What was she so upset about? She never forgot it. She still talks about it. So what? I told her I was Catholic when we first met. Big deal. I’m Jewish. Same thing.

HUSBAND

Once the message is sent, received, and acknowledged, phase three tends to dominate the interaction. While it would seem that the two persons would be ready to open up to one another, in fact the opposite is true. Now that something important is at stake, a real possibility of a lasting bond, both persons seem to go into “projective” posture.

Persons in the deceptive phase begin to present the “they” that they would like the other person to perceive they are and each of us desperately wants to be. The projected image is not realistic, however. Deception here is as much of self as of the other. The impact on marriage is severe, for it is at this phase that many marriages occur, bonding between two projected images. Partners believe in the “magical mystical healing powers of marriage,” that marriage will somehow in some way solve any problem. The more idealistic the projected images, the more denial is employed, and the more denial before marriage, the more disappointment in marriage. It takes a great amount of energy to keep denying how we really are, and “leakage” occurs. On some level, it takes recognition of what is being denied to maintain the denial, and the recognition is present in both partners. They continue, however, to trust in the illusion of the healing power of marriage without presenting the “real patients.”

One clear dimension of bonding emerges so far. Marriage will only make any problem worse, and that applies most directly to any sexual problem. It probably explains in part why second marriages are almost twice as likely to divorce as first marriages. Marrying at the “deceptive phase,” the time of projection of image, is a mistake. It can be corrected through techniques to be described later, but it is one of the major contributions to the high divorce rate in our country. One of my clinical rules is to tell spouses, “Never divorce someone you don’t know, and be sure you start with yourself.”

*50\97\8*

The attack may be accompanied by a fever which lasts for two to four days, and there may be typical virus infection symptoms such as aches and pains and tiredness. The lymph glands in the area may be enlarged and tender. Pain many be felt in the area supplied by the sensory nerve and mistaken for a muscular pain or a strain.

Some four to eight days later, the typical rash appears. It starts as a reddening of the skin, then small blisters filled with a clear fluid develop. They dry up and scab, and finally disappear to leave scars which may persist for months or occasionally years.

If the infection is severe or if the person’s immunity is low, the condition may spread, resulting in a few vesicles like those in chicken pox on other parts of the body. Sometimes the infection can extend along the spinal cord. Occasionally the motor cells of the front of the spinal cord are involved, and this can cause weakness or paralysis of muscles.

The most common area affected is the trunk, when the thoracic part of the spinal cord is involved. But it may affect other areas and the lesions extend down the arm or leg.

*559/71/1*

Diabetes may show itself for the first time during pregnancy. Strict control is necessary to reduce the risk to the baby. Babies of diabetic mothers tend to be premature, to weigh more and to be at increased risk of developing abnormalities. Control of the diabetes during the pregnancy reduces these risks.

The symptoms of diabetes may be increased thirst, the passing of large quantities of urine and weight loss. Other symptoms are tiredness, muscular weakness, urine infections and thrush. In the juvenile onset type, the person may be thin.

The illness may rapidly progress to ketosis, where the body starts to burn up its fat reserves and acetone is noted on the breath and the urine contains ketones, breakdown products of fat. This can lead to coma and death.

Infection may be the precipitating factor in bringing on the diabetes or in leading to coma in known diabetics.

Those with juvenile onset diabetes almost always require insulin. This must be given by injection as it is destroyed in the stomach and therefore cannot be taken orally. It is prepared from either beef or pig pancreas.

*302/71/1*

Is your child hyperactive? Does he show impulsiveness, poor co-ordination and a short attention span?

The term hyperactivity, or hyperkynesis, has now given way in medical circles to “minimal brain dysfunction”.

In children with this condition, there is no demonstrable cause and it occurs in the absence of other neurological abnormalities.

There are some doctors who deny that such a syndrome exists; they feel it is merely an attempt to put label on a group of children who are more difficult than others.

Certainly, most children seem to grow out of this problem but it may still cause them and their parents a great deal of worry and trouble.

Treatment has always been unsatisfactory. Sedatives, antidepressants and even stimulants like amphetamine have been used with less than moderate success.

In 1974, Dr Ben Feingold claimed in the U.S. that he had produced a dramatic 50 per cent improvement in hyperactive children by placing them on a diet which excluded naturally occurring and added salicylates. Other food additives and colorings were also placed on the banned list.

This diet has been widely used in Australia and the U.S., but results so far are still equivocal. The advocates of the elimination diet claim it works well and the sceptics claim any response is due to the placebo effect.

The diet is very restrictive and easily broken, either by accident or design.

The diagnosis of hyperactivity or minimal brain dysfunction, should not be made by the parents but by a doctor skilled in dealing with these cases.

Parents should be wary of starting their children on a restrictive diet without the advice of a dietitian.

Treatment with a drug methylphenidate, marketed as Ritalin, has been shown to give good control for most children.

*52/71/1*

It is possible to find some types of cancer before any symptoms have developed, that is, while a person is still perfectly healthy and has noticed absolutely nothing wrong. This is discussed at the end of this chapter. However, most cases of cancer are diagnosed after one or more symptoms have developed. I described ni.mv of these early warning symptoms in the last chapter.

How do we go about finding the cause for such symptoms? There are two essential, basic steps. First, we have to find some of actually seeing the source of the problem. Second, if it looks at all suspicious of cancer, we have to obtain a specimen to be examined under the microscope. A word that is often used in tHerring to the trouble spot is lesion. This is a general word winch covers any abnormality, not just cancer. Because it is so Ui-neral it is a useful word to use when we don’t know exactly what the problem is.

*59/40/1*

If you had a premature menopause, especially as the result of the removal of both ovaries, and either can’t or won’t take HRT, then you should take steps to reduce your chances of getting osteoporosis. The two main medical treatments currently available for osteoporosis that don’t involve oestrogen are calcitonin and etidronate.

Etidronate. Marketed as Didronel PMO, this is a breakthrough in the non-hormonal treatment of osteoporosis of the spine. It, too, appears to work by reducing the activity of die osteoclasts, and trials show it can lead to a small increase in bone mass and to a reduced risk of fracture. It is taken on a cyclical basis: 14 days of etidronate, followed by 76 days of calcium supplements. Etidronate is not the right treatment for everyone, and because it has not been available under general prescription for very long, many GPs are rather uncertain about which patients it is most suitable for, but if you send an s.a.e. to the National Osteoporosis Society, they will be able to give you (or your doctor) more information.

*70\42\4*

Fluid is sometimes used in the pelvis before a hysteroscopy to separate the abdominal organs. Could you explain why fluid is used instead of gas and the reasons why one or the other may be used? Do they have any adverse effects?

The procedure of hysteroscopy can be used for diagnosis or treatment, but in either case the uterus must be filled with something so that there is space for the hysteroscope to move about. The materials most commonly used to achieve this are carbon dioxide gas, or fluids such as glycine, dextrose, sorbitol/mannitol, saline and dextran.

Carbon dioxide has been found to be particularly useful for diagnostic hysteroscopy, but it has limited usefulness during surgery because blood causes the formation of bubbles that obscure the view. Consequently carbon dioxide gas tends to be reserved for diagnosing the cause of a problem, while fluid is the norm when hysteroscopic surgery is performed.

Occasionally the fluid or the gas is absorbed into the bloodstream, causing significant problems including an electrical imbalance of the body fluids, fluid overload, or swelling in the lungs or brain. There are several effective methods to prevent complications associated with the absorption of gas or fluid, the most important of which is for the medical team to keep a meticulous record of the amount of material instilled in the uterus and recovered from it.

Who should I see about heavy and prolonged bleeding around the time of menopause?

It would be a good idea to see a gynaecologist as heavy and prolonged bleeding near the time of menopause may be due to cancer. This possibility must be excluded before you embark on treatments such as drug therapy, endometrial resection or hysterectomy.

*83\198\4*

The power of suggestion. Whilst in the hypnotic state, the person’s awareness is narrowed but is heightened and sharpened. So the suggestions of the hypnotist are totally received with minimal rejection. There are some very good hypnotic subjects who can go into a very deep hypnotic state. They can see imagined objects suggested to them or they can abolish the perception of pain if the appropriate suggestion is given. Hence hypnosis has been used in the management of chronic pain. The suggestion can also be made to change certain behaviours, and this has been used successfully to treat people who wish to give up smoking. The suggestion that the person can relax easily at night re-establishes confidence in sleeping and is very useful in some cases of insomnia.

Memory and age regression. Another most interesting feature of hypnosis is its influence on memory. People under hypnosis can remember things that they cannot remember whilst in the fully awake state. They can be taken back in time, to relive a period when they were much younger, this is called age regression.

Post-hypnotic suggestion. This is another unique phenomenon in hypnosis. Whilst under hypnosis, it is possible to suggest to the person that after he wakes up from the present trance he will perform a task such as blowing his nose when the hypnotist gives a pre-arranged signal. The person is then awakened from hypnosis, and may have apparently forgotten what went on whilst under hypnosis. After a while, conversations unrelated to hypnosis take place; then the hypnotist, without warning, claps his hands, which is the pre-arranged signal in this case. The person, seeing the signal, starts to have an irresistable urge to blow his nose. He may make some excuse that his nose is itchy and then blow his nose. Most people feel uncomfortable until the posthypnotic suggestion is carried out.

*85\174\4*

In ordinary circumstances pain hurts. Because it hurts we react to it. We therefore rarely experience pain in pure form.

I have warned you that some of these ideas are at first a little hard to accept. This idea is basic to our management of pain, so please go along with me.

You can actually prove this easily enough. Take a pin and stick it lightly into your forearm. It hurts, you screw up your face and perhaps say “Ow” under your breath. You would tell me that the painful stimulus hurts, and you react to it. This is not quite true. I do not think that there is a time sequence to these two events—the hurting and the reaction to it. I think they occur together, or the reacting may in fact precede the hurting. This is also easy to prove. Now decide to yourself that you will stick the pin in yourself again, but this time you will not in any way react to it. Make sure your face muscles are calm and easy. Now stick in the pin. Yes, you feel it. But this time there is no hurt. If we do not react to it, there is little or no hurt in the painful stimulus. At the same time we feel it. The sensation that we feel in these circumstances is some approach to pain in pure form.

It is important that we fully understand this, and know it to be true; so repeat the little experiment on yourself, and also do it to a friend.

We must conclude that pain is not an unbearable sensation, provided that we do not react to it. This is true of much more severe pain than a pinprick.

*107\57\2*

Q. Okay, let us start with the x-ray examination. The patient is referred to the radiologist for this. What takes place?

A. When making the appointment, the patient is given instructions, and it is essential these be carried out exactly. Usually, not eating food or drinking fluids for a certain number of hours before the examination is recommended. Unless this is strictly adhered to, it could ruin the pictures, and so negate the value of the test. Sticking to the recommendations is essential.

Q. How does the barium come into the picture?

A. When you arrive for the test you will be given a glass of fluid which has been flavoured to mask the otherwise rather unpleasant taste of the barium. It doesn’t taste too bad, although many still complain. Really it is a small price to pay for a correct diagnosis. The barium enters the stomach, duodenum and bowel, and coats the lining with particles which accurately show their outline during the x-ray examination. The doctor may also give you a tablet to take which gives a feeling of fullness, but this is also important to make the pictures much clearer. It should not be burped up.

Q. Is the examination painful?

A. Fortunately, it does not hurt, for you cannot feel the x-rays going through the body. You will be placed in numerous positions, usually lying on an examination table which isn’t too comfy. You may be tilted from a standing to lying position, and turned this way and that, on one side then the other, and asked to hold your breath whilst he pushes his buttons. The tummy might be pressed.

You may be given an injection to ease down stomach movements. This may make you see double for a short time, and is worth knowing about beforehand, for it is better to have somebody present to drive you home later in case there are temporary difficulties.

Q. Does it take very long?

A. The whole examination takes about 10 to 15 minutes. You are awake the whole time, and will probably be given verbal instructions to follow. Try and co-operate as much as possible for this helps the radiologist arrive at a correct diagnosis. In some offices you may be able to see what is going on, for television screens are now widely used, and you can actually see your own inside in glorious black-and-white (sorry, no colour yet) on the screen. The doctor usually takes a series of pictures which will demonstrate the ulcer in various positions. Also, if there is any other pathology present, such as a hiatus hernia, or growth — hopefully not, but one may be present in the stomach, often with few if any symptoms.

Q. How does the patient feel afterwards?

A. After the examination there are very few if any unpleasant effects. Occasionally the injection (if given) may cause blurring of the vision for a while, but this soon passes off. Constipation is common for a day or two due to the barium, and a laxative may be recommended. A mild one is best, or bran with breakfast for several days, or prunes, or raisins and figs can often do a better job than artificial medications. Today, there is a swing away from laxatives.

Q. Are these examinations safe for pregnant women?

A. Today, great care is taken to avoid x-rays as far as possible during pregnancy, for it is believed the rays may be harmful to the developing baby. So, this diagnostic test may be delayed until after the baby is born, unless it is urgent. In any case, with women in the reproductive age groups, the ‘Ten Day Rule’ is now widely applied.

This says that x-rays are carried out only in the ten day interval immediately following the start of a normal menstrual period.

During this time the woman is not likely to be pregnant, for ovulation has not occurred. After this interval of course, ovulation and possible pregnancy is a chance, and is a risk better avoided. This of course applies to women who are not taking active contraceptive measures. In any case, efforts to avoid exposure of the reproductive organs may be made.

Q. Are x-rays always accurate, and do they always diagnose ulcers or are they sometimes missed? I have heard all kinds of stories.

A. One must remember that x-rays are only shadows, and despite the skill of the radiologist and his experience, ulcers may be missed. It is claimed that these examinations will correctly pick up 70-80% of peptic ulcers. Some claim the figure is higher, some lower. If it is a definite ‘positive’, then the ulcer is certainly present. If it is ‘negative’, and symptoms are present, then an error is possible. The doctors always do their best, but some cases are very difficult, especially if the ulcer is small and very shallow.

Q. What happens after this examination?

A. The results are delivered back to your doctor, and in due course you contact him again, and he goes over the results in detail. If you have an ulcer, treatment will follow.

Q. What about the other form of investigation you mentioned?

A. Endoscopy today is very widely carried out, and some doctors prefer this to start with, eliminating the x-rays. On the other hand, some doctors prefer it as an adjunct and have both performed. In my opinion, as x-rays are known to have possible harmful effects in some people, and are inadvisable in pregnant women, the endoscope is often quicker, more accurate and a better form of investigation.

*10\61\2*