“Recommendations to the general public regarding screening for elevated homocysteine levels should not yet be encouraged until further evidence from clinical trials indicate that” (homocysteine is a direct cause of heart disease), reported Dr. Eva Lonn, author of the study and associate professor of McMaster Medical School. Some individuals who have suffered from a heart condition, but do not have risk factors “should be screened for elevated homocysteine levels to see whether this may be the cause,” Dr. Lonn concluded.

While some studies indicate that elevated levels of homocysteine are significantly associated with an increased risk of coronary vascular disease, other studies do not. A meta-analysis (an analysis of several studies combined) of 27 studies involving approximately 4,000 participants, cited in the current review, estimated that approximately 10 percent of coronary heart disease may be attributed to hyperhomocystinemia. Conversely, a recent large study of healthy physicians failed to show a significant relationship between blood homocysteine levels and risk for several cardiovascular-related diseases.

One reason for the inconsistency of findings may be attributed to the possibility that folate, vitamin B6 and vitamin B12 may have an association with cardiovascular disease risk, independent of homocysteine levels. Another possibility is that folate may merely be a “marker” for diets rich in fruits and vegetables, which have been shown to lower risk of cardiovascular disease and may contain substances that protect the vascular system.

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Even so, there remain many individuals who develop heart and other cardiovascular diseases, such as stroke, who do not possess these particular risk factors. While controlling for previously established risk factors including: age, sex, family history as well as those mentioned above, scientists have recognized an association between moderately elevated plasma homocysteine levels and increased risk for cardiovascular disease.

What is homocysteine and how was it first thought to be associated with cardiovascular disease? Homocysteine is an amino acid that is produced during normal body metabolism. For homocysteine to be further processed, adequate levels of folate, vitamins B6 and B12 are necessary. If they are not present, homocysteine can build to high levels in the blood (hyperhomocystinemia).

Folate and vitamin B12, two vitamins that directly influence homocysteine levels, are obtained from the diet. Folate is most commonly found in fruits, such as bananas and oranges; vegetables, primarily green leafy ones, and legumes, such as beans. Because folate plays such a significant role in the human body, it is now being added to whole grain products. Vitamin B12, needed in smaller quantities than folate, is only available in animal products.

Hyperhomocystinemia can be caused by several rare genetic disorders which share common factors that lead to premature blood clot formation and cardiovascular related problems. The Sept. 7, 1999 Annals of Internal Medicine published a review of evidence on the association between homocysteine and cardiovascular disease. Researchers sought to determine the strength of the association between elevated homocysteine levels and risk for cardiovascular disease, in addition to the benefits of homocysteine-lowering therapies.

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Stop it at the source. Help your kids deal with peer pressure by teaching them to become more comfortable saying no to pressures to smoke.

As an adult, that may sound easy. But for a kid who wants to be accepted, saying no to peers is tough. It is a skill that takes practice. Start by doing some role-playing. Here’s how:

Pretend you are someone trying to get your kid to smoke. Really put the pressure on.
Help your child develop a set of “no thanks” comments. The comments should fit the child’s personality and be in his or her own words.
Try to keep things light and fun.
Here are some other tips:

If your kid is shy, suggest that he or she simply say, “No thanks” and then quickly leave the area.
If your kid is more outgoing, maybe a statement such as, “No way! I don’t want to smell like an ashtray” will work.
Help your kid practice responses so that they become strong, sure and convincing.

Remember, just because your kid is comfortable saying no today, that doesn’t mean he or she will always remain that way. So, it’s a good idea to revisit the issue from time to time, making sure they always have the skills to turn down tobacco.

There are many other ways to help your kids not give in to peer pressure. Know that even though their peers have tremendous influence over what they do, you are also a powerful force in their lives.

While it may seem like they don’t listen to anything you say, realize that they still want to live up to the expectations you have for them.

Tom Behan, co-owner and co-founder of the Alaska Club Network in Anchorage, Alaska, is the newly elected IHRSA president. Two new members were also elected to the IHRSA board of directors: Greg Lappin, general manager of Rochester Athletic Club in Rochester, Minn., and Joe Moore, president of Moore’s Fitness in Centerville, Ohio. David Giampaolo, an international ambassador to the IHRSA Board, will serve on the board of directors beginning.

IHRSA increased its number of board members from nine to 12, beginning with the 2002-2003 term. The term length of board members was also increased from three years to four to provide greater continuity of board leadership.

“As the state of the industry gets stronger, so too does our IHRSA Board,” said John McCarthy, IHRSA’s executive director. “I am confident that under the leadership of Tom Behan, the 12 IHRSA board members will continue to provide important direction to the association as IHRSA fulfills its mission to grow, protect and promote the commercial club industry.”

An Act Perhaps — but Not a Class Act
My own research into chiropractic began in 1986 after some disturbing experiences with two Orange County, California, chiropractors. Both were self-proclaimed fervent Christians. Myself a Christian, and then unemployed, I responded to this classified ad in the Orange County Register:

Sales
Motivated and experienced salesperson needed for dynamic, growing Health Care Facility. To educate the public on health care, emphasize prevention and wellness. Must be enthusiastic, positive, prof l and REALLY care about people. Potential for BIG BUCKS. Call&

Of course, the uppercase “big bucks” didn’t suggest to me a “class” organization, but I sent a resume out of curiosity. I had been both a teacher and a salesman and felt I had a good general knowledge of health. The position turned out to be that of pitchman for a chiropractor. The hireling was to set up a table in shopping malls and at health fairs and offer “health passes” (allegedly a hundred-dollar value!) to those who signed up for a free exam. The doc said I would make $1,000 to $1,300 a week, working only on weekends! He asked me to undergo the exam, apparently so that I would learn about what I’d be pitching. I agreed.

Fishy Chiropractors
A series of six interview/pre-employment propaganda sessions followed. It was a mind-boggling, almost mesmeric hustle. I stuck it out but suspected strongly that the chiropractor wanted me to become his patient, not his employee. Finally I called him a fraud to his face. Through a large ad in the Yellow Pages, I contacted another “pious” chiropractor. I went to his office and requested advice on how to report the classified advertiser to the proper authorities. All this guy had to do was give me the address of the State Board of Chiropractic Examiners, but he hesitated and said he’d think about it and get back to me.

Although his ad in the Yellow Pages featured a large Christian fish symbol, I was taken aback when he said he wanted to lead me in prayer! After we prayed, he told me he was a multilevel-marketing distributor and invited me to an “opportunity” meeting. He said he was forsaking chiropractic because of experiences like the one I’d had with the classified advertiser. Yet he stated that the next time I had a cold, I could come by and he’d treat me without charge!

Nine days later, I phoned him to ask again to whom should I complain about his “predecessor.” He (the distributor) hadn’t called me. And he has never answered my question. I told him (in a very “un-Christianlike” manner) that he was full of a certain waste product. He hung up.

High incomes and the title “doctor” lend too much credibility to both the medical and non-medical pronouncements of physicians — the professionals to whom many chiropractors misrepresent themselves as equivalent or superior.

Chiropractors have lower incomes, but because all chiropractors are “doctors,” and because most practicing chiropractors conduct themselves as providers of primary care, chiropractors in general have way too much popular credibility. Their pronouncements, as Magner makes clear, are too often pseudomedical, too often ridiculous, and too often dangerous.

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When I was initially invited to become a parenting columnist for drkoop.com, I was incredibly honored but could not imagine accepting the offer. Who was I to write about parenting? I’m in the trenches with everyone else. I am struggling with the never-ending challenges and dilemmas, feeling my way, going down paths I have never before encountered. I found the prospect of writing for an anonymous audience daunting. I was excited and scared. What did I do? I called my parents.

After expressing her excitement and pride, as well as providing words of encouragement and faith in my abilities, my mother said, “Pretend you are writing to me.” (She meant it might be less intimidating if I thought I had an audience of one but she also was saying that although I might be reluctant to offer strangers anything that might smack of ‘advice,’ I was never shy about offering my opinions to her…).

She then handed the phone to Eli, my step-father. He heard my terror and said, “Wait a minute.” After searching around for what seemed like a long time, he came back to the phone, and told me that he had just read an issue of “Modern Maturity” for the first time that day. (Modern Maturity is the magazine of the American Association of Retired Persons.) He wanted to read something to me and proceeded to quote Jerry Della Femina, who was featured in the issue.

Mr. Della Femina has been named one of the 100 most influential advertising figures of the 20th century for the work he did on groundbreaking commercials. In addition to starting several restaurants, owning a newspaper, and serving as a columnist, he was about to launch a Web site for doctors at the time of the magazine interview, which focused on “creativity.”

Mr. Della Femina, who grew up with a learning disability, shared his secrets about creativity. Eli chose to share one of them with me: “Failure is the mother of all creativity. My advice to anybody who wants to be creative is to get into something that will fail. I’ve failed at a lot of things in my life and I hope to fail at a lot more. Most people are afraid to fail, but once you’ve done it you find out it’s not that terrible. There’s a sense of freedom that you get from taking chances. My favorite nine words in the world are Kris Kristofferson’s line in the song, ‘Me and Bobby McGee’: ‘Freedom’s just another word for nothing left to lose.’”

What a powerful suggestion. Failure is such an uncomfortable concept. We do such acrobatics to avoid it at all costs. We prejudge our efforts, censor, imagine public criticism, and limit our choices.

Is it possible to short circuit “performance anxiety”: immerse oneself in the moment, in the creative act and, at least temporarily, ignore the possible outcome? Not to abandon the goal of doing one’s best, but to call upon all of one’s creative energies and apply oneself with abandon?

I wonder how we can harness Mr. Della Femina’s words in our efforts to consult with our children when they face challenges in life. What do we even consider a “successful” experience or a “failure”? Do we strive to protect our children from failure, and in doing so, do we inadvertently deprive them of experiences that stretch and instruct them and enrich their lives? By giving up a focus on a perfect outcome , do we free ourselves to enjoy the journey and the process? To discover treasures about ourselves and the world around us, even if we do not reach our destination?

Fortunately there are certain identifiable attitudes and behaviors that these women have in common. So let me share with you what I have learned from them!
Remain positive — Focus on what’s good, even in unfortunate circumstances. A negative attitude will age you beyond your years, whereas a hopeful, positive one will draw others to you and make you appear younger than you really are.

Continue to experience new things — New knowledge allows each of us to revisit the wonder and excitement of childhood. Take dance lessons, become computer literate or take an industrial arts class! Your enthusiasm will make you feel young at heart.

Nurture your relationships — It’s a wonderful feeling to be part of a community of supportive people. The give and take of close relationships adds a unique richness to life. And age is irrelevant when you are with people who love you!

Remain flexible — Routine can be useful, but it can also turn into inflexibility — a sure sign of old age. So routinely vary your routine! Eat spaghetti for breakfast or take a different route to work. The change will add interest and texture to your life, and keep you from becoming stodgy.

Add a spiritual component — What does it all mean? As we age, we tend to ask more questions about life, death and the purpose of existence. A spiritual foundation helps us to explain the ups and downs of life. It gives us strength to deal with life’s hardships.

Have fun — There is nothing more likely to keep you youthful than laughter or than fun, non-goal directed activities. Going to the zoo, reading comic books or building a sand castle may seem like kid stuff, but that’s the point! Schedule “mandatory” fun time into your calendar and see the difference it makes in your overall attitude and stress level.

Care and feeding of your body — Adequate rest, vigorous exercise and a balanced diet will contribute greatly to your “fountain of youth.” And so will an occasional ice cream sundae!

Dare to dream — No matter how old you are, dreams for the future will keep you young at heart. Working toward something you are excited about keeps enthusiasm high and recognition of aches and pains low!

The sweetest music comes from an old violin — Rather than focusing on lost physical prowess or those laugh lines around your eyes, capitalize on the advantages of getting older, such as the life perspective and wisdom you will develop as you mature.

Love your work — Find work about which you are passionate. When your livelihood holds meaning for you, you can become totally absorbed in it. And since you spend a huge portion of your waking hours on the job, you might as well love it.
Well, I hate to break the news to you ? there is no fountain of youth. And remaining young –both physically and emotionally — will take some conscious effort on your part. The good news is that if you incorporate the above elements into your life, your efforts will pay off in a big way!

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Certain entertainment systems can also help you attract new members. Some prospective members may not join your facility if you do not have enough TVs, or if they don’t like the music being played. This may sound picky, but these amenities may be the deciding factor between your club and another.

What is right for your club

While your members may not let you know about other problems at your club, you can bet you will hear about your music, television or other entertainment systems. This is a true testament to how important distraction is to your members. If one machine is broken, they can move on to the next, but if your television is broken, or on the wrong channel, or if your music isn’t on, you can bet you will hear about it. Some of your members would choose not working out at all tositting on a bike for 45 minutes without being able to watch “must-see TV.”

As always, listen to your members. Find out what kind of music they like and what television programs they watch, and remember that these will change throughout the day.

Ask if fitness tracking is something they are interested in and would use, and then research the different offerings and decide which is best for your members.

Most people need a little push when it comes to exercising, and entertainment can be that push. If they know they can watch a movie while walking on the treadmill, check their email while riding a bike, listen to music while lifting weights, and then log and track their results when it is all over, your members may be more motivated to get off the couch and into your club.

Radioactive iodine can not be administered to a pregnant woman, because it would permanently damage the baby’s thyroid gland or could conceivably cause other problems with the infant. Surgery is also best avoided during pregnancy unless it is absolutely necessary. So, antithyroid drugs are really the only treatment available in this situation.

Pregnant women with Graves’ disease are treated usually with PTU, since it does not cross the placenta very well. Your physician will attempt to use the smallest dose of this medicine possible.

Fortunately, Graves’ disease often improves during the course of pregnancy and patients may b able to stop the PTU altogether. However, a watchful eye must be kept on the thyroid hormone levels during the first six months after delivery, since Graves’ disease frequently returns at this time.

Small to moderate doses of PTU are safe for the nursing mother to take. Radioactive iodine cannot be used until after nursing has stopped.

Do I wish to become pregnant soon?
My advice to women with Graves’ disease who wish to become pregnant in the near future is to take a radioactive iodine treatment (or have surgery if they prefer) so that the Graves’ disease is over and done with.

This makes things simpler by avoiding the need to use antithyroid drugs during pregnancy and afterward during nursing. Although the patient will probably need to take a thyroid hormone supplement after the treatment, this is very safe to use during pregnancy and the dosage is easily adjusted.

One word of caution, however. A woman should wait six months after a radioactive iodine treatment before becoming pregnant.

Do I have significant Graves’ eye disease?
Recent medical studies have shown that a radioactive treatment may result in worsening of the eye problems in Graves’ disease. Usually the degree of worsening is not great, and this only happens in a few patients.

However, because of this concern, I usually advise patients with severe Graves’ eye disease not to take a radioactive treatment until their eye problems have calmed down. Long-term medications or surgery are, I believe, a better choice for these patients.

Another approach, however, is to have the patient take a steroid hormone, such as prednisone, for two to three months after the radioactive iodine treatment. This seems to prevent any worsening of the eye problems.

Am I a child?
Although Graves’ disease is less common in children than in adults, it does occur in childhood, and it can cause significant behavioral difficulties in addition to the other symptoms noted above. I use the same considerations in advising parents about the treatment of their children with Graves’ disease as I do in treating adults.

Thus, I suggest that medications, radioactive iodine and surgery are all options. However, some physicians prefer not to use radioactive iodine in children, though there is no evidence that this results in adverse consequences.

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Also, patients don’t have to make a decision right away about taking a radioactive iodine treatment or having surgery. Many patients decide to start on PTU or methimazole along with a beta-blocker, and then rethink their options after they are feeling better and calmer.

I think this is a good short-term approach to treating the disease, and I often recommend it to my patients. Remember also that the choice of therapy belongs to the patient. The physician may make recommendations to the patient based on her or his experience, and the patient should consider these suggestions carefully. But it is important that the patient feel comfortable with the treatment that he or she chooses.

In considering the long-term treatment options of antithyroid prescription drugs, radioactive iodine or surgery, patients might ask themselves the following questions:

How well do I take medications?
If you decide to take antithyroid drugs for the long term, you will need to take several pills a day for many months. Some individuals just do not like to take medications, and they know that they will have trouble keeping on schedule with their pills.

If you fall into this category, you might want to consider a radioactive iodine treatment early on. As discussed above, you are still likely to end up on a thyroid supplement once a day after this treatment, but that will be easier that sticking with antithyroid drugs.

How quickly do I want to get this Graves’ disease out of my life?
If you are very anxious to get your Graves’ disease over and done with, then surgery offers you the best treatment option. After surgery you will be placed on a thyroid hormone supplement that may require adjusting, but then you are done. From start to finish, this should take about two months. A radioactive iodine treatment will accomplish the same thing in about six months.

With antithyroid drugs, you are in for the long haul, with no assurances as to when you will be able to stop the medications. Most physicians recommend sticking with the medications for at least six to 12 months. Of course, if the medications are adjusted properly, you should be feeling quite well during your treatment. But you will still require checkups about every three to six months after the initial adjustment period.

Do I really want to have surgery?
In my experience, most people want to avoid surgery if possible. In treating Graves’ disease, surgery is rarely absolutely necessary. Furthermore, the risks of surgical complications involving the vocal cords or the parathyroid glands (though unlikely) often give patients second thoughts about this form of therapy. Since two other good forms of treatment are available, most patients elect not to have surgery.

How comfortable do I feel swallowing a pill that is radioactive?
As a physician and a medical scientist, I think a radioactive iodine treatment is a safe and very effective form of therapy for Graves’ disease. Many of my patients choose this form of therapy.

However, some patients feel uncomfortable with this treatment, despite reassurances that it is safe. Also some patients don’t like the idea that radioactive iodine (and surgery) causes permanent damage to their thyroid gland. They would rather work with medications for several months to see if their Graves’ disease will reverse itself.