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At this time of year and beforebirthdays, people are always looking for gifts that people withdiabetes will appreciate. Joslin Diabetes has a list and somesuggestions that could be appropriate. I will say that the bookslisted in the blog should be considered with care as the AmericanDiabetes Association is not known for low carbohydrate cookbooks, butsome may appreciate them.
Books of any kind should be purchasedwith care because a book about type 1 diabetes may be veryappropriate for a person with type 1 diabetes, but not appreciated bya person with type 2 diabetes. Another consideration should be aboutthe subject matter covered in the book. Also, consider if the personis likes to read. A book that I received as a combination birthdayand Christmas present is much appreciated – Joslin's DiabetesDeskbook, Updated Second Edition. Read my review here. Youmay read a little about it here and there are some other books aswell. Yes, they are advertised for healthcare professionals, butsometimes these can benefit patients as well. I will be asking forthe Educating Your Patient with Diabetes but only afterI have a chance to see the book and preview the table of contents andlook at a few chapters.
These books and many other excellentbooks may be found at Amazon and I will provide this link. There areseveral pages of diabetes books. Most are excellent to good, butthere are a few I would not want in my library.
One suggestion from the Joslin blog is thepossible purchase of an electronic food scale that calculates thecarb counts of food. This may be on the expensive side for manypeople, but could be of value if you have the funds. One the lessexpensive side is items like a pedometer or resistance bands. Readthe entire Joslin blog as ideas are presented to the end of the blog.
Even at this late date, do not forgetthat a printout of books can be given and specify the amount that youare willing to pay for the book or books. I have had people do thisfor me, I always enjoyed looking at the selection they were offering,and I made it a point always to choose the best book I was interestedin and could stay below what they were willing to spend. One time, Idid ask for one book over the amount offered, but I made sure that Ipaid the excess. The book had just been published and I had plannedto buy it myself, but had hints about books so I had held off. Healso wanted the book so I told him that we could split the cost, hewould let me use it for six months until his birthday, and then hecould own it.
3 Ocak 2013 Perşembe
Wheat Belly Review
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I have now finished reading WheatBelly by William Davis MD. Yes, I am late to the reporting. Therefore, this will be a review that is different than what manywrite. I knew that David Mendosa and Tom Naughton had writtenreviews and I sought out their blogs. After recording them, I wentto the search engine and typed in “wheat belly by william davisreview” and pressed the enter key. I received 147,000 results. Atfirst glance, not all entries are book reviews and of course, manyitems are repeated several times with some different wording.
Before going further, I will say thattaking so long to read the book helped me understand many of thepoints Dr. Davis put forth. I have greatly reduced the amount ofwheat I consume by about 90%, and the weight is declining. I haveenjoyed reading many of the reviews that were written even before Ipurchased the book. I am happy to report that many of the reviewsare positive and the one review that disputes some of the studies Dr.Davis uses is not negative either.
The Grain Foods Foundation is naturallysticking out against Dr. Davis because he is a threat to theirbusiness. Most of the time they quote the same unproven points aboutgrains, especially whole grains, are healthy for us. They have theirexperts and very few studies that conclusively support this, but bothsides of this issue have “experts.” You may read several blogs on the GrainFoods Foundation blog site here. Sometimes the comments are betterthan the blog. There are several blogs following this in the monthof September 2011.
I would urge everyone to read a blog byPeter Bronski, who with his wife, have the blog, “No Gluten, NoProblem” blog site. I think he does raise some good issues. I willadmit that in Chapter 7, Dr. Davis is a bit glib in his discussion ofdiabetes. Eliminating wheat for many people with type 2 diabetes, dohave good results and some are able to eliminate medications totally– at least until they revert to old habits. Diabetes is notcurable yet, but people reading chapter may think they are cured.
David Mendosa wrote his review here. Tom Naughton had a two-part interview here and here. Tom also hadtwo very good articles about the reactions of the grain producershere and here. Tom makes valid points and I enjoy reading his blogs. Then go to BalancedBites and read the review by Diane Sanfilippo,BS, Certified Nutrition Consultant, one of four women writing for theblog site. After completing that blog, take time to read the reviewby Dana Carpender on “Hold the Toast” blog site, and author of“500 Low Carb Recipes.”
If you haven't read Wheat Bellyby William Davis MD, it is worth the time and there is muchto be said for the fact that wheat is not the wheat of biblical timesor even 100 years ago. It has been so perverted with geneticsengineering that is does not resemble the wheat of old. It can causediabetes and other health problems and is a real problem similar tohigh fructose corn syrup. Our modern agriculture is trying to feedthe world, but in doing so has created health problems that arespreading around the world. We need someone to point this out, likeDr. Davis.
I have now finished reading WheatBelly by William Davis MD. Yes, I am late to the reporting. Therefore, this will be a review that is different than what manywrite. I knew that David Mendosa and Tom Naughton had writtenreviews and I sought out their blogs. After recording them, I wentto the search engine and typed in “wheat belly by william davisreview” and pressed the enter key. I received 147,000 results. Atfirst glance, not all entries are book reviews and of course, manyitems are repeated several times with some different wording.
Before going further, I will say thattaking so long to read the book helped me understand many of thepoints Dr. Davis put forth. I have greatly reduced the amount ofwheat I consume by about 90%, and the weight is declining. I haveenjoyed reading many of the reviews that were written even before Ipurchased the book. I am happy to report that many of the reviewsare positive and the one review that disputes some of the studies Dr.Davis uses is not negative either.
The Grain Foods Foundation is naturallysticking out against Dr. Davis because he is a threat to theirbusiness. Most of the time they quote the same unproven points aboutgrains, especially whole grains, are healthy for us. They have theirexperts and very few studies that conclusively support this, but bothsides of this issue have “experts.” You may read several blogs on the GrainFoods Foundation blog site here. Sometimes the comments are betterthan the blog. There are several blogs following this in the monthof September 2011.
I would urge everyone to read a blog byPeter Bronski, who with his wife, have the blog, “No Gluten, NoProblem” blog site. I think he does raise some good issues. I willadmit that in Chapter 7, Dr. Davis is a bit glib in his discussion ofdiabetes. Eliminating wheat for many people with type 2 diabetes, dohave good results and some are able to eliminate medications totally– at least until they revert to old habits. Diabetes is notcurable yet, but people reading chapter may think they are cured.
David Mendosa wrote his review here. Tom Naughton had a two-part interview here and here. Tom also hadtwo very good articles about the reactions of the grain producershere and here. Tom makes valid points and I enjoy reading his blogs. Then go to BalancedBites and read the review by Diane Sanfilippo,BS, Certified Nutrition Consultant, one of four women writing for theblog site. After completing that blog, take time to read the reviewby Dana Carpender on “Hold the Toast” blog site, and author of“500 Low Carb Recipes.”
If you haven't read Wheat Bellyby William Davis MD, it is worth the time and there is muchto be said for the fact that wheat is not the wheat of biblical timesor even 100 years ago. It has been so perverted with geneticsengineering that is does not resemble the wheat of old. It can causediabetes and other health problems and is a real problem similar tohigh fructose corn syrup. Our modern agriculture is trying to feedthe world, but in doing so has created health problems that arespreading around the world. We need someone to point this out, likeDr. Davis.
Have You Been Evaluated for Patient Adherence?
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This is the first in an on going seriesfrom Joslin's Diabetes Deskbook. Thebook is interesting as a patient and I will write blogs about theexcerpts from Diabetesin Control dot com. There is much available for good discussion.
The first two paragraphs are a key tothis discussion. “The gap in meetingclinical targets is in large part due to the gap that presentlyexists between actual and optimal treatment goals and strategies forpatients and physicians.
Even whenpatients have an ongoing relationship with their primary physician,they often fall short of the recommended treatment goals due to gapsbetween actual and ideal treatment strategies. Collaboration is thekey to closing this gap. Your patients are the most underusedresource in your clinical practice. If you and your patients are ableto jointly establish aligned goals, they will improve their health,and you will improve the efficiency of your practice and outcomesthat you can achieve.”
Often there is a difference of opinionabout optimal treatment goals between patients and physicians. Sometimes this is on purpose and at other times, it is difficult todetermine why they are different. In reading the deskbook, it iseasy to discern some of the reasons for the differences in goals. Younger patients may want to manage their diabetes very stringentlyand the physician does not want the goals to be so tight.
Then when it comes to the elderly, someare still capable of tight management and the physicians aredemanding that they loosen up their management. This is when thephysician needs to step back and reassess the patient to determine ifthey are indeed capable of this maintenance and if encouragement isin order rather that changing goals.
The five steps outlined in this excerptare enlightening, if only more physicians would see them as valuable. The patient and physician may have a long history, but this does notmean that the physician is in command. The steps include:
First Step - When you enter theroom where the patient is, start with a simple open-ended questionlike "What brings you in today?" Other questions are alsouseful and the doctor needs to listen to the patient. Most patientstake about 32 seconds to create the answer and finish theirstatement. Most physicians make the mistake of interrupting at about23 seconds to ask another question or redirect the discussion. Thismay make it seem to the patient that the doctor is in autopilot andnot listening to them.
Second Step – Be sure to helpthe patient focus on their risk factors, and to appreciate theirclinical importance. Many doctors fail here by not explainingcarefully the risk factors and working with the patient to help themunderstand them. The discussion of all the risk factors at once doesnot work... ”This unfocused shotgunapproach often leads to inaction, or to the wrong action.”
Third Step - If you and thepatient have succeeded in reaching an agreement about a general goalsuch as A1c, then ask the patient how they would like to get there. Letting the patient set a goal can be guided to a point, to make thepatient desire to take the action to obtain a better A1c. However,the doctor cannot set the goal and expect the patient to meet it. When the patient sets a goal that is attainable and does, this is thepositive reinforcement that the patient needs and will work for othergoals knowing that the doctor is there with him/her to make sure thegoal is attainable. If the patient falls short and the doctor hasthe daily data – blood glucose readings, food log, and otherrecords the patient has maintained, the doctor should be able tooffer guidance to help the patient achieve the goal by the nextvisit. Fourth Step - Having chosen agoal and a treatment strategy, it is important to encourage thepatient not to lose momentum. “Rememberthat there are different paths to achieving the same result, withdifferent combinations of lifestyle changes and medications. If theirstrategy doesn't seem optimal, you can then suggest: "I havesome information on what strategies have worked for other patientssimilar to you. Would you like to hear some of these possibilities?"” Different techniques work fordifferent patients and doctors need to work with patients to assistthem and thereby increase their value and help the patient keep thedesire to do more to meet the goal.Fifth Step - Keep Cycling - Thehardest work involves the first four steps described above. Oftenphysicians and patients come up short of reaching their goals becausethey lose momentum. Encouragement is important. Because the patientis the person managing their diabetes on a daily basis, knowing thatthe doctor is helping them set reasonable goals and assisting them inachieving these goals, makes the doctor more appreciated.This statement from the excerpt isimportant, and I quote, “This is a greattime to be treating people with diabetes, and those without diabeteswho are at risk for cardiovascular disease. Clinical results areimproving dramatically; and while clinical gaps continue to exist,they are responsive to a number of different approaches. Thisprovides an opportunity for the physician, but an opportunity that isbest addressed through collaboration with your patient. Thephysician's role is to evaluate the patient's disease state, listencarefully to their concerns, and then provide the needed informationthat will help to inform and form the patient's choices. The patientcontrols their disease, whether they want to or not. You need to bethe best guide possible in their journey toward health.”
This is the first in an on going seriesfrom Joslin's Diabetes Deskbook. Thebook is interesting as a patient and I will write blogs about theexcerpts from Diabetesin Control dot com. There is much available for good discussion.
The first two paragraphs are a key tothis discussion. “The gap in meetingclinical targets is in large part due to the gap that presentlyexists between actual and optimal treatment goals and strategies forpatients and physicians.
Even whenpatients have an ongoing relationship with their primary physician,they often fall short of the recommended treatment goals due to gapsbetween actual and ideal treatment strategies. Collaboration is thekey to closing this gap. Your patients are the most underusedresource in your clinical practice. If you and your patients are ableto jointly establish aligned goals, they will improve their health,and you will improve the efficiency of your practice and outcomesthat you can achieve.”
Often there is a difference of opinionabout optimal treatment goals between patients and physicians. Sometimes this is on purpose and at other times, it is difficult todetermine why they are different. In reading the deskbook, it iseasy to discern some of the reasons for the differences in goals. Younger patients may want to manage their diabetes very stringentlyand the physician does not want the goals to be so tight.
Then when it comes to the elderly, someare still capable of tight management and the physicians aredemanding that they loosen up their management. This is when thephysician needs to step back and reassess the patient to determine ifthey are indeed capable of this maintenance and if encouragement isin order rather that changing goals.
The five steps outlined in this excerptare enlightening, if only more physicians would see them as valuable. The patient and physician may have a long history, but this does notmean that the physician is in command. The steps include:
First Step - When you enter theroom where the patient is, start with a simple open-ended questionlike "What brings you in today?" Other questions are alsouseful and the doctor needs to listen to the patient. Most patientstake about 32 seconds to create the answer and finish theirstatement. Most physicians make the mistake of interrupting at about23 seconds to ask another question or redirect the discussion. Thismay make it seem to the patient that the doctor is in autopilot andnot listening to them.
Second Step – Be sure to helpthe patient focus on their risk factors, and to appreciate theirclinical importance. Many doctors fail here by not explainingcarefully the risk factors and working with the patient to help themunderstand them. The discussion of all the risk factors at once doesnot work... ”This unfocused shotgunapproach often leads to inaction, or to the wrong action.”
Third Step - If you and thepatient have succeeded in reaching an agreement about a general goalsuch as A1c, then ask the patient how they would like to get there. Letting the patient set a goal can be guided to a point, to make thepatient desire to take the action to obtain a better A1c. However,the doctor cannot set the goal and expect the patient to meet it. When the patient sets a goal that is attainable and does, this is thepositive reinforcement that the patient needs and will work for othergoals knowing that the doctor is there with him/her to make sure thegoal is attainable. If the patient falls short and the doctor hasthe daily data – blood glucose readings, food log, and otherrecords the patient has maintained, the doctor should be able tooffer guidance to help the patient achieve the goal by the nextvisit. Fourth Step - Having chosen agoal and a treatment strategy, it is important to encourage thepatient not to lose momentum. “Rememberthat there are different paths to achieving the same result, withdifferent combinations of lifestyle changes and medications. If theirstrategy doesn't seem optimal, you can then suggest: "I havesome information on what strategies have worked for other patientssimilar to you. Would you like to hear some of these possibilities?"” Different techniques work fordifferent patients and doctors need to work with patients to assistthem and thereby increase their value and help the patient keep thedesire to do more to meet the goal.Fifth Step - Keep Cycling - Thehardest work involves the first four steps described above. Oftenphysicians and patients come up short of reaching their goals becausethey lose momentum. Encouragement is important. Because the patientis the person managing their diabetes on a daily basis, knowing thatthe doctor is helping them set reasonable goals and assisting them inachieving these goals, makes the doctor more appreciated.This statement from the excerpt isimportant, and I quote, “This is a greattime to be treating people with diabetes, and those without diabeteswho are at risk for cardiovascular disease. Clinical results areimproving dramatically; and while clinical gaps continue to exist,they are responsive to a number of different approaches. Thisprovides an opportunity for the physician, but an opportunity that isbest addressed through collaboration with your patient. Thephysician's role is to evaluate the patient's disease state, listencarefully to their concerns, and then provide the needed informationthat will help to inform and form the patient's choices. The patientcontrols their disease, whether they want to or not. You need to bethe best guide possible in their journey toward health.”
Joslin Advocates for SMBG
To contact us Click HERE
This is an interesting turn of events. Normally I am the one complaining about the lack of self-monitoringof blood glucose, but now Joslin Diabetes Center is asking in theirbook Joslin's Diabetes Deskbook, 2nd Ed, Excerpt #4: Do YourPatients Self-Monitor Their Blood Glucose Enough? For this, Ihave to ask if they will appeal to the Centers for Medicare andMedicaid Services (CMS) to up the number of test strips that diabetespatients can be reimbursed.
I complain because people do not testenough and use the results to help manage their diabetes in as moreinformed manner. I appreciate Joslin's statement, “Itis imperative that people who are self-monitoring know what to dowith the results of their glucose checking so that they can takeactive steps to improve their control. They should be giveninstructions on how to interpret their results, what they can dothemselves in response to the results, and when they should call forhelp.” At least the authorsknow and understand the importance of education and that it should bepart of everydiabetes treatment plan.
Too many doctors do not even prescribea meter and test strips for patients on oral medications, meaningpatients with type 2 diabetes. This excerpt should be requiredreading for these self-important doctors. All doctors do eithergive out meters and prescribe test strips or inform their patientswhere to obtain testing supplies for people with type 1 diabetes andfor people with type 2 diabetes on insulin.
I like what is covered in chapter 3. They state that, “Goals of diabetestreatment need to be defined in terms of self-monitoring results.” This is a great statement, which patients with diabetes need tounderstand. This brings both patients and physicians into thepicture and makes each a participant. The patients are responsiblefor gathering the information, doing this diligently, and providingthis information to the physicians. Then the physicians areresponsible for taking this information and helping the patients setgoals (whether new or revised) to help then manage their diabetesmore effectively.
In summary, here are a few reasons whySMBG should be performed:1. To provide data about glucose patterns that can be used by thehealthcare team, working with the patient, to make treatmentmanageable.2. To provide data with which patients themselves can make dailydecisions on treatment adjustments.3. To provide feedback on how effectively the individual is managingdaily self-care routines, including medical nutrition therapy,physical activity, and medication use.
These are by no means the only reasonsand the tables uses are adapted from the American DiabetesAssociation and are therefore not ideal, but can only be interpretedas suggestive for patients that are elderly or have other diseases,which affect their ability to manage their diabetes more effectively. Those patients that are younger and fully able to manage theirdiabetes need to consider using these tables.
Another area of concern is a few of the“diabetes coaches” that tell their people not to give theinformation to their doctors. Granted some doctors do not know whatto do with the information, but they are on their way out of practiceas patients become more empowered. I have crossed paths with a fewof these “coaches” and know they are attempting to hide what theyare doing. Not that they are giving out advice that is out of line,but too often these “coaches” are practicing medicine without alicense. They may not have intended to, but they do cross the linetime after time.
This is an interesting turn of events. Normally I am the one complaining about the lack of self-monitoringof blood glucose, but now Joslin Diabetes Center is asking in theirbook Joslin's Diabetes Deskbook, 2nd Ed, Excerpt #4: Do YourPatients Self-Monitor Their Blood Glucose Enough? For this, Ihave to ask if they will appeal to the Centers for Medicare andMedicaid Services (CMS) to up the number of test strips that diabetespatients can be reimbursed.
I complain because people do not testenough and use the results to help manage their diabetes in as moreinformed manner. I appreciate Joslin's statement, “Itis imperative that people who are self-monitoring know what to dowith the results of their glucose checking so that they can takeactive steps to improve their control. They should be giveninstructions on how to interpret their results, what they can dothemselves in response to the results, and when they should call forhelp.” At least the authorsknow and understand the importance of education and that it should bepart of everydiabetes treatment plan.
Too many doctors do not even prescribea meter and test strips for patients on oral medications, meaningpatients with type 2 diabetes. This excerpt should be requiredreading for these self-important doctors. All doctors do eithergive out meters and prescribe test strips or inform their patientswhere to obtain testing supplies for people with type 1 diabetes andfor people with type 2 diabetes on insulin.
I like what is covered in chapter 3. They state that, “Goals of diabetestreatment need to be defined in terms of self-monitoring results.” This is a great statement, which patients with diabetes need tounderstand. This brings both patients and physicians into thepicture and makes each a participant. The patients are responsiblefor gathering the information, doing this diligently, and providingthis information to the physicians. Then the physicians areresponsible for taking this information and helping the patients setgoals (whether new or revised) to help then manage their diabetesmore effectively.
In summary, here are a few reasons whySMBG should be performed:1. To provide data about glucose patterns that can be used by thehealthcare team, working with the patient, to make treatmentmanageable.2. To provide data with which patients themselves can make dailydecisions on treatment adjustments.3. To provide feedback on how effectively the individual is managingdaily self-care routines, including medical nutrition therapy,physical activity, and medication use.
These are by no means the only reasonsand the tables uses are adapted from the American DiabetesAssociation and are therefore not ideal, but can only be interpretedas suggestive for patients that are elderly or have other diseases,which affect their ability to manage their diabetes more effectively. Those patients that are younger and fully able to manage theirdiabetes need to consider using these tables.
Another area of concern is a few of the“diabetes coaches” that tell their people not to give theinformation to their doctors. Granted some doctors do not know whatto do with the information, but they are on their way out of practiceas patients become more empowered. I have crossed paths with a fewof these “coaches” and know they are attempting to hide what theyare doing. Not that they are giving out advice that is out of line,but too often these “coaches” are practicing medicine without alicense. They may not have intended to, but they do cross the linetime after time.
Sulfonylureas May Increase Cardiovascular Events
To contact us Click HERE
Sulfonylureas seem to be coming undermore scrutiny lately. This is apparently justified on several frontsbecause of changes that have alerted researchers of some very realproblems. Many of these problems were not part of the requirementsor perceived requirements when the drugs were originally approved bythe Food and Drug Administration.
Gretchen Becker wrote about this class of drugs causing pancreas fatigue and decline of the functionality ofthese drugs when used for extended periods. While I am a believer ofthis, this discussion is still controversial and more research isneeded to prove this beyond argument. I am one of the fortunatepeople because of my allergy so this is not something I need toconcern myself with in my lifetime. This was also the reason that Isuspect my doctor was so willing to move me to insulin when the oralmedications were not helping manage my blood glucose levels.
Recently, another concern has beenbrought to the front. The American Diabetes Association stated thatsulfonylurea drugs are insulin-production stimulants that have beenin use since the 1950s. Metformin, also dating to the 1950s, works bylowering blood glucose levels by reducing the quantity of glucoseentering the blood. A recent multi-year study published in the Nov.6 issue of the journal Annals of Internal Medicine found thatsulfonylurea use was associated with a 21 percent increased risk ofacute myocardial infarction, stroke, or death.
For comparison purposes to determinethe impact of the two drugs on cardiovascular results, a pool of morethan 250,000 veterans over the age of 18 was used. No average age ofthe study is given and none of the participants had any seriousmedical complications other than diabetes at the start. Almost100,000 were placed on a standard regimen of sulfonylurea therapy,while slightly over 155,000 took metformin.
The authors stated that theirobservations were consistent with previous indications that metforminis associated with fewer serious heart issues than sulfonylureas. Even with this, the researchers stated that the findings suggestmetformin should be the oral treatment of choice. They did stressmore testing is needed to determine if their findings would apply towomen or other racial and ethnic groups since 97 percent of theirstudy participants were men and 75 percent were white.
While the findings pointing to thissituation have probably been there for several decades the U.S. Foodand Drug Administration did not require testing for cardiovascularoutcomes when looking at diabetes drugs until very recently.
The drugs used for the study includefor metformin, the brand names of Glucophage and Fortamet (orGlucophage XR). The drugs used for sulfonylureas include glyburide(brand name - DiaBeta) and glipizide (brand name - Glucotrol). Noother sulfonylureas were mentioned, therefore, we cannot know if theothers are more or less likely to cause cardiovascular problems.
Sulfonylureas seem to be coming undermore scrutiny lately. This is apparently justified on several frontsbecause of changes that have alerted researchers of some very realproblems. Many of these problems were not part of the requirementsor perceived requirements when the drugs were originally approved bythe Food and Drug Administration.
Gretchen Becker wrote about this class of drugs causing pancreas fatigue and decline of the functionality ofthese drugs when used for extended periods. While I am a believer ofthis, this discussion is still controversial and more research isneeded to prove this beyond argument. I am one of the fortunatepeople because of my allergy so this is not something I need toconcern myself with in my lifetime. This was also the reason that Isuspect my doctor was so willing to move me to insulin when the oralmedications were not helping manage my blood glucose levels.
Recently, another concern has beenbrought to the front. The American Diabetes Association stated thatsulfonylurea drugs are insulin-production stimulants that have beenin use since the 1950s. Metformin, also dating to the 1950s, works bylowering blood glucose levels by reducing the quantity of glucoseentering the blood. A recent multi-year study published in the Nov.6 issue of the journal Annals of Internal Medicine found thatsulfonylurea use was associated with a 21 percent increased risk ofacute myocardial infarction, stroke, or death.
For comparison purposes to determinethe impact of the two drugs on cardiovascular results, a pool of morethan 250,000 veterans over the age of 18 was used. No average age ofthe study is given and none of the participants had any seriousmedical complications other than diabetes at the start. Almost100,000 were placed on a standard regimen of sulfonylurea therapy,while slightly over 155,000 took metformin.
The authors stated that theirobservations were consistent with previous indications that metforminis associated with fewer serious heart issues than sulfonylureas. Even with this, the researchers stated that the findings suggestmetformin should be the oral treatment of choice. They did stressmore testing is needed to determine if their findings would apply towomen or other racial and ethnic groups since 97 percent of theirstudy participants were men and 75 percent were white.
While the findings pointing to thissituation have probably been there for several decades the U.S. Foodand Drug Administration did not require testing for cardiovascularoutcomes when looking at diabetes drugs until very recently.
The drugs used for the study includefor metformin, the brand names of Glucophage and Fortamet (orGlucophage XR). The drugs used for sulfonylureas include glyburide(brand name - DiaBeta) and glipizide (brand name - Glucotrol). Noother sulfonylureas were mentioned, therefore, we cannot know if theothers are more or less likely to cause cardiovascular problems.
2 Ocak 2013 Çarşamba
Do You Have Happy or Unhappy Feet?
To contact us Click HERE
Most articles about shoes are writtenfor women, by women, and I do not totally understand why. Is itbecause women own more pairs of shoes and require a pair for everydress they wear and others for when they hike, or get out in thecountry? Men often wear shoes that do not fit properly and then theywonder why they have sore feet and areas on their feet that are hardbecause of calluses that aren't taken care of until sores develop.
Why is that people with diabetes refuseto take care of their feet until forced to because of a possibleamputation looming. Yes, I am being anything but understanding orsympathetic toward people who have diabetes and insist on abusingtheir feet. When they start complaining about feet that hurt, theyknow that I will not feel any sympathy and may be very difficult toget along with. Yes, I am aware of this being the wrong way to makefriends and influence people. Even in the diabetes clinic, I seepeople wearing shoes that are wrong – spike heels, flip-flops,sandals with poor heal support and other improper shoes.
I have finally met two doctors that arevery strong advocates for proper footwear. I could not believe itwhen I heard it, but one doctor will not treat patients for footproblems, men or women, wearing improper footwear. The type 2patient, a man wearing flip-flops had cut his foot at home afterdropping a glass container, which broke in many pieces. The doctortold him he would need to go the emergency room for treatment. TheER doctor did treat him, but said he would need to purchase a properset of house slippers or shoes to continue being treated if he hadproblems healing.
Both doctors are very set on peoplewith diabetes wearing proper footwear. The doctor that has his ownpractice does have a foot measuring device to show people the correctsize and posters showing the incorrect footwear for both men andwomen. If you don't want to be embarrassed when he insists onmeasuring your foot and tells you your shoes are too small, you willwant to avoid this doctor. His advice is correct though as manypeople insist on wearing shoes that are too small for them. A fewpeople do wear shoes that are too large. This is an invitation fordeveloping blisters and calluses.
This article from WebMD has someexcellent pointers and even if the United Kingdom is the setting, theinformation is still valid. The information given shows that only 25to 40 percent of people with diabetes wear shoes that are the correctsize. Because the information given is great, I will quote it. “When people with diabetes startexperiencing nerve damage or numbness, they often gravitate towardshoes that are too small because tight shoes make it easier for themto feel the snugness on their feet. They mistake that tightness forgood support. Instead, they need to wear shoes with comfortable --not tight – support.”
“Once youknow your correct size, here are nine guidelines for choosing shoeswhen you have diabetes:1. Look for shoes that don't come to a pointat the toe. Instead, choose shoes with a spacious "toe box"-- the forward tip of the shoe where the toes are. That way your toeswon't be crushed together. When your toes have space, it lessens thechance of corns, calluses, and blisters that can turn into ulcers andeventually infections. 2. If the shoe's insole is removable, takeit out and step on it. Your foot should fit comfortably on top of itwith no overlap. If your foot is bigger than the insole, then yourfoot will be crammed inside the shoe when you wear it. Choose adifferent shoe. 3. Avoid high-heeled shoes because they putunnatural pressure on the ball of your foot. If you have neuropathy,you may not realize that you are sore there or even getting calluses.High heels also can cause balance issues and ligament damage. 4. Steer clear of sandals, flip flops, orother open-toe shoes. Straps can put pressure on parts of your foot,leading to sores and blisters. In addition, open shoes can leave yoususceptible to injury like cuts. They also can allow gravel and smallstones to get inside the shoe. These can rub against your feet,causing sores and blisters. 5. Consider laced shoes instead of slip-ons.They often provide better support and a better fit. 6. Try on shoes at the end of the day.That's when your feet are more likely to be a little swollen. Ifshoes are comfortable when your feet are swollen, they should feelfine the rest of the time, too. 7. Don't buy shoes if they areuncomfortable, planning to break them in as you wear them. Shoesshould feel good when you first try them on. If you take off newshoes after wearing them a couple hours and find red, sensitivespots, don't wear them again. 8. Buy at least two pairs of supportive,comfortable shoes. Each pair will likely have different pressurepoints on your feet, so it will relieve the pressure when youalternate wearing different shoes. It will also allow your shoes todry and air out when you don't wear them every day. 9. In some cases, the cost of special shoesis covered by Medicare for people with diabetes. You must meetcertain criteria -- such as foot deformities, past foot ulcers, orcalluses that can lead to nerve damage -- and must have a doctor'sprescription. Talk to your podiatrist or primary care doctor for moreinformation.”
The above is areason everyone with diabetes should see a podiatrist at leastyearly, if not quarterly to have their feet examined and problemsfound early and corrected.
If you find shoesthat fit correctly, wear them at all times – except when sleeping. Do not go barefoot, even around you own house. This is where mostproblems start for people that have neuropathy or other footnumbness, as they don't feel anything when they step on somethingsharp and injure themselves. Then the area becomes infected andproblems start.
Now one finalword of advice, before you opt for the overly uncomfortable shoes onspecial occasions, talk with a podiatrist first. Let the podiatristtell you if these shoes can be worn for short periods of time likethat special party. If the podiatrist advises against this, dofollow the directions as it is your feet and you don't want to seethe doctor later to correct the damage you could have prevented.
Most articles about shoes are writtenfor women, by women, and I do not totally understand why. Is itbecause women own more pairs of shoes and require a pair for everydress they wear and others for when they hike, or get out in thecountry? Men often wear shoes that do not fit properly and then theywonder why they have sore feet and areas on their feet that are hardbecause of calluses that aren't taken care of until sores develop.
Why is that people with diabetes refuseto take care of their feet until forced to because of a possibleamputation looming. Yes, I am being anything but understanding orsympathetic toward people who have diabetes and insist on abusingtheir feet. When they start complaining about feet that hurt, theyknow that I will not feel any sympathy and may be very difficult toget along with. Yes, I am aware of this being the wrong way to makefriends and influence people. Even in the diabetes clinic, I seepeople wearing shoes that are wrong – spike heels, flip-flops,sandals with poor heal support and other improper shoes.
I have finally met two doctors that arevery strong advocates for proper footwear. I could not believe itwhen I heard it, but one doctor will not treat patients for footproblems, men or women, wearing improper footwear. The type 2patient, a man wearing flip-flops had cut his foot at home afterdropping a glass container, which broke in many pieces. The doctortold him he would need to go the emergency room for treatment. TheER doctor did treat him, but said he would need to purchase a properset of house slippers or shoes to continue being treated if he hadproblems healing.
Both doctors are very set on peoplewith diabetes wearing proper footwear. The doctor that has his ownpractice does have a foot measuring device to show people the correctsize and posters showing the incorrect footwear for both men andwomen. If you don't want to be embarrassed when he insists onmeasuring your foot and tells you your shoes are too small, you willwant to avoid this doctor. His advice is correct though as manypeople insist on wearing shoes that are too small for them. A fewpeople do wear shoes that are too large. This is an invitation fordeveloping blisters and calluses.
This article from WebMD has someexcellent pointers and even if the United Kingdom is the setting, theinformation is still valid. The information given shows that only 25to 40 percent of people with diabetes wear shoes that are the correctsize. Because the information given is great, I will quote it. “When people with diabetes startexperiencing nerve damage or numbness, they often gravitate towardshoes that are too small because tight shoes make it easier for themto feel the snugness on their feet. They mistake that tightness forgood support. Instead, they need to wear shoes with comfortable --not tight – support.”
“Once youknow your correct size, here are nine guidelines for choosing shoeswhen you have diabetes:1. Look for shoes that don't come to a pointat the toe. Instead, choose shoes with a spacious "toe box"-- the forward tip of the shoe where the toes are. That way your toeswon't be crushed together. When your toes have space, it lessens thechance of corns, calluses, and blisters that can turn into ulcers andeventually infections. 2. If the shoe's insole is removable, takeit out and step on it. Your foot should fit comfortably on top of itwith no overlap. If your foot is bigger than the insole, then yourfoot will be crammed inside the shoe when you wear it. Choose adifferent shoe. 3. Avoid high-heeled shoes because they putunnatural pressure on the ball of your foot. If you have neuropathy,you may not realize that you are sore there or even getting calluses.High heels also can cause balance issues and ligament damage. 4. Steer clear of sandals, flip flops, orother open-toe shoes. Straps can put pressure on parts of your foot,leading to sores and blisters. In addition, open shoes can leave yoususceptible to injury like cuts. They also can allow gravel and smallstones to get inside the shoe. These can rub against your feet,causing sores and blisters. 5. Consider laced shoes instead of slip-ons.They often provide better support and a better fit. 6. Try on shoes at the end of the day.That's when your feet are more likely to be a little swollen. Ifshoes are comfortable when your feet are swollen, they should feelfine the rest of the time, too. 7. Don't buy shoes if they areuncomfortable, planning to break them in as you wear them. Shoesshould feel good when you first try them on. If you take off newshoes after wearing them a couple hours and find red, sensitivespots, don't wear them again. 8. Buy at least two pairs of supportive,comfortable shoes. Each pair will likely have different pressurepoints on your feet, so it will relieve the pressure when youalternate wearing different shoes. It will also allow your shoes todry and air out when you don't wear them every day. 9. In some cases, the cost of special shoesis covered by Medicare for people with diabetes. You must meetcertain criteria -- such as foot deformities, past foot ulcers, orcalluses that can lead to nerve damage -- and must have a doctor'sprescription. Talk to your podiatrist or primary care doctor for moreinformation.”
The above is areason everyone with diabetes should see a podiatrist at leastyearly, if not quarterly to have their feet examined and problemsfound early and corrected.
If you find shoesthat fit correctly, wear them at all times – except when sleeping. Do not go barefoot, even around you own house. This is where mostproblems start for people that have neuropathy or other footnumbness, as they don't feel anything when they step on somethingsharp and injure themselves. Then the area becomes infected andproblems start.
Now one finalword of advice, before you opt for the overly uncomfortable shoes onspecial occasions, talk with a podiatrist first. Let the podiatristtell you if these shoes can be worn for short periods of time likethat special party. If the podiatrist advises against this, dofollow the directions as it is your feet and you don't want to seethe doctor later to correct the damage you could have prevented.
Nutrients - Vitamin B12
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Vitamin B12
OverviewAll B vitamins are water-soluble,meaning that the body does not store them. Vitamin B12, also calledcobalamin, is one of 8 B vitamins. It is important to know that allB vitamins help the body convert food (carbohydrates) into fuel(glucose), which is used to produce energy. These B vitamins,commonly referred to as B complex vitamins, also help the body usefats and protein. B complex vitamins are also used for healthy skin,hair, eyes, and liver. They help the nervous system functionproperly.
Vitamin B12 is an especially importantvitamin for maintaining healthy nerve cells, and it helps in theproduction of DNA and RNA, the body's genetic material. Vitamin B12also works closely with vitamin B9, also called folate or folic acid,to help make red blood cells and to help iron work better in thebody. Folate and B12 work together to produce S-adenosylmethionine(SAMe), a compound involved in immune function and mood.
Vitamins B12, B6, and B9 work togetherto control blood levels of the amino acid homocysteine. High levelsof homocysteine are associated with heart disease. However,researchers aren't sure whether homocysteine is a cause of heartdisease or just a marker that indicates someone may have heartdisease.
It' s rare for young people to bedeficient in vitamin B12, but it' s not uncommon for older people tobe mildly deficient. That may be because their diets are not ashealthy or because they have less stomach acid, which the body needsto absorb B12. Low levels of B12 can cause a range of symptomsincluding fatigue, shortness of breath, diarrhea, nervousness,numbness, or tingling sensation in the fingers and toes. Severedeficiency of B12 causes nerve damage.
Others at risk for B12 deficiencyinclude:1. Vegans, vegetarians who also don't eat dairy or eggs -- vitaminB12 is found only in animal products2. People with problems absorbing nutrients, due to conditions suchas Crohn's disease, pancreatic disease, and people who have hadweight loss surgery3. People who are infected with Helicobacter pylori, an organism inthe intestines that can cause an ulcer. H. pylori damages stomachcells that make intrinsic factor, a substance the body needs toabsorb B124. People with an eating disorder5. People with HIV6. The elderly
Folic acid (vitamin B9), especiallywhen taken in high doses, can mask the symptoms of a vitamin B12deficiency. The danger is that without symptoms, someone with avitamin B12 deficiency may not know it, and could run the risk ofdeveloping nerve damage. Anyone planning to take more than 800 mcg offolic acid should talk to their doctor first, to make sure they donot have a B12 deficiency.
Vitamin B12
Vitamin B12 isbound to protein in food. The activity of hydrochloric acid andgastric protease in the stomach releases vitamin B12 from itsprotein. Once it is released, vitamin B12 begins to workquickly. It is important for the formation of red blood cells,neurological function, and DNA synthesis. It also supports thedigestive system in keeping glucose levels stable. A simple blood test can determine thelevel of B12 in the body. Adults who have a value below 170 to 250pg/ml are considered deficient in the vitamin. An elevated bloodhomocysteine level or elevated methylmalconic acid level may alsosuggest a B12 deficiency.
TestsVitamin B12 and folate are ordered todetect deficiencies and to help diagnose the cause of certainanemias. One type of associated anemia is pernicious anemia, anautoimmune disease that affects the absorption of B12. Thismegaloblastic anemia occurs when the body produces antibodies againstthe gastric parietal cells or the intrinsic factor, resulting in B12malabsorption.
Folate, B12, and an assortment of othertests may be ordered to help evaluate the general health andnutritional status of a person with signs of significant malnutritionor dietary malabsorption. This may include people with alcoholism,other liver diseases, gastric cancer, and those with malabsorptionconditions such as celiac disease, tropical sprue, Crohn’s disease,inflammatory bowel disease, and cystic fibrosis.
B12 and folate may also be ordered toaid in diagnosis when an individual presents with an altered mentalstate or other behavioral changes, especially in the elderly. B12 maybe ordered with folate, by itself, or with other screening laboratorytests (antinuclear antibody, CRP, rheumatoid factor, CBC andchemistry blood tests) to help establish reasons why a person showssymptoms of neuropathy.
In those treated for known B12 andfolate deficiencies, these tests will be ordered occasionally tomonitor the effectiveness of treatment. This is especially true inthose who cannot properly absorb B12 and/or folate and must havelifelong treatment.
Recommended Daily AllowanceIf you are considering taking a B12supplement, ask your health care provider to help you determine theright dose for you.Daily recommendations for dietaryvitamin B12 are listed below.Pediatric Newborns - 6 months: 0.4 mcg(adequate intake) Infants 6 months - 1 year: 0.5mcg (adequate intake) Children 1 - 3 years: 0.9 mcg(RDA) Children 4 - 8 years: 1.2 mcg(RDA) Children 9 - 13 years: 1.8 mcg(RDA) Teens 14 - 18 years: 2.4 mcg(RDA)Adult 19 years and older: 2.4 mcg(RDA)* Pregnant women: 2.6 mcg (RDA) Breastfeeding women: 2.8 mcg(RDA)*Because 10 - 30% of older people maynot absorb B12 from food very well, people over 50 should meet theirdaily requirement through either foods fortified with vitamin B12 ora supplement containing B12.
CautionsIf the B12 deficiency is not remedied,permanent nerve damage can occur. Neuropathy is a common problem forpeople with diabetes, who experience pain, tingling, and numbness intheir arms, hands, legs, and feet, resulting in sores.
Vitamin B12 is an especially importantvitamin for maintaining healthy nerve cells, and it helps in theproduction of DNA and RNA, the body's genetic material. Vitamin B12also works closely with vitamin B9, also called folate or folic acid,to help make red blood cells and to help iron work better in thebody.
Food SourcesVitamin B12 is found only in animalfoods. Liver, sardines, and salmon rank highest, with liver runningaway with it. Kidney, eggs, beef, and pork are also good sources.There are no vegetarian sources. Supplements include -Methylcobalamin is probably the best.
PrecautionsOne large study found that women whotook 1,000 mcg of vitamin B12 along with 2500 mcg of folic acid and500 mg of vitamin B6 daily reduced their risk of developing AMD, aneye disease that can cause loss of vision.
Fatigue is one of the symptoms of avitamin B12 deficiency. One preliminary study indicated that peoplewith chronic fatigue syndrome might benefit from B12 injections,although more research is needed to know for sure.
Although there is no evidence thatvitamin B12 alone reduces the risk of breast cancer, populationstudies have shown that women who get more folate in their diet havelower risk of breast cancer. Vitamin B12 works with folate in thebody, so it may help contribute to a lesser risk. Another preliminarystudy suggested that postmenopausal women who had the lowest amountsof B12 in their diet had an increased risk for breast cancer.
Studies suggest that vitamin B12supplements may improve sperm counts and sperm mobility. However, thestudies were of poor quality. Better studies are needed to seewhether B12 has any real effect.
Possible InteractionsIf you are currently being treated withany of the following medications, you should not use vitamin B12supplements without first talking to your health care provider.Medications that reduce levels of B12in the body include:Anti-seizure medications -- includingphenytoin (Dilantin), phenobarbital, primidone (Mysoline)Chemotherapy medications --particularly methotrexateColchicine -- used to treat goutBile acid sequestrants -- used to lowercholesterol; include colestipol (Colestid), cholestyramine(Questran), and colsevelam (Welchol)H2 blockers -- used to reduce stomachacid; include cimetidine (Tagamet), famotidine (Pepcid AC),ranitidine (Zantac)Metformin (Glucophage) -- medicationtaken for diabetesProton pump inhibitors -- used toreduce stomach acid; include esomeprazole (Nexium), lansprazole(Prevacid), omeprazole (Prilosec), and rabeprazole (Aciphex)
Antibiotics, Tetracycline -- VitaminB12 should not be taken at the same time as tetracycline because itinterferes with the absorption and effectiveness of this medication.Vitamin B12 should be taken at different times of the day fromtetracycline. All vitamin B complex supplements act in this way andshould be taken at different times from tetracycline. In addition,long-term use of antibiotics can lower vitamin B levels in the body,particularly B2, B9, B12, and vitamin H (biotin), which is consideredpart of the B complex vitamins.
Vitamin B12
OverviewAll B vitamins are water-soluble,meaning that the body does not store them. Vitamin B12, also calledcobalamin, is one of 8 B vitamins. It is important to know that allB vitamins help the body convert food (carbohydrates) into fuel(glucose), which is used to produce energy. These B vitamins,commonly referred to as B complex vitamins, also help the body usefats and protein. B complex vitamins are also used for healthy skin,hair, eyes, and liver. They help the nervous system functionproperly.
Vitamin B12 is an especially importantvitamin for maintaining healthy nerve cells, and it helps in theproduction of DNA and RNA, the body's genetic material. Vitamin B12also works closely with vitamin B9, also called folate or folic acid,to help make red blood cells and to help iron work better in thebody. Folate and B12 work together to produce S-adenosylmethionine(SAMe), a compound involved in immune function and mood.
Vitamins B12, B6, and B9 work togetherto control blood levels of the amino acid homocysteine. High levelsof homocysteine are associated with heart disease. However,researchers aren't sure whether homocysteine is a cause of heartdisease or just a marker that indicates someone may have heartdisease.
It' s rare for young people to bedeficient in vitamin B12, but it' s not uncommon for older people tobe mildly deficient. That may be because their diets are not ashealthy or because they have less stomach acid, which the body needsto absorb B12. Low levels of B12 can cause a range of symptomsincluding fatigue, shortness of breath, diarrhea, nervousness,numbness, or tingling sensation in the fingers and toes. Severedeficiency of B12 causes nerve damage.
Others at risk for B12 deficiencyinclude:1. Vegans, vegetarians who also don't eat dairy or eggs -- vitaminB12 is found only in animal products2. People with problems absorbing nutrients, due to conditions suchas Crohn's disease, pancreatic disease, and people who have hadweight loss surgery3. People who are infected with Helicobacter pylori, an organism inthe intestines that can cause an ulcer. H. pylori damages stomachcells that make intrinsic factor, a substance the body needs toabsorb B124. People with an eating disorder5. People with HIV6. The elderly
Folic acid (vitamin B9), especiallywhen taken in high doses, can mask the symptoms of a vitamin B12deficiency. The danger is that without symptoms, someone with avitamin B12 deficiency may not know it, and could run the risk ofdeveloping nerve damage. Anyone planning to take more than 800 mcg offolic acid should talk to their doctor first, to make sure they donot have a B12 deficiency.
Vitamin B12
Vitamin B12 isbound to protein in food. The activity of hydrochloric acid andgastric protease in the stomach releases vitamin B12 from itsprotein. Once it is released, vitamin B12 begins to workquickly. It is important for the formation of red blood cells,neurological function, and DNA synthesis. It also supports thedigestive system in keeping glucose levels stable. A simple blood test can determine thelevel of B12 in the body. Adults who have a value below 170 to 250pg/ml are considered deficient in the vitamin. An elevated bloodhomocysteine level or elevated methylmalconic acid level may alsosuggest a B12 deficiency.
TestsVitamin B12 and folate are ordered todetect deficiencies and to help diagnose the cause of certainanemias. One type of associated anemia is pernicious anemia, anautoimmune disease that affects the absorption of B12. Thismegaloblastic anemia occurs when the body produces antibodies againstthe gastric parietal cells or the intrinsic factor, resulting in B12malabsorption.
Folate, B12, and an assortment of othertests may be ordered to help evaluate the general health andnutritional status of a person with signs of significant malnutritionor dietary malabsorption. This may include people with alcoholism,other liver diseases, gastric cancer, and those with malabsorptionconditions such as celiac disease, tropical sprue, Crohn’s disease,inflammatory bowel disease, and cystic fibrosis.
B12 and folate may also be ordered toaid in diagnosis when an individual presents with an altered mentalstate or other behavioral changes, especially in the elderly. B12 maybe ordered with folate, by itself, or with other screening laboratorytests (antinuclear antibody, CRP, rheumatoid factor, CBC andchemistry blood tests) to help establish reasons why a person showssymptoms of neuropathy.
In those treated for known B12 andfolate deficiencies, these tests will be ordered occasionally tomonitor the effectiveness of treatment. This is especially true inthose who cannot properly absorb B12 and/or folate and must havelifelong treatment.
Recommended Daily AllowanceIf you are considering taking a B12supplement, ask your health care provider to help you determine theright dose for you.Daily recommendations for dietaryvitamin B12 are listed below.Pediatric Newborns - 6 months: 0.4 mcg(adequate intake) Infants 6 months - 1 year: 0.5mcg (adequate intake) Children 1 - 3 years: 0.9 mcg(RDA) Children 4 - 8 years: 1.2 mcg(RDA) Children 9 - 13 years: 1.8 mcg(RDA) Teens 14 - 18 years: 2.4 mcg(RDA)Adult 19 years and older: 2.4 mcg(RDA)* Pregnant women: 2.6 mcg (RDA) Breastfeeding women: 2.8 mcg(RDA)*Because 10 - 30% of older people maynot absorb B12 from food very well, people over 50 should meet theirdaily requirement through either foods fortified with vitamin B12 ora supplement containing B12.
CautionsIf the B12 deficiency is not remedied,permanent nerve damage can occur. Neuropathy is a common problem forpeople with diabetes, who experience pain, tingling, and numbness intheir arms, hands, legs, and feet, resulting in sores.
Vitamin B12 is an especially importantvitamin for maintaining healthy nerve cells, and it helps in theproduction of DNA and RNA, the body's genetic material. Vitamin B12also works closely with vitamin B9, also called folate or folic acid,to help make red blood cells and to help iron work better in thebody.
Food SourcesVitamin B12 is found only in animalfoods. Liver, sardines, and salmon rank highest, with liver runningaway with it. Kidney, eggs, beef, and pork are also good sources.There are no vegetarian sources. Supplements include -Methylcobalamin is probably the best.
PrecautionsOne large study found that women whotook 1,000 mcg of vitamin B12 along with 2500 mcg of folic acid and500 mg of vitamin B6 daily reduced their risk of developing AMD, aneye disease that can cause loss of vision.
Fatigue is one of the symptoms of avitamin B12 deficiency. One preliminary study indicated that peoplewith chronic fatigue syndrome might benefit from B12 injections,although more research is needed to know for sure.
Although there is no evidence thatvitamin B12 alone reduces the risk of breast cancer, populationstudies have shown that women who get more folate in their diet havelower risk of breast cancer. Vitamin B12 works with folate in thebody, so it may help contribute to a lesser risk. Another preliminarystudy suggested that postmenopausal women who had the lowest amountsof B12 in their diet had an increased risk for breast cancer.
Studies suggest that vitamin B12supplements may improve sperm counts and sperm mobility. However, thestudies were of poor quality. Better studies are needed to seewhether B12 has any real effect.
Possible InteractionsIf you are currently being treated withany of the following medications, you should not use vitamin B12supplements without first talking to your health care provider.Medications that reduce levels of B12in the body include:Anti-seizure medications -- includingphenytoin (Dilantin), phenobarbital, primidone (Mysoline)Chemotherapy medications --particularly methotrexateColchicine -- used to treat goutBile acid sequestrants -- used to lowercholesterol; include colestipol (Colestid), cholestyramine(Questran), and colsevelam (Welchol)H2 blockers -- used to reduce stomachacid; include cimetidine (Tagamet), famotidine (Pepcid AC),ranitidine (Zantac)Metformin (Glucophage) -- medicationtaken for diabetesProton pump inhibitors -- used toreduce stomach acid; include esomeprazole (Nexium), lansprazole(Prevacid), omeprazole (Prilosec), and rabeprazole (Aciphex)
Antibiotics, Tetracycline -- VitaminB12 should not be taken at the same time as tetracycline because itinterferes with the absorption and effectiveness of this medication.Vitamin B12 should be taken at different times of the day fromtetracycline. All vitamin B complex supplements act in this way andshould be taken at different times from tetracycline. In addition,long-term use of antibiotics can lower vitamin B levels in the body,particularly B2, B9, B12, and vitamin H (biotin), which is consideredpart of the B complex vitamins.
A Guide for Hospital Discharge Planning
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I could not have ended this year with abetter topic. Hospital discharge planning is not something to beignored, but often it is, much to the detriment of the patient andtheir safety after being discharged. Therefore, if you are expectingto have this happen to you, or you are a caregiver for someone beingdischarged from a hospital, take time to read this and I mean reallydigest the contents. Then you can print out a copy to have with youto remind you of important points.
Not all hospitals are equal and some dovery good at discharging patients. It is the hospitals that are notdoing things properly that need to be challenged. The high points ofthis guide are: 1. What is discharge planning?2. Why is good discharge planning so important?3. The caregiver's role in the discharge process4. Getting help at home5. Discharge to a facility6. Paying for care after discharge7. What if you feel it's too early for discharge?8. Improving the system9. Conclusion
Below the conclusion is someinformation for caregivers. Some may seem overkill, but to make thisadaptable for many people, this section needs to be large.
The other website that is so importantis this one - http://www.nextstepincare.org./
Do not allow hospitals to discharge youwithout knowing your rights and procedures that hospitals need tofollow to see that you receive the proper care after discharge.
I could not have ended this year with abetter topic. Hospital discharge planning is not something to beignored, but often it is, much to the detriment of the patient andtheir safety after being discharged. Therefore, if you are expectingto have this happen to you, or you are a caregiver for someone beingdischarged from a hospital, take time to read this and I mean reallydigest the contents. Then you can print out a copy to have with youto remind you of important points.
Not all hospitals are equal and some dovery good at discharging patients. It is the hospitals that are notdoing things properly that need to be challenged. The high points ofthis guide are: 1. What is discharge planning?2. Why is good discharge planning so important?3. The caregiver's role in the discharge process4. Getting help at home5. Discharge to a facility6. Paying for care after discharge7. What if you feel it's too early for discharge?8. Improving the system9. Conclusion
Below the conclusion is someinformation for caregivers. Some may seem overkill, but to make thisadaptable for many people, this section needs to be large.
The other website that is so importantis this one - http://www.nextstepincare.org./
Do not allow hospitals to discharge youwithout knowing your rights and procedures that hospitals need tofollow to see that you receive the proper care after discharge.
What Is Happening to Type 2 Bloggers?
To contact us Click HERE
Making my review of type 2 bloggers inthe last two weeks, I was very surprised at the number that havedeleted their blogs entirely. What happened?
I know that a few have exited toFacebook and they are active there, but the rest I have not found onFacebook either. It is discouraging to have to remove twelvebloggers from my list. If you read this, please let me know whathappened. A couple had been very active up until suddenly their blogwas gone.
I am sorry to see many of them notblogging.
Making my review of type 2 bloggers inthe last two weeks, I was very surprised at the number that havedeleted their blogs entirely. What happened?
I know that a few have exited toFacebook and they are active there, but the rest I have not found onFacebook either. It is discouraging to have to remove twelvebloggers from my list. If you read this, please let me know whathappened. A couple had been very active up until suddenly their blogwas gone.
I am sorry to see many of them notblogging.
Wearable Technology Can Monitor Rehabilitation
To contact us Click HERE
This technology is happening and willbe second nature to many of us in the near future – if the Food andDrug Administration does not get in the way. I will admit when Ifirst read the short article, I had to laugh at the way it looks on aperson, but manufacturers may change this as they perfect the fit andwork on the design.
I can envision many other types ofoutfits that could be designed for recording information from thehuman body and some of them could be fashioned for undergarments. Until TSA is mandated or given an order to take a doctor's writtennotice, I can imagine their strip searching patients wearing anythinglike this when traveling.
Neurorehabilitation researchers fromItaly have developed a low cost, wearable system, consisting ofstrain sensors made of conductive elastomers printed onto fabric.(Credit: Paolo Tormene)
A low voltage battery powers thesensors. This enables sending data to a computer via a Bluetoothdevice. The device was tested in a healthy person and used tocollect a comprehensive set of over 600 movements, at varying speedsand number of repetitions, over a range of movements. In the study,a wireless inertial sensor (MEMS) using triaxial accelerometers andmagnetometers confirmed the accuracy of the results and wereaccurately able to measure movement.
It is understandable that the system isnot designed for high precision, but for ease of use, to beinexpensive, and an aid in the development of portable, remotemonitoring of rehabilitation. Now it will be very interesting to seewhat is developed next for monitoring other health problems and ifthis is usable for monitoring some chronic diseases.
This technology is happening and willbe second nature to many of us in the near future – if the Food andDrug Administration does not get in the way. I will admit when Ifirst read the short article, I had to laugh at the way it looks on aperson, but manufacturers may change this as they perfect the fit andwork on the design.
I can envision many other types ofoutfits that could be designed for recording information from thehuman body and some of them could be fashioned for undergarments. Until TSA is mandated or given an order to take a doctor's writtennotice, I can imagine their strip searching patients wearing anythinglike this when traveling.
Neurorehabilitation researchers fromItaly have developed a low cost, wearable system, consisting ofstrain sensors made of conductive elastomers printed onto fabric.(Credit: Paolo Tormene)
A low voltage battery powers thesensors. This enables sending data to a computer via a Bluetoothdevice. The device was tested in a healthy person and used tocollect a comprehensive set of over 600 movements, at varying speedsand number of repetitions, over a range of movements. In the study,a wireless inertial sensor (MEMS) using triaxial accelerometers andmagnetometers confirmed the accuracy of the results and wereaccurately able to measure movement.
It is understandable that the system isnot designed for high precision, but for ease of use, to beinexpensive, and an aid in the development of portable, remotemonitoring of rehabilitation. Now it will be very interesting to seewhat is developed next for monitoring other health problems and ifthis is usable for monitoring some chronic diseases.
1 Ocak 2013 Salı
Obama to Decide Whether to Expand Military's Animal Cruelty Policy
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The Department of Defense is asking President Obama for permission to expand the military's current animal cruelty policy to include abandonment and to also apply to personal pets rather than just those owned by the military. The constant relocation and reassignment of military families has resulted in many pets simply being left behind, abandoned, and unattended. Stars and Stripes is reporting that the problem is so great in places like Hawaii and Germany that local shelters are reluctant to adopt pets to Americans and/or military families at all.
The military is further concerned that the problem will worsen as United Airlines, the airline contracted to transport military personnel, refuses to permit certain breeds of dogs, such as American Staffordshire Terriers, on their planes, and will not waive this restriction for the Defense Department.
While I fully support holding those who choose to have a pet responsible for caring for that pet and accountable to the authorities for not doing so, I would also suggest that the military drop United Airlines and contract with another carrier so those with "banned" family dogs can travel without the additional heartbreak of the loss of a pet or the expense of funding their own flights on another airline. It seems an unnecessary stressor for those who would otherwise not abandon their pet.
In fact, if all pet lovers chose, in sympathy, to fly with different airlines - maybe we would see an attitude change from United.
The president is expected to decide this spring.
The Department of Defense is asking President Obama for permission to expand the military's current animal cruelty policy to include abandonment and to also apply to personal pets rather than just those owned by the military. The constant relocation and reassignment of military families has resulted in many pets simply being left behind, abandoned, and unattended. Stars and Stripes is reporting that the problem is so great in places like Hawaii and Germany that local shelters are reluctant to adopt pets to Americans and/or military families at all.The military is further concerned that the problem will worsen as United Airlines, the airline contracted to transport military personnel, refuses to permit certain breeds of dogs, such as American Staffordshire Terriers, on their planes, and will not waive this restriction for the Defense Department.
While I fully support holding those who choose to have a pet responsible for caring for that pet and accountable to the authorities for not doing so, I would also suggest that the military drop United Airlines and contract with another carrier so those with "banned" family dogs can travel without the additional heartbreak of the loss of a pet or the expense of funding their own flights on another airline. It seems an unnecessary stressor for those who would otherwise not abandon their pet.
In fact, if all pet lovers chose, in sympathy, to fly with different airlines - maybe we would see an attitude change from United.
The president is expected to decide this spring.
"Something's Happening Here - What It Is Ain't Exactly Clear..."
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I wasn’t going to write about this – but – it has beenbothering me. Last week, the aspca (NOTa national umbrella organization) subsidized adoptions across the country for acouple of days. The subsidy allowed some shelters to give away pets, or tocharge 10 or 20 dollars for the pet. So whyhas this been nagging at me?
I began to wonder why they are really doing this. Promoting adoptions is the obvious answer butis it the correct one? You and I will never know – but here is what I think.The aspca has been and is under fire for fundraising in everyone’s neighborhoodand amassing approximately 188,024,402 million dollars in New Yorkto the detriment of all the other spcas and the animals they serve. They getaway with it because consumers believe that they are the “national office” and thatevery spca in the country is a chapter which receives funding from them. Not true. Each spca is a separate and independent legalentity and it could affect the aspca’s ability to raise funds if they disclosedthat. In fact, out of that near 185,000,000million dollars, they grant out fewerthan 6 million but spend over 25 million on fundraising.
So, they throw pocket change at this adoption promotion,publicize the hell out of it and generate more smoke for the mirrors.
But was it a good event that helped animals? In Californiathey worked mostly with government pounds where adopters are not screened andall one needs is the fee to take home an animal. At no charge or even with anominal charge many animals very likely went to hoarders, backyard sellers, and other entitiesthat had only plans to resell the pets at a huge mark up. How many sales werean impulse grab where the pet was returned or simply turned out? It is easy to empty ashelter but not so easy to have the adoption stick and actually find the pet ahome. It is neither a success nor even an adoption if the pet is not kept. Doyou think the aspca is tracking that or is even concerned about that? I don't know, but if so, the event business model would have been different. Of course there are those of us who would cherish a pet for life that we found on the street or received at no cost. I am not talking about us.
I think that my disquietude comes from the fear that manyof these animals might be in awful places as a result of the aspca’s publicrelations effort to appear to be funding animals in areas in which they solicitdonations and provide nothing in return.
They could be throwing couch cushion change to seem to besomething they are not, while perhaps tossing pets to the very real wolves.
Please donate locally.
I wasn’t going to write about this – but – it has beenbothering me. Last week, the aspca (NOTa national umbrella organization) subsidized adoptions across the country for acouple of days. The subsidy allowed some shelters to give away pets, or tocharge 10 or 20 dollars for the pet. So whyhas this been nagging at me?
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| Courtesy spcaL |
So, they throw pocket change at this adoption promotion,publicize the hell out of it and generate more smoke for the mirrors.
But was it a good event that helped animals? In Californiathey worked mostly with government pounds where adopters are not screened andall one needs is the fee to take home an animal. At no charge or even with anominal charge many animals very likely went to hoarders, backyard sellers, and other entitiesthat had only plans to resell the pets at a huge mark up. How many sales werean impulse grab where the pet was returned or simply turned out? It is easy to empty ashelter but not so easy to have the adoption stick and actually find the pet ahome. It is neither a success nor even an adoption if the pet is not kept. Doyou think the aspca is tracking that or is even concerned about that? I don't know, but if so, the event business model would have been different. Of course there are those of us who would cherish a pet for life that we found on the street or received at no cost. I am not talking about us.
I think that my disquietude comes from the fear that manyof these animals might be in awful places as a result of the aspca’s publicrelations effort to appear to be funding animals in areas in which they solicitdonations and provide nothing in return.
They could be throwing couch cushion change to seem to besomething they are not, while perhaps tossing pets to the very real wolves.
Please donate locally.
Stop the Cruel and Bullying "Sport"of Hounding California's Bears and Bobcats
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Senate Bill 1221 will stop the cruel and bullying pastime of “hounding” bears and bobcats.
"Hounding" is a hunting practice where dogs are first sprayed with a bear attractant and fitted with high‐tech radio collars, that permit the hunters to hunt remotely. The dogs can chase the bear or bobcats for miles until they are treed or exhausted, at which time the tip-switch on the collars alerts the hunters, who, arrive and shoot a weary animal at point blank range. Essentially, the hounds take all the risks while the "sport" hunter lounges around in the park waiting for the signal to exert him or herself enough to shoot a trapped, immobilized animal.
Notwithstanding the terrifying ordeal suffered by the target animal, the hounds don't fare much better. They are not treated as pets but as working animals. They get injured running, hit by cars, and are often wounded or killed by the target animal or any other wildlife (such as deer) that they may encounter. There are reports of shelters receiving these dogs dehydrated, skinny and injured after they are no longer any use to the "sportsman".
I respectfully submit that this form of hunting is neither sport nor sportsman like. As comedian Paul Rodriguez said: "In a sport both sides should know they are in the game".
Not only do the animals not know they are playing - the bullies are cheating.
It is time to end this practice in California. Please contact your representatives http://www.leginfo.ca.gov/yourleg.html and urge them to pass SB 1221.
Thank you.
Senate Bill 1221 will stop the cruel and bullying pastime of “hounding” bears and bobcats.
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| Courtesy Google Images |
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| Courtesy Google Images |
I respectfully submit that this form of hunting is neither sport nor sportsman like. As comedian Paul Rodriguez said: "In a sport both sides should know they are in the game".
Not only do the animals not know they are playing - the bullies are cheating.
It is time to end this practice in California. Please contact your representatives http://www.leginfo.ca.gov/yourleg.html and urge them to pass SB 1221.
Thank you.
Rihanna's Dog Got "Minxed"
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The latest trend in manicures and pedicures is the minx manicure. It is a process where pictures and patterns are painted onto fingernails and toenails thereby instantly transforming ordinary fingers and toes into works of art.
It was only a matter of time before this new art form appeared on a pet. In this case it was Rihanna's dog. She posted a photo of her dog with the caption "Bitch got minx."
The product is said to be toxic, odorless, chemical free and perfectly safe for natural nails. However, before you try something like this on your pet, use common sense. When in doubt, ask a veterinarian - is this safe for pets? Procedures and materials deemed safe for people may still have adverse effect on animals.
If it's safe - make sure it's something your pet tolerates and is comfortable doing. If your dog needs a sedative to do it, it most likely should not be done.
Need I say- don't even think about this for a cat!
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| Courtesy Instagram |
It was only a matter of time before this new art form appeared on a pet. In this case it was Rihanna's dog. She posted a photo of her dog with the caption "Bitch got minx."
The product is said to be toxic, odorless, chemical free and perfectly safe for natural nails. However, before you try something like this on your pet, use common sense. When in doubt, ask a veterinarian - is this safe for pets? Procedures and materials deemed safe for people may still have adverse effect on animals.
If it's safe - make sure it's something your pet tolerates and is comfortable doing. If your dog needs a sedative to do it, it most likely should not be done.
Need I say- don't even think about this for a cat!
Don't Be Bamboozled This Holiday Season: Give Locally
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As we again come upon the busiest fund-raising season of the yearI, again urge you to know your charity and donate locally. We are a generousand empathetic people who react with our hearts when seeing the ravages of a hurricane on the news, or expensive television ads of forlorn children andinjured animals. We respond with our purses when celebrities beg for donationsand plead with viewers to join them in giving. I do too - but I worry about howoften we can be disappointed and develop charity fatigue. I fear for those whostill need the help after the compassionate tire of giving.
The combination ofgenerosity, disaster, and fame can add up to a veritable "candystore" for the unprincipled, greedy and the opportunistic as nonexistentcharities put up web sites to solicit funds, as the well-intended start theirown charities but run them poorly, and as existing charities spend their fundon public relations, television spots and the appearance of helping rather thanactually serving the needy. I am truly terrified that those who can give, willstop, believing that they are not making a difference or that they have beenbamboozled. What will happen to your spcaLA and to those vulnerable populationsthat desperately need a helping hand and a voice!
Rather than souring on giving, research the situation, ask questionsand make sure your gift is going to whom and where you so intend. For example, in the animal welfareindustry, aspca, the New York City spca is not an umbrellaorganization which funnels funds to other spcas by zip code as is the case withother real national charities like Leukemia and Lymphoma Society. spcasthroughout the country are individual legal entities and not chapters of anymother organization. Yet aspca spends tens of millions of dollars annuallyon television and other fundraising outlets which omitthat significant fact. Many consumers are duped and upset uponlearning that their donation did not help abused and unwanted animals intheir communities. By the way, to their credit, hsus, began putting suchlanguage (that they are not affiliated with local humane societies) on theirnew television spots to avoid creating a misimpression and thereby attractingmisinformed donors. I hope this is a first step in putting meaningfuldisclaimers on all of their materials.
So please, consider donating to an existing legitimate localorganization that you can visit, talk to, and just see in action. Frequently,your local charity may be providing international relief as well or isaffiliated with one who is.
Giving locally also helps to strengthen the community in which youlive. It is especially true in these horrid economic times where thephilanthropic entities are filling gaps left by the government and the for-profitsector. If the reputable local nonprofits fail - there will be no relief.Additionally, bolstering the local charities boosts the local economy, providesjobs, resources and allows the community to thrive. Stronger communities resultin stronger cities, states and countries. Our ability to help others improveswith our own increased strength and solvency.
Charity begins athome. It is only when we stand strong that we can lift another.
For those of you in California: The Attorney General has issued a report and a warning to us to be careful about giving to charities where a lot or all of donated funds are used to pay professional fundraisers. See the Associated Press story on this issue as well as the actual report.
 |
| Courtesy spcaLA |
As we again come upon the busiest fund-raising season of the yearI, again urge you to know your charity and donate locally. We are a generousand empathetic people who react with our hearts when seeing the ravages of a hurricane on the news, or expensive television ads of forlorn children andinjured animals. We respond with our purses when celebrities beg for donationsand plead with viewers to join them in giving. I do too - but I worry about howoften we can be disappointed and develop charity fatigue. I fear for those whostill need the help after the compassionate tire of giving.
The combination ofgenerosity, disaster, and fame can add up to a veritable "candystore" for the unprincipled, greedy and the opportunistic as nonexistentcharities put up web sites to solicit funds, as the well-intended start theirown charities but run them poorly, and as existing charities spend their fundon public relations, television spots and the appearance of helping rather thanactually serving the needy. I am truly terrified that those who can give, willstop, believing that they are not making a difference or that they have beenbamboozled. What will happen to your spcaLA and to those vulnerable populationsthat desperately need a helping hand and a voice!
Rather than souring on giving, research the situation, ask questionsand make sure your gift is going to whom and where you so intend. For example, in the animal welfareindustry, aspca, the New York City spca is not an umbrellaorganization which funnels funds to other spcas by zip code as is the case withother real national charities like Leukemia and Lymphoma Society. spcasthroughout the country are individual legal entities and not chapters of anymother organization. Yet aspca spends tens of millions of dollars annuallyon television and other fundraising outlets which omitthat significant fact. Many consumers are duped and upset uponlearning that their donation did not help abused and unwanted animals intheir communities. By the way, to their credit, hsus, began putting suchlanguage (that they are not affiliated with local humane societies) on theirnew television spots to avoid creating a misimpression and thereby attractingmisinformed donors. I hope this is a first step in putting meaningfuldisclaimers on all of their materials.
So please, consider donating to an existing legitimate localorganization that you can visit, talk to, and just see in action. Frequently,your local charity may be providing international relief as well or isaffiliated with one who is.
Giving locally also helps to strengthen the community in which youlive. It is especially true in these horrid economic times where thephilanthropic entities are filling gaps left by the government and the for-profitsector. If the reputable local nonprofits fail - there will be no relief.Additionally, bolstering the local charities boosts the local economy, providesjobs, resources and allows the community to thrive. Stronger communities resultin stronger cities, states and countries. Our ability to help others improveswith our own increased strength and solvency.
Charity begins athome. It is only when we stand strong that we can lift another.
For those of you in California: The Attorney General has issued a report and a warning to us to be careful about giving to charities where a lot or all of donated funds are used to pay professional fundraisers. See the Associated Press story on this issue as well as the actual report.
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