Fitness - What Is Fitness?

Aristotle helped define the standards of fitness 2,500 years ago when he taught that a thing that suits its purpose well is fit. Fortunately for us, the cardiovascular system, lungs, skeleton, muscles, endocrine system and all the other amazing components of the body function for our purpose: to live well.

Exercising aids fitness in numerous ways, each involving one or more of those systems.

Increased physical activity causes the heart to work harder than at rest. That increases blood flow, floods tissues with fresh oxygen and removes cellular waste products.

Exercise causes the lungs to draw in extra oxygen to bathe the tissues and help power the heart. Exhalation removes carbon dioxide, a waste product of certain biochemical reactions.

Regular, moderate exercise helps raise HDL (High-Density Lipoprotein) cholesterol (the 'good' type). It helps regulate blood sugar levels and converts stored fat into sugars that are used to provide energy. That process also prevents obesity.

The other benefits of a regular fitness program are more obvious and usually among the more direct goals of most people who make the effort: increased muscle mass, toned legs, buttocks, arms, stomach and healthier looking skin. Along the way, the individual receives the added value of greater strength, improved balance, higher endurance and (often) a better frame of mind.

Different types of routines will emphasize one area more than another. Aerobic routines help the cardiovascular and pulmonary systems, weight lifting focuses on building muscle tone and mass, yoga and pilates helps balance, flexibility and muscular control. But each of these, and several more, help more than just the intended focus group. The body is an integrated system and improving one area almost always has beneficial consequences for others.

All those benefits, at least to a moderate degree, can be had for minimal daily effort. Moderate intensity activity for 30 minutes per day, at least five days per week, will go a long way toward optimizing fitness.

A brisk walk, taking the stairs up one or two flights, a short daily jog, jumping rope and many other simple activities can be carried out with no special equipment or training.

More intense activity, done properly, can raise that level even further. A vigorous tennis game, a few laps in the swimming pool, an hour on the treadmill or exercise bike, or any of a dozen others, can raise your fitness to a peak with only a moderate investment of time and money.

For the truly committed there are, of course, a thousand and one classes at the gym, and every conceivable kind of home fitness equipment to fit a variety of budgets. A daily routine using free weights, followed by a good jog around the park will keep all systems functioning well.

And, as Aristotle taught all those centuries ago, to function well is to live well.

Lyme Disease and Humans

Lyme

Lyme disease is probably the most common vectored disease in the world. Its causative agent is a spirochete: Borrelia burgdorferi. Borrelia normally requires both a tick host of the Ixodes genus and a warm-blooded host to complete its infectious cycle, but insects may occasionally also be vectors, transmitting Borrelia from one host to another.

Spirochetes undergo multiple changes as the ticks are biting their warm-blooded host. But these pale in comparison with the changes that occur inside a human.

Inside the Human

If left alone once inside a warm-blooded host, spirochetes move through the blood stream, reproduce slowly, produce blebs, change shape, and move into the host's organs and tissues where they give off toxins that often reduce host mobility. Reduced host mobility increases the probability that new ticks will find and bite the infected host and transfer the spirochetes to more vertebrates.

Spirochetes Release “Cluster Bombs”

Each active bacterium releases into the body thousands of infectious packages, called blebs. Although the bacteria reproduce only about once every two weeks, these blebs are produced almost continuously, are hyper infective and appear to cause most of the symptoms of LD. Blebs are a sort of smoke screen against the immune system. As immune cells and antibodies are attacking the blebs, the bacteria (hidden inside other cells) can continue to release more blebs without injury. Since blebs are not true cells, they may be destroyed without eliminating the actual bacteria.

Borrelia Attacks our Immune System
Our immune response is slowed down and even rendered ineffective by bacteria that can rapidly change their surface characteristics. Borrelia's ability to swiftly generate new combinations of surface proteins while the tick is feeding makes it important to remove I. scapularis ticks early in the feeding bout. But it is even more important to be treated as soon after infection begins as possible. If Borrelia are given time to change their surface proteins and develop other defenses against our immune systems and antibiotics, Borrelia may become able to escape our most concerted efforts to eradicate them.

Spirochetes are Shape Shifters

As if the arsenal of attack by ticks and spirochetes does not perplex the host's immune system enough, the bacteria will change their characteristics when the host marshalls defenses against the spirochetes. They seem to have programs that instruct them to:
  • Produce new forms of both surface protein groups (vlsE and Osp).
  • Change shape and discard surface proteins.
  • Move from the blood stream into body fluids.
  • Enter cells and become invisible to antibodies and killer T-cells.
  • Destroy immune system cells.
  • Hide behind the blood-brain barrier where many antibiotics cannot penetrate.
There are no fewer than three shapes of Borrelia, two of which are highly infective:
  • the spirochetal form,
  • an L-form that discards its cell wall and integrated surface proteins, and
  • a cystic form that enters cells and becomes inactive.
The infective shapes of Borrelia disrupt cell function, destroy connections between them, and eventually kill the cells. Being inactive, the cystic form is resistant to antibiotics, does not present antigens to the immune system, and escapes destruction from most medications. The few medications that are active against the cystic forms are dangerous.

Neurological Damage

Most neurological damage in the body is caused by the L-form of Borrelia. This form easily enters cells, can break into small round cells (cocci), and in the nervous system, disrupts connections (synapses), destroys neurons and their supporting tissues, and produce holes (lesions) in the brain that cannot be repaired. These changes become manifest as:
  • altered sensory perception,
  • forgetfulness,
  • muscle weakness,
  • slow or rapid heartbeat,
  • low or high blood pressure,
  • personality changes,
  • dementia – sometimes extreme,
  • “Lyme rage,”
  • and many others.
A full blown disease with these characteristics needs a multi-pronged attack to be eliminated.

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Lyme Disease and Ticks

Lyme

Most people have been or know someone affected by Lyme Disease. The ticks that transmit this disease are found in all of the US, Canada, Mexico, European and most Asian countries. When they bite, they can inject the bacteria that cause Lyme disease and other diseases.

Early Symptoms of Lyme Disease

Lyme disease begins after a tick bite. This is sometimes followed by a bulls-eye rash, becoming exhausted in the middle of the day – totally incapable of continuing without collapsing in bed, flu-like symptoms that may or may not go away, or suddenly developing arthritis. Since any of these symptoms could be something else, diagnosing LD is difficult.

Diagnosis Difficulties

The bulls-eye rash is diagnostic for Lyme disease and treatment often begins with no further testing, but almost 50% of people affected have no or atypical rashes. When Lyme disease is suspected, doctors send blood samples for testing. This test looks for antibodies in response to the bacterium. If the test is positive, the standard treatment is two weeks of antibiotics. If it provides a false negative diagnosis (which it does about 40% of the time), the patient may be sent away and not properly treated for some time and require extensive treatments to cure the disease. Which antibiotics, the duration and mode of administration, and the bacterium's response to treatment vary widely.

Borrelia burgdorferi and its Effects
Borrelia burgdorferi, is a spirochete transmitted by the black-legged tick, Ixodes scapularis (previously called I. dammini). Once infected, spirochetes travel through the blood stream and affect many organs, often burrowing into the cells, and wreaking havoc wherever they settle: They trigger arthritis; cause heart arrhythmias, (rarely) heart attack, weaken cardiac muscle; alter sensory input, motor control, disrupt thought processes, may cause paralysis of facial muscles (Bell's palsy) and other muscle groups; trigger muscle pain (myalgia), weakness, and sometimes tetany; produce rashes – often with a bullseye appearance; and can cross the placenta, causing fetal abnormalities.

The Ticks

The tick's role in transmitting Lyme Disease was noted shortly after the identification and naming of Lyme Disease in 1977. Ticks usually hatch without internal parasites, obtaining them over a period of several days as they feed from previously infected hosts.

About 50% of black-legged ticks carry B. burgdorferi. Almost 20% carry the agent for Babesiosis or Ehrlichiosis, and half of this second group carries two of the three agents. As treatments are different, doctors often test for all three agents when a patient presents an infection after a tick bite.
Tick development includes four stages: egg, larva, nymph, and adult. As sit and wait predators, they feed only once during each stage after the egg. They climb vegetation and hold on until something knocks them off or they are carried away by an animal.

Tick Development: Three Stages

Larvae, the size of the dot in the letter “i,” usually hatch in the spring, wait low in the vegetation, and feed on small mammals or birds. Larvae molt about three months after feeding, and the nymphs climb about a foot off the ground to feed on medium or large mammals and birds that walk by. At the end of the summer, the nymph molts to the adult stage.

Most feeding adult ticks are females. Males attempt to mate shortly after molting, may not feed again, and die soon after mating. A female must feed so her eggs can develop, and can live up to a year without feeding. She only becomes sexually receptive after engorging while feeding for at least a day. After mating, she swells to ten times her already swollen size, all the time transferring bacteria to the host. See the article “Lyme Disease: Warding Off The Disease” to find out how to reduce your chances of obtaining Lyme disease.

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A Bit Too Old to Know The Abbreviations, But Never To Old to Laugh

Giggle

Have you laughed at all today? Do you know the last time you laughed? How about laughed out loud. LOL. How about laughing while watching a great TV show? Can you even remember the last time you laughed? Catherine Kalamis, in “Laugh Your Way to Health” (Choice magazine, March 2001), said that a 10-minute bout of laughing can have the following effects:
  • As the person laughs, carbon dioxide is driven out of the body and replaced by oxygen-rich air, providing physical and mental freshness.
  • Laughing can produce anti-inflammatory agents that can aid back pain or arthritis.
  • Laughing encourages muscles to relax and exercises muscles all over the body, from the scalp to the legs.
  • Laughing reduces levels of cortisol, the stress hormone.
  • It is also thought that laughter may possibly aid immune system responses, (though the evidence for that is primarily anecdotal).
  • Laughing exercises facial muscles to prevent sagging.
  • Laughing boosts the production of “feel-good” endorphin hormones.
Giggle, snort, and laugh till it hurts. You -- and everyone around you -- will be healthier. Laughter or cheering triggered strong brain activity in listeners, particularly the brain areas that control the muscles of the face -- which means listeners were primed to smile or laugh, too. The response was automatic -- and contagious

A study performed at the University of Maryland noted that laughter seems to cause the tissue that forms the inner lining of blood vessels to relax or expand, increasing blood flow. Mental stress, on the other hand, causes the opposite effect: making vessels constrict, and thus reducing blood flow. That finding confirms earlier studies that suggest a link between emotional stress and the narrowing of these linings, called the endothelium.

The endothelium is the layer of thin, flat cells that lines the interior surface of blood vessels. Endothelial cells line the entire circulatory system, from the heart to the smallest capillary. In small blood vessels and capillaries, endothelial cells are often the only type of cell present. Endothelial cells are involved in many aspects of vascular biology, including:
  • Vasoconstriction and vasodilation, and hence the control of blood pressure
  • Blood clotting (thrombosis and fibrinolysis)
  • Atherosclerosis
  • Formation of new blood vessels (angiogenesis)
  • Inflammation and swelling (edema)
So: Stress is bad. Laughing is good. Laughter is good for both body and soul. It can thwart stress, boost the immune system, and help protect against the flu and even cancer. In a study, men who watched a favorite funny video had lower levels of stress hormones and higher amounts of growth hormone, both of which bolster the immune response. And study participants had more of the natural killer cells that target tumors and viruses.

Just anticipating a chuckle or guffaw can keep you healthy and reduce stress. In another study, people who knew in advance that they would be watching a funny movie had elevated levels of growth hormone and more beta-endorphins (feel-good brain chemicals that block pain and help you relax). And these levels held steady throughout the hour of viewing as well as afterwards, for up to 24 hours. A mere 30 minutes of comic relief may be all you need for similar health benefits.

So go ahead, laugh often and out loud. It's your -- and your friends', family's, and cronies' -- best medicine.

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Incorrect Diagnosis of Lyme Disease

Lyme Disease

Misdiagnosis of Lyme disease is rampant. In the 40% to 45% of cases where there is no rash after infection, the early symptoms of Lyme disease are difficult to classify. Diagnostic tests are only 50% to 60% reliable. The disease mimics many other conditions, and some doctors will not diagnose it based on symptoms if test results are negative.

The Basis for Misdiagnosis

Without seeing a tick or rash, the symptoms are varied, vague, and mimic many maladies: flu, chronic fatigue syndrome, multiple sclerosis (MS), lupus, rheumatoid arthritis, neurological disorders, cardiac arrhythmias, muscle weakness, and others.

During the progression of Lyme disease, the symptoms change as bacteria move out of the blood, transform, and mutate. The immune response is depressed, and the organism becomes extremely difficult to detect. In addition, the bacteria produce blebs (packages of active Borrelia enzymes) that attach to antibodies and divert T-cells (attack cells) from the bacteria themselves.

The Necessary Tests for Diagnosis

Positive results on both the ELISA test and Western Blot test are required by the Center for Disease Control (CDC) in order to report a case of Lyme disease. Because there are large numbers of antigens on bleb surfaces, antibodies bind to the blebs and become invisible to the ELISA test for Lyme disease, and ELISA test results are falsely negative forty to sixty percent of the time.

The Western Blot test is far more accurate because it looks for proteins shed from the bacteria and the blebs. The Infectious Diseases Society of America (IDSA) requires that five of the sixteen possible protein bands be present for a positive diagnosis. Yet IDSA instructs physicians to ignore the presence of the bands for OspA and OspB, found in all strains of Borrelia, because these bands might show up in patients if they were previously vaccinated against Lyme disease.

Opposing Ideas Regarding Diagnosis

IDSA guidelines restrict physicians from ordering the Western Blot test before the ELISA test or if the ELISA test results are negative. Thus, the better of the two diagnostic tests is not available if the weaker of the two tests does not first indicate the presence of Lyme disease antibodies. Unfortunately, most physicians honor IDSA guidelines.

The International Lyme and Associated Diseases Society (ILADS) has determined that requiring this combination of test results means that about 90% of all cases of Lyme disease are not reportable. Unfortunately for many patients, physicians who follow the IDSA guidelines also misdiagnose approximately 90% of their patients, whereas physicians who understand the ILADS view provide the necessary treatment.

There are two new tests for Lyme disease: a C6 test where an artificially produced complex of surface proteins binds to antibodies already attached to the surfaces of blebs, allowing them to be identified; the other looks for OspA. These tests are supposed to have few false negatives and almost zero false positives. Unfortunately for patients, IDSA (but not ILAD) refuses to acknowledge the validity of these tests.

How Borrelia Fools the Immune System
Borrelia presents many complexes of surface antigens. Presentation of a large number of complexes delays or renders our immune responses ineffective. Additionally, the bacteria soon leave the blood stream, moving into tissue fluids and cells, reducing the intensity of the antibody response. After entering a warm-blooded host, Bb continues to remove and produce newly altered surface proteins, presenting new antigen complexes to the immune system. These complexes give the bacteria respite from attack. They grow and keep the disease active. As the immune system cannot produce antibodies against molecules that it has not been exposed to, it remains a step or two behind the bacteria.

The Results of Incorrect Diagnosis

Many people suffer or have their lives destroyed because Lyme disease is not properly diagnosed. It happens every day: a patient tells his doctor he is experiencing extreme fatigue, aches and pains in his joints and major muscles, lack of concentration, depression, and digestive upset.

She asks, “Did you see a tick?” “No.”

“Did you get a rash?” “No.”

“Then you do not have Lyme Disease.”

When he asks to be tested for Lyme disease, some doctors refuse, others will reluctantly order a test. If the test comes back negative, the doctor states the patient does not have Lyme disease, and the patient's symptoms may be treated. Because of misdiagnosis or late diagnosis, these patients suffer years of misery and hospitalizations. When the tests come back positive, and the patient is given minimal treatment with antibiotics, he is told he is cured, but now has developed autoimmune problems or post Lyme syndrome, and there is nothing further that can be done.

The most damaging feature of Lyme disease care is not misdiagnosis, however: It is the absence of treatment or insufficient treatment.

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Emotional Health and Your Heart

Emotional Health

Tears may be dried up— But the heart, never.
—Marguerite de Valois

What makes a healthy heart? Certainly a healthful diet that includes Omega 3 fatty acids, regular exercise, adequate sleep, very moderate alcohol consumption, and no smoking. But did you realize that your emotional health is actually a better predictor of heart health than your other healthful habits?

Scientist William Harvey (1578-1657) noticed a connection between heart and emotional health as early as 1625. Early physician William Osler said that the typical heart disease patient is “a keen and ambitious man, the indicator of whose engine is always ‘full speed ahead’.” Of course, to any woman reading Osler’s observation, it is clear that things have changed for our gender; today, heart disease is the leading cause of death for today’s woman, who seems always on the go and buffeted by conflicting demands.

Even so, the connection between emotions and heart disease is somewhat poorly understood. Anger, depression, anxiety, loneliness, and constant stress are the feelings that researchers have identified as putting women—and men—at risk for heart disease. Researchers and cardiologists Dr. Meyer S. Friedman and Dr. Ray Rosenman are credited with coining the term “Type A Personality” in the 1950’s as basically an angry person who possesses three traits: free-floating hostility, impatience, and insecurity. “Trait anger” has also been associated with sudden cardiac death. People who score high on hostility scales more rapidly develop atherosclerosis. Perhaps most frightening of all, a Harvard study shows that 1 in 40 heart attack survivors experienced an “episode of anger” two hours before their heart attack.

For women, perhaps the most pertinent emotional experience associated with heart problems is depression, because depression is much more common for women than for men. A recent study demonstrated that patients who were depressed were three times more likely to die in the year following a heart attack. Also, women were twice as likely as men to develop depression after a heart attack.
Many people think of a depressed person as someone who is so deeply sad, hopeless, and lethargic that they are unable to function, but this is not so. There is also minor depression, in which a person has only a few symptoms, and dysthymia, a low-grade level of depression that continues for two years or longer. Depression can also occur after a major life-changing event such as a move. Finally, depression can be caused by a medical condition, such as multiple sclerosis or diabetes.

The problem with depression is that a woman who is depressed is less likely to notice her physical symptoms, or to do anything about them. It is well known that people who are depressed have trouble complying with their doctor’s orders, including taking medication. A depressed woman is less likely to exercise or eat a healthful diet. All of these factors can lead to ill health, including heart disease.

Anxiety and chronic stress can also precipitate heart disease. Anxiety may be generalized—in other words, a person may worry and feel keyed up—much of the time, no matter what is happening, or it may be specific, as in a phobia of some kind. Obsessive-compulsive disorder, as well as its associated personality disorder, is also a manifestation of anxiety. Intense anxiety can trigger cardiac arrest as the heartbeat abruptly turns fast and uncoordinated. Fortunately, anxiety is one of the easiest problems to treat, and for most people it can be managed without medication.

Chronic stress—work woes, financial problems, troubled marriage, caregiving, and even environmental stresses such as natural disasters—have also been linked with the development of heart disease. In my practice as a psychologist who teaches people ways to manage stress, I can say that the problem for most women is “must disease,” as in “I must do everything—today!—and I must do it well, and I must please everyone.” The only “must” in my mind is that women must learn to relax!

Further proof that anger, depression, anxiety, and stress lead to heart disease comes from the improvements that occur when these states are treated. The well-known Recurrent Coronary Prevention Project studied over 1,000 men and women who received routine medical care and group counseling about risk factors, or care plus group therapy to modify Type A traits. Those who attended group therapy had a whopping 44% reduction in second heart attacks. A similar longitudinal study demonstrated that not only do people who receive stress management have a significant reduction in second cardiac events, they also save an average of $1,228 in medical costs per year.

A whole-person approach to cardiac disease prevention is critical. When anyone recommends that you see a behavioral health specialist—a mental health practitioner who specializes in mind/body approaches—to help in your quest for better health and a longer life, take heed. Don’t make that well-meaning person wheedle, cajole, and beg you to do something good for yourself. Remember “must syndrome”? That seems to include putting everyone else’s needs first. Women must learn to recognize the signs that they need help managing stress or anger, or ending depression or anxiety.

Here are some concrete tips that you can implement today to help strengthen your emotional health:

  • Understand what triggers a stress response for you. Either eliminate the trigger or find new ways to cope.
  • Develop a daily relaxation practice: yoga, meditation, journal writing, biofeedback, guided imagery, walking, etc.
  • Limit exposure to negative people and events.
  • Develop an optimistic outlook. You don’t need to be a Pollyanna, but when the odds are with you, you have every right—and deserve—to feel positive.
  • Increase positive social support. Join a club, volunteer, get active in church, etc.
  • Talk to a psychotherapist if you have stress, anxiety, depression, or excessive anger that doesn’t resolve within a few weeks after your efforts to change.
Your physical health doesn’t end at the invisible line that you’ve drawn between on your neck between your body and your brain. Your physical health largely depends on your emotional well-being. If you have cardiac disease or wish to prevent it, all the fish oil and 30 minute walks you can possibly do may not be enough if you are unhappy. As a woman, you deserve a better quality of life. Change is always possible, and if you cannot do it alone, help from your physician or a health psychologist is always available.

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What is Duane Syndrome

Duane Syndrome

What is Duane Syndrome?

Duane syndrome (DS) is an eye movement disorder that is present at birth and characterized by a limited ability to move an eye inward towards the nose, outward towards the ear or in both directions. The frequency of DS in the general population of individuals with eye movement disorders is approximately 1-5%. About 40% of patients develop esotropia, a head turn toward the eye to maintain single binocular vision, or they maintain a straight head but accept esotropia, and suppression, if available.

A child with Duane Syndrome

My son was born with DS and diagnosed around 18 months of age. I had noticed a slight “lazy” eye and discussed it with our pediatrician. The recommendation was to watch it until he was a year old. As the year progressed the eye became worse and we were referred to a pediatric ophthalmologist. During the initial visit eye exercises, dilation and a vision screening were completed. The signs and symptoms the ophthalmologist discussed were: the upshoot or downshoot of the eye, a head tilt or turn and eye misalignment.

As early as three months old, my son had a head tilt that seemed flirtatious in nature and then linked to his reoccurring ear infections. As I understand the diagnosis, the head tilt is a natural solution to correct the double vision an individual sees, or to align the eyes. Photographs were the best tool in reviewing his symptoms; there were not many where he was looking straight at the camera, more common are pictures where his head is tilted to the right. The head tilt is so that he can see what is in front of him. More noticeable is his head turn where it appears he is trying to look behind him but actually looking to the right.

Developmentally he is right on target and has not appeared to be hindered in any way. My son is all boy and very adventurous. Climbing and running seems to come as natural as sitting up. He frequently trips or falls in very familiar spaces, sometimes over his own feet. My guess is that this is both developmentally normal and attributed to Duane Syndrome. There are times when he has trouble with depth perception, for example when food is located in a certain location to the right he appears not to see it, in reality he seeing double. Instinctively he eliminates the area by not acknowledging that there is food available.

He is now almost 20 months and will be having surgery to help alleviate the head tilt/turn. The surgery will take the existing muscle and split it into two muscles. This will not “cure” DS but reduce the side affects and improve alignment.

The most frustrating part of DS is trying to make sense of all the information. As a person who has never experienced DS, or double vision, it is hard to imagine what your child is experiencing. The most helpful resources have been internet groups where other families share their experiences and resources.

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