Situated within a purpose built unit at Oldchurch Hospital, Romford the new Havering Alliance MRI Centre opened in February 1998 and is now successfully providing the highest possible quality medical images to a whole range of patients from the local area.

Detailed images are produced using a doughnut shaped magnet linked to a high powered computer. A report on the images is made by a Consultant Radiologist. The £million unit is the latest technology from Siemens and can now boast the highest quality service available anywhere in the country.

MRI (Magnetic Resonance Imaging) is recognised as the definitive study for examination of the spine and surrounding structures, able to diagnose conditions such as disc, nerve, ligament and bony abnormalities. An MRI scan should provide an accurate diagnosis of any structural cause of back pain. MRI has no harmful side effects and normally takes about 20 minutes.

The Centre is a unique partnership between the NHS and private sector which enables direct access to a range of local clinicians.

Both Havering Hospitals and Alliance Medical recognise that the scanner should be open to all those requiring its services within the local community, at an acceptable cost. Referrals can be made by Osteopaths, Chiropractors and GPs as well as Hospital Doctors.

Telling people I teach The Alexander Technique is great fun. Usually they say: 'Oh, that's about posture/body alignment, isn't it?' (In fact, it has more to do with poise in activity.) As they pronounce the word 'posture' they begin a series of sheepish movements, aimed at attaining what they consider to be 'good posture', which generally entails thrusting the chest out and pulling the head back. In so doing they provide a fine illustration of what the founder of the Alexander Technique, F. M. Alexander, termed 'endgaining'.

Endgaining (literally doing what you think is necessary to reach your end or goal) is a very powerful force that can, I think, be divided into 4 components:

1. 1. Deciding what you feel is required of you 'posture-wise' - or in any number of other situations.
2. 2. Narrowing your focus of attention down to that one thing.
3. 3. Doing what you think you should do.
4. 4. Doing what you feel you need to do in order to please/impress others.

(3 and 4 correspond to what Peter Moore calls 'The British Disease'.) People who have suffered back and other problems with a resultant loss of freedom of movement understandably want, at the very least, to be no worse off than they were before, to 'get back to their old selves'. In so doing they tend to endgain. Certainly the alternatives look pretty stark: either they can do what they did before, in the way they did it before, or else they have to consider a limitation of their possibilities and confront a degree of disability. In reality the way in which they did what they did before probably played some part in the creation or aggravation of their problems, in which case the endgaining wish to'get back to their old selves' is not the best way forward. But equally unless they can envisage a means or possibility of change, they have no third viable option.

The Alexander Technique is a process of re-education. It is about learning to take thinking into activity, connecting up mind and body. Instead of trying to do what we have always done in our old habitual or unconscious way, we learn that we can elevate our activity to the plane of consciousness, letting our thinking exert a qualitative effect on the way we move. Instead of acting on automatic pilot, we can stop, 'free our necks' as we say in the Alexander world, think and then proceed in the best way available to us. This process of stopping (inhibition), freeing our necks (undoing undue muscle tension) and thinking can help us to get in and out of a chair better, to walk and run more easily and generally to move in a lighter way. By reducing muscular tension, all sorts of physical activities we find difficult or painful can become freer and easier. Nor do the effects have to stop at the physical; inhibition can empower us to beat the dreaded 'British Disease', at least some of the time - and it can be quite enlightening to see just how often we all fall victim to the said disease. Inhibition can even enable us to stop before we react emotionally in a knee-jerk way (who, us?); before we hurl abuse at other drivers on the road, shriek at our near and dear ones, or kick the cat etc… Having stopped and considered we can abort our original intention, or proceed to do whatever it is, with better 'use' of ourselves than we otherwise would have had9. Endgaining limits us, whereas the Alexander Technique opens up any number of new possibilities.

To learn the Technique you need 'hands on' experience with an Alexander teacher who will teach you about stopping (inhibition), thinking (direction) and proceeding in a more effective way (attending to the means whereby). Teachers use their hands to enable pupils to release undue muscular tension and to rediscover the natural poise we all enjoyed as children. In the process, the teacher will also help you to realise where and how much you endgain and how you can take possession of the tools for change.

That said, there is one more thing: we all endgain like crazy, most of the time, in most areas of our lives. That includes even the paragon writing this piece; my desire to impart my conviction about the value of the Alexander Technique to you could be seen as well… endgaining - endgaining doesn't have to be a dishonourable thing. The question is did you spot it?

For lessons in Havering and Brentwood contact: Annie Kornfeld MSTAT Telephone: 01708 456868

Promises Fitness Expert Joan Price

Joan Price Says, Yes, You CAN Get in Shape! Make Exercise a Treat, Not a Treatment (Pacifica Press, 1996) makes starting an exercise program easy and non- threatening. Readers of the book will set goals, overcome old issues, learn the latest fitness facts, choose from an appealing array of options, create their own program, and sidestep those excuses that used to throw them off the path of best intentions.

Author Joan Price, M.A., is a fitness professional whose specialty is motivating beginners. Her goal is to help exercise newcomers through the first six months. "By then, they'll be seeing and feeling results, and the program will be a habit," says Price. "Best of all, because it's their own program not some doctor's or celebrity's they'll enjoy it. And that's the secret to sticking with it."

Joan Price Says, Yes, You CAN Get in Shape! is not a book for or about genetically perfect hard bodies, committed athletes, or gym rats. It is an accessible and entertaining shape-up guide for the rest of us. Men and women of all ages who are looking for health improvement, weight management, and enhanced quality of life with a program that fits, not disrupts, their lives will find this the ultimate fitness guide.

Joan Price is a nationally recognized fitness instructor, speaker, writer, and consultant based in Sebastopol, CA. She offers motivating tips and wisdom based on more than a decade of experience at getting nonexercisers to make fitness a habit. Over fifty and the survivor of two devastating automobile accidents, Price is motivating, easy to relate to, and entertaining. She individualizes every step of creating a well-rounded, satisfying fitness program. Readers end up with a routine that will work for them, because it's based on their personal choices and takes much less time each week than they expect.

Some topics covered by Joan Price Says, Yes, You CAN Get in Shape! include:

• *How to turn getting older into getting better stronger, fitter, and leaner
• *How to personalize an exercise program for success
• *Tips for choosing a health club or not!
• *Exercise time savers 10 minutes does it
• *Travel tips taking the fitness habit on the road
• *Risky exercises and what to do instead
• *How to stick to a "shape up" resolution despite past failures

Joan Price Says, Yes, You CAN Get in Shape! Make Exercise a Treat, Not a Treatment by Joan Price, M.A.

ISBN 0-935553-16-9 LCCN 96-18255 6" x 9" trade paperback $17.95 224 pages Pacifica Press, Pacifica, CA USA

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Fighting Back - Standing up to Back Pain...

by Maggie Hayward

Relief from back pain is at hand in 'Fighting Back', a new self-help video to be released by Warner Vision on March 9th '98, price £10.99. It will enable the Uk's 27m back pain sufferers - some 60% of the adult population - to alleviate symptoms through gentle exercise in the comfort of their own home.

The 60 minute release is the brainchild of Maggie Hayward, 58, who has been afflicted with severe back pain since the age of 18.

She produced a video on discovery that regular controlled movement improved the condition which traditional treatment, including surgery, drugs, a body corset, Osteopathy, Chiropractic, Faith Healing, and acupuncture had failed to combat. She had three major operations in which a disc had been removed, her vertebrae were fused together and plates and screws inserted into her spine.

Presented by TV personality, Judi Spiers, 'Fighting Back' provides information, advice and support for back pain sufferers. With the expert guidance of chartered physiotherapist Carol Sweet, viewers were taken through a structured exercise routine used in the Pain Management Programme at the Manchester and Salford Pain Centre. It also highlights the personal stories of seven patients, aged from 13 to 58, who all appear on the video.

A mother of four and grandmother, Maggie raised money to make 'Fighting Back' on completion of the NHS-run Salford-based course which taught her to deal with her problem for the first time in more that 38 years. Maggie said: "It is now widely accepted that gentle movement will do more to minimise back pain that total bed rest. The Pain Management Programme showed me that through regular daily exercise, I could combat my condition and recover my self esteem. I got my life back and wanted others to share the same benefits."

'Fighting Back' differs from other exercise videos in that it provides a first hand insight into the condition which is responsible for 116m days off work each year with an annual cost to British industry of at least £5.1 billion.

Dr.Chris Spanswick, Director of the Manchester and Salford Pain Centre, added: "There is a group of people who continue to feel major pain even though they have been all the appropriate treatments. Maggie provides a sympathetic and thought-provoking look at back pain, from the viewpoint of a genuine sufferer, and, through her experiences, offers a blueprint for making day-to-day life more bearable."

Fighting Back is NOW! available in all good retailers nationwide i.e. WH Simth and Virgin.

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ACCEPTING is only the beginning...

by Edwina Milner

Many of us who have chronic pain have had to accept that doctors cannot make the pain go away. We have tried various prescribed drugs, have undergone operations, physical therapy and complementary therapies, but still have the pain. It seems incredible that there is not a pill or a manipulation or operation to solve it. Accepting is hard.

But this is just the beginning. While we should never give up hope of some new treatment being discovered, we need to manage our pain right now. Your doctor may have explored every possibility appropriate for your condition and feel that your learning the techniques of pain management would now be useful. So talk with them. Perhaps they will refer you to a pain management programme, if you show ready and willing.

So are you ready?

On a pain management programme, your pain will be acknowledged. For although pain is invisible, it is real, physically and emotionally. It is not 'all in the mind'. You will also become part of a group of similar people, and find that you are not alone. Many of us have become frustrated, anxious or depressed, with many losses such as employment, social life, hobbies, valued relationships and roles, and are concerned - rightly so - about the future. But now you are ready to move on.

Many programmes in the larger centres have a professional team of multi-disciplinary staff, so all angles are covered. The most successful programmes seem to me to be those where you live in for a week or so, then go back for follow-up days, for it is easier to learn how to manage pain while away from home and all its distractions.

Programmes can vary, but basically, you will need a high degree of commitment to put into daily practice what you are taught. The more you put in, the better you will cope. It is not easy, that is why pain management programmes exist, to teach you how. Your focus moves to actively managing, so the pain itself can fade into the background.

There are quite a few of us 'graduates' of such programmes around the UK now, we can look back with gratitude to the staff who patiently showed us the techniques and who steadfastly kept us motivated. Perhaps we have not so much got 'back to where we were' before the pain came, as having let go and moved on.

I now lead a very different but meaningful life. For you to contemplate this for yourself may seem scary right now. But nothing ever stays the same, life is always changing. Yet change can also hold potential for something new and exciting. Fear can hold us back. Yet if you have chronic pain, are feeling miserable and hopeless, what have you got to lose.

Apart from pain management programmes, you may also find some support through a local group run by volunteers who also have chronic pain. These are great places to encourage each other, exchange ideas, borrow books, audio tapes, to learn more, be understood and have a feeling of belongingess.

However, to actually move from the identity of being a 'pain sufferer' to becoming a 'pain manager' in its fullest sense, I really believe that the best way to move on is to attend a full pain management programme.

We are all on a journey.

Copyright© Edwina Milner 1998

Edmil@zetnet.co.uk

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ARACHNOIDITIS

I wouldn't be surprised when you read this title if some are wondering what do "spiders" have to do with back problems. This is a very common reaction. In fact, I overheard my daughter say "Mommy has angry spiders in her back!" Although this article is not about "spiders", it is about a condition involving the middle layer (Arachnoid) of the spinal nerve which was named for its "webbed like" look and nature. A simple definition of Arachnoiditis is an inflammation and swelling of the "Arachnoid" layer or meninges, that envelop the spinal cord and the brain.

Unfortunately, this is not the only misunderstanding about this condition. I have arachnoiditis and speaking for most of us who have it, the misunderstandings about it has given us almost the same amount of pain as the condition itself. I will explain this in my story.

Until 1994 I was an active woman who enjoyed dance (tap, jazz & ballet), aerobics, camping, and had practiced Yoga for 12 years. Four years prior to 1994 I started having occasional back problems, those of which were remedied by the occasional visits to the chiropractor. In the early part of 1994 my symptoms started to change to radiating pains down my right leg. After exhausting the help of my chiropractor, myfamily medical practitioner and physical therapy I ended up seeing an orthopedic surgeon in Feb. 1995. A MRI and Diskogram revealed that my disk at level L5-S1 was totally blown-out, with nerve impingement.

In May 1995 I had an anterior laparoscopic diskectomy/fusion (using a doner bone plug) at level L5-S1. After this surgery the radiating pain in my legs became more severe. They became bilaterial and I started to get burning feelings in my feet and toes. I also began to have sensations like stakes were being thrusted up my feet.

My surgeon told me that my fusion was not solid and in Dec 1995 I underwent a second surgery. This time it was posterior (the conventional way) using slices of my hip/buttocks bone to piece-in providing a solid fusion. 8 months later I was not better, but worse.

My surgeon said there is no reason for me to be in pain as my fusion was solid. He turned me over to his pain management center where I went through an extensive 6 week, 5 days a week; 8 hour day of P.T., O.T. biofeedback, group and individual counseling sessions. All narcotic medications were stopped and were replaced with high amounts of anti-depressants.

I left the clinic taking 8-10 Zoloft medication a day, however, feeling more depressed than ever and in pain that hit a level 10 on a pain rate scale of 0-10. . This lead me back to my family physician. He weaned me off the high amounts of anti-depressants and substituted both non-narcotic and narcotic medications so I could get my pain to a level which would allow me to search for a physician that could tell me what was going on with my body.

From January to July of 1997 I saw several physicians from local doctors to big "infamous" clinics both in the midwest and the eastern areas of the United States. It was at these clinics where I received my diagnosis… Adhesive Arachnoiditis in an advance stage. (I also was diagnosed with a dural tear, a fusion site which was NOT fused, anddegenerative disk disease.) However, when the first diagnosis of arachnoiditis was made, I was told this is a normal healing process. It was at the other two clinics (one clinic was run by a doctor who is researching Arachnoiditis) who actually knew what Adhesive Arachnoiditis was and how it was effecting my body.

The evidence of this was there all along on my MRI films and revealed that during my first surgery the dura layer of my spinal nerve was torn. Apparently some foreign matter invaded the subarachnoid space which resulted in the layers to become inflamed and swollen. A "sticky" substance developed and all three nerve layers began to adhere to one another. Leaving a trail of scar tissue in its place. The end result is incapacitating pain and neurological deficits. By the time I received my diagnosis I started getting involuntary jerking (first legs, then both lower and upper body extremities) and other neurological problems. I was told there is no cure and the disease can be progressive. Any movement of the effected are will cause more irritation and inflammation.

I was pleased to have a diagnosis; however, finding proper treatment was just about as difficult as finding the diagnosis. I did, however, find a support group while "net surfing" one evening and it was this development which was the turning point for me. I found COFWA (Circle of Friend With Arachnoiditis). This "on-line" support group was started in March of 1997, by Donna Zevnik-Sawatzky, who has had "A" for several years. The group started with three individuals from the U.S. and a little over one year has grown to over 250 members from around the world and has also expanded off-line.

I found that I was not alone! I read the journals of other members and was amazed that others are going through the same experiences and frustrations with physicians not knowing what it was, and leaving them in pain. They also were made to think that the pain was in their head and they had some sort of psychiatric problem or were just out looking to get "drugs" to satisfy a high!

As upset as I was with the medical profession, through the group I have been able to educate myself and I have found there is a reason for this ignorance of physicians. First of all there are 3 types of Arachnoiditis. For the sake of brevity I'll just talk about two. The first is Arachnoid adhesives which is normal scarring from surgery. This is what most doctors think when they hear the word. Another type is Adhesive arachnoiditis which Dr. Charles V. Burton, of the Institute For Low Back and Neck Care in Minneapolis, MN, describes as "much less common; may be progressive; potentially serious with possible "dramtic anatomic change"; disability due to "constant and incapacitating" pain." This is what I have and most of our members have.

Also, I found out what is helping most members and what isn't. I was given a name of a pain management specialist close to my area who has been treating me since December and who has restored some quality back into my life.

Through the group I have also learned that surgery isn't the most common way of developing "A". Most cases are caused from "oil-base" myelographic dies. Other cases are caused by other dyes, epidurals and other injections that may be given through the spinal region.

Adhesive Arachnoiditis may progress into Calcification or Calcified Arachnoiditis. This is considered the last stage and causes lack of bladder and/or bowel function and may lead to paraplegia.

As of this date I consider myself fortunate. In February I had the Intrathecal infusion pump implanted. This "pump" is continually putting medication into the effected area. I'm still on some oral medication, but the pump has decreased this amount substantially ridding me of some horrible side effects and saving my liver and other organs from damage. It has allowed me to sit longer, stand longer and enjoy some activities that earlier I had to give-up.

My future… I don't know. I have to take it day-by-day. Considering the rapid pace my "Arach." has progressed in three years, I know I have to be cautious. I will, however, take advantage of every day that I have a pain level low enough to be functional and neurological symptoms under control.

Most of our members were diagnosed as having Failed Back Surgery Syndrome. It took physicians who were familiar with Arachnoiditis to diagnose us correctly. All it took were MRI (T-2) images. We welcome new members at COFWA. Membership is free. COFWA also has "information packets" that are available to our members, along with "'physician packets" that include basic fact sheets and more technical information. Education is the key to our quality of life, education will be the key to our cure!

I want to thank Peter Moore for allowing me to write this piece for "Think-Back", as well as those who took the time to read it.

Best regards to all,