Tuesday, April 9, 2013

Weight Loss Drugs Have Dubious Approval

July 18 was a red letter day for Qsymia, a new drug that just received FDA approval for weight loss. There were press releases and newscasts about the event.

As the television news moved through their analysis and shared their tests of the drug, a certain level of misgivings about the product arose in my mind. Certain concerns were not being addressed.

  • How effective is this drug?
  • What are the side effects?
  • Are there contraindications for people with heart and lung conditions?
  • Is it safe to take this drug without supervision of a doctor?

My first choice for investigating this drug with high approval from the FDA was an July 18 article from Consumer Reports. After reading their negative review, I went to my next choice for information, the FDA announce of its approval.

Consumer Reports answered all of my questions. How was that possible when the broadcast news sidestepped those issues? It was even more important, then, to see what the FDA reported with regard to use of the drug. There was disclosure. Why the drug was given approval in the first place is a mystery.

According to either reports, the effectiveness is limited. The trials were conducted over a year's amount of time and with a control group as well as the group using the drug. The study group, according to Consumer Reports, fared not significantly better than the control group, although the FDA claims the study group lost approximately 6.7% and 8.9% (normal dosage and maximum dosage) more than those who consumed the placebo. Both groups used a calorie controlled diet coupled with exercise.

It was interesting to note that in some cases Qsymia yielded no effects after a 12-week course of treatment. In those instances, the dose was increased. Some weight loss was achieved after the change. But what the consequences were in regard to the known, reported risks was not shared.

As to side effects, Consumer Reports shares that ". . . it can increase heart rate and should not be used by people who have heart disease or have suffered a stroke." The FDA discloses that, "The most common side effects of Qsymia are tingling of hands and feet (paresthesia), dizziness, altered taste sensation, insomnia, constipation, and dry mouth."

There are definitely contraindications for people with heart and lung diseases. In fact, it poses a high risk of heart attack or stroke. Women who are or could become pregnant are also advised not to take the drug because of the risks to the unborn child, namely, increased risk of the child being born with a cleft lip or palate.

Yes, there are additional risks that are reported by Consumer Reports. Those include an increase in the risk of glaucoma, kidney stones, mood problems such as anxiety and depression, and suicidal behavior or thinking about suicide (ideation).

The drug can only be dispensed through Risk Evaluation and Mitigation Strategy, or REMS, where doctors and pharmacies have been informed about the studies and the results of them. So the answer to my last concern is, no, it should definitely not be taken without supervision of a doctor. Because of the risks involved, it's understandable and not an advertising gimmick designed to frighten the public. As a consumer, I have no problem drawing my own conclusions about whether this could be used as an over the counter product. But it seemed prudent to allow the experts to speak. Both Consumer Report and the FDA strongly recommend that this drug only be used under doctor supervision.


Lipozene came to my attention when it was advertised on a late night / early morning commercial on August 4. For a mere $30, it is possible to get a two-month supply of the pills that will melt away the fat according to the ad. That representation was guaranteed with a money back offer if the customer was not satisfied.
The first question is whether it is safe for those who suffer from other health conditions, particularly heart or lung disease, not to mention adverse reaction to whatever ingredients the pills contain. The second question is how it compares to Qsymia both in quality and effectiveness.

A quick search engine query brought forth a lot of information about Lipozene. It would behoove the prudent (and not) to investigate before leaping. As it turned out, Lipozene is proven to be a scam. Our About Guide, Millicent Odunze, M.D., does a wonderful job of parsing out the ad's claims.

The most significant thing that comes to my mind as I view any of the weight loss advertisement and health news installments is "how much weight and over what period of time". Dr. Odunze says the claims are that you can lose a little less than 4 pounds of body fat within two months. Dr. Odunze is quick to point out that body fat and body weight are two different things. One pound of body fat, she suggests, is the equivalent of 1/3 of a pound of body weight. It's important to understand that on a weight loss diet of moderate calories that includes exercise and so on should amount to a maximum of three pounds of body weight loss in approximately one week. The average is approximately 5 to 10 pounds in one month. Yes, that was body weight, not fat.

In addition to bashing nearly everything in Lipozene's ad, plastic surgeon Odunze advises us of what it would take to lose approximately four pounds in two months:
For those who can't bear to exercise and want to do the least amount of work possible, consider this. It takes a 3500 calorie deficit to lose one pound. To lose the four pounds in eight weeks that LIPOZENE boasts about, you need to create a 14,000 calorie deficit total. You can do this by eating just 230 less per day for those 8 weeks. That's one candy bar!

We all can do that!

But this notion of using Lipozene should be put off by the words of just one doctor. Let us investigate some other independent sources to see what they have to say. The entry "Glucomannan" in Wikipedia tells us about Lipozene. It is a dietary fiber supplement used to cleanse the colon "sold as nutritional supplements for constipation, obesity, high cholesterol, acne vulgaris and type 2 diabetes" and are "made from the ground corm of the konjac plant." Another name for it is the broom of the intestine. It's a cleanser.

There are findings that Lipozene has positive effects on cholesterol that impacts Diabetes Type 2 and obesity. The chemical reactions and findings regarding the supplement are spelled out in the Wikipedia listing. The health risks from this fiber supplement are if the water regimen is not followed, the risk of choking and holding the fiber are posed because it cannot be flushed from the body's system. It's more a constipation remedy than a weight loss product.

Linda Bell writes the "Thin Report" and informs us that there are no overtly negative risks or dangers from use of this product. The biggest danger she points out is doing business with the company that markets the product. There doesn't seem to be any correlating information, let alone effects, relating to Qsymia. It doesn't appear Lipozene has any negative effects related to heart or lung diseases.

What to Do in Regard to Either or Both

After looking at the risks, benefits, and consequences of using either of these medical drugs, it appears ill advised to use either for the sake of weight loss.

Sponsored link: Health & Personal Care Products

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Don't Be Embarrassed, Just Be Their Eyes

It was embarrassing. I was undone. I kept my composure but also kept my voice at a very low volume. I hoped no one could hear us. Most of all, I hoped no one was paying attention to what we were doing and that we weren't making a scene. The last thing I wanted was for people to see her being needy because in fact, she was definitely not needy.

What brought about the anecdote was an evening's adventure to Fisherman's Wharf with my second cousin - who had glaucoma. She had explained that she had it. My interpretation was that her vision was cloudy - period. She still continued to drive, according to her accounts. In fact, she did drive me to some locations and took me sightseeing when I visited The City in order to attend the Accepted Students Reception. But the idea that she had very little sight and that she could no longer read things for herself, even with the assistance of glasses, completely escaped me.

I was beside myself. I survived. I gossiped to my mother that I was completely mortified with embarrassment. Mother said little about the matter but asked probing questions. In hindsight, the questions were probably so that she could call Irene and blather what I'd said about the evening, thus distressing Irene. I don't know. What I do know is that Irene looked forward to our having more adventures, especially with the way I threw in the unexpected to create fun, excitement, and laughter.

That brings me to my point. Few people understand essentially any of the illnesses that impact our society until the illness becomes personal in some way. Even when it's personal, as it affects a relative, we still don't understand. We simply accept the relative as who they are with a little extra on the side. It takes their explaining the illness, the accommodations, how it impacts them, and how the world is now that it's altered by the illness. It takes our understanding by listening carefully and asking the right questions in order to understand. It takes our being responsible by acting according to the ramifications that are impacting the kin and being respectful of them. And it requires that we do as much as possible to educate ourselves to speak and act in an appropriate manner. That's why I'm talking to you about one aspect of low vision I want to lead you to a few resources that aid in understanding the disease and a few other resources that will help you gain the training to know what the person is experiencing so that you can be both their assistant as well as their friend.

It wasn't until I began doing volunteer and accommodation provider work for the low vision and blind community that any comprehension of what they experience became part of my understanding. It was absolutely appropriate for me to read the menu to Irene. Because she trusted me, it was entirely alright for me to help her select the correct dollar bills so that our tab could be paid and the appropriate tip left for our server.

We didn't talk about Irene's glaucoma. Instead, we talked about her experiences as an R.N., her teaching career, her students, her travels to foreign countries and what she experienced. She spoke of a sweetheart who took her on a trip. But that was the end of the reference. For me, he never had a name. She was excited for me because, aside from her, I was the second person in all of the family of our generations who had completed a bachelor's degree and then strove to earn an advanced degree in a profession. She wanted to help me prepare for the battles that lay ahead for a woman making her way through advanced studies.

The Resnick Lighthouse for the Blind had many trainings for their volunteers. The purpose was to help them comprehend the different types of diseases that impact individuals and cause them to have either low vision or to go blind. The trainings also involved appreciating what a day in the life of a person with no vision is like. There were exercises to assist in that awareness. A speaker who is blind shared what her life is like and was willing to answer any questions about her life that would help the group better understand the various circumstances that impact her life.

What the group gleaned from the exercises and the presentation is that a person with no vision or impaired sight is just like anyone else. The trouble was that the blind have a permanent mask over their eyes that blocks the vision and cannot be removed. All other concerns are essentially the same as any other person's.
We Lighthouse volunteers also had the opportunity to learn about using a cab, making transfers by use of a paddle (for those who use wheelchairs or do not have the use of their legs), how to listen for traffic signals (talking light and talking signs), and how to be sighted guides.

Things made a lot of sense after that education. There was no need to have been embarrassed on Fisherman's Wharf nor anywhere on account of Irene's glaucoma. It was merely a new way to appreciate her and the things that become part of one's life. Actually, no type of impairment is reason to be embarrassed either as the person with the condition nor as the friend, provider of services, nor relation. Depending on how determined the person is, you may find yourself panting in order to keep up with them!


Sponsored link: Glaucoma, The Complete Guide: The Definitive Guide to Managing Your Condition and Saving Your Sight
Sponsored link: Understanding Glaucoma (Home Use)

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Impact of the Vanishing Middle Class

Before the Democratic Convention began, someone asked about the definition of the Middle Class. With so much rhetoric flying across the nation about who is in the Middle Class, where the poverty line resides, who are considered the rich (the Upper Class), and who is going about begging for a living, it was time to stop and answer the question. To a great extent, it impacts and colors how Government, both Federal and State, determine how health care dollars are allocated and to whom.

The person who posed the question had the following commentary to support it. "It used to be those who were not living in poverty but also not those living in luxury. Some of those in the upper regions have been fortunate enough to ease their way into the upper echelons. Some of those who were on the border of the low".

Without doing research in order to proffer an answer to the question, I responded by informing via historical definitions and paradigms. "Upper middle" and "lower middle" were terms used to allow the scale to be a five-part measurement, not three. Those terms allowed recognition of those who had escaped the low income level (but were not poverty) yet had not reached middle ground of "middle income." The complement of that is "upper middle" which, as I said, is the complement of "lower middle".

It's a good critical thinking question. A lot of us need to renew our acquaintance with the real numbers and the concepts. This calls for some research to flesh out what the "official" definitions are, not the speculations and unsupported opinions generated by a social conversation. I was able to find distinctions with regard to "midde", "upper", and "lower" on Google. The links are here. I also found what appears to be a useful 2010 article from Reuters News.

The speculations on how the define the classes evolved. Some examples of what was shared included:

Poor use to mean, you did not have a car, a cell phone, excess money for family trips, you had clothes from the second hand. Another expressed it in dollar amounts by noting that $50,000-200,000 middle was tantamount to being middle class by definition but their personal income definition was more toward $50-100 lower being lower and $150-200 being the upper middle. Yet another person in this very active conversation expressed an observation that Middle Class, Inner Class, Outer Class (Inner=upper & Outer=Lower). Ultimately, that person felt there aren't really any parameters at all. Just someone putting labels on classes. Someone else saw the answer to the question in terms of the ones who pay taxes - classic bell curve - the only place government can actually get real revenue. Yet another person expressed the definition in terms of fiscal burden by saying the middle class is the 50% who don't pay "taxes"; they are the poor who pay no income taxes. This person was quick to point out a very subtle counter argument the 50% under scrutiny do pay "taxes" in the long run that include payroll taxes, sales taxes, and so on.

The 50% are the ones who find theirselves in the uncomfortable position of having gained an enormous amount of formal education and training but are underpaid while cost of living and CPI continue to spiral upward. They find their selves in foreclosure or bankruptcy (or both) and forced to seek welfare and food stamps. They're so eager to survive that they don't notice the fine print on the "lending papers" that says the funds are merely grants that will need to be repaid at a future date or out of their remaining assets on their death.

They are also the ones who discover their government is the one that's been plundering their bank accounts for student loan debts, absconding their vehicles, issuing health insurance with monthly premiums that are 3/4 of what would be paid for rent. Unfortunately, the same government programs that issue the health insurance coverage (medicaid) does not pay any of the medical or doctor bills. Thus, the person in need finds theirself in even deeper debt; therefore, it means little ability to save their drowning self.

Meanwhile, all of the other aspects of Life and Living are still impacting them at an increasing rate. Nothing seems to be getting done. They begin to be coerced into doing things that are not part of their normal way of handling business or simply let go because there simply isn't enough of "their self" to do any more without killing their own self.

It is definitely not a pretty picture. Many of us would rather pretend it doesn't exist or rationalize it away as attributed to those low lifes who are too lazy to do anything for theirselves.

One person became dismayed. They felt the question is one with no specific answer, simply because it is used in relation to the terms "rich" and "poor". They expressed the observation that While none of the vast majority of people want to admit to being poor because they expend so much effort everyday toward not being it. In striking constrast to that type of self image and following any good advice from an inspirational speaker, those who are not financially considered in the middle class certainly do not consider themselves rich. The answer is subjective.

A conversationalist pointed out that a large part of the middle class definition problem lies with the bill of goods presented by the different tiers of government via the media. The person posited the idea that consuming (and possessing) things is the measure of ones' prosperity. Unfortunately, we no longer consider the quality of life until near the end of it, implying that quality of life should be part of the definition and that quality of life has a bearing on how well we live. That interpretation was supported as the conversationalist opined, "Who is to say that one who has no actual "money", but that does have a solid roof over their head, enough wholesome food in their belly, other people that care about (not just for) them, and interests that stimulate them are not rich. Conversely, can those lacking any of these, but with all they possessions they can acquire, be not poor?"

The person who initiated the discussion thanked those who responded. He also came to the conclusion that the 'Middle Class' is a moving target based on more variables than merely income. Based on what I found, it would be a good exercise in family learning for all generations to do the research and reading together and then discuss what is gleaned from the information. Be certain you share the conclusions with us!

Sponsored Link: Health Disparities in the United States: Social Class, Race, Ethnicity, and Health
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Recovering from the Shock

Things came to an abrupt stop on September 11, 2001. The news was difficult to fathom. The accounts were too incredible. The images conjured up from the radio account of what was happening were in fact accurate. The remaining events of the day were grist for proving one's mettle and abilities. Priorities needed to be reordered while progress on what was scheduled to occur was maintained as best as possible.

Still, one shock after another kept unfolding.

The news kept unfolding. The Pentagon was hit. Cognizance of the fact that there were people populating these buildings, going about their usual routines for opening a business were present in at least my mind. Innocent people who had absolutely nothing to do with the warfare going on in some remote part of the world far, far away from the United States. Then a report was given that a plane that supposedly was headed for the White House was diverted to a field in Pennsylvania.

Priorities kept being reordered. On the news that there was no transportation to Los Angeles' downtown area, it was time to simply stop and do the alternative activities. I returned to my SOHO and wrote When All Are Losing Their Heads. There was nothing else to do in order to dispell the acidic events. Then diffuse the situations by writing about them. And focus on what's needed in order to be a leader in times of distress, disorder, mayhem, and disaster.

The next shock was the fact that there was an aborted attempt at destroying the White House, one of the symbols of America and its freedoms. My projects were waiting for me and my responsibilities were making their demands. For me, it was a matter of sublimating the news in deference to getting things accomplished.

It must be that all of us became numb that day. I think all of us simply put ourselves on a mental autopilot so that functioning and accomplishing and progress toward Tomorrow could happen. A year later, an editor solicited responses from her readers as to whether they would be doing anything to recognize the events of a year earlier. Many responded in similar fashion. They were all in business either for their own selves or for a company. There was no time to physically stop. But there were moments when waiting for a conveyance or other precipitating event forced the waters of time and cognition to part and allow the stirrings of the mind to capture the feelings, to give them a higher position. But essentiall, everything was all in the course of a day.

It's significant to note that these emotions we Americans felt were the same as those who live in battle zones around the world. The shock, the numbness, the coping as best as one can have become routine patterns. You have to ask yourself how people can possibly live in that type of atmosphere, in that type of constant agitation, and keep their stability. A woman who lives in one of those areas was interviewed on an old Oprah show. She said drugs, especially Valium, are sold at pharmacies throughout her city as though they are aspirin. The drugs help to dull the senses and bear the toll that the bombings and straffing take on one's soul, mind, and body. The drugs help keep the psyche glued together.

It's been eleven years since the attack. We have healed. The World Trade Center is rebuilt.

The Pentagon has been restored and stands majestically on its original base.

The September 11 Memorial is a wonderful symbol of the past and pool of our coming together. It looks more like a peace pond than a monument. Let us look forward to that type of reality for our mental state and our global future.

Sponsored link: Leadership in Dangerous Situations: A Handbook for the Armed Forces, Emergency Services and First Responders

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Keeping up with Metro

Yes! In this age of social media, Smartphones, iPads, Twitter, and text messaging, Metropolitan Transit Authority (Metro) has burst forward with its technology. They're using it to make commuting for passengers to be aware of commuting issues and recently created some enhancements to the experience.

It's so annoying to think you're commuting on one of the trains and then discover the route you thought was open and accessible is down or closed because of repairs or an emergency or just has become an inconvenience for your purposes. Had there been advance notice - or at least a bulletin on those electronic signs over the tracks - some alternative options could have been put into play. Those concerns and a few others were raised at a recent Accessibility Committee meeting. And Metro came up with a solution.

Using existing technology (i.e., no additional expenditures to make modifications and enhancements), Metro now offers tweets about situations and things related to the transportation service. Announcements, more accurately called "alerts," of some conditions will now be made on the electronic bulletins that overhang the train platforms. But there are more solutions than merely the platform overheads. It's possible to receive general news and service alerts about Metro via social media channels such as Twitter or mobile device.

In fact, passengers who need to use the elevators can receive alerts about which ones aren't in operation. With the latter, it's now possible to alter your itinerary so that you exit at a portion of the station that's close to an operating elevator or else exit at a station where one is in operation.

Not only are there three levels of alerts available, those alerts can be received in any of three ways. Of course, there's reading the service alerts via the website if you've not already ventured out on your travels. It's also possible to download the Metro Mobile App or a third-party app so that the alerts can be sent to your mobile device. Or you can receive the alerts via your Twitter account as a text message.

There are three levels of Twitter alerts that can be followed.

Subscribe to @metrolosangeles to receive alerts about all Metro news, alerts, elevator outages, and to send direct messages to the service.

If that's too much information and you only want to receive service alerts, subscribe to @metroLAalerts.

Information about elevator outages can be received by subscribing to @metroLAelevator.

Anyone may subscribe to only one type of alert or all three, depending on preferences and needs. These text notices can be sent to one's mobile device by sending a command to whichever alert you want to receive

  • "metrolosangeles ON 40404"
  • "metroLAalerts ON 40404"
  • "metroLAelevator ON 40404"
To cancel any of the alerts, it's only necessary to send a new command for whichever was subscribed but substitute the word command "OFF".

Yes, there are more ways to know what's happening and how to plan your travels via Metro. And things are getting better as far as availability of information.

Sponsored Link: The Rough Guide to Android Phones and Tablets
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Return to Work Conversations

On January 14, Robin Roberts (host of Good Morning America) made a scheduled announcement about her health status. She's been away on medical leave since August 2012 because of a rare bone marrow disease. With all the brouhaha on January 13 to entice viewers to tune in and learn what the news would be, in addition to the smiles on every face that pronounced the upcoming announcement, it was a foregone conclusion that it involved something with regard to imminent return to work. And it was.

While the news about her return to work was celebratory for all, Robin talked about some of the expected and probably didn't realize she also disclosed unexpected information. Most people diagnosed with and treated for a major illness are put on some degree of disability and remain in that status for the rest of their lives. They become part of the 97% that Romney and Ryan spoke during the 2012 campaign who subsist on entitlements and expect a handout in order to survive in an economy with increasing inflation and little real money. There are few exceptions where there is a discussion about return to work; there are fewer about accommodations in order to make that a possibility.

Robin talked about the partnership of her doctors and care providers had with regard to formulating a plan for how she will transition from being ill to gradually working her way back to the studio and full time work. She outlined the stepped process and the various types of subtle dangers of being in the studio and under the lights. She shared conversations about regaining her energy. She will not be left floundering for answers and searching for what may be appropriate and safe in the way of accommodations during her early days of work resumption and progressing to "normal" life.

Viewing Robin's announcement and the recitation of her recovery and re-entry regimen could cause some with jaded healthcare perspectives to feel she is receiving privileged treatment. Some have the opinion that because she's already in front of the camera as part of her livelihood and career, that there's a foregone conclusion that she will be returning to work, not sidelined as disabled. Her non-visible disability, albeit temporary, does not color her employment opportunities nor her right to work and earn a living.

There are those who suffer from non-visible impairments but they are not counseled in clear and specific terms about what accommodations are required for them to resume full, meaningful employment in their chosen profession. Few are counseled about what to do or what restrictions could apply to them as it relates to their line of work.

My health issue focus of choice is coronary conditions. It could easily be other non-visible conditions such as back injury, emphysema, or venous stasis ulcers. Because the heart is so central to our well being but impairments of the organ are not visible, it is my focus. There are scales for measuring disability and whether a person is still employable. There is a presumption that the disability scale for physical activity is used by doctors in order to determine whether it's feasible for a person to look forward to returning to full time work, with or without restrictions. Does that conversation happen so that the patient is aware of all of the options available to them? If they're well below retirement age, they're not savoring the idea of spending the rest of their life subsisting on social Security Disability Income and restrictions on whether or not they may work. Even if they are able to find various types of employment, they're at a loss when it comes to truthfully responding to the question, "Are you able to satisfactorily perform the principle duties of this position with or without moderate accommodations?" And if they respond that they will probably need some accommodations, the question of which and what types of accommodations should be requested comes into play.

In addition to the activity scale, there is also the disabling conditions scale that covers a large number of issues. Our focus today relates to Cardiovascular Disorders. There are eight subsections of that type of disease and all have different ratings with regard to level of disability of an individual. It is possible for a person to have more than one condition co-existing with others.

How many suffer heart attack

How many people are suffering heart attack in the u.s every year? According to Americanheart.org, there are 1,255,000 heart attacks per year in the United States. This includes new heart attacks as well as recurring heart attacks. In the United States about 1.5 million Americans suffer a heart attack every year, from which as many as 500,000 die. I could not locate information about the number of individuals who survive heart attack and return to work.

What I could find, however, is individuals do return to work after heart attack. In fact, ehealthMD offers a very detailed article about Living After A Heart Attack that includes information about a sensible return, timing, as well as not often covered information about cardiac rehabilitation. What is it like to live every day with Heart Attack? Read real life accounts from people living with this condition can be found in an article on the condition at ThirdAge.com.

So this leads to how many suffer from congestive heart failure (CHF) and the number of those survivors who return to work. According to Staying in Shape, there are approximately 5 million Americans who suffer from the disease. Although their information is quite extensive, they do not answer the question about the number who return to work after being diagnosed with CHF. However, their article is dense with information about various other related matters as well as rehabilitation therapy.

There are guidelines for patients who suffer from heart failure and desire to return to work. The Job Accommodation Network (called JAN) has an accommodation series that includes heart conditions. It would be wise to refer to that resource first when seeking guidance on what to do in order to accommodate a worker with a heart condition. It therefore appers a return to work is not out of the question and in certain conditions can be done with success. Another place where guidelines for restriction and accommodation guidance regarding health condition can be found on MDGuidelines. There is advice available for the patient in regard to the advisability of returning to work full time available in many places. One of them is Heart Failure Matters.

Most of the language relating to heart attack and CHF put the two conditions into the same category of heart failure and heart disease. The information, in most respects, about after care, prognosis, and recommendations is similar.

What is worth noting is the fact that most people are 100% invested in their physician and rely on their professional to tell them what they need to know. Survivors and their families don't ask questions. When they are put on total, 100% disability, there are no questions about returning to work, extent of activities that are acceptable (except for sex), life expectancy, medications and what they do, alternative treatments. The physician takes it for granted that if there are no questions the patient has all of the information they need and will ask if there's something that needs clarification. Additionally, the physician is focused on the condition, not the person, and their focus remains in that area. People are living in a sea of being uneducated and possible risk for another attack that didn't need to happen.

What all of this means is be proactive with regard to your health condition. It may not be visible but it is definitely real and it is mandatory that it be handled and managed properly. A dismissive physician, when it comes to questions about the condition and management of it, is not serving your needs. Form a healthy partnership with your medical practitioners. Find someone who will communicate with you in an understandable fashion. Find someone who will have not only your health condition but also you in the upper parts of their mind and concern.

Sponsored Link: Heart Failure: Evaluation and Care of Patients With Left-Ventricular Systolic Dysfunction (Clinical Practice Guideline Number 11)

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Need a Lift? An Overview

The fact of the matter is that Southern California is essentially based on ranch style planning, design, and landscaping. That is to say, it's broad and expansive. Other cities are developed with the thought that land space is limited; therefore, build up by using air space and essentially zero setback clearances between buildings.

That, in turn, creates smaller distances between destinations. What that boils down to in terms of getting from Point A to Point B is that Southern California is more conducive to using a car than many of the other forms of transportation. Since the auto is becoming a luxury item in terms of cost and fuel, and because environmentally speaking, using a personal auto is becoming a less desirable option, it's important for Southern California real estate planners to come up with transportation options that will get people to and from their various destinations with ease. Timely transport and reliability are also significant issues. Those two issues are intensified when it comes to quickly getting through and out of dangerous areas without becoming a statistic.

Then comes taking stock of the needs of the population and its demographics. The aged, those without vehicles of any type, and the disabled still need to commute at various times and need a reliable means of doing so. Affordability of transportation, especially for these populations, makes the ability to go and come a precious commodity. It's difficult to find ways to balance the demands and come up with a workable solution that satisfies the needs of as many as possible.

Unfortunately, there are parts of any city that suffer from no public or private convenience transportation system, limited service, or the distances between one connection point and another is great. In those situations, it's the same as being stranded given the amount of effort (and time) it takes to transition from one connection spot to another. Again, this is particularly true of locations in areas of high crime, low to lower income residents, and areas densely populated by immigrant and protected class residents. It becomes an additional barrier to moving into mainstream and quality of life.

Metropolitan Transit Authority (MTA) is constantly looking for ways to serve the public more efficiently, safely, and courteously in whatever way they can with their bus and rail systems. The sad situation is that while Administration is receptive to the complaints that reach their Customer Relations Center, not all of the employees are aware of those complaints or are of another mindset. That means retraining efforts are repeated until the matter is finally resolved in some way.

There are many ways to look at the services provided by MTA. And there are alternatives to MTA such as cabs, shuttles, community vans, carpools, and accessibility transports available in addition to the friend or family member who can handle the commute issues. The most significant areas where transportation options play a vital role on the constituent population are where the demographics are skewed with dense numbers of lower income residents, the disabled or aged, and areas beset by a high crime rate.

Let us look at how some transportation issues are impacting various segments of commuters, whether regular riders or those who have several other options available to them, and whether there are challenges with using those options.

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Only What's Necessary

"Defiant Requiem: Resistance" is airing now on PBS's KOCE. A few minutes ago, tell of how the Jews were ordered to prepare for their displacement. They were only allowed to take 50 kilos of belongings with them. The narrator speaks of how bewildered the people were as to how they would choose what to take of the lifetime of belongings. The defiant requiem is the singing of Verdi's Requiem to the Nazis.

Imagine a person preparing to escape domestic abuse. Imagine that person has reached the Isolation stage which means they have absolutely NO ONE to look to for assistance or refuge. Imagine that they must leave behind a lifetime of belongings and take only what they can carry.

How do you choose what to take? Take only what is necessary and has utility in some way. Take only what can be used for many purposes. Be glad of those items and take no more.

Be careful of where you go. People are not to be trusted. Be cautious of what you say, what you do, and how you sleep. You are leaving a place where within any day and within a short time, the next time the violence occurs will be your last.

Take only what is necessary.

It's ironic that today is eight days after I got my cats into shelter in 1999. They tried desperately to tell me the shelter personnel were not to be trusted and that they were being taken to a dangerous place.

I was numb from suppressing all of the feelings buried inside. I tried to show the cats how to suppress their animal instincts. It was futile. I wept when they were gone.

The day had started with bright sunshine and warm temperatures. After the shelter personnel left, the sky clouded over and a light rain fell. Now I remember. It was not me who wept. It was the skies that wept for me. I merely sat alone in the 1500 sq. ft. house, now alone and still in danger. I sat alone. My body was robbed of feeling. My emotions were somewhere in another dimension. My mind was blind to anything other than survival and making certain what I could carry - only what was necessary - was well hidden.

My next efforts were focused on finding a place where I could go and petitioning all of the women's domestic violence shelters I could call without having their number show up on the phone bill. I petitioned to get a bed and safety.

Unfortunately, the form of danger I was enduring was not yet recognized as falling under the category of domestic violence. Why? Because the harm came from a relative.

Over the years, I've endeavored to bring awareness and understanding about the many ways in which domestic abuse and violence affects every aspect of our business and social lives. At least three different people and in different venues have told me I will never be allowed to present this information. My voice has been stopped; but not my fingers.

The message must be delivered and the knowledge put forth. If it does not happen, stupid mistakes will be made that will compromise the safety of not just one person but all those who are in their company on the day the abuser learns of the target's whereabouts. They will learn of the target's whereabouts and then go there. And when they reach the target, there will be more statistics about the multiple murders that occurred at that place.

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