The skull X-ray gives only limited information, e.g. it will show fractures, sinusitis, or inflammation of the bone. A tumour within the skull may show itself by thinning or thickening of the bone overlying it. Shadows of calcium can be seen in various areas within the skull cavity, e.g. a common place is the pineal gland; this is normal but, since this gland is central, a displacement signifies a growth pushing it to the other side. Calcium can also be seen when deposited in a slow-growing tumour, abscess, or blood vessel malformation. These alarming features are virtually never found in a patient with migraine. In fact, the skull X-ray of 100 people without headaches would show abnormalities about as often as those of 100 migraine sufferers. The X-ray is justified on the grounds that something may be discovered, albeit rarely.An X-ray of the chest is occasionally done as a screening measure in eliminating certain causes of headache, e.g. in tumour of the lung, which may spread to the head.Since headache may be due to neck trouble, an X-ray of the cervical spine is sometimes indicated. Although migraine is not usually caused by problems in the neck, wear and tear of the neck vertebrae can cause pain with consequent spasm of the neck muscles, which pull on the scalp to give tension (muscle contraction) headache; treatment of arthritic pain can often relieve these headaches. Pressure on the roots of the cervical nerves also causes pain, particularly over the back of the head.
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In addition, if you are just beginning to remember or deal with traumatic sexual experiences, you may have flashbacks to the assault. During sex or in sexual situations, thoughts, feelings, and even visual images of the traumatic incident may appear in your mind, sometimes so forcefully that you actually confuse what is happening now with what happened then, or you look at your partner and see your abuser instead. This is a truly terrifying experience.Indeed, Rebecca, a twenty-three-year-old sales clerk who could “go only so far” with her fiance before feeling her sexual urges turn into panic and disgust, was disturbed by that type of flashback. She called our office one morning and insisted on seeing us as soon as possible. “It was awful,” she declared. Her skin was pale, her eyes red-rimmed with dark circles around them. She did not have to tell us she had not slept since watching her fiance turn into her stepbrother right before her eyes. “We were doing what we usually do,” she continued, “making it as romantic as we could. We’d lit some candles and Joey turned around to switch off the lamp, only when he turned back he wasn’t Joey anymore. He was Ronnie, my stepbrother. He looked like Ronnie, looked like he was wearing Ronnie’s striped pajamas. When he took my hand I was sure he was going to put it on his penis and say, ‘Make it feel good, Becky. Rub it like I taught you to. If you do it good, maybe I’ll teach you something new.’ That’s what Ronnie used to say. I think I even heard Joey say it. I don’t know. I’m so scared. Am I losing my mind?”If you have a flashback, you too may think you are losing your mind. You are not. Many sexual assault victims have them and learn to overcome them by using specific techniques like those we have included in Chapter Six, or others you can find out about by reading any of the excellent resources listed in the Bibliography.Of course, incest and child molestation are not the only types of traumatic sexual experiences linked to ISD. Rape or any other form of sexual assault—no matter how old you are when you experience it—leaves you terrified, emotionally devastated, sometimes physically injured, and almost always plagued by a pervasive sense of powerlessness and by fears about losing control. For months, years, or decades, you may find that you cannot become sexually aroused without feeling afraid and experiencing many of the same reactions to sex that incest victims do. A 1983 study of female survivors of sexual assault showed that more than half of them had long-standing sexual desire difficulties, including ISD.*107\261\8*
Because hospitalization accounts for 80 percent of the health care bill and because hospitalization costs are so high, the medical profession has developed a series of alternatives to hospital care. The alternatives include expanded outpatient clinics, chronic care facilities, home care programs, and hospice programs. Although the motivation for these changes has been economic, the result has been humane: most people prefer almost any health care setting to a hospital. Expanded Outpatient Facilities-Outpatient facilities—physicians’ offices, clinics, or specialized facilities—now offer many of the procedures and treatments that previously required hospitalization. Examples of these procedures and treatments include blood transfusions, some intravenous treatments, specialized diagnostic examinations like CAT scans or MRI scans, endoscopy, induced sputum tests to diagnose Pneumocystis pneumonia, and most minor surgical procedures. The biggest reason that outpatient facilities have expanded their services is cost: treatments done on an outpatient basis are substantially less expensive than those done in a hospital. Another reason that outpatient facilities have expanded is that insurers will not reimburse people who are only admitted to the hospital to get some types of treatments and procedures. And to make things more confusing, some insurers now reimburse only those treatments done in a hospital. The contradiction in reimbursement rules is difficult to understand but important to know about. Talk to your insurance company, your social worker, and your physician. It may be that the test you need will cost more to do in the hospital, but the final bill to you will still be less.*171\191\2*