Fibromyalgia Newsletter #50

FMS COMMUNITY NEWSLETTER # 50
April 25, 2004

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April 25, 2004
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2131 subscribers
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Editor: Mary McKennell
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Editorā€™s Corner
"What happened to the newsletter?ā€™ some of you may have been wondering. Limiting my time on the computer has been one of the few things that it has been within my power to control. I took that one little thing that I had some control over and did it. Also we got new puppies in January. It has been 15 years since we had puppies in the household. My husband and I were much younger then! I had forgotten how demanding they could be. But they have also been the source of joy and laughter. They have calmed down some so that I do not have to constantly have them within my sight. So I am back at the computer and getting caught up on a number of projects.
Perhaps you have heard of a book called The Purpose Driven Life. I read this book twice in a setting where we went rapidly through the book in 8 weeks. Each time I gained insight from reading it. Currently I am in a small discussion group where we are moving through it at a much slower pace and having a great time in the process.
One of the chapters asks the question "How do you see your life?" I have had a great deal of fun going around asking people this question in recent weeks. The way that you see your life shapes your life. Rick Warren says in this book that how you define life determines your destiny. Your perspective will influence how you invest your time, spend your money, use your talents and value your relationships.
If I were to ask you how you picture life, what image would come to your mind? That image is your life metaphor. This unspoken metaphor influences your life more than your realize. I have asked this question in my support groups and posed the query to various friends and acquaintances. I have been totally fascinated with the responses that I have received and what I have learned about people in the process.
To give you an example, some people might describe their life as a party, or a race, a roller coaster, living in a minefield or a journey.
If you think life is a party then you will place great emphasis on having fun. If you see it as a race then you place value on speed and are probably in a hurry all of the time. If a minefield describes your life then you tread very cautiously in order to prevent explosions.
I have been giving a great deal of thought to whether the metaphor shifts or changes once we are living with chronic illness. Or is changing the way we view life part of the answer to successfully living with this crud? If it does not change in some way is that perhaps one of the roadblocks to becoming the best that we can be? One of the most delightful answers that I got was from someone in one of my support groups who said that she had changed from being a survivor to a thriver as a result of her illness. Her illness has caused her to slow down and take joy in the moment.
Long before my FMS, MPS & CFIDS fully blossomed, my friends would tell me that I seemed to thrive in the midst of crisis and I came to think of my life as a roller coaster. Everything in the self-help literature talks about the need for pacing yourself, setting limits, etc. As I began learning more about how to manage these conditions I began to describe my life as being on a balance beam. I realized that part of the problem was that I was still on the roller coaster and trying to be on a balance beam at the same time. No wonder I was feeling dizzy all the time!
I am trying to change my motion metaphor to a carousel. A carousel is a bit slower. It still has its ups and downs but they donā€™t jolt you as severely as a roller coaster's dips and dives. I am still trying to figure out how to be on a balance beam and a carousel at the same time though. At any rate itā€™s a lot safer to be on a balance beam on a carousel than on a roller coaster. And carousels can go fast in some circumstances. There is this marvelous carousel in Monterey, Ca. That really zooms. Maybe I donā€™t have to do both at the same time after all. I know I need to live life slower in order to be the best that I can be.
I hope that this question of "how do you view your life?" gives you something to think about. If nothing else it provides for some fascinating conversations with people. I would love to know what some of you come up with for your personal metaphors!
On with the newsletter! I am fairly certain that the next edition will not take 3 months to find its way into cyber space. But if once again I find myself in need of something to control, this endeavor may be it. Meanwhile, this edition should occupy you for quite awhile. The last article is definitely Christian so skip it, if that is offensive to you. Otherwise, I hope that you find some encouragement in it.
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FROM BRUCE CAMPBELL: (bruce.c-@flash.net)
Since the last newsletter was sent out there are several items that have been featured at the CFIDS & Fibromyalgia Self-Help web site http://www.CFIDSselfhelp.org
Check out one of the recent Success Stories series. CFIDS patient Margaret Fergusson explains how she used self-help to improve from 15% to 70% functionality.

Depression, which is common in long-term illness, sometimes leads to thoughts of suicide. Guest author Lisa Lorden offers ideas for coping when life seems hopeless in an article on depression and suicide.

"Developing a Partnership with Your Doctor" The article, which suggests how to make your medical visits productive, is the third in a four-part series on self-management. The series describes things you can do to help yourself when you are a patient with a long-term illness.
And finally there is an article by Lisa Lorden on what you can learn from participating in a self-help program.
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FROM ROASLIND JOFFE:
rosa-@common-goals.com
www.common-goals.com
I laughed when I saw a news photo of a smiling John Kerry playing hockey, because I knew that his campaign staff had read the same article I did. The writer maintained that Kerry had a chance of winning the primary race in New Hampshire if he could convince people he was just a "regular guy".

So what did his staff do? They reacted by having him photographed in a rink, trying to look like he did this all the time and was having fun, like the "regular guys" in New Hampshire would.

Howard Dean reacted to the media's criticism that he didn't seem like a "normal" family guy by bringing his wife to the campaign podium - after insisting that his family life is a private matter.

Here's a question: Why can't these guys learn that the more they stay in a reactive position, the less people really believe them? (Yes, I know that John Kerry won New Hampshire but it wasn't because he looked happy on skates. And, it won't necessarily get him the nomination.)

This is what I think: when you really want something and fear takes over, it becomes difficult to act thoughtfully and from strength. Fear makes you wait, put out feelers, spend a lot of energy trying to gauge the response, and then react. You live in a defensive position. It's okay to drive defensively but it becomes a problem when you live that way.

I thought of this when I read an email from a reader who wanted to know if I thought that she should tell her boss of 2 years that she has depression. And, she added, they have a good relationship.

It might seem odd that she can't figure out the right time to tell someone whom she's known for 2 years about her chronic illness. But, living with chronic illness can do that to you. Not unlike trying to win an election, it can keep you on the defensive, trying to gauge other's reactions, rather than being proactive and creating your message.

In my business, CIcoach.com, I introduce myself by saying that I work with people who have chronic illness who want to thrive in the workplace. Then I say that I can do this because I've lived with chronic illness for 25 years. It's funny, but I feel lucky that I can talk about CI right at the outset because this information promotes what I do. I no longer have to worry about when or how to bring this up.

Each relationship and each encounter is different and that can make talking about this difficult. Unless you're careful, this can create a reactive, rather than a pro-active situation.

With that in mind, I suggest to you three pitfalls to avoid:

1. Letting other people form their own opinions about why you're handling your work differently.

2. Assuming that people already know what they need to know about your situation and thinking that if they wanted to help, they would.

3. Waiting until you've under-performed in the eyes of your colleagues for so long or so badly that no one wants to see you succeed or believes that you can.

Don't be like those guys who run for office. Create your message so others don't do it for you. Think about what you want to say about your illness, to whom you should say it and when you want to talk about it.

If you see missed career opportunities, have problems with co-workers or lack the support you need because you don't know how to talk about your chronic illness, contact me. Email me or call me and let's talk about how my program, Living with Chronic Illness and Unhappy in Your Job can help you be more successful in your work.
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"Talkin' 'bout chronic illness"

Why is it tough not to get upset by responses to your chronic illness or condition? Because it's easy to feel isolated when you are sick in a healthy world. It's even more isolating when your illness is not visible. And, sometimes the more you say, the worse you feel. So, what can you do?
I offer you these 3 ideas to consider:

(1) Many people are misinformed about chronic illnesses. When you have to explain that you are unable to do something, focus your message on how the disease affects you, rather than on the disease itself.
Ā· "I can't go on the hike because my Crohn's disease requires me to be near a bathroom at all times."

You might choose not to name your disease, because of incorrect associations.
Ā· "I have a condition that makes it difficult for me to stand up for too long."
Ā· "I have an auto immune illness which requires that I have frequent doctor's appointments."

(2) Chronic illnesses are frequently invisible. This means that although you can feel very differently than the way you did yesterday, you look the same. That can really cause a disconnect for other people!

So how do you convey how you currently feel when it seems counter to what others see? When I used to say, "I'm in an MS flare," I would invariably get a blank stare. I've learned that it's best to stick to what can easily be grasped.

Which do you think is more effective?

Ā· "I can't attend the meeting because I'm in an MS flare."
Ā· "I can't attend the meeting because I'm having trouble walking today."

Try it out for yourself!

(3) Unfortunately, even the most thoughtful people can forget to think before they speak. (Or fail to consider how others will hear what they say.) Inevitably you'll get a response, as Julie has, "Asthma keeps you at home in cold weather? I thought you were tougher than that."

When you have to say that you can't do something because you feel poorly (dizziness, pain, fatigue, etc.), you hope to get empathy and acceptance. So, when you get the response, "Oh, yeah, that happens to me - but I don't let it get in my way," it's easy to want to strangle the person who said it. (This is when you give yourself points for resisting the temptation!)

Many people tell me that they find that the best response is no response. I'll accept that this might be true, occasionally. But the fact is that most people have no clue about your experience. I know this is difficult to do but wouldn't you rather reduce your isolation and help someone understand your world better?

The next time someone says, "I don't see why this should stop you," try this:

"Unfortunately, asthma does make it difficult for me to be outside when it's very cold. But, I've found ways to successfully keep my life going, meet my commitments and minimize leaving the house during the winter."

For most of us, these aren't easy messages to deliver. They don't exactly roll off the tongue. But, I've found that if you practice this (try saying it aloud to yourself while you look in the mirror), it will not only become easier, you might actually grow comfortable with it.

When you craft a thoughtful reply the next time someone offers an ignorant response, you will decrease your isolation. You will also go some distance toward educating people about what it's like to live with chronic illness.
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Should Job Hunters Reveal Chronic Illness?
The Pros and Cons
January 13, 2004
By JOANN S. LUBLIN
Staff Reporter of THE WALL STREET JOURNAL

Graphic artist Lisa Hall hid her stiff and swollen fingers during job interviews last spring with Kaestle Boos Associates, an architectural firm in New Britain, Conn.
The firm hired Ms. Hall without knowing that she has had scleroderma since 2000. The chronic connective-tissue disease typically kills patients within 10 years. If she had divulged her disorder before she joined, "the safer route would have been to hire someone else," says Laura Morris, her supervisor. But, she adds, "I'm glad I didn't."
To tell or not to tell is a complex question that job hunters with a chronic illness must confront. Thanks to improved treatments, many of the 125 million Americans with a chronic condition hold jobs or seek work. Federal disability law bars most employers from asking about an applicant's ailments. However, the U.S. Supreme Court has ruled that a company may refuse to hire a prospect whose medical condition might be worsened by a particular job.
Individuals with a potentially debilitating though unobvious chronic illness often keep silent about their condition during their job search. "If you disclose beforehand, employers can find a million other reasons not to hire you," warns Darren Flomberg, a career coach and rehabilitation counselor for the Five O'Clock Club, a career-counseling network in New York.
Ms. Hall agrees that favoritism toward healthy candidates "is a fact of life." So in applying to Kaestle Boos, the 34-year-old artist decided "to play off my ability, my experience and my background."
But covering up her disease deeply disturbed Ms. Hall. "I didn't want to lie," she explains. A week after she started work, the probationary staffer felt comfortable enough to tell Ms. Morris and other colleagues about her scleroderma. "I said, 'I want no special treatment. I may have a bad day once in a while.' " She promised to make up work missed due to her medical appointments.
Some bosses would feel betrayed by a new hire's deceptive behavior. Ms. Morris reacted differently. "My concern was, 'Can she do the job?' " the marketing manager recalls. Her qualms soon dissipated. Ms. Hall demonstrated she's very talented and thrives under pressure. "It's nice and calming when things start to go crazy and Lisa says, 'We'll figure it out,' " Ms. Morris says.
Chronic-illness coach Rosalind Joffe makes an equally convincing case for pre-employment disclosure. Ms. Joffe, diagnosed with multiple sclerosis 25 years ago, has divulged her disease in advance of landing spots as a teacher and a mediator. "More people should consider [disclosure] as an option because there are real upsides," the Newton, Mass., coach contends.
Ms. Joffe urges clients to bring up their chronic condition while negotiating an offer. Then, both sides "know what's on the table. You're more likely to walk into a situation that's more flexible," she says. You don't have to provide many details about your symptoms, she continues. "Say, 'I have a chronic illness and this is how it affects me.' "
Bring up your chronic illness during the recruitment process "if there's more than a 10% chance of there being a problem during your employment," concurs New York executive coach Dee Soder. Explain what you've done to reduce the chances of a flare-up, she suggests. Hiring managers appreciate "that you're taking the unpredictability out of it."
Heeding such advice, 22-year-old Amanda Daly revealed her mild multiple sclerosis after a Massachusetts museum offered her an historical interpreter's post last spring. The museum wanted the fresh college graduate to wear a wool costume and mainly work outside. She knew she might tire easily doing so on hot days. Officials agreed that she could work largely indoors or take a different outdoor assignment that didn't require a costume.
The Boston-area resident, who had begun job hunting in January, spurned the offer because she disliked the prospect of an 80-mile roundtrip commute. She later cited her illness in cover letters to employers that serve the disabled or promote their interest in diverse candidates. That gambit hasn't paid off yet.
The accomplished young singer is now debating whether she should disclose her disease during a second round of job interviews with a Boston music organization this month. "You don't want to be sneaky," she says. But "everybody has something that employers will find out with time. And I don't have a visible disability."
A New Jersey newspaper reporter informed management about her ulcerative colitis before she accepted her current spot in September 2002. Her upfront frankness paid off when she needed a weeklong hospital treatment last month for the chronic colon inflammation. Higher-ups "were all incredibly supportive, [with] no questions asked," remembers the 28-year-old journalist. "If employers feel like they've been duped, they have much less reason to be supportive about your missing work."
In the final analysis, chronically ill applicants must carefully weigh the pluses and minuses of exposing their malady sooner rather than later. As Ms. Joffe notes: "There's no right or wrong."
URL for this article:
http://online.wsj.com/article/0,,SB10739498076300700,00.html
Copyright 2004 Dow Jones & Company, Inc. All Rights Reserved

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Trauma And Worry
BY DR. DOROTHY MCCOY
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 an 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 it.

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 mindā€™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.
Ā© Copyright Dr. Dorothy McCoy

http://www.pioneerthinking.com/trauma.html
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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 sleep?
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 sleep?

~ Florence Cardinal

Copyright Ā© 2003 About, Inc. About and About.com are registered trademarks of About, Inc. The About logo is a trademark of About, Inc. All rights reserved.

http://sleepdisorders.about.com/cs/sleephygiene/a/sleep_p.htm
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MedWatch - The FDA Safety Information and Adverse Event Reporting Program

The FDA asked manufacturers of the following antidepressant drugs to include in their labeling a Warning statement that recommends close observation ofadult and pediatric patients for worsening depression or the emergence ofsuicidality when treated with these agents. The drugs that are the focus ofthis new Warning are: Prozac (fluoxetine); Zoloft (sertraline); Paxil(paroxetine); Luvox (fluvoxamine); Celexa (citalopram); Lexapro
(escitalopram); Wellbutrin (bupropion); Effexor (venlafaxine); Serzone
(nefazodone); and Remeron (mirtazapine).

See the 2004 MedWatch safety summary, including links to the drug
information page and the FDA Public Health Advisory, at:

http://www.fda.gov/medwatch/SAFETY/2004/safety04.htm#antidepressants
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How to Reduce Your Risk of Heart Disease and Alzheimer's
By John McKenzie

ā€” It is one of the greatest fears of growing old: losing your memory to Alzheimer's disease.
An estimated 4.5 million Americans have the disease and the number is growing. But who are those most at risk? Researchers are now discovering a direct link between Alzheimer's and heart disease.
This link between brain damage and heart damage was discovered during a series of autopsies more than 20 years ago.
While working in the Kentucky medical examiner's office, Larry Sparks was checking brain tissues looking for early signs of Alzheimer's disease.
He noticed that those who had the telltale plaques of Alzheimer's had one thing in common:
"I took the slides ā€¦ and put them into two piles, those with heart disease and those without heart disease. And all the plaques and tangles showed up in the pile with heart disease," said Sparks, who is now a scientist with Sun Health Research Institute in Arizona.
That finding, for the first time, suggested heart disease could be a forerunner of brain disease.
"The link between heart disease and Alzheimer's disease is growing in strength every few months," said Bill Thies, the scientific director of the Alzheimer's Association. "And we predict it will continue to grow."
"I'm not surprised that there's a relationship," he said. "The heart is the organ that supplies essential elements to many parts of the body, and the brain is just one of the first."
Risk Factors
A series of studies has revealed that the very same risk factors for heart disease also put people at greater risk of developing Alzheimer's.
In one study, people with high cholesterol in their 40s and 50s were three to five times more likely to become demented in their 60s and 70s.
"We found that excess cholesterol in the blood," Sparks told ABCNEWS, "leads to increased cholesterol in the brain and that increased production of cholesterol in the brain promotes production of plaques."
High blood pressure ā€” above 140/90 ā€” also increases the risk of Alzheimer's by damaging blood vessels.
"They become more stiff and this may lead to a decrease in the nutrients that can get to the brain and feed cells in the brain," said Lenore Launer, chief neuroepidemiologist at the National Institute on Aging.
Moderate smoking ā€” 10 to 20 cigarettes a day ā€” according to some research, can double or triple the chances of becoming demented.
"With every cigarette you smoke, there's probably an increased risk," Launer told ABCNEWS.
And preliminary Obesity research suggests the more overweight you are at 70 years of age, the greater your Alzheimer's risk.
The good news, researchers say, is that this is the first set of risk factors they've identified that people can actually do something about. Medications and lifestyle changes that have been used to promote heart health may actually protect brain health as well.
Copyright Ā© 2003 ABC News Internet Ventures.

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Rand Study Says Disability Rates Rise, Finds Link to Obesity
January 8, 2004 - Arlington, VA - (RAND) The obesity epidemic caused disability rates to rise sharply in the last two decades among Americans younger than 60, according to a new study by RAND Corporation researchers.
The RAND Health study was published in the January edition of the journal Health Affairs.
The study found that the number of people ages 30-49 who were disabled in their ability to care for themselves or perform other routine tasks increased by more than 50 percent from 1984 to 2000.
For people ages 30-39, the number reporting disabilities rose from 118 per 10,000 people to 182 per 10,000 people from 1984 to 1996. For those ages 40-49, the numbers rose from 212 per 10,000 to 278 per 10,000 during the same period. In addition, researchers found smaller but still significant increases for those ages 18-29 and those ages 50-59.
In contrast, disability declined by more than 10 percent for people ages 60-69, the study found.
The study results surprised researchers, who warn that the increase in the disability rate could have severe consequences for the nationā€™s future health costs.
"People who are disabled generally use a lot more medical services so in the long run this trend could add a lot of costs to the nationā€™s health care bill," said Dana Goldman, a study co-author and director of health economics at RAND Health.
Some portion of the rise in disability may be explained by disability insurance incentives and advancing medical technology that saves the lives of people who even a few years ago might have died, according to the study. But the only factor researchers could identify that would explain such a large jump in disability is obesity.
"Obesity is the only trend that is commensurate in size with what we found happening with disability," said Darius Lakdawalla, lead author of the report and a RAND economist. "Itā€™s the only suspect. We found that there is something going on with peopleā€™s health and that the increase is not just a case of people dropping out of the workforce and going on the public dole."
Musculoskeletal problems (such as chronic back pain), which are linked to obesity, are one of the nationā€™s leading causes of disability, along with mental illness. Obesity also is a major factor in the development of diabetes, which accounts for a small number of disability claims.
The number of disability cases attributed to musculoskeletal problems (primarily back problems) and diabetes grew more rapidly than those from other problems during the study period, with the proportion of diabetes-related disability doubling.
Since 1984, disability among the nationā€™s older population has dropped, even though this group was considered most at risk for disabilities, the RAND study found.
Researchers had known that the number of people filing for disability benefits had risen during the study period. But the increase generally had been attributed to relaxed standards for disability claims that have made it easier to file for benefits.
Researchers found that disability rates rose for all demographic groups not in the age 60-69 category: for whites and non-whites, for those who worked and those who didnā€™t, and for people with all levels of education.
Researchers conducted the study by examining information collected from 1984 to 2000 by the National Health Interview Survey, a nationwide survey that collects a wide array of information from about 36,000 households annually.
Beginning in 1984, the survey asked participants a variety of questions about whether they needed help with personal care or other routine needsā€”the information analyzed by RAND Health researchers.
RAND researchers say their findings show there should be better efforts to study disability trends among younger people.
"We need to study this trend further and improve our measurement tools because the rise in disability has enormous consequences for public finances," Goldman said.
Support for the study was provided by the Centers for Medicare and Medicaid Services and the National Institute on Aging. Jay Bhattacharya, an assistant professor of medicine at the Stanford University School of Medicine, is another author of the report.
RAND Health is the nationā€™s largest independent health policy research organization, with a broad research portfolio that focuses on health care quality, costs, and delivery, among other topics.

~ RAND Corporation

Copyright Ā© 2004 About, Inc. About and About.com are registered trademarks of About, Inc. The About logo is a trademark of About, Inc. All rights reserved.

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A Biological Basis for Repressed Memories
Jan 11 2004

Research reveals for the first time the biological mechanism that the brain uses to block unwanted memories. The study, published in the journal Science, demonstrates how unpleasant memories can be repressed.
Psychology Professor John Gabrieli, a co-author of the study, is quoted in a Stanford University press release as stating "The big news is that we've shown how the human brain blocks an unwanted memory, that there is such a mechanism and it has a biological basis. It gets you past the possibility that there's nothing in the brain that would suppress a memory ā€“ that it was all a misunderstood fiction."
Michael Anderson, the paper's lead author, summarized the results this way: "It's amazing to think that we've broken new ground on this ā€¦ that there is a clear neurobiological basis for motivated forgetting. Repression has been a vague and controversial construct for over a century, in part because it has been unclear how such a mechanism could be implemented in the brain. The study provides a clear model for how this occurs by grounding it firmly in an essential human ability ā€“ the ability to control behavior."
The issues surrounding "repressed memories" and "false memories" are complex. Studies have demonstrated that both sorts of memories can be created in the laboratory. We are less certain what this means when confronted with a newly emerged memory of childhood abuse.
In the current study, twenty-four volunteers aged 19 to 31 were given 36 pairs of unrelated nouns, such as "bicycle-roach," and asked to remember them at 5 second intervals. They were tested on memorizing the pairs until they got about three-quarters of them right. They were then tested while having their brains scanned using functional magnetic resonance imaging (fMRI).
The researchers randomly divided the 36 word pairs into three sets of 12. In the first set the subjects were asked to look at the first word in the pair (presented by itself) and recall and think about the second word. In the second set, subjects were asked to look at the first word and not recall or think of the second word. The third set of pairs served as a baseline and was not used during the brain scanning part of the study.
Subjects were then retested on all 36 word pairs. They remembered fewer of the word pairs they had actively tried to not think of than the baseline pairs, even though they had not been exposed to the baseline group for 30 minutes.
The fMRI results showed that controlling unwanted memories was associated with increased activation of the left and right frontal cortex. This led to reduced activation of the hippocampus (one part of the brain associated with memory). The more subjects activated their frontal cortex during the experiment, the better they were at suppressing unwanted memories.
Clearly we can repress unwanted memories. The fMRI results are interesting, since they confirm that the brain areas involved are the ones that we might predict would be involved. Studies like this should silence those who take the extreme position that memories can't be repressed. It does not address whether repressed memories that are later recovered are true.

~ Leonard Holmes, Ph.D.
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"Stress Hormone" Levels Abnormal
Both persons under stress and those suffering from depression may have abnormally elevated cortisol levels.
Cortisol is produced in and secreted by the adrenal glands in response to control signals from the pituitary gland and hypothalamus of the brain. While cortisol itself has many important functions for the body including regulation of metabolism and blood pressure, its role in the bodily stress response has earned it the nickname of "stress hormone." Cortisol secretion is increased in response to physical and psychological stress of any kind. When the stressful event or situation is over, cortisol levels return to normal.
Interestingly, doctors have shown that in both depressed adults and children, the hypothalamic-pituitary-adrenal axis activity is increased, leading to continually elevated levels of cortisol. This situation is similar to that seen in persons experiencing chronic stress, who may also have sustained higher-than-normal levels of cortisol.
While prolonged increases in cortisol levels can lead to changes in mood, a causal relationship between elevated cortisol levels and depression has not been firmly established. Clinical depression is a complex condition likely resulting from a combination of inherited, biochemical, and environmental factors. Elevation of cortisol through a prolonged stress response is only one factor that may be related to the mood changes associated with depression.

~ Melissa C. Stoppler
Copyright Ā© 2004 About, Inc. About and About.com are registered trademarks of About, Inc. The About logo is a trademark of About, Inc. All rights reserved.

http://stress.about.com/cs/cortisol/a/aa122803_p.htm
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UNDERSTANDING MIGRAINES
"...with so much pain, that he nearly went mad..."
"A healthy, robust man of middle age (was suffering from) troublesome pain which came on every day at the same hour at the same spot above the orbit of the left eye, where the nerve emerges from the opening of the frontal bone; after a short time the left eye began to redden and to overflow with tears; then he felt as if his eye was slowly forced out of its orbit with so much pain, that he nearly went mad. After a few hours all these evils ceased, and nothing in the eye appeared at all changed."ļ€†
For those who have experienced them, cluster headaches are the most painful headache anyone can have. The pain has been described as "boring," "tearing," or "burning." Analogies also are used, such as "a hot poker in the eye", or as if "the eye is being pushed out."ļ€‡ Anyone who has ever had a cluster headache has no doubt what they are. It's no exaggeration to say that the pain and desperation of cluster headaches have actually led to suicides.
As with any head pain, the place to start is with getting a diagnosis so you can get the proper treatment. A valuable tool in helping you and your doctor with a diagnosis is a headache diary.
Cluster headaches have been known by many names throughout the years - migrainous neuralgia, histamine cephalagia, petrosal neuralgia, sphenopalatine neuralgia, Sluder's Neuralgia and Horton's Headache, just to name a few. Its final designation came from the headache's pattern to cluster, both in number of headaches per day and number of days in an attack.
The universally accepted criteria for diagnosis and classification is that of the International Headache Society. The basic criteria for Cluster Headaches is:
At least 5 attacks fulfilling B-D.
Severe or very severe unilateral orbital, supraorbital and/or temporal pain lasting 15 to 180 minutes if untreated.
Headache is accompanied by at least one of the following:
ipsilateral (occurring on the same side as the pain) conjunctival injection and/or lacrimation
ipsilateral nasal congestion and/or rhinorrhea
ipsilateral eyelid edema
ipsilateral forehead and facial sweating
ipsilateral miosis or ptosis
a sense of restlessness or agitation
Not attributed to another disorderĀ³
Translated into English, all of that says the headache is accompanied by at least one of these symptoms on the same side as the pain: redness and/or swelling of the eye, tearing, nasal congestion and/or runny nose, swollen eyelid, forehead and facial perspiration, decreased pupil size, or droopy eyelid. Once the cluster starts, the pain intensifies rapidly and has often been called a "suicide headache" due to the extremely overwhelming pain.ļ€‡
It can be difficult, especially before diagnosis, to differentiate between cluster headaches and Migraine attacks. Adding to the confusion, it's not unusual for people to experience both clusters and Migraines, and possibly tension headaches as well. Clusters may vary from Migraines is some notable ways:
Unlike Migraine, cluster headaches do not have discernible phases (i.e.. prodrome, aura, headache and postdrome). At the start of an attack, a cluster usually headache comes on without any warning; however, some individuals in a few studies have reported an aura or premonitory warning. Gastrointestinal symptoms are not usually reported with cluster headaches; although nausea has been reported in up to 40% of cases; vomiting is rare.Ā¹
Clusters, unlike Migraines, can be short in duration, anywhere from 15-180 minutes per attack, occurring several times a day over many days or weeks. Clusters can go into remission, giving the patient weeks, months or even years of relief from attacks. During an individual cluster period, the pain almost always occurs on the same side. Many patients report that clusters will wake them from a sound sleep in the middle of the night.
During a cluster headache, it is more often very difficult to lie down, and people are known to pace the floor or keep moving in some other way. During a Migraine attack, movement most often worsens the pain, making it far preferable to lie down.
Cluster headaches are more common in men than women. Interestingly, the estimated prevalence ration has been changing drastically over they years. By 1995, the ration was estimated to be 2.1:1, far closer than in the past. Researchers theorize that women have long been misdiagnosed because cluster headaches were thought to be so predominantly found in men.ļ€‰ Migraines are more common in women than women at a ration of 4:1.
Cluster headaches are far less common, occurring in 0.04% of the population. Migraine occurs in 12% of the population.ļ€‰
Cluster headaches usually begin between the ages of 20 and 30. With Migraines, no similar age range can be estimated.

As with Migraine, the head pain is just a part of the cluster attack. Knowing what to expect with a cluster attack can help the patient and his/her doctor treat the attacks more effectively. With cluster headaches, as with any other head pain disorder, the keys are the proper diagnosis, a good medical team, patient education, and a good support system. Once diagnosed, most cluster sufferers can be helped with a good treatment regimen that may include preventive medications as well as abortive and/or pain medications. If you suspect you have cluster headaches, and your doctor hasn't been able to help you, the care of a good headache specialist is definitely in order.
__________________
References:
ļ€† Description from the mid-20th century. "Headache in Clinical Practice, Second Edition." Stephen D. Silberstein, Richard B. Lipton, Peter J. Goadsby. Isis Medical Media, 2002.
ļ€‡ "Wolff's Headache and Other Head Pain," seventh edition. Stephen D. Silberstein, MD, Richard B. Lipton, MD, and Donald J. Dalessio, MD. Oxford University Press, 2001.

Ā³ International Headache Society, "The International Classification of Headache Disorders, Second Edition." Cephalalgia: An International Journal of Headache, Vol. 24, Supplement 1, 2004.
ļ€‰ "An Atlas of Headache." Stephen D. Silberstein, MD; Alan Stiles, DMD; William B Young, MD; Todd D. Rozen, MD. Parthenon Publishing, 2002.

~ Deborah Wirtel & Teri Robert
Copyright Ā© 2004 About, Inc. About and About.com are registered trademarks of About, Inc. The About logo is a trademark of About, Inc. All rights reserved.

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