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There is the evidence of my own experience and my work with patients which shows that we have within us the ability to control excessive pain. But our everyday experience of life makes it equally clear that under ordinary circumstances we are quite unable to use this ability. It would seem that we, civilized people, have somehow lost the knack of using it. On the other hand, some primitive peoples still retain this ability to some extent, and as a result cope with the pain of severe injury better than the more civilized and sophisticated Western peoples. This idea is quite important to our self-management of pain because it makes us realize that we are not attempting something new and difficult, but instead are merely relearning now to use an ability that we already have within us.

Our Lack of Experience of Pain-One reason for our relative inability to cope with excessive pain is simply our lack of experience in the matter. Life in Western communities is so organized now that we have very little firsthand experience of pain except an occasional visit to the dentist; and even he gives us an injection if he thinks it necessary or if we wish it This is all a very wonderful advance in the history of man but it has this unfortunate side-effect, that we are less able to cope with severe pain if it should befall us; and we turn more and more to the use of drugs for pain of less and less severity.

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Q. We often hear of the disastrous complications that may occur in patients with peptic ulcers. What are these and how serious?

A. Complications may certainly take place and can be serious, and in certain cases life-endangering. Fortunately, according to recently published reports, there seems to be a fairly large reduction in these complications over the past decade and hopefully this trend will continue. With today’s quick and accurate methods of early diagnosis and excellent methods for treatment it is highly likely complications may gradually become unusual.

Q. Are the complications usually serious?

A. In most cases they are and often represent a surgical emergency. It is generally obvious the person is acutely ill and needs urgent hospital care.

Q. Let’s consider the complications. Which one comes first?

A. Let’s start with haemorrhage or haematemesis as the doctors say. This may present as acute vomiting of bright red blood, or vomitus with the appearance of ‘coffee grounds’ (the more common). There is often the passage of loose, black, ‘tarry’ stools (‘melaena’), or even bright red blood via the back passage. There is a sudden onset of weakness, faintness and dizziness, chilliness, thirst, cold moist skin and a desire to have a bowel action. This may be in a person with a dyspeptic history or even in those with no such history. It indicates the ulcer has increased in size. It has eroded a large artery or vein in the wall of the duodenum.

Q. If this happens what does the patient or those who are with him do?

A. This is a surgical emergency and demands urgent medical assistance. Do not delay. Get the patient to a doctor or hospital as promptly as possible. Often a blood transfusion is required and full investigation necessary. Promptness is essential.

Q. What is next on the list of complications?

A. Perforation. This usually occurs in males between 25 and 40 years. It indicates the ulcer has ruptured through its wall and contents are spilling into the abdominal cavity. There is usually an acute onset of pain in the epigastric region (just below the breast-bone). It often radiates to the right shoulder or right lower abdomen. There may be nausea or vomiting. This may be followed by a temporary reduction in pain. This could last a few hours. This is followed by a sudden board-like rigidity of the abdominal wall; there is a fever, rebound tenderness (when the area is pressed), an increased heart rate and often signs of prostration.

Q. What treatment is carried out?

A. Acute cases require urgent medical assistance. Any symptoms that come in this category must be treated as a surgical emergency. Although these cases are often ‘acute’, milder ‘sub-acute’ or ‘chronic’ ones occur, in which the perforation in a milder form occurs over a period of time.

Q. What comes next?

A. Penetration. Sometimes the ulcer penetrates into adjoining structures rather than rupturing into the abdominal space. It may involve adjacent organs such as the pancreas, liver, bile ducts or the omentum. This may be indicated by radiation of the pain into the back, nocturnal distress, inadequate or no relief from food or medication. Symptoms such as this in a person who has suffered ‘ulcers’ or ‘dyspepsia’ indicate an immediate need for expert medical attention and investigation.

Q. Earlier on you talked about ulcers forming near the pylorus, the narrow canal leading from the stomach to the duodenum. How does this fit into the picture?

A. It may cause obstruction. About 30 per cent of patients with a duodenal ulcer suffer obstruction of the pylorus, the canal joining the stomach to the duodenum. There may be no symptoms. Alternatively, it may produce fullness in the epigastric region, and vomiting may occur soon after a meal. This will contain much undigested, recently eaten food. This also needs proper medical investigation.

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This is a well-known discipline that broadly speaking consists of two separate yet closely-linked components: first, there’s a series of static or stretching exercises as well as breathing exercises; secondly, there are meditation techniques that aim to help the subject attain a state of peace and harmony within the inner self.

At the physical level, yoga has proven itself to be an extremely effective way of loosening and mobilising joints whose movement has become restricted. Additionally, the meditation techniques can help reduce mental and emotional stress which can at times exacerbate back problems.

Although nearly all yoga exercises are considered to be safe for a moderately fit person, they can create a great deal of pressure on parts of the back and neck, and it’s therefore essential that even the simplest of yoga exercises should only be undertaken under the supervision of a fully qualified teacher. Naturally, should you join a yoga class, make sure that the instructor is fully aware of any existing difficulties you may have.

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