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Welcome to my blog

Hello. I am iciclehunter and this is my diary. My job title is "osteopath", and my work is hunting for clues, detective work, problem-solving. These things involve reason and science, but are not limited by them. They also involve the eye of experience, and "hunches". Thus, some would regard my activities as those of a quack, a title I assume here with irony. I am writing this blog because I like writing. I am quite opinionated, and perhaps I suffer from a repressed need for expression. I have no particular prior "agenda"; if I have any bees in my bonnet, no doubt they will make themselves apparent by their buzzing. All names and identifying details of any people featuring in these anecdotes have been changed. Thank you for reading.

Friday, 11 November 2016

Ordinary people in a quantum universe

I don't "do" politics so let's just get around that by calling this social commentary. And to be fair, this is one big turn of events.

Marty McFly, back to the future after meddling in the 50s, finds things at home the same yet weirdly different*. Quantum theorists propose multiple universes all going on at once, separated only by veils of probability. President-elect Donald Trump sits in the White House with President Obama having had an "excellent discussion". Had Marty driven the DeLorean back to to 1965, he might have heard Dylan singing, "Something is happening here but you don't know what it is, do you, Mr Jones?"

Do you, Mr Jones? No man, no way you don't, is what they say. That is, of course, if you are a member of what they - those people who like to sort the world into black and white boxes  -  call the "liberal elite", out of touch with "ordinary people".

As if "ordinary" were some kind of badge of honour. As if all things "elite" were shameful. As if one cannot be "ordinary" and "elite" at the same time. As if we were not all elite performers at being own individual selves. As if extra-ordinary people must somehow be held in contempt.

Whatever, it is obvious, now, that the received wisdom of "the establishment" severely underestimated the breadth and depth of discontent of the dispossessed and disregarded. Or at any rate those who have been feeling that way. Of course it is easy to understand that if one feels, rightly or wrongly, that things cannot get any worse, then one is ready to choose any hope of change over the maintenance of what is seen as a static status quo.

Without, of course, taking some things into account:
  1. Actually, yes it could get worse. Tariffs on Chinese imports? No more cheap stuff for the poor. More jobs for Americans? What about, only if Americans will accept the low wages Trump will expect them to? Sum this up and the overall benefits to the "ordinary people" from modestly increased numbers of people in work, if achieved, might well be insufficient to offset, in "ordinary" people's minds, the disadvantage of prohibitively expensive clothes and household goods. That is not an unlikely scenario.
  2. That an alleged fraud (e.g. Trump "University") and tax dodger, a known liar, an unpleasant oaf of a man who insults and harasses women, mocks the disabled, and insults Mexicans and muslims, a loudmouth trigger-happy cowboy who shoots from the hip, might not actually be the most trustworthy of people.
  3. That a man born a millionnaire, neither a self-made man nor a blue-collar worker, has ever been able to put himself in the shoes of the "ordinary" unemployed steel worker from the Rust Belt, might be a little bit doubtful. That it is all an act and a lie might not be improbable.
  4. That a property tycoon might not be expected to possess the knowledge and skill sets necessary to govern the most powerful nation on the planet.
They say be careful what you wish for. Is a choice in blatant disregard for these obvious concerns a careful choice? Is it a quality choice? But then, in an election, it is quantity that counts. That is how it should be, it is not pretty but (according to Churchill) it is the best system we know. And the numbers voted for "change". Any change at all, please, just give us a change! There speak some desperate people.

We'll just have to wait and see how it all turns out. Doc (liberal, elitist Doc!) didn't believe Marty that Ronald Reagan ("The actor?!?") was to become President. Arguably that didn't turn out too badly, and he was certainly popular. And happily, Donald rhymes with Ronald. Maybe, if we listen hard, we can hear a twisted, anti-matter version of Dylan singing still, to his Mr Jones, in this strange new version of the universe we now inhabit. See you in the future (God willing).


* See the 1985 film, Back to the Future.


Post-script, 12/11/2016

I read that people have been protesting violently on the streets of America at Trump's election victory. I have great regard for many Americans - their ingenuity, intelligence, talent, guts and drive - but, Dear America, at the moment I am under the fleeting and I am sure false impression that you are a nation of raving lunatics. I think the election of Trump was an act of folly, but now I see the other lot have nothing to envy anybody in the matter of lunacy. It was an election won democratically. Your fellow Americans chose quite convincingly the person they wanted as President. And you, Americans, go and riot on the streets? What, exactly, is your problem? What, exactly, do you expect from your protestations? In fact, WTF?

Thursday, 6 October 2016

Lyme disease: the great divide

I crave cool air; it's like a thirst. Late summer and early autumn have been particularly warm and humid. Luckily the cool sea is only 50 yards away. My tolerance of the heat, and especially this muggy warmth, has plummeted, a fact which I might attribute to The Alien Entity, but like so many other things, one cannot be sure. It is now five months since I became symptomatic, and three months since my first progress report: sufficient time for me to have gathered together a number of further impressions and reflections which I think are worth committing to writing. In my first post on this subject I concentrated on my subjective experience. In this one I would like to talk more about perceptions, beliefs and knowledge. Prior to getting into that  difficult subject though, I will briefly update the reader on what has happened with regard to my symptoms since I last posted.

Second progress report


Firstly, I regained the lost hearing in my left ear after 10 days, a relief as I had read that Lyme-related "sudden sensorineural hearing loss" (SNHL), sometimes resolves and sometimes never does. Then I went through a period of mental fog in which attempts at concentration were futile. Time slowed down and I perceived and thought in slow motion. My other symptoms lessened in frequency, intensity, and duration, but persisted.

Doctor would not give me any more antibiotics. He said I had had enough (two courses of doxycycline of about 2 weeks each, and one 12 day course of azythromycin). I understand his point of view: a free and easy supply of antibiotics means a world full of antibiotic resistant pathogenic micro-organisms. He averred that the normal course was that my symptoms would gradually diminish and finally disappear in time. But that, of course, was something he had read on his official medical intranet, rather than something he had learned from experience. I asked him about my blood tests. The first, done after the second course of antibiotics, was positive. The second, after the end of my antibiotic treatment, was also positive.

I asked: Does this mean The Alien Entity is still in my body? No, it just means that its presence has stimulated antibody production. So what was the point of the post-treatment test? (Here some professional back-peddling couched in waffle padding). So, how can we be sure that the antibiotic treatment has been effective? We can't be absolutely sure, but I really wouldn't worry, so long as your symptoms are diminishing.

I decided not to press the matter further: Doctor had obviously come to the far reaches of his pertinent knowledge. He then did a useful thing: he booked me an appointment with Internal Medicine to oversee my case.

At Internal Medicine I was seen by a pleasant young lady who was quite thorough within the common boundaries of day-to-day, run-of-the-mill medical knowledge and practice, but because of those boundaries, similarly limited. She did explain the tests a little more thoroughly. These are antibody assays which test for one or both of two different kinds of antibodies: IgG and IgM. Once infected, IgG will appear and remain in the blood. IgM on the other hand, will rise rapidly on initial infection and remain only as long as an active infection is present. That is, once the micro-organism is eliminated, it will subside and no longer appear at significant levels. I vaguely remembered this information from my own immunology classes way back in the day. So, I asked...

  • What did these two antibodies say in my case? Prior to treatment both IgG and IgM were positive.
  • What about after treatment? Only IgG was tested.
  • Wasn't that a bit pointless, given that it tells us nothing about an active infection? Yes.
  • So shall we test for IgM now? There's not much point. If it's positive, it might be a false positive, and if it's negative it might be a false negative.
  • So, if I understand you correctly, you will rely entirely on the evolution of my symptoms...? That is correct.

Uhm... you don't need to be a doctor to realise that this confusion doesn't show the actual practice of medicine in its best or its most rational light. And yet my impression is that doctors themselves (or, so as not to unfairly generalise, many of them) do not notice that, or bother to give it more than a passing thought. What if my symptoms, those which characterised my infection or related to it, persist after antibiotic treatment is concluded, and, just for the sake of argument, my IgM test result were negative? This appears to happen to many people. And this is precisely where, I read and hear, a lot of doctors begin to lose interest.

What is my current condition? I have irregular, mild bouts of the old, familiar toe stabbing, usually the same old right big toe, but occasionally other toes or other parts of my feet. A common site for mild pin-prick sensations are the corners of the nail beds of my fingers, mostly the index or middle fingers of either hand. Odd or what? I have occasional, brief waves of very mild pain through my feet. Overall my impression is that these are diminishing in frequency. Yet it seems that every time I have said to someone that my symptoms are leaving me, they hit me again in defiance the very next day. Is that a physical effect or a psychological one? Who can tell?

There are things I have found to make my symptoms reappear or worsen: getting hot, engaging in strenuous activity, over-exerting myself mentally, dehydration, too much alcohol, too much coffee. And things that make me feel generally better: sleep, sleep, sleep... light exercise, cool weather, drinking water.

I have had to come to terms with not doing things I love, in order to conserve my energy. Principally that means reducing my long, rugged cliff, coast and hill walks. I always have a symptomatic day afterwards. But I will not stop them completely, because they lift my mood. It is ironical that I got Lyme precisely because I love rough and forest walking.

The remaining symptom that troubles me most is a constant, pervasive tiredness, and a somewhat depressed mood. I want my energy back. I feel diminished as a person without it, and that affects my mood. I want my old self back. I hear this is a common refrain from Lyme-affected people.

Knowledge and the great divide


From my doctors I have learned an intriguing fact: that, concerning Lyme disease, there exists a vast gulf between the basic official knowledge in the possession of most doctors, generalists and specialists alike, and the experiences, needs, knowledge and beliefs of their patients.

This, to an extent, is inevitable, and we shouldn't blame doctors for this. The field of medicine is itself so mind-bogglingly vast that no doctor can be expected to know more than the basics about all the diseases they are supposed to keep in their mental inventories. The problem comes when the doctor irrationally believes that what he or she knows is all that really needs knowing, or when, even acknowledging that it is not, he or she is reluctant to find out more. Which, I believe, happens quite a lot.

So, I have learned that there is a body of basic common official knowledge about Lyme disease, and another body of somewhat more in-depth and sophisticated unofficial knowledge. Now there is an intriguing idea! "Official knowledge" contrasted with "unofficial knowledge".

The first kind is in the possession of the Common or Garden GP, and even the Common or Garden Mr Consultant. It consists in the few notes they learned at medical school. This is what it says, in a nutshell:

  • Lyme disease is caused by a spirochaete bacteria called Borrelia burgdoferi, borne by ticks.
  • It begins days to weeks after a tick bite with a characteristic bulls-eye rash spreading around the bite, high temperature, malaise and joint pains.
  • Then other symptoms can develop and become chronic if the disease is left untreated.
  • It is easily treatable with a short course of antibiotics.
  • That's about it.

The second kind, the unofficial knowledge is a little more difficult to define or encapsulate. It is the knowledge owned by the person who also owns chronic Lyme-related symptoms. It consists of perceptions, experience, interpretations of that experience, and beliefs based on reading, interactions with other affected people, and personal reflection. It has many facets. Here are a few, just by way of example, that are ignored, elude or denied by common official knowledge:

  • The range of symptoms that can be "caused by" Lyme disease is almost as wide and varied as the range of unpleasant human experience.
  • Many people are affected by constant or recurrent symptoms long after normal antibiotic protocols are completed.
  • Effective antibiotic treatment may require courses much longer than the conventionally recommended ones, and repeated treatment.
  • Many people are affected by these symptoms after tick bites but in the absence of positive antibody tests.
  • Many people experience aggravations of their symptoms in response to various triggers or stimuli, pharmacological, dietary, behavioural or environmental. (Chronic Lyme patients call this kind of phenomenon a "Herx", a term their doctors do not know that refers to a process they do not know of: the Jarisch-Herxheimer reaction.)
  • Borrelia burgdoferi can hide in the body, undetectable to the normal blood tests, either by living inside the blood cells for a part of their life cycle, or by forming little cysts around themselves within the person's tissues.
  • The toxins released by dying spirochaetes can be taken up and stored in fat cells, and can be released later under certain conditions, causing a bout of symptoms.
  • Several other tick-borne infectious microorganisms may be picked up at the same time as Borrelia burgdoferi. They too, can cause unpleasant symptoms and serious illness, but are unknown to or ignored by most doctors. They are not usually tested for.

I wish to state that the fact that I have enumerated these points of both official and unofficial knowledge does not necessarily mean I endorse their veracity. For the moment, I am still too ignorant to differentiate between the true and the false. I strongly suspect that neither of these two kinds of knowledge is the whole truth and nothing but the truth. Both require unbiased critical examination. I intend to engage in some of this in another post, not this one. My objective here has been simply to illustrate the divide great that exists between, on the one hand, the effective sum of medical knowledge as it is applied by the vast majority of practitioners, and on the other, the conceptual corpus of their patients. To be honest, as far as debating concepts is concerned, the average medic is out of his or her league here, compared with the average chronic patient.

What's in a name?


What do we understand by the terms "Lyme disease", "disease" even,  and "chronic"?

I ask this because some doctors (of those who, to give credit where credit is due, have at least got as far as having thought about it) deny the existence of chronic Lyme disease, whereas many patients with chronic Lyme-related symptoms vehemently affirm its reality. So it seems to me that as stumbling blocks to mutual comprehension, the concepts, definitions and semantics may be worthy of consideration.

To the medical scientist (and consequently to those doctors of mindsets more rigidly shackled to the principles of modern science) physical "disease" means, for all intents and purposes, "symptoms which can be related to detectable abnormalities in the tissues, physiological fluids or physiological processes of the affected person". Or increasingly nowadays (and controversially), just "the presence of detectable deviations from the statistical norm in the tissues, physiological fluids or physiological processes of a person" even in the absence of any symptoms. ("High" total and LDL cholesterol in an otherwise healthy person is a case in point). What is not covered by either of these definitions is the presence of symptoms without detectable abnormalities - precisely the predicament of many of those who believe they are affected by chronic Lyme disease.

To the medical scientist (and the more rigidly shackled doctors) "Lyme disease" means, for all intents and purposes, "active infection by B. burdoferi". This working definition seems to me to be of little practical value at present. On the one hand, conventional testing practices for B. burgdoferi are currently very imperfect and of limited value. On the other, co-infection by other tick-borne parasites, which are rarely tested for, seems to be common. Until or unless this situation is improved, perhaps it would be better to retire the term "Lyme disease" in favour of a term such as "tick-borne infection". But then, what of chronic symptoms arising from a primary infection?

A "chronic" disease is a persistent or recurrent disease. Many people who believe they have chronic Lyme disease also believe that their persistent symptoms must be attributable to the persistence of the initial infection. Many doctors deny this. I must confess, I can think of several alternative explanations. I have read writings by affected people that the belief in a persistent infection, validated by a positive test result, is felt to be somehow necessary for their mental well-being. That is, if we can prove the existence of an active infection by finding a test that will demonstrate it (never mind the possibility of false positives), then our symptoms are justified. I have the greatest sympathy with those affected by the emotional impact of distressing, unexplained symptoms. But nobody should feel they need to provide concrete justification for very real experiences - and all experiences are "real" -from any kind of moral or ethical standpoint. From a practical one yes, if, and only if, it will lead to appropriate treatment. But we should be wary of our own biases. My position has always been that it is more beneficial in the long term to look in the eye and come to terms with uncomfortable truths than to slumber under comforting untruths. What is needed here is open-mindedness all round. Yes, chronic infection is a possibility. Yes, there are other equally likely explanations for persistent symptoms. We do not yet know enough.

At what point is the disease not the disease? If, (capital IF) chronic symptoms, related to an initial infection, can no longer be explained by the continued presence of those parasites in the body (we will say, just for the sake of argument, that the antibiotics worked and the alien entities are vanquished), what then is the explanation for their persistence? And crucially, in that case, if the infection is no more, is it to be considered the same "disease" as before, or is it a different "disease", one that sometimes develops out of the first one? In a shorter phrase, do we still call it "Lyme" or do we not? And there, I believe lies the dissonance between patients and doctors.

Patients want to say: "I have chronic Lyme disease."
Doctors say: "But you have no active infection now, so it is not Lyme disease any more." If he or she is more aware, he will say, "You have Post-treatment Lyme Disease Syndrome". The doctor, believing this, has no choice but to treat the patient symptomatically. This difference in concept and terminology is the cause of a lot of resentment and entrenched positions. But entrenched positions are exactly what are not needed if we want to get to the bottom of all this. It is an unnecessary argument. We do not yet know enough.

Lymies


I have spent a little time in the support forums, and have developed positive feelings about them, but with reservations. On the one hand they provide valuable social and emotional support. There's a lot of nice tending and befriending. They can also are useful sources of information, so long as one does not take every piece of advice as gospel. On the other hand, I am a little apprehensive about a certain tendency I suspect exists in us to attach excessively to the sense of group belonging, and to our identity as a Lyme sufferer. A fellow Lymie. The danger is that we begin to identify with our disease. We label ourselves. Once we are labelled we are trapped. We possess and converse in a lexicon of esoteric jargon incomprehensible to the outside world. There is an assumption that we are in it for the long term, which can be a powerful conditioning agent to the newly diagnosed. All this shared social and cultural structure, the edifice we build around our condition, by subtle psychological mechanisms can help to bind us into a state of chronicity. But I want to say, "I wish you well with all my heart, but hey, I'm outa here!"

I do not wish this to be taken personally by anybody involved in online support groups, as indeed I am myself. It is a personal observation, not a criticism. Just a thing of which I wish to be to be a little wary, while benefiting from the practical help and encouraging words, and contributing too, in my way. Dependency, once acquired, is a difficult thing to shake off.

We Lymies tend to attribute all our ailments and discomforts to our special disease. In my case, apart from the primary presenting symptoms which took me to the doctor in the first place, I could cite: general tiredness, depressed mood, heat intolerance, disturbed sleep patterns, and a new difficulty in controlling my blood pressure (my hypertension preceded my Lyme by years, but was until recently under reasonable pharmacological and lifestyle control). Goodness knows there are a great many people with far more chronic, extensive and unpleasant lists than me. Yet the kind of relationship that many of the reported chronic symptoms have with any initial B. borrelia infection is unclear, and remains for the time being a matter of assumptions, conjecture, beliefs.

Lyme disease is rapidly increasing in incidence and prevalence. Climate change has been suggested as one cause of this. Another is increased awareness. Suddenly everybody knows somebody with Lyme disease. A lady friend of mine was out to lunch in London with three girl friends, all of whom told her they had Lyme disease. I have little doubt that many of those who claim the disease do so with solid justification. But it is becoming fashionable, too! Others, with only the flimsiest foundation, will clutch at the straw Lyme offers, as the latest in-vogue disease, to explain any persistent, undiagnosed symptoms. The upside of this raised profile will hopefully be more funds, more research, more knowledge, wider understanding, better diagnostics, improved treatment.

Questions


I have made a list of a number of questions which, in another post, I would like to critically appraise:
  1. First and foremost, I would like to come to an educated guess as to the likely processes behind chronicity. The assumption by many affected by chronic Lyme-related symptoms is that these are due to continued infection. This may or may not be true, or may be true in some cases but not others. I would like greater clarity on this.
  2. The assumption by many affected by chronic Lyme-related symptoms that any sudden acute aggravation is due to the Jarisch-Herxheimer reaction has, I think, a shaky foundation. Sometimes it is likely to be the correct explanation, other times there are other, equally or more likely explanations. I would like to understand better what is going on.
  3. There is clearly a problem with testing for B. burgdoferi. Conventional methods come up short. Valid and reliable alternative methods may not be widely available. Other alternative methods may not be any more reliable than conventional methods, or may lack any objective validity at all. I would like to understand more about this.
  4. B. burgdoferi has been accused of devious methods which enable it to survive attack and avoid detection whilst in the body (e.g. entry into blood cells, encysting). I would like to know whether these mechanisms have been reliably demonstrated, or whether they are simply a part of the folk mythology surrounding a mysterious disease.
If any readers can help me with these questions, I would be grateful. Thank you for reading.

To be continued.


Saturday, 17 September 2016

Stress - how to survive and thrive

I have written a book about stress, how it affects people and what people can do about it. I wrote this book because I realised that many of the health problems presented to me by my patients have an important emotional component, in which stress is a main player. Indeed, my book started off life as an educational pamphlet for patients, but it developed and grew into a comprehensive guide to overcoming stress. Here is what I say in my book, reduced to fit into a nutshell...

Stress is not what happens to us - it is a tension caused by an interaction between us and the outside world. It is due to a mismatch between the demands placed upon us and how well we feel able to respond to them, in which either the demands are too great or our capacity to respond to them is inadequate. How things affect us depends on our attitude to them. Our capacity to respond depends on our resources and our resourcefulness.

Often we intuitively know what stress feels like for us, but stress symptoms differ for different people and different kinds of stress. Stress affects our thinking, emotions, physical body and behaviour. Methods have been developed to assess how much stress we have experienced or are experiencing.

Stress is not what happens to you, it is what happens with you when you attempt to meet a challenge. Three stages are involved in assessing the challenge: we first become aware of a potential threat (it announces itself), then we weigh it up, then we weigh up our options. How a challenging event or situation affects you, depends upon an array of things:
  • About you: your background, personality, experience, beliefs, values and self-belief.
  • About the situation: its nature, proximity, magnitude and duration.
  • About your resources: the material, personal, social and spiritual help available.

Nobody knows the trouble you've seen, because your own experience of stress is unique. Contexts in which stress develops can be daily hassles (“bothers”) or major life-changing events (“earthquakes”). Stress may be sudden and intense (“lightning bolts”) or long and drawn out but less intense (“desert crossings”). Selye's General Adaptation Syndrome describes three stages of stress: alarm, resistance and exhaustion. We shall call them "modes". Stress involves mental, physical and behavioural changes.

Stress can enhance or harm. The bodily effects of stress are regulated by our hormones and by the nervous system. The bodily and mental responses to stress have biological and evolutionary purpose, but ill health can be generated by long term stress. Our beliefs, attitudes and behaviour can make the difference between experiencing the negative effects of stress, and enjoying meaningful, fulfilling lives.

You cannot change your stress without first knowing your stress. Knowing your stress means knowing:
  • What triggers it.
  • What you feel when you are stressed.
  • What kinds of thoughts you have when you are stressed.
  • What things you tend to do when you are stressed.
  • This knowledge will allow you to change.

There are many ways of coping with a given situation. Our habitual ways of coping can be counter-productive and detrimental in the long term. You can learn to recognise your habitual coping strategies and change them into better ones. To do this you must change your world within.

Behaviour experiments can help you to learn the benefits of new ways of coping. First observe your habitual ways of coping. A coping diary can help you to do this. Question yourself about the appropriateness of your responses. When you recognise the cues that make you stressed, stop your automatic responses, take your time and choose better ones. Review results, adapt and improve.

Problems are only as big as our attitude to them allows them to be. Beware of the thought goblins in your mind! You can change the way you think. Be prepared to question your beliefs. Imbue your mind with thought allies.

It is easier to have a healthy mind if your body is healthy. First get the basics right:
  • Healthy diet and good hydration.
  • Manage alcohol intake, cut out smoking and other "recreational" drugs.
  • Good rest and sleep.
  • Appropriated activity and exercise.

You can prepare yourself for stressful situations by:
  • Practising basic positive responses in a safe environment.
  • Learning some positive self-instructions.
You can negotiate stressful situations successfully by:
  • Stopping your automatic responses.
  • Taking your time and choosing an appropriate response.
  • Being aware, calm, flexible, brave and fair.
You can promote relaxation by practising:
  • Slow abdominal breathing.
  • Imagination and visualisation.
  • Voluntary muscle relaxation.
This will relax you if you feel stressed, relax tight muscles, and promote more general, long-term relaxation, by a number of mechanisms. Exercises only work if you do them.

You can apply the principles of learning to change your thought patterns. Also, get used to asking yourself why you thought a certain thought (meta-thinking). You can swap thought goblins for thought allies by knowing yourself, questioning yourself, stopping your habitual responses, taking control, reviewing results. Behaviour experiments will set you on your way. See what happens if you approach things differently for a while.

A better ability to solve problems will reduce your stress. Problem-solving is a skill you can learn. Problem-solving requires method. A ten-step procedure for rational roblem solving is given. But intuitions and strong gut feelings can also provide valuable answers or insights.

Chronic stress deadens emotional experience. Emotions have useful functions and enrich our lives.It is not healthy to suppress emotions nor to allow them unbridled free rein. Allow yourself to experience emotions without interpreting them or attaching value judgements to them. It is normal for intense emotions to pass quite quickly. They do so if you do not dwell on them. All head or all heart are not healthy, they need to be balanced.

Good communication helps avoid tension and conflict between people. Good communication involves a number of skills which can be learned, and perfected through practice. A strong and balanced ego is an asset in good communication.

Help and support from other people is a major buffer against stress. It may be emotional, practical or material. Help and support are available to everyone. It can come from family, friends, support groups, charities, or government organisations. The Internet is a great resource.

Coping has the fundamental goals of reducing, simplifying, and/or sharing the challenges you face. Basic options: Alter, Avoid, Accept, Adapt. Challenges may be practical and/or emotional, from without and/or from within. Ask yourself:
  • Does the challenge require solutions to practical problems or emotional ones?
  • Do I have better leverage acting on the outside situation, or acting within myself? 
The stress-busting tool box: Organisation, Emotional expression, Modifying responses, Self-nurturing and development, Seeking help, RRE (Rest Relaxation, Entertainment). Use the right tools for the job!

Inner strength is a quiet confidence that you possess the capacities and resources to be able to deal effectively with the situations life confronts you with. Inner strength comes from mastery and belief. You can develop it by:
  • Keeping good health.
  • Positive thoughts and optimism.
  • Being inspired by positive people.
  • Personal development.
  • Recognising your affinities.
  • Keeping wise words in mind.
  • Keeping an inner sanctum.
  • Believing in something bigger.
  • Loving.

Self-awareness empowers all your other efforts to live without stress. Some questions to ask: What is the nature of my pain and what is my deepest need? What am I like? What are my affinities? What are my strengths? What are my limitations? What are my valued principles of living?

My book ends with a chapter of "reminders, golden rules and tips". Obviously I recommend my book. It is called Stress: Survive and Thrive. You can buy the Kindle version from Amazon. The paperback version will be available shortly.

Thursday, 18 August 2016

Spiritual reflection II

There is an oft repeated mantra among my fellow practitioners of alternative medicine, that holism acknowledges/addresses the unity of the body, mind and spirit. While I consider myself to be a spiritual person in my way, I have problems with this. Firstly, my way is not everybody's way, and my conception of spirituality is not necessarily that of yours or another person's. But the above proposition falsely and a little presumptuously assumes a shared belief.

The belief it assumes is the existence of some immaterial or energetic aspect of the human being other than anything that can be encompassed by the words "mind" or "body". This is purely belief, because the existence of such a "spirit" is not a universally accepted fact. The spiritually inclined but open-minded have also to consider at least the possibility that an entity called the spirit does not, in fact, exist. A patient might well ask, "In my book, there is no "spirit", does this mean I cannot be treated holistically?" At this point the practitioner, to care for that patient, would have no choice but to act as if. As if, "The spirit is there, you are just unaware of it". If that patient got wind of this, it would be just about as annoying to them as being talked at about the real "truth" by a pair of Jehovah's Witnesses. (They always travel in twos). Even if there were a shared belief, between those interacting, in something called "spirit", there is no guarantee that the thing believed in would have the same description, meaning or connotations. It is clear that different people who believe in a spirit may give very different definitions or descriptions of it.

Secondly, I would ask what special skills the people who repeat the mind-body-spirit mantra, over and above those who don't, have in ministering to the spiritual side. I would hazard a guess: on average, none. No doubt they would argue that treating the patient as a whole person (whatever that means to the individual practitioner) is enough. Body, mind and spirit being facets of the one whole, any improvement in any one of these facets will automatically bring about improvement in the others. Mens sana in corpore sano, stated Juvenal. Being a wise man, he left out the spirit, so great is the complexity and controversy of the argument. But let us ignore that omission. There is that school of thought that our body, mind and spirit find health or ill health as a whole. That is, for example, one cannot be unhealthy in body and be strong in mind and spirit. I am not of that opinion. History is full of examples of extraordinary people who despite the ravages of illness or age, have shown a strength of character and a determination of spirit that has transcended physical weakness. Nevertheless, these people are exceptional, characterised by their extraordinariness. Their psychological and/or spiritual characteristics are so strong that they can overcome severe physical limitations.

On the other hand, while physical health may not be an absolute requisite for inner strength, it cannot be doubted that for most people, lack of the former may detract from the latter. Good health and feelings of well-being and energy can only enhance our ability to feel effective and confident within ourselves, to think clearly and to persist determinedly in adversity. So that is why attention to healthy living, such as diet, fluid intake, sleep, rest and exercise help to lay down the physical context in which inner strength can develop, as well as the physical energy to carry through our will. Let us never have to reflect that the will is strong but the body weak!

But where does the spirit fit into this general consideration. A while ago I had a discussion with some colleagues about this. Most of them stuck to the point of view that spirit, mind and body find health in parallel. My own point of view was that if "spirit" has any kind of special meaning of its own, it must transcend the limitations of body and mind, limitations such as disease, for example. I do not know if such a spirit exists, so I have to find a lower level explanation that will allow for it but not depend upon it.

Myself, so far as medicine and holism are concerned, I regard the spirit in a much more down-to-earth way. For myself, I would define the spiritual dimension of healing as all things that "lift the spirit" in the colloquial sense. By that I do not mean good cheer or temporary enthusiasms. I mean feelings of deep and enduring enthusiasm, energy, joy and love of life. The word "enthusiasm" comes from the Greek en ("in") and theos ("God"), which produced enthousiasmos ("divine inspiration"). Let us say, for simplicity, that enthusiasm is a particular state of love. Different people may find this in a cathedral or in a cave, at Lourdes or Mecca or Benares, in the wild wood or by a wild sea, up a mountain or in the desert, in poetry, prayer or dance, in deep attention to the performance of one's craft or in full song, in group worship or in quiet meditation. In this sense, I urge everybody to seek to enrich the spirit.

Tiredness and the right dose of enjoyment

I have a burner for essential oils in the corner of my waiting room. I usually use lemon balm essence, which gives off a lovely fresh, energising aroma. While I was lighting the burner's tea candle this morning the fan happened to be directing air towards it, and I noticed how the air flow made lighting the candle difficult. It was not strong enough to put the flame out, but neither was the flame strong enough to take easily in the flow of the air. I reflected on a question a lady asked me just the other day. The lady is chronically fatigued, although I am not using that term as a diagnostic label. However, she confided that she loves to dance, and on those occasions when she goes out, has a glass of wine and a good time, the next day she feels full of energy. The question was, should she do this, or is she putting her health at risk. My answer was yes, absolutely, to do things she loves doing, but that it must be dosed. If you are in such a situation, you need to learn, by graded steps and through trial and error, what dosing is positive (amount and frequency) and what dosing is a toxic. Just as a flame needs oxygen, and blowing on embers will brighten them, a too forceful wind will blow a flame out and scatter the embers.

Saturday, 13 August 2016

Osteopathy - general plan that is tolerant of our ignorance

One of my patients needed written clarification of the things we discussed at our first meeting. She writes:

Could please tell me what your working hypothesis is of what is happening in my body to cause my symptoms? Also, what is your approach is for treating this?

In my reply, as premises to the comments specific to her case, I made the following points:
  1. We don't know everything (nor even a small part) about the way the body works, so we need an approach which is tolerant of our ignorance.
  2. In osteopathy, the working hypothesis is not as important as the general plan. The general plan says: "Be faithful to osteopathic principles and treat the patterns you find." The beauty of this is that it allows you to do useful work even if your working hypothesis may actually be wrong.
  3. Especially in chronic cases, chasing a single, clear "cause" is a wild goose chase. It is much more realistic and useful to think in terms of a network of multiple, reciprocal influences, each of which contributes to the maintenance of the whole (dysfunctional) system.
  4. The more you focus on detail, the less you appreciate the basic general patterns.
  5. As an osteopath I approach all problems in the same way (see number 2 above). The most important principle for the osteopath is to reduce at least one kind of stress and strain from the body (the mechanical kind), so that the whole organism, unloaded a little, frees up some resources for healing.


Thursday, 11 August 2016

Snakes, migration, and ecological change

Josephine hurt her arm bashing a snake with a stick. She tells me she and her husband have seen snakes several times in the garden of their house in the campo, of two different kinds. There were once no snakes on this island, but they have become increasingly populous in the past ten years, probably introduced in the trees and plants that are imported for people's land and gardens.

The The Montpellier Snake (Malpolon monspessulanus): 
a mildly venemous snake now present here

The official and popular line is that this is a bad thing. The introduction of new, alien species will change the ecology. These snakes will eat all the lizards. The Wall Lizard, for example, which used to be unique to these parts, but in its turn has now migrated and become naturalised in parts of the mainland. Then, who knows what will happen?

A Wall Lizard - Threatened by snakes? 

People are afraid of these new inhabitants of our island, thinking them to be dangerous. In fact, only one of the three species of snakes known to exist on Ibiza carries any venom, and then only mild and of a small quantity. But I think the reason why Josefa bashed the snake on the head with a stick has more to do with an ancient, atavistic fear buried deep in the collective psyche of humanity. When Adam and Eve (and the snake) were cast out of the Garden of Eden, God dealt with the evil serpent thus:

“Because you have done this, 
“Cursed are you above all livestock 
    and all wild animals! 
You will crawl on your belly 
    and you will eat dust 
    all the days of your life. 
And I will put enmity 
    between you and the woman, 
    and between your offspring and hers; 
he will crush your head, 
    and you will strike his heel.” (Genesis) 

So Josephine attempted to crush the serpents head.

But is the introduction of new species to an environment necessarily a bad thing? It is certainly true that a single species can have far reaching and dramatic consequences for an ecosystem. The video on this web page will probably amaze you at to what extent the reintroduction of wolves to the Yellowstone National Park changed the environment.

Nevertheless, nature has a way of adjusting to change. Species will always invade new territories, and compete with the existing species. The fittest will survive and in doing so, change the environment. That is the way it always has been and always will be.

What may happen as a result of human activities is that we aid the transportation of plants and animals from one part of the planet to another, so the process happens faster. But quite apart from this aspect of our activities, humans are changing their own ecology more than any snake could be responsible for. We spend a great deal of time and effort clumsily attempting to undo the inconveniences we have ignorantly inflicted upon ourselves.

Then, good and bad are human constructs, they have no meaning outside a human perspective. Places we call "tropical paradises" are, for the creatures that naturally inhabit them, both abundantly generous and cruelly perilous environments. John Steinbeck (in The Log from the Sea of Cortez) described the region of Magdalen Bay in Baja California thus:

"The abundance of life here gives one an exuberance, a feeling of fullness and richness.... The sea here swarms with life, and probably the ocean bed is equally rich.... There was food everywhere. Everything ate everything else with a furious exuberance."

In nature, everything eats everything else. For this reason people who profess to "love animals" tend to find nature disturbing: it confounds our human notions of "good" and "bad".

Beyond what we think about it or do to it, nature can look after itself, it will always adjust, but not necessarily congenially to our desires or ideals.