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BUAH MERAH HEALTH BENEFITS
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What is Buah Merah?
Red fruit (Buah Merah) is abundant with fruit crops mafaat kind which comes through the land of Papua. Red fruit generally recognized by the name of the city kuansu Wamena. Red fruit features a scientific term for the fruit of Pandanus conoideus Lam is a number of plants and pandan-Pandanan just like the pandanus tree. Red fruit can easily develop as tall as 16 meters having a trunk that may grow readily up to Five to six meters. Red fruit has been utilized by local residents as food items or even as medication. Red fruits are normally found in Manokwari, Jayapura, and also Wamena Nabire.
Red fruit at the moment grew to become extremely popular as soon as the qualities and also advantages happen to be well known to deal with numerous illnesses. Distribute the recognition of red fruit along with Sagat rapidly; even just in a few of the herbal ingredients which are created right together with the red fruit is sold at extremely expensive. A few of the products produced from oil of red fruit is really a red fruit and red fruit. Presently, red fruit farming has additionally been carried out in certain places away from home region, Papua. Red fruit plant is really a plant which is even now a family along with pandan plant. Pandanus conoideus within their habitat (Guinea) grew outside the lowlands close to the coastline towards the highlands. In reality, on the hills Jayawijaya diketinggian 2500 m above sea level. These types of plants can be obtained.
Health benefits of Red fruit (Buah Merah)
Some of the nnumerous health benefits of Red fruit (Buah Merah) as listed below. Read them to know more:
1. AIDS
Even though specialists have numerous years of attempting to make a cure for AIDS continues to be medication haven’t been discovered. Maybe you yourself really feel unconfident in regards to the effectiveness of red fruits on this one. However the effectiveness of red fruit has been shown to avoid AIDS. One is free of the grip of the death from AIDS is Agustina Sawery.
Agustina Sawery had decreased his bodyweight from 50 kg to 27 kg. He’d anal illness, damaged liver function, mouth bercendawan and also lung infections. Agustina apparently just looking forward to the hour of his death. Therefore he found the Drs I Made Budi MS.Saat Made is widely known that in Papua simply because often treat diseases just like cancer with red fruit extract. Agustina then given a red fruit extract taken 3 times each day.
Since using the situation started to enhance red fruit. Who had dropped his bodyweight to be elevated to 27 kg from 46 kg. Her skin is perhaps all smooth busik been returned. Hair which had fallen started to grow once again. Agustina turn out to be much healthier. It really is documented that the capability to heal AIDS red fruit is because of the red fruit that contains tocopherol as well as beta-carotene is extremely higher. Both the content of this work as anti-oxidants and may enhance the defense mechanisms. Tocopherol and also beta-carotene ultimately mix to collapse the amino acids necessary for virus that triggers AIDS, HIV, and so the virus can’t set up his life.
2. Cancer and Tumors
Cancer is really a illness brought on by the development of tissue cells usually are not regular. Cancer cells will certainly expand quickly, unmanageable, and can continue to divide and after that infiltrate the nearby tissue (invasive) and also will continue to distribute over the connective tissue, blood, and also strike important organs and also spinal-cord. Under regular situations, the cells will break down only when there is replacing of cells which have died and also broken. Rather cancer cells will certainly divide continues even when the body doesn’t need it, so will the buildup of new cells are known as cancerous tumors. Stacking cells are immediate and also damage normal tissue, therefore interfering with the organs they undertake.
Cancer may appear in a variety of tissues in several bodily organs in every body, from feet to head. Whenever cancer takes place on the surface of the body, it might be effortlessly discovered and also handled. But when there is within the body, the cancer will probably be hard to know and often don’t have any signs and symptoms. If signs take place, they often come with an sophisticated phase that it’s hard to deal with.
Cancer isn’t a moderate illness. The first step within the management of cancer recognition effectively would be that the symptoms which show up on a person’s body is genuinely dangerous cancer cells. This particular discovery can be carried out simply by study of biopsy, so the therapy step can be carried out swiftly and also accurately. The next step is a healing treatment within a conventional manner. However this way of treatments for cancer usually can’t be resolved as a whole. Here, the function of therapeutic plants / herbs.
The primary role of the red fruit is usually to boost the individual’s defense mechanisms and also localize the cancer cells to ensure that cancer cells usually do not effortlessly distributed, and much more effortlessly eliminated, in addition to non-toxic which makes it more secure for the affected person. Role of red fruit in assisting of cancers Disease Brought on by it recovery process tocopherol and also beta-carotene content comparatively higher the which, both of these substances interact as anti-oxidants and boost the defense mechanisms. As anti-oxidants, these types of substances may play a role equally Prevent and also suppressed reproductive cancer cells. Omega 3 is included in the red fruit may also restore the objective of Damaged tissue, so it’s suitable for breast cancer sufferer.
3. Stroke and High Blood
Heart stroke is brought on by the freezing and also thinning bloodstream. One reason for this ailment is hypertension. High blood pressure levels leads to blood clots to ensure that narrows blood vessels, leading to decreased blood flow. Furthermore, the blood vessels can break. This ailment, if not deadly, may cause paralysis of hands or legs. High blood pressure levels by itself brought on by the heart which pumps blood too rapidly. This really is one of these as a result of insufficient oxygen or even oxygen on the blood is simply too thicker.
Red fruit that contains tocopherol that may weaken blood and also speed up the blood flow so that oxygen content within blood to become usual.
4. Uric acid
Dsebabkan uric acid due to the disruption so the objective of the liver to generate excessive uric acid. Uric acid eventually become covered in the kidney stone and also was taken up to the ends of fingers and also toes and build up there.
Tocopherols within red fruit thin the blood and also enhance the work system lever. Work system within the liver, soon after being restored, creating usual amounts of uric acid.
5. Diabetes Mellitus (Diabetes)
Diabetes mellitus, Also known as just diabetes, is really a number of metabolic illnesses in which an individual has got higher amounts of blood sugar levels, possibly Because the body doesn’t Create sufficient insulin, or even don’t react Because cells towards the insulin Which is made.
Diabetes takes place when the body doesn’t create sufficient insulin to keep normal blood glucose levels or even whenever cells don’t react properly to blood insulin. The primary objective of diabetes therapy is to keep blood glucose levels in the usual range. Blood glucose is usual very hard to keep up, yet getting nearer to the normal array, then the chance of a short-term or even long-term problems are much less. Management of diabetes consists of weight loss, diet and exercise.
Typical medical treatment is by using insulin injections. Diabetes recovery process could be aided simply by red fruit oil usage Due to normally contain vitamin E or even tocopherol. Tocopherol in the red fruit will certainly enhance the work of the pancreas that discharges insulin function to become ideal. To obtain optimum work of red fruit oil, diabetes mellitus sufferer is advised to prevent utilize diets along with foods result in diabetes mellitus which (containing carbohydrates and also excessive sugars).
6. Osteoporosis
Buah Merah is actually calcium abundant and has about 55.000 mg for each 100 gram. It provides the bones along with much-needed calcium that will help avoid osteoporosis, that is mainly brought on by insufficient calcium.
7. Eye Disorders
Higher beta-carotene content within red fruits can easily resolve many different types of eye illnesses brought on by insufficient vitamin A. Beta-carotene is soaked up and also refined with the body into vitamin A.
8. Improve Intelligence
The content of omega 3 and also omega 6 in the red fruit can easily promote the brain functions and also improve cleverness. As a result, red fruit ideal for usage by kids.
9. Increase Passion and Fertility
Red fruit, in accordance with people who consume it, might help improve male sexual arousal. Result of therapy differs, there exists a response soon after Fifteen minutes of consuming it, there’s also a few hours after consuming it.
Vitamin E in the red fruit increases sperm manufacturing. Additionally, red fruit that contains higher energy, specifically 360 calories.
Along with the properties which have been mentioned previously, red fruit may also said to deal with gastric illnesses, hemorrhoids, lung disorders and so on.
10. Hepatitis
Hepatitis is actually a condition in which liver function is essentially because of the virus. Hepatitis B and C usually are not handled may develop into liver cancer (sorosis).Red juice consists of antiviral and also anti-oxidant that could prevent the development of cancer cells. Additionally, the red fruit encourage the regrowth of liver cells.
11. Cholesterol
High cholesterol levels within the blood vessels, particularly triglycerides and also HDL (High Density Lipoprotein), can result in calcification as well as thinning of blood vessels within the heart, brain and also kidney. The trigger may be the usage of foods that contains saturated fatty acid overload.Red juice can easily counteract cholesterol within the blood vessels.
12. D. Lupus
Lupus is definitely an autoimmune illness in which the body’s defense mechanisms hyperactive and also assaults Will become regular, healthy tissue. This particular results in signs and symptoms Just like swelling, inflammation, and also injury to important joints, skin, kidneys, blood, the heart, and also Lungs.
Below normal functionality, the immune system tends to make proteins known as antibodies so as to safeguard and also combat antigens Just like bacteria and viruses. Lupus helps make the defense mechanisms Not able to distinguish In between antigens and healthy tissue. This brings the immune system to direct antibodies against the healthy tissue – not only antigens – Leading to inflammation, discomfort, and also damaged tissues.
Antibodies were found within a individual’s body which acts to fight the origin of the illness to be contained in the body. Distinctively, this particular lupus antibodies created within the body looks extreme. The end result, antibodies in fact assault the cells of the healthy body tissue. This problem is known as autoimmunity.
Lupus is really an illness in which the defense mechanisms within the body tissue is recognized as a distant object. Result of the immune system could be on numerous organ systems of the body just like skin tissue, muscle, bone, kidney, central nervous system, coronary heart, lungs, lining of the lungs, liver, digestive system, eyes, brain, and also bloodstream as well as cell- blood cells.
Lupus is usually a illness of the dangerous new disease is the same as cancer. Not just a few pengindap illness isn’t above help, the world’s individuals with the illness Lupus discovered 5 million people, a lot more than 100 thousand new cases occur every year.
Red fruit role in assisting with regard to diseases is simply by improving stamina of the sufferers. Red fruit treatment within this disease can serve as an anti-oxidant. Ingested red fruit oil likely to raise the defense mechanisms, so That individuals will get powerful stamina and be Capable to reverse the illness. Up to now individuals with lupus WHO take in red fruit has revealed optimistic improvement.
More about Red fruit(Buah Merah)
These woodsy plants develop to have five limbs forked. Ribbon-shaped foliage is spiny-burr edges small. Plant height can certainly achieve 15 meters. Its roots constitute the root of the air which strung to the height of one meter through the bottom of the stem. These types of plants carry fruit in the age of 3 years from planting. Red fruit is commonly a lengthy oval-shaped or even relatively square. 30-120 cm long pieces. 10-25 cm diameter fruit. The fruit is usually red, brown, and a few are yellow. External skin of the fruit looks like a jackfruit. In Papua, a region which had become the heart of red fruit are areas which are over the slopes of the mountains Jayawijaya. Among them Bokondini, Kelila, Pasema, Kenyam, Karubaga and Kobakma. For individuals in Wamena, red fruit for the food offered within the party burns custom stone. However, there are numerous who utilize it as medication. Typically, Red Fruit of the historic genetic been ingested as effective in treating several illnesses just like avoiding different eye diseases, intestinal tract worms, skin, and also enhance stamina levels.
Scientific distinction of Red Fruit
Kingdom: Plantae
Division: Magnoliophyta
Class: Liliopsida
Order: Pandanales
Family: Pandanaceae
Genus: Pandanus
Species: P. Conoideus
Binomial namePandanus conoideus
Effectiveness Papua Red Fruit
Red fruit, so far not really a few individuals along with long-term and also degenerative illnesses, just like diabetic issues, cholesterol levels, cardiovascular disease, cancer and also AIDS, that formerly had lost hope of life can easily breathe in again soon after listening to the red fruit has the ability to deal with these types of illnesses. Besides containing anti-oxidant and also antiviral ingredients in higher amounts, red fruit furthermore consist of important minerals and vitamins are relatively complete. Nutrition included in the red fruit turned out to be extremely effective to deal with numerous degenerative illnesses and also metabolic problems brought on by defective diet. Red juice prepared from 100% fruit Pandanus conoideus Lam consist of anti-oxidant materials in large amounts. In whom beta-carotene, tocopherols, and also virblastin. Additionally, red fruit also include oleic acid and linoleic acid, unsaturated essential fatty acids are often soaked up from the body. The content of unsaturated fatty acids, beta carotene, tocopherol, energy, (omega 3, omega 6, omega 9), calcium as well as other energetic ingredients turned out to be extremely important in assisting the recovery process.
Red fruit referred to as a traditional medicinal practices of Papua, that empirically has been confirmed as a substitute medication for stopping illnesses just like cancer, hiv aids, tumor, hypertension, and so on.. Presently the red fruit has already been effortlessly received, because the quantity of suppliers or even sellers who provide products red juice. Additionally it is most likely that simply allows you to confuse to select the product of fine red juice, red juice product quality, genuine and pure. However, in case you have to become cautious in the choice.
The content of the most notable of the red fruit is definitely an anti-oxidant. Probably the most essential anti-oxidants just like beta-carotene, tocopherols, as well as calcium. In reality, the calcium content in the red fruit is definitely the maximum on earth. Calcium is important within the metabolic process of the body to enhance health problems. Calcium works as a cofactor in speeding up and also increasing the body’s metabolic procedures.
History of Red fruit(Buah Merah)
Around 2000 the very first study ever done for this plant was completed by a Biologist and Lecturer from the Cendrawasih University, Dr. Made Budi MSC.
Dr Budi noticed the communities in Wamena, Timika and also the villages within the Jayawijava Mountains as well as their traditional habits. He noticed these folks ingesting huge amounts of the red fruit as foodstuff, as worm medication or even as treatment for blindness illnesses and all sorts of skin types illnesses. Dr Budi realized that the communities that he was watching were rarely impacted by degenerative type illnesses just like high blood pressure, diabetic issues, cardiovascular disease or even cancers plus they hardly ever experienced the common cold or flu regardless of the cold weather. Throughout his investigation, Dr. Budi administered Buah Merah Oil to 30 fowls that had contracted an extremely dangerous virus. Out from the 30 fowls that he examined, all 30 fowls survived and also fully restored from the virus. According to his study and these particular test results, he then began to deal with individuals with high cholesterol levels, rheumatics and also cancer, along with mind-boggling success. Buah Merah was finally given the green light in the year 2005 and also the first patent for industrial scale production was issued.
Buah Merah (Pandanus Conoideus) only has been in the marketplace since 2005 therefore it is an extremely new product and never too many people are familiar with it yet, however in the near future its recognition is anticipated to explode. Because of its globally success so far, it easily can become the largest Medical development of the Century.
Buah Merah Mix - a Powerful Antioxidants
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+63920.657.8094
Sunday, May 3, 2009
Good Friends Are Good for You
Good Friends Are Good for You
They might get on your nerves at times, but good friends have bigger benefits than you may realize.
By Tom Valeo
By Tom Valeo
WebMD FeatureReviewed by Brunilda Nazario, MD"You got to have friends to make that day last long," sings Bette Midler. But good friends may help your life last longer, too, according to an Australian study. Conducted by the Centre for Ageing Studies at Flinders University, the study followed nearly 1,500 older people for 10 years. It found that those who had a large network of friends outlived those with the fewest friends by 22%.
Why is this so? The authors suspect that good friends discourage unhealthy behaviors such as smoking and heavy drinking. And the companionship provided by friends may ward off depression, boost self-esteem, and provide support. Also, as people age, they may become more selective in their choice of friends, so they spend more time with people they like.
Close relationships with children and relatives, in contrast, had almost no effect on longevity. Lynne C. Giles, one of the four researchers who conducted the study, emphasized that family ties are important; they just seem to have little effect on survival.
The Health Benefits of Good Friends
Lots of research has shown the health benefits of social support.
One such study, reported in the journal Cancer, followed 61 women with advanced ovarian cancer. Those with ample social support had much lower levels of a protein linked to more aggressive types of cancer. Lower levels of the protein, known as interleukin 6, or IL-6, also boosted the effectiveness of chemotherapy. Women with weak social support had levels of IL-6 that were 70% higher in general, and two-and-a-half times higher in the area around the tumor.
In 1989, David Spiegel, MD, a professor of psychiatry at Stanford University, published a landmark paper in Lancet. Itshowed that women with breast cancer who participated in a support group lived twice as long as those who didn't. They also had much less pain.
Sheldon Cohen, PhD, a psychology professor at Carnegie Mellon University, in Pittsburgh, has shown that strong social support helps people cope with stress.
"Friends help you face adverse events," Cohen tells WebMD. "They provide material aid, emotional support, and information that helps you deal with the stressors. There may be broader effects as well. Friends encourage you to take better care of yourself. And people with wider social networks are higher in self-esteem, and they feel they have more control over their lives."
Other studies have shown that people with fewer friends tend to die sooner after having a heart attack than people with a strong social network. Having lots of friends may even reduce your chances of catching a cold. That's true even though you're probably exposed to more viruses if you spend a lot of time with others.
"People with social support have fewer cardiovascular problems and immune problems, and lower levels of cortisol -- a stress hormone," says Tasha R. Howe, PhD, associate professor of psychology at Humboldt State University. "Why? The evolutionary argument maintains that humans are social animals, and we have evolved to be in groups. We have always needed others for our survival. It's in our genes. Therefore, people with social connections feel more relaxed and at peace, which is related to better health."
Friends Can Be Stressful
Friends can be a source of stress, though. In fact, friends can cause more stress than others precisely because we care so much about them.
Julianne Holt-Lunstad, PhD, an assistant professor of psychology at Brigham Young University, has found that dealing with people who arouse conflicted feelings in us can raise blood pressure more than dealing with people we don't like.
"My colleagues and I were interested in relationships that contain a mix of positivity and negativity," she says. "For example, you might love your mother very much, but still find her overbearing or critical at times."
By attaching people to portable blood pressure monitors, Holt-Lunstad and her colleagues found that blood pressure was highest when people were interacting with someone they felt ambivalent about.
What she found really surprising was that these interactions caused higher blood pressure than those with people the research subjects felt completely negative about. "We suspect that people we feel positive toward can hurt us that much more when they make a snide comment or don't come through for us because they are important to us. Friends may help us cope with stress, but they also may create stress."
So would we be better off having no friends at all?
Hardly. "One thing research shows is that as one's social network gets smaller, one's risk for mortality increases," Holt-Lunstad says. "And it's a strong correlation -- almost as strong as the correlation between smoking and mortality."
The Impact of Loneliness
What about loners? Are they at greater risk of dying because they prefer to be alone?
Only if they feel lonely. One study found that drug use among young people was higher among those who said they were lonely. Older lonely people tended to have higher blood pressure and poorer sleep quality. They also were more tense and anxious.
Another study found that college freshmen who had small social networks and claimed to be lonely had weaker immune responses to flu vaccinations. They also had higher levels of stress hormones in their blood.
Unfortunately, Americans have fewer friends than they used to, according to a recent study, "Social Isolation in America," published in the American Sociological Review. The authors found that from 1985 to 2004, the number of Americans who feel they have someone with whom they can discuss important matters dropped by nearly one-third. The number of people who said they had no one they could discuss such matters with tripled to nearly 25%. The authors suspect that long work hours and the popularity of the Internet may contribute to the decline in close relationships.
The study also found that the percentage of people who talk about important matters only to family members increased from 57% to 80%. Those who depend solely on their spouse for these talks increased from 5% to 9%.
How Women's Friendships Are Different From Men's
In general, women are better at maintaining friendships than men. Women "tend and befriend," says Shelley E. Taylor, PhD, a psychology professor at UCLA. They respond to stress by protecting and nurturing others ("tending"), and by seeking support from others ("befriending"). This pattern regulates the seeking, giving, and receipt of social support, Taylor says. It produces health benefits by reducing psychological and biological stress.
And Margaret Gibbs, PhD, a professor of psychology at Fairleigh Dickinson University, found that men and women relate to others differently throughout life.
"We found that women seemed more geared to empathy, while male friendships are more geared to companionship and altruism," she tells WebMD. "Male friendships are more about helping each other -- mending the lawn mower, that sort of thing. Women's friendships tend to have a more emotional content -- listening to friends' stories and coming up with helpful solutions."
Monday, April 27, 2009
Mexico Swine Flu Epidemic Worries World
Mexico Swine Flu Epidemic Worries World
Swine Flu Deaths in Healthy Young People Raise Fears of Pandemic
By Daniel J. DeNoon
WebMD Health NewsReviewed by Louise Chang, MDApril 24, 2009 -- Mexico's deadly swine flu outbreak is caused by the same virus identified in the U.S., says CDC Acting Director Richard Besser, MD.
The CDC is analyzing 14 virus samples sent from Mexico. Seven of them, the CDC learned today, are very similar to the unusual swine flu strain isolated from U.S. patients.
Swine Flu Outbreak:
Get the Facts
Get the latest swine flu information from the WebMD and the CDC, plus other facts you need to know.
Swine Flu FAQ
CDC Swine Flu updates
Swine Flu Case Count Rising
Swine Flu Sickens 2 California Kids
© 2009 WebMD, LLC. All rights reserved.
"People are concerned about this situation," Besser said at a news conference. "We are worried as well. Our concern has grown since yesterday."
Sixty people in Mexico have died of the flu -- and so far, 16 of the deaths are confirmed cases of swine flu, news sources quote Mexican officials as saying.
World Health Organization spokesman Gregory Hartl told the Canadian news agency CBC that there have been some 800 cases in Mexico City, where schools are closed due to the outbreak.
Alarmingly, the flu outbreak in Mexico is striking healthy young people -- a pattern that would be expected if a flu virus new to humans emerged.
"Because these cases are not happening in the very old or the very young, which happens with seasonal influenza, this is an unusual event and a cause for heightened concern," Hartl said in a CBC interview.
That's not the only eyebrow-raising feature of the swine flu outbreaks. Infections have occurred in Mexico, California, and Texas -- where warm weather should mean the end of the normal flu season, says William Schaffner, MD, president-elect of the National Foundation for Infectious Diseases and chair of preventive medicine and infectious diseases at Vanderbilt University.
"Will we see this flu virus transmitted in the warm months? That would give us heartburn," Schaffner tells WebMD. "And is this a harbinger of things to come during our next flu season?"
Another disconcerting feature of the outbreak is that it's probably too late to contain it to limited geographical areas.
"We are seeing cases in Texas and California with no connection between them. This makes us think there has been transmission from person to person through many cycles," Besser said. "For containment we need limitation to a confined geographical area, and we have not seen that here."
The World Health Organization is convening an expert panel to determine whether to raise its pandemic flu alert level. Because of bird flu, we're at level 3. If the panel finds evidence of "increased human-to-human transmission" it goes to level 4. If there's evidence of "significant human-to-human transmission," it goes to level 5.
A pandemic will be declared only if there is "efficient and sustained human-to-human transmission" of a new flu virus. That clearly has not happened yet.
"Whether or not this [swine flu] strain causes a widespread pandemic will depend on its transmissibility among humans. That has not yet been fully elucidated, but should be shortly," Pascal James Imperato, MD, MPH, professor and dean of public health at SUNY Downstate Medical Center, Brooklyn, N.Y., tells WebMD.
Should there be a pandemic -- something that is far from certain -- the CDC has already begun work on a vaccine. Would it be ready by next flu season?
"It would be an Olympic sprint -- a mammoth feat -- to produce a flu vaccine by October," Schaffner says.
What You Should Do Now
Infectious disease experts agree with the CDC that now is a good time to think about what you'd do if there were a widespread flu outbreak.
Here's what you can do right now: Wash your hands often and well.
The CDC has not yet warned travelers to avoid the San Diego or San Antonio areas, and it is not restricting travel to or from Mexico. However, travelers to or from those areas should be sure to use all normal precautions to avoid catching or spreading a cold or flu.
People who live in or visit those areas and who get flu-like symptoms should see a doctor to get tested for the swine flu virus.
Swine Flu Deaths in Healthy Young People Raise Fears of Pandemic
By Daniel J. DeNoon
WebMD Health NewsReviewed by Louise Chang, MDApril 24, 2009 -- Mexico's deadly swine flu outbreak is caused by the same virus identified in the U.S., says CDC Acting Director Richard Besser, MD.
The CDC is analyzing 14 virus samples sent from Mexico. Seven of them, the CDC learned today, are very similar to the unusual swine flu strain isolated from U.S. patients.
Swine Flu Outbreak:
Get the Facts
Get the latest swine flu information from the WebMD and the CDC, plus other facts you need to know.
Swine Flu FAQ
CDC Swine Flu updates
Swine Flu Case Count Rising
Swine Flu Sickens 2 California Kids
© 2009 WebMD, LLC. All rights reserved.
"People are concerned about this situation," Besser said at a news conference. "We are worried as well. Our concern has grown since yesterday."
Sixty people in Mexico have died of the flu -- and so far, 16 of the deaths are confirmed cases of swine flu, news sources quote Mexican officials as saying.
World Health Organization spokesman Gregory Hartl told the Canadian news agency CBC that there have been some 800 cases in Mexico City, where schools are closed due to the outbreak.
Alarmingly, the flu outbreak in Mexico is striking healthy young people -- a pattern that would be expected if a flu virus new to humans emerged.
"Because these cases are not happening in the very old or the very young, which happens with seasonal influenza, this is an unusual event and a cause for heightened concern," Hartl said in a CBC interview.
That's not the only eyebrow-raising feature of the swine flu outbreaks. Infections have occurred in Mexico, California, and Texas -- where warm weather should mean the end of the normal flu season, says William Schaffner, MD, president-elect of the National Foundation for Infectious Diseases and chair of preventive medicine and infectious diseases at Vanderbilt University.
"Will we see this flu virus transmitted in the warm months? That would give us heartburn," Schaffner tells WebMD. "And is this a harbinger of things to come during our next flu season?"
Another disconcerting feature of the outbreak is that it's probably too late to contain it to limited geographical areas.
"We are seeing cases in Texas and California with no connection between them. This makes us think there has been transmission from person to person through many cycles," Besser said. "For containment we need limitation to a confined geographical area, and we have not seen that here."
The World Health Organization is convening an expert panel to determine whether to raise its pandemic flu alert level. Because of bird flu, we're at level 3. If the panel finds evidence of "increased human-to-human transmission" it goes to level 4. If there's evidence of "significant human-to-human transmission," it goes to level 5.
A pandemic will be declared only if there is "efficient and sustained human-to-human transmission" of a new flu virus. That clearly has not happened yet.
"Whether or not this [swine flu] strain causes a widespread pandemic will depend on its transmissibility among humans. That has not yet been fully elucidated, but should be shortly," Pascal James Imperato, MD, MPH, professor and dean of public health at SUNY Downstate Medical Center, Brooklyn, N.Y., tells WebMD.
Should there be a pandemic -- something that is far from certain -- the CDC has already begun work on a vaccine. Would it be ready by next flu season?
"It would be an Olympic sprint -- a mammoth feat -- to produce a flu vaccine by October," Schaffner says.
What You Should Do Now
Infectious disease experts agree with the CDC that now is a good time to think about what you'd do if there were a widespread flu outbreak.
Here's what you can do right now: Wash your hands often and well.
The CDC has not yet warned travelers to avoid the San Diego or San Antonio areas, and it is not restricting travel to or from Mexico. However, travelers to or from those areas should be sure to use all normal precautions to avoid catching or spreading a cold or flu.
People who live in or visit those areas and who get flu-like symptoms should see a doctor to get tested for the swine flu virus.
Swine Flu FAQ
Swine Flu FAQ
WebMD Provides Answers to Your Questions About Swine Flu
By Daniel J. DeNoon
WebMD Health NewsReviewed by Louise Chang, MD The swine flu virus in the U.S. is the same one causing a deadly epidemic in Mexico. What is swine flu? What can we do about it? WebMD answers your questions.
What Is Swine Flu?
Like humans, pigs get the flu. Four different type A swine flu strains commonly circulate among pigs. Most recent swine flu viruses have belonged to the H1N1 and H3N2 subtypes. Pigs typically get sick but usually don't die from swine flu.
The new swine flu virus infecting humans is very unusual. It's somehow acquired genes from swine, bird, and human flu bugs. And it's also got genes from Eurasian swine flu viruses that aren't supposed to be in North America.
Do Humans Get Swine Flu?
Normally, swine flu bugs don't infect people. Historically, there's a case every year or two in the U.S. among people who have contact with live pigs.
But from December 2005 to January 2009 there was an uptick in swine flu cases. There were 12 human swine flu infections during this time. Eleven of these people had direct or indirect contact with pigs; in the twelfth case it was not known whether there was pig contact.
It's possible this uptick was due to improved reporting systems, but the CDC says "genetic changes in swine flu viruses and other factors might also be a factor."
The new swine flu virus is different. It's not yet clear that it's here to stay. But it is infecting humans, and that has world health officials keeping a close eye on it.
What Are the Symptoms of Swine Flu?
Swine flu symptoms are similar to regular flu symptoms and include cough, sore throat, fever, chills, headache, and fatigue. Some patients have also reported nausea and diarrhea. There is no easy way to distinguish swine flu from other types of flu or other germs. It takes a lab test to tell whether it's swine flu.
Can Swine Flu Spread From Person to Person?
The U.S. residents infected with swine flu virus had no direct contact with pigs. The CDC says it's likely that the infections represent widely separated cycles of human-to-human infections.
Have There Been Previous Swine Flu Outbreaks?
If swine flu sounds familiar to you, it's probably because you remember or have read about the 1976 swine flu outbreak at Fort Dix, N.J., among military recruits. It lasted about a month and then went away as mysteriously as it appeared. As many as 240 people were infected; one died.
The swine flu that spread at Fort Dix was the H1N1 strain. That's the same flu strain that caused the disastrous flu pandemic of 1918-1919, resulting in tens of millions of deaths.
Concern that a new H1N1 pandemic might return with winter led to a crash program to create a vaccine and vaccinate all Americans against swine flu. That vaccine program ran into all kinds of problems -- not the least of which was public perception that the vaccine caused excessive rates of dangerous reactions. After more than 40 million people were vaccinated, the effort was abandoned.
As it turned out, there was no swine flu epidemic
I Got a Flu Shot. Am I Protected Against Swine Flu?
No. There is currently no swine flu vaccine.
It's possible that the seasonal flu vaccine might provide partial protection against H3N2 swine flu bugs. But the strain that appeared in California is the H1N1 swine flu strain. It is very different from the H1N1 human flu strain included in the seasonal flu vaccine.
It's not known whether previous infection with human type A H1N1 flu might provide partial protection against the type A H1N1 swine flu in the current outbreak.
However, the CDC has made a "vaccine seed" from swine flu isolated from an infected person, and has begun the process of developing a vaccine should the need arise. Whether a vaccine could be produced in quantity by next flu season is a huge question.
How Serious Is the Public Health Threat of a Swine Flu Epidemic?
Any flu epidemic is worrisome, especially when a new strain of flu bug is involved.
"Influenza A viruses new to the human population that are able to efficiently transmit from person to person and cause illness may represent a pandemic threat," the CDC warns.
It's worrisome that, unlike seasonal flu, the swine flu outbreak in Mexico is attacking healthy young people. That's a hallmark of pandemic flu bugs.
But it takes more than a new virus spreading among humans to make a pandemic. The virus has to be able to spread efficiently from one person to another, and transmission has to be sustained over time. In addition, the virus has to spread geographically.
Is There a Treatment for Swine Flu?
Yes. While the swine flu bug is resistant to older flu medicines, it remains sensitive to Tamiflu and to Relenza.
Can You Get Swine Flu by Eating Pork?
No. You can only catch swine flu from being around an infected pig -- or, if it's the new swine flu virus, from an infected person.
WebMD Provides Answers to Your Questions About Swine Flu
By Daniel J. DeNoon
WebMD Health NewsReviewed by Louise Chang, MD The swine flu virus in the U.S. is the same one causing a deadly epidemic in Mexico. What is swine flu? What can we do about it? WebMD answers your questions.
What Is Swine Flu?
Like humans, pigs get the flu. Four different type A swine flu strains commonly circulate among pigs. Most recent swine flu viruses have belonged to the H1N1 and H3N2 subtypes. Pigs typically get sick but usually don't die from swine flu.
The new swine flu virus infecting humans is very unusual. It's somehow acquired genes from swine, bird, and human flu bugs. And it's also got genes from Eurasian swine flu viruses that aren't supposed to be in North America.
Do Humans Get Swine Flu?
Normally, swine flu bugs don't infect people. Historically, there's a case every year or two in the U.S. among people who have contact with live pigs.
But from December 2005 to January 2009 there was an uptick in swine flu cases. There were 12 human swine flu infections during this time. Eleven of these people had direct or indirect contact with pigs; in the twelfth case it was not known whether there was pig contact.
It's possible this uptick was due to improved reporting systems, but the CDC says "genetic changes in swine flu viruses and other factors might also be a factor."
The new swine flu virus is different. It's not yet clear that it's here to stay. But it is infecting humans, and that has world health officials keeping a close eye on it.
What Are the Symptoms of Swine Flu?
Swine flu symptoms are similar to regular flu symptoms and include cough, sore throat, fever, chills, headache, and fatigue. Some patients have also reported nausea and diarrhea. There is no easy way to distinguish swine flu from other types of flu or other germs. It takes a lab test to tell whether it's swine flu.
Can Swine Flu Spread From Person to Person?
The U.S. residents infected with swine flu virus had no direct contact with pigs. The CDC says it's likely that the infections represent widely separated cycles of human-to-human infections.
Have There Been Previous Swine Flu Outbreaks?
If swine flu sounds familiar to you, it's probably because you remember or have read about the 1976 swine flu outbreak at Fort Dix, N.J., among military recruits. It lasted about a month and then went away as mysteriously as it appeared. As many as 240 people were infected; one died.
The swine flu that spread at Fort Dix was the H1N1 strain. That's the same flu strain that caused the disastrous flu pandemic of 1918-1919, resulting in tens of millions of deaths.
Concern that a new H1N1 pandemic might return with winter led to a crash program to create a vaccine and vaccinate all Americans against swine flu. That vaccine program ran into all kinds of problems -- not the least of which was public perception that the vaccine caused excessive rates of dangerous reactions. After more than 40 million people were vaccinated, the effort was abandoned.
As it turned out, there was no swine flu epidemic
I Got a Flu Shot. Am I Protected Against Swine Flu?
No. There is currently no swine flu vaccine.
It's possible that the seasonal flu vaccine might provide partial protection against H3N2 swine flu bugs. But the strain that appeared in California is the H1N1 swine flu strain. It is very different from the H1N1 human flu strain included in the seasonal flu vaccine.
It's not known whether previous infection with human type A H1N1 flu might provide partial protection against the type A H1N1 swine flu in the current outbreak.
However, the CDC has made a "vaccine seed" from swine flu isolated from an infected person, and has begun the process of developing a vaccine should the need arise. Whether a vaccine could be produced in quantity by next flu season is a huge question.
How Serious Is the Public Health Threat of a Swine Flu Epidemic?
Any flu epidemic is worrisome, especially when a new strain of flu bug is involved.
"Influenza A viruses new to the human population that are able to efficiently transmit from person to person and cause illness may represent a pandemic threat," the CDC warns.
It's worrisome that, unlike seasonal flu, the swine flu outbreak in Mexico is attacking healthy young people. That's a hallmark of pandemic flu bugs.
But it takes more than a new virus spreading among humans to make a pandemic. The virus has to be able to spread efficiently from one person to another, and transmission has to be sustained over time. In addition, the virus has to spread geographically.
Is There a Treatment for Swine Flu?
Yes. While the swine flu bug is resistant to older flu medicines, it remains sensitive to Tamiflu and to Relenza.
Can You Get Swine Flu by Eating Pork?
No. You can only catch swine flu from being around an infected pig -- or, if it's the new swine flu virus, from an infected person.
Swine Flu: U.S. Declares Public Health Emergency
Swine Flu: U.S. Declares Public Health Emergency
CDC Has Reports of at Least 20 People in the U.S. Sickened by Swine Flu
By Miranda Hitti
By Miranda Hitti
WebMD Health NewsReviewed by Louise Chang, MDApril 26, 2009 -- The U.S. government today declared the swine flu outbreak a public health emergency. Swine flu has sickened at least 20 people in the U.S., by the CDC's latest count.
"We are declaring today a public health emergency," Secretary of Homeland Security Janet Napolitano said today at a White House news briefing. That declaration is "standard operating procedure," Napolitano said. "It is similar to what we do when we see a hurricane approaching a site. The hurricane might not actually hit but allows you to take a number of preparatory steps. We really don't know ultimately what the size or seriousness of this outbreak is going to be."
Swine Flu Outbreak:
Get the Facts
Get the latest swine flu information from the WebMD and the CDC, plus other facts you need to know.
Swine Flu FAQ
CDC Swine Flu updates
Swine Flu Case Count Rising
Swine Flu Sickens 2 California Kids
© 2009 WebMD, LLC. All rights reserved.
As part of the emergency, the Department of Homeland Security is releasing 25% of stockpiled antivirals -- Tamiflu and Relenza -- to the states.
Here's what officials want you to do: Stay home if you're sick, avoid close contact with people who are sick, wash your hands often, avoid touching your eyes, nose, and mouth, cover your mouth or nose with a tissue when coughing or sneezin g, and keep up with health information in your own community.
The CDC has gotten reports of lab-confirmed swine flu cases in eight people in New York City, seven people in California, two in Texas, two in Kansas, and one in Ohio.
All of those swine flu cases have been relatively mild, although one person was briefly hospitalized, according to Keiji Fukuda, MD, assistant director-general for health security and environment at the World Health Organization.
The eight swine flu cases in New York City involved students at Saint Francis Preparatory School in Queens. All have recovered fully, according to a news release from the New York City Department of Health and Mental Hygiene.
So far, U.S. cases of swine flu have been milder than those seen in Mexico, where the World Health Organization has confirmed that at least 20 people have died from swine flu; health officials are investigating dozens more deaths in Mexico.
More swine flu cases are likely in the U.S. as public health officials heighten their hunt for the new strain of swine flu virus, notes Anne Schuchat, MD, the CDC's interim deputy director for science and public health program. Her advice: Be prepared for the possibility that there may be severe cases, and even fatalities, in the U.S.
"I do fear that we will have deaths here," Schuchat said today at a news conference.
Countries around the world are watching for the virus, and scientists are scrambling to learn more about the virus and stop it before it becomes a pandemic.
Fukuda says the global health community is taking the swine flu threat "very seriously" but wants more information before deciding whether to raise the WHO's pandemic alert level from phase 3 to phase 4.
An influenza pandemic occurs when a new influenza type A virus emerges for which there is little or no immunity in the human population, begins to cause serious illness, and then spreads easily from person to person worldwide, according to background information from the U.S. Department of Health and Human Services.
The WHO has a scale ranging from phase 1 (low risk of a flu pandemic) to phase 6 (a full-blown pandemic is under way).
Swine Flu Symptoms
Symptoms of swine flu seen in U.S. patients so far have been "relatively nonspecific -- high fever, cough sore throat, muscle aches, possibly vomiting and diarrhea in some numbers," says Schuchat.
The problem is, those symptoms aren't unique to swine flu.
They "can be caused by so many different things," Schuchat says, which makes it "impossible" for a patient to tell if they have swine flu, as opposed to another flu virus or a different illness.
"This is a dilemma, a challenge, we're wrestling with," says Schuchat. She encourages patients to use their judgment about whether they're sick enough to see a doctor, and to definitely do so if they've recently been to a high-risk area, such as Mexico.
Schuchat also notes that there have been cases of the virus spreading from person to person in the U.S. The two confirmed cases in Kansas are a husband and wife, one of whom traveled to Mexico. Two days after returning home, the spouse became ill, says Schuchat.
WebMD Senior Writer Daniel J. DeNoon contributed to this report.
Saturday, April 18, 2009
Build a Better Date Night
Build a Better Date Night
Feature from "Good Housekeeping" MagazineBy Sarah Mahoney
Whether your trysts are regular or once in a blue moon, you can rev up your romantic routine. For more great dates, check out these 7 fun ideas.
Tell the truth: Did your date nights vanish years ago, along with sleeping in, Sunday brunches, and reading the newspaper over coffee? Or have they become as stale as, well, 15 years of the missionary position?
In either case, you're due for a refresher. Couples should give special time together a high priority, because it not only helps you stay connected, the latest research reports, but it also makes both partners happier. "Date night is one of the best ways couples have to pull back from the fray and remember there's an 'us' hidden in the swirl of their daily lives — and really focus on maintaining and celebrating their connection to each other," says Pepper Schwartz, Ph.D., a sociology professor at the University of Washington in Seattle and relationship expert from perfectmatch.com.
To help keep your marriage strong, date night should be fun — of course — but you should also make it novel in some way, or you'll grow bored with your time together and, possibly, with each other, says Arthur Aron, Ph.D., a psychology professor at the State University of New York at Stony Brook who researches couples' interactions. That doesn't mean that you have to give up your beloved French film nights or ballroom dancing sessions and start bungee jumping just for the sake of novelty. Rather, you should simply make the effort to think creatively about how to spend your time together. "My wife and I love the ballet," says Aron, "and my sister gave us a backstage tour at the local dance company, so we got a different perspective on something we already enjoy."
To discover how to spice up date nights, we found three couples who faced challenges and asked them to road-test expert fix-it advice. Read on to see what worked — and why.
The Kitchen Cure
Names: Nina and Jayme Deibler
Hometown: Pittsburgh
Married: 4 years; she's 37, he's 38
Kids: A daughter, 2
Their challenge: Making date night happen at all
"My husband and I used to have great dates," Nina says. "We both love good food, and we'd often spend five or six hours cooking and experimenting with different wines."
But since their daughter was born, finding couple time has gotten harder. "I travel frequently for my job, and Jayme often works evenings and weekends," she says. "So when we do have a few hours, we usually want to spend them with our daughter."
"Working parents worry that time spent as a couple subtracts from time spent with their kids," explains Schwartz. "But when couples feel guilty leaving a child with a sitter, I tell them, 'This isn't selfish, it's protecting both your marriage and your family.'"
Expert Makeover
"It's great that these two have such a strong common interest," says James M. Graham, Ph.D., assistant professor of psychology at Western Washington University in Bellingham. "I'd like them to indulge their passions in a project they can finish in a few hours — one with a unique twist. Experimenting together makes a date more satisfying, just as team-building exercises draw people closer."
When a couple has to overcome a new challenge, their sense of accomplishment after they succeed is magnified. "Dates that allow that kind of growth let you surprise yourself and your partner," he says, "and see each other in a new light." Just keep changes and challenges moderate. "This should be fun, not traumatic."
The Deiblers decided to try making sushi — a dish they love in restaurants but had never prepared themselves. They bought the basic equipment (including a book of instructions) at a favorite cooking store and arranged for Nina's mom to take care of their toddler for a few hours.
The verdict: A huge hit
Her take: "The expert really nailed it when he suggested a project for us — this was great. And it was a challenge: The rice had to be just the right temperature, and some of the chopping and rolling was tricky. We did need the time without our daughter, but several of my neighbors want to trade babysitting so we can all have date nights. I found this experience very inspiring — it made me feel like we were dating again. Next time, I want to try cooking Indian food."
His take: "The food turned out really well, and we had the kind of fun we haven't for ages. It reminded me how good we are at working together and how we complement each other: Nina did the organizing and the shopping, and got the rice going. Then we took turns chopping and wrapping, tasting as we went along. And because we did it all between 5 and 7:30, we are confident now that we can make something like this happen at least every other week."
5-Minute Fixes
Names: Cate and Dan Adams
Hometown: Salt Lake City
Married: 18 years; both are 49
Kids: Twin girls, 16
Their challenge: Making limited time together feel meaningful
"We've always tried to do date nights, even before we had kids," says Cate. "Then, after the girls were born, we didn't go out often. Now that they're older, we both work full-time and still don't go out much.
"After our last anniversary, we decided that we'd try to spend five minutes each day just talking and connecting. And it's helped. But we'd like to find a way to make that time more special."
Expert Makeover
The experts loved the five-minute ritual, which eases the scheduling pressure that prevents many date nights from happening at all. But Schwartz advised the Adamses to expand beyond their "How was your day?" conversations and get creative. She suggested that they develop ways to mix it up by brainstorming together and surprising each other. She emphasizes that no one, including the Adamses, should feel pressured to come up with something novel for every single date. There's nothing wrong with what the two do now: chat in the kitchen while Dan does the dishes. But sharing a glass of wine, going for a short walk, or just sitting on the deck once a week can make those few moments feel more special.
The overachieving couple decided that they would come up with something different to do every single day for an entire week. One night, they traded foot massages. The next, Cate asked Dan to show her how to fix a flat tire on her bicycle. Another evening, each drew a picture of the best thing that happened to them that day. And one night, after Dan noticed someone selling weird-looking rocks on eBay, they raced down to the creek that runs through their backyard to see who could find the most eBay-worthy stones.
The verdict: Sure, it was nice, but enough already!
Her take: "The night we brainstormed was funny, and we laughed a lot throughout the week. But the best part, honestly, was all the talking we did while we were doing these things. In almost every case, we wound up spending much longer than five minutes, and it was good to realize we could make that much time for each other."
His take: "We had some fun with this, but I missed the quietness — and the spontaneity — of just being able to sit down and talk with Cate and decompress. And having to think of something new to do every night just wouldn't be sustainable in the long run, obviously. But I can see doing something special more often than we do now."
The Active Answer
Names: Camille and Kent Boskovich
Hometown: La Grange, IL
Married: 22 years; both are 47
Kids: A son, 19, and a daughter, 17
Their challenge: Spicing up their tried-and-true routine
These two spend plenty of time together — and enjoy it. They work out at the same gym, they have dinner out once a week, and they often spend weekends driving to their daughter's hockey tournaments in other cities.
Still, "our dates are pretty boring," Camille says. And while they enjoy elaborate events — from opera to White Sox games — they're looking for date ideas that don't take much advance scheduling.
Dating can be complex for couples like this, as they anticipate an empty house — and a kid-less social calendar. Even people with common interests, like these two, need to expand their dating repertoire, says Aron. He advised them to explore more in the fitness realm. They already enjoy it, and his research shows that couples typically find shared physical activity one of the best ways to bond. Aron actually persuaded spouses to Velcro themselves together and crawl across gym mats — and found that it made them feel more in love than they had before this unusual exercise.
"It's really important that they pick something they're both new to," he says — maybe a swing-dance class or snowshoeing. But they shouldn't worry that every activity has to be a perfect fit, says Schwartz. "Think of yourself as an anthropologist doing research, and remember, if you don't like it, you don't have to try it again," she says. Plus, even a bad date can be a good bonding experience and provide a couple with a shared memory to laugh about later.
After looking at their options, Camille and Kent tried a fitness yoga class at their health club: She had taken a few classes in the past but was still a novice, and he had always been interested in giving it a go.
The verdict: Mixed reviews but headed in the right direction
Her take: "I was surprised Kent was game to try this, but it was really great. The instructor asked us to do some tough poses, and Kent kept shooting me a look like, 'Are you kidding me?' On the one hand, I worried that he wasn't enjoying it that much. On the other, it was funny — and it really felt good to do something besides going out to dinner, especially something physical and healthy. So this inspired us: We're going to do a few sessions with a trainer next."
His take: "Honestly, is this a better date than going out for dinner and sharing a bottle of wine? No way. But that said, it was OK, and I would try it again. I'm looking forward to the training sessions. I'm a treadmill guy, so it'll be good to add weights — and fun to do it with my wife."
Originally published on January 15, 2009
Feature from "Good Housekeeping" MagazineBy Sarah Mahoney
Whether your trysts are regular or once in a blue moon, you can rev up your romantic routine. For more great dates, check out these 7 fun ideas.
Tell the truth: Did your date nights vanish years ago, along with sleeping in, Sunday brunches, and reading the newspaper over coffee? Or have they become as stale as, well, 15 years of the missionary position?
In either case, you're due for a refresher. Couples should give special time together a high priority, because it not only helps you stay connected, the latest research reports, but it also makes both partners happier. "Date night is one of the best ways couples have to pull back from the fray and remember there's an 'us' hidden in the swirl of their daily lives — and really focus on maintaining and celebrating their connection to each other," says Pepper Schwartz, Ph.D., a sociology professor at the University of Washington in Seattle and relationship expert from perfectmatch.com.
To help keep your marriage strong, date night should be fun — of course — but you should also make it novel in some way, or you'll grow bored with your time together and, possibly, with each other, says Arthur Aron, Ph.D., a psychology professor at the State University of New York at Stony Brook who researches couples' interactions. That doesn't mean that you have to give up your beloved French film nights or ballroom dancing sessions and start bungee jumping just for the sake of novelty. Rather, you should simply make the effort to think creatively about how to spend your time together. "My wife and I love the ballet," says Aron, "and my sister gave us a backstage tour at the local dance company, so we got a different perspective on something we already enjoy."
To discover how to spice up date nights, we found three couples who faced challenges and asked them to road-test expert fix-it advice. Read on to see what worked — and why.
The Kitchen Cure
Names: Nina and Jayme Deibler
Hometown: Pittsburgh
Married: 4 years; she's 37, he's 38
Kids: A daughter, 2
Their challenge: Making date night happen at all
"My husband and I used to have great dates," Nina says. "We both love good food, and we'd often spend five or six hours cooking and experimenting with different wines."
But since their daughter was born, finding couple time has gotten harder. "I travel frequently for my job, and Jayme often works evenings and weekends," she says. "So when we do have a few hours, we usually want to spend them with our daughter."
"Working parents worry that time spent as a couple subtracts from time spent with their kids," explains Schwartz. "But when couples feel guilty leaving a child with a sitter, I tell them, 'This isn't selfish, it's protecting both your marriage and your family.'"
Expert Makeover
"It's great that these two have such a strong common interest," says James M. Graham, Ph.D., assistant professor of psychology at Western Washington University in Bellingham. "I'd like them to indulge their passions in a project they can finish in a few hours — one with a unique twist. Experimenting together makes a date more satisfying, just as team-building exercises draw people closer."
When a couple has to overcome a new challenge, their sense of accomplishment after they succeed is magnified. "Dates that allow that kind of growth let you surprise yourself and your partner," he says, "and see each other in a new light." Just keep changes and challenges moderate. "This should be fun, not traumatic."
The Deiblers decided to try making sushi — a dish they love in restaurants but had never prepared themselves. They bought the basic equipment (including a book of instructions) at a favorite cooking store and arranged for Nina's mom to take care of their toddler for a few hours.
The verdict: A huge hit
Her take: "The expert really nailed it when he suggested a project for us — this was great. And it was a challenge: The rice had to be just the right temperature, and some of the chopping and rolling was tricky. We did need the time without our daughter, but several of my neighbors want to trade babysitting so we can all have date nights. I found this experience very inspiring — it made me feel like we were dating again. Next time, I want to try cooking Indian food."
His take: "The food turned out really well, and we had the kind of fun we haven't for ages. It reminded me how good we are at working together and how we complement each other: Nina did the organizing and the shopping, and got the rice going. Then we took turns chopping and wrapping, tasting as we went along. And because we did it all between 5 and 7:30, we are confident now that we can make something like this happen at least every other week."
5-Minute Fixes
Names: Cate and Dan Adams
Hometown: Salt Lake City
Married: 18 years; both are 49
Kids: Twin girls, 16
Their challenge: Making limited time together feel meaningful
"We've always tried to do date nights, even before we had kids," says Cate. "Then, after the girls were born, we didn't go out often. Now that they're older, we both work full-time and still don't go out much.
"After our last anniversary, we decided that we'd try to spend five minutes each day just talking and connecting. And it's helped. But we'd like to find a way to make that time more special."
Expert Makeover
The experts loved the five-minute ritual, which eases the scheduling pressure that prevents many date nights from happening at all. But Schwartz advised the Adamses to expand beyond their "How was your day?" conversations and get creative. She suggested that they develop ways to mix it up by brainstorming together and surprising each other. She emphasizes that no one, including the Adamses, should feel pressured to come up with something novel for every single date. There's nothing wrong with what the two do now: chat in the kitchen while Dan does the dishes. But sharing a glass of wine, going for a short walk, or just sitting on the deck once a week can make those few moments feel more special.
The overachieving couple decided that they would come up with something different to do every single day for an entire week. One night, they traded foot massages. The next, Cate asked Dan to show her how to fix a flat tire on her bicycle. Another evening, each drew a picture of the best thing that happened to them that day. And one night, after Dan noticed someone selling weird-looking rocks on eBay, they raced down to the creek that runs through their backyard to see who could find the most eBay-worthy stones.
The verdict: Sure, it was nice, but enough already!
Her take: "The night we brainstormed was funny, and we laughed a lot throughout the week. But the best part, honestly, was all the talking we did while we were doing these things. In almost every case, we wound up spending much longer than five minutes, and it was good to realize we could make that much time for each other."
His take: "We had some fun with this, but I missed the quietness — and the spontaneity — of just being able to sit down and talk with Cate and decompress. And having to think of something new to do every night just wouldn't be sustainable in the long run, obviously. But I can see doing something special more often than we do now."
The Active Answer
Names: Camille and Kent Boskovich
Hometown: La Grange, IL
Married: 22 years; both are 47
Kids: A son, 19, and a daughter, 17
Their challenge: Spicing up their tried-and-true routine
These two spend plenty of time together — and enjoy it. They work out at the same gym, they have dinner out once a week, and they often spend weekends driving to their daughter's hockey tournaments in other cities.
Still, "our dates are pretty boring," Camille says. And while they enjoy elaborate events — from opera to White Sox games — they're looking for date ideas that don't take much advance scheduling.
Dating can be complex for couples like this, as they anticipate an empty house — and a kid-less social calendar. Even people with common interests, like these two, need to expand their dating repertoire, says Aron. He advised them to explore more in the fitness realm. They already enjoy it, and his research shows that couples typically find shared physical activity one of the best ways to bond. Aron actually persuaded spouses to Velcro themselves together and crawl across gym mats — and found that it made them feel more in love than they had before this unusual exercise.
"It's really important that they pick something they're both new to," he says — maybe a swing-dance class or snowshoeing. But they shouldn't worry that every activity has to be a perfect fit, says Schwartz. "Think of yourself as an anthropologist doing research, and remember, if you don't like it, you don't have to try it again," she says. Plus, even a bad date can be a good bonding experience and provide a couple with a shared memory to laugh about later.
After looking at their options, Camille and Kent tried a fitness yoga class at their health club: She had taken a few classes in the past but was still a novice, and he had always been interested in giving it a go.
The verdict: Mixed reviews but headed in the right direction
Her take: "I was surprised Kent was game to try this, but it was really great. The instructor asked us to do some tough poses, and Kent kept shooting me a look like, 'Are you kidding me?' On the one hand, I worried that he wasn't enjoying it that much. On the other, it was funny — and it really felt good to do something besides going out to dinner, especially something physical and healthy. So this inspired us: We're going to do a few sessions with a trainer next."
His take: "Honestly, is this a better date than going out for dinner and sharing a bottle of wine? No way. But that said, it was OK, and I would try it again. I'm looking forward to the training sessions. I'm a treadmill guy, so it'll be good to add weights — and fun to do it with my wife."
Originally published on January 15, 2009
10 Ways to Catch a Liar
10 Ways to Catch a Liar
Experts have 10 tips that can let you know if someone isn't telling you the whole truth.
By Heather Hatfield
J.J. Newberry was a trained federal agent, skilled in the art of deception detection. So when a witness to a shooting sat in front of him and tried to tell him that when she heard gunshots she didn't look, she just ran -- he knew she was lying.
How did Newberry reach this conclusion? The answer is by recognizing telltale signs that a person isn't being honest, like inconsistencies in a story, behavior that's different from a person's norm, or too much detail in an explanation.
While using these signs to catch a liar takes extensive training and practice, it's no longer only for authorities like Newberry. Now, the average person can become adept at identifying dishonesty, and it's not as hard as you might think. Experts tell WebMD the top 10 ways to let the truth be known.
Tip No. 1: Inconsistencies
"When you want to know if someone is lying, look for inconsistencies in what they are saying," says Newberry, who was a federal agent for 30 years and a police officer for five.
When the woman he was questioning said she ran and hid after hearing gunshots -- without looking -- Newberry saw the inconsistency immediately.
"There was something that just didn't fit," says Newberry. "She heard gunshots but she didn't look? I knew that was inconsistent with how a person would respond to a situation like that."
So when she wasn't paying attention, he banged on the table. She looked right at him.
"When a person hears a noise, it's a natural reaction to look toward it," Newberry tells WebMD. "I knew she heard those gunshots, looked in the direction from which they came, saw the shooter, and then ran."
Sure enough, he was right.
"Her story was just illogical," says Newberry. "And that's what you should look for when you're talking to someone who isn't being truthful. Are there inconsistencies that just don't fit?"
Tip No. 2: Ask the Unexpected
"About 4% of people are accomplished liars and they can do it well," says Newberry. "But because there are no Pinocchio responses to a lie, you have to catch them in it."
Sir Walter Scott put it best: "Oh what a tangled web we weave, when first we practice to deceive!" But how can you a catch a person in his own web of lies?
"Watch them carefully," says Newberry. "And then when they don't expect it, ask them one question that they are not prepared to answer to trip them up."
Tip No. 3: Gauge Against a Baseline
"One of the most important indicators of dishonesty is changes in behavior," says Maureen O'Sullivan, PhD, a professor of psychology at the University of San Francisco. "You want to pay attention to someone who is generally anxious, but now looks calm. Or, someone who is generally calm but now looks anxious."
The trick, explains O'Sullivan, is to gauge their behavior against a baseline. Is a person's behavior falling away from how they would normally act? If it is, that could mean that something is up.
Tip No. 4: Look for Insincere Emotions
"Most people can't fake smile," says O'Sullivan. "The timing will be wrong, it will be held too long, or it will be blended with other things. Maybe it will be a combination of an angry face with a smile; you can tell because their lips are smaller and less full than in a sincere smile."
These fake emotions are a good indicator that something has gone afoul.
Tip No. 5: Pay Attention to Gut Reactions
"People say, 'Oh, it was a gut reaction or women's intuition,' but what I think they are picking up on are the deviations of true emotions," O'Sullivan tells WebMD.
While an average person might not know what it is he's seeing when he thinks someone isn't being honest and attribute his suspicion to instinct, a scientist would be able to pinpoint it exactly -- which leads us to tip no. 6.
Tip No. 6: Watch for Microexpressions
When Joe Schmo has a gut feeling, Paul Ekman, a renowned expert in lie detection, sees microexpressions.
"A microexpression is a very brief expression, usually about a 25th of a second, that is always a concealed emotion," says Ekman, PhD, professor emeritus of psychology at the University of California Medical School in San Francisco.
So when a person is acting happy, but in actuality is really upset about something, for instance, his true emotion will be revealed in a subconscious flash of anger on his face. Whether the concealed emotion is fear, anger, happiness, or jealousy, that feeling will appear on the face in the blink of an eye. The trick is to see it.
"Almost everyone -- 99% of those we've tested in about 10,000 people -- won't see them," says Ekman. "But it can be taught."
In fact, in less than an hour, the average person can learn to see microexpressions.
Tip No. 7: Look for Contradictions
"The general rule is anything that a person does with their voice or their gesture that doesn't fit the words they are saying can indicate a lie," says Ekman. "For example, this is going to sound amazing, but it is true. Sometimes when people are lying and saying, 'Yes, she's the one that took the money,' they will without knowing it make a slight head shake 'no.' That's a gesture and it completely contradicts what they're saying in words."
These contradictions, explains Ekman, can be between the voice and the words, the gesture and the voice, the gesture and the words, or the face and the words.
"It's some aspect of demeanor that is contradicting another aspect," Ekman tells WebMD.
Tip No. 8: A Sense of Unease
"When someone isn't making eye contact and that's against how they normally act, it can mean they're not being honest," says Jenn Berman, PhD, a psychologist in private practice. "They look away, they're sweating, they look uneasy ... anything that isn't normal and indicates anxiety."
Tip No. 9: Too Much Detail
"When you say to someone, 'Oh, where were you?' and they say, 'I went to the store and I needed to get eggs and milk and sugar and I almost hit a dog so I had to go slow,' and on and on, they're giving you too much detail," says Berman.
Too much detail could mean they've put a lot of thought into how they're going to get out of a situation and they've crafted a complicated lie as a solution.
Tip No. 10: Don't Ignore the Truth
"It's more important to recognize when someone is telling the truth than telling a lie because people can look like they're lying but be telling truth," says Newberry.
While it sounds confusing, finding the truth buried under a lie can sometimes help find the answer to an important question: Why is a person lying?
These 10 truth tips, experts agree, all help detect deception. What they don't do is tell you why a person is lying and what the lie means.
"Microexpressions don't tell you the reason," says Ekman. "They just tell you what the concealed emotion is and that there is an emotion being concealed."
When you think someone is lying, you have to either know the person well enough to understand why he or she might lie, or be a people expert.
"You can see a microexpression, but you have to have more social-emotional intelligence on people to use it accurately," says O'Sullivan. "You have to be a good judge of people to understand what it means."
Extra Tip: Be Trusting
"In general we have a choice about which stance we take in life," says Ekman. "If we take a suspicious stance life is not going to be too pleasant, but we won't get misled very often. If we take a trusting stance, life is going to be a lot more pleasant but sometimes we are going to be taken in. As a parent or a friend, you're much better off being trusting rather than looking for lies all the time."
Experts have 10 tips that can let you know if someone isn't telling you the whole truth.
By Heather Hatfield
J.J. Newberry was a trained federal agent, skilled in the art of deception detection. So when a witness to a shooting sat in front of him and tried to tell him that when she heard gunshots she didn't look, she just ran -- he knew she was lying.
How did Newberry reach this conclusion? The answer is by recognizing telltale signs that a person isn't being honest, like inconsistencies in a story, behavior that's different from a person's norm, or too much detail in an explanation.
While using these signs to catch a liar takes extensive training and practice, it's no longer only for authorities like Newberry. Now, the average person can become adept at identifying dishonesty, and it's not as hard as you might think. Experts tell WebMD the top 10 ways to let the truth be known.
Tip No. 1: Inconsistencies
"When you want to know if someone is lying, look for inconsistencies in what they are saying," says Newberry, who was a federal agent for 30 years and a police officer for five.
When the woman he was questioning said she ran and hid after hearing gunshots -- without looking -- Newberry saw the inconsistency immediately.
"There was something that just didn't fit," says Newberry. "She heard gunshots but she didn't look? I knew that was inconsistent with how a person would respond to a situation like that."
So when she wasn't paying attention, he banged on the table. She looked right at him.
"When a person hears a noise, it's a natural reaction to look toward it," Newberry tells WebMD. "I knew she heard those gunshots, looked in the direction from which they came, saw the shooter, and then ran."
Sure enough, he was right.
"Her story was just illogical," says Newberry. "And that's what you should look for when you're talking to someone who isn't being truthful. Are there inconsistencies that just don't fit?"
Tip No. 2: Ask the Unexpected
"About 4% of people are accomplished liars and they can do it well," says Newberry. "But because there are no Pinocchio responses to a lie, you have to catch them in it."
Sir Walter Scott put it best: "Oh what a tangled web we weave, when first we practice to deceive!" But how can you a catch a person in his own web of lies?
"Watch them carefully," says Newberry. "And then when they don't expect it, ask them one question that they are not prepared to answer to trip them up."
Tip No. 3: Gauge Against a Baseline
"One of the most important indicators of dishonesty is changes in behavior," says Maureen O'Sullivan, PhD, a professor of psychology at the University of San Francisco. "You want to pay attention to someone who is generally anxious, but now looks calm. Or, someone who is generally calm but now looks anxious."
The trick, explains O'Sullivan, is to gauge their behavior against a baseline. Is a person's behavior falling away from how they would normally act? If it is, that could mean that something is up.
Tip No. 4: Look for Insincere Emotions
"Most people can't fake smile," says O'Sullivan. "The timing will be wrong, it will be held too long, or it will be blended with other things. Maybe it will be a combination of an angry face with a smile; you can tell because their lips are smaller and less full than in a sincere smile."
These fake emotions are a good indicator that something has gone afoul.
Tip No. 5: Pay Attention to Gut Reactions
"People say, 'Oh, it was a gut reaction or women's intuition,' but what I think they are picking up on are the deviations of true emotions," O'Sullivan tells WebMD.
While an average person might not know what it is he's seeing when he thinks someone isn't being honest and attribute his suspicion to instinct, a scientist would be able to pinpoint it exactly -- which leads us to tip no. 6.
Tip No. 6: Watch for Microexpressions
When Joe Schmo has a gut feeling, Paul Ekman, a renowned expert in lie detection, sees microexpressions.
"A microexpression is a very brief expression, usually about a 25th of a second, that is always a concealed emotion," says Ekman, PhD, professor emeritus of psychology at the University of California Medical School in San Francisco.
So when a person is acting happy, but in actuality is really upset about something, for instance, his true emotion will be revealed in a subconscious flash of anger on his face. Whether the concealed emotion is fear, anger, happiness, or jealousy, that feeling will appear on the face in the blink of an eye. The trick is to see it.
"Almost everyone -- 99% of those we've tested in about 10,000 people -- won't see them," says Ekman. "But it can be taught."
In fact, in less than an hour, the average person can learn to see microexpressions.
Tip No. 7: Look for Contradictions
"The general rule is anything that a person does with their voice or their gesture that doesn't fit the words they are saying can indicate a lie," says Ekman. "For example, this is going to sound amazing, but it is true. Sometimes when people are lying and saying, 'Yes, she's the one that took the money,' they will without knowing it make a slight head shake 'no.' That's a gesture and it completely contradicts what they're saying in words."
These contradictions, explains Ekman, can be between the voice and the words, the gesture and the voice, the gesture and the words, or the face and the words.
"It's some aspect of demeanor that is contradicting another aspect," Ekman tells WebMD.
Tip No. 8: A Sense of Unease
"When someone isn't making eye contact and that's against how they normally act, it can mean they're not being honest," says Jenn Berman, PhD, a psychologist in private practice. "They look away, they're sweating, they look uneasy ... anything that isn't normal and indicates anxiety."
Tip No. 9: Too Much Detail
"When you say to someone, 'Oh, where were you?' and they say, 'I went to the store and I needed to get eggs and milk and sugar and I almost hit a dog so I had to go slow,' and on and on, they're giving you too much detail," says Berman.
Too much detail could mean they've put a lot of thought into how they're going to get out of a situation and they've crafted a complicated lie as a solution.
Tip No. 10: Don't Ignore the Truth
"It's more important to recognize when someone is telling the truth than telling a lie because people can look like they're lying but be telling truth," says Newberry.
While it sounds confusing, finding the truth buried under a lie can sometimes help find the answer to an important question: Why is a person lying?
These 10 truth tips, experts agree, all help detect deception. What they don't do is tell you why a person is lying and what the lie means.
"Microexpressions don't tell you the reason," says Ekman. "They just tell you what the concealed emotion is and that there is an emotion being concealed."
When you think someone is lying, you have to either know the person well enough to understand why he or she might lie, or be a people expert.
"You can see a microexpression, but you have to have more social-emotional intelligence on people to use it accurately," says O'Sullivan. "You have to be a good judge of people to understand what it means."
Extra Tip: Be Trusting
"In general we have a choice about which stance we take in life," says Ekman. "If we take a suspicious stance life is not going to be too pleasant, but we won't get misled very often. If we take a trusting stance, life is going to be a lot more pleasant but sometimes we are going to be taken in. As a parent or a friend, you're much better off being trusting rather than looking for lies all the time."
Thursday, April 16, 2009
Can You Trust Your Mammogram?
Can You Trust Your Mammogram?
WebMD Feature from "Good Housekeeping" MagazineBy Fran Smith
Why even smart doctors miss breast cancer - and how to make sure you're getting the best care.
No matter what you know about other diseases, breast cancer is probably the one that scares you most. It is frightening, striking nearly 182,000 women this year and plunging them into a world of complicated, arduous treatment. So it's heartening to know that more women are being diagnosed early, when the odds of beating the cancer are as high as 98 percent. Prevention and treatment are becoming personalized, thanks to genetic tests and new types of drugs. And after decades of no change, the death rate has finally begun to drop — about 2 percent annually since 1990.
Yet behind these impressive statistics lies one dumbfoundingly scary fact: Just because better tools and treatment exist is no guarantee that you'll get any of them. Your mammogram could be interpreted inaccurately, a lump could be incorrectly diagnosed, and you may not receive the best treatment for you simply because of where you live, the type of surgeon you choose — or even the doctor's sex.
That's why it's more important than ever to know the right questions to ask. Breast cancer is a complex disease (some researchers suspect it's at least five genetically distinct conditions), and no single approach works best for everybody. At every step — when you have your annual mammogram or get a suspicious lump checked out or undergo treatment — you should, at the very least, receive care that meets the scientific guidelines issued by leading cancer organizations. Here's how to make sure you do.
Screening Snafus
When you get a mammogram, it's common to have a stab of anxiety about what the radiologist will find. What should also concern you: the doctor who's doing the detecting.
The news: In a new study, researchers reviewed nearly half a million mammograms performed at 44 facilities. At the best centers, doctors identified cancer when it was present just about 100% of the time; at others, that number was closer to 70%, says study leader Stephen Taplin, M.D., M.P.H., a senior scientist at the National Cancer Institute. Facilities with a breast-imaging specialist (defined here as a doctor who spends at least half her time reading mammograms) had the best record.
Why it matters: Getting a regular mammogram is key to finding breast cancer early. Five-year survival rates drop from a high of 98.1% for early, breast-only tumors to 27.1% for advanced cancer that has spread to distant organs.
What you should do: When you call for an appointment, ask if there's a breast-imaging specialist on staff. If not, shop around, advises Diana Miglioretti, Ph.D., a researcher with the Group Health Center for Health Studies in Seattle. "I'd go to someone who has been interpreting screening mammograms for at least 10 years."
Follow-up Foul-ups
If your screening mammogram is abnormal or you have a lump, the next step is often a diagnostic X-ray, which takes magnified close-ups of the suspicious tissue.
The news: In theory, diagnostic mammograms should be easier to interpret than screening ones because the doctor knows where trouble may be lurking. Yet the largest study analyzing how well radiologists do on these critical exams found they missed 21 percent of cancers on average. The real shocker was the range: The top performer found every tumor, while the worst missed an astonishing 73 percent. Doctors affiliated with academic medical centers did best: They correctly diagnosed 88 percent of cancers.
Why it matters: Missing a tumor at this step could mean a delay in diagnosis — possibly a dangerous one, if a tumor isn't detected and treated before the cancer has spread.
What you should do: As with screening X-rays, the doctor who reads your diagnostic X-ray should be someone who specializes in mammograms, says Miglioretti, who led the study. Unless you live in a rural area, you should be able to find such a specialist no more than an hour or two away. "It's worth the drive," she says.
Surgical Biases
The biggest decision many women face when they're diagnosed with breast cancer is whether to have a mastectomy (removal of the entire breast) or a lumpectomy (only the tumor and surrounding tissue are cut out). In many cases, breast-conserving surgery, including lymph node testing and follow-up radiation, has the same lifesaving benefits as mastectomy. Yet your surgeon may not explain the options and consequences clearly or evenhandedly.
The news: Clinical guidelines developed by leading organizations favor breast-conserving surgery because it's less drastic. That's true whether you live in Augusta, ME, or Augusta, GA. Yet a review of 800,000 patient records found that while 70% in the Northeast had breast-sparing surgery, only 58% of those in the South did (the numbers for the West and Midwest were 63 percent and 61 percent, respectively). The review didn't look for a why, but study leader Jack Sariego, M.D., professor of surgery at Temple University, notes that the more rural South likely has fewer radiation facilities and fewer academic medical centers to promote surgical advances.
Beyond your zip code, the type of surgeon and hospital you choose may affect the recommendation you'll receive. Doctors who treat a lot of breast cancer or who work in cancer centers or academic medical centers suggest lumpectomy more often than general surgeons in the community. Surgeons trained after 1981 are also more likely to recommend a lumpectomy than older doctors, past research from the University of North Carolina at Chapel Hill has shown.
Why it matters: In a survey of 1,132 women who had either a lumpectomy or a mastectomy, almost half indicated they did not understand the risks and benefits of their choice.
What you should do: Ask loads of questions, starting with, "Am I a candidate for breast-conserving surgery, and if not, why not?" advises Dr. Sariego. Do your own research. And don't be shy about asking the first surgeon to recommend another for a second opinion. Better yet, look on your own: A recent study shows you're more likely to wind up with someone experienced and affiliated with a cancer program, compared with women who rely on referrals from their doctor or health plan, says Steven Katz, M.D., professor of medicine and health management and policy at the University of Michigan.
While you're asking questions, find out how your lymph nodes will be tested to see if the cancer has spread. A newer procedure, called sentinel-node biopsy, is less invasive and far less likely to cause permanent arm swelling than old-fashioned lymph node removal, but about 35 percent of patients aren't getting it, a recent multicenter study found.
Post-Surgery Neglect
Lumpectomy is just as effective as mastectomy only if it includes lymph node testing and a course of radiation treatments — generally five days a week for about six weeks. That's something your surgeon should make clear before you choose one procedure over the other.
The news: In 2003, only 71 percent of lumpectomy patients followed through with radiation, down from 79 percent in 1992, University of Minnesota epidemiologist Beth Virnig, Ph.D., reported last December. "A lot of women with serious breast cancer are not getting comprehensive treatment," she says.
Why it matters: If you don't undergo a full course of radiation, your chances of local recurrence within 10 years are as high as 30 percent, says Dr. Katz. (If you do, they drop to about 8 to 10 percent.)
What you should do: Talk with a radiation oncologist before surgery. Ask how long your treatment will last and what the side effects might be. For that matter, talk with all the specialists who may be involved in your postsurgical care. Women often feel panicked and pressured to start treatment immediately, but it's usually safe to wait two to three weeks.
Reticence on Reconstruction
If a lumpectomy isn't right for you, a mastectomy followed by reconstruction is an alternative — but you may have to bring up the subject.
The news: Only about one-quarter of surgeons regularly send patients for a plastic surgery consultation before they make their lumpectomy or mastectomy decision, researchers from the University of Michigan found in a 2007 study. Who's most likely to make that referral? Women surgeons — as well as those who treat a lot of breast cancer. Reconstruction can be done during the same surgery as the mastectomy, but it requires the general and plastic surgeons to share turf and mesh schedules, which may be inconvenient for them — even if it's good for you.
Why it matters: Both procedures will alter your appearance, but in different ways. This may seem like a minor worry when you're newly diagnosed and terrified, but it's likely to become important when you're well.
What you should do: "Ask your surgeon how your breast will look, how your clothing will fit," says Amy Alderman, M.D., M.P.H., an assistant professor of surgery at the University of Michigan. Even if you're sure you want breast-conserving surgery, you may want to consult with a plastic surgeon. Lumpectomy sometimes changes the breast more than women expect; a specialist can help you assess what might happen in your case. This is not vanity: Women who end up with extremely uneven breasts are more likely to be depressed and to worry that their cancer will return, a brand-new University of Michigan study found. Or you may want to seek out a breast surgeon who's experienced in oncoplastic techniques, which can improve the look of the breast.
Thankfully, the days of "Doctor knows best" are behind us. But that means breast cancer patients have to work with their physicians to make tough choices. To do that, women must share their fears and desires. "The doctor only knows what's on your X-ray and pathology report," says Karen Sepucha, Ph.D., a senior scientist with the Health Decision Research Unit at Massachusetts General Hospital: "What you care about needs to get on the table."
And you have to be the one who makes sure it does.
More Ways to Get the Answers You Need
Going for a Third Opinion
Kim Friedrich, 37
Mastic, NY
Kim Friedrich was in shock. In February 2007, her left breast had a tumor one-and-a-half times the size of a golf ball; because it was so big and aggressive, the surgeon told her she needed to have that breast removed, as well as the other as a precaution. A second doctor agreed. "I kept seeing myself on my deathbed," Friedrich says. She'd look at her two daughters and seize up with grief — would they grow up without her? While she would have done anything to live, she wasn't convinced she had to lose her breasts. Neither doctor had taken much time with her, she realized. Friedrich began to do research and talked to everyone she could. When an acquaintance raved about her breast specialist, at a cancer center a three-hour drive away, Friedrich pressed for an appointment. The mastectomy recommendations did not surprise the doctor. "That's old thinking," he told her. His advice: a course of chemotherapy (which shrank the tumor down to the size of a pea), followed by a lumpectomy and radiation. It was very tough, but Friedrich has no doubt she chose the right treatment — and doctor: "I got two quick assessments, and felt like they were thinking, 'Let's just do what's fastest and move on to the next patient.'"
When It's Not "Nothing"
Amalia Rigoni, 50
Olympia Fields, IL
Although she'd had a normal mammogram just a few months earlier, in March 2000, Amalia Rigoni was uneasy about a lump she felt in her lower right breast. Both her gynecologist and internist said she was fine. A diagnostic mammogram detected nothing. Still, she insisted on seeing a surgeon. That doctor, a general surgeon, told her to come back in six months. So Rigoni tried another tack: "If your mother had breast cancer, where would you send her?" The surgeon recommended a breast specialist who'd been his professor. The specialist checked her by closing his eyes and palpating the breast. "I don't like the feel of that lump," he said. "It was surreal," Rigoni recalls. "But I said, 'Thank God. At least I know what's going on.'" Almost nine years later — after a mastectomy, reconstruction, radiation, and three years of the drug tamoxifen followed by five on Femara — she's fine. Now Rigoni's a hotline coordinator for Breast Cancer Network of Strength, counseling women who may be facing the same struggle to get answers. "I tell them that doctors may know medicine, but you know your body. If something doesn't feel right, get it checked out." And, she adds, "go to a specialist."
Filling the Info Gap
Evelyn White, 48
San Francisco, CA
Support groups can provide invaluable information that patients may not get from their doctors. Evelyn White, for example, says her medical care was "great." She was diagnosed with breast cancer in February 2006, and underwent a mastectomy. But the chemo that followed left her unable to move — and she was suffering terrible crying jags. A friend thought it might be the medicine that White was taking for nausea — Ativan, a powerful sedative. She asked her doctor about stopping the drug and then, at a meeting of a cancer survivors' organization, heard about an alternative. There was a newer drug, Emend, developed specifically to prevent the nausea of chemotherapy — without causing depression. Once her physician switched the meds, "I felt a thousand percent better, physically and emotionally," says White. Later, the group helped in another key way. White had assumed her cancer was genetic (her sister was a survivor as well), and she was worried that her daughter, 24, might be at increased risk. Armed with information she got from a meeting, she underwent testing and, last year, was thrilled to be able to strike that worry off her list.
WebMD Feature from "Good Housekeeping" MagazineBy Fran Smith
Why even smart doctors miss breast cancer - and how to make sure you're getting the best care.
No matter what you know about other diseases, breast cancer is probably the one that scares you most. It is frightening, striking nearly 182,000 women this year and plunging them into a world of complicated, arduous treatment. So it's heartening to know that more women are being diagnosed early, when the odds of beating the cancer are as high as 98 percent. Prevention and treatment are becoming personalized, thanks to genetic tests and new types of drugs. And after decades of no change, the death rate has finally begun to drop — about 2 percent annually since 1990.
Yet behind these impressive statistics lies one dumbfoundingly scary fact: Just because better tools and treatment exist is no guarantee that you'll get any of them. Your mammogram could be interpreted inaccurately, a lump could be incorrectly diagnosed, and you may not receive the best treatment for you simply because of where you live, the type of surgeon you choose — or even the doctor's sex.
That's why it's more important than ever to know the right questions to ask. Breast cancer is a complex disease (some researchers suspect it's at least five genetically distinct conditions), and no single approach works best for everybody. At every step — when you have your annual mammogram or get a suspicious lump checked out or undergo treatment — you should, at the very least, receive care that meets the scientific guidelines issued by leading cancer organizations. Here's how to make sure you do.
Screening Snafus
When you get a mammogram, it's common to have a stab of anxiety about what the radiologist will find. What should also concern you: the doctor who's doing the detecting.
The news: In a new study, researchers reviewed nearly half a million mammograms performed at 44 facilities. At the best centers, doctors identified cancer when it was present just about 100% of the time; at others, that number was closer to 70%, says study leader Stephen Taplin, M.D., M.P.H., a senior scientist at the National Cancer Institute. Facilities with a breast-imaging specialist (defined here as a doctor who spends at least half her time reading mammograms) had the best record.
Why it matters: Getting a regular mammogram is key to finding breast cancer early. Five-year survival rates drop from a high of 98.1% for early, breast-only tumors to 27.1% for advanced cancer that has spread to distant organs.
What you should do: When you call for an appointment, ask if there's a breast-imaging specialist on staff. If not, shop around, advises Diana Miglioretti, Ph.D., a researcher with the Group Health Center for Health Studies in Seattle. "I'd go to someone who has been interpreting screening mammograms for at least 10 years."
Follow-up Foul-ups
If your screening mammogram is abnormal or you have a lump, the next step is often a diagnostic X-ray, which takes magnified close-ups of the suspicious tissue.
The news: In theory, diagnostic mammograms should be easier to interpret than screening ones because the doctor knows where trouble may be lurking. Yet the largest study analyzing how well radiologists do on these critical exams found they missed 21 percent of cancers on average. The real shocker was the range: The top performer found every tumor, while the worst missed an astonishing 73 percent. Doctors affiliated with academic medical centers did best: They correctly diagnosed 88 percent of cancers.
Why it matters: Missing a tumor at this step could mean a delay in diagnosis — possibly a dangerous one, if a tumor isn't detected and treated before the cancer has spread.
What you should do: As with screening X-rays, the doctor who reads your diagnostic X-ray should be someone who specializes in mammograms, says Miglioretti, who led the study. Unless you live in a rural area, you should be able to find such a specialist no more than an hour or two away. "It's worth the drive," she says.
Surgical Biases
The biggest decision many women face when they're diagnosed with breast cancer is whether to have a mastectomy (removal of the entire breast) or a lumpectomy (only the tumor and surrounding tissue are cut out). In many cases, breast-conserving surgery, including lymph node testing and follow-up radiation, has the same lifesaving benefits as mastectomy. Yet your surgeon may not explain the options and consequences clearly or evenhandedly.
The news: Clinical guidelines developed by leading organizations favor breast-conserving surgery because it's less drastic. That's true whether you live in Augusta, ME, or Augusta, GA. Yet a review of 800,000 patient records found that while 70% in the Northeast had breast-sparing surgery, only 58% of those in the South did (the numbers for the West and Midwest were 63 percent and 61 percent, respectively). The review didn't look for a why, but study leader Jack Sariego, M.D., professor of surgery at Temple University, notes that the more rural South likely has fewer radiation facilities and fewer academic medical centers to promote surgical advances.
Beyond your zip code, the type of surgeon and hospital you choose may affect the recommendation you'll receive. Doctors who treat a lot of breast cancer or who work in cancer centers or academic medical centers suggest lumpectomy more often than general surgeons in the community. Surgeons trained after 1981 are also more likely to recommend a lumpectomy than older doctors, past research from the University of North Carolina at Chapel Hill has shown.
Why it matters: In a survey of 1,132 women who had either a lumpectomy or a mastectomy, almost half indicated they did not understand the risks and benefits of their choice.
What you should do: Ask loads of questions, starting with, "Am I a candidate for breast-conserving surgery, and if not, why not?" advises Dr. Sariego. Do your own research. And don't be shy about asking the first surgeon to recommend another for a second opinion. Better yet, look on your own: A recent study shows you're more likely to wind up with someone experienced and affiliated with a cancer program, compared with women who rely on referrals from their doctor or health plan, says Steven Katz, M.D., professor of medicine and health management and policy at the University of Michigan.
While you're asking questions, find out how your lymph nodes will be tested to see if the cancer has spread. A newer procedure, called sentinel-node biopsy, is less invasive and far less likely to cause permanent arm swelling than old-fashioned lymph node removal, but about 35 percent of patients aren't getting it, a recent multicenter study found.
Post-Surgery Neglect
Lumpectomy is just as effective as mastectomy only if it includes lymph node testing and a course of radiation treatments — generally five days a week for about six weeks. That's something your surgeon should make clear before you choose one procedure over the other.
The news: In 2003, only 71 percent of lumpectomy patients followed through with radiation, down from 79 percent in 1992, University of Minnesota epidemiologist Beth Virnig, Ph.D., reported last December. "A lot of women with serious breast cancer are not getting comprehensive treatment," she says.
Why it matters: If you don't undergo a full course of radiation, your chances of local recurrence within 10 years are as high as 30 percent, says Dr. Katz. (If you do, they drop to about 8 to 10 percent.)
What you should do: Talk with a radiation oncologist before surgery. Ask how long your treatment will last and what the side effects might be. For that matter, talk with all the specialists who may be involved in your postsurgical care. Women often feel panicked and pressured to start treatment immediately, but it's usually safe to wait two to three weeks.
Reticence on Reconstruction
If a lumpectomy isn't right for you, a mastectomy followed by reconstruction is an alternative — but you may have to bring up the subject.
The news: Only about one-quarter of surgeons regularly send patients for a plastic surgery consultation before they make their lumpectomy or mastectomy decision, researchers from the University of Michigan found in a 2007 study. Who's most likely to make that referral? Women surgeons — as well as those who treat a lot of breast cancer. Reconstruction can be done during the same surgery as the mastectomy, but it requires the general and plastic surgeons to share turf and mesh schedules, which may be inconvenient for them — even if it's good for you.
Why it matters: Both procedures will alter your appearance, but in different ways. This may seem like a minor worry when you're newly diagnosed and terrified, but it's likely to become important when you're well.
What you should do: "Ask your surgeon how your breast will look, how your clothing will fit," says Amy Alderman, M.D., M.P.H., an assistant professor of surgery at the University of Michigan. Even if you're sure you want breast-conserving surgery, you may want to consult with a plastic surgeon. Lumpectomy sometimes changes the breast more than women expect; a specialist can help you assess what might happen in your case. This is not vanity: Women who end up with extremely uneven breasts are more likely to be depressed and to worry that their cancer will return, a brand-new University of Michigan study found. Or you may want to seek out a breast surgeon who's experienced in oncoplastic techniques, which can improve the look of the breast.
Thankfully, the days of "Doctor knows best" are behind us. But that means breast cancer patients have to work with their physicians to make tough choices. To do that, women must share their fears and desires. "The doctor only knows what's on your X-ray and pathology report," says Karen Sepucha, Ph.D., a senior scientist with the Health Decision Research Unit at Massachusetts General Hospital: "What you care about needs to get on the table."
And you have to be the one who makes sure it does.
More Ways to Get the Answers You Need
Going for a Third Opinion
Kim Friedrich, 37
Mastic, NY
Kim Friedrich was in shock. In February 2007, her left breast had a tumor one-and-a-half times the size of a golf ball; because it was so big and aggressive, the surgeon told her she needed to have that breast removed, as well as the other as a precaution. A second doctor agreed. "I kept seeing myself on my deathbed," Friedrich says. She'd look at her two daughters and seize up with grief — would they grow up without her? While she would have done anything to live, she wasn't convinced she had to lose her breasts. Neither doctor had taken much time with her, she realized. Friedrich began to do research and talked to everyone she could. When an acquaintance raved about her breast specialist, at a cancer center a three-hour drive away, Friedrich pressed for an appointment. The mastectomy recommendations did not surprise the doctor. "That's old thinking," he told her. His advice: a course of chemotherapy (which shrank the tumor down to the size of a pea), followed by a lumpectomy and radiation. It was very tough, but Friedrich has no doubt she chose the right treatment — and doctor: "I got two quick assessments, and felt like they were thinking, 'Let's just do what's fastest and move on to the next patient.'"
When It's Not "Nothing"
Amalia Rigoni, 50
Olympia Fields, IL
Although she'd had a normal mammogram just a few months earlier, in March 2000, Amalia Rigoni was uneasy about a lump she felt in her lower right breast. Both her gynecologist and internist said she was fine. A diagnostic mammogram detected nothing. Still, she insisted on seeing a surgeon. That doctor, a general surgeon, told her to come back in six months. So Rigoni tried another tack: "If your mother had breast cancer, where would you send her?" The surgeon recommended a breast specialist who'd been his professor. The specialist checked her by closing his eyes and palpating the breast. "I don't like the feel of that lump," he said. "It was surreal," Rigoni recalls. "But I said, 'Thank God. At least I know what's going on.'" Almost nine years later — after a mastectomy, reconstruction, radiation, and three years of the drug tamoxifen followed by five on Femara — she's fine. Now Rigoni's a hotline coordinator for Breast Cancer Network of Strength, counseling women who may be facing the same struggle to get answers. "I tell them that doctors may know medicine, but you know your body. If something doesn't feel right, get it checked out." And, she adds, "go to a specialist."
Filling the Info Gap
Evelyn White, 48
San Francisco, CA
Support groups can provide invaluable information that patients may not get from their doctors. Evelyn White, for example, says her medical care was "great." She was diagnosed with breast cancer in February 2006, and underwent a mastectomy. But the chemo that followed left her unable to move — and she was suffering terrible crying jags. A friend thought it might be the medicine that White was taking for nausea — Ativan, a powerful sedative. She asked her doctor about stopping the drug and then, at a meeting of a cancer survivors' organization, heard about an alternative. There was a newer drug, Emend, developed specifically to prevent the nausea of chemotherapy — without causing depression. Once her physician switched the meds, "I felt a thousand percent better, physically and emotionally," says White. Later, the group helped in another key way. White had assumed her cancer was genetic (her sister was a survivor as well), and she was worried that her daughter, 24, might be at increased risk. Armed with information she got from a meeting, she underwent testing and, last year, was thrilled to be able to strike that worry off her list.
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