Abdominal Pain Quotes

Most people in Atlanta don't have an accent. It's pretty urban. A lot of people speak gangsta, though," I add jokingly. "Fo' shiz," he replies in his polite English accent. I spurt orangey-red soup across the table. St. Clair gives a surprised ha-HA kind of laugh, and I'm laughing too, the painful kind like abdominal crunches. He hands me a napkin to wipe my chin. "Fo'. Shiz." He repeats it solemnly. Cough cough. "Please don't ever stop saying that. It's too-" I gasp. "Much." "You oughtn't to have said that. Now I shall have to save it for special occasions." "My birthday is in February." Cough choke wheeze. "Please don't forget.

I am progressing along the path of life in my ordinary contentedly fallen and godless condition, absorbed in a merry meeting with my friends for the morrow or a bit of work that tickles my vanity today, a holiday or a new book, when suddenly a stab of abdominal pain that threatens serious disease, or a headline in the newspapers that threatens us all with destruction, sends this whole pack of cards tumbling down. At first I am overwhelmed, and all my little happinesses look like broken toys. Then, slowly and reluctantly, bit by bit, I try to bring myself into the frame of mind that I should be in at all times. I remind myself that all these toys were never intended to possess my heart, that my true good is in another world, and my only real treasure is Christ. And perhaps, by God's grace, I succeed, and for a day or two become a creature consciously dependent on God and drawing its strength from the right sources.

His favorites were the arm curl machine and the abdominal machine, where he would lift hard for long minutes and then fight a few last painful crunches.Not that I made a habit of standing there and staring at him as he worked out.That would be creepy.I watched him on the surveillance cameras behind the reception desk.

Somatic Symptoms: People with Complex PTSD often have medical unexplained physical symptoms such as abdominal pains, headaches, joint and muscle pain, stomach problems, and elimination problems. These people are sometimes most unfortunately mislabeled as hypochondriacs or as exaggerating their physical problems. But these problems are real, even though they may not be related to a specific physical diagnosis. Some dissociative parts are stuck in the past experiences that involved pain may intrude such that a person experiences unexplained pain or other physical symptoms. And more generally, chronic stress affects the body in all kinds of ways, just as it does the mind. In fact, the mind and body cannot be separated. Unfortunately, the connection between current physical symptoms and past traumatizing events is not always so clear to either the individual or the physician, at least for a while. At the same time we know that people who have suffered from serious medical, problems. It is therefore very important that you have physical problems checked out, to make sure you do not have a problem from which you need medical help.

If you eat a destroying angel, for the rest of the day you’ll feel fine. Later that night, or the next morning, you’ll start exhibiting cholera-like symptoms—vomiting, abdominal pain, and severe diarrhea. Then you start to feel better. At the point where you start to feel better, the damage is probably irreversible. Amanita mushrooms contain amatoxin, which binds to an enzyme that is used to read information from DNA. It hobbles the enzyme, effectively interrupting the process by which cells follow DNA’s instructions. Amatoxin causes irreversible damage to whatever cells it collects in. Since most of your body is made of cells,4 this is bad. Death is generally caused by liver or kidney failure, since those are the first sensitive organs in which the toxin accumulates. Sometimes intensive care and a liver transplant can be enough to save a patient, but a sizable percentage of those who eat Amanita mushrooms die.

Many people infected with C. diff are sick with diarrhea, abdominal pain, nausea, and weight loss. Others are “carriers” of C. diff with no signs or symptoms of disease. Some of these carriers have been recently infected with C. diff but have recovered and now feel well. But carriers still have the C. diff organism in their stools and can serve as a silent reservoir of infection in hospitals and nursing homes.

Fiona decided to take the warnings of her abdominal pain to heart. She left her husband when it became clear that he was unwilling to give up his drug addiction. With her two children, she has moved to a new town and filed for divorce. She is no longer experiencing pain.

Those who experience symptoms complain of abdominal pain, nausea, diarrhea, constipation, and intestinal distress. Some people, however, don’t experience obvious signs of gastrointestinal trouble, but they could nevertheless be experiencing a silent attack elsewhere in their body, such as in their nervous system.

Calm down. Let's assess the situation," Drew said, crossing one leg over the other and folding his hands on his knee. "Have you noticed any of the following: unidentified discharge, burning sensation when you urinate, lower abdominal pain, testicular pain, pain during sex, fever, headache, sore throat, weight loss, chronic diarrhea or night sweats?" He sounded like a f**king commercial for syphilis.

When this story goes out into the world, I may become the most famous hermaphrodite in history. There have been others before me. Alexina Barbin attended a girls’ boarding school in France before becoming Abel. She left behind an autobiography, which Michel Foucault discovered in the archives of the French Department of Public Hygiene. (Her memoirs, which end shortly before her suicide, make unsatisfactory reading, and it was after finishing them years ago that I first got the idea to write my own.) Gottlieb Göttlich, born in 1798, lived as Marie Rosine until the age of thirty-three. One day abdominal pains sent Marie to the doctor. The physician checked for a hernia and found undescended testicles instead. From then on, Marie donned men’s clothes, took the name of Gottlieb, and made a fortune traveling around Europe, exhibiting himself to medical men.

Now algae bloomed as never before, causing snail populations to explode. The snails hosted tiny parasitic worms that harbored schistosomiasis, a horrible disease that leaves its victims chronically prostrate with abdominal pain, high fever, fatigue, and diarrhea. Schistosomiasis had been unknown in the region before Ford came along; after Fordlandia, it was endemic. Malaria, yellow fever, elephantiasis, and hookworm were rife as well. Agonizing discomfort could come from almost anywhere. The river teemed with a little fish, the candiru, or toothpick fish, which would swim into any available human orifice (most notoriously the penis), then extend prickly, backward-facing spines, making it impossible to dislodge. On land, maggots from the botfly Dermatobia hominis burrowed into the skin and hatched eggs; victims knew of an infestation when they could see wriggling just under their skin or when sores erupted and newborn maggots spilled out. Beyond the camp boundaries, vipers and jaguars

Pop told me many times after that that he had sent a wire forthwith to Jesse Paine, an old friend and neighbor of ours from Passaic Avenue, then residing in Los Angeles, asking what, if anything, had happened to Lou, his wife. Two weeks later he received a letter saying that Jesse was sorry not to have been able to answer the telegram sooner, the reason being that Lou had been ill; in fact at the time the telegram had arrived, she was in the hospital where, that day, she had been given up for dead, following a serious abdominal operation

PRESCRIPTION 5 Low Back and Trunk   This prescription can be used to treat these symptoms and restrictions: Abdominal pain Compromised breathing Hip extension range of motion Hip pain Low back pain Sciatica Spinal rotation, flexion and extension range of motion   Overview Methods: Contract and relax Pressure wave Smash and floss Tools: Small ball Large ball Small bouncy ball or under-inflated soccer/volleyball Total time:  14 minutes   This prescription is great for treating low back pain and supporting the hardworking muscles of your trunk. We’ve established that poor spinal mechanics and sitting can cause adaptive stiffness and irritation in the discs, ligaments, and muscles around your spine and trunk. And when that happens, low back pain is often the result. Although there are other contributing factors to consider, like previous injuries, arthritis, obesity, and stress, we would argue that one of the leading causes of low back pain and trunk-related problems stems from poor posture, prolonged sitting, and a lack of basic self-maintenance. Having spent the majority of this book outlining a protocol for preventing and resolving the issue from a mechanical standpoint, let’s turn our attention to the maintenance side of things. This prescription targets the muscles that are responsible for keeping your spine braced, as well as the muscles that may get stiff when you move poorly or sit for too long.

I am progressing along the path of life in my ordinary contentedly fallen and godless condition, absorbed in a merry meeting with my friends for the morrow or a bit of work that tickles my vanity today, a holiday or a new book, when suddenly a stab of abdominal pain that threatens serious disease, or a headline in the newspapers that threatens us all with destruction, sends this whole pack of cards tumbling down. At first I am overwhelmed, and all my little happinesses look like broken toys. Then, slowly and reluctantly, bit by bit, I try to bring myself into the frame of mind that I should be in at all times. I remind myself that all these toys were never intended to possess my heart, that my true good is in another world and my only real treasure is Christ. And perhaps, by God’s grace, I succeed, and for a day or two become a creature consciously dependent on God and drawing its strength from the right sources. But the moment the threat is withdrawn, my whole nature leaps back to the toys: I am even anxious, God forgive me, to banish from my mind the only thing that supported me under the threat because it is now associated with the misery of those few days. Thus the terrible necessity of tribulation is only too clear. God has had me for but forty-eight hours and then only by dint of taking everything else away from me. Let Him but sheathe that sword for a moment and I behave like a puppy when the hated bath is over—I shake myself as dry as I can and race off to reacquire my comfortable dirtiness, if not in the nearest manure heap, at least in the nearest flower bed. And that is why tribulations cannot cease until God either sees us remade or sees that our remaking is now hopeless.

In 1937, Gunda Lawrence, a teacher and homemaker from South Dakota, lay close to death from abdominal cancer. Doctors at the Mayo Clinic in Minnesota had given her three months to live. Luckily, Mrs. Lawrence had two exceptional and devoted sons—John, a gifted physician, and Ernest, one of the most brilliant physicists of the twentieth century. Ernest was head of the new Radiation Laboratory at the University of California at Berkeley and had just invented the cyclotron, a particle accelerator that generated massive amounts of radioactivity as a side effect of energizing protons. They had in effect the most powerful X-ray machine in the country at their disposal, capable of generating a million volts of energy. Without any certainty what the consequences would be—no one had ever tried anything remotely like this on humans before—the brothers aimed a deuteron beam directly into their mother’s belly. It was an agonizing experience, so painful and distressing to poor Mrs. Lawrence that she begged her sons to let her die. “At times I felt very cruel in not giving in,” John recorded later. Happily, after a few treatments, Mrs. Lawrence’s cancer went into remission and she lived another twenty-two years. More important, a new field of cancer treatment had been born.

To digest gluten, the cells of the intestinal wall produce a specific enzyme called transglutaminase. Transglutaminase breaks down gluten into its smaller building blocks, the peptides gliadin and glutenin. The cells of the intestinal wall then absorb these into circulation. The GALT scans their surfaces, as it does with all things absorbed, in search of threatening surface codes. For reasons that only nature understands, the surface of the glutenin peptide is not coded as threatening, but gliadin is in people with a genetic predisposition. T cells in the GALT will mediate the production of gliadin antibodies. These same antibodies, however, often attack the intestinal wall’s natural transglutaminase enzyme, essentially tearing apart the intestinal wall, piece by piece. This shrinks and erodes the villi and microvilli, the finger-like tendrils in the small intestine that maximize its surface area; this results in an inability of the small intestine to absorb any nutrients at all. In its most severe expression, this is known as celiac disease, which presents as weight loss, diarrhea, bloating, abdominal pain, and an overall failure to thrive.

These are the most common complaints of older children with unhealthy sleep schedules. So if your child doesn’t appear to be very sick but has frequent headaches or episodes of vague abdominal pain, especially near the end of the day, ask yourself if he might be overtired.

I had diarrhea and abdominal pain. It started in January 2018 after a strange non-contagious flu-like sickness during the new year. I was not the only one to get this sickness, it was one of the worst flu seasons in modern history.

Children and adults with developmental trauma frequently experience chronic abdominal pain, headaches, chest pain, fainting, and seizure-like episodes—all very common symptoms related to a sensitized stress response.

Patients are taught that there is no correct way to bend or lift, one doesn't need to avoid soft chairs or mattresses, corsets and collars are unnecessary, and in general the great number of admonitions and prohibitions that have become part of back pain folklore are simply without foundation, because TMS is a harmless condition, and there is nothing structurally wrong with the back. Running is not bad for the spine; weak abdominal muscles do not cause back pain; strong back muscles do not prevent back pain; it is perfectly all right to arch the back, swim the crawl or breast stroke; man was meant to walk upright (Homo sapiens and his ancestors have been doing so for somewhere between 3 and 4 million years); a short leg does not cause back pain. One could go on and on. (page 110)

And indeed, many trauma-related health problems are dismissed, missed, and misunderstood. But once you understand more about neuroscience, and how our senses and brain translate experience into “biological” activity, the artificial distinctions disappear. If you understand the neurobiology of trauma, you know that a physical “abnormality” is causing the abdominal pain seen with sensitized dissociation. You begin to see that a person’s “worldview” can change their immune system, and that a positive conversation with a friend can influence how a patient’s heart or lungs function that day. The interconnectedness becomes clear.

But the scientific literature says that heartburn and GERD (gastroesophageal reflux disease, a.k.a. acid reflux) are not considered to be diseases of excess stomach acid. Experts now know that acid reflux is caused by excess gas forcing the lower esophageal valve (LES) to open and allows acid to hit your throat. Your esophageal valve is like a water dam. When you have too much gas inside your body, it “breaks the dam” and forces a “flood” of acid up your throat causing pain and discomfort in your chest. That’s when you taste that bitter bile. Yes, heartburn happens when the pressure and gas in your abdominal cavity get too high. The main cause of excess gas is low stomach acid. Research has proven that low stomach acid leads to both poor digestion of carbohydrates and bacterial overgrowth which causes an overload of gas.

classical views by recommending against excessive intercourse for men, warning that such activity “was likely to produce numerous undesirable side effects including weakness, trembling, nervousness, ringing in the ears, protruding eyeballs, abdominal pain and hemorrhage.

Long ago, abdominal pains were called "cowardice grass." This is because they come suddenly and render a person immobile.

Scott James felt the third impact as the bullet punched through his vest on the lower right side of his chest. The pain was intense, and quickly grew worse as his abdominal cavity filled with pooling blood. Scott

ICD-10-CM diagnosis code R19.00 Intra-abdominal and pelvic swelling, mass and lump, unspecified site R10.1 Pain localized to upper abdomen R10.10 Upper abdominal pain, unspecified R10.11 Right upper quadrant pain R10.12 Left upper quadrant pain R10.13 Epigastric pain R10.2 Pelvic and perineal pain R10.3 Pain localized to other parts of lower abdomen R10.30 Lower abdominal pain, unspecified R10.31Right lower quadrant pain R10.32Left lower quadrant pain R10.33Periumbilical pain R10.8Other abdominal pain R10.81 Abdominal tenderness R10.811 Right upper quadrant abdominal tenderness R10.812 Left upper quadrant abdominal tenderness R10.813Right lower quadrant abdominal tenderness R10.814 Left lower quadrant abdominal tenderness R10.815 Periumbilic abdominal tenderness R10.816 Epigastric abdominal tenderness R10.817Generalized abdominal tenderness R10.819 unspecified site R10.82Rebound abdominal tenderness R10.821 Right upper quadrant rebound abdominal tenderness R10.822Left upper quadrant rebound abdominal tenderness R10.823 Right lower quadrant rebound abdominal tenderness R10.824 Left lower quadrant rebound abdominal tenderness R10.825 Periumbilic rebound abdominal tenderness R10.826Epigastric rebound abdominal tenderness R10.827 Generalized rebound abdominal tenderness R10.829 unspecified site R10.83 Colic R10.84 Generalized abdominal pain R10.9 Unspecified abdominal pain

Here are some examples of long, over-stretched muscles at odds with short, tight muscles: rhomboids versus pectoralis major infraspinatus and teres minor versus subscapularis and pectoralis major superficial spinal muscles versus abdominal muscles hamstrings versus the rectus femoris triceps versus the biceps supinator versus pronator teres

DENGUE FEVER (BREAKBONE FEVER) Dengue fever is a viral infection found throughout Central America. In Costa Rica outbreaks involving thousands of people occur every year. Dengue is transmitted by aedes mosquitoes, which often bite during the daytime and are usually found close to human habitations, often indoors. They breed primarily in artificial water containers such as jars, barrels, cans, plastic containers and discarded tires. Dengue is especially common in densely populated, urban environments. Dengue usually causes flulike symptoms including fever, muscle aches, joint pains, headaches, nausea and vomiting, often followed by a rash. Most cases resolve uneventfully in a few days. Severe cases usually occur in children under the age of 15 who are experiencing their second dengue infection. There is no treatment for dengue fever except taking analgesics such as acetaminophen/paracetamol (Tylenol) and drinking plenty of fluids. Severe cases may require hospitalization for intravenous fluids and supportive care. There is no vaccine. The key to prevention is taking insect-protection measures. HEPATITIS A Hepatitis A is the second-most-common travel-related infection (after traveler’s diarrhea). It’s a viral infection of the liver that is usually acquired by ingestion of contaminated water, food or ice, though it may also be acquired by direct contact with infected persons. Symptoms may include fever, malaise, jaundice, nausea, vomiting and abdominal pain. Most cases resolve without complications, though hepatitis A occasionally causes severe liver damage. There is no treatment. The vaccine for hepatitis A is extremely safe and highly effective. You should get vaccinated before you go to Costa Rica. Because the safety of hepatitis A vaccine has not been established for pregnant women or children under the age of two, they should instead be given a gammaglobulin injection. LEISHMANIASIS Leishmaniasis occurs in the mountains and jungles of all Central American countries. The infection is transmitted by sand flies, which are about one-third the size of mosquitoes. Most cases occur in newly cleared forest or areas of secondary growth. The highest incidence is in Puerto Viejo de Talamanca. It causes slow-growing ulcers over exposed parts of the body There is no vaccine. RABIES Rabies is a viral infection of the brain and spinal cord that is almost always fatal. The rabies virus is carried in the saliva of infected animals and is typically transmitted through an animal bite, though contamination of any break in the skin with infected saliva may result in rabies. Rabies occurs in all Central American countries. However, in Costa Rica only two cases have been reported over the last 30 years. TYPHOID Typhoid fever is caused by ingestion of food or water contaminated by a species of salmonella known as Salmonella typhi . Fever occurs in virtually all cases. Other symptoms may include headache, malaise, muscle aches, dizziness, loss of appetite, nausea and abdominal pain. A pretrip vaccination for typoid is recommended, but not required. It’s usually given orally, and is also available as an injection. TRAVELER’S DIARRHEA Tap water is safe and of a high quality in Costa Rica, but when you’re far off the beaten path it’s best to avoid tap water unless it has been boiled, filtered or chemically disinfected (iodine tablets). To prevent diarrhea, be wary of dairy products that might contain unpasteurized milk; and be highly selective when eating food from street vendors.

Enteric-coated peppermint-oil capsules: prevention and reduction of abdominal spasms Peony-licorice formula: prevention and reduction of abdominal spasms (For intermittent use only: can cause reversible low potassium and high blood pressure with daily use). Iberogast (nine-herb product): reduction of abdominal pain, control of gut hypersensitivity, normalized movement of the bowels Observing

palate is a wall or septum that separates the oral cavity from the nasal cavity, forming the roof of the mouth. This important structure makes it possible to chew and breathe at the same time. The hard palate—the anterior portion of the roof of the mouth—is formed by the maxillae and palatine bones and is covered by a mucous membrane; it forms a bony partition between the oral and nasal cavities. The soft palate, which forms the posterior portion of the roof of the mouth, is an arch-shaped muscular partition between the oropharynx and nasopharynx that is lined with mucous membrane. Hanging from the free border of the soft palate is a conical ¯ muscular process called the uvula ( U-vu¯ -la � little grape). During swallowing, the soft palate and uvula are drawn superiorly, closing off the nasopharynx and preventing swallowed • C L I N I C A L C O N N E C T I O N Per i toni t is A common cause of peritonitis, an acute inflammation of the peritoneum, is contamination of the peritoneum by infectious microbes, which can result from accidental or surgical wounds in the abdominal wall, or from perforation or rupture of abdominal organs.If, for example, bacteria gain access to the peritoneal cavity through an intestinal perforation or rupture of the appendix, they can produce an acute, life-threatening form of peritonitis. A less serious (but still painful) form of peritonitis can result from the rubbing together of inflamed peritoneal surfaces. Peritonitis is of particularly grave concern to those who rely on peritoneal dialysis, a procedure in which the peritoneum is used to filter the blood when the kidneys do not function properly (see page 1048). •

The patient in question was a young woman whose parents brought her in because she complained incessantly of stomach pains. Freud diagnosed her with hysteria. A few months later, she died of abdominal cancer.

The following lists some of the signs and symptoms of gluten sensitivity: diarrhea or loose stools, abdominal pain, bloating or abdominal distention, excessive gas, pale and foul-smelling stool, irritability, depression, weight loss, anemia, fatigue, general weakness, muscle cramps, achy legs, tingling in the face or extremities, dermatitis herpetiformis (painful skin rash or rough texture), mouth sores and mottled tooth discoloration. If you note that you have more than three of these signs or symptoms, it may indicate you have a sensitivity to gluten.

They found that the enteric-coated capsules of red pepper powder were able to significantly decrease the intensity of abdominal pain and bloating, suggesting “a way of dealing with this frequent and distressing functional disease…”52

A person’s “worldview” can change their immune system, and…a positive conversation with a friend can influence how a patient’s heart or lungs function that day. The interconnectedness becomes clear…everything matters…belonging is biology, and disconnection destroys our health. Trauma is disconnecting, and that impacts every system in our body...To this day, the role that trauma and developmental adversity play in mental and physical health remains underappreciated. children and adults with developmental trauma frequently experience chronic abdominal pain, headaches, chest pain, fainting, and seizure-like episodes-all very common symptoms related to a sensitized stress response.

Most people, including their physicians, simply accept that diarrhea, constipation, gastritis, bloating, abdominal discomfort/pain, inflammatory bowel syndromes, or almost any other gastrointestinal condition is largely inevitable and typically occurring for seemingly no clear-cut reason, or just the inevitable consequence of growing older. The standard therapeutic goal aims to lessen the gut-related symptoms as best as possible with a variety of prescription and over-the-counter agents. Similarly, there is virtually no awareness that CPC sets the stage for the inflammation causing and sustaining some gastrointestinal cancers, even though chronic inflammation in the gut is recognized as an important factor in the development of cancers there.

(In the late 1890s, in an ingenious effort to obtain equal pay for equal work, one of the new woman physicians, Stanford University’s Dr. Clelia Duel Mosher, invented a series of abdominal breathing exercises to counteract menstrual pain, called “moshers.”)

Conventional medical training had taught me that these pains were primarily due to a variety of structural abnormalities of the spine, most commonly arthritic and disc disorders, or to a vague group of muscle conditions attributed to poor posture, underexercise, overexertion, and the like. Pain in the legs or arms was presumed due to compression (pinching) of nerves. However, it was not at all clear how these abnormalities actually produced the pain. The rationale for the treatment prescribed was equally perplexing. Treatment included injections, deep heat in the form of ultrasound, massage, and exercise. No one was sure what these regimens were supposed to do, but they seemed to help in some cases. It was said that the exercise strengthened the abdominal and back muscles and that this somehow supported the spine and prevented pain.

Rabbit Illness I suggests recording the following possible signs when a rabbit has eaten a toxic plant: abdominal tenderness, hemorrhage, difficulty breathing, depression, diarrhea, anorexia, mouth irritation, pain, convulsions, vomiting, weakness, and death. If your rabbit likes to dig, I recommends removing dormant bulbs and filling your flower beds with rabbit-safe plants. How about a or a dedicated burrowing area or container full of plants and vegetables your rabbit can eat? For more rabbit enhancement tips, contact our pet lover team. Rabbit Safe Flowers and Plant Rabbit-safe plants include chickweed, clover, chamomile, dandelion, nasturtium, nettle, rose, pansy, marigold, and sunflower. Rabbit-safe garden vegetables include kale, romaine lettuce, bok choy, carrot greens (carrots themselves are high in sugar, so eat them in moderation), basil, and broccoli greens. Now you’re ready to start a sunny day by looking around your garden and plucking all the plants that could get your rabbit in trouble.

neuroscience, and how our senses and brain translate experience into “biological” activity, the artificial distinctions disappear. If you understand the neurobiology of trauma, you know that a physical “abnormality” is causing the abdominal pain seen with sensitized dissociation. You begin to see that a person’s “worldview” can change their immune system, and that a positive conversation with a friend can influence how a patient’s heart or lungs function that day. The interconnectedness becomes clear. As you said, Oprah, everything matters.

Then she asked a series of questions, targeting issues that tend to arise in patients with terminal illness. Did Cox have pain? How was her appetite, thirst, sleeping? Any trouble with confusion, anxiety, or restlessness? Had her shortness of breath grown worse? Was there chest pain or heart palpitations? Abdominal discomfort? Trouble with constipation or urination or walking?

Women wait sixty-five minutes to men's forty-nine before getting treatment for abdominal pain in the emergency room. Young women are seven times more likely to be sent home from the hospital in the middle of having a heart attack. Women face long delays, often years long, to get diagnosed even with diseases that are quite common in women. And they experience longer diagnostic delays in comparison to men for nearly everything, from brain tumors to rare genetic disorders.

Someone or other must be to blame that I feel ill’ – this kind of conclusion is peculiar to all sick people, and in fact becomes more insistent, the more they remain in ignorance of the true reason, the phys- iological one, why they feel ill (this can, perhaps, be a disease of the nervus sympaticus, or lie in an excessive secretion of bile, or in a deficiency of potassium sulphate and phosphate in the blood, or in abdominal stricture interrupting the blood circulation, or in degeneration of the ovaries and such like). The sufferers, one and all, are frighteningly willing and inven- tive in their pretexts for painful emotions; they even enjoy being mis- trustful and dwelling on wrongs and imagined slights: they rummage through the bowels of their past and present for obscure, questionable stories that will allow them to wallow in tortured suspicion, and intoxi- cate themselves with their own poisonous wickedness – they rip open the oldest wounds and make themselves bleed to death from scars long-since healed, they make evil-doers out of friend, wife, child and anyone else near to them. ‘I suffer: someone or other must be guilty’ – and every sick sheep thinks the same. But his shepherd, the ascetic priest, says to him, ‘Quite right, my sheep! Somebody must be to blame: but you yourself are this somebody, you yourself alone are to blame for it, you yourself alone are to blame for yourself’ . . . That is bold enough, wrong enough: but at least one thing has been achieved by it, the direction of ressentiment is, as I said – changed.

I’d known Nick was built. His family had a membership at my parents’ health club, and sometimes he came in to lift weights. His favorites were the arm curl machine and the abdominal machine, where he would lift hard for long minutes and then fight for a few last painful crunches. Not that I made a habit of standing there and staring at him as he worked out. That would be creepy. I watched him on the surveillance camera behind the reception desk.

Imbalance of the adrenal hormones is one of the most common conditions I see in my practice. The typical cause is chronic stress, which can result in diminished adrenal function (sometimes called “adrenal exhaustion” or “adrenal fatigue”) and may include the depletion of DHEA. DHEA and cortisol levels are most reliably determined using saliva tests. It takes time to resolve adrenal depletion, which is a condition that typically brews for months, if not years. You can promote adrenal balance by attending to the basics: Learn stress-management techniques, drink plenty of water, and regulate your blood sugar levels by eating small meals throughout the day. Along with potential bone loss, some of the most common symptoms of adrenal imbalance are listed below: • allergies/ asthma • arthritis • chemical sensitivities • morning/ evening fatigue • high blood sugar • inflammation • increased abdominal fat • memory lapses • sleep disturbances • susceptibility to infections • autoimmune illness • sugar cravings • aches and pains • infertility • chronic illness • elevated triglycerides • depression or anxiety • nervousness or irritability

Tossing the man aside, Rezkin kicked up into the groin of the striker who was now standing over him. The striker cringed but seemed to use the pain to power a downward strike of his sword. Rezkin kicked out with his other foot, bashing the man’s hands free from the hilt. He must have lost some of his grip on the sword with the groin impact. Rezkin clenched his abdominals and lurched up, ripping through the man’s intestines and stomach with his favorite curved dagger. At that moment a throwing dagger sliced through Rezkin’s right bicep and imbedded itself in the suffering striker’s shoulder. The young man jerked the striker around and threw him toward his rear attacker.

I would later learn that unexplained somatic symptoms, particularly abdominal pain, may be a marker for depression.

There was one part of my job, though, that was unsettling. As I proceeded in my training, I began to see that many patients I encountered were being steered onto set diagnostic pathways. Our teachers did it, expounding on “algorithms,” which were basically recipes that lumped patients into groups with similar symptoms. Our peers did it, noting how much faster it was to see patients not as Mrs. Smith, the chatty mother of four, or Father Cogliano, the Italian priest, but as their “chief complaints” of headache and abdominal pain.