January 11, 2004


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January 11, 2004
2090 subscribers and 8 new subscribers.
Welcome aboard new subscribers!
Editor: Mary McKennell
Editor’s Corner:
"Though no one can go back and make a brand new start, anyone can start
from now and make a brand new ending."
~ Carl Bard
I can’t think of anything better for a January newsletter than to lead
off with a piece that Lisa Lorden put together back in 1998.
Happy 2004 to you!
The Art of Letting Go Dateline: 12/30/98
"And now let us welcome the New Year
Full of things that have never been."
- Rainer Maria Rilke
'Tis the season of New Year's Resolutions.
People make them, and frequently they break them. Many center around a
few general principles:
"I will cram more into every moment than I did last year,"
"I will efficiently organize my day so as to be most productive," or
"I will discipline myself to become a goal-accomplishing machine."
For perfectionists, New Year's resolutions are about being more perfect.
They are appealing and natural, especially to those who rely on
achievement as a means of self-esteem.
Many people with Chronic Fatigue Syndrome and Fibromyalgia recognize
themselves in this category: we often measure our worth in the currency
of how much we do. Yet the typical goals declared on January 1st of each
year may be more unrealistic than ever.

In his book, "Don't Just Do Something, Sit There", Richard Eyre explains
how some of the notions of traditional wisdom are outdated or
inaccurate. He argues that we need new paradigms to "reflect our world
as it really is, and our lifestyles as they really ought to be." This is
particularly true for people who are disabled by chronic illness.
Perhaps we need to rethink these annual goals and look to the New Year
with a spirit of "Anti-Resolutions"—that is, to release ourselves from
the obligation of things we are not able to do and consider alternatives
more supportive of healing and recovery.
Let's look at some typical January 1st declarations and how they might
be transformed to better fit the lives of people with Chronic Fatigue
Syndrome or Fibromyalgia.
I will exercise every day, even if I don't feel like it.
I won't continue any exercise that results in a worsening of my

I will manage my time so that I can do more.
I will give up unrealistic goals and make it a goal to do less.

I will wake up an hour earlier each morning.
I will try to nap an hour each day.

I will work harder to get that promotion this year.
I will acknowledge my health is more important than that promotion this

I will be more generous to others with my time and energy.
I will be more protective of my time and energy in order to take better
care of myself.

I will return phone calls promptly.
I will answer the phone less frequently.

I will accomplish all the items on my To-Do List.
I will eliminate most of the items on my To-Do List.

The "transformed" list of resolutions may look quite different from the
traditional one. But is it any less important? And is it any less
challenging? It's funny how determination and will power can be so
difficult to apply in the reverse. We may know how to commit ourselves
to goals and work to
achieve them, but can we have similar determination to rest and to heal?
Can our will power be devoted to "letting go"? Consider making your own
such list of "anti-resolutions" that focus not on getting things done,
but on improving your health and quality of life. Or you may not want to
any resolutions at all. This year, the most empowering declaration for
us might be that we will make no resolutions, set no quantified goals,
and rely on no concrete measures of success. Instead, we can open our
bodies and minds to be healed and open our hearts to contentment and
peace. Healing
requires no resolutions—it requires only that we live each day the best
way we know how, listening to our bodies, and nurturing our souls. Even
if we abandon every resolution we've ever made, perhaps we will start to
experience the healing value of letting go.
--Lisa Lorden
"Some people may think that having a routine-driven life is boring, but
for me it has been liberating. My illness is not running my life, I am."
So writes FM patient Joan Buchman in an article at the
CFIDS/Fibromyalgia Self-Help program website ( ).

How do you keep hope alive when you have a long-term illness? For some
ideas on meeting this challenge, read the feature article at the
CFIDS/Fibromyalgia Self-Help program website
( ): "The Anatomy of Hope."
Registration for the next session of the CFIDS/Fibromyalgia Self-Help
Course ends January 12th. The course, which begins a week later on
January 19th, is an 8-week, solution-oriented email discussion group
that focuses on practical strategies for coping with common problems of
CFIDS and fibromyalgia. The cost of the course, which includes a copy of
"The CFIDS & Fibromyalgia Self-Help Book," is $25. Visit the website to
learn more and to register: .


Take The Mystery Out of Living with Chronic Illness

What I Want You to Know About What It's Like For Me To Live with Chronic
1. Everyone knows that health, like weather, is unpredictable. For
healthy people, however, this is background stuff. But, living with
chronic illness means that unpredictable and unreliable health is a
reality that I face daily. Please understand if I have to cancel our

2. I don't want pity or sympathy. You can't know how I feel nor do I
expect you to. It feels good to get empathy, such as, "I understand" .
And, once in a while, it's really nice to hear encouragement, such as,
"You do a great job with this".

3. I know it doesn't make sense, but I can look fine, even when I feel
terrible. When I hear, "But you look so good", however, I wonder if you
believe me.

4. You probably think you're being helpful telling me about other
people's success with getting better. But, Aunt Gertrude (who went into
remission when she tried the new diet) or your boss, Phil, (who stopped
working and is cured) aren't me. This sounds like advice that I haven't
asked for.

5. When I mention my chronic illness, please don't "skip" over it and
look away. It doesn't feel polite or respectful of my privacy. It feels
like you're avoiding the topic. In fact, I appreciate the questions that
show genuine interest in my experience, such as, "What does that mean
for you?"

6. Have you ever noticed how often people pass you in the office halls
with a quick, "Hi, how ya' doing " -- and keep walking? I know it's just
a greeting but I don't have a quick or simple answer. I'm still
responding to the question five minutes later, in my head. It's
difficult to carry on simple, "normal" office banter when you don't feel
"normal" and your health doesn't fit in a sound bite. So, if you ask,
"How ya' doing' ?", be prepared for more than you might have bargained.

7. Healthy people can work (or play) too hard and make up for pushing
their bodies without too much wear and tear. But, I don't know how hard
I can push myself. Some days, walking upstairs to the water cooler feels
like I ran the marathon. Sometimes it can take weeks for me to return to
feeling "normal" after I work a few late nights and weekends. Yet, other
times, I can do this without a problem. Go figure.

8. I know how difficult it is for me to understand and accept my
fluctuating symptoms. It's even harder for others to get it, especially
when I look the same through it all. Because my symptoms aren't
(usually) visible, it makes nervous about what others believe about my
health and think of me. When I have to "slow down" or not show up
because of my chronic illness, it means others have to pick up the
pieces to keep things going. That's a very uncomfortable feeling.

9. People tell me, "Take care of yourself". But how should I interpret
this message when working 10 hour days/6 days a week is considered a
virtue? I want to have high standards for my performance and be
respected for what I do, just like everyone else.

10. Don't assume that because I have a chronic illness, I'm unable to
take care of myself or to do my job. If I say I can do it, I will. I
might have to ask for help at times. But, that's my responsibility.

11. I'm no heroine (or hero). A hero does something that helps humanity.
I'm just trying to do the best with the hand that's been dealt to me.
Just like everyone else.

Use this List as Your New Year's Gift to Yourself -- and Give it to
Others! Take it and make it your own - cut and paste it - and then hand
it out to your friends, family and co-workers. I'll bet they'll thank
you for it.

PLEASE email me your ideas and feedback. What do you agree with? What
would you change? What would you add? This is a work in progress for us

Ten Steps From Patient to Person
Making the journey from patient to person takes time. The isolation and
fear that can overwhelm a person with chronic pain grows over time. And
the return to a fuller, more rewarding life also takes time.
It’s a journey with many phases. The ACPA describes these phases as Ten
The ACPA’s Ten Steps For Moving From Patient To Person.

STEP 1: Accept the Pain
Learn all you can about your physical condition. Understand that there
may be no current cure and accept that you will need to deal with the
fact of pain in your life.
STEP 2: Get Involved
Take an active role in your own recovery. Follow your doctor's advice
and ask what you can do to move from a passive role into one of
partnership in your own health care.
STEP 3: Learn to Set Priorities
Look beyond your pain to the things that are important in your life.
List the things that you would like to do. Setting priorities can help
you find a starting point to lead you back into a more active life.
STEP 4: Set Realistic Goals
We all walk before we run. Set goals that are within your power to
accomplish or break a larger goal down into manageable steps. And take
time to enjoy your successes.
STEP 5: Know Your Basic Rights
We all have basic rights. Among these are the right to be treated with
respect, to say no without guilt, to do less than humanly possible, to
make mistakes, and to not need to justify your decisions, with words or
STEP 6: Recognize Emotions
Our bodies and minds are one. Emotions directly affect physical well
being. By acknowledging and dealing with your feelings, you can reduce
stress and decrease the pain you feel.
STEP 7: Learn to Relax
Pain increases in times of stress. Relaxation exercises are one way of
reclaiming control of your body. Deep breathing, visualization, and
other relaxation techniques can help you to better manage the pain you
live with.
STEP 8: Exercise
Most people with chronic pain fear exercise. But unused muscles feel
more pain than toned flexible ones. With your doctor, identify a modest
exercise program that you can do safely. As you build strength, your
pain can decrease. You'll feel better about yourself, too.
STEP 9: See the Total Picture
As you learn to set priorities, reach goals, assert your basic rights,
deal with your feelings, relax, and regain control of your body, you
will see that pain does not need to be the center of your life. You can
choose to focus on your abilities, not your disabilities. You will grow
stronger in your belief that you can live a normal life in spite of
chronic pain.
STEP 10: Reach Out
It is estimated that one person in three suffers with some form of
chronic pain. Once you have begun to find ways to manage your chronic
pain problem, reach out and share what you know. Living with chronic
pain is an ongoing learning experience. We all support and learn from
each other.
Tips for Staying Well in 2004
Ayurveda, the ancient science of healing from India, considers one of
its primary objectives to be preserving the continued good health of the
healthy. Here are four recommendations from this time-tested healing
science for staying well in 2004.

Taking control of your own well being can be daunting at first. It takes
time, commitment and energy to stay well, especially when the definition
of ‘well’ is not just ‘the state of being disease-free’ but ‘the state
of being totally healthy in mind and body.’ Too often, we reserve the
bulk of our time, commitment and energy for making money, or having fun,
or even just surviving, and the result is that well-being is relegated
to going for the annual physical or popping a daily multivitamin.
Ayurveda, the ancient healing tradition from India, encourages you to
make time everyday for your well-being, and reap the rewards of total
health for life. Many ayurvedic recommendations appear basic, simple,
just ‘common sense,’ but after reading this article, sit back and
analyze how frequently these basic wellness needs are bypassed on a
daily basis in the crush of day-to-day living, and you’ll realize that
it’s truly time to go back to the basics to stay well.

Eat fresh whole foods, and cook your own meals
Ayurvedic healers down the centuries would have nodded in approval if
they had heard Hippocrates’ advice to "let food be thy medicine."
According to the ayurvedic texts, if your diet and eating habits are
unwholesome, all the medicines in the world won’t be able to keep you
well; and if your diet and eating habits are wholesome, it’s quite
likely you’ll never need any medicine to keep you well. These texts were
written in another age, but there are choices that we can make even in
today’s fast-paced world to eat well. Choosing fresh over canned, whole
over processed or refined, and organic or natural over foods containing
additives or chemical preservatives whenever you can are good ways to
get back to the basics of eating well.
Here are some suggestions to make it easier to eat well:
Time-saving kitchenware such as a pressure cooker to cook lentils or a
slow-cooker to cook wholesome one-dish meals from scratch can make the
process of cooking your own meals easier.
Involve the whole family in the task of preparing fresh meals: when
everyone contributes to the meal, your time and effort are reduced, and
mealtimes become the more companionable because of the joint effort.
Browse magazines for healthy recipes utilizing fresh whole ingredients
that can be made in 30 minutes or less.
Keep a diary of the number of times you routinely eat out or eat bought
meals, and then slowly start whittling down that number until you’re
mainly eating meals you’ve made with fresh ingredients that are best for

Practice mindful eating
Your digestive system converts the food you eat into the nutritive
essence your body uses to build healthy blood, cells and tissues. A
wholesome, balanced diet suited to your unique nutritional needs is the
first step towards good health. But equally important is a digestive
system that works smoothly and efficiently. Only when the nutrients you
feed your physiology are fully digested, absorbed and utilized is the
process of nutrition complete.
Here are some ayurvedic tips to help your digestive system turn in a
stellar performance after every meal:
Eat your most substantial meal around mid-day. That’s when your
digestive ‘fire’ peaks. Eat smaller meals at breakfast and dinner.
Sit down to eat every meal, and try to maintain your attention on your
food while you eat.
Do not eat when you are angry, stressed or upset.
Offer thanks before you begin a meal.
Do not drink too much water with a meal, and avoid iced beverages
because they douse the digestive fire. Do not combine milk with salty or
sour tastes.
Add digestion-enhancing herbs and spices to dishes.
Try not to work or watch TV while you eat.
Exercise in moderation every morning.
Drink lots of water through the day.
Ayurvedic digestion toners such as Amalaki (Indian Gooseberry) and
Triphala can help kick-start a sluggish or irregular digestive system.

Get enough quality sleep
Sleep is when your physiology recharges for the next day. Both quantity
and quality of sleep are important. Rather than go by a
one-size-fits-all ‘eight hours a night’ rule, tune in to your physiology
for a few days to figure out what you, as a unique individual, need to
wake up rested, refreshed and ready to dive into what the new day
offers. Ayurvedic healers recommend retiring early and rising early to
stay in tune with what Nature intended for human beings as activity and
rest times—sleep obtained in the later part of the night or during the
day is often less productive in terms of replenishing the mind and body.
Woo restful sleep with these tips:
Banish the TV, the computer and work-related material from the bedroom.
When you enter your bedroom, your mind should be getting ready to wind
down, not get stimulated.
An hour before you go to bed, diffuse a soothing aroma in your bedroom.
Lavender has been shown to be helpful in lulling the mind and body into
Make sure your bedroom is neither too warm nor too cool.
Keep your bedroom quiet and dark. Choose cool soothing colors for
bedroom décor.
Wear loose comfortable clothing.
Stay active during the day and avoid daytime naps.
Eat light at night, and make sure you’re done with your last meal of the
day at least two hours before you retire. Warm milk makes a soothing
bedtime beverage.
When you get into bed, lie on your back with your legs stretched out and
your arms straight and loose, and practice deep breathing for a few
Jatamansi and poppy seeds are traditional ayurvedic sleep aids that are
gentle and non-habit-forming.

Manage stress
Stress cannot be banished from our lives completely, and some stress is
actually good for us. But too much stress, or stress that stays around
for extended periods of time, eventually depletes the physiology. Stress
in excess creates free radicals in the body, and leads to disease as
well as early aging. And it’s not just the big traumas that create
harmful levels of stress in the physiology, little things that happen
everyday, like that spat with a co-worker, worrying about your credit
card bill or piled-up chores that make you feel overloaded, can create
chronic stress. Managing stress is, therefore, crucial to stay well.
Try these ayurvedic suggestions for managing stress:
A daily self-massage is replenishing and relaxing. Choose a massage oil
that is suited to your constitution. Although sesame oil is the
traditional recommendation, almond, coconut, olive or jojoba are
alternatives to consider. For best results, perform the massage in the
morning, before your shower or bath.
Meditate for about thirty minutes everyday. The ayurvedic herb Brahmi
helps enhance the results from meditation by supporting mind-body-spirit
Set some time aside in each day for a relaxing activity, whether it’s
listening to uplifting music or taking a stroll along the seashore. Even
fifteen minutes can help recharge a tired mind and body.
Cultivate the pleasant company of nurturing people to recharge your mind
and emotions.
Diffuse relaxing aromas in your work area or home—rose, jasmine,
lavender, sweet orange or ylang ylang balance the mind, senses and
Exercise everyday, in moderation. The best time to exercise according to
ayurveda is in the early morning.
Note: This material is educational, and is not intended to
diagnose,treat, cure or prevent any disease. If you have a medical
concern, please consult your physician.
Copyright AyurBalance, Inc. 2003


Prescription Errors Rising
LEESBURG, Va., June 10, 2000 -- Five-year-old Brendan Ward had a
bed-wetting problem, so his doctor prescribed a medication containing 50
milligrams of imipramine per teaspoon.
Brendan's mother took the prescription to Leesburg Pharmacy, where a
technician mistyped the amount as 250 milligrams, five times the correct
amount. The pharmacist on duty didn't notice the error and filled it as
the technician had typed it.
Brendan's mother gave her little boy a teaspoonful of medicine at
bedtime that night, April 5. The next morning, she found his cold,
lifeless body in his bed.
Shocking? Definitely. Tragic? Extremely. Unusual? Not at all.
In fact, because of a shortage of pharmacists and the steady increase in
the use of prescription medications, the rate of death and injury from
botched prescriptions is skyrocketing, officials say.
There are as many as 7,000 deaths annually in the United States from
incorrect prescriptions, according to Carmen Catizone of the National
Association of Boards of Pharmacy. He told The Washington Post that as
many as 5 percent of the 3 billion prescriptions filled each year are
With the number of prescriptions expected to climb to 4 billion by 2004
and the number of pharmacists steadily decreasing, there are bound to be
"problems down the road," Catizone said.
The owner of the Leesburg Pharmacy called Brendan Ward's death "a
pharmacist's worst nightmare" and said he has tightened procedures to
ensure that at least two pharmacists review every prescription before it
goes out the door.
What You Can Do It's not easy for consumers to protect themselves
against such errors, but there are steps you can take:
Read the prescription your doctor gives you aloud. Ask the physician to
confirm it.
Verify the dosages and drug names with your doctor.
Before going to the pharmacy, write down the dosage and drug names.
Go to a reputable pharmacy, one that has more than a single pharmacist
working with clerk and technician helpers. You can contact your state
pharmacy board for information. Some will tell you if a pharmacist has
been disciplined in the past.
When you pick up the prescription, check the labels and make sure the
dosages and drug names match what you have written down.
These steps are not foolproof but they're a good start.
The Brain-Body Connection and the Relationship Between Depression and

Most primary care clinicians have an intuitive sense that depression and
somatization are often comorbid states. Generalists have historically
resisted temptations to view individuals in dualistic terms and
understand that the brain is connected to the rest of the body, either
"hard-wired" through the central nervous system or "soft-wired" through
neurohormonal pathways. In many cases, illness cannot be easily
dissected into mental vs. somatic categories. This instinctive wisdom is
continually borne out in scientific investigation and has important
implications for the strategies we use to assess, diagnose, and treat
Major depression is highly prevalent and a major cause of disability.
The World Health Organization expects that by 2020, depression will rank
second only to ischemic heart disease in terms of disability. Depression
also influences the morbidity and mortality of a number of somatic
illnesses. The list grows steadily but is headlined by research
documenting significantly higher mortality in depressed patients post
acute myocardial infarction. Depression and chronic pain share synaptic
monoamine underpinnings. Recent research suggests that addressing this
connection is important in achieving robust responses to treatment. In
particular, antidepressants that affect more than one monoamine system
(e.g., dual reuptake inhibitors of serotonin and norepinephrine) seem to
possess a greater ability to both affect chronic pain states and
demonstrate higher rates of symptom remission in randomized studies of
major depression.
This article will provide documentation of the shared clinical domains
of mood and pain. It will discuss current conceptualizations of central
nervous system pathophysiology in relationship and review recent
clinical investigations in the area.
*This summary mentions off-label uses for some medications. These may
describe clinical uses for medications that have not been approved by
the US Food and Drug Administration.
The article continues at:

Beyond Depression: The Somatic/Affective Interface

Depression has traditionally been viewed as a syndrome with an affective
core accompanied by associated problems such as sleep, appetite,
decreased concentration, loss of interest, fatigue, and suicidal
behaviors. Yet somatic symptoms are often present and may be the primary
presenting problem in some individuals. These physical symptoms are wide
ranging and include complaints such as headache, constipation, back
pain, chest pain, dizziness, musculoskeletal complaints, and weakness.
The lack of recognition of depression in the face of physical symptoms
has resulted in the tendency by medical practitioners to misdiagnosis
and undertreat depression. Alternatively, the lack of attention by the
psychiatrist to physical symptoms in the depressed individual has
resulted in neglect of this important area. In both cases, optimal
treatment and functioning of the individual are compromised unless both
areas are included in the overall treatment.
The entire article can be found at:
The section on IBS is interesting.
Blessings in disguise

If you look at your problems as problems, they will continue
to hold you down. See them instead as blessings in disguise,
and that is what they will truly become.

If you treat the challenges as excuses for failure, you'll
have plenty of excuses but not much else. Approach those
challenges instead as pathways to success, and that is
precisely what they will be.

There is more than enough richness in life for all those who
are willing to recognize it. That richness most often comes
wrapped in challenge so as to keep its value intact.

For if the good things in life had no cost at all, they would
not be worth very much. It is the effort, the discipline, the
commitment to overcome any challenge, that makes a dream
worth reaching.

So whatever stands in the way of your dream is really a
blessing in disguise. For when you work your way through it,
you arrive at the place you most want to be.

Ralph Marston


Copyright (C) 2003 Ralph S. Marston, Jr

Eli Lilly and Company: Long-Term Study Suggests Cymbalta Demonstrates
High Tolerability and Safety; One-Year Data Shows High Likelihood of
Remission from Depression

INDIANAPOLIS--(BUSINESS WIRE)--11/19/2003--Cymbalta(TM) (duloxetine
HCl)(TM) was safe and well tolerated in a 52-week open-label study of
1,279 patients with major depressive disorder, according to data
published in the current issue of the Journal of Clinical Psychiatry.

There were no significant tolerability issues attributable to chronic
vs. acute use of the investigational agent Cymbalta; patients who
tolerated Cymbalta during the early period of the trial were likely to
tolerate long-term dosing. Of the patients in the study, 520 remained on
Cymbalta for at least 360 days, yielding approximately 808 patient-years
of total exposure.

In addition, patients in the study who responded to treatment with
Cymbalta had a high probability of achieving remission. Remission rates
at 52 weeks in this study were close to response rates (81.8 percent and
89.1 percent, respectively), implying that patients who responded had a
high probability of achieving complete resolution of their depressive

"Long-term tolerability is important for antidepressant effectiveness in
the complete treatment of depression. The higher-than-expected
completion rate in this open-label study implies that Cymbalta was
well-tolerated in these patients and was effective in helping them
relieve their depressive illness," said Joel Raskin, MD, Lilly senior
clinical research physician and lead author of the study.

Study Highlights

-- Cymbalta was safely administered and well-tolerated in long-term
chronic dosing, despite higher dosages than those used in most other
Cymbalta studies.

-- Most treatment-emergent adverse events were either mild or moderate
in severity and occurred early in the study.

-- Efficacy was demonstrated on all assessed measures, both clinician-
and patient-rated. Furthermore, discontinuation due to adverse events
over the entire 52-week study was 17 percent - a favorable rate given
the long duration of the study.


Data were gathered from a 52-week, open-label, multinational study of
1,279 adult outpatients who met the criteria for major depressive
disorder. Patients were administered duloxetine 80 to 120 mg/day as two
equal doses of 40 mg or 60 mg.

Efficacy was assessed using the Clinical Global Impression-Severity
(CGI-Severity) scale, the Hamilton Depression Rating Scale (HAMD(17)),
the Beck Depression Inventory-II and the Patient Global
Impression-Improvement (PGI-Improvement) scale. Patient-rated quality
was evaluated with the Sheehan Disability Scale. Response was defined as
a 50 percent decrease from baseline on the HAMD(17) total score and
remission was defined as a HAMD(17) total score of less than or equal to

Mean changes from baseline to last observation in laboratory analyses,
vital signs and electrocardiograms intervals were assessed using an
analysis of variance with models that included the investigator.
Longitudinal mean changes and categorical changes were assessed using
likelihood-based, mixed-models repeated measures and last observation
carried forward.


Discontinuation due to adverse events over the entire 52-week study was
17 percent -- a favorable rate given the long duration of the study. The
most common reasons for discontinuation included adverse event (17
percent), personal conflict/other reasons (10.2 percent), and lost to
follow-up (9.3 percent).

The most common treatment-emergent adverse events in the study included
nausea (34 percent), somnolence (29.8 percent), insomnia (31.3 percent),
headache (30.4 percent), dry mouth (23.5 percent), constipation (21.3
percent) and dizziness (23.3 percent). Most side effects occurred early
in the study and generally dissipated over time. Only one side effect
(headache) occurred in more than 10 percent of patients in weeks 9-52 of
the study.

The rate of serious adverse events per patient-year-exposure was low --
roughly 1 event per 13 years of exposure. A total of 64 patients
experienced serious adverse events, but investigators considered most
unrelated to the study medication.


Efficacy was demonstrated on all assessed measures, both clinician-and
patient-rated. The high rates of improvement at week one and two, while
difficult to define and assess, were consistent with results from
double-blind, placebo-controlled studies.(1-3)

Accumulating evidence suggests complete resolution of disease symptoms,
or remission, rather than simple treatment response, should be the
primary goal of depression treatment. Current medical literature
suggests that depressed patients frequently experience lingering
symptoms, such as persistent unexplained pain, putting them at a higher
risk for relapse or recurrence.(4)

Although interpreting results in an open-label study can be problematic,
the remission rates in this 52-week study were high, implying Cymbalta
was effective in relieving the symptoms of major depression in these

"By treating a broad spectrum of depressive symptoms - emotional and
physical - Cymbalta, once approved by the FDA, may help more patients
achieve remission," Raskin said. "These data show that these patients
were able to easily tolerate Cymbalta over the long-term, enabling them
to achieve even higher rates of response and remission the longer they
remain on therapy."
                                            FM and the Immune System
The immune system may be compromised in FMS sufferers. Natural Killer
(NK) cells seek out and destroy foreign invaders in our bodies. When FMS
patients' NK cells were tested by I. Jon Russell, M.D., they were found
to be in normal amounts, but their activity was low. Researchers do not
know why this is so, but serotonin may influence the activity of these
NK cells.
A high incidence of immune-reactive proteins have been found in the skin
of FMS patients. These are not normally seen in a healthy person's skin.
In other words, proteins are leaking through the blood vessel walls and
accumulating in surrounding tissues, which often occurs in conditions
that have an immunologic component.
(Source: Taking Charge of Fibromyalgia, by Julie Kelly, M.S., R.N., and
Rosalie Devonshire, M.S.W.)

Zinc is crucial for immunity. Thirty days of suboptimal zinc intake can
cause a 30% to 80% loss of immune defense. Studies show that zinc is
important for natural killer (NK) cells to multiply and function. NK
cells are the body's first-line defense against certain types of cancer.
Supplemental zinc has been shown to increase antibody response and
T-cell counts. Zinc deficiency also causes the thymus to atrophy.
(Source: Life Extension magazine. February 2003)


Fibromyalgia Common in Diabetes Patients
A recent study discovered a higher prevalence of fibromyalgia in
patients with types 1 and 2 diabetes.

The study involved forty-five patients with type 1 diabetes, 55 patients
with type 2 and 50 healthy control subjects. Patients were diagnosed
with fibromyalgia according to the 1990 American College of Rheumatology

Researchers found a high association between the two conditions.
Fibromyalgia was diagnosed in seventeen of the diabetes patients
compared to only one patient in the control group. However, no
significant difference was found between the two diabetes groups.
Patients with both fibromyalgia and diabetes had higher numbers of
tender points, pain scores and levels of HbA(1c), and reported an
increase in the incidence of headaches, fatigue and sleep disturbances
as compared with the control group.

The study concluded that fibromyalgia was a common finding in diabetes
patients and suggested that its occurrence may be related to the control
of the disease.

Source: Fibromyalgia in diabetes mellitus. Rheumatol Int 2003 May 20
Your Body May Know You're Depressed Before You Do
New Campaign Focuses On Link Between Physical Pain And Depression
December 2003 (Newstream) -- If you suffer from chronic aches and pains,
it may be your body's way of telling you you're depressed. A new
national campaign, sponsored by professional and patient advocacy
groups, is now raising public awareness of the link between pain and
depression. The goal is to target millions of Americans who don't get
treatment because they think that depression is only associated with
mood and sadness.
A survey by "Freedom From Fear," a non-profit patient advocacy group,
found almost half of the respondents said physical symptoms disrupted
their family life. Forty-three percent said their social lives suffered
and 40 percent said their work was adversely affected. According to both
psychiatrists and pain specialists, pain is frequently a symptom of
depression and often times is a primary symptom that patients express to
their doctors.
It's proven that depression can elevate the pain signal in the emotional
center of the brain. One key factor may be an imbalance in
norepinephrine and serotonin -- two neurotransmitters that regulate mood
and inhibit pain. Medically restoring this balance can reduce the
suffering of pain and depression.
Depression affects more than 19 million American adults each year and
studies show that 80% complain to their doctors first about physical
symptoms. Experts recommend that patients talk to their physician about
both their mood and their painful physical symptoms.
For more information, log onto
Merck Discontinues Development of MK-0869 for Depression
WHITEHOUSE STATION, N.J.--(BUSINESS WIRE)--11/12/2003--Merck & Co., Inc.
announced today that it is discontinuing its Phase III clinical
development program for its substance P antagonist investigational
product, MK-0869, for the treatment of depression.

The Phase III clinical program was halted because the compound failed to
demonstrate efficacy for the treatment of depression.

"There are significant challenges in scientific research, and
unfortunately, sometimes disappointments," said Peter S. Kim, Ph.D.,
president, Merck Research Laboratories. "While we had reason to believe
that the compound could be effective in the treatment of depression, the
results of the Phase III trials did not demonstrate efficacy. Although
Merck will not be continuing its clinical development program for
MK-0869 in depression, we remain committed to our neuroscience research
programs at our facilities in the United States and the United Kingdom,"
he said.

"If the only prayer you say in your whole life is 'thank you,' that
would suffice."--Meister Eckhart
"An attitude of gratitude," we sometimes hear, will help us on our path.
There certainly are enough things for us to worry about, grieve over,
and complain about. They have their place.
But as we mature and no longer use artificial escapes, we learn that joy
can exist side by side with grief.
Gratitude is a tonic for our self-pity. Saying "thank you" actually
opens us to receive more of life's blessings which sit there waiting for
us to notice.
In a pleasant moment we can look around and say, "Aren't we lucky!"
That's a kind of prayer, and it connects us with our Higher Power. No
matter how painful or worrisome a day may be, we can be thankful for our
growth. Gratitude is so simple we sometimes dismiss it while looking for
a more complicated answer in our lives. We can say "thank you" for all
the simple things like trees, cool air, food to eat, and love between
It is a risk to be so grateful. Who will be in control? Perhaps God.
God, thank you for all that comes to me without my efforts.
Touchstones by Anonymous copyright 1986

Meet Cheryl. She is a normal, middle-aged woman with a husband,
children, and even a few grandchildren. In early November, 2003, Cheryl
was diagnosed with small cell lung cancer. She now walks a path she
fervently wishes nobody ever had to. In Cheryl's Story, she shares with
us just what having lung cancer is like, and how quickly it has changed
her world. "It's harder to have cancer than it is to quit smoking." It
is Cheryl's hope that by sharing her story, she will encourage people to
quit smoking and stay that way.
Serotonin affects the perception of pain, helping to "turn down the
volume." It also promotes deep, restful sleep. Studies have found that
levels of serotonin may be low or that the neurotransmitter may not be
processed effectively in people with fibromyalgia. Decreased levels of
serotonin may also lead to a change in the amount of substance P that is
released (thus sending pronounced pain messages to the brain) and lower
levels of stress hormones.
(Source: Natural Treatments for Fibromyalgia: An A to Z Guide, by Kenna
Simmons. An official publication of the Arthritis Foundation, available

There is some evidence that lavender aromatherapy may help relieve
anxiety and promote relaxation. [Jour Adv Nurs 1995 Jan; 21(1):34 and
Int Jour Neurosci 1998;96(3-4):217.] As for pain relief benefits, a
small study of people with rheumatoid arthritis showed mixed results.
After using massage with lavender aromatherapy, most reported no pain
relief; however, participants used fewer painkillers after the study, so
they may have felt less pain. But it's not clear whether the benefit, if
any, came from massage or aromatherapy. [Nurs Stan 1998;13:34.]
(Source: Natural Treatments for Fibromyalgia: An A to Z Guide, by Kenna
Simmons. An official publication of the Arthritis Foundation, available
Ginseng may help fight a number of illnesses. Animal research and a
small number of human studies have shown that it stimulates specialized
immune cells called "killer T cells" that help rid the body of
Studies have suggested that ginseng may lessen fatigue and reduce stress
by acting as a central nervous system stimulant, but the evidence is not
(Source: Natural Treatments for Fibromyalgia: An A to Z Guide, by Kenna
Simmons. An official publication of the Arthritis Foundation, available

The above "sound bites" courtesty of
My Cup of Tea

Chase away the chills with hot tea and you might lower your cholesterol.

In a study of black tea, people who combined a moderately low-fat diet
with frequent tea consumption lowered their LDL (bad) cholesterol as
much as 8 percent more than people who followed only the diet portion of
the cholesterol-lowering plan. Tea also is a rich source of
heart-healthy flavonoids.

RealAge Benefit: Reducing your total cholesterol to 160 mg/dl or lower
can make your RealAge as much as 1 year younger.

Raptiva Approved for Psoriasis Treatment
High-Tech Drug Blocks Immune Cells That Cause Psoriasis
By Daniel DeNoon
WebMD Medical News

Oct. 28, 2003 -- Raptiva is the newest drug to gain FDA approval for
chronic moderate to severe psoriasis.
It's the second so-called biologic agent to treat the autoimmune
problems at the heart of psoriasis. Raptiva -- generic name, efalizumab
-- is a designer antibody. It's designed to throw a monkey wrench into
the mechanisms by which immune cells cause psoriasis.
"I've been treating psoriasis for over 15 years and have always been
frustrated by the limited options available to treat patients with this
chronic disease," Craig Leonardi, MD, clinical associate professor of
dermatology of Saint Louis University in St. Louis, Mo., and a Raptiva
clinical investigator, says in a news release. "Raptiva has the
potential to break the cycle of intermittent therapy by offering
patients and their doctors a convenient treatment regimen that can be
used continuously."
"This is not just a victory for psoriasis patients, it is a victory for
biomedical research," Gail Zimmerman, president and CEO of the Psoriasis
Foundation, says in a news release. "In just 20 years we have gone from
having little understanding of the roots of psoriasis to seeing the FDA
approve drugs, like Raptiva, that improve a patient's symptoms by
targeting specific cells in the immune system. The biologic revolution
is generating valuable new choices for those living with this incurable
Raptiva is administered by a once-weekly injection under the skin.
Patients give themselves the simple injections at home.
Other biologic drugs that can or could potentially be used to treat
psoriasis include:
Amevive, the first systemic biologic agent approved specifically for
psoriasis treatment. It's given by intravenous feed or intramuscular
Enbrel is approved for psoriatic rheumatoid arthritis. It's given twice
weekly by skin injection. The FDA is reviewing it for treatment of
Remicade is approved for rheumatoid arthritis and Crohn's disease. It's
given by intravenous infusion every several weeks. It is also in
advanced clinical trials for treatment of psoriasis.
Side Effects
In clinical trials, common adverse events that occurred at least 2% more
frequently in patients treated with Raptiva than in patients treated
with placebo include:
Headache, chills, fever, nausea, and muscle pain. These symptoms usually
followed the first two Raptiva injections. Subsequent injections were no
more likely to cause these symptoms than placebo.
Infection (mostly upper respiratory infections)
Raptiva suppresses the immune system. It therefore can increase risk of
infection and reactivate existing latent infections. It's not known
whether Raptiva affects cancer risk, although some immune-suppressing
drugs do increase the risk of some cancers.
When It Will Be Available
Raptiva is expected to be available by the end of 2003. Invented by the
small biotech firm XOMA, Raptiva is manufactured by Genentech Inc., a
WebMD sponsor.
Basis of Approval
Raptiva approval is based on clinical trials involving some 2,700
psoriasis patients.

SOURCES: News release, Genentech. News release, Psoriasis Foundation.

© 2003 WebMD Inc. All rights reserved.
Current trends in fibromyalgia research
BlankExpert Opin Pharmacother. 2003 Oct;4(10):1687-95. Related Articles,
Current trends in fibromyalgia research.
Marcus DA.
Pain Evaluation & Treatment Institute, 5750 Centre Avenue, Pittsburgh,
PA 15206, USA.
The development of standardised criteria for the diagnosis of
fibromyalgia in 1990 has allowed careful study of this chronically
painful syndrome. Epidemiological studies show increased symptoms and
disability in patients with fibromyalgia, compared with other conditions
associated with chronic, widespread pain. In addition, prevalence and
severity of fibromyalgia symptoms are increased in women. Current
studies have identified strong evidence for central sensitisation in
fibromyalgia. Data from these studies may expand effective treatment
options for fibromyalgia.
PMID: 14521479 [PubMed - in process]

New insights for neuromuscular and autoimmune disorders
These are some of the research findings about multiple sclerosis (MS)
published in 2003. This research can help progress towards a cure not
only for MS, but for other neuromuscular disorders (such as amyotrophic
lateral sclerosis, ALS) and autoimmune disorders (such as Guillain-Barre
syndrome and chronic inflammatory demyelinating polyneuropathy, CIDP).
Fighting The Flu... With Food!
by Katherine Howdy Tate, MPH, RD, LDN
I hope it hasn’t hit you yet, but chances are it has. This holiday
season has ushered in its fair share of nasty colds, not to mention the
dreaded flu.
Even I sit here in a Sudafed fog wondering how my usually very steely
system let me down now. But, the truth is that I let it down. This is a
do-as-I-say, not do-as-I-did primer on how to keep your immune system up
to ward off the infectious illnesses that will dampen that holiday
Are you malnourished? While you might think not, many people skip meals
now more than any other time. Getting out of your routine happens due to
presents that must be bought, errands that have to be run and parties
that couldn’t survive without your attendance. I can’t even remember the
last time I ate with a utensil other than a frilly toothpick.
If cheese balls, pecans and spinach dip sound like a balanced meal,
chances are you are depleting those nutrition stores, which in turn
lowers your resistance to infections. Don’t skip the meals of real food.
Sometimes it can’t be helped, but work at making time for healthy meals
or at least a bowl of cereal, a salad, yogurt, fruit or cut up raw
vegetables. I don’t care how cute those holiday cookies are, a breakfast
they don’t make.
Vitamin C. You already knew that this was the cold-fighting antioxidant.
Vitamin C increases the production of infection-fighting white blood
cells and antibodies and increases levels of interferon, which is the
antibody that coats cell surfaces, thereby preventing the entry of
Don’t overdose on the stuff though, as some people can get diarrhea from
massive doses. About 200 milligrams is the recommended amount that can
be obtained from eating fruits and fortified foods. Why do you think
oranges and grapefruit are in season this time of year? Go get a bag of
delicious little navels and vow to eat them instead of fudge.
Vitamin E. This antioxidant stimulates the production of natural killer
cells and B-cells that destroy nasty germs and bacteria. This protection
for the immune system is especially important in the elderly, whose
immune function is reduced, which results in an increase in infections
and cancer.
Studies have shown that the previously recommended 15 milligrams
recommended is not as beneficial as the currently recommended 200
milligrams, which is hard to get with diet alone. Food sources include
plant oils, nuts, green leafy vegetables and wheat germ, although a
supplement is especially important for the elderly and other populations
with lowered immunity.
Zinc. While some studies have shown that the zinc lozenges can lower the
incidence and severity of infections, other studies have failed to show
this. More than 75 milligrams a day can actually inhibit immune
Good zinc sources are oysters or fortified cereal.
Hot Foods. Spice things up with chili peppers, hot mustards, pepper,
onions and garlic. Such foods contain substances called "mucolytics,"
which liquefy the sinuses a bit to ease congestion.
Hot Chicken Soup. The so-called "Jewish penicillin" is apparently more
than a bowl of TLC and soothing hot vapors. One study showed that there
are anti-inflammatory properties in the soup that stopped the movement
of neutrophils, which stimulates the release of mucous. Just a little
food for thought when you’re choosing your sick food.
Try to keep a routine as much as possible, including exercise. Pop a
multivitamin right now for good measure, drink lots and lots and lots of
water and don’t forget those oranges.
Among its many health benefits, vitamin C helps to boost levels of the
energizing brain chemical norepinephrine, which produces a feeling of
alertness and increases concentration. This is especially important for
those with fibromyalgia [and Chronic Fatigue Syndrome] who experience
periods of inattentiveness or "fibro fog" [brain fog].

*However, my fibro fog hit on this one and I deleted the source of
information! --editor
According to Harris McIlwain, M.D., "Malic acid, derived from the food
you eat, may play a key role in energy production, especially for those
with arthritis and related diseases. In several studies, patients with
FMS and other types of arthritis took malic acid. Within 48 hours of
supplementation, almost all had reduction of pain. Likewise, upon
discontinuation of malic acid, the improvement was quickly lost."
Source: Pain-Free Arthritis: A 7-Step Program for Feeling Better Again,
by Harris H. McIlwain, M.D., and Debra Fulghum Bruce, M.S. Published by
Owl Books and available at
Relaxin, a polypeptide similar to insulin, is secreted by the ovaries in
females and in the seminal tubules of males. Samuel Yue, M.D., finds
that Relaxin treatment decreases fatigue and muscle tension and spasm,
restores sleep quality, improves cognition, increases growth hormone
secretion, improves cardiac function, stabilizes the autonomic nervous
system, and regulates sex hormones.
FMS, and especially CFS, have been viewed as disorders of the immune
system, with underlying viral or bacterial infections suspected as
cofactors. No specific pathogen or immune abnormality has been
consistently or uniquely associated with either illness.
In theories pointing to immune dysregulation, an agent causes an initial
infection, dysregulating the immune system and thus allowing previously
dormant viruses to emerge from latency and actively reproduce.
Cytokines, produced in response to reactivated viruses, continue to
cause symptoms. Activation of certain cytokines may cause disruption of
the hypothalamic-pituitary-adrenal (HPA) axis, with abnormal levels of
HPA-related chemicals creating a vicious cycle and persistent symptoms.
Essential fatty acids (EFAs) are not naturally produced in the body, and
they supply linoleic and alpha-linolenic acid that have
anti-inflammatory properties. They help maintain normal membrane
structure and regulation of cell function, mediate cytokine effects,
modulate the HPA axis, and may have antiviral properties. Anecdotally,
EFAs improve pain, fatigue, and depression. They may decrease muscle
fatigue, morning stiffness, and joint tenderness; help the digestive,
cardiovascular, and immune systems; and assist reproductive functioning,
metabolism, and brain functioning.
DMAE (dimethylaminoethanol) is a supplement said to enhance
acetylcholine systhesis, increasing alertness, memory, energy, sleep and
mood. This supplement has not been widely tested for CFS/FMS patients.
DMAE is a natural food component, found especially in fish, and is also
a natural metabolite of the human body. It helps memory and learning
ability and raises blood choline levels.

Source: Chronic Fatigue Syndrome, Fibromyalgia, and Other Invisible
Illnesses - The Comprehensive Guide, by Katrina Berne, Ph.D. Published
by Hunter House books and available at
If you have fibromyalgia (FM), you should avoid high-impact exercise.
Impact is any motion that has you jumping and landing with a force
harder than normal walking. Doing exercise that includes moderate to
high-impact movements is almost never well tolerated by people with FM.
Examples of high-impact exercise are jogging, aerobic dance (not
specifically designated as low impact), double-footed jump roping,
jumping jacks, and similar movements. This type of movement almost
always causes muscles affected with FM to spasm and harden.
(Source: "Fibromyalgia: Simple Relief Through Movement" by Stacie L.
Bigelow, M.A.)
Stockpile fun distractions. We all need to keep lists handy of the
things that make us happy. One of the cruelties of having fibromyalgia
or Chronic Fatigue Syndrome is that when we need distractions most, we
are least equipped to seek them out. For this reason it is important to
compile a list of your favorite activities when you are feeling
optimistic to be used when you most need them. People with fibromyalgia
often describe how even their worst pain can be put on a back burner, so
to speak, when they become engrossed in an activity. This is not only a
psychological but a physiological response: our brains can only process
so much input at once. When we are engrossed in a beautiful movie,
talking to a good friend on the phone, or listening to our favorite
music while lying on a heating pad or in the bathtub, we can trick our
pain receptors into leaving us alone! Meanwhile, improvements in spirit
have an added impact on our entire well-being. Laughter is good
medicine; while dwelling on our troubles tends to compound them.
(Source: "Maintaining a Positive Attitude with Fibromyalgia and Chronic
Fatigue Syndrome: Ten Strategies" by Deborah A. Barrett, Ph.D.)
No matter how well you have prioritized your tasks, if you don’t pace
yourself properly, you may not have the stamina to carry out your plan.
Estimate your energy level realistically, and allow for some adjustments
as your fibromyalgia [or Chronic Fatigue Syndrome] symptoms worsen or
improve. Here are some tips:
• Take breaks during or between tasks, before you get too tired. A ratio
of 10 minutes of rest to every 50 minutes of activity works well for
many. When your symptoms are more active, rest longer and more
• Alternate light and heavy tasks, doing the toughest jobs when you’re
feeling your best. Stick to the time you planned to work and then quit –
you’ll get more done in the long run than if you wear yourself out.
• Avoid rushing. You’ll be more efficient at a comfortable pace than on
a hectic schedule that invites mistakes and accidents. Allow time for
the unexpected.
• Divide big jobs into little ones.
• Avoid activities that tax you beyond endurance. Just say no.

"All of us tend to push our limits, but we need to save that behavior
for times when something really good or important is at stake. Otherwise
we wind up with worse symptoms and worsening disease processes. We tend
to believe that we can't take a break because we have so much to do,
but, in fact, as we get more fatigued our efficiency drops off. It is
more effective to take breaks and come back refreshed."

"Although not all psychologists agree, many believe that keeping our
minds active will prevent memory loss and mental deterioration. Mental
activity can help prevent boredom, provide fun, and distract us from
unpleasant symptoms. We can do puzzles such as crosswords or play games
of varying levels of difficulty. Or, we may want to read, think, or
write about ideas or issues that interest us - the theory of relativity,
maybe, or why cats play with string. Anything helps, as long as it keeps
the mind active."
"In most conditions, for most people, the passive approach - going to a
doctor, a series of doctors, or other healers and saying 'fix me' -
offers much less than a 50-50 chance of success. One large study of
people with cancer found that only 22% of those who reacted passively
were still alive after ten years, compared to 75% of those who reacted
with a 'fighting spirit.' The difference in outcomes - though not
necessarily in mortality - can be as great or greater in other
conditions, particularly chronic ones."

(Source: The Art of Getting Well: A Five-Step Plan for Maximizing Health
When You Have a Chronic Illness, by David Spero, R.N. Published by
Hunter House and available at or by calling
While it may seem like the logical therapy for pain, a vigorous massage
can paradoxically make pain worse. A number of people have reported
worsened pain after general massage. The reason for the aggravation of
pain is probably due to the practice of placing excessive pressure on
nerve endings to relieve knotty muscles. Nerve compression only
exacerbates the pain created by an already irritated nervous system.
Vigorous massage can also release accumulated toxins into the system.
Patients with Chronic Fatigue Syndrome may feel general malaise after
massage because of the sluggish elimination of these toxins. On the
other hand, gentle massage is often beneficial.
(Source: "Chronic Fatigue Syndrome: A Treatment Guide" by Erica F.
Verrillo and Lauren M. Gellman)
Grape seed extract is a flavonoid, a plant substance with antioxidant
properties that protect cells from damage by free radicals (unstable
oxygen molecules). As its name suggests, the extract is made from the
seeds, and sometimes the skins, of red grapes.
Some laboratory tests suggest that active ingredients in grape seed
extract, called procyanidolic oligomers (PCOs) or proanthocyanidins,
have 50 times greater antioxidant activity than Vitamin C or E. PCOs may
also improve blood circulation and help strengthen blood vessels, and
may help reduce swelling after surgery or injury.
People with fibromyalgia may take grape seed extract because its
antioxidant power may help protect muscle cells from damage.
NADH is a coenzyme that the body makes from vitamin B3 (niacin). As
their name suggests, coenzymes help enzymes work properly; enzymes are
proteins that act as catalysts to change other substances in the body,
such as changing food into energy.
NADH is used by the brain to make certain neurotransmitters and
stimulates the production of ATP, which helps release energy in cells.
Since some researchers believe an ATP deficiency contributes to
fibromyalgia, NADH has been suggested as a supplement that may lessen
fatigue and boost energy [a Georgetown University Medical Center study
showed that NADH significantly boosted energy levels in CFS patients].
(Source: Natural Treatments for Fibromyalgia: An A to Z Guide, by Kenna
Simmons. An official publication of the Arthritis Foundation. To
purchase, visit
Perhaps the most popular relaxation modality is music therapy. Whether
New Age, rock, jazz, or classical, many people find that music distracts
them from the painful moment, helping to reduce mental stress. In fact,
in some hospitals, staff members give patients tapes of soothing music
and reassuring voice-overs to use during surgical procedures. In
clinical studies, both doctors and patients agreed that listening to
music produced greater decreases in peaks of tension, and produced
greater compliance with relaxation practice. While the studies are
limited, it's thought that music therapy can help to improve mood and
pain tolerance. This therapy is thought to enhance the parasympathetic
response through the effects of sound, encouraging relaxation at a deep
(Source: The Women's Guide to Ending Pain: An 8-Step Program, by Howard
S. Smith, M.D., and Debra Fulghum Bruce, M.S. Published by John Wiley &
Sons, Inc.)
Several studies have examined ginger's nausea-relieving properties.
Results have been mixed: There is some evidence that ginger is effective
in treating motion sickness, and nausea caused by other drugs or
anesthesia. [Br J Anaesth 2000;84(3):367] Ginger has also been studied
to see if it helped women with severe nausea during pregnancy; several
small studies suggested it was indeed effective.
An uncontrolled study of the effect of ginger on arthritis and muscle
pain showed that all patients with musculoskeletal pain found relief,
and three-fourths of those with rheumatoid arthritis or osteoarthritis
also saw a decrease in pain and swelling [Med Hypotheses 1992
Some studies show that acupuncture is helpful in relieving both chronic
and sudden pain, though other studies show it is not effective for
chronic pain. However, a recent study in Brazil examined the use of
acupuncture in the treatment of fibromyalgia and found that it
significantly reduced both pain and depression. [Rheumawire 11/22/02.]
The study also found that benefits from acupuncture, which was
administered once a week, started about two to three weeks into
treatment and reached its full effect at around five weeks.
(Source: Natural Treatments for Fibromyalgia: An A to Z Guide, by Kenna
Simmons. An official publication of the Arthritis Foundation. To
purchase, visit
To determine collagen and muscle pathology in fibromyalgia (FM)
patients, muscle biopsies were obtained from 27 female FM patients, and
from eight age-matched female control subjects. Amino acids were
determined by HPLC and electron microscopy was performed. The FM
patients had lower hydroxyproline and lower total concentration of the
major amino acids of collagen than the controls.
No significant difference was seen in the concentration of the major
amino acids of myosin or of total protein. Electron microscopy showed no
significant differences between FM patients and controls although
atrophied muscle fibrils occurred in FM patients only, but frequencies
were not significantly different.
It was concluded that the fibromyalgia patients studied had a
significantly lower amount of intramuscular collagen. This may lower the
threshold for muscle micro-injury and thereby result in non-specific
signs of muscle pathology.
(Source: Rheumatology (Oxford), 2003 Jul 16. Gronemann ST, Ribel-Madsen
S, Bartels EM, Danneskiold-Samsoe B, Bliddal H.)

These snips from books gleaned from

Virus-Related Muscle Damage Tied to Chronic

Chronic fatigue syndrome seems to occur sometimes after a virus
infection. Now, researchers have shown that some patients with the
syndrome have evidence of virus in their muscles, and this in turn is
linked to abnormal muscle function. Researchers at Imperial College in
London looked for RNA from enteroviruses in muscle biopsies taken from
48 patients with chronic fatigue syndrome and from 29 people with normal
muscles. Muscle biopsy samples from 10 of the 48 chronic fatigue
patients were positive for enterovirus RNA. In addition, the patients
with chronic fatigue syndrome went through an exercise test on the day
of the biopsy, and the researchers measured the patients' blood levels
of lactic acid before and after the test. Twenty-eight patients had an
abnormal lactate response to exercise, "reflecting impaired muscle
energy metabolism." Moreover, 9 of the 10 subjects who tested positive
for the presence of virus in their muscles had this abnormal response.
The team concludes s that their findings support the notion that chronic
fatigue syndrome has different causes, "and that some cases have a
peripheral component to their fatigue related to muscle dysfunction."

Functional status of persons with chronic
fatigue syndrome
Scant research has adequately addressed the impact of chronic fatigue
syndrome on patients' daily activities and quality of life. Enumerating
specific problems related to quality of life in chronic fatigue syndrome
patients can help us to better understand and manage this illness. This
study addresses issues of functional status in persons with chronic
fatigue syndrome and other fatiguing illnesses in a population based
sample, which can be generalized to all persons with chronic fatigue.
Until recently, fibromyalgia was considered an adult disorder; children
were thought not to get it. Then, in a study published in the Journal of
Rheumatology in 1993, a team of doctors in Israel reported that 6.2
percent of 338 healthy schoolchildren between the ages of nine and 15
met the criteria for the fibromyalgia syndrome. At nearly the same time,
a rheumatologist in the US asserted that 45% of the children referred to
him had FM. Of these 15 children, nine had been diagnosed incorrectly
with juvenile chronic arthritis, three had been told they had growing
pains, and two had been given a psychiatric diagnosis. Since then,
doctors have been paying more attention to children's complaints of pain
and are diagnosing FM with increasing frequency.
Fibromyalgia Takes Different Tolls on Different People
Fibromyalgia patients, who suffer pain in the muscles, joints, ligaments
and tendons, are not all the same and can be classified into three
distinct subgroups, a new study suggests.

Tragic Case In Florida Highlights Need For Talking Early
The tragic case in Florida involving Terri Schiavo has gathered national
attention and highlights the vital importance for all of us to document
our wishes about medical care, so they can be taken seriously should we
not be able to speak for ourselves. Terri Schiavo incurred severe brain
damage over a decade ago due to a possible stroke. She has become the
center of a painful controversy between her husband and her family,
which now involves the governor and legislature of Florida, about
whether the artificial nutrition and hydration keeping her alive should
be discontinued. The case is very difficult for one main reason - Ms.
Schiavo did not have any written documentation (called Advance
Directives) in place at the time of her injury. Thus, there is no
written proof of how she would like to be cared for.
For background information about this case see the article that appeared
in the St. Petersburg Times on October 28, 2003 entitled "Understanding
Terri Schiavo" by going to the following link:
Partnership for Caring plays a crucial role in helping people avoid such
a tough situation. Our Web site includes free advance directive
documents, which you can download at no charge, along with other
resources to help you plan for difficult end-of-life decisions. To get
your free advance directive and other resources, and to read Partnership
for Caring President Karen O. Kaplan's statement on the Schiavo matter,
please visit the PFC Web site at
VA to Survey Gulf War Veterans' Health
WASHINGTON (Dec. 15, 2003) -- Veterans of the first Gulf War recently
received a letter from the Department of Veterans Affairs (VA) asking
them to take part in a survey about their health.
"We are committed to finding answers for veterans who still suffer from
a variety of symptoms and illnesses resulting from their service in the
first Gulf War," said Secretary of Veterans Affairs Anthony J. Principi.
"With soldiers returning every day from operations there, pursuing these
answers remains a top priority."
The survey, called the Longitudinal Health Study of Gulf War Era
Veterans, is a follow-up to one conducted in 1995-1996 on the health of
30,000 veterans of the 1990-1991 Gulf War.
A letter signed by Principi was sent to veterans explaining the study's
purpose and procedures for enrolling and encouraging their
participation, whether or not they took part in the original survey or
served in the Gulf War theater.
Participation is voluntary. Veterans fill out a detailed survey with
questions about general health, functional status, chronic medical
conditions, unexplained multi-symptom illnesses, doctor and hospital
visits and treatments. All information is confidential.
Dr. Han K. Kang, director of VA's environmental epidemiology service,
who conducted the earlier study, will lead the research effort.
You're are like a snowflake:
Snowflakes are incredibly beautiful upon close inspection, although they
seem the same, all are wonderfully unique.
God created snowflakes as nature's reminder to us, that although in many
ways we are the same, we too are
Incredibly beautiful and unique!

What Is This Thing Called Sleep?

Untangling the Mysteries
Ever since time began, man has puzzled over the mysteries of sleep. What
is it? Where does the mind go when the eyes close? Why do we need to
Sure, a few answers and theories have evolved over the years, but, truth
be known, we're really not much farther ahead in untangling the
mysterious web of sleep than we were in caveman days.
To the best of my knowledge, no human has ever died from lack of sleep.
Rats, however deprived of sleep for two or three weeks, will die. And,
while man may not die, both his physical and mental health do suffer.
Lack of sleep weakens the immune system allowing a variety of diseases
and disorders to enter the body. Diabetes, high blood pressure and heart
disease are all caused, or at least aggravated by sleep deprivation.
Even cancer finds a bigger welcome into the body of anyone who is
lacking sleep.
It isn't just man who needs sleep. All animals, birds, reptiles and even
insects spend time in the somnolent state. And, believe it or not, but
even our leafy friends need periods of rest, although with plants,
rather than sleep, this is called dormancy.
But none of this answers the question of what sleep is. Why does the
body temperature drop? Why do bodily functions slow down? Why do we
breathe deeper and more slowly as we sink into slumber?
We still aren't sure of what processes take place in the brain. REM
(Rapid Eye Movement) sleep shows the sleeper is dreaming. Dreams and
nightmares only add to the mystery. Perhaps dreams are the brain's way
of clearing out the useless debris of the day. Perhaps nightmares help
us deal with our hidden fears.
Perhaps. But we can't be sure. Not yet. Researchers are digging deeper
into these mysteries, but progress is slow. Like the early cavemen, we
can only lay in our beds at night and wonder: What is this thing called

~ Florence Cardinal

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Trauma And Worry
Worry can spark action if you worry and recognize that a plan of action
is necessary-- and you act. Under those circumstance worry is serving
you well.

Worry can spark your imagination. Sometimes having a cerebral cortex is
not much fun. Imagination can litter our internal environment with every
manner of fearful possibility. Many of the fearful possibilities do not
exist outside of our fertile imaginations. Nonetheless, they trigger the
same damaging chemical and physical changes as a actual emergency.

Physical and Chemical Changes. When you worry, which often accompanies
trauma , your body begins to pump out an array of chemicals (such as
adrenaline) that increase the flow of blood and oxygen to your brain and
skeletal muscles. Your blood also clots faster, ready to repair any
injuries you sustain in your "fight or flight."
Possible Consequences of Worry and Stress

You may be all keyed up with nothing to fight or flee and no way to turn
off the stress chemicals. You become a ticking bomb that is not allowed
to explode-consequently, you may implode. If this happens frequently or
over a long period of time, it can have a serious effect on your health.

Every system in your body is affected by worry. In addition to raising
blood pressure and increasing blood clotting, worry can prompt your
liver to produce more cholesterol, all of which can raise your risk of
heart attack and stroke. Muscle tension can give rise to headaches, back
pain, and other body aches. Worry can also trigger an increase in
stomach acid and either slow or speed up muscle contractions in your
intestines, which can lead to stomach aches, constipation, diarrhea, gas
or heartburn.
Worry can affect your skin (rash or itch). It can impact your
respiratory system and aggravating asthma. Growing evidence even
suggests that chronic worry can compromise your immune system, making
you more vulnerable to bacteria, viruses, perhaps even cancer.
What should I do?
Talk to someone. Talking to someone about your fears or concerns can
shine the light of reason on the products of your imagination. Take
action! When nature gave us the imagination to help us identify
potential threats, she also gave us fear to spur us to take protective
action. Make a plan and follow it through. Learn to let go. Learn to let
go. No, I did not make a mistake, at least not this time-that statement
bears repeating. In other words, this is very important. Sometimes
knowing the difference between a situation over which you have control
and one over which you have no control can help. If there is nothing you
can do -acceptance-may be the answer. If you have a clergy person with
whom to talk he or she may be able to guide you. However, if you find
that you are unable to function, please consult your primary care
physician for a referral to a therapist. You deserve to feel well.

Switch gears.
Think of something over which you have control or a least something more
pleasant. Do something you enjoy, perhaps with a friend. You can also
test reality with a friend. (Chou, 2000) Help someone who truly needs

Work those muscles.
Exercise is an incredible way to relieve stress, burn calories, decrease
depression and work toward wellness.

Stop the worry before if has the opportunity to take control of your
emotions and thoughts. You must work quickly and strike when you first
become aware of the negative thoughts that fuel worry. Do something:
exercise, splash cold water on your face, snap a rubber band, call a
friend, or imagine a big flashing stop sign in your mind’s eye. You may
want to listen to a relaxation CD or go on a mini vacation in your mind.
Whatever you choose should channel your thoughts in another more
positive direction.

Practice, Practice, Practice.
It will soon become second nature to relax, exercise, or change
thoughts, rather than doing the old counter-productive worrying.

Caution: You may want to avoid eating or drinking alcoholic beverages to
medicate the discomfort of anxiety and worry. They can be very dangerous
soothing behaviors and as one could predict-- they do not work. The
original problems are still there--they simply have company.

Be well-- you deserve it.
© Copyright Dr. Dorothy McCoy

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