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We have dubbed the medical conditions that lead to a diagnosis dilemma “mystery maladies order colospa 135 mg overnight delivery muscle relaxant non-prescription. Deﬁnition of Mystery Maladies • Conditions cheap colospa online visa muscle relaxant without drowsiness, syndromes discount generic colospa canada muscle relaxant with ibuprofen, or symptoms that cannot be diagnosed easily or neatly despite advances in medical technology • Misdiagnosed chronic conditions • Symptoms that have no known cause or origin • Conditions or syndromes that are now identiﬁable but until recently were considered “mysteries” and may still be unfamiliar to many physicians 21 Copyright © 2005 by Lynn Dannheisser and Jerry Rosenbaum effective 135mg colospa quinine muscle relaxant mechanism. Say, for exam- ple, that you have a persistent cough following what appears to have been a cold. You make an appointment with your primary care physician and tell her your symptoms. She peers in your throat and ears, feels your glands, and listens to your chest. After asking some additional questions, she decides on a treatment plan based on an established protocol. She may prescribe a course of antibiotics, rest, and plenty of ﬂuids, and she might advise you to avoid milk products that can cause mucus. Unfortunately, you don’t get better—and so your mystery mal- ady begins. The following scenario is not atypical for many mystery malady sufferers. You call your physician again; she is somewhat perplexed but suggests a different antibiotic and perhaps an expectorant. Out of concern and in an abundance of caution, she refers you to a specialist, perhaps a pulmonolo- gist, an allergist, or both, and you make the rounds. These physicians, in turn, may send you for x-rays, blood tests, and other medical tests. The end result is a laundry list of possible diagnoses, a ﬁstful of medical bills, and a medicine cabinet full of prescriptions that offer you no relief. Perhaps you’re now among the 65 percent of people who take prescribed allergy medica- tions but don’t actually have allergies. At this point, you’re confused, worried, and even slightly depressed because you’re still coughing and you can’t seem to get well. Now you may be thinking the real reason behind your medical problem must be “stress” or, depending on how fearful you’ve become, some undetected form of lung cancer. Soon your upbeat and generally good-natured physicians and their staff start to sound annoyed when you call yet again because they’ve been unable to help you. Either you’ve given up entirely on doctors or you may still be search- ing for the right one who will have the answers. Your friends and relatives encourage you to visit a renowned diagnos- tic clinic for yet another opinion. Although you are still coughing, at least you feel a temporary reprieve from your anxieties because surely these doc- tors will be able to make a deﬁnitive diagnosis. The day of your appoint- ment arrives and so do you, along with all your records, a list of questions, All About Mystery Maladies: A New Mind-Set 23 and renewed conﬁdence that your mysterious symptoms will ﬁnally be iden- tiﬁed and treated. The clinic physicians review your records, perform their own physical exams, administer new tests, and repeat others. After this visit, the doctors are absolutely certain of what you don’t have, but they don’t seem to know exactly what you do have. You diligently try to follow their treatment suggestions and obtain some relief, but your symp- toms still don’t go away completely. The following table lists some examples of mystery maladies, and following that are some statistics of how many people suffer from them. We’ll discuss many of these mystery maladies in case studies throughout the book. Examples of Mystery Maladies Adrenal fatigue Fluid retention Anxiety/somatization Food allergies/sensitivities disorders* Headaches* Autoimmune disorders Heavy metal poisoning Biomechanical pain* Hemorrhoids Blurred vision Inﬂammatory bowel disease Breathing difﬁculties Interstitial cystitis Burning hands Lupus* Chest pain Mold allergies Childhood diseases Mood swings Chronic fatigue syndrome* Multiple chemical sensitivities* Constipation Multiple sclerosis* Depression Nausea Diarrhea Parasites Digestive disturbances Pelvic pain* Dizziness or loss of balance Reﬂex sympathetic dystrophy* Fibromyalgia* Sleep disturbances* (continued) *Statistics for these selected mystery maladies are presented in the following list. All About Mystery Maladies: A New Mind-Set 25 • Five percent of patients who experience trauma to an extremity are esti- mated to have reﬂex sympathetic dystrophy,10 but because of confusion over the diagnosis the true incidence is unknown. Many of these mystery malady patients are told their medical problem is “psychosomatic. As these patients already know, there are some things doctors simply don’t understand yet. But it seems like the medical community has only recently begun to admit this. Aronowitz, “We need to recognize and accommodate the essential continuity between persons who have symptoms that have been given a name and disease-like status and persons whose suffering remains unnamed and unrecognized. Kurt Kroenke writes, “Clearly, the era of studying one symptom in isolation is over, and clinicians should know that patients who present with one [of these conditions] often have several other symptom syndromes as well. More likely than not, no one but you (or perhaps your family or friends) is willing or able to make this effort. Diagnosing Your Own Mystery Malady So, you may ask, how can the lay public accomplish what the most highly skilled and expertly trained medical practitioners cannot? We know it’s pos- sible not only from our personal experience but also from observing the suc- cess of others who have used our revolutionary Eight Steps to Self-Diagnosis. This method was developed by a layperson (Lynn) with a physician’s assis- tance (Dr. It has been used successfully by many people who have no particular medical expertise. For example, eight-year-old David, whose case study appears in Chap- ter 13, developed numerous cavities in his teeth from an early age, and his mother’s attempt to circumvent that problem ended up causing a mystery malady that no pediatrician could identify or resolve. Using the Eight Steps, his caring and persistent mother unearthed the solution, which none of their doctors may have known about at the time. Similarly, David’s Uncle Gor- don (in an unrelated case study told in Chapter 12) suffered from a lifelong and unending series of mystery maladies whose roots were eventually rec- ognized as being psychiatric in nature. All About Mystery Maladies: A New Mind-Set 27 Fortunately, both David and his uncle ﬁnally had their mystery mal- adies diagnosed correctly, and they are now enjoying good health because they and their physicians used many of the techniques and tools we describe in this book. But tools and techniques are only part of our self-diagnostic method; developing a new mind-set toward unraveling mystery maladies is the ﬁrst threshold we must cross, so let’s begin there. Even though you’re more than ready for some real answers and the information we’ve provided thus far may make sense, you may be still skep- tical. How can you possibly be expected to solve your mystery malady when you are tired, suffering, and feeling sick? Your sense of hope or optimism may have eroded along with your physical condition. We understand that the mere thought of undertaking our program may feel so overwhelming that you may want to run for cover. That’s certainly how I (Lynn) felt several years ago, as I struggled with what seemed like a stunning aggregate of unexplainable physical symptoms.
If a tetraplegic patient vomits cheap colospa 135 mg with mastercard spasms right side, gastric contents are easily aspirated because the patient cannot cough effectively order 135 mg colospa overnight delivery muscle relaxant brand names. Ileus may also be precipitated by an excessive lumbar lordosis if too bulky a lumbar pillow is used for thoracolumbar injuries order colospa with visa muscle relaxant flexeril 10 mg. When perforation occurs it often presents a week after injury with referred pain to the shoulder buy discount colospa 135 mg on line spasms below breastbone, but during the stage of spinal shock guarding and rigidity will be absent and tachycardia may not develop. A supine decubitus abdominal film usually shows free gas in the peritoneal cavity. Use of steroids and antibiotics (b) An American study (NASCIS 2) suggested that a short course Figure 4. A later study (NASCIS 3) suggested that patients decubitus view showing massive collection of free gas under the anterior abdominal wall. Recently the use of or perforation steroids has been challenged, and their use has not been universally accepted. Policy concerning steroid treatment • Treat with proton pump inhibitor or H2-receptor antagonist should be agreed with the local spinal injuries unit. If treatment is When the patient is transferred from trolley to bed the whole started 3–8 hours after injury, the infusion is continued for of the back must be inspected for bruising, abrasions, or signs 47 hours. The patient should be turned every two 19 ABC of Spinal Cord Injury hours between supine and right and left lateral positions to prevent pressure sores, and the skin should be inspected at each turn. Manual turning can be achieved on a standard hospital bed, by lifting patients to one side (using the method described in chapter 8 on nursing) and then log rolling them into the lateral position. Alternatively, an electrically driven turning and tilting bed can be used. Another convenient solution is the Stryker frame, in which a patient is “sandwiched” between anterior and posterior sections, which can then be turned between the supine and prone positions by the inbuilt circular turning mechanism, but tetraplegic patients may not tolerate the prone position. Nursing care requires the use of pillows to separate the legs, maintain alignment of the spine, and prevent the formation of contractures. In injuries of the cervical spine a neck roll is used to maintain cervical lordosis. Care of the joints and limbs The joints must be passively moved through the full range each day to prevent stiffness and contractures in those joints which may later recover function and to prevent contractures Figure 4. In the lateral position, note the slight tilt on the opposing side to prevent the patient sliding keep the tetraplegic hand in the position of function are out of alignment. Foot drop and equinus contracture are prevented by placing a vertical pillow between the foot of the bed and the soles of the feet. Skeletal traction of lower limb fractures should be avoided, but early internal or external fixation of limb fractures is often indicated to assist nursing, particularly as pressure sores in anaesthetic areas may develop unnoticed in plaster casts. Later analgesia In the ward environment, diamorphine administered as a low-dose subcutaneous constant infusion, once the correct initial dose has been titrated, gives excellent pain relief, especially if combined with a non-steroidal anti-inflammatory Figure 4. Close observation is essential and naloxone must always be available in case of respiratory depression. As a result, some injuries Following spinal cord trauma, occult injuries can easily compromise associated with high morbidity, for example scaphoid fracture, recovery or aggravate disability. Complete clinical re-assessments may not generate symptoms during early management. The must be performed regularly during the first month after injury diagnosis of such injuries can be difficult in any trauma patient but in spinal cord injury, the symptoms and signs are often • Chen CF, Lien IN, Wu MC. Respiratory function in patients abolished by sensory and motor impairments. Paraplegia some of these injuries compromise rehabilitation and the 1990;28:81–6 ultimate functional outcome. Daily re-evaluation of trauma • Menter RR, Bach J, Brown DJ, Gutteridge G, Watt J. A patients helps to overcome these diagnostic difficulties and is review of the respiratory management of a patient with very important during the first month after injury. High dose Further reading methylprednisolone in the management of acute spinal cord injury—a systematic review from a clinical perspective. Administration of methylprednisolone for Spinal Cord 2000;38:273–86 24 or 48 hours or tirilazad mesylate for 48 hours in the • Tromans AM, Mecci M, Barrett FH, Ward TA, Grundy DJ. JAMA The use of BiPAP biphasic positive airway pressure system 1997;277:1597–604 in acute spinal cord injury. Spinal Cord 1998;36:481–4 20 5 Early management and complications—II David Grundy, Andrew Swain The anatomy of spinal cord injury The radiographic appearances of the spine after injury are not a 1 1 reliable guide to the severity of spinal cord damage. They C1 2 Cervical 2 3 represent the final or “recoil” position of the vertebrae and do 2 3 segments 1–8 4 Cervical roots not necessarily indicate the forces generated in the injury. The 3 4 5 4 5 6 spinal cord ends at the lower border of the first lumbar vertebra 5 6 7 in adults, the remainder of the spinal canal being occupied by 6 7 8 7 1 1 the nerve roots of the cauda equina. There is greater room for T1 2 2 the neural structures in the cervical and lumbar canals, but Thoracic 2 3 3 3 4 4 in the thoracic region the spinal cord diameter and that of the segments 1–12 5 5 4 6 6 neural canal more nearly approximate. The blood supply of the 7 Thoracic roots 5 7 cervical spinal cord is good, whereas that of the thoracic cord, 8 6 8 9 especially at its midpoint, is relatively poor. These factors may 7 9 10 explain the greater preponderance of complete lesions seen after 10 8 11 11 injuries to the thoracic spine. The initial injury is mechanical, Lumbar 9 10 12 12 segments 1–5 but there is usually an early ischaemic lesion that may rapidly 11 1 progress to cord necrosis. Extension of this, often many segments Sacral 12 1 segments 1–5 L1 2 below the level of the lesion, accounts for the observation that 2 2 3 3 on occasion patients have lower motor neurone or flaccid 4 3 Lumbar roots paralysis when upper motor neurone or spastic paralysis would 5 4 have been expected from the site of the bony injury. Because of S1 4 2 5 the potential for regeneration of peripheral nerves, neurological 3 1 5 4 2 recovery is unpredictable in lesions of the cauda equina. Treatment should be aimed at stabilising the spine to avoid further damage by movement and also to relieve cord compression. Applied through skull calipers, • To relieve pressure on spinal cord in case of burst fractures traction is aimed at reducing any fracture or dislocation, • To splint the spine relieving pressure on the cord in the case of burst fractures, and splinting the spine. Of the various skull calipers available, spring-loaded types such as the Gardner-Wells are the most suitable for inserting in the emergency department. Local anaesthetic is infiltrated into the scalp down to the periosteum about 2. No incisions need be made, and the spring loading of one of the screws determines when the correct tension has been reached. The University of Virginia caliper is similar in action and easily applied. The Cone caliper is satisfactory but requires small scalp incisions and the drilling of 1mm impressions in the outer table of the skull. Insertion too far anteriorly interferes with temporalis function and causes trismus.
For example discount 135 mg colospa with visa muscle relaxant machine, both Hanna discount colospa 135mg on line back spasms 36 weeks pregnant, who is a Buddhist generic colospa 135 mg fast delivery spasms under xiphoid process, and Lorraine order colospa from india muscle relaxant carisoprodol, who follows new age spirituality, felt they had changed in terms of the value they placed on material things. There was a point in my life that I could have never said that, they’re only things, they do not matter. Whether the changes these people perceive occur on the level of value systems, personality, or in the whole person, they are experienced as positive change. According to Lindsay, I got my orthotics and balanced my feet and started having my chiropractic done and balanced my hips. I think it’s important for everybody to find things that help them be the best person they can. That’s why I’m exploring it [alternative therapies], cause I want to be the best possible person I can. Again, it is the ideology contained within their alternative models of health and healing that makes them better people. In Hanna’s words, Yoga philosophy is to be basically a very good person with high moral standards. Love your neighbour as yourself, that type of thing, but a lot 90 | Using Alternative Therapies: A Qualitative Analysis more self-discipline, mental and physical discipline, and to be a nice person, treat other people the best way you can, don’t judge people, and I suppose the philosophy is to improve yourself. HEALING THE SELF McGuire (1987:376) contends that “the very rhetorics of healing in mod- ern Western societies emphasize individual choice and transformation. For instance, Easthope (1993:294) asserts that “The healer’s task is to reconstruct... Consequently, the reconstruction of the individual engendered through his or her participation in alternative therapies does not merely enable the person to better cope with disease, but can also provide the individual with the means to change his or her self-perceptions. Moreover, for the people I spoke with, self-healing not only means developing the ability to relieve one’s own physical, emotional, or spiritual ailments; it also means acquiring the ability to heal the self. In particular, they are reshaping their personal identity, that which is unique to the individual (Goffman 1963). They are recasting their perceptions of self to account for perceived changes in identity from sick to healthy and from negative to positive. They are engaged in what Corbin and Strauss (1987:264) call biographical work, which includes “its review, maintenance, repair and alteration,” where alteration refers to “transitions to identity which are prescribed or at least permitted within the persons’ established universe of discourse” (Berger 1963, Travisano 1981:244); this is in contrast to notions of conversions which imply that one’s past identity is completely jettisoned in favour of a new identity (Berger 1963; Travisano 1981). Thus these people have constructed a new sense of self which they incorporate within the totality of their personal identities. Alternative Healing and the Self | 91 McGuire (1987:374) contends that the symbolic embodiment of ideology has the power to change people. She asserts that “through rituals and symbols of transformation, believers experience changes in themselves,” and Glik (1990:160) likewise concludes that it is through “the adoption of strong... Accordingly, for these people, being in a state of health does not depend exclusively on physical soundness as defined under biomedicine. Rather, under their alternative models of health and healing, “to be healed is not necessarily the same as to be cured” (McGuire and Kantor 1987:233). For instance, Jane told me, “Health to me is not necessarily a physical definition of health but just a sense of your own well-being. And they’re all completely part of you, and all completely intertwined, and you can’t really be healthy on one level if you’re not on the others. But by no means just the physical level because actually ill health starts on a level other than the physical and eventually manifests on the physical. Thus, under their alternative ideologies of health and healing, “the disease is rendered secondary” (Coward 1989:47). In contrast, biomedicine defines ill health as “a deviation from normal biological functioning” (Mishler 1989:3) that greatly reduces the boundaries within which one can be healthy. Moreover, an attendant consequence of biomedically defined ill health is the loss of self engendered by disease, chronic illness, and disability (Bury 1982, 1991; Charmaz 1983, 1991; Corbin and Strauss 1988). More precisely, it is the assumption that alternative health is manifested in engagement in an ongoing process of healing which allows one to be healthy even in the face of disease or infirmity. For instance, Grace saw herself as healthy despite the fact that she is paralysed. A further reflection of their belief that to be healthy is to be continually engaged in healing is that the changes to self these people perceive are experienced as a dynamic, rather than static, process. While this core assumption is what ultimately allows the people who participated in this research to perceive themselves as healthy despite the presence of biomedically defined ill health, different informants emphasized different elements of their alternative models of health and healing as the particular ideological mechanisms they employed for this type of change to self. For example, Laura is able to see herself as healthy by invoking the alternative healing notion of the body’s ability to heal itself: “I’m healthy right now despite the fact that I have a cold because I know that my body is strong enough to fight it. By this time they hold little hope of realizing typical adult identities in the outer world. For example, in telling me about how a friend of his had reconstructed herself through participation in alternative therapies, Greg said, I know of case histories and people who actually have rebuilt themselves. Rebuilt is the best word I can think Alternative Healing and the Self | 93 of and he [the alternative practitioner] did it without making her take pills, without marginalizing her. Because if it’s not treatable the doctors will say, ‘Well, you’re going to have to settle for this. For instance, Kottow (1992) and Feigen and Tiver (1986) argue that alternative health care is dangerous because it gives people the false hope of curing what ails them. Conversely, others argue that alternative therapies offer people renewed hope that they will find a solution to their health problem (Murray and Rubel 1992). The relevant issue for these informants, however, is not whether or not their alternative models of health and healing provide them with valid or false hopes of a cure. Rather, it is that they offer the hope of constructing a healthy sense of self. Therefore, the hope held out by alternative approaches to health care comes in two forms: the hope of “different possibilities for alleviating human suffering” (Stambolovic 1996:603) certainly; but more importantly, from a symbolic interactionist perspective on the self, it is the hope of “changing psycho-social structures,” among which is what we may consider to be a well role (Glik and Kronenfeld 1989). The hope of achieving healthy self-perceptions is possible for these people because unlike Charmaz’s (1987:287) informants who were seeking a restored self, trying to “reconstruct... The people who participated in this research experienced two types of identity change through their use of alternative therapies. For some, experiencing alternative approaches to health and health care led them to begin the process of taking on an alternative practitioner or healer identity. For others, participation in alternative health care resulted in changes to perceptions of self. What is central to both types of identity-change experienced by the people who spoke with me is the ideology contained within the alternative model of health and healing. This ideology is both the motivator for taking on the identity of an alternative healer and the mechanism through which they construct a healthy sense of self. Notwithstanding the fact that these informants experienced positive changes to self through adoption of alternative ideologies of health and 94 | Using Alternative Therapies: A Qualitative Analysis healing, participation in these forms of health care can also have a negative impact on identity.