Will Pregnancy Be Safe With My Medical Condition?

Pregnancy can be a worrying at the best of times, but if you also have a chronic illness or medical complaint it can be even more so.

Long-term conditions including diabetes, depression and mental health problems, rheumatoid arthritis and epilepsy, often need medication, which may or may not be safe for your baby. This is why it's so important to see a health professional as soon as possible – ideally before you conceive when you're planning your pregnancy to discuss the implications of pregnancy for your medical condition. Medical conditions may also affect your pregnancy – for instance having poorly controlled blood sugar can result in you having a large baby.

The good news is that obstetrics specialists can offer highly personalised care for you and your baby with more check-ups and ultrasound scans if needed to check your baby's growth and development.

If you have a medical condition your GP or midwife will usually refer you for specialist care by an obstetrician and they'll keep a close eye on you and tell about what medication is safe to take in pregnancy or best avoided. Do not be alarmed by this – instead be reassured that the likelihood is you'll still have a healthy pregnancy and baby – they're just making sure any risks posed by your condition are minimised.

Pregnancy and diabetes

Diabetes is the medical name for when your blood sugar (glucose) is too high. The best way to make sure you have a healthy pregnancy is to get your blood sugar under control before you become pregnant. Experts say you should aim for an HbAlc test score of 6.5 per cent or less.

There are various types of diabetes including:

• Type I: This is where the body stops producing a hormone called insulin which helps regulate blood sugar. It usually begins in childhood and those affected need insulin injections or insulin via a wearable pump.

• Type 2: Caused by your body not producing enough insulin, type 2 diabetes is usually lifestyle-related to obesity. It can be controlled with lifestyle changes and tablets to lower blood sugar.

• Gestational diabetes: This is a specific type of diabetes that develops in pregnancy, in the second or third trimester and is usually detected by a blood sugar test in the 24 – 28 week window. It happens when pregnancy hormones disrupt the production of insulin.

If you have any of the above and your blood sugar is not controlled, there's a risk you could have a very large baby and need a caesarean delivery. That's why you'll be offered more frequent check-ups and blood and urine tests and ultrasound scans to check your baby is not growing too big. Do not worry too much though – pregnant women with diabetes do have health pregnancies and babies.

Pregnant women with diabetes are also advised to take a higher dose of folic acid supplements, 5mg a day as opposed to the 400mcg recommended by the Department of Health.

Epilepsy and Pregnancy

Epilepsy is the medical name for an intense burst of electrical activity in the brain and can cause disruption to the normal function of the brain or seizures. It affects 600,000 people in the UK and many take anti-seizure drugs to prevent attacks.

Ideally, you should discuss your care with a neurologist before you become pregnant as some types of anti-epileptic drugs do carry a risk of birth defects and you may need to change your tablets before you conceive. You may also be advised to take a higher dose of folic acid of 5mg a day.

However, if you become pregnant while taking epilepsy medication do not stop taking your tablets without seeing a doctor first. Stopping you medication suddenly could result in an increased numbers of seizures. See your GP as soon as possible and they can recommend you about what to do.

If your seizures are well controlled you may not need specialist care, but if your seizures become more frequent or severe in pregnancy you may need to be under the care of a neurologist and an obstetrician.

Mental health problems in pregnancy

If you are on medication for a mental health condition such as depression do not stop taking your medication without discussing it with your doctor first. Abrupt discontinuation can worsen your condition. Talk through your options with your doctors; although antidepressants are not usually recommended in pregnancy they can be prescribed if the benefits outweigh the risks.

Rheumatoid Arthritis

Rheumatoid arthritis is an autoimmune condition where the bodies own antibodies attack the lining of joints causing swelling, pain, inflammation and joint damage.

Seventy five per cent of women with RA report their symptoms actually improve and go into temporary remission during pregnancy though, usually in the second trimester. Symptoms usually return about six weeks after giving birth.

Talk to your specialist before you plan to become pregnant though as there are some drugs you may need to stop as they can affect fertility. Many RA drugs are considered safe in pregnancy so discuss the risks and benefits with your consultant.

Multiple Sclerosis (MS) in pregnancy

MS is a neurological condition, which affects 100,000 people in the UK. It affects three times as many women as men and is commonly diagnosed between the 20 to 40 age groups.

Women MS can with have healthy babies and pregnancies but there are some drugs they may need to discontinue before they try for a baby, so they should discuss this with their neurologist. The usual advice is to wait three months before trying to conceive.

Golf Tips – Build The Perfect Putting Stroke

Do you believe that amateur golfers (including of course you) can build a 'perfect putting stroke'? As an advanced PGA golf professional who has been coaching amateur golfers for many years, I strongly believe amateur golfers can build a putting stroke that is as close to perfect as many of the top golf professionals.

What does it take to build the perfect putting stroke?

  • Good instruction! That is where I can help of course.
  • Good feedback when you are practicing. You need to know you are executing drills correctly.
  • Time – you can not do it overnight.

What makes up a perfect putting stroke?

I often tell my pupils that a golf swing and a putting stroke are like a jig-saw.

You need to work on different parts of your putting stroke and then when you put it all together you'll get the complete picture – a 'finished' putting stroke. Luckily with putting it's quite easy to work on separate parts of the putting stroke. Some elements are easier to master than others since putting is very static – in fact the more stable and still you are when putting the better.

So – what are the different elements of the putting stroke?

Here are a few to whet your appetite, and note that each element needs to be perfect in it's own right:

  • Putting grip. The putter should lay in the palm of your hands, not in your fingers. Your putting grip needs to ensure you deliver the putter head back to the ball at precisely 90 degrees to your target line.
  • Alignment. Your shoulders, hips and feet all need to be aligned parallel to your target. Note they should not be aiming at the actual target – imagine you are standing on one rail of a railway track and the ball is on the other track.
  • Ball position. Another crucial part of putting , but it's amazing how many people get this wrong. It's a simple part of the putting stroke to get right though, and luckily the ball position never changes when you are putting.
  • Stance. Your stance has to do two things. Firstly create a stable platform – in putting there should be no body movement at all. Secondly it needs to enable you to swing the putter along a straight line so you can hit the ball precisely at the target.
  • The actual stroke. If you've got the above parts of your putting stroke right, the actual putting stroke is very simple. All you need to do is rock your shoulders back and forth – at the right speed of course – and you'll always hit a good putt. There really is very little to go wrong during the actual putting.

Is it as simple as that?

In terms of the mechanics of the putting stroke, there are only a few more parts of the jig-saw you need to master including tempo, but not much else …

Do I need to master anything else to be a great putter?

Yes I'm afraid you will need to work on some other parts of your putting to be a great putter.

These include:

  • Reading the greens.
  • Judging pace.
  • Psychology. This is a huge area in its own right, but if you have the best stroke in the world but cave under pressure then it's not going to be much use. You need to control your emotions when under pressure to hole crucial putts. This is another area that I can really help you master.

How will my putting benefit?

Assuming you can master the mechanics (which is not that hard) and the other elements such as reading greens (much harder but still within your grasp), then your putting will be:

  • Consistent
  • Reliable
  • Does not break down under pressure

You will also find when you are standing over a putt that you have amazing confidence. The thought of three-putting will not even enter your mind, though of course every golfer including the best pro's occasionally do this. You'll thrive on pressure situations in match-play as well since you'll have confidence in your putting stroke.

High-Dose Vitamin D and the Decreased Incidence of Chronic Disease

It is well known that vitamin D deficiency is associated with osteoporosis, bone fracture, increased falls, muscle weakness, increased risk of certain cancers (particularly breast and colon, and possibly prostate), autoimmune diseases, obesity, insulin resistance and type 2 diabetes, schizophrenia, depression, asthma, lung dysfunction, influenza, kidney disease, high blood pressure, and cardiovascular disease. Even complications of pregnancy, preeclampsia (pregnancy-induced hypertension) and gestational diabetes, are associated with vitamin D deficiency. In infants, the vitamin’s insufficiency has also been linked to low birth weight (caused by low levels from the mother during pregancy) neonatal hypocalcemia (low blood calcium), poor postnatal growth, bone fragility, and increased incidence of autoimmune diseases and childhood asthma.

Prevention of Osteoporosis

The standard recommended dose of 400 IU/day of vitamin D was in general to help maintain “good health,” and to help reduce the risk of osteoporosis, falls, and hip fractures. Over the last 5 years, there has been an explosion of studies expanding our knowledge and indicating that higher doses have much more of an effect on overall health and on the prevention of various chronic diseases than just bone development and the prevention of osteoporosis. This was standard while I was practicing medicine to recommend calcium, magnesium, and vitamin D to women of menopausal age. However, I now recommend doses much higher than 400 IU/day.

Insulin Resistance

A common problem I saw in my medical practice, associated with aging and increased weight was insulin resistance, which often led to metabolic syndrome or full-blow Type 2 diabetes. To help reduce the risk of diabetes, metabolic syndrome, and insulin resistance I would encourage my patients to maintain a low-glycemic diet, exercise at least 4 times a week, and be on a broad spectrum nutritional supplementation program. Often this made the difference for people who took it seriously and made significant changes.

Insulin resistance begins with oxidation of insulin receptors. Anything that cause more oxidation, and therefore more inflammation, can lead to insulin resistance, and ultimatley Type 2 diabetes. Continued consumption of high-glycemic food (simple sugars and starches) will damage insulin receptors via inflammation/oxidation. With continued oxidation and inflammation of insulin receptors full-blown Type 2 diabetes develops. Lately, it has been discovered that vitamin D deficiency is a contributing cause to insulin resistance, giving further support to my recommending higher doses.

Although not all studies have been consistent and demonstrating a reversal of insulin resistance with vitamin D supplementation, the studies that have shown benefits in reversign insulin resistance have been the studies demonstrating blood serum 25-hydroxvitamin D (or 25-OH-D) concentrations that were at least in the range of 35 – 42 ng/ml. This may suggest that high doses may be needed to see a benefit in the prevention, and possible reversal of insulin resistance.

Decreased Risk of Breast and Colon Cancer Associated with Supplementation

As a former practicing board-certified Ob/Gyn, I had many patients who had a history of breast cancer, or a family history of breast cancer. Colon cancer was also a concern, as its incidence is second to breast cancer. A decreased risk of breast and colon cancer (and possibly prostate cancer) has been associated when blood serum levels of 25-hydroxvitamin D (25-OH-D) are 40 ng/ml or above. For most women, this would require a dailly dose near 4000 IU/day.

I had many patients using tamoxifen to treat or suppress the recurrence of breast cancer. However, tamoxifen has its own concerns (among them possible endometrial cancer). Interestingly, much like drugs that are used to treat breast cancer, such as tamoxifen, vitamin D enters breast cancer cells and triggers apoptosis; whicself-destruction, or “cellular death,” of cancer cells. Actually, several various antioxidants; e.g., turmeric extract, polyphenolic compounds; such as grape seed extract, cruciferous extract, resveratrol, green tea extract, and olive extract) all cause apoptosis, or cellular self-destruction. The benefit of apoptosis compared to chemotherapy drugs and radiation therapy is that it causes cancer cell dealth without toxicity or destruction to normal cells.

Although the knowledge and use of antioxidants to kill cancer cells is as of yet limited, and thefore too early to be used to replace current toxic therapies for cancer, there is much promise for vitamins and other antioxidants in the near future. According to the research, I am a believer that antioxidants, and like substancs may help to prevent to the initiation of cancer, and therefore, along with a proper diet and lifestyle, everyone should be taking quaility supplements.

Specifc to this article, as I have searched to find out what dose of vitamin D women “should be” taking for preventative measures against breast, ovarian, and colon cancer, I have discovered that the studies have shown an association between women whose serum 25-OH-D levels of at least 52 ng/ml or higher and a 50% decreased incidence of breast cancer. Ovarian and colon cancers are similar in that there is a significant decreased incidence when 25-OH-D levels are above 50 ng/ml; and particular when they reach 80 ng/ml.

As I speak on the “Power of Nutritional Supplementation,” both in lectures and on my audio CD, I suggest that among other nutrients, when one considers there are so many potential health benefits to be obtained from nutritional supplementation of specific vitamins, let alone a full-range of quality supplements, with virtually no toxic effects, I have to ask why would anyone wait to supplement?

Reduced Risk of Heart Disease Associated with Vitamin D

Vitamin D deficiency increases the risk of both ischemic and non-ischemic heart disease. Supplementation also helps control blood pressure, it influences parathyroid hormone levels, influences the function of heart muscle, and plays a role in reduction of inflammation and calcification of blood vessels, thus helping to reduce atherosclerosis.

The risk for heart disease is particularly high when 25-OH-D blood levels are below 15 ng/ml. With 25-OH-D levels above 30 ng/ml cardiac benefits may possibly be significant. Obviously, more studies are needed to draw conclusions about this vitamin’s role in maintaining and/or reducing cardiovascular disease, but once again, I can only say that there is now enough evidence when taken as a whole, for everyone to consider supplementing with adequate doses of this all-important vitamin for any or “all” of the potential health benefits.

Reduced Risk of Influenza with Vitamin D

It is well established that vitamin D reduces the incidence of respiratory infections. Children who have been found to have the lowest 25-hydroxyvitamin D blood levels are 11 times more likely to develop respiratory infections. I have been asked about the safety and effectiveness of children supplementing with this vitamin. One can only look to clinical information. Children with recurrent respiratory infections have been given as high a dose as 60,000 IU of vitamin D3 (the active form) each week (for six weeks), and found to have not one such infection for the following 6 months!

Many people suffer and die from influenza, or the “flu.” They don’t die of the viral infection per se, as much as they die from the body’s over-reaction. The influenza virus causes an uncontrolled over-production of inflammatory cytokines. Interestingly, vitamin D turns down this process by “down regulating” the expression of pro-inflammatory cytokines, such as tumor necrosis factor-alpha.

Actually, the pro-inflammatory cytokine process is the same inflammatory process that occurs in chronic disease, such as inflammation of arteries in atherosclerosis, inflammation in arthritis, damage to neurons, and inflammation and damage caused by cancer cells and by the aging process itself.

Think about the possibilities of reducing inflammation, by down regulating cytokines (tumor necrosis factor alpha, etc.) and thus reducing the incidence and progression of many chronic degenerative diseases, including heart disease, cancer, Alzheimer’s disease, arthritis, diabetes, respiratory infections, liver and kidney disease, and the aging process itself!

Regarding vitamin D (really a hormone) and the protection of respiratory infections and influenza, in addition to the down regulation of inflammatory cytokines, this unique hormone also up-regulates the expression of anti-microbial peptides in immune cells. Anti-microbial peptides damage the outer lipid membranes of influenza viruses, bacteria, and fungi allowing the white blood cells (macrophages) from the immune system to eliminate them from the body.

I suggest that adults and children supplement with much higher doses than what was has been traditionally recommended to reduce the incidence of respiratory infections and help support the immune system, particularly during winter months when exposure to sunlight is decreased.

Vitmain D May Help Reduce the Risk of Complications of Pregnancy

Maintaining health during pregnancy is a chief concern of mine because it is critical that women get proper cellular nutrition throughout their pregnancies. Optimal supplementation should take place before a woman even knows she’s pregnant. This is one reason why I recommend all women of child-bearing age be on a full-spectrum of quality nutritional supplements. Now, with recent information about the benefits of vitamin D during pregnancy, the amount of vitamin D in prenatal vitamins is quite inadequate,…at least in my opinion.

Vitamin D plays a key role for calcium metabolism during pregnancy and development in order to prevent infantile rickets and adult osteomalacia. During pregnancy, calcium demands rapidly increase, particularly in the third trimester. Because of this, vitamin D, which is required for calcium incorporation into the bones becomes crucial for proper skeletal growth and optimal maternal and fetal outcomes. Despite widespread use of prenatal vitamins containing what is thought to be “adequate” doses of vitamin D, there is still a vitamin D deficiency epidemic among pregnant and lactating women.

It is even more important that a pregnant woman have optimal vitamin D blood levels than a non-pregnant woman, as her baby’s health depends on it,…not only during fetal life, but during the next two decades of that baby’s life!

Low vitamin D levels during pregnancy and infancy are associated with maternal preeclampsia and pregnancy-induced hypertension, neonatal low birth weight and hypocalcemia, poor postnatal growth, bone fragility, and increased incidence of autoimmune diseases and asthma of the child.

During pregnancy a minimum blood level of vitamin D (25-hydroxyVitamin D) should be at least 32 ng/ml or greater; and optimally closer to 50 ng/ml. In order to achieve and maintain 25-hydroxvitamin D serum levels at 32 – 50 ng/ml, I suggest that pregnant and lactating women would possibly need to supplement with a dose between 2000 and 4000 IU/day of vitamin D3 per day, which is both safe and effective. Of course, this is beyond the level found in all prenatal vitamins.

Childhood Asthma Linked to Vitamin D Deficiency

The asthma epidemic may be explained in part by the vitamin D deficiency epidemic. There is a direct correlation between low serum vitamin D levels and higher risks for asthma exacerbations. Vitamin D plays a role in fetal lung growth and development. Epidemiologic evidence suggests that higher prenatal vitamin D intake has a protective role against wheezing illnesses in children. Vitamin D may protect against wheezing illnesses through its multiple immune effects as discussed above. In addition, vitamin D may play a therapeutic role among asthmatics from becoming steroid resistant.

Above I indicated that vitamin D plays an important role in reducing the risk of respiratory infections. In children, and adults for that matter, with asthma, supplementation with high dose vitamin D is of even more importance, as a respiratory infection can trigger attack.

Measuring Your Vitamin D Status

The question on most people’s mind is, “How much vitamin D is the right dose?” The best way to know one’s “correct” dose is to know your 25-hydroxyVitamin D blood level. This is the metabolically-active form of vitamin D, and is also known as calcidiol. It is abbreviated as 25-OH-D. In the past, “adequate” blood levels were set to prevent rickets and then osteoporosis. The myriad benefits and safety of vitamin D is coming to light.

Most laboratories have a normal reference range for 25-OH-D of 32 – 100 ng/ml. After studying what many of the experts in the field of vitamin D deficiency treatment have recommended, it varying widely, I am in line with suggesting that one’s “optimal” serum 25-OH-D level should be between 50 – 80 ng/ml.

What Dose of Vitamin D is Optimal?

The vitamin D dose required to attain a serum level range of 50 – 80 ng/ml will vary from person to person, mostly based upon body mass (weight) and sun exposure. Although this will vary considerably, a 150 lb person who supplements with 2000 IU of vitamin D per day may attain blood level range of 25-OH-D between 30 and 45 ng/ml, depending upon sun exposure. In my experience, it seems that this same person may need to take 4000 IU/day, or more, to attain optimal blood levels between 50 and 80 ng/ml.

Again, from my experience, and it this will vary widely. A person who weighs 225 lbs. may require a dose of 10,000 IU/day to maintain 25-hydroxyVitamin D blood serum levels between 50 and 80 ng/ml. A person’s true dose can only be determined by blood tests and titration (adjustments based upon the blood tests).

My suggestion would be to start with vitamin D at either 4000 to 6000 IU/day, depending upon your weight; or you may safely opt to take 10,000 IU/day, and then have your 25-OH-D blood level tested about 6 to 8 weeks later. Your optimal blood level target range for optimal health is 50 – 80 ng/ml. Therefore, once you know your blood level, you may adjust your daily vitamin D intake accordingly.

Are High Doses of Vitamin D Safe?

Is long-term “high dose” of vitamin D3 safe? There may be concern that high doses of vitamin D may elevate serum calcium levels and cause kidney stones in those at risk. There was a study in which vitamin D deficient patients received either a single oral, or a single intramuscular injection of 300,000 IU of vitamin D and followed for 12 weeks. During the 12 weeks not one person had elevated levels of serum calcium (or hypercalcemia).

This doesn’t mean that chronic super high doses of vitamin D will not raise blood calcium levels; however, there are no credible reports of vitamin D toxicity with chronic daily vitamin D3 supplementation up to 10,000 IU/day, including elevation of blood calcium. In fact, many vitamin D expert clinicians are routinely recommending doses well above 10,000 IU/day. Hypercalcemia (an elevated serum calcium level) is only observed with synthetic vitamin D analogues, such as calcitriol.

Since it is safe for most people to supplement with vitamin D with doses as high as 10,000 IU/day (and possibly higher) without concern, my recommendation of a starting dose between 4000 – 6000 IU/day is quite conservative.

Are there Contraindications for High-Dose Vitamin D?

Primary hyperparathyroidism is the main contraindication. Also, high dose vitamin D3 supplementation may cause elevation of serum calcium levels in patients with sarcoidosis, tuberculosis, or lymphoma. Therefore, in such cases, patients dosing with levels above 2000 IU per day should do so only with caution AND under the care and direction of a physician.

One Last Word: Maintain Proper Ratios and Balance of Vitamins

Vitamin D3 is obviously safe. It has been underestimated as an important vitamin for many decades for maintaining optimal health at least, and possibly for reducing the risk of many chronic diseases if boosted to optimal blood levels. However, as will all vitamins, minerals, antioxidants, essential fatty acids, or any other nutrient, vitamin D should be taken in balance! All nutrients should be used to supplement a healthy diet, and used in conjunction with exercise and a healthy lifestyle.

Balance and proper ratios of nutrients are critical, as in the case of vitamin D with vitamin A. Vitamin A can neutralize the beneficial effects of vitamin D. In addition, many people are aware that high doses of vitamin A can be toxic to the liver and cause birth defects. However, most are not aware that vitamin A and vitamin D compete for each other’s function in the body. Supplementing with excess amounts of vitamin A can suppress the important cancer-fighting effects of vitamin D.

Most multivitamin preparations contain vit A. Vitamin A (or pre-formed vitamin A) is different from pro-vitamin A, or beta-carotene. Beta-carotene does not interfere with vitamin D. Nor is beta-carotene associated with birth defects or liver problems.

Therefore, in choosing a quality, broad spectrum supplement brand, it is my suggestion to choose one that provides beta-carotene (a.k.a. “pro-vitamin A”), not vitamin A. This is just one of many criteria in choosing a quality supplement brand. As it relates to this article, choose a supplement that provides a daily dose of vitamin D3 of at least 2000 IU/day,…and consider taking at least 4000 IU/day and having your blood tested to achieve the target range of 50 – 80 ng/ml.

We should never rely on one vitamin, juice, or magic potion to cure all our problems. However, we should not ignore the ever-emerging evidence and promise that science is uncovering of the benefits nature has to offer in helping us to maintain optimal health.

I am a major proponent of using a broad spectrum of high quality vitamins, minerals, antioxidants, and essential fatty acids at proper doses and balance, along with healthy eating and proper lifestyle. I do not claim that all the answers are found in one vitamin or antioxidant, but many of the answers to optimal health are found in the synergistic action of the blend and balance of the fullest range of supplementation we are willing to incorporate into our lives.

Treating Mental Health and Forensic Populations

No longer is it possible to assess and/or treat a mental health population without also interfacing with forensic issues such as legal infractions, Courts, violence, sexual behavior problems, delinquency, crime, Not Guilty by Reason of Insanity, substance abuse, and others. The training and approaches to the mental health population is different than that for a forensic population. So what is to be done, if a person has both issues? We must be cross trained for dually affected clients.

How Are the Populations Different

A Mental Health population is comprised primarily Axis I disorders, such as Bipolar Disorder, Schizophrenia, Major Depression, PTSD, and Anxiety Disorders. Daily functioning is on a continuum. Recovery is quick for some and slow for others and is also on a continuum. Well controlled intermittent, mild to moderate episodes of a mood or anxiety disorder will not necessarily interfere with daily functioning. Someone with severe, chronic Schizophrenia or Mood Disorder requiring periodic hospitalizations and extensive community support, will have impairment in daily functioning. Goals for these folks are often pro-social and involve being an active member of society. A therapist can be fairly sure that the mental health client without forensic issues will be relatively honest in his or her interactions and the therapist can take most of what he/she says at face value. An emphasis on a strengths model works well when no personality disorder is involved.

A forensic population can be defined as having personality disorders, interpersonal difficulties, behavioral problems, multiple problems and life long courses of various levels of dysfunction or difficulty. Again, this population fills the full spectrum of effective daily functioning. However, social functioning is often the most severe impairment. There are issues of trust, appropriate relationships, ego centrism, moral development, honesty, manipulation, and danger to self and others. They often have a negative view of themselves and others, especially authority figures. Moral development is often delayed leaving them at the egocentric stage of development. This means that what serves the self is what matters and empathy for others and the ability to have an honest relationship with another person may not yet have developed. Their goals are often self-serving.

The capacity to understand the importance of the best interest of the group through laws and rules that we voluntarily follow, may not be well understood. Many, if not most, have histories of childhood abuse, neglect, or exposure to domestic violence. The assessment and interventions with this population is necessarily different that those for a people with no Axis II disorder or trait. The people with forensic issues do not always tell the truth because of their lack of trust in relationships. The therapist cannot take what he/she says at face value. The therapist must separate the sincere from the manipulative moves for self-gain. The internal boundaries are such that they need the therapist to put external boundaries into place for them. Information must be checked with other sources of information.

How Assessment Tools Differ

In a mental health population, assessment can quite effectively be done through instruments such as the MMPI-A, BASC, and MACI. These self-report tools are quite sufficient for this population and will elucidate psychological dynamics and mental illness, if present. Self-report is not as much of an issue as it is in the forensic population, where third party verification is more important. However when a youth has multiple problems, both mental health and forensic, a combination of tools is preferred.

Forensic evaluation tools rely less on self-report because of the trust issues and because it is not always in the client’s best interest to be completely truthful. Self-report assessment instruments can be used, but third party and official reports should also be used in the evaluation phase of a forensic assessment. Courts are concerned with public safety, therefore, the need for tools that assess future risk of dangerousness to others. Risk of future aggression and sexual behavior problems that have been derived from statistical models (actuarial tools) should be part of the evaluation since clinical assessment of risk of future dangerousness is only a little better than chance. While risk assessments are not perfect, they are better than clinical judgment in this area.

How are Interventions Different?

Major Mental Illnesses, while often chronic, can often be very effectively treated with medication and therapy. At the higher functioning end of the continuum, therapy can be supportive, psychotherapeutic, family, or cognitive behavioral. Therapists are trained to accept what the client presents and start where the client is functioning and how the client sees the world. The clients are usually self-motivated and seek therapy voluntarily. They accept responsibility for their behaviors and for making changes in their lives. Use of a strengths model is often very effective. Many people recover fully and lead quite “normal,” non-disrupted lives. When someone is on the lower end of the continuum, with major disruption in every day functioning (work and family),despite medication and therapy, major supports for housing, jobs, and activities of daily living and medication are needed for a very long time, perhaps a life time. However, their life goals are often still pro-social. Serlf-directed care works well with the mental health population without Axis II diagnoses.

In the area of intervention, different approaches are needed for the forensic population. Some level of social and family dysfunction is generally intergenerational and lifelong. These clients are often Court ordered to an assessment or therapy or they are having significant problems at work or within the family causing others to seek assessment or therapy for them. They do not always accept responsibility for their actions or for changing. There are skill deficits that need to be addressed, such as social skills, anger management, and problem solving. You cannot take what these clients say at face value. Third party information is always needed. This is because you need to trust someone in order to be honest with them and most of these folks have been abused, neglected, or exposed to domestic violence and a suspicious arm’s length treatment of others is a coping strategy that is difficult to give up.

This population often has multiple problems so that Multi-systemic Therapy that approaches many areas that need to be addressed is often effective (treating the whole person). Group work and trauma therapies are also good tools. Self-directed therapy may not be effective because of the need to protect oneself from what may appear to be an unsafe world. Nurturing, setting good boundaries, and structure are essential in this work. Motivational interviewing and stages of change can be very helpful. When clients have issues in the mental health and forensic arenas, both approaches must be used to the extent possible.


Clients in a mental health setting range from the single diagnosis of a major mental Illness to the dual diagnosis of a major mental illness and a personality disorder and/or forensic/legal issue. The approaches to these dissimilar populations is unique when clients are dually diagnosed, both approaches are needed. Assessments and treatment for a mental health population can be self-directed and strengths based.

However, the approach for the forensic population cannot be self-directed because the client’s goals are often antisocial and by definition counter to the best interests of society. The therapist or evaluator cannot accept everything the client says at face value because not being honest is part of the disorder that the therapist is treating. Motivational interviewing seems to blend the views of traditional mental health and forensics in a way that is beneficial for the client and society.

Pick Up Girls and Women Successfully, Without Needing Any Pickup Lines

I’d like to let you into a little secret about dating girls. All women, whatever their age, want and expect eligible males to make passes at them.

Women goes to bars and clubs, and other places where people gather, purely for the purpose of being available and hoping that the right guy is going to come along and ask them out.

You don’t have to memorize a joke book of corny pickup lines. In fact using any kind of pickup line to try and get to know a female is more likely to blow up in your face. You see, women and girls are hoping to be approached in an open and honest manner.

Trying to use a pickup line may make them laugh, but it certainly will not impress them. And, believe me, you do want to impress them — but in the right way.

You’ll make a good impression on all the women in the room if you clean, your hair is tidy, your face shaven or your beard and mustache well-trimmed. a hint of aftershave or under-arm deodorant will not go astray. And you will want to have your shoes and your teeth brushed and clean.

All of these things seem terribly exciting and basic, but they are a strong indicator to any girl or woman that you take pride in your appearance. And having pride in your appearance is an indicator that you have good self-esteem.

Clean clothes are a must, as a clean hands and fingernails, for women do look for these things. While smart clothing, like a coat and tie are a plus under most circumstances.

If you look good like this, and you walk across confidently, you will be ahead of the game before you even open your mouth. All you have to do now is speak confidently and directly. Don’t try to be smart… spice just say something like, “I think you look beautiful. How about (fill in the blanks):

– having a dance with me?

– coming to a movie?

– going out with me to the theater?

– coming out to dinner with me?

– just having a coffee with me?

– letting me buy you a drink?

– sitting down with me, so we can talk?

Note than in NONE of these openings do you ask her to have sex with you. 99% of women would like to have some kind of relationship with you before they get around to thinking about sex. Space they want to feel that you see them as someone special and not just an easy lay.

In real life, very few women or girls are interested in one-night-stands. The few who really are interested in a one-nighter are likely to have self-esteem problems, and you would do very well to stay clear of them.

Ask the lady out politely and be seen to treat them well when you are in public. It shows you know how to treat a lady. Then, when you get to know them on a more personal level lady will let you know exactly how she likes to be treated. So pay attention, then you will do well.

Hair Replacement Treatment Options – Surgery and Other Non – Surgical Solutions

No matter how much you think hair loss is a problem, there are now very effective solutions for the condition. Any bald male or even female you see today obviously doesn’t have the money to get their “hairs back” or they just don’t want to!

Surgery in particular has proved very effective in getting back hairs lost in the past. I see lots more people today with hair who previously didn’t have any on top of their heads. Unless you knew they previously had bald hair, there’s no way you would believe by looking at their hairs today.

Minoxidil and cortizene injections are other medications that are effective in treating male hair loss. Also, topical immunotherapy is equally effective as a treatment option to cure Alopecia. Other treatment options include the use of dinitrochilorobenzene as a topical solution on the scalp of the individual having Alopecia.

Non-surgical hair replacement solutions for Alopecia includes the use of toupees, wigs or hairpieces to hide the scalp, eye brows, mustache and other part of the body where Alopecia have taken over. Other treatment options in this category include: sensigraft hair replacement, low level laser therapy and reallusions.

If that hair loss is bothering you then going for a hair replacement option will be helpful for you. There are centers where you can undergo these procedures and have your hair loss worries taken care of. The Internet is a good source of information about these centers, especially if you are looking for one close to where you live or where you work.

Hair Growth Remedies – Successful Remedy for Hair Loss

Looking for hair growth remedies? Do not go away we have the best natural hair loss treatment. Of course you've heard this a lot before. Many products say that they are the best and the most successful. But they are not like Provillus.

Why should you use Provillus?

-It Is natural. No chemicals are used in this product.
-It Can be used by both genders. There are 2 separate products for males and females.
-It Is affordable. It will be cheaper than hair pieces or wigs on the long run.

Who can use Provillus?

A lot of people used hair growth remedies, but it was not very successful for them. Of course nothing is successful 100%. But having an efficient natural hair loss treatment like Provillus, will make a difference. Nowadays, most people are going back to nature. They do not like any chemicals to get into their bodies.

Provillus is a natural hair loss treatment. It works in a scientific basis, so there are two separate products for both genders. As a matter of fact, lately, not only men are looking for hair growth remedies, but women as well.

The most important part is that Provillus is a cheap natural hair loss treatment especially that any hair growth remedies will not be paid by your insurance. So, you have to be careful when you buy any of them.

Various people who used Provillus believe it is very helpful, but others hate it without any cause. Why do not you try it by yourself to get to the bottom of it?

Digital Hearing Aids – The New Hearing Aid Technology

Hearing aid technology is ever-improving. The first form of hearing assistance that was effective to some degree was in the form of ram horn shaped amplifier used in Europe. This material was the predecessor for hearing technology which we have today. Even earlier than that, the first forms of hearing assistance were wooden ears that one would attach to their ears. It was believed that if these ears were attached and were designed in the shape of an animal with a strong sense of hearing, then the one wearing it would not suffer hearing loss or feel that they were deaf while wearing them. An important advance was the introduction of "digital" hearing aids. Unlike analog aids, digital hearing aids take sound and convert into a digital signal using a computer chip in the hearing aid. If your primary concern is finding the cheapest hearing aid possible, you might look into an analog hearing aid; they are less expensive than their digital counterparts. Just a hundred years ago if you suffered from hearing loss, any tool used to assist your hearing really could not help much but thanks to today's modern technology such as computers, there is real help out there for those who need it.

Digital hearing aids, however, come with a vast amount of quality-of-life advantages: While analog hearing aids can only make sounds louder and can not differentiate between them, digital aids can distinguish between speech and background noise. That means an increased clarity in conversation, less frustrating movies, parties and dinners, and an all-around increase in ability to distinguish sound well. Digital hearing aids are also programmable unlike the older forms out there, and come with a litany of exciting hearing options, from SoundRecover, which can transpose normally difficult-to-hear high frequencies to lower ones that can be hear more easily; to DuoPhone, which helps hearing loss sufferers using the telephone by automatically sending sounds to both ears. Not only that, but they work also with bluetooth technology; people who before could not use a cell phone now can have a conversation over the phone, something no one thought would ever be possible for anyone with hearing loss. This has been possible thanks to great advancement in computers and all of technology in society today.

Digital hearing aids work by converting sound-waves into binary code. A computer chip in the aid converts the sound into a digital signal before re-rendering it in the ear. Because of this, the sound can be manipulated more easily than in an analog hearing aid, which works primarily by enhancing the volume of the sound. Before this, sound would just be amplified and it would cause a large feedback sound as well. Not only was this bad, but it could possibly continue to even damage the ear as a result; thanks to the new technology, the feedback from the sound amplification is no longer such a problem as it was as early as ten years ago. It is really unbelievable how far technology has come in the last ten years. If you were to ask an audiologist (a doctor which specializes in hearing) or an ENT (ear, nose and throat) professional, they would tell you the same thing as well, just slightly more detailed. They may also discuss with you the surgical options that may be available to fix your hearing. A warning now: those are very high risk and if there is a problem during the operation, then it can not only be inneffective, but it damage your hearing further and possibly cause Tinnitus which is also known as ringing in the ears. If that happens, sadly there is no cure for Tinnitus and it will be permanent.

The only negative that can be brought up is that neither type of hearing aid is covered with insurance, primarily because hearing loss is so prevalent. If a high-quality hearing aid is your primary concern, you should strongly consider a digital version over an analog one. Astounding technology is The. Digital hearing aids are On far superior to the hearing aids and over time will become so great That no matter what hearing loss, it will help the one 's wearing the aid hear better than ever 's . Like most technology, digital is best and eventually the more old fashioned styles will end up in the trash or possibly in some museum someday in the future as relics of how humans tried to combat hearing loss. It will only get better for those who unfortunately suffer from hearing loss and must seek help for it. Perhaps someday they may even find a cure for the deafness that does not involve any evasive action such as surgery. Without such great technology, we would probably still be using useless methods that would only hurt our hearing more than it could ever help.

Natural Therapy For Stuttering and Stammering

Stuttering and stammering is a big issue for a lot of people. Most people assume that these speech impediments are just a childhood phase and that people grow out of them, but that is not the case. There are lots of adults that have suffered from stuttering their entire lives. If you are one of those people then you know how tough life can be.

It is hard to communicate with new people because you fear that your stuttering is going to be an issue. Too many times in the past, you have tried talking to someone new but your stuttering got the better of you. Then they giggled at you and it hurt your feelings. Also, it is extremely hard to date. You can’t feel comfortable around someone because you don’t want to scare him or her off with your stutter. You are fed up with living this way and it is time that you made a change.

A natural therapy for stuttering and stammering is to take a class such as yoga. Yoga will help to slow your body down and definitely decrease your nerves. In turn, this will help you to regain control over your body and you can control the pace in which you speak. After several classes you will realize that you are much more relaxed and you feel much more comfortable in your own skin. Then talking with new people will become a breeze since your nerves and your stutter won’t be an issue any longer.

Pablo Picasso – The African Period

Picasso's Rose Period was followed by an even more radical departure in style. From 1907 to 1909 Picasso's art was influenced by his interest in so-called "primitive" arts, especially African Masks. This period, consequently, became known as the African Period. His paintings, typified by simplified, angular forms, were rendered in a muted palette of reds and browns.

Around this time, the French empire was expanding into Africa, and African artifacts were being brought back to Paris museums, exposing Picasso to a truly unique form of art. It explored emotional and psychological areas not seen in western art, which was regarded by the avant garde as subservient to the world of appearances. For them, the faculty of imagination, emotion and mystical experience was more important than that of mere sight. In African art, which possessed remarkable expressive power, they saw a response to those higher faculties.

Picasso's most remarkable achievement from this period , the painting Les Demoiselles d'Avignon, came at the beginning of 1907 and is arguably the most influential painting of the twentieth century. Following this work, Picasso began painting in a style influenced by the two figures on the right side of the painting, the figures themselves inspired by African masks, with their striped patterns and oval forms.

In 1907 the painting was considered extremely daring. The influence of African art led to distortions and visual incongruities. For example, at the bottom right of the picture, the figure's head is turned in a way which is anatomically impossible. Surprisingly, even Picasso's fellow painters, stalwarts of the avant garde, reacted negatively to Les Demoiselles d'Avignon. Henri Matisse is alleged to have told Picasso that he was trying to ridicule the modern movement.

How to Become a Good Hairdresser

A hairdresser is a widespread term used to refer someone whose profession is to cut or style hair in order to change or maintain a person’s image. This profession is the combination of hair coloring, hair-cutting and hair texture techniques. It is not easy to become a good hairdresser, there are some definite characteristics or nature or some exceptional qualities that makes a hairdresser popular.

Experience is the most vital quality that makes a hairdresser successful in his/her career.The class of work or skill must have to best otherwise it is difficult to build reputation. Personality is another mental, spiritual, and physical trait that distinguishes one hairdresser from others. To become successful and prosper in life a hairdresser need to grow a pleasing personality that attracts people to come.

Enthusiasm, the ability to listen same as the ability to make small talk helps to understand the demand of clients. Good behavior is most important because anyone who comes in a salon, he must expect a good behavior from the hairdresser during hairdressing. In a salon, people receive service by paying money, why he/she will come again if he/she gains negative attitude? In case of salon, it is difficult to build reputation without professional, talented hairdresser because slow service, indifferent stylists, gossipy assistants can mean a negative salon experience.

A hairdresser should have the ability to make client to feel that he or she is the most important person to sit in the chair. If you make them feel important, you’ll become important to them. A good sense of artistic aesthetic helps in working with hair coloring. A good hairdresser must have good knowledge on various hair related problems and their solutions such as how to get rid from crack on hair,early hair falling, dandruff etc.

Passion of fashion is very essential quality to become a good hairdresser. Every hairdresser should have the knowledge of the latest trends because the new generation always want to express themselves with new look matching the present time.

The Most Accredited Information on CNA Training

A nurse assistant is someone who takes care of the sick people after the doctor has diagnosed the problem a patient has. If you want to be a nurse assistant, you need to undergo the CNA training program. This training will enable you to effectively cater to the needs of sick people you are assigned to. In addition to that, the training is mandatory for anyone who wants to be a nurse assistant. To join the program, you have to register and attend classes either in your local area or follow them online. Once the classes are over, you will be subjected to an exam which will prove your capability to help patients and afterwards be given a certification if you pass it.

This career offers many exciting opportunities especially to people who are dedicated and motivated to make a difference in the lives of other people. It is well rewarding career that will not be affected by the economic downtrend which normally hits people in other professions. If you find joy in working with people you should consider joining the CNA training college and start your journey towards building a career in this area.

It is easy to join the CNA training. You don’t require having a degree, all you are required to posses is a GED or a high school diploma. With these minimal qualifications, you can earn a place in this program. If you are interested to know how long the program takes, it is very short. You will be required to train for between 4 to 8 weeks. In this duration, you will be expected to attend classes either online or in a medical school. Typically, you will have 100 hours which cover 11 modules. The 100 hours are normally divided equally into two sessions, one with practical training and the other one in a classroom. Training is done by highly qualified professionals and therefore, quality is guaranteed. It is both full-time and part-time depending on your schedule.

After the duration of CNA training is over, you will be required to do a state examination and upon passing this CNA test; you will be awarded with the much coveted CNA certificate. With this certification, you will be eligible to work as a certified nurse assistant and the job attracts decent salaries, which are of course above the minimum wages. The specific amount of money you earn at the end of the month will however, vary depending upon the specific place you are working in.

If you are one of the people who are not able to attend your training in the nearby institution, and you resort to online CNA training, worry not, as it is also offered by highly experienced health professionals. However, one backdrop you will get from the online program is that you will not be able to attend the practical lessons and rather everything will be taught theoretically. The bottom line is that you will pass your exams and get practical knowledge as you begin working. So don’t despair if you are already doing the online program.

Wilderness Therapy: What Is and What It Isn’t

Wilderness therapy is a growing field of psychotherapy that uses an outdoor setting to encourage personal growth, positive change, and building of self-esteem as a type of cognitive behavioral therapy. There are as many different approaches to wilderness therapy as there are practitioners, but the common thread they all have is that nature is a powerful force of both balance and change in ways that can be representational to individuals struggling with life challenges.

Traditional counseling is modified to be more appropriate in an outdoor setting, whether it is engaging in horticultural activities, or exploring Oklahoma’s wilderness through horseback riding or on foot. The interconnectedness of the individual with the greater world and other people is reinforced in these settings while self-reflection is also encouraged without the distractions of modern living such as cell phones or television. Because of this, wilderness therapy is a useful course of therapy along with more traditional treatments for addiction, depression, anxiety, and other obsessive behavior.

However, the majority of wilderness therapy centers tend to be geared more toward teens and young adults who are having problems facing the challenges of growing up. Peer pressure, the need to perform well in school, family problems, drugs, and a myriad of other struggles are particularly overwhelming for younger people already stressed by the inherent changes brought about by adolescence itself.

Wilderness treatment centers are not the same as boot camps used as intervention by families for at-risk teens or young adults who are exhibiting out of control behavior in an attempt to regain control over their child. Boot camps style behavior modification approaches are far more aggressive and are modeled on the strict discipline of military recruit training camps. Some are run by the U.S. penal system in an attempt to rehabilitate criminals from returning to past life choices that got them in trouble in the first place. Private boot camps that focus on helping adolescents follow a similar model and unlike the more passive approach of wilderness treatment centers are based on an atmosphere of strictly enforced discipline.

Some equate wilderness therapy with boot camps, but their similarities are quite superficial. Boot camps may be located in a rugged environment, but they tend to have a one-size-fits-all approach in how they encourage self-esteem and self-discipline. Wilderness therapy meanwhile generally takes a more customized and individualistic approach, teaching people how to adjust their way of thinking about challenging situations to encourage more positive decision making.

A Healthy Diet Plan


Free diet plan is based on balanced intake of fats, proteins and carbohydrates in different calorie count. Free diet plan stimulates your body burn the fat much easier, only by changing your daily calorie intake. Free diet plans are so common in society that many people have very restrictive ideas about what is healthy and natural in free diet plans eating. The best thing about free diet plan is that you burn the fat only.


Studies show that a lifestyle approach to nutrition, not a short term crash diet, is most likely to lead to permanent weight loss. You should consult with a health care professional before starting any diet, exercise or supplementation program, before taking any medication, or if you have or suspect you might have a health problem. Monitor your weight or the way your clothing fits on a weekly basis and add or take away calories from your current diet according to what has been happening with your body.


The Diet Planner is merely a pattern to show individuals an example of what can be eaten for a certain number of calories while dieting. Be sure and follow the information outlined in the Planner Information. The first rule when formulating a diet plan should be to count calories. Do not pay attention to any free diet meal plans, grapefruit diet plan or loss weight fast anorexia tips you've read in the newspapers.


Health & Fitness – Choosing a free diet program is a very difficult task. Healthy eating varies in response to your free diet plans hunger, emotions, schedule, and accessibility to free diet plans food. Healthy eating means leaving half your free diet plans dessert on your plate because you have recognized you are full and satisfied. Healthy eating means being able to eat when free diet plans and to continue eating until you are both physically and psychologically satisfied.


Try adding or subtracting 100-200 calories per day, and test that level for about a week before you make a decision. The rest of your daily calories can come from carbs. If you are willing to track calories, use a maintenance figure you know is accurate as a starting point, or multiply your body weight by 15 to get an approximation of your maintenance calorie level. * If you have 150-200 pounds to lose, you will need to add an additional 400 calories per day to your diet plan. Do NOT go below 1,200 calories per day or you may lose your hair, your muscles, and any chance of winning the Lotto. If you require a 1,500 calorie diet, simply add 150 more calories to your daily diet. The above calculations are based on average calorie intake of 2250 calories.


Highly effective people and free diet plans achievers always double up and do two things at once whenever possible. We're all in the same boat in the free diet plans beginning and free diet plans intermediate learning stages. So far, the best free diet plans book I've ever read on free diet plans for fat loss is Chris Aceto's "Everything You Need to Know About free diet plans. In addition, free diet plans also contain antioxidants and phytochemicals which have been shown to prevent cancer, heart disease, strokes, and other diseases. A recent study of 23 lean men and 23 obese men found little difference in the total number of free diet plans calories each group consumed. No more than 25 percent of your total free diet plans calories should come from fat, fewer than 10 percent from saturated fat, the most damaging form discussed in detail in the GHF free diet plans component.

Weight Loss Little Secret

If you are looking for a diet plan that works but still have not able to find one, then you are just one of many people who are searching for that effective quick weight loss diet plan. The main reason why people have a hard time finding for the diet plan that works for them because they are expecting for a "quick fix". Most obese people want to see the effect of the diet plan right away.

One of the secrets of a successful quick weight loss is accepting that you overeat. Most of us heard the saying "you are what you eat" – it means that some foods can be bad on your digestive tract and figure. Many of us try use different weight loss plan like reducing our calorie intake each day. But reducing your calorie intake is a tedious job. You have must ignore many foods in order to lose weight and calculate your calorie intake each day. Take note calories are one of our natural sources of energy but it just comes with fat. Lowering down your calorie intake each day may have unwanted effects to our body.

It is very essential to have knowledge about foods that uphold weight loss. Not only that you already know which food to choose, but you can mix these foods to satisfy your appetite while not gaining weight. And also try to avoid overeating, if you eat three large meals each day; try to slice it down to 5 or 6 small meals each day. Eating small meals has been proven to help you burn more calories each day.

Finding for foods that that supports weight loss is available on the web. But if you do not want to use some of your time to research and experiment for your diet plan that suits you, then try to use Fat Loss 4 Idiots. This diet plan has been proven to keep fat at bay for many people.

Check this out! This plan does not support starvation or reducing your calorie intake each day to lose weight. This diet plan will teach you on what foods that you will eat at the right time each day. You can enjoy many foods as well as loss weight quickly. A little secret about fat loss 4 idiots is that it focuses more on confusing calories to burn fat by changing your meals with pattern at the right time each day. This is what they called Calorie Shifting.