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Accidents Happen But Who’s Going to Pay the Bills?

2010
07.12
Pigeon Lake Publishing is pleased to announce the publication of its newest book, Accidents Happen but Who’s Going to Pay the Bills: A Consumer’s Guide to the California Personal Injury and Wrongful Death System.

Accidents Happen Book
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From two prominent California attorneys comes a compelling, straightforward and no nonsense book, Accidents Happen But Who’s Going to Pay the Bills?: A Consumer’s Guide the the California Personal Injury and Wrongful Death System. Accidents Happen But Who’s Going to Pay the Bills?  is a guide to help you understand what to do when your loved one has been involved in an accident in California. From minor impact collisions to catastrophic injury and wrongful death cases, this book provides real-life examples and scenarios to illustrate often complex legal theories. This book will discuss how to find a lawyer and determine if you even need one. Find out how insurance companies and attorneys determine the value of your case. Learn about the process of handling a claim from start all the way through litigation and then trial. Being injured in an accident can change your life. This book will arm you with the tools and information you need to make responsible decisions during those times.
About the Authors

Reza Torkzadeh is a California attorney who has dedicated his practice to only representing victims and families of serious injury and wrongful death cases. Reza was selected as a Super Lawyers Rising Star in 2010. Only 2.5% of the attorneys in the country are selected for that honor.
Allen P. Wilkinson was admitted to the California State Bar in 1979. He started his career working for the legendary San Francisco trial lawyer Melvin Belli. He is the author of the popular consumer book Everybody’s Guide to the Law published by HarperCollins. Allen has also written numerous articles and chapters for legal publications and is a consultant currently residing in Laguna Woods.
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Allen P. Wilkinson
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Stroke

2010
05.19

Stroke is the number three cause of death in the United States, behind only heart disease and cancer. It is also one of the leading causes of disability in America. If you have a stroke, recovery is difficult at best and you could be disabled for the rest of your life. People who are at risk for stroke should eliminate as much as possible salt from their diet, take their medications as prescribed by the doctor and get plenty of exercise. The goal is to reduce one’s blood pressure to less than 120/80 mm Hg.

Stroke is a medical emergency that can cause permanent and extensive problems if not treated immediately. Almost 800,000 Americans suffer a new or recurrent stroke each year. That means, on average, a stroke occurs every 40 seconds. Strokes kill more than 137,000 people a year, about 1 of every 18 deaths in the United States. On average, every 4 minutes someone dies of a stroke. 40 percent of deaths due to stroke are in men, while the other 60 percent are women. The stroke death rates per 100,000 for specific groups were approximately 42 percent for white males, 41 percent for white females, 68 percent for black males, and 57 percent for black females.

There are two types of stroke: ischemic and hemorrhagic. An ischemic stroke, which is the most often of the two, accounting for about 87 percent of all strokes, occurs by a clot that obstructs the flow of blood to the brain. The underlying condition of an ischemic stroke is the development of fatty deposits lining the arteries walls, a condition called atherosclerosis. These fatty deposits can cause two types of obstruction: (1) Cerrebral thrombosis, which involves a blood clot (a “thrombus”) that develops at the clogged part of the vessel, or (2) a cerebral embolism, which generally refers to a blood clot that forms at another location in the circulatory system, usually the heart and large arteries of the upper chest and neck. The blood clot breaks loose, enters the bloodstream, and travels through the brain’s blood vessels until it reaches vessels too small to let it pass.  A second cause of an embolism is an irregular heartbeat known as atrial fibrillation, which creates conditions where clots can form in the heart, dislodge, and travel to the brain.

Hemorrhagic stroke accounts for approximately 13 percent of stroke cases. It results from a weakened vessel that ruptures and bleeds into the surrounding brain. The blood accumulates and compresses the surrounding brain tissue. Hemorrhagic strokes occur when a weakened blood vessel ruptures. There are two types of hemorrhagic strokes, aneurysms and arteriovenous malformations.

Symptoms of a stroke include:

  • Sudden numbness or weakness of the face, arm, or leg, especially on one side of the body
  • Sudden confusion, difficulty speaking or understanding
  • Sudden trouble seeing in one or both eyes
  • Sudden trouble walking, dizziness, loss of balance, or coordination
  • Sudden severe headache with no known cause

If you or someone with you has one or more of these symptoms, dial 911 immediately to summon the paramedics or emergency medical technicians. Every second counts and it is usually faster for the paramedics or EMTs to get to you and begin treatment as opposed to your trying to take the victim to the hospital. Check the time so you’ll know when the first symptoms appear, as it is essential to get medical treatment started. If given within three hours of the start of symptoms, a clot-busting drug can be administered. This drug (tissue plasminogen activator, or tPA) can reduce long-term disability for the most common type of stroke. TPA is the only drug approved by the Food and Drug Administration (FDA) for the treatment of stroke within three hours of the onset of stroke symptoms.

A transient ischemic attack (TIA) is often referred to as a mini-stroke or a warning-stroke, as it produces stroke-like symptoms but no lasting damage. TIAs have the same symptoms as a stroke, but they are only temporary. However, if you have a TIA, you should visit your doctor as soon as possible to be put on a health regimen, which usually includes diet, exercise, and blood thinners such as aspirin or warfarin (Coumadin and others) that will reduce the chances of your having a full-blown stroke later down the line.

To keep your platelets from sticking together and forming a clot that could result in a heart attack, your doctor may have you take an 81 mgs. aspirin a day, combined with the prescription drug Plavix.

Stroke in Children

Although rare, children can suffer strokes as well as adults. A common cause of strokes in children occurs when a blood clot forms in the heart and travels to the brain. This can be caused by congenital (existing from birth) heart problems such as abnormal valves or infections. In these cases, the child may need surgery or medications.  In sickle cell disease, the blood cell can’t carry enough oxygen to the brain and blood vessels leading to the brain may have narrowed or closed. About ten percent of children who have sickle cell disease suffer a stroke. There is a high risk of repeat strokes, but the risk can be reduced by a blood transfusion.

When a blood vessel on or in the brain ruptures, blood flows into brain areas where it’s not supposed to go. It may pool in brain tissues, resulting in a blood clot. Also, because the vessel is ruptured, blood isn’t transported to where it’s supposed to go. As a result, the brain is deprived of oxygen, which may lead to permanent injury. This type of stroke is most often caused by rupturing or weakened or malformed arteries known as AVMs (arteriovenous malformations), and the risk of this kind of stroke is higher with certain illnesses, such as hemophilia.

Recovery from a stroke is different with each child. Prompt medical treatment and rehabilitation therapy can maximize recovery. In general, most younger people will recover more abilities than older people who have strokes. Children often recover the use of their arms and legs, as well as their ability to speak after a stroke.

The effects of a stroke in a child are generally the same as in an adult. The most common symptoms are:

  • Weakness (hemiparesis) or paralysis (hemiplegia) on one side of the body
  • Unilateral neglect, which causes the stroke victim to ignore or forget his weaker side
  • Difficulty with speech and language (aphasia) or trouble swallowing (dysphagia)
  • Decreased field of vision and trouble with visual perception
  • Loss of emotional control and changes in mood
  • Cognitive changes or problems with memory, judgment, and problem-solving
  • Behavior changes or personality changes, improper language or actions

If your child experiences some or all of the above symptoms, and there is no apparent reason for the symptoms, be safe and assume that it may be a stroke that requires immediate attention. Dial 911 to summon the paramedics or emergency medical technicians immediately. If your child goes into full cardiac arrest, someone trained in CPR should begin emergency treatment. If you are a parent, you should take a class on CPR so you will be able to perform it in an emergency situation.

Category Health |

Allen P. Wilkinson
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Breast Cancer

2010
05.17

1 in 8 women (about 13 percent) who live to be 80 will have breast cancer at least one time. That figure rises if there is a history of breast cancer in the family. Breast cancer is the second most common form of cancer in women, behind only non-melanoma skin cancer. It is the number one cause of cancer death in Hispanic women, and the second most common cancer death (behind lung cancer) in white and black women. Each year, over 190,000 women are diagnosed with breast cancer, while more than 40,000 women die from it. About 2,000 men are diagnosed with invasive breast cancer each year, making up less than one percent of all new breast cancer cases each year. The good news is that the rate of deaths from breast cancer in women has been declining in the last few years. This is thought to be due to the result of advancements in treatment, earlier detection through screening, and increased awareness. Today, over 2.5 million women in the United States have survived breast cancer. The good news is that, with better screening methods—including regular mammograms and self-examinations—the number of deaths from breast cancer has been decreasing.

12 out of 100 average women will get breast cancer. If there is a family history of breast cancer, out of 100 women between 24 and 60 will get breast cancer, depending on how strong the family history is. Having a family history makes it 2 to 5 times more likely that a woman with a family history of breast cancer than the average woman with no family history of breast cancer. If you are at a high risk of developing breast cancer, you will need extra examinations and testing. Taking certain anti-cancer drugs may help some women prevent breast cancer. You can have surgery to remove both breasts, which prevents most incidents of breast cancer. You may also have surgery to remove your ovaries, as this will help to prevent both breast and ovarian cancer.

Breast cancer cases were on a twenty-year increase until 1999, when the amount of breast cancer cases declined. One theory for this decrease is that the decrease is due to women’s reduced use of hormone replacement therapy (HRT). A large study, called the Women’s Health Initiative, was published in 2002, which suggested a connection between HRT and an increased risk of breast cancer.

Risk Factors

The top risk factors for developing breast cancer are being a woman and your age. By age group, 4 out of 1,000 women in their 30s develop breast cancer; 15 out of 1,000 women in their 40s; 26 out of 1,000 women in their 50s; and 37 out of 1,000 women in their 60s. Other conditions that increase the risk of developing breast cancer include a personal history of cancer (including previous cancer in the same breast), a family history of breast cancer in the woman’s mother, sister, daughter, or two or more other close relatives such as cousins, especially if they were diagnosed with breast cancer before age 50. Women who inherit specific genetic mutations in the BRCA1 and BRCA2 genes are more likely to get breast cancer, as well as an increased risk of colon or ovarian cancer. Genetic tests are available to determine whether a woman has the gene mutations long before any cancer appears. Genetic testing can show whether a woman has the specific genetic changes known to greatly increase the risk of breast (or ovarian) cancer.

Race is a factor in developing breast cancer. More white women than black, Hispanic, or Asian women get breast cancer. Black women, however, tend to get breast cancer at an earlier age and are more likely to die from breast cancer. This is thought to be due to black women getting a more aggressive form of breast cancer, and receiving lower quality health care.

Another factor in developing breast is the exposure of the woman’s breast to significant amounts of radiation at a young age, especially among women who were treated for Hodgkin’s lymphoma. Studies show that the younger a woman was when she received the radiation treatment, the higher her risk for developing breast cancer later in life. Women who had their children before the age of 30 have a lower risk of developing breast cancer than women who have children after 30. A woman who breast feeds her baby also has a lower risk of developing breast cancer; the longer she breast feeds her baby, the lower her risk of breast cancer. Women who do not have children have an increased chance of developing brain cancer.

The use of hormone therapy with estrogen and progestin or estrogen and testosterone have an increased risk of developing breast cancer. The risk of breast cancer is less if the woman is being treated with estrogen alone. This increased risk returns to normal over time after the hormones are stopped. A woman who begins menstruation before age 12 and begins menopause after 55 increases the risk of developing breast cancer. The experts in this field believe that the longer you have higher estrogen, the more risk you have for breast cancer. Having extra fat and drinking alcohol both lead to higher levels of estrogen. Women who have gone through menopause should avoid long-term, high-dose hormones. If they do use hormone therapy for menopause symptoms, they should use a low dose for as short of time as possible.

A woman’s risk of breast cancer doubles if she has a first-degree relative (mother, sister, or daughter) who has been diagnosed with breast cancer. 20 to 30 percent of women diagnosed with breast cancer have a family history of breast cancer. Five to 10 percent of breast cancers are caused by gene mutations inherited from one’s mother or father. Women with mutations of certain genes have up to an 80 percent risk of developing breast cancer during their lifetime, and they are often diagnosed at a younger age (below 50). About 90 percent of breast cancers are not due to heredity, but to genetic abnormalities resulting from the aging process and life in general.

If you undergo a total or complete mastectomy (removal of the breast), you should be aware that the surgeon will also take some or all of the lymph nodes under the arm to determine whether the cancer has spread to other parts of the body. Your doctor may prescribe medication to control the nausea and vomiting that many women endure while being treated for breast cancer.

Testing for Breast Cancer

Women who are 40 years old and older should have a mammogram every year for as long as the woman is in good health. Women should have clinical breast examinations about every three years for women in their 20s and 30s, and every year for women 40 and older. Women should know how their breasts normally look and feel and promptly report any changes in their breast(s) to their health care provider. Starting in their 20s, women should conduct breast self-examinations. You should ask your physician to show you how to conduct a breast self-exam. Some women, because of their family history, a genetic tendency, or certain other factors, should be screened with an MRI in addition to mammograms. The number of women who fall into this category in the United States is two percent.

Catching Breast Cancer Early

If breast cancer is caught at an early stage, the doctor may treat it with chemotherapy to shrink it prior to its removal. This is known as neoadjuvant therapy. If it is necessary to remove your breast, you will have to undergo chemotherapy, radiation, or hormone therapy or a combination of them to destroy any cancer cells that might be left in the body after breast surgery. This is called adjuvant therapy and is used to reduce the chances that your cancer will return. Before starting any treatment, talk with your doctor openly and frankly to learn of the benefits of the different treatments, their rate of success, and their side effects.

If the breast cancer is found at an early stage and surgery is the preferred method of treatment, it might be able to save the majority of the breast by doing a simple or total lumpectomy (known as breast-conserving surgery), which is the removal of only the cancerous lump in the breast along with some of the tissue around it. After surgery, you will have to have additional treatment, such as radiation or medicine, to kill off any rogue cancer cells that were not removed by the lumpectomy. In a “modified radical mastectomy,” the surgeon removes some of the lymph nodes under the arm and sometimes part of the chest wall muscles. A course of radiation is usually prescribed after the lumpectomy to make sure the surgeon got all the cancer cells and destroy those cancer cells that he or she may have missed. There is also the radical mastectomy in which the surgeon removes the breast, chest muscles, and all of the lymph nodes under the arm. While once a common procedure, radical mastectomy is rarely used now because it does not improve the survival rate or risk for recurrence when compared with other surgical treatments.

Besides what the doctor can do for you, there is much you can do for yourself to reduce your chances of developing breast cancer. First, you should eat a healthy diet with plenty of fruits, vegetables, and whole grains. A low-fat diet with limited red meat may lower your breast cancer risk. Second, be active. Try to get 30 to 60 minutes of exercise at least five days a week. Staying active may reduce your breast cancer risk. Third, do not drink more than one alcoholic drink a day. Alcohol leads to extra estrogen in the body, which raises your risk of developing breast cancer.

If you have a strong family history of breast cancer or are otherwise at a high risk of developing breast cancer, you should discuss with your doctor taking medication (e.g., tamoxifen or an aromatase inhibitor) as a prophylactic measure to reduce your chances of developing brain cancer. If you are at an extremely high risk of developing breast cancer, you may choose to undergo breast removal before you develop breast cancer. For example, the actress Christina Applegate underwent breast removal surgery even though she had no sign of cancer, but was at a high risk of breast cancer. A preventive or “prophylactic mastectomy” reduces the woman’s chances of developing breast cancer by 90 percent. A cancer risk assessment, genetic test, and psychological counseling are all recommended for women who may be considering this treatment option.

Breast Reconstruction

When you are going to have a breast removed, one important consideration is whether you are going to have reconstruction of the area of the removed breast. You should talk about your options with the surgeon before the mastectomy is performed. Reconstructive surgery can be done immediately after the breast, tissue, and lymph node are removed, or it can be done at a later date. Instead of reconstructive surgery, you may choose to use a breast prosthesis. If you can’t make up your mind on whether or not to have reconstructive surgery and what kind, you should have the surgery performed as soon as possible to prevent the cancer from spreading. You can always make up your mind as to whether or not to have an implant or reconstructive surgery at a later date.

There are basically two methods of reconstruction, which are done by a plastic surgeon. One method is to use a saline or silicone implant. The other method is to use fat, muscle, and skin from your buttocks, thighs, abdomen, and other areas in what is known as “tissue flap surgery.”  This type of surgery is more complicated than implant surgery, but the results look and feel more natural and last longer than implants. Breast implant is an easier surgery with a quicker recovery time, and creates less scarring than tissue flap surgery. A tissue flap surgery should last for the rest of your life and because it uses your own tissue, you will most likely have more feeling in the new breast than with an implant. While most women are good candidates for breast reconstruction surgery, some are not. Breast reconstruction surgery should not be done if the woman is obese, has blood flow problems (bad circulation), or other serious health problems, such as diabetes, high blood pressure, or heart disease. Sit down with the plastic surgeon and discuss in detail the benefits and risks of both procedures. For instance, silicon implants may leak without causing any symptoms; hence, the U.S. Food and Drug Administration recommends that women who get silicone implants have MRI tests three years after the implant, and every two years after that.

After you have had breast removal surgery that is not the end of the story. Depending upon your unique situation, you will have to undergo radiation or medication therapy. You will have to see your doctor for follow-up visits every 3 to 6 months for 3 years and then every six months until 5 years have passed since you were diagnosed with breast cancer. You will also undergo regular mammograms to see if there is any return of the cancer. The doctor will also investigate lumps that can be felt during a breasts exam.

The diagnosis of breast cancer and the removal of a breast is a physically and emotionally traumatic event in a woman’s life. It is not at all unusual for the woman to feel a sense of denial, anger, loss, and grief over the removal of one or both breasts. Women who have had one or both breasts removed should be watched for signs in her change of personality and other evidence of mental health issues. If the woman is becoming depressed, not “her old self,” not doing the things she used to enjoy doing, a therapist or group of breast cancer survivors can be of immeasurable help. The American Cancer Association has support groups throughout the nation of people dealing with cancer, and it is often a good idea to join such a group to learn how to adapt to your new situation.

Category Breast Cancer, Health |

Allen P. Wilkinson
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High Blood Pressure

2010
05.17

High blood pressure (HBP)—also known as hypertension—affects millions of Americans. HBP is known as the “silent killer” because it slowly builds up with poor diet, and inactivity and does not have any symptoms. Over time, if the force of the blood flow through the arteries gets stretched beyond its healthy limit, health problems result. High blood pressure is normally controlled through a proper diet and regular exercise. High blood pressure normally isn’t immediately dangerous, but if your systolic pressure rises above 180 or your diastolic level is greater than 110, you should seek immediate medical help. As a silent killer, high blood pressure can permanently damage your heart, brain, eyes, and kidneys before you feel anything. High blood pressure can often lead to heart attack and heart failure, stroke, kidney failure, peripheral artery disease (PAD; a condition in which the blood does not flow freely through the arms and legs), and other health problems.

High blood pressure does not affect only those people who are anxious, nervous, or jittery all the time. People that are calm and relaxed can still have high blood pressure that needs medical attention. By keeping your blood pressure in a healthy range, you are reducing your risk of your vascular walls becoming overstretched and injured. You are also reducing your risk of your heart having to pump harder to make up for the blockages. Finally, good blood pressure rates protect your entire body so that your tissue receives regular supplies of blood that is rich in the oxygen it needs. High blood pressure can cause a variety of medical problems, including vascular weakness, vascular scarring, an increased risk of blood clots, an increased risk of plaque build-up in your arteries, tissue and organ damage from narrow and blocked arteries, and an increased workload on the circulatory system.

Factors that coexist with high blood pressure to cause you health problems include age, heredity (including race), overweight or obesity, smoking, high cholesterol, diabetes, and lack of physical activity.

Because it doesn’t have symptoms, high blood pressure can cause serious health conditions. At the top of the list is damage to the heart and coronary arteries, including heart attack, heart disease, stroke, erectile dysfunction (impotence), congestive heart failure, atherosclerosis (the fatty buildups in the arteries that cause them to harden), kidney disease, memory loss, fluid in the lungs, angina, and vision problems that could end in blindness.

20 percent of people do not know that they have high blood pressure.  69 percent of people known to have high blood pressure are receiving treatment for it, while 31 percent are not. If you do not know your blood pressure, you should have your health care professional take it to assess your condition. Just because you feel fine does not mean that your blood pressure is not too high. The test is painless, non-invasive, and only takes a couple of minutes. But the information gleaned from those few minutes could  result in a finding of high blood pressure, appropriate treatment of it, and add years and quality to your life.

The ideal standard for blood pressure is no greater than 120/80 (mm/dL, which is short for millimeters of mercury per deciliter). The first number (120) measures the rate of pressure being put on your arteries when the heart is pumping (the systolic number). The second number (80) is called the diastolic number, the force upon your arteries when your heart is resting between beats.

Blood Pressure                  Systolic                           Diastolic

Category                             mm Hg                           mm Hg

(upper #)                         (lower #)

Normal                                less than 120     and          less than 80

Prehypertension                  120-139              or           80-89

High Blood Pressure           140-159              or            90-99

(Hypertension)

Stage 1

High Blood Pressure

(Hypertension)                  160 or higher       or            100 or higher

Stage 2

Hypertensive crisis

(Emergency medical            Higher than 180   or           higher than 110

care needed)

A single high reading does not mean that you have high blood pressure. However, if your blood pressure is usually 140/90 or higher, your doctor will want you to make lifestyle changes (such as eating more healthfully and getting more physical activity) and/or prescribe you medication, such as a beta blocker, an “ACE” inhibitor, or a calcium channel blocker. If your doctor prescribes medication for your high blood pressure, it is critical that you take it regularly, preferably at the same time of day every day, to keep your blood pressure normal. In addition to medication, your physician will advise you to eat a heart-healthy diet and get regular exercise.

Many people who have high blood pressure and have been prescribed medications by their doctors avoid taking the prescription medication and opt for homeopathic (natural) remedies alone. This is a dangerous practice. Today’s high blood pressure prescription medications work wonders in controlling high blood pressure, with little risks of adverse events or unpleasant side effects. Homeopathic remedies reduce blood pressure only a little, if at all, while the high blood pressure causes further damage to your cardiovascular system.  Modern medications can lower your risk of heart attack and blood vessel diseases, stroke, and kidney disease. You may have to take high blood pressure pills for the rest of your life, the alternative—an early death—makes it worth it.

If you have high blood pressure, you will need to monitor your use of other drugs, including over-the-counter drugs that you may think are harmless. If you have high blood pressure or are being treated for high blood pressure, let your physician know. Before you buy a cold or flu preparation, be forewarned that they probably contain a decongestant that can cause your blood pressure to rise. Talk to the pharmacist before buying and using the over-the-counter drug to ensure it will not affect your blood pressure or interfere with the workings of the drugs your physician has prescribed for you.

People with high blood pressure should keep their sodium intake at 1,500 milligrams (mgs.) per day from all sources.

If you get a blood pressure reading of 180 or higher for the systolic number (the top number, which is when the heart is pumping) or a reading of 110 or higher for the diastolic number (when your heart is at rest), you should wait a couple of minutes and retest yourself. If your numbers are still that high, call 911 immediately for prompt intervention.

If you have high blood pressure, high cholesterol, or are overweight, you must adopt a heart healthy lifestyle to reach an optimum state of health. You do not need just to go on a diet; you need to make some serious lifestyle changes. Lifestyle modifications include:

  • Eating a heart-healthy diet, which may include reducing or eliminating salt (in some people, sodium increases blood pressure because it holds excess fluid in the body, placing an added burden on your heart)
  • Getting regular physical exercise
  • Maintain a healthy weight
  • Manage stress
  • Limit your alcohol intake (two glasses a day for men, one for women)
  • Stop smoking and try to stay away from places where people smoke
  • If your doctor has prescribe medication to manage your high blood pressure, be sure to take it regularly and according to your doctor’s directions
  • Eat foods high in potassium; a diet that includes natural sources of potassium is important in controlling blood pressure because it blunts the effects of sodium. Potassium-rich foods include sweet potatoes, potatoes, greens, spinach, mushrooms lima beans, beans, bananas, tomatos (including juice or sauce), oranges and orange juice, cantaloupe, grapefruit, fat-free or low fat (1 percent) milk fat-free yogurt, halibut, and tuna.

The above-listed lifestyle changes should be followed by everyone whose blood pressure falls in the pre-hypertensive state (systolic number between 120 and 139 mm/dL or diastolic number between 80 and 89 mm/dL), or even by people who have normal blood pressure levels as a preventive measure. If you have high blood pressure, the goal of treatment is not simply to bring it within acceptable ranges. You must be conscious of your blood pressure levels for the rest of your life.

Stroke

Hjgh blood pressure is the single largest risk factor for stroke. Stroke is the number 3 killer in the United States and one of the leading causes of disability. If you have a stroke, recovery is difficult at best and you could be disabled for the rest of your life. People who are at risk for stroke should eliminate as much as possible salt from their diet, take their medications as prescribed by the doctor and get plenty of exercise. The goal is to reduce one’s blood pressure to less than 120/80 mm Hg.

Hjgh blood pressure is the single largest risk factor for stroke. Stroke is the number 3 killer in the United States and one of the leading causes of disability. If you have a stroke, recovery is difficult at best and you could be disabled for the rest of your life. People who are at risk for stroke should eliminate as much as possible salt from their diet, take their medications as prescribed by the doctor and get plenty of exercise. The goal is to reduce one’s blood pressure to less than 120/80 mmHg.

Primary Pulmonary Hypertension

When we speak of high blood pressure, we normally refer to the pressure in the arteries in the arms, legs, etc. Pulmonary hypertension, on the other hand, refers to the pressure in the arteries flowing from the lungs to the heart. The lungs reoxygenate the blood and send the oxygen-rich blood to the heart, which pumps it out to the rest of the body. The heart is made up of four chambers. The top right chamber (atrium) is where blood that has distributed its oxygen goes, which then pumps it to the lower right chamber (ventricle). The lower right chamber then pumps the blood into the lungs, where it takes on oxygen. The reoxygenated blood is then sent to the upper left chamber, where it is held until it passes to the bottom left chamber, which pumps the blood into the arteries. The lower left chamber (ventricle) is the workhorse of the blood/heart system.

The pulmonary arteries that supply the lungs can constrict and their walls may harden so that they can’t carry much blood. The pressure builds up and the heart works harder, trying to force the blood through. If the pressure is high enough, ultimately the heart can’t keep up and less blood can circulate through the lungs to pick up oxygen. A person suffering from pulmonary hypertension may experience fatigue, dizziness, or shortness of breath. In the first stage, the person may feel that he or she is simply “out of shape” because general fatigue and tiredness are often the first symptoms. As the condition gets worse, you may experience swelling in the legs or ankles, bluish discoloration of the lips and skin, and chest pains. These symptoms indicate that your body is not circulating enough oxygen-rich blood from your lungs that needs treatment.

Primary pulmonary hypertension is a rare condition, and its diagnosis is often delayed by the slow onset of symptoms, many of which are symptomatic of other conditions. There are only about 500 to 1,000 new cases of primary pulmonary hypertension diagnosed each year, the majority of cases involving women between the ages of 21 and 40.

People with primary pulmonary hypertension should not smoke, they should avoid high altitudes, engage in physical activity only after discussing the situation with the doctor, be informed about which over-the-counter drugs they can take or ask the pharmacist, and get prompt antibiotic treatment for respiratory tract infections, pneumonia, and the flu. Women with primary pulmonary hypertension should avoid getting pregnant by practicing a safe and effective method of contraception. However, they should avoid oral contraceptives (the “pill”) as they can aggravate primary pulmonary hypertension. Doctors recommend that the most effective form of avoid pregnancy in women with PPH is surgical sterilization.

Low Blood Pressure

Can your blood pressure be too low? Generally, if you are not experiencing any symptoms from your low pressure, it is not a problem and may in fact lengthen your life. However, if it gets so low that you can’t stand without passing out (fainting is medically called “syncope,” and results from too little blood getting to the brain because of low blood pressure), you are dizzy or lightheaded, dehydration and unusual thirst, lack of concentration, blurred vision, nausea, cold, clammy, and pale skin, rapid, shallow breathing, fatigue, or depression, you should promptly seek medical attention.

When two or more drugs are being by the patient, the person may experience lightheadedness when moving from a prone or sitting position to standing up. This type of low blood pressure is called orthostatic hypotension. It can be dangerous because if the person faints (“syncope” in medical terms)), he may hit his head on a hard surface, causing injury. If you have been prescribed two or more drugs and are experiencing lightheadedness or even fainting, call your doctor. She will probably tell you to stand up slowly, in stages. If you are fainting because of the interaction of two or more drugs and getting up slowly is not helping any, call your doctor and he can prescribe alternate medications that hopefully won’t have the same side effects. . Because there are so many good drugs available, work with your doctor to find the drug that provides the best results with the least side effects.

Category Health, High Blood Pressure |

Allen P. Wilkinson
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Metabolic Syndrome & Insulin Resistance

2010
05.17

Some people have a constellation of conditions that place them at greater risk of developing cardiovascular disease and diabetes. This is known as metabolic syndrome and affects about 35 percent of adults in the United States. When these factors are considered together, the person’s chances of developing future cardiovascular problems are high than any one factor alone.

Metabolic syndrome is present when a person has three or more of the following factors:

  • Abdominal obesity
  • Triglyceride level of 150 mg/dL or treater
  • HDL cholesterol of less than 40 mg/dL in men or less than 50 mg/dL in women
  • Systolic blood pressure (top number) of 130 mm Hg or greater
  • Diastolic blood pressure (bottom number) of 85 mm Hg or greater

Metabolic syndrome is closely related to a generalized metabolic disorder called insulin resistance, which results in the person’s body being unable to use insulin efficiently. Metabolic syndrome is also called insulin resistance syndrome.

Some people develop insulin resistance because of genetic factors. However, many people develop insulin resistance and metabolic syndrome by putting on excess fact, not getting enough exercise or other physical activity, or eating a diet high in carbohydrates (more than 60 percent of daily caloric intake from carbohydrates).

Metabolic syndrome is treated with medications, especially medications to remove the body’s sensitivity to insulin, lower cholesterol, and lower blood pressure. Other crucial elements of treatment of metabolic syndrome include maintaining a healthy weight, adopting a heart-healthy diet, and making physical activity part of your daily routine.

Category Health |

Allen P. Wilkinson
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Diet & Exercise

2010
05.17

Diet and exercise play critical roles in the prevention and treatment of heart attacks, high blood pressure, heart disease, and, diabetes. You need to maintain a healthy weight for your age and height, eat a low-fat low-carbohydrate diet, and get regular physical activity.

Here is an overview of what you need to do to keep health disease, stroke, high blood pressure, and obesity at bay:

  • Eat a low fat, healthy diet and limit your portions
  • Get at least 30 minutes of exercise four to five times a week
  • Quit smoking (and get those around you to stop as well)
  • Manage your high blood pressure
  • Keep your cholesterol under 200
  • Maintain a healthy weight
  • If you are diabetic, follow your doctor’s instructions and become informed about diabetics
  • Limit your daily alcohol intake to two glasses for men, one for women
  • Reduce stress

Weight

Obesity is a strong precursor to heart disease, as it requires the heart to work harder and also causes extra pressure on the joints. Obesity puts you at risk for high cholesterol, high blood pressure, insulin resistance, and Type II diabetes, the very things that increase your risk of cardiovascular disease. Therefore, it is crucial that you maintain a healthy weight for your age and height. An overweight or obese person can reduce their blood pressure levels significantly if they lose at least 10 pounds. Weight loss reduces the strain on the heart. You can reduce your weight by eating healthfully and keeping your food intake at 1,500 to 1,800 calories a day. In addition to eating less, you can lose weight by engaging in physical activity each way. One suggestion is to start walking at a moderate pace for 30 minutes 5 times a week. If you can’t walk 30 minutes all at once for any reason, you can break your walks down to as little as 10 minutes three times a day. If you eat well and healthfully and keep your caloric intake at a reasonable level, and supplement this with 300 minutes a week of moderate-intensity aerobic activity (such as walking, jogging, biking, or swimming), you will be well on your way to your goal of achieving optimal health.

Diet

  • Fruits
  • Vegetables
  • Fat-free or low fat (1 percent) dairy products
  • While-grain, high-fiber foods
  • Fish at least twice a week, especially fatty fish containing Omega 3 fatty acids such as those found in salmon, trout, and herring
  • Skinless poultry
  • Beans
  • Seeds and nuts

The above recommendations are from the American Health Association’s Dietary Approaches to Stop Hypertension (D.A.S.H.) eating plan. Compared to the typical American diet, D.A.S.H. contains less red meat, less fats (especially trans fats, which one should attempt to delete from one’s diet completely if possible), less sodium (salt), and fewer sweets and less added sugar and sugar-containing beverages. The D.A.S.H. has been found to lower blood pressure especially effective in African Americans and persons diagnosed with hypertension.

If you get the urge to snack, don’t reach for a power bar or candy bar. Try instead to eat a fruit or vegetable. It will cost you less and be more compatible with your goal of getting to your ideal weight

Physical Activity

Exercise is an important part of the overall plan to strengthen your heart, lower your blood presume, and lessen your chances of developing heart disease. Studies have shown that thirty minutes of physical activity on five or more days can help avoid heart disease tremendously. The activity need not be a hot and heavy match of racquetball or tennis; half an hour of brisk walking at least five days a week is all you need to do. Swimming is an especially good form of exercise, as it exercises most of your muscle groups and is non-impact. If you are unable to spend half-an-hour in a day for physical activity, you can cut it down into three sessions of 10 minutes each. 30 minutes of physical activity five times a week not only strengthens the heart muscle, it helps to reduce blood pressure, control weight, and reduce stress.

You must exercise at a moderate rate of intensity. If you’re walking and can carry on a normal conversation or sign songs, you are most likely not walking fast enough. If you can exchange brief sentences easily while, but cannot carry on a comfortable or continuous conversation, you are probably exercising at an ideal rate. If you have trouble speaking even in short sentences and get out of breath quickly, you are probably exercising to vigorously.

When exercising, your aim should be to increase your heart rate to 50 to 85 percent of your maximum heart rate. Your maximum heart rate is generally 220 minus your age.

Age                 Target Heart                               Average Maximum

Rate Zone (50-85%)                   Heart Rate (100%)

20 years            100-170 beats per minute        200 beats per minute

25 years             98-166 beats per minute         195 beats per minute

30 years             95-162 beats per minute          190 beats per minute

35 years             93-157 beats per minute          185 beats per minute

40 years             90-153 beats per minute          180 beats per minute

45 years             88-149 beats per minute          175 beats per minute

50 years             85-145 beats per minute          170 beats per minute

55 years             83-140 beats per minute          165 beats per minute

60 years             80-136 beats per minute          160 beats per minute

65 years             78-132 beats per minute          155 beats per minute

70 years             75-128 beats per minute          150 beats per minute

If you have been sedentary for a while, exercise at the lowest part of your target heart rate (50 percent) for the first few weeks. Then gradually increase the intensity or time of your activity. If you were a star athlete in high school or college but have been sitting in an office chair at work and on the couch weekends watching college and pro sports, do not attempt to exercise at the peak rate. You will become short of breath and you may sprain or strain a ligament. Or it may be so intense that you stop exercising altogether.

Your activity should be something that you enjoy rather than dread. You don’t have to become a hard-core triathlete. If walking, jogging, or biking is not your cup of tea, you might try a dance class or a vigorous game of basketball or racquetball. If you are planning on joining a health club, don’t try to keep up with the other participants. Most of them may have been taking the dance class or aerobic workout for a year or more, and all you will get out of trying to keep up with the advanced students are sore limbs and even strains or sprains of an ankle or knee. If you’re one of those people who don’t like to do things alone, ask a friend or neighbor if he or she would be interested in going to class with you. Before you start exercise, always remember to stretch and warm-up before beginning the activity, and cool down appropriately when you’re done.

In addition to vigorous aerobic activity, you should also do some strength and flexibility training. Although you won’t notice a weight loss from anaerobic activity, muscle is much more dense than fat so you’ll look better and be in better shape than if you just did aerobic exercises alone. Health clubs can set you up with a personal trainer to design a program just for you.

Stress has not been shown to be a factor in heart disease, but the way you cope with stress may well have a bearing on your cardiovascular system. In a stressful situation, our bodies release the stress hormones adrenaline (epinephrine) and cortisol into the blood. While stress has not been linked to heart disease, how you deal with stress may play a large part. For instance, you may drink more alcohol, eat more food, and be less physically active when you are stressed out.

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Allen P. Wilkinson
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Cholesterol

2010
05.17

Almost 107 million Americans age 20 and older have total blood cholesterol levels of 200 milligrams per deciliter (mg/dL) and higher. Approximately 51 million are men, while nearly 56 million are women. Of those persons having a cholesterol over 200 mg/dL, over 37 million have total cholesterol levels of 240 mg/dL or higher.

When people say their cholesterol is high (or low for that matter), the fact is that overall cholesterol is only part of the picture. Your total cholesterol should be 200 or less. Then there are low density lipoproteins (LDL), also known as “bad cholesterol.” If your risk for heart disease is low, your LDL should be less than 160 mg/dL. If your risk of heart disease is intermediate, your LDL should be less than 130 mg/dl. If you are at high risk for heart disease, your LDL should be less than 100 mg/dl. LDL can form plaque along the inner walls of the artery, reducing the amount of blood that can flow through them. Plaque is a thick, hard, deposit that can narrow the blood vessels and make them less flexible. The condition of plaque build up in the inner walls of the arteries is known as atherosclerosis. If a lump of plaque breaks off, it can cause a heart attack or stroke by lodging in a narrow artery and cutting off blood supply to the heart or brain.

For persons age 20 and older, the following groups have an LDL cholesterol of 130 mg/dL or higher:

  1. Non-Hispanic whites, almost 32 percent of men and 34 percent of women
  2. Non-Hispanic blacks, about 32 and a half percent of men and nearly 30 percent of women
  3. For Mexican Americans, 39 percent of men and almost 31 percent of women.

LDL levels of 130-159 mg/dL are considered borderline high, levels of 160 to 189 mg./dL are classified as high, and levels of 190 mg/dL or higher are categprozed as being very high.

In addition to bad cholesterol (LDL), which should be as low as possible, there is also “good” cholesterol that should be as high as possible. These are known as high density lipoproteins (HDL), which should be above 40 mg./dL or higher for men and 50 mg./dL or higher for women.  The reason it is known as “good” cholesterol is that HDLs seem to take excess cholesterol out from the arterial plaque, slowing its buildup. HDL levels of less than 40 mg/dL are associated with a higher risk of coronary heart disease.

Among Americans age 20 and older, the following have an HDL cholesterol of less than 40:

  1. For non-Hispanic whites, 26.2 percent of men and nearly 9 percent of women
  2. For non-Hispanic blacks, 15.5 percent of men and almost 7 percent of women
  3. For Mexican Americans, 27.7 of men and 13 percent of women.

In addition to total cholesterol, LDL, and HDL, your fat profile includes triglycerides, which is a form of fat made in the body. High triglycerides can be due to being overweight or obese, living a sedentary lifestyle, lack of regular physical activity, cigarette smoking, excess alcohol assumption, and a diet very high in carbohydrates (at least 60 percent of total calories). People who have high triglycerides usually have high LDL (“bad” cholesterol) and low HDL (“good” cholesterol). Two other causes of high triglyceride levels are heart disease and diabetes.

If you do not know your cholesterol, LDL, HDL, and triglyceride levels, you should make an appointment with your doctor to get a blood test that will provide this information. You may feel fine, but your cholesterol and fat (“lipid”) levels may be high, slowly building their way up to causing you heart disease or stroke.

High levels of cholesterol and fats can be treated with lifestyle modifications, a healthy diet, regular exercise, weight management, and medication, particularly the “statin” category of drugs.

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Allen P. Wilkinson
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Obesity

2010
05.17

Obesity is a chronic condition like diabetes and heart disease. A certain amount of body fat is needed for storing energy, heat insulation, shock absorption and other functions. A person has traditionally been considered obese if he or she was more than 20 percent over their ideal rate. That ideal weight took into account the person’s height, age, sex, and build. Obesity is now more precisely defined by the National Institutes of Health as a body mass index (BMI) of 30 or above.

Whether you are obese is determined today by your BMI, which is a measure of body fat based on height and weight that applies to both adult men and women. Calculating your BMI is extremely easy. Just go to www.nhlbisupport.com/bmi/  and enter your height and weight where indicated and click on the “Compute BMI” button. If your BMI is less than 18.5, you are underweight. If it is between 18.5 and 24.9, you are normal weight. If your BMI is 25 to 29.9 you are overweight, and if your BMI is 30 or greater, you are obese. Since the BMI describes the body weight relative to height, it correlates strongly in adults with the total body fat content for most people. “Morbid obesity” exists when a person is either 50 to 100 percent over normal weight, has a BMI of 40 or higher, or is sufficiently overweight to severely interfere with health or normal function.

The World Health Organization uses a classification system using the BMI to define overweight and obesity. A BMI of 25 to 29.9 is defined as “pre-obese.” A BMI of 30 to 34.99 is defined as “Obese class I.” A BMI of 35 to 39.99 is defined as “Obese class II.” A BMI of greater than 40.00 is defined as “Obese class III.”

Unfortunately, obesity rates in the United States have reached epidemic proportions. 58 million Americans are overweight; 40 million are obese; and 3 million are morbidly obese. Eight out of every 10 Americans over 25 are overweight. 78 percent of Americans are not meeting basic activity level recommendations; 25 percent are completely sedentary. There has been a 76 percent rise in Type II diabetes in adults 30 to 40 years old since 1990. The good news is that, while the number of obese people doubled from 1980 to 2002, the increase in obesity is slowing. There was no significant change in obesity prevalence between 2003-2004 and 2005-2006. Blacks have a 51 higher prevalence of obesity and Hispanics have a 21 percent higher obesity prevalence compared with whites.

There are many risks and complications with obesity, including:

· Insulin resistance

· Type II diabetes (also called adult-onset diabetes)

· Hypertension (i.e., high blood pressure)

· High cholesterol

· Stroke

· Heart attack  (coronary heart disease)

· Congestive heart failure

· Breathing problems

· Certain types of cancer (such as colon cancer in both sexes, cancer of the rectum and prostate in men, and breast cancer in women)

· Gallstones

· Gout and gouty arthritis

· Osteoarthritis (degenerative arthritis) of the knees, hips, and lower back

· Sleep apnea

· Depression

· Metabolic syndrome (a large waistline, a higher than normal triglyceride  level, a lower than normal HDL cholesterol level, high blood pressure, and higher than normal fasting blood sugars)

Extreme obesity can cause a gradual decrease in the level of oxygen in your blood, a condition called hypoxemia. Decreased blood oxygen levels and sleep apnea may cause a person to feel sleepy during the day. The conditions may lead to high blood pressure and pulmonary hypertension. In extreme cases, especially when not treated, this can lead to right-sided heart failure and ultimately death.

In addition to the amount of fat a person carries, an important factor is where the fat is located. People are divided into two classes: pears and apples. Women usually collect fat in their hips and buttocks, giving their figure a pear shape. Men usually collect fat around the middle, giving them the appearance of an apple. Apple-shaped people whose fat is concentrated mostly in the abdomen are more likely to develop many of the health problems associated with obesity. Men with waists at or greater than 40 inches and women with waists at or over 35 inches tend to have increased health risks related to obesity.

CAUSES OF OBESITY

There is no single cause of obesity. However, some factors that can contribute to obesity include:

1. Genetics – If one or both of your parents are obese, you have a good chance of inheriting the “fat” gene. Children of obese parents are 10 times more likely to be obese than children of parents of normal weight.

2. Overeating – If you eat more calories than you burn off every day, you are going to gain weight. Binge eating is also a cause of obesity.

3. Sedentary lifestyle – If you spend much of your time watching television or playing video games rather than getting some exercise, you are likely to become obese.

4. Underactive thyroid (hypothyroidism) – this may lead to weight gain, but usually only 10 to 15 pounds.

5. Ethnicity – African-American women and Hispanic women tend to experience weight gain earlier in life than Caucasian and Asian women. Hispanic men develop obesity earlier that Caucasian and African-American men.

6. Drugs – Some prescription medications may also contribute to weight gain and obesity. This is especially true among antidepressants, antipsychotics, anti-seizure medications, diabetes medications used to lower blood sugar levels in the blood, and corticosteroids.

7. A diet high in simple carbohydrates – Carbohydrates increase blood insulin levels, which in turn stimulate insulin release by the pancreas, and insulin promotes the growth of fat tissue and can cause weight gain. Simple carbohydrates, such as sugar, fructose, desserts, soft drinks, beer, and wine contribute to weight gain because they are more rapidly absorbed into the blood-stream than complex carbohydrates, such as those found in pasta, brown rice, whole grains, vegetables, and raw fruits.

8. Lack of sleep – The less people sleep, the more likely they are to be overweight or obese. For example, people who report sleeping 5 hours a night are much more likely to become obese compared with people who get 7 to 8 hours of sleep a night.

9. Emotional factors – Some people tend to eat excessively in response to psychological triggers such as boredom, sadness, stress, or anger.

10. Childhood weight – A person’s weight during childhood, adolescence, and early adulthood may also influence the development of adult obesity. Being mildly overweight in the early 20’s was linked to a substantial incidence of obesity by age 35. Being overweight during older childhood is highly predictive of adult obesity, especially if a parent is also obese. Being overweight as a teenager is a strong predictor of adult obesity.

11. Environmental factors – A person’s lifestyle and associated  behaviors such as what a person eats and how active he or she is a predictor of obesity.

12. Low socioeconomic status – Being overweight and obese are common in groups with low incomes. For example, women who have low incomes are about 50 percent more likely to be obese than women who have higher incomes. Among children and teens, overweight in non-Hispanic White teens is related to lower family incomes. Low-income families buy more high-calorie, high-fat foods, which may add to the problem

TREATING OBESITY

A combination of a healthy diet and regular exercise appears to work better than either alone. Dietitians and nutrition experts state that your best bet at long-term weight loss is by losing only 2 pounds a week through diet and exercise. It doesn’t matter what diet you’re on: the South Beach Diet, a low-carb diet, or you undergo gastric bypass or lap band surgery. Weight loss is achieved one way and one way only: take in fewer calories each day than you burn off (metabolize). It’s that simple. Of course, the calories should come from eating healthy foods rather than fatty foods or fast foods. Many people find that keeping a food journal of what they eat and/or joining a weight loss group helps them  learn to eat healthy food and manage how many calories they eat each day.

Exercise is a critical element in losing weight and keeping it off. Not only will you look better, lose weight, and turn fat into muscle, it will also help you manage diabetes, as well as high blood pressure and heart disease. At a minimum, you should do aerobic exercises—such as a moderate walk, jog, bicycling, swim, or other exercise that will increase your rate above 100 at least 30 minutes a day, three times a week. There are also minor things you can do every day that add up to burning calories and getting in better shape. For instance you should use the stairs rather than the elevator, park farther away from the store, or walk instead of drive whenever possible. Before beginning any exercise program, you should first get a complete physical examination from your doctor and discuss with him or her your proposed exercise regimen and dietary goals.

There are many over-the-counter drugs and herbs that promise rapid weight loss. Most of these drugs are ineffective and may be downright dangerous. Before you start using any over-the-counter weight loss drugs, talk to your doctor. The one over-the-counter that has scientifically been proven to reduce weight is Ally. Ally used to be a prescription drug and works by blocking the amount of fat your intestines absorb. Two prescription weight-loss drugs are Meridia (subutramine) and Xenical (oristat). Usually you can lose five to 10 pounds using these medications, but once you stop using them you usually gain the weight back unless you have made lifestyle changes.

Weight-loss surgery is another option for the very obese who have not been able to lose weight through diet and exercise. Surgery is not a quick fix for obesity, and the person must still be committed to eating a healthy diet and exercising regularly after the surgery.  The two most common weight-loss surgeries are laparoscopic gastric banding and gastric bypass surgery (bariatric surgery).

With laparoscopic gastric banding, the surgeon places a band around the upper part of the stomach, creating a small pouch to hold food. The band makes you feel full after eating small amounts of food. Gastric bypass surgery helps you lose weight by changing how your stomach and small intestine handle the food you eat. After the surgery, you will not be able to eat as much as before, and your body will not absorb all the calories and nutrients from the food you eat.

If you are considering surgery to treat your obesity, you need to be aware that the health dangers of gastric reduction surgery are significant, and complications are common (10 to 20 percent of patients who have weight-loss operations require follow-up operations to correct complications). However, the risks of the surgery may be outweighed by its benefits. After the operation, patients typically have to eat a drastic diet regimen, exercise, and, in the case of surgeries such as gastric bypass, lifelong nutritional supplementation. Patients who had gastric bypass surgery lost 30 percent more weight in the first year after surgery than patients who had lap band surgery. As with any type of surgery, especially when general anesthesia is used, there are risks involved and you should thoroughly discuss the risks and benefits of the surgery with the doctor before making your decision to undergo it.

If you need to lose weight, you should not think of it as going on a diet but as a change in lifestyle. A “diet” implies that you lose a certain amount of weight, and once you reach your target, you revert to your old ways. Rather, to succeed with your weight loss goal, you will have to make lifestyle changes, where not only do you start eating properly and begin exercising regularly and continue to do so after you’ve lost your weight. It is something you will have to do for the rest of your life. Even modest weight loss can improve your health.

CHILDHOOD AND ADOLESCENT OBESITY

The prevalence of obesity in children and teens has increased tremendously, in the last two decades with approximately 20 percent of children and adolescents being overweight or obese. Since 1980, overweight rates have doubled among children and tripled among adolescents, increasing the number of years they are exposed to the health risks of diabetes. In male children and adolescents, being overweight is highest for Mexican Americans (about 22 percent), compared with 17 percent for non-Hispanic whites and about 16 percent for non-Hispanic Blacks. In female children and adolescents, being overweight is highest for non-Hispanic Blacks (23 percent), compared with 16 percent for Mexican Americans, and about 14 percent for non-Hispanic whites.

The adult BMI discussed above does not apply to children and teens, as children and teens are still growing, the amount of body fat changes with age, and the amount of body fat differs between girls and boys. What is used to determine whether your child is normal weight, overweight, or obese is called the BMI-for-age percentile. A child’s or teen’s BMI-for-age percentile shows how his or her BMI compares with other boys and girls of the same age. You can find your child’s BMI by going here.

If your child’s BMI is less than the 5th percentile, he or she is underweight. If your child’s BMI is in the 5th to less than the 85th percentile, your child is at a healthy weight. If your child’s BMI is in the 85th to less than the 95th percentile, he or she is overweight. Your child is obese if his or her BMI is equal to or greater than the 95th percentile.

Type II diabetes (adult-onset diabetes) is now being diagnosed more and more in children. In some communities almost half of the pediatric diabetes are Type II, when in the past that total was close to zero. Although childhood-onset Type II diabetes is still a rare condition, overweight children with this disease are at risk of developing the same complications of diabetes as adults, such as kidney disease, blindness, and amputations.

Between 8 and 45 percent of newly diagnosed cases of childhood diabetes are Type II, associated with obesity. In 1990, four percent of childhood diabetes was Type II, while in 2009 it is 20 percent. Of children diagnosed with Type II diabetes in 2009, 85 percent of them are obese.

The causes of childhood and adolescent obesity are complex and include genetic, biological, behavioral, and cultural factors. If one parent is obese there is a 50 percent chance that the children will also be obese. If both parents are obese, the child’s risk of developing diabetes is 80 percent. Obesity in children and adolescents can be related to:

· a family history of obesity

· poor eating habits (e.g., fast foods, processed snacks)

· overeating or bingeing

· lack of exercise

· stressful life events or changes (for example, separations, divorce, moves, death of a loved one, child abuse)

· low self-esteem

· depression or other psychiatric problem

· steroids and some psychiatric medications

· low socioeconomic status

Many schools no longer have a class in physical education where the school children could get a period’s worth of exercise, despite the recommendation that children get at least one hour of physical activity a day.

Obesity in children and teens is associated with an increased risk of emotional problems, such as lower self-esteem, depression, anxiety, and obsessive-compulsive disorder and being physically or emotionally bullied by schoolmates.

Category Health, Obesity |

Allen P. Wilkinson
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Children, Teens and Young Adults on Antidepressants and the Risk of Suicide

2010
04.29

Many mental illnesses and disorders were long thought to begin only after childhood and adolescence. However, research in recent years has revealed that half of all lifetime mental illnesses begin by age 14. Despite the high number of children and adolescents having mental illness, fewer than one in five of affected children get the help they need. Due to the small pool of child and adolescent psychiatrists, psychologists, and other mental health professionals serving the 18 and under population—especially in rural areas—pediatricians, primary health physicians, and general practitioners are frequently being called upon to assess and treat young patients with even the most serious of the mental health disorders. However, a Canadian study found that most physicians did not have enough knowledge and support to detect and manage mental health conditions in pediatric patients.

If an examination rules out a physical condition, the physician must turn his or her attention to the child’s mental state. Distinguishing between normal developmental behavior from a true mental disorder can be difficult for even the seasoned child and adolescent psychiatrist. The pediatrician or primary care provider who has no psychiatrist in the area to whom to refer the young patient may be called upon to diagnose and treat a child with a constellation of symptoms that could be diagnosed as any or a number of disorders, such as conduct disorder, bipolar disorder, oppositional defiant disorder, attention-deficit/hyperactivity disorder, panic disorder, delinquency, borderline personality, or some other psychiatric condition sharing similar symptoms, all requiring different types of treatment.

Not only are personal relationships with family and friends affected by children with mental disorders, but proper psychological development of the child, performance at school, social integration, self-esteem, and ultimately functioning as a well-adjusted adult all depend upon proper mental health care while growing up. Youths with untreated mental illness often end up in the criminal justice system. In fact, nearly 60 percent of boys and girls involved in state and local juvenile justice systems throughout the country suffer from mental disorders, at least 20 percent of whom experience symptoms so severe that their ability to function is significantly impaired.

The diagnosis of mental disorders is not an exact science; diagnosis with absolute precision and certainty is impossible. It is that much harder in patients under 25. And with restrictions on many insurance companies as to the amount of time a mental health professional may spend examining a child for the purpose of making a diagnosis, many diagnoses and subsequent treatments are wrong and do more harm than good. For instance, many managed care companies offer a single one-hour diagnostic session with a child or adolescent psychiatrist or psychologist to determine a child or adolescent’s mental status. The American Academy of Child and Adolescent Psychiatry takes the position that such restrictions “are inadequate and may lead to insufficient information, condensed evaluations, diagnostic errors, and inadequate treatment planning.”

According to the Centers for Disease Control National Vital Statistics Report, suicide is the third leading cause of death among 15- to 24-year-olds (behind only accidents and homicides), and the sixth leading cause of death for five- to 14-year-olds. Although suicides account for only about 1.4 percent of all deaths in the United States annually, they comprise 12 percent of all deaths among 15 to 24-year-olds.

In 2007, the latest year for which data is available, there were approximately 4,030 suicides in youths between the ages of 15 and 24, and 195 suicides in children ages 5 to 14. Over 150,000 trips to U.S. emergency rooms are made each year after attempted suicides or other self-harm incidents among persons aged 10 to 24 years of age. Among young people ages 15 to 24 years old, there is one successful suicide for every 100-200 attempts. The most consistently reported pattern is that the risk of first onset for suicidal behavior increases significantly at the start of adolescence (12 years), peaks at 16 years, and remains elevated into the early 20s.

In one study, the researchers found that 14.5 percent of high school students reported having contemplated suicide in the previous 12 months, 11.3 percent had made a suicide plan, 6.9 percent reported that they had actually attempted suicide one or more times during the same period, and two percent had made a suicide attempt that resulted in an injury, poisoning, or an overdose that required medical attention.

Over 90 percent of attempted or completed suicide victims under 19 years of age have at least one psychiatric disorder, untreated depression being foremost among them. As many as one in 33 children and one in eight adolescents suffer from clinical depression, known in the mental health profession as major depressive disorder (MDD). Untreated depression is generally considered the third highest risk factor for suicide among youth, behind only previous suicide attempts and a history of suicide in the family, although some experts feel that untreated depression is the most common cause of suicide.

In children and adolescents, the symptoms of major depression are often different than those of adult depression. Some of the symptoms of a depressed child or adolescent are irritability, hostility, grumpiness, an easy loss of temper, poor school performance, persistent boredom, and risk taking (especially in depressed adolescents). Unexplained aches and pains are also common symptoms of depression in young people.

Since untreated depression is one of the leading causes of suicide in children, adolescents, and young adults, and depression is thought to be largely due to a “chemical imbalance” involving certain neurotransmitters in the brain (serotonin, norepinephrine, and dopamine), it is only natural that physicians would prescribe antidepressants to their depressed young patients as an integral part of their overall mental and physical health treatment plan, in addition to a course of psychotherapy and other treatments. In recognition of the fact that many attempted and completed child and adolescent suicides are due to underlying depression, from 1990 through 2003 the prescriptions for and use of antidepressants—in particular the “new” generation of antidepressants, “selective serotonin reuptake inhibitors” (SSRIs) such as Prozac, Paxil, and Zoloft, and the SSRI/norepinephrine reuptake inhibitor drug Effexor—by children, adolescents, and young adults had been rising significantly each year. During those years, the number of attempted and completed suicides in these age groups went down.

In October 2003, the FDA issued a Public Health Advisory warning that there is twice the risk (from 2 percent to 4 percent) in suicidal ideation and behavior in children under the age of 19 who were not actively suicidal when they are starting treatment with one of the newer antidepressants (sometimes as soon as 10 days after starting the antidepressant or when the dosage of the antidepressant is increased or decreased.)

A year later, in October 2004, the FDA issued another public health advisory requiring antidepressant manufacturers to include a “black box” warning in its prescribing information—the most serious action the FDA can take short of withdrawing approval of the drug (i.e., taking the drug off the market). The black box warning is required for all antidepressants—not just the SSRIs—regarding the risk of suicidality at certain times in pediatric patients being treated for depression. In May 2007, the FDA extended the warning to include the risk to young adults under 25.

After the FDA’s October 2003 Public Health Advisory, the overall rate of new depression diagnoses in patients 18 and under declined and the number of patients in this age group who were being prescribed the newer antidepressants decreased. The exception to this trend involved the number of patients in this age group who were prescribed fluoxetine (generic Prozac), the only antidepressant approved by the FDA for pediatric use.

Before 2003, SSRI prescriptions had steadily increased since 1987. Aside from minor fluctuations in 1993 (a one percent increase) and in 2000 (a three percent increase), the child and adolescent suicide rate consistently declined for the 15 years from 1988 to 2003. However, after the FDA’s 2003 public health advisory regarding several reports of children and adolescents taking antidepressants who attempted or committed suicide, the number of depressed youths being prescribed an antidepressant declined by some 20 percent, and in 2004 the suicide rate in U.S. adolescents increased by a record 14 percent from 2003. These increases in completed suicide occurred despite decreasing overall SSRI prescriptions among these age groups. Other countries, such as Canada and the Netherlands, reported similar increases in suicide among children, adolescents, and young adults when the number of prescriptions for SSRIs decreased.

The number of attempted and completed suicides among children and adolescents in the United States has increased since the black box warning was required. However, most completed suicides have no trace of an antidepressant in their system. In Canada, a similar lack of antidepressants in the systems of the “vast majority” of children and adolescents who had successfully completed suicide was found. As two psychiatrists pondered, “If SSRIs increase the risk of suicide, it is unclear why these drugs are so rarely found on toxicological examinations of youth after suicide.” Another study stated that if the FDA’s conclusion that there may be a causal link between suicide and antidepressants were correct, “we would have expected to see decreases in the suicide rate during the period of declining SSRI prescription rates, but instead we saw an increase in suicide rates, and the increase was greatest in the age range most affected by the decline in SSRI prescription rates. This finding suggests that SSRIs confer a protective effect.”

The new warning balances the efficacy of antidepressants in youthful patient against the risk of drug-induced-suicide. According to the black-box warning, such monitoring should include at least weekly face-to-face contact with patients or their family members or caregivers during the first four weeks of treatment, then biweekly visits for the next four weeks, then at 12 weeks, and as clinically indicated beyond 12 weeks. Additional contact by telephone may be appropriate between face-to-face visits. Clinical evidence, however, reveals that this observation regimen is not being adhered to.

During the 12-month period from August 2006 to July 2007, 62 percent of the total number of antidepressant prescriptions during the year were written by general practitioners, not psychiatrists. While pediatricians (who were included in the general practitioners category) prescribed 25 percent of all stimulants, they wrote prescriptions for only 21 percent of antidepressants during that time frame. The authors of one article concluded that, “[g]iven the large role of primary care providers in psychotropic drug prescribing, additional efforts may be needed to enhance the quality of psychiatric treatment in general practice settings across a range of psychiatric conditions.”

Because untreated depression is a leading cause of suicide in youth, pediatricians and other physicians who treat patients under 25 should routinely screen their young patients for this debilitating, life-threatening condition. The health care provider should also inquire into the medical and psychiatric history of the patient’s parents, specifically asking about whether a parent suffered from depression, committed suicide, or sexually abused the patient, as these are increased markers for a suicide attempt by the young patient.

If a child or adolescent patient is diagnosed with major depression, and the health care provider is reluctant to prescribe antidepressants for fear of the increase in suicidal thinking and behavior, the health care provider must provide alternative and approved methods of treatment or refer the patient to another health care provider who will provide appropriate treatment, whether it be in the form of prescribing psychotropic medication or employing regular psychotherapy sessions. Two particular forms of psychotherapy have been shown to be helpful in treating depressed patients. One is cognitive behavioral therapy, which helps the patient learn new ways of thinking and behaving. The other is interpersonal therapy, which helps patients understand and work through troubled personal relationships. Some health care providers are prescribing newer atypical antipsychotics (e.g., Abilify, Risperdal, and Seroquel) and other non-antidepressant psychoactive drugs in place of antidepressants, often with a less than efficacious result and a higher risk of side effects than the newer generation of antidepressants.

In seriously depressed youths, a major study sponsored by the National Institute of Mental Health involving adolescents having a mean age of 15 found that, after 12 weeks, the most effective treatment for adolescents with major depression was a combination of fluoxetine (Prozac) and Cognitive-Behavioral Therapy (CBT), rather than either one alone or placebo.

It is clear that compared to placebo the overall benefits of the newer antidepressants are successful in treating major depression in children, adolescents, and young adults and in reducing the risk of completed suicide. Although there may be a higher risk of suicidal thoughts and behavior at certain times, the health care provider can minimize the risk with proper monitoring of the patient. Deliberately not diagnosing major depression in pediatric patients to avoid the antidepressant-suicide issue can only lead to untreated depression and a much higher risk of completed suicides.

As two psychiatrists wrote, two facts are undisputed: (1) pediatric suicide is most common in children with untreated major depression, and (2) SSRIs are rarely found to be present at the time of death in suicide victims, suggesting that SSRIs are not likely to be a causal factor in a substantial proportion of child and adolescent suicide. These writers further state:

If the intent of the pediatric black box warning was to save lives, the warning failed, and in fact may have had the opposite effect; more children and adolescents have committed suicide since it was introduced. If the FDA’s goal is to ensure that children and adults treated with antidepressants receive adequate follow-up care to better detect and treat emergent suicidal thoughts, the current black box warning is not a useful approach; what should be considered instead is better education and training of physicians.

Major depression in a child, teenager, or young adult is a serious mental health disorder that if left untreated or inadequately treated can lead to the youth’s isolation, anhedonia, risk taking, change in personality, inability to tend to his or her basic personal hygiene, suicidal thoughts and attempts, and, in the worst cases, completed suicide. Mental health care providers who diagnose (or should have diagnosed) a child, adolescent, or young adult patient with major depressive disorder must weigh the pros of prescribing antidepressants and their attendant risks against the cons of not prescribing such drugs and using other forms of treatment. However, health care providers cannot simply ignore major depression in a young patient and do nothing because of the increased risk of suicide inherent in untreated depression.

If your child has been acting strangely lately—e.g., an outgoing child becoming more introverted and keeping to himself, getting into trouble at school, grades dropping, listening to songs about death, suicide, or there being “only one way out,” or repeatedly playing songs by rock stars such as Kurt Cobain (the leader of the band Nirvana, who killed himself with a shotgun while at the top of his popularity)—you should immediately get the child to a mental health professional for an examination and evaluation.

Category Psychology |

Allen P. Wilkinson
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SING! Live the Life You Dream of

2010
04.26
Most men lead lives of quiet desperation
and go to the grave with the song still in them.

- Henry David Thoreau

When she was five years old, Melanie Kinchen knew she wanted to be a doctor. When she was ten, an acquaintance of her mother asked Melanie if she knew what she wanted to do when she grew up. Melanie replied that she was going to go to an Ivy League university, become a doctor, and be the head of a clinic with “lots of people” working for her.

Twenty-five years later, Melanie’s mother ran into her old acquaintance, who cynically asked, “Whatever became of that odd child of yours?” Her mother stated that her “odd child” had gone to Yale, graduated from Harvard Medical School, did her residency and fellowship at Johns Hopkins Hospital, and now was a respected back surgeon and Director of the Spine Center at a highly regarded regional hospital. Melanie is singing her song just as she had laid it out years before. Thoreau would be proud of her.

Singing one’s song means being true to oneself, living a full, passionate, and authentic life. The philosopher Soren Kierkegaard said the goal of life is “to be that self which one truly is.” Finding your true song can be like peeling away the layers of an artichoke until the heart reveals itself. Your song may be buried deep under layers of pain, sorrow, discouragement, depression, anxiety, abuse, failure in the face of heightened (and unrealistic) expectations, lack of affection and support, or conditional or withheld love. As a person becomes clearer about who he or she really is, that person will be in a better position to decide what he or she wants out of life, what his or her song is and to begin singing it.

Often people follow their parents’ or someone else’s expectations as to their education and occupation, rather than discovering for themselves what really turns them on. The late psychologist Carl Rogers stated that people must move away from the person or direction they were told they ought to be or should go. Rogers found that many people put on a facade to try to please others, but when they were free, they moved away from being that person.

One of Rogers’s clients, looking back at some of the process he had been through, wrote, toward the end of therapy: “I finally felt that I simply had to begin doing what I wanted to do, not what I thought I should do, and regardless of what other people feel I should do. This is a complete reversal of my whole life. I’ve always felt I had to do things because they were expected of me, or more important, to make people like me. The hell with it! I think from now on I’m just going to be me — rich or poor, good or bad, rational or irrational, logical or illogical, famous or infamous.’”

Oprah Winfrey says that, “Your job is not just to do what your parents say, what your teachers say, what society says, but to figure out what your heart calling is and to be led by that.” Winfrey tells people to “[u]nderstand that the right to choose your own path is a sacred privilege.” Meditation teacher and former Buddhist monk Jason Siff says, “You can’t really tell someone that this or that is something they should really do. It’s for each person to find his way to something that really suits and fulfills him.”

Singing your song is not about the amount of money you make or the material things you accumulate, the size of the house you buy with its Olympic-size swimming pool, tennis court, and horse stables, the price and speed capabilities of the car you drive, the make and vintage of the wine you drink, or the number of lovers you have had. The British philosopher Bertrand Russell said: “The most valuable things in life are not measured in monetary terms. The really important things are not houses and lands, stocks and bonds, automobiles and real estate, but friendships, trust, confidence, empathy, mercy, love and faith.”

Singing your song can mean giving up a lavish lifestyle in favor of a lower paying yet emotionally satisfying life. Former President Jimmy Carter has dedicated his life to public service, and with every nail he pounds in building a new home for an underprivileged family through Habitat for Humanity, he is truly singing his song.

Few have overcome as much adversity to sing her song as loud and clear as Oprah Winfrey. She was born to a poor single teenage mother in Mississippi and lived with her grandmother on a farm with no indoor plumbing. When she was 6, she moved to her mother’s home in Milwaukee, and a few years later to her father’s in Nashville. She was physically abused as a child and was raped when she was 9 years old. She gave birth to a son at 14, but he died a short time later. A voracious reader as a child—she started reading the Bible at 3— she wrote a note to her kindergarten teacher that she didn’t belong there, and was quickly put in the first grade. After the first grade, she was advanced to the third grade. A seventh-grade teacher noticed Oprah reading during lunch and managed to get her a scholarship to a better school.

With her winning personality and good looks, Oprah managed to win several beauty contests. But it was being crowned “Miss Fire Prevention” at 17 in Nashville that the tide turned. She was interviewed on a local radio show and for a lark was invited to read copy on the air and was hired to read the news. And the rest, as the saying goes, is history. Oprah says that she always knew that she was destined for success. And of singing one’s song, she says, “The biggest adventure you can take is to live the life of your dreams.”

Many people are afraid of singing their song out of a fear of failure. Dr. Wayne Dyer observes in his book The Sky’s the Limit that when we are young children we are not intimidated by making mistakes. Failure was nothing to be avoided or ashamed of, he states, but rather something to be welcomed because “you instinctively knew that you couldn’t learn anything unless you were willing to fail at it first. . . . If children were made in such a way that they were afraid to try new things because they feared failure, they would never get out of their cribs! Likewise, adults who fear failure simply vegetate.”

On the other hand, some people don’t risk singing their song out of the fear of success. In her book Overcoming the Fear of Success, Dr. Martha Friedman talks about the difference between external and internal success. External success consists of all the trappings of fortune, fame, power, prestige, and possessions. But without internal success, external success is hollow, leaving us unfulfilled and asking, “Is that all there is?” In Dr. Friedman’s words, “The sort of success I mean consists of this: getting to do what you really want to do in your work life and in your love life, doing it very well, and feeling good about yourself doing it. The fear of success is not getting what you really want because you unconsciously feel you don’t deserve it.”

Dr. Friedman sees the fear of success as a paradox: “On a conscious level, everyone wants to be successful. But on an unconscious level, it’s quite a different story. There, in the unconscious, is where many of us do our best, without realizing it, to ensure that success is never reached and, if it is, that it doesn’t last.” This concept is not new. Freud found that people occasionally fell ill precisely because a deeply seated and long cherished wish had been fulfilled. According to Freud, apparently “they could not endure their bliss, for the causative connection between this fulfillment and the falling ill there can be no question.”

One person who has had more than his share of success and failure is British billionaire entrepreneur and adventurer Sir Richard Branson. The “rebel billionaire” has been called the closest thing there is to a real James Bond. He presides over more than 200 companies and 50,000 employees, and now is working on Virgin Galactic, an airplane/spaceship that will take people into suborbital space, where they will experience weightlessness and see the curvature of the earth. Yet Branson has had to overcome his own difficulties, including mild dyslexia and a poor academic record. In fact, he dropped out of high school to start publishing a magazine, and the seeds of success were planted when he began a business of selling records.

But Branson is not all about business. He has risked life and limb in pursuit of various ventures, such as his several unsuccessful attempts to circumnavigate the world in a hot air balloon. Four times he has been forced to be pulled out of cold angry seas by rescue helicopters. But in the process of singing his song, Branson has set records for crossing the Atlantic in a boat in the fastest time and time and distance records for flying a hot air balloon across the Pacific. Branson says that, while the many businesses he has started play an important role in his life, “equally as important is my belief that every minute of every day should be lived as wholeheartedly as possible.” As for singing his song, Branson says: “Sometimes I wake up in the mornings and feel like I’ve just had the most incredible dream. I’ve just dreamt my life.”

Neil Young has been writing and singing songs since he was a teenager in the 1960s and has no thoughts of stopping. He doesn’t do it for the adulation of millions, once stating: “I don’t give a f*** if my audience is a hundred or a hundred million. It doesn’t make any difference to me. I’m convinced that what sells and what I do are two completely different things. If they meet, it’s a coincidence.”

Like his music, Young is always evolving. His parents divorced when he was ten, and some of the closest people to him have died from drug overdoses. Yet Young remains passionate about singing his song, metaphorically and literally. Young’s philosophy is best summed up in the name of his song Rust Never Sleeps.

Once you know your song, when are you going to start singing it? When you graduate from college? When you get married? When you have your first child? When your last child leaves home? When you turn a pivotal age, like 30, 40, or 50? When you retire? Emerson said that “we are always getting ready to live, but never living.” Dyer observes that “‘futurizing’ can become the most destructive of habits. The present is always used up in planning for the future, which never quite comes.”  As John Lennon so eloquently put it, “Life is what happens when you’re busy making other plans.”

Before you know it, there is little or no future left to sing your song. Or the unexpected gets in the way—a heart attack, a car accident, the birth of a child with a serious physical or mental defect. Life often does not turn out the way we hope or plan; every moment is precious.

The late psychologist Rollo May once had a client who stated that he knew only two things: one, that he would be dead someday, and, two, that he was not yet dead. The client said, “The only question is what shall I do between those two points.” The student would be well-advised to take author Henry James’s advice and “[l]ive all you can; it’s a mistake not to.”

8 TIPS TO LIVING YOUR DREAMS

1. Make Every Day Count. Dr. Teddy Blecher, co-founder of the Community and Individual Development Association (CIDA) City Campus in Johannesburg, South Africa, states that when you look back on your deathbed one day and ask, “Was it all worth it? Will you be able to say every day would have made it worth it?”

2 . Learn to Enjoy Life. 19th Century Baptist preacher Charles Spurgeon stated, “It is not how much we have, but how much we enjoy that makes happiness.” The Talmud states that “everyone will be called to account for all the legitimate pleasures which he or she has failed to enjoy.”

3. Don’t Worry, Be Happy. His Holiness the Dalai Lama believes that the purpose of life “is to be happy. From the core of our being, we simply desire contentment.” Gandhi said, “Happiness is when what you think, what you say, and what you do are in harmony.”

4. Stop and Smell the Roses. Famed University of Chicago psychologist Mihaly Csikszentmihalyi says that, “It really does not make sense to go through the motions of existence if one does not appreciate as much of it as possible.”

5. Live in the Moment and Be Aware. Eric Berne, M.D., the father of transactional analysis, said, “The aware person is alive because he knows how he feels, where he is and when it is. He knows that after he dies the trees will still be there, but he will not be there to look at them again, so he wants to see them now with as much poignancy as possible.”

6. Be Yourself. In Hamlet, Polonius exhorts, “This above all: to thine own self be true.”

7. Things Aren’t Important . . . Contemporary spiritual leader and author Eckhart Tolle writes in A New Earth, “Many people don’t realize until they are on their deathbed and everything external falls away that no thing ever had anything to do with who they are. In the proximity of death, the whole concept of ownership stands revealed as ultimately meaningless.”

8. . . . Relationships Are. The Dalai Lama teaches that, “The need for love lies at the very foundation of human existence. It results from the interdependence we all share with one another. However capable and skillful an individual may be, left alone he or she will not survive.”

Category Self-Help |

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