I like cow's milk but lately have been suffering from indigestion from it, even though I am not lactose intolerant. I have seen in the supermarket of late a wide variety of non-dairy milks not only from soybeans but also from almonds, coconut and cashew nuts. They're relatively expensive, but I thought it might be worth trying them if they are nutritious. Can you compare these products with cow's milk and tell me which are the most healthful? M.D., Beersheba Veteran clinical nutritionist Dr. Olga Raz comments: None of the beverages you mention is milk, and they don't have the nutritional value of cow's milk. Therefore, I do not recommend them, except, perhaps, for soy “milk” that is enriched with calcium. You can try goat or sheep milk, if it is processed properly (pasteurized) by a legitimate company. If you have no problem of lactose intolerance, it is likely that one of these two should suit you – and they will also give you the high nutritional value of real dairy milk. Our 13-year-old son has complaints of chronic pains in his muscles and sometimes his bones. He has fallen down and been a bit banged up from sports injuries, but nothing serious. We took him to a number of doctors, and they never found anything. They just said they were “harmless growing pains.” Is there anything they are missing? N.M., Yehud Dr. Daniel Stuckey, an anesthesiologist and responsible for the pediatric pain clinic at Dana-Dwek Hospital at the Tel Aviv Medical Center, answers: The complaint is a very common one. A third of all children and teens suffer from some kind of pain in their muscles and skeleton. A fifth of all children have chronic pain, which is defined as pain occurring for three months or more. It is not only real but also widespread. Awareness of chronic pain in children is growing, and we have begun to realize that it is a disease of its own, resulting from physiological changes in the peripheral nervous system, neurons in the dorsal horn, glia cells in the spine and neurotransmitters. All these can bring about injuries, psychological events, serious emotional stress, a lack of physical activity and more. After a disease or injury, the body recovers. But sometimes the pain continues even after recovery. Injury can initiate a process of local inflammation that includes the release of cytokines, growth factors and other neurotransmitters. A similar process takes place in the spine that causes central sensitization with “a wind-up phenomenon,” which involves changes in the nervous system. The stimulus that usually does not hurt is felt as pain. An imbalance of other neurotransmitters, including glutamate, substance P, serotonin and noradrenalin, limits the ability of the body to reduce the pain reaction. In addition, the level of pain is influenced by increased emotional stress, poor sleep quality and more. Chronic pain can affect the quality of life, studies, social activity and psychological well-being. If children are unable to participate in sports because of the pain, they can feel left out and feel low self-esteem. Treatment of chronic pain in children is multidisciplinary. In our clinic, we have an anesthesiologist, psychologist and physiotherapist. We accept youngsters with all kinds of pain, including chronic stomachaches and postsurgical and neuropathic pain. Treatment is based on the three Ps – pharmacology, psychology and physiotherapy. They learn to reduce their anxiety and stress. Most children can get good treatment in the community, if they follow the recommendations they received in the clinic, but sometimes, in serious cases, we prefer that our pain experts give their own intensive treatment. International pediatric centers with pain clinics have shown that multidisciplinary centers reduce the cost of treatment, visits to hospital emergency rooms and going to various other specialists. In summary, chronic pain in children involves a variety of factors with biological, physical and psychological implications. It's important to recognize the basis for chronic pain in youngsters and raise awareness of the phenomenon, so they can get the help they need. Rx for Readers welcomes queries from readers about medical problems. Experts will answer those we find most interesting. Write Rx for Readers, The Jerusalem Post, POB 81, Jerusalem 9100002, fax your question to Judy Siegel-Itzkovich at (02) 538-9527, or email it to jsiegel@jpost.com, giving your initials, age and place of residence.
