The condition where the fingers go cold, white or blue in response to exposure to cold is called Raynaud’s phenomenon first described by Maurice Raynaud, a medical professor in Paris, in 1862.

We now call Raynaud’s disease only those cases which appear to occur spontaneously and use the term Raynaud’s phenomenon for those where there is a definite underlying cause.

The disease is more common in young women but young men are also affected. The nerves which control the arteries of the fingers appear to be oversensitive. The arteries may go into spasm and prevent any blood flow under a variety of stimuli.

This may be exposure to cold such as going out in cold weather, putting the hands in cold water or just reaching into the refrigerator. Emotional factors may also play a part.

Raynaud’s phenomenon may occur in a number of potentially serious disorders such as systemic lupus erythematosis, polyarteritis nodosa and scleroderma. These are usually regarded as auto-immune diseases, where the body, as it were, develops allergies to its own tissues, producing antibodies which cause inflammation. The blood vessels are involved in this inflammation.

Buerger’s disease involves inflammation of both arteries and veins and is believed to occur only in smokers. Workers using vibrating tools may develop Raynaud’s phenomenon after many years.

Treatment consists in treating the underlying cause, if there is one. Some cases may respond to the use of drugs to dilate the arteries. Cutting the nerves which constrict the vessels may be of some use.

Most cases of Raynaud’s disease require no treatment, only care in avoiding the precipitating factor of cold exposure.

*547/71/1*

The person may feel that no one really cares for him. He may blame others for his problems. The depression may deepen and self-pity turn to self-blame and guilt.

He feels he is letting down his family, his employer and his friends. He assumes he is worthless and nothing can help him.

Depression may not get deeper but may arrest at any level or persist for many years. Some people are chronically depressed.

Depression may be masked and thus not recognised by doctor or patient. This is more common in those individuals who cannot accept the idea of emotional illness and regard it as a sign of weakness.

This depression may show more in physical symptoms. Pain, particularly chronic pain, may be the means of a person expressing his underlying depression. This pain is real, not imaginary or a form of malingering. The doctor may recognise that the patient is depressed but believe the depression is the result of the chronic pain rather than the cause of it. Treatment of the depression will usually relieve or minimise the associated pain.

*290/71/1*

Diphtheria, the severe disease of childhood, is now rare, mainly due to widespread immunisation.

But we should not be complacent and neglect to immunise our children as isolated outbreaks still occur, especially in unimmunised children, and the germ is still common, even if the infection is rare.

Some people, especially adults, while not actually developing the disease, may be carriers and cause its spread. They harbor the bacterium in their nose and may infect unimmunised people.

Many adults have a waning or poor immunity to diphtheria, but can be “boosted” by having an injection. Diphtheria vaccine is combined with tetanus vaccine and is available to adults.

When having a tetanus “shot” to bring this immunisation up to date, it would be valuable to have a “shot” of adult CDT, that is, combined diphtheria and tetanus vaccine.

Triple Antigen is the usual vaccine given to babies. This contains vaccines against diphtheria, tetanus and whooping cough. The whooping cough vaccine is prone to cause reactions in older children, so is dropped from the vaccine for this age group and CDT, combined tetanus and diphtheria vaccine, used instead.

*39/71/1*

Without effective treatment, the primary cancer continues to grow at a fairly steady rate, pressing on, and eventually growing through, nearby structures. Sooner or later, nearly all untreated

or unsuccessfully treated cancers give rise to secondary growths.

For each particular type of cancer, there is a characteristic or average pattern. For example, a cancer starting in the bone usually spreads through the bloodstream very early, and the first

secondary growths are nearly always in the lungs. A cancer starting in the bowel usually takes quite a few months before it metastasizes. It then generally goes first through the lymph

channels and next through the bloodstream. The first blood- borne secondary growths usually appear in the liver. Of course, as with all averages, we do not see the same pattern in every

individual. One person with a bowel cancer may not have any warning signs of the disease until a complete blockage of the bowel develops. At the operation, the surgeon may find no traces

of cancer elsewhere. Another person with exactly the same size primary bowel cancer could have multiple secondary growths in the liver, with no symptoms at all from the primary tumour.

Everyone is different, but there are average or usual patterns to guide you and your practitioner in best planning your tests and treatment.

*47/40/1*

There is a list of relative contraindications to HRT, that is those conditions in which you and your doctor will need to consider the balance between the risks and the benefits:

• Angina, or if you have a family history of heart disease, was previously thought to be an absolute contraindication, but with research now showing that HRT can offer positive protection against heart disease, medical opinion is changing about this. Your doctor will be able to advise you according to your particular condition, and may suggest a non-oral type, such as the patch or implant.

• The risk if you have had deep vein thrombosis depends on how any previous thrombosis occurred. If it first occurred after you had been bedridden for a long time because of illness or a major operation, such as a hip replacement, and especially if it happened long before the menopause, then your doctor may feel it is unlikely to happen again in normal circumstances, so HRT would probably be possible. However, if the thrombosis occurred for no apparent reason, then your doctor would probably want to investigate it, and may then decide against HRT in your case. If the thrombosis occurred while you used the contraceptive pill, he will probably advise against HRT.

• Diabetics can usually take HRT safely, but as it can affect the way carbohydrates are broken down in the body, very careful monitoring would be necessary, and the diabetes would need to be stabilised before a course of HRT was started.

*57\42\4*

For most women, hysterectomy does not adversely affect sexuality. In studies of the effects of the operation on sexual interest and response, a minority of women — between 7 and 20% depending on the study — report some decrease in sexual function after hysterectomy. About the same proportion report an improvement, and more than half report no change. When partners of women who have had the operation are asked about its impact on sexuality, many have no comment, over a third say they are happy their partners had the operation for reasons such as removal of the fear of an unwanted pregnancy. A small minority express dissatisfaction saying things like the vagina is ‘too tight’ or ‘too dry’.

Although the overwhelming consensus from recent studies that have followed women through the experience of hysterectomy is of a clear reduction in the disabling symptoms that lead to surgery, many women continue to have concerns about the effects of hysterectomy on sexuality and sexual function. The picture is complex because at around the age when most women have a hysterectomy they may also be starting or passing through menopause. The changes associated with this transition may themselves have an impact on sexuality and sexual function and these may be incorrectly blamed on the hysterectomy.

Doctors have been aware of sexual difficulties in a minority of women who have had a hysterectomy and have sometimes attributed it to post-surgical depression or concerns about self-image. These conclusions have been questioned in recent years, with an increasing number of medical practitioners and sex therapists suggesting that the procedure itself contributes to post-surgical difficulties in some women. Our ignorance of the role of the uterus and cervix in sexual response may be partly responsible for the occurrence of these difficulties.

A generation ago, it was believed that a woman’s major sexual response was centred in her clitoris and vagina. Recent research suggests, however, that for some women there are sexual sensations associated with the uterus itself. In the process of performing a hysterectomy, major arteries, veins and nerves that flow to and from the uterus are inevitably cut. It is possible that this interference may play a role in the sexual dysfunction reported by some women after hysterectomy. For some men, too, sexual satisfaction and response may be influenced by the presence of the cervix, against which the penis taps during intercourse.

There are several main ways in which hysterectomy can change sexual response. These changes may be either positive or negative.

• Removal of the fear of pregnancy may allow women and their partners to engage in sex with fewer inhibitions.

• Reduction or elimination of heavy and prolonged menstrual bleeding may enhance the experience of orgasm and intercourse.

• This same positive outcome may occur as a result of removing adhesions, fibroids and other causes of chronic pelvic pain when the uterus is taken.

• Alteration of the size and shape of the vagina during the surgery may make the sensations associated with sex more or less pleasurable for one or both partners.

• Removal of the main part of the uterus may eliminate pleasurable sensations associated with its contraction and movement. These sensations may occur during sexual foreplay, for example when the clitoris, breasts, vulva and vagina are touched, as well as during intercourse.

• Removal of the cervix may reduce sexual satisfaction. This is because of the pleasure that a woman and her partner may derive from the tapping of the penis on the cervix during intercourse.

• Creation of new scar tissue in the pelvis or vagina as a result of a hysterectomy may cause intercourse to become more painful.

• Changes in hormone production, particularly marked if the ovaries are removed at the time of the hysterectomy, may lead to intercourse becoming less pleasurable. These hormone changes — which tend to be more acute than when menopause occurs without surgical intervention — may result in several ill-effects. Decreased oestrogen levels may be associated with a general drying and thinning of the vagina. This may in turn result in painful intercourse, and severe night sweats and insomnia leading to feelings of fatigue. A decreased output of androgen hormones, including testosterone, by the ovaries may also reduce sexual interest (libido) in women. ‘Psychological effects on either partner, related to feelings of loss of the uterus, may lead to decreased pleasure in intercourse. This is more likely to occur if intercourse has been valued mainly for the children that may result from it.

*71\198\4*

According to The Oxford Dictionary, hygiene is the principles of maintaining health, such as by cleanliness. There is one part of hygiene which maintains good health at night and promotes sleep. This is ‘sleep hygiene’, and this has become standard terminology among sleep experts. There are five important items that are relevant to sleep hygiene and which are essential for the problem sleeper to consider: Drinks, Bedroom, Clocks, Biological clocks and Regular exercise.

Practising good sleep hygiene is an important alternative to taking sleeping pills.

People who do not work or take any exercise during the day will have too much time on their hands. They will tend to have frequent naps during the day and will not need as much sleep at night. For them there is not much difference between the activities during the day and those at night. These people do not accept the fact that they have already had too much sleep in the day and do not need much more sleep at night. They believe they are suffering from insomnia. A good day is normally a busy active day, so that in the evening you feel tired, as if you have achieved a lot and have earned a good night’s rest Regular exercise will keep your body healthy, keep your muscles strong, your heart and circulation in good shape, and also let off any tension that has accumulated in your body. It has been shown that exercise increases the amount of NREM sleep. However, if strenuous exercise is undertaken too close to sleep time, it may delay sleep onset. Exercise should be finished at least three hours before bedtime. Exercise and activities like aerobics, jogging, tennis, swimming, golf, gardening, and fishing are all very good for health. After all, sleeping well is a sign of good health, and good health starts with good hygiene.

*73\174\4*

Like writer’s cramp, spasmodic torticollis or wryneck is a condition which is widely considered to be uninfluenced by any form of treatment. In fact, the most recently advocated treatment involves a destructive operation on the brain.

A seventeen-year-old schoolboy had this condition in quite advanced form so that his head was held twisted to one side with his chin over his shoulder. When for a moment he was able to bring his head to the front, there would be a sudden spasm of the muscles, and his head would be jerked to the side again.

I believe that this strange symptom had an unconscious symbolic meaning for the patient; and in fact it seemed that this lad was turning away from his father and the principles for which he stood,

I taught him to relax the rest of his body and to experience this relaxation in his mind. In doing this we had to ignore the spasm of the muscles in his neck. Then when he had mastered the exercises he was gradually able to bring his neck muscles to relax for a few moments, then for longer periods; until after several weeks of practice the condition completely cleared.

An interesting point was that the muscles on one side of his neck had grown to an unusual thickness as a result of the spasm. Some weeks after the spasm was relieved these returned to normal size.

His mother wrote, “I wish to take this opportunity of thanking you for the treatment you gave . . . earlier in the year. Without your help, I am quite sure he would not have recovered as he has done, and we are all very grateful to you. So far as … himself is concerned, he seems to be completely recovered, and his approach to life and its problems has, generally speaking, become much calmer and more reasonable than it was for some time past.” At Christmas the boy sent a card, “It is wonderful to be able to do things normally again.”

The mother spoke of the treatment I gave him. But remember that I merely showed him how to do it himself, just in the same way that I have set down here.

I have been a little doubtful of the wisdom of including these two cases—the writer’s cramp and the wryneck—because it is so easy for people to say to themselves, “It is impossible that such a simple approach could cure such difficult conditions.” Please do not be put off by the

simplicity of this approach. Remember that the regression is an essential factor,

I have just recently seen a man with a wryneck condition, and I think I could have helped him. But he rejected the idea: “How could this help me, when all the other treatment has done me no good.” The simplicity of the treatment is indeed its greatest difficulty.

Furthermore, please do not let the apparent diversity of all these conditions confuse

you—nail-biting, blushing, writer’s cramp, wryneck and even smoking. There is no diversity. They are all motivated by the one factor, anxiety. Our exercises reduce our anxiety and so allow the symptoms to subside.

*95\57\2*

Constipation is one of the most common ailments of civilized man. It does not exist among primitive people. It is a result of sedentary life in combination with denatured, refined, and devitalized foods—conditions for which our body was not made.

It is a common observation that many people afflicted with arthritis have a long record of chronic constipation preceding the onset of the disease.

Constipation is the root of many evils. It causes great discomfort and can be a contributing or major cause of a great many diseases. It may lead to such disorders as hemorrhoids, varicose veins, hernia, upset digestion, nervous irritability, skin eruptions, eczema, muddy complexion, and headaches. “Bad breath”—a national disgrace on which mouthwash manufacturers are now making millions of dollars—is more often than not a direct result of constipation. (Needless to say, no mouthwash can correct bad breath caused by constipation, since foul odor comes from the stomach and the lungs, not from the mouth!)

But constipation can also lead to many more serious diseases, such as impaired function of liver, gall bladder, kidneys, and other vital organs, and can be one of the major contributing causes of arthritis.

Your intestines house billions of different bacteria which help your digestive system break down the food you eat and thus aid their housing organism in its metabolic processes. Some of these are what we call “friendly bacteria,” some are “unfriendly” or putrefactive bacteria. When the diet is unbalanced, as in the case of too much refined and overcooked carbohydrates and too much animal protein, the balance of the intestinal flora is disturbed, harmful bacteria take over, and the result is sluggish bowels, gas, putrefaction, and constipation. Toxins (poisons) created by bacterial metabolism and putrefaction remain in the intestines and, as a result of prolonged constipation, are absorbed by the bloodstream, poisoning the whole organism. Chronic constipation will eventually weaken the muscles of the large intestine so that they will not be able to function properly and expel waste matter from the colon. Chronically constipated and sluggish intestines lead to chronic autointoxication or self-poisoning.

As was pointed out in Chapter 6, the impaired elimination of metabolic wastes and toxins from the system, and resultant autointoxication, is one of the most prominent syndromes or characteristics of arthritis. Therefore, those afflicted with arthritis should make a special effort to overcome constipation— this largely ignored and neglected but very dangerous ailment. Even if you do not suffer from arthritis as yet, but are badly constipated, make sure you correct this trouble before it leads to more serious complications.

*53\176\2*

The aims of treatment of febrile convulsion are three-fold:

• to stop the convulsion;

• to treat any underlying infection (e.g. urinary tract infection, otitis media) which might have caused fever;

• to prevent further febrile convulsions.

Febrile convulsions in most children stop of their own accord, usually after 4-5 minutes.

Short-lived febrile convulsions are not dangerous and do not cause brain damage. If a child convulses for more than 10 minutes then a doctor must be called immediately, or the child must be taken to the Accident and Emergency department of the nearest hospital. It is important to try and stop a convulsion, as there is a slight risk that prolonged febrile convulsions, lasting more than 30 minutes, may contribute to the later development of epilepsy (see p. 30). In order to stop a prolonged febrile convulsion, a doctor may give a medicine called diazepam (also called Valium or Stesolid), either by an injection into a vein or by a small tube inserted into the rectum, from which it is rapidly absorbed.

Some children who have had a first febrile convulsion will be admitted to hospital for observation and to find a cause of any underlying infection. Antibiotics may be given if an infection is found. A time in hospital may help to relieve parental anxiety. Interviews have revealed that the parents of at least half of the children who have their first febrile convulsion believe that their child is about to die, or has died. It is important to understand this concern and anxiety, to explain that this almost never happens, and reassure that children almost always make a full recovery following a febrile convulsion.

About one third of children will have a second or even third febrile convulsion. The risk of a child having a second or third febrile convulsion is greater if:

• the child is aged less than 12-15 months (and particularly if a girl);

• if the first febrile convulsion lasted more than 15-20 minutes or involved only one. side of the body (i.e. was a complex febrile convulsion);

• if the parents or brother or sister has had febrile convulsions, or has epilepsy.

There are some simple measures which can be taken to prevent further or recurrent febrile seizures. These measures include (whenever a child has an infection and is showing a rise in temperature):

• undressing the child;

• sponging him or her with tepid (lukewarm) water, and

• giving regular paracetamol (Calpol) (every 3-4 hours) which brings down the temperature. It is not a good idea to use aspirin for this purpose in very young children, as this drug may bring on further problems in the liver.

There are certain situations in which a parent might anticipate that a child’s temperature may well increase, and therefore that a febrile convulsion may occur. Such a situation might be after an immunization or vaccination (for example, the ‘triple’ vaccine, given three times in the first year of life, or the MMR (mumps, measles, rubella) vaccine given between 15 and 18 months of age). It is quite safe and sensible to give paracetamol at the time of vaccination and for 24-48 hours afterwards. With the MMR vaccine, there may be a very mild measles-like illness (with a high fever) 8-10 days after the vaccine has been given, and again, it would be wise to anticipate this and give paracetamol around that time.

In the past, anti-epileptic drugs were used to try and prevent further febrile convulsions from happening. It was shown that sodium valproate (Epilim) and phenytoin (Epanutin) were unsuccessful in preventing further febrile convulsions, and also did not alter the occurrence of convulsions without fever—that is, epileptic seizures. Although phenobarbitone has been shown to be effective in certain cases, this drug may cause significant side-effects in young children. In those few children who have repeated or long febrile convulsions, diazepam (Valium, Stesolid) may be given rectally, by parents after brief training. This medicine is used to prevent or stop the convulsion from lasting more than 30 minutes, but is only rarely necessary.

In a large prospective study of over 50 000 children carried out by the National Institute of Neurological and Communicative Disorders and Strokes in the USA, the incidence of febrile convulsions was 3.1 per cent, and the recurrence rate 32 per cent. By the time that the children had reached the age of seven years, more than one non-febrile seizure (that is, epilepsy) had developed in 0.5 per cent of those who had never had a febrile convulsion, and in four times as many—2 per cent—of those who had had a febrile convulsion. Children who had had prolonged or focal febrile convulsions, with evidence of pre-existing impaired development, were eight times more likely to develop epilepsy by the age of seven years than children with simple febrile convulsions, and 18 times more likely than children who had never had a febrile convulsion at all.

These figures show that one cannot deny the relation between some febrile convulsions (the complex and prolonged) and epilepsy. However, the parents of a child with one uncomplicated convulsion who has developed normally can be assured that the chances of subsequent epilepsy developing are very low—that the child has about 98 chances out of 100 of reaching the age of seven years without the occurrence of non-febrile seizures.

*89\188\2*