Health Care and the Christmas Story

December the 25th has special meaning to millions of people, not only in America, but around the world. This date has historically marked the celebration of the birth of Christ, the Savior of the world--Emmanuel. God with us! Mankind was provided a special gift on that first Christmas day two thousand years ago in Bethlehem, the City of David. Now, in 2012, modern celebrations focus in a big way on the Holiday, more than the Reason for the Season.

In Roman times, life was hard. Life was short, and many people died young. The region where Jesus was born was known as a wasteland by those who lived there and did not want to be there, like Roman soldiers and slaves from all over the known conquered world.

Shortly before Jesus was born, the Roman emperor Caesar Augustus decided that a census be taken throughout the Roman Empire, including the land of Israel. People were required to return to their ancestral homes for registration. For Joseph and Mary, that meant leaving Nazareth, which is a town in the northern district of Galilee, and traveling to Bethlehem, which is in the southern region called Judah or Judea. After they arrived in Bethlehem, Mary was ready to give birth to Jesus, according to AboutBibleProphecy.com.

So, Joseph and Mary went to a manger because they could not find other lodging. It was a manger, where animals are kept, that served as the humble place of birth for Jesus. Bethlehem is an important city for Messianic prophecy. King David, who ruled over Israel about 1,000 years before the time of Jesus, was born in Bethlehem. And the Hebrew prophet Micah, who lived about 700 years before Jesus, announced that Bethlehem would be the birthplace for the Messiah:

"But you, Bethlehem Ephrathah, though you are small among the clans of Judah, out of you will come for me one who will be ruler over Israel, whose origins are from of old, from ancient times." - Micah 5:2 (NIV translation). More information can be also found at this website: http://www.aboutbibleprophecy.com/loj1.htm .

Now, here is the Story of the first Christmas, according to the New International Version of Luke 2: 1-20: "In those days Caesar Augustus issued a decree that a census should be taken of the entire Roman world. 2 (This was the first census that took place while[a] Quirinius was governor of Syria.) 3 And everyone went to their own town to register.

4 So Joseph also went up from the town of Nazareth in Galilee to Judea, to Bethlehem the town of David, because he belonged to the house and line of David. 5 He went there to register with Mary, who was pledged to be married to him and was expecting a child. 6 While they were there, the time came for the baby to be born, 7 and she gave birth to her firstborn, a son. She wrapped him in cloths and placed him in a manger, because there was no guest room available for them.

8 And there were shepherds living out in the fields nearby, keeping watch over their flocks at night. 9 An angel of the Lord appeared to them, and the glory of the Lord shone around them, and they were terrified. 10 But the angel said to them, “Do not be afraid. I bring you good news that will cause great joy for all the people. 11 Today in the town of David a Savior has been born to you; he is the Messiah, the Lord. 12 This will be a sign to you: You will find a baby wrapped in cloths and lying in a manger.”

13 Suddenly a great company of the heavenly host appeared with the angel, praising God and saying, 14 'Glory to God in the highest heaven, and on earth peace to those on whom his favor rests.' 15 When the angels had left them and gone into heaven, the shepherds said to one another, “Let’s go to Bethlehem and see this thing that has happened, which the Lord has told us about.”

16 So they hurried off and found Mary and Joseph, and the baby, who was lying in the manger. 17 When they had seen him, they spread the word concerning what had been told them about this child, 18 and all who heard it were amazed at what the shepherds said to them. 19 But Mary treasured up all these things and pondered them in her heart. 20 The shepherds returned, glorifying and praising God for all the things they had heard and seen, which were just as they had been told."

The historical events of that period had a profound influence on the thought and way of life of the Jews and consequently on the development of Jewish medical art as well. As a result of the Babylonian Exile, of Greek rule followed by the Hasmonean Wars, the rise of Christianity and the Exile after the destruction of the Second Temple, the Jewish community became wide open to influences from neighboring countries and to foreign philosophies, which had their effect on every walk of life, including medicine, according to The Jewish Virtual Library.

The sources for this period are the Apocryphal books, Greco-Roman writings of Jews and non-Jews, the Mishnah, the Jerusalem and Babylonian Talmuds, the Midrashim, and, in part, the recently discovered Dead Sea Scrolls. None of these sources is a medical book as such. Except for a few cases, medical matters are dealt with mainly to illustrate points of ritual, or civil and criminal law. The influence of Persian and Babylonian magic medicine is clear from references to amulets, the evil eye, demons, etc.

The Greek influence on Jewish medical thought was considerable, but we find that the scholars were not blind adherents of the humoral pathology, but rather followers of anatomic pathology. This was doubtless based on their experiments and observations of sick animals before and after slaughter, as well as on their studies of human bodies and corpses. One of the interpretations given to the name of the sect known as Essenes is "healers." Their medicine mainly influenced Christian medicine and medical thought. They studied and collected herbs and roots for healing purposes, though their chief remedies were prayer, mystic formulas, and amulets.

Abiding faith was all that was considered necessary for curing physical and mental diseases as well as chronic defects such as blindness, lameness, and deafness. The medicine mentioned in the New Testament is almost entirely of this type of miracle cure. By contrast, the attitude of Jewish scholars of the time, and later those of the Talmud, is generally a scientific one, according to the Jewish Virtual Library.

The medicines mentioned in the Talmud include powders, medicated drinks, juices, balsams, bandages, compresses, and incense. Meat and eggs were considered to be the most nourishing foods; fried food or food containing fat was regarded as difficult to digest. The eating of vegetables throughout the year and the drinking of fresh water at every meal were recommended. Baths and mineral waters were regarded as general strengthening tonics and as therapeutics for certain skin diseases. Herbs were used for constipation; and purges were recommended in serious cases, except for pregnant women. The use of opium as an analgesic and hypnotic drug was known, and warning was given against overdosing. Anything useful for healing purposes was permitted at any time, even on the Sabbath.

Surgeons operated in special halls. "Sleeping drugs" were used as anesthetics. From descriptions of operations, knowledge has been learned of trepannings, amputations, and removal of the spleen. A cesarean was also performed, but it is not clear whether the operation was done on a living or on an already dead body. In general, the life of the mother had priority and therefore the killing of a fetus during a difficult birth was allowed. Wound edges were cut in order to ensure complete and clean healing. Surgeons wore special operation aprons . Much more detailed material about healthcare in Biblical days can be found at this website: http://www.jewishvirtuallibrary.org/jsource/judaica/ejud_0002_0013_0_13493.html .

Life was difficult, even hazardous, in those days. Jesus was born in a location that was dirty and definitely highly unsanitary, especially by today’s standard. Yet, He survived and lived a full life until He gave His life at the age of 33--crucified on a cross, and buried in a borrowed tomb. The Good News is that three days later God the Father raised Him from the dead, and Jesus overcame both death and the grave. For those who believe, it is the story of salvation and everlasting life. If you haven’t discovered it, the Christmas story is where it begins, but the end is still being told. Don’t overlook the Life that was given amid all the glitz of the Season. It would be a shame to receive presents, but miss the greatest Gift of all. Jesus is the Reason.

Merry Christmas!

Health Care and Holiday Toy Safety

During the weeks leading up to Christmas and the Holidays, the malls, stores, and most all retail locations are packed with shoppers. And, the closer you get to December 25th, the more robust are the crowds. Even online shopping is setting new records for monies being spent for gifts. For children, this time of year presents a huge opportunity for their parents and other family and friends to spend money, especially for all kinds of toys. And there are thousands to choose from both the stores and online.

According to the American Research Group which has been tracking spending habits since 1985, Shoppers around the country say they are planning to spend an average of $854 for gifts this holiday season, up from $646 last year according to the twenty-seventh annual survey on holiday spending from the American Research Group, Inc. In telephone interviews with a random sample of 1,100 adults nationwide conducted November 11 through 14, 2012, the average planned spending of $854 for 2012 is up over 32% from average planned spending in the 2011 survey and the planned spending matches planned spending of $859 in 2007. More details can be found at this site: http://americanresearchgroup.com/holiday/ .

Costs can rise for families, especially for parents with underage children, as reported by Yahoo Finance this month. According to an article released by MSN in December 2011, American parents planned to spend an average of $271 per child in Christmas gifts. One in 10 parents said the plan was to spend over $500 per child. While this is just an average, American families can definitely spend an astronomical amount of money on Christmas gifts. Larger families with several children may have to work even harder to avoid the holiday spending hangover. While this excess would be better placed elsewhere, such as parents creating strong financial futures for their families, these warnings often fall on deaf ears. Christmas spending has taken a dramatic increase in recent years and shows no signs of slowing down. More details about average spending during this Season can be found at this site: http://finance.yahoo.com/news/average-cost-american-christmas-222932405.html .

According to eDocAmerica, the Campaign for a Commercial-Free Childhood (CCFC) is a consumer-advocacy group whose stated mission is to "support parents' efforts to raise healthy families by limiting commercial access to children and ending the exploitive practice of child-targeted marketing." Each year, they announce their worst toy of the year, which has the dubious distinction of being given the TOADY (Toys Oppressive And Destructive to Young children) award. While in the past toys with potential for injury headed the list of worst toys, this year's TOADY award finalists were toys that involved cell phone technology, unhealthy foods, and what they consider to be inappropriate gender-marketing.

This year's worst toy was the Laugh & Learn Apptivity Monkey from Fisher-Price. This toy, a stuffed monkey that holds an Apple digital device, is marketed for children 6 to 36 months of age. Fisher-Price promotes the Apptivity Monkey as the "best of both worlds for baby—a soft, cuddly friend to hold and hug, plus fun interactive learning with your iPhone or iPod touch!" This is counter to a policy issued by the American Academy of Pediatrics (AAP) that discourages TV and other media use by children younger than 2 years.

Two other contenders for the TOADY award, TheO Ball and Put Me in the Story app also utilized cell phones or cell phone apps. With the questionable goal of promoting physical activity, TheO Ball was designed to "hold your phone within its cushioned grasp, allowing you to literally throw your phone around to play games without fear of damage." Put Me in the Story app, allows popular children's stories to become e-books starring their own child. Many voters felt that this placed too much emphasis on the "me" and was a poor substitute for interactive book reading involving parent and child.

Other top five contenders included LEGO's Butterfly Beauty Shop and the 7-11 Slurpee Machine. The Beauty Shop encourages girls to "get primped and pretty and have some serious salon fun". CCFC felt that this toy promoted condescending stereotypes. Concerns regarding the 7-11 Slurpee Machine centered on children creating sugary treats that could lead to obesity or diabetes.

On the other side of the coin were Good Housekeeping's Best Toy Awards 2012 and Parenting Magazine's Best New Toys of 2012. In selecting their toys, Good Housekeeping considered those that incorporated "creativity, skill-building, problem-solving, and strategy". One hundred thirty-five different toys were "tested" by 140 children in laboratory and home settings to determine the 24 toys that made their best list. Editors from Parenting Magazine selected their best toys after attending the American International Toy Fair in New York. Twenty-five toys made the cut as the "Best in Play" for 2012.

Toy safety is paramount, especially when you are spending hundreds of dollars during the Holidays. According to www.Gifts.com, this holiday season, don't grant your kids' wishes for the newest, coolest toys until you know they're safe. With new product recalls almost daily, choosing safe and healthy toys can be a daunting task. Before you buy, double check that the toy you're considering meets safe shopping guidelines. Here are some tips:

• Is the toy age-appropriate? It's essential to adhere to the age guidelines indicated on toy packaging—because even a toy for a 3-year-old could have parts too small for a 2-year-old to handle properly.

• Are there any small, loose parts that your child can swallow? If you're not sure, consider the toilet paper tube test—anything that can pass through the tube is too small to be given to a child under 3 years old. Marbles, coins and balls are common culprits. Also, make sure that any buttons, eyes and noses are tightly secured.

• Could any part of the toy be bitten off and swallowed? Little kids love to chew their toys, so avoid any toys that have small pieces that can be easily gnawed off.

• Does the toy have a string, ribbon, straps or cord longer than 7 inches? For young children, avoid these toys or remove the strings to prevent strangulation.

• Is your toy non-toxic? Check to make sure the toy has a non-toxic, durable finish and check art supplies for the ACMI (Art and Creative Material Institute, Inc.) seal—this means its non-toxic.

• Could any part cut small hands or fingers? Look for points, edges or breakable parts that could be sharp and avoid those toys for kids under eight. If you're considering a ride-on, is it sturdy and stable, and does the recipient have all the proper safety equipment (helmet, kneepads, etc.) required to use it?

• Does the toy include magnets? Building sets, action figures, puzzles or dolls containing small, powerful magnets can be fatal is swallowed by children.

• Could the toy be a fire hazard? Fabric toys should be labeled as flame retardant or flame resistant. And electrical toys with batteries or electric plugs pose a burn hazard so they should be avoided for kids under eight.

• If you're considering a ride-on, is it sturdy and stable? And, does the recipient have all the proper safety equipment (helmet, kneepads, etc.) required to use it?

• Does the toy include any throwing or shooting projectiles? It's best to avoid these toys because they can cause injuries, especially to the eyes.

• Could the toy contain questionable chemicals? Phthalates have been banned in children's toys and children's care articles since February 2009, and stricter standards are in place for lead and other potentially toxic chemicals, too. But if you want to know about any trace amounts of these types of chemicals, look up levels for specific toys on www.HealthyStuff.org .

• Has the product been recalled? Toys have been some of the largest category of recalled children's products. Always double check product recalls online at the U.S. Consumer Products Safety Commission before you wrap, especially if you purchased a toy months before the holiday.

More informational tips about this subject can be found at this site: http://www.gifts.com/christmas/holiday-toys-safety-guide.html .

Check your merchandise before you purchase, and make sure the store has a good return policy if you feel that the toy has some safety issues. If you find out that certain toys are hazardous, then by all means get your money back. Safety is critical to the health and wellbeing of your child. Use good resources such as internet sites that provide safety tips and health hazard warnings before you buy. Talk to store managers to see if they have had any problems with any toys. They want to make a sale, but they also are very keen on your repeat business. The last thing any business or store wants is a lawsuit over a toy, and they sure are keenly sensitive to bad media attention and disgruntled parents.

Shop safely, and have fun. Try to avoid stressful times if you can when you are looking for that perfect gift. Do your research before you go, and try to avoid impulse buys. Make a shopping game plan. Above all, use your common sense to spend money on toys that help kids, and not hurt them. The Holidays are a great time to experience the Joy of the Season. Don't ruin the fun by making bad choices, including your toys. Enjoy your family time by seeing the smiles and hearing the giggles of your children when they unwrap those perfect toys. Your kids will be excited, and you'll have peace of mind.

Until next time.

Health Care and Holiday Travel

During December and early January every year, millions of people ramp up travel plans, especially for the Holidays. According to US News & World Report, chances are, you'll be traveling during the holiday season to reconnect with family and friends or take a much-needed vacation. While holiday travel can be great for your psyche, it can take a hefty toll on your health.

The journey itself can be filled with stress—traffic, flight delays and those new, more invasive airport security screenings—as well as causing a disruption in your sleep schedule and eating habits; all of these can lower your immune system's ability to fight off the flu and cold germs, making you more prone to getting sick. Once you arrive at your destination, you'll likely face large festive meals combined with a lot of sitting and schmoozing, not great for your waistline. If you have a smart action plan, though, you might be able to clear some of these hurdles to stay healthy and fit during the holiday season.

Here are 10 tips for dealing with holiday travel provided by leading fitness and travel experts, according to US News & World Report:

1. Plan meals in advance—“Pack your carry-on with healthy goodies so you have something on hand when hunger strikes," says vegan travel blogger Carolyn Scott-Hamilton, creator of the Healthy Voyager website and radio show. She recommends bringing a small bag of nuts, a few low-sugar energy bars or your favorite sandwich to eat during the flight. If you don't have time to pack some snacks, use an app like the free GateGuru to find out where you can get a healthy meal at the airport. If you're driving to your destination, avoid eating a heavy meal right before you hit the road to keep from getting drowsy; instead, eat a small low-fat meal and tote along some snacks to stay energized throughout your drive.

2. Get a full night's rest--Make sleep a top priority on the night before your trip. Get the packing and other preparations done early in the day, so you're not driving drowsy on the road or slugging through the airport with a fatigue headache. Research has shown skipping even a few hours of sleep can make you more susceptible to catching a cold the next day. And it can cause you to be a less alert driver, which is why the AAA recommends getting at least six hours of shut-eye before a long road trip. If you can't, get a designated driver to help you out. And, “if you're flying, make use of that in-flight pillow, blanket and eye mask on the airplane to help you recover those lost winks”, says Scott-Hamilton.

3. Stay active--Exercise will boost your energy and mood while traveling, says Mark Verstegen, a trainer and founder of Core Performance, who serves as the director of performance for the NFL Players Association. Wear comfortable shoes so you can walk around the airport terminal instead of sitting down to wait for boarding. And make a few trips up and down the aisle during your flight, even if you don't need the restroom. In the car, take breaks every two or three hours for a quick burst of fresh air and brisk walk around the service station. "Even ten minutes will do," Verstegen says.

4. Skip the in-flight cocktail, coffee and caffeinated beverages--Alcoholic beverages can have a stronger effect when you're imbibing at high altitudes and may enhance jet-lag symptoms like fatigue, dizziness, headaches or mental grogginess. And they can be very dehydrating. So, too, can coffee and other caffeinated beverages. Your best bet is to drink plenty of water. If you know you've got a long wait at the airport and want to avoid spending $5 on bottled water, tote along an empty bottle and fill it up at a water fountain after you pass through security, recommends Scott-Hamilton.

5. Prepare for unexpected delays--These can be stressful since they're largely out of your control, but preparing for them can help you deal better, says Elizabeth Lombardo, psychologist and author of A Happy You: Your Ultimate Prescription for Happiness. Pack some movies and books that you've been dying to get through. Also, keep things in perspective. "Yes, it is a bummer to be stuck in the airport or in traffic, but it's not the end of the world," Lombardo says. Consider how lucky you are, she adds, that you are going to visit people you love or have the means to travel to a fun place.

6. Plan family activities around fitness--Skating, tobogganing or caroling are fun ideas, suggests Jill Houk, who co-owns Centered Chef Food Studios, a health-focused catering company. If the family would rather stay cozy by the fire, offer to walk the dog or jog to the store for the cranberry sauce. Plan your activity for early in the day because it's far tougher to get up and moving after dinner, points out Verstegen.

7. Bring your own breakfast--Save your calories for lunch or dinner, and skip those 1,000-calorie breakfasts of pancakes, bacon and French toast, Houk says. She suggests toting along some cereal bars, apples, dried fruit or instant unsweetened oatmeal, just in case dried cereal isn't a morning option where you're staying.

8. Plug in to stay on track--Fitness websites and mobile apps make it easy to work out at Mom's house, even if you don't have equipment. MyFitnessPal, which is available free online and for download to iPhones and Androids, lets you track your daily exercise and nutrition and determine how many calories you're burning, say, sledding with your nieces or how many you're consuming in that Samuel Adams Holiday Porter. Comprehensive programs like Adidas’ miCoach allow you to tap into your personalized workouts and coaching instructions, or you can easily plan out a running path in your area via MapMyFitness.com.

9. Follow an 80/20 rule at dinner--Yes, you can have your holiday favorites, if you limit the portion sizes. Load up your plate with 80 percent fresh or steamed vegetables and fruits and 20 percent everything else, says Houk.

10. Avoid the holiday splurge-and-starve cycle--When people eat a large meal or overindulge, "there's a tendency to say 'I overate at dinner last night, so I'll just skip breakfast and lunch.'" Steer clear of that downward spiral, he says. It’s much better to break the cycle right away by starting the next morning with a quick walk and light, nutritious breakfast, and fill up with a snack and a glass of water before you sit down to the next tempting meal.

Safety is also a primary concern. According to the National Crime Prevention Council, here are a few suggestions following these safety tips to avoid problems during your travels:

Personal Travel Plan: Think Before You Go:

• File a “travel plan.” Let someone know where you are going, the route you plan to take, when you plan to arrive and how to contact you. If you deviate from that plan, let someone know.
• Travel with friends. There is safety in numbers.

Driving: On the Road Again:

• Always lock your car doors. Keep valuables out of sight, preferably in the trunk of your car.
• Never pick up hitchhikers.
• Park in well-lighted areas and close to the building.

Travel Destination: Checking In:

• Store valuables in the room safe or in the facility’s main safe.
• Don’t tell strangers the name of your hotel, your room number, or other personal information.

Personal Safety: On the Town:

• Avoid carrying large amounts of cash. Take only the cash you need in your purse or wallet.
• Avoid going off with strangers, and always use the buddy system.
• Avoid using alcohol and other drugs. Impaired judgment can put you in potentially dangerous situations.

Much more information on additional safety tips can be found at the NCPC website: http://www.examiner.com/article/holiday-travel-safety-tips-from-the-national-crime-prevention-council .

Regardless if you are going to travel 100 miles, or 1,000 miles, or even 10,000 miles from home during this time of year, use common sense to find your way to your destination. Although a GPS navigator is great to get directions and to locate your final resting spot, it is not equipped to make judgment calls or get you out of hot water if you make mistakes. Use the tips noted in this blog to help with your health and happiness when you travel.

Until next time.

Take Tamoxifen for Ten? Not Without a Good Surveillance Plan

There's a study out from England that says premenopausal women with ER positive cancer get a benefit from taking tamoxifen for ten years. This recommendation doubles the previous treatment regimen of five years.

I'll probably hear about it at my next cancer followup, and I'll decline because I had a rocky four years on this drug. So much so that side effects eventually made me stop taking it one year early.

I'm very weakly ER positive anyway, so it's unclear how effective tamoxifen is for me. However, when you're young with cancer, they will insist you take everything. And I get that, but experience also tells me when I've reached my limit with something.

I do know one thing, though. If I were to take one more day of tamoxifen, I would insist there be a surveillance plan to make sure I wasn't developing endometrial cancer, a known risk of the drug. After experiencing problems with tamoxifen, which aren't so very rare, I couldn't believe standard of care doesn't include annual pelvic ultrasounds and endometrial biopsies.

I see that as vital for anyone taking this drug for any amount of time; it's beyond mandatory before signing up for ten years.

Good Enough, I Guess (and Hope)

So mammograms don't work for me, that's old news. The new news is that instead of follow-up MRIs, I am now getting ultrasounds.

It's not by choice, though I will admit I'm not too sad about the change. This all came about after technicians and nurses (many of them, oh so many) couldn't find a vein to use for the MRI contrast.

After eight painful attempts by four different people the first time, my doctor said we could try placing a central line for the test and then remove it after.

That's like the port I had for chemo. I didn't have to think too long to decide that was way too intense for one medical test.

So I said let's try it again, and I talked with everyone all along the scheduling route and my doctor to make sure the medical folks were ready for me this time with hot packs, warm towels, good needles and the best blood drawer they have. I complied by drinking hundreds of gallons of water so I would be well hydrated.

They asked me to come in an hour early for the appointment so they wouldn't have to rush. Except they wasted all but five minutes of that head start by making me wait out front and then in the MRI holding area.

They weren't ready for me back in the procedure room, either. I let them have one shot at me and told the nurse to get out of there when she started digging.

So I threw in the towel and asked my doctor to order an ultrasound instead. I also called the "Customer Care" line to complain about what I consider an entire waste of my time and the fact that their breast care center is ill-equipped to deal with an issue that is to be expected to a higher degree among their patients.

Lymph node dissections limit many of us to only one--or no--arms that can take a needle poke. Prolonged treatment and several surgeries have damaged the veins we do have, and I swear my veins have learned to dive when they sense people want at them.

So anyway, I finally had the follow-up test I've been trying to get for months. And I'm glad I didn't have to get the MRI contrast, or hang upside down or hear the machine's loud banging noises.

The ultrasound took longer and was messier with all the gel goop, but overall, it's an easier test. It's not the preferred method though; an MRI is more sensitive and the best test for dense breasts. But an ultrasound did catch my two tumors that were missed by mammogram. So I'm willing to believe an ultrasound is a good enough test for me, and right now, it's the only one I can have.

I'm still wondering how they are going to do my twice yearly bloodwork and any other test or procedure that I might need.

I don't know if the much drier climate out here contributes to what has always been an issue for me or if I just need to find an entire new medical center with people who can find my veins. It's probably a little of both.

Health Care and Snow

During the Winter Season, many parts of the US and the world experience snowfall. It can be a beautiful sight when the white flakes come drifting down and cover all the ground and vegetation. Picture post cards and Christmas cards are abundant with scenes of snow that paint a picture of a white blanket covering the countryside. And, for those romantics in the audience, snow is a reminder of simpler times when you were a child with memories of sledding and building snowmen. And, thousands of people go skiing when they are at resorts or in the mountains. But snow can also be a challenge in certain circumstances, and this frozen precipitation has some dangerous consequences at times.

According to the National Snow and Ice Data Center, snow cover is a part of the cryosphere which traces its origins to the Greek word kryos for frost. Snow is precipitation in the form of ice crystals. It originates in clouds when temperatures are below the freezing point (0 degrees Celsius, or 32 degrees Fahrenheit), when water vapor in the atmosphere condenses directly into ice without going through the liquid stage. Once an ice crystal has formed, it absorbs and freezes additional water vapor from the surrounding air, growing into a snow crystal or snow pellet, which then falls to Earth. Snow falls in several forms:

• Snowflakes are clusters of ice crystals that fall from a cloud.

• Snow pellets, or graupel, are opaque ice particles in the atmosphere. They form as ice crystals fall through supercooled cloud droplets, which are below freezing but remain a liquid. The cloud droplets then freeze to the crystals, forming a lumpy mass. Graupel tends to be soft and crumbly.

• Sleet is composed of drops of rain or drizzle that freeze into ice as they fall, and is sometimes called a wintery mix of rain and snow. These small, translucent balls of ice are usually smaller than 0.76 centimeters (0.30 inches) in diameter. Official weather observations may list sleet as ice pellets. In some parts of the United States, the term sleet can refer to a mixture of ice pellets and freezing rain.

More information can be found at this website: http://nsidc.org/cryosphere/snow/ .

According to Yahoo News, if you're dealing with ice and snow where you are, here are a few things to keep in mind:

1.) Car accidents: Slippery surfaces equal accidents waiting to happen!

Everybody knows that ice is slippery, but a lot of people still try to drive in inclement weather, anyway. In fact, yesterday morning, my husband was determined to drive to work, even though the roads were in terrible shape. He lasted just a few hours in the office before he was on his way home. The drive, which usually takes about 45 minutes, took him well over two hours, mainly because there were many car accidents.

There's a good reason why people are urged to stay home during severe weather. You may think your work is crucial, and it may very well be. But, unless your work literally makes the difference between someone's life or death, you really should consider staying home when the roads are icy. You may be the world's best driver, but you'll still have to deal with people who are driving too fast for the road conditions and you could still get in an accident. The choice to stay home or go to work is ultimately up to you, but if you think you're being a hero by trying to go to work when the weather is bad, think about how effective you'll be if you end up getting badly hurt or even killed in a car accident. And consider that if you do get hurt, one of your family members or friends may have to go out in the weather to take care of you. Please be safe and try not to drive when the roads are bad. And for heaven's sake, as tempting as it may be, try to resist the urge to go shopping on snow days... unless you can walk to the mall! And even then, be careful. You can hurt yourself slipping on the ice, too.

2.) Heart attacks, sore muscles, and dehydration: Shoveling snow may be risky for some people!

There's a huge pile of snow in your driveway. Your sidewalk is totally covered with the white stuff. You want to clear it away with your snow shovel. If your heart is healthy, shoveling snow may provide you with an excellent chance for some exercise. But did you know studies have shown that shoveling snow puts some people at risk for heart attacks or other cardiovascular problems?

It's true. Shoveling snow is hard work and people who have heart issues may not realize how much they're exerting themselves when they clear snow. The cold weather causes the coronary arteries to constrict. Even people in good physical shape with healthy hearts tend to overexert themselves while they are shoveling snow. Consider that each shovel full of snow can weigh as much as fifteen pounds. If, in one minute, you move ten to twelve loads of snow with your shovel, you will have moved several hundred pounds of the stuff. That's a lot of work, even for someone whose heart is in excellent shape.

Aside from your heart muscle, the muscles in the rest of your body might also take quite a beating during a session spent shoveling snow. If you're not used to getting regular exercise, you may end up very stiff and sore or even injured if you're not careful.

3.) Hypothermia and frostbite: When you get too cold.

Frostbite and hypothermia are two different conditions that can occur when the weather gets cold.

Hypothermia--When your body temperature dips below 96 degrees Fahrenheit, that's hypothermia, and it doesn't have to be freezing cold outside for you to be at risk. According to the National Weather Service Weather Forecast Office in Omaha, Nebraska, you can get hypothermia even by being underdressed on a 60 degree day. Elderly people are especially at risk for hypothermia, since they tend to take more medications and have medical conditions that can affect their circulation and their ability to resist the cold. Some older people also have trouble shivering effectively, which is the body's way of warming you up.

When the weather gets cold, be sure to dress in layers to keep your body temperature from dropping too low. If you can afford it, set your thermostat between 68 and 70 degrees during cold weather. Keep your pantry stocked with nutritious food; eat hot foods and drink warm drinks on cold days. Wear a hat, gloves or mittens, boots, and a scarf if you must venture outside. If you or someone you're with starts to feel sluggish or has trouble thinking clearly, call your doctor or an ambulance. In the meantime, try to get warm by wrapping up in blankets. If you're with another person or a pet, consider huddling close together so you can share body heat.

Frostbite--When the weather gets extremely cold, your body does its best to protect your vital organs above all else. In order to do that, your body diverts blood flow that would ordinarily go to your extremities to your vital organs. If your hands, feet, ears, or nose are not properly protected in extremely cold weather, they can end up freezing.

To avoid frostbite, try to avoid going outside when it's extremely cold. If you must go outside, bundle up in layers. Be sure to protect the exposed areas of your skin and keep your skin dry. Stay out of the wind as much as possible and drink fluids to increase your blood's volume. Don't drink alcohol or caffeinated beverages, since they tend to be dehydrating and constrict your blood vessels. Drinking alcohol and smoking cigarettes can also put you at risk, since they affect the way your body handles the cold.

If you start to experience frostbite, go indoors and warm up those cold extremities. Take a warm bath or use your armpits, a warm companion or pet, or warm clothes to get the blood flowing again. If your skin appears to be blue, swollen, very blistered, is very painful or feels hard and numb, get to a hospital. Frostbite that isn't promptly treated can lead to gangrene. More details can be found at this website: http://voices.yahoo.com/avoiding-three-common-ice-snow-health-hazards-7587394.html .

Yes, snow is beautiful to look at, but it can also be dangerous. Use common sense when working outside during the winter and in snowy conditions. Blizzards are dangerous and can be deadly, and so can thunderstorms that occur during the winter and create serious safety concerns. Be careful when walking and especially when driving in snow. The winter time can be fun, and snow can be a great source of beauty and recreation. Just be careful. You’ll want to stay around to enjoy it this time next year.

Until next time.

Sell Annuity Payment Tips

At first look, it is not a very hard query to response, but it is often met with a minutes doubt that comes before the reaction. The follow-up query is actually more important: "Just because I can offer premium costs, should I?" Tip #1: Do not Let Annuity Payments Be the First Factors You Sell During times of economical problems, those things individuals usually get rid of of first are their insurance products. Rather than find ways of reducing down on insignificant costs that are the real cause of their economical struggling, they concentrate on their "investment profile." Most individuals would do much better promoting their activities vehicles, jewellery, elegant devices and other splendid luxuries before promoting costs. Tip #2: Just Sell a Part of Your Annuity Payments A few years ago, once you buy your premium, it is a done deal with no going back. These days, you now have choices. Another industry has designed to be able to offer premium. Like most marketplaces, this additional industry was recognized to deal with the needs of those who need to offer premium agreements. Suppliers can place all or just a section of their premium agreements up available on the industry and arrange for a group sum of money in return for the costs. For example, if you have an premium that is spending out $6,000 per month, but have made the decision that you do not need that much for your per month costs, you can offer a section of that transaction. In return for this section of your transaction, the customer will pay you a pre-specified group sum of money. The selling of just a section of your costs provides you fluid money you can use for immediate investing while keeping a amount of the premium costs for your per month costs.

Health Care and Holiday Plants

During the Holiday Season, with decorations taking on a more prominent visual affect, it's important to realize how much plants and certain greenery take on such an important role. Also, you should know what to expect when you have live plants or even cut vegetation and floral arrangements to arrange and manage during these winter months. Christmas especially is a time when the plants you use for decoration can create a stunning scene when arranged correctly and properly handled during this Season.

Plants play a big role in our holiday celebrations, according to Marie Ianotti with the Gardening Guide on About.com. Whether you're giving holiday plants or using them as decorations, indoors and out, certain plants have become an intrinsic holiday traditions. Beautiful as they are in the store, holiday plants don't always make an easy transition into your home. Here are some tips for choosing holiday plants and caring for them through the holidays and afterward:

1.) Poinsettias--Poinsettias are everywhere at Christmastime. Red flowers would seem an obvious choice for Christmas, but now poinsettias come in pastel shades of cream and pink and you’ll even find them dyed, painted and done up in glitter and bows. Now poinsettias can be used to celebrate multiple holidays and look right at home in any decor.

2.) Christmas Cactus--Who would have thought a cactus would become a symbol of Christmas? Cactus make excellent houseplants, if you can resist the temptation to fuss over them. And unlike the poinsettia, the Christmas cactus just seems to know that Christmas is the perfect time to bloom and let it all hang out.

3.) Cyclamen--There are many cyclamen species that are grown in the garden, butCyclamen persicum, or the Florist Cyclamen, is often grown as a house plant and is popular around Thanksgiving and Christmas because that’s when it tends to be in bloom. Cyclamen make a wonderful holiday plant because they adapt well as houseplants, blooming again for next year’s holidays.

4.) Maybe you don’t think of Christmas trees as holiday plants, but when you stop to think about it, a live Christmas tree is just that. It can be a tree you intend to plant outdoors, after the holidays, or a potted evergreen you want to keep as a houseplant or display on the patio. Take care in choosing which type of live evergreen you want for your Christmas tree, because it’s only going to get bigger.

5.) Amaryllis--Much like Poinsettias, Amaryllis plants have been popular at Christmas time partly because they come in so many shades of red. Also like Poinsettia, Amaryllis don’t necessarily bloom at Christmastime, when left to their own devices. The Amaryllis is a huge bulb that’s actually very easy to grow and care for. The bulbs are widely available in December, so they make a great gift. They may not bloom until later in the spring, but unlike Poinsettia, they are eager repeat bloomers.

According to the West Virginia University Extension Center, flowering plants provide beauty and are a traditional gift item. Most of these decorative plants are harmless, but some may be hazardous or even dangerous to children and pets if part of the plant is eaten or handled. Even plants that are not toxic do present choking hazards in children. Holiday plants with berries present the most common poison hazard. These include mistletoe, holly, bittersweet, and Jerusalem cherry. For example, Mistletoe is a semi-parasitic plant. It manufactures its own food, but must obtain water and minerals from the host plant. American mistletoe, Phoradendron serotinum, grows in deciduous trees from New Jersey southward to Florida and Texas. Mistletoe sold during the holiday season is gathered in the wild. Most mistletoe is harvested in Oklahoma and Texas. Mistletoe has been used in the treatment of several ailments, including pleurisy, gout, epilepsy, rabies, and poisoning. However, its white berries, which appear in winter, are poisonous. For safety reasons, the live berries are often replaced with artificial, plastic berries.

To be on the safe side, keep holiday plants out of reach of children and pets. Remember to pick up and dispose of all leaves or berries that fall from your plant. Christmas trees are also a problem. The needles, even though they are not poisonous, are a choking hazard. Many plants contain toxic substances, and these substances cause a variety of symptoms from mild stomach ache, skin rash, swelling of the mouth and throat to involvement of the heart, kidneys, and other organs. The level of toxicity for a particular chemical substance is relative to the body mass, the amount ingested and/or the rate of ingestion. Some safety rules to follow in regard to plants include:

1. Never eat any part of an unknown plant.
2. Never chew on jewelry, etc., made from plant material or allow children to do so.
3. Never attempt to make your own "nature tea" unless you are positive of the plant you are using and the recipe.
4. Make sure the herbs you grow are edible and safe.
5. Never allow children to play around plants without supervision.
6. Store seeds, bulbs, tubers, etc., out of the reach of children.

In the event of poisoning or suspected poisoning, call the poison control center nearest you. More info on this topic can be found at this site: http://www.wvu.edu/~agexten/hortcult/flowers/holiplts.htm .

According to the University of Vermont Extension Department of Science, for more details on toxic plants of all types, including common houseplants, consult the second edition of the Handbook of Poisonous and Injurious Plants by doctors Nelson, Shih, and Balick. From Springer Publishing, it is one of the most authoritative, up-to-date, and affordable such references for human poisoning by plants, and is used in many poison control centers.

If you suspect poisoning, seek immediate professional help. Unless told to do so by such doctors, do NOT make the person vomit. Call your local poison control center, often at your local hospital. Or, you can call the toll-free National Poison Control Center hotline (800-222-1222) and talk with poison control experts. This national service is available anytime, and can answer any questions on poisoning even if not from plants and even if not an emergency.

Several of your favorite holiday plants should be kept from children and pets, yet often they pose no serious danger in small amounts. There are many other and more toxic substances to children in homes to be mindful of, especially cosmetics and personal care products. More info about holiday plant toxicity can be found at this website: http://perrysperennials.info/articles/toxic.html .

You may also suffer from airborne allergies that make it difficult to have live plants or greenery in your home during the Holiday Season, such as suffering reactions to evergreens and other types of plants and flowers. If that is the case, then don’t feel bad about decorating with manufactured trees and plants, especially if you are willing to pay more for realistic, higher grade decorations. If you have problems during the Holidays with any type of real vegetation, seek medical advice as quickly as possible. You sure don’t want to spend this time of year in the hospital or emergency room. Be careful with your kids and pets, and protect everyone in your home at all times when there are real, live plants and flowers to be used during your festive occasions.

Until next time.

Health Care and Alcohol Poisoning During the Holidays

Drinking alcohol has significant consequences, especially if imbibing is done in excess. During the Holidays, many individuals push themselves to participate in as many parties and activities as possible. Also, during this Season is when most accidents occur due to alcoholic consumption, and the death rate also increases as a higher percentage of adults and teens are guilty of drinking and driving—definitely not smart. Plus, it’s against the law.

Another popular sport, particularly in the college age crowd, is binge drinking. According to the Centers for Disease Control (CDC), binge drinking is the most common pattern of excessive alcohol use in the United States. The National Institute on Alcohol Abuse and Alcoholism defines binge drinking as a pattern of drinking that brings a person’s blood alcohol concentration (BAC) to 0.08 grams percent or above. This typically happens when men consume 5 or more drinks, and when women consume 4 or more drinks, in about 2 hours. More info can be found at this site: http://www.cdc.gov/alcohol/fact-sheets/binge-drinking.htm .

Most people who binge drink are not alcohol dependent. According to the CDC, national surveys show the following statistics about binge drinking:

• One in six U.S. adults binge drinks about four times a month, consuming about eight drinks per binge.
• While binge drinking is more common among young adults aged 18–34 years, binge drinkers aged 65 years and older report binge drinking more often—an average of five to six times a month.
• Binge drinking is more common among those with household incomes of $75,000 or more than among those with lower incomes.
• Approximately 92% of U.S. adults who drink excessively report binge drinking in the past 30 days.
• Although college students commonly binge drink, 70% of binge drinking episodes involve adults age 26 years and older.
• The prevalence of binge drinking among men is twice the prevalence among women.
• Binge drinkers are 14 times more likely to report alcohol-impaired driving than non-binge drinkers.
• About 90% of the alcohol consumed by youth under the age of 21 in the United States is in the form of binge drinks.
• More than half of the alcohol consumed by adults in the United States is in the form of binge drinks.

According to Medical News Today, when somebody consumes an alcoholic drink, their liver has to filter out the alcohol, a toxin, from their blood. We absorb alcohol much more quickly than food - alcohol gets to our bloodstream much faster. However, the liver can only process a limited amount of alcohol; approximately one unit of alcohol every hour. If you drink two units in one hour, there will be an extra unit in your bloodstream. If during the next hour you drink another two units, you will have two units floating around in your bloodstream at the end of two hours after your drinking session. The faster you drink, the higher your BAC (blood alcohol concentration) becomes. If you drink too fast, your BAC can spike dangerously high.

Rapid drinking can bring your BAC so high that your mental and physical functions become negatively affected. Your breathing, heartbeat and gag reflex - which are controlled by types of nerves - might not work properly. You become breathless, you may choke, and your heart rhythm might become irregular. If your BAC is high enough, these physical functions can stop working, the patient stops breathing and passes out (loses consciousness). In the USA approximately 50,000 cases of alcohol poisoning are reported annually. About one patient dies each week in the USA from alcohol poisoning. Those at highest risk of suffering from alcohol poisoning are college students, chronic alcoholics, those taking medications that might clash with alcohol, and sometimes children who may drink because they wish to know what it is like, according to Medical News Today. A significant amount of additional info can be found at this website: http://www.medicalnewstoday.com/articles/215627.php .

Do you know the signs of acute alcohol poisoning? Do you know what to do if someone is suffering from its effects? Your friend who had way too much to drink, may not just be sleeping it off. If he or she is suffering from acute alcohol poisoning, as a result of drinking too much too quickly, they could die if you do not intervene. How do you tell the difference between being passed out and alcohol poisoning?

According to the Mayo Clinic, alcohol poisoning symptoms include:

• Confusion, stupor
• Vomiting
• Seizures
• Slow breathing (less than eight breaths a minute)
• Irregular breathing (a gap of more than 10 seconds between breaths)
• Blue-tinged skin or pale skin
• Low body temperature (hypothermia)
• Unconsciousness ("passing out"), and can't be roused

It's not necessary for all of these symptoms to be present before you seek help. A person who is unconscious or can't be roused is at risk of dying. If you suspect that someone has alcohol poisoning — even if you don't see the classic signs and symptoms — seek immediate medical care. In an emergency, follow these suggestions:

• If the person is unconscious, breathing less than eight times a minute or has repeated, uncontrolled vomiting, call 911 or your local emergency number immediately. Keep in mind that even when someone is unconscious or has stopped drinking, alcohol continues to be released into the bloodstream and the level of alcohol in the body continues to rise. Never assume that a person will "sleep off" alcohol poisoning.

• If the person is conscious, call 800-222-1222 (in the U.S.), and you'll automatically be routed to your local poison control center. The staff at the poison control center or emergency call center can instruct you as to whether you should take the person directly to a hospital. All calls to poison control centers are confidential.

• Be prepared to provide information. If you know, be sure to tell hospital or emergency personnel the kind and amount of alcohol the person drank, and when.

• Don't leave an unconscious person alone. While waiting for help, don't try to make the person vomit. Alcohol poisoning affects the way your gag reflex works. That means someone with alcohol poisoning may choke on his or her own vomit or accidentally inhale (aspirate) vomit into the lungs, which could cause a fatal lung injury.

• Much more information can be found at this site: http://www.mayoclinic.com/health/alcohol-poisoning/DS00861 .

Alcohol poisoning is a life threatening situation. During the Holidays, don’t let yourself or any friends or relatives over indulge with alcohol of any type. The festivities of the Season should not be tragically interrupted by someone who has not learned self control with alcohol. Do yourself and everyone around a favor when it comes to drinking. Slow down, or just don’t drink. And, in particular, if you are out in a crowd at a restaurant or home, have a designated driver or call a cab to take you home. You sure don’t want to be on the evening news as the next lead story of a traffic fatality.

Until next time.

Health Care and Holiday Foods

It’s time once again to break out the stretchy pants. The holidays are upon you, and you’re thinking “Let the feasting begin!” Have you noticed that as the years go by, your waist line is an indicator of your appetite? Have you been feeding at the trough so many years during November and December that you don’t even notice that your clothes are getting tighter as the season progresses? What about all those calories that get consumed once the parties, buffets, and gift baskets start flowing? Are you guilty of surfing the wave of the holidays’ food tsunami?

For many, the holidays are the most wonderful — and least heart-healthy — time of the year. Grandma’s fudge is a sentimental favorite, and the neighbor’s cake balls are a decadent habit. Indulging a little won’t hurt — but planning ahead will make for merry meals that are healthy too. Do you decorate for the holidays with a lot of color? Treat your dinner plate the same way, according to the American Heart Association.

“Half of a meal should comprise fruits and vegetables that consist of a variety of colors,” said Vilma Andari, president and founder of Nutra Health Food and a spokeswoman for the American Heart Association. “The other two quarters should be whole grains and healthy proteins.” Make your holiday meals festive and healthy with a variety of richly colored fruits and vegetables — and don’t forget the herbs and spices. “Try to work fruits and veggies into everything from soups and stews to casseroles instead of just side dishes,” Andari said. See more details at this website: http://www.heart.org/HEARTORG/Conditions/Seasonal-Heart-Healthy-Holiday-Foods_UCM_433897_Article.jsp .

‘Tis the Season to be jolly—you pack on pounds that you promise to take off next year. According to Health.com, if you simply cannot resist a calorie-laden holiday treat, at least consume it in moderation. Here are 50 holiday diet hazards you and your family should avoid, along with healthy options that only taste indulgent, found at this website: http://www.health.com/health/gallery/0,,20440821,00.html .

Your tactic for avoiding temptation may be to steer clear of all the special treats and divert yourself with only healthy foods, according to EatingWell.com. Great in theory, but not so perfect in practice. Lots of foods that are packed with antioxidants, vitamins and minerals are also full of calories. And when you're mindlessly munching as you're mingling, those calories can add up fast.

Don't assume that just because something is healthy it is also low-cal. If you like the healthy treats that sometimes show up at holiday parties, that's great! Have them—in moderation. If you'd rather sample some of the special seasonal treats, just put two or three of the most delicious-looking hors d'oeuvres on your plate and enjoy. Before you head out to party, check out these surprisingly unhealthy holiday calorie bombs and better bets to choose instead. More information can be found at http://www.eatingwell.com/nutrition_health/nutrition_news_information/healthy_holiday_food_to_avoid_and_healthier_foods_to_eat_instead .

According to Men’s Health magazine online, the average person consumes an extra 600 calories a day between Thanksgiving and New Year's, which translates to an extra six pounds of belly fat heading into January. Whether your weakness is mayo-spiked deviled eggs or rum-spiked eggnog, there are more than enough temptations to go around in these merry times. And while everybody is entitled to a bit of indulgence during the holidays, there's a fine line between festive and fattening. To help you better understand that line, Men’s Health has pinpointed the very worst of the season's eatings and suggested some satisfying alternatives that should make your New Year's resolution a little easier to attain. You can find more information at their website: http://eatthis.menshealth.com/slideshow/best-and-worst-holiday-foods .

Feeling like you want to skim some fat off your own thighs instead of the turkey's? Surprise! There are actually a lot of holiday foods that, if you prepare them in a healthful way and watch your portions, reap countless nutritional benefits and can even help you lose weight, according to FitnessMagazine.com. Find out what works best for you. There are healthy tips for preparing and eating good food located at http://www.fitnessmagazine.com/recipes/healthy-eating/superfoods/healthy-holiday-superfoods/ .

However, if you are looking for really good holiday food treats that you just can’t resist, the Food Network has some great options at their site: http://www.foodnetwork.com/holidays-and-parties/index.html .

So, if you’re waiting for that jolly old elf to show up at your fireside hearth, at least try not to consume all the cookies on the plate your kids left for Santa. If you get tempted, remember to go fat free. At least that way you’ll be able to justify your sweet tooth. And speaking of your teeth, make sure you brush before you toddle off to bed over the next few weeks. You may be going into a food coma if you over indulge, but at least your oral hygiene is better off after you take care of your smile.

Until next time.



How To Find An Asbestos Lawyer

If you or a family member has been clinically diagnosed or dead as a result of Asbestosis, Asbestos or another mesothelioma relevant sickness you quickly need to discover an mesothelioma attorney as you may be able to declare for agreement. Asbestos relevant diseases take many years to create and so by enough time a analysis is created you may be beyond the period of your efforts and energy and effort permitted by your declares Law Of Restrictions. Even so, it is essential that you discover and talk with an mesothelioma attorney as quickly as possible after a analysis has been created by your physician to start judge process. The thought of contesting a long judge fight may seem complicated but many mesothelioma attorneys are able to settle a agreement out of judge guaranteeing that your family members are not knowledgeable with devastating costs and failures due to your sickness. The process of discovering a excellent mesothelioma attorney can at times experience like a trial. Circumstances including mesothelioma relevant sickness and loss of life have been known to get large financial payment which is why it is essential that the mesothelioma attorney you select is knowledgeable and certified to deal with mesothelioma cases. You can start your look for by discussing to visitors about their encounter and knowledge with an mesothelioma attorney. They may also know somebody in a similar situation to yours who may be able to relate you to a excellent mesothelioma attorney or offer advice. Another method of discovering an mesothelioma attorney is to google look for. There are mesothelioma sickness relevant boards where individuals talk about and discuss information regarding their sickness and lawful situations. Many mesothelioma attorneys promote through the World Wide Web. A great place to look for is in an mesothelioma attorney's listing. You will discover a attorney who focuses primarily on mesothelioma relevant cases by nation, state, area and town. Once you have chosen a attorney contact them and ask for a free assessment. This assessment will allow you to talk about your situation, the charges and generally 'size him or her up'. Be sure to talk about the fee framework thoroughly so there are no unpleasant excitement when the bill comes. When selecting an mesothelioma attorney there are some very important questions you need to ask. You need to discover out how much encounter he or she may have managing mesothelioma relevant cases and what has been the success rate in regards to statements. Your mesothelioma attorney might have other individuals who have used their services whom are willing to provide a referrals to deal with. An 'aged' company who has a traditional in the neighborhood can have its benefits over a young 'top gun' kind of company in that it has recognized believe in, commitment and regard amongst the individuals it symbolizes and it is not likely to keep town instantaneously. Establishing the reliability of the mesothelioma attorney is critical. Are there any problems or legal cases awaiting or currently being knowledgeable by the mesothelioma lawyer? Are the attorneys qualifications freely shown for customers to see and if not, demand to see them? If you select a regional attorney ask members amongst the group about the attorney's popularity and if he or she is well considered amongst his or her colleagues. When discussing to a attorney be sure to set up that he or she is the person who will be managing your situation. It is not uncommon to experience somewhat anxious when discussing to your lawyer; after all, they seem to talk a different terminology to the rest of us. Speak in your regular vocabulary; do not try to talk in lawful conditions. If you don't understand something your attorney says, always ask for explanation.

BRA Need Goes Beyond a Day

The topic of BRA Day, a national Breast Reconstruction Awareness Day, has been discussed on various breast cancer blogs. I've weighed in with my opinion in the comments sections but haven't developed my own post on the matter, until now.

I can appreciate the points that other bloggers make--that reconstruction isn't the big deal here. Saving lives is what's important when you get a bc diagnosis.

Yes, I very much agree. But reconstruction is not unimportant either.

To share information about my experience with the process is the reason I started this blog. It seemed important enough to me to do that, and even though I often think I might pull the plug on this virtual diary, I still come up with things to say on the topic.

Mostly that's because I'm still not done with reconstruction, a process I started more than four years ago. And I guess that's my main point. Reconstruction, like so many other things in life, is different for every person.

No one has an easy choice or an easy time with reconstruction; I'd rather we all never have to experience this or the cancer that brings it into our lives.

But I would say there is a continuum of complexity when it comes to reconstruction. The more treatment you have to have, the harder it becomes to put things back together. Specifically, women who must undergo radiation have fewer viable reconstruction options.

Implants in such a case have a high fail rate. So, even though there are very many competent implant doctors even in smaller towns, this route isn't feasible for many women.

And this is where things get tricky. Chances are you won't be able to find a plastic surgeon who can do the advanced fat flap transfer techniques who is also in-network with your insurance. It will also be very difficult to find a surgeon who has done many, many, many of these techniques close to home, unless you happen to live in or near a large city.

At the very least, this means having to travel far and wrangle a special agreement out of the plastic surgeon and your insurance to pay for the work, unless you're lucky enough for money not to matter. Then you'll need to line up local doctor support, which also can be problematic.

The information to do this is more or less out there on the Internet, but it's not easy to compile or compare. If you go ahead with a more complex route, you will feel like you wish there were more support, more information.

But I'm not sure a BRA Day is going to provide that. In fact, my guess is the aim here is much more superficial and financial.

So I don't support the day per se, but I do very much support more good, unbiased, reliable information about the trickier types of reconstruction that aren't readily available everywhere and that are often cost prohibitive.

There should be wider knowledge among all health care professionals about the many different reconstruction options. There should also be more real, good information widely available for women to make a reconstruction choice or to decline reconstruction. And it sure would be nice if finding a way to pay for what you need wasn't so damn hard.

Thank You for Not Ripping Me Off

After a very frustrating day yesterday dealing with a medical provider who essentially balance bills in advance--wants at least some of the money that falls between what they want to charge and what the insurance company will pay as reasonable and customary--I want to take a minute and thank someone.

I want to thank my plastic surgeon who did a very good job on my two DIEP surgeries. She didn't balance bill me at all. Her staff worked to get an in-network exception since she also isn't in-network with most insurance. An in-network exception means the insurance company admits they don't have a doctor in-network who can do this type of work, and because of that, they will cover costs at an in-network rather than out-of-network benefit level in this case.

She took what she got from insurance this way and then what I would have had to pay through my in-network co-insurance, etc (I had none for either of these surgeries as other treatment quickly pushed me past our family's out of network max for the years) and called it good. I never saw a bill for that "gap cost," the amount between what she billed and what the insurance paid.

So I know it can be handled better, that plastic surgeons who choose to take reconstruction patients with insurance can (and should) work to get the better in-network benefit level for both them and the patient and then call it a day.

After all, they are often working with patients who have endured years of paying out-of-pocket-maximum levels on their insurance. To ask for more is simply greedy and unprofessional in my opinion.

In fact, my biggest pet peeve is "billing coordinators" who try to defend and/or explain their policies that plain and simple rip off cancer patients looking for reconstruction. Asking for any dollar more than you are due via the best insurance agreement you can work to get is wrong.

Sadly, there are a lot of them out there, especially if you need a more specialized type of reconstruction.

Reconstruction--Never, Ever a Simple Process

I've been thinking about doing a year-end push to finish up my reconstruction, but it could be that there's not enough time to work out the annoying details.

Two things made me decide to even think about trying this--there is a study about Cook nipple implants with one of the four sites nearby, and our insurance deductible will be much higher next year.

So I've been in touch with the study site, but I'm not loving their emphasis on the financial side of things. They offer a free cosmetic consultation but charge reconstruction patients a consultation fee. They'll refund it if my insurance company pays 100% of the amount they submit. Ummm, we all know that's not going to happen; it's why they insist on the fee in the first place.

Secondly, they are not in-network with any insurance. This is not uncommon for plastic surgeons, but it does make the financials a pain in the butt. I mean to the point it could easily stop you from getting anything done at all.

This place won't just help me secure an in-network exception (since my insurance likely doesn't have another local doctor doing this type of nipple) and then take what that pays them, plus my 10% co-pay under the in-network agreement.

No, they figure a cost that's 20-30% of what they want to charge (not reasonable and customary that the insurance will knock it back to) and ask me to pay that up front, before the surgery. Then they keep my money and whatever the insurance pays.

Not exactly the most honorable process, if you ask me. Clearly they want to pad what they get from insurance patients, from cancer patients. I know we're not nearly as lucrative as cash-paying, elective cosmetic patients, but to be so blatant about it strikes a sour note with me.

Especially since this is a clinical study, where I would think the doctor and his practice are getting money from the biotech company that makes the nipple.

Nah, this strikes me as too greedy. I have calls and e-mails in to Cook and the other study site directors to see how they charge.

I'll keep you posted.

Things That Make This Much Sense Should Just Happen

A fabulous post urging that 30% of breast cancer funding should be directed toward researching metastatic breast cancer, the only breast cancer that kills.

The other 30% figure signifies the percentage of women who get breast cancer that will see it spread at some point in their lives.

As the article points out, this is now my fight. Like others who have already been diagnosed and treated, prevention and detection efforts, which receive the lion's share of funding, are of no use to me.

Seriously, if great progress can be made on the metastatic bc research front in ten years with adequate funding, I say let's start yesterday.

It's a no-brainer for me to say that if my cancer ever does come back and/or spread, I'd want some good research, some cure, out there for me.

Wouldn't we all?

Thanks to Nancy's Point for steering me toward information about this effort.

Something I'm Curious About

After you've been treated for breast cancer, does your medical center/health care provider order an annual screening mammogram, or do they order a diagnostic mammogram?

I ask because I recently discovered my new medical home has a protocol of always ordering a diagnostic rather than screening mammogram for yearly followup of all people who have had breast cancer.

I was told that even if a doctor orders a screening mammogram for me, if the person who schedules the mammogram sees that I had breast cancer, he or she will change the order to a diagnostic mammogram. Something about the radiologists preferring it this way.

So what's the difference between them? As it was explained to me and as I've experienced it, with a diagnostic mammogram, the radiologist tech trots the results down to the radiologist, who reads them on the spot and either gives you the all clear and lets you go or keeps you there for further imaging such as an ultrasound or MRI. By contrast, you leave after a screening mammogram, the radiologist reads it when she/he gets to it and your doctor gets back to you with results sometime after that.

The other huge difference is that since 2010, screening mammograms have been covered 100% with no co-pay. That's not the case for diagnostic mammograms--all your deductibles and co-pays and co-insurance apply.

Which is a big deal for someone like me, someone for whom mammograms don't work anyway.

I'd prefer to skip mammograms and their radiation completely, but every health insurance I've ever had makes me get one to prove I have dense breasts, which means you can't tell what's going on in there with a mammogram.

What I need is an MRI, which I can use a failed mammogram to get. But why should I have to pay for that mammogram if there's no reason to? After all, I need to save that money to pay the several hundred dollars I'll still have to shell out every year for an MRI.

I thought we were supposed to be moving toward individualized health care, a protocol like this belies those claims. After all, if a patient tells you mammograms don't work for her but we still need one to get the MRI, why would you order the cadillac version? Just to charge her?

Actually, this is one instance I would call medical waste. A diagnostic mammogram should only be used when there is stong suspicion of an immediate issue. When I turned up six years ago for my first-ever mammogram because I felt two huge lumps, that should have triggered a diagnostic mammogram. Some quick turnaround and followup testing would have been useful all the way around. But I'm guessing I didn't get the diagnostic mammogram because I didn't have any history of disease at that point.

I also didn't know then that mammograms are useless for me and for up to 40 percent of other women.

I know this now and am finding it both frustrating and expensive that medical professionals act like they don't know.

I offered this constructive criticism to my medical providers: The protocol should be always order screening mammograms since they are free, unless specific cases would benefit from a diagnostic mammogram. The health care provider should then have to explain why the person would benefit and then also explain there will be a cost for this type of mammogram over the screening mammogram.

That would at least give me a chance to tell them they're full of it and get what I need.

Mammograms Aren't Always Enough

Now that it's no longer October, I will post my annual awareness message about mammograms and how they aren't enough for many women.

This year when you schedule your mammogram and show up for the test, don't stop there. When you get the little postal card that says you're okay, pick up the phone and call the doctor who ordered the exam.

Ask your doctor or the nurse to send you or read you the entire radiologist report. If it mentions you have dense breasts (sometimes stated as "scattered fibroglandular densities"), ask your doctor if you need a follow up test such as an ultrasound or MRI to actually see inside your breasts.

The problem is that both breast density and cancer show up white on a mammogram. I've heard it said that "you could hide a Buick" inside breast density and never know it's there. So if you have dense breasts (up to 40 percent of women do), it could be preventing a good reading of your mammogram. And, no, density has nothing to do with how large or small your breasts are. It's generally a fact of being younger (premenopausal), though it can apply to older women, too. As we age breast density turns to fat, and fat is easy to see through on a mammogram.

More and more states are passing laws that make health care providers inform women if they have dense breasts, and for good reason--not only does this make reading a mammogram difficult, it also increases your chance of developing breast cancer.

Having to think about, then schedule and get a mammogram every year is not fun, but the fact is if you stop there, there's a chance you aren't getting the effective breast surveillance you might think you are.

This article provides more information and also states that there is contention around the issue, but as one whose two, 2.5 cm cancerous lumps didn't show at all on a mammogram but were revealed by an ultrasound, with a followup MRI showing even more areas of concern, I think you can guess where I come down on this.

High Deductible Plans Not Good News

As more and more companies are moving to high deductible health plans, I have just one question: How are they not discriminatory against people who actually NEED health care?

I get that their intent is to make people decide against "unneeded" care or to shop around to get the cheapest care (as if that is possible; the information to do this is just not available). But all things are not equal on the health care needs front.

There are people who will never need to use the system; others will have to have treatment or tests or medicine and will be faced with a huge deductible--$10,000 or more before partial coverage will kick in.

If you have a family, I can't imagine these plans are a good gamble even if everyone is in fine health. If one or more members actually has health care needs, it's a huge blow to the bottom line--for not just one year but for every year.

I can't see how this is anything else except moving in a very bad direction.

Breast Cancer Awareness Means Hearing the Whole Message

Or at least it should. If you read the comments after the article I liked to in my last post, you're up to speed. I'm betting it's not the story you're hearing on the street.

No, that story is all about finding breast cancer early enough to result in a 98 percent cure rate. The rest of the story is the reason I keep this blog.

The whole story explains it's not a cure rate, because there is no cure yet for breast cancer or any other type of cancer. It's a survival rate, and it's one for only five years out. Not a lot of time by my reckoning, especially not when you're diagnosed at 37.5 years old, as I was. There's also no "early enough," because women diagnosed at any stage and with any statistics going in can one day, any day progress to Stage IV, which is always terminal. This progression will happen to 20-30% of those who get breast cancer.

Myself? Like most who get breast cancer early, mine was extremely aggressive--grade 3 out of 3, Her2Neu+++ and had spread to three out of twelve lymph nodes as well as out of one lymph node and into the tissues surrounding it. I was stage IIB, very close to IIIa, so not early stage. Middle stage.

But there isn't enough research to say if my cancer is going to come back and kill me or if I will die of something else one day. Every single survivor is in this boat of uncertainty.

And we're the lucky ones, because we haven't yet found ourselves in that 30 percent who know where this is all headed. Thirty percent--it's a rate that hasn't changed in more than 20 years!!!!

Cure NOW!!!!!!!!!!!!!!


**Thank you to the women who commented on this article for the statistics I've been searching for, which I've included in this article.

Just Read the Comments on This One

http://fairoaks-carmichael.patch.com/articles/survivor-heads-local-susan-g-komen-affiliate#comment_5071826

Baby, It's Cold Out There

Be glad if you're not out there having to look for a job right now. Things are brutal.

I still can't believe that the first thing I was told in a recent interview was: "This year, all those hired for this position will not be getting time away from work for lunch. You will still get to eat a lunch, but you will be working when you do so."

Wow, that came out of left field! I had about ten questions as a result of hearing this, but of course, this is a job interview, and if I wanted the job no questions were welcome. This was a lump it or leave it statement if ever I've heard one.

Nevertheless, anything else was drowned out by the questions racing through my mind: "What? Isn't that illegal? Does everyone working here have this requirement this year? Why are they doing this--to save money? Do you (the many people sitting around the table of high rank) follow this as well? If not, why not?

A little Internet searching gave me some basic answers; I'll never get the specific ones I'm still wondering about. Making someone work during their lunch hour is illegal in the state where I lived most of my life. Apparently, it's not illegal in the new state I call home, though it is beyond the pale enough to mention first and foremost in an interview.

However, just because I'm in a different locale doesn't mean my view on this practice is any different than it was before. It stinks, and if it isn't illegal, it should be. It should always be illegal.

Now before you go telling me you have to work through your lunch, too, think about if that isn't a choice you make. This question will help you answer that: When you were hired, did they inform you specifically that you would never, ever get a lunch free from duty?

I've worked many jobs where the work essentially required that I work through lunch or skip lunch entirely to meet deadlines. But that was never an all the time thing (though at times it might have felt it) nor was it a condition of my employment. There were also days I left the building to go home for lunch or to meet others out for lunch. And if I wanted to, I could negotiate leaving early, etc. in exchange for the time I worked over lunch.

So absolutely 100% different. That those lowest on the totem pole are being required to accept these conditions to employment scares me. It should scare all of us.

They're Looking Into Breast Cancer after Pregnancy

As someone affected by this and someone who has met countless women in the same boat, this line of research seems important.

Long ago, I was looking at article after article in the New England Journal of Medicine online that described exactly my experience--having a child at an older age (almost 35) and then discovering breast cancer within three years.

The researchers of this latest study are calling breast cancer associated with pregnancy any bc found within five years of giving birth.

When I was reading through the journal articles some years ago, it seemed this is similar to the increased risk women who use Hormone Replacement Therapy face. It seems a concentrated burst of hormones for any reason can trigger bc, especially as a woman gets older than 30.

Anyway, very interesting research. I can't wait to read more about what they discover.