Trauma factors are defined as any situation that is a threat to life. These include life-threatening accidents, being involved in military combat, being abducted or witnessing an abduction, experiencing a natural disaster, being diagnosed with a life-threatening disease or being physically or emotionally abused. Although the symptoms that occur after a traumatic situation are not permanent, they can result in diseases that require treatment.

In particular, reliving similar traumatic situations more than once, trying to escape from situations that remind the individual of the trauma, continually visualising the trauma through dreams and flashbacks can all occur. These occur due to acute stress or post-traumatic stress disorder. Acute stress and post-traumatic stress disorders are treated by psychiatric specialists.

What must be done to prevent these disorders?

It is firstly necessary to understand the symptoms that a traumatic situation will cause. The first symptoms after experiencing trauma are surprise and the inability to accept the situation. Subsequently, feelings of fear, despair, anger, guilt, unhappiness, and remorse set in alongside a feeling of hope and relief due to the danger being over. Sleep deficiency, tiredness, nightmares, loss of memory and concentration, headaches, loss of appetite and motivation, back pain and heart palpitations may also accompany these symptoms.

The same trauma does not cause the same symptoms in everyone. Furthermore, even if the trauma is destructive, it does not cause situations that require clinical treatment in the majority of people. Certain individuals will struggle more, especially those who have experienced significant trauma in their childhood years, those who have certain personality disorders, who do not have good familial and friendship support, who have had considerable stress in their recent past, who consume too much alcohol, or are more susceptible to clinical diseases.

What must be done in the case of trauma?

Firstly, give it some time. It may take weeks or even months to understand, accept and learn to live with what has happened. Try to evaluate what is going on. Instead of thinking about what could have happened, try to evaluate what has happened and how you can prevent it next time. Contact others that have experienced similar trauma. It will be useful to get together with others that have been through similar situations and exchange life stories. This is why it is useful to create support groups and charities. Cry. Do not avoid expressing emotions. If needed, then cry Call for help and support. It may be useful to talk about and discuss the situation. It is important to get support from family and friends.

Spare time for yourself. You may sometimes want to be alone or spend some time with certain people. It may be useful to limit your other duties and spare time for yourself. Talk about the topic. You may want to talk about the topic from time to time. This will comfort you. Sometimes, talking about the topic can increase the emotions of sadness and result in crying. Do not shy away from this.

Return to your normal life. Return to your normal life as quickly as possible. Eat regular meals even if you do not have an appetite. Return to your previous exercise and sport activities even if you may struggle to do so. Try to return to your normal activities with friends. Apart from the time that you spend talking to support groups, try to return to your normal activities and enjoy time with your friends, spare time for life. Manage your time well. The confusion of the trauma may have turned your whole life upside down. It will be useful to plan and manage your time well. Try to use all possible support factors. Try to use all available support groups including friends, relatives, family, social aid and try not to remain alone.

Do physical exercises. Exercises such as running, bike riding, walking going to the gym etc. may be helpful. Relaxing exercises. Do relaxing exercises such as stretching, breathing, yoga and go for a massage. Art activities. Join musical and artistic activities. Do not let the mixed emotions worry you. Trying to lock up the emotions will cause them to build up and make it more difficult to overcome in the future. Avoid using substances such as alcohol or drugs to deal with your problems and worries. Due to the fact that we often make inappropriate decisions because of our emotional state at this time, do not make life-changing decisions. Postpone them.

Regardless of all this, if you have stress due to the trauma you must seek the help of a professional. This is especially the case if you relive similar traumatic situations more than once, try to escape from situations that remind you of the trauma, and continually visualise the trauma through dreams and flashbacks, where psychiatric help is recommended.

Assoc. Prof. Dr. İpek Sönmez
Head of Department of Psychiatry

Our hands are at the forefront of our social interaction and their appearance is important. However, when the weather starts to cool down, our hands start to dry up, causing chapping and even bleeding. Hand eczema, which is an allergic reaction seen
in both adults and children, is a disease that can both be treated and prevented with simple precautions.

What is eczema and hand eczema?
Eczema is an itchy skin disease that causes redness, scaling, and blisters. Hand eczema is where the eczema forms in the palms, fingers and/or the back of the hand. It
causes dryness, redness, peeling, sweating, irritation and sometimes pain

What causes hand eczema?
When hands are subjected to water, cold, dry air, cleaning materials containing irritants, chemical substances, plastic gloves and soil, they can become irritated.

The skin reacts to this irritation in the form of redness, blisters, itching and pain. Chronic hand eczema due to repetitive and long-term eczema can cause calluses, chapping and bleeding.

What are the symptoms of hand eczema?
In the first stages (acute), eczema causes redness, blistering, sweating and scabbing that results in flaking. During the subacute phase (after the acute phase), slight redness, flaking and scabbing occurs. During the advanced (chronic) phase, the skin on the hands thickens, flaking worsens and slits occur on the hands.

In which cases and for who is eczema more common?
This disease is more commonly seen in women. Additionally, children and adults who are genetically susceptible to allergies may have this disease. Occupations that require constant contact with irritant substances and allergens can increase the risk of this disease.

This includes cleaners, health personnel, hairdressers, laundry workers, metal workers, those who work in the food industry, car mechanics, builders, typographers, painters etc. Hand eczema is also common in housewives that are often in contact with water, soap and detergents. Hand eczema is common in those who have painting, drawing, crafts, or gardening as their hobby. In recent years, there have been scientific publications that have shown that “slime” has become a popular choice of toy for children, which also causes hand eczema.

How is hand eczema diagnosed?
Hand eczema can be diagnosed upon examination. In some cases, in order to distinguish it from other diseases, a fungi inspection and hand skin biopsy may be needed. A patch test can be conducted to determine the cause of hand eczemas that are thought to be allergic.

How is hand eczema treated?
he firstly determined and the patient must avoid contact To treat this disease, the causes of the hand eczema must with these factors as much as possible. The substances that the patient is in contact with on a daily basis must he determined. If the cause is thought to be allergic in nature then the allergens must be determined with a patch test.

The hands must not come into contact with soap and water for long periods of time-they must not be washed frequently. The pH value of the soaps that the patient uses must be suitable for the skin’s pH and they must also not contain perfume or colorants. The patient’s hands must not touch water that is either too cold or too hot – they must
use warm water. Before washing their hands, the patient must remove their rings. The irritants that collect under the rings can cause the eczema to flare up.

Hands must be moisturised often with a moisturiser that does not contain allergens or irritants in order to protect the skin. Barrier creams reduce the loss of moisture and
the possibility of getting hand eczema by helping to protect the skin. It is suitable to moisturise the hands after they have been washed and fully dried.

In cases where the patient has to be in contact with water, detergents and other irritants, cotton “eczema gloves” must be worn under a plastic glove. The gloves must not be worn for long periods of time due to the fact that they will cause perspiration. Powdered gloves must be avoided. Direct contact with acidic foods such as tomatoes, oranges and lemons must be avoided. The patient’s hands must not touch water that is either too cold or too hot, they must use warm water.

The medical treatment consists of topical cortisone creams/pomades that are recommended by a doctor and accompanying moisturisers. Topical antibiotic
creams/pomades can be advised for some cases. Thinning creams can be added to the treatment for cases where the skin has thickened. Medicine containing cortisone can be
used in cases where the eczema is severe, where cortisone vials can be inserted intramuscularly or injected through the veins. In cases where these treatments do not work, pimecrolimus, cyclosporin, methotrexate, phototherapy and alitretinoin treatments can be applied. The period of treatment depends on the severity of the disease, how far it has spread and how long the patient has had this disease. When subjected to substances that are triggers, the hand eczema can reoccur. In such cases the patient must be examined by a doctor once more and their treatment must be readjusted.

Dr. Serap Maden, MD. Dermatology

Hyperventilation means moving more air through the chest than the body can deal with. Most people have experienced hyperventilation – also called over-breathing – to some degree, usually in the form of an acute attack. It’s a normal reaction to sudden danger or excitement, and the signs are easy to pick.

• Breathing and heart rates speed up.
• Adrenalin pours into the bloodstream.
• The nervous system is on ‘red alert’.
• Muscles tense up.

Sometimes people faint or collapse – or find super-human reservoirs of strength. When the stressful event is over, the body returns to its normal relaxed state.
Less easy to spot is chronic hyperventilation, a

breathing pattern disorder in which over-breathing becomes a habit – usually in response to prolonged stress or tension. More widespread symptoms are felt, and at times these appear out of the blue. The symptoms may mimic serious disease or remind the sufferer of the perhaps frightening events surrounding a past acute attack. When this happens more widespread symptoms mysteriously occur.

• Breathlessness at rest for no apparent reason
• Frequent deep sighs or yawning
• Chest-wall pains
• Palpitations
• Light-headedness and feeling ‘spaced out’
• Tingling or numb lips or extremities
• Gut upsets or irritable bowel syndrome
• Achy muscles or joints, or tremors
• Tiredness, weakness, broken sleep, nightmares
• Sexual problems
• Clammy hands and high anxiety or phobias

cascade of symptoms

When over-breathing becomes chronic the balance between the oxygen-rich air we breathe in and carbon-dioxide-rich air we breathe out is upset: carbon dioxide levels start to drop.

Far from being just a waste gas at the end of the respiratory cycle, carbon dioxide is a powerful governor of many of the body’s systems – including blood flow to the brain. With chronic over­breathing the normal acid/alkaline balance (pH) of the tissues is altered. The body becomes more alkaline, and the nerve cells are the first to respond to this respiratory alkalosis. Dizziness and tingling or numbness are often the first signs.

The autonomic nervous system, which looks after the body’s involuntary functions (for example, heart rate, blood pressure and digestion), is affected too. This system is divided into two: the sympathetic, which governs action and ‘get up and go’, and the parasympathetic, which is responsible for rest, recuperation and calmness. Low carbon dioxide levels stimulate the sympathetic nervous system more than the parasympathetic, putting the body on continuous red alert.

If carbon dioxide levels in the blood fall further with continued over-breathing, body cells begin to produce lactic acid in an effort to balance their pH. Muscles ache. Metabolism is less efficient.

Exhaustion and chronic tiredness soon follow, with feelings of physical and mental depression – all typical signs of long-term chronic hyperventilation.

Not only nerve cells are affected.

Muscle cells become more twitchy, and the smooth muscles of our blood vessels, airways and gut tighten and constrict in response to lowered carbon dioxide. There is an increased release of

Autonomic nerwus system, controller of involuntary body functions

histamines, which aggravates allergic responses. The heart starts pounding and the hyperventilator may feel panic-stricken, with palpitations and feelings of ‘air hunger’.

When carbon dioxide levels are too low oxygen clings to its carriers – the red blood cells – and tissues, especially the brain, become starved of oxygen. The brain may have its oxygen supply cut by as much as 50 per cent, making it difficult to concentrate, let alone feel part of this planet. The drop in oxygen supply to the brain stimulates the breathing control centre to increase breathing ** and the chronic nature of the hyperventilation is reinforced.

As the oxygen and carbon dioxide exchanges fuel every cell in our body, every system is ultimately going to be affected – leading to a distressing as well as puzzling range of symptoms.

Why does chronic hyperventilation happen?

Over-breathing is a normal reaction to stress or strain: it only becomes abnormal when stresses and strains reach levels that lead to chronic hyperventilation and outbreaks of symptoms. These stresses and strains may have started from:

•  organic causes, for example, asthma, physical pain, pneumonia, anaemia, chronic chest or heart disease;
•  physiological causes, for example, fever, high progesterone levels, prolonged talking, high altitude, diabetes, liver or kidney disease;
•  psychological and social causes, for example, fear, anxiety, depression, perfectionist personality, separation/divorce, redundancy, unemployment, loneliness;
•  drugs, for example, nicotine, caffeine, aspirin, amphetamines.

While these original causes may be dealt with, stabilised or cured, in certain people the respiratory centre in the brain is reset and the over-breathing becomes habitual. Even though the bad times are over, the increased breathing rate stays.

World-wide, the 1990s have been a decade of change and uncertainty. Our minds evolved in an ancestral environment that lacked the Pressure, noise and speed of the present electronic age.

we’re constantly bombarded with information and our brains often can’t cope with it all. We need to consciously take time out to counter this mega­stimulation, but few of us do.

The increase in stress disorders and diseases is alarming. Computerisation has pinned many workers in front of screens for extended periods of time, but the human body is not designed for prolonged sitting. We experience maximum stimulation from minimum effort and breathing is affected.

Adapting to rapid change is especially difficult if the change is unwanted or out of personal control. Stress levels soar, and with them adrenalin levels and heart rate, and nervous exhaustion follows – all fuelled by over-active lungs.

Is hyperventilation a modem disorder?

For centuries philosophers and scientists have understood the importance of good breathing. Hippocrates, the father of Western medicine, noted in the fifth century BC: ‘The brain exercises the greatest power in mankind – but the air supplies sense to it’

Adherents of both Buddhism, which originated in India also in the fifth century BC, and Taoism, from ancient China, combined breathing with relaxation and exercise to harmonise heart rate, breathing, digestion and circulation. Yoga and t’ai chi are modem versions of these ancient wisdoms.

Despite well-observed accounts in Western literature of ‘breathless’ heroines or heroes with their ‘breath taken away’, little was understood about the link between over-breathing and ill- health. The first detailed medical description of

hyperventilation was not published until 1871, in a study of 300 American Civil War soldiers. A doctor noticed ‘disabling shortness of breath, irritable heart and oppression of breathing’ and thought the cause of these problems lay in the heart.

Around the turn of the century other medical researchers experimented with normal subjects, asking them to hyperventilate voluntarily; their results noted neurological effects (tingling and muscles spasms) as well.

The term hyperventilation syndrome (HVS) was coined in the 1930s. One British physician called it ‘one of the commonest chronic afflictions of sedentary town dwellers’. Breathing into a paper bag (re-inhaling carbon dioxide-rich air) became a popular treatment for acute attacks of HVS at this time.

No theatre would be without a paper bag in the wings ready for stage-fright victims, frozen in respiratory alkalosis (terror) while awaiting their cue. However, while the paper bag method may be useful in helping with acute panic attacks, it is of no use to chronic over-breathers. It may temporarily restore normal blood gases, but it does nothing to correct the underlying cause – breathing pattern disorders.

It is extremely dangerous during an acute asthma attack to tiy to control rapid wheezy breathing using a paper bag. Increased drives to breathe normal during an attack. It is on record that at least one person has breathed their last into a brown paper bag.

Recent medical research has revealed more about the physiological system derangements, metabolic imbalances and anxiety-related symptoms caused by habitual over-breathing, but it is still an under­recognised and under-treated disorder.

Whether it is primarily a mental or a physical health problem has been hotly debated. Fortunately, the move towards holistic medicine, in which body and soul are treated together, has been of benefit to the vast number of people suffering from chronic hyperventilation and to their doctors, who can add this distressing disorder to their diagnostic repertoire.

I had a medical file as thick as a phone book and I always seemed to be at the doctors having tests for this and that. Nothing was ever found to be really wrong. But a locum picked it straight away. My breathing was grossly askew and my symptoms were a result of this. At last I had something to work on.

Dr. Mike Thomas

Caring for YOUR HAIR

We can all have bad hair days, and styling is not the only problem. Hair can become greasy, dandruff may take a hold and hairlines may recede. But there’s a lot you can do to keep your hair and scalp in top condition, and counter hair loss. Here are some tips.

• Don’t brush your hair or at least don’t brush it too vigorously or for too long. Following the traditional advice of ‘a hundred strokes before bedtime’ is now known to risk damaging the hair. Brushing pulls out hair that isn’t ready to fall out yet, often breaks healthy hairs, and scratches the scalp. Brush gently for styling only – not to stimulate the scalp.
• Dye naturally If you want to colour or lighten your hair without resorting to the chemicals of commercial hair dyes, why not choose herbal preparations such as henna for a shining brown or chamomile to lift mouse to blonde. But be warned, while natural dyes are better for you, they can be messy to apply and the results are not always totally reliable. If you decide to use a commercial hair dye, choose a temporary or semi-permanent one, simply because there is a very small increased risk of breast and bladder cancer associated with the long-term use of permanent dyes. Whatever dye you choose, test a little on an unobtrusive patch before treating your whole head.
• Rinse with herbs Calm over-greasy hair with this ‘leave-in’ herbal conditioner treatment, which can help to reduce the amount of oily sebum produced by the sebaceous glands in hair follicles. Mix a teaspoon each of dried rosemary leaves, dried chamomile flowers and dried stinging nettle leaves in a bowl and pour on 100ml of water and a tablespoon of fruit vinegar. Leave for 10 minutes then strain. Apply this liquid to damp hair after washing and leave it in without rinsing.

Using natural products eliminates the slight risk of cancer associated with permanent dyes

Smooth-flowing Mood that brings oxygon and essential nutrients to every celt in the body is vital for health and wellbeing. To improve your circulation and reduce your risk of disease, you need a healthy level of fats and other blood constituents as welt as optimum blood pressure. Find out how to achieve this in effective and sometimes surprising ways.

Better
BLOOD

There’s plenty you can do to keep your blood healthy and able to supply the body with the nutrients it needs. Your diet and the amount of exercise you take can influence the composition of your blood. Genetics and environmental factors also have a role to play.

• Have beans with your steak Iron is the key component of haemoglobin, the oxygen-carrying substance in red blood cells. To maximise your absorption of this valuable mineral, eat vegetable, meat or fish sources of iron in the same meal. Iron-rich foods include meat, poultry, fish, dark green vegetables, dried beans and dried fruits. The adult body contains around 4g of iron, half of which is found in our red blood cells. If iron levels fall too low, anaemia (low levels of red blood cells) can result.

• Drink orange juice with your muesli Did you know that some foods can actually block the absorption of iron from our diet? Notable iron-blocking foods include fibre-rich wholemeal cereals, dairy products, such as milk and cheese, and drinks such as tea, coffee and chocolate. It’s not possible – or advisable – to avoid many of these foods, but you can counteract their effect on iron absorption by drinking beverages between rather than with meals and by having foods or drinks that are rich in vitamin C, which boosts iron uptake. Citrus fruits, such as oranges, are particularly high in vitamin C.

• Sprinkle nuts on your salad seeds, nuts, oats, barley and soya products actively lower your blood levels of cholesterol. A study has found that including a portfolio of foods that actively lower cholesterol may be more effective, especially for lowering heart-damaging LDL cholesterol, than a low saturated fat diet alone. Try adding cholesterol-lowering foods to your low-fat regime to maximise the benefits.

• Drink green tea to improve your balance of ‘good* to ‘bad’ cholesterol. Chinese researchers have found that green tea helps lower blood levels of bad’ low-density lipoprotein (LDL) cholesterol without affecting ‘good’ hlgh-deroity lipoprotein (HDL) cholesterol. So while using other cholesterol-lighting tactics such as avoiding fatty foods, enjoy green tea as often as you like.

• Watch the label For blood vessel health the most important ingredients to avoid are transfats, which appear on labels in the UK as ‘hydrogenated fats’ or ‘partially

MAKING RAVIOLI IS TRULY SATISFYING and fun – especially if you get others involved. In Italy, this typically happens, with the matriarch in charge of quality control. You should have enough filling here for about 20 ravioli. Any pasta dough that isn’t used can be re-rolled into thin sheets and cut into thick strips to make pappardelle or tagliatelle.

SERVES 4-5

Pasta dough:

pinch of saffron strands
1 tbsp boiling water
550g Italian ’00’ flour
¼tsp fine sea salt
4 medium eggs, plus 6 egg yolks
2 tbsp olive oil

Filling:
2 tbsp olive oil
2 garlic cloves, peeled and finely chopped
500g spinach leaves
15g butter
1A tsp freshly grated nutmeg
sea salt and black pepper
150g ricotta cheese
75g Parmesan, freshly grated
75g pine nuts, lightly toasted squeeze of lemon juice, to taste beaten egg, for brushing

Sage butter:
75g unsalted butter, diced
2 tbsp double cream
6 sage sprigs, leaves shredded

To serve:
Parmesan, for grating

For the pasta, lightly crush the saffron in a bowl, pour on the boiling water and leave to infuse until cooled. Put the rest of the ingredients into a food processor, add the saffron water and whiz until the mix resembles coarse crumbs; add a little more water if needed. Tip into a bowl and press into a ball with your hands. Turn onto a lightly floured surface and knead until smooth. The dough should be soft but not sticky; if it feels too wet, knead in a little more flour. Wrap in cling film and chill for 30 minutes.

To make the filling, heat the olive oil in a large frying pan and fry the garlic until lightly golden. Add the spinach and cook for 2-3 minutes until the liquid released has been absorbed. Increase the heat slightly and stir in the butter, nutmeg and seasoning. Drain and roughly chop the spinach. In a large bowl, beat together the ricotta, Parmesan and toasted pine nuts. Stir in the spinach and a touch of lemon juice. Taste and adjust the seasoning if necessary, then cover and chill for at least 30 minutes.

Cut the pasta into 8 pieces, roll into balls and keep each wrapped until needed. Using a pasta machine, roll each ball into a long sheet, about 80 x 13cm, passing it repeatedly through the rollers and narrowing the setting gradually until you reach the thinnest setting. Cover with a damp tea towel. To shape the ravioli, follow my guide (on the preceding pages).

For the sage butter, melt the butter in a saucepan and heat until it begins to brown. Take off the heat and let stand for 1 minute, then strain through a fine sieve into a clean pan. Heat slowly, then stir in the cream and sage.

Bring a large pan of lightly salted water to the boil, add the ravioli and cook for 2-3 minutes. Drain well and toss with the sage butter. Grate over a little extra Parmesan and serve at once.

SERVES 4

1 bream, scaled and gutted, about 700g
4cm knob of fresh root ginger, peeled
4 spring onions, trimmed
1 long red chilli, deseeded
2 tbsp Shaoxing or Chinese rice wine (or dry sherry)
2 tbsp light soy sauce
2 tbsp sesame oil

Make slashes in the fish, about 2.5cm apart, slightly on the diagonal, without cutting right through to the bone. Slice the ginger, spring onions and red chilli lengthways into thin matchsticks.

Scatter a little ginger and spring onion over a heatproof plate, large enough to take the fish. Lay the bream on the plate and stuff the fish cavity with a little ginger, spring onion and chilli. Drizzle the rice wine and soy sauce over the fish, then scatter over the rest of the ginger, spring onion and chilli.

Place an inverted heatproof bowl in a large wok and pour in enough water to come halfway up the sides of the bowl. Put the lid on the wok and bring the water to the boil. Now carefully lower the plate containing the fish into the pan, placing it on the upturned bowl; avoid touching the sides of the hot wok. Put the lid back on and steam over a high heat until the fish is just cooked – a knife should slide easily into the thickest part of the flesh. It will take about 10-15 minutes.

As soon as the fish is ready, carefully lift the plate from the steamer. Heat the sesame oil in a small pan until smoking hot, then immediately pour over the fish. Bring the plate to the table and serve at once, with rice and a vegetable dish on the side.