The foot is a limb that is not given much importance when compared to other vital organs such as the brain or heart. However, the foot is a very complex mechanical structure that is made of 26 bones, 33 joints, and more than 100 muscles and ligaments. About a quarter of the bones in the human body and about a fifth of the joints are found in our two feet. That is why Leonardo da Vinci described the human foot as an engineering and artistic masterpiece.

A healthy person takes about 5,000 steps a day. Given a life of eighty years, a person takes about 150 million steps throughout their life. Assuming that each step is 75 cm, a person walks about 110,000 kilometers throughout his life. This corresponds to walking around the equator about 3 times. Apart from that, a typical person stands for around 2-4 hours a day. During all these activities, the human foot carries the entire body’s weight. In standing position, body weight is supported by two feet while activities such as walking and running are done by only one foot for a certain period of time. While standing, the feet carry 100% of their body weight, while walking, this rate rises up to 150%. While walking, the foot that needs to be lifted from the ground approaches the ground again with an acceleration in the same direction as gravity. Therefore, the impact force at the moment the foot touches the ground corresponds to 150% of a person’s body weight. In cases of severe effects such as running and jumping, this force easily increases up to 5 times the body weight and up to 10 times in some people. For a person weighing 70 kilograms, this force can be 105 kg (or about 1050 Newton) in walking, and easily 350 kg (or about 3500 Newton) in running or jumping. Assuming that a person walking for an hour takes 5,000 steps, the foot pulls a total of about 500 tons of load (5,000 steps x 105 kg). In running, this figure will increase approximately three times.

The foot has been created with a wonderful mechanical and construction design that is able to consistently sustain such high loads. The bones and muscles of the foot add two different belt designs to it. One of them, the structure called the longitudinal belt starts from the heel bone (calcaneus) and ends with its metatarsal bones (Figure 1). Some researchers claim that the long arch is divided into two parts as the inner (medial arch) and the outer arch (lateral arch). However, both structures resemble bridges built in arches. The second arch on the foot is called the transverse arch. This belt is perpendicular to the long belt from the right side of the foot to the left side and is shorter in length (Figure 2).

Therefore, the foot is a marvelous structure consisting of roughly two arches. This structure of the foot can be compared to arch bridges or a dam. The arch structure is known as the strongest structure against steep loads in construction areas due to the robustness of the designs against compression forces in cases of vertical loading. Therefore, hydroelectric dams are constructed in the form of arches or arcs in order to make the most resistant model against hydrostatic pressure.

The arch structure of the foot is very flexible and can also move up and down like a car suspension and acts as a shock absorption. If there was no such structure on the foot, the impact forces during walking and running activities would be higher and cause chronic foot pain. The flatfoot complication is a result of a damage in the arch structure in the foot which comes from birth or develops afterwards. Flatfoot patients are often unable to perform long-term activities and experience foot pain as well as complications in other organs of the body.

Our feet’s arch structure is not the only factor involved in shock absorption that is designed against mechanical forces. The layer of fat on the bottom of the foot also contributes to this process. In a healthy person, this fat layer, which has a height of 2.5 cm under the heel, drops to 5-7 mm in the front part of the foot. It also helps to distribute the vertical and horizontal forces caused by standing or walking evenly on the sole of the foot. At the same time, it serves as a source of heat insulation and helps protect our feet from hot or cold surfaces. In some diseases such as diabetes, in which this fat layer melts or decreases, wounds called foot ulcers can develop because the shock absorption and load distribution get damaged. Mechanical pressure is calculated by dividing the amount of mechanical force by the surface area on which it is applied, meaning that smaller surfaces areas are subjected to more pressure. This is why very tiny needles, despite weighing almost nothing, can pierce our skin and cause pain. Similarly, damage to the fat layer under the foot causes the forces applied under the foot to act on a limited surface area. For example, the reduction of fat in the area just below the heads of the metatarsal bones reduces the “cushioning” effect in this area and causes a pressure in high values. This extra pressure can cause tissue damage along with the aforementioned foot ulcers.

Such a situation that will cause pain in a normal person cannot be felt by many diabetics. If diabetes is not well controlled, neuropathy or a “lack of feeling” may occur as a complication. Dead nerve cells become unable to feel pain which can result in people not knowing about harm that is being done to their body. Diabetic patients who develop neuropathy would not feel fatty layer damage and accompanying high pressure values whereas a typical person normally would. Untreated foot ulcers can become infected and can turn into gangrene. Since the gangrenous foot has to be cut, diabetes unfortunately causes a large number of amputations. Such amputations are sadly quite frequent throughout the world due to diabetic neuropathy. Dr. Paul Brand, who studied diabetic foot ulcers, defined pain as a gift from God that no one wanted. Sometimes, what we do not like might be better for us (Qur’an 2:216); likewise, pain can cause a lot of trouble to people but it can also alert us of dangers and harm to our bodies.

Thus, foot care is very important in diabetics. The following three actions are recommended to patients; daily inspection of the foot; daily washing; and control of the inside of the shoes. The pest, pebble, or similar hard object in the shoe that can be very harmful for diabetics with loss of sensation would be removed this way. On the other hand, when such a hard object remains in the shoes, patients may step on them repeatedly without feeling it which will likely lead to an ulcer case.

With its pain that works like a health alarm, extraordinary mechanical loads it carries, heat insulation and shock absorbing features, the human foot is a wonder of art that calls for contemplation.

Sometimes, your back itches slightly and scratching it at that perfect spot fills you with an odd sense of happiness. Other times, you notice a biting itch on your arm and a chickpea-like redness shows up there. Oh, those mosquitoes! It is rarely likely to catch a mosquito in the act, and sometimes it even feels as if their bites just appear out of thin air. As you scratch the blister to soothe the itchiness, your eyes scan the room to locate its infamous proboscis. You see it on a wall, plump with the blood it sucked from you. You cannot help thinking: Why do their bites always leave so much itching? Or even, what is the purpose of itching at all?

Itching is an unpleasant feeling we perceive by our skin and mucous membranes, and an occasionally uncomfortable and sometimes very excruciating feeling.

Itching, just like pain, is a sensation intrinsic to our body to protect itself [1].  It is the way our skin “talks” to us. Indeed animals, even fish, itch too. When itched, our skin instinctively and in its own tongue tells us, “There is something that bothers me and I want you to push it away from me immediately!” If it was not for itching, we would not notice a spider walking on our arm. We would not be disturbed by lice and scabies mites or even fungi that settled on our skin, and we would not try to protect ourselves from these pests either.

An ordinary scabies patient has an average number of about 15-20 adult scabies mites on their skin. In the case of Norwegian or crusted scabies, which is most commonly observed among the elderly, the bedridden, people with seriously weakened immune systems, or those who are unable to itch themselves sufficiently, there are thousands of parasites under the thick crusts of the skin [2]. Itching accelerates the blood circulation on the itched parts, and tissues virtually prepare to fight infection by the rushing blood cells and substances [3]. Yet, millions of people also suffer from chronic itching and scratch their itches much more than usual. To understand this, we need to set on a journey from our skin to our brain.

Human skin consists of three layers: epidermis, dermis and subcutis (also known as hypodermis). The dermis layer in the middle makes glove-like protrusions upward into the epidermis. At the top of these protrusions are mechanoreceptors and nerve endings that allow our skin to sense stimulus (such as temperature, sharpness, pressure, vibration, pain, or itching) [3]. With these receptors, our skin functions as one of our five sensory organs and more like an “alarm system” of our body against changing conditions outside. This alarm system has been created so perfectly that each component knows exactly what stimulus to detect.

Previously, it was thought that pain and itching were sensed by the same receptors (nociceptors) and that mild stimuli were responsible for itching while strong stimuli were responsible for pain [4]. Yet, a contradiction existed because while pain triggered an avoidance reflex, itching activated the scratching reflex. In recent years, it was discovered that the receptors (pruriceptors) that perceive the itching sensation on the skin are the free boundary terminations of C-fibers with myelin-free, slow conduction velocity extending in the form of tree branches toward the upper layer of the skin. Furthermore, it was found that the skin cells themselves behave like itch receptors [3, 4]. When we receive a stimulus that induces itching, such as a mosquito bite which leaves anticoagulant substances on our skin, the mast cells in the skin tissue spring to defense against those alien substances. This ensues the secretion of the bodily defense system called mediators, substances that are produced and stored by mast cells as precursor for emergency conditions. Histamine is the most known of these substances and is the most important mediator in itching conditions [5]. Histamine binds to receptors found for itself in myelin-free C fibers that are tasked for detecting itching on the skin. If we consider histamine as a key, the lock that it fits into is on the nerve that senses itching. Thus, the itching nerve is stimulated by histamine.

The nerves receiving this stimulus connect to the spinal cord at their respective levels and transfer the message to another nerve. Each of these transfer processes is mediated neurotransmitters. The last message transmitted to the brain through these nerves is assessed by the brain and labeled as “itching” [6]. The brain determines the coordinates of the itching location and orders the scratching action to the related muscle system. A new journey that conveys messages from the brain to the arm muscles ends with scratching. Considering the swift rubbing action when we feel an ant walking on our face and scratch to push it away, we may value how fast and perfect our brain and transmission system work.

It is also rather odd how soothing itching can be despite its initially uncomfortable feeling, almost as if our body is rewarding us for saving it from a threat. There are several reasons for this contradiction. Scratching causes a low-intensity pain on the skin. Pain and itch are positioned on the skin alternately. The transmission of the sensation of pain is prioritized while the transmission of itching is prevented [7]. Consequently, our brain senses the pain and, in response, secretes the hormone called serotonin to soothe the body. Although this makes us feel relaxed for a short time, the brain continues to transmit virtual sense of itching by connecting to the receptors that are located on the spinal cord along the same nerve path with the receptors for serotonin [8]. This condition, which may be termed as a vicious cycle of itching-scratching, unsurprisingly infuriates patients. Scratching the same area on the skin continuously causes the production of new mediators and oversensitivity of itching nerves, which can thus turn itching into a chronic distress. Chronic itching can often result as a complication from skin diseases such as scabies, lice, eczema, fungal diseases, or drug allergies. It can also result from a systemic disease such as chronic renal failure, cholestatic liver diseases, thyroid problems, iron deficiency anemia, blood diseases and, rarely, cancers [7]. Itching in systemic diseases can be triggered by mediators on the skin but also by neurotransmitters in the intermediate pathway. This kind of itching cannot be controlled by drugs called antihistamines which block the histamine pathway. Sometimes the brain will receive false itching alarms due to post-shingles contraindications or nerve damage in the vertebrae. Such episodes of itching need to be addressed to prevent adverse outcomes. At times, the reason an itch can occur can even be psychological when there seems to be no need for an itch. According to research, scratching activates the brain’s reward center which triggers the addiction mechanism. Patients in that case are thrilled as they itch constantly [9].

As doors in this mysterious journey of science are opened one after another, we discover that nothing has been created without a purpose, including apparently discomforting sensations such as itching, which, it turns out, is how our skin communicates with us!

References

1. Arıcan O. Kasintinin patofizyolojisi, klinigi ve tedavisi Turkderm 2005;39(2):88-97
2. Jonston G, Sladden M. 2005 Scabies: diagnosis and treatment BMJ;17;331(7517):619-22
3. Guyton AC, Hall JE. Tıbbi Fizyoloji 10. Baski 2001.p815-42
4. Schmelz M. Itch and pain. Neurosci Biobehav Rev 2010;34(2):171-6
5. Arck P, Raus R. From the Brain-skin connection. Neuroimmunomodulation 2006;13(5-6)347-56
6. Metz M, Stander S. Chronic pruritus pathogenesis clinical aspects and treatment. J Eur Acad Dermatol Veneral 2010;24(11)1249-60
7. Metz M, Grundman S, Stander S. Pruritus: an overview of current concepts. Vet Dermatol 2011;22(2):121-31
8. Chen ZF et all. Descending control of itching transmission by Serotonergic System via 5-HT1A-facilitated GRP-GRPR signaling. Neuron Vol.84(4) Nov.19-2014

9. Chan YH et all. Brain’s Reward Circuits Mediate Itch Relief. A functional MRI Study of Active Scratching. Dec. 2013

Nooriye is a 39-year-old Iraqi female. She had a pretty normal life until a group of terrorists knocked on her door. Her two sons were killed in front of her. She was abused and tortured for days, as was her husband. Rebels eventually took her husband and left. Some neighbors helped her to bury her sons and provided her with shelter and food. She was about to kill herself when, miraculously, her husband came back 57 days later. He never told her what he went through during those 57 days. They were both in extreme pain but able to hold onto each other.

They immigrated to the U.S. a year later. Her husband found a job and is still working. They are safe now, but it has not been enough to heal them. Both still have nightmares and flashbacks. She spends all her time in her home. She stares at walls, feels numb and very fearful, and cries every day. Her speech is sparse, and she never smiles. She goes out with husband once a day but grabs his hand and won’t let him go when they are out. When faced with stress, she often passes out.

Her husband “has to be strong because she is the only thing he has,” although he also has extreme pain. He hides his tears from his wife, is unable to sleep at night, feels guilty, and misses his sons. He is afraid to make any Iraqi friends and stays away from mosques.

Obviously, providing a safe place, food, and a job is not enough to heal these people’s pain. Invisible wounds and problems are much harder to treat than visible ones.

In this article we will try to elucidate some elements of what Nooriye and thousands of other families have been exposed to all around the world.

Mass trauma

When a group of people, regardless of size, experience psychological effects after a trauma that was suffered collectively, this is called a mass trauma. Sometimes an entire society witnesses the same trauma, and this may cause a collective sentiment, often resulting in a shift in that society’s culture and mass actions.^1,2

Wars, political violence, natural disasters, exile, torture, and terrorism are examples of mass trauma. The Holocaust, the Atomic bombing of Hiroshima and Nagasaki, slavery in the United States, and the 9/11 attacks are well-known collective traumas.

Collective traumas have been shown to play a key role in group identity formation. Having the same problems, suffering from the same pain, and being under the same pressures bring individuals together. This togetherness eventually helps to build a community, a group, and sometimes a nation. Almost every nation has traumatic events in their history. Even the concept of “nation” is extensively affected by these events.

Nevertheless, despite its role in building group identity, mass trauma is still individually painful. In fact, the effects of mass trauma can be very deep and transferred through the generations. In 1966, clinicians observed that large numbers of children of Holocaust survivors were seeking treatment in psychiatric clinics in Canada. Moreover, when compared to the general population, the grandchildren of Holocaust survivors were three times more likely to seek clinical psychiatric help.³

Post-Traumatic Stress Disorder

According to the National Center for Posttraumatic Stress Disorder, the most common stress reactions in the wake of disaster may include the following:

Emotional reactions, including shock, fear, grief, anger, guilt, shame, feeling helpless, feeling numb, and sadness.

Cognitive reactions, including confusion, indecisiveness, worrying, shortened attention span, and trouble concentrating.

Physical reactions, including tension, fatigue, edginess, insomnia, bodily aches and pains, startling easily, racing heartbeat, nausea, change in appetite, and changes in other bodily desires.

Interpersonal reactions, including distrust, conflict, withdrawal, work or school problems, irritability, loss of intimacy, and feeling rejected or abandoned.⁴

Several factors present in the acute-phase recovery environment of a disaster have been found to aggravate stress reactions and therefore increase survivors’ risk of developing negative outcomes. These include:

• Lack of emotional and social support
• Presence of other stressors such as fatigue, cold, hunger, fear, uncertainty, loss, dislocation, and other psychologically stressful experiences
• Difficulties at the scene
• Lack of information about the nature and reasons for the event
• Lack of, or interference with, self-determination and self-management
• Treatment [given] in an authoritarian or impersonal manner
• Lack of follow-up support in the weeks following the exposure

Protective factors that may mitigate negative effects include:

• Social support
• Higher income and education
• Successful mastery of past disasters and traumatic events
• Limitation or reduction of exposure to any of the aggravating factors listed above
• Provision of information about expectations and availability of recovery services
• Care, concern and understanding on the part of the recovery services personnel
• Provision of regular and appropriate information concerning the emergency and reasons for action.⁵

In most cases, the symptoms of trauma eventually disappear, but unfortunately, some of the survivors of the mass trauma will eventually develop Post-Traumatic Stress Disorder (PTSD). PTSD is a mental disorder resulting from exposure to an extreme traumatic stressor.

The National Comorbidity Survey Replication (NCS-R), conducted between February 2001 and April 2003 in the U.S., estimated the lifetime prevalence of PTSD among adult Americans to be 6.8%.⁶ The lifetime prevalence of PTSD among men was found to be 3.6% and among women 9.7%. ⁷

PTSD is described in the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM 5) which is published by the American Psychiatric Association, as:

Criterion A (at least one required): The person was exposed to: death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence, in the following way(s):

• Direct exposure
• Witnessing the trauma
• Learning that a relative or close friend was exposed to a trauma
• Indirect exposure to aversive details of the trauma, usually in the course of professional duties (e.g., first responders, medics)

Criterion B (at least one required): The traumatic event is persistently re-experienced, in the following way(s):

• Intrusive thoughts
• Nightmares
• Flashbacks
• Emotional distress after exposure to traumatic reminders
• Physical reactivity after exposure to traumatic reminders

Criterion C (at least one required): Avoidance of trauma-related stimuli after the trauma, in the following way(s):

• Trauma-related thoughts or feelings
• Trauma-related reminders

Criterion D (at least two required): Negative thoughts or feelings that began or worsened after the trauma, in the following way(s):

• Inability to recall key features of the trauma
• Overly negative thoughts and assumptions about oneself or the world
• Exaggerated blame of self or others for causing the trauma
• Negative affect
• Decreased interest in activities
• Feeling isolated
• Difficulty experiencing positive affect

Criterion E (two required): Trauma-related arousal and reactivity that began or worsened after the trauma, in the following way(s):

• Irritability or aggression
• Risky or destructive behavior
• Hypervigilance
• Heightened startle reaction
• Difficulty concentrating
• Difficulty sleeping

Criterion F (required): Symptoms last for more than 1 month.

Criterion G (required): Symptoms create distress or functional impairment (e.g., social, occupational).

Criterion H (required): Symptoms are not due to medication, substance use, or other illness.⁸

Treatment for mass trauma:

Treatment for mass trauma should be delivered at two different levels: the community level and the individual level.

1. Community level:

Dr. Frantz Omar Fanon gives the recipe for mass trauma treatment at the community level: “Mass trauma can be alleviated through cohesive and collective efforts such as recognition, remembrance, solidarity, communal therapy and massive cooperation.”

The statement above can be a topic for a separate article. Here, we would like to express the importance of the remembrance days. People comes together on remembrance days and remind the victims that they are not alone and not forgotten. This can be therapeutic for the victims and alleviate their pain.

2. Individual level

PTSD treatment includes pharmacotherapy (medical treatment) and psychotherapy. Some of the medications which have been helpful combatting depression are selective serotonin reuptake inhibitors (SSRIs), such as Fluoxetine (Prozac), Sertraline (Zoloft), Paroxetine (Paxil), and serotonin-norepinephrine reuptake inhibitors (SNRIs) such as Venlafaxine (Effexor) and Duloxetine (Cymbalta).

There are several therapy types that have been shown to be effective at treating PTSD. Trauma-focused psychotherapies are the most highly recommended psychotherapies for PTSD. In these therapy types the treatment focuses on the memory of the traumatic event or its meaning. These treatments use different techniques to help a victim process their traumatic experience. Some involve visualizing, talking, or thinking about the traumatic memory. Others focus on changing unhelpful beliefs about the trauma. Prolonged exposure therapy, Cognitive Processing Therapy, Eye-Movement Desensitization and Reprocessing, Brief Eclectic Psychotherapy, and Narrative Exposure Therapy are the some of the therapies that have been found to be helpful for PTSD patients.

Additionally, spirituality might help treat PTSD, too. A study of Bosnia-Herzegovina war veterans suggested that veterans who prayed had significantly higher levels of incorporation, self-protection, and reactive formation and significantly lower levels of regression, compensation, transferring, lack of control, and aggressiveness than their peers who did not pray. ⁹

In brief, providing shelter, food, and a safe environment are mandatory for trauma patients, but they aren’t nearly enough. Psychological traumas are very hard to treat, and treatment may take years. It has been shown that soldiers who have somebody to share their war experience/trauma with, have a lower risk for PTSD when compared with the ones who can’t talk to anybody. Victims need professional help along with community support. Trauma can be alleviated through cohesive and collective efforts and cooperation. Praying for the trauma victims, as politicians suggested for recent hurricane victims, definitely has some social impact. It has also been shown that medication/prayers decrease PTSD symptoms ¹⁰; however, showing support and empathy, listening to victims, and acts of remembrance are the other key elements of community support.

References

1. Lisa Gale Garrigues, “Slave and Slave Holders Break Free of History’s Trauma“, Yes Magazine, August 2, 2013
2. Updegraff, Silvler, Holman, “Searching for and Finding Meaning in Collective Trauma, Journal of Personal and Social Psychology, September 2008
3. Coffey, R. (1998). Unspeakable truths and happy endings. Sidran Press. ISBN1-886968-05-5
4. https://www.ptsd.va.gov/professional/pages/handouts-pdf/Reactions.pdf
5. NSW Institute of Psychiatry and Centre for Mental Health. (2000). Disaster Mental Health Response Handbook.North Sydney: NSW Health.
6. Kessler, R.C., Berglund, P., Delmer, O., Jin, R., Merikangas, K.R., & Walters, E.E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6): 593-602.
7. National Comorbidity Survey. (2005). NCS-R appendix tables: Table 1. Lifetime prevalence of DSM-IV/WMH-CIDI disorders by sex and cohort. Table 2. Twelve-month prevalence of DSM-IV/WMH-CIDI disorders by sex and cohort. Accessed at: http://www.hcp.med.harvard.edu/ncs/publications.php
8. American Psychiatric Association. (2013) Diagnostic and statistical manual of mental disorders, (5th ed.). Washington, DC.
9. Pajević I, Sinanović O, Hasanović M. Association of Islamic Prayer with Psychological Stability in Bosnian War Veterans. J Relig Health. 2017 Dec;56(6):2317-2329. doi: 10.1007/s10943-017-0431-z.
10. Gallegos AM, Crean HF, Pigeon WR, Heffner KL. Meditationand yoga for posttraumatic stress disorder: A meta-analytic review of randomized controlled trials. Clin Psychol Rev. 2017 Dec; 58:115-124. doi: 10.1016/j.cpr.2017.10.004.

Gastro-esophageal reflux disease (GERD) is among the most common chronic diseases in the Western world, affecting up to 30% of the general population in Europe and the US. It is a condition which develops when the acidic contents of the stomach flow backwards into the esophagus and cause what’s known as heartburn. While most patients respond well to the standard therapy of proton pump inhibitors which block acid-secreting cells in the stomach, we are still trying to understand the molecular reasons why 30-40% of reflux patients do not respond adequately to acid-suppressant therapy. Not only does GERD have a significant negative impact on health-related quality of life, but the over-subscription of ineffective drugs causes a significant economic burden on healthcare.

Heartburn is the most noticeable and troublesome symptom of GERD. From what we currently understand about the pathophysiology of the disease, we know that the reflux of acid evokes different types of pain, but the basic mechanisms and pathways by which this pain is generated is incompletely understood. The junction between the esophagus and stomach is structurally and functionally designed in a way to ensure that any acid secreted in the gastrointestinal tract flows towards the stomach, and not up onto the lining of the esophagus. This function is served by the muscle structure sitting at this junction, called the lower esophageal sphincter (LES), which ensures that the ingested food following a meal does not reflux. However, there are several factors which can make the LES’s job more difficult. One of the most obvious factors includes the excessive consumption of food, particularly during the later hours of the day. There is convincing evidence that 90% of reflux episodes occur post-prandially, due to minor elevations of intragastric pressure which causes the LES to relax and therefore allow the reflux of acid. In more advanced cases of reflux disease, acid pockets form at the gastroesophageal junction where unbuffered acid collects into a reservoir. When the LES fails in this setting, there is reflux of a higher volume of acid.

Focusing on the microscopic structure of the esophagus and stomach, we can see a minute yet essential difference between the linings of these two gastrointestinal organs. The esophagus has a stratified squamous epithelial lining, which acts as a tight protective barrier against food but is readily damaged when exposed to a chemical environment. On the other hand, the stomach is lined by tall columnar epithelium, which is designed to withstand very low pH and high levels of proteolytic activity. Our gastrointestinal tract (and the human body in its entirety) is perfectly designed to carry out the specific role of transporting food from the oral cavity from the esophagus to the stomach, where it is digested for our nourishment. It is oftentimes our greediness and overindulgence which disrupt the perfect order of our anatomy at a molecular level, resulting in the macroscopic changes we see at endoscopy and the symptomatic discomfort we feel from the painful circumstances of reflux. 

The stomach is our center of nourishment. Given that every food particle has the purpose of nourishing the cells of our body, why do we so commonly make the mistake of eating excessively, nocturnally, and quickly? Fatty foods influence the relaxation of the lower esophageal sphincter, along with alcohol, coffee, and acidic drinks. Large meals and rapid food intake distend the stomach, increase intragastric pressure and facilitating the reflux of acid from the stomach. Given these, it is plain to see that, in most cases, simple lifestyle changes can prevent the development of such chronic and discomforting diseases. The following verse in the Holy Qur’an offers a short but very effective prescription: “Eat and drink, but do not be wasteful” (7:31).

The philosopher and physician Ibn Sina (Avicenna) summarized the science of medicine as follows: “Eat little when you eat, and after eating do not eat again for a certain period of time; health lies in digestion. There is nothing heavier for the body to tolerate than putting food after food in the stomach.” Frugality in eating is also echoed in the teachings of Prophet Muhammad, peace be upon him, who famously said “There is no vessel which the son of Adam can fill more evil than his stomach, for it is sufficient for him to take a few mouthfuls in order to straighten his back; but if he must, then fill one-third with food, one-third with drink, and one-third with air” (Tirmidhi).

The lifestyle factors that are strongly associated with GERD are obesity and smoking. In the 30-40% of GERD patients who do not respond to acid-suppressant therapy, simple lifestyle changes such as cutting out acidic drinks and eating more slowly, and not after 7 pm have been effective alternative treatments. While our understanding of molecular pain mechanisms of the esophagus need further improvement, the simple act of making minor changes in our eating habits can ensure that the anatomy and function of our gastrointestinal tract remains optimal.

Every essential oil gets its uniqueness not just due to one of its components but because of its delicate and complex admixture. The individual perfume and therapeutic value of each essential oil depends on this balance.

What is aromatherapy?

Aromatherapy is the practice of using essential oils, also known as volatile plant oils, for physical and psychological health. These essential oils and/or essences are concentrated liquids that are extracted from many different types of wild or cultivated plants. Essential oils can be obtained from different parts of the plant, such as the flower, leaves, fruits, bark, roots, and resins. Some examples of essentials oils are Agar oil, highly coveted for its wonderful fragrance, and Geranium oil, used in herbal medicine. As for essences, they can be obtained not only from flowers and resins but also from chemicals such as benzoins, and plants such as gaiacs and pines. Some examples of resins that can be used for their essences are Asafoetida, which is dried latex that certain Ferula plants exude from their tap root, and Myrrh, which comes from thorny plants of the genus Commiphora.

A brief history of aromatherapy

It’s hard to say when people first started using aromatherapy, partly because the practice of using plant-derived ingredients for medicinal (and other) purposes is as old as time. There is evidence that the Chinese may have used aromatherapy several thousands of years ago, with an emphasis on maintaining harmony and equilibrium. Some years after this the Egyptians were able to develop a machine that could distill cedar wood oil. Later on, the Greeks adapted aromatherapy from the Egyptians. “Istenshaque,” a form of aromatherapy, was first practiced in the Greek system of medicine by Hippocrates (460-370 BC). In the 11^th century, the renowned Avicenna developed a coiled cooling pipe that made the essential oil distillation process much faster. The term “aromatherapy” was eventually coined by the French chemist and scholar Dr. Rene Maurice Gattefoss’e (1881-1950) in 1930 and thereafter practiced as a medical science for the treatment of various diseases.

What are essential oils composed of?

From a chemical analysis standpoint and by chromatography it is evident that essential oils are not single entities but can instead be classified as compounds. Additionally, essential oils are volatile in steam, which means they will turn into a gas in the presence of steam. They differ entirely in both chemical and physical properties from fixed oils, which are also known as non-volatile oils. Animal or vegetable oils are very common types of fixed oils. Essential oils consist of many organic constituents which unite in a delicate and complex balance to produce a wide range of therapeutic and olfactory qualities. For example, the oil of the eucalyptus leaf contains no less than 250 different constituents. In one study, researchers were able to identify 40 different compounds in tea tree oil using chromatography methods (Journal of Agriculture and Food Chemistry). Every essential oil gets its uniqueness not just due to one of its components but because of its delicate and complex admixture. The individual perfume and therapeutic value of each essential oil depends on this balance.

Scope & methods

• Olfaction (shamoom): Aromatic medicines either in dried or liquid forms are kept in a vessel and the fumes are inhaled. Rose oil is often used in this manner.
• Inhalation (lakhlakha): Aromatic medicines or pungent medicines either dried or liquid forms are kept in a wide mouthed bottle and then inhaled. With this method the vapors of the medicines not only reach up to the nose but can reach down in to the respiratory passage as well. Camphor is a common choice for inhalation therapy.
• Massage (dalak): Some treatments involve massaging the oil into the skin directly, and can be one of the more effective treatment methods.
• Poultices: Essential oils used in poultices bring out impurities of the skin. These treatments sooth irritation and relieve congestion and pain. Most frequently, poultices are made up of linseed (Alsi) or mustard. These are particularly useful for chest complaints and skin diseases.
• Compresses: Used externally, particularly on eyes. They can be either hot or cold depending on the effect required.

Base oils and carrier oils

Most essential oils are not used in their pure, undiluted sate. Rather, they are mixed into a fixed plant oil base, like almond, soya, or wheat germ. These base or carrier oils act as balancing and stabilizing agents. They are typically pure, have little to no smell, and are easy for essential oils to dissolve in. The ratio of essential oils to base oils differs for each oil. For example, 2 to 3 drops of essential oil to 5 ml of base oil can be used for the body, and 1 drop essential oil to 5 ml base oil can be used for the face.

Some commonly used oils

• Almond oil: Oil extracted from bitter and sweet almond.
  Constituents: Olein is the chief constituent. Other constituents are glyceride and linoleic acid.
  Action: Skin softening agent, lubricant, nourishing and revitalizing.
  Uses: Wonderful for dry, wrinkled hands. Very beneficial for eczema and skin irritation of any kind.
• Castor oil:
  Constituents: Major constituents are palmatic, fatty acids, ricinoleic acid and glycerine.
  Uses: as soothing agent for skin rashes, in embalming, eczema, dryness of the skin.
• Soya oil:
  Constituents: Oleic, linoleic, stearic and palmitic acid.
  Action: Lowers cholesterol levels.
  Uses: To be taken every day in salad dressing or with rice dishes.
• Sage leaf (Salvia officinalis)
  Action: Antiseptic, astringent.
  Uses: Mouth washes and gargle, Alzheimer’s disease, memory loss.
• Thyme & thyme oil (Thymus vulgaris)
  Action: Antiseptic, anti-tussive, expectorant, spasmolytic.
  Uses: Cough cold, spasmodic pain.
• Lavender oil (Lavendula angustifolia)
  Action: Masks disagreeable odors, heals skin burn and acts as relaxant in premenstrual tension.
  Uses: In ointment, rheumatic pain.
• Aniseed (Pimpinella anisum)
  Action: Carminative, appetizer, hepto-tonic, stomachic, diuretic, emmenogogue, galactogogue, analgesic.
  Uses: flatulence, loss of appetite, liver disorders, indigestion, renal disorders, to stimulate lactation, for pain.
• Fennel (Foeniculum vulgare)
  Action: Carminative, stomachic, diuretic, emmenogogue & galactogogue and vermicide.
  Uses: flatulence, loss of appetite, indigestion, renal disorders, to stimulate lactation and worm infestation.
• Cumin (Cumin cyminum)
  Action: General tonic, digestive, antiseptic, bactericide, carminative, detergent (Jaali)
  Uses:Indigestion, loss of appetite, infections, flatulence, skin disorders.
• Cinnamon oil (Cinnamomum zeylanicum)
  Action: Rubefacient, carminative, powerful germicide, anti-rheumatic, digestive, analgesic, detergent.
  Uses: Skin disorders, flatulence, infection, arthritis and indigestion.
• Camphor (Cinnamomum camphora)
  Action: externally: rubefacient, internally-mild antiseptic, carminative, antipyretic.
  Uses: skin disorders, infections, flatulence and fever.
• Caraway (Carum carvi)
  Action: Carminative, antispasmodic, galactogogauge and emmenogogue.
  Uses: Flatulance, colic, stimulate lactation and dysmenorrhea.
• Myrrh (Commiphora)
  Action: Antiseptic, antibiotic, stomachic, emmenogogue, diuretic, anti-inflammatory, wound healing properties.
  Uses: as an essence and in perfumes, mouth wash, in anti-ulcer treatment and is cytoprotective.
• Clove oil (Eugenia caryophyllus)
  Action: Stimulant, antiseptic, stomachic, expectorant, sedative, carminative, antispasmodic, digestive.
  Uses: Mouth and tooth infection, flatulence, rheumatic pain, bronchitis, cold.
• Eucalyptus oil (Eucalyptus globus)
  Action: Decongestant.
  Uses: Internally: Mixtures, inhalations, lozenges. Externally: In ointments and liniments.
• Chamomile (Matricaria chamomilla)
  Action: Antiseptic, anxiolytic, digestive, disinfectant, carminative antipyretic.
  Uses: Insomnia, headache, migraine, facial neuralgia, sinusitis, dermatitis, acne, eczema, abscesses, boils, amenorrhea, pre-menstrual tension, cystitis, colic, loss of appetite.
• Sandal wood (Santalum album)
  Action: Calming action on dry skin, aphrodisiac.
  Uses: For dry and chapped skin.
• Rose oil (Rosa domascena)
  Action: Cardio tonic, resolvent, anti-inflammatory.
  Uses: In perfumery, palpitation, inflammation.

Precautions while using essential oils

Although essential oils are useful for treating a number of ailments you should still take the necessary precautions before using them. For example, you should always perform a skin test before using an essential oil, since everyone is unique and reacts differently to different oils. Body size, age, and sex also makes a difference. As for storage, essential oils should always be stored in dark glass bottles away from sunlight.

In our era that is characterized by stressful environments and ever-changing life styles, essential oil aromatherapy offers an optimal answer to the emerging health burden of degenerative diseases. It not only offers therapeutic but also preventative and restorative health benefits, without most of the side effects of modern treatment schedules. Hence aromatherapy with its wide scope and application potential offers a therapeutic solution for not only diseased body systems but also soothes the soul and the spirit, thereby taking care of the stress component that is prominent in many illnesses.

There are two types of pain. One is called sharp or acute pain, which for example might be caused by the prick of a needle, an injury from broken glass or a sharp object like a knife, or contact of skin with a hot object like an element. Such sharp pain is especially important to protect the body through reflex. Similarly, sharp pain in internal organs such as the stomach or intestines may result from a puncture or blockage that prevents the transport of oxygen, or leakage of toxic material such as the stomach acid.

Another type of pain is continuous or chronic pain, of which one obvious example is rheumatic pain. Cancer pain is mostly chronic, although cancer may also cause sharp pain. Whether chronic or sharp, cancer pain can be unbearable, and only endurable with morphine.

What can we do about pain?

Medication should be our last resort when dealing with pain. We should remember that every drug is potentially a poison, and drugs, especially when used for a long time and in high doses, can have numerous adverse effects. Thus no drug, including aspirin, is fully innocent.

The cause of pain must first be diagnosed by a physician. A pain in the chest may simply be a muscle pain, or conversely may be as deadly as a heart attack.

After diagnosis comes the required treatment or operation. Intense pain from appendicitis, for example, is easily treated with an operation. Pain from a heart attack, which causes pain in the left part of the chest, left shoulder and left arm, must be dealt with very seriously under the supervision of a cardiologist.

The first measure to be taken in case of a headache, backache, or neck ache is to avoid the position or movement that causes the pain. Consider the following analogy: the wheels of your car are not properly aligned. One side of the tire is worn due to friction, and thus blows out or loses traction. This result is inevitable, unless one corrects the misalignment leading to friction and wear. The damage cannot be prevented by putting on ear plugs and pretending it doesn’t exist.

If your neck has an ache, you should consult a physician to diagnose the cause. The pain may be related to how you use your pillow; so you can get rid of the pain by simply adjusting the pillow based on your preferred sleeping position, or you may need to buy a new pillow. The pain may also be caused by keeping the head in the same direction for prolonged periods to watch TV or looking into the monitor, we may just need to do some simple physical exercise and sit up right. Desk jobs and extended cell phone use are primary causes of neck aches. Resorting to painkillers immediately is not the right thing to do in such cases. A drug may ease the pain temporarily, but as in the car analogy, we may end up with a flat tire. Painkillers do not resolve the injury to the neck and what is worse, despite the intensifying pain you may not be aware of the body’s warnings, and finally have a serious case of hernia that may require an operation that runs the risk for death or paralysis.

The most important cause of backache is a vicious circle of inactivity and obesity. If a person does not exercise, they will put on weight and as one puts on weight they cannot exercise. Carelessness when picking up something is one of the most common causes of backaches. Obesity is one of the most common causes of herniated disc. Obesity prevents doing exercise; back muscles weaken as one does not exercise, and this leads to a herniated disc. If we do not take necessary care about these and look to drugs for treatment, we may not feel the pain, but the injury and hernia continue to exist. The risk is much lower among those who observe meditation and other religious practices that include physical activity like bowing, prostrating, sitting and standing upright. Eating little and leaving the table before being full are among many prophetic advices that are useful for our health.

The same is true for knee injuries such as meniscus tears and ligament sprains. Our knees are some of our most precious assets. We should be careful about our knees when standing up from a squat or getting on or off a car so that they will not slip sideways. Dangerous, rigorous exercises or movements that may harm the bones and cartilage in the knees, such as lifting heavy weights and jumping off a height, should be avoided, especially after a certain age. Sitting crossed-legged or squatting for long periods may stretch cruciate ligaments too much, and a slight move may cause their rupture.

One of the most common types of headaches is stress-related headaches. In these headaches the muscles in the head become tense, causing the vessels to contract and leaving tissues without oxygen. If we learn how to deal with stress, we can ease the headache and become happier. We should fight stress consciously and actively. We can overcome headaches not by sitting idly but by mental preparation and activity targeting stress.

Cupping and other complementary treatments can be tried before medication. Performing regular prayers may help relieve the aches in the head, neck, and knees, because these prayers reduce stress and are a form of exercise. Washing yourself as a part of prayers includes exercise, cleaning, and getting rid of the stress-related static electricity through water. Cleaning the top of the head, massaging the ears inside out, and washing the face and feet are known to reduce stress and discharge static electricity.

Endorphins, a group of hormones secreted within the brain, are in fact given the task of acting as painkillers in our body. They are thousands of times more powerful than morphine and help us fight headaches. Most of the ache, especially in chronic pains, is eliminated by the “pain-control systems” which were installed in our brains; what we feel as pain is in fact whatever remains after this elimination. Were it not for this mechanism, which is a sign of great compassion, life would be insufferable because of pains.

Takagi R. et al. Bioengineering a 3D integumentary organ system from iPS cells using an in vivo transplantation model. Science Advances, April 2016.

Skin is the human body’s largest organ, weighing 3.6 kg and having a total area of 2 m2. It acts as a waterproof shield against extreme temperatures, harmful chemicals, and infectious agents. Once skin is damaged beyond the ability of the body’s self-repair mechanisms, re-generation of patient-specific skin cells in lab conditions could be an essential tool used for successful skin grafts. Although there have been many methods developed to generate skin cells in lab conditions, none of these approaches gave rise to functional skin cells, complete with hair follicles and exocrine glands. In a recent study, scientists demonstrated the first lab-grown skin that contains hair follicles and sweat glands, making this skin akin to biological skin. Using a special cocktail of chemicals, scientists were able to first convert gum cells from mice into undifferentiated stem cells, then they directed these stem cells into mouse skin cells. Next, they grafted the artificial skin cells onto genetically modified hairless mice. The grafted skin cells ended up maturing into skin cells capable of growing hair, excreting oil, and connecting with the nerve and muscle cells of the test animals. Although these experiments were conducted only on mice, it still represents a leap of sophistication in the development of artificial skin. In the future, researchers hope that this technique will have applications for patients with serious burns, scars, or alopecia, and it could potentially be an alternative to animal testing for chemical products.

More Friends, Less Pain

Johnson KVA & Robin IM. Pain tolerance predicts human social network size. Scientific Reports, April 2016.

According to a recent study, people with large groups of friends have higher pain thresholds. In this study, scientists focused on the chemical endorphin, a major regulator of the brain’s pain and pleasure circuitry. Although these two senses seem like opposites, both are fundamentally reward behaviors, since we search for things that give us pleasure and avoid painful stimuli. Endorphins not only make us feel good, but also act as a pain reliever – one that is even stronger than morphine. Endorphins have also been shown to build and maintain social bonds. Scientists hypothesized that if endorphins help social bonding, people with more friends would have a higher endorphin count – and thus, a higher pain threshold. The research team recruited 101 adults, aged between 18 and 34, and asked them to fill out a social network questionnaire, which asked how many people they contacted on a weekly or monthly basis. Next, researchers tested the participants’ pain tolerances through the wall sit test, in which participants had to squat against a wall with their knees at a 90 degree angle and to hold the pose as long as possible. Interestingly, those with larger social networks showed significantly higher thresholds to pain. This study is one of many studies that linked social behavior and physical fitness. There has been a lot of evidence that suggests having an active social life and a bigger circle of friends can prevent depression, contribute to successful aging, and promote longevity. Our social lives are as critical to our overall health as our diets and exercise habits.

Three Potentially Habitable Planets Discovered

Gillon M et al. Temperate Earth-sized planets transiting a nearby ultracool dwarf star. Nature, May 2016.

The search for life on Earth-like planets beyond our solar system has been very active, thanks to new high-precision instruments and advanced analysis techniques. Scientists have discovered hundreds of terrestrial worlds over the past few years, including some that are the right distance from their host stars to contain liquid water. Astronomers have been investigating these habitable planets, and one research group, using the Transiting Planets and Planetesimals Small Telescope (TRAPPIST) at the La Silla Observatory in Chile’s Atacama Desert, recently discovered three Earth-like planets orbiting an ultracool dwarf star just 40 light-years from Earth. The planetary system is named TRAPPIST-1 and the three planets are designated TRAPPIST-1b, c, and d. These three planets orbit very close to the star, at 1-3% of the distance that Earth lies from the sun. A year on them passes in only 1.5-4.5 Earth days. They have sizes and temperatures similar to those of Venus and Earth, and are the most promising candidates found so far in the search for life outside our solar system. Scientists are already excited about further studying these planets in greater detail. They plan to use the Hubble space telescope to investigate whether the planets have their own atmospheres or not. If they do, analysis of the presence and proportions of water, carbon dioxide, and ozone in their atmospheres will shed light on the real possibility of “life” on these planets.

In the past, the area missing a tooth could be filled by bridge implants by eroding the enamel on neighboring teeth. In cases where there was a large gap or no teeth to use as connectors, removable implants were used. In other words, present healthy teeth would be treated to compensate for the missing teeth; if the number and health of the remaining teeth was not sufficient, removable implants would be produced that gave the “ready to fall out” feeling. The imperfections of this type of implant led scientists to pursue new ideas.

Scientists have tried to fill in missing teeth with artificial roots and with implants mounted over these by mimicking the existing tooth root. This way, there is no need to treat and erode the healthy enamel of neighboring teeth in the gap. These artificial roots, which are positioned into the jaw bone by a surgical operation, are called a “tooth implant.” Modern-day implants are generally composed of two main parts.

One of these is the fixture part which is secured into the jaw bone by screws; the other is the support part (abutment) which mimics the visible parts of the tooth in the mouth. Approximately 3-4 months of curing time is required for the fusion of bone and implant (osseointegration), which is screwed together by a surgical operation. Towards the end of this time, the implant is built over the abutment. The length of time necessary for the implant to integrate with the bone to replace a tooth which can be extracted so quickly is rather noteworthy despite ongoing studies to reduce the wait time and successful attempts to do so.

Employed materials

Even though the main logic for implants is the mimicry of the tooth and the root, the materials utilized are quite variable. The history of such implants goes back thousands of years. The employment of bamboo sticks in tooth restorations could be seen in some civilizations, such as ancient China. Mayans used sea shells, which were recently shown to be biologically suitable as implant material. Maggiolo produced a tooth root by using gold, in 1809. In the beginning of the 20th century, Lambotte prepared implants using materials such as aluminum, silver, brass, copper, and gold.

These newer implant methods have failed because of the insufficient strength of the majority of the materials and the failure to fit into biological tissues. The initial employment of titanium and its alloys in the 1950’s almost opened a new age in implantology and enabled the successful use of these materials up until today. However, these titanium implants, which are considered successful, have a very limited ability to mimic tooth roots:

• Once the implant is in place, for reasons such as aging and improper tooth brushing, tooth gum recession and resurfacing of the bright faces of the implants which mimic the root surface can take place. This leads to undesirable displays. Even though gum recession can also occur in natural teeth for similar reasons, this situation is not as disturbing as with implants. This is because the tooth root color is similar to that of the tooth surface.
• Under normal conditions, implants should be fused to integrate with the bone (osseointegration). Integrated implants are considered successful clinically. A similar case to this bondage, which is unwanted clinically, is the fusing of tooth and bone which can be seen generally in dead teeth and is called ankylosis. Many hardships can be encountered when the tooth that is fused with the jaw bone is required to be removed. The same thing also applies to the implant. If an implant is set to be extracted for a reason, even if just a small amount must be removed, the surrounding jaw bone must be removed as well. However, a natural tooth is not bonded so tightly to the jaw bone, as if the tooth is healthy, it is suspended over the jaw bone through small suspension-like structures. When a tooth is needed to be pulled as a result of trauma or tooth rotting, only these suspensions are detached; thus any damage to the jaw bone is averted. Present efforts to design similar mechanisms for implants have not been successful yet.
• When a disease develops in our natural teeth, we feel pain and take action before it is too late. However, diseases within implants are rarely encountered as pain; generally, when the pain is felt, the implant is already disconnected from the bone and it is lost. Toothache often felt as a strong pain is a blessing granted to us. If the implants were built with pain mechanisms, just like in our natural teeth, we could take action at the beginning of the disease and avoid the time and financial losses.
• Even a healthy tooth, which we think of as immobile, can move via microscopic ligaments for 0.1 mm around its root on a type of pad. The tooth root is created in a perfect fashion to resist the strong chewing power that can be generated from many directions in the mouth through these ligaments, which are wrapped around different sides and which come from different angles. However, these ligaments, which act as a suspension, do not exist in between the implant and jaw bone. Therefore, implants are almost immobile. Even though it may seem like a good thing for them to be immobile and tightly fixed, there may be intense power spots generated on the implant or jaw bone since these forces acting on the implants are transmitted to the jaw bone without being dispersed. Forces densely acting on small areas can lead to fractures of the material, including tiny screws or porcelain plating, and can damage the bone tissue. Investigators once understood that these tiny, suspension-like structures won’t form around the implant, so they engaged in mounting tiny Teflon or spring pieces inside the implant to generate suspension. However, these imitated suspensions failed to resist the chewing forces that can go up to 400 kg at times, and their use was aborted after a short time.
• Teeth can be examined by the method of tapping with small hand tools (percussion). These small impacts cause pain in case of an abscess at the tooth root. By taking necessary actions, the tooth can survive longer. It is impossible to do such determination and diagnosis with implants.

As it is seen, making less successful artificial implants as opposed to real teeth is quite a cumbersome, costly, painful, and time consuming job. Despite all of these imperfections, because of their numerous advantages over traditional implants, the popularity of dental implants continues to increase, and is preferred by dentists and patients. In addition, implants are seen as an inevitable treatment option when tooth loss occurs, and may ultimately provide patient relief in the long run.

Despite progress made in implants, it’s clear that our teeth were created in such a perfect way, down to the very smallest detail, that they cannot be replaced. Science is well aware of the fact that we will never fully be able to replicate tooth structure. Therefore, studies are shifting towards stem cell research. This way, instead of foreign substances, the missing tooth will be compensated as if by planting tooth seeds by using human’s own cells. Nonetheless, the opportunities that are discovered via all these efforts will never replace the natural teeth that were so perfectly created for us.

After that question, I found myself at the doctors.

“If your heart is OK, then your body is OK,” she told me with worrying eyes.

“I’ve never had pain in my chest for this long,” I told her. “It feels as if somebody is sitting on my heart. But if I put my hand on my chest, that warmth helps to alleviate the pain.”

She was concerned. We stopped and she urged me to go to the ER immediately.

“I need to pray,” I told her. “It will take ten minutes and I will be at the hospital praying room. There are always a few people there, so don’t worry.”

She nodded. “I believe in the power of the prayer and meditation,” she added. And she ensured that I see a specialist for the chest pain.

I left that building and crossed the road to go to the other building. I was holding my heart, thinking the metaphors that we think of as a mundane saying. None of the metaphorical descriptions were solely poetry or were merely linguistic elaboration. Rather, they all meant what is untold and unseen and indescribable. At that moment I realized this heart was given to me. I was doing my best for a month to satisfy her needs and to ease her tension. But she was behaving as a separate and independent unit that has her own free will. I realized this for the first time in my life. Maybe the metaphor for this case would be extending a helping a hand to my heart, or to surround her with muscles. Maybe I forced too much on her, or did not appreciate the help my individual organs, my body as a whole, have given me.

That night, a friend of mine, not knowing what I had been thinking during the day, told me that we should talk to our bodies. “You should thank your feet that carried you all those years, my friend,” she said. “You should appreciate your eyes, which never gave up on you. You should thank your arms and hands since you would be speechless without them as a writer. You should thank your brain, for she listened to her Owner all these years and served you to be a better human every day.” “You know,” I added, “you are so right. After all, the one who cannot thank people and things cannot thank their Owner, the Beautiful, the Merciful, the Wise, the Choice Maker!”

I have been reading a lot lately. But there is something we learn from life and other people that no book can cover. Thus, I believe humankind is a unique book, its own kind of scripture. Humans read the universe with one eye, and the Scriptures with the other. Thus, we are given double eyes. And humans stand at the conjunction of these two books of meaning, being ourselves the third book which is uniquely because it is not just a book to read but also a reader. The more humans read these two books, the more we become a readable book.

So what is written in me? I suppose the basis of all lines is this sentence I heard from my doctor today: Save your heart, if the heart is good then your body and mind will be healthy. I wish I knew the language of the heart that would make my body healthy and would make my mind a reader and my self a book. The heart is at the center of human life, both in the physical and metaphysical senses. The heart is at the heart of the fact that humankind is a book to be read and discovered. The heart defines what we feel and motivates us in life. The heart defines which way the mind will travel. The heart is the teacher of the mind. Do you think we can unravel the language of the heart?

O heart! You and your suffering for Him exist; ah, how nice it is always to be concerned with Him and suffering for Him! That suffering is, in fact, your cure.
O you who are seeking the world; you are like a day laborer in this world;
and you, lover of Paradise, are also far distant from truth.
O you, who are unaware of the truth and pleased with the two worlds,
You are excused, for you have not felt
the pleasure of suffering for the Beloved’s sake. (Rumi)

How does suffering become a cure or a pleasure? Just like hot peppers do. Why do we consume hot peppers, even though they are painful to eat? In his article, Ali Fethi Toprak explains that experts think hot peppers “are good for our health by lowering blood pressure, having antimicrobial effects, and increasing salivation thus making a boring diet fun.” Kocabas also suggests that, according to some studies, the capsaicin present in hot peppers could be used as a pain suppressor.

Also in this issue, Katharine Branning explains that researchers have discovered a link between the heavy consumption of isot pepper and the very low cancer rates in southeast Turkey. The “research has provided conclusive evidence that isot pepper does indeed possess substantial anti-cancer properties.” In Branning’s piece, the very hot isot pepper does not only help cure cancer, but is also an emblem of dialogue, friendship, and mercy, stretching across cultures and religions.

In her heartbreaking memoir, Magdalena Rusanova tells us about her father, who she lost when she was a child. As we read along, we trace each and every threshold she needed to surpass in her life as she grew into adolescence, developed relationships with others, and faced important choices. Even though her father’s memory faded as the years passed, and despite her pain, there was one significant piece of advice he had given her, which happened to guide her all her life. Choosing the right guide is necessary for an unwavering walk in our lives, as Niyazi-i Misri says,

Let not any guide lead you, for he may make it
too difficult to proceed;
It is very easy for one whose guide is perfect
to advance along this path.
The right guide can even help us discover the pleasure in pain.