FMS COMMUNITY NEWSLETTER # 41
April 20.2003

 

 

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subscribers and 15 new subscribers. Welcome aboard new
subscribers!
Editor of the Week: Mary McKennell
___________________________________________________
Living within strict limits can be frustrating, leading to repeated
cycles of push and crash. This week's article at the CFIDS/Fibromyalgia
Self-Help program describes five ways to expand your activity level
without increasing symptoms.
The previous feature article, still available on our site
(http://www.cfidsselfhelp.org) is "Writing is Good Medicine." Guest
author Lisa Lorden explains how writing can improve your health.

Our bi-weekly articles include several series: "Success Stories"
(personal accounts of successful coping and recovery), "Ten Keys to
Coping and Recovery" and "What Works for Managing CFIDS and
Fibromyalgia."

Bruce Campbell, Ph.D., Director
CFIDS/Fibromyalgia Self-Help Program
http://www.cfidsselfhelp.org

*******************************************************
EDITOR'S CORNER:
The more I read and study about this illness that I have, the more
amazed I am at the complexity of the illness that chose my body to live
in. Do you sometimes feel overwhelmed with all that we need to learn in
order to care for ourselves? I certainly do! I started my work life as a
community services social worker and then found myself as a medical
social worker, learning an entirely different language. I had a great
deal of interest in how illness impacts people and their families and
friends. I have done some workshops on the topic-but never dreamed at
the time that it would end up applying to me. Now that I have become an
educator on the invisible illness realm, I have picked up a lot of new
additions to my vocabulary. I certainly know much more about muscles and
their names then I ever dreamed I would need to know!
My goal in assisting with this website is to equip each of us with the
tools to continue to fight our battle. Whether I am doing "just" the
research end of things or editing, I am always thinking about "What
types of information do we need to quiet this Beast within?" I am also
looking for information on general health to equip us with knowledge so
that we do not blame everything on FM/CFS/CMP but become aware of
warning signs for other conditions that can co-exist.
I also think about remission a lot. Sometimes I think of it very
longingly on days that are not my best. Some of us may not even believe
that such a thing is possible. But I continue to hold onto that hope. It
is how I have come to blend acceptance with a fighting spirit. I do not
think that remission means that we get well and are suddenly free of all
of the trappings of our illness. Once we find the right formula for
ourselves, we have to keep on doing on what we know to do. Remission
takes work. Those of us who subscribe to this newsletter who have FMS/
CFS/ CMP, or any other variety of alphabet soup illness, happen to share
an illness that is very high maintenance.
My hope is that whatever level a person is at today, a better day is
possible tomorrow. Whether a person is just starting to explore
protocols or attempting to 'blend' protocols to find a personal "fit",
improvement remains possible. Unfortunately there is not a
one-size-fits-all package at the present time. So we must each search
and apply our tools in our own way and circumstances. Improvement
remains possible. Survival remains possible. They remain possible so
long as a person questions and tries. Failure comes at that moment we
stop trying and the Beast within wins.
I hope that the information we strive to present here at this website
and through this newsletter enables you to continue to find your
personal fit and your tools to fight the battle.
************************************
TOPICS IN THIS NEWSLETTER:
1)Lessons in Crisis
2)The Road to Resilience
3)Redefining Your Self-Image
4)Estrogen Helps Fight Pain
5)'Many Faces of Pain' Photo Exhibit Coming April 22
6)Metal A Common Cause of Skin Allergy
7)CFS & Allergies
8)Multiple Chemical Sensitivity is A Growing Problem
9)Environmental Epidemilogy and Risk Factors
   For Auto-Immune Disease
10)Protein Intake and Kidney Function
11)Tips for Diet and CFS
12)When Should Endoscopy Be Done in the Patient with Reflux?
13)War's Stress Takes A Toll on the Homefront
14)Insomniacs More Aggravated By Daily Stress
15)Prevention of Migraines
16)Expanding the Diagnosis and Treatment of Migraines
17)Do You Have Adult ADD?
18)What is SARS?
19)Playing a Video Game May Provide Chronic Pain
         Relief
20)Put More Laughter Into Your Life
**********************************************

LESSONS IN CRISIS
Out of every crisis comes the chance to be reborn.....
-- Nena O'Neill
It is not our smooth passages that reveal new understandings, but the
strenuous, uphill battles that benefit us with the knowledge we need to
grow. Looking on our challenges as gifts whose resolution promises
greater comfort makes them agreeable, perhaps even prized. Without
them we stagnate, and life's joys are few.
Life is a series of lessons. And our crises are our homework. The
patience and the trust we developed while living through last week's
crisis has prepared us for greater benefits from those that lie ahead.
Knowing that a crisis guarantees us the growth we deserve makes its
sting endurable.
Every crisis is followed by a time of easy stepping. These restful
periods let us adjust to our new stage of development, and they invite
us to store up our strength, our energy for the tests that lie ahead.
Every stage of an experience has its roots in the past and leans toward
the future. I'll trust that whatever I encounter today, I'm prepared for

and will benefit from.
From:
The Promise of a New Day by Karen Casey and Martha Vanceburg copyright
1983, 1991
**************************************************
THE ROAD TO RESILIENCE
How do people deal with difficult events that change their lives? The
death of a loved one, loss of a job, serious illness, terrorist attacks
and other traumatic events: these are all examples of very challenging
life experiences. Many people react to such circumstances with a flood
of strong emotions and a sense of uncertainty.
Yet people generally adapt well over time to life-changing situations
and stressful conditions. What enables them to do so? It involves
resilience, an ongoing process that requires time and effort and engages
people in taking a number of steps.
This brochure is intended to help readers with taking their own road to
resilience. The information within describes resilience and some factors
that affect how people deal with hardship. Much of the brochure focuses
on developing and using a personal strategy for enhancing resilience.
http://helping.apa.org/resilience/
AOL users: <a href=" http://helping.apa.org/resilience/"> Read it here
</a>
**********************************************

REDEFINING YOUR SELF IMAGE

Gregg Charles Fisher, a CFS patient, writes, "Often, a poor self-image
is at the root of the difficulties people experience when coping with
CFS. A poor self-image can be just as debilitating as any physical
symptoms and can exacerbate negative emotions. It is not difficult to
understand why CFS is powerful enough to damage even the healthiest
self-image. This illness may prevent you from being free and
independent. You are no longer able to base your sense of worth on your
accomplishments at work and at play. Now any achievements, even minor
ones, may seem few and far between.
At least for the present, you need to build a new sense of self. I knew
who the old me was, and I dream of who the healed me will be, but right
now I have to concentrate on defining the present me. I accomplish this
by doing what gives me a sense of fulfillment and purpose now, including
activities I barely considered undertaking when I was well, such as
doing a simple puzzle or growing plants. Your life may have changed, but
it is no less significant. You must constantly remind yourself that you
are important, and you may have to change ingrained attitudes about what
constitutes self-worth."
"One of the most important pieces of advice I can give any friend or
family member affected by CFS is to rely on the help of others. When our
CFS support group first began, I imagined its sole purpose would be to
help those of us with this illness cope with our affliction. I never
dreamed it would also serve as a place where family and friends could
find comfort and understanding.
Don't be afraid to include your loved one among the people you go to for
help. When my wife and I first became ill, I made the foolish mistake of
keeping most of my emotions locked away, deep inside. I felt guilty
burdening her with them; it seemed selfish to ask her to help me. I
hoped that if I ignored my feelings, the problems and resentments would
just go away. But suppressed emotions don't go away - they fester and
grow."
(Source: Chronic Fatigue Syndrome: A complete guide to symptoms,
treatments, and solving the practical problems of CFS. By Gregg Charles
Fisher, with contributions by Paul Cheney, M.D., Ph.D., Nelson Gantz,
M.D., David Klonoff, M.D., and James Oleske, M.D.)
SOURCE: www.ImmuneSupport.com

********************************************************
ESTROGEN HELPS FIGHT PAIN
By Colette Bouchez
HealthScoutNews Reporter

A woman's tolerance of pain may have more to do with the power of her
reproductive hormones than the strength of her muscles.
That's the theory a group of Michigan researchers presented Feb. 18 at
the annual meeting of the American Association for the Advancement of
Science in Denver.
"Our studies have shown that although pain is influenced by both
genetics and brain chemistry, it is clear that gender and hormones also
play a role in our individual response to pain," says Dr. Jon-Kar
Zubieta, lead researcher and a University of Michigan neuroscientist.
The key to pain response in women, Zubieta says, may be the hormone
estrogen.
"When estrogen levels are high, the brain's natural pain chemicals --
endorphins or enkephalins -- are much more potent. The response is much
greater than when estrogen levels are low," Zubieta says.
Pregnancy, he adds, is a good example of this brain chemistry in motion:
One of the reasons women can tolerate the pain of childbirth is that
just before they deliver, estrogen levels are soaring.
According to his new research, this hormone activity increases the
number of receptor sites in the brain where such natural pain-relieving
chemicals as endorphins can "dock."
The more "ports" available to receive the endorphins, the greater the
ability of the brain to control the pain response, and ultimately, the
less pain a woman feels, Zubieta says.
For pain management expert Allen Lebovits, the research makes good sense
and it may help open the door for better and more efficient use of
anesthesia, particularly in women.
"We don't routinely question women about where they are in their
menstrual cycle when we are prescribing pain medications or even
anesthesia. But if these studies prove right, then perhaps that should
be something that doctors should consider when prescribing certain
medications for women," says Lebovits, co-director of the pain
management program at New York University Medical Center.
Zubieta and his colleagues spent several years using positron-emission
topography (PET) scans to document brain changes linked to hormone
activity. Rather than rely on just the images of brain chemistry in
motion, they used the scans to document actual changes in the levels of
brain chemicals under varying conditions.
In their first study, published in the July 2001 issue of Science,
researchers injected the jaws of volunteers with a harmless solution
designed to initiate a painful muscle spasm. Using the PET scan they
documented how, within 20 minutes, the pain response activated
endorphins, the brain's natural pain-mediating chemicals. Not
surprisingly, Zubieta says, the rise in endorphin activity correlated
with a reduction in the volunteers' perception of pain.
In the latest study, they used the same techniques to document how a
woman responds to pain during high and low phases of estrogen
production.
In the first part of the study, jaw pain was induced during the early
follicular phase of the menstrual cycle -- a time when estrogen levels
are low. In the second part, the women were given an estrogen patch to
wear for one week, and the jaw pain experiment was repeated. In both
instances, researchers recorded the women's reactions to the pain, while
the PET documented brain activity.
The result: Under high estrogen conditions, the number of brain
receptors available to receive endorphins increased dramatically,
compared to the low estrogen conditions. During high estrogen times, the
women also showed what researchers called a "remarkable" ability to
release endorphins and activate the receptor sites.
The women reported less pain when estrogen levels were high, even though
the level of pain inflicted was the same as it was during their low
estrogen cycle, Zubieta says.
The data, now being confirmed in larger studies, hints at the powerful
effects of female hormones on the pain and stress response, he adds.
More information
To learn more about the effects of estrogen on brain chemistry, visit
Southern Illinois University Carbondale.
For more on how the brain controls pain, visit The National Institute of
Neurological Disorders and Stroke.
Copyright C 2003 ScoutNews, LLC. All rights reserved.
http://www.healthcentral.com/news/NewsFullText.cfm?id=511828
******************************************************

UNVEILING OF "THE MANY FACES OF PAIN" PHOTO EXHBIT


NASHVILLE, Tenn., April 14 /PRNewswire/ -- The "Many Faces of Pain"
photo exhibition, part of a national tour paying tribute to the 50
million Americans who live with persistent pain, will be unveiled on
April 22, 2003 following a consumer awareness program hosted by Corbin
Bernsen and William Leone M.D. The "Many Faces of Pain" program and
exhibit is sponsored by Partners Against Pain(R) in collaboration with
Dr. Leone and The Pain Management Group, to raise awareness of the
importance of appropriate pain management.

The "Many Faces of Pain" program will be held in the Nashville Marriott
at Vanderbilt University, Parthenon Ballroom, from 6:30-8:30 PM on April
22, with a reception following to view the exhibit. The photo exhibit
will be available for public viewing from 9:00 am - 4:00 PM daily at The
Pain Management Group, 5801 Crossings Blvd., Antioch, from April 23
through April 25 or online at www.partnersagainstpain.com.

The exhibit features black and white photographs of people who have
experienced persistent pain due to an illness or medical condition, but
through appropriate pain management are now able to live relatively
normal lives. Celebrities featured in the exhibit include Debbie Allen,
Corbin Bernsen, Lynda Carter, Bo Derek, Karen Duffy, Olympia Dukakis,
Mia Farrow, Earl "The Pearl" Monroe, Tony Randall, Christopher Reeve,
Doris Roberts, Joe Theisman, and the late Robert Urich.

"One step in alleviating pain and suffering is to educate healthcare
professionals about proper pain treatment and make patients aware that
they have the right to appropriate pain management," said William Leone,
M.D., "This can help give hope and spread the word that, in this day and
age, people do not have to live with pain."

When persistent pain is not properly treated, or left untreated, it can
lead to depression, loss of function and lost workdays. Persistent pain
is caused by a wide range of specific illnesses or medical conditions.
Many of these relate to skeletal problems, which include lower, middle
and upper back pain. Arthritis, headaches, and nerve problems also can
cause persistent pain. In addition, pain can result from sports or
work-related injuries, following surgery or as a result of a car
accident.

According to a national survey commissioned by Partners Against Pain(R),
34 percent of people with pain feel they can't function as a normal
human being, and 31 percent reported that they sometimes hurt so badly
they don't want to go on living. Yet, 80 percent of patients surveyed
thought that their pain was a normal part of their medical condition and
something with which they must live.

"Pain can be managed," said Dr. Leone. "Patients need to talk with their
physicians about the severity and frequency of their pain experience
because this helps healthcare professionals prescribe the most
appropriate and effective pain management regimen. Each sufferer has
different needs, but they can be helped."

Partners Against Pain(R) is an educational program sponsored by Purdue
Pharma.

http://www.prnewswire.com

*****************************************************************
METAL A COMMON CAUSE OF SKIN ALLERGY

You may love those new earrings, but they may not love you if you have a
metal allergy.
Metal is the most common trigger for allergic contact dermatitis, which
can cause an itchy rash and redness on your skin, according to
information presented March 24 at the annual meeting of the American
Academy of Dermatology in San Francisco.
Allergic contact dermatitis accounts for a significant number of visits
to dermatologists. Metal is a common cause of allergic contact
dermatitis because of the popularity of body piercing, which can result
in irritation and rashes on most any part of the body.
Symptoms of metal allergy usually occur within six to 24 hours after
exposure. Affected skin can become red, swollen and blistered. The skin
may eventually darken and become leathery and cracked.
The rash is usually limited to the area of contact with the metal. But
in severe cases, the rash can extend beyond the contact area, especially
if the allergen is on your fingers, which then touch your face, eyelids
or genitals.
Symptoms usually disappear when the offending piece of metal is removed.
The most common metal allergen is nickel, which is used in costume
jewelry, clothing ornamentation, zippers, buttons, snaps and virtually
all common metal objects. About 16 percent of all people are allergic to
nickel.
Cobalt and chromate are two other common metal allergens.
--Robert Preidt
Copyright C 2003 ScoutNews, LLC. All rights reserved.
******************************************************
CFS AND ALLERGIES
Sensitivities to chemicals and odors are considered to be in a separate
class from true allergies because they are not mediated by the same
immunologic mechanisms. There is considerable discussion as to what
actually causes chemical sensitivities, but most researchers agree that
they also involve immune system activation. Patients with chemical
sensitivities as their most debilitating symptoms are said to have
environmental allergy or chemical sensitivity syndrome. However, these
symptoms are frequently seen in CFIDS, usually in a mild form, and the
symptoms are elicited only by direct questioning. It is my feeling that
in patients with severe chemical sensitivities who also have the
symptoms of exhaustion, joint and muscle pain, headache, sore throat,
and abdominal discomfort, CFIDS probably is the cause of the chemical
sensitivities.
As many as 80% of CFS patients have a history of allergies, compared to
15% of the general population. When an allergic reaction occurs, the IgE
antibody binds to the allergen (the foreign substance that induces the
allergy), causing a release of histamine. Histamine is responsible for
many of the symptoms related to allergy, such as fatigue, headaches,
respiratory problems, and so on. Since such a high percentage of CFS
patients have allergies, it may be possible that their immune systems
are overreacting to the presence of general infectious agents in the
same way they overreact to the presence of allergens.
(Source: Chronic Fatigue Syndrome: A complete guide to symptoms,
treatments, and solving the practical problems of CFS. By Gregg Charles
Fisher, with contributions by Paul Cheney, M.D., Ph.D., Nelson Gantz,
M.D., David Klonoff, M.D., and James Oleske, M.D.)
SOURCE: www.ImmuneSupport.com
**************************************************
One person's scent, another person's poison
Multiple chemical sensitivity is a growing problem
Moira MacDonald
National Post

Saturday, March 29, 2003
For Kathy Dickinson, daily living is a series of calculated manoeuvres
through an invisible obstacle course.
The obstacle course is created by a barrage of chemicals found in
ordinary products, from air fresheners to rubber mats. For the
51-year-old former Ottawa civil servant, perfumes and fragrances are the
worst offenders. It means she cannot go to many indoor public gatherings
or the theatre where there is an abundance of perfume. She always
carries an anti-nausea medication, and while she feels lucky she can
still go to the grocery store, she starts to get sick if the floor has
been freshly washed.
Read the remainder of the article at:
http://www.nationalpost.com/specialreports/bodyandhealth/20030106/story.
html?id=77805B38-157C-4203-A5F7-7A14FE99666D
AOL users: <a href=
"http://www.nationalpost.com/specialreports/bodyandhealth/20030106/story
.html?id=77805B38-157C-4203-A5F7-7A14FE99666D"> Read it here </a>
**************************************************
Environmental Epidemiology and Risk Factors for Autoimmune Disease
from Current Opinion in Rheumatology
Posted 03/18/2003
M. A. Dooley, MD, MPH, S. L. Hogan, PhD, MPH
Abstract and Introduction
Abstract
It has long been recognized that environmental influences play an
important role in the risk of developing chronic rheumatic disease.
Defining specific pathogenic environmental mediators that may trigger
the development or progression of autoimmune disease remains a focus of
increasing investigative effort. Factors promoting disease may not be
identical to factors that influence the severity or progression of the
disorder. Human monozygotic twin studies, animal studies, and genetic
models demonstrate that genetic influences strongly determine whether
one will develop autoimmunity, however, genes affecting the metabolism
of exogenous agents that may trigger disease expression have only
recently drawn attention. In this article the authors review recent
reports that advance our understanding of previously recognized
environmental risk factors and challenge accepted beliefs that increased
estrogenic exposures predate the incidence of autoimmune disorders,
systemic lupus erythematosus in particular.

Read the article at:

http://www.medscape.com/viewarticle/449854?mpid=11371&WebLogicSession=Pp
owhOPLDwHn9iRSi0lKLXxIjH9NGaUkQUI2zTjkZKImYkQlZ4td|-2465443541808592662/
184161393/6/7001/7001/7002/7002/7001/-1

AOL USERS: <a href=
"http://www.medscape.com/viewarticle/449854?mpid=11371&WebLogicSession=P
powhOPLDwHn9iRSi0lKLXxIjH9NGaUkQUI2zTjkZKImYkQlZ4td|-2465443541808592662
/184161393/6/7001/7001/7002/7002/7001/-1"> read it here </a>
***************************************************************
Protein Intake and Kidney Function
BOSTON (Ivanhoe Newswire) -- High-protein diets have become very popular
in the United States. Recently the American Heart Association revised
their guidelines suggesting that a high-protein diet may have adverse
effects on the kidneys. A new study shows this is only true if the
person had kidney problems before starting the high-protein diet.
Research shows in a person with moderate to severe kidney insufficiency,
a low-protein diet can slow kidney function decline. However, the impact
of a high-protein diet has not been established. Researchers from
Brigham and Women's Hospital and Harvard Medical School conducted a
study to look at the association between protein in the diet and kidney
function in women.
The study used information from participants in the Nurses' Health
Study. More than 1,600 women in this study were 42 to 68 years old in
1989 and gave blood samples in 1989 and 2000. The women answered
food-frequency questionnaires to determine their protein intake.
Researchers report a high-protein diet was not associated with a loss of
kidney function in women with normal kidney function. However, the study
found a high protein diet could have adverse effects on women who
already had mild kidney insufficiency. Specifically, authors report
those women who had mild kidney problems accelerated the decline of
their kidneys if they had a high-protein diet, particularly a high
intake of nondairy animal protein. Authors of the study comment,
"Additional large prospective studies of adequate duration are needed to
further address this issue."
http://www.ivanhoe.com/newsalert/.
SOURCE: Annals of Internal Medicine, 2003;138:460-468
*******************************************************

TIPS FOR DIET AND CFS
According to Dr. David Klonoff, "A well-balanced diet is part of the
treatment for all chronic illnesses. Although Chronic Fatigue Syndrome
is not primarily a dietary disorder, like any debilitating illness, it
may lead to a disinterest in self-care and then to unhealthy dietary
practices. Any patient interested in a very healthy diet can meet with a
dietician or find books to read at the local library or bookstore.
There are several points about diet for CFS that I, as an
endocrinologist, feel strongly about. For one, many patients with CFS
also suffer from meal-induced hypoglycemia. They may feel weak, shaky,
and sweaty a few hours after a meal. The symptoms tend to be provoked by
large meals containing sweets and are relieved by eating. These
hypoglycemic patients should avoid sweets and eat frequent small meals
containing large amounts of starches and proteins.
Also, many patients develop hypoglycemic symptoms from drinking
caffeine. A study demonstrated that when a person drinks diet soda with
caffeine, compared to without caffeine, hypoglycemic symptoms will occur
at higher blood sugar levels. If the blood sugar levels in a patient is
frequently on the borderline of being too low, then caffeine intake will
render that person hypoglycemic. Thus, if you are prone to hypoglycemic
symptoms, avoid caffeine."
(Source: Chronic Fatigue Syndrome: A complete guide to symptoms,
treatments, and solving the practical problems of CFS. By Gregg Charles
Fisher, with contributions by Paul Cheney, M.D., Ph.D., Nelson Gantz,
M.D., David Klonoff, M.D., and James Oleske, M.D.)
SOURCE: www.ImmuneSupport.com
*********************************************

When Should Endoscopy Be Done in the Patient With Reflux?


Historically, subspecialists have often depended on objective diagnostic
tests in the initial management of disease processes (ie,
gastroenterologists would use a test such as endoscopy to diagnose
gastroesophageal reflux disease [GERD]), whereas primary care physicians
(PCPs) have often relied on clinical findings or the results of trials
of empirical therapy to make a disease diagnosis. This disparity in
initial clinical approach in GERD management between specialist
gastroenterologists and PCPs is now especially questionable, given that
community-based studies have shown that 40% to 60% of patients with
reflux symptoms have no objective endoscopic findings of GERD.[1] Thus,
endoscopy only has a sensitivity of approximately 50% for diagnosing
GERD. It is my opinion that this relatively modest (at best) sensitivity
for endoscopy as a diagnostic test for GERD is underappreciated by many
PCPs referring patients with suspected GERD for this procedure as a
diagnostic tool. Furthermore, the charges for upper gastrointestinal
tract endoscopy and the additional hidden costs (lost productivity,
wages, etc., for the patient on the day of the procedure), result in a
substantial societal and healthcare system burden financially when
endoscopy is used in this setting as a routine diagnostic test. Thus,
referring every patient with reflux symptoms for endoscopy is not
justifiable, given the substantial cost coupled with the poor
sensitivity.

The article continues at:
http://www.medscape.com/viewarticle/450231?mpid=11033
AOL users <a href=
"http://www.medscape.com/viewarticle/450231?mpid=11033"> Read it here
</a>
***********************************************
War's Stress Takes a Toll on the Homefront
By Amanda Gardner
HealthScoutNews Reporter

The war has come home, if not physically, then certainly in stress and
anxiety levels.
Not only is the media showing a constant barrage of images from Iraq but
many cities now have a stepped-up police and military presence,
pharmacies are advertising potassium iodide to counter radioactivity and
the Department of Homeland Security is matter-of-factly telling you how
to protect your family and your home from chemical attacks.
This new life has a price.
"These threats and danger signals are being pumped through the media at
this rapid pace, and it serves to really drive people's fear and anxiety
levels way up," says Stephen Maren, an associate professor of psychology
and neuroscience at the University of Michigan in Ann Arbor.
"Our natural response to threat is to mobilize the fear response, which
has all sorts of physiological consequences," he adds.
"People are more psychologically vulnerable," adds Alan Hilfer, director
of psychological training at Maimonides Medical Center in New York City.
"People are more vigilant. They're startling easier. Anxiety is higher
and our threshold is lower."
Part of it is the feeling of sheer helplessness in the face of events
that are so far away but which nevertheless hit home hard.
"When you feel like you don't have any control over the situation, that
predisposes anyone to higher levels of anxiety," Maren says.
Those feelings are then worsened by the images and reports of the fierce
fighting and increased death tolls of recent days.
"When things don't live up to expectations, it results in negative
psychological states. And in some sense that's what we're facing now,"
Maren says. "The U.S. military spokespeople were clearly hyping a very
confident stance and now, although they are saying everything meets with
expectations, nonetheless it does feel like we've come up short of
expectations. And that just generally upsets people."
Those who lived through the terrorist attacks in New York City or
Washington, D.C. and those who served during the 1991 Gulf War may be
particularly vulnerable, experts say.
"It's important to have memories of bad things to protect us from future
occurrences, but sometimes it almost gets overly active so that you end
up with post-traumatic stress disorder or shell shock," Maren says. "If
you elaborate these fear memories and it works too well, you can hear a
car backfire and have a flashback." Even the televised images from Iraq
could trigger a flashback, Maren adds.
For the "average" person, the stress could manifest itself in headaches,
backaches, upset stomach, anxiety, colds, difficulty focusing or
concentrating, changes in appetite, increased irritability and fatigue.
"It's all predicated on how one interprets or perceives or thinks about
what's put before them," says Joshua Klapow, an associate professor of
psychology and healthcare organization and policy at the University of
Alabama at Birmingham. "We're going to have varying levels of stress and
anxiety, which means people are going to have to do different things to
cope successfully."
Even though everyone has their own way of coping, there are some basic
guidelines that won't hurt -- and could even help -- in these stressful
times:
Pay attention to your physical well-being, Klapow advises. That means
getting enough sleep, eating properly and doing what you can to boost
your immunity. Exercise and relaxation techniques such as meditation,
prayer, yoga or diaphragmatic breathing can be particularly helpful.
Stick to your usual routine as much as possible. "To combat distress, we
have to try to keep the environment as normal as it has been, because it
decreases cues to the brain of the stressful situation," Klapow says.
Keep busy and distract yourself. "Make yourself preoccupied and occupied
all the time, but not with war news," Hilfer advises. "If you think
about this all of the time and you're particularly vulnerable, you'll
make a mess out of yourself."

Seek out family and friends, bearing in mind that different people will
have different preferences for "war talk."
Limit -- but don't eliminate -- information from the war. "People don't
need to be informed every minute of the day," Hilfer cautions. "They
need to be able to take breaks, dose out other news a little more
judiciously in their lives. Listen every now and then but don't be
addicted to it."
Realize that even if you "successfully" cope, you may not feel good.
"This stressful time is not necessarily going to feel good even if you
do all the things you can do to manage stress," Klapow says. "It's not
going to make it go away. It's going to increase your chances of
building resilience and living through this."
If you're doing everything you can to manage your stress levels and yet
are continuing to feel extremely anxious and are not able to function
normally, consider seeking professional help.
More information
The American Psychological Association has more on building resilience
in a time of war and on finding a psychologist.
Copyright C 2003 ScoutNews, LLC. All rights reserved.
*******************************************************
Insomniacs More Aggravated by Daily Stress
By Alison McCook
NEW YORK (Reuters Health) - People with insomnia appear to be more
aggravated by the minor stresses that pop up in daily life and rate
their lives as more stressful than those who get good zzz's, new
research from Canada suggests.
A bad night's sleep may cause a bad daytime temper and vice versa, but
the relationship between insomnia and response to stress is likely a
"vicious cycle," study author Dr. Charles M. Morin of the Universite
Laval in Quebec told Reuters Health.
People who have trouble dealing with stress may have trouble sleeping at
night, which can then lead to poor attention, trouble concentrating and
bad mood during the next day, he said.

"So all of that is going to make you perceive your world as worse than
it really is," Morin noted. This may aggravate the response to the next
day's trials and tribulations, such as traffic jams or missing a train.
"Yes, stress can cause insomnia, but insomnia can also aggravate the
daytime stress," the researcher explained.

People with insomnia are often treated with sleeping pills, but this
one-sided technique could, in some cases, miss the point, Morin said.
The Canadian researcher said he recommends that doctors treating
patients with insomnia also look at how each patient responds to stress,
and provide them with strategies to better cope with the anxieties that
come from day-to-day living and occasional insomnia.
For instance, lying in bed worrying about how bad it's going to feel the
next day if you don't fall asleep is just going to make nodding off even
harder, Morin noted. Consequently, as part of treatment for insomnia,
Morin said he tries to "'de-catastrophize' the impact of insomnia."
"Yes, it's going to affect your daytime functioning, but at the same
time, it's not going to kill you the next day," he said.
To obtain their findings, Morin and his colleagues followed 67 people
for 21 days, asking them to record stressful daily events, how they
responded to them and how well they slept.
Forty study participants had insomnia, defined as taking more than 30
minutes to fall asleep on at least three nights each week for at least
six months and experiencing daytime symptoms associated with lack of
sleep.
The other 27 study participants were considered good sleepers, meaning
they were satisfied with their sleep and had no complaints that
resembled insomnia, according to the report in the journal Psychosomatic
Medicine.
Although good and bad sleepers reported the same number of stressful
events during the day, people with insomnia appeared more aggrieved by
their occasional tribulations, and rated their lives as more stressful
than good sleepers.

Insomniacs also tended to rely more often on emotion-oriented coping
strategies, in which they focus on emotions -- often negative ones --
rather than on strategies for solving their sleep-time and daytime
problems. Researchers have shown that emotion-oriented strategies are
less successful in sorting out problems than other strategies.

Furthermore, people with sleeping problems also said their mind can
become hyperactive, or that they have trouble quieting thoughts from the
previous day. This tendency, along with their coping strategies, may
affect the relationship between daytime stress and sleeping, Morin said.


SOURCE: Psychosomatic Medicine 2003;65:259-267.

****************************************************
Headache
Randolph W. Evans, MD

Prevention of Migraines
A number of factors may justify daily preventive medication for patients
with migraines [see Table 1]. Indications for preventive treatment are
as follows: the headaches significantly interfere with the patient's
daily routine, despite acute treatment; acute medications are
contraindicated, ineffective, or overused or have intolerable side
effects; frequent migraines (two or more attacks a week); uncommon
migraine types (hemiplegic, basilar, prolonged aura, or migrainous
infarction); the cost of acute medications is significantly greater than
the cost of preventive medication; and patient preference (i.e., the
patient is willing to risk the possibility of side effects from the
preventive medication to reduce the frequency of headaches).
Several general principles apply to the use of preventive medications:
The clinician should start with a low dose of medication and increase it
slowly, depending on the response and whether side effects occur.
Each medication should be given a trial of 2 to 3 months at an adequate
dose.
Overused medications that may be causing rebound headache and that may
decrease the efficacy of preventive treatment should be discontinued or
tapered (depending on the drug).
The patient should keep a headache diary to monitor his or her
headaches.
The clinician should educate the patient about the rationale for
treatment and possible side effects and should address the patient's
expectations for treatment.
The article continues at:
http://www.medscape.com/viewarticle/451414_print
AOL users <ahref="http://www.medscape.com/viewarticle/451414_print">
Read it here </a>

***************************************************

Expanding the Diagnosis and Treatment of Migraine
Review the impact of demonstrations through studies such as Landmark and
SUMMIT, about the diagnosis and treatment of migraine. Evolving
information creates the option for new treatment strategies and goals.

Contents of This Article
Sinus or Migraine? Sinus Headache as Migraine
by Curtis Schreiber, MD
Trying to Define the Migraine Headache
From the Pilot Study to the SUMMIT Study: How Many Sinus Headaches are
Migraines
Sinus Features in the Sinus Presentation of Migraines
SUMMIT Study Findings and Conclusions
Evaluating the Efficacy of Sumatriptan
Sumatriptan Efficacy Study Findings
Conclusions

Headache Diagnosis in Primary Care: Results of the Landmark Study
by Larry Newman, MD
Introduction to the Landmark Study
Making the Diagnoses in the Landmark Study
What Factors Influence Diagnosis of Migraine?
What Factors Influence Diagnosis of Migraine? From the Patient's
Perspective
Conclusions From the Landmark Study

Acute Treatment Goals in Migraine
by Stephen Landy, MD
Migraine Treatment: Goals, Considerations, and Strategies
A Look at Initiation of Migraine Treatment
Treatment Issues to Consider
Additional Treatment Issues to Consider

Read about it here:
http://www.medscape.com/viewprogram/2275_pnt
AOL users: <a href="http://www.medscape.com/viewprogram/2275_pnt"> Read
it here </a>

*******************************************************
Do You Have Adult ADD?
Maybe your brain seems like it's here one minute and gone the next.
Maybe you can't follow directions that include more than one or two
steps. Maybe you lose track of time, or maybe you chronically
procrastinate. Maybe you think you're depressed and try to make yourself
feel better with alcohol. Or maybe you need many cups of coffee to stay
on track all day.

Maybe you're an impulsive overspender. Maybe you liven up everyone you
meet, but deep down inside you feel lonely and sad. Maybe you have lots
of creative ideas, but you just don't know how to organize them and put
them into action.

Well, just maybe you have attention deficit disorder (ADD). Many people
have ADD without knowing it because most people still think it's a
condition found only in children, particularly boys. So whenever they
find themselves wandering from one task to another, they never think it
might be ADD.
http://www.prevention.com/cda/feature2002/0,4780,5085,00.html
AOL users: <a href=
"http://www.prevention.com/cda/feature2002/0,4780,5085,00.html"> read it
here <a/>

************************************************************
What is SARS?


Severe acute respiratory syndrome, or SARS, is spreading around the
globe. Much of Asia is already in a state of panic, and dozens of cases
have been reported in the U.S. and Canada. Learn about this mysterious
condition. Click here:
http://www.howstuffworks.com/sars.htm
AOL Users: <a href= "http://www.howstuffworks.com/sars.htm"> Read it
here </a>

Editor's note: I read several articles on the topic and decided on this
one. If you are not familiar with this site
already, you are in for a treat! Do you have children in your life who
are always asking questions about things
and you don't have a clue as to the answer? This is the place to go! Or
if you just have an inquistive
mind this is the web site for you!
***********************************************************

Playing a Video Game May Provide Chronic Pain Relief
By Jennifer Warner
WebMD Medical News
March 14, 2003 -- Fighting off invaders or playing extreme sports may
seem like an unlikely strategy to ward off pain, but a new study
suggests that playing active video games may be effective for chronic
pain relief. Researchers say that playing an engaging video game may
actually distract someone's attention away from a painful activity and
help people with chronic pain conditions, especially children. It's not
the first time visual distractions have been shown to increase pain
tolerance, but this study compared the effectiveness of different types
of video games on perceived pain and also took peoples' game-playing
personalities into account.
Researcher Bryan Raudenbush, assistant professor of psychology at
Wheeling Jesuit University in Wheeling, W. Va., and colleagues measured
pain threshold, tolerance, and ratings of 30 adults who participated in
either a mental video game, active video game, or nothing at all 10
minutes before a pain test. The participants also completed
questionnaires about their competitiveness, aggressiveness, and video
game playing habits.
The study found that regardless of the person's personality or gaming
experience, playing an active video game reduced their pain rating and
increased pain tolerance compared with the other conditions.
The findings are scheduled to be presented later this year at the
Conference of the North American Society for the Psychology of Sport and
Physical Activity, in Savannah, Ga. Researchers say the study suggests
that active video game play may be an effective addition to chronic pain
relief techniques for many patients, "regardless of aggressive or
competitive tendencies, or prior video game playing habits."

*********************************************************
PUT MORE LAUGHTER INTO YOUR LIFE
Children laugh 146 times a day, adults laugh only 4 times a day.... no
wonder we're so unhappy...

Sometimes when you have a stressful day or week, you need some silliness
to break up the day. Here is your dose... Follow the instructions to
find your new name.

The following in an excerpt from a children's book, "Captain Underpants
and the Perilous Plot of Professor Poopypants" by Dave Pilkey.

The evil Professor forces everyone to assume new names... Use the third
letter of your first name to determine your New first name:

a = poopsie
b = lumpy
c = buttercup
d = gidget
e = crusty
f = greasy
g = fluffy
h = cheeseball
i = chim-chim
j = stinky
k = flunky
l = boobie
m = pinky
n = zippy
o = goober
p=doofus
q = slimy
r = loopy
s = snotty
t = tulefel
u = dorkey
v = squeezit
w = oprah
x = skipper
y = dinky
z = zsa-zsa

Use the second letter of your last name to determine the first half of
your new last name:

a = apple
b = toilet
c = giggle
d = burger
e = girdle
f = barf
g = lizard
h = waffle
i = cootie
j = monkey
k = potty
l = liver
m = banana
n = rhino
o = bubble
p = hamster
q = toad
r = gizzard
s = pizza
t = gerbil
u = chicken
v = pickle
w = chuckle
x = tofu
y = gorilla
z = stinker

Use the fourth letter of your last name to determine the second half of
your new last name:

a = head
b = mouth
c = face
d = nose
e = tush
f = breath
g = pants
h = shorts
i = lips
j = honker
k = butt
l = brain
m = tushie
n = chunks
o = hiney
p = biscuits
q = toes
r = buns
s = fanny
t = sniffer
u = sprinkles
v = kisser
w = squirt
x = humperdinck
y = brains
z = juice


And remember that children laugh an average of 146 times a day; adults
laugh an average of 4 times a day. Put more laughter in your life!!!

I am going to go play my favorite video game now. Until next time keep
laughing.

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