The Lockerbie Bomber, cancer, handling pain

A large part of media analysis takes the view that most decisions made by people in power, turn out in hindsight, to be wrong. The families of the Lockerbie victims naturally want full justice to be done. Many of them are furious that Abdelbaset Ali al-Megrahi was allowed to go home to die with a prognosis of 3 months to live. What the media do not analysise is that by releasing him on compassionate grounds, the Scottish Government gave him something to live for. Had he stayed in prison he might well have lived for 3 months or so. Going home to a welcome from his family and the attention of people who cared for him as a person gave him hope, joy, and a future - all the qualities that enable the human race to survive against all odds.

Over the years a number of my patients have or have had cancer. One man who came to see me for an unusual muscle condition had prostrate cancer. He was not given long to life. Whether it was the treatment on the muscle condition, or of improving blood flow, his prostrate cancer incidentally made a dramatic improvement. The consultant told him that he was not going to die of the cancer, so he got married. He was 82 when he first came to me.
Another man had a terminal prognosis from a respiratory condition. He is still alive and kicking. He asked the consultant what was the longest someone had ever lived after being diagnosed with the condition. The consultant said, 14 years. This man has cheerfully decided that his life expectancy is 14 years less the time he has had it already.
People say to me, "You not only treat me but you give me hope." So often they go to see health professionals who say things like, "What do you expect? Its your age." "You'll be in a wheelchair if you try to have children", (that lady now has two healthy children). "Its arthritis, there is nothing you can do." "Stop going to the gym, its too dangerous to exercise" (that man is now training for tri-athlons)." Its a disc prolapse or collapse, we are not going to operate, there is nothing you can do." "It is a frozen shoulder, it will take 18 months to heal." All of phrases have been used by people many times. In most instances we have seen a return to good health in far shorter times than if they had accepted the bad news and resigned themselves to it. As health professionals we need to take care to avoid transferring our own frustrations onto the people who come to us for help and advice. Sun Simiao wrote in his Essential Prescriptions,
"Whenever a physician treats an illness, he must quiet his spirit and settle his will. He must be free of wants and desires, and he must first develop a heart full of great compassion and empathy."1

The human spirit is far stronger, deeper and more creative than most of us can imagine. Some people survive the worst of experiences. Others succumb to the smallest accident. Dr Judith Trager wrote a book called, The Worst Is Over: What to Say When Every Moment Counts--Verbal First Aid to Calm, Relieve Pain, Promote Healing, and Save Lives She positively talked people in crisis into a process of healing. Through positive suggestion, people who were bleeding from an artery at a road accident could make their bodies bleed just enough to cleanse the wounds, then stop when they needed to preserve their blood.  They could focus their minds on the help that was going to come, not on the prospect of imminent death. When I came home after my own major accident I met someone called Simon. He too had a serious accident. The first thing that he told me was, "Healing starts in the mind. You tell yourself you are going to heal and you will." He had been hit by an articulated truck, broken numerous ribs and lost his spleen.
How to Handle Pain
When you are injured start by completely resting. Calm down your heart rate by controlling your breathing. Allow your mind to take on board where you are now and what tissues are injured. Examine yourself both physically and mentally. Imagine you are the doctor or paramedic. Ask yourself, Where does it hurt? What hurts? Does it feel like sort tissues or hard tissues?muscles, bones, organs, ligaments, nerves or connective tissues? Does the pain come and go? Does it lessen with painkillers or do they make no difference? Does stretching help or make it worse? Can you localise the pain by saying to yourself, "I am not in pain; the pain is in me. It is not going to last; it is temporary. Someone has had it before so they can help me. There was a time when I was not in pain, What has changed in my life to bring on the pain?
Now start to visualise what is happening in your body. The troops are arriving at the source of the pain. Special red blood cells called platelets plug the leaks. Special white blood cells called leukocytes and eosinophils arrive to fill up the area with healing chemicals such as bradykinins (they create inflammation). As the inflammation reaches a limit over 2 to 4 days the macrophages (lit. 'big eaters') arrive. They digest the toxins and by products of inflammation. Over a period of weeks the new collagen cells proliferate and remodel into scar tissue. The bones heal with a lump called callous. Skin cells recover with some scarring, muscles rebuild but not as elastic as before.
Chronic pain is harder to handle but you can develop strategies to manage it.
What slows down the healing process
Taking too many anti-inflammatories or steroids. These drugs mimic the body's response to stress but in much larger doses than we produce ourselves. Take only enough to see you through the worst of the pain. Omega 3 oils (DHA and EPA) have an anti-inflammatory effect (take 3 a day). Turmeric, chilli, fenugreek, bromelain (extract of pineapple core) are all anti-inflammatory.
Getting your joints manipulated in the first four days. In the first 4 days the tissues are repairing and almost plastic in their make up. Strong manipulation can be very harmful at this early stage. Gentle manipulation and lymphatic massage or acupuncture are very soothing and promote healing.
What speeds up the healing process
Use covered ice if the skin is not broken. Ice limits excessive inflammation and constricts the blood vessels. Later they dilate and improve blood flow. For small areas try rubbing an ice cube directly on the skin it until the cube melts. If the skin is broken you must concentrate on cleaning the wounds and possibly taking anti-biotics or using them directly on the skin. Grit, saliva and mud are all sources of infection.
Gently massaging around bruising but not directly over it clears the bruising. Blood in tissues is an irritant that slowly disperses through the lymphatic vessels. The lympathics link in chains back to the heart. Their main collection areas are the back of the ankles, the inside of the thighs and groins, under the diaphragm behind the oesophagus or food pipe, down the sides of the neck, under the armpits and alongside the breasts, then finally back into the venous return to the heart under the left collar bone. Massaging through lymph glands clears inflammation faster and promotes neutrophylls or white blood cells to detox the body.
Listening to music, unwind, do what you enjoy.
Take anti-oxidants and eat highly nutritious foods.
Rest then stretch and rest again.
Keep asking questions about your pain but don't assume that because someone is a professional they have the answers. Your own body has the answers and a treasure chest of healing chemicals to cope with emergencies.
Keep a positive attitude, you will heal, you will get better. Keep company with positive people and those who make you laugh when you yourself are healing. Watch anything that makes you laugh.
Go for massage, gentle manipulation, acupuncture or any other therapy that has helped you in the past.
Take up a new hobby, sport, or interest, get involved with others. It helps them and takes your mind off your self.

Increase your energy and integration through yoga breathing

Our yoga teacher Toby gave an interesting homily, or talk with a meaning, this evening. He talked about the word 'yoga' being related to the word for 'yoke'. A yoke implies being joined together, the union of two ideas, causes, souls or whatever, going in the same direction. Jesus Christ had the same idea when he said, "Come to me all you who are weary and heavy laden and I will give you rest. Take my yoke upon you, let me teach you because I am humble and gentle, and you will find rest for your souls."

B.K.S. Iyengar talks about yoga being the union of the individual self with the universal self. Carl Jung had the idea of a individual unconscious that connects with a collective unconscious mind through dreams, common experiences or tendencies to behave in a certain manner. These are called archetypes. Hinduism likens us to islands of ideas connected by a deep ocean.

When I commuted to London for 11 years I used to dream up inventions. It was not possible to fulfil them but slowly I saw some of them come to fruition by others who put their minds and resources into the ideas. From this experience I came to believe that there is a collective wisdom in humanity that some of us tap into. Foolishness is often an inability to listen to or act upon advice.

Toby felt that the role that yoga played for us was to unite the mind with the body. By bringing the mind and the physical practice in the body together we coud both focus and calm the mind. The force that links the two is the breath. The breath itself is under both voluntary and autonomic control. We have such a strong instinct to breathe that we do not need to think about it. However we can control the breath through pranayama or yoga breathing exercises. There is nothing strange about these exercises. They simply bring the body under the control of the mind. There is a simple exercise to let you practice in my video on the neck and the diaphragm.

Improve your neck and breathing


Most people who have asthma, IBS, acid reflux, hiatus hernia, gall bladder pain, or heart conditions have a shallow breathing technique. By steady practice you not only help your digestion but improve the oxygen levels in your muscles. I often see long distance cyclists who improve their stamina by breathing more deeply. Our other yoga teacher Andreas Wren puts it very clearly when he says that the first move we every make is an in-breath and the last move we ever make is an out-breath. Its what we make of our life in between that matters.

Living with Warfarin, INR,

 Before reading this please be aware that I am not a doctor. I am writing this because I have first hand experience of a heart condition that meant I had to be on warfarin for over a year. Please check any information or agree any changes to  medication with your doctor first.

If you have been affected by a blood clot, stroke, DVT (deep vein thrombosis), or heart arrythmia (irregular rhythm) or heart condition such as atrial fibrillation, you might be put onto warfarin (Coumadin). Irregular heart beats could produce turbulence and lead to bits of heart valves breaking into the bloodstream. Blood clots are formed when platelets get "stuck" in the capillary system or the arteries start to harden as they degenerate. Calcium is also needed for them to form.

Warfarin thins the blood by inhibiting the action of an enzyme that converts vitamin K to an active form.
It has a stronger action than aspirin or clopidogrel which inhibit platelet activity. Once you are put on warfarin the level in your bloodstream must be measured at least weekly until you are stable and know your own levels. Testing might then be reduced to fortnightly. The level must not be altered rapidly. It is a bit like steering a barge on the canal. The barge takes a while to respond, if you move the tiller too far it will hit the bank. Blood clotting rates are measured as an INR (Internation Normalised Ratio). A therapeutic dose is normally between 2 and 3, (or 4 if you are waiting for an operation).

Warfarin will have a stronger effect if you take non-steroidal anti-inflammatories like neurofen or aspirin. It might also have more effect if you are on metformin for diabetes. Some anti-biotics also reduce vitamin K levels in the blood. Bromelain which is extracted from pineapple core might increase its effect. Grapefruit or grapefruit juice is an active substance that can increase the effect of medication. High levels of anti-oxidants like vitamin C might affect the level.

More importantly, foods that contain vitamin K will reduce the effect of warfarin. If your diet regularly includes green leafy vegetables such as cabbage, broccoli, lettuce and spinach you might reach a stable level on warfarin without having to make changes, the dose will be higher. But if you change your diet frequently it will be harder to stabilise. Foods that are very high in vitamin K are alfalfa sprouts and watercress. There were times on warfarin that I simply had a craving and ate a whole bag of watercress. It is as if my body needed to stock up again. Green vegetables (and cauliflower, oranges, tahini and honey are also good sources of calcium). Calcium is needed for blood clotting and muscle function. You might be led to believe that you must not eat these foods at all. Taking these foods is not harmful, but stopping them or changing your diet might lead to a change in your INR levels.

Long Term Effects of Warfarin (Coumadin)
Tiredness is a common side effect. My suspicion is that it lowers calcium uptake and leads to energy loss in muscles. Frequent bruising at the slightest knock, break down of capillaries around the eyes and nose, in the legs and all signs of too high a dose for too long. Nose bleeds are another sign of capillary breakdown. A blow to the head could lead to a haemorrhagic stroke (a bleed in the brain). If you have a sudden severe "thunderclap" headache the physician must be informed that you have been on warfarin. The biggest long term risk is osteoporosis. I suspect that the increase in hip and other fractures from falls could correlate with increased numbers of elderly people on warfarin. As long ago as 1975 scientists isolated a substance called osteocalcium from the bones of chicks. Vitamin K acted as a catalyst to start bone formation around this protein framework.



Conclusion
Doctors have to weigh up the benefits of a mediation against the risks of its side effects. In my case I am glad that I took warfarin, unpleasant though it was. It enabled me to have numerous complex heart procedures that led to a great improvement in my energy levels. It is up to you, talk with your own GP or specialist physician.

Cracked Heels, dry feet, hard skin

Wearing sandals with no socks, walking in bare feet, canoeing and wading in the mud or sand, all lead to cracked heels and feet. You take your feet for granted until they cause you pain. Then you are desperate to find someone to help you. Infection and the lack of sensitivity are the main dangers. Keeping your feet clean is obvious but it really helps. A number of soldiers come to see me for help with their aches and injuries. The last SAS training involved 3 weeks of exercises. One day recently they had to walk for 40 miles carrying over 70 lb (32 Kg) packs and a rifle. The latest qualifying training co-incided with the Tour de France. One soldier said to me that the cyclists would have cold baths, masseurs every night, calorie measured food intake and a host of support for drinks. The SAS trainees had to go to the canteen at night or eat army rations and expend about the same energy as the Tour de France cyclists.
It is obvious, but keep your feet clean and moisturise. We use light olive oil for massage, you could use it every day. On a trip take some alcohol hand gel, tweezers and a needle, remove any tiny splinters. Try the inner pith of citrus fruits if you have no gel. Grapefruit works particularly well. If my heels crack when I am away I use superglue, dribble a little on, let it dry then add a little more. An emery board or pumice stone keeps the dry skin smooth. The best foot cream that we have come across is:
Scholl, Cracked Heel Repair Cream. It is brilliant.
Find someone to give you a foot massage or reflexology. Practice yoga balance postures or simply balance on one foot when you are waiting for someone. There are 26 bones in each foot and 72,000 nerve endings. Your feet form a tripod between the big toe, the cuboid in the outer border and the calcaneus in the heel. Pain in one big toe can be caused by stubbing the toe or other damage. However numbness in the big toe can indicate nerve root entrapment. It could relate to the nerve that comes out below the 5th lumbar vertebra in your back. If you are local to Milton Keynes we can treat that problem with success in most cases
Someone said to me recently that I was the first person to give them a really deep foot massage. They called it an "X ray massage."
Bunions are formed when the big toes are damaged or the arches in your feet start to collapse. The big toe is pushed over into or under the other toes and you walk by rolling off the inside of your big toe not the front of it. If your piriformis muscles in the pelvis are short the feet will externally rotate. You develop the "Charlie Chaplin walk" which is inefficient. That can be cured by muscles energy techniques and piriformis stretches.
To test whether your arches still have some spring in them look at your feet when you are standing. Do they have arches or not? Then sit with your legs dangling. Is the arch higher or are they still flat? If the arch is higher you still have some spring in them. You can work on that and strengthen them. If the arches are still flat you will need orthotics to support them. Podiatrists call orthotics, orthoses (from the Greek, orthosis - making straight).

Caeder Idris, Dolgellau, Mountain Navigation

Peter Cliff wrote a book called Mountain Navigation. In it he has a chapter called, "If Lost".
He writes, "The really bad one is where you don't even know which mountain you are on. In this case work your way downhill following streams, as these tend to lead eventually to habitation; and read this book again!" I have done that, but streams tend to follow the shortest route down. There is nothing worse than following a stream in icy conditions, only to find that it drops over a frozen precipice.
Normally you are temporarily not sure exactly where you are; well that happens to me sometimes. Here is some advice. Before you start look at your compass and lay it on your map. One of the scales will fit the map. It might even say 1:50000 or 1:25000. That tells you how many kilometres you intend to walk. If you are with others try Naismith's group rule. You will walk at 4 km and hour or 1 km in 15 minutes, plus 40 minutes for every 1,000 feet (300 metres) that you climb. Make the downhill sections 4 km an hour unless you are a fell runner. If you are really fit you might walk at 5 km an hour plus 30 minutes for every 300 metres climbed. Keep your breaks fairly short and take your compass bearings when you are somewhere sheltered, not when you are hanging onto your ice axe to avoid being blasted off your feet.

If you are not quite sure where you are take a compass bearing straight down a slope. Ask yourself, Where could this slope be on the map. Does the compass bearing fit the slope that we are on? In our case the bearing I wanted us to walk on went straight over a cliff. That indicated we were not quite in the right place.

Walk back to where you last knew you were. Have a close look at the features to see if you recognise them. Grazing sheep might just move. My daughter Zoe was not convinced by the assertion that the sheep were below us when we came across a slope.

Wear enough clothes especially a hat and gloves. I tried walking Caeder Idris in a gale and pouring rain wearing socks and sandals. That worked OK but the trousers did not work. most Rohan trousers are made of polamide which is nylon. It doesn't keep any heat in at all when it is wet. Goretex jackets need your body heat to push the moisture out through the fabric. If your hands are blue and your body heat has gone the Goretex doesn't work and you get wetter. It's best to wear a bit more. Many cases of hypothermia happen because people are dehydrated, and don't eat soon enough. We sometimes forget to drink enough when it is cold and wet.

Rheumatoid arthritis

Rheumatoid arthritis is an inflammatory condition in the blood circulation that damages synovial (fluid bearing) joints. It is different to osteo-arthritis in that it tends to affect the base of the thumbs on both sides. Osteo-arthritis affects weight bearing or joints that have been damaged in the past. It might only affect one side. During a flare up you could feel heat or swelling in some joints.
Some accepted causes are:
1) Auto-immunity - the body reacts to antigens in the bloodstream by forming immunoglobulins. Tests would include looking for an immunoglobulin that is specific to IgG. Immunoglobulins engulf bacteria, viruses, allergens and antigens. Antigens are protein substances that cause the immune system to react. Rheumatoid arthritis is an over reaction in which the immune system starts to inflame the synovial joints and break them down over a period of time. (Synovial means 'like an egg'. It refers to the slippery fluid that lubricates your joints).
Antigens might include undigested proteins that come through the walls of the gut into the bloodstream, (known as leaky gut syndrome). If you think about most of the reactive foods that cause intolerance they contain proteins. For instance egg whites, milk casein, wheat gluten, soya proteins, brazil nuts. Intolerance is different from allergy. If you had an allergy say to shellfish like prawns, coconuts or to peanuts you would react quickly in a matter of minutes to hours. Your lips might swell and feel numb. You might feel tingling, nausea. You might develop a skin rash or itchiness. The immunoglobulin reaction is often IgE related. Intolerance however takes longer to develop. The antigen in the food has to reach the bloodstream and lead to an immunoglobulin IgG reaction. That might take between 12 and 72 hours. You need to remember this if you are keeping a food diary. Examples might be a persistent cough due to a reaction to yeast or to hazelnuts or a reaction to white fish, carrots or garlic.
Avoiding one food at a time and keeping a diary
2) Genetic - some families have a disposition to inflammatory arthritis of which rheumatoid is one. Ankylosing spondylitis, scleroderma, lupus erythematosis, Reiter's syndrome, psoriatic arthritis are other examples. They are less common in under developed countries which might point to food allergies or environmental factors. Sexually transmitted diseases can lead to some forms of inflammatory arthritis.
3) Infections from bacteria, mycoplasma (bacteria without a cell wall), viruses, or fungi.
4) Major stress in your life or a sudden change of circumstances has a dramatic effect on your immune system. It can tip your body into a state of emergency. Stress management can help you combined with a course of acupuncture.


Conventional medical treatment is quite crude. It relies on masking the pain and suppressing the immune system with steroids. Steroids are the body's emergency drugs. They have a wonderful effect at first but are extremely hard to come off and cause unpleasant long-term side effects. It is better to find someone who will help you to examine possible allergens or infections.
For more information or specialist help with treating the disease refer to the Breakspear Medical Group Ltd.
http://www.breakspearmedical.com
If you want help with musculoskeletal effects and commonsense food approaches book with us for an appointment: info@johnperrott.com

Dervla Murphy, Madam Guyon, Richard Bach,Esther Ranzom

Have you ever wondered what motivates you? Do goals fire you into action?  Do you lay out your list of tasks for the day and steadily work through them? Can you picture yourself completing all of those tasks?
Our daughter Zoe has just off to Portugal having won yet another prize at work. Whatever goal they set her she exceeds it.  She organises her time and her team to achieve the most they can in a day with the most amount of fun and reward thrown in. Earning money can be very appealing not for what it is, but for the opportunities it gives. Too many people have been deluded into pursuing things that money cannot buy. In Dervla Murphy's book, Silverland she quotes a Buryat friend called Todo (p.162), "People forget now what has been known for thousands of years. It's good to have enough money, bad and dangerous to have too much. Very rich people are not free; they live in their own sort of Gulag.

On the other hand there are those of us who dream. We create something in our heads that when the ingredients are combined gives a moment of perfection. Some of us are fortunate to look back to a happy childhood and try to recreate what it is we had. Others of us look forward to a future of security and safety. The past has gone, we can do nothing about it. The future is all we have. The present has not fulfilled our dream.

I live somewhere in-between; I dream, but not big dreams. There are moments in the day that I think, this is a dream come true. It might be on my yoga mat holding an asana that I had never held before. It might be soaking up the warmth of the sun with friends and family, surrounded by beautiful colours. It might be a serendipitous discovery of something  knew, an insight or revelation that comes to me. It might be a feeling in the body of strength and energy. Once I was paddling to the Old Man of Hoy with my friend Chris. I looked at his blonde hair, like a Vikings. Behind his yellow boat the 1100 foot sandstone cliffs rose out of the deep water glinting in the sunlight. A black fin cut through the surface between our boats.
We rose and fell on the huge sea like tiny corks. It put me completely into awe like a dream. All we could do was to keep on paddling by the seat of our pants, allowed for a few hours into this magnificent world untamed by mankind.

What is it that you dream? Richard Bach said in, The Gift of Wings, "I never knew anyone who having held onto a dream and worked towards its fulfilment has not one day found that dream to come true." That might be hard to digest for those of us who lack opportunities in life, but how many of us turn down opportunities when they come. Esther Ranzom always finds a way to give, to help others when they need it. But she also believes that when an opportunity comes your way you take it. I find that if you have a hunch to train in something, to educate yourself along a line that interests you, one day you will be presented with an opportunity to explore and use all that you have spent years learning.

In many things you appear to fail, or not yet succeed, depending on whether you are a half cup empty person or a half cup full person. Yet nothing of what you have attempted will be wasted if you hold onto it.

The mystic Madam Guyon was locked away for a time but she could still look upwards to the stars. Her view was not limited by her walls. "Two prisoners looked through the prison bars. One saw the earth, the other saw the stars. "  What do you see?