When pain lingers, another fear comes to us. Most of us fear death when faced directly with it, and lingering pain brings the fear of death even when the doctors assure us that there is nothing seriously wrong. Fear brings doubts: “Doctors make mistakes; and anyway they don’t tell you the worst.” If the pain is in the abdomen we are soon convinced that it is due to cancer; if it is in the chest we think of a coronary. Even when the pain is in some other part, if fear takes over, the same thoughts come to us. Strange as it may seem, in these circumstances the pain may spread so that we feel it in the heart, and fear leads us to think that the injury to our leg has brought on a heart attack.
The Destructive Effect of Pain-We can see, then, that instead of being a helpful warning against injury, pain that is too severe and too prolonged, when associated with distress and guilt and fear, soon becomes a destructive influence to both body and mind. It is only with the stoutest heart that morale does not weaken; and with failure of morale in any illness the healing process is correspondingly retarded. So anything that we can do in the way of learning the control of pain will not only boost our morale, but will also have an indirect effect on the physical healing of our body.
As an example of this process it is as well to recall that some years ago it was the custom to change the bandages on surgical wounds very frequently. This, particularly in the case of burns, would cause the patient great pain. The patient would wait in fear for the next change of dressings.
Children would scream at the approach of the nurses. Even before the advent of the antibiotic drugs, the change to less frequent dressings improved, both morale and healing.
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Q. Let us spend a few moments in summing up the various forms of investigation and treatment currently available and see how it works out.
A. Why not. Symptoms lead to medical investigation. This may include a medical examination and history taking, then probably either a barium meal x-ray examination of the stomach and duodenum, an endoscopic examination of the same areas. A diagnosis of chronic peptic ulcer is made, being either in the stomach or duodenum. If in the stomach, a biopsy will indicate if it is only an ulcer or an ulcer plus cancer. Provided the diagnosis of an ulcer is confirmed there are four most likely courses available. The patient may be given antacids in large doses, or cimetidine, or colloidal bismuth or he or she may be admitted to hospital. Antacids may give symptomatic relief and hospital care may cause the ulcer to heal. With cimetidine and colloidal bismuth healing usually occurs rapidly. In 3 weeks, about 50% improvement; in 6 weeks, about 75%; in 9 weeks, about 90%.
Q. What if healing does not occur?
A. If healing is slow or absent (and the experts say that this occurs in about 10% of cases), then the diagnosis must be re-checked. Hopefully, the gastric ulcer will not turn out to be a cancer after all — but it is always a possibility which certainly warrants verification. Or it may be due to the patient surreptitiously taking some other form of medication, such as analgesics which are notorious for creating gastric bleeding and ulcers. If a peptic ulcer is still in evidence a variant to cimetidine may be tried, such as ranitidine, or the patient may be hospitalised for treatment there.
This is the current routine often recommended by gastroenterologists. Today, diagnosis and treatment of peptic ulcers have never been better. There is no reason why anyone with an ulcer should put up with the pain and discomfort that it entails. Adequate investigation and therapy are readily, and fairly cheaply, available to everybody in this country.
Q. Do some people complain of costs?
A. Some misguided individuals complain that medication is costly. These people are misguided in the extreme. At present the government in this country picks up the bulk of the tab for most of the forms of ulcer treatment. However, even if the patient had to pay the entire drug cost himself, this is minimal when the alternatives are considered.
In the bad old days a severe ulcer required up to three months’ absence from work plus, in many cases, the financial hardship that this entailed, plus the costs of hospitalisation, drugs, medical attention, etc. The economics were often mind-blowing and bank-busting.
But today, within a few days, with a relatively small drug bill, the patient may be back to work again, with symptoms gone and the ulcer well on the way to healing. The economics have taken a dramatic change for the better. I always tell my patients never to begrudge the small price they are paying for their medication. The very same persons who complain will think nothing of going out to dinner for the evening with friends and blowing twice the sum as it costs, for example, for the retail price for six weeks’ cimetidine treatment. If you are tempted to complain of costs, please remember the alternatives which in the past used to be dramatically expensive.
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Although still considered by many as more of an ‘alternative’ therapy than physiotherapy, osteopathy has nevertheless gained great acceptance from the medical profession. Developed in the late 19th century by Andrew Taylor Still, osteopathy is based on the underlying principle that ‘structure governs function’, and the therapy therefore relies primarily on manipulative techniques, these being mainly applied to the back and neck.
Central to the osteopathic concept is that much of the pain and disability affecting people stems from abnormalities in the function of the musculoskeletal system rather than in any identifiable or discernible pathology. According to osteopaths, impaired function in one part of the musculoskeletal system can exist without symptoms but may throw considerable strain on another part of the body.
Like physiotherapists, osteopaths build up a full picture of the patient’s particular dysfunction, which may have developed over a long period of time. Says the Osteopathic Information Service: “Osteopaths do not look on patients simply as back sufferers but as individuals with their own unique requirements. Treatment is designed to correct each individual’s mechanical and spinal problems in order to stimulate their own natural healing processes.”
A recent survey of osteopathic practices throughout the county revealed that more than half of the patients had sought help because of low back trouble.
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