Mind, Body, Spirit

Are CDC's Swine Flu Stats Hogwash?

Laurieboris — Sun, 15 Nov 2009 21:47:44 GMT

Seems like every time I check the news, headlines abound touting the latest deaths from swine flu. Some sources have said that the H1N1 virus is the most prevalent flu virus in the world. In. The. World. It's also reported that if you have or have had the flu, it's most likely H1N1, which therefore makes you immune from further outbreaks, so you needn't worry about getting vaccinated. But, they say, if you haven't already gotten sick, then you should rush to your doctor and get your vaccine. Now. Immediately.

Wait a minute. Before you roll up your sleeves or consider yourself immune, get a shot of this: Odds are good, according to a three-month-long CBS news investigation, that if you've had the flu, it wasn't H1N1. It might not even have been the flu.

CBS's bullshit-meters went into the red zone in late July, when the Centers for Disease Control (CDC) advised American state's health departments to stop testing for H1N1. They also stopped calculating individual cases. The reason? Why bother, when we already have an epidemic?

But several intrepid and suspicious health officials (members of the Council for State and Territorial Epidemiologists (CSTE) kept testing and counting. They told CBS investigators that continuing to keep an eye on this virus – which was new, affected different age groups than seasonal flu and could continually be changing – was important.

Because the CDC made their decision to put the kibosh on testing so hastily, the CSTE wasn't given time to offer their feedback or opinions. When they posted questions on the CDC website, they were ignored. Even filing a Freedom of Information act request went unheeded. After two months without a response, they went to all 50 states to get their individual breakdowns prior to the CDC advisory to stop testing.

Their findings? Of those people who were tested for H1N1, the vast majority turned out to be negative. According to the statistics released by CBS (and questions linger why they only released data on a few states) negative H1N1 tests accounted for 97% of the cases in Georgia. 93% of cases tested in Alaska. 83% and 86% in Florida and California, respectively.

Yes, this virus can be deadly. But if you've already been sick, and have been told based on a description of your symptoms that it was "highly probable" that you had H1N1, you may not have…and you may not be immune from the actual virus.

Deciding whether or not to get vaccinated? That's up to you. But it helps if we're given accurate data to make that decision.

This just makes me wonder if the exaggeration was simply statistical, was caused by a shortage of resources, or was an attempt to push more vaccine.

My bullshit meter is in the red zone, too. What do you think?

Scent-Sational New Study

Laurieboris — Sun, 08 Nov 2009 21:11:24 GMT

Think about the scents that have stuck with you the longest from your childhood. Perhaps a whiff of cinnamon brings back the cinnamon toast your mother made you when you were sick. (I know that was my favorite!) Open a new box of crayons for your child and you become a child yourself, coloring outside the lines on a lazy Sunday afternoon. Peanut butter, oranges, Play-Doh…these have been identified as the strongest memory-joggers in a poll done years ago.

I've worked with scent as a writing prompt…once, a writing teacher passed a box around the table and had us withdraw one item. We'd have a whiff and then write about whatever the scent stirred up. It was amazing the memories, good or bad, that one good inhale provided. I can't pump gas without being reminded of camping with my family on the islands of Lake George each summer, and stopping the motorboat to fuel up before we took off for our site.

So I wasn't too surprised that a medical study done in Israel confirmed the link between scent and memory.

According to Israeli scientist Yaara Yeshurun at the Weizmann Institute of Science, "We found that the first pairing or association between an object and a smell had a distinct signature in the brain." The study appears in the journal Current Biology. "This 'etching' of initial odor memories in the brain was equal for good and bad smells, but was unique for odor."

First, they exposed volunteers with a group of objects, linking them with a particular odor and also a sound – some pleasant, some not so pleasant, like rotting fish or a power drill.

A week later, the subjects were tested again, and could still recall the smells…and more frequently, the bad ones.

MRIs done of the volunteers' brains showed that very specific parts of the brain lit up when associations were made between object and odor…but not sounds.

More study needs to be done, but the scientists were enthusiastic that the results could one day lead to better treatment for trauma patients.

What's your favorite smell from your early years? Your least favorite? What memories do they trigger?

Tired of Hearing Insomnia Will Make Me Fat

Laurieboris — Tue, 03 Nov 2009 14:17:53 GMT

Did you know that according to a recent health survey, West Virginia is the most sleep-deprived state in the US? It's up there at double the national rate - probably a side effect of health problems like obesity, the researchers concluded. Or the residents' sleeplessness caused the obesity. One of those chicken-or-egg things, they said.

Excuse me, but if I read one more article about one more study that concludes that (horror upon horrors) skimping on sleep will make me gain weight, I'm going to bust a gut.

Not that I'm snubbing America's appalling obesity problem, but to focus so tightly on weight gain until the public perception becomes that a pudgy belly is the sole side effect of staying up late to watch Letterman discounts the devastation that chronic insomnia can wage…on your health, on your relationships, on your family, on your job, even on the public good.

And I should know.

About four years ago, a combination of health horrors blended together to leave me chronically sleep deprived. I'm not talking about losing couple of hours here or there, but sleeping 2-3 hours a night (if I slept at all) for a period of 3-4 months.

Nothing seemed to alleviate my nightly agony. Any medication I was prescribed would only work for a few hours, if at all. Family, web sites and professionals recommended remedies that also fell flat. Valerian root? Had the opposite effect on me, leaving me too hopped up to sleep. Same with Benadryl. At the very least, the women's magazines suggested I sneak in an afternoon nap. But I'm not a napper. I'd just lie there, staring at the ceiling and cursing my odd lot of DNA and fate.

At the time, I had recently returned to work after a back injury put me out on four months of disability leave. My physical therapist recommended, and my boss approved, a gradual schedule that started me part-time and eased me back into a full-time schedule over a period of a month or so.

But I was so dazed and weakened by lack of sleep that I could barely make it through the four-hour shifts I'd promised. Most days I struggled to get in by 9:30 and staggered out at 12:30 or 1:00. When the images on the monitor began to swirl, I had to leave even earlier. Some days I couldn't make it in at all. Some days I'd suddenly find myself at work, and couldn't remember how I got there. Also, I got sick, lost my appetite and a lot of weight (so much for that theory that sleep deprivation makes you fat…at least in my case.)

In retrospect, I shouldn't have been behind the wheel during those months. I could have killed someone, or myself. At one point I realized this, and limited my driving to days when I felt most alert. My therapist (whom, I realized later, wasn't helping me) agreed to phone sessions instead of making me drive to her office.

Eventually, it seemed clear enough to my boss that at the rate I was "progressing," I'd never make it back to my full-time schedule. My work performance, once stellar, turned pathetic. I was too ashamed to tell my boss, a woman I greatly respect and admire, about my health problems. So I could hardly blame the company for letting me go.

My last day was on a Friday in October. On Sunday morning, I broke down. Literally, I felt like I had broken. I was having trouble forming words. My lips formed the beginnings, but that's all I could get out. Then the convulsions started. Husband took me to the emergency room because he thought I'd had a stroke. In the ER, I started crying and couldn't stop. By that afternoon, I was admitted to the hospital.

Some good things resulted from that. I got a better therapist, and appropriate treatment. I learned some behavioral strategies that helped with negative thinking and depression.

And I started sleeping. It took a while, but my health, and healthy weight, returned.

I still have the occasional bad night, but I consider myself lucky. During those sleepless months, I could have nodded off behind the wheel and crashed. My sleep deprivation could have triggered serious health problems, like diabetes, heart disease, worsening depression, cognitive impairment, hallucinations, or a severely compromised immune system.

And, yes, like everybody's been warning us about, obesity.

If you've been cheating your sleep to get more done, you're only cheating yourself. If you can't sleep despite all the usual things people tell you to try, then get help. Please. Please.

So…how's your sleep? Do you conk out and sleep through the night? Do you toss and turn? Are you a light sleeper? Wake up a few times? When you can't sleep, what's worked for you?

Chocolate Meditation? Pinch Me, I'm Dreaming!

Laurieboris — Fri, 30 Oct 2009 16:42:58 GMT

Oh, be still, my beating chocolate-loving heart! If mindfulness meditation hasn't been working for you, or if you simply want a new routine, then maybe you'll like chocolate meditation, courtesy of Elizabeth Scott's Stress Management blog. If you've never tried meditation before, this is such an easy and yummy way to start.

It has the same benefit as mindfulness meditation, but you may find it easier to stick with…probably has something to do with the immediate reward, don't you think?

To start, get one small piece of chocolate. Something bite-size is preferable (and no, not the "bite-size" of the woman in the photo.) You really don't need every much at all. If you don't like chocolate or can't eat it, try this with some other small, flavorful, bite sized food like a raisin.

Keep your piece of chocolate handy as you get comfortable in your favorite chair. Close your eyes and take a few deep, slow breaths to help relax your body. Breathe in…breathe out…breathe in…breathe out…ahhh…you're feeling better already.

Take a small bite of your chocolate. Keep it on your tongue as it melts. How does it taste? How does it really taste? Pay attention to all the flavors as you allow yourself to stay in this moment, totally absorbed in the experience. How does your mouth feel? Your tongue? Your teeth? All this while, continue taking slow, deep breaths through your nose, and concentrate on all the sensations.

Swallow. Focus your attention on the sensation of the chocolate sliding down your throat. The emptiness of your mouth…the aftertaste (if any)…how does that feel?

Take a second bite, and focus even down to how your arm, hand and fingers feel as they reach for the chocolate and bring it to your mouth. As before, "be with" all the sensations as you allow this second bite to melt…everything your feeling right now, in this moment.

If other thoughts pop into your head, gently move them back to the current experience you're having with the chocolate. The point of mindfulness meditation is to stay in the "now" as much as possible.

Sit with your experience. You can continue with the meditation if you like, breathing deeply and focusing on the lingering sensation, or continue with your day.

If you're new to meditation, you might find that a regular practice can help you lower your stress and in turn, your blood pressure. It could also reduce anxiety and improve your sleep. And a bonus…if you've got a serious chocolate jones, you may find that this mindful focus on one or two tiny bites could be enough to satisfy you.

Enjoy!

Estrogen in Bioidenticals? I Hope So!

Laurieboris — Tue, 27 Oct 2009 18:05:40 GMT

When my doctor and I finally figured out that the wacky symptoms I'd been having - whiplash mood swings, insomnia, irregular periods, feeling hot minute, cold the next - pointed to perimenopause (that period of 4-10 years when your body transitions to menopause), she presented me with a variety of options. One, do nothing and learn to live with it. Two, try natural remedies like black cohosh, Vitamin E, flax seed, and whatever else worked for me. Three, get a prescription for synthetic hormone replacement therapy (she gave me a sample of a Premarin patch I could try, and an RX.) And four, if I didn't want the Premarin, she suggested bioidentical hormone replacement therapy, and slipped me the business card of a compounding pharmacist who she claimed was God's gift to women.

Option 1 was already out. When I'm not sleeping, I want to kill people, and that's bad. I considered Option 2 and would have gone there if my symptoms were not as severe. I eyed the prescription and sample patch that was Option 3…and it made me queasy. I'd read about the 2002 study that once again put HRT in the doghouse for increasing cancer and stroke risks. My mother had already stopped taking it. Option 4, from what I'd heard about it, seemed like my best and safest bet.

"He'll work with you and come up with just the dosage you need," my gyno said. "This guy knows more about menopause than most women."

I called Glenn, a soft-spoken and incredibly patient man, and we talked for the better part of an hour. He told me that while he'd started doing general compounding (a compounding pharmacist creates special versions of medications for people – and sometimes animals – who can't tolerate the usual prescription stuff), his wife had such an awful, wrenching time with menopause that he shifted his focus. He didn't want to see another woman go through what his wife went through. Not only did he compound various forms of "natural" estrogens and progesterones (he said that these substances are as close to what your body normally makes – or made – as you're going to come) but he offers weekly workshops on the hormones involved in menopause and what's happening with your body at different stages.

After experimenting around with differing dosages (he judges effectiveness not by blood or saliva tests – which he and many others call ineffective, since they fluctuate like crazy – but by how the patient is feeling), we found a formula I could live with. This has changed as I've progressed through perimenopause to menopause, but Glenn has always been right there, working with my doctor and me, and when time comes for me to taper off (which is also my choice), he'll be there to walk me through that, too.

Yes, like all alternative therapies, "natural" HRT has had its ups and downs in the public eye. Every so often, Big Pharma tries to shut down compounding pharmacists and especially the form of estrogen they use (estriol) which is approved for use in Europe but not in the US (I don't know why). They parade out studies that bioidentical hormones aren't FDA approved, have not been shown to be effective, have the same health risks as HRT, etc. But if you look closely at many of these studies, the funding can be traced back to one source: the pharmaceutical firm that makes Premarin, the top-selling synthetic HRT.

How about that.

You also might have seen or read Suzanne Somers' book about bioidentical hormones, or saw her when she appeared on Oprah to promote it. This caused a major hooplah, and many called Somers a "quack" who had no business telling women to ditch their Premarin patches and start rubbing progesterone cream into their arms.

Last year, thanks to grassroots support and the IACP (International Association of Compounding Pharmacists), compounding pharmacists like Glenn were able to beat back an FDA lawsuit that would have banned them from selling compounds made from estriol. Which would have forced me to take synthetic hormones or wait the month or two it might take for things like black cohosh and Vitamin E to work.

Now, I guess, the FDA has regrouped and is itching for a rematch. An article put out by the AP yesterday chapped my rump. The headline? "Bioidentical not FDA-approved, contain estrogen."

Well, duh. That's why I take them. Any woman who works with an ethical, licensed compounding pharmacist should know that their bioidentical HRT (unless you're taking just progesterone) contains estrogen. Every order (at least my order) comes with a warning – just like the literature you'd get if you filled a prescription with a traditional pharmacist – outlining the risks and the possible side effects.

And FDA approval? Holy Christmas. I've seen what drugs have been put out under the blanket of FDA approval, and what they can do to people, myself included. One of the main reasons the FDA approval has been withheld from compounded bioidenticals is because the dosages vary depending on the prescribers' needs, and there's no way the FDA can verify the effectiveness of all of these doses. But being able to get a dose that fits my body is one of the main reasons I chose bioidentical HRT. I can get lactose free capsules free of the dyes and fillers and whatever that can be added to synthetic prescription drugs.

In this article (which was horridly biased, in my opinion), the writer found a couple of women to interview who seemed only to know that bioidenticals are "natural" and better than synthetics. These women had "no other knowledge base than fear" when they made their selection.

Then, several unreferenced doctors nodded in agreement that women are getting products of "unknown risk" that "still contain the estrogen many of them fear."

Which, in my opinion, is another bogus attempt to discredit a form of treatment that has benefited so many women. Odd how in this article, no interviews were done with women who may have been tremendously helped by BHRT.

I don't know for certain that bioidenticals are indeed "natural." I do know that for me, they work. I take them, fully informed, and feel much better about it than slapping a patch full of God-knows-what on my ass. Maybe you feel differently, but that's OK. Everybody is different, and you have to do what feels right for you.

However, if you are interested in trying bioidentical hormone replacement therapy, don't feel discouraged by the FDA machine or by your own doctor, who might be buying into the Big Pharma misinformation campaign. But do educate yourself. Go to the IACP website. Choose a competent, licensed compounding pharmacy. Talk to the pharmacist. Know the risks and the benefits. See if it's right for you.

So…if any of you are going through perimenopause, how has it been for you? Have you chosen to tough out your symptoms, or get help from your gyno? Have any of you tried bioidenticals? If yes, what's been your experience? And those of you who are trying alternatives like black cohosh, how's that working out for you?

Photo by Alex Capelli

Higher Ambulance Fees For Obese: Fair or Discrimination?

Laurieboris — Sun, 25 Oct 2009 23:42:22 GMT

Imagine this: your typical two-person EMT crew gets a call to rush to the aid of a critically ill man – and when they arrive, sirens blazing, they find that he weighs over a thousand pounds. How are they going to get this patient onto a standard stretcher, lift him into their rig (if he'll even fit), then out again, and through the emergency room doors?

According to a report by the Associated Press, this happened to a man in Kansas. The crew's stretcher wasn't strong enough to carry him. Nor was the crew. Even if they could pick him up, he wouldn't fit into the back of the ambulance.

The crew called in an idea. Ken Keller of the Kansas Board of Emergency Medical Services approved it: hire a flatbed truck and a forklift to transport this man safely to the hospital, bed and all, where they had another forklift waiting to get him down.

Not the most dignified way to get to the hospital, but it saved his life.

The ambulance company picked up the tab for the equipment rentals and extra labor needed to get this man to the ER. Until very recently, ambulance companies all over the US have been absorbing these unusual expenses as a part of doing business…sometimes even partnering with local fire departments to get extra muscle to move heavier patients.

But with more Americans growing larger and larger, and ambulance companies' profits pared down to the bone, some have lobbied to pass these costs on to their heaviest customers…or, more frequently, to these customers' insurance providers, or Medicaid or Medicare. This, they reason, will cover modified ambulances and sturdier stretchers. After all, hospitals have been doing it for years. They offer special beds, wheelchairs and walkers for larger patients, and sometimes charge insurance companies more for them, as they would for patients who are on many prescription drugs, or require ventilators, or ICU stays.

Fair is fair, according to some ambulance companies.

"In order for these systems to survive and continue to provide their services there has to be some way to recover those costs," said Jim Buell, a director at the American Ambulance Association.

The Obesity Action Coalition calls it discrimination. "Ambulance services are a critical public service and should accommodate the needs of all of those who require them at a fair cost," said Joseph Nadglowski, president of the OAC.

But "fair cost" is something that's still up for debate. Many small-town ambulance companies simply can't afford the specialized equipment needed to transport heavier people with dignity. In Topeka, the ambulance squad shelled out around $10,000 to retool a rig designed to carry patients up to 1,600 pounds. (I can't even imagine how someone can get to be that obese, but if you live in Topeka, the EMTs are ready for you.)

Colorado Springs has also raised their rates, as have Washington and Oregon. On average, it costs roughly two and a half times as much to transport an extremely obese patient than it does to bring in someone of normal weight.

"It's really an emerging area," said Susan Pisano, a spokeswoman for an insurance industry trade group. "It is one more way that obesity is contributing to health costs."

Obesity also hits us in our collective healthcare pocketbook because of increased rates of diabetes, heart disease, stroke and over a dozen other diseases, including some cancers. The costs to treat these diseases is pooled into the rates we all pay for health insurance.

As far as increased ambulance costs, I think that it's a case of personal responsibility coming smack up against public welfare. Yes, we can all hit 911 and get help in an emergency, regardless of our ability to pay. In America, we often take this for granted, or at least I have. If your size could cause great hardships to those whose job it is to save your life (including not just costs of extra equipment but possible back injuries to those who are transporting you), then you should pony up the fees.

In many communities, the ambulance companies are strictly volunteer and only work for donations. But how can they accommodate people who can't be lifted by the crews, or transported using their equipment? How can they afford all that specialized gear, especially when so many of us are growing larger and larger (30% of us are obese and among those, 5% are morbidly so – 100 lbs or more over their healthy body weights)? Where is that extra money supposed to come from?

But I can see the other side of this coin: Where does that point of "inconvenience" stop? Should ambulance companies charge you extra if you live up five or six flights of stairs in a building with no elevator? Or if your excess poundage is not due to personal responsibility but to a medical disorder? Or if you are an alcoholic or abuse drugs, and this makes you violent causes risk or even harm to the EMT crews? Where does it stop?

Sigh. Well. I'm tired of talking now. It's your turn. Do you think it's fair for the ambulance companies to charge obese patients at higher rates? Or do you think it's a fairly obvious case of discrimination?

Photo courtesy of Dick Blume/The Syracuse Post Standard

Comfort Foods Still Top Grocery Sellers

Laurieboris — Fri, 23 Oct 2009 16:16:54 GMT

Sorry, Michelle Obama. You can lead people to broccoli, apparently, but you can’t make them buy. At least that’s the message thumbing its nose at us loud and clear from Information Resources Inc. The Chicago based market info services firm calculated the top 10 best-sellers in American grocery stores for the last year (ending June 14, 2009.) Produce in any form, fresh or frozen, didn’t even make the list. Nor did meat, fish, eggs or even toilet paper. (I know, you’d think, right?)

The warnings that soda (both diet and regular) does little but pile on pounds and erode your teeth have, for the most part, gone unheeded. Carbonated beverages top the list of best-selling grocery items, and sales are up almost 2% from last year. I’m hoping that a healthy portion of these sales is from seltzer water.

Not a big surprise that beer and wine are up – sales of alcoholic beverages often rise during a recession. Or that cigarettes (scratching the bottom of the bestseller’s list at 11) are down, given their higher price, additional taxes and waning social acceptance of smoking. Sneaking cigs in the rain at a proscribed distance from nearly any building anywhere in America while braving dirty looks is bound to give a smoker another reason to quit…or at least cut down.

Sales of salty snacks are up…probably those downing a beer want some pretzels or chips to go along with them. Sounds like someone’s having one big honking party and I’m bitter that I’m not invited.

Frozen dinners and entrees are holding their own (hopefully, you may find something green- and that may have once been alive - alongside the Salisbury steak.)

Cold cereals, #9 on the list, showed a 2.12% increase, but, apparently, we’ve been eating it straight out of the box – grocery stores are reporting a whopping 8.44% drop in sales of milk, which accounted for 11.2 billion dollars in purchases last year.

Guess we don’t “got milk” after all. Or maybe it’s just getting too expensive.

We do like our fresh bread and rolls (third best-seller after milk, and up 4.77%), and our “natural” cheese (that’s up 7.75%...uh…sorry Velveeta fans.)

It sounds like America’s tanking up on grilled cheese sandwiches and potato chips, and washing it down with a Coke. Which may be comfort food at its down-and-dirty best, and in times like these I have no judgments on the comfort food (take away my chocolate at your own peril), but a daily diet of it is not exactly a formula for good health.

Hey, America…at least slip a few slices of tomato into that grilled cheese, OK?

So…what’s in your grocery cart? Or…what’s NOT been in it lately?

Cancer Society Says, "Is That Mammogram Really Helpful?"

Laurieboris — Thu, 22 Oct 2009 16:45:19 GMT

As if you couldn’t tell from all that pink spewed across the landscape, it’s National Breast Cancer Awareness Month. From this (and from me) you all know the drill: make that appointment, take those steps to reduce the discomfort, and GET THAT MAMMO!!

Um…but wait a minute. Now the American Cancer Society is saying that perhaps they’d been a little too hasty, with both mammograms and prostate screening. Perhaps we’ve been overscreening, and perhaps overtreating cancers that might not be deadly.

“We don’t want people to panic,” said Dr. Otis Brawley, chief medical officer of the ACS. “But I’m admitting that American medicine has overpromised when it comes to screening. The advantages to screening have been exaggerated.”

But…but…I’ve got my pink t-shirt. My pink ribbon pins. I strip to the waist and get my yearly mammograms and urge other women to do the same. Lots of men I know cowboy up and get their prostate screenings (PSAs). Now they’re saying…don’t sweat it?

Not exactly. While the ACS has concerns, they don’t want you to stop getting screened. But they want it made more clear that mammograms, while helpful, don’t tell the whole picture when it comes to breast cancer.

For instance, your films might reflect false positives that alarm patients and result in invasive biopsies. Or they could show small cancers that may not be life threatening. Sometimes doctors jump in and over treat these small tumors, subjecting your body to the ravages of chemotherapy and radiation. The ACS estimates (according to an article in the New York Times) that for every 100 women told they have breast cancer, nearly a third of those tumors are so slow-growing, they might never be harmful. And some cancers, found at an early stage, still end up becoming deadly.

Excuse me, but what the…?

According to Dr. Brawley, “the benefits of early detection are often overstated.” He wants to clarify that although screenings are still useful, and can save lives, the ACS has been putting out simplistic messages. They want people to know the limitations, benefits and risks of screening tests - that you could be over treated or undertreated. This, the ACS believes, will help researchers in their quest to improve the tests and even develop new ones.

He also said that “the issue here is, as we look at cancer medicine over the last 35 or 40 years, we have always worked to treat cancer or find cancer early. And we never sat back and actually thought, ‘Are we treating the cancers that need to be treated?’”

It’s a good question. One that you should ask your own doctor, if your mammogram comes back “abnormal.”

I share the concerns of some in the medical community that this admission could end up becoming a political football. Another headline discouraging women from getting tested. Another “damned if you do, damned if you don’t” issue for doctors. “Politically, it’s almost unacceptable,” said Dr. Peter Albertsen, chief and program director of the urology division at the University of Connecticut Health Center. “If you question overdiagnosis in breast cancer, you are against women. If you question overdiagnosis in prostate cancer, you are against men.”

Sigh.

I would still recommend that you get your regular screenings. Just know what you’re getting into. Talk to your doctor about all the risks and benefits. If something comes back questionable, ask him or her what it could be and what are the risks of treating versus not treating. Get a second opinion, if you'd like. Knowledge is power, after all. And so are all of those pink ribbons.

So…what do you think? Have you ever gotten a “false positive” on your mammo? Do you get them regularly? Or will you, when your doctor recommends that you start?

Can You Teach Yourself To Be More Intuitive?

Laurieboris — Tue, 20 Oct 2009 16:24:16 GMT

I’ve been thinking a lot lately about intuition. I find that I’m sensing more than I used to, picking up on things, but I’m just now taking my first baby steps. For much of my life, I’d kept that pushy inner voice at arm’s length. Refused to listen. I don’t know how much of that was pure willfulness and how much was simply not wanting a reminder that I was about to make a bad decision. And then the wall came tumbling down. There I sat, in the rubble of the consequences of not having listened to my gut, rolling my eyes and telling that little chatterbox, “I know, I know, I should have done X, Y, or Z thing you said.”

Sigh.

But some say that you can actually train yourself to be more intuitive. Scientists are finding that intuition isn’t something mystical, something that only special people are born with, but a super-specialized way of thinking. “It’s a learned experience – something we might not even be aware we had – that is instantly accessible,” says David Myers, Ph.D., author of “Intuition: Its Powers and Perils.” In an interview with Shape magazine, he described how you can connect with your inner voice by asking yourself these six questions:

1. You and your environment: are you in sync?

Firefighters seem to know when to get out of dangerous situations. They’ve learned this by paying attention to a subconscious checklist of details about their environments. Try this to become more attuned to your surroundings: start with a few places you’re well acquainted with. Maybe your home, or your office, or your neighborhood. Look for three things you may never have noticed before. For instance, I spend a lot of time at home, so I have a pretty keen awareness about what’s supposed to be where. So I can tell if something’s out of place that might be a hazard to me (stuff I might trip over) or to anyone who might be due to visit, especially if that’s someone with a baby or a dog (yes, I let my neighbors come in with their dogs). Once you become more acquainted with your environment, and its changes, you can use this information to make a decision. For instance, perhaps you sense something out of place in the family room, and notice that your teenager has plugged one too many adapters into a power strip. This could be a fire hazard, or at the very least could blow a fuse. So you could decide to either put another strip into another outlet, or have an electrician install a new outlet.

2. You and your listening skills: “I’m sorry, what did you say?"

You can tune up your intuition by training yourself to be a better listener. The more info you absorb, the bigger database your mind has when time comes to make an important decision. Start by taking a mental inventory of your listening style: do you cut people off? Are you thinking about the next thing you want to say while the other person is talking? Are you always trying to get your point across at the expense of listening to the other person’s point of view? Even if you don’t have any of these habits, there’s always room for improvement. Some journalists called Bill Clinton an “active listener.” He kept eye contact with the person he was speaking with. “You’re less likely to interrupt someone you’re staring at,” said Joan Marie Whelan, author of “Soul Discovery.” Try this for a while and you might find that you’re picking up on more clues that could feed your intuitive skills.

3. You and body language: how fluent are you?

Being able to recognize cues from facial expressions and other non-verbal communication can give you valuable information. Get to know what some of these cues mean while you’re listening to someone speak (and really listening.) If someone is smiling, and their eyes crinkle up, then they mean it. If a smile only involves the lips, the person could be faking it. Check out what these expressions mean and see if they don’t help you improve your intuitive skills.

4. You and risk: do you shrink away?

If the idea of taking a risk makes you quiver, then try amping it up. I don’t mean dangerous stuff like cliff diving…but going out on that limb a little. “When you take risks, you’re being proactive, which helps you control events better than when you’re reactive,” says Whelan. And it could help your intuitive skills. Try pushing a bit out of your comfort zone. Go to a different place for coffee just because it feels right. When something inside you tells you to call a particular friend, pick up the phone. This could get you in the habit of listening to your gut. Good things could result.

5. You and your inner voice: Do you tell it to shut up?

Watch any quiz show. A contestant will burst out with an answer, and, given some time, will inevitably second-guess himself. The sad music plays, and he walks out empty handed. So often, that first instinct is the right one. If a firefighter second-guessed his gut, it could be disastrous. And some studies show that second-guessing your thought process could up your error rate by 30%. So if something gives you a strong message, and you’re unsure of how to proceed, stop and ask yourself questions about it (like, “what am I reacting to?”) before you say, “Final answer, Regis!”

6. You and chilling out: can you let yourself relax?

Maybe some of you have experienced this as well. I often get my best creative ideas when I’m out for a walk, floating in the pool, or taking a shower. I’ve set my conscious mind on “pause,” which lets insight and creativity flow free. “Giving yourself permission to let go of your focus and ignore all the maybes and what ifs can make room for you to follow more intuitive ideas,” says Mark Jung-Beeman, Ph.D., a cognitive neuroscientist from Northwestern University. Try giving your brain a “timeout” for 30 minutes a day - exercise, get back to nature, catch up with the latest gossip - and let your thoughts flow freely. You might come back with an idea or an insight you never would have imagined.

So how are your intuitive skills? Do you think that intuition can be learned, or are some people naturally better at it than others? And how do you feel about the phrase “women’s intuition?” Is it a myth, or is there some truth to it?

Can You Control Pain With Your Mind?

Laurieboris — Sun, 18 Oct 2009 21:43:05 GMT

I’ve always thought so…in fact, that’s the whole basis behind mind-body techniques like self-hypnosis. You get into a deep state of relaxation, go to your “happy place” and give yourself suggestions like, “the pain in my knee (ankle, foot, back, whatever) doesn’t trouble me.” Hey, it’s worked for me. So has meditation and deep breathing. Some use prayer. Some simply ignore their pain and go about their business, bless their stoic hearts.

PNN’s own ProComicDiva had a similar, positive experience with acupressure. When post-surgical back pain made it damned near impossible for her to walk, a friend suggested an acupressurist. With a light touch on a specific spot on her ear, she was – only after a few visits – pain free.

Still, writing off many of these mind-body-spirit techniques as mere placebo analgesia is the “party line” of some in the traditional medical profession. They think that if you strongly believe a particular treatment will offer pain relief, it will…temporarily. But so far no one has been able to explain exactly how.

Now maybe we’re getting closer. Scientists in Germany have concluded that the placebo effect can be measured…not just in the brain, but also in the base of the spinal cord, where sensations of pain are processed. This is also called the “dorsal horn,” where Diva’s acupressurist told her that her pain signals had become “scrambled.”

Dr. Falk Eippert, from the University Medical Center Hamburg-Eppendorf, first measured the pain threshold of their subjects (15 healthy young men) by applying heat to their arms. Next, his researchers had the volunteers rub a different cream into each arm. They told the men that one cream is a very effective painkiller, and that the other was not (in reality, both creams were inactive.) After juicing them with more heat, the participants reported that they felt less pain in the arms that had been smeared with the “effective painkiller.”

The researchers then took functional MRI scans of the young men’s spinal cords. They found that when the subjects were told that both arms received the effective cream, the dorsal horn showed less activity compared to when they were told the cream was useless.

Eippert’s team concluded that placebo analgesia works by inhibiting the activity of the body’s pain centers in the central nervous system…and psychological factors could be the trigger.

Take that, you AMA nonbelievers. True, it’s a small sample of a homogenous group. (And why weren’t women tested?) Still, it’s the gold-plated, double-blind evidence that many of us have been looking for, that the placebo effect is NOT simply psychological, but a complex mix of the psychological and the physical.

This could be interesting news in the further study of conditions that are rooted in the central nervous system, like pain and depression (and, possibly, fibromyalgia?)

While Eippert and company weren’t exactly sure what mechanisms tell the spine to tone it down when a placebo is given, they speculate that the body’s natural painkilling substances (like serotonin, and endorphins) could be the factors.

Makes sense to me. From my head all the way down to my dorsal horn.

So what do you think about this new study? Have you tried any mind-body treatments that have helped your pain? Has anything you tried worked for a couple weeks and then stopped?

Brown Rice Boring? Try These Great Grains!

Laurieboris — Fri, 16 Oct 2009 16:26:39 GMT

I’ve changed my diet radically in the last few years – much less meat (I’m closing in on vegan now), much more scratch cooking – but when an opportunity came along to participate in a series of workshops given by a local holistic nutritionist, I jumped. Her focus is on how to get more energy by improving your diet…ditching the empty calories and stimulants and adding whole foods in a way that works best for your body.

For the last couple of weeks, she’s been encouraging us to experiment with whole grains. While I’ve had some disasters (baby steps, you know?), this has been good for me. Like a lot of gluten-sensitive people, I tend to get into that brown rice rut. I make a big pot on the weekend, and add this or that to it for different meals. Salt, pepper, olive oil, garlic, beans and veggies, and it’s dinner. Cinnamon, ginger, almonds, pumpkin seeds, chopped apple and it’s breakfast. Occasionally, I’ll dip into the quinoa…but that’s about it. Otherwise it’s…sigh…brown rice again. If you’re getting into that rut (or if you want to experiment with some new types of whole foods), try some of these (gluten free) grains:

Quinoa looks like birdseed and is very high in protein (contains all eight essential amino acids). Compared with wheat, it’s also higher in calcium, iron, magnesium and other nutrients. It has a crunchy yet creamy texture, and tastes a bit nutty. It’s more of a savory than a sweet grain, so I’d serve this as a pilaf, or on its own with a bit of salt and pepper and maybe a dab of butter or olive oil. To cook, use 2 cups of water (or veggie broth, for a change of pace) to 1 cup of quinoa (rinsed several times in a mesh strainer.) Put water and rinsed quinoa in a pan, bring to a boil and simmer for 15-20 minutes.

Millet (a much finer textured bird-seed-looking grain than quinoa) tastes milder than quinoa, and could substitute for rice in many recipes. It’s nearly 15% protein, and chock full of vitamin E, B-complex vitamins and other nutrients. You may have to experiment around with how much water you use to get the texture you desire. Start with 1 cup of millet to 2-1/2 to 3 cups of water. (Rinse the millet first in a mesh strainer.) Like quinoa, bring water and millet to a boil and then simmer for about 20-30 minutes, depending upon your stove. If you want it fluffy like a grain, leave it alone while simmering. If you want a creamy texture, stir frequently while cooking and add extra water as needed. My first attempt at cooking millet was not so great (the nutritionist told me that you could mix quinoa and millet together, as they cook at the same time, but this wasn’t the case on my stove. My second attempt was a disaster – I put the millet up to simmer and then I found out a neighbor’s brother had died. So…forgot about the simmering pot for about 45 minutes. I had mush on top of hardened goop stuck to the pan. But cooked well, it could make a nice substitute for your normal hot breakfast cereal, with the added punch of getting more whole grains into your diet. (The pot is still soaking.) Or try the faux "mashed potatoes" recipe below.

Amaranth is actually a seed, and is related to Swiss chard and spinach. It’s another great source of protein, and compared with wheat, has almost four times the calcium and double the iron and magnesium. It’s mild and rather sweet-tasting…. and your kids might actually like it.

If you’re feeling adventurous, try this Asian take on millet…could make an interesting replacement for mashed potatoes (and it’s a lot more nutritious.) Thank you to Mark Bittman for the inspiration. Feel free to improvise as you wish. Subbing an equal amount of cauliflower, and adding roasted garlic instead of the ginger makes this closer to “real” mashed potatoes.

Mashed Millet with Carrot, Ginger, Sesame and Soy

Ingredients:

2 T of peanut oil

1 cup of millet

Soy sauce or tamari, to taste

Fresh ground pepper

2 T of peeled and chopped fresh ginger

½ lb of carrots, peeled and chopped

3 cups of water or veggie stock

Toasted sesame oil, for garnish

Toasted sesame seeds, for garnish*

1. Put oil in a large pot with a lid, and heat to medium. Add millet and ginger and stir constantly until it toasts golden brown; about 2-3 minutes.

2. Sprinkle with soy sauce/tamari and pepper, add carrots and 2-1/2 cups of liquid. Bring to a boil, lower heat until the mixture is bubbling gently along, and cover. This should take about 30 minutes. Add liquid if the mixture looks too dry.

3. Remove from heat and mash with potato masher or immersion blender if you have one. You could also let this cool a bit, and run it through a food mill or food processor.

4. Serve garnished with a sprinkle of toasted sesame oil and sesame seeds

*To toast sesame seeds, heat a dry pan to medium and toss in a handful or so of seeds. Stir frequently until they are nice and toasty – keep them moving so they don’t burn and as soon as they are golden brown, take them off the heat. They might continue to cook, so transfer to a heat-safe bowl to let them cool.

Could It Be? A Cause For Chronic Fatigue Syndrome?

Laurieboris — Thu, 15 Oct 2009 00:13:17 GMT

Dominie Soo Bush, a piano teacher living in Florida, developed Chronic Fatigue Syndrome (as well as fibromyalgia – the two often arrive together) in 1987 after what she calls “a nasty virus and a lung infection.” She was so incapacitated with fatigue that there were times when she had to go to bed, too tired to even hold her head up any more.

“However,” she writes in her web site, “since I couldn't sleep, I would just lie there feeling depressed, thinking of all the work that needed to be done. Typically I would only have energy until about 10 a.m.--then I could barely function. Even the process of eating--chewing, swallowing, digesting--was exhausting at times! Forcing myself to do physical exercise just made things worse. On days requiring a massive (for me) amount of energy, such as driving 4 hours to visit my parents on the other side of the state, I would be in an agony of exhaustion!”

The Mayo Clinic defines Chronic Fatigue Syndrome (sometimes also called Myalgic Encephalomyelitis or ME) as “a complicated disorder characterized by extreme fatigue that may worsen with physical or mental activity, but doesn't improve with rest.”

Like most of us who live with a condition that most in the medical community don’t understand, we try everything – medications that sometimes work, sometimes don’t, and sometimes induce intolerable side effects. We try doctor after doctor, therapy after therapy, and eventually learn whatever set of self-treatment protocols works for us. And sometimes that changes, too. Coupled with some professionals who think that the condition is “all in our heads,” it’s no wonder that we’re frustrated.

But could a study published in the journal Science be the key that turns the lock that could open up a whole new world of health for Dominie and the 1-to-4 million other Americans who live with CFS?

Could it be that a virus is to blame?

Although the data is not inclusive, and much more study needs to be done to determine if the isolated virus really is the culprit or if it’s only part of larger collection of underlying health problems, it’s cause to give many researchers and patients hope.

And unfortunately, it’s not a virus that’s as simple as one that causes colds or the flu…contract it, and deal with it until it passes. It’s a retrovirus, currently called XMRV, which is in the same family as the virus that causes AIDS and leukemia. So it may not be as easy to shake. It’s not lethal, but it lingers.

Still, Dr. Judy Mikovits, lead author of the study (done at the Whittemore Peterson Institute in Reno, Nevada, founded by parents of a woman who has CFS) believes that this virus will be found – eventually - in all CFS patients. She also expects a test to become available “within weeks.”

While these study findings will probably peak the interest of many in the CFS community, several supposed “breakthroughs” in the past have proved to be nothing but dead ends.

The Centers for Disease Control and Prevention is already downplaying the virus theory. (Thanks, guys.) Dr. William C. Reeves, who directs public health research on CFS at the CDC, noted that the study was “exciting but preliminary.” They are doing their own research to see if they can confirm Dr. Mikovitz’s findings. “If we validate it, great,” he said. “My expectation is that we will not.”

Dr. Mikovitz remains optimistic. “I think this establishes what had always been considered a psychiatric disease as an infectious disease.”

I think it’s also an amazing step that instead of waiting for the medical community or the government to approve research funds to study these “unsexy” diseases (you know, the ones that don't have celebrities raising scads money for them), some in the private sector are stepping up to create research facilities like the Whittmore Peterson Institute.

Do you know anyone with Chronic Fatigue Syndrome? Ever have it yourself? What was your experience with it? What helped you?

Image courtesy of cynthia_lmb

Emotional Stress Can Eat You Alive!

Laurieboris — Sun, 11 Oct 2009 21:24:55 GMT

It’s one of those odd coincidences of the universe when what I plan to share with you is exactly what I need to be doing for myself. Or maybe it’s not so odd. Perhaps it’s a gentle reminder…sometimes a not-so-gentle one…that I could be taking better care of my emotional health. Especially during this very stressful time I’m going through.

Because you can do crunches until you drop…could eat kale and tofu and blueberries until you never want to see them again…but if you ignore your emotional well-being and shove all those upsets under the rug, they’re going to come back to bite you in the ass in some way...usually at the worst possible time.

All those anxieties, frustrations, all those arguments that go unresolved and unrelieved build up in your system. And since your physical body is connected to your spiritual and mental body, here’s what happens:

First, let’s imagine that something happens to you at work. Maybe a coworker snubs you, or you get passed by for a project you really wanted. Or, a more likely scenario these days, your hours get cut, and when you complain, your boss says it’s either that or lose your job. And you just suck it all up. This emotional stress causes changes to your sympathetic nervous system, which activates that old “fight or flight” response. Your adrenal glands are stimulated, making your heart pump faster and increasing respiration, and releasing more cortisol, which releases more glucose into your blood. Your digestive system slows down, to make more blood available to your muscles (since it can’t tell the difference between having to run from a rabid raccoon or having an argument with your boyfriend.) Even more glucose is pumped into your blood, should you need a secondary burst of energy.

OK, these reactions are damned useful, should a mugger confront you, or you have to run to catch a train. But unrelenting stimulation of the sympathetic nervous system by the accumulation of all the tiny insults we put up with over the course of the day, the week, the month…like many of us are doing these days…and you’re setting yourself up for a physical train wreck.

For instance, all that extra cortisol that flooded into your system is still sitting there. At the very least, it can make you gain a few pounds around your waist. But it can also set you up for a major metabolic upset that could lead to diabetes. Adrenal fatigue could throw your thyroid for a loop. And any of these low-grade stressors could upset the delicate balance of your immune system and create systemic inflammation, which could lead to a whole basket of nasties, from weight gain to sleep disturbances to heart conditions to cancer. It even accelerates the aging process. Can you say Botox, anyone?

But you don’t have to sit there and take it (or the Botox). If you’re getting mentally beaten up, here are a few things you can do to keep that stress from beating up your body:

1. Breathe in, breathe out, breathe in… Yes, this is my favorite way to keep my stress pot from boiling over. Find a quiet place, get comfortable and just…breathe. Breathe deeply and regularly, and soon this will activate your parasympathetic nervous system, which will relax your muscles and improve your digestion. (Best not to do this while driving.) If you need some prompting, Dr. Andrew Weil offers an excellent audio download of breathing exercises for a variety of situations.

2. Make a daily practice of it. Pick some quiet activity your enjoy and that fits in with your personality and lifestyle. That could be a session of deep breathing, meditation, prayer, guided imagery, listening to quiet music – whatever works for you. One that I enjoy is pairing deep breathing with an audio CD of ocean waves. I find the rhythm of the waves especially soothing. Another method that Dr. Ben Kim recommends is to combine any of the above with visualization…getting into a quiet mode and imagining yourself floating through your day being able to react to whatever life throws at you with emotional poise and balance.

3. Get nutrients into your bod that promote emotional health. Eat well, that’s a given – but nutrients like B vitamins, Vitamin D and omega-3 fatty acids make your nervous system especially happy. Supplement if you need to, but first try to get these goodies through foods like whole grains and legumes, dairy products (if you can tolerate them) and fatty, cold water fish like salmon and herring.

4. Express thyself. Have a daily emotional checkup to find out what’s behind those hurt feelings. How does getting snubbed by a coworker make you feel? How did the argument start? Getting real with yourself is an essential part of keeping those immediate upsets from becoming the kind of chronic emotional stress that can harm your health. And again, how you do it depends on your personal style. Talk it out with your friends. Write it out of your body in your journal or your blog. If need be, take it to a professional therapist. Hey, we all need a little help now and again.

5. Move that body! You knew I was going to sneak this in somewhere, didn’t you? Yes, lace up those sneaks and get some exercise. Studies up the wazoo show that regular exercise can keep your emotional body healthy and help prevent depression. Doesn’t matter what you do…just do it!

6. Know when to walk away…and when to run. No, this one’s not about exercise. Or poker. This is about knowing when to remove yourself from a situation that’s causing you stress. It can keep your body from absorbing a heap of hurt. For instance, today, Husband and I had an argument. At one point, I just knew that if I stayed a minute longer, I’d start saying things I might regret. So I grabbed my keys and went for a drive (after having taken a bunch of deep breaths before turning the ignition on…please, never drive angry.) It doesn’t always have to be that dramatic. And it could take some practice. A good example of this is when Sally’s computer crashed last week and she just walked away (I'm sorry, I can't find the link to that piece.) She could have stayed and fumed and cursed, and this would have given her emotional health a big fat black eye. But she knew that the best path was to just…get away for a time. Maybe you just want to sit with this concept for a while and consider where it might come in handy in your life. Or, you could use that beautiful pass that Writergrrl gave us (Arrgh! Sorry, I can't find this link, either. WG, maybe you can help.) I have used it several times to get out of political arguments. It’s a lovely thing.

So…I’ll shut up now and listen. It’s your turn. What’s your escape valve when the pressure cooker gets turned up in your life?

Coconut Macaroons

Laurieboris — Sat, 10 Oct 2009 01:08:47 GMT

A few of you have been asking for this recipe, and here it is. So it’s not the healthiest thing you can put in your mouth, but who doesn’t need a treat now and again? Well-being is about balance, right? (Some say the right balance of coconut to chocolate...)

I started making these chocolate-dipped macaroons as a holiday gift to my physical therapist, in appreciation for his outstanding talent and skill and for letting me take up space in his clinic/gym for the last four years. Seemed like every other week I’d walk in and see an apple pie or other wonderful goodie one of Tom’s clients had made for him. He’d offer me a piece, and then tease me by saying, “So, when are you going to bake for me?” (Knowing that I cringe when it comes to baking.)

Finally I did. Now when December rolls around, he asks when I’m going to bring in “those coconut things.”

Although he’s worth it, I swear I spoil that man rotten.

Coconut Macaroons (makes 2-½ dozen)

Ingredients:

1-1/2 tablespoons of cornstarch
3 cups of shredded, unsweetened coconut
3 egg whites

½ teaspoon vanilla extract
¾ cups of sugar (use less, if you prefer)
4 oz. of bittersweet chocolate, broken up*

1. Heat oven to 350°.

2. Mix coconut, cornstarch, sugar, egg whites and vanilla in a heat-proof bowl.

3. Place bowl over a pot of boiling water (or use a double-boiler, if you’ve got one.) Stir until the mixture gets thick…about 4 minutes. Remove from heat and set aside.

4. Place a bit less than a tablespoon of the mixture on an ungreased cookie sheet (note: I find it easier - less stickage - to line the cookie sheets with parchment paper.)

5. Bake for 10-15 minutes or until lightly golden but still soft and chewy. Remove to a wire rack to cool.

6. Melt chocolate in a small, microwave-safe bowl (not plastic) by nuking on high for 1 minute (adjust for your wattage.) Stir until smooth. Heat a little more if needed. Carefully dip bottoms of macaroons into the chocolate, and let excess drip back into the bowl. Place on a wax-paper lined (cool) baking sheet and put in fridge to set.

*Use the best quality chocolate that fits your budget. It makes a difference!

Got Flu? When To Stay Home, When To Seek Help

Laurieboris — Thu, 08 Oct 2009 00:15:25 GMT

Despite your usual good-health precautions, you have a sore throat, a fever, a wicked cough, and feel like a Volkswagen is sitting on your chest. You’re pretty much sure it’s the flu…maybe H1N1…but is it bad enough to call the doctor? Go to the emergency room? You don’t want to show up at the ER only to have them tell you to go home, get plenty of rest and drink lots of fluids…but what if it’s serious?

Well…it’s Google to the rescue! Not only has the search engine already put on its scrubs earlier this year to help the CDC track the spread of flu (based on what kind of symptoms people around the country are searching), a just-launched program can now help you winnow out your symptoms.

Just go to http://www.h1n1responsecenter.com. Answer a few questions (it’s only designed for people over 12), like age, sex, whether or not you have a fever, or other symptoms, and the program may conclude a “probability” of your having swine flu. It can tell you whether you may be better off lying low at home or calling your doctor. But…if it thinks your symptoms might be more serious, for example, if you’re having trouble breathing or started to feel better but the fever and an even worse cough came back - it will flash out a warning to get thyself to medical care ASAP. Not exactly in those words, of course, but something like that.

While it may give some people unnecessary call for alarm, it’s a good attempt to help keep people who aren’t terribly sick out of already crowded emergency rooms…and to help those who are (or those who are caring for them) make vital decisions about whether or not to seek immediate medical attention.

The program is modeled after the one Emory University uses to do triage calculations. It also includes links to the CDC to get more information about H1N1 (I don’t know about you, but I’m still having a problem typing that.) It also gives you an option to let them store the answers to your questions (so the CDC can do further tracking of H1N1 progress) or keep them private.

But here’s hoping you and your loved ones stay well and won’t need the program at all.