Concerned and interested parents of adolescents sometimes rely on medical practitioners and look to them for teen counseling related to smoking prevention and quitting. Not all medical practitioners offer the same screening, counseling, or spend the same amount of time with patients. These parents may be interested in weighing the report of the following survey study conducted at the University of Rochester. They conducted a study on smoking prevention and cessation screening and counseling given to adolescents by various medical practitioners.

What was studied: The researchers set out to describe what screening and counseling was given to adolescents about smoking prevention and quitting and to examine the effect of different factors relating to the physician that would affect this. 371 pediatricians and family doctors in the New York City area responded to the survey, out of 564 invited to participate. In analyzing the results of this study, the doctors’ specialty, gender, familiarity with National Cancer Institute guidelines, time spent with the teen, and the factor of confidentiality –time spent lone with the teen– were measured. The results were associated with better smoking counseling performance.

Questions asked of teens             How may Drs Asked
Asked teens about smoking                                       91%

Assessed smokers on motivation to quit             81%

Helped teens set a quit date                                       34%

Scheduled follow-up visits                                          28%

Asked whether teen’s friends smoked                     41%

Asked about smokeless tobacco use                        32%

In order to measure how good their counseling might be, the study determined whether the doctors were familiar or not with the Guidelines of the National Cancer Institute. The highter that number, the more were the doctors who knew what the Guidelines were and thus would be more likely to provide effective counseling.

Physician Performance and Knowledge                               Family Doctors               Pediatricians

Smoking mean counseling performance score P<.001                    61%                             53%

Familiarity with National Cancer Institute guidelines P<.001            48%                             27%

Next they examined how much time the doctors spent with the teen and whether the discussion took place in private:

Time and Privacy Factors    Female Physicians

time spent with their last adolescent patient 63%

time alone with adolescent patients 85%

From this table, it’s clear that more women doctors spoke in private to the teens than did their male counterparts, though the results didn’t say how the male doctors fared.

To contrast with this, in Nova Scotia, Canada, a trial is ending that couples nurse practitioners with physicians. These nurse practitioners, among other duties, are taking over those tasks that can help the physician better with his or her practice. Among the recognized weaknesses of physicians is counseling. The initial results suggest that the nurse practitioners are making a positive difference, though some physicians continue to resist nurse practitioners because of protection of their traditional territory and autonomy. But dollars, common sense, and demand from consumers for better care may bring about a change for the betterment of the health of citizens. As more nurse practitioners become involved, will they help to make a difference in the area of smoking cessation and prevention? One can only hope.

Often times the best experts can be the sufferers themselves. So, here we have an account about causes and treatments written from the perspective of a present sufferer. Sometimes, it really does take one to know one….

It Takes One to Know One…

An Introduction to Crimson

My name is Crimson and I suffer from major depression. It’s brilliantly complemented by a bipolar disorder too. I’ve been recently diagnosed, two years ago to be exact, but more than likely, I have had it all my life. It just wasn’t so apparent until now. Presently, I’m in the 2nd month of the 7th episode within two years.

While I am a private practice psychiatrist, I thought that I would keep the clinical discussion to a minimum because there wouldn’t be much that hasn’t already been said. So, the goal here is to incorporate info from the eyes of the beholder and let the best experts, sufferers themselves, write the feature content from their perspective.

What is depression?

One out of four women and one out of eight men will suffer from it at some point during their lifetime. The clinical term is Major Depression or Unipolar Depression. It’s classified as a mood disorder, and it may only occur once in a person’s life, yet, it can occur multiple times. Episodes can last as long as 9-16 months.

What causes depression?

Depression is triggered. It’s the bullet in the gun, shot from the mind via a chemical imbalance in the brain. Normally, the first depressive episode is triggered by some stressful event like a divorce, loss of a job or loved one. After the initial exposure, it appears that a person is more susceptible to recurrences. There are also triggers that result from physiological and medical causes, but the result is the same.

As far as what really causes depression, it’s a matter of opinion. We all have our own internal yardstick for measuring what affects us. Some people may loose a job or loved one and be devastated by it. Others lose their job and they’re not at all surprised.

For me, maybe it was moving to California; maybe it was from the certain way the rain fell down one day, or a song I heard by Nine Inch Nails. I cannot really say for certain what it was, but I know when it happens as all other sufferers do. One day things just look different. Even your own reflection is slightly askew. And if there are people that live with you, God help them because there isn/t much they can really do for you. As for tending to daily tasks, it’s like trying to start a Saab at the steering column … nothing gets going…

Can depression sufferers recover?

Certainly, but you’re not really cured. The treatments, which normally involve some combination of therapy and/or medications, will help to ease the pain. The medications can make the condition tolerable so that you can function on some level. But, they do have to be taken consistently and many sufferers tend to faze them out. The primary reason is, usually, because of the side effects. Once we stop them, though, we’re targets again for that gun to fire that bullet at anytime.

You wouldn’t be alone in admitting that you use the medications intermittently. I, too, have gone on and off them, for various reasons.

Can people recover without meds?

Sure, and those that have will often say that they simply got tired of being depressed. While that may seem to minimize the efforts of the rest of us, we can all understand how that could work. With the way the mind/psyche can work, there is truth to the cliche’ ‘you get out what you put in.’ Having said this, it doesn’t work for everybody, because there are definitely biological factors.

In other words, what gets you out of it can be as individual as what gets you into it. For instance, I was driving around one day and I’m sure there was somewhere I was supposed to be, but I couldn’t recall where. While driving, I was distracted by a motorcycle cop who was tucked off to the side of the road along a side street. His intention was too, obviously, snare speeders. So, I passed him and pulled over just after a bend in the road. I parked there for about an hour and I flashed oncoming traffic. For those of you who don’t know: this is a ritual not practiced in Southern California for some reason. But, it’s done in the Northeast regions of the US as a way of signaling fellow motorists that there’s a ’speed-trap’ ahead (we know to watch our speed). People caught on here that day, though; as I could see, their brake lights come on in my rearview mirror.

In any event, I got such a charge from doing this that the rest of the week my mood was even-keeled. And, for the rest of that day, I had a smile on my face that a plastic surgeon couldn’t have removed. So, you begin to learn what is apt to trigger you as well as what might bring you out of it — whatever that may be. ..soak it up for all that it’s worth. I know that this is not conventional psychological practice, however, there are things that you just cannot learn in school. It really does take one to know one.

If you’re finding that as you get older it’s sometimes harder for you to achieve and maintain an erection, you’re not alone. An estimated 52 percent of men between the ages of 40 and 70 experience erectile dysfunction (ED) some or all of the time.

Similar to the explanation women received for years regarding PMS-”it’s all in your head”-standard medical thought held ,until recently, that in 90 percent of cases, ED was caused purely by psychological factors.

In recent years, medical understanding of erections have increased, and we now know that in most cases ED is related to a mix of physical and psychological factors. What that means, practically speaking, is that your virility is a reflection of your overall physical and psychological health.

A penis that seems inappropriately flaccid is giving you a cue to take a closer look at the state of your well-being. It’s an attitude well represented by the reply my friend John* made when I asked him what strategies he’s developed to deal with impotence: “I ask God, I want to know, what’s going on?”

Your Personal Distant Early Warning Signal. What’s going on might be serious. ED can give early warning of a number of conditions, including the following:

* arteriosclerosis (Erections involve a large flow of blood into the penis; blocked penile arteries are a frequent factor in ED, and indicate that arteries elsewhere in the body are clogged as well.)

* diabetes

* hormonal disturbances

* malnutrition

* multiple sclerosis

* Parkinson’s disease

* prostate enlargement/prostate surgery

* sexually transmitted diseases

* thyroid imbalances

* trauma to the head or spinal cord

An inability to “get it up,” even if it occurs only sporadically, means it’s time for a complete check-up. ED is also strongly associated with other lifestyle and medical factors:

* excess alcohol consumption (affects prostate health and hormone
balance)

* cigarette smoking (a contributing factor in arteriosclerosis)

* prescription drug use (Over 200 commonly used drugs can cause impotence.

If you’re taking any medications, consult your doctor about adjusting the dose to stop the side effect of impotence.)

* bicycle riding (To minimize the potential of developing ED due to cycling, use one of the new seats designed with a gap in the middle to avoid damage to nerves critical in the erection process; also, use a bike that doesn’t have a top tube-falling on it can cause trauma and ED. Stop riding if you experience numbness or tingling in the crotch.)

Finally, emotional factors can play a powerful role in ED. To help you determine whether emotional or physical issues are predominant in your ED, ask your doctor for a Nocturnal Penile Tumescence (NPT) test kit. The NPT measures the frequency, rigidity, and length of erections that occur in sleep. The inhibitions that might keep your erection at bay while you’re awake aren’t in the forefront during sleep. If it turns out that you’re continuing to have normal erections while asleep, then your ED is most likely emotional rather than physical in origin.

ED: Sometimes It Can Work For You

The emotional factor in ED can have a hidden silver lining, by giving you important information about yourself and your partner. As John puts it, “As I get older, I know what I want, I know what pleases me. At 22, it was everyone. At 43, it’s one in a thousand.” For John, his response in bed is one “good way to check out how much I like the person. Maybe I’m not really interested in her.” John also feels that how a woman responds to an episode of ED tells him a lot about what kind of person she is: “It’s kind of a measuring stick-if she’s okay with that then I like her.”

John likes to respond to his episodic ED by focussing more on other types of intimacy with his partner. He explains, “I like kissing, eye contact, tenderness, touching. I don’t always want to get off, I just want to feel loved, to feel like I’m in my mother’s womb. That’s the most primal urge of all. Sometimes I just need that touching. There are many women I follow into a boudoir, and sex is just one of my reasons for doing it.”

According to Tom Lue, MD, writing in Contemporary Diagnosis and Management of Male Erectile Health, the main causes of emotionally based ED are anxiety and fear of failure, depression, marital or relationship conflict, ignorance and misinformation about normal anatomy and sexual function, religious scruples about sex, and obsessive-compulsive personality disorders.

Again, emotionally based ED is a distant early warning signal. Taking it seriously, even if it is “all in your head” can lead to valuable self-knowledge and healing of emotional issues before they become severe enough to affect your physical health.

The Viagra Option

The drug Viagra® (sildenafil citrate, made by Pfizer Inc., New York City) has been fervently embraced as a “cure” for impotence. This drug helps enough blood to flow into the penis to cause an erection. If you’ve read this far, though, you’ve probably realized that Viagra might not be your most satisfactory solution for impotence, especially over the long term. If you value your total health and well-being, do you really want to take Viagra for impotence when the real problem is malnutrition, for instance? And how important is it to prove you can perform to a partner you don’t respect or like?

Viagra also has some potentially serious side effects. It’s not safe to use it in combination with any drugs containing nitrates. At high doses, it can damage the retinas, and many individuals who use it report light sensitivity or the appearance of a bluish tinge in their visual field. Headaches and sudden blood pressure falls have occurred in some individuals. Some Viagra users have experienced persistent erections that don’t subside within a couple of hours (priapism). Unless treated immediately, priapism can damage the penis and cause permanent impotence. A number of heart attacks, some fatal, have been associated with Viagra use. However, the exact cause of these heart attacks has not been established.

Viagra can be a helpful aid in breaking the vicious circle of impotence caused by performance anxiety. It is also of great value to men with impotence caused by certain kinds of spinal cord injuries.

A Holistic Approach to ED.

A more holistic approach to ED than Viagra provides is an approach that respects the message your symptom is trying to deliver. While more effort is involved than popping a pill, it’s worth it if your longterm health is important to you:

* Get a complete check-up to rule out illness.

* If it turns out that you’ve developed arteriosclerosis, diabetes, enlarged prostate, multiple sclerosis or another condition, effective holistic and nutritional treatments are available either on a stand-alone basis, or as a complement to traditional medical care. Many people have found these alternative treatments most effective for reversing these conditions. Consult a qualified naturopathic physician to get started on your healing journey.

* If your ED is emotionally based, a number of techniques can help you resolve the issues: counseling, keeping a personal journal, meditation, yoga, regular relaxation.

Good nutrition plays an important role in the health of the penis, prostate, and other sexual organs (not to mention the rest of your body).

A diet based on organically grown whole foods, including plenty of vegetables and fruits along with beans, whole grains, and organic animal foods is your best bet. Writing in the August 1999 issue of Alternative & Complementary Therapies, Stephen Holt M.D., F.A.C.P., also suggests a nutritional supplement protocol for optimal sexual functioning:

* Vitamin E, 600 IU daily (consult your doctor before using vitamin E if you are on blood thinning drugs)
* Vitamin C, 100 milligrams daily
* Vitamin B complex, one tablet of average potency formula daily
* Phosphatidylcholine, 1000 milligrams daily
* Zinc, 20 milligrams daily
* EPA (fish oil constituent), 450 milligrams daily
* DHA (fish oil constituent), 300 milligrams daily

* Herbs such as green oat extract, damiana, ginkgo biloba, true unicorn root, saw palmetto, Asian ginseng, Siberian ginseng, and others have all been found helpful for impotence. In addition, some homeopathic remedies counter potency problems. Note that herbs and homeopathics work best in combination with a healthy diet. Consult a qualified practitioner to establish which herbal or homeopathic remedy is best for you.

The holistic approach briefly outlined above takes the view that true virility exists throughout the whole body, not just in the penis. For maximum pleasure, it seems, the best strategy is to take good care of yourself throughout life and reap the rewards, both in and out of bed.

* Not his real name.

Have you ever seen photos taken of the earth from far away? Yes, Planet Earth is a jewel, and even up close its magnificence is breathtaking if you’re looking at all the mountains, hillsides, and islands. But have you ever seen the parts that nobody talks about?

When my mom would take me on outings, we often came across what’s known as a landfill. A landfill is a plot of land where tons of garbage is dumped everyday. A landfill is neither a pretty site, nor a sweet-smelling one. When I would ask my mom what it is we passed and why it’s there, she’d respond with, oh, that’s just a landfill. That’s where all the trash is dumped, but it doesn’t matter. Well, it does matter, and there is nothing positive about it!

When I see city streets it baffles me the things people toss. Often, I see trashcans filled with sweaters, empty computer boxes, newspapers, and baskets. I ask myself, why is it so difficult to collapse and fold the box and place it with the newspapers in a recycling bin and why couldn’t they gather the sweaters and basket and call Goodwill? What puzzles me is it never occurs to anyone that a less fortunate person could use a dented basket or a mend worthy sweater. The earth sure doesn’t need it! I recognize I can’t stand on a corner with a megaphone and yell, reduce, reuse, recycle, or else! I do know that education is the key and each person needs to be more responsible.

There are three levels of environmental awareness. The 1st is what’s known as an eco-warrior. This person reduces waste and consumption, reuses everything, and recycles. This person also educates others. It is unfortunate that more people don’t assume this role. The 2nd is one who is ignorant and uninformed. This person needs to be educated about the importance of recycling and environmental responsibility. The 3rd is one who is informed and aware of the problem, but does nothing.

The 3 R’s Concept. The 1st is reduction. This means reducing in every aspect; consumption, materialism, luxury, and more. The average (mainstream) person goes to the supermarket, eats out, buys ready-made food, and consistently has a need for new things. The end result is excessive consumerism. When something is no longer wanted or needed, 9 out of 10 times, the item is tossed in the garbage. This brings me to the 2nd R, Reuse. Most people are so caught up in their daily life, they don’t even think about this. The reuse concept is simple. When you shop for food, clothing, or personal items, don’t toss the bag or container. Reuse it for something else. This may sound weird, and people may look at you funny, but it may even create a conversation piece.

Some stores compensate you each time you reuse your own container. It may not sound like much, but over time it can accumulate. The best part is yours is one less bag to add to that full trash can. One of the many important reasons to keep most things out of the trash is that wind carries things and the plastic bag could wind up in the street or in a tree, hurting a wild creature. Many animals have been known to get strangled or try to eat plastic bags.

When I shop, I bring a sturdy canvas bag, bulk, and herbs and spice bags with me. I have 3-6 tote bags that are very durable and can hold several pounds of groceries. They’re easier to carry and have comfortable straps. When I need ingredients for baking or cooking, I buy bulk, not packaged, whenever possible. I go to the bulk section of the health food store and buy ingredients like wheat flour and sea salt and I select the amounts that I want. I love it! I use my spice bags for herbs and spices, like cinnamon and thyme. When I need more ingredients, I keep the bags and reuse them, or put them in the recycling bin.

The 3rd R, Recycling. Recycling has been done for years. Many schools collect 1,000’s of newspapers, instead of tossing them. They are saving many trees and landfill space. Although recycling is practiced, especially in green-minded communities, I’m amazed at the rows of filled trashcans…

A stupid, stupid thought.

For information’s sake, miscarriages occur in 15-20% of all pregnancies but in all actuality, the numbers are probably much higher since many women experience a miscarriage before they knew they were actually pregnant. Most of the time the reason is that there are chromosomal abnormalities in the baby, those that would prevent the baby from living after birth.

For a mother’s sake who has just experienced a miscarriage - it hurts the same even if she knows in her heart of hearts that there wasn’t a single thing she could have done to prevent the miscarriage.

Now you ask why there is an article on miscarriage on a site about infertility. Why? Because many couples who are experiencing infertility are doing so because they are one, having trouble getting pregnant or two, having trouble maintining a pregnancy.

The question to answer to the reader, provided that you, the reader, are not the mother who just experienced a miscarriage - what can you do to help? I found the most helpful thing anyone could do is be quiet and be on standby. I needed shoulders to cry on, I needed to be hugged, I needed to be told that my baby (yes, baby) was loved and that I will see my baby one day in the future. I did not need friends telling me that I could have more babies, that what I lost was not a baby but ‘just a fetus’ and that I am ok and that is all that counts. Even though these phrases sound OK to you, they are not OK. They hurt. If you do not know what to say, don’t avoid your friend, spouse or daughter - just be there and be there in silence. She will come to you and she won’t know what to say either.

My heart goes out to you, the mother’s, who have lost their babies. It’s hard and the hurt never goes away but you will learn how to not think about it on a daily basis and you will continue to grow and thrive as a woman. There are other’s out there that know how you feel. If you are having trouble coping, contact your local hospital and ask for a support group. Just knowing you are not alone will make it feel different, maybe not better, but at least different.

Sometimes infections can cause auto-antibodies to be produced and this may be a causes of Lupus. When the immune system goes wrong, antibodies can be formed that bind to parts of the body (an auto-antibody). The antibodies circulate in the blood, but sometimes cell walls let these antibodies in. These can then attack the DNA in the cell’s nucleus. That’s why some organs are attacked during a flare while others aren’t.

To further complicate things, lupus flares and infections mimic each other. Both conditions show signs of fever, chills, pain, lack of energy and motivation. The only way to know for sure is to get a blood test that will measure your white blood count. Some physicians find a C-reactive protein (CRP) blood test to be helpful in differentiating active lupus from infection, but this is controversial.

The treatment of infections in lupus patients is basically the same as for other patients. Even those taking high doses of immunosuppressive medications for their lupus may respond well to antibiotics. The use of sulfa and penicillin drugs in the treatment of infections should be avoided whenever possible, because they can increase photosensitivity and they may aggravate the condition. Bacterial infections have a tendency to adapt genetically and resist antibiotics over time. You should urge your doctor to use caution when using antibiotics for fear of the drugs becoming less effective. Some bacteria build a tolerance to antibiotics, making it difficult to treat diseases such as meningitis and lyme disease. To prevent possible infections, patients at high risk of infection often benefit from taking antibiotics before dental treatment or surgical procedures. This is especially important if you have had joint replacements, as there is an increased risk of infection. In general, individuals with lupus should avoid exposure to people with colds or other infections.

There seems to be some controversy regarding immunization shots and lupus patients. It seems the medical society is at odds as to whether or not getting immunizations, including flu shots, is detrimental to lupus patients. Lupus patients make fewer antibodies that circulate for shorter periods of time and have more adverse reactions after receiving a flu shot but there seems to be some agreement that flu shots are safe. However it is not recommended for patients who are on steroids, i.e., prednisone or cytotoxic, i.e., (cytoxan, imuran) therapy to receive live vaccines because these drugs hamper the immune system thus running the risk of infection or a flare. It is important that lupus patients consult their rheumatologist before receiving any type of allergy shots (immunotherapy). In 1989, the World Health Organization recommended that patients with autoimmune diseases not take allergy shots (immunotherapy) because they will flare.

According to a report from the Lupus Foundation of America, infections that occur in people with lupus fall into two categories. The first category includes infections caused by organisms which can induce infection in anybody. This category includes organisms such as streptococcus (which causes strep throat) and staphylococcus (which causes staph infections). The second category consists of “opportunistic” infections. Opportunistic infections are caused by organisms capable of inducing disease only when one’s immune system is weakened. Most of the opportunistic infections are fungal, parasitic or protozoan.

The most common infections that lupus patients contract involve the respiratory tract, skin and urinary tract and usually these are not serious and only a few lupus patients will need aggressive hospital treatment for infections. However, infections in lupus patients tend to last longer and require a longer course of treatment with antibiotics than infections in people who do not have lupus. It is also important to know that hydrocortisone medications increase the likelihood of fungal infections because it eliminates both good and bad bacteria making yeast and thrush infections hard to control. In someone with an impaired immune system, however, such infections, called dermatophytoses, can persist for long periods Fungi can also invade internal organs of the body, especially the lungs, where the infections resemble pneumonia or pulmonary tuberculosis. Lupus patients are at an unusually high risk for contracting salmonella, herpes zoster and candida (yeast) infections. Oral infection and yeast infection are common among lupus patients and should be avoided at all cost. Bacterial infections are also common with urinary tract and respiratory tract infections being quite common especially if you have allergies.

The fight to be healthy is dependent on the support of physicians and knowing yourself. Anytime something is amiss it is important to step back and evaluate what is going on and seek medical attention.

Glossary

Antibodies-proteins produced by white blood cells (B lymphocytes). Their normal function is to stick to bacteria and make them easy for the white blood cells to capture and destroy.

Autoimmune-means that the immune system treats the body as if was a foreign component and builds anibodies against it in other words, the body is fighting itself.

Fungus Infections-diseases caused by the growth of fungi in or on the body. In most healthy people fungal infections are mild, involving only the skin, hair, nails, or other superficial sites, and they clear up spontaneously. See Thrush.

Immune system-a group of cells, molecules and organs that act together to defend the body against foreign invaders that may cause disease. The health of the body is dependent on the immune system’s ability to recognize and repel invaders.

Infection-injurious contamination of the body or part of the body by pathogenic agents, such as fungi (see Fungus Infections), bacteria, protozoa, rickettsiae, or viruses, or by the toxins that these agents may produce.
Herpes zoster, or shingles-is caused by the same virus that causes chicken pox. The rash of blisters, usually confined to one side of the body, erupts when dormant virus particles reproduce in the nerves supplying the skin. Because the virus damages nerves in particular, pain, sometimes severe, may persist for many months after the rash heals. Herpes zoster may occur at any age, but older and immunosuppressed patients are most frequently and seriously affected.

Hydrocortisone-also known as cortisol, common names for 17-hydroxy-corticosterone, the principal hormone secreted by the outer layer, or cortex, of the adrenal gland. Hydrocortisone affects the metabolism of carbohydrate, protein, and fat; the maturation of white blood cells; the retention of salt and water in the body; the activity of the nervous system; and the regulation of blood pressure. Secretion of hydrocortisone from the adrenal cortex is stimulated by the pituitary hormone ACTH.

Protozoan-collective name for animal-like, single-celled organisms, some of which may form colonies. In the classification followed in this encyclopedia the protozoa are placed in the kingdom Protista with other single-celled organisms that have membrane-enclosed nuclei. Protozoa have little or no differentiation into tissue systems. Several phyla are commonly recognized. They include flagellated Zoomastigina, many species of which live as parasites in plants and animals; the amoeboid Sarcodina, which includes the both important components of the plankton; ciliated&#8195;Foraminifera and Radiolaria Ciliophora, many with specialized structures suggesting the mouth and anus of higher organisms; Cnidosporidia, parasites of invertebrates, fish, and a few reptiles and amphibians; and Sporozoa, many species of which are parasites of animals (including humans). More than 20,000 species are known, including such familiar forms as paramecium and amoeba.

Thrush-A fungal infection characterized by creamy-white, curdlike patches on the tongue and other mucosal surfaces of the mouth. The disease is caused by an overgrowth of Candida albicans, a species of yeast that normally inhabits the mucous membranes as a benign saprophyte. Those most susceptible to thrush include adults whose immune systems have been weakened by antibiotics, steroids, or, most commonly, acquired immune deficiency syndrome (AIDS). Infants can become infected during birth if the mother has a vaginal yeast infection. When the curdlike discharge is removed from patches of thrush, raw and bleeding areas are visible and can be especially painful. If left untreated, these superficial lesions may allow the yeast to spread to other areas of the body. In cases of severe immunosuppression or prolonged antibiotic therapy, the organism can invade the major organs, causing serious complications. Diagnosis requires microscopic identification of the pseudomycelial (branching-arms) forms. Generally, thrush is treated with a topical (surface) agent such as miconazole or clotrimazole.

Weight training improves your body composition. With more than half of American adults overweight (54%), we are in desperate need of methods to improve body composition. Weight training will increase the amount of lean mass a person has. This, combined with fat loss from cardiovascular training and good nutrition will improve your body composition (lowering your % fat).

Consistency is the most important component in building strength. Training two or three times a week every week is far better than training with heavier weights whenever you get around to it.

To improve your muscles, you have to push them beyond their normal range of comfort. Challenging your muscles beyond their normal state is what makes them respond by growing and improving. This is termed as “overloading” your muscles.

It is available at a much lower price when compared to other ED medications. You have the option to buy Vardenafil over the Internet. Because of today’s rampant demand for impotency drugs such as Vardenafil, many pharmacies are offering this medication online. Besides supplying you with inexpensive medicines, online stores give you detailed product descriptions to help you properly use them. Be aware that it may cause side effects like nausea, headache, back pain, blurred vision, etc. just like other medications, but it is also very successful in treating ED. Upon the appearance of any side effect, stop consuming the drug and see your physician ASAP.

****** “Soup Nazi is a reference to a popular Seinfeld show about a foreign soup magnet that made the most incredible soup, but was a tyrant. This “Soup Nazi” would tolerate no questions from his faithful soup addicts and he would kick any complaining customer out- never to be served again. ********

Today dawned foggy here in the Midwest. A light mist is falling and there is a chill in the air. It is a soup day. Growing up with my Italian Grandmother, there was always a kettle of something bubbling on her old gas stove. You never knew what was in it, and sometimes the contents of the kettle could be downright scary! Being from the old country, she was known for concocting strange herbal remedies, snacks, and even natural pesticides on that stove. Most of the time the old, worn kettle contained minestre, an Italian soup that is almost impossible to describe, for it was a mixture of Italian pasta sauce, whatever vegetable that was available, a small pasta like baby-sized shells, and any available leftover meat. The closest and most accurate comparison would be to a vegetable minestrone. Her stove was a stage of sorts. Of course, it may be chicken vegetable minestrone, beef vegetable, chicken pastina, dandelion egg drop, wedding soup, or a cast of many other characters on any giving day. We never knew which steaming treasure would have a starring role, but we were always sure we would leave that kitchen with the lingering memory of new, flavorful meal that would place a warm feeling deep down, not only in our stomachs, but in our souls. This warmth was one that our dear Nana (Grandma in our southern Italian dialect- Calabreze) kindled in our souls.

My grandmother was a woman that stood just underneath five feet of height. An assiduous sprite, this woman had an endless energy, as well as a mighty spirit. The matriarch to nine brothers and sisters (She was the oldest of ten and nurtured them from infancy, for she had a sickly mother.), eight children, twenty-three grandchildren, and dozens of great-grandchildren too numerous to count.

On these misty autumn days, warm, happy memories surface. Images of soup simmering in a huge kettle on the stove in our old house on Silver Street come to me. Nestled among the maples, this house sat high atop the largest hill in the small community of Waynesburg, Ohio. A community sprinkled with many Italian families such as ours- a town that is a welcome breath of fresh air. Our family home lives on in my heart- a place of so much love and history. You see my grandparents moved into that house with their overflowing brood of eight in the 20’s, shortly after their marriage. A home that has withstood the ravages of the depression; a home that survived both world wars, sending young men off to battle that were its residents; this is a place that is home to the comforting ghosts of yesterday. My home for seven years too. My parents lived with my grandma for a time, taking care of her, until we bought a new place. When we moved, she came with us, but that home is the place that our entire family still envisions when the word “home” is uttered. This is a timeless and comforting place that still touches the heart and soothes the soul. This home continues to stand today, and it is still resided in by family members- a gentile home on a high hilltop that is continues to be loved by the many people that were nurtured within its walls. Many things conjure up the vision of that house. The scent of sauce cooking, a wintry day, a child’s giggle, or the blustery winds of fall. These things take us back to that home on the hill and into Grandma’s kitchen where we smell the manestre simmering, bringing us home again.
Recipe Included Below:

Designer Soup for a Nation: Beef Vegetable Minestre

Why the name? Well, this makes enough soup for a nation, and you can design it for your needs. This is an interactive article almost. You see, as I write this, I too am making this soup. This is something that you do on a day that you will be home all day. A great soup for writers, really. Making this soup will give you that needed break that you need. I would love to hear back from you about how you liked it. Email Kat here: ohiobar@sssnet.com.
A small beef roast with the bone still in it. (This type of roast is difficult to find in many areas, so you can buy a small beef roast and a soup bone separately.)
A very large soup kettle filled with water
1 cup of sliced carrots
1 cup of sliced celery
1 large can of whole tomatoes or crushed tomatoes
7 medium potatoes (peeled and diced largely)
1 can of corn
1 can of green beans
1 can of peas
2 medium onions diced rather large
1/2 head of cabbage cut into one-two inch chunks
1/2 pound of any very small pasta (Optional)
1/3 cup of barley (Optional)
1/4 cup of dried Northern or other beans after soaking (Optional)

Note: Only use ONE of the options or NONEof the options, but never more than one at a time.

After filling the large soup kettle with water, allow it to boil for about forty minutes. Skim the fat from the top. Keep it at medium -high heat. After removing all of the fat, add the whole tomatoes (squeeze and then cut into eighths or quarters), carrots, celery, and onions. (If you want to add Northern beans, this is the time to do that.)

Allow the soup to simmer for another thirty minutes at medium-high. Then add the potatoes and all the canned vegetables. Here is where you lower the heat to medium. After two hours or so, add the cabbage, lowering the heart to medium-low. Check the soup ocassionally. Be sure to lower the soup to simmer approximately one hour after the cabbage is added. This is where I stop. My favorite soup does not have the additional pasta, barley, or dried beans. Adding these is nice for a change, though. Continue simmering this all day long uncovered so it will thicken. Serve with homemade Italian bread. (Pick it up at the bakery! I would..) Store the uneaten portion in a large bowl for up to a week. You can also freeze this delicious soup too.

Adding Optional Ingredients

At the same time as you add the cabbage, you can also add either the pasta or the barley.

There are countless variations to this recipe. Here are a few examples:

Beef Vegetable Minus Peas or Cabbage (you can omit peas or cabbage if this is not to your family’s liking. My husband doesn’t like peas, so I do not add them.)

Beef Vegetable Minus Dried Northern beans (My girls and I detest dried beans. Yuck!!!)

Beef Vegetable with Barley (This is a filling soup.)

Beef Vegetable Pasta (This is like a beefy vegetable minestrone.)

Vegetarian Vegetable (For vegetarian fare, omit the beef and make a vegetable broth with the onions, carrots, Northern beans, tomatoes, and celery instead of using the bones and roast.)

This is really a mix and match kind of soup. You can design it to your families desires and needs. I hope you enjoy it. Bon Appetit!

“Preventive care is the most effective way to avoid sprains and strains. Before engaging in any strenuous sports activity, get in shape.”

A walk in the woods could turn into disaster with a severe sprained ankle if there is no way to get to a medical facility. Hikers in isolated country may find themselves in a life-threatening situation secondary to over-exposure to weather if they lose mobility.

Here are some things you should know before setting out to enjoy mother nature.

Sprains occur when an individual stretches and/or tears a ligament, the tissue that connects two bones. The knee ligament, for example, attaches the upper and lower leg, and comes into play during any activity that requires walking.

The most prevalent part of the body to sprain is the arm or leg. For instance, a baseball player sliding into first base can sprain an arm while a jogger running on an uneven country road can sprain a leg. Any physical activity has the potential to rupture ligaments or move joints out of alignment.

Dr. Jonathan Mimeone, M., who works at James Madison University’s Health Center, says “during the winter he sees ten to one more snowboarding accidents than skiing mishaps. He contributes this “to the fact that snowboarders are younger and more aggressive and believe they can tear up the slopes and jump over moguls with impunity.” Dr. Mimeone is a general practitioner at the Harrisonburg, Virginia facility.

The problem with snowboards is that unlike skis the bindings that secure the foot to the board do not release when the rider falls. This has the tendency to cause more injuries to knee and ankle ligaments.

Sprains are further broken down into three categories: mild, moderate, and severe. In the case of a mild sprain, there will only be slight swelling at the place of injury. However, in the other two instances, swelling can be severe enough to impede normal joint movement and internal bleeding will often occur.

In contrast, strains result from a tearing and/or stretching of a muscle or tendon and are a result of lifting a heavy object or from over-using a particular muscle. For example, trying to move a couch may cause back strain, while playing basketball five days a week, for an extended period of time, may result in a strained thigh. Thankfully, strains are not as severe as sprains, but they do have a tendency to recur if not treated properly.

“If a person tears a tendon, they should be referred to an orthopedic surgeon or taken to the hospital’s emergency room. He or she could have very possibly fractured a bone as well as sprained a muscle,” says Malone.

The most effective remedy to treat sprains and strains is to follow the RICE method recommended by professional athletic trainers and emergency medical technicians.

First, Rest the muscle. Second, apply Ice several times a day for the first 48 hours after injury. Third, Compression, which requires placing athletic tape or an ace bandage on the injury. Fourth, Elevate the injured part above heart level for the first two days to reduce swelling. In addition, taking aspirin or ibuprofen will relieve muscle pain.

Sprains and strains may heal naturally if given adequate rest. However there are a number of reasons why you should go to a doctor for a sprain.

Some of the most common reasons for getting medical attention are:

1. If the joint or muscle swells up like a balloon
2. If a homemade cast has been put on the injured area
3. If you cannot move the joint
4. Or if the limb begins to darken and/or numbness sets in.

“A torn tendon will almost always require surgery,” says Malone. “After the operation the tendon must be immobilized three to four weeks followed by six weeks of physical therapy.”

Physical therapy is sometimes a painful, but a vital element of treatment. To illustrate, when a person severely injures a limb, the muscle begins to atrophy and scar tissue will develop. Progressively higher weight bearing exercises, over a period of six weeks, will allow the tendon to heal and regain strength.

Preventive care is the most effective way to avoid sprains and strains. Before engaging in any strenuous sports activity, get in shape. If the most daring sport you compete in is surfing the internet, do not think you can go out and ski all day without running a high risk of injury. Furthermore, once you reach the slopes or get to the gym, do some range of motion stretching in order to warm up, but avoid over-stretching because this may predispose you to injury.

After playing a sport or exercising, warm down slowly with similar range-of-motion stretching to avoid stiff joints and muscles, one cause of muscle tears if activity is suddenly resumed after your body has cooled down.