Irritable Bowel Syndrome (IBS) is a common condition. It affects 14-17% of all adults. Nearly 80% of sufferers are women, perhaps due to hormonal changes that come with the menstrual cycle. IBS can run in families. However, although genetics tends to play a part in IBS, it is not necessarily a rule of thumb that if your parent has IBS, you will also have IBS. It is a physical problem, NOT A RESULT OF EMOTIONAL OR PSYCHIATRIC DISORDER. In some people the nerves in the bowel are like stereo playing at full volume at all times. The everyday wear and tear gets amplified and can lead to terrible cramps, diarrhea, constipation or a mixture of all three. Almost a third of sufferers get IBS after having the flu or food poisoning. In these cases, the symptoms are milder and disappear after 3 to 5 years. IBS can be caused by poor diet, use of drugs such as laxatives, codeine and aspirin preparations, food allergies/intolerances, stress, anxiety and depression.

The functioning of the intestine usually is smooth and unnoticed. However, in people with IBS the muscles of the intestine can go into spasm, causing discomfort and pain. Also, there can be excessive secretions (acids, mucus). Problems in the intestine can affect other parts of the digestive tract such as the stomach.

Other symptoms of IBS are:

• abdominal pain, often due to the spasms mentioned earlier or trapped gas, the pain may be sharp and well defined or dull
• bloating (burping and gas), usually occurs right after meals and tends to be worse at the end of the day or during the night
• indigestion often results from excessive acid secretion along with a spasm at the exit valve from the stomach, heartburn and/or nausea may also occur

• Lifestyle changes - adequate sleep and regular exercise, eliminate negative stresses.
• Change of diet - a diet with more fibre helps some people.
  • eat three meals a day if agreeable to your system, some people find eating smaller meals more often through the day to be more helpful (make sure you eat a balanced diet)
  • restrict coffee, teas and colas
  • little alcohol
  • eliminate citrus fruits and juices, fried and fatty foods, strong spices, chocolate and peppermint if you experience heartburn or indigestion
• Medications - stool softeners and antidiarrheal agents may help. Avoid any unnecessary medications (those that do not seem to help).
  • Antispasmodics, such as ibuprofen may alleviate cramps
  • Tricyclic antidepressants have a chemical property that reduces sensitivity to pain.
  • Fresh mint leaves brewed into a strong tea creates a natural antispasmodic.

It is important to remember that IBS is not life-threatening. Nevertheless, it is wise to seek professional advice form your doctor. Once you learn to manage your symptoms, you can usually lead a normal life, with perhaps only occasional or only temporary inconvenience to your lifestyle and activities.

It is reassuring to know your doctor has ruled out other diseases which may appear similar to Irritable Bowel Syndrome. Self-medication over long periods of time with laxatives or bulk-producing remedies, without knowing what you are treating, may lead to medicine dependencies. This becomes expensive and doesn't provide you with any satisfactory relief.

Research has not yet been able to determine exactly why certain people suffer from IBS. The condition usually begins in young adulthood, and occasionally in adolescence.

Your doctor can help practice a healthier lifestyle. If you work towards healthier goals, you may find your flare-ups occur less frequently and eventually your symptoms could disappear altogether.

Compiled from:
Chatelaine, "Are you a 'Gut Reactor'?", Susan Hirshorn with research by Kim Pittaway, Apr. '97, p. 168.
Living with IBS: Irritable Bowel Syndrome, Reed & Carnrick Division, Block Drug Co. (Canada) Ltd.

The Painexplained.ca Campaign targets five top barriers preventing Canadians from accessing effective pain care

Toronto, November 3, 2008 – Canadian doctors, patients, researchers, and other healthcare professionals are condemning the barriers that prevent Canadians from accessing proper and timely pain care. As part of this year’s National Pain Awareness Week (November 2 – 8, 2008), the Painexplained.ca Campaign is targeting key reasons why Canadians are suffering needlessly or excessively from acute and chronic pain.

“Our concern is this: how many of the six million Canadians out there in moderate-tosevere chronic pain are suffering unnecessarily?” said Dr. Barry Sessle, President of the Canadian Pain Society and Campaign Co-Founder. “We know that too many are not getting the timely care they desperately want and deserve. That’s why we are targeting key barriers that cause greatest delay and distress to Canadian pain patients.”

“When you or someone you love is suffering, every minute spent waiting for proper pain care feels like a travesty,” said Lynn Cooper, President of the Canadian Pain Coalition and Campaign Founding Member. “It is unacceptable that so many of us are living with pain that could have been prevented, cured, or reduced with proper and timely care.”

Five key issues have been identified which are exacerbating the struggle of Canadians with untreated or undertreated pain:

1. Canadian Healthcare Professionals are insufficiently trained about pain: A 2007 audit of 41 Canadian undergraduate Healthcare Professional programs revealed that 67% of all healthcare programs surveyed could not identify specific training in the mechanisms, diagnosis or treatment of pain. The same study revealed that Canadian veterinary students get five times as much specific training about pain as medical students. (Source: Watt-Watson/McGillion/Hunter, 2007)


2. Pain Patients are struggling to find doctors able and willing to help: Over 14% of chronic pain patients report being refused care by a doctor or having their care terminated because of their pain. Many new physicians are refusing to take on these patients, leaving them with nowhere to turn. 15% of chronic pain patients also report being discouraged from receiving a pain treatment necessary to relieve their pain. (Source: Nanos Research, Oct 2008)


3. Doctors feel reluctant to prescribe needed pain medications: Best practice pain management often calls for the use of opioids and other powerful medications. Historic regulatory actions against pain doctors have put a ‘chill’ on general willingness to prescribe pain medications, making it harder for legitimate pain patients to access proper pain care.


4. Wait times for effective pain care are unacceptable: An audit of wait times confirmed that some Canadians must wait as long as five years to receive care from an academic pain clinic. The risk of suicide while waiting for care is double that of the general population. (Source: CPS).


5. Out-dated attitudes make us reluctant to ‘speak up’ for proper pain care: Many Canadians mistakenly feel that pain is a normal part of their disease or the healing and aging processes, and therefore don’t speak up to get treatment. But over time, the chemical and structural changes in the nervous system of those suffering unrelieved pain actually causes our nerve pathways to become ‘sensitized’. This makes the pain more difficult (if not impossible) to treat effectively.

“New knowledge and best practices now exist that can help prevent, manage and even cure chronic pain,” Dr. James Henry, Scientific Director of the Michael G. DeGroote Institute for Pain Research and Care at McMaster University, and President of the Canadian Pain Foundation. “But patients aren’t yet benefiting from this knowledge, in part because of these systemic barriers. It’s time we did better for Canadians living with pain.”

Painexplained.ca is a new campaign supported by the Canadian Pain Society, Canadian Pain Coalition, the Canadian Pain Foundation and other partner groups, companies and individuals. The campaign seeks to raise awareness and promote better prevention and management of all types of pain in Canada.

For more information

What are Migraine and Tension Headaches?

Just about everyone has experienced occasional headaches. Headaches often reflect the kind of lifestyle a person maintains; not enough rest, too much stress, etc. Sometimes people experience headaches because of weather changes.

There are some people whose daily routines are changed because of debilitating headaches.

You may feel controlled by headaches. However, you can gain back that control through understanding how you are affected by headaches and making the changes necessary to gain back that control.

Identify the type of headache you have. Your doctor can help with this. A medical history and tests can give the doctor important information so he can help you with your headaches.

You will have a treatment plan that helps relieve headaches and prevent future headaches. Keeping a journal can be a big help in this regard.  You should include:

• date and time the symptoms start and stop
• emotional factors (did it begin after an argument)
• environmental factors
• type and severity of pain
• any pain medications you took (dosage and did it help).

There are several common triggers to be aware of if you wish to regain some control of your life. These triggers are the following: not eating regular meals, keeping inconsistent hours, not getting enough sleep, stress, minor illness, bright lights, loud noises and strong odours, eye strain, excessive amounts of caffeine.

Migraine Headaches

Does the pain clearly begin or stay on one side of your head?

Do you see bright spots or flashes of light before your headaches start?

Do you have a headache the same time every week or month? Do they begin after a specific event?

Are your headaches accompanied by nausea or vomiting?

Two or more 'yes' answers means you have Migraines. It may be associated with aura (changes in sight or sensation). The pain may last 8 to 24 hours. You may feel shaky for the next day or two.

Tension Headaches:

Does the pain feel like a tight band around your head?

Do you also have pain in your shoulders or neck?

Do you get a headache after doing one activity, like typing, for a long time?

Can you continue your daily activity despite the headaches?

Do you often clench your jaw or grind your teeth?

Two or more 'yes' answers means you have Tension Headaches. It is often short-lived but some last for days, weeks or even years.

When you have a headache, it is not your brain that is hurting. It is the nerves in bones, blood vessels and muscles in your head that are irritated. These nerves send pain messages to your brain. It judges where the pain is and how bad it is. Sometimes pain relayed by the nerve causes tingling, pain or numbness at other sites. This is called REFERRED PAIN.

Relief for Migraines:

Use cold to help numb the pain. Place a cold cloth or bag of frozen peas on the pain site for 10 minutes. Wait twenty minutes, then repeat.

Shield your eyes from direct light.

Drink plenty of liquids to avoid dehydration if you are vomiting. Drinking flat pop can help the nausea.

Relief for Tension Headaches:

Massage will help reduce pain by increasing blood circulation.

Moist heat can increase muscle relaxation.

Brush your scalp with a soft hairbrush for relief.

Reducing Headaches:

Medication (conventional/alternative) can control, stop or prevent pain (i.e. feverfew). Examine your environment. There may be a light glare, poor air quality, etc. contributing to your headaches.

Avoid foods that trigger pain.

Changing little things (like hold the telephone to your ear for long periods) can decrease stress on the body. Have a regular sleep schedule. Headaches can be brought on by too little or too much sleep.

Do exercise to reduce stress and raise the body's level of natural pain killers.

Several times a day, mental check your body to locate areas of stress and relieve them. Relaxation exercises can help you relax, release tension, and control pain. It may take you a few tries before you are comfortable and see a difference in how you feel.

1. Sit in a comfortable position.
2. Breathe deeply and evenly.
3. Every time you breathe out, let your body release tension.
4. Let thoughts flow through.
5. Let yourself drift.
6. Imagine relaxing thoughts or images (e.g. "warm and heavy", "calm and peaceful", "it's o.k.", "being on the woods or at the beach").
7. End with a deep breath and stretch.

Compiled from:
Migraine/Tension headaches, Krames Communications.

Definition:

MPS is a neuromuscular condition. It happens because of mechanical failure. Repetitive motion injury, trauma, and illness cause trigger points and these points are all over the body. It affects as many men as women. The pain is in specific spots rather than generalized as with Fibromyalgia.

Diagnosis:

Fibromyalgia seems to trigger MPS. Others say that MPS (specific, local) triggers FMS (general, overall). We often say that people suffering from Fibromyalgia have 18 trigger points. They are actually called tender points because they hurt when pressure is applied. However, MPS has trigger points. It hurts somewhere else when pressure is applied to a trigger point. This is called referred pain.

Treatment:

Very similar to Fibromyalgia.

1. Identify active and latent (latent means not painful unless pushed) trigger points and perpetuating factors.

2. Estimate the degree of limitation on a person's life as a result of having particular trigger points (causing the most debilitating effects).

3. Develop a specific treatment program dealing with the specific trigger points.

Compiled from:

Fibromyalgia Syndrome, An Informational Guide for FMS Patients, Their Families, Friends and Employers. Robert Bennett, MD. Distributed by: National Fibromyalgia Research Association, Inc.

Fibromyalgia and Chronic Myofascial Pain Syndrome. A Survival Manual. Devin Starlanyl, MD,MaryEllenCopeland,MS,MA.

The Fibromyalgia Help Book: A Practical Guide to Living Better with Fibromyalgia. Jenny Fransen,RN,I.JanRussell,MD,PhD.

Taking charge of your Fibromyalgia: A Self Management Program for your Fibromyalgia. Julie Kelly,MSRN&RosalieDevonshire,BA.

Shirley Soleil's lecture notes. Notes from Dr. Cheryl Lycette's Workshop presentation April 1997.

Editor’s Note on Fibromyalgia

Fibromyalgia has received continued attention over the years. There is a greater understanding of its effects on the body and its symptoms are better understood. Fibromyalgia is more widely accepted by the medical profession as a physical rather than a psychological illness. Two medications, Gabapentin and Lyrica, are prescribed for many patients with Fibromyalgia. They are similar BUT not exactly the same. Therefore, if you have a reaction to one do not discount the other as a possible treatment. A careful and personal regiment of tracking footsteps, using a pedometer, is a very effective way to move towards a consistent healthier lifestyle. As we learn more about Fibromygia the greater the potential for healthier lives and decrease in numbers suffering from it.

Definition:

Fibro - refers to fibrous tissues such as tendons and ligaments.

my - muscle

algia - pain

Fibromyalgia or Fibromyalgia Pain Syndrome (FMS) is a wide-spread chronic pain condition, that can lead to constant exhaustion. There are many symptoms and a connection with other health problems such as arthritis, Chronic Fatigue Syndrome, thyroid, etc.

Fibromyalgia affects men, women, and children. However, women between the age of 25 and 50 seem most affected (the ratio of women to men is 9 to 1). Children are often misdiagnosed as having growing pains or behavioral problems.

Diagnosis:

Fibromyalgia is diagnosed in two steps.

1. Other illnesses and conditions are ruled out using
1. a medical history and
2. laboratory tests.
2. Apply the criteria explained below. (In 1986, a committee of 24 doctors from medical centres across North America began a study to determine criteria for the classification of Fibromyalgia.)


• History of widespread pain (present for at least three months). Pain is considered widespread when it is felt in ALL of the following regions:


1. left side of the body
2. right side of the body
3. above the waist
4. below the waist
5. axil skeleton (cervical spine or anterior chest or thoracic spine or lower back). Shoulder and buttock pain is considered pain on the side or sides reported; 'lower back' is considered pain below the waist.


• Pain on digital palpitation in 11 of the 18 tender point sites (9 on each side).For a tender point to be considered positive, the person MUST state that the palpitation was 'painful'. Digital palpitation should be performed with an approximate force of four kg.

Musculoskeletal pain and fatigue experienced by Fibromyalgia patients is a chronic problem that tends to have a waxing and waning intensity. There is often a concern on the part of patients and sometimes physicians, that FMS is the early phase of a more severe disease, such as multiple sclerosis, systemic lupus esthematosus, etc. Long-term follow up of Fibromyalgia patients has shown that it is very unusual for them to develop another rheumatic disease or neurological condition. However, it is quite common for patients with "well established" rheumatic diseases, such as rheumatoid arthritis, systemic lupus and Sjogren's Syndrome to have Fibromyalgia. Due to varying levels of pain and fatigue, there is inevitable contraction of social, vocational and avocational activities that leads to a reduced quality of life.

Fibromyalgia patients have widespread body pain. Although many Fibromyalgia patients are aware of the pain when they are resting, it is most noticeable when they use their muscles, particularly with repetitive activities. Their discomfort can be so severe it may significantly limit their ability to lead a full life. As a consequence of muscle pain, many FMS patients limit their activities including exercise routines. This results in their becoming physically unfit, which eventually makes their Fibromyalgia symptoms worse.

Generally, people with Fibromyalgia state that they hurt all over, especially in the parts that are used the most. Stiffness, especially on waking, sleep disorders, irritable bowel syndrome (see separate sheet), irritable bladder syndrome, premenstrual syndrome, restless leg syndrome, headaches (especially migraines and tension headaches) (see separate sheet), muscle spasms, cold intolerance, TMJ (see separate sheet), cognitive difficulties, numbness and tingling in the extremities are some of the symptoms. Other common symptoms include a decreased sense of energy, disturbances of sleep, and varying degrees of anxiety and depression related to patients' changed physical status.

We do not know what causes Fibromyalgia. Many people pinpoint a time when the symptoms started, for example, after a trauma, such as a car accident. Others say that their symptoms came on gradually.

Treatment:

Treatment centers on the symptoms, not the illness.

In general, drugs used to treat musculoskeletal pain, such as aspirin, non-steroidals and cortisone are not particularly helpful in this situation. Also, routine use of sleeping pills such as Halcion, Restoril, Valium, etc. should be avoided as they impair the quality of deep sleep.

Low dosages of antidepressants are often used to treat pain, especially muscle spasms in the legs and sleep disorders. Zostrix (capaiscin cream) is an over-the-counter cream that can be helpful in alleviating pain. It (capaiscin) is found in foods such as hot peppers and Tabasco sauce and penetrates through the skin and into muscles.

If you have Fibromyalgia, decrease the amount of stress placed on the liver. If your liver isn't able to function properly, the body becomes more prone to pain, fatigue and allergic reactions. The juice of one half lemon, unsweetened in water, 20 minutes before breakfast daily, can help improve liver function (if you have any pain that appears to originate from the gall bladder you may be reacting to the lemon). Dandelion and Milk Thistle also help the liver.

Many people with Fibromyalgia have problems with decreased oxygen flow to the muscles, resulting in lactic acid build-up that leads to pain. To help alleviate this use the following daily: B vitamin complex (50 mg once/twice daily), elemental calcium (citrate or aspartate, 1000-1200 mg/daily), magnesium (citrate or aspartate, 400-500 mg/daily), vitamin D (400-600 i.u.) and manganese (150 mg/daily). Apple cider vinegar (must say "pure" on label) can be helpful for reducing muscle pain, as it contains malic acid. Chronic muscle pain has been linked to heavy muscle toxicity with some people and malic acid has the ability to bind with these and carry them out of the body. Two teaspoons of vinegar daily is enough.

Feverfew is a natural pain reliever. It is especially helpful for migraine headaches. The pill form is usually taken (1-2, 125-150 mg up to four times daily) when needed. You may need to take it regularly if it does not help your pain. Caffeine may intensify pain. Decaffeinated tea or coffee also have other chemicals (other than caffeine) that can be harmful as well, so do not drink decaffeinated tea or coffee either.

Eat as close to a vegetarian diet as possible. There is arachidonic acid in meat that stimulates the production of inflammation and pain. People with Fibromyalgia tend to be deficient in the essential fatty acids. Essential fatty acids act as natural anti-inflammatories. Flaxseed oil, borage oil, evening primrose oil are a few of the oils containing essential fatty acids. If you take evening primrose oil take either the marine blend or take cod liver oil with it because fish oil is required to help evening primrose oil work effectively.

If you suffer from digestive problems with Fibromyalgia you can take digestive enzymes containing amylase, protease and lipase (1-2 at each meal) or as needed.

Panax ginseng is good for increasing energy (25-50 mg/daily), but you should not take Panax ginseng if you are diabetic or suffer from hypertension.

Exercise according to the body's needs and ability. Overall, FMS patients must avoid impact loading exertion such as jogging, basketball, high-impact aerobics, etc. Low-impact aerobics such as regular walking, the use of a stationary exercycle and pool therapy utilizing an Aqua jogger (a floatation device that allows the user to walk or run in the swimming pool while remaining upright) seem to be the most suitable activities for FMS patients to pursue. Supervision by a physical therapist or exercise physiologist is of benefit. In general, 20 minutes of physical activity, three times a week at 70% of maximum heart rate (220 minus your age) is sufficient to maintain a reasonable level of aerobic fitness.

Massage, hydrotherapy, physiotherapy, heat, and rest are of benefit. None cure Fibromyalgia but give much needed relief from pain.

Massage assists the removal of waste from muscles, while increasing blood and nutrient flow. This results in a greater availability of oxygen to cells.

Massage is useful for those with Fibromyalgia. Fibromyalgia affects all of the major systems (circulatory, respiratory, lymphatic, digestive, immune and endocrine) of the body and all of these systems respond favorably to massage. That means massage helps move a person towards wellness.

Hydrotherapy, a part of some physiotherapy clinics, has been used since the 1930's to address a wide variety of conditions. You may be able to join an aquatic (aerobics in the water) program at your community center. Hydrotherapy gives people benefits such as gravity-free exercise, local heat and massage, relaxation and pain management.

Particularly painful areas may be helped for a short time (2-3 months) by tender point injections. This involves injecting a tender point with a local anesthetic (usually 1% Procaine) and then stretching the involved muscle with a technique called spray and stretch. It should be noted the injection of a tender point is quite painful (indeed, if it is not painful the injection is seldom successful). After the injection, there is typically a 2-4 day lag before any beneficial effects are noted.

Compiled from:

Fibromyalgia Syndrome. An Informational Guide for FMS Patients, Their Families, Friends and Employers. Robert Bennett, MD. Distributed by: National Fibromyalgia Research Association, Inc.

Fibromyalgia and Chronic Myofascial Pain Syndrome. A Survival Manual. Devin Starlanyl, MD, Mary Ellen Copeland, MS, MA.

The Fibromyalgia Help Book: A Practical Guide to Living Better with Fibromyalgia. Jenny Fransen, RN, I. Jan Russell, MD, PhD.

Taking charge of your Fibromyalgia: A Self Management Program for your Fibromyalgia. Julie Kelly, MS RN & Rosalie Devonshire, BA.

Shirley Soleil's lecture notes. Notes from Dr. Cheryl Lycette's Workshop presentation April 1997.

TMJ (temporomandibular) disorders are a family of problems related to your complex jaw joint. If you've had symptoms like pain or a clicking sound, you'll be glad to know that these problems are more easily diagnosed and treated than they were in the past.

TMJ disorders develop for many reasons. You might clench or grind your teeth, tightening your jaw muscles and stressing your TM joint. Or, you may have a damaged jaw joint due to an injury or disease. Whatever the cause, the results may include a misaligned bite, pain, clicking or grating noises when you open your mouth, or trouble opening your mouth wide.

Environmental Sensitivities

* Are you aware of grinding or clenching your teeth?
* Do you wake up with sore, stiff muscles around your jaws?
* Do you have frequent headaches or neck aches? Does the pain get worse when you clench your teeth?
* Does stress make your clenching and pain worse?
* Does your jaw click, pop, grate, catch or lock when you open your mouth?
* Is it difficult or painful to open your mouth, eat or yawn?
* Have you ever injured your neck, head or jaw?
* Have you had problems (such as arthritis) with other joints?
* Do you have teeth that no longer touch when you bite?
* Do your teeth meet differently from time to time?
* Is it hard to use your front teeth to bite or tear food?
* Are your teeth sensitive, loose, broken or worn?

The more times you answered "yes", the more likely it is that you have a TM disorder. Understanding TM disorder will also help you understand how they're treated.

Understanding TM Disorders

When you understand the anatomy involved in your TM disorder, you can better understand your role in relieving your symptoms.

Muscles Provide Power

Around your jaw joint are groups of muscles that contract and relax so you can open and close your mouth, talk and chew. When they are flexible and not under stress, they work in harmony with other parts of your jaw.

Jaws Form Joints

Your TM joints are where your upper jaw and lower jaw (mandible) meet. Like gears of a car, the joints have moving parts that allow the lower jaw to move. This lets you open and close your mouth for talking, biting and chewing.

Your Dental and Medical Evaluation

An evaluation confirms a diagnosis of TM disorder. It also clarifies the causes of your disorder, helping to set the stage for treatment.

Your dental and medical history helps your doctor gather information on your symptoms, your overall health, and your family history of any related problems. With the answers you give, your doctor begins to determine the causes of your disorder. Your might be asked: Are you under stress at work or home? Do you clench or grind your teeth? Have you had bite problems or joint disorders?

Your doctor examines you to detect your symptoms. One technique is to firmly touch (palpate) your muscles and jaw joint, checking for pain, muscle tension and tenderness. Your doctor may also insert a little finger into your ear to feel how smoothly your jaw works. A stethoscope picks up clicking sounds in your joint and a ruler measures how wide you can open your jaw.

Diagnostic tests pinpoint even further the possible cause of your TM disorder, indicating what the best treatment might be for you.

Imaging Tests: Tomographic or transcranial x-rays are head x-rays that record images of bones and reveal joint damage, fracture, or tumors. MRI (magnetic resonance imaging) produces detailed images of soft tissue, revealing damage in disks or ligaments.

Dental Casts: Dental casts are models of your teeth that help determine how muscle or jaw problems such as bruxism have affected your teeth and your bite. Casts help your doctor study if your teeth have worn down or how your teeth line up. Your doctor takes an impression of your mouth and forms plaster models, which may be mounted on a jaw movement simulator. This mechanical device helps reproduce the movement of your lower jaw.

Your Treatment Program

Treatment works best with a team approach of self-care and professional care. Treatment may take time and include many options.

Resting your Jaw: The most important kind of self-care, resting your jaw relaxes muscles and takes the pressure off your joint, which can then heal more easily. The key to resting your jaw is keeping your teeth apart. Practicing good posture, eating soft foods, and reducing stress will also relax tense muscles and help give your jaw a break.

Keep your teeth apart: Bring your teeth together only when swallowing or eating. Learn to recognize when you clench your teeth, such as when you're under stress; then relax your jaw and separate your teeth.

Practice good posture: Good head, neck and back posture help maintain good jaw posture, too. Try to hold your head up straight, avoid leaning on your hand when reading or watching TV, and use a lumbar roll for support behind your lower back.

Eat soft foods: Eat soft foods like eggs, yogurt, casseroles, and soup. Don't chew gum, and avoid hard foods like carrots (or put them in a blender before eating them). Eating soft foods is a temporary measure that helps you rest your jaw.

Applying Ice and Heat

Ice: Massage with ice directly on the painful area the first 24-48 hours after injury. Apply for 3-5 minutes or until the area becomes numb. Repeat several times.

Heat and Ice: Apply moist heat on tense muscles for 10 minutes, then lightly brush the painful area with an ice cube. Rewarm the area for 1-2 minutes. Repeat ice and heat combination 4-5 times.

Exercising Your Jaw

Open and close: Looking in a mirror, gently open and close your mouth straight up and down, keeping your two upper teeth and two bottom teeth aligned. Do this exercise for a few minutes in the morning and in the evening.

Taking Medications

Aspirin is a very effective pain reliever. Your doctor may also prescribe an anti-inflammatory to help reduce the pain and swelling or a muscle relaxant.

Biofeedback

This technique helps you know what's going on inside your body, so you can learn to consciously control your body's stress responses, such as tightening muscles around your jaw.

Relaxation Techniques

Deep breathing may lessen tension. Or try yoga or visualizing something peaceful, like basking in the warmth of a sunny meadow filled with flowers.

Getting Support

Support from a group or individual may help you manage stress, ease the isolation caused by chronic pain, or help you contact other TM disorder patients.

Electrical Stimulation

An electrical impulse sent through your skin relaxes muscles, aids circulation and relieves pain.

Painless sound waves reduce pain and swelling in your joint and muscles, and improve circulation.

Occlusal Splint

How a Splint Works: Your doctor makes a splint to help diagnose and improve your joint problems. There are different types of splints for different purposes. A bruxism splint or night guard - worn mostly at night - helps you stop clenching or grinding your teeth and reduces muscle tension. An anterior positioning appliance moves your jaw slightly forward, relieving pressure on parts of your jaw. It may be worn 24 hours a day to help your jaw heal. An orthopedic stabilization appliance - worn 24 hours or just at night - relaxes muscles and lets your joint move into its proper position.

"I sound funny when I talk..." At first, your voice may sound different because you've got a bulky piece of material in your mouth. Try reading out loud for a few nights to adjust to talking with a splint.

"I can't eat anything..." Yes, you can still eat with your splint, although you'll probably need to change your diet by eating softer foods. Later, you may only have to wear your splint at night.

Orthodontics

Orthodontics is a kind of dental work that moves and repositions groups of teeth to create a stable bite. Braces are the most common type of orthodontics.

Restorative Work

Restorative dental work changes the shape or size of individual teeth to create a stable bite. If a tooth is missing, a bridge may be built to replace it. If a tooth is too big, it can be "shaved down" to make your teeth hit more evenly (occlusal adjustment). If a tooth is too small, a crown can be added so teeth come together better.

Surgery

Surgery can help restore your jaw joint and eliminate the pain and other symptoms of TM disorders. With other treatment available, surgery is rarely needed, especially if a problem is diagnosed and treated early. In some cases, however, the joint becomes so severely damaged that surgery is needed to correct it.

Compiled from:

TM Disorders: A Guide to Managing your Temporomandibular Joint Problem. Consultant - Charles McNeil, DDS, Contributions - Patricia Rodd, PT. Kramer Communications.

What is SAD?

The pituitary gland, a gland regulated by the sun located in the skull, produces a chemical called melatonin to regulate sleep. When the amount of daylight decreases, the pituitary gland may not be producing the right amount of melatonin in some people. Seasonal Affective Disorder (SAD) is the result of this situation.

A person with SAD may become fatigued, depressed, have insomnia, irritability, headaches, loss of concentration, muscle aches, sadness, lack of sex drive and crave carbohydrates. The season during which most people are affected is October to April. Two thirds of SAD sufferers have an immediate family member with SAD. Four times as many women as men have SAD.

There is a difference between winter SAD (mentioned above) and summer SAD. This may be because serotonin, a chemical in the brain that exudes feelings of well-being, fluctuates over the course of the year. It is at its lowest during spring and early summer. Symptoms can be similar to winter SAD but people with summer SAD can have different symptoms such as agitation, lack of appetite, and more frequent suicidal thoughts. There are no cravings for carbohydrates and sugar with summer SAD.

SAD can be made worse by stress, PMS and panic attacks. Treatments include light therapy, medication (tricyclic antidepressants, serotonin enhancers, monoamino oxidase inhibitors (MAOIs), tithium carbonate), pineal gland extract, melatonin, exercise, diet and counseling. Of all of these ideas, light therapy seems to have the greatest effect on the symptoms of SAD.

Full spectrum lighting has a wider range of wave lengths than standard fluorescent lights. It closely resembles natural daylight. The light levels are eight times the level of typical room lighting. If you spend two or more hours a day (three feet away) in front of the light panel you can see a decrease in symptoms and perhaps the symptoms will disappear. You can read, mend, do crafts, etc. while sitting in front of the light panel. Test it for yourself by using 2-150 watt bulbs and aluminum reflectors or buy the panel.

Compiled from:

"Are you a 'gut reactor'?". Chatelaine. Susan Hirshorn with research by Kim Pittaway. p. 168. Apr. '97.

Don't be SAD. Celeste A. Peters. Good Health Books. p. 9. Calgary 1994.

Dead to the world. Healthwatch. Janne Macrae. p. 17.

SAD - Paul Bergner Alwt. p. 2. Jan. '89 in Update Winter '93.

Snooze blues. Healthwatch. Victoria Clayton. p. 18.

Sleep/wake Disorders of Canada - pamphlets.

The Sunday Daily News. p. 33. Apr. 7/96.

Definition:

Chronic Fatigue Syndrome (CFS) is one of fifty names for an illness that has caused suffering since the 1850s. Some other names for this illness are Chronic Epstein-Barr Virus Disease, Chronic Fatigue, and Immune Dysfunction Syndrome (CFIDS), and Post-Viral Fatigue Syndrome (PVFS). The emphasis is put on 'fatigue'. Over the years there has been much discussion regarding the need to change the name. There are so many more symptoms than chronic fatigue to deal with when a person has CFS.

The term Chronic Fatigue Syndrome is used primarily in North America. Myalgic Encephalomyelitis (ME) is used in most other countries. Neither term is satisfactory. People with CFS have many other symptoms contributing to their disability besides fatigue. Seldom is an infection in the brain found in those who have ME as was once suspected.

CFS/ME affects thousands of men, women and children. The majority of sufferers seem to be women between the ages of 30 and 50. Generally these people are high functioning, productive individuals. There are some differences in how children of different age groups are affected by the illness. This topic is dealt with later.

Adults generally fall into one of the following categories. Twenty-five percent are bedridden, 40% are able to maintain part-time work, 35% work full-time, and 50% are disabled and can not work for varying periods of time.

Diagnosis:

Chronic Fatigue Syndrome is the fourth most frequent reason people go to an internist. Whether going to a physician or specialist it is very difficult to get a quick diagnosis of CFS/ME because there is no known cause. There are many theories about what causes CFS. Viruses, bacteria, parasites, abnormal blood cell shape, low blood pressure, and hypoglycemia are some of the theories being studied by researchers around the world.

There are no specific tests (i.e. blood, x-ray) for CFS/ME. A doctor may order a battery of tests to eliminate other medical conditions. Others simply gather information about your symptoms and decide from his own observations that you have CFS. Either way, you can aid in finding a diagnosis by noting the various symptoms you experience and telling your physician about them.

Fatigue is the most obvious symptom. This is not fatigue that disappears after a good night's sleep. It must be severe unexplained fatigue which persists or relapses for 6 months or longer; is not caused by exertion, or substantially relieved by rest; has an identifiable onset (i.e. not lifelong fatigue); and results in a substantial reduction in previous levels of occupational, educational, social or personal activities. This chronic fatigue is not a symptom of an illness that the person has or recently had.

According to Dr. Michael Rosenbaum and Dr. Murray Susser, patients have the following symptoms:

Symptom/Sign Frequency (%)

Fatigue:

* easy fatiguability 95
* fatigue alternating with periods of normalcy 70
* can do regular work in spite of fatigue 60
* can work only part-time 25
* house-bound 15
* bedridden 15

Other Symptoms:

* headache 80
* low grade afternoon fever 78
* swollen lymph glands 70
* poor concentration 70
* sore throat 70
* depression 70
* allergies 65
* muscle aches, joint pain 50
* anxiety attacks 50
* mental confusion 50
* sleep disturbances 50
* abdominal problems 35
* weight loss 20
* skin rash 15

Treatments:

Before seeing any medical practitioner, keep a journal of the symptoms (time, severity, improvements, relapses, physical, emotional, and mental state). This is necessary to enable your doctor or other medical person to make an accurate diagnosis and give appropriate treatment. The journal is needed because you may be limited by memory and cognitive problems in remembering everything accurately.

General Practitioner - your doctor will focus on treating the symptoms, not CFS. (As was already mentioned there is no cure for CFS.) It could be medication to help with pain or headaches. He uses conventional methods for treating you. If you feel that these conventional treatments are not appropriate for you then go to a Naturopath, Acupuncturist, or use other alternative approaches.

Naturopath - concentrates on getting the body's balance back into healthy regions. They do this by several methods - herbal remedies, detoxification, Rotational Diets, etc. The appropriate approach is the one that addresses your specific needs.

Acupuncturist - can help with allergies and pain. By using the Chinese concept of Yen and Yang, he can help your body regain balance.

There are practical steps you can take to help move yourself towards wellness.

1. Rest, especially at the beginning and during relapses. Your body will tell you when it needs a much needed break.
2. Eat nutritious meals, they give energy and build up the immune system. Unhealthy fats and processed sugar deplete energy levels.
3. Be careful about taking antibiotics. They flush out natural bacteria, weaken your immune system, cause allergic reactions and counteract vitamin therapy. If you take antibiotics, consider taking some natural remedies to offset the damage they may do to your body.
4. Exercise according to your body's abilities.
5. There are some natural remedies that people find helpful. Try one at a time so that you know what works and what doesn't. We are very individual in our illness and also with how we respond to remedies. If one does not work, another may.

1. Magnesium is very good for fatigue. Most people take it close to bedtime. A few people find that taking it close to bedtime actually keeps them awake. You may want to try taking it at bedtime and see how you do. If it seems to keep you awake, try taking it earlier in the day. Magnesium also helps with muscle spasms. Most people take calcium with the magnesium.
2. Evening primrose oil along with fish oil (in order for the primrose oil to work effectively, you need to take the fish oil). Halibut or cod liver oil is the best. The evening primrose oil helps you to feel better in general.
3. Vitamin C, B complex, and E are natural antioxidants and antihistamines. These can help with allergies. If you start having a reaction, taking a vitamin C (1 or 2 grams) can cut it short.
4. Grape seed extract helps with pain.

Generally, a three to seven year recovery rate is given for those suffering from CFS. However, there are those who are 85-90% better within six months. Others are still very ill twenty years later.

Children with CFS/ME:

Some points to consider if you suspect your child has CFS/ME are:

* The illness is very rare in children under the age of five.
* Children with CFS/ME will often have a history of allergies or asthma.
* No obvious sex preference in children under the age of 12.
* In the younger child the onset is usually gradual (over months or even years, adults with CFS/ME for many years generally had a gradual onset of symptoms).
* Fatigue is not a predominant factor in younger children.
* Symptoms tend to blend together in younger children.
* Symptoms are less severe than with the adult.
* The course of the illness is milder but more prolonged. Relatively few become symptom free in a few years.

Because younger children are not able to accurately describe a new onset of fatigue, the following criteria can be used to diagnose him/her:

1. Six of the eight major symptoms: fatigue, headaches, sore throat, lymph node pain, muscle pain, joint pain, abdominal pain, or neurologic symptoms or five of eight major symptoms plus two of three minor symptoms; fever/chills/night sweats, eye pain, skin rash.
2. Persistence of the symptoms for at least six months.
3. No other illness suggested by clinical or laboratory evaluation.

Adolescents:

Adolescents are at a critical stage of life. They are discovering who they are, where they want to go, learning interpersonal skills, etc. Having CFS can be especially difficult because it affects all of these important aspects of life. Some who do not have a strong sense of who they are can shift from seeing themselves as being able-bodied to seeing themselves as disabled, therefore, affecting their self-esteem. So, although the illness affects them in ways similar to adults, there are some differences to consider.

* Most common age of acute onset is at the time of puberty.
* Acute onset of symptoms - the majority will be well or nearly well within three years.
* They have significant difficulties in social and school functioning.

Compiled from:

ME Association of Canada pamphlets.

Solving the Puzzle of Chronic Fatigue Syndrome. Michael Rosenbaum, MD, Murray Susser, MD.

CFS/CFIDS/ME in Children. David S. Ball, MD, FAAP.

Chronic Fatigue Syndrome: The Facts. The New Brunswick ME/CFS Association.

Allergies affect approximately 40 million Americans. Allergies are not taken seriously because they are so common. Shellfish and nuts are two of the few allergies that are life threatening.

Definition:

Allergies are caused by a disorder in which the body becomes hypersensitive to particular substances (allergens) that stimulate the immune system.

Body's response: Overaggressive immune system - the immune system thinks the body is being attacked by a serious invader.

Underaggressive immune system - a reduced immune system function that leads to other problems such as lingering colds, lots of infections, etc.

Auto-immune - the immune system thinks a part of the body is an enemy and attacks it.

Kinds of Allergies:

The main allergies are:

Inhalant Allergies - reaction to things you breathe - pollens (grasses, flowers, trees), moulds, spores, animal danders. They are easy to diagnose - RAST (Radio Allergo Sorbency Test) - a blood test that measures the quantity of IgE antibodies to specific allergens.

Food Allergies - reaction to food and drinks. They are harder to diagnose. The most common food allergies are corn, wheat, egg, yeast, soy, dairy products, fish, chocolate, chicken and nuts. Skin tests though not totally accurate with regards to food allergies can still be used to give you direction in helping yourself move towards wellness.

There are two types of food allergies:

1. Cyclic - repeated exposure will make the food allergy worse. By avoiding the food for 2-3 months and then reintroducing it into your diet will tell you if you can now eat the food. Sometimes years go by before a person can eat the food. Remember not to eat too much of that food too often or you'll have a reaction.

2. Fixed - If you have a reaction to the food after two years it is permanent. In other words, whenever you eat that food you will have a reaction.

As there are two types of food allergies, there are two reactions:

1. Immediate - immediate reactions are usually mediated by an antibody called IgE. The body recognizes the foods as an allergen (an enemy) and releases histamines to attack, resulting in symptoms such as hives, wheezing, eczema, rhinitus, swelling of lips and face, or in extreme cases, anaphylactic shock.

2. Delayed - delayed food reactions are generally mediated by the IgG antibodies. The reaction can occur days later and makes it difficult to diagnose. Symptoms include headaches (especially migraine), indigestion, heartburn, fatigue, depression, bowel problems, etc.

Allergens not flushed out of the body can turn into infections. Taking natural antihistamines (vitamin C, B & E) can help you body flush out the allergens.

*People can be addicted to allergy inducing foods. People crave these foods and have a difficult time giving them up. Like any addiction, a person develops a tolerance level to the food. In order to achieve a high from that food, a person needs to consume more and more of it. Not only does the person feel better emotionally, but physically because eating the food stops some of the symptoms. If the person does not eat the food within hours (10-12) he can suffer from withdrawal symptoms. These include fatigue, weakness, aches, pains, depression and a general hung-over feeling.

Compiled from:
Patient binder received from the Fall River Environmental Health Clinic. Lecture notes from Shirley Soleil.

Detoxification keeps the body clean so that accumulated chemicals (man-made or natural) do not destroy the body.

Desensitization works by exposing you to a very small dose of the allergen. The dose is gradually increased until your body becomes accustomed to the presence of the allergen and stops reacting.

Elimination Diet means taking the offending food out of your diet. You then reintroduce the food and observe to see if a reaction occurs. An example is as follows:

• Week 1-3 - no offending foods
• Week 4 - have eggs
• Week 5 - have eggs and oranges
• Week 6 - have eggs, oranges and wheat
• Week 7 - have these foods and any other offending food

If you have any reactions you can figure out which foods you need to avoid.

Intravenous (IV) Therapy is used to give patients vitamins and minerals. Often people with environmental problems cannot process the nutrients from foods or they process too little from foods. IV Therapy helps some people for short periods of time and others receive benefit over long periods of time.

Because scents are such a serious problem let's look at them more closely (over 4000 chemicals used in the fragrance industry).

We usually do not smell many of the scents we and others are emitting until we become hypersensitive. These chemicals could be causing minor problems for years but we do not see the cause/effect. However, as time passes our bodies become weakened from constant exposure. Overloaded passageways in our bodies - the back up of chemicals in the blood stream, muscles, nervous system, organs, etc. - lead to a variety of symptoms. Poor air quality, the length of time the chemical clings to clothes, closed in buildings, etc. hold these chemicals and our bodies absorb them.

Fact Sheet:

• 15-25% of the population has some breathing problem such as hay fever or asthma that is adversely affected by strong odors from scented products.
• Strongly scented products can trigger migraines; 17% of Canadians suffer from migraines.
• The incidence of environmental discomforts and illnesses is increasing.
• Ventilation systems of many buildings are not able to extract all chemicals from the air and instead recirculate them.

Please note that you should always check with your doctor before undertaking any type of treatment.