October 1, 2003

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October 1, 2003
2117 subscribers and 9 new subscribers. Welcome aboard new
Editor: Mary McKennell
Editor’s Corner:
Being sick is hard work isn’t it? Recently, a friend was reminiscing
with me about a trip we took together. She said that being together for
those few days helped give her a better understanding of my health
situation and the fine line I walk physically and emotionally every day.
Does that sentence resonate with you? She went on to say that her prayer
for me was to consistently find that ever-elusive balance in it all. I
thought she summed it up very well. I often feel like I am walking on a
balance beam to keep things on an even keel and it takes a lot of
Finding that ever-elusive balance of living with a chronic illness
requires a lot of work. We need to gather enough information about our
illness so that we know how to manage our symptoms as best we can and
develop some quality of life. There are still the dimensions of
balancing work and play, rest and activity, being with people and being
alone. Oh, and then there is that other factor of balancing our grief
and joy. You know, those emotions that keep popping up and demanding
attention. There is a fine line that we walk that requires acknowledging
and accepting our limitations, which requires some grieving. But there
are gifts that we can take joy in that help to balance that grieving.
Both aspects of our emotions are equally important to acknowledge.
We are an amazing group of people! Pain and fatigue are our familiar
companions in everyday life and drain our energy. Yet we find the energy
to do all of this balance beam work. Part of our energy gets used for
routine tasks like getting out of bed, dressing ourselves, cooking
meals. Some days those tasks alone are pretty amazing aren’t they? For
those, like myself who are still in the full-time work force, there is
the added dimension of doing the balancing act in the work place and
keeping on an even keel. Recently a friend from work stopped by the
house on a day when I was not doing well. I was attempting to be
hospitable and was pulling out makings for sandwiches. That simple task
wore me out and I had to sit down and rest. She had not seen this side
of me before as I have good shields that I use while working. She
remarked that she hadn’t realized before how difficult my daily life is.
It’s certainly helpful when people have their own little epiphanies of
our lifestyle isn’t it? Now, if I could just get her to stop thumping me
on the back when she greets me…
Stop and reflect on what a courageous person you are. Living with an
illness that is not life-threatening but irrevocably changes your life
takes a great deal of courage. The next time someone even alludes to you
being lazy reflect on what a hard worker you are!
It is our hope that we can ease the task of information gathering
through this newsletter and the other information on our FMS Community
web site.
September came and went without a newsletter because I was occupied with
my balancing act.

Disclaimer: This newsletter ends with an article that is based on
Christian beliefs. I realize that may not fit everyone who reads this
newsletter. This short article had something important to say about our
caregivers and our families who are also impacted by our illness. If you
are not of the Christian persuasion then just stop reading at that
Illnesses that can’t be cured have to be managed. This week we launch a
series of three articles focusing on one aspect of illness management:
treatment of symptoms. The first article discusses strategies for
managing fatigue. Other articles will treat pain and poor sleep. You can
read them at the CFIDS/Fibromyalgia Self-Help program website:
Other series include: "Success Stories" (personal accounts of successful
coping and recovery), "Ten Keys to Successful Coping" and "What Works
for Managing CFIDS and Fibromyalgia."

Bruce Campbell, Ph.D., Director
Let's face it, a backup plan makes sense, chronic illness or not. Anyone
who leads a military campaign, rolls out new products or organizes
family vacations knows this. But, chronic illness makes the unexpected
even more likely. You have to be prepared with alternatives and be
comfortable with change on a moment's notice.
This article by Rosalind Joffe continues at:
October is National Rehabilitation Month. Here are some employment
facts about people with disabilities in the United States:
- People with disabilities are among our friends, family members,
co-workers and respected leaders.
- Among adults with disabilities of working age (18-64), three out
of ten (32%) work full or part-time, compared to eight out of ten
(81%) of those without disabilities, a gap of 49 percentage points.
(National Organization on Disabilities (N.O.D./Harris, 2000).
- The likelihood of experiencing a disability increases with age,
with disability rates among those age 55-64 at 27.8%. In 2001, the
first of the 76 million Baby Boomers will reach age 55.
- The more severe the disabilities, the less likely a person is to
be employed. People with slight disabilities are eight times more
likely to be employed than people with very severe disabilities (64%
versus 8% respectively [N.O.D./Harris, 2000]).
- Over the past 14 years, the percentage of people who say they are
unable to work has risen steadily from 29% to 43%.
ESSAY CONTEST TOPIC: A surprise positive from living with CFS/ME or FM.
Essay must be 300 words or less.
One entry per person.
Entry Deadline is October 31, 2003.
Essay Contest Winner will have their original essay printed in our 'CF
Alliance 2003 Winter Newsletter' and receive the book, 'Treating and
Beating Fibromyalgia and Chronic Fatigue Syndrome' by
Dr. Rodger Murphree.
*Please mail or email your essay entry along with your name, email
address and regular mailing address to:
CF Alliance
PO Box 9204
Bardonia, NY 10954
Note: All email contest entries must be placed into an email, no
attachments accepted.
Contest participants retain all copyrights to their original work.
Contest judges' decision is final.
Please contact us with questions.
Visit us at:
New Textbook Teaches Pain Management

September 8, 2003 05:07 PM EDT
WASHINGTON - An estimated 50 million Americans suffer from persistent
pain, yet most medical students have no courses focused on treating
pain, according to the American Academy of Pain Medicine.
"Untreated pain, tragically, is an epidemic in the United States," Dr.
Louis Sullivan, former Health and Human Services secretary, said Monday
as he announced an initiative to promote education on pain management at
the country's medical schools.
The American Academy of Pain Medicine has developed a Web-based textbook
that will be available to medical students without charge beginning
September 2004. It covers the neurobiology of pain, patient evaluation
and common types of pain, such as cancer and pediatric pain, and
includes self-tests.
The project is financed by a grant from the Purdue Pharma Fund, a branch
of the drug company that makes the painkiller OxyContin.
Dr. Daniel Carr, director of the project and a professor of pain
research at Boston's New England Medical Center, said the textbook
focuses on medical and behavioral treatments for pain, because they are
backed by more research than alternative therapies such as acupuncture.
Only 3 percent of medical schools require students to take a course on
pain management, according to a survey of 125 schools by the Association
of American Medical Colleges in 2000 and 2001.
Developed with the participation of the Association of American Medical
Colleges, the new textbook will be tested in he coming months at the
Morehouse School of Medicine, in Atlanta; the University of Connecticut
School of Medicine, in Farmington, Conn.; and the Texas College of
Osteopathic Medicine, in Fort Worth, Texas.
While millions of Americans suffer from pain in silence, the abuse of
prescription drugs is well documented. Nearly 3 million young people,
age 12 to 17, said they had used prescription drugs for nonmedical
reasons at least once, according to a January 2003 government report.
OxyContin, a brand name for the drug oxycodone, is among the most-abused
prescription medications.
Nevertheless, project director Carr said, "The burden of undertreated
pain dwarfs overtreated pain" in the overall society.
On the Net:
American Academy of Pain Medicine:
Most people with chronic fatigue are in a posture, whether sitting or
standing, that tends to reinforce fatigue. The manner in which the body
is held usually reflects energy levels. When the body is slouched,
shoulders slumped, and head down, diaphragmatic breathing is more
difficult. Poor posture promotes shallow breathing and low energy
levels. Notice while standing or sitting that when you breathe with the
diaphragm, it changes your posture to expand the chest cavity. As a
result of good diaphragmatic breathing, the spine becomes more erect,
the shoulders are pushed back, and the head is pulled up. Energetic
posture and good diaphragmatic breathing usually go hand-in-hand.
(Source: "Chronic Fatigue Syndrome: How You Can Benefit from Diet,
Vitamins, Minerals, Herbs, Exercise and Other Natural Methods" by
Michael T. Murray, N.D.)
Healthy Siblings of Kids with Chronic Illness Need a Place They Can Be

It's hard to be the healthy sibling of a kid with chronic illness. So
often the healthy sibling is overlooked and afraid. They may feel that
they've lost their place in the family, as everyone rallies around the
child that is sick. They may feel guilty for being healthy or jealous of
their sick sibling. It may seem that no one is interested in how they
are doing and that they have no one to talk to. We're working to change
There is a private, online community where healthy siblings of kids with
chronic fatigue syndrome, Fibromyalgia and Orthostatic Intolerance can
talk openly about their experiences. This is the Siblings' Club section
of The Pediatric Network forum.
We need your help to get the Siblings' Club off to a good start. We are
looking for healthy siblings that will commit to posting at least a few
times per month. We also need help spreading the word about this
project. It will take a special effort to connect with healthy siblings
of kids with chronic illness, because most are not connected with
support groups and other organizations. We would appreciate it if you
would personally tell the families you know about this resource and
would include it in your support group and newsletter discussions.
You can access The Pediatric Network online community by going to our
home page at and following the links to the
forum. To protect the privacy of our members we require that you obtain
a free EzBoard account and apply for forum membership before reading
posts. If you have technical questions about accessing the forum you may
write to Rebecca Moore at
We want healthy siblings to know that they are not alone. With your
help, we'll spread the word about this project and will recruit a core
group of siblings to post in and lead this section. We'll create a warm
place where siblings can be themselves.
For more information contact Mary Robinson or Rebecca Moore at or visit their website at
Check out the Pediatric Network for Chronic Fatigue Syndrome,
Fibromyalgia, and Orthostatic Intolerance. You'll find an active forum
and extensive library at

I am conducting a research study as a requirement for the doctoral
degree in nursing. The main goal of this dissertation is the development
of a valid and reliable measure of a patient's level of empowerment
while living with a chronic health condition. The questionnaire is
posted through the Internet firm called ‘Form Site’
( which ensures saving the collected data in
secured files on their server until retrieved by the researcher.
The questionnaire is composed of 60 items intended to measure patient
empowerment. Personal information will be kept confidential and
participants will not be identified, by coding the questionnaires and
then destroying them upon completion of the study. There is no apparent
harm associated with completing the questionnaire. Participants have the
right to quit the study at any time when they feel uncomfortable or
unable to continue.
Your assistance is instrumental for recruitment of participants,
completion of the study, and dissemination of knowledge regarding
empowerment of patients living with chronic health conditions. You will
create a link from your website to the questionnaire to be completed by
interested participants.
I appreciate your assistance and looking forward to hearing from you.
Don’t hesitate to contact the principal investigator if you have any
modifications, suggestions, or ideas concerning the instrument or the
human subject protection.
Should you have any questions or concerns regarding this study, please
contact the principal investigator of this project Dr. Carolyn D’Avanzo
who can be reached at phone # (860) 486-0540 or via E.mail Address:
If you have any questions concerning the rights of patients as research
participants, you may contact the University of Connecticut
Institutional Review Board (IRB) at (860) 486-8802. An IRB is a group of
people that reviews research studies and protects the rights of people
involved in research.
The link to the questionnaire is:
Project Director
Ismat Mikky, BSN, MSN, PhDc, RN
Doctoral nursing student
University of Connecticut School of Nursing

Boost Your Brain Power with Creatine?

08-18-2003 Royal Society Proc B News release

Research undertaken by scientists at the University of Sydney and
Macquarie University in Australia has shown that taking creatine, a
compound found in muscle tissue, as a dietary supplement can give a
significant boost to both working memory and general intelligence.

The work, to be published in a forthcoming Proceedings B, a learned
journal published by the Royal Society, monitored the effect of creatine
supplementation on 45 young adult vegetarian subjects in a double-blind,
placebo-controlled experiment.

"The level of creatine supplementation chosen was 5g per day as this is
a level that has previously been shown to increase brain creatine
levels. This level is comparable to that taken to boost sports fitness,"
explains Dr. Caroline Rae who led the research. "Vegetarians or vegans
were chosen for the study as carnivores and omnivores obtain a variable
level of creatine depending on the amount and type of meat they eat -
although to reach the level of supplementation in this experiment would
involve eating around 2 kg of meat a day!"

Creatine power

Athletes and fitness fanatics have known that creatine supplementation
can increase sports performance and the compound - a close relative of
the amino acids - has also been trialed successfully in the treatment of
neurological, neuromuscular and atherosclerotic disease. "We know that
creatine plays a pivotal role in maintaining energy levels in the
brain," says Dr. Rae. "So it was a reasonable hypothesis that
supplementing a diet with creatine could assist brain function."

The experiment tested this hypothesis by giving the one group of
subjects a creatine supplement and a second group a placebo for six
weeks, followed by a six week period with no intake and a final six week
period when the control and placebo group were swapped. Intelligence and
memory were tested at four points: the start of the trial; the end of
the first six week period; and the start and endpoint of the final six
week period.

Testing tasks

The effect on working memory was tested using a backward digit span test
in which the subject has to repeat in reverse order progressively longer
verbal random number sequences. Intelligence was tested using Ravens
Advanced Progressive Matrices - a methodology commonly used for IQ
assessment involving completion of pattern sequences. The test is a well
validated measure of general ability with minimal dependence on cultural
factors. "Both of these tests require fast brain power and the Raven's
task was conducted under time pressure," says Dr. Rae. "The results were
clear with both our experimental groups and in both test scenarios:
creatine supplementation gave a significant measurable boost to brain

For example in the digit span test subjects ability to remember long
numbers, like telephone numbers, improved from a number length of about
7 to an average of 8.5 digits."

The study shows that increased creatine intake results in improved brain
function, similar to effects shown previously in muscle and heart. The
results agree with previous observations showing that brain creatine
levels correlate with improved recognition memory and reduce mental
fatigue. "These findings underline a dynamic and significant role of
brain energy capacity in influencing brain performance," says Dr. Rae.
"Increasing the energy available for computation increases the power of
the brain and this is reflected directly in improved general ability."

A short term boost?

Long term supplementation with creatine has yet to be declared truly
safe as there have been reported effects on glucose homeostasis (the
regulation of blood sugar levels) and potential subjects with a medical
history of diabetes were excluded from the experiment.

In addition taking the supplement can have some antisocial effects. "To
be frank taking the supplement can make you a considerably less
'fragrant' person," says Dr. Rae. "However creatine supplementation may
be of use to those requiring boosted mental performance in the short
term - for example university students."

Editorial Notes:

The paper: Oral creatine monohydrate supplementation improves brain
performance: a double-blind, placebo controlled, cross-over trial by
Caroline Rae, Alison Digney, Sally McEwan and Timothy Bates will be
published on FirstCite on Wednesday 13 August 2003 and then as part of
Proceedings of the Royal Society: Biological Sciences – Vol. 270, No.
1529 on 22 October 2003.

Source: The Royal Society Proceedings B. Proceedings B is published by
the Royal Society and publishes peer-reviewed research in all aspects of
biology. Papers featured in this publication do not reflect the
Society's views or policies.

The Royal Society is an independent academy promoting the natural and
applied sciences. Founded in 1660, the Society has three roles, as the
UK academy of science, as a learned Society and as a funding agency. It
responds to individual demand with selection by merit not by field.

Multiple Sclerosis: A Case for Early Treatment
Christina Caon, BSc, MSN, RN, Omar Khan, MD
Medscape Neurology & Neurosurgery 5(2), 2003. © 2003 Medscape
Posted 08/13/2003
Multiple sclerosis (MS) has emerged as a treatable disorder, with
several disease-modifying therapies (DMTs) now licensed in the United
States for MS treatment. Although all 5 DMTs (glatiramer acetate, 3
interferons, and mitoxantrone) were tested in phase 3 randomized,
controlled trials and shown to be superior to placebo, no therapy has
ever been shown to halt disease progression.[1-5] Because MS is a
chronic, unpredictable disease that is clinically variable from patient
to patient, treatment choices for patients with MS can pose a dilemma
despite the plethora of information. Nonetheless, the use of DMTs in
definite relapsing-remitting multiple sclerosis (RRMS) is well
More recently, clinicians and scientists have focused on the early
treatment of MS, presenting a new challenge in MS therapeutics. Several
lines of evidence suggest that early treatment should be considered.
Despite positive outcomes in treatment trials of clinically isolated
syndromes (CIS) in patients considered at high risk of developing
definite MS, many debate whether early treatment of patients with CIS
affects long-term disability. The lack of data demonstrating an effect
of DMT on long-term disability in CIS patients combined with the
economic consequences of these medications argue in favor of a
conservative approach in this population. This argument is further
strengthened by the fact that despite the well-established efficacy of
interferon beta (IFN-beta) and glatiramer acetate in RRMS, it is also
well recognized that all existing DMTs are only partially effective.
Overall, a growing body of evidence suggests that treatment with a DMT
in patients presenting with CIS is beneficial and may delay the
development of clinically definite MS. We will examine data supporting
early treatment of MS and also take into account the revised diagnostic
criteria for MS[6] which may enable clinicians to make the diagnosis and
initiate treatment early.
This article continues at
Eli Lilly and Company: New Research Shows Cymbalta Reduces Anxiety
Symptoms Associated with Depression

Significant Improvement Seen as Early as Week 1; Risk of Treatment

Emergent Anxiety No Greater Than With Placebo

The investigational drug Cymbalta(TM) (duloxetine HCl) demonstrated
rapid relief of anxiety symptoms associated with depression that was
sustained for the length of the study period, according to new data
published in the journal Depression and Anxiety. In clinical studies,
researchers attribute the medication's effect on a broad spectrum of
depression symptoms, which include emotional and painful physical
symptoms as well as anxiety, to its dual reuptake inhibition of both
serotonin and norepinephrine.

"As anxiety is a key symptom of depression, treating this symptom plays
a significant role in the overall treatment of depression and in a
patient's ability to ultimately achieve complete recovery," said David
Dunner, M.D., executive director, University of Washington Center for
Anxiety and Depression. "With these patients also at an increased risk
for recurrence and suicide, early and effective intervention is critical
to the overall health and safety of the patient."

Highlights of this retrospective analysis of four clinical studies
-- Cymbalta, in doses of 60 mg and higher, administered once
daily, reduced the anxiety symptoms associated with depression
when compared to placebo.

-- Depressed patients treated with Cymbalta 60 mg daily showed
significant improvements in mean anxiety scores when compared
to placebo treated patients.

-- Significant differences were detected as early as week 1 and
were sustained throughout the 9 weeks of acute treatment.

-- Cymbalta significantly reduced mean anxiety scores
statistically more than did the active comparators (fluoxetine
20 mg or paroxetine 20 mg).

-- Cymbalta-treated patients did not experience treatment
emergent anxiety any more often than those taking placebo.


Data were drawn from four multi-site, randomized, double-blind,
placebo-controlled studies of patients who met criteria for major
depressive disorder (MDD). Results were analyzed using the HAMD17 and
Hamilton Anxiety Rating Scale (HAMA).

Patients were randomized into four studies. Studies 3 and 4 included
Cymbalta at 60 mg/d (N=249) and placebo (N=253). Study 1 included
Cymbalta 120 mg/d (N=68), fluoxetine 20 mg/d (N=33), and placebo (N=66),
while study 2 analyzed the efficacy of Cymbalta 40 mg/d (N=86), Cymbalta
80 mg/d (N=86), paroxetine 20 mg/d (N=87), and placebo (N=89). Studies 1
and 2 lasted for nine weeks, while studies 3 and 4 lasted for eight

About Cymbalta

In placebo controlled clinical trials for Major Depressive Disorder,
Cymbalta had a favorable safety profile. The most commonly observed
adverse events (greater than or equal to 5% and at least twice placebo)
for Cymbalta vs. placebo (n = 1,139 vs. 777) were: nausea (20% vs. 7%),
dry mouth (15% vs. 6%), constipation (11% vs. 4%), decreased appetite
(8% vs. 2%), fatigue (8% vs. 4%), somnolence (7% vs. 3%) and increased
sweating (6% vs. 2%). In these studies, anxiety was reported as an
adverse event (3% vs 2%). The overall discontinuation rate due to
adverse events for Cymbalta vs. placebo was 10% vs. 4%. Nausea was the
only common adverse event reported as a reason for discontinuation and
considered to be drug related (1.4% vs. 0.1 %).

The US Food and Drug Administration issued an approvable letter for
Cymbalta (duloxetine for depression) in September 2002. Duloxetine
hydrochloride is also being studied by Lilly for treatment of stress
urinary incontinence, a condition mediated by serotonin and

Lilly, a leading innovation-driven corporation, is developing a growing
portfolio of best-in-class pharmaceutical products by applying the
latest research from its own worldwide laboratories and from
collaborations with eminent scientific organizations. Headquartered in
Indianapolis, Ind., Lilly provides answers - through medicines and
information - for some of the world's most urgent medical needs.
Additional information about Lilly is available at


Eli Lilly and Company

Anne Griffin (US), 317-276-3254
pager 877-591-1407
Eli Lilly and Company
Jennifer Yoder (Global), 317-433-3445
cell 317-652-0912
SOURCE: Eli Lilly and Company

Overcoming Chronic Fatigue with Procrit: Interview with Barry Hurwitz,

09-26-2003 Ivanhoe Broadcast News Transcript: Q & A with Barry Hurwitz,
Ph.D., Professor of Psychology and Biomedical Engineering, University of
Miami, Miami, Florida. In this full-length doctor's interview, Barry
Hurwitz, Ph.D., explains how a drug typically used in cancer patients
may help people with Chronic Fatigue Syndrome.
TOPIC: Overcoming Chronic Fatigue
Do we know what causes Chronic Fatigue Syndrome (CFS)?
Dr. Hurwitz: No. The cause is unknown. There are many important clues,
and we're learning more and more as a consequence of this study and
other studies around the country. But we don't know yet what the cause
There is a stigma that some doctors dismiss Chronic Fatigue Syndrome. Is
it challenging to diagnose?
Dr. Hurwitz: Yes. It's very difficult to diagnose it. You diagnose it by
elimination of other potential ailments, and as a consequence, many
individuals are misdiagnosed or undiagnosed. Today, about 1.3 million
people in the United States have Chronic Fatigue Syndrome. It's more
prevalent than multiple sclerosis, for example.
It's four-times more prevalent than multiple sclerosis and eight-times
more prevalent than lupus. But 85 percent to 90 percent of the people
who have chronic fatigue are undiagnosed. They're living with a disease.
They don't realize they have this, what the reasons for this persistent
and severe fatigue and relapsing. Sometimes they feel better, and
sometimes they don't. They just don't understand what's going on, and
they're pulling up their socks trying to make do, but they really have a
problem. There's a physical basis for this problem. Unfortunately, in
today's medical environment, physicians don't have a treatment for it,
so there's not much that can be offered at this time, which is the
reason for this study.
This article continues at:
Increased Cortisol Levels Linked to Decrease in Attention

Pippa Wysong
Aug. 11, 2003 — Corticosteroids may be responsible for cognitive
complaints symptoms in patients who take high doses of the medication
Elevated cortisol levels have already been recognized for their
detrimental effects in conditions such as Cushing's Disease, and recent
evidence suggests they have a detrimental effect on conditions such as
major depression and Alzheimer's disease.
But not much is known about whether corticosteroid medication may
influence memory, attention or mood, said Alan Frol, PhD, a
neuropsychologist at the Southwestern Medical Center at Dallas, Texas.
At the recent 111th annual conference of the American Psychological
Association (APA), in Toronto, Canada, Dr. Frol, presented findings from
a small study comparing cognitive and mood measures of patients who took
high doses of corticosteroids to those who did not.
The study included 28 patients with either asthma or rheumatoid
arthritis, 14 (50%) of whom took 10 mg or more of corticosteroid
medication daily. It is not uncommon for corticosteroid users to have
some cognitive complaints, he said.
All participants underwent various standard tests, such as structured
clinical interviews for DSM-IV (SCID), to measure mood and various
cognitive functions. Patients with major psychiatric conditions,
neurologic disease, or substance abuse disorders were excluded.
Patients were divided into two groups of 14; users of high dose
corticosteroids, and those who had minimal or no exposure.
Dr. Frol told Medscape Medical News, with the corticosteroid users, "We
found there was some mild decrease in terms of their cognitive skills,
looking at their attention, working memory and verbal learning memory."
Corticosteroid users also had increased depressive symptoms compared to
the controls, though these were at subclinical levels.
The high-dose users did have some complaints about memory, attention and
concentration problems. "These were subjective complaints affected by
the mood rather than actual cognitive functioning," Dr. Frol said.
The researchers are also investigating whether regular use of
corticosteroids or other compounds affect hippocampus volume. Some
studies in the medical literature suggest this part of the brain may
become smaller with the drug over time. Changes in the hippocampus
affect verbal learning and memory, according to Dr. Frol.
Because of this apparent connection to mood, it is possible cortisol
could become a target for future treatments, he said.
Past studies have shown that increased levels of glucocorticoids, such
as those associated with stress, result in decreased learning and
memory, said Rodney Vanderploeg, PhD, neuropsychologist at the James A.
Haley Veterans' Hospital in Tampa, Florida.
At the APA, Dr. Vanderploeg presented an unrelated study which showed
that subclinical impairments in attention, memory and psychological
functioning occurred in people who have normal levels of cortisol, but
whose levels sit at the high end of the normal range.
While cognitive effects were evident, Dr. Vanderploeg said, "They were
small and clinically insignificant."
Dr. Frol's study was funded by a grant from the National Institutes of
APA 111th Annual Conference: Poster Session A-7, A-8. Presented Aug. 8,
Reviewed by Gary D. Vogin, MD
Pippa Wysong is a freelance writer for Medscape.
Bumpy Road Ahead
Sliding textured insoles into your active footwear may help protect you
from sprains and strains.
Nubby or textured insoles increase foot sensitivity and may help the
brain gather important information about body positioning. Researchers
speculate that this extra information may help people make subtle,
injury-preventing adjustments to balance, weight distribution, or gait
when needed.
Copyright© 2003, RealAge, Inc
Salt Assault

Even if you never touch the saltshaker, there's a good chance you could
be getting too much sodium in your diet.
Americans' average salt intake is nearly twice the recommended daily
limit, and high sodium intake may contribute to hypertension. Most
dietary sodium comes from prepackaged items, such as spaghetti sauce,
frozen pizza, canned soups or vegetables, and salty chips or pretzels.
Choose reduced- or low-sodium alternatives whenever possible.

RealAge Benefit: Keeping your blood pressure at 115/76 mm Hg can make
your RealAge as much as 12 years younger.

The average American consumes over 4,000 milligrams of sodium per day --
about the equivalent of a heaping teaspoonful. The government
recommendation is to consume no more than 2,400 milligrams of sodium per
day. For Optimum RealAge benefits, try to limit your sodium intake to
less than 1,600 milligrams per day. Check the label of your favorite
prepackaged, frozen, and canned items and choose the ones with the least
amount of sodium. Better yet, prepare foods from scratch whenever
possible so you can control the sodium content yourself.
Physical Activity Definitions Broadened to Include Daily Activities


Even moderate types of exercise provide health benefits. For that
reason, a state-based survey, conducted by the Centers for Disease
Control and Prevention (CDC) for the first time includes a broader
definition of physical activity.
The survey provides a more comprehensive picture of Americans’ daily
lifestyles and includes physical activity measures such as gardening,
vacuuming, and brisk walking to do errands, in addition to more
traditional forms of exercise.
The report published in the August 15 issue of MMWR, "New Physical
Activity Measures include Lifestyle Activities, Behavioral Risk Factor
Surveillance System (BRFSS) 2001" provides baseline data nationally and
for each state and U.S. territory based upon the measurements used for
"Physical activity is not an all or nothing proposition, said HHS
Secretary Tommy G. Thompson. "We cannot overstate how critical physical
activity is for our good health and we want every American to understand
that small steps toward a more physically active life yield significant
health benefits."
CDC, along with the American College of Sports Medicine, recommends
adults ages 18 and older participate in a minimum of 30 minutes of
moderate-intensity physical activity on most days of the week. This
study is the first BRFSS report to use the broader definition of
physical activity and detail the percentage of people in each state who
are meeting these recommendations. Even with the broader definition of
exercise, however, only 45 percent of adults met the physical activity
recommendations in 2001.
"It is important for all of us to remember that sedentary lifestyles
increase our risk of obesity, heart disease, hypertension, diabetes, and
other chronic diseases. The burden of these diseases can be reduced with
a minimum of 30 minutes of moderate-intensity physical activity five or
more days a week," said CDC Director Dr. Julie L. Gerberding.
The 2001 lifestyle physical activity questions profiled respondents’
activities in a usual week. The respondents were asked to recall
moderate- and vigorous-intensity activities separately, thereby
increasing the potential to recall less intense lifestyle activities.
The BRFSS is a population-based, random-digit-dialed telephone survey of
adults aged 18 and older. The new report facilitates the transition from
the 2000 BRFSS leisure-time activity questions to the updated lifestyle
activity questions of the 2001 BRFSS by comparing overall U.S. and
state-specific prevalence estimates for adults who meet recommendations
from both survey years.
New Physical Activity Measures include Lifestyle Activities, Behavioral
Risk Factor Surveillance System (BRFSS) 2001 is published in this week’s
Morbidity and Mortality Report and can be found at
Don't Forget Breakfast
It fights obesity, diabetes, and heart disease all day
by Holly McCord, RD, with Gloria McVeigh

If mornings are a mad dash at your house, breakfast may seem like a
luxury you can't afford. But breakfast isn't just important for kids. A
new Harvard Medical School study found that breakfast eaters have
one-half the risk of developing obesity and insulin resistance, a major
risk factor for diabetes and heart disease, compared with breakfast
skippers. The researchers think that the key may be calorie control, and
breakfast has an almost magical ability to help with that throughout the

Magical Meal
"When we eat, our body experiences something called the 'thermic
effect,' which means we burn calories just by digesting and absorbing
our food," says Lona Sandon, RD, assistant professor at the University
of Texas Southwestern Medical Center. "If you get up at 7 am, skip
breakfast, and don't eat your first meal until noon, that's 5 hours
during which your calorie burn has slowed down," Sandon explains.

Need more reasons to nosh? Breakfast eaters eat less fat and fewer
calorie-dense foods all day, studies show, and consuming most of your
calories early in the day means you're less likely to overeat or snack
in the evening.

Here or to Go?
The trick to eating a healthy breakfast is to stock up on foods that are
easy to eat. Sandon recommends adding these foods to your grocery
basket: fat-free milk, low-fat yogurt, orange juice with calcium, peanut
butter, almonds, walnuts, bananas, whole grain cereals, breads, and
waffles. And Prevention editors like these new morning-friendly items:

Harvest Bay TenderFruit is almost as juicy as fresh, with the packaged
convenience of dried. At supermarkets and health food stores. (Peaches:
102 cal, 0 g fat, 2 g fiber)

Oster's In2itive Blend-n-Go single-serving jar fits their blender, then
converts to a dishwasher-safe travel cup. Check out www.GotMilk? for
Licuado recipes for calcium-rich, milk-based licuados (smoothies).
Lactose intolerant? Just substitute soy milk.

Try An Experiment With Your Mother-In-Law
By Richard Altschuler
Does the expiration date on a bottle of a medication mean anything? If a
bottle of Tylenol, for example, says something like "Do not use after
June 1998," and it is August 2002, should you take the Tylenol? Should
you discard it? Can you get hurt if you take it? Will it simply have
lost its potency and do you no good?
In other words, are drug manufacturers being honest with us when they
put an expiration date on their medications, or is the practice of
dating just another drug industry scam, to get us to buy new medications
when the old ones that purportedly have "expired" are still perfectly
These are the pressing questions I investigated after my mother-in-law
recently said to me, "It doesn't mean anything," when I pointed out that
the Tylenol she was about to take had "expired" 4 years and a few months
ago. I was a bit mocking in my pronouncement -- feeling superior that I
had noticed the chemical corpse in her cabinet -- but she was equally
adamant in her reply, and is generally very sage about medical issues.
So I gave her a glass of water with the purportedly "dead" drug, of
which she took 2 capsules for a pain in the upper back. About a half
hour later she reported the pain seemed to have eased up a bit. I said
"You could be having a placebo effect," not wanting to simply concede
she was right about the drug, and also not actually knowing what I was
talking about. I was just happy to hear that her pain had eased, even
before we had our evening cocktails and hot tub dip (we were in "Leisure
World," near Laguna Beach, California, where the hot tub is bigger than
most Manhattan apartments, and "Heaven," as generally portrayed, would
be raucous by comparison).
Upon my return to NYC and high-speed connection, I immediately scoured
the medical databases and general literature for the answer to my
question about drug expiration labeling. And voila, no sooner than I
could say "Screwed again by the pharmaceutical industry," I had my
answer. Here are the simple facts:
First, the expiration date, required by law in the United States,
beginning in 1979, specifies only the date the manufacturer guarantees
the full potency and safety of the drug -- it does not mean how long the
drug is actually "good" or safe to use. Second, medical authorities
uniformly say it is safe to take drugs past their expiration date -- no
matter how "expired" the drugs purportedly are. Except for possibly the
rarest of exceptions, you won't get hurt and you certainly won't get
killed. A contested example of a rare exception is a case of renal
tubular damage purportedly caused by expired tetracycline (reported by
G. W. Frimpter and colleagues in JAMA, 1963;184:111). This outcome
(disputed by other scientists) was supposedly caused by a chemical
transformation of the active ingredient. Third, studies show that
expired drugs may lose some of their potency over time, from as little
as 5% or less to 50% or more (though usually much less than the latter).
Even 10 years after the "expiration date," most drugs have a good deal
of their original potency. So wisdom dictates that if your life does
depend on an expired drug, and you must have 100% or so of its original
strength, you should probably toss it and get a refill, in accordance
with the cliché, "better safe than sorry." If your life does not depend
on an expired drug -- such as that for headache, hay fever, or menstrual
cramps -- take it and see what happens.
One of the largest studies ever conducted that supports the above points
about "expired drug" labeling was done by the US military 15 years ago,
according to a feature story in the Wall Street Journal (March 29,
2000), reported by Laurie P. Cohen. The military was sitting on a $1
billion stockpile of drugs and facing the daunting process of destroying
and replacing its supply every 2 to 3 years, so it began a testing
program to see if it could extend the life of its inventory. The
testing, conducted by the US Food and Drug Administration (FDA),
ultimately covered more than 100 drugs, prescription and
over-the-counter. The results showed that about 90% of them were safe
and effective as far as 15 years past their original expiration date.
In light of these results, a former director of the testing program,
Francis Flaherty, said he concluded that expiration dates put on by
manufacturers typically have no bearing on whether a drug is usable for
longer. Mr. Flaherty noted that a drug maker is required to prove only
that a drug is still good on whatever expiration date the company
chooses to set. The expiration date doesn't mean, or even suggest, that
the drug will stop being effective after that, nor that it will become
harmful. "Manufacturers put expiration dates on for marketing, rather
than scientific, reasons," said Mr. Flaherty, a pharmacist at the FDA
until his retirement in 1999. "It's not profitable for them to have
products on a shelf for 10 years. They want turnover."
The FDA cautioned there isn't enough evidence from the program, which is
weighted toward drugs used during combat, to conclude most drugs in
consumers' medicine cabinets are potent beyond the expiration date. Joel
Davis, however, a former FDA expiration-date compliance chief, said that
with a handful of exceptions -- notably nitroglycerin, insulin, and some
liquid antibiotics -- most drugs are probably as durable as those the
agency has tested for the military. "Most drugs degrade very slowly," he
said. "In all likelihood, you can take a product you have at home and
keep it for many years, especially if it's in the refrigerator."
Consider aspirin. Bayer AG puts 2-year or 3-year dates on aspirin and
says that it should be discarded after that. However, Chris Allen, a
vice president at the Bayer unit that makes aspirin, said the dating is
"pretty conservative"; when Bayer has tested 4-year-old aspirin, it
remained 100% effective, he said. So why doesn't Bayer set a 4-year
expiration date? Because the company often changes packaging, and it
undertakes "continuous improvement programs," Mr. Allen said. Each
change triggers a need for more expiration-date testing, and testing
each time for a 4-year life would be impractical. Bayer has never tested
aspirin beyond 4 years, Mr. Allen said. But Jens Carstensen has. Dr.
Carstensen, professor emeritus at the University of Wisconsin's pharmacy
school, who wrote what is considered the main text on drug stability,
said, "I did a study of different aspirins, and after 5 years, Bayer was
still excellent. Aspirin, if made correctly, is very stable.
Okay, I concede. My mother-in-law was right, once again. And I was
wrong, once again, and with a wiseacre attitude to boot. Sorry mom. Now
I think I'll take a swig of the 10-year dead package of Alka Seltzer in
my medicine chest -- to ease the nausea I'm feeling from calculating how
many billions of dollars the pharmaceutical industry bilks out of
unknowing consumers every year who discard perfectly good drugs and buy
new ones because they trust the industry's "expiration date labeling."
Reprinted with permission of Redflagsdaily
A Bladder Matter

Sipping on some green tea could help keep your bladder healthy.
A compound found in green tea was shown to inhibit the growth of bladder
cancer in recent cell studies. The compound, a type of catechin, was
injected directly into the cells, blocking their growth. Other studies
have shown bladder benefits from drinking green tea.

RealAge Benefit: Actively patrolling your health can make your RealAge
as much as 12 years younger.

Most risk factors for bladder cancer are outside your control. However,
the most significant risk factor for bladder cancer is within your
control. Smoking is estimated to be responsible for almost half of
bladder cancer deaths in men. You also may be at higher risk if you are
male, are over age50, have a genetic history of bladder cancer in your
family, or are African American.

Do you suffer from an overactive bladder? Click on the link below to
find out

A report from the American Headache Society Annual Scientific Meeting:
Botox for Head Pain
A new study, the largest to date, adds to the evidence that Botox
alleviates and prevents headache and Migraine pain.
For the patient who is difficult to treat, Botox actually may be less
expensive than standard therapy.
Botox tends to cause fewer side effects than standard medications.
Insurance often does not pay for Botox as a headache or Migraine
Botulinum toxin type A, brand name Botox®, is an effective preventative
therapy for headache and Migraine pain in chronic sufferers, according
to the largest study performed to date, presented at the 45th Annual
Scientific Meeting of the American Headache Society (AHS) in June.
Eighty percent of patients in the study said that after treatment with
Botox, their head pain was less frequent, less intense, or both. The
study focused on 271 patients who suffer from Migraines and other head
pain, three-quarters of whom had tried many other therapies, without
success. Half had been over-using medications in an effort to relieve
"Many of these patients otherwise would be left with narcotics as their
best option," said Andrew M. Blumenfeld, M.D., principal investigator of
the study and chief of neurology at Kaiser Permanente in San Diego. "Our
study also shows Botox causes fewer side effects than many of the
standard medications." Research published previously by Dr. Blumenfeld
suggests treating chronic head pain patients with Botox is less
expensive than standard therapy.
In the study, patients were treated every three months, with a minimum
of 2 treatments and a maximum of 5 treatments.
80% (217) said their head pain episodes were less frequent, less intense
or both.
60.5% (164) reported good to excellent pain relief.
19.5% (53) reported some pain relief.
20% (54) reported no relief.
Compared to standard medications, which can cause a number of side
effects, such as upset stomach, drowsiness and weight gain, side effects
from Botox treatment are relatively rare. About 95% of patients in his
study reported no side effects, said Dr. Blumenfeld. Among the side
effects people did experience were:
eyelid drooping (1%)
eyebrow drooping (1%)
neck muscle weakness (1%)
other effects such as flu-like symptoms or head pain (2%).
Botox is given in the form of a liquid injected under the skin, usually
but not always, into muscles. Dr. Blumenfeld uses about 30 injections
per treatment, and generally favors a moderately low dose of Botox.
Researchers are unsure why Botox relieves head pain. For its other uses
-- including alleviating wrinkles and treating certain medical
conditions -- the purified protein relaxes the overactive muscle by
blocking nerve impulses that trigger contractions. For Migraines, there
is no muscle component. Scientists believe Botox works by blocking the
protein that carries the message of pain to the brain.
Relief typically takes effect two to three weeks after injections. The
longer the treatments continue, the better the pain relief, said Dr.
Blumenfeld. He said some patients who had overused oral medications were
able to stop taking those medications entirely after being treated with
Botox is approved by the Food and Drug Administration (FDA) for
treatment of blepharospasm (eyelid spasm), strabismus (crossed eyes),
cervical dystonia (painful neck spasms) and wrinkles between the
eyebrows, but not for headache or Migraine. Studies to obtain FDA
approval for that use are proceeding. As with most other headache and
Migraine preventive drugs, Botox is currently being prescribed legally,
Many private insurers do not pay for Botox for headache and Migraine
prevention, although sometimes it is covered on a case-by-case basis.
Medicare in four states -- Indiana, Kentucky, Ohio and West Virginia --
pays for Botox therapy for headaches and Migraine. Private insurance
companies often follow Medicare’s lead in paying for treatments.
American Headache Society. Botox Relieved Headache With Few Side
Effects, Suggests Largest Study Yet. June, 2003.
Intensive Exercise Helpful in Rheumatoid Arthritis
Laurie Barclay, MD
Sept. 10, 2003 — Intensive exercise improves functional ability in
rheumatoid arthritis (RA) better than does usual care, according to the
results of a randomized trial published in the September issue of
Arthritis & Rheumatism.
"This study demonstrates that participation in long-term high-intensity
exercise classes decreases the level of psychological distress in RA
patients," lead author Zuzana de Jong, MD, from Leiden University
Medical Center in the Netherlands, says in a news release.
Although the benefits of regular exercise with a moderate-to-high level
of intensity are well recognized to promote muscle strength and
cardiovascular fitness, physicians have traditionally warned patients
with RA against weight-bearing workouts due to fear of stress and damage
to inflamed joints.
Of 300 subjects with RA enrolled in this study, 79% were women. Median
age was 54 years. Half of the subjects received an intensive exercise
program, Rheumatoid Arthritis Patients In Training (RAPIT), consisting
of biweekly one-hour sessions including 20 minutes of bicycling, 20
minutes of an exercise circuit to build muscle strength and endurance as
well as joint mobility, and 20 minutes of high impact sports activities
such as badminton, volleyball, soccer, and basketball. Each session was
preceded and followed by 15 minutes of warm-up and cool-down exercises.
The remaining 150 subjects received usual care for RA, including
physical therapy at the discretion of their treating physician.
At study initiation, both groups were similar in most clinical
parameters, but average duration of disease was 7.5 years in the
physical therapy group and 5 years in the RAPIT group. There were also
differences in use of disease-modifying antirheumatic drugs and in
baseline radiographic damage of the hands and feet. During the two-year
study, there were no significant differences between groups in disease
activity markers, including joint swelling or joint pain, or in use of
antirheumatic drugs and analgesics.
Of 150 subjects enrolled in RAPIT, 136 regularly participated in their
training sessions for the full two years. After correction for baseline
differences, the RAPIT group had greater improvement than did the usual
care group in functional ability, including climbing stairs as well as
repetitive and complex tasks, measured with the McMaster Toronto
Arthritis Patient Preference Disability Questionnaire.
The RAPIT group also fared better than the usual care group in physical
capacity, determined by aerobic fitness and muscle strength, and in
feeling more optimistic and capable of coping. Although functional
ability for the RAPIT group improved by nearly the same extent in each
of the study years, physical capacity plateaued after the first year.
Median radiographic damage of the large joints did not increase in
either group during the study, but subjects in both groups with greater
joint damage at study entry had slightly more progression in damage, and
this was more pronounced in the RAPIT group.
"In early RA, functional ability and physical capacity deteriorate
quickly, while the large joints are still relatively spared. The
cost-benefit ratio is probably most favorable in these patients," Dr. de
Jong says. "Until more research is done, it seems wise to offer
individually designed exercises that spare the damaged joints to RA
patients with considerable damage of the large joints who wish to
participate in long-term intensive programs."
The Dutch Health Care Insurance Board supported this study.
Arthritis Rheum. 2003;48(9):2415-2424
Reviewed by Gary D. Vogin, MD

Check It Out
Take time to check out how the portion sizes of our food have increased
over the last few years. Go to and
take the quiz. This goes a long way in explaining part of our problem
with weight in our society. Don’t blame all of it on your illness!


Power Bars, Power Calories
(HealthDayNews) -- Power bars and energy drinks may make handy snacks
but they are often less nutritious than they purport to be, says The
Johns Hopkins Hospital.
While they're fortified with vitamins and minerals, power bars are also
loaded with calories. According to recent studies by,
the labels on 65 percent of energy bars claimed they contained less
carbohydrates, fat and sodium than they actually did.
And sports drinks sometimes contain ingredients that haven't been
approved by the US Food and Drug Administration, such as gingko biloba
and echinacea.
As an alternative for a quick snack, try regular water, fresh fruit and
other whole foods.
-- Felicity Stone
Copyright © 2003 ScoutNews, LLC. All rights reserved.
Last Updated: June 30, 2003

Pain Syndrome Strikes Mostly Women
By Christopher Gearon
Researchers are trying to pinpoint the cause of a mysterious syndrome
that causes pain, fatigue and other maladies so they can treat it
It's called fibromyalgia and it strikes mostly women like Donna Paduano.

Nine years ago, Paduano was in a failing marriage, raising two young
sons in Connecticut, working full time and managing some chronic health
problems. Such challenges would wear anyone out, but Paduano was feeling
more than fatigued—she was also in pain.
"It felt like somebody hit me with a baseball bat —but all the time,"
says Paduano, who was told by a rheumatologist that she was suffering
from fibromyalgia.
Says the 43 year-old Paduano, who has rebuilt her life in San Diego:
"You're not going to die from fibromyalgia, but you'll always have to
live with the chronic pain. That's what fibromyalgia is."
The Symptoms of Fibromyalgia?
In fact, fibromyalgia is a chronic pain disorder characterized by
generalized muscle pain. Sufferers count about a half dozen "tender
points" where pain is intense. These points are in the neck, shoulders,
below the elbows, and the lower back, hips and legs.
Paduano primarily experienced fatigue, generalized soreness and pain in
her back and shoulders.
And fibromyalgia can be accompanied by a host of other wide-ranging
conditions, ranging from irritable bowel syndrome to depression.
A Condition Often Misdiagnosed
Although people have suffered with it for a long time, fibromyalgia only
got its name in the last decade. But because of the far-ranging and
seemingly disparate symptoms, many physicians misdiagnose the condition
as osteoarthritis, depression or anxiety. Even more disconcerting to
Paduano and fellow sufferers is that fibromyalgia is considered by many
doctors a "waste basket" diagnosis—often reserved for hypochondriacs and
preoccupied women.
Fibromyalgia strikes an estimated 4 million to 6 million Americans. It's
especially common in older women. Dr. Don Goldenberg, a medical advisor
at the Arthritis Foundation, says 3 percent of women have fibromyalgia
at age 40; 7 percent by age 70.
Goldenberg, also chief of rheumatology at Newton-Wellesley (Mass.)
Hospital says about 80% of those with fibromyalgia suffer from extreme
fatigue and sleep disturbance, while irritable bowel syndrome plagues as
many as 70 percent of sufferers. Other common problems, in addition to
depression, include anxiety, headaches and cognitive problems.
For Mary Anne Saathoff, president of the Fibromyalgia Alliance of
America and herself a sufferer, it was leg pains and sleep disorders
that began as a child and worsened with adulthood.
"I felt more dead than alive," says Saathoff who was diagnosed in 1986
with fibrositis—fibromyalgia's precursor name. "It certainly takes a
great toll."
No Proven Cause, No Known Cure
The medical community has only recently started to get a handle on
fibromyalgia. In the 1980s a few specialists began developing treatments
for the non-fatal condition, and in 1990, the American College of
Rheumatology gave the syndrome its name. Within the last decade,
researchers have learned more.
"We no longer think this is a disease primarily of muscle," Goldenberg
says, "but one of the central nervous system."
While researchers have not proven what causes fibromyalgia, there are a
number of theories, according to the National Institute of Arthritis and
Musculoskeletal and Skin Diseases.
The leading theory is that fibromyalgia is caused by a disregulation or
imbalance of neurotransmitters in the brain like serotonin, which helps
to ease physical pain.
Some scientists believe an unidentified infectious agent, such as a
virus, may trigger fibromyalgia in certain people. Extreme stress,
injury and trauma are also believed to trigger the syndrome.
When confronted in this way, the brain moves into a defensive posture to
protect itself. "A lot of things showing up [in research] are very
complex," says Tamara Liller, head of the Fibromyalgia Association of
Greater Washington, Inc.
Liller, who has suffered with the condition for 20 years, this is why
the average primary care physician still does not have a good handle on
the condition. "You're getting into heavy duty brain theorizing."
Some of the most exciting research on fibromyalgia involves the Flexyx
Neurotherapy System (FSN). Developed a decade ago by California social
psychologist Len Ochs for research on learning disabled kids, FSN uses
pulsed radio waves to subtly manipulate brain wave activity and help the
brain function normally.
Coping with Fibromyalgia
Coping with fibromyalgia is "like peeling an onion," Liller says. With
so many symptoms, "you have to peel away at the layers to get people to
feel better. What's tough with fibromyalgia is that not everyone
responds the same way [to treatment]."
What works for one fibromyalgia sufferer may not work for another,
however, medication and exercise are known widely for helping to manage
the condition.
Like many fibromyalgia sufferers, Paduano takes low-level doses of the
antidepressant Elavil which helps her relax and break the cycles of
disturbed sleep that exacerbate her pain. The same antidepressant also
helped Saathoff drop what had become mandatory naps and to feel better
Exercise is also critical to combating the symptoms of this condition.
Paduano finds that water exercises are particularly helpful. She also
believes that meditation has helped her to limit the medications that
she would otherwise need to help manage her symptoms.
"The people who seem to do well are the ones who are open-minded and
open to working with others in a multi-practice approach," Liller says.
Such an approach may include one or more of the following: physical
therapy, massage, chiropractic, osteopathy, aerobic exercise,
biofeedback and other relaxation therapies, behavioral therapy,
acupuncture and nutritional therapy.
In their "Encyclopedia of Natural Medicine," noted naturopaths Michael
Murray and Joseph Pizzorno recommend that those with fibromyalgia take
100 mg of 5-Hydroxytryptophan (100 mg), St. John's Wort extract (300 mg,
0.3% hypericin content) and magnesium (150 to 250 mg) three times a day.
5-HTP is converted to serotonin. Low levels of serotonin levels are
linked to depression and to fibromyalgia. St. John's Wort extract
together with 5-HTP were shown to have "significantly better results"
than either one alone, the authors said. Magnesium helps to boost
But Goldenberg of the Arthritis Foundation says getting a correct
diagnosis and information on the syndrome goes a long way to help
sufferers manage fibromyalgia. He and others also stress the importance
of finding a physician who is familiar with the syndrome—and to find one
who will listen.
Article continues at:
Ironic Banshees
You've probably heard the old saying, "She screamed like a banshee." I
didn't learn much about banshees in school but I deduce that they are
dead people who scream loudly. That seems unpleasant enough. But lately
I have been learning more about the bad qualities of banshees. I've
overheard these nuggets from people who apparently have detailed banshee
"I had to pee like a banshee."
"My head hurt like a banshee."
"I was sweating like a banshee."
It's no wonder that banshees are rarely invited to parties. No one wants
to hang around with a screaming, peeing, sweating, dead person with a
headache, especially if beer is involved.
I've also learned recently that "ironic" means anything you want it to
mean. Example:
Me: "I heard that Bob was killed by a meteor."
Induhvidual: "Wow. That's ironic."
Me: "Why is it ironic? Was he an astronomer?"
Induhvidual: "No, it's ironic because, you know, what are the
Me: "So anything unlikely is automatically ironic?"
Induhvidual: "No, it also needs to be bad."
Me: "This conversation is ironic."
Induhvidual: "Shut up! You're making me pee like a banshee!"
Scott Adams <>;
Because the Food and Drug Administration has failed to fully uphold the
law, Congress is looking into making changes that will undermine many of
the freedoms that American consumers of dietary supplements hold dear.
Those of us who use dietary supplements,such as vitamins, to protect
our health may want to take a look at this page:
                                                THOUGHTS ON THOUGHT

Imagine someone saying to you: "I am your constant companion. I am your
greatest helper or your heaviest burden. I will push you onward or drag
you down to failure. I am completely at your command. I am easily
managed, but you must be firm with me. Those who are great, I have made
great. Those who are failures, I have made failures. You may run me for
profit or run me for ruin. It makes no difference to me. Take me, train
me, be firm with me, and I will place the world at your feet. Be easy
with me, casual with me, convenient with me, and I will destroy every
dream you have. Who am I? I am your thinking." What is your thinking
saying to you? And more importantly, what kind of guidance do you
provide your own thoughts?
Source and author unknown

Mindfulness-Based Stress Reduction
Being "mindful" can help overcome debilitating stress.

Mindfulness-based stress reduction (MBSR) is a meditation technique with
proven benefits in reduction of stress symptoms and improved quality of
life in persons suffering from a variety of physical and mental
conditions. Based upon the concept of being "mindful," or having a
heightened awareness of the present, this technique can be learned by
nearly anyone.
Mindfulness has been defined as the state of attention and awareness of
present experiences, bringing oneself in touch with inner wisdom and
moment-by-moment awareness of what one experiences and feels. Paying
attention to sounds, breathing rhythms, inner feelings, and our reaction
patterns to specific situations are all part of being mindful. Mindful
meditation, or MBSR, involves a series of simple meditation exercises,
often coupled with physical stretching, to help achieve the mindful
MBSR was developed in 1979 by Dr. Jon Kabat-Zinn and colleagues at the
University of Massachusetts Stress Reduction Clinic, the oldest and
largest hospital-based stress reduction clinic in the world. MBSR is
usually learned through a course lasting several weeks that involves
daily practice sessions lasting 20-30 minutes. Formal practice of MBSR
involves true meditation exercises, while informal practice can be
achieved through attempting to create a non-judgmental, moment-to-moment
increased awareness of daily situations.
Researchers have documented the value of MBSR for stress and symptom
management in conditions ranging from sleep disorders to cancer. In a
2001 report in the journal General Hospital Psychiatry, Dr. Diane K.
Reibel and colleagues at the Center for Integrative Medicine at Thomas
Jefferson University documented increased vitality and decreased pain
levels in 136 persons with a range of chronic conditions who practiced
this technique.
For more information:
Dr. Jon Kabat-Zinn has written a number of books on mindfulness and
MBSR, including Full Catastrophe Living.


Sadness is not Depression
We all feel sad sometimes. Sadness is a normal emotion that can make
life more interesting. Much art and poetry is inspired by sadness and
melancholy. Sadness almost always accompanies loss. When we say goodbye
to a loved one we usually feel sad. The sadness is even deeper if a
close relationship has ended or a loved one has died.
Sadness also helps us appreciate happiness. When our mood eventually
changes from sadness toward happiness the sense of contrast adds to the
enjoyment of the mood.
Here are some ways to experience normal sadness in a healthy way and to
allow this emotion to enrich your life:
Allow yourself to be sad. Denying such feelings may force them
underground, where they can do more damage with time. Cry if you feel
like it. Notice if you feel relief after the tears stop.
If you are feeling sad, plan a sadness day. Plan a day or evening just
to be alone, listen to melancholy music, and to observe your thoughts
and feelings. Planning time to be unhappy can be actually feel good. It
can help you ultimately move into a more happy mood.
Think about the context of the sad feelings. Are they related to a loss
or an unhappy event? It's usually not as simple as discovering the
"cause" of the sadness, but it may be possible to understand factors
Sadness can result from a change that you didn't expect, or it can
signal the need for a change in your life. Change is usually stressful,
but it is necessary for growth.
Know when sadness turns into depression. Get help if this happens rather
than getting stuck in it.
Get help if you experience more than a couple of the following symptoms
of depression:
Persistent sad, anxious, or "empty" mood
Feelings of hopelessness, pessimism
Feelings of guilt, worthlessness, helplessness
Loss of interest or pleasure in hobbies and activities that were once
enjoyed, including sex
Decreased energy, fatigue, being "slowed down"
Difficulty concentrating, remembering, making decisions
Insomnia, early-morning awakening, or oversleeping
Appetite and/or weight loss or overeating and weight gain
Thoughts of death or suicide; suicide attempts
Restlessness, irritability
Persistent physical symptoms that do not respond to treatment, such as
headaches, digestive disorders, and chronic pain. (List taken from NIMH)

~ Leonard Holmes, Ph.D.

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Slow Down Therapy

1. Slow down; God is still in heaven. You are not responsible for doing
it all yourself, right now.

2. Remember a happy, peaceful time in your past. Rest there. Each moment
has richness that takes a lifetime to savor.
3. Set your own pace. When someone is pushing you, it's OK to tell them
they're pushing.
4. Take nothing for granted: watch water flow, the corn grow, the leaves
blow, your neighbor mow.

5. Taste your food. God gives it to delight as well as to nourish.

6. Notice the sun and the moon as they rise and set. They are remarkable
for their steady pattern of movement, not their speed.

7. Quit planning how you're going to use what you know, learn, or
possess. God's gifts just are; be grateful and their purpose will be
8. When you talk with someone, don't think about what you'll say next.
Thoughts will spring up naturally if you let them.

9. Talk and play with children. It will bring out the unhurried little
person inside you.

10. Create a place in your your your
heart...where you can go for quiet and recollection. You deserve it.

11. Allow yourself time to be lazy and unproductive. Rest isn't luxury;
it's a necessity.

12. Listen to the wind blow. It carries a message of yesterday and
tomorrow-and now. NOW counts.

13. Rest on your laurels. They bring comfort whatever their size, age,
or condition.

14. Talk slower. Talk less. Don't talk. Communication isn't measured
by words.

15. Give yourself permission to be late sometimes. Life is for living,
not scheduling.

16. Listen to the song of a bird; the complete song. Music and nature
are gifts, but only if you are willing to receive them.
17. Take time just to think. Action is good and necessary, but it's
fruitful only if we muse, ponder, and mull.

18. Make time for play-the things you like to do. Whatever your age,
your inner child needs re-creation.

19. Watch and listen to the night sky. It speaks.

20. Listen to the words you speak, especially in prayer.

21. Learn to stand back and let others take their turn as
leaders.There will always be new opportunities for you to
step out in front again.

22. Divide big jobs into little jobs. If God took six days to create
the universe, can you hope to do any better?

23. When you find yourself rushing and anxious, stop. Ask yourself
"WHY?" you are rushing and anxious. The reasons may improve your

24. Take time to read the Bible. Thoughtful reading is enriching

25. Direct your life with purposeful choices, not with speed and
efficiency. The best musician is one who plays with expression and
meaning, not the one who finishes first.

26. Take a day off alone; make a retreat. You can learn from monks and
hermits without becoming one.

27. Pet a furry friend. You will give and get the gift of now.

28. Work with your hands. It frees the mind.

29. Take time to wonder. Without wonder, life is merely existence.

30. Sit in the dark. It will teach you to see and hear, taste and

31. Once in a while, turn down the lights, the volume, the throttle, the
invitations. Less really can be more.

32. Let go. Nothing is usually the hardest thing to do - but often it
is the best.

33. Take a walk-but don't go anywhere. If you walk just to get
somewhere, you sacrifice the walking.

34. Count your friends. If you have one, you are lucky. If you have
more, you are blessed. Bless them in return.

35. Count your blessings - one at a time and slowly
--author unknown

"In the day of my trouble I will call to You,
for You will answer me" (Psalm 86:7, NIV).

The Job family lost everything in a flash,
including children, houses, barns, myriad animals,
wealth, and health. Mrs. Job experienced the same
losses as her husband, aside from the acute disease
that attacked his whole body.

Job suffered with an unknown disease for which
here was no treatment. Mrs. Job was powerless to
cope with the huge change she saw in her mate. One
day he was declared "the greatest man among all the
people of the East" (Job 11:3b), and the next she
saw a desperate man who sat among the ashes with a
shaved head and torn clothing, scraping his oozing
wounds with broken pieces of pottery. Mrs. Job was
traumatized by the shocking nature of Job's affliction.

Although Job was the one suffering, we cannot discount
the fragility of Mrs. Job's emotions. In a day she
had lost everything. Once wealthy as a couple, they
had nothing left except themselves. Mrs. Job must
have wondered if her husband would die, leaving her
impoverished as a widow. How her heart must have
cried out for reassurance.

Mrs. Job most likely was despondent and depressed when
she verbally lashed out at Job with, "Are you still h
olding onto your integrity? Curse God and die"
(Job 2:9, NIV). She so desperately wanted him to do
something, even if it meant compromising his ideals
and beliefs. Job's succinct answer continues to be
appropriate for us. "Shall we accept good from God,
and not trouble?" (Job 2:10, NIV).

Calamity strikes everywhere. We may lose our health,
job, or possessions. In all our trials we must retain
our priorities and perspective. Illness seldom affects
just one person. Coping may be harder for those looking
on than for the one who is ill. Our loved ones want
us to recover and they often feel helpless to intercede
on our behalf.

Just as Mrs. Job required understanding and reassurance,
we need to reach out in love to those who faithfully
care for us. We are able to give to others because
God remains our source for love, patience, kindness
and joy. There is no limit to His supply. God will
instruct us how to be responsive and sensitive to
family and caregivers so affected by our illness.
Encourage all of them today!


Patricia Knight feels blessed by God with her
supportive, caring, loving husband who daily helps
make like a little easier for her as she struggles
with 2 chronic neurological illnesses.

Compliments of Rest Ministries, serving people
Who live with chronic illness or pain.
Rest Ministries, Inc.
PO Box 502928, San Diego, CA 92150
toll-free 1-888-751-REST (7378)
copyright 2003

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