S.

A.A gastrectomy involves surgical removal of part of the stomach, with the remaining stomach being surgically attached to the small intestine. The most common reasons for this operation are stomach cancer or complicated ulcers (ulcers that have perforated through the stomach wall or are bleeding profusely). I’d be interested to know the reason for your gastrectomy, since it was done when you were in your 20s.

A. Regardless of why your gastrectomy was performed, the problems you are now having with blood in your stool are unlikely to be related to the condition that necessitated your surgery. You state that you have blood in your stool. Is this something that was found when your doctor tested your stool as a routine yearly exam, or is it obvious blood that you can see in the stool? The difference is important because it may indicate where the bleeding is originating. Tiny amounts of blood in the stool, which often are not visible to patients, may indicate slow bleeding anywhere in the intestinal tract. Red, visible blood in the stool is usually of colonic origin, while a black, tarry stool usually indicates blood that has been exposed to acid and is from a location in the upper digestive tract.

One of the long-term side effects of gastrectomy is the formation of ulcers at the point where the stomach has been surgically attached to the small intestine. This may stem from a poor blood supply at the attachment site, caused by chronic scarring and/or exposure to stomach acid. Since you say you have had prior endoscopies, I wonder if this finding was present earlier.

Also, aspirin and other nonsteroidal anti-inflammatory prescription drugs without prescriptions can exacerbate stomach ulcers. So, your use of Excedrin (which contains aspirin) could be contributing to this process. It would be a good idea to avoid NSAIDs if at all possible. As to your chronic headaches, I am not sure if you mean migraines. If that is your diagnosis, you may benefit from medications that may prevent attacks, such as beta-blockers or certain antidepressants (Elavil). Alternatively, there are several medications, such as sumatriptan (Imitrex), that can abort a migraine attack once it has begun. You should discuss these options with your doctor.

Whatever the possible causes of your bleeding, the proper recommendation is to have endoscopy — in your case both upper and lower endoscopy. As you near age 50, the risk of colon polyps or cancer increases, and this alone would be a reason to perform a lower endoscopy (colonoscopy) after blood is found in your stool. The upper endoscopy will examine your remaining stomach and the site where it attaches to your small intestine, specifically looking for ulcers in that location. Another reason to have this exam is that patients who’ve had a subtotal gastrectomy face a slightly elevated risk of cancer in the remaining stomach remnant.

You should not fear these exams, and you should discuss your anxiety with your gastroenterologist. If you woke up during your last endoscopy, the most likely reason was inadequate anesthesia. Endoscopy uses a form of anesthesia known as conscious sedation, in which you receive both a sedative and an analgesic. You should be more comfortable next time if you discuss your last experience with your doctor before the exam.

they require staff with relevant training and competency.

they require staff with basic knowledge about the service system.

they offer an important contact point with consumers.

they require staff with sensitivity to human relations and cultural diversity (such as the necessity of linguistic and cultural competency).

One confusion about the terms of screening, initial assessment and ongoing assessment lies in their relationships to other terms such as intake, referral and triage. Screening and assessment are also easily conflated because both tend to be performed during consumers’ initial access to the service system. In this issue brief, intake and referral are not considered a behavioral health screening, but are viewed as an administrative gathering of data about the appropriateness for a behavioral health referral.

What follows is a sample list of components for each of the three terms, and for each term, a suggested application of credentials.

Screening

Screening is intended to gather basic identifying data for an in-depth evaluation. Its components may include some of the following:

Determining eligibility for services and verifying existing diagnosis, if any.

Gathering additional socio-demographic information beyond intake data.

Organizing basic information about presenting problems and issues, and developmental and service history.

Evaluating risk factors for behavioral health, including risk to harm self or others.

Determining level of care.

Assessing natural support system.

Providing follow-up on the referral.

It would appear that these activities can be easily performed by Bachelor’s-level personnel with appropriate training, provided that there are standardized and validated protocols for assessing risk factors and determining levels of care.

Initial Assessment

Initial assessment is intended to provide a comprehensive evaluation of functioning to assist service planning and intervention, including a comprehensive assessment of functioning status, such as:

Psychosocial evaluation

Other functioning assessment

Determination of services to help address the condition

Using an example from the Community Partnership of Southern Arizona that is based on state rules, an initial assessment includes:6

CPSA Provider Agency Comprehensive Psycho-social Assessment

Arizona Level of Functioning Assessment (ALFA) and Service Level Guidelines

Client Assessment Form

Clinical Global Impression (CGI)

Health Status Questionnaire (SF-12)

Good professional judgment about the consumer’s functioning is called for during initial assessment, and this should require the participation of credentialed professionals. However, should assessment tools be standardized – even computerized – the workload of credentialed professionals can be lessened. In fact, it is not unreasonable to argue that the gathering of information needed for initial assessment can be performed by personnel with adequate in-service training and supervision by credentialed professionals, even though those personnel might not have behavioral health credentials themselves.

Ongoing Assessment

Ongoing assessment beyond initial assessment is intended to assist the treatment process and determine service outcomes. Its components may minimally include the following:

In-depth assessment over time beyond initial assessment (especially when the condition was unstable during initial assessment or there are questions about co-occurring disorders).

Development of treatment plan.

Interdisciplinary team review of progress.

Periodic review of treatment outcomes.

It is clear that at the stage when consumers are involved in treatment, more than one discipline is needed to review treatment progress and determine treatment outcomes. Here, credentialed professionals work in unison with other professionals, as well as consumers and families, toward achieving the goals of recovery and rehabilitation.

To summarize up to this point:

The screening function can be standardized and administered by non-credentialed personnel with appropriate in-service training.

The initial assessment function can also be standardized in order to be administered by staff (with input from consumers and families), with credentialed staff responsible for its interpretation for diagnoses and evaluation. Already in many jurisdictions, mental health and substance abuse screening and assessment formats have been standardized to allow for easy administration and electronic data exchange.7 Moreover, computer software is becoming more readily available and accessible for timely exchange of clinical information, which in turn promotes continuity of care.8

Ongoing assessment beyond the initial assessment as part of the process of service delivery is a responsibility shared by multiple teams and responsible personnel.

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Asthma is a respiratory condition where the lining of the airways becomes inflamed and swollen producing mucus while the muscles around them tighten — causing symptoms of coughing, wheezing and breathlessness.

People suffering from asthma already have sensitive airways. But often, a trigger will cause symptoms to recur. These triggers can be allergies to pollen or animal hair, exercise, sudden temperature changes, some foods and medications, cigarette smoke, dust and stress.

Although some medicines trigger an asthma attack in certain individuals, not everyone will be affected. The worst culprits are usually over-the-counter medications that are bought without a doctor’s prescription. Aspirin affects 3% of asthmatics with one tablet alone causing a severe attack within two minutes to two hours. It can also be found as an ingredient in the manufacture of many other medications, so it is necessary to read the medicine packet very carefully before embarking on a course of treatment.

Other medications that can cause difficulties:
Ibuprofen and Indomethacin/Naproxin for rheumatic pain
Voltarol/Dicofenae sodium a prescription drug given for arthritis, gout, orthopaedic, dental and minor surgery
Paracetemol (although this usually has a mild effect and only in certain individuals)
Beta Blockers in the form of tablets
ACE inhibitors (captopril, enalapril, lisinopril)

A patient should always remind their doctor and pharmacist of their asthma before beginning any new treatments.

Food allergies can also cause a flare up in asthmatics with an accompanying tingling in the mouth, vomiting, diarrhea, skin rash, shortness of breath, wheezing and sometimes swelling of the face. These symptoms can appear within just a few minutes of eating the offending food or even up to two hours later. Some foods responsible are peanuts, sesame, dairy products such as milk and cheese, fish, eggs, shellfish as well as food coloring, dyes and preservatives. Histamine is another allergen as is Royal Jelly, propolis and bee venom. Although not allergic in origin, cold drinks can also trigger an asthma attack.

A doctor will refer anyone with a suspected food allergy to a specialist allergy clinic. A dietary history will be taken of what has been eaten, along with accompanying symptoms and other allergic reactions within the patient’s family. There are several tests that can be given to determine the cause of an attack. The skin prick test is where samples of suspected allergens are tested on the skin of the forearm and any reactions noted. This test is painless and the results are known within a short period of time. A blood test is another relatively simple test for these allergies.

There is also a test we call the Food Challenge. Samples of food are disguised and fed to the patient to see if there is a worsening in their condition, but this should only be undertaken under specialized guidance. An Exclusion Diet is where the foods suspected of causing the attacks are avoided for several weeks. A diary of symptoms is kept before, during and after the test along with peak flow readings. The suspected foods are then gradually reintroduced into the diet and any reactions are noted. Complementary tests for food allergies consist of electrodermal testing, hair analysis and applied kinesiology.

Exercise is a very common trigger for asthma attacks causing symptoms of chest tightness, wheezing, coughing and breathing difficulties. In particular, cycling and running have been found to be two of the worst culprits of exercise-induced asthma. Also, exercising in the cold air can worsen the condition by inflaming the airways. Prevention can consist of exercising indoors in a gym or perhaps swimming as there is usually a humid atmosphere near a pool. Asthmatics should always warm up ten minutes prior to exercising as well as warm down afterwards. If it is necessary to exercise in cold temperatures, the mouth and nose should be covered with a scarf.

Basic asthma care consists of taking drugs to relieve the inflammation of the airways. There are two groups of asthma medications. Bronchodilators stop attacks once they’ve begun by relaxing the muscles in the airways and allowing easier breathing. These are non-steroidal, anti-inflammatory and give short-term relief. However, they should not be over-used; when abused, bronchodilators can actually worsen the condition. Anti-inflammatories prevent an asthma attack from even starting by keeping the airways open, decreasing mucus and reducing swelling. Often, these are called “preventers” and are in the form of an inhaled corticosteroid that should not be confused with the anabolic steroids so often misused in the sports world. It is very necessary for an individual to take these on a regular basis in order for them to work, even when feeling well. Corticosteroids come in the form of sprays, pills, liquids and injections. They give few side effects, although there could be some symptoms if taken in the pill or liquid form over a long period of time. Side effects can consist of a sore throat, thrush, nervousness, a rapid heartbeat, insomnia, loss of appetite and nausea.

There are several inhalation devices that can be used to deliver asthma medication directly into the system. A metered dose inhaler is a small device that uses a chemical propellant to push the medication from the inhaler into the mouth. Nebulizers give a fine mist through a mask fitted over the mouth and nose by using oxygen or air under pressure. These are particularly useful in giving medicine to babies and children too young to use an inhaler as well as to give medication to elderly and acutely ill patients. Rotary or dry powder inhalers deliver the medication without using any chemical propellants such as the damaging CFCs (chlorofluorocarbons) that have wreaked such havoc on the ozone layer. Inhalers need to be used correctly and the prescribing doctor should teach their patient how to use their inhaler or nebulizer properly.

The progress of a person’s asthma is often recorded by a peak flow meter. This is a hand-held device that measures how fast a person can expel air from their lungs. Patients are often asked to keep diaries or charts to measure their progress so that the physician knows when and if their medication level needs to be altered.

Several complementary medicines have been found to help improve asthma symptoms, although these should never replace the use of conventional medications. Acupuncture has been shown to have short-term benefits in those people with allergy-triggered asthma. Herbal remedies such as coleys forskholii, ginkgo biloba, tylophora asthmatica, ephedra and saiboku-to have been useful in relieving symptoms but should only be given by a qualified herbalist or naturopath.

Yoga, hypnosis and relaxation techniques can help in the cases of stress-induced asthma by allowing the individual to learn techniques to cope with their anxiety. The Buteyko technique (named after the Russian professor who created it) is a system of breathing exercises and behavioural changes that alters the balance of oxygen and carbon dioxide in exhaled air. Many people undertaking this treatment have noted an improvement in their condition but more research is needed on the subject before any firm conclusions as to its efficacy can be noted.

“People just don’t understand how you can have a headache every day,” says Watkins-Price. “They can’t understand the magnitude of how painful, how frustrating and how debilitating they are.”

Like most severely disabled headache patients, Watkins Price has seen a long list of physicians, from family practitioners to chiropractors to neurologists, and has been subjected to a myriad of tests, including magnetic resonance imaging (MRI) and electroencephalograms (EEG). She now suffers from an extreme form of migraine known as transformed migraine, which in some cases is believed to result from overuse of pain medications.

“They just kept giving me Demerol,” Watkins-Price says, describing a life consumed by a vicious cycle of doctor visits, powerful pain medications and frequent trips to the emergency room. “I was taking medication every two to four hours. I think I was in the emergency room when somebody gave me Dr. Kaniecki’s card.”

Six years ago, she dialed the phone number on that card ­ and changed her life.

Two to four times a year, Watkins-Price makes the two-hour drive from Johnstown, Pa., to Pittsburgh to see the doctor that has helped her manage her disease for the last six years, Dr. Robert Kaniecki, director of the University of Pittsburgh Headache Center.

When Kaniecki first saw Watkins-Price in 1995, he hospitalized her for several days to begin a detoxification process made necessary by many years of consuming pain medications. The cornerstone of that treatment was dyhydroergotamine, or including DHE, a drug that often can break the migraine cycle.

For most chronic headache sufferers, effective treatment is a life-changing experience. In just days, Watkins-Price went from being essentially bed-ridden, self-exiled to a life in total darkness, dependent on others to feed and bathe her, to being able to walk outside.

Kaniecki says her experience is typical among severely disabled headache sufferers, stressing the goal is to manage the headache and minimize its impact on the patient’s lifestyle rather than completely eliminate the pain. It’s a slow process that usually takes from three to ive years to achieve acceptable results.

“There’s still a sense out there that treating migraine means treating pain,” Kaniecki says, adding most chronic headache patients suffer from a chemical imbalance in the brain, usually a deficiency of the neurotransmitterserotonin.

Severe chronic headache disease is life-altering on more levels than simply coping with pain. Watkins-Price says the decision to have children was a difficult one.

“I thought, how am I going to be able to take care of a baby when my mom has to come over and take care of me,” she says, adding there have been many times when the pain was so intense she simply couldn’t function, requiring her husband to pick her up and carry her to bed.

And pregnancy can mean changing treatment regimines, often for less effective drugs that won’t endanger a developing fetus.

“You have to really watch what you can be one when youa’re pregnant,” Watkins-Price says, explaining Kaniecki worked with her to find a combination of therapies that allowed her to manage her pain without creating additional risk for her child.

She said routine management her headache also involves juggling of medications because some drugs tend to lose their effectiveness when taken for long periods of time. Kaniecki periodically alters her regimine to allow the best quality of life possible. She is currently on a high daily maintenance dose of 60 mg Prozac®, a serotonin lifter, and occasional injections of Imitrix®, a headache-specific drug that produces a rapid boost in serotonin.

While not cured — she still has a headache that never goes away — Watkins-Price is able to manage her pain with a variety of drugs and close monitoring by Kaniecki. And perhaps even more important, she has control of her life. In addition to working full-time as a first-grade teacher — something she never dreamed of until six years ago — she now has two children, ages 2 and 6 months. And finally, a life she can call her own.

Mary has endometriosis.

If you are a woman with endometriosis, you may have one or more of the symptoms described above, or others, which include:

* Severe cramps during menstrual periods and ovulation
* Bleeding between periods
* Backache
* Pain during intercourse or orgasm
* Pain/cramping during bowel movements
* Painful/frequent urination

The pain a person with endometriosis feels is not linked to how severe the disorder is, and a woman with advanced endometriosis may have no symptoms, while another with mild disease experiences severe pain.

If you have endometriosis, you also have a 30 to 40 % chance of infertility and may need treatment for it.

What is endometriosis?
Endometriosis is caused when tissues that are normally found in the uterus are found outside it in the abdomen. This tissue may stick to areas such as the bladder, the rectum, the area behind the uterus (the cul-de-sac), the fallopian tubes and uterine ligaments, the colon or the abdominal wall.

This tissue that escapes the uterus responds to hormones just as the uterus does, and “bleeds” during the monthly cycle, causing irritation and inflammation. Vesicles, or fluid filled sacs, become filled with blood early in the disease process. As time goes on, these vesicles may turn dark in color, and eventually fill with scar tissue. At this point they no longer respond to hormone influences.

What Causes It?
There are several theories about the causes of endometriosis. Dr. John Sampson proposed in the 1920s that during menstruation, uterine tissue escapes through the fallopian tubes into the abdominal cavity. This is called retrograde menstruation, and occurs in 70% to 80% of women. The escaping cells are believed to implant in a certain area, and to grow into an endometrial spot. The problem with this theory is that most women with retrograde menstruation do NOT develop endometriosis, and women after a hysterectomy have developed it. Also, there are reported cases of MEN who developed endometriosis after prostate surgery when undergoing estrogen therapy.

Another theory ties this disorder with genetics, since sisters and first-degree relatives of a woman with endometriosis have a greater chance of developing it.

Some researchers propose that early embryonic tissue that stays undifferentiated into adulthood develops into endometriosis when the tissue is exposed to hormones. Other theories are that uterine cells “migrate” through the bloodstream or lymph system to other areas of the body.

Staging
Endometriosis tends to progress over time, and the American Society for Reproductive Medicine has published a standard for staging endometriosis. It stages endometriosis from Stage I, or minimal, up to stage IV, or severe, where large endometriomas (tumor-like growths) and adhesions (scar tissue) occur.

Diagnosis
Before making a diagnosis, the doctor will do a thorough history and physical exam. If symptoms of endometriosis are present, he may then do a laparoscopy (inserting a small lighted scope into the abdomen) to allow him to directly view the fallopian tubes, ovaries, and abdominal cavity. A biopsy (small amount of tissue extracted) may be done to confirm the diagnosis in a laboratory.

Treatment Options
No treatment:
No treatment other than pain relievers for cramping may be an option, especially if the diagnosis is new, to see if the symptoms will fade without aggressive therapy.

Medications:
Since the tissue implants in endometriosis respond to hormones, medications to treat it are directed towards decreasing the amount of estrogen stimulation of the sites. The thought is that with less estrogen, the activity in the sites will be reduced and the disease will not progress.

These medications include oral contraceptives (low-dose combinations of estrogen and progesterone). The symptoms of menstrual cramping and ovulatory pain may be reduced for women with endometriosis on these medications since ovulation is suppressed and periods are shorter and lighter.

Depo-Provera, a long acting injected form of progesterone, may be given to prevent ovulation and to reduce estrogen levels. Side effects such as irregular bleeding, bloating, weight gain, and permanent suppression of ovulation may occur in some women.

Gonado-tropin releasing hormone (GNRH) analogs are used to suppress ovary function and induce chemical menopause. They are often tried for a period of 6 to 12 months, and frequently bring symptom relief, although they are very expensive. They can also cause side effects that mimic menopause, such as hot flashes, headache, sleep disruption, vaginal dryness, osteoporosis, decreased libido and others. Letting the endometrial sites “rest” during the drug treatment allows them to heal (and stops the inflammation cycle). Normal ovary function and hormone production resumes when the drugs are discontinued.

Surgery
The goals of surgery include removing the endometriosis, pain relief, and attempting to restore fertility in advanced cases.

Surgery by incision may be done to remove large endometriomas, or dark scar-filled vesicles. Laser surgery is also increasing in popularity. The physician will try to remove all of the disease while preserving the organs of the pelvis, and to maintain fertility if possible.

Endometriosis is better understood now than years ago, and research is ongoing to find effective methods of controlling pain, relieving symptoms, and restoring fertility to the woman who deals with this disorder. If you, like Mary, suffer with endometriosis, the treatment options are increasing as time goes on, and the possibility of relief is much greater.

If you suffer from this problem, you might not be able to experience full and powerful erections. People who have this condition may think that few others have the same problem, but in reality, millions of men suffer from this problem. Results of the Massachusetts Male Study indicated that approximately half of healthy males aged 40 to 70 experienced problems with erections at least occasionally.

If the blood flow is restricted in the small blood vessels that are connected with the penis, erectile problems may occur. This is similar to the cause of migraine headaches, which occur when the arteries in the head narrow and cause a buildup. Stress, anxiety, anger and fatigue can all play a role in this dysfunction.

Not only can high levels of Cholesterol have an effect on the cardiac arteries, it can also reduce blood flow to the penis, thereby causing erectile dysfunction. Ginseng has been considered to be an aphrodisiac, but actually it only produces the energy and endurance levels for men — certainly those factors are important.

The natural therapy includes nutrients made of garlic. In India, men rub an ointment made of garlic and fat on their penises and in order to maintain an erection, they lean back. Zinc is also necessary for the production of testosterone. It is helpful to take supplements if a man has a deficiency.

If you suffer from a zinc deficiency, your sperm count might be low, you may have prostate problems, and if you are young, your sexual organs may not completely develop. Calcium and Magnesium are other nutrients that are critical for erections.

Depo-Provera is an injectable form of progesterone. This article discusses what it is, how it works, side effects, and other considerations.
Depo-Provera is an injectable form of the hormone progestin (medroxyprogesterone acetate), and has been in use as a contraceptive since 1992, when the FDA first approved its use.
How It Works
Progestin is a synthetic form of the hormone progesterone, which is made by the ovaries during the second half of the menstrual cycle, and is also released during pregnancy. Progesterone has several effects, including changing the lining of the uterus (endometrium) to make it more difficult for a fertilized egg to implant, and causing the mucous in the cervix to thicken (which helps prevent the entrance of sperm). It also suppresses ovulation, or the maturing and releasing of eggs. Without ovulation, pregnancy cannot occur. Depo-Provera is degraded slowly over several months after being injected, and is considered most appropriate for use by women who want to delay pregnancy for at least one year.

Effectiveness
When Depo-Provera is taken as recommended, it is 99.7 % effective at preventing pregnancy. One advantage to Depo-Provera is that a woman does not need to remember to take a daily pill or to use a barrier method, and this keeps the failure rate when on it very low. It is more effective than either the pill, condoms, an IUD, or the diaphragm. But it cannot protect a woman against sexually transmitted diseases such as chlamydia or HIV.

How It Is Taken
Depo-Provera is administered as a shot in a medical provider’s office once every three months and is only available by prescription. The medical provider must first do a thorough physical exam, and the shot is given in the arm or buttocks muscle. The shot is given within 5 days after the beginning of a normal menstrual period (or else the woman has to use back-up contraception for several weeks). Depo-Provera is considered a reversible form of birth control and a woman needs to continue the shots every three months or she will become fertile again.

Side Effects
Most women on Depo-Provera notice menstruation changes during the first six months such as irregular periods or spotty periods, breakthrough bleeding (bleeding or spotting between periods), or heavier bleeding than normal. After six months to a year of taking Depo-Provera, periods may be missed or stop altogether. This is not considered harmful, and the periods start again once the Depo-Provera is stopped. Pregnancy-like symptoms such as weight gain, tender breasts, abdominal discomfort, and darkened spots on the face can occur. Dizziness, rashes, fatigue, depression, hair loss, change in sexual drive, an increased appetite, acne, and headaches are other side effects that have been noted. Most of these side effects lessen within a few months after starting Depo-Provera.

Some concerns have been raised that the lowered estrogen levels while on Depo-Provera can lead to decreased bone density, and follow up studies are being done to address this issue.
If a woman has diabetes, she should let her medical provider know before starting Depo-Provera, since Depo-Provera may affect insulin levels slightly.

It can take up to a full year to become pregnant after having an injection, and the hormone effects will stay in a woman’s system until they are cleared out. If a woman has liver disease, a history of stroke, breast cancer, a history of strokes, unexplained uterine/vaginal bleeding, or she suspects pregnancy, she should not take Depo-Provera. It is important for a woman to notify her health care provider immediately if she experiences chest pain, shortness of breath, heavy vaginal bleeding, a severe headache, or unusual pain or swelling in her legs while on Depo-Provera.

Other Benefits
Depo-Provera can be taken by women who are breastfeeding, since the hormone progesterone does not interfere with the production or quality of breast milk, and it has no known ill effects on the nursing baby.

Depo-Provera has other benefits that include the fact that it contains no estrogen (so there is no risk related to estrogen use), and in some women reduces cramping, and reduces anemia (because periods are lighter). It can also help protect against endometrial and ovarian cancer.

Women today have more options than ever before in their choice of contraceptive. Depo-Provera is an injectable, longer lasting form of hormone birth control that offers the advantage of freedom from a daily pill or barrier method, yet it is reversible once it is discontinued. A woman should weigh factors such as whether she wants to become pregnant quickly after discontinuing birth control (it can take up to 18 months for pregnancy to occur after discontinuing Depo-Provera), convenience, her risk of side effects, cost, and other factors and discuss them with her medical care provider before making a decision.

Some parents have total charge of children and are alone to raise them. Others see their spouse return home at the end of a workday, but the children are still under foot and sometimes they can test your stamina and press your buttons like the true experts that they are. The little darlings can drive a person to senseless distraction. In the midst of this insanity, you want to quit and wonder just how you’ll do it.

Children nowadays are into everything and they know things that often astound us. When you began smoking, perhaps smoking was considered ‘cool’ or ‘kewl’. Smoking ads were everywhere, suggesting that it was the way to be. Hollywood films glamorized the cigarette and made a woman with a long cigarette holder look sophisticated. A surprisingly high number of Hollywood films still feature characters smoking. Most likely, you began smoking years go when you were young yourself. But today’s school and public education programs have taught children for the most part that it’s not like that. Some children actually voice their displeasure about their parent’s smoking, even though you are giving them a conflicting example.

While some children would never criticize their parents at a young age, they nevertheless give hints about their displeasure. If your child has ever voiced a remark about a dirty ashtray or the smell of smoke, it’s an indicator that they’ve taken notice and are not happy about it. They would be happier if you were not smoking, even though they love you.

So why not enlist them in your quit plan? You will need the support of people around you, and it’s surprising how supportive children can be.

Even if the children are very young, find out what they know about smoking and what they think the dangers and risks are. They may surprise you. If they start pressing your buttons and drive you up a wall and down another one, you can ask them to draw pictures of a smoke-free family, while you compose yourself.

They will need to understand that stopping smoking, although seemingly done in one instant, nevertheless is not a thing that happens in one quick moment. They have to be told that it’s a battle you’re beginning and that for a few months, you will have strong urges to smoke. At such moments, you may feel stressed and will need their encouragement and their help. You can explain that just as they have had ‘time outs’ alone, you might need some too.

Rewards are an important part of quitting and you must focus your rewards on yourself for the hard work you’re doing. Too many smokers forget about rewarding themselves positively and neglect the truth that what is happening in the quitting process is a makeover. So why not take some of the money saved from not smoking and hire a sitter a couple of afternoons a week? This one thing can restore your balance and self-worth, not to mention refresh your outlook and resolve to keep the quit.

Look upon quitting as something that can be done. Others with children have been through it. Just remember to be kind to yourself in the first few weeks. Take it one day at a time and you can and will be successful.

The opinions sprinkled throughout this document are coming from a vegetarian viewpoint. If you like your meat, by all means, enjoy it for the summer.

In the “dog days” of summer, not many of us like to cook, or be in a hot kitchen. And most cooked food tends to be on the heavy side—not good for a hot summer day. There are the typical summer foods such as salads, fruit, and sandwiches. Are there any other summer foods that do not involve meat? What about planning a menu around these great summer foods? And is there a lower calorie, higher satisfying meal plan? Never fear—the Summer Weight Loss Menu Planner is here!

The typical American summer picnic meal usually consists of some type of meat, starch, and maybe a vegetable if you’re lucky. Or maybe, if you are really lucky, some fruit as well. And then, we also can’t forget the pop, cookies, pies, etc. Oh, and the ice cream! Summer is famous for ice cream! Which, by the way, is my favorite dessert. What if I told you that you could have your ice cream, and enjoy fewer calories? Or, that you can have your hot dog with fewer calories?? Would that be a blessing in disguise? Read on, and you will learn different substitutes for your favorite foods, and you can save half the calories.

Veggie hot dogs have become a little more popular in the last few years, and there are some that taste great, and others that you can use as a mini baseball bat. First of all, let’s just look at the calories of a chicken hot-dog (the healthy alternative to pork or beef, right?) versus a vegetarian hot dog. One chicken hot dog has 120 calories. Not bad, compared to the other hot dogs, right? Not really, when you consider that one vegetarian hot dog contains only 40 calories. (This depends on the brand you buy, but they are generally around the same amount.) This may something to think about when you are planning your picnic meal.

Then, let’s look at the different brands of hot dogs. Morningstar Farms makes a variety of vegetarian alternatives, which are great tasting, and healthy. However, their hot dogs are less than desirable. When heated, they are okay; but when they cool down, they have the consistency of plastic. Not a very good alternative when you are trying to make the switch from meat to meat alternatives. There are other brands that taste better, including Super Links and Big Franks made by Worthington and Loma Linda. These brands are a little hard to find in a regular store, but there is a web site that carries these products, and more! http://www.nomeat.com carries a wide variety of products and brands, including the brands you see in the stores. They also have a recipe section where you can find recipes in which you can use the products you buy there.

So, you have a place to buy your vegetarian alternatives to meat; now what do you serve with them? Most people like to serve potato salad, macaroni salad, etc. Or you can have more food for fewer calories if you choose fruit. Most of us like fruit, so this is not a big switch. If you like potato salad, go ahead and have some. The point to this? Use fruit, with all of its fiber, to fill you up, and have a little taste of the higher calorie foods. Any fruit would be fine for weight loss, and summer is the prime season for the best tasting fruit.

So what about dessert? Most everyone knows that frozen yogurt has less calories than ice cream. What if you are cutting out all dairy products? You can still have your frozen dessert treats, if you choose a tofu-based treat. But isn’t tofu a main dish sort of thing? As I have touched in another article, tofu is a blank slate, and does not have any flavor before it is worked with. Tofu can be made into cheesecakes, ice creams, puddings, etc. It truly is a versatile food. Tofutti makes excellent ice cream! I just recently began buying that instead of the dairy ice cream, and it has even passed a picky eater’s approval–my kids!

You can also make your own cakes and cookies without all the extra fat and calories. How, you ask? Well, take a look at your favorite cookie or cake recipe. Do you notice the eggs and hard fats? Take out many calories and unhealthful items in there and replace them with lower calorie, healthier alternatives. If you are wondering what you can replace them with, I will show you in future recipes and articles. (Don’t forget to look for more vegetarian, lower calorie recipes coming soon in a paid report!) One alternative you can use right now is egg substitutes, such as Egg Beaters. They have the same properties as eggs, but have only 30 calories per serving. So all you are adding to your recipes with egg replacers may be 60 calories at the most. As far as the butter, you can make your own nut butters, or coconut butter, and save yourself some calories. You can even you more flour and water.

There are just a few suggestions in this article. But, if you look around and keep your options open, I am sure that you can come up with even more appetizing suggestions for me.

I will never forget that phone call, the moment is frozen in my mind. It was the pediatrician, the doctor himself, and not the nurse. “The nurse always calls with test results,” I thought to myself, “this is not good.”

“Well,” he said, “it looks like the EEG is showing some seizures.” I tried to wrap my mind around the concept. I knew nothing of seizures at the time, had known only a few epileptics and, though I knew what to do for someone during a seizure, I was unable to grasp the concept that my child had this terrible disorder.

“Is it epilepsy?” I asked, feeling like an idiot, like I should know more on the subject somehow.

“Yes,” he said, hesitating a bit. “We need to start him on tegretol…” And that was the beginning. Little did I know just how much our lives would now change.

It had started about six months earlier, when our perfect little boy, then about two years old, suddenly started speaking less and losing words in his vocabulary. I was pregnant at the time with our second son, so we thought for a while it might be jealousy. It eventually became apparent that this was not the case. As we began evaluations to get him into speech therapy, his preschool teacher noticed him staring oddly, then resuming his activity. It was recommended we have him evaluated for seizures.

Ridiculous as I thought it was at the time, we agreed and began the process, seeing the neurologist a few weeks later. He asked all the right questions, honing in on exactly what was wrong. As we walked to the parking lot, I looked at my husband, Ron, and said, “He knows exactly what is going on with Rob. He just cannot say without the right tests.” About a week later, we prepared for the EEG: keeping Robbie up all night so he would sleep the next morning. Little did we know at the time that this would become a yearly ritual.

The EEG went smoothly, the tech did not believe he saw any seizures, “But the doctor will need to review the tape,” he told us. Just being official, I thought at the time, nothing to worry about. But then that call came. It was seizures, and a lot of them.

Rob was having absence seizures, once called petit mal. He would stare off into space for a few seconds and then pick-up and carry on as if nothing had happened. As often as he was doing this, perhaps hundreds of times a day, he was missing out on important stimuli. Our pediatrician once described it as flipping channels on the TV, never getting to watch an entire show and not being able to know what is going on around him. We noticed some odd behaviors starting, repetitious actions, as to be able to make his world predictable so when he “ checked out” he would be able to deal with his surroundings when he came back. He withdrew socially and started having tantrums more often. This is not uncommon in children who have communication disorders. It becomes very frustrating to try to get across the simplest need or want, and they act out of that frustration. Robbie had lost his speech, perhaps because his brain was trying to deal with the world checking out every few minutes. We had thought of Landau Kleffner Syndrome, another seizure disorder, as his symptoms were almost classic for it. His seizure type and location of the seizures did not fit the profile, however, so this was ruled out.

For months, we went to the doctor every few weeks to measure Robbie’s medication levels and make sure that his liver function was not being affected by his meds. As his medication began to work, it became every few months. He started a preschool program for special needs children and began to receive intense speech therapy. In the mean time, I began to pour over every book I could find on the subject, I researched epilepsy as best I could at the local library. Not having the advantage of the Internet at the time, my library was limited, but I was able to find out about epilepsy and absence seizures.Along with the technical aspects of epilepsy, I learned much more from Robbie himself. First, I learned to treat him like any other child. If a child is never pushed a little, there will be no need from him or her to try to improve. I also learned, no matter what the “experts” say, don’t give up hope. A child’s value is not dictated by IQ, there is much more and every child has potential. Mostly, I learned patience. Not with Robbie, per se, but with epilepsy. Nothing will work overnight, the brain and body need time to heal and grow. All we can do is make sure the child get the therapy and medicine that is needed, and sit back and wait.

We have been very lucky. Robbie’s seizures were very easily controlled with tegretol and, after three years of drug therapy, we were able to successfully wean him from his medication. He still is behind in speech and some learning issues, almost exactly two years behind, as if he had to start all over again when the seizures began. I still worry, I think I always will. Will he fall sometime, bump his head, and begin having seizures again? Will hormones during puberty bring them on again? Only time will answer these questions, in the mean time, I do not let these thoughts consume me. I do mourn a bit for the carefree childhood he has lost, but I really think what he has had to endure will make him stronger. I have gone on to share our experiences, as I am doing now, to help others realize they are not alone, as I once felt.

And Robbie? Well, I am not sure he really understands what has happened to him, but I know he does realize he is different somehow. He is growing more social again and the odd behaviors we once saw are fading. I hope one day to have a normally functioning son. Though his IQ tests out quite low, I know he is a bright boy, and, more importantly, a sweet and loving child without a mean bone in his body (though I doubt his little brothers would agree). And he is still our perfect little boy.

Parenting a child with epilepsy, whether the child has developmental problems or not, means having to accept the child for what he or she is and loving them unconditionally. It means accepting life in and out of doctor’s offices, clinics, and hospitals. Rejoice in small steps and don’t let the setbacks discourage you. In the end, all that can be seen is a wonderful gift of a child.