Morphine injected into the subarachnoid space, or diffusing into the subarachnoid space after epidural injection, will diffuse into the dorsal horn of the spinal cord and produce analgesia by interaction with opioid receptors. The theoretic advantages of intraspinal morphine include:•    the use of much smaller doses of morphine•    delivered close to the site of action (the spinal opioid receptors)•    less central side effects•    less systemic side effects•  no neurological deficits as occur with neurosurgery or anaesthetic blocks However, after epidural injection only 10-20% of the morphine diffuses into thesubarachnoid space and there is significant systemic absorption from the epidural space. Plasma levels may be equivalent to those following systemic administration, accounting for the central and systemic side effects. At the same time, the drug concentration in the CSF is much higher than after systemic administration, producing superior analgesia. There will be some rostral diffusion of morphine injected or diffusing into the subarachnoid space, predisposing to central side effects. *49\55\2*

You might be given a simple antacid or a drug in the cimetidine group such as Tagamet. It cannot be denied that these drugs are effective – but it is unwise to stay on them for long periods.Side-effectsI first came across large numbers of people who were given these drugs for gastro-intestinal disturbances when they were withdrawing from drugs in the benzodiazepine group such as diazepam or lorazepam. They were also given to people who were having withdrawal symptoms from antidepressant drugs such as amytiiptyline or the MAOI inhibitors. Many were left on cimetidine on repeat prescription for long periods without review. Long after the tranquillizer or antidepressantwithdrawal was over many people reported feeling ill when they tried to stop cimetidine. A rebound over-production of gastric acid could be expected, but they also reported: irritability, insomnia, panic attacks and feeling generally very low. On the positive side, many users said that the bowel symptoms such as constipation and colic (many had suffered this for years) disappeared within two weeks of the discontinuation of the cimetidine or allied drug.Fungal infections of the skin and gastro-intestinal tract have also been reported with these drugs.Cimetidine (Tagamet – a weaker version of the prescription drug) is now on free-sale in the UK. If it helps, use only in the short term (and not before you have had a firm diagnosis from your doctor). If it make you feel anxious or irritable you would be well advised to look for a natural approach to the problem of overacidity, such as changing your diet and lifestyle. If the symptoms persist, see your doctor with a view to some investigations. If your doctor is unwilling to see if you are producing too much or too little hydrochloric acid, this test can be arranged by a doctor who practises Clinical Nutrition.*30\326\8*

•Anti-caking agents ensure that products, such as salt, flow freely; •Antioxidants prevent food containing fats and oils from becoming rancid;•Artificial sweeteners are used to sweeten low-joule foods;•Bleaching agents whiten foods, such as flour;•Colours restore losses during processing and storage, and ensure a uniform colour in the finished product;•Emulsifers ensure that oil and water mixtures do not separate into layers;•Enzymes break down food, such as milk into curds and whey;•Flavour enhancers bring out the flavour of the food without imparting a flavour of their own;•Flour treatment agents improve flour performance in bread making;•Food acids maintain a constant acid level in food despite variations in the acid level of ingredients;•Humectants prevent foods from drying out;•Mineral salts enhance the texture of foods, such as processed meats, which might lose fats or juices;•Preservatives prolong the shelf-life of food;•Propellants are used in aerosol containers;•Thickeners and vegetable gums ensure constant consistency;•Vitamins make up for losses in processing and storage, and are added to certain foods to supplement dietary intake. Food additives are numbered as follows: 100-181 Colours200 – 297 Preservatives and food acids300 – 381 Antioxidants, food acids and mineral salts400 – 492 Vegetable gums, emulsifiers, some anti-caking agents, humectants, mineral salts500 – 579 More mineral salts and anti-caking agents 600 – 637 Flavour enhancers900 – 1202 Bleaching and flour treatment agents and propellants1400- 1450 Thickeners1505 – 1520 Miscellaneous additives*37\148\2*