We all evolve our own particular ways of coping with tension. Some people relieve it by “blowing their top” and ventilating their emotion, and in this way they dissipate their anxiety; some develop a studied calm in their approach to things; while with others the anxiety is concentrated in one particular limb or organ, so that the rest of the body is free. Other people cope with inner tension by making sure that they have everything just right. They feel that if everything is right there can be nothing to worry about. These are the perfectionists. They like everything neat and tidy and in order. This is likely to become an obsession with them so that they become preoccupied with it and spend much of their time checking things over time and again. In this way they are inclined to fuss over every minor detail. It soon comes about that there is no time for the really important things, for with all their attention focused on the details they lose sight of the main issues. There is a tendency for the mind to keep churning over some particular subject and be unable to make the normal transition to other subjects of thought. At the same time the need to have things just right leads to doubts about whether things are right or not. In this way the obsessive is continually in doubt, so that he becomes a constant worrier and has such difficulty in making up his mind that even trivial decisions may become a matter of great effort. He seems to see two sides to every question; and when it comes to some important matter, such as marriage or choice of occupation, he simply dithers and is unable to come to any decision.

Nevertheless, the perfectionist way of avoiding inner tensions works reasonably well in some circumstances. It is effective if the person is able to live a methodical routine way of life that allows everything to be neat and tidy and in its right place. But if something happens to change this way of life so that he can no longer follow set routines, then he becomes tense and anxious because his way of preventing tension does not work in the new set of circumstances.

This was the case with a young woman whom I have recently seen. She had been a very good nurse, in fact she had been top of her year because she was so neat and thorough that she always had everything in order. She liked her work and was free of tension as she was able to avoid worry by having everything in order. However she married, and quickly had two children. In the new circumstances with two babies to care for she was no longer able to have everything around her in perfect order. She could no longer cope with her inner tensions and broke down with severe anxiety.

Another perfectionist woman was successful in running a milk bar with her husband in a country town. Then they went to live on a dairy farm, but the presence of the mud and dirt from the cows so conflicted with her perfectionistic tendencies that she broke down with severe tension and anxiety.

*15/57/2*

So far we have considered the principal different types of epileptic seizures.

Paediatricians and neurologists recognize that certain clusters of symptoms and signs and patients’ characteristics go together, and this is what we mean by a syndrome. The idea of epilepsy syndromes goes back many years, but a revised scheme or classification of epilepsy was proposed by the International League Against Epilepsy (ILAE) in 1989. In this classification, an epileptic syndrome is characterized by both clinical and EEG findings. On the clinical side, the age at onset of seizures, the family history, the seizure type(s), and neurological findings are all relevant to the classification, as is the appearance of the EEG between and during seizures. Identifying epileptic syndromes allows greater precision of diagnosis and of prognosis than simply classifying seizure types.

The same type of seizure can occur in different syndromes. For example, tonic-clonic (grand mal) seizures can occur in association with typical absences (primary generalized epilepsy) or in association with partial seizures (location-related epilepsy). Conversely a person with one syndrome may have seizures of more than one type. For example, a child with primary generalized epilepsy may have both absence and tonic-clonic seizures (both petit and grand mal). Identifying an epileptic syndrome helps to select the most appropriate investigations, decide on the most appropriate anti-epileptic treatment, and to predict most accurately the outcome. However, it must be understood that even if an epilepsy syndrome is identified, this does not necessarily give any information about the underlying cause of the epilepsy. Indeed, one syndrome such as West’s syndrome may have several more or less well identified causes.

Many of the different epilepsy syndromes begin in childhood, and are best characterized by onset by age. However, it is important to think in terms of the two great divisions of primary generalized epilepsy, in which the seizure discharge is generalized from the beginning, and location-related epilepsy, in which the seizure begins in one particular part (location) of the cortex, even if the seizure then becomes a secondary generalized one. A location-related epilepsy usually implies some local structural damage to, or disorder of, nerve cells. One example would be seizures following a head injury.

Some syndromes have common features and a predictable outcome. For example, some children develop nocturnal partial seizures often occurring at night, and characterized by large EEG spikes over the central and temporal regions of the brain on one side. Others are rather loose collections of a few common characteristics irregularly linked together.

In the opinion of most experts, only about 40-50 per cent of children with epilepsy can be ‘put into’ an epilepsy syndrome. When these children cannot be ‘put into’ or classified into an epilepsy syndrome, then the children’s epilepsy must be classified according to the seizure type or types that the child is experiencing, and this used as the best basis for prognostic judgement.

The question of inheritance of epilepsy, but with the advances in genetic research, the classification of epilepsy syndromes may eventually become replaced by specific epilepsy disorders or diseases classified genetically. However, for the time being, the concept of epilepsy syndromes is of some use.

*14/188/2*

The discovery of cortisone was hailed by medical science as one of the milestones of medical progress. We all remember, about 15 years ago, how much enthusiasm and excitement there was, both among doctors and arthritis sufferers. The world was made to believe that medical science finally had conquered this baffling disease.

It didn’t take many years before it became evident that cortisone was one of those remedies which are so pertinently called “remedy worse than the disease.” The “miracle” drug was found to have so many dangerous side effects that now many responsible and conscientious practitioners would not even touch it.

Cortisone is a hormone and is normally secreted by the adrenal glands. Now it is manufactured synthetically. Many other related hormone drugs are on the market, such as prednisone and prednisolone.

Although it is recognized that a derangement of the functions of the adrenal glands and other glands of the endocrine system contributes to the development of arthritis, the artificial use of these hormones, especially synthetically produced ones, does not mean the same as support or correction of the body’s own impaired glandular functions. On the contrary, instead of rehabilitating and revitalizing the functions of the glands, these drugs only damage them further and may bring about a complete breakdown of the body’s own healing powers, as far as arthritis is concerned.

Here is a partial list of side effects caused by cortisone: peptic ulcers; osteoporosis (softening of bones) with spontaneous fractures; mental disturbances; psychoses; neuropathy or the degeneration of nerves; PSC (posterior subcapsular cataracts); acne; hirsutism (excessive hair growth, particularly in women); diabetes; hypertension; disturbance in the metabolism and utilization of protein and fats; reactivation of tuberculosis; retention of salt and water in the tissues with resultant strain on heart and kidneys;11 probable reduction of resistance to carcinogenesis (susceptibility to cancer); etc.

This list should be enough to discourage anybody from using this dangerous drug. It can damage the liver, the kidneys, the blood, the bones, the nerves, as well as other vital organs of the body.

Worst of all, cortisone therapy causes adrenal atrophy and undermines and disturbs the entire biochemical stability of the arthritic patient.13 Corticosteroid therapy has a damaging effect on the joints12 and can cause deterioration of the tissues of the joints.13 Once cortisone is taken or injected over any appreciable length of time, it will cause such a breakdown of the organs and the functions of the body that often it will be impossible to bring the patient back to a state of health again. The Swedish doctors, Karl-Otto Aly, M.D., Lars-Erik Essen, M.D., and Jem Hamberg, M.D.—the pioneers of biological medicine in Sweden, whom I spoke with in regard to cortisone therapy—all unanimously stated that by far the worst adverse effect of cortisone therapy, even worse than its toxic side effects, is its damaging and undermining effect on the body’s own healing activity. It is very difficult, often impossible, to successfully employ biological treatments and restore a patient to complete health if he has used cortisone for any extended period of time.

Cortisone is a diabolical drug. It suppresses symptoms of arthritis so well that the patient believes it has made him well-suddenly he can walk, run, dance. But this is only for a moment. When the effect of cortisone wears off, the patient feels worse than ever. So he becomes addicted to it, and the withdrawal symptoms grow more painful the longer he uses it. Discontinuance of cortisone therapy is, therefore, accompanied by a great deal of suffering.

It is evident from the above why cortisone failed to fulfill its early promise and why now it can be counted out as an effective arthritis remedy.

*14/176/2*

The operation most commonly used in an effort to permanently cure back troubles caused by one or more discs is spinal fusion. Much more popular in the United States than in this country, this is an operation in which two or more vertebrae are essentially welded together and any troublesome discs between them removed. There are various ways of performing this procedure, but the one used most nowadays involves both anterior and posterior fusion of the vertebrae, the spine being approached from the front (via the abdomen) and then through the back. The damaged disc is then replaced by a bone graft.

Just how good the results of spinal fusion are is still a matter for debate by experts as the operation so far has not been the subject of a properly-controlled trial. Certainly, there are many patients who have benefited greatly from spinal fusion; in other instances, the results have been less favourable. More may be known in a year or two about the true benefits – and risks – of spinal fusion as a trial to compare its results with those achieved through non-surgical rehabilitation programmes is being set up.

Laser disc decompression is an alternative way of dealing with bulging discs that is currently being pioneered in America, but it also remains the subject of some controversy about just how effective and free from long-term side-effects it is.

This method has proven itself useful in dealing with a disc that bulges but where no part of the disc’s soft centre is actually protruding from it, the pressure on the nerves resulting purely from the fact that the disc is larger than it would normally be.

Here’s how this procedure is performed. A silicon optical fibre is temporarily inserted into the disc. Energy from a laser is transmitted into the disc via the fibre and this causes the loss of water and some of the substance that makes up the centre of the disc. As the pressure within the disc is decreased because of the loss of material, it shrinks and pulls the offending bulge off the nerve root, so decreasing or eliminating the pain.

The procedure takes about 15 to 30 minutes, followed by two to three hours in the recovery room. The advantages of this method is that operating time and hospitalisation is kept to a minimum, and that it can be suitable for patients who are surgical risks, for example, those with heart trouble or age-related problems. The proponents of this approach say that there have been no major complications to date and the degree of success is about 80 per cent so far.

*14/124/2*

Apart from friendly bacteria, there are other “friends” which live happily in our bodies. Medical science calls them parasites. Their activity in a healthy body is limited to the intestines, which is, strictly speaking, outside the body proper.

In particular, humans are hosts to the “human intestinal fluke” (fasciolopsis buskii). Fluke means “flat” , because it belongs to a family of flatworms. If you eat meat and other animal products, you could have many more parasites like for example Eurytrema, the pancreatic parasite of cattle.

These parasites have to go through certain stages to multiply. A pure and healthy body can predict these stages, expel the eggs before they have time to hatch, and therefore we could live in symbiosis with our “friends”, because their population is limited.

However, very special processes occur if we have certain toxins in our body, called solvents. Examples of solvents are: benzene, all types of alcohol (propyl, wood alcohol), toluene, xylene etc..

The liver, kidneys, and other blood purifying organs in our body are overloaded with requests to process the above solvents, together with other toxins you take with your food, and they are unable to detect and kill tiny little stages of parasites, thereby allowing them to circulate around the body with the bloodstream. In addition, the existence of solvents forces thousands of parasite eggs to hatch prematurely. Flukes in various stages grow and multiply everywhere around the body, attaching themselves to any organ where favourable conditions exist.

Some of the possible consequences are listed below:

propyl alcohol : accumulates in your liver. Adult flukes occupy the liver, but eggs and other stages circulate and grow everywhere around your body, producing excessive amounts of powerful cell growth hormones, forcing your organ cells to divide. This is exactly what our Medical science calls cancer. 100% of cancer patients have propyl alcohol in their bodies.

wood alcohol (methanol) : accumulates in your pancreas and in the eyes. The favourite spot for adult flukes becomes the pancreas. Their activity causes diabetes. 100% of people with diabetes have wood alcohol in their pancreas.

benzene : this extremely toxic solvent (comparable in toxicity* to a radioactive uranium) accumulates in your thymus gland, gradually damaging it. Adult flukes colonise the thymus gland, which, by the way, produces T-cells, identified by our Medical Science to be related to the functions of our immune system. Fluke activity gradually reduces the capacity of the thymus gland to produce T-cells. When the thymus gland cannot produce enough T-cells, our immune system can fail completely. The condition of low T-cells count is what the medical profession calls AIDS (Acquired Immune Deficiency Syndrome). 100% of all AIDS patients have benzene in their thymus gland. If you have the tiniest amount of benzene accumulated in you thymus, your immune system is impaired and you get sick more frequently.

toluene and xylene: they go to your brain. Adult flukes colonise your brain and you develop Alzheimer disease.

Solvents in prostate: Adult flukes colonise the prostate and you develop chronic prostatitis. In the case of uterus: in the presence of adult flukes you develop endometriosis etc., etc..

The above are just a few examples of the many diseases caused by the existence of various toxins in our body, after our parasite friends have taken advantage of it.

*14/96/8*

Bleeding from the vagina at any time during pregnancy is a symptom that must be reported immediately to the doctor. In the early stages of pregnancy it could indicate an impending miscarriage.

But from the twenty-eighth week on, it could mean a serious complication which demands instant and expert medical care.

1. Placenta Praevia. Placenta praevia means that the placenta (later to become the afterbirth at the confinement) is located low down in the womb. Usually it is high up in the upper part. But sometimes it settles in this abnormal situation. Problems can occur if any parts of the placenta encroach on the outlet from the womb.

This means that when labour commences and it is time for baby to be born, the placenta must come first. This, of course, is quite impossible, and serious haemorrhaging, jeopardizing the life of both infant and mother, could result.

Therefore any bleeding occurring from the twenty-eighth week on must be regarded with care and suspicion. Usually there is no pain.

The doctor will admit you to hospital at once. If pregnancy is in the time segment between the twenty-eighth and thirty-sixth weeks, every effort will be made to let the pregnancy continue before any interference is made. This gives baby an improved chance of survival. Bed rest and medication is the regular method of treatment. Many cases settle down until the vital thirty-sixth or thirty-seventh week has been reached.

At this stage, the patient is taken to the theatre, given a general anaesthetic, and the pelvic area is examined. It is then frequently necessary to deliver the baby by means of a surgical operation called Caesarean section. This is through an incision in the lower part of the abdomen. The results of this operation are usually excellent, and it can be a life-saving measure for both mother and her baby. A blood transfusion is generally given, but recuperation afterwards is generally rapid.

2. Accidental Haemorrhage. This occurs very occasionally, in about 2 per cent of pregnancies, compared with the frequency of placenta praevia which is around 1 per cent.

The placenta (afterbirth) is located in the normal situation. For reasons that are not clearly understood, the placenta starts to come away from its usually firm adhesion to the wall of the womb. As this happens, bleeding must occur. Some appears via the vagina as a haemorrhage.

The degree varies, and the treatment also varies accordingly. In mild cases, if the pregnancy has not advanced to the thirty-seventh week, hospital care is given and every effort made to let the pregnancy continue. Blood transfusions are given, and medication ordered according to the patient’s condition.

When the thirty-seventh week has been reached and baby has a fair chance of surviving, labour may be induced, and a happy result is often the outcome. Sometimes, in more urgent cases, surgical intervention and a Caesarean section operation become essential.

*14/76/5*

Vanessa is a scientist in her mid-forties who has suffered from recurrent depressions for as long as she can remember. During her depressed periods, which can last for months at a time, Vanessa withdraws from others, needs to sleep a great deal of the time, has difficulty concentrating and feels sad and worthless. Although a highly intelligent woman, she lacks confidence in her abilities and for many years worked in a job that was beneath her skills and qualifications. She was reluctant to ask her boss for a promotion, however, as she questioned whether she deserved it and feared that her request would be denied, which would confirm her sense of worthlessness.

In the past, Vanessa was treated with Lustral during the worst parts of her depression, requiring dosages of as much as 150 mg per day in order to obtain therapeutic effects. Although the medication removed the most painful aspects of her depressions, it also sedated her. In addition, she felt that it took away her range of feelings so that she was unable to respond fully to the events in her life, unable to muster great joy in response to good news or feel appropriately sad when bad things happened. As she described it, T felt zombified,’ and for this reason she would discontinue the medication shortly after emerging from her depression.

Vanessa happened to be in one of her depressions when St John’s Wort was becoming widely publicized in the US and she decided to try the herbal remedy at the dosage of 300 mg three times a day. After a few weeks she felt it was helping her – but now, instead of her feelings being flattened out, she felt greater swings in mood than before. Within the same day her mood would fluctuate several times from good humour to despair and discouragement. On the advice of a psychiatrist, Vanessa added Lustral to the mix, trying only 50 mg per day, one-third of the amount that she had previously required. For the first time in her life, she felt good in a sustained way without feeling medicated. As she put it, T feel like myself at my best all of the time. I get upset when things go wrong and happy when they go right, but they feel like normal feelings, not depression nor like being a dull zombie.’

Since feeling better, Vanessa has managed to travel and socialize much more freely and happily than had ever previously been possible. She has also plucked up the courage to ask her boss for a promotion, which he readily agreed she deserved and promptly took the necessary steps to make happen.

In another patient of mine, a combination of Prozac and St John’s Wort appears promising. The young woman in question wanted to switch from Prozac 20 mg per day to St John’s Wort because she had gained weight while on Prozac. Several weeks after the switch she began to feel depressed and we decided to restart her Prozac at a lower dosage of 10 mg per day in conjunction with the St John’s Wort. This combination appeared to hold her depressive symptoms in check, but we have yet to see whether it helps her to lose the weight she gained on the higher dose of Prozac.

The lesson to be learned from this young woman and from Vanessa is that one does not have to choose between herbal and pharmaceutical anti-depressants. The best outcome may come from mixing the two. I would not, however, recommend trying such mixtures on your own, since medications can interact adversely as well as favourably and one is best off having a doctor involved to minimize the chance of that happening.

*14/75/2*

Q. Patient compliance. What does that mean?

A. Many people are professional pill-takers. They seem to love it, and will avidly watch the clock, work out large, written schedules and so on, and take their medication exactly as ordered by the doctor, come what may.

But on the other hand, many patients are just the opposite. They hate medication, and dislike swallowing tablets for any reason. Therefore, they tend to forget, often by coincidence, but also, often on purpose. This is called patient non-compliance — the patient is not sticking to, or complying with, the doctor’s recommendations. After all, the physician is recommending a routine which has been carefully worked out by the people who invented and researched the medication which is known to give the best possible results. So, by not complying, the patient is reducing the chances of the medication doing its prescribed function. That means, in healing the ulcer. From experience, doctors know that, in the main, the fewer tablets required, and the fewer actions needed, the more likely will the patient comply. Therefore, if medication taken once or twice a day gives the same benefits as medication taken four times a day, then so much the better.

Q. Do you think some patients start and stop medication willy nilly, just as they see fit themselves?

A. Most certainly and this is unwise, especially with cimetidine treatment. Many incorrectly translate symptom removal (or more correctly, pain removal) as a sign that the ulcer has healed, when in fact it has only commenced to heal. So they cease medication, only to find the pain rapidly returns. Often they will foolishly condemn the medication or the doctor when in truth it is their own fault entirely. This note is re-injected here to point out the desirability of compliance to directions.

Q. In short, the patient should read the label and do as it says?

A. Certainly. The doctor will tailor make the prescription routine to suit the patient, whether it be twice or four times a day, or any other system. From time to time, experience indicates that variations are desirable for the individual patient, and these may be translated into specific instructions. Please … follow your physician’s advice on medication at all times, and adhere to it rigidly. That is the best advice today.

Q. After a patient has been relieved of his symptoms, and has taken medication as prescribed for the requisite length of time, what then? Is he cured forever, or, did I hear you say earlier, recurrences were possible?

A. Although symptoms subside rapidly, and the ulcer heals more slowly, the majority may be cured of their ulcer with therapy. However, once treatment stops and acid production resumes, recurrences are likely, and do take place in many patients.

Q. So what is the answer to ulcer recurrence?

A. At present, the line of thinking is to keep the patient on a small maintenance dose of cimetidine. This will keep the acid levels of the stomach at a much lower level than in the pre-treatment era, and this may effectively prevent recurrences in many cases. The drug appears to be very safe, and it seems that long term therapy may be the ideal. The drug has not been available for a sufficiently long period of time to be absolutely certain of all this, but this is the current trend of thinking and line of therapy. So far, it appears to be working very well.

*14/61/2*

For many of us, our first massive over-exposure to an allergenic substance comes when we are babies. The substance is usually food. Up until the age of ten months the cells lining the wall of our intestines are still so under-developed that they are not able to absorb foods selectively. As a result, all foods are absorbed rapidly. This is the way nature has planned it. Up until that age we are supposed to be on mother’s milk exclusively and absorbing from it, not only nutrients, but her antibodies as well.

As antibodies are whole proteins and very large in size it is important that the intestinal cells be under-developed. Otherwise the antibodies would be too large to pass from the digestive tract into the blood. The passage of the mother’s antibodies to the child in this way is called passive immunity and is important for the development of the child’s resistance to disease.

Problems begin when solid foods such as eggs, meat, fish, chicken, cows milk and cheese are eaten before the cells of the intestine are fully developed. Because the baby’s intestinal cells are under-developed, proteins from these foods are absorbed into the blood. The proteins are not broken down into amino acids because the baby’s pancreas is not yet sufficiently developed to produce the digestive enzymes needed to do this.

Amino acids are the result of fully digested protein and don’t elicit allergic reactions in the blood. Whole proteins, on the other hand, are undigested foods and do bring about allergic reactions. Undigested food proteins are allergens.

*14/18/9*

There are a few more aspects of epileptic seizures that require explanation.

Some people may have a warning of seizure. The first type of warning is a vague feeling of an impending seizure, particularly before a tonic-clonic (grand mal) seizure. This prodrome may last several hours. It has no obvious physiological explanation, but it is remarked upon too often by people to be lightly dismissed as due to imaginary reconstruction of events. The prodrome is usually unpleasant—a feeling of mental heaviness or depression. Less commonly, elation and energetic activity may herald a seizure. The second type of warning, known as an aura, is not really a warning at all, but the initial symptom of the seizure itself. Examples of such auras include the epigastric sensation of partial seizures arising in one part of the temporal lobe, or the brief tingling in one hand which precedes a partial seizure arising in the parietal lobe which rapidly generalizes to a grand mal seizure.

Another phrase requiring definition is post-ictal paresis. An ictus is another older synonym for a seizure. Post-ictal paresis indicates weakness of left or right limbs following a convulsion primarily affecting those limbs. Sometimes known as Todd’s paresis, after the neurologist who first described it, it indicates some structural problem in the hemisphere on the side opposite to the weak limbs. The weakness may last from a few minutes up to 48 hours. Post-ictal amnesia, post-ictal confusion, post-ictal sleep, and post-ictal headache have already been described.

Post-ictal automatism is the phenomenon in which a person can undertake some fairly complex act, such as undressing and putting themselves to bed, of which they have no subsequent memory. Status epilepticus is a phrase used to indicate seizures occurring so close together that one seizure runs into another, without recovery of normal cerebral function between seizures. This may happen with any type of seizure, so that a neurologist speaks of absence status, partial status, or tonic-clonic (grand mal) status. In the first two types, the diagnosis may be difficult to reach unless the subject is already known to the doctor. The person may be found in the street or at home confused and inaccessible to conversation because of continuing seizure discharges.

Grand mal status epilepticus, in which the person does not recover consciousness between generalized tonic-clonic convulsions, is a medical emergency. The lack of normal respiratory movements, in association with the extreme muscular contractions during the seizures, throw a considerable stress upon the cardiovascular system.

Finally, a partial seizure in which the seizure discharge continues but remains confined to one part of the motor cortex results in continuous twitching of muscles in one part of a limb on the opposite side of the body. For example, the index finger and thumb may continue to twitch for days or even weeks, without any spread of seizure discharge to other muscles, and with no disturbance of consciousness. This is known as epilepsia partialis continua.

*13/188/2*