Kids today aren't put off by graphic images. Between TV, movies and games, they are bombarded with graphic scenes at every turn. So very many of them are, simply, numb to them.

Worse than that, I know a lot of kids / teens that would find the images (above) 'cool' and might actually go out of there way to get their hands on the cigarette packs just to shock and impress their friends. The exact opposite goal of this mandated change.

Yes, I know that this doesn't apply to all kids. But, in my opinion, the kids who would be put off by the pictures are not going to be buying cigarettes or taking up smoking to begin with. So, again, this campaign is not effectively reaching at-risk kids and teens.

Of course, for now, it's all a mute point as a judge has granted a temporary injunction - in favor of tobacco companies. What do you think? Is it possible for companies and government to keep cigarettes out of kids' hands?

Or is that a job for Mom and Dad?

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I am not a medical / healthcare professional. I simply offer my opinion of what I read in the news and on the 'Net. Nothing written here is intended to be medical advice or to substitute for consultation with a healthcare professional.

Always consult your physician about any health conditions or concerns.

Good News

According to Jay Zagorsky, research scientist at Ohio State University's Center for Human Resource Research and co-author of the study, "Not only is there not a 'Freshman 15,' there doesn't appear to be even a 'college 15' for most students." Apparently, only about 10 percent of students put on that much weight and - even better - about ¼ actually lose weight in their first year.

Bad News

Comparing non-college young adults to freshmen, it appears that weight gain is tied to aging more than school. Both groups gained weight in the equivalent year, with students putting on about ½ pound more than their non-studious counterparts. An average of 3.5 pounds for men hitting the books; 3.0 pounds for the non-matriculators. (Women gained about a pound less than the men.)

Reasoning

It is believed that the reasons college-age youth put on weight - regardless of post-secondary pursuits - are the same. They've, frequently, moved away from home and are living on a tight budget. They can't afford more expensive healthy foods, like fruits and veggies. They also, finally away from Mom and Dad, don't have to eat said fruits and veggies, if they don't want to. And many of them don't want to.

Additionally, at this point in their lives, they may be less active than they were in high school. Few athletes go on to play college sports and there are minimal phys-ed requirements in college. Not to mention, non-collegiates have fewer opportunities for rigorous, organized athleticism.

Bottom Line

Eighteen- and nineteen-year-olds can expect to put on a few pounds once they get out of school. How many pounds will depend on diet, activity, and metabolic luck. Just one more reason to eat healthy and exercise - early, and often.

Me? I ate a lot of pasta al burro and had a wicked metabolism that first year of college. What about you?

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* Full-length scientific articles are often only available to the public if purchased. The link to the full version of this study was working at the time of this posting.

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Statistics

Okay, this is the slightly boring part - stay with me, please?

An estimated 11% of the world's population, or about 766,700,000 people, suffer from migraines. This includes kids and adults of all ages. Of those 766M miserable people, about 30% (230,010,000) experience auras.

In the study, conducted at Montefiore Headache Center in New York, 14 of 2,100 participants (0.667%) reported olfactory hallucinations. Translated to the aura-suffering migraine population, meaning - potentially - 1,534,167 people around the world may experience these phantom smells.

Phew! That's enough to trigger a headache.

What Types of Smells?

If migraines weren't ugly enough, most of the sufferers who reported imagined smells prior to an attack didn't smell roses and potpourri. Although some did mention the scent of coffee or oranges.

According to Dr. Matthew S. Robbins, senior researcher on the new study, "The most common [scent] was of the burning or smoke variety." With a general burning smell topping the list, other reports included cigar smoke, wood smoke, and burned popcorn odors. (I was good until the burned popcorn part. Ick.)

The next pattern of smells, after burning, was what the researchers called decomposition smells - garbage or sewage odors. Now that's an addition to a migraine that no one needs to experience.

Bottom Line

Although an extremely small (calculated) number of people suffer strange, phantom smells prior to onset, it is something - if you get migraines - to consider.

My understanding is that migraine medications are most effective if taken before the attack has taken hold. This means that any weapon in a sufferer's arsenal that provides a heads-up (pardon the pun) is a good thing.

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I am not a medical / healthcare professional. I simply offer my opinion of what I read in the news and on the 'Net. Nothing written here is intended to be medical advice or to substitute for consultation with a healthcare professional.

Always consult your physician about any health conditions or concerns.

Supplement Users

One of the first things that surprised me was that most of the people who indicated they used nutritional supplements didn't actually need them. These participants already had better diets and got enough nutrients through what they ate.

This means that taking vitamins and minerals only resulted in excess intake. While the risks from too much zinc or magnesium aren't known, taking too much calcium (in supplement form) has been linked to kidney stones. Excess iron is stored in the organs and can lead to cirrhosis and heart failure^[1]

Supplement Non-Users

Conversely, those participants who indicated no use of nutritional supplements also suffered from poorer diets. They were the ones, it appears, in need of additional minerals, yet they weren't getting / taking them.

Daily Requirements

One odd notation, in the article I read, related to the way people use supplements.

Everyone knows that there is an RDA (or whatever it's called these days) on containers of vitamins and minerals. Most of these items have been evaluated and the FDA has determined what the average individual needs every day. This is not the starting point for supplementation.

Yet, many of the survey participants were treating these numbers as the minimum amount - dosing upward from there. This almost guarantees, especially when their diet is sufficient, that individuals are getting too much of what they're taking.

Conclusions

Since researchers determined that those who need them least, take supplements most often, I have to wonder if it tends to boil down to income in the end. People who can afford supplements (which are not inexpensive) can also afford better quality food - fresh fruits and vegetables, and lean meats. They (possibly) eat less fast food, as well.

Individuals and families who are struggling financially, who can't afford more expensive meats and produce, probably can't afford vitamin and mineral pills to assist with the nutrition that their diets are lacking. Another catch-22 for families that are caught in the monetary crises crippling so much of society.

Just one more reason to make junk food more expensive, and lettuce, carrots, potatoes, and chicken breasts cheaper.

Typical symptoms are the same as for women:

• A lump or swelling in the chest area
• Dimpled or puckered skin
• A nipple that is inverted (facing inward)
• Redness or scaling of the nipple or breast skin
• Discharge from the nipple

Both men and women can develop lumps in the breast that are non-cancerous. But it is incredibly important for anyone with changes in the tissue in and around the breast to seek medical advice. Only a medical professional can determine whether those changes are benign or something that need further attention.

If you are female, I hope that you perform monthly exams. It is your first line of defense.

If you are male, please realize that you are not immune to breast cancer. If you notice changes in your body, tell your doctor.

Breast cancer is treatable - the earlier it's caught, the better the hope for a full recovery.

I must admit, I loved the article from snopes.com. No one knows where the eight-glasses-a-day rule came from, and there are most certainly experts on both sides of the issue, pointing fingers and crying foul. But I was looking for information about how much fluid we lose on a daily basis. This quote, I think covers it:

To replace daily losses of water, an average-sized adult with healthy kidneys sitting in a temperate climate needs no more than one liter of fluid, according to Jurgen Schnermann, a kidney physiologist at the National Institutes of Health.

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Food

Not all of the fluids that we take in during an average day come from beverages. Depending on our diet, we could be adding two or three of those 8 oz. glasses through fruits and vegetables, alone.

Foods with high fluid content include:

• 1 medium Apple - 4 oz.
• ½ medium Cucumber - 5 oz.
• ½ medium Grapefruit - 4 oz.
• 1 small Potato, baked 5 oz.
• 1 small Potato, boiled 6 ⅓ oz.
• ¾ cup Soup, average - 5 ⅓ oz.
• 1 small Tomato - 4 oz.
• ½ cup Watermelon - 2 ½ oz.

It's easy to see, with just these few items, how simple it is - especially right now when produce is at its best - to keep hydrated. All without guzzling copious amounts of water.

Bad Beverages

Not all fluids are created equal.

Caffeine

For years, we have been told that drinking coffee and tea leads to dehydration. This is apparently based on the fact that coffee and tea contain caffeine, and caffeine has a diuretic effect on the body. However, a 2003 review of medical and scientific literature for the period of January 1966–March 2002 found that, in simple terms, if you indulge in caffeine on a regular basis, you are likely to be immune to the mildly diuretic effects.

If you rarely drink tea or coffee, when you do indulge, you may spend more time in the bathroom than your neighbor - the caffeine junkie. But there is no evidence, according to this review, that simply having a cup or two of coffee will cause you to pee out more than you drank. You probably don't need to drink extra water to counteract the caffeine.

Alcohol

Like caffeine, alcohol has a diuretic effect on the body. However, it's just a little more aggressive. (If you've ever had two beers and peed out four, you know what I mean.)

To paraphrase this article on kidney function: to conserve water, the pituitary gland excretes vasopressin (also called anti-diuretic hormone or ADH) which, in turn, increases permeability of the nephrons in the kidneys. More water is kept in the bloodstream; less is released in urine. Alcohol causes dehydration by blocking release of ADH, removing fluid from the system and sending it to the bladder.

If you regularly consume large amounts of alcohol, you are regularly at risk for dehydration. You may very well need those 6 to 8 glasses of water per day, just to keep up. That glass of wine with dinner? Probably not an issue.

Fluid Loss

Perspiration

People who live in the desert or exercise regularly, know that excessive sweating leads to excessive fluid loss. By the time you're thirsty, according to common wisdom, you are already 2% dehydrated. So, for us desert dwellers and you exercisers, 6 to 8 glasses of some sort of fluid every day is already the norm.

If not, it probably should be.

Illness

Vomiting, diarrhea, and/or a sweaty fever are other ways we suffer fluid loss. In the midst of a nasty bout of the flu or a wicked virus, it's not always easy to get enough fluids. Your stomach may simply reject everything you try to swallow.

Even if it's only a few sips of water, followed by a few more, fluids are critical when you're sick.

Conclusion

What I have tried to do is look at fluid intake and common causes of dehydration - whether they hold water (pardon the pun) or not. I'm no medical expert, but it seems to me that, when clean drinking water is readily available, hydration is reasonably simple. And, despite the hue and cry from some quarters, I believe that few of us are at risk of imminent death from dehydration.

I don't suppose that taking in 48 to 64 ounces (6 to 8 8-oz glasses) of fluids over the course of the day is going to hurt anyone. I just don't see it as some do-it-or-you'll-die mandate. Especially when there's really no scientific basis for it.

What do you think? Good or bad? Sane or silly?

Disturbing Sunscreen Secrets

Originally published in Women's Health , this article looks at 10 things the average consumer may not know about sunscreens. Here are four of them:

Ingredients

Retinyl palmitate, a vitamin-A compound found in almost half of all American sunscreens, is added to help reduce the signs of aging caused by sun exposure. Sounds good, doesn't it? However, in truth, it "may speed up the development of skin cancer–related tumors and lesions when used on skin hit with sunlight." In a nutshell, retinyl palmitate and sunshine look like a bad combination.

Not to mention:

Oxybenzone and octinoxate, common block chemicals, are linked to allergic contact dermatitis and photocontact dermatitis (irritation caused when certain chemicals are on skin that’s exposed to sunlight), as well as hormone disruption, in lab animals.

UVA vs. UVB

Just a quick reminder: UVA rays cause wrinkles, UVB rays cause sunburns, and both have been linked to skin cancer.

The SPF number on that bottle of sunscreen relates only to protection against sunburn. To protect against those wrinkle rays, you need something entirely different.

Titanium dioxide and zinc oxide have been around for a number of years. The solid white, Kabuki-mask effect was so unpopular that many manufacturers started adding colors. (Yeah, that was a lot better. Not.) Today, most preparations are transparent.

There are also two chemical-based ingredients, now available: Avobenzone (a.k.a. Parsol 1789) and Ecamsule (a.k.a. Mexoryl SX). Avobenzone is one of the most effective of its type and is fairly easy to find in U.S. sunscreens. Ecamsule, a more recent addition to the American sunscreen arsenal, is even more effective; it is also harder to find and much more expensive.

Expiration Dates

Something I didn't realize or even consider, sunscreens expire. Ingredients, designed to maintain the potency of the product, are only effective for a limited time. Generally, three years is the outside limit. After that, you're not going to get the same level of protection.

In addition, lying around in the sun at the beach or the pool is just as bad for your sunblock as it is for your skin. Heat in general is the enemy. So, store it in a cool place indoors and, outdoors, try to keep it in the shade. (Pretty much the only way to survive summer in Arizona. {winks} )

Labels Lie

Not surprisingly, not everything you read on a bottle of sunblock is the god's truth. One of the more common misrepresentations has to do with SPF factors. The assumption is that the higher the number, the greater the protection. That isn't necessarily the truth:

“People think they’re doing themselves a favor by using high SPF, but the difference is incremental. SPF 15 filters out 93 percent of UVB rays; SPF 30 protects against 97 percent; SPF 50, 98 percent; and SPF 100, 99 percent–and that’s only if you apply enough of it.”

Another crossed-my-fingers-when-I-said-that issue relates to coverage. The terms 'waterproof' and 'all-day' sound impressive and reassuring, but may be far from the truth. In fact, common wisdom says sunscreen should be reapplied every 2 hours, no matter what's on the bottle.

New Sunscreen Regulations from the FDA

Directly related to these sunscreen issues, the FDA has issued new regulations for sunscreen manufacturers. They officially go into effect in 2012. And I quote:

The new regulations promote a change in terminology:

• Sunscreens that have UVA and UVB protection will be known as broad spectrum. SPF, which protects from UVB radiation, will remain on the package.
• SPF ratings 15 and above will be permitted to state that they protect against early skin aging and reduce the risk of skin cancer. SPF’s below 15 help prevent sunburn but offer no other protection.
• The highest SPF rating will be 50+ as studies have shown there is no additional benefit gained beyond this.
• Waterproof or sweat proof sunscreens will be vigorously tested to determine the exact amount of time they provide sun protection. This helps consumers know how often it’s necessary to reapply in order to reduce the risk of burning. Most sunscreens should be reapplied every two hours, which is the longest amount of time allowed.

The hope is that sunscreen makers won't wait until next year to make these changes. I can imagine that there would be some marketing benefit to being the first to comply.

Let's hope that, by next summer, we'll know what we're really getting in that bottle of sunscreen.

Think about it for a minute. You wouldn't cut up chicken and then, without disinfecting the board and knife, slice up your veggies. But, by not washing your totes between trips, you might well be doing exactly that. Especially if we're talking about foods that are eaten raw - carrots, celery, lettuce, tomatoes.

Researchers ran tests on reusable totes and found that 50% were positive for coliform bacteria - the group that includes E. coli. In fact, 12% of the bags tested actually had E. coli. That's a sobering thought, in these days of contamination scares.

The good news? Hand or machine washing killed over 99% of those bacteria.

So - always wash your bags between uses. We take so much care purchasing, preparing, and cooking our foods. Let's not contaminate it before we even get into the kitchen.

Just so we're all on the same page here, we're not talking about a case of nerves. This isn't sweaty palms or butterflies in the stomach over a first date. Although it can begin that way.

The kind of anxiety we're talking about is crippling, all out of proportion to the situation. Most everyone gets a little jumpy over new situations. But when it devolves into heart palpitations, shortness of breath, shaking, dizziness, and fight-or-flight reactions; when the physical and mental manifestations make it impossible to function - then, it's time to get help.

Cognitive-Behavioral Therapy (CBT)

CBT is not, in and of itself, therapy. Rather it is an umbrella term for therapies "based on the idea that our thoughts cause our feelings and behaviors, not external things, like people, situations, and events.^[1]"

Cognitive-behavioral therapy doesn't say thoughts are wrong or tell people how to think. It begins with the premise that people who seek this form of therapy don't like the way they feel and want to do something to change those feelings. CBT therapists teach their clients how to do that. How to unlearn damaging reactions and behaviors.

For Example:

Years ago, I was married to a man who had issues with working every day and paying his portion of the bills. This caused me great anxiety, as we couldn't survive solely on my income. A natural anxiety, all things considered, that imagined starvation and homelessness.

The problem was, in my mind the situation magnified to such a point that spending any money caused intense panic. I simply 'knew' that the minute I paid out anything, something would happen and we'd be out on the street, living in our cars. Those thoughts became so internalized, so completely ingrained, that I couldn't pay bills.

Credit counseling, in this case, wasn't the answer. I had to change my thought process; recognize that I was way over the top and doing myself serious financial damage. It took time, and counseling, but I got there. (Sadly, not before I did some serious damage to my credit rating.)

Medications

There are a number of medications that are effective for anxiety. As with any other condition, not everyone responds to all treatments. Sometimes, the side effects override the benefits.

Rather than attempt to describe all forms of medications that are prescribed for anxiety disorders, let's look at what the medications (when they work) accomplish. In a nutshell, they reduce the physical symptoms of panic attacks. By eliminating or reducing these crippling mental and emotional reactions, medications offer patients time to calmly and rationally assess the situation and manage their response to the trigger.

For Example:

In my I-can't-pay-the-bills-cuz-I'll-end-up-homeless scenario, just opening a credit card bill was enough to make my heart pound, my palms sweat. I'd get dizzy and have trouble catching my breath. Once these symptoms kicked in, there wasn't much I could do but hold on for the ride.

With medication, the extreme physical fight-or-flight didn't happen. This aborted the roller coaster ride, before it even got started. Or, more accurately, lowered the peaks and raised the valleys of the anxiety.

Because I didn't have to deal with the immediate panic, I was able to (literally) take a deep breath and do the right thing. It didn't solve the problem of a husband who was financially irresponsible. But it did keep me from giving in to damaging behavior patterns.

Bottom Line

Anxiety and panic disorders are potentially crippling conditions. They keep people from functioning and, often, lead to additional problems because of the dysfunction. Untreated, life becomes a series of ever more crippling thoughts and irrational behaviors.

Therapy or medication alone is, frequently, insufficient to combat the combination of physical and mental processes that comprise anxiety and/or panic disorders. Reducing physical symptoms and retraining thought patterns is, from my experience, the best management option.

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1. Source: National Association of Cognitive-Behavioral Therapists, What is CBT?

Definitions

Stepping away from the article and into the study itself, there are some basic definitions that impact the understanding of this study.

It is important to note that there are differences between screening and clinical surveillance. With screening, apparently healthy people are targeted to help them make better-informed health care choices. ... Clinical surveillance, on the other hand, involves the targeted use of diagnostic tests and questionnaires to either rule out or rule in a diagnosis among people who have a relatively high probability of having that condition by virtue of having already been identified in some way.

In other words, arbitrarily screening all toddlers for autism vs. testing children whose parents and/or pediatrician have already noticed possible problems or delays in development, or who are at higher risk.

Testing

Another question in the study was the effectiveness of current testing methods.

Some tests are incredibly good at determining children who are not at risk, but frequently fail to diagnose those who are: Checklist for Autism Spectrum Disorders in Toddlers (CHAT). Even with modifications, M-CHAT, the test is unable to diagnose 15% of children with autism.

Other tests generate a number of false positives, in addition to false negatives: Social Communication Questionnaire (SCQ). The SCQ, according to the study, suffers from 15% false positives (not identifying children who don't have autism) and 25% false negatives (not identifying children who do have autism).

For routine community-wide testing, the available testing options were deemed insufficient. And, as the accuracy of the results are questionable, the "potential burdens on families of receiving a misdiagnosis (either a false-positive or a false-negative) may be enormous, and there might be labeling effects that can be hard to remove."

Treatment

Along with the question of accurately assessing which children have autism, there is the question of severity and treatment.

There are varying (widely varying) differences in the abilities and disabilities of children with autism. This is not measles or whooping cough, where you either have it or you don't. Each child is unique and must be treated according to his/her needs. Therein lies the problem.

Unlike interventions for phenylketonuria or congenital thyroid disease, there is no strong evidence of the effectiveness of the various autism therapies currently provided. In addition, the availability of these therapies is limited (there are waitlists often as long as >1 year in many therapy centers), and the cost is often prohibitive.

Programs for children with autism are difficult to find, difficult to get in to, and expensive. Even something as simple as behavioral therapy for a higher-functioning autistic is, pardon the term, a crap-shoot. If a program or service exists, and has room for one more, the quality of the therapy may be so poor as to be more harm than good. (I know.)

Conclusions

Strictly from the standpoint of testing all children for Autism Spectrum Disorders (ASDs), it appears that this study of current literature makes a valid point. Lacking accurate testing and readily available treatment options, arbitrarily subjecting children and families to testing seems pointless.

Ongoing research is certainly needed to assess the effectiveness and acceptability of screening programs for ASDs. ... [B]ecause the implications of instituting a major program without sound research-based evidence are so enormous, we believe that the child health community has an important responsibility to undertake [such] clinical trials as a matter of priority. At this time we recommend careful surveillance and assessment of all preschoolers who present with impairments in their development of language, social function, or cognitive skills that result in activity limitations, but we believe that community screening of all preschoolers is premature.

I repeat: "We recommend careful surveillance and assessment of all preschoolers who present with impairments in their development of language, social function, or cognitive skills that result in activity limitations." No one should, for a moment, take this study to mean that children should never be tested and families should not demand all available support and assistance. That would simply undo all of the progress that has been made.

And that, my friends, would be a crime against our children.

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* This link to the full [PDF] article in Pediatrics  is valid as of this posting. Journals frequently limit access to full articles and, subsequent to this writing, access may be removed.

A parental poll, cited in the article, was specifically asking about Fragile X Syndrome. An incurable genetic condition, FXS is caused by a change in the FMR1 gene which makes a protein that is required for proper growth of the brain. The mutation makes the gene produce little, or none, of this protein.

Symptoms include delayed motor skills (crawling and/or walking), hand clapping or biting, hyperactivity, mental retardation, speech and/or language delay, and avoidance of eye contact. Only about 1 in 4,000 boys and 1 in 6,000 girls develop Fragile X Syndrome.

Yes

There are those who want to know; who want to be prepared for possibilities. All possibilities.

As rare as the syndrome is, parents feel the need to know.

No

Some parents don't believe in testing infants unnecessarily. Others believe, as one mother put it, "Knowing can cause anxiety. The chances of it happening are very small; don't know how it will unfold. Not knowing will not make you treat your child a certain way."

Me (and You?)

Personally, I don't think I'd want to know. Being a chronic worrier, I'd drive myself and my child crazy looking for signs and symptoms that probably weren't there. And, heaven forbid, my child should develop FXS - would knowing sooner have any positive effect?

What about you? Would you want your child tested? Why or why not?

Compelling Findings

According to this study, published May 4th, "... low-salt diets actually increase the risk of death from heart attack and stroke -- and in fact don't prevent high blood pressure." And this isn't the first research to point out the disparity between dietary dogma and cold, hard facts.

Back in 2006, a report published in the American Journal of Medicine  found that "Lower sodium {emphasis mine} has been associated with stimulation of the sympathetic nervous system, that, in turn, has been associated with adverse [cardiovascular disease] and mortality outcomes. Sodium restriction may also influence insulin resistance."

Going back further, a 1998 article in Science , The (Political) Science of Salt, discusses the controversy. It mentions a Perspective: Biomedicine article which states: "Salt has little effect on blood pressure, and the most effective diet-induced changes in blood pressure can be achieved with a menu low in fat but high in calcium, fruits, and vegetables."

Salt and Fluid Balance

The body needs sodium. As Grist author, Kristin Wartman, explains:

Sodium is important for maintaining blood volume, it works in concert with potassium ... and ... calcium. ... [It] exists in all of the fluids in our body and is essential to water balance regulation, nerve stimulation, and proper function of the adrenal glands. It is also crucial to maintaining mental acuity ... This is part of the reason sodium deficiency (sunstroke, heat exhaustion) leads to confusion and lethargy as the human brain is extremely sensitive to changing sodium levels in the body.

Truth About Table Salt

Not to say that refined salt, the form that hits our french fries, is good for you. The article in Grist points out how salt is manufactured for the table. It's a tad scary.

In a nutshell, all trace elements are removed and the salt is heated to 1200° F. This leaves 100% sodium chloride, plus industrial additives like anticaking agents, dextrose, and aluminum. The additives turn the salt purple, so it's bleached to make it pretty and white.

Wouldn't call this a good food. (Unrefined sea salt is the best option.)

Bottom Line

I find all of this incredibly interesting. Early research indicated that salt was bad for blood pressure. That research stuck and, despite years of more accurate studies, those in charge of dietary recommendations refuse to change.

The potential correlation between sodium restriction and serious health issues is worth noting. As a society, we are suffering an increase in diabetes diagnoses that is nearly epidemic. Is this societal increase in insulin resistance a direct result of the push to limit salt intake? The timing is certainly intriguing.

Also interesting timing: milk and fresh fruits and vegetables are being priced right out of the diet of most American households. Yet, we put the blame for obesity, high blood pressure, and cardiovascular disease on sodium and fast food.

But that's a fight for another day.

Memorial Day weekend is the beginning of the sunfest that will last just three short months. Sadly, your skin may not share your joy. Beyond dehydration and wrinkling, all that basking and embracing can cause serious problems.

Don't Fry Day, the Friday before Memorial Day, was created by the National Council on Skin Cancer Prevention as a reminder to protect our skin. Important all year, we tend to be a lot more … uncovered from June to September, exposing more skin to damaging rays.

So, before you head out this summer, remember: Slip! Slop! Slap!...and Wrap when you’re outdoors — slip on a shirt, slop on sunscreen of SPF 15 or higher, slap on a hat, and wrap on sunglasses.

I know, I know! It's summer! You don't want to cover up anymore - been there, done that for months and months and months.

But - and you know this is true - the life you save may be your own.

As it is, I go to bed when I (finally) can't keep my eyes open anymore. Then, lay in bed for anywhere from 2 to 3 hours. About the time the sun is rising, I roll over (for the 53rd time) and go to sleep.

It's usually between 2pm and 5pm when I drag myself out of the bedroom, jonesing for caffeine, and looking like something the cat spit up  dragged in. After about 2 hours checking email, reviewing 12 versions of social media, and waiting for the coffee to kick in - I finally get to work on something. Sort of.

I need a schedule fix. I need to be able to sleep at night and get up at a decent hour. I really, really do. I think I need NightFood™

Just found these and, I must admit, they sound pretty darned good: “NightFood™ bars are delicious, and are formulated to help you fall asleep, and sleep better. Just as importantly, a delicious cookies n’cream NightFood™ bar can help you eliminate cravings and unhealthy snack options from your evening."

Of course, I'm always  reluctant to trust  skeptical about  proprietary ingredients - especially at doses that, reputedly, equal 80mg of caffeine. And there are a lot of sugars in here - 9g and 150 calories in a 40g bar; plus some iffy oils - fractionated palm kernel oil leads the uh-oh list. And melatonin - which does encourage relaxation - is last on the what's-in-this-list.

With that said, the NightFood™ bar didn't scare me witless (although the sugars and oils look pretty bad) - or convince me that it would help me sleep. But, I just can't get away from the proprietary cocoa derivative (Chocamine) and its apparent caffeine jolt.

Would like to try it. Just don't think I'd eat it on a regular basis.

Current Treatment Options

The best options, currently, for patients with HCV are pegylated interferon and ribavirin – a shot and a pill. But the side effects are horrendous - Alopecia, Anemia, Anorexia, Cough, Depression, Erythema, Fatigue, Myalgia, Nausea, and Pruritus; bad enough that many patients are forced to stop treatment before realizing full benefits.

Why? Because treatment is not quick – minimum 24 weeks, up to 48 weeks (or more) for resistant genotypes. Can you imagine a weekly shot that you know will hurt like the devil, make you sick to your stomach and achy (at least) all over? That will exhaust you and cause a level of over-all itching that would make a saint scream?

Add in the rarer, but more serious: "angina, arrhythmias, autoimmune conditions, blindness from optic neuritis or retinal ischemia or thrombosis, bronchiolitis obliterans, bronchoconstriction, cardiomyopathy, diabetes, gout, hepatic dysfunction, injection site necrosis, myocardial infarction, pancreatitis, pericardial effusion, pneumonia or pneumonitis, psychosis, relapse of drug addiction, renal failure, sarcoidosis, suicide attempt, thyroid dysfunction, and urticaria."^[1] It becomes obvious – quite quickly – that anything which shortens the treatment period would be a god-send.

New Treatment Options

The new medications – the first released in 10 years, I must mention – work by, basically, starving HCV. They block a protein, protease, that the virus needs in order to reproduce.

Neither Incivek nor Victrelis are designed to replace current treatments; they are taken in conjunction with pegylated interferon and ribavirin. The addition of these new drugs, is expected to shorten treatment periods and dramatically improve outcomes.

Unlike current treatment options, these new medications will be made available, not only to patients who have never been treated, but to patients who failed earlier treatments. This is huge as with interferon and ribavirin, once a patient fails to reach a "sustained viralogic response" - little or no measurable virus in the bloodstream - the treatment is considered a failure.

Rarely is a second course of treatment considered.

Bottom Line

There are millions of people in need of an effective treatment option.

Statistics: "About 170 million people around the world are infected with hepatitis C, some 3.2 million of them in the United States. The blood-borne disease can lead to liver cancer, cirrhosis, liver transplants and death."

Although a slow-growing, asymptomatic virus – it is possible to have HepC for decades without symptoms – eventually, HCV will begin to seriously damage the liver. And, due to this liver damage, cause all manner of related health issues. It is irreversible (without treatment) and is the leading cause of liver transplants in the United States.

Thousands of patients have been putting off treatment, waiting and hoping for the release of these new medications. Having gone through the current standard treatment regimen with Mark, I can certainly understand why.

Here's hoping that a cure just hit the market.

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1. ©Am Fam Physician. 2005 Aug 15;72(4):655-662.

Depression

Two studies, one British and one American, have found a link to depression in the same DNA region: chromosome 3p25-26. Genetic studies of depression, historically, have a lot of trouble repeating results. For two research groups, working separately, to reach the same conclusion is pretty amazing.

This is an incredible leap forward toward, at the very least, potentially more effective treatments. With major depression hitting up to 20 percent of the population at some point and recurring depression affecting nearly 4 percent, treatment is critical. And although there are a lot of medications on the market, they're only helpful to about half of the patients who take them.

Obesity

Another British study, published in Nature Genetics, is looking at KLF14. This gene is already linked to type 2 diabetes and cholesterol, but it wasn't clear what it did. Until now.

Researchers believe that KLF14 is a type of master switch, controlling other genes found in fat tissue. Those other genes are linked to a number of metabolic functions, including body mass index, insulin, and glucose levels. In addition, there may be a connection to changes in muscles and the liver that are related to development of conditions such as diabetes.

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Lots of exciting news, the impact of which will (probably) take years to realize. There will never be a 'skinny' pill or a 'happy' pill (at least I hope not), but anything that could reduce the risk of related conditions would be incredible.

Stress

We're not talking about "Oh, crap! The store's out of Joe's favorite chip dip!" here. (Well, unless Joe starts throwing punches if he doesn't get it.) Or, maybe, in a sense, we are.

It's the kind of stress that makes someone physically and emotionally ill. And it isn't the same from person to person. I hate crowds - with a passion; the thought of December in a mall sends me into a panic. But I have friends who love it.

And - it's not (generally) a one-off deal. For example, if I were married to dip-loving-Joe, the first tantrum probably wouldn't overly stress me. But, after a couple of years, the idea of shopping and risking his wrath would send me over the edge - every time I had to go to the store.

Causes aside, the symptoms of being stressed are pretty similar, across the board.

Physical Effects

Looking at it, this is a fairly consistent list:

Headaches, neck and back pain, shaky or sweaty hands, drymouth, dizziness, frequent colds or allergy attacks - just start the list. Some people eat more, stutter and stammer, blush a lot, sleep more. Personally, I suffer stomach problems, loss of appetite, heart palpitations, insomnia, ringing in my ears, and grind my teeth more. (Wow, that's a lot of misery.)

Mental/Emotional Effects

There is an even longer list of stress-induced problems:

Forgetfulness, nightmares, depression or mood swings, confusion, anxiety, inability to make decisions, frustration, paranoia, and feeling overwhelmed are not uncommon. I tend to become more uncoordinated, irritable, withdrawn, insecure, unfocused, and jumpy. When I'm stressed, loud noises nearly do me in.

Basically, unrelieved stress makes functioning a real challenge. And increases the difficulty level of ... life, the universe, and every single day - a hundred-fold, or more.

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Now, imagine trying to convince your body to let sperm meet egg; to let that chance at new life attach itself and grow into a new, wonderful person.

Frankly, if I were that life -- waiting to happen? I'd just sit back, whistle softly, and wait for the next bus. This one's way too toxic.

And if Joe's driving the bus? Fuhgeddaboudit!

No Parent Present

My first thought was to question how a child could be at the doctor's office without a parent or guardian. Then, I realized that this scenario was probably more directed at exams for teens, who might prefer to keep medical appointments without Mom or Dad tagging along.

In that case, it certainly makes sense that a third-party, preferably with some sort of medical knowledge, would be present to protect teen patients.

Suspected Child Abuse

This is the sadder of the two scenarios.

In cases of suspected child abuse, the presence of a parent could easily intimidate or frighten the child into silence or outright denial. It would also, quite probably, interfere with the ability of the doctor to establish trust and help their patient.

Again, in this case, having a nurse or other medical professional present is in the best interest of the child.

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In the policy statement, published in the journal Pediatrics, the American Academy of Pediatrics (AAP) makes several recommendations.

• Clear communication as to the nature of the exam, with the parent or, in the case of a teen, with the patient;
• Pelvic, rectal, and breast exams should include a chaperone, although the patient has the right to refuse;
• If the patient refuses a chaperone, alternatives should be made available to the patient and/or parent;
• Pediatricians should develop policy, for their individual practices, on chaperones and document any non-adherence to their policy.

The language in the statement falls short of mandating chaperones; repeatedly using the word should, rather than must. I suppose not all medical practices have sufficient medical staff to allow for chaperones. Perhaps making it mandatory would create a financial hardship for them; or that may be the AAPs concern.

Whether that's the case or not, patient care should (there's that word again) take priority. What do you think?

Perhaps it's my limited medical education (okay, none) that leads me down this road to ... the wrong conclusion. But, hang in there.

From what I understand of autism and ADHD, these aren't everybody's-got-it conditions. That there would be a gene - AUTS2, @#$ME, IM%$#! - linked to these conditions is a huge (in my feeble mind) discovery.

Then, someone links this gene to a person's potential for alcohol abuse - bigger and bigger hugeness. Except, if I'm reading this right, it's all backwards. Again, hang in there.

The one thing that alcoholism and ADHD, as well as some forms of autism, have in common is impulse control issues. As these are - if we can all agree - not everybody's-got-it conditions, then logic would say that the rarer form of the gene might be the one responsible. But this study indicates that it's the common form of the gene that is more prevalent in those who - potentially - abuse alcohol.

See how I'm feeling backwards - I mean how the results seem backwards?

There is an interesting column in Yahoo! Health: Eat This, Not That that shares some wisdom, and ideas, about what we stuff in our faces. Not everything we think of as healthy is, actually.

The Bad News

Pancake Syrup & Alfredo

The obvious items, in a column called 10 Worst Supermarket Foods, are pancake syrup and a couple of Alfredo dishes. Nothing - home- or restaurant-made - is going to be good for your waistline when the two primary ingredients are butter and heavy cream. And, well, pancake syrup in all its sweet, maple-y goodness. Need I say more?

But the syrup, at least, offers alternatives. (Alfredo is just going to be deliciously loaded with calories, fat, and cholesterol.) The article provides a sugar-free syrup recommendation; there are plenty on the market.

You'll probably have to try a few, until you find one that you like. They don't all taste the same - trust me. Mrs. Butterworth's and Kroger offer decent options. But watch out - not all items labeled lite are. And some brands substitute sodium for ... I'm not sure what. Flavor?

Yogurt

I'd like to say that this one surprised me. We love yogurt, but manic carb-checking brought us up short. The 'bad' item in this article actually has 36g sugar and 3g saturated fat. There are desserts with less sugar.

We've become addicted to quite fond of the low-carb store-brand from Kroger. Before I continue - this is not all-natural, no-additives yogurt. It has quite a list of ingredients, most of which are added proteins.

Bottom line? It has only 80 calories, a net 3 carbs (3 from sugars and 1 from proteins), and only costs $0.44/each. Plus, just as important to us, it's creamy, rich, and tastes great. Not to mention there are a ton of flavors, with more popping up all the time.

This isn't yogurt, for yogurt's sake. But, if you eat a lot of it - better to choose one that isn't loaded with sugar and fat.

"Healthy" Entrees

We don't, generally, eat these. They tend to be small and overly expensive. Now, I see that they can also be very non-healthy.

Admittedly, I've given them a look; trying to come up with something quick for dinner isn't always easy. So, I did know that they almost all tend to be pretty carb-loaded. It's from the filler pastas and rices that they use.

Another issue is the sodium is so many of these meals. Anyone concerned about their health and weight will avoid loading up on salt, as well as sugars.

And let's not forget the saturated fat. Because these meals tend to have that, too.

The Good News

Dig out the apron and the cookware. We're going to 'fix' some of these bad foods.

Pancake Syrup & Alfredo

We've already discussed the syrup - lite and sugar-free options abound. If you can't give up pancakes, these are a great way to lower the impact of that breakfast.

For Alfredo, there are recipes - yes, you'll have to cook your own - for a healthier Alfredo. Although I love the stuff, this isn't something we eat; so I can't verify that this recipe is as good as it sounds. If you try it, let me know what you think.

Yogurt

This is something, now that I've read through the process, that I would love to try: homemade yogurt. There is - literally - nothing in it but milk and yogurt cultures. You can't get any healthier than that.

And, if you're not fond of plain, you can add any flavor that makes your taste buds happy - cocoa, bananas, pears, berries, lemon, granola. The only limits are your imagination - and the contents of your fridge and pantry.

Healthy Entrees

When my kids were little, their dad and I used to spend one day every other week (or so) making our own frozen dinners. It was actually great fun and eliminated the "What am I going to cook tonight?" issue. Plus, we knew what we were eating, since we were the ones that put it together.

By using leaner meats - ground turkey, instead of ground beef, for example - you can put a little bit of time and a whole lot of health into your meals. Anything that you can buy frozen is fair game: chili, casseroles, stews, soups.

Just like flavoring homemade yogurt, the only limits are your imagination. (If you're carb-watching, there's a great Recipe Forum at LowCarbFriends.com.)

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There are healthy options at the store - depending on your health needs, quite a few.

Basically, look for fewer ingredients and more you can pronounce - the simpler, the better. Best of all? Don't buy pre-made; make it yourself.

You'll be happier and healthier - knowing exactly what you're eating.

Creatine Basics

What Is It?

Simply put (we're protecting that last brain cell, after all), creatine is an organic acid found in vertebrates, made from amino acids in the kidney and liver, and located mostly in skeletal muscle. Existing in fish and meat, creatine is not found vegetables. Because the body can make it, it's considered a non-essential (not needed in the diet) nutrient.

What Does It Do?

Naturally occuring creatine is transported in the blood to tissues, like the brain and muscles, that demand lots of energy. In those muscles, creatine combines with a phosphate to become phosphocreatine (creatine phosphate) and making rapid energy production possible. In other words, it helps feed the muscles during brief, high-intensity exercise such as sprinting and resistance training.

Creatine Supplements

Creatine has become a very popular supplement with athletes, leading to many research studies into its effectiveness. Reviews are decidedly mixed.

Do They Work?

Several studies report an increase in muscle mass with creatine use. However, because creatine tends to raise fluid levels in muscle tissue, some experts question whether this is true muscle building. In addition, many of the studies have been small (40 participants or less), so the results are generally deemed insufficient to draw conclusions.

It's interesting to note that there is no evidence that creatine provides any benefit for a) aerobic exercise, b) people over 60, and c) endurance athletes. Which, given how creatine aids in rapid energy creation, makes a great deal of sense.

Are They Safe?

Heads? They might be. Tails? They might not.

Most of my sources mentioned some level of concern about kidney and liver damage. Those sources also indicate that people with underlying kidney or liver disease should probably not take creatine supplements. At the same time - often in the same paragraph - they state that no significant changes in kidney function markers or liver enzymes were noted.

Are There Side Effects?

Digestive system upsets, muscle cramps, heat intolerance and/or dehydration, changes in insulin activity, abnormal heart rhythms, and blood clots in the legs are consistently listed as possible side effects. Less serious issues include headache, dizziness, increased thirst, anxiety, and irritability. Allergic reactions, particularly asthmatic symptoms, were also mentioned.

Conclusions?

Who knows?

From what I've read, there's no definitive proof that creatine supplements are effective, beyond a very narrow group of younger athletes. And there isn't definitive proof that they aren't. {POP!}

Aw, shoot! There went that last brain cell.

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Resources:

• http://www.mayoclinic.com/health/creatine/NS_patient-creatine
• http://www.ncbi.nlm.nih.gov/pubmed/12184144
• http://www.ncbi.nlm.nih.gov/pubmed/12701815
• http://www.nlm.nih.gov/medlineplus/druginfo/natural/873.html
• http://en.wikipedia.org/wiki/Creatine
• http://en.wikipedia.org/wiki/Creatine_supplements

The culprit is ... wait for it ... Nicotine.

What I found interesting is the phrasing found in of some of the news stories. (Emphasis is mine.)

For one:

... their tests showed concentrations of nicotine on the order of what is generally found in smokers causes HbA1c levels to rise.

and another:

... found that nicotine, when added to human blood samples, raised levels of hemoglobin A1c (HbA1c) by as much as 34%.

and, yet, another:

Using human blood samples, the scientists showed that nicotine concentrations typical of those in smokers appeared to raise long-term blood sugar levels in diabetics.

I have to say - hmmmm? Either all of the sources I read - or there's an interesting point here.

The study, as best I can surmise, was not done on diabetic or pre-diabetic smokers. Or even on the blood of diabetic or pre-diabetic smokers. It appears that the study involved adding nicotine to blood samples - in an amount that was judged to be "typical of those in smokers." Hmmmm?

Not being a scientist, I can only question what I read. As a curious soul, with a ... questioning ... mind, I do have to wonder. Is adding nicotine - a lab-created solution, I assume - to blood samples, in whatever quantity, the same as what happens to the blood in the body of a smoker?

What do you think?

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References:

• http://www.endocrineweb.com/news/type-1-diabetes/5042-researchers-uncover-first-hard-evidence-nicotine-raises-blood-sugar-levels
• http://healthland.time.com/2011/03/27/why-smoking-is-a-bad-idea-for-diabetics/
• http://www.nursingtimes.net/nursing-practice/clinical-specialisms/diabetes/smoking-linked-to-serious-complications-with-diabetes/5027831.article

Cellphones and Brain Cells

I know it seems backwards, but I'm presenting the results before the method. Frankly, because I find the method more interesting.

Study Results

This study showed that the brain reacts to the electromagnetic radiation from a cellphone. With less than an hour of contact, brain activity increased by 7 percent in the area nearest the antenna. Whether that change was good or bad for brain health, was not a goal of the study; so we just don't know.

Study Method

In a randomized study from 2009, forty-seven participants had their brain activity measured after holding cellphones to their left and right ears for 50 minutes. Not too exciting, you say? Just you wait.

(Yeah, I have a picture in my head of a bunch of people, with electrodes stuck to their heads, cellphones on each ear, sitting around doing nothing else for nearly an hour.)

Fearing that if the subjects of the study knew when/if the phone was active, it would stimulate brain activity, researchers created a blind: On the first day, none of the phones were on. The second day, only the right was turned on - and muted. No auditory stimulation.

I think that's pretty cool. But, perhaps, could have been a little ... cooler.

Study Modifications

First, the study could have been larger. The more bodies, the better - when it comes to scientific studies. Surely they could have found a couple hundred people, or more, with nothing better to do for a couple of hours. (Pick me! Pick me!)

Second, just to increase the randomization, why not have some of the phones on the left ear active on the second day. I know, activity is activity - but, again, this is supposed to be science. Randomize the randomization.

Lastly, were certain types of brain cells stimulated? Or all cells within a specific range? The report doesn't say, so we don't know if this was part of the research.

All in all, pretty interesting stuff. (Okay, I've officially become a science nerd.)

One of the last things that the doctor and I talked about was the priority of a renal diet, over a diabetic diet. So, given the 5,000 other options, I decided to focus on food.

Electrolytes

Just as with the liver, electrolyte imbalances seem to be indicative of renal problems. In hepatic conditions, sodium and potassium balances are critical. Apparently, with kidneys, it's a phosphorus and calcium disconnect that triggers red flags.

Phosphorus and Calcium

The body needs phosphorus to build and maintain bones and teeth, as well as nerve and muscle function. However, too much phosphorus keeps the body from absorbing calcium. When that happens, the body starts stealing calcium from bones to make up for it.

This leads to weak bones, as well as itchy skin, and bone and joint pain. Eating less peanut butter, cheese, nuts, and ice cream - foods high in phosphorus - is recommended. Non-cola drinks, sherbet, zucchini, broccoli, and non-dairy substitutes for milk products are preferred.

Calcium supplements may be required, with the addition of vitamin D to help maintain proper balance. Cutting out foods that are high in phosphorus may negate the need for calcium pills - something that your doctor should decide, after careful review of lab results.

Sodium and Potassium

Sodium is required by the body to manage fluid levels, regulate blood pressure, and control muscle contractions. Potassium keeps nerves and muscles working properly, especially the heart. Excess of both electrolytes are cleared through the kidneys.

When the kidneys aren't functioning properly, sodium levels may rise; leading to fluid retention in the hands, feet, and face, and an elevation in blood pressure. Excess potassium, found in greens, tomatoes, potatoes, bananas, broccoli, and chocolate, can cause irregular heart rhythms.

It's fairly easy to control salt intake. Simply take away the shaker and carefully read food labels. Obvious items to avoid include bouillon, canned soups and vegetables, salty snacks, bacon, cold cuts, and boxed dinner or side dish mixes. Colas tend to be rather high in sodium, as well.

Proteins and Carbs

This is where diabetes and kidney disease crash - violently.

The body converts carbs, which are hiding everywhere, into sugars. Therefore, a diabetic diet counsels low carbs, more protein. Not too difficult, until you factor in kidney disease.

One of the waste products created when the liver processes proteins is urea, a substance that contains nitrogen and clears through urine. When kidneys don't function properly, excess urea and nitrogen build up in the system. This condition, called uremia, can cause itching, mental impairment, nausea, and fluid build-up in the lungs or around the heart.

(One source indicated a direct correlation between excess urea and muscle loss.)

Obviously, too much protein is detrimental for anyone with kidney disease; just as it is for those with liver disease. But the alternative - carbs - are a no-no for diabetics. As with everything else, a balance between proteins and carbs is critical.

Our Dilemma

With the exception of calcium and phosphorus, these dietary restrictions aren't all that new to us. When Mark was dying from end-stage liver disease, we doled out milligrams of sodium and grams of protein like a miser pinches pennies. It wasn't easy, but we learned and got pretty good at it.

These days, we've got to factor in diabetes. That means the foods he ate, in massive quantities, to make up for being denied proteins are now (pardon the pun) off the table.

Frankly, I'm not quite certain how we're going to put all of this information together (and it's only a small part of what we have to consider) to create a diet that will not aggravate Mark's liver and kidneys, or shoot his blood glucose through the roof.

But I'm working on it. Any and all advice is extremely welcome.

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How It Works

I'm not a transplant expert or a medical professional, but between what we've experienced and what's on the 'Net, here's a brief description of what happens. And where improvements could be made.

Getting Listed

When a patient has an illness affecting what they call a 'solid' organ, i.e., heart, liver, and/or kidneys, doctors monitor the progression of that illness. As symptoms worsen and treatments fail to resolve the condition, a determination is made that the only next step is organ transplantation. But, the patient isn't automatically put on a transplant list.

Tests are done to determine overall health, ability to survive the surgery, mental stability, stable support system, and lifestyle. The results of these examinations are reviewed by the transplant center's committees; people whose job it is to determine the best candidates for transplant. Patients meeting the strict criteria are then place on the region's transplant list.

Patients actively abusing alcohol and/or drugs, living on the street without support from family or friends, or whose cancer (as an example) has progressed to other organs are rarely considered good candidates. Their chances of long-term survival are generally poor.

Organ Allocation

There are 11 geographic regions in the OPTN system. Patients are listed and organs distributed within those regions. This is to guarantee the condition of the organs at the time of transplant^[1] and maximize patient survival.

It's a good plan. Unless the liver that will save your life is in Tennessee and you're in California. Then, it's a problem. (Steve Jobs resolved it by going from CA to TN to 'pick up' his new organ.)

As compatible livers become available in a region, they are offered to those who, based on strict objective criteria, are a) most in need of transplant, b) healthy enough to survive the surgery, and c) least likely to reject the organ.

Crossing Regions

There's no law, that I could find, stating a patient can't be on more than one waiting list. In fact, a patient in New York was recently advised to try getting listed in Ohio, where the wait isn't as long for a new liver. Nice, if you've got the time -- and the money.

When you are on a transplant list, you have to be able to get to wherever that organ becomes available. And get there really, really quick. If you've ever tried to book a last minute flight, you know that that ain't cheap and it ain't easy.

This is why most transplant centers require patients to move to their region and/or center for the weeks and months prior to transplant. Again, not cheap or easy.

Moving Organs

There has been some talk among transplant experts about offering organs to the sickest patients regionally, then nationally. Currently, if the patient at the top of a region's list isn't a good match, the available organ is offered to a less sick patient in the same region.

Naturally, given the limitations on storing organs^[1], if no regional match was found there would have to be a strict limit on how far away the next recipient could be. To this end, some experts have suggested creation of larger super regions, allowing more patients access to the limited number of available hearts, livers, and lungs.

Organ Donation

From 2000 through 2009, (if I'm reading the graphs correctly) 20,000-35,000 new kidney patients were put on organ waiting lists - each year; 10,000-12,000 liver patients were added yearly. For those same years, on average, 5% of kidney patients and 8% of liver patients on those lists died waiting.

As of this moment, there are more than 100,000 people in the United States waiting for a heart, lung, kidney, or other organ. Over 70,000 of them are well enough - right now, today - to have that surgery. All they need is a donor.

Next month, April, is National Donate Life Month, so I'm a little early. Nonetheless, one huge step that can be taken right now - it doesn't require a consensus, quorum, or majority vote - is for each of us to become an organ donor.

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1. OPTN states that hearts and lungs need to be transplanted within 6 hours, while livers can be preserved for up to 24 hours.
   An article in eMedicine on Organ Preservation methods states that the liver and pancreas can be reliably stored for 12-18 hours, kidneys for 36-48 hours, heart transplant should occur within 4 hours of organ removal, and lung transplant, ideally, within 6 hours.

Sibutramine

Brand names: Ectiva / Meridia / Raductil / Reductil / Sibutral

How It Works

Like SSRIs (Prozac, Paxil, Zoloft), SNRIs (Cymbalta, Effexor, Pristiq), and DRIs (Zyban, Ritalin, Cocaine), sibutramine keeps the brain from reabsorbing serotonin, norepinephrine, and dopamine. This appears to help cells in the brain better send and receive signals.

Blocking serotonin and norephedrine reuptake seems to improve mood, reduce anxiety and compulsive behaviors (OCD). The increased dopamine has a stimulant effect which is believed to improve mood, reduce fatigue and anxiety, and suppress appetite.

What It Does

Although an SNRI like Cymbalta, Meridia was never proven to be an effective antidepressant. Its ability to inhibit reabsorption of dopamine (similar to the actions of amphetamines) does make it effective for some people as an appetite suppressant.

Several sources indicate that patients who lost weight immediately while taking sibutramine were most likely to continue losing weight. It was suggested, however, that those who failed to lose 4 pounds during the first 4 weeks of treatment may be advised to discontinue Meridia.

Why It's a Problem

Blood Pressure

According to the original documentation for sibutramine (see Pharmacycode link below), "Meridia substantially increases blood pressure and/or pulse rate" in some users. The WARNINGS section recommended: a.) frequent blood pressure monitoring and b.) careful prescription, possibly not at all for patients with uncontrolled or poorly controlled hypertension. By August 2010, two months before Abbott voluntarily pulled it from the market, the drug was contraindicated for anyone with heart conditions or blood pressure issues.

Interactions

According to information on Drugs.com, 804 drugs interact with sibutramine. Of those 800+ medications, more than 200 have major interactions.

Naturally, other SSRIs, SNRIs, DRIs, antidepressants, muscle relaxants, diet pills, and stimulants will increase the effects of Meridia. But many prescription and OTC allergy, cold, and migraine medications can also increase the risk of elevated pulse, blood pressure, heart attack, or stroke.

If that weren't enough, sibutramine increases the bleeding risks associated with NSAIDs (aspirin, Motrin, Aleve, Celebrex) and anticoagulants (Coumadin, Heparin). It may also add to the risk of emotional disturbances and suicidal thoughts associated with some central nervous system depressants.

Bottom Line

Now, this discontinued drug is showing up - illegally - in over-the-counter weight loss supplements. Sibutramine was risky enough, when patients knew what they were taking and were monitored by a physician. How much more dangerous will it be when people don't even realize they're taking it?

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References:

• http://en.wikipedia.org/wiki/Selective_serotonin_reuptake_inhibitor
• http://en.wikipedia.org/wiki/Serotonin-norepinephrine_reuptake_inhibitor
• http://en.wikipedia.org/wiki/Dopamine_reuptake_inhibitor
• http://en.wikipedia.org/wiki/Serotonin–norepinephrine–dopamine_reuptake_inhibitor
• http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000097/
• http://pharmacycode.com/fda/Sibutramine
• http://www.drugs.com/drug-interactions/sibutramine.html

Perhaps we should begin with a few definitions. Just what drugs are antipsychotics and what are the problems?

Antipsychotics

There are, primarily, two 'generations' of antipsychotics: typical (older) and atypical (newer).

Typical or First-Generation

Typical antipsychotics, discovered in the 1950s, weren't considered or called typical until after the development and clinical use of the newer medications. They work by keeping dopamine from attaching to receptors; by keeping dopamine levels down. The problem with this first generation was the almost certainty of extrapyramidal symptoms^[1].

Drugs in this group include^[2]:

Part of this group, Compazine (prochlorperazine) is a potent antipsychotic, but is only used as a short-term treatment for nausea and vertigo.

Atypical or Second-Generation

These drugs were developed in the 1990s, with the hopes that they would cause fewer extrapyramidal side effects^[1]. They also work by blocking dopamine, but in different ways - not only from typical antipsychotics, but from each other.

Drugs in this group include^[3]:

Also atypical, but developed more recently: Abilify (aripiprazole) and Saphris (asenapine). Symbyax, a combination of Prozac and Zyprexa (fluoxetine and olanzapine), is also included in this group.

FDA Drug Label Changes

Evidence

Based on a review of adverse events reports, the FDA has concluded that when mothers were treated in the third trimester with any antipsychotic, there was a risk of extrapyramidal signs^[1] and/or withdrawal in their infants.

Symptoms included tremors, agitation, feeding disorders, drowsiness, abnormal changes in muscle tension, and respiratory distress. For many newborns, these effects subsided quickly; others required longer hospitalization.

Actions

Convinced that the risks apply to all antipsychotics, the FDA has modified the Pregnancy section of the labels for every drug in this class and notified healthcare professionals.

The new label offers more detailed information for psychiatrists, OB/GYNs, and their patients. It explains specific symptoms and that onset may be immediate or delayed. It reminds patients to not stop taking medications without consulting their physician and reminds physicians to closely monitor newborns.

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1. Extrapyramidal signs/side effects include sustained muscle contractions, causing muscle twisting and repetitive movements (dystonias); inability to sit still (akathisia); muscle rigidity and tremor (pseudoparkinsonism); involuntary repetitive movements, primarily of the mouth and face (tardive dyskinesia).
2. About.com: Typical Antipsychotics and NIMH: Alphabetical List of Medications
3. About.com: Atypical Antipsychotics and NIMH: Alphabetical List of Medications

I was going to say that I don't understand these attacks, and I guess deep down I don't. The money invested now will only save billions in the future. Funding for NIH and CDC is not a frivolous use of taxpayers' dollars. The risk is great, if this funding is cut off.

If the proposed $1.6 billion in cuts to NIH and $1.75 billion in cuts to CDC are enacted:

- Research studies funded through the NIDDK, which are essential to move us closer to a cure and better treatments for diabetes, will be jeopardized.

- DDT's ability to help people avoid diabetes and its devastating complications would severely be reduced. This would lead to more hospitalizations and more emergency room visits, which will add to the already high cost of diabetes.

- The DDT's effort to prevent diabetes through the proven community-based National Diabetes Prevention Program will not move forward. Studies have shown this program could save $190 billion over ten years.

I guess if you're a member of the House, with all the benefits therein, you don't worry about healthcare for yourself. And, apparently, if you're a Republican you don't worry about healthcare for your constituents.

Just recently, I heard Congresswoman Rosa L. DeLauro speak before a congressional committee. I sat in my chair and applauded as she pointed out the disparity between healthcare coverage available to the public and healthcare coverage available to the members of Congress. Hand-in-glove with that disparity are the proposed cuts to medical research and disease prevention across so many areas.

Diabetes is just one condition that needs support, research, and a cure. Don't let the House take that away.

The site that started this didn't really have any original information. They'd copied, verbatim and without attribution, from several sources: WebMD and Amazon.com, for two. Plagarism notwithstanding, there don't seem to be many issues with acetyl L-carnitine (ALC), and some interesting potential benefits.

What It Is

ALC is an altered (acetylated) form of L-carnitine, a form of an amino acid (lysine) that helps the body make energy. It is naturally produced in the body and, although found in both plants and animals, more concentrated in meat, poultry, fish, and dairy - animal sources. In typical metabolic fashion, the body converts L-carnitine to acetyl L-carnitine, and ... wait for it ... acetyl L-carnitine to L-carnitine.

What It Does

This converted form of L-carnitine helps fatty acids enter skeletal and cardiac muscle cells to produce energy. It also helps move other compounds out of those cells to prevent accumulation. Crossing the blood-brain barrier, ALC has been shown to act as an antioxidant on brain tissue. By relaxing smooth muscle cells, acetyl L-carnitine has the ability to widen blood vessels (vasodilation) and improve blood flow.

What It Means

One study found that, because it acts on skeletal muscle cells, "the major tissue of insulin-stimulated glucose disposal^[1]," ALC may improve insulin-resistance in type 2 diabetics. Increased oxidant production and reduced L-carnitine levels are believed to contribute to negative symptoms of aging, making supplementation with ALC a potential treatment^[2].

Additionally, due to its vasodilation properties, acetyl L-carnitine may benefit patients with conditions or risk factors related to restricted blood flow^[2], such as:

• Angina
• Heart Attack
• Heart Failure
• Peripheral Artery Disease
• Diabetic Neuropathy

Caveats

Most of these studies and the information available are based on research with animals. Research on the effectiveness of acetyl L-carnitine supplementation in humans is limited and the results tend to be mixed. In addition, oral ALC supplements were often less effective than intra-venous injections^[2].

Lastly, due to the impact on blood vessels, ALC has known interactions with clotting medications, such as Acenocoumarol (Sintrom) and Warfarin (Coumadin). This could lead to excessive delays in clotting and an increased risk of bruising and bleeding^[3].

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1. Acetyl-l-carnitine inhibits TNF-a-induced insulin resistance via AMPK pathway in rat skeletal muscle cells
   FEBS Letters, Volume 583, Issue 2, Pages 470-474
   Zhaofeng. Zhang, Ming. Zhao, Qiong. Li, Haifeng. Zhao, Junbo. Wang, Yong. Li
2. Linus Pauling Institute at Oregon State University: L-Carnitine
3. WebMD: Acetyl-L-Carnitine

From The Experts

Depression

According to MedicineNet.com:

Depression: An illness that involves the body, mood, and thoughts, that affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. A depressive disorder is not the same as a passing blue mood. It is not a sign of personal weakness or a condition that can be wished away. People with a depressive disease cannot merely "pull themselves together" and get better. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people with depression.

Depression, simply put, is not 'the blues' or a down day. It is a definable mood disorder, with causes and triggers that vary from person to person, which digs in and hangs on - like that poor kitten in the poster - by it's sharp, pointy claws.

Anxiety

The DSM-IV has a good, overall definition of Anxiety Disorders:

Anxiety Disorders categorize a large number of disorders where the primary feature is abnormal or inappropriate anxiety. Everybody has experienced anxiety. Think about the last time a loud noise frightened you and remember the feelings inside your body. Chances are you experienced an increased heart rate, tensed muscles, and perhaps an acute sense of focus as you tried to determine the source of the noise. These are all symptoms of anxiety. They are also part of a normal process in our bodies called the 'flight or flight' phenomenon. This means that your body is preparing itself to either fight or protect itself or to flee a dangerous situation.

These symptoms become a problem when they occur without any recognizable stimulus or when the stimulus does not warrant such a reaction. In other words, inappropriate anxiety is when a person's heart races, breathing increases, and muscles tense without any reason for them to do so. Once a medical cause is ruled out, an anxiety disorder may be the culprit.

An anxiety disorder is not sweaty palms and butterflies before a job interview or a first date. It is feeling like that little kitten in the poster - constantly poised on the edge of disaster, tense, frightened, shaking; crippled with fear, even when safely on the ground.

From The Layman

From where I sit, prescribing psychiatric medications without clinical evaluation is a bit like saying, "Oh, stubbed your toe? How about some Valium?" or "Hmmm? Broke a nail? Let's try a little morphine."

Rough Days

People can have a rough day; in fact, they frequently do. It's called life.

Yes, it's sad when the guy you're dating is also dating someone 20 years younger, and 20 pounds thinner. When you don't get an 'A' on that English paper you slaved over for three weeks. When the manufacturer discontinues your favorite moisturizer.

It's nerve-wracking, when the bill collectors keep calling. Or you've missed a work deadline and have to 'fess up. Or one of the kids gets into a fight at school. Or the cable goes out in the middle of the Super Bowl.

That's life and it frequently sucks. The only cure is to get up, get over it, and do what comes next. Eventually, the day ends and a new day starts, with the sincere hope that it won't be quite as crappy as the day before.

Really Bad Days

Some people also have really bad days. Days they wouldn't wish on their worst enemy; days that last for weeks, months, and years. Trust me, I know.

Bad days where the sadness and pain is so overwhelming that you hope and pray that your mind and heart will simply ... stop. Where you can find no reason to get up and go on. Where you know, through the chemical morass overwhelming your brain, that the entire world will be better off without you; that no one will miss you or notice your departure.

Days where the anxiety is so severe that you curl up in a corner and pray that your brain and heart don't simply explode. Where every noise triggers a fight-or-flight response that leaves you panicked and shaking from head to toe. Where there is no coherent thought; only fear.

That, too, may be your life; day after day after day. You can't get over it and do what comes next; you may not even be able to get out of bed. The knowledge that the day will end only fills you with the dreadful 'knowledge' that tomorrow will, somehow, be worse.

The Bottom Line

I'm no medical or mental health professional. Heck, some days I don't even feel like a mental health owner. But I know the difference between a crappy day and the crippling inability to function with no discernable cause.

Depression or Sadness

Sure, when your SO decides to move on, or you lose your job, it feels like the world has ended. You may even tell people, "I'm so depressed." Clinically? Not necessarily.

Sadness - serious, serious sadness - is a natural response in such situations. You react, mourn, and (eventually) get on with life. This is not the condition we define as depression, for one simple reason: it is an emotional reaction to a very specific problem. It runs a natural course and ends.

Of course, if both events hit within the same week, that could trigger a need for some counseling, endorphin-releasing exercise and/or chocolate therapy, or even a mild sleeping-aid. But, this is not run-for-the-Prozac depression. It's life being crappy, all over your hopes and dreams and plans for the future.

Anxiety or Nerves

I get nervous when I have to fly, speak to a crowd, or interview for a job. My palms sweat, my heart beats a little quicker, and my mouth gets dry. Anxiety? Absolutely, but not a clinical disorder.

For most of us, nerves in such situations are natural. We all have specific things we really, really hate to do or are naturally afraid of. If they aren't important, we ignore them and move along with our lives. If they can't be avoided, we suck it up and get it over with.

Concerns about driving in bad weather or anxiety over safety in a really bad neighborhood aren't over the top. Nerves are a normal and healthy response to new or potentially risky situations. They don't require medication; they require acknowledgment, analysis, and appropriate action.

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This isn't the equivalent of taking an aspirin for a headache. It's more like chemotherapy, administered by a dentist, for a mosquito bite.

The United States Organic Deception

One line from this article says it all: "[O]f all the certified organic labels, most of them can still contain varying amounts of non-organic ingredients that will effectively negate any benefit of the organically-grown ingredients."

There are 3 labels, directly related to the food we buy and the quality/quantity of organic ingredients.

• Products labeled "100% Organic" must contain only organically produced ingredients
• Products labeled "Certified Organic" must contain at least 95 percent organic ingredients
• The label "Made with Organic Ingredients" can contain anywhere between 70 to 95 percent organic ingredients

As you can see, there's a lot of wiggle room in the last 2 groups for not-so-organic (read: pesticide-treated) items. It's a bit like buying organic lettuce, tomatoes, carrots, green peppers, celery, and onion - then dressing them with motor oil. Sure, the veggies are pesticide-free, but I still wouldn't eat the salad.

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Keep Monsanto Out of Your Garden this Spring

This is another "Crap! I didn't know that!" moment for me. It isn't enough that Monsanto has given us "Roundup, genetically-engineered beets, corn, and other crops, the fact that they sue farmers after their seeds (a monopoly of their own) contaminate the farmers' own fields, Agent Orange....we could go on and on."

They now own about 40% of the seed market for home vegetable gardens. And that just can't be good.

Think about it for a minute. You're trying to feed yourself and your family the right way, maybe save some money by growing your own food. Then along comes the king of GMOs, putting heaven-knows-what in those little seed packets.

If you're planning your garden, getting a little misty at the thought of all those incredible veggies you'll be enjoying in a few months, this is the article you need to read first.

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National Geographic: Tundra Landscapes

And something that's just plain gorgeous.

View, enjoy, download, and save these amazing pictures. I can't imagine more beautiful images to add to my wallpaper. Of course, there is the very real risk that I'll spend hours taking virtual vacations ~ around the world.

Aw, heck. There are worse ways to kill a couple of days.

Chemistry

Methylenedioxypyrovalerone (MDPV)

Despite headlines calling MDPV 'synthetic cocaine,' it is an analog^[2] of pyrovalerone - a drug developed in the late 1960s to treat chronic fatigue and as an appetite suppressant. According to the DEA Office of Diversion Control, "MDPV is structurally related to cathinone, an active alkaloid found in the khat plant."

With a chemical structure more like MDMA (Ecstasy) than cocaine, it reportedly acts in a manner similar to Ritalin or Concerta (methylphenidate), and Wellbutrin (buproprion) - only much, much stronger. The high is more like that from cocaine - more 'selfish,' less 'social' - which may account for the comparison.

Mephedrone

From what I've read, mephedrone is also derived from (or chemically similar to)^[3] cathinone compounds found in Catha edulis (khat), a flowering plant of East Africa and the Arabian Peninsula. First synthesized in the late 1920s, mephedrone was virtually unknown until its rediscovery in 2003. By 2007, it was available on the Internet; in 2008, Israel was the first country to make it illegal. (The EU ruled it illegal across Europe in December, 2010.)

Belonging to the amphetamine and cathinone drug classes, mephedrone is reported to have a high more like MDMA (Ecstasy) (I love everyone!) than cocaine (Everyone should love me!). However, users also report a strong desire to take more before they completely come down, which seems more like the reports on cocaine.

Side Effects

Neither drug has been extensively studied, so the accounts of side effects are mostly from users.

Methylenedioxypyrovalerone (MDPV)

Once again, from the DEA Office of Diversion Control:

The acute side effects of MDPV include tachycardia, hypertension, vasoconstriction, and sweating.  The duration of the subjective effects is about 3 to 4 hours and the side effects continuing a total of 6 to 8 hours after administration.  Higher doses of MDPV have caused intense, prolonged panic attacks in stimulant-intolerant users.  Users have reported bouts of psychosis induced by sleep deprivation and becoming addicted after using higher doses or using at more frequent dosing intervals.

Mephedrone

Medical News Today reports:

According to a survey by Mixmag, a dancing and clubbing magazine:

• 67% of users experienced hyperhidrosis (excessive sweating)
• 51% of users experienced headaches
• 43% of users experienced heart palpitations
• 27% of users experienced nausea
• 15% of users had blue or cold fingers

Non-survey (anecdotal) reports indicate mephedrone may have the following effects on some users:

• Severe panic attacks
• Hallucinations
• Paranoia

The comments section of this article adds more rather frightening, first-hand stories of mephedrone side effects and withdrawal.

Given the similarities between these two drugs, one can only imagine the potential dangers of combining them.

United States

Neither MDPV nor mephedrone are approved for medical use in the United States. Official information on users of either drug in the United States is virtually non-existent.

Sources

Officials know, based on Internet company locations, that some of these 'bath salts' are entering the United States from Europe. In an article about mephedrone last year, Guardian News and Media, quoting Druglink magazine, noted that "[d]ealers in Britain are spending £2,500 to ship one kilogram from China, then sell it at £10 a gram for a profit of £7,500." (This was before EU laws changed.)

A quick search shows that mephedrone 'research chemicals' can be purchased online from sources in Latvia, Cameroon, the US, the UK, and Malaysia. MDPV can be ordered from the same companies, as well as ones in China, Hungary, Germany, and Spain.

Illicit Distribution

While not yet illegal in the United States, state and local law enforcement in several states report encounters with MDPV. There were 75 reports from January to September, 2010; 2 in 2009. Information from the DEA on mephedrone simply mentions Internet sales and promotions.

Twenty-five states report interaction with individuals who have used 'bath salts.' Louisiana leads the nation, with almost 50% of all encounters. As a result, they have outlawed these products, rapidly reducing calls and sending shoppers across state lines. A northern Mississippi county responded to 30 calls in only two months, possibly due to an increase in cross-state traffic.

More than one state is considering following Louisiana's lead and enacting bans.

Control Status

Because they aren't marketed for human consumption, neither mephedrone nor MDPV appear on a U.S. drug schedule. However, as they are considered analog(ue)s of Schedule I drugs, a provision of the Controlled Substance Act (Title 21 United States Code 813) would allow prosecution of cases involving one or both of the substances.

Outlook

People are dying from shooting, sniffing, and smoking this stuff. Manufacturers and sellers get around laws in the United States by labeling their products "not for human consumption," though there's little doubt in anyone's mind the precise intent of these items. It can take years for the federal government to review, regulate, and get these substances off the market.

And, honestly, pulling 'bath salts' will probably do nothing more than make room for the next designer drugs.

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1. AZCentral.com: Officials Fear Bath Salts are Growing Drug Problem
2. ChemiCool.com: "An analog is a drug whose structure is related to that of another drug but whose chemical and biological properties may be quite different." (Ed. note: Frequently, the term is used to describe, right or wrong, an artificial derivative of a specific drug or chemical.)
3. a.) Wikipedia: "Mephedrone ... is chemically similar to the cathinone compounds found in the khat plant of eastern Africa."
   b.) Medical News Today: "Mephedrone is a synthetic (artificial) substance based on the (cathinone) compounds that exist in the Khat plant of East Africa."

Even the so-called (Internet) experts don't always agree on the nuts-and-bolts of supplements for pregnant women. Since we're messing with (pardon the language) two lives here, my gut tells me to go with the obstetrician. S/He can (and should) look at medical history, current blood work, and determine the mother-to-be's unique requirements.

Recommended Ingredients

According to a 2009 article in WebMD, the basic prenatal vitamin should include:

• 400 mcg of folic acid
• 400 IU of vitamin D (Note: look for D3; vitamin D2 can be toxic.)
• 200 to 300 mg of calcium
• 70 mg of vitamin C
• 3 mg of thiamine
• 2 mg of riboflavin
• 20 mg of niacine
• 6 mcg of vitamin B12
• 10 mg of vitamin E
• 15 mg of zinc
• 17 mg of iron

This is a short list, considering that it doesn't address vitamin A, omega-3s, and iodine. It also doesn't mention the myriad of additional ... stuff ... that the Internet-available prenatal vitamins like to throw in to the mix, e.g., probiotics, ginger root, or inositol. In and of themselves, these add-ins are probably benign; but pregnancy seems like an iffy time to test that theory.

Toxic Ingredients

Not to mention, lead levels. Yup, that's right - lead. In 2008 the FDA tested 324 women's and children's vitamins (purchased over the Internet) and only found four (4) with zero lead. For pregnant and lactating women, one brand with a three-step regimen offered the highest and lowest lead levels - from no detected lead to a whopping 8.97µg Pb/day estimated exposure.

Hopefully, in the 29 months since they posted the results, some of the manufacturers have corrected this problem. Or pulled their products. (The 3-step regimen is still out there, and carried by drugstore.com; I'm hoping they've modified their supplement.)

Common Sense

It can't be overstated that pregnancy is the wrong time to mess with the chemical balance of your body. Nature's already doing that for you.

Eating well is the best way to get your vitamins. Unfortunately, morning (and afternoon and evening) sickness, loss of appetite, inability to tolerate certain foods, and difficulty affording a diet full of fruits, veggies, and healthy proteins often get in the way.

A multiple vitamin, designed for this time in your life, may be just what the doctor ordered. But - please - let the doctor help you choose. Your body and your baby will thank you.

It's estimated that 150,000 tons - yes, tons - of contaminated feed may have been fed to animals. By consuming this dioxin-laced food, the contamination spread to eggs, poultry meat, and pork. (South Korea and China have already banned imports of German eggs, chicken, and pork products.)

Some of those eggs made it to the Netherlands, where they were processed and mixed with non-contaminated eggs. This liquid egg product was then shipped to the UK for use by bakeries and manufacturers in products for human consumption. Although officials said the level of dioxins in the mixed eggs didn't pose a health risk, it's still a frightening prospect - not knowing what might be in that cake, quiche, or jar of mayonnaise.

Today, Germany announced an anti-dioxin action plan that sets higher standards for the production of animal feed. This plan includes a licensing system for oil and fat producers, as well as mandatory separation of fats and oils intended for industrial use and those meant to be a component in animal feed.

In addition, animal feed producers will be required to personally test their ingredients and report the results to authorities. Private laboratories will also be required to report discovery of suspect items in food or animal feed.

"The government will investigate expanding the criminal law to food and feed safety regulations, possibly making infringements of food safety law a criminal rather than civil offence," according to the Reuters article. This comes amid suspicions that the Harles and Jentzsch plant in Schleswig-Holstein may have operated illegally. It, apparently, sought to avoid official regulations by not registering the company, according to an earlier statement by a spokesman for the German Agriculture Minister, and is now in bankruptcy (insolvency).

Today's article explains that "prosecutors in Germany are investigating the cause of the contamination and specifically whether industrial fats and feeds company Harles and Jentzsch distributed fatty acids meant for industrial paper production to animal feed processors." Dutch and EU authorities are also investigating the possible involvement of an intermediate trader.

Even if that were the case, if a third-party mixed up the shipments - delivering the industrial product to the feed manufacturer - wouldn't there be obvious labeling differences to eliminate improper application of the ingredients? I'd be willing to bet that the mandatory separation of industrial and feed ingredients is going to include some strict new labeling guidelines, as well. If not, they probably should.

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1. ""Dioxins" refers to a group of chlorinated organic chemicals with similar chemical structures. Dioxins have no uses. They are formed unintentionally and released as byproducts of human activities such as waste incineration, fuels combustion, chlorine bleaching of pulp and paper, or pesticide manufacturing."
   "Scientific Facts on Dioxins." GreenFacts - Facts on Health and the Environment. 13 Dec. 2004. Web. 14 Jan. 2011. <http://www.greenfacts.org/en/dioxins/index.htm>

Pantothenic Acid Basics

As with any vitamin or mineral treatment (for any condition), the assumption is that an underlying deficiency is to blame. Correct the deficiency; correct the condition. However, vitamin B₅ is found in so many foods that it's difficult to imagine deficiency is common.

For example: wheat germ, whole-grain cereals and breads, brewer's yeast; legumes, lentils, peanuts, split peas, soybeans, sunflower seeds; avocado, broccoli, cauliflower, corn, kale, sweet potatoes, tomatoes; egg yolks, milk; organ meats (such as beef liver and kidney), chicken, duck, turkey; lobster, and salmon are all good sources of this vitamin.

Take out the sweet potatoes and (ewwww! ) organ meat, and I could easily see this as my regular diet.

Pantothenic Acid and Acne

From where I sit, I can actually see a couple of reasons why vitamin B₅ would/could be considered helpful with acne.

1. Stress: I've done a couple of posts (at least) about me, stress, and acne. In my system, if you combine the first two (me & stress), you get the third (acne). As B vitamins, especially B₅, are frequently touted for their (as yet, unproven) anti-stress properties, I can see the rationale for a benefit to acne sufferers.
   
   Doesn't mean it's true, just that I can see the logic behind the argument.
2. Hormones: This one is even more compelling. Acne begins in puberty, as hormones (generated by the adrenal glands) increase dramatically. Sebum production explodes, hair follicles clog up, and acne blooms. (A simplified and not exactly complete description, but sufficient for this discussion.)
   
   It could be presumed that Pantothenic acid's impact on adrenal hormones would translate to an ability to reduce breakouts. Only one small study, from the 1990s, proposes vitamin B₅ as an acne treatment/cure. (Search: Lit-Hung Leung)

Pantothenic Acid Safety

Safe doses and levels, not surprisingly, is where things get a little sticky and where opinions begin to diverge. Thankfully, recommended daily intakes (RDIs) of vitamin B₅ are fairly standard from source to source: Ages 14-18, 5mg; 19 and up, 5mg; pregnant women, 6mg; and nursing mothers, 7mg. (The EU RDA is 6mg; UK has no RDA for this vitamin, that I could find.)

Some experts add that pantothenic acid is safe at these RDIs, or moderately higher (a rather vague limit), but warn extremely high doses could, among other issues, increase the risk for bleeding. (The National Institutes of Health tell hemophiliacs to not take B₅, as it might increase clotting time.)

Other sources insist that no upper limit has been established and even mega doses (10g/day) may only cause minor intestinal issues or diarrhea. Physician-monitored treatments for rheumatoid arthritis (2,000mg/day) and cholesterol reduction (900mg/day), while exceeding the RDIs, do not approach mega amounts.

There does seem to be a consensus that higher doses of a single B vitamin (no matter which one) can, over time, create an imbalance in the other B vitamins. In a nutshell, the body will pull what it needs from where it can find it to attempt to create balance. If you must take a supplement, B-complex (containing all eight B vitamins) is best.

Bottom Line?

It is somewhat logical, given how pantothenic acid acts on that body, that it could (in theory) have a benefit to acne sufferers - depending on the cause of their acne. However, there is virtually no documented evidence. Not to mention, there are no active or planned studies into B₅ as an acne cure, or even treatment option.

There is also no consensus as to what doses of this vitamin are safe. Common sense would say that tons of anything - good or bad - isn't healthy. And when you start ingesting amounts that are 1,000-2,000 times greater than recommended, I have to believe that the risks are going to outweight any (unproven) benefits.

All of which takes us back to the standards: healthy diet, and keeping skin and hair clean is the best defense against breakouts. And, for pete's sake, keep your hands off your face! (That last one was for me. {wink})

Hepatitis C

Basics

Hepatitis C is an infection, caused by a virus (HCV), that just loves liver cells. A member of the Flaviviridae family of viruses, HCV is related to those that cause yellow fever and dengue. It is not, however, related to other hepatitis viruses.

The virus settles into the cells of the liver and, when the immune system sends out white blood cells to attack the virus, the liver develops inflammation. Over time, usually many years, the inflammation leads to scarring of the liver tissue. This scarring, called cirrhosis , causes the liver to stop functioning and leads to a number of serious complications, even death.

Genotypes

Although they all share the same basic structure, there are a number of variations or genetic profiles (genotypes) in the hepatitis C virus. These variations are why it has been, and continues to be, extremely difficult to develop an effective vaccine.

Depending on the source, there are at least 6 or up to 11 HCV genetic variations. Within these 6 to 11 genotypes, there are further variations:

1a - mostly found in North & South America; also common in Australia
1b - mostly found in Europe and Asia.
2a - is the most common genotype 2 in Japan and China.
2b - is the most common genotype 2 in the U.S. and Northern Europe.
2c - the most common genotype 2 in Western and Southern Europe.
3a - highly prevalent here in Australia (40% of cases) and South Asia.
4a - highly prevalent in Egypt
4c - highly prevalent in Central Africa
5a - highly prevalent only in South Africa
6a - restricted to Hong Kong, Macau and Vietnam
7a & 7b - common in Thailand
8a, 8b & 9a - prevalent in Vietnam
10a & 11a - found in Indonesia

Beyond genotypes 1, 2, and 3, there isn't much information published about treatment options. As far as the first three, genotype 1 is the most difficult. It requires a longer treatment period (48+ weeks, compared to 24 weeks), with a very low cure rate; 2 and 3 each average (depending on the source) a 75-80% cure rate.

Treatment News

Merck: Boceprevir

In a January 6 news release, Merck announced that both the FDA and the European Medicines Agency (EMA) have granted an accelerated review / assessment for boceprevir. An oral protease inhibitor^[1], boceprevir is designed for "the treatment of chronic HCV genotype 1 infection, in combination with standard therapy, in adult patients with compensated liver disease^[2] who are previously untreated or who have failed previous therapy."

What that means is the FDA and EMA both believe that boceprevir offers a potentially valuable treatment option, unlike anything currently available for genotype 1 Hep C patients. They have agreed to expedite the review and approval process to get this critically needed treatment onto the market. Great news.

Vertex: Telaprevir

Another protease inhibitor, telaprevir has been part of a number of studies involving more than 2,500 people with genotype 1 HCV. The studies included patients who had never received treatment, as well as those who failed to achieve a sustained viral response (SVR) with standard treatment.

Vertex has been accepted for acclerated assessment by the EMA and is awaiting a decision from the FDA on a Priority Review.

Pharmasset: PSI-7977 & PSI-938

These two drugs are types of nucleotide analogs^[3]. PSI-7977 has been combined with standard treatments (pegylated interferon and ribavirin) in patients with genotypes 1, 2, and 3. The primary focus appears to be treatment of individuals with genotypes 2 and 3.

There were no reports of serious adverse events and, in fact, all adverse events were consistent with those reported during treatment with pegylated interferon and ribavirin alone. Even better, all patients in the study experienced rapid suppression of the virus, with a viral load below detection limits through the 12 week treatment period. They will be followed for 24 weeks after treatment, to monitor SVR.

Additional studies, involving PSI-938 alone and in combination with PSI-7977, are either underway or enrolling patients.

Bottom Line?

Hepatitis C, first identified in 1979, is a slow-developing virus that can attack the liver for decades before any symptoms appear. It is the most common blood-borne infection, and the leading cause of liver transplantation, in the United States. However, the actual number of Americans infected with the virus is unknown.

At the beginning of this post, I quoted numbers from one source. Another, citing a corrected estimate from 2005, indicates 5 million Americans have been infected and 3.9 million currently have chronic HCV. The Centers for Disease Control (CDC) posted similar numbers in 2008: "3.2 million persons in the United States have chronic HCV infection. Infection is most prevalent among those born during 1945–1965, the majority of whom were likely infected during the 1970s and 1980s when rates were highest."

Looking at those dates, one would think that new cases would be few and far between. However, the facts tell a different story. Due to the lack of symptoms and little routine testing, it can take decades for 'new' cases to be reported.

For those of us dealing with Hepatitis C, it's exciting to see the flurry of activity and the focus on finding a cure; especially for those suffering with, the difficult to treat, genotype 1.

What isn't mentioned, in all of these news releases about potential cures, is the incredible cost of medical care. Estimates put the annual cost for Americans with chronic Hep C at $9 billion; with a lifetime cost in the $360 billion range. The cost of liver transplantation alone is believed to be nearly $300 million per year.

With the current economy, it's not surprising that the State of Arizona (effective October 1, 2010) no longer covers liver transplants for patients with HCV. I don't know how many other states have followed suit. But, the bottom line is pretty obvious.

Patients with chronic Hepatitis C are rapidly running out of options. We need a cure.

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1. Protease Inhibitor: " A compound that interferes with the ability of certain enzymes to break down proteins. Some protease inhibitors can keep a virus from making copies of itself (for example, AIDS virus protease inhibitors), and some can prevent cancer cells from spreading."
2. Compensated Liver Disease: A diseased "liver that can still perform many of its important functions. Individuals with compensated cirrhosis may be symptom-free and complication-free; however, this stage of illness can progress in severity very fast."
3. Nucleotide Analogs: "Compounds that look like the nucleotides in DNA; they are used as antiviral compounds because the nucleic acids assembled with these analogs fall apart. Therefore, the viral genome cannot be copied and the infection cycle is broken."

National Birth Defects Prevention Month

The theme for 2011 is "Medication Use Before, During, and After Pregnancy."

Most birth defects can't be prevented because the causes are unknown. However, it is possible for women to reduce the risk to their unborn child. Taking a supplement containing 400mcg of folic acid daily, starting before pregnancy, has been shown to prevent serious defects of the brain and spine.

Just as critical to the health of the fetus is the health of the future mother. Pre-pregnancy check-ups and a careful review of the safety of all current medications cannot be over-emphasized.

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National Volunteer Blood Donor Month

This is the month when the Red Cross thanks its blood donors and urges everyone who can donate to help save lives by giving blood. From americasblood.org:

• It only takes about an hour - including registration, blood collection, and refreshments - to donate blood; two hours to donate platelets.
• Whole blood can be donated every 56 days, allowing time for regeneration between donations; platelets, up to 24 times a year.
• While red blood cells can be stored for 42 days (plasma, 5 days; platelets, frozen up to 12 months), most blood centers keep only a 3-day inventory.

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Cervical Health Awareness Month

Most cervical cancers, seventy percent, are caused by two human papillomaviruses (HPVs). Any man or woman who is sexually active is at risk for exposure to HPVs. As with other STDs, condoms do offer some protection.

The greatest weapon in the fight against cervical cancer is the Pap test. This is because, unlike many other cancers, when caught early, cervical cancer is almost 100% curable. It helps that cervical cancer is rather slow progressing, so it's easier to catch at an early, treatable stage.

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Glaucoma Awareness Month

A group of eye diseases that gradually destroy vision, glaucoma is the second leading cause of blindness in the world. Although more common in middle-aged and older people, glaucoma can affect persons of any age. The most common forms have virtually no symptoms, until (beginning with peripheral vision) severe vision loss occurs.

Glaucoma is the leading cause of blindness in African-Americans, with older Hispanics at nearly the same risk for this disease. Others at risk include people over 60, diabetics, the severely nearsighted, and relatives of those with glaucoma. Regular eye exams are critical.

The most common forms of glaucoma increase pressure in the eye, causing damage to the optic nerve. Although there is no cure, treatments are available to reduce intra-ocular pressure and, thereby, slow progression of the disease.

Dyslexia

What It Is

LD.org has a more elaborate explanation, but the basic problem is a neurological condition that interferes with the brain's ability to process and interpret information. One of the first signs seems to be difficulty identifying letters. The most commonly confused are b and d; p and q. This leads to a cascading series of problems.

By being unable to tell letters apart, kids develop problems reading, writing, and pronouncing words. Their communication skills are hampered. As these abilities become more critical to their education, they fall further and further behind their classmates.

What It Isn't

Dyslexia is not a sign of diminished intelligence. It is not laziness on the part of students. This condition is, also, not unique to or more prevalent in any particular socio-economic group.

The Latest Study

"The team used two different imaging techniques, including functional magnetic resonance imaging, which measures oxygen used by the brain during different activities, and diffusion tensor magnetic resonance imaging or DTI, which reveals connections between brain areas." During testing, they found some identified dyslexics had more activity in a specific part of the brain, as well as stronger connections in certain fibers that connect the front and back of the brain.

These results later correlated to improved skills in the students with increased brain activity. Interesting information and researchers are hoping that it will lead to improved teaching methods for dyslexic students.

I must agree with the only comment posted on the article: What does this mean for kids whose brainscans don't have this increased activity? Are programs going to be developed for children who might not improve?

Back in my teens, my cousin developed multiple sclerosis. Over the years her condition worsened and improved, and worsened. One possible cause given, even back then, was her amalgam fillings.

Eventually, she went in and had her fillings replaced. Within a very short time, she was out of the wheelchair and walking unaided. Or so I heard through the family grapevine. I doubt that her story is unique.

There are plenty of sites screaming about the dangers of mercury fillings. The better ones link to studies on the subject. Although much of the information is rather old, it is compelling.

One study, published in 1998 in Alternative Medicine Review noted dramatic differences in cerebrospinal fluid, following removal of dental amalgam fillings. Most intriguing? "Mercury has been documented to accumulate in the very areas of the nervous system from which the most dramatic clinical symptoms of MS originate."

The researchers stated that this is not a cause-and-effect determination. Their results did not prove that metal fillings cause multiple sclerosis. However, they did suggest further research and the consideration that chronic low-grade mercury exposure may play a part in some patients' MS development.

I'm not certain what I think about this controversy. Although I did wonder about the makeup of the FDA's panel of outside experts. Are there members who depend, in any way, on the dental industry? Just how much of a personal stake do panelists have in the outcome of the amalgam decision?

I looked up the Dental Products Panel, but haven't checked employment histories for questionable relationships. It's entirely possible that dental product manufacturers contribute to the schools and departments where these panelists teach. Or that they have influences that aren't obvious to me.

Does that create a conflict of interest? Should we, as consumers, be concerned about the panel's rulings? Without a consumer representative (that I could see, anyway), who's looking out for us and our health?

Personally, I have a mouth full of fillings. There is little doubt that they are amalgam. I can't say that I suffer from any ill-effects; but I've also never had the mercury levels in my brain checked.

(How, exactly, does one do that - shy of an autopsy?)

To start, I am no health expert. When I find an article on a subject that interests me, I always need to do a lot more reading. For example, before I can even attempt to judge information on omega-3s and depression, I have to educate myself on omega-3s. And - once again - I'm taking all of you with me!

Omega-3 Fatty Acids

Definition

Omega-3s are a family of polyunsaturated fatty acids (PUFAs) that the body cannot make on its own. They have been called 'essential' fatty acids (EFAs) because of their importance in normal growth and brain function. The three most common (and most studied) omega-3s are docosahexaenoic acid (DHA), eicosapentaenoic acid (EPA), and alpha-linolenic acid (ALA).

Sources

DHA and EPA are found in certain cold-water fatty fish, e.g., sardines, halibut, herring, lake trout, mackerel, salmon, striped sea bass, albacore tuna, and whitefish. ALA, on the other hand, is a plant-based Omega-3 found in soy beans, walnuts, flaxseed, and canola and olive oils. The body converts ALA to EPA, and further to DHA.

Benefits

This is where the waters get a little muddy. Depending on the source (see the Google search results below), omega-3s do everything but the dishes. Proven benefits are a little harder to find, outside cardiovascular research.

There is evidence that EPA and DHA can (especially, when taken together) reduce inflammation, improve cholesterol levels, lower triglycerides, prevent plaque build-up in arteries, and improve blood flow. ALA (the form frequently found in supplements), on the other hand, doesn't seem to offer the same benefits.

Concentrated in the brain, omega-3s are believed to play an important role in cognitive function and behavior. Studies in Great Britain, Australia, and Indonesia showed that children whose diets were higher in omega-3s performed better in school, with fewer behavior problems. Hence, the hope for benefit to people with depression and behavioral disorders.

Omega-3s and Depression

The article that inspired this post is based on an analysis (as yet, unpublished and not peer-reviewed) of previous clinical trials. Paid for by the National Institutes of Health, researchers combined the results of other studies and looked for patterns of omega-3s' impact on depression. They found a lot of information, inspiring further research; but nothing actually provided definitive conclusions.

Part of the problem is that many of the studies involved DHA alone. Few note any benefit to this solo-therapy approach. (My digging into other sources, listed below, showed similar results.) As mentioned, combining DHA and EPA seems to be more effective - regardless of the condition being treated.

Another problem? Although there is an indication that DHA-deficiencies have been linked to depression, the clinical trials failed to note whether any of the participants actually suffered from deficiencies. I quote: "However, it's unknown if the depressed people in the study were DHA-deficient and therefore the supplements were simply returning their DHA levels to normal, or if an added boost of DHA/EPA was helpful even for those with sufficient levels, Davis said."

What bothers me - rereading that last sentence - is casually comparing DHA to DHA/EPA. Over and over, I have read that adding EPA (sometimes in large amounts) to DHA is much more effective than DHA alone. Lumping them together, in the same sentence as though they were interchangeable treatments, is a serious apples-and-oranges comparison that flies in the face of valid methodology.

(Without access to the actual paper being presented this week, it's impossible to tell whether the disconnect is a flaw in the science or in the reporting. In other words, I'm not certain whether the researchers are mixing a lovely fruit salad or if the reporter failed to properly set-up the quote. Common, but frustrating.)

Conclusions

Depression is a serious condition. Improperly managed (or ignored) the implications are literally life-and-death. From where I sit, as a sufferer, any nature-based treatment is exciting. Especially one that offers other health benefits.

Chemical anti-depressants, while immensely improved since the early days, are still chemicals. Often it's a crap-shoot whether any particular drug will be effective for any particular patient. And, even then, the side effects and/or interactions can be serious.

The most, from where I sit, that can be decided by this new information is that we need more information. Hopefully, quality research will follow.

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As always, arbitrarily taking supplements - of any kind - is to be avoided. If you feel that adding omega-3s to your diet is a good idea, talk to your physician. Combining these supplements with cholesterol meds or blood thinners increases the effects and carries serious risks.

In addition, know the manufacturer. Just as fish can be contaminated with mercury and other pollutants, so can fish oil supplements.

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References

Google Search: Define: Omega-3 Fatty Acids

Mayo Clinic: Omega-3 Fatty Acids, Fish Oil, Alpha-linolenic Acid

Science Daily: Scientists Learn How Food Affects The Brain: Omega 3 Especially Important

University of Maryland Medical Center: Omega-3 Fatty Acids

Wikipedia: Omega-3 Fatty Acid

Why, when it was determined that the Fort Washington plant had quality control lapses, unsanitary conditions, and manufacturing 'insufficiencies' did they not immediately recall any and all products that had been made there? Seriously.

For months, J&J has been pulling products - a few here and a few there (sometimes a ton here and there) - from the market. Adult medications and children's medications; cold meds and antacids. The one constant - they all came from the same place.

Investigations continue and it is entirely possible (probable?) that new recalls will occur. "[I]t could discover lapses in its earlier processes that could warrant new product recalls, J&J cautioned." Wouldn't a complete if-it-came-from-Fort-Washington-yank-it have actually done less damage to their credibility?

Maybe. But now that we're getting contact lenses - not from Pennsylvania - that were improperly processed, I have to wonder if everything from Johnson & Johnson isn't a risk. (Especially if one lives in Asia or Europe.) After all, "[t]he company is already under criminal and congressional investigation in the United States..."

If that weren't bad enough, recent notices are not being posted publically. The justification being that consumers don't need to take action. It's sufficient that wholesalers and retailers stop shipping or pull products from their shelves.

Really? This fulfills your "claims to be striving for greater transparency?" For protecting consumers?

Hormone Levels

Human growth hormone deficiencies are real. They happen when children don't produce enough or after removal of the pituitary gland in young adults. At that point, injections - prescribed and administered by a physician - are a logical next step.

However, the natural decline in hormone production associated with aging is not a deficiency. It does not need to be reversed. And attempting to do so may actually be detrimental.

Studies have shown (in animals and humans) that individuals who naturally produce more hGH are more likely to die at a younger age. While animals with disorders that suppressed production of growth hormones experienced a longer lifespan. The body knows when it needs growth hormones and it knows when it doesn't.

Who am I to argue with Mother Nature?

Muscle Mass

The natural production of growth hormone in our youth is designed to build muscles to support our growing skeletal system. (One reason doctors don't like to see teens on fasting diets - it messes with muscle development at a critical time in their lives.) Which brings me to the other heavily touted 'benefit' of hGH supplementation - increased muscle mass.

A small, brief study involving several men over age 61 did show an increase in muscle mass in some of the men. But - and this is a big BUT - there was no corresponding increase in muscle strength. Just what we all need, big biceps and the inability to lift a coffee cup. Ooh yeah! Sign me up!

Supplements

Then, there's the safety and effectiveness of supplements. As an unregulated industry, manufacturers can say (almost) anything about their products without fear of reprisal. Unless, and until, they claim to treat or cure specific conditions or disorders, it's all legal.

This is the group telling you that their products are safe. These are the people who say "Lose 10 pounds in 7 days!" or "Look 10 years younger in just 2 weeks!" They don't care that growth hormone supplements are absorbed in the digestive tract and have absolutely no effect on hormone levels. As long as they make their money, it's not their problem.

Add to that - there is no way to know exactly what's in each happy little pill. Sure, the bottle has a list of ingredients. But - without regulation - manufacturers can (and do) throw anything they like in there, in any amounts. (How many supplements have been recalled lately because they contained illegal prescription drugs?)

Bottom Line?

Ponce de Leon spent his entire life searching for the fountain of youth. He never found it - because it doesn't exist.

If these products did what they claim - it would be all over the 6 o'clock news. Reputable retailers would be lining their shelves (and their pockets). And this miracle cure wouldn't have to sneak into the country in crates marked "Made in China."

Origins of Haiti Cholera

Before the recent outbreak, the CDC indicated cholera was unlikely to occur in Haiti because there was no cholera bacteria there. That bears repeating - No Cholera Bacteria in Haiti. In addition, most relief workers were from places where cholera was not a threat.

Over 3 days (October 9, 12, and 16), new troops deployed to a U.N. peacekeepers base, rumored to have an incredible stench and waste leaking into the nearby waterway. On October 20, Haiti radio announced that 19 people - living at the mouth of the Artibonite River - had died. Within 24 hours, cholera was confirmed as the cause of death.

That U.N. base? It's manned by troops from Nepal, where cholera outbreaks (yup, more than one) happened over the summer. And where 75% of the population, though contagious, show no symptoms of cholera.

That smell? The septic system:

"... when the AP visited on Oct. 27, a tank was clearly overflowing. The back of the base smelled like a toilet had exploded. Reeking, dark liquid flowed out of a broken pipe, toward the river, from next to what the soldiers said were latrines. U.N. military police were taking samples in clear jars with sky-blue U.N. lids, clearly horrified.

"At the shovel-dug waste pits across the street sat yellow-brown pools of feces where ducks and pigs swam in the overflow. The path to the river ran straight downhill."

The investigation continues.

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Lead and Cadmium in Novelty Glasses

Once again, novelty glasses have been found to contain unsafe levels of lead and/or cadmium. Imported from China and sold at the Warner Brothers Studio store, one set of glasses were found to have a lead content of 16 to 30.2 percent. Designated as collectibles for adults (by the importer), therein lies the controversy.

Lead is not regulated in products for adults. The health risk is for children whose developing nervous systems are endangered by exposure to lead. However, these glasses are sold next to kids' t-shirts by Warner Brothers and touted as "a perfect way to serve cold drinks to your children or guests" by another online retailer.

Over at Coca-Cola, a set of novelty glasses that were designed to look like the manufacturer's soft drink cans have come under fire. The all-red Coke glasses leached cadmium from external decorations during testing by the Associated Press. Unlike lead, which is only regulated in products for children, cadmium exposure harms adults and children equally and is strictly limited in products, as well as the workplace.

Both companies have agreed to recall these new glasses.

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Kids' ER Visits Down

It's been three years since the voluntary recall of cough and cold medications marketed to kids two and younger. Two years since withdrawal of the same medications for children aged four and under. Since then, the incidence of emergency room treatment for overdose and adverse reactions, in children under 2, has been cut in half; 2,790 before withdrawal compared to 1,248 after.

However, 75% of those treated were not given medication by parents. They 'got into it' while unsupervised; the same percentage of 'self-medication' seen pre-recall. Researchers say it is also possible that adverse events remained high because parents were giving their youngsters adult medications, as the versions for children are no longer available.

Please remember, mom and dad - 1.) Kids under 4 do not benefit from cough and cold medications; they do, however, suffer serious reactions. 2.) Don't give more than an age-appropriate dose of acetaminophen or ibuprofen for fever relief; and only for a high fever. 3.) Use a bulb syringe to remove mucus, saline nose drops to keep breathing passages open, and a vaporizer for congestion. 4.) Don't spare the fluids.

Never give adult medications - in any amount - to a child. Children do not process medications in the same way that adults process them; a sedative can make them 'hyper' and a stimulant, lethargic. Do not give aspirin or products containing aspirin to anyone under the age of 19, due to the risk of developing Reyes Syndrome.

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Children of Divorce and Stroke Risk

These results were presented, today, at the 63rd Annual GSA Scientific Meeting.

Researchers reviewed information compiled in a 2005 survey performed by Statistics Canada. Data collected from 13,134 respondents in Manitoba and Saskatchewan, looked at how many were children of divorce and how many had experienced a stroke. Just over 10% had divorced parents and almost 2.0% had experienced a stroke, at some point in their lives. This, according to reports, indicates a 2.2 times greater risk of stroke for children of divorce.

My concerns: 1.) Stroke statistics were not included (in any story I could find) for participants whose parents were not divorced. 2.) These 'children' experienced their parents' divorce more than 50 years ago, when divorces were more rare, the shame was much greater, and trauma (perhaps) more severe. 3.) The findings have not been peer-reviewed or published.

No, children do not want their parents to get divorced - ever. It is a stressful situation for everyone. But it is not the same. Society does not shun the divorced; children are not tormented because they come from a 'broken' home.

There is no reason to believe that children of divorce in 2010 will be forever scarred and permanently stressed by the change in their family dynamic. At least, for those children, I certainly hope they aren't.

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Results of a recent study confirm that moms' mealtime tactics are tied to kids' eating habits. But, oddly enough, it may be in the reverse direction. It isn't necessarily what moms do that creates the problems. Just as likely, moms become pushy and controlling in response to what the kids are eating or not eating at the table and perceptions of the child's weight.

Mothers who think their child may be too thin, may start forcing more time at the table or larger portions that must be finished. When the child is believed to be overweight, moms may strictly limit calories or foods that are perceived as unhealthy. In both cases, children tend to rebel - refusing to eat or overeating at every opportunity.

All I know, from personal experience, is that the more I was forced, the more I didn't want to eat. Probably why I weighed 120lbs (or less) and was nearly 6 feet tall as a high school senior. And why, to this day, I am seriously resistant to "You have to eat."

It may be a control issue, where what and how much we eat is the only part of our lives where we have absolute control. Or we may simply be stubborn souls who hate being told what to do. Either way, conflict at meal time is seriously bad for everyone's digestion.

The review was for chromium, a mineral that we need in small amounts and get from foods like broccoli, potatoes, grape juice, garlic, and orange juice. It is believed to help combat insulin resistance, which is a contributing factor for development of type 2 diabetes. Although, according to the National Institutes of Health, research is inconclusive.

What caught my attention was in the conclusion: not recommending a diet pill whose main ingredient is chromium. It's a valid theory, since there is also no conclusive research that the effect on blood sugar also contributes to weight loss. So, good review, right? Yes and no.

You see, the number-two weight loss pill on the site was something that contained 500mcg of chromium as the main ingredient.

A little background: The study involved 4,000 adults, born to mothers who were enrolled between 1959 and 1966. Researchers collected data on the mothers' smoking habits during pregnancy. In 1999, when they were 33 through 40, a review was done of the offsprings' health and criminal records.

It was determined that when the mothers smoked at least a pack (20+ cigarettes) per day during pregnancy, their kids were 30% more likely to have a criminal record. Additionally, those same children were deemed more likely to repeat offend. Did I mention anti-smoking clap-trap?!

Well, maybe and maybe not. Even the researchers admit that they are unable to definitively prove causality - that smoking mothers give birth to future criminals more frequently than non-smoking mothers. At most, they suggest that heavy maternal smoking may present a risk factor. That I can accept.

On the other hand, which is what damaged my 'mad,' maternal smoking has been linked to smaller birth weights and other health issues in kids. Studies on animals suggest that nicotine has a negative effect on the developing brain, especially neurotransmitters. In turn, neurotransmitter malfunction is considered a factor in some disorders, including ADHD, bipolar disorder, and OCD.^[1]

So, if we want to extrapolate:

1. Maternal smoking exposes the fetus' developing brain to nicotine.
2. Nicotine exposure has been shown to negatively impact developing neurotransmitters in the brain.
3. Neurotransmitter problems may contribute to development of certain mental health conditions.
4. Persons with some mental health disorders are more likely to engage in criminal behaviors.
5. Therefore, ergo, and towit - maternal smoking contributes to criminal behaviors in their offspring.

It's a reasonable conclusion, given presumed truths. And, honestly, just one more reason to not smoke.

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1. "Information About Mental Illness and the Brain." The Science of Mental Illness. National Institute of Mental Health, National Institutes of Health. Web. 15 November 2010. <http://science.education.nih.gov/supplements/nih5/mental/guide/info-mental-a.htm>

Whether they are all from the same manufacturer is anyone's guess. (They hide their registration information.) But the lists of ingredients, taken directly from each 'official' site, say a great deal:

Site Z

- Created on November 12, 2007, this site appears to be the first of the three.

• 'Z' Ingredients:
  Purified Water, Organic Aloe Vera, (20%), Herbal Extract containing White Willow, Licorice Root, Calendula, Comfrey, Rosemary, Walnut Shell (exfoliant), MSM (Bio Available Sulfur), Redmond Clay, Vegetable Glycerin, Oat Flour, Jojoba Oil, Tea, Xanthan, Avocado Oil, Carbomer, Tea Tree Oil, GermAll Plus preservative, essential oils of Lavender and Bergamot, Hyaluronic Acid. Grapefruit seed extract, Idebenone, DMAE, Green Tea Extract, Grape Seed Extract, Silk Peptides, Glucosamine HCL, Vitamin C (Ascorbyl Palmitate), Camelia Oil, Rose Hip Seed Oil, Amaranth Oil, Rosemary Extract, Vitamin A Retinol Palmitate

Site P

- Created on January 30, 2009, this site has the exact same testimonials and shopping cart id as Site 'Z'.

• 'P' Ingredients:
  Purified Water, Organic Aloe Vera, (20%), Herbal Extract containing White Willow, Licorice Root, Calendula, Comfrey, Rosemary, Walnut Shell (exfoliant), MSM (Bio Available Sulfur), Redmond Clay, Vegetable Glycerin, Oat Flour, Jojoba Oil, Tea, Xanthan, Avocado Oil, Carbomer, Tea Tree Oil, GermAll Plus preservative, essential oils of Lavender and Bergamot, Hyaluronic Acid. Grapefruit seed extract, Idebenone, DMAE, Green Tea Extract, Grape Seed Extract, Silk Peptides, Glucosamine HCL, Vitamin C (Ascorbyl Palmitate), Camelia Oil, Rose Hip Seed Oil, Amaranth Oil, Rosemary Extract, Vitamin A Retinol Palmitate

Site A

- Created on September 04, 2009, this site has different testimonials and shopping cart id from Sites 'Z' and 'P'.

• The full list of 'A' Ingredients:
  Purified Water, Organic Aloe Vera, (20%), Herbal Extract containing White Willow, Licorice Root, Calendula, Comfrey, Rosemary, Walnut Shell (exfoliant), MSM (Bio Available Sulfur), Redmond Clay, Vegetable Glycerin, Oat Flour, Jojoba Oil, Tea, Xanthan, Avocado Oil, Carbomer, Tea Tree Oil, GermAll Plus preservative, essential oils of Lavender and Bergamot, Hyaluronic Acid. Grapefruit seed extract, Idebenone, DMAE, Green Tea Extract, Grape Seed Extract, Silk Peptides, Glucosamine HCL, Vitamin C (Ascorbyl Palmitate), Camelia Oil, Rose Hip Seed Oil, Amaranth Oil, Rosemary Extract, Vitamin A Retinol Palmitate

The fact that these ingredient lists are - word for word, including odd punctuation - identical, leads one to believe that the products have to come from the same company. Which isn't necessarily illegal, just incredibly misleading. And, with no way to know exactly how much of what is in them, worthy of some skepticism.

Through a 'testimonial' site for Product 'P' (as well as a couple of complaint sites), I found company information: Experimental Nutrition Research (ENR), LLC 8345 Reseda Blvd Ste 204 Northridge, CA 91324-5951 818-885-8722. (Some sites place them, previously, in Los Angeles or North Carolina.) Product 'Z' shares this distributor / maker, according to comments on the complaint site. I cannot connect Product 'A' to ENR, but it's new and there don't seem to be any complaints. Yet.

Calories

In a nutshell, the Twinkie-diet worked for the professor because he was cutting calories. With the exception of water and air, (and plain tea and coffee) everything we put into our bodies provides some type of 'calorie.' Good or bad isn't really the point of this discussion.

We need calories to feed our cells; to make muscles work and organs function. But how hungry are those cells? Just how many calories do we need?

Calorie Needs - by Age & Activity

Based on 2005 USDA/HHS guidelines, Estimated Calorie Requirements:
For adult females (sedentary to very active): ages 19-30, 2,000 to 2,400 calories; ages 31-50, 1,800 to 2,200 calories; and ages 51+, 1,600 to 2,000-2,200 calories.
For adult males (sedentary to very active): ages 19-30, 2,400 to 3,000 calories; ages 31-50, 2,200 to 2,800-3,000 calories; and ages 51+, 2,000 to 2,400-2,800 calories.

Okay. I'm female, 51+, and fairly sedentary - so my requirements are estimated at about 1,600 calories/day. But does this make sense? Is this a good number?

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Ideal Body Weight (IBW)

General guidelines are just that, general. In my opinion, to be of real use they need to be a bit more fine-tuned. Let's start by seeing what my ideal weight is. From there, we can look at what calories I need to maintain / achieve that weight.

Published by the American Diabetes Association in 1964, The Hamwi Formulas only look at height and body frame:
For men: 106 lb for the first 5 ft; 6 lb for each inch over 5 ft
For women: 100 lb for the first 5 ft; 5 lb for each inch over 5 ft
Small frames: subtract 10%
Large frames: add 10%

For me, 6-feet tall and 'small-boned', that's 100 + 60 - 16 (10%) = 144 IBW. Admittedly, I haven't been measured recently and, at my age, am probably a little shorter than that. But, it's a ballpark number that seems to be fairly consistent with when I feel my best.

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Calorie Needs - by Weight & Activity

Based on my age, the USDA/HHS chart puts my calorie needs at 1,600/day. According to Dr. Hamwi, my 'ideal' weight is 144 pounds. Do those two numbers correspond? There are a few ways to find out.

• Standard calculations say:
  Sedentary or Obese = IBW x 10
  Low Activity or 55+ = IBW x 13
  Moderate Activity = IBW x 15
  Strenuous Activity = IBW x 18

  For me: 144 x 13 = 1,872 seems high; 144 x 10 = 1,440 seems low. Maybe split the difference at 1,656 calories/day?

• A two step process: calculating BMR and applying an activity-based formula is a little more involved.
  1. This BMR calculator shows for me (53yo, female, 6 ft, 144 lbs) a BMR of 1,370. This means that I, without getting out of bed or raising my heartrate, will (theoretically) burn 1,370 calories/day just being alive. (Here's the BMR formula, if you want to calculate manually.)
  2. Once you have your Basal Metabolic Rate (BMR), applying the Harris Benedict Equation tells you how many calories you can consume, per day, to maintain your IBW at your activity level:
     Sedentary (little or no exercise) = BMR x 1.2
     Lightly active (light exercise/sports 1-3 days/week) = BMR x 1.375
     Moderately active (moderate exercise/sports 3-5 days/week) = BMR x 1.55
     Very active (hard exercise/sports 6-7 days a week) = BMR x 1.725
     Extra active (very hard exercise/sports & physical job or 2x training) = BMR x 1.9
     

  Taking my BMR and the formula gives me 1,370 x 1.2 = 1,644 calories/day to achieve or maintain my Ideal Body Weight of 144 lbs.

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Conclusion

General or specific, these guidelines, calculators, and formulae seem to pretty much agree. Given that they use different types of information to draw their conclusions, that's rather amazing. It appears, regardless of method, that I should be taking in about 1,630 calories per day ((1,600 + 1,656 + 1644) / 3 = 1,633.33) if I want to reach my ideal weight.

Unfortunately, it also looks as though I'm about six pounds away from that ideal. Could be much worse; in fact, I fully expected it to be. But we still have the holidays to survive and I love Christmas cookies and candies. {sigh}

What do I do now? One calorie, two calorie, three calorie, ... oh, my.

Asbestos and the Navy

Not surprisingly, veterans (especially Navy vets) make up a large percentage of those with asbestos-related illnesses and cancers. A fire at sea is a frightening thing - death by fire or in the ocean. Therefore, due to its fire-resistant properties, virtually every part of a Navy vessel contained asbestos.

There literally was no safe place onboard. While some rooms were more heavily treated, asbestos was in the pipes and the pipes ran everywhere. Those who worked in shipyards and dry docks, repairing and refitting the ships, had the greatest exposure.

Asbestos Products

While lead in house paint was banned and is rarely an exposure risk in the 21st century, there is no way of knowing how many buildings still contain asbestos insulation. In addition, asbestos was frequently added to cement. That treated cement was used in thousands of public works projects and uncounted building structures.

For years, manufacturers added asbestos to thicken textured paints. Construction products, from wallboard to adhesives, benefitted from the improved strength and insulation. The variety of items to which this inexpensive mineral was added boggles the mind.

As does the fact that, to this day, there are consumer products that can - legally - contain traces of asbestos.

Prognosis

To my mind, as long as asbestos continues to be mined and allowed into even one product, consumers and workers will continue to develop asbestos-related illnesses. And lawsuits against irresponsible companies will keep lawyers in court.

Looking at the search results shows that, for the information superhighway, weight is synonymous with weight loss. (Well, except for the site that calculates what you'd weigh on Venus or Mars.) The message is that everyone looking for weight information is interested in the latest greatest pills, potions, and plans to get skinny.

Frankly, as the artist intended, neither silhouette is a healthy ideal. But one shape is routinely reviled; while the other is draped in designer rags and celebrated as 'beauty.' Society tells the woman on the left that she won't be happy, loved, or beautiful until she looks like the woman on the right. Horse hockey!

Companies and websites prey on our innate desire to fit in, to be accepted, and to be considered attractive. But there is a huge difference between wanting the 'right' jeans or the 'cool' cell phone and trying to starve down to a BMI of 0. (A BMI of 18.5 to 24.9 is considered healthy.)

It's that balance that we've lost sight of. In my case, at almost 6 feet tall and (most days) about 150 pounds, I'm considered well within the healthy range. In fact, I could gain 25 pounds and still be 'technically' healthy. My small frame couldn't carry the extra weight, but it would still be considered a 'good' weight.

I don't think that anyone's goal should be to emulate a small percentage of the population that lives an unnatural existence, in the spotlight of popular culture. We need to learn how healthy looks and feels - it's different from person to person. And we need to revise what is, and isn't, beautiful.

When we can love ourselves and each other honestly, in all our shapes and sizes, perhaps we won't need to comfort ourselves with food. Or starve to death to find acceptance.

Of course, when you get right down to it - which is not an easy thing - the individual ingredients in Lipofuze are not, necessarily, that bad. It's that everyone and their brother are jumping on the bandwagon; hoping to make a fortune from people who believe that losing 5-10 pounds per week is healthy. With apologies to T.S. Eliot: "I tell you once, and once again ... veracity's not there!"

There are no quick fixes or overnight miracles. To truly and safely lose weight takes willpower and self-control, diet changes and exercise -- and time. The snake oil salesmen count on our impatience and our vehement denial that we're emulating Bustopher Jones.

Alzheimer's Awareness Month

Learn about this disease and the amazing caregivers who give so much. For 2010, The Shriver Report offers a look into the effect on women as caregivers, advocates, and sufferers of this disease. A recent poll revealed that two-thirds of Americans with Alzheimer's and 60% of unpaid caregivers are women. In simple numbers, 10,000,000 (ten million) women are dealing with this disease.

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American Diabetes Month

"This November, the American Diabetes Association is asking: How will you Stop Diabetes®? The future is in your hands." Diabetes.org offers fact sheets, newsletter inserts, posters, and contests to help share information and inspire involvement in the battle to find a cure for this potentially deadly disease. Unless you're diabetic or living with one, you have no idea how difficult daily life can become. And how desperately a cure is needed.

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Christmas Seals Month

If you're like me, this one was a little ... "Huh?" Christmas  Seals? in November? Well, it does make sense, when you look at the history. Begun in 1904 as an effort to raise funds for victims of tuberculosis, the American Lung Association adopted the use of Christmas Seals in 1927. They have been the main source of donations ever since. Donations that fund research into cures for respiratory diseases and offer financial assistance for patients.

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National Epilepsy Awareness Month

Back when my kids were toddlers, I had a friend whose middle child had - to put it mildly - health problems. The petit mal seizures that began about the same time that she started school were probably the worst. This year, the Epilepsy Foundation is asking everyone to "Get Seizure Smart" with information on types of seizures and, most importantly, first aid. Something my friend could have used 25+ years ago.

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National Hospice Month

Since 1978, the United States has honored the work of the hospice and palliative care community; something that meant very little to me until 2004. Denied a transplant by the VA medical center in Portland, Mark was (basically) sent home to die in May of that year. I will never be able to adequately describe what Hospice of the Valley did for us in those dark days.

Hospice isn't just about supporting the terminally ill. Although 1.56 million people were helped by hospice and palliative care organizations in 2009. It's about supporting and helping the caregivers and loved ones, as well. An effort that deserves our help.

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While you're admiring the fall colors, digging out that pumpkin pie recipe, and picking sides for the Turkey-Bowl games (Detroit used to be a great bet; Dallas was known to lose), won't you take a moment and lend a hand where it is so desperately needed? You don't have to give money (this is a difficult time for many of us), but you can share information and teach others, who can teach others, who can - if we're all blessed this year - help find a cure.

Keeping clean, whether with special products like body wash for acne or simply a good, mild soap is one important part of the equation. But it isn't the whole story. And it isn't the complete solution.

One of Mark's sons is hydrophobic - he dips two fingers in the water to do dishes and has to be bribed to take a shower. His skin is hideous. Another son showers more frequently, but still gets acne on his back.

Near the end of my second marriage, I was sleeping more in the recliner than in the bed. When I moved to Arizona, I was suffering severe breakouts across my upper back and shoulders. Certainly, stress played a pretty large part in my acne.

But Mark's son and I share, in my opinion, the same acne trigger. He rarely changed the sheets on his bed, spending long hours sitting there during the day. And, at night, sleeping on that same bedding.

In my case, I didn't think of the chair as a bed. And, like my stepson, was sleeping on whatever accumulated there during the day. Regular showers didn't help as much, because, in each case, we both went back to a dirty bed every night.

Of course, I could be totally off base. I'm no dermatologist. What do you think?

First, there are a lot of research articles. Not a bad thing, but not really where I wanted to start. I need - immediate - practical, day-to-day information and ideas; if not an actual collection of menus and recipes.

As a sidebar, the few articles I did pull up were complete. Unlike so many publication sites where you get an abstract and then have to pay for the full report. So, great news; but I'm saving the research for another day.

Off to try the Low Carb Articles. Happiness! and Joy! With titles like "Low-carb foods that every house should have as a staple?" - more news-you-can-use-now and less medical-speak.

This page also lead me to Contradictions about Carbs and Diabetes Continue, an article on About.com (not usually one of my favorite resources). The author is a prediabetic who maintains the "Low Carb Diets" section as well as the "Low Carb Diets Blog." I think I'll be spending some time with her, as well.

It feels good to have options and ideas at my fingertips. Like this may actually be a doable deal, after all. If -- big IF -- I can manage to get Mark to try spaghetti from squash (8g carbs), instead of semolina (40g carbs).

Any tips, tricks, or sneaky suggestions? He has the palate of a gourmand and the soul of a Irishman - meat and potatoes, all the way. This could be ... interesting.

Most recently, it was high insulin production and reduced estrogen. Not together, mind you; but two different articles. The question is: is there any good news in all of this information?

From previous research, I know that stress increases production of cortisol which shoots fat to the belly like an arrow to a target. Alcohol and smoking kick up cortisol, as well. Looks like there's a lot of meditation and nicotine substitutes in my future.

Then, we have the blood sugar factor. I was looking at low-GI diets to help control Mark's glucose levels. What I found was that they also help people (like me) who over-produce insulin - another contributor to production of belly fat.

Now, none of these issues are gender-specific. In fact, they more frequently affect men. That is - until menopause. At this point, women lose any advantage they had because of reduced estrogen and a more 'manly' biology.

Then, there's the extra layer of fat that women have. Actually, that's a bit of a myth. Women don't have an extra layer, just a thicker layer, of fat under our skin. And it isn't isolated to any one spot. Nonetheless, it sure feels like it's all living just below my belly button.

With all of that good news, I haven't even gotten to the best part. Although all of the above contribute to development of belly fat, there isn't much you can do to remove it - specifically. It requires all over fat loss, though reducing cortisol, toning abs, etc. might just keep more fat from piling on.

Marginally easier is looking at the safety and benefits of cosmetics ingredients. These things go in cycles. An ingredient hits the market, makes claims of god-like powers, and everyone jumps on the bandwagon. Or a researcher suggests that a particular substance is unhealthy, manufacturers rush to remove it, and sellers scream, "We don't use that! Buy from us!"

To that end, I'm reading about the risks associated with cosmetics containing parabens, alkyl hydroxy benzoate  preservatives. Look for methyl-, ethyl-, propyl-, or butylparaben. It has been determined that these chemicals are estrogenic, meaning they mimic estrogen in the body. Estrogenic activity is associated with certain forms of breast cancer.

We know that chemicals can be absorbed through the skin. Parabens have been found in some breast tumors. The thought process is that where estrogen is contraindicated, smearing something with parabens on the skin is a danger. Well, this is the broad-stroke concept.

The Cosmetic Ingredient Review (CIR) has been assessing the safety of these preservatives since 1984; revisiting their findings in 2003 and 2005. They determined parabens were safe at 25% of the containing product. As levels generally range from 1/100th- to 3/10ths- of one-percent, the risk would seem to be non-existent.

Additionally, it has not been proven that parabens cause cancer. Levels of parabens in non-cancerous tissue have never been measured. A 2005 study, published in Critical Reviews in Toxicology , calculated maximum daily exposure and determined it was highly unlikely that parabens could increase the risk of breast cancer.

With that said, I guess it comes down to this: Just how many chemicals do we need to put into and onto our bodies? And would it hurt anything to avoid one or two?

The gist of the report was that 9 percent of women with incurable cancer were still getting mammograms; 5.8 percent, pap tests. Of men diagnosed with advanced cancer, 15 percent were still being screened for prostate cancer. Naturally, my first thought was, "Why?"

Some of the answers made sense. People who routinely get these exams, just keep having them done. I can, I suppose, understand that. And, yet ... If you knew you were dying, why would you bother?

One possible reason made me stop cold. Doctors may not be telling their patients that "they are not likely to benefit from having a mammogram for breast cancer because their lymphoma is so advanced." That is upsetting on so many levels.

Isn't it a doctor's responsibility to ensure that patients understand their condition, their options, and their rights? Is the desire to avoid an emotional scene or confrontation making cowards out of the medical profession? Or do they really think that ignorance is bliss?