A gross! Twelve dozen!  144!  How I like this number!

Can you remember learning your multiplication tables?  I shall never forget it, because for one seemingly endless term, every week up a number, I had to rattle through my tables in front of the whole class.  It was absolutely nerve-wracking because the slightest slip would bring immediate derision and a lengthy spell in the corner. 

However, although still very young, I had adopted the habit of leafing through a book first from the back. I was aware, therefore, that my purgatory would terminate with 12 x 12 = 144. I couldn’t wait and started to learn my tables backwards, which was quite easy to begin with, until I had to grapple with my 9 times table which made me stutter a little.

Nevertheless the final day of term eventually arrived but, before I could race screaming joyously through the gates, I had to pass the mathematical proficiency test.....Twelve twelves? 144!  Well done, Wells: you are dismissed.

I have to admit that a similar feeling of relief overwhelms me as I start this Newsletter. After all, twelve years is a long time and I thought that I would run out of jottings years ago but, thanks to you, I still ramble on. This month has been particularly rewarding......
Pommade Divine divulged.
The words “Pommade Divine” jumped out of your last newsletter and sparked many childhood memories, e-mailed Alice Rugheimer.  It was one of the very few things in my mother’s medicine cabinet - a glass jar with a black lid, full of a wonderful smelling pale cream-coloured ointment. I can’t really describe the smell, but it was very distinctive and memorable, quite medicinal but soft and balmy. Definitely an oily textured ointment rather than a cream. The jar was produced whenever we fell off our ponies or bikes, out of apple trees, or after sibling punch-ups and “magically” the threatening big black bruises never appeared.  She never applied it to open wounds.  I imagine it contained arnica (?).  I think of it as one of those marvellous old-fashioned medicaments like Tiger Balm, Friar’s Balsam, Golden Eye Ointment, etc.  I should be very interested to hear more on the subject, and if it is still available.

Hopefully, I may have a few answers soon.

RLS response.
I was interested to note your request for information on the treatment of fidgety, or as I call it, restless legs.  I suffer from this affliction myself and have spoken recently to my doctor about it. He explained that it was a lack of circulation in the small blood vessels, and ways to help are.....wrote Barbara Childs.....

Exercise such as walking, but not too much as it makes it worse in my experience.  Massage night and morning but, if like me, increasing age, girth and arthritis make self-massage difficult then try dry skin brushing.

And the best bit of advice was quinine [interestingly, I’ve heard of this before] which can be taken in tablet form, but is available in tonic water, enhanced by a little gin containing juniper berries which helps with the water retention that aggravates restless legs......Schhh! This sounds like my kind of treatment!  

I must admit that I have not suffered as much since I started forcing G&T past my lips and remembering to massage night and morning, when time allows.  I used to spend hours standing in front of the TV rocking from side to side, or walking on the spot, or even kneeling on the floor with my forearms resting on a stool.

I have also seen some web sites devoted to Restless Legs Syndrome, most say it is a neurological disorder, but I don’t think anyone really knows, or cares.  They say reducing caffeine, alcohol and smoking will help [Don’t they always!].

Other people say applying heat, or standing on a cold surface (the bottom of the bath), or placing the feet in a bowl of cold water can help.  Most seem to find out by trial and error what works best for them.

It’s a miserable problem as it affects people during the evening, spoiling their social life, and through the night disturbing sleep and leaving them fatigued during the day.

Sorry I can’t be more help, I hope someone can!

My own initial “sweep” of the literature suggested that restless legs syndrome (RLS) is a vascular condition, of unknown cause, which occurs most often in those suffering from a neurosis and in the elderly, but I was not so sure.

Parasomnias.
Parasomnias are motor or autonomic disturbances that occur during sleep or are exaggerated by sleep.  Some of the main parasomnias include nightmares, night terrors, sleepwalking (somnambulism), restless legs syndrome, periodic movements in sleep, nocturnal enuresis (bedwetting), bruxism (teeth grinding), head banging, and aggression during sleep.  Jumping Jehoshaphat!  It is fortunate that my Rhodesian Ridgeback Mungu, who is partial to joining us upon the bed, suffers only from restless legs syndrome!

Parasomnias are common but rarely require treatment other than the symptomatic treatment of sleep-related medical problems.

Restless legs syndrome.
Restless legs syndrome is characterized during waking by an irresistible urge to move the legs.  Almost all patients with restless legs syndrome have nocturnal myoclonus [Kaplan H,
Sadock B. Modern synopsis of comprehensive textbook of psychiatry/IV. Baltimore: Williams & Wilkins. 1985: 558-574].

Nocturnal myoclonus is a neuromuscular disorder characterized by repeated contractions of one or more muscle groups, typically of the leg, during sleep.  Each jerk usually lasts less than 10 seconds.  The person is normally unaware of the myoclonus and only complains of either frequent nocturnal awakenings or excessive daytime sleepiness, but questioning the sleep partner reveals the myoclonus.

If there is a family history of restless leg syndrome (about one-third of all people with this syndrome), a high-dosage folic acid 35-60mg daily therapy can be helpful [Botez M. et al.
Neurologic disorders responsive to folic acid therapy. Can. Med. Assoc. J., 1976; 115: 217-223].  In cases of familial restless legs syndrome, there appears to be a higher need for folic acid.  Restless legs syndrome is also a common finding in people with malabsorption syndromes [Ibid. Botez M. et al.].

Folic acid is a water-soluble constituent of the vitamin B complex; found in certain nuts, leafy plants, yeast, liver and kidney. It has antianaemic properties, and in conjunction with vitamin B12 is important in formation of red blood cells in the bone marrow.  It is effective in preventing sprue, and pernicious and megaloblastic anaemia: it is commonly deficient in the average diet.

If there is no family history, measure serum ferritin levels [ferritin is an iron protein complex formed in the intestinal mucosa and stored in the liver, spleen, and bone marrow; essential for haemapoiesis]. Serum ferritin is the best method for measuring iron stores. The association between low iron levels and restless legs syndrome was documented in clinical studies more than 30 years ago. A recent study reproduced these observations, finding serum ferritin levels to be reduced in the patients with restless legs syndrome compared with control subjects. [O’Keefe S.T. et al. Iron status and restless legs syndrome in the elderly. Age Ageing 1994; 23: 200-203].

The conclusion of the study, “Iron deficiency, with or without anaemia”, is an important contributor to the development of RLS (restless leg syndrome) in elderly patients, and iron supplements can produce a significant reduction in symptoms.

For nocturnal myoclonus as well as muscle cramps at night, magnesium (250mg at bedtime) and/or vitamin E (400-800 IU daily) may be helpful and, if the patient is over 50, Ginkgo biloba extract (80mg three times daily) may also be used.

My goodness, I know nothing about supplements and so it would be as well to check with those who do.

Meanwhile Patricia Beeson, a Remedial Masseuse and Clinical Aromatherapist for eleven years, opines that RLS is caused by both muscle spasms and poor circulation. She suggests that regular massage of the whole legs and hips will release spasms and improve circulation. She also always gives advice as to skin brushing and self-massage.

For immediate relief, she recommends that you elevate the legs straight up against the wall for ten minutes.  This will help the blood to drain the legs a lot quicker and to bring new oxygenated blood to the muscles. If the muscles are not hypertonic they will be more able to process the build up of lactic acid so causing the legs to become much less restless. 

Is this why perhaps Mungu, during the night, will sometimes jump suddenly off the bed and roll upon his back with legs outstretched? I kid you not.

Koalas, not so cuddly!
I’ve been told that drinking as little as 5ml of eucalyptus oil can be fatal: how then does the koala bear survive? e-mailed a curious reader [See last month’s Newsletter]. Just my kind of question! 

Koalas may ingest comparatively large amounts of eucalyptus oil in their diet of eucalyptus leaves. The same amounts of eucalyptus oil would almost certainly kill a grown man. The simple explanation is that koalas generate sufficient amounts of glucuronic acid to be able to conjugate it to any oil ingested, thus allowing the water-soluble glucuronides of the various oil constituents to be eliminated in their urine.  Man does not produce glucuronic acid in the same large amounts as the koala and thus cannot eliminate the oil quickly enough.

By the way, I recollect that when I first handled a koala it urinated over me immediately. In fact, the same happened on many subsequent occasions and I learned quickly to hold them at arm’s length on first acquaintance: they are not nearly as cuddly as they appear, particularly full-grown adults!

Pedantry?
Whilst browsing through the “Supplementary Knowledge” column of a recent copy of International Therapist, I spotted....Tea tree oil (traditionally spelt ‘ti-tree’)....which always grates a little because I am not at all sure that it was ever traditionally spelt ‘ti-tree’, although the eminent Patricia Davis in her splendid Aromatherapy: An A-Z would have me believe otherwise.

I recollect that when I read first An A-Z, back in 1988, I was a little surprised....I prefer to use the traditional spelling Ti-tree for this oil, rather than the newer form, in order to avoid any confusion with the tea that is drunk (Camellia thea Link)....since it is generally assumed that the name Tea tree (Melaleuca alternifolia Cheel) comes from the resemblance seen by early settlers between it and the real tea plant of China. Ti tree should refer rather to the ‘ti kouka’, the ‘cabbage tree’ (Cordyline australis (Forster f.) Endl.) of New Zealand, which was eaten formerly by the extinct, ostrich-like, moa.

When it comes to the correct spelling of ‘T’ tree, I prefer to take as my cue Penfold and Morrison’s [surely the leading exponents on the matter] assertion in their introduction to “Tea Tree” Oils in Ernest Guenther’s seminal work The Essential Oils (Vol. IV).... “Australia is rich in myrtaceous shrubs and small trees belonging to such genera as Leptospermum, Melaleuca, Kunzea, Baekea, etc., which are collectively known by the vernacular term of “Tea Trees”, not “Ti-Trees”.” 

Aromatherapy and Addiction.
I’ve applied for a job helping alcohol and drug services.  The position is helping alcohol and substance abuse by using complementary therapies.  The interview is on Friday [four days’ time!] and I’m struggling to find any info.  Have you any ideas, that is essential oils which will help the above?

Phew!  This got me reaching for my Buckle [Clinical Aromatherapy 2nd. Edition], Spencer & Jacobs [Complementary and Alternative Medicine 2nd. Edition] and Vickers [Massage and Aromatherapy].

Substance dependence and abuse can be either a cause or a consequence of mental health care. People who are addicted to alcohol or receational drugs often seek mental health services. On the other hand, some people become dependent on medication to treat mental health problems.  Dependence on tranquillizers, for example, is widespread.

Massage and aromatherapy have been used in the treatment of substance dependence.  Some practitioners say that treatment aids the elimination of “toxins”from the body. Others have pointed out that massage and aromatherapy can be an effective treatment for some of the symptoms associated with withdrawal, for example, physical pain. However, many workers stress a more general psychotherapeutic role.  There is often an underlying psychological reason why people abuse alcohol and recreational drugs and massage and aromatherapy are said to aid the psychotherapeutic process in some cases.

According to some workers, massage and aromatherapy may also be of benefit by providing a suitable surrogate for experiences associated with substance abuse.  For example, treatment, like recreational drugs, is pleasurable.
Similarly, in tranquillizer addiction, the therapies can provide an alternative means of dealing with anxiety.  This is not so much a case that an individual will deal with a specific crisis by having a massage, or sniffing an oil, instead of taking medication. Rather, massage and aromatherapy are said to help individuals to generate the confidence that they can deal with anxiety other than by the use of tranquillizers.  As one mental health worker put it: “Massage can help people to relax by giving them a concrete experience of relaxation.”

Nevertheless, there is little published literature on the use of essential oils for alcohol or chemical dependency withdrawal.  Some anecdotal success with weaning patients from antidepressants and night sedation using diffusers at night and face tissues during the day has been achieved. Limited success with helping reduce the cravings of women withdrawing from alcohol has also been achieved using specific inhaled essential oils [Lundgren, W. 1999. Clary sage (Salvia sclarea L.) for withdrawal cravings in alcoholic women. Unpublished dissertation. Hunter, N.Y.: R.J. Buckle Associates].

Caldwell [Caldwell, N. 2001. Effects of ylang ylang (Cananga odorata genuina Hook & Thom. f.) on cravings of women with substance abuse. Hunter, N.Y.: R.J. Buckle Associates] explored the effects of ylang ylang in a small, controlled study of 10 women suffering from cravings following withdrawal of substance abuse. All women were taking orthodox medication.

Each participant put two drops of the oil on a cotton square and put the square in her pillowcase every night for seven nights. The participants were also asked to put two to three drops of oil on a cotton handkerchief, carry the handkerchief with them for seven days, and smell it if they experienced a craving.  The participants were asked to record the number of cravings, their intensity, and any other comments.

The results showed the number of cravings went down. However, ylang ylang did not prevent the cravings completely. 80% of this very small experimental group believed “smelling the oil relieved the stress and anxiety of that moment.” Caldwell notes that ylang ylang’s positive effect might be enhanced by using a diffuser at night.

Olfactory loss is common in alcoholics [Shear, P. et al. 1992. Olfactory loss in alcoholics: correlations with cortical and subcortical MRI indices. Alcohol. 9(3), 247-255], cocaine users [Schwartz, R. et al. 1998. Nasal symptoms associated with cocaine abuse during adolescence. Archives of Otolaryngology-Head & Neck Surgery. 115(1), 63-64] and heroin addicts [Perl, E. et al. 1997. Taste and odour reactivity in heroin addicts. Israel Journal of Psychiatry and Related Sciences. 34(4), 290-299].  Loss of smell, however, is not thought to   affect the transfer of the volatile molecules unless there is damage to the olfactory nerve. Loss of smell in addicts is thought to be due to damage to the cortical and subcortical brain regions [Ibid. Shear et al. 1992], but it is possible there is nerve damage due to snorting or sniffing cocaine, heroin, and glue. 
      
Considering causes of dependence.
Researchers agree that the causes of addiction are complex and probably varied [Meyer, R.E. Finding paradigms for the future of alcoholism research: an interdisciplinary perspective. Alcohol. Clin. Exp. Res. 25(9): 1393, 2001].  Although many people use drugs such as nicotine and alcohol, the majority rarely misuse these substances. Whereas some individuals with addiction move in and out of treatment programmes for years or even throughout their lifetime, others may have spontaneous remission. Genetics provides one method of explaining the aetiology or epidemiology of addictive behaviours, but exceptions abound. However, no one theory has been able to explain the phenomenon known as addiction, or dependence.

Sociologists have typically focused on social interactions or cultural norms [Ibid. Meyer R.E. 2001].  Social change, cultural expectations, inequalities in the social system, and the impact of “labelling” have all been cited as casual factors. Psychologic traditions differ because their models of substance abuse typically implicate mental or behavioural disorders that arise out of physical and environmental factors.  Substance abuse may provide relief from suffering or provide a stimulating distraction.  Recently, psychiatry has branched toward physiologic approaches and turned its attention to the role of genetics and neuroscience in the aetiology and maintenance of addiction [Ibid. Meyer, R.E. 2001].

Despite cultural differences in the behaviour manifestations of substance use, recent neurochemical and molecular findings provide strong evidence for physiologic models of dependence [Higgins S.T. Comments. In Onken LS, Blaine JD, Boren JJ, editors: Integrating behavioural therapies with medications in the treatment of drug dependence. NIDA Research Monograph No. 150, Rockville, Md., 1995, US Department of Health and Human Services, p. 170]. Research has shown that genetic influences are related to characteristics of alcohol and drug abuse, such as alcohol-metabolizing enzymes, personality traits, and related neurochemical receptors. Although alcoholism has been the focus of research efforts, evidence suggests that genetic explanations may be applicable to other substances [Winger G. et al: A handbook on drug and alcohol abuse: the biomedical aspects. 3rd. Edition. 1992].

Numerous advances have been made in neurochemistry and molecular biology, with profound implications for addictions research. Knowledge of the molecular pharmacology of most drugs of abuse has led researchers to examine the roles of neurotransmitters in addiction. Findings have implicated serotonin, dopamine, and endogenous opioid activity in the brain in many aspects of drug use and abuse [Nutt DJ: Addiction: brain mechanisms and their treatment implications. Lancet. 347:31, 1996].

Can CAM help?
In a summary review of CAM therapies, research suggests that acupuncture is safe and cost-effective and may be helpful in the treatment of addictions.  Several nutritional therapies, such as zinc supplements, glutamine, and healthful diets, have shown positive trends in preliminary tests.

However, as far as other therapies are concerned, whether the majority of studies report positive (biofeedback, prayer, light therapy, herbs), negative (hypnosis), or inconclusive (hallucinogens) outcomes, little can be said about the efficacy of these methods.

Methodologic problems such as inadequate statistical analysis, inclusion/exclusion criteria, handling of dropouts, and reliability and validity of measurement tools reduce confidence in other findings involving prayer, yoga, neuroelectric therapy, transcendental meditation, restricted environmental stimulation therapy, and relaxation.  Furthermore, despite clinical use, a few therapies either have been evaluated very little (e.g., eye movement and desensitization and reprocessing), or not at all (e.g., homoeopathy, aromatherapy) for the treatment of addictions.

It seems that there is still much to do. High-quality research is needed to further our understanding both of CAM and of the physiology of addictions. However, with the proper research and guidance, some CAM therapies for the treatment of addiction offer promise.

Fathoming fibroids.
Do you have any experience with uterine fibroids and aromatherapy that you can share, oils to recommend or other resources that might be helpful? e-mailed an American therapist.

I fear that too many think that I’m an aromatherapist: I’m not!  Therefore I depend heavily upon all of you to let me know what you suggest. However I always endeavour to find out a little about the ailment so that I can better understand what might assist it.

Uterine fibroids (leiomyomas) are found in about 20% of women older than 30. Although small fibroids may not require treatment, the management of symptomatic fibroids has traditionally been surgical. However, because they are oestrogen responsive the use of gonadorelin and its analogues in the treatment of uterine fibroids has been discussed [Friedman, A.J. et al. Efficacy and safety considerations in women with uterine leiomyomas treated with gonadotropin-releasing hormone agonists: the estrogen threshold hypothesis.  Am. J. Obstet. Gynecol. 1990; 163: 1114-19].

Results have been encouraging but it is uncertain whether such treatment will provide an alternative to surgery since when treatment stops uterine and fibroid volume tend to return to pretreatment levels [Anonymous. Uterine fibroids: medical treatment or surgery? Lancet, 1986, ii: 1197]. Hot flushes and vaginal dryness are a common problem with gonadorelin therapy and bone loss may occur. The administration of the oestrogens, once the uterine fibroid size has significantly reduced, has been tried in order to counteract these side-effects. However, concern has been expressed that the use of gonadorelin analogues for treating fibroids may complicate the differentiation of benign and malignant growths [Meyer. W.R. et al. Unsuspected leiomyosarcoma: treatment with a gonadotropin-releasing hormone analogue. Obstet. Gynecol. 1990; 75( suppl): 529-32].

Nevertheless, it is interesting to take a closer look at gonadorelin and its action so that we can better understand what we might seek to achieve through aromatherapy.

Gonadorelin is a synthetic form of hypothalamic gonadotrophin-releasing hormone. It stimulates the synthesis and release of follicle-stimulating hormone and, in particular, luteinising hormone in the anterior lobe of the pituitary. The secretion of endogenous gonadotrophin-releasing hormone is pulsatile and is controlled by several factors including circulating sex hormones.  Gonadotrophic hormones, released from the pituitary gland in response to gonadorelin, stimulate secretion of sex hormones from the gonads.  A single dose of gonadorelin or one of its analogues has the effect of increasing circulating sex hormones; continued administration leads to down-regulation of gonadorelin-receptor synthesis in the pituitary and results in a paradoxical reduction in sex-hormone secretion.

Although I have no scientific reason whatsoever to think it relevant at present, I would probably contact Barbara Chopin Lucks who has been researching Vitex agnus castus (Chaste tree). I just think that it might have a bearing on the question or, at the very least, I am sure that she will have a few ideas.

On a more general level, I would mention that fibroids are a frequent cause of heavy bleeding.  They are not a symptom of menopause, nor are they caused by it, but they often become a nuisance around this time.  This is simply because they grow very slowly, and may take 20 years to reach a size where they cause discomfort or heavy bleeding, so a fibroid that has been forming since a woman was in her twenties will often come to light in her 40s. The growth of fibroids is influenced by oestrogen and small fibroids will often shrink and disappear without intervention at the end of the menopause.
There used to be a tendency among doctors to regard hysterectomy as the only treatment, however if the fibroids are small and not causing too much trouble, it is now considered a better policy to “wait and see”.  Small fibroids can also sometimes be removed surgically without removing the womb, but where they are large and deeply embedded in the tissue of the womb, hysterectomy may be the only practical solution.

I understand that herbal treatments have proved very successful in reducing fibroids, especially when combined with hydrotherapy and special exercises to improve circulation in the pelvic region. At a women’s health centre in Geneva, every woman between 40 and 50 with fibroids showed improvement within six months when treated in this way, although some needed to continue the treatment for longer before they were completely free of symptoms.

Meanwhile, here are a few suggestions that might help......

Exercises to improve the circulation in the pelvic area: these include sitting cross-legged and rocking from side to side, circling the hips as if swinging a hula-hoop, and Kegel exercises.

A detoxifying diet: fresh raw vegetables and fruit, fruit juices and copious amounts of spring water for 3 to 4 days at a time, repeated as often as possible.

Herbs to improve lymphatic drainage: ask a herbal professional because I know that some can have unpleasant and dangerous side-effects.

Any of these measures helps to stabilize fibroids (prevent them getting any bigger) and in many cases have been shown to reduce the size of fibroids (and therefore the amount of pain and bleeding they cause). They are more effective if used jointly, diet+herbs+exercise.

Acupuncture and homoeopathy also have both helped many women.

Morphea.
I have had some funny scar-like areas appear around my waistband which start off looking like bruises, e-mailed Alix Allen. The diagnosis is Morphea.  I’m not sure if you have talked about it in your newsletter before?  I’ve tried lavender to help, but have you or any of your readers got any other ideas?

Briefly, morphea (also known as localised scleroderma) is a disorder characterized by thickening and induration of the skin and subcutaneous tissue due to excessive collagen deposition.  Morphea subtypes are classified according to the clinical presentation and depth of tissue involvement: they include plaque-type, generalized, linear, and deep varieties. It is usually asymptomatic, and, most often, the onset of lesions is insidious, although they can occasionally develop rapidly. 

Overproduction of collagen by lesional fibroblasts is common to all forms of morphea, but the exact mechanism appears to be unknown. Proposed factors involved in the pathogenesis include endothelial cell injury, immunologic and inflammatory activation, and dysregulation of collagen production.  An autoimmune aetiology is supported by the frequent presence of autoantibodies in patients with morphea.

In the United States, the incidence rate of morphea has been estimated to be 27 new cases per one million population per year. However, the actual incidence of morphea may be higher because many cases may not come to medical attention due to the benign nature of morphea.

My first idea would probably be Gotu Kola (Centella asiatica (L.) Urban), because the standardized extract of Gotu Kola has been tested in several trials in the treatment of scleroderma (including systemic sclerosis) [Fontan, I. et al. Localized scleroderma. Concours Med. 1987; 109: 498-504, amongst others]. In addition to decreasing skin induration, patients have noticed a lessening of arthralgia and improved finger motility.  It is presumed that the positive therapeutic response is as a result of Gotu Kola’s eutrophic effect on connective tissue, thereby preventing the excessive collagen synthesis.

The majority of clinical trials on Gotu Kola utilized proprietary formulas (e.g., Madecassol, TECA, and Centelase).  These standardized extracts contain asiatocoside (40%), asiatic acid (29-30%), madecassic acid (29-30%), and madecassoside (1-2%). Daily dosage was 60-120 mg/day.   Centella asiatica and its extracts are very well tolerated , especially orally.

Finally......
I seem to have covered a lot about many things, but very little about essential oils.  Do you mind?

charles@essentiallyoils.com
 

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