative practitioners. Although these therapies would seem at first to have but little role to play in managing sciatica and back problems, they can help in a variety of ways, including:

They can help a patient bring about lifestyle changes indicated for improving his condition. For example, hypnosis can help someone stick to a diet.

Affect how the patient looks at and reacts to his difficulties. While hypnosis may perhaps make no difference to the extent of sciatica, it certainly can alter the way someone reacts to it when it happens, either by making him less aware of it or by increasing his level of tolerance to it. ? These therapies are also particularly useful for reducing stress and anxiety, these often being an exacerbating factor in all kinds of back-connected problems.

Hypnosis and hypnotherapy both depend on the power of suggestion, whether the suggestions originate from the practitioner or the patient himself. In fact, it is generally believed that no one is ever hypnotised by anyone else, and that what invariably happens is that the subject hypnotises himself, the hypnotist merely providing a conduit for this self-hypnosis.

Not every patient is a suitable subject for this approach, and there is considerable individual variation in the extent to which people respond to this technique, some falling almost immediately into a deep trance-like state at the first suggestion while others totally fail to respond. There is, however, no need for a subject to attain a deep hypnotic state before hypnosis can work, the very lightest of trances being enough to achieve results.

Hypnosis can be tried out at very little cost and with minimal risk by buying one or more of the self-hypnosis tapes that are commonly advertised in newspapers and magazines. These tapes, of course, are usually aimed at creating generally beneficial effects – such as inducing relaxation or reducing reaction to pain – but often can be adapted by the user so that the suggestions they contain become directly relevant to the problem. Many hypnotists will also provide patients with individualised tapes they can later use at home to reinforce suggestions made during previous treatment sessions.

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Having extolled the benefits of increasing the amount of environmental light, I hesitate to confuse matters by mentioning that for some depressed people, an opposite solution may solve the problem – that is, increasing the daily exposure to darkness. Dr Thomas Wehr at the US National Institute of Mental Health has suggested that a cause of depression in some people may be our use of artificial lighting to shorten the hours of darkness to which we are exposed each day. Certain people, he argues, may be physically unable to cope with the legacy of Thomas Edison – universal illumination of the night – and may benefit by returning the night to its natural length. By adopting this strategy for one man, a middle-aged engineer who had cycled in and out of depression for years, Wehr and colleagues enabled him to stay free of depression for many months simply by asking him to remain in darkness for 12 to 14 hours each day. Since then a few other individuals have derived similar benefit from this treatment. Although at this time extending the hours of darkness remains a highly novel treatment that may benefit only a few of those patients who cycle in and out of depression, it is another demonstration of the importance of the environment in regulating mood, and the value of manipulating the environment as part of an overall treatment plan for depression.

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Three interlocking circles, the area of which is roughly proportional to the frequency of occurrence of various types of seizure. The central circle incorporates tonic-clonic (grand mal) seizures. The left-hand circle contains partial seizures, many of which become secondarily generalized, as indicated by the considerable overlap between the two circles. Most partial seizures arise from some focal area of structural abnormality within the brain. These seizures can be said to be symptomatic of some underlying problem—so-called symptomatic epilepsy.

The right-hand circle indicates typical absences (petit mal seizures). About 30 per cent of children with petit mal also have grand mal seizures, as is indicated by the overlap between right hand and centre circles. Such primary generalized epilepsy is not symptomatic of underlying structural brain disease, and may be said to be constitutional or idiopathic epilepsy.

The area of the centre circle that is not overlapped by the left and right hand circles contains those subjects who only have tonic-clonic (grand mal) seizures. Such cryptogenic epilepsy (epilepsy of hidden cause), less common since the advent of sophisticated investigations, should not be called idiopathic. Two possibilities exist—either the petit mal trait was not obvious in childhood, and grand mal seizures are the only manifestation of idiopathic epilepsy, or the seizure discharge from a small lesion becomes generalized so quickly that its initial partial phase is overlooked. It is often difficult to distinguish between the two possibilities even with prolonged EEG recording, unless a seizure actually occurs during the record.

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Symptoms: feeling of breathing difficulty, when the child is actually getting many fall breaths of air; tingling or numbness in hands and feet; muscle spasms; fainting.

Home care:

Remain calm and reassure the child.

Have the child breathe into a paper bag placed loosely over the mouth and nose.

Precaution

Rapid, deep breathing that causes fainting has become a party stunt in some circles. Discourage

this kind of game.

Hyperventilation is a breathing difficulty in which too-rapid or too-deep breathing causes a marked loss of carbon dioxide from the blood. There are many physical illnesses that cause difficulty in breathing, including asthma, diphtheria, colds, croup, hay fever, and pneumonia. Hyperventilation, however, is not a physical illness at all. It causes the sensation of difficult breathing or air hunger, but there is no physical condition preventing the person from taking in or letting out air.

Hyperventilation is common in older children, teenagers, and young adults. The person complains, often bitterly or fearfully, of being unable to “get enough air,” while at the same time taking deep breaths in and out with no visible difficulty. The rate of breathing may be rapid or normal. There is no abnormal sound to the breathing as in croup, bronchitis, or asthma. Temperature and color are both normal, and there is no cough. In fact, the deep breathing can be recognized as sighing, one sigh right after another, and lasting for minutes or hours. The cause is essentially the same as that of sighing: nervous tension, fear, anxiety, or depression.

If hyperventilation continues long enough, the person will experience tingling and numbness in the hands and feet, followed by spasms of the muscles that control the hands, fingers, ankles, and toes. This is caused by breathing out too much carbon dioxide. If hyperventilation continues long enough, fainting can occur. Unconsciousness temporarily cures the condition, and the person recovers.

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Obviously the prevention of depression is a vastly complex subject and involves many different facets of life.

•     Prevention begins in the cradle by breastfeeding totally and by ensuring that a child is brought up to feel wanted and loved for itself. The more stable a home life the child has the better, though some instability is inevitable and certainly will not necessarily produce depression later in life. Preventive measures are especially valuable in any family in which there is a history of depression or suicide, if only because clinical experience shows that both are more likely once they have been ‘sanctioned’ already within a family. Attending to a baby’s needs for food, comfort and attention as soon as he or she expresses them makes the baby think well of the world and tends to produce a less frustrated personality.

•     Healthy eating right from weaning will help too, especially in the prevention of hypoglycemia, premenstrual tension and certain other biochemical causes of depression.

•     Social causes are often unpreventable except with endless money, other resources and social engineering, but much can be done to alleviate loneliness and isolation in the young mother. The other social remedies are beyond the range of a book such as this.

•     Keeping off drugs unless absolutely essential is a very good preventive, simply because so many people are on one drug or another that promotes depression. Find other ways (perhaps from this book) of dealing with the underlying problems. Come off the Pill or try adding vitamin B6 if you are depressed while taking it.

•     Understanding what is going on during pregnancy and labour and a feeling that you have a say in what happens to you and your baby will help prevent post-natal depression. Try to choose a hospital that intervenes as little as possible, if only because it has been found that women who have forceps deliveries, Caesarean sections, and so on, have higher levels of post-natal depression than those who do not.

Keep your baby with you all the time, day and night, right from delivery. If at all possible the baby should be exclusively breast-fed for at least six months or so. This reduces post-natal depression in you and sets your baby up for the future both psychologically and nutritionally. Food allergies (now known to be a cause of depression) are less common in breastfed babies than in bottle-feds.

Lastly, watch that you don’t become overstretched physically and mentally. Take care of yourself and don’t push yourself too hard. Learn to relax, eat well.

By no means all depression can be prevented, but with some long- and short-term planning such as this it could be a greatly reduced burden on society and on families.

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It is not really possible to isolate any single part of a trial process as being independent of any other part. The whole procedure depends upon every aspect relating to the overall requirement. There are, however, some basic comments which may be aimed at the selection of trial procedures for new substances of therapeutic value.

Before a decision on the precise form of trial to use in order to assess the therapeutic value of a new substance is made, it is essential that the specific characteristics displayed by the substances are recognized. A decision which causes an inappropriate trial procedure to be adopted can result in valuable therapeutic properties being missed. Unfortunately, such decisions happen, possibly because the present system of trials is at fault in being rather narrow in outlook. The two main forms of trials used to assess the therapeutic value of substances in live subjects are known as the double blind and the double blind crossover procedures.

The double blind trial is one in which two groups of patients are used. One group is treated with the substance under evaluation and the other group with a placebo. Neither group of patients, nor the doctors actively engaged in the trials, know which patients are receiving which treatment. To do this the ‘active’ substance and placebo are coded so that no one other than the person holding the code knows which is which. The purpose of the double blind is to minimize the chances of psychological influence and personal bias being involved.

The double blind crossover trial incorporates the same procedure except that, after a period of treatment, the patient groups have their treatment crossed over. This means that patients who first received substance ‘X’ will now get substance ‘Y’, and vice versa.

In both types of trial the code is not broken until the treatment process is completed. In this way no one knows which substance is doing what until the final results are analyzed.

There is little to criticize in the principle of these trial procedures, as long as we bear in mind the factors which can influence any trial work on living subjects. The double blind trial seems to be soundly based an uncomplicated. From an outside viewpoint this trial procedure would seem to be the best one available. The same cannot be said for the double blind crossover trial, however. This procedure has some characteristics which make it a mo unsuitable choice except, perhaps, in special cases. Perhaps we can clarify this suggestion by carrying out an imaginary double blind crossover trial of our own using one imaginary substance.

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For those women who do not want to undergo breast reconstruction, but who want to restore the natural outline of a partially or totally removed breast, a wide range of artificial breasts, known as prostheses, is available. Breast prosthesis is worn inside the bra, and can be matched to the other breast to make it indistinguishable in terms of size and shape.

Temporary prostheses

Immediately following surgery, you can wear a light, temporary prosthesis which will not press on your wound as it heals. A breast care nurse or other specialist nurse will probably help you to choose and fit a prosthesis of this type before you leave hospital.

The commonly used breast shapes are washable and have a lightweight fibre filling which can be added to or removed to make them the correct size. They are simply placed inside your bra, which should be as good a fit as possible so that the breast shape remains in place. Safety pins or press studs sewn on to the prosthesis and the inside of the bra cup will also help to prevent the shape from becoming dislodged as you move.

Permanent prostheses

Some 6 to 8 weeks after your operation, or following your course of radiotherapy if you have one, a heavier, permanent prosthesis can be fitted to match the size, shape and weight of your other breast. These prostheses are made from silicone and have a skin-like texture. Although a silicone breast shape can be placed in a cotton cover which can be removed for washing, it is more often left uncovered so that it can mould to the contours of your chest wall. The cover may be useful if the prosthesis becomes uncomfortable or when you are hot.

Some manufacturers make tinted prostheses for women with darker skins, and the breast care nurse should be able to advise you about how to select the right one for your skin colour.

All the permanent prostheses have a nipple outline, but it is now also possible to have a separate, textured and pigmented nipple and areola, and these are available in a variety of skin tones. The nipple may be attached permanently or semi-permanently to the breast form. Although the artificial nipples look very realistic, they cannot retract and become erect, and it is now possible to have an artificial nipple to place over the nipple of your other breast so that the two always match.

A self-supporting prosthesis which will stick to their chest wall can be worn by women who do not have large breasts. Modern self-supporting prostheses allow complete freedom of movement and will stay in place during the playing of sports such as tennis, horse-riding and swimming. Sports bras are only normally necessary for any particularly vigorous sporting activity. This type of prosthesis is useful for women who do not normally wear a bra, and those who like to wear strapless dresses.

The silicone which gives the breast shape bulk and form may be too heavy for women with large breasts. Although pads worn under the bra straps may help to take some of the weight off the shoulders, if this does not improve the situation, a lighter prosthesis can be used, for example one with a silicone front and a foam-type infill. If you have any problems of this sort, your breast care nurse should be able to sort them out for you.

It is quite all right to swim when wearing a silicone prosthesis, as it should not be affected by sea water or the chlorine in a swimming pool. However, it is probably advisable to rinse it in tap water and dry it afterwards.

Although silicone prostheses do not usually cause skin irritation, they can occasionally do so, and if you do develop a rash or skin reaction, the breast care nurse should be able to advise you or refer you to a consultant if necessary. Very rarely, a woman may have an allergic reaction to her breast form, but skin irritation is more likely to be due to a sweat rash.

Take your time when making your choice of prosthesis. There is a wide variety available, and you should be able to find exactly the right one, particularly if you are assisted by an experienced fitter. A tight-fitting T-shirt or sweater worn when trying the different prostheses will enable you to get a good idea of their shape and how well they fit.

If you have had a partial mastectomy which has left your breasts only slightly different in size and shape, the breast care nurse will be able to augment your affected breast with a silicone shell, rather like a thin, scooped out prosthesis. Alternatively, a small, light prosthesis can be stitched into your bra cup.

Partial prostheses are also available in a range of sizes and shapes.

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Duphaston has been used to treat women with endometriosis in Australia for over 25 years. It has also been used to treat a variety of other conditions, including amenorrhea (absence of periods), dysmenorrhoea (painful periods), PMS (premenstrual syndrome) and abnormal uterine bleeding.

Duphaston is a progestogen (synthetic progesterone) which is very similar to the naturally occurring progesterone produced by the ovaries.

Duphaston is manufactured by Ethnor in the form of small, white tablets, each of which contain 10 milligrams of Duphaston. It is sometimes also known by its chemical name, dydrogesterone.

How Duphaston works

It is not known precisely how Duphaston eradicates endometrial implants because, unlike the other drugs used in the treatment of endometriosis, it does not stop menstruation and it does not usually stop ovulation at the dosages that are most commonly used. It is thought that Duphaston probably works by inhibiting the growth of the misplaced endometrial cells in some way, causing them to gradually waste away.

Dosages of Duphaston generally used

There are several approaches to the use of Duphaston for the treatment of endometriosis. The dosage recommended will depend largely on the practices of the gynecologist and, to a lesser degree, on the severity of the condition and the woman’s response to the treatment.

The majority of gynecologists will recommend 10 to 30 milligrams of Duphaston daily (one to three tablets daily) for six to twelve months. A few gynecologists will recommend taking the tablets cyclically from the 5th to the 25th day of the menstrual cycle each month for six to twelve months.

At these relatively low dosages most women will continue to menstruate and many will continue to ovulate regardless of whether the Duphaston is taken daily or cyclically.

In contrast, some gynecologists will recommend significantly higher dosages of Duphaston because they believe that the treatment is more likely to be effective if menstruation is stopped. These gynaecologists will generally recommend 30 to 60 milligrams of Duphaston a day (three to six tablets a day) for six to twelve months. The dosage recommended will usually depend on the response to the drug, the final dosage usually being the minimum required to stop menstruation and ovulation.

Although the usual length of treatment with Duphaston is six to twelve months there is no evidence that prolonged or repeated courses cause long-term side effects.

You should make an appointment to visit your gynecologist about six to eight weeks after you start your course of Duphaston so that you can discuss how the treatment is progressing.

Thereafter, you should visit every two to three months for the remainder of your course of Duphaston.

Duphaston can only be supplied under the Pharmaceutical Benefits Scheme for endometriosis if you have been definitely diagnosed during a laparoscopy or laparotomy and if your doctor fills in a special prescription form known as an ‘Authority’. If this is done one month’s supply of Duphaston will only cost you the maximum cost of a script under the Pharmaceutical Benefits Scheme as opposed to its full cost.

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Like the TCAs, antidepressants of the MAOI class raise the levels of crucial neurotransmitters, but they do so in a different way, by inhibiting the action of an enzyme called monoamine oxidase. This enzyme breaks down certain compounds in the blood. By keeping monoamine oxidase from doing its job, the drug allows higher levels of certain neurotransmitters to circulate.

Studies show that two MAOIs, phenelzine and isocarboxazid, effectively reduce or eliminate bingeing. The dosages are the same as those used in treating depression. Drugs of this class pose a somewhat greater risk of side effects, such as lower blood pressure, agitation, or sleep disturbances, than do the TCAs.

There’s another problem with MAOIs. Because they interfere with enzyme action, they affect the body’s ability to break down an amino acid called tyramine. Too much tyramine floating around in the bloodstream can cause problems related to high blood pressure, such as excruciating headaches, internal bleeding and even death.

Certain foods contain high amounts of tyramine. The list includes cheeses, wines, beers, pickled herring, liver, yeast extract (including brewer’s yeast), salami, pepperoni, bologna, yogurt, and fava beans. A patient should only take an MAOI if she understands the risk involved and agrees not to eat any foods containing tyramine.

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Everyone in Regina Owens’s life understands that nothing interferes with her workouts. After all, it was this kind of passion and devotion that enabled her to lose 65 pounds and reduce her dress size from a 22 to a 10.

Each day, Regina rises at 4:30 A.M. for a 5-mile walk. In the evening, after work, she packs herself and her kids in the car and drives 30 miles to a gym. While she lifts weights for an hour, her kids do their homework.

“Yes, I’m obsessive. But at least the whole exercise thing is a healthy obsession for me. That hasn’t always been so,” says Regina, a 46-year-old housing director from Eustis, Florida.

Indeed, before Regina latched on to exercise, she was eating too much and abusing sleeping pills—her ways of coping with the emotional strain of a difficult marriage. Turning her life around required that she pursue health as obsessively as she once had those destructive behaviors. “I needed to do something positive, and I needed to do it wholeheartedly,” she says.

She began by taking long walks around a lake near her home. During those walks, she thought about her problems and her desire to change. Within a few months, she was averaging between 8 and 10 miles a day. She began eating better, too, by reducing her fat intake, restricting sweets, and learning to control her compulsive snacking. She took up weightlifting and studied to become a certified trainer, which she now does as a sideline.

“To succeed, I knew I had to go at it full force,” she says. “Later, my motivation came from seeing my body go through this incredible transformation. I got leaner and fitter.

“Once that started happening, my workouts became something I needed to do,” she says. “Now, if I don’t get my workout in, I don’t feel like my day is complete.”

WINNING ACTION

Work with your personality, not against it. Concentrate on turning negative obsessions and behaviors into healthy passions and choices. Be obsessive, but in a positive way, if that suits your personality. If you’re more laid-back, focus on making small changes. Find the style that works for you.

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