Hair loss, no matter what the cause, creates enormous stress and fear of complete baldness. Initial reactions often include avoiding hair washing, changing hair products and taking vitamin or zinc tablets, none of which are successful. In most situations, the hair loss is temporary and new hair will re-grow after a few months without any treatment.If hair loss is caused by iron deficiency, a high iron diet and iron supplements should be taken. Red meat and liver are particularly good sources of iron and are better absorbed than vegetable sources or iron tablets. Vitamin С aids the absorption of iron, so it is wise to include foods such as citrus fruits, tomatoes and raw green vegetables which contain high amounts of vitamin С in your diet.Iron deficiency due to heavy menstrual losses may require gynecological treatment in the form of hormone therapy, curettage of the uterus or even hysterectomy in severe cases.Although hair loss is usually only temporary, a topical preparation called Minoxidil can be used to slow down hair fall and stimulate new hair growth until normal growth returns.People who experience genuine hair loss are generally frightened of dyeing or curling their hair, thinking this may aggravate the condition. On the contrary, it is often useful to have the hair gently dyed or permed to make it appear thicker. Over-conditioning should be avoided, however, as it can make the hair look limp and thin.
*37/150/5*

Those who care for someone in pain are involved in a sequence of reactions that can stretch out for very long periods. It begins with fear, which can grow into terror and a sense of catastrophe. Fear is infectious. At first there may be anxiety about the pain and its meaning and consequences. This anxiety can generalize into the carer being anxious about everything, and can show itself as agitation. We have seen the way the initial period of vigorous escape melds into a quieter period in which the victim guards the painful area and avoids movement. This can be a time of inactivity, doziness, loss of appetite and a desire to be left alone. After operations or accidents, this phase can continue, even when the pain has gone, into a state where the patient feels flattened, with no energy and a feeling of apathy. This time had not been well studied until recently. It was believed to be the long period of healing and was certainly marked by surprise and frustration when the patients longed to get up and resume their normal activity. This stage of apathy certainly irritates the patients and their carers when expectation predicts recovery but it does not come. The condition has similarities with chronic fatigue syndrome, although that state is not usually preceeded by dramatic illness. Exercise seems to make the condition worse and the patient is faced with a prolonged, irritating period of passivity with the fading hope that it will eventually go, although it normally does. Self-limiting and puzzling epochs of stillness have in the past attracted little sympathy or attention from doctors and are trying times for patient and carer.Professor Hall and his team in the Anaesthetic Department at St George’s Medical School in London recently began a special study of the phenomenon. They compared the course of recovery of patients who had had a hip replacement with those who had had an abdominal operation. Hip replacement these days may be thought of as a routine operation but, in fact, it involves first the exposure of the hip joint, which is buried deep in the mass of muscle making up our upper leg, and then sawing off the top of the large femur bone and its joint, before replacing it with a plastic and metal prosthesis. By contrast, operations on the abdomen may seem minor in terms of the amount of tissue disturbed by the surgery. The abdominal wall, which is quite thin, is cut open to expose the viscera. These organs in the abdomen and pelvis have a limited supply of sensory nerves. The diseased parts are located and removed and the abdominal wall is sewn up. The speed of eventual full recovery was compared in the two types of operation and a striking difference was observed, with the hip-replacement patient bouncing back far more quickly than those with abdominal operations. It is clear that the amount of damaged tissue cannot be the factor that leads to the prolonged exhaustion.Patients who will have a hip replacement have usually gone through a very long period of developing distress resulting from the slow onset of osteoarthritis. It begins with pain in the upper leg on movement and with aching at the end of the day. As it develops, movement becomes more and more limited and there is extreme difficulty in walking and a nagging pain at rest which begins to disturb sleep. Analgesics help to ease the pain in the early stages but have little effect on the movement, and eventually these patients become crippled and exhausted by their struggle and lack of sleep. They have a very positive attitude to the operation and have good reason to look forward to relief from pain and a return of movement. Many have already experienced the operation on their other hip, and most will have witnessed their fellow suffers make a splendid recovery.By extreme contrast, people who have their abdomens opened and explored by surgeons have a far more worrying and doubt-provoking experience. They have suffered growing vague discomfort, sometimes not even frankly painful, seeming to originate from somewhere in the depths of their mysterious bodies. They feel poorly and frightened by the very vagueness of what is wrong and what the prognosis might be. Doctors peering into one’s various orifices can be a shaking invasion of one’s guarded personal space. Even more so, surgeons rooting around among one’s viscera is ultimately frightening by itself, and who knows what they found or missed?The St George’s group believe that it must be the fundamental difference in patient’s attitude which explains the striking difference of their long-term postoperative recovery time. They may be right but one must not forget that the nature of the tissue that has been disturbed by the operation is very different. It could be that the body’s recovery and defence mechanisms are very different when muscles and joints are damaged from when organs within our bodies suffer. It is crucial that we accept this phenomenon of sickness malaise as a problem to be understood and controlled, rather than ignored as it has been in the past. Apathy in growing children is famous for driving parents to distraction when their offspring exhibit contemptuous boredom with the very events which lit up the parents in their youth. Caring for a friend who sinks into a torpor of apathy and abandons their former pleasures can be equally irritating.Carers must take an attitude to a form of intense activity exhibited by some pain sufferers: the search for cure. This can become an obsession, with the patient being consumed with certainty that somewhere, someone has the complete answer. When doctors are involved, this state can move from the sad to the frankly dangerous. The insistence of a pitiful wreck of a patient puts tremendous pressure on physicians and surgeons. Desperation breeds desperate measures. An escalation of invasion can result in the repetition of failed operations and the use of untested dramatic new procedures. The Sloane-Kettering cancer hospital in New York believes that 2,3 per cent of the pain problems they witness are caused by the therapy. It has been one of the clear advantages of the pain clinics to be discussed later that they have protected patients from excessive overenthusiastic therapy.A more gentle and innocuous response of patients is to turn to the wide variety of complementary medicine after their physicians and surgeons have failed to relieve their pain. No matter how barmy the theory, these practices flourish. In Chapter 9, I promoted the merits of the placebo. The effective alternative therapists have a number of advantages on their side. They can give more time to the patient than the overstretched health professionals. They often maintain an exuberant enthusiasm, which has faded in their jaded academic colleagues. They can therefore offer more warmth, optimism and attention to patients who are beginning to feel lonely and abandoned. The younger alternative therapists tend to be lovely people, whereas cynicism can settle on their seniors.When pain persists, it is almost inevitable that depression is added to anxiety. With no end in sight and the progressive decrease of possible activity, the patients naturally turn in on themselves. They are sad and it becomes more difficult for others to cope with the sadness. The patient becomes crotchety, particularly with the well-meaning efforts of others to get them out of their shells. This cycle leads to a sense of loneliness and alienation. ‘Why me?’ they ask angrily. ‘No-one cares.’ ‘They don’t believe I am in pain.’ ‘What is going to happen to me?’. These descents into melancholy need professional treatment. In the meantime, those who care are themselves pushed to desperation and even anger and retreat. The carers face burn-out and need relief, a break and a community to share their problems.I write as a warning to carers about what may happen, not about what inevitably happens. There are those in pain and their friends who have a built-in genius for coping. Their secret is never to deny the pain or its consequences, but face both with reality. They observe and experiment with what makes it better with no expectations of miraculous cure. They become expert at spotting diversions which give brief relief and then expand these periods of distraction until they become a way of life.*81\219\2*

The latest approach to eating to keep the blood glucose levels stable and therefore reduce Cortisol levels – is the Glycaemic Diet: this is similar to the diet already discussed but places more of an accent on the ratio of protein to carbohydrate. The work of American Dr Elias Ilyia has proven that this eating plan reduces the stress on the body by balancing the level of insulin produced. It therefore reduces Cortisol levels. Dr Ilyia suggests eating a ratio of one part protein to seven parts carbohydrate, although Dr Andrew Wright in his leaflet ‘Glycaemic Eating’ suggests that it is more effective with a higher ratio of protein: one and half parts protein to two parts carbohydrate. His book on this diet stresses the importance of choosing ‘good’ – slowly absorbed – carbohydrates (such as whole grains) and gives recipes. This book is due to be published in 1999.Although it might seem simplistic, eating to keep the blood sugar levels stable is the first step in lowering Cortisol levels and therefore bringing DHEA levels into balance. By eating in a way which puts the pancreas under stress, you start the chain reaction which upsetsthe output of many other hormones. If you are anxious or have any stress-related symptoms you cannot afford to ignore this. You might say, ‘but I have skipped breakfast, had a sandwich for lunch and a large evening meal for years’ – exactly! You are paying the price for that now with anxiety, fatigue, mood swings and so on. These are symptoms of hypoglycaemia. Try running your car without petrol or expecting an empty ink cartridge to print out your letters. This is exactly what you are doing to your body. It won’t stand for this for ever and will complain with the symptoms mentioned. Hypoglycaemia also increases the risk of degenerative illnesses and maturity-onset diabetes.*106\326\8*