Crisis Intervention – A Critique

Crisis events are not only associated with adverse mental health conditions for our students, but also with significant learning difficulties. As educators, it is important for us to know what we can do immediately following a crisis involving our students in order to prevent the traumatization that contributes to these negative outcomes.

Crisis intervention in schools today is still in its infancy. No single model has been adopted because of the lack of scientific research indicating a reason to do so. We simply do not yet know what works best with students in schools. We grapple with what will work most effectively, as we continue to rely on cognitive approaches or so-called “talking cures” that ignore the physiology of trauma. Recent scientific research has not supported the use of what is still a widely adopted crisis intervention model: Jeffrey T. Mitchell’s model of critical-incident stress debriefing (CISD). Several studies have found Mitchell’s model to be no more effective than no intervention at all, and in some cases, found it actually increased posttraumatic stress symptoms in a number of the recipients.

Within approximately forty-five minutes, with up to thirty individuals at a time, CISD involves a “fact phase” during which basic information is provided to inform those involved of what to expect. Facts disseminated include common stress reactions and other more debilitating symptoms. This is followed by a “feeling phase” during which, the up to thirty participants are encouraged to answer such questions as “What was the worst part of the incident for you personally?” This phase is followed by suggestions for coping with stress and then “reentry” into the world.

At a presentation Mitchell made of his model that I attended with school district personnel and state department mental health workers, I was most struck by how uncomfortable the audience was as they listened to his proposal. The body language of the audience members indicated that their own stress levels were increased when only watching the video shown of a debriefing session. Many audience members actually rose and left the presentation visibly shaking their heads. During the video, we watched several people delve into the worst part of the trauma for them, clearly becoming aroused physiologically and emotionally, yet within moments, the time was up and the group was left with one last caution. “Be careful driving home,” they were warned, “as you may still be upset” after leaving the intervention.

Individuals have spoken out about their experiences participating in debriefing sessions. After 9-11, for example, many participants indicated that the intervention was not helpful. One participant said that he was “numb” throughout the session and that, weeks later, he was still having nightmares and often felt as though he was choking (Groopman, 2004). Another participant said that hearing other victims describe what they saw and what they suffered was too much. He had to flee the session when another participant described seeing a body part roll down a sidewalk (Begley, 2003). After an earthquake in Turkey, a recipient said, “It was as if the debriefers opened me up as in surgery and didn’t stitch me back up (Begley, 2003, p. 1).”

Cognitive approaches, such as Mitchell’s, that ignore the body’s physiology have the potential to create hysteria because of how readily the body experiences overwhelm. When the body goes through a flooding of stress and emotion, which often happens as one recalls the worst part of the trauma, it protects itself by creating another reality or dissociated state. Hysteria is a form of dissociation. Participants who become hysterical during debriefing sessions are removed from the group so they do not distract other group members (Mitchell & Everly, 1996a). Rather than accept this as an expected outcome of crisis intervention, however, we can bring our new knowledge of the brain and body to the work we do to prevent such responses.

Adaptations of Mitchell’s model are what many educators in the field of crisis intervention rely upon. Some hesitate to make broad conclusions that the model is not helpful (Brock & Jimerson, 2002) despite the growing number of studies that support abandoning debriefing approaches (Gist & Devilly, 2002). Practitioners “remain committed to the principle of debriefing” because “clinical experience” suggests value in the “opportunity to express feelings (Deahl, Gillham, Thomas, Searle, & Srinivasan, 1994, p. 64).” Others consider economic reasons for the continued use of the approach (Arendt & Elklit, 2001). We need something, and it seems we lack any other efficient model to work from. Why else would we continue to use debriefing techniques when calls for caution and restraint have been heard from so many responsible scientists and practitioners (Gist & Devilly, 2002)?

Instead of heeding the many warnings to abandon, debriefers continue their work by creating adaptations of their model. The concern with that response, however, is that without careful consideration of how crises impact the brain and body’s physiology, intervention models continue to be developed and implemented that have the potential to cause the harm described by too many recipients.

In a review of recent developments in the field of crisis intervention, I was alarmed to find how little discussion there was of how the brain and body are impacted by trauma. Crises are repeatedly referred to as psychological events that have to be intervened with psychologically, as though trauma happens to the mind alone. We seem to be determined that our cognitive mind is the most powerful tool we have for healing, when in fact, it is the body, mediated by the ancient reptilian brain, that has the wisdom to know how to naturally recover from trauma and heal itself.

Most people recover from catastrophic events naturally and spontaneously over time. In fact, any “abnormal” behavior witnessed in the aftermath of trauma is actually part of a healthy process of recovery (Groopman, 2004) during which the body does what it knows how to do to process stress to its natural completion. Recall the impala that takes moments to shake off the stress from its attack and then carries on (see chapter four). Whether we are aware of it or not, in most cases, our body naturally finds a way to do the same. It is only a small percentage of people who experience a catastrophic event that will require formal intervention. This small percentage is comprised mostly of individuals with previous histories of trauma, with “fragile emotional profiles and few available resources (Torem & DePalma, 2003, p. 12).” For example, we know that students with previous exposure to traumatic events are more at risk due to the accumulation effect of stress on the nervous system. “The new [traumatic] energy necessitates the formation of more symptoms…[so that the traumatic] response not only becomes chronic, it intensifies” (Levine, 1997, p. 105).

More vulnerable students will likely need formal assistance in recovering from a crisis at school. For the majority, however, we know that the body has the capacity to heal itself, and that healing from stress and trauma is possible simply by being in community with others. These are important points to keep in mind when creating an effective crisis intervention model for schools. Dr. Steven Hyman, the provost of Harvard University, reminds us that the rituals we have adopted through our various cultures can be supportive in our healing and recovery from crisis events. He makes note of shivahs in Jewish cultures and wakes among Catholics. Dr. Hyman stated that, “No one should have to tell anyone anything! Particularly not in the scripted way of a debriefing.” Dr. Hyman has argued that when facing crises it is the power of our social networks that helps us create a sense of meaning and safety in our lives (Groopman, 2004).

Dr. Hyman is not the only responsible academic making statements that “no one should have to tell anyone anything.” A panel of eminent researchers assembled by the American Psychological Society – Richard McNally of Harvard University, Richard Bryant of the University of New South Wales, and Anke Ehlers of King’s College London – has reached a clear conclusion: “Pushing people to talk about their feelings and thoughts very soon after a trauma may not be beneficial…For scientific and ethical reasons, professionals should cease compulsory debriefing of trauma-exposed people (Begley, 2003, p. 2).

With a growing number of studies cautioning us to abandon debriefing approaches, why is telling the story and verbally going over the details of a crisis still considered helpful? Why are cognitive and narrative approaches to crisis intervention gaining support in some professional circles? This trend may be part of a prevailing cultural bias that we can talk our way out of anything. Talking is, for most counselors, the best-known and most comfortable mode of operation. However, no explanation seems to warrant that, as ethical professionals, we ignore a striking body of evidence. Exposure techniques used in cognitive approaches to trauma are “not good for people with brains and not good for people with bodies;” telling the “story will re-traumatize and make things worse (van der Kolk, 2002).”

Dr. van der Kolk, when recently speaking at a professional conference, was open about the fact that like most counselors, he did not know how to pace the work he did with trauma survivors. Like most counselors today, he said he “wasn’t mindful about the effect of having people talk about these very scary things.” Learning about trauma’s impact on the brain is what prompted him to speak around the world educating professionals about the dangers of re-telling the story and the so-called “talking cure.” Crisis intervention specialists working in schools are beginning to acknowledge the dangers. School crisis management research summaries provided in the official newspaper of the National Association of School Psychologists (NASP) stated that early crisis interventions involving detailed verbal recollections of events may not be helpful and may place those with high arousal at greater risk (Brock & Jimerson, 2002).

What seems to be most helpful about current approaches in managing crises is meeting in a group and disseminating information. Litz and colleagues published a study comparing the CISD model with cognitive-behavioral therapy (CBT) (Litz, Gray, Bryant, & Adler, 2002). Common between the approaches was education on typical reactions and instruction in coping skills for stress and anxiety. Results indicated that meeting in a group is what helped to maintain morale and cohesion. Group interventions seemed to serve as an opportunity for those in the group to feel less stigmatized, more validated, and empowered. Psycho-education or dissemination of information regarding what to expect was also cited as a helpful part of these crisis approaches. Even single sessions when they were supportive rather than therapeutic were helpful when they (a) assessed for the need for sustained treatment, (b) provided psychological first aid, and (c) offered education about trauma and treatment resources.

Some group interventions have been found to reduce anxiety, improve self-efficacy, and enhance group cohesion (Shalev, Peri, Rogel-Fuchs, Ursano, & Marlowe, 1998). They have also been found to play a role in reducing alcohol misuse (Deahl, Srinivsan, Jones, Thomas, Neblett, & Jolly, 2000). However, it has also been found that single-session group crisis interventions are insufficient for high-risk trauma survivors, those with poor pre-trauma mental health (Larsson, Michel, & Lundin, 2000). Individuals with previous traumas, such as burns, accidents or violent crime, may actually be harmed by single-session group crisis intervention (Bisson, Jenkins, Alexander, & Bannister, 1997; Mayou, Ehlers, & Hobbs, 2000). This information is invaluable as we continue to work together as educators to develop an effective crisis intervention model.

Common Myths About Crises

It is important to address some of the myths that persist today regarding the impact of trauma on our students. These myths are pervasive and stem from outdated beliefs about children that we now have the brain research to refute.

Some Events are More Traumatic than Others

I have witnessed professionals in the field of crisis intervention delve into lengthy presentations about certain events being more traumatic than others. For the most part, these discussions are not helpful. I listened to one presenter talk extensively about a broken arm from a physical assault being more traumatic than a broken arm from a car accident, and about war being more traumatic than an earthquake. It is not a matter of some events being more traumatic than others. Trauma is not in the event; it is in the nervous system (Levine, 1997). Depending on the condition of the individual’s nervous system and available resources before, during, and after the event, what may seem benign to some can be very debilitating to another. Believing that some events can be objectively judged for everyone as more or less traumatic leads to very dangerous assumptions about individual students. We cannot expect that some students will be less traumatized by what we have judged as a less frightening event. This is how we misunderstand students and fail to see their trauma-related symptoms after an event that was terrifying to them.

Trauma Causes Psychological Injury

While it is true that trauma has the potential to induce psychological injury, such a statement does not reflect the whole truth concerning the damage caused by traumatization. When people who are traumatized learn that crises are not simply psychological events but physiological ones, they experience relief. What they are going through is not “in their head;” it is the natural response of the body. People suffer years of anguish following a car accident, for example, or a surgery, believing that they must be going crazy. Their medical doctors tell them that there is nothing physically wrong with them, that there is no reason for their suffering. No one talks to them about what their brain and body have gone through so they conclude that the problem must be in their head. With that conclusion comes the belief that they must be in need of some form of talk therapy. I have seen firsthand how this conclusion leads to hopelessness, as traumatized people make numerous attempts at various forms of therapy with little or no success. They know they do not feel the same inside. They know they have applied all the cognitive techniques they were taught by their well-meaning therapists. They simply do not get better.

Medical tests cannot detect the problem and psychological approaches that do not intervene with the body’s response to trauma leave traumatized people feeling like they are going crazy. When we look at physiology, however, we find answers. We learn that, among other physiological changes, traumatization increases resting heart rates and decreases cortisol levels. Hormones and neurotransmitters are altered in the short term or long term depending upon previous history and resources. Physiological symptoms require a physiological approach. This is what is missing from the crisis intervention programs used today.

Children Look to Adults to Determine How Threatening an Event Is

No matter how young children are, pre-verbal or verbal, they have their own nervous system, their own brain, their own body and mind, and they experience life and its events as much as anyone else. They may not have words for their experiences, and they may look to adults for comfort and understanding in the face of a frightening event, but they do not need to be guided when to feel fear. We cannot tell a student that they are fine and what happened is “no big deal” if, in fact, it was a big deal to them. We stand the risk of shutting down their body’s natural healing mechanism when we do so. There are ways to support the natural process of healing and there are ways to undermine it. Telling students how to feel is an example of how our cognitive mind can interfere with the body’s capacity to heal.

A colleague of mine once shared that when she was a young girl she fell from her bicycle and badly hurt her knee. She was so stunned from the fall that she could not cry. She realized as an adult looking back on the event that she must have been in a state of shock because all she felt was numb. When she arrived at the door of her home and her mother saw that she had been injured but was not crying she was praised for being such a brave girl. “Look at what a good girl you are,” her mother said, “You are not even crying.” After that incident, my colleague said that she made sure she did not cry no matter what else came her way. She used her words, the power of her cognitive mind, to shut down her body’s natural responses so that she would be regarded as brave and strong.

Adults have no way of knowing how threatening or frightening an event is to a child. If we think we can decide objectively what a student’s subjective experience will be, we have no chance of understanding or intervening with students in crisis.

Developmental Immaturity Can be Protective

Some believe that the younger a student is, the less the student will experience fear and terror. This is not supported by scientific evidence. One Nationally Certificated School Psychologist (NCSP) made a presentation at my school district encouraging us to utilize his crisis intervention model. As part of the introduction to his work, he said that both developmentally mature and gifted students are more vulnerable and impacted by crises than their less well-developed peers. Smarter students can be more traumatized than less intelligent students because they realize the event was threatening, he said. They realize the event was traumatic because they are cognitively sophisticated enough to judge the event as threatening. According to this presenter, “Developmentally immature students don’t understand the event, so it is not traumatic for them.”

Trauma is a physiological event that impacts everyone in its wake (to varying degrees) regardless of level of intellect. The school psychologist’s statements demonstrate a dangerous ignorance of science and what the brain and body experience in the face of threat.

Current Attempts at Crisis Intervention in Schools

Several educational professionals from various areas of expertise have attempted to develop crisis intervention models that will meet the needs of schools. Three different men who each developed their own approach presented to my school district on three separate occasions. I will review each of their proposals: (1) Bill Saltzman from the National Center for Child Traumatic Stress, (2) Michael Hass from Chapman University in Orange County, California, and (3) Stephen Brock, a nationally credited school psychologist and coordinator of the Crisis Management in the Schools Interest Group.

Saltzman

Dr. Bill Saltzman’s approach emphasizes the need to tailor crisis intervention to the developmental level of the students being served (Saltzman, 2003). He reminds us that students’ responses may be specific to their age and stage of development. For instance, preschoolers may display cognitive confusion. They may not know that the danger is over when a crisis event ends and may need to be given repeated concrete clarifications for anticipated confusions. Older, school-age students may display specific fears triggered by traumatic reminders. They may require help in identifying and articulating those reminders as well as associated anxieties. They may benefit from being encouraged not to generalize, according to Saltzman. Adolescents, on the other hand, may begin to exhibit posttraumatic acting out behavior such as drug use, delinquency, or sexual activity. Saltzman postulates that helping adolescents understand the acting out behavior as an effort to numb their response to, or to voice their anger over, the event may be of benefit.

Importance is placed on family and friendship. Maintaining and nurturing relationships is critical after a crisis event for students at every stage of development. Saltzman points out that sometimes crisis events cause physical relocations that can abruptly interrupt usual daily contact with loved ones. When this happens, it is helpful to make the effort to keep relational ties regardless of physical separation in order to be comforted by them.

Saltzman makes clear that it is always important to reintegrate students back into the school and classroom environment as soon as possible. Somatic complaints and specific fears related to school or loss of a loved one may make it difficult for a student to want to enter back into school. The family and the school need to work together to make sure students’ fears are resolved and attendance in school is maintained.

Saltzman’s model includes an initial interview protocol that asks crisis survivors questions in seven stages. The first step is to gather factual information about where the student was during the event, what they were exposed to and how they knew the people involved. One important question to ask at this stage is whether or not the student has ever experienced any other kind of crisis or trauma, including subjection to violence, serious illness or sudden, unexpected loss. The next four stages of questions have to do with the students’ responses to the crisis. What was their subjective response to the event? Are they exhibiting new behaviors or new concerns since the event? What type of grief responses are they displaying? Finally, in the sixth stage of the interview, students are asked about their coping mechanisms before the final stage of closing the interview is done.

Saltzman’s approach is useful. Awareness and consideration of the different expressions and needs of students at varying developmental levels is helpful. Caution should be made, however, that during times of crises, students may easily and quickly regress back to earlier stages of development so that even adolescents display the behaviors of pre-school children. Saltzman highlighted “anxious attachment” as a possible pre-school response that may involve clinging and not wanting to be away from the parent or worrying about when the parent is coming back. This can happen with teenagers. Like pre-school students, adolescents may also greatly benefit from being reassured about “consistent caretaking” of being picked up after school and always knowing where their caretakers are.

In a review of all of Saltzman’s hypothesized responses of students at different ages, it was easy to see that any one of these responses could come from a student at any developmental level. We do not want to make assumptions about how a student will act given their age. If we have expectations we may not see what we need to. Nonetheless, it is useful to be aware of the possibility of age and stage differences. Especially in teenagers should we expect to see such age-specific behaviors as “premature entrance into adulthood.” Certainly that is something specific to adolescence. However, behaviors attributed to adolescence in Saltzman’s approach, such as “life threatening re-enactment, self-destructive or accident-prone behavior, abrupt shifts in interpersonal relationships, and desires and plans to take revenge,” are readily seen in some younger school age children after a crisis event.

Saltzman’s approach, like most, is cognitive and emphasizes the use of verbal language and asking questions. It is unclear how soon after a crisis event all of the questions from the initial interview protocol are to be asked. Like other cognitive approaches, including the debriefing model, Saltzman asks crisis survivors to talk about their “most disturbing moment” and “worst fear.” We need to learn from the examples we now have available to us that this kind of questioning may increase suffering.

Hass

Dr. Michael Hass has attempted to help schools develop a crisis intervention model utilizing the principles of Solution Focused Brief Counseling (Hass, 2002). His emphasis, like most others, is on interviewing the crisis survivor. The stages of crisis interviewing in his approach include role clarification, a description of the problem, an exploration of current coping efforts, “scaling” of coping progress, formulation of the “next step,” and closure. The focus of this approach is on the establishment of helpful coping skills. Questions during the interview are intended to facilitate coping in order to empower students to take action on their own behalf.

Examples of coping questions include: What are you doing to take care of yourself in this situation? Who do you think would be most helpful to you at this time? What about that person would be most helpful? Have you been through a frightening situation before? How did you get through it then? Developing resources for the student to draw upon during difficult times is key. “Scaling” questions are also related to coping. They help students rate how much better or worse they think they are doing and give a gauge to crisis counselors of how much progress has been made. Together, the counselors and students problem-solve to arrive at solutions for moving the scale in the desired direction.

During Hass’ presentation, he highlighted the importance of telling the story of what happened during the crisis. He stated that researchers have found that putting a traumatic incident into language is a critical feature of the healing process. The idea being that language helps the images and feelings we have about a frightening event become more organized, understood and resolved.

The studies that Hass was referring to were led by Dr. Edna Foa, a professor of psychology at the University of Pennsylvania who, twenty years ago, began studying rape victims. She found that most rape victims spontaneously recovered without the need for formal intervention, but that fifteen per cent developed symptoms of posttraumatic stress (Groopman, 2004). Foa devised a technique of storytelling to restore resilience in those who continued to suffer. The women were asked to tell their story into a tape recorder and listen to it, then re-tell it and listen to it, and so on. Within approximately twenty sessions, Foa found that twenty-nine of the thirty participants experienced a marked improvement in their symptoms and ability to function. She attributed their improvement to the changing of the story over time. It became more organized, with a beginning, a middle, and an end. It was hypothesized that because they were able to give such a well-developed account of the incident, they were more likely to develop perspective on the event, create a sense of distance from it, feel a sense of closure about it, and feel more hopeful about the future.

Hass’ overall focus on strengthening and empowering students to cope after a traumatic event is very helpful. It is important to create a balance in the nervous system between the alarm response triggered by the event and whatever will be soothing to that sense of alarm. However, it is dangerous to recommend a technique to professionals who work with school-aged children, when the few studies that support such an approach have been done with adult women who experienced sexual assault. The appropriateness of using such an approach with students may be suspect, especially when other eminent professionals in the field have seen that telling the story can re-traumatize the victim (van der Kolk, 2002). It is true that when trauma survivors can tell their story in an organized, fluid way without becoming overwhelmed by it, this can be a sign that they are recovering from the experience. Telling the story at some point in a trauma survivors’ treatment may be relevant. However, we are not talking about adults receiving therapy. We are talking about crisis intervention for school-aged students. Now that so many responsible scientists and practitioners are warning us that telling the story can cause hysteria and re-traumatization, it is best not to endorse such an approach to schools.

Brock

Dr. Stephen Brock developed a model of crisis intervention for schools that takes into account the different stages of the event (Brock & Jimerson, 2002). The first stage is the impact, or when the crisis occurs. The next stage is the first phase of the school’s response to the event, which he calls “recoil.” Immediately after the event, the students involved receive “psychological first aid” and, in some cases, medical intervention. Support systems need to be enlisted during this phase, ensuring that loved ones are located and reunited. Psycho-education groups, caregiver training, and informational flyers are also important at this time, as is risk screening and referral for students who may require more intense intervention.

The “postimpact” phase occurs in the days and weeks after the event. This is the time that Brock suggests that group crisis debriefings occur, as well as ongoing psychological first aid, psychotherapy, and crisis prevention/preparedness for the future. Rituals and memorials may be helpful at this time, as well as in the next phase of “recovery/reconstruction.”

Recovery/reconstruction, the final stage of the approach, involves anniversary preparedness. Anniversary reactions have been found to be as intense as initial ones (Gabriel, 1992).

Brock recommends that, before the school responds in the recoil phase, all pertinent staff members meet as a team, clarify their roles, and decide who will do what. There will be a different part to play for school psychologists, nurses, counselors, and administrators.

The psychological first aid approach developed by Brock specifically for schools is called Group Crisis Intervention (GCI). It is designed to work with large groups of students who experienced a common crisis. Such large groups are typically classrooms. The approach is not intended for use with severely traumatized students, whose crisis reactions are thought to interfere with GCI (Brock, 2002). Like in Mitchell’s model, these students are removed from the group and referred to mental health professionals. It is suggested that GCI occur at the start of the first full school day following resolution of the event to ensure that participants are psychologically ready to talk about the crisis (Brock, 2002).

The six-step model includes an introduction, provision of facts and dispelling of rumors, sharing stories, sharing reactions, empowerment, and closing. GCI is ideally completed in one session lasting one to three hours, depending on the developmental level of the classroom of students. Similar to other approaches, group facilitators introduce themselves and define their roles. Opportunities are provided for students to share their stories, their reactions, and become “empowered” through a focus on coping and stress management.

Garcinia Cambogia Supplement for Weight Loss

Garcinia cambogia has become a leading weight loss supplement for adults around the world looking to achieve their weight loss goals. This supplement is made from a fruit, providing a natural and safe supplement with outstanding results.

The product arrives in the form of capsules which are then taken twice per day; one half an hour before breakfast and the other half an hour before lunch. These tablets help reduce appetite while stopping fat cell formation. What this means is that your body uses existing fat for energy, ensuring you lose weight quickly and effectively.

When you find a garcinia cambogia supplier, you can’t place your order and expect the capsules to do all the hard work themselves. You will want to help them along to improve your results and speed up your weight loss progress.

Water is an essential element to any diet. Water doesn’t contain any calories and helps flush the body of any unwanted toxins. The good news is that water also helps keep you hydrated, so it’s imperative that whether you are taking garcinia cambogia or not, that you drink at least eight glasses of water each day.

Many people eat because they think they are hungry, when in fact they are actually suffering from dehydration. So when taking your capsules, ensure you take them with a full glass of water, water also helps fill you up, reducing the amount you eat in a single sitting.

The next step to effective weight loss is to eat a healthy and well-balanced diet. Don’t fall into the trap of choosing a low calorie diet that will leave you hungry and unable to stick to it long term. Eating a well-balanced diet filled with fruit and vegetables is the best way to reach your goal weight.

Take your three meals a day and break them into six smaller meals. Eating smaller meals reduces the risk of being hungry, helps increase energy levels and improves metabolism. Incorporating a healthy eating plan with garcinia cambogia is a recipe for success and the ability to reach your goal weight in the shortest possible time.

Exercise is important to any weight loss routine, though you don’t have to spend hours in the gym. Once you find your garcinia cambogia supplier and feel you are ready to start your weight loss program, start with some moderate exercise. A brisk walk around the block, a swim on a daily basis or a cycle through the forest with the family three times a week is all you need to get your heart pumping and your body burning calories.

It is essential that you choose a garcinia cambogia supplier that will provide you with a high quality, natural and safe product. With weight loss supplements in such high demand, there are many “fly by night” companies that are watering down their products and selling them as the genuine product. The problem is that you don’t achieve the results you expect, so spend some time researching the company to ensure that you are getting what you pay for.

The company should have a good online reputation and the best way to determine this is to type their name into your search engine and see what results come up. Take the time to go through the results and look at customer reviews on review sites and online forums, this will give you some indication to the type of company you are about to purchase from.

The important factors to take into consideration is whether they are FDA registered, GMP approved and what they put in their capsules. They should provide you with a complete ingredients list to put your mind at ease.

UB04 Form – What is a UB04 Form, Where Do I Get One, and How Do I Fill it Out?

Do you need to get a UB04 form completed for an insurance company?  What is a UB04 form?  Where do you find one?  And how do you fill it out?  We run across these questions often in the world of medical billing.  Most medical health insurance claims are filed on CMS 1500 forms (sometimes called HCFA forms).  These are more common to most people.   Many billers don’t know when to use the CMS forms and when to use the UB 04 forms.

The UB04 claim form is used by facilities rather than physicians for their health insurance billing.  Hospitals, rehabilitation centers, ambulatory surgery centers, clinics, etc need to bill their services on the UB04 form in order to get paid.  Physician billing is done on the CMS 1500 claim forms. 

Every once in awhile we get a call from a person who is trying to get an insurance claim paid and they are told by the insurance company that they must file the claim on a UB04 claim form.  These people don’t have a clue what this form is or how to complete it.  They may have had to admit a loved one into a drug and alcohol rehab facility and now find that the facility doesn’t participate with their insurance plan.  These facilities often don’t file UB04 forms and can not help the family get reimbursed by the insurance company.

Many times the family has paid up front for the services of the facility and are now trying to get the insurance company to reimburse them.  The insurance policy may pay out of network but the claim must be filed correctly on a UB04 form.  Often times people are trying to collect many thousands of dollars on the claim.  Required fields on the UBO4 form include rev codes, value codes and type of bill.  What do you put in these fields?   These forms can be very confusing.  Where do you get the correct information to complete the forms?  And which fields are required on the form?  If the facility does not have a UB04 form to fill out, where do you get one? 

Unfortunately the answers are not easy.  The Rev codes represent the procedure codes.  The type of bill is a three digit number that represents the type of facility, the bill classification and the frequency of the bill.  The value codes are required fields only in certain situations.  It is very difficult to complete these forms correctly without previous experience or proper training.  Another catch is that the forms were changed in May 2007 to allow for use of the NPI number.  You must understand NPI numbers completely to determine where you should be entering an individual NPI number or a group NPI number.  And when you try to find UB04 forms for sale, you find they are available in boxes of 2500.

If you find yourself needing to file a claim on a UB04 form and don’t know what you are doing, make sure you look into it fully.  Claims are often denied time after time for information being incomplete or incorrect.  If your claim is for a lot of money, you may not want to wait months for payment.

Copyright November 2008 – Alice Scott

Learn How to Dunk or 10 Ways to Improve Your Vertical Jump

Let’s be blunt about it: if you play basketball, there’s two leagues of people – those who can dunk, and those who cannot. Although you might think it’s just a question of height, this is not at all the case. Of course, being tall helps, but even average height people – 5ft 9 or 5ft 10 – can learn to perform amazing dunks. How? It’s obvious – by improving their vertical jump. Now, there is a lot of ways to skin the jumping cat, but not all are equally effective (and some can actually be rather dangerous). I’ve put together a collection of tips and tricks that helped me improve my vertical jump from near nothing (after knee surgery on my jump leg and rehabilitation) to over 30 inches within 9 months.

Tip 10) Always warm up before exercise. Trying to push your muscles to the max without warming up appropriately before (with light exercises such as running up or down stairs, or jumping with a jumprope) is a bad idea and can easily lead to strains and other problems.

Tip 9) A basic jumping exercise is the squat with weight. While standing, slowly bend your knees with your back straight. Go down pretty low (you shouldn’t feel any pain or be uncomfortable), then slowly go back up. Doing this slow is key for building up quad muscle volume and power. Start without weights and increase difficulty by gradually raising the number of repetitions. People with major jumping power can easily do 100+ such squats. If you hold a weight such a dumbbell or barbell, hold it behind your head,

in one vertical line with your spine.

Tip 8) Separate weight training days from speed/plyometric days. Medical studies have shown that mixing these different types of exercises is actually bad for the results.

Tip 7) Use jumping rope. Although sometimes shunned as “uncool”, it is the basic plyometric exercise and one of the best ways to improve the explosiveness and power of your legs.

Tip 6) Never relax and let go during your waking time. During my rehab, I was hell-bent on getting my leg back to the same power level as before, and beyond that. I didn’t just exercise every day – I did it nearly

permanently. Of course, you can’t do heavy squats or plyometrics all the time because your legs can just do so much until they tire. However, even little things like walking toe-heel style instead of flat-footed, standing on half-bent legs while doing household stuff, or playing with your quads and calves while

sitting, are very effective when done regularly over a long period of time.

Tip 5) Calf exercise. It’s not only the big upper leg muscle groups that determine your total jump height. Powerful calves can easily add another couple of inches that you may be missing for a resounding dunk. The basic calf exercise is toe raises: stand upright, raise on your toes, go down, and repeat it 50-100 times. When your calves feel hot and burning, it’s time to make a break. A somewhat better variation is: stand on some stable horizontal ledge only with your toes and front part of the foot. Hold yourself at something with your hand. Go down with your heels about 30-45 degrees below the ledge, then push up until you are on your toes. Repeat as many times as you need to tire your calves. Again, key is slow and steady. Don’t pump up and down. It may be easier, but the effect is nowhere near the same.

Tip 4) Don’t overwork your leg muscles. Our muscles grow best when subjected to a cycle-wise load: a heavy workout, then a day of rest or just light exercise. To push your maximum jumping ability, you need

the large leg muscles to perform at their peak (and beyond). When overworked, they are unable to deliver that performance, and your jump does not improve despite exercising. A sign of overworking is when your leg muscles ache or burn.

Tip 3) Don’t just jump mindlessly. Focus on jumping completely. With every jump, aim to leap as high as you can. Scientific tests have shown that persistent focus on a physical activity improves the results by 10-20% on average.

Tip 2) Don’t expect results too soon, and never give up. I know several guys who bought expensive plyometric programs or jumpsoles expecting some kind of miracle within a few days. There’s no such thing

though, so once they didn’t see the quick results, their determination sizzled away and their jumpsoles would sit gathering dust. Although there are good programs around, there’s no miracles. The only thing that will radically improve your vertical is tenacity. Exercise a lot. Regularly. Make it your habit. Do it for months. Then – and only then – the really impressive results will come.

Tip 1) Plyometric exercise. You may have heard the word. Basically it stands for making a muscle contract immediately following relaxation, and repeating it many times. Applied to jumping in a basic case, it means that you jump, go down in the knees when you land relaxing your muscles, and immediately jump up again from the crouched position. This is tiring as hell, and for a reason – it puts the maximum stress on the

large leg muscles. If you are not used to it, your legs will probably ache after a few dozen repetitions. However, nothing beats this kind of exercise if you want to improve your jump quickly.

These tips should already get you underway, but they are just the tip of the iceberg. There’s a bunch of other highly effective, yet not so widely known techniques on quickly improving your vertical. Check out

http://www.howtodunk.org for a lot more effective, hands-on info on learning to dunk.

How to Improve Eyesight Naturally – Know Tips That Can Improve Your Vision

There are ways on how to improve eyesight naturally that does not involve taking medicines or undergoing surgical procedures to improve vision.

Poor vision seems to come with advancing age and this is mostly due to the straining of the eyes. Poor eyesight is also partly caused by a poor diet plan and other factors such as staring at a computer screen for prolonged hours and reading in poor light.

Wearing lenses and eyeglasses can help correct eye problems and help people have clear vision however there are certain things that one can do to improve vision naturally. These ways on how to improve eyesight naturally can also help in treating eye strain. Long-term correction of vision disorders can also be achieved through these methods. Improving your vision naturally costs nothing so they are better options than

Tips on How to Improve Eyesight Naturally

In a way, exerting effort to boost your vision naturally is better than relying on contact lenses and glasses. Why is this?

These vision aids provide clear eyesight by altering refraction which can worsen vision overtime. Contact lenses and glasses fixes your eye focus but it does not work to treat the root cause of the problem. Doing eye exercises and training your vision naturally on the other hand deal with the factors that cause poor or blurry vision. The methods of improving your eyesight naturally helps relax the eye muscles and enhance blood circulation in the eye area.

The following are some useful tips on how to improve eyesight naturally:

  • Perform eye exercises regularly. This will naturally improve vision and correct underlying cause of eyesight problems. A good eye exercise you can do is blinking your eyes quickly for a few seconds and close them. After a few seconds, open them again and repeat the same 3-4 times. Another exercise is nodding your head up and down and while you’re doing this, focus your eyes on the ceiling and your toes respectively. If you work in front of the computer, stare at distant objects for at least 30 seconds after every hour to exercise your eyes and avoid straining them.
  • Maintain a healthy diet. Eating healthy, this is one of the best tips on how to improve eyesight naturally. Include lots of fruits and vegetables in your diet and notice your eyesight become sharper. Opt for vegetables and fruits that contain essential vitamins which are beneficial to the eyes like coloured vegetables like pumpkin and carrots. Reducing your intake of sugary foods will also help you improve your eye vision if you have poor eyesight.
  • Make use of herbal remedies. There are some herbs known to treat vision disorders and improve eye health. Rooibos tea is a great herb to use when trying to improve vision naturally. Rooibos contain high percentage of antioxidants that can help poor eyesight. Blueberries, bilberries and mahonia grape extract are also known to improve vision naturally.
  • Relax your eyes. Straining is one of the reasons why eyesight weaken. One good way to relax your eyes is by closing and palming them in a dark room. To so this, sit in a chair and position yourself in an upright position. Close your eyes then place your palm over your eyes. Make sure that no light enters your eyes and remain in that position for 10 minutes.
  • Get enough sleep. Another useful tip on how to improve eyesight naturally is to get adequate sleep. Not having enough sleep can cause tired eyes, eyestrain, blurred vision and other problems. You use your eyes to focus on things during the daytime and sleep is your body’s way of shutting them and relaxing them properly. 8 hours is the recommended hours of sleep to help relax the eye muscles and improve their focusing power in the daytime.
  • Take dietary supplements. Dietary supplements when taken in the right dosage can also improve vision. The best supplements for the eyes are those based on vitamin E, vitamin C, zinc and omega-3 fatty acids. You cannot overdose on vitamin C but you must watch your dosage of the others. Make use of these dietary supplements under strict medical supervision.

Aside from these tips on how to improve eyesight naturally, avoiding stress is also a good way to keep your eyes healthy. Following a proper eye care is also necessary to make eyesight better. It goes without saying that you must avoid immersing yourself in hours after hours of TV watching, facing your computer all day, reading until your eyes water, etc. Always take some time out of your daily work to relax your eyes – this won’t take more than a few minutes and can do you a lot of good to keep your vision sharp and clear for always.

These tips on how to improve eyesight naturally should help you boost your vision without relying in medicines and resorting to using contacts and glasses.

Best Places For Medical Treatment in Damascus, Syria

Damascus is the capital of Syria; it is also an important hub for science, culture, politics, art, and commercial activities. The city is also known to be oldest city in the world that has been inhabited continuously. The country has state hospitals in every province but most of the good hospitals are concentrated in the capital Damascus. The treatment at government hospitals is almost free and the fee charged by private hospitals is also regulated by the government.

The New Medical Center is one the prime healthcare centre in Damascus. The hospital was set up in the year 1991 and has facilities and knowhow for almost all medical and surgical practices. It is outfitted with highly advanced infrastructure and the team at the hospital is well trained. The hospital is equipped to conduct pediatric surgery, plastic surgery, general surgery and kidney transplants. The address for this hospital is Misat sq. Bernia Street, P.O.Box 7465.

The Dr. Shami-Attar-Bdeir-Medical Care Center was established by the Attar Group in 1981. The MCC provides excellent medical care to its patients and is equipped with latest medical technology and a well trained staff. Surgeries in the fields of obstetrics, gynecology, ENT, ophthalmology and neurology apart from plastic surgery and general surgery are carried out at the hospital regularly. The hospital has advanced scanning systems and a modern Intensive Care Unit. The hospital carries out open heart surgeries and the hospital has a 100 bed capacity.

The Italian hospital in Damascus was built in 1936. It is one of the important healthcare facilities in the city. Through the years the hospital has come to be known as a modern hospital that provides good services at treatment to its patients. The hospital is located at Tilyani and the contact numbers are 332-9404; 332-6030/1.

The Al-Asadi Hospital located in Mazzeh, Western Villas Damascus specializes in heart surgery and Bridi Clinic at Rawda Street, near Arnous Square has facilities for both medical and dental ailments. The contact number is 3338210.

Medical Clinic is located on Youth City Street, Building 27, East Villas, Mezzeh Damascus 7937; the contact person in this clinic is Dr Al-Hussein Saied Moshaaoeh. The clinic offers treatment for general medicine related issues.

International Medical & Digestive Clinic found on Salhia Street, Cinema Amir Building is run by Dr M Jaber is and provides treatment for digestive and other stomach related illnesses.

Apart from the hospitals listed above there are some well known doctors in Damascus that can be contacted depending on the nature of the problem. Dr. Moufid Jokhadar is a famous cardiologist and is contact number is 331-2766/ 333-2337. Dr. Anan Haffar is a pediatrician and his address is Jisr Al Abyed, Damascus; phone numbers are 333-4283/371-2822. For obstetrics and gynecological issues you could contact Dr. Ahmad Dahman at 70, Mazraa Malek, Al Fadel Street.

Work and Asbestos Related Diseases, Part Three

If you are an asbestos worker ask the Joint Health and Safety Committee (JHSC) or your employer about the asbestos control program in your workplace or about the management program for asbestos in buildings.

Control programs are very important to be carried out in workplaces where there are hazardous minerals like asbestos that can affect workers with severe pathologies such as malignant mesothelioma cancer, malignant lung cancer or asbestos related disease among others.

Other important thing is to visit the doctor regularly to stay informed about your health, (but this one must be specialist in the disease) whether or not you work or work in contact with asbestos at your job. He can order you different exams in order to know the current state of your health.

The law states that you can choose to be part of a medical surveillance program if it is needed. Every two years, the employee will offer and pay for the medical surveillance program in such case.

According to experts a program of medical surveillance includes chest x-rays, lung functions tests, regular physical exams and medical and work history tracking.

Through a medical surveillance program like this it will be possible to help you to find an asbestos-related disease or other related conditions early, and stop them on time and do not get worse.

The Workplace Safety and Insurance Board (WSIB) may help you to find out if you are entitled to compensation if you worked exposed to asbestos, analyzing your medical report, after you talk will your employer and file a claim with the WSIB if you have an asbestos-related disease.

In conclusion, there are many things that you have to do for prevent developing of asbestos related disease, but the Workplace Safety and Insurance Board (WSIB) could have been very useful and a good start point. Particularly in the case of compensations for by asbestos related workers.

How to Improve Your Health

If you want to be successful in life improve your health and if you want to be happy in life then too improve your health. Unless a person is healthy he is neither able to remain happy nor successful in life. You should take care of your health to enjoy the pleasures of life.

The top priority of a person should always be health. If you are fit and healthy then only can you think of moving ahead in life and maintaining relationships and taking responsibilities.

It is very important for a person to assess his or her physical health. You can see the external problems but you should also know your body from within. If you have some external problem you always go to the doctor to have it checked. But at times when you do not feel good from within and find no symptoms of ill health you do not make an effort to go for a check up. It is here when we create problems for us. Whenever you feel weak or low visit your doctor. You could be facing some health problems which could be tackled easily rather than delaying and making it worse. Your body starts showing symptoms if it is unwell. The symptom could be physical as well as emotional. Never ignore the symptoms your body gives such as falling of the hair, often feeling weak and lethargic and getting irritated fast. These could be indications of serious problems.

Give time to yourself and improve healthcare. There are different ways of improving your health and it only requires a little of your time. You have to learn to be cautious towards your health.

How to improve health?

It is not very difficult. You have to see to what you are eating. Are you eating healthy food or only junk food? Do you take juices, fruits and vegetables in your diet? Is your diet balanced with all the vitamins, minerals and proteins? These are the questions you should often ask yourself and include that food which you do not have at all. You should avoid any kind of deficiency. At times you avoid certain food out of lack of interest and as a result facing health problems.

Overeating is also a factor responsible for an unhealthy body. Obesity is one of the main problems today. To avoid obesity you have to have a controlled diet. Avoid too much of fatty food. Again include juices in your diet. Vegetables juices give you a lot of energy as and at the same time they contain fewer calories. You should include fruits and vegetables in your food.

Exercises are a good way of health care. Exercises keep you physically fit and active. The muscles are strengthened when you exercise and there is proper circulation of blood. You could do any type of exercise such as aerobics, yoga exercise or just do some basic exercises. They not only keep you physically fit but also relieve you from stress.

To improve your health it is very important to improve your lifestyle. What you eat? How you eat? When do you eat? How much do you sleep? These questions tell you much about your lifestyle. When people do not eat healthy, that is they take too much of fatty food, they skip meals, do not have proper timings to eat, do not take much of vegetables and fruits and they do not take proper sleep then we can say that their way of lifestyle is unhealthy. They are the people who often face health problems.

So for a healthy living eat well, sleep well and exercise well.

Find more information visit: How to improve your health [http://www.keepcondom.com/articles/health-nutrition/improve-your-health.htm]

The Most Effective Herbal Treatment For Infertility

Infertility problems today are raging. A lot of couples today seek medical attention but to no extent. They have given so much time and effort, not to mention the expense, but still they couldn’t find the best herbal treatment for infertility problem. Still there are a few medical practitioners who advice their patients to try the use of herbal medicine that these couples don’t know the most effective treatment for the disorder.

Herbal medicine is the study or use of medicinal herbs to prevent or treat diseases or to promote health and healing. It may be a drug or preparation that is made from plant or plants that is used for treatment or promotion of health. Moringa Oleifera is considered as the most effective herbal treatment for infertility.

Moringa Oleifera is also called ben oil tree, horseradish tree, drumstick tree or sahijan is a short, slender, perennial tree about twenty five to thirty feet tall. It is also called “The Multi-Purpose Wonder” because of it usefulness. Every part of the tree can be used either for a dish to taste better or other things or a lot of nameless benefits.

Moringa Olfeira contains nutritional values such as:

Vitamin C – is the safest and most effective nutrient for the body. Not only that it helps the maximum absorption of Vitamins A, D, E and K but it is also an effective cure for the common colds and helps improve the immune system. The benefits of vitamin C also include the protection against cardiovascular diseases, prenatal health problems and eye disease. It is also promotes healthy skin.

Vitamin A – is also called retinol and a fat soluble vitamin and helps your eyes adjust to light and keeps your body’s mucous membranes moist. Vitamin A also has antioxidant properties which help neutralize free radicals in the body that cause tissue and cellular damage.

Calcium – is good for your bones and teeth. Most people do not have or fail to include Calcium in their diet which results to Calcium insufficiency. It is important to include calcium in the diet because it helps to strengthen the bones and teeth. In addition, Calcium plays a great role in the sperm motility.

Potassium – helps neutralize fluid and electrolyte balance in the cell. It helps prevent high blood pressure, promotes regular contraction, regulates transfer of nutrients to the different cells in the body and maintains the water balance in the body tissues and cells.

Protein – is essential to the structure and function of all living cells and viruses.

The Moringa Olfeira leaf contain 7 times the Vitamin C in oranges, 4 times the Vitamin A in carrots, 4 times the Calcium in milk, 3 times the potassium in banana and 2 times the protein in yoghurt. All of which significantly help a man or a woman’s fertility level. You not only can achieve a well and sound healthy body but you can also treat your infertility problem with this herb.

Inpatient VS Outpatient Medical Coding

Medical coding professionals form an important link between healthcare practitioners and health insurance carriers like Medicaid and Medicare. Part of the health information management team in a healthcare establishment, medical coders assign standardized codes to the diagnoses, treatments and other clinical procedures being performed there.

These codified documents then pass into the hands of medical billing professionals who use them to bill health insurance companies, government, or patients directly.

Thus, if it were not for these professionals soldiering on, healthcare practitioners would not be getting reimbursed for their services, at least not as efficiently and smoothly as they are now.

Inpatient VS Outpatient Coding

The field of medical coding offers two broad career paths that aspirants can pursue – outpatient coding and inpatient coding. There are some differences in not just the training required for the two career paths, but also in the job itself. Here’s some more information on inpatient vs. outpatient coding:

Outpatient medical coding: As the name suggests, outpatient coding involves coding the medical charts of patients who are discharged from a healthcare facility within 24 hours. So, outpatient medical coders are responsible for charting the medical records of patients who receive treatments or undergo diagnostic procedures in clinics, doctor offices or hospital emergency rooms on the same-day basis.

Inpatient medical coding: This refers to coding the records of patients who are required to stay in a hospital or any other healthcare unit for more than 24 hours, hence the name inpatient coding. Since the medical records of patients who are admitted to a hospital for treatment tend to be a lot more complex, this naturally makes the job of inpatient medical coders that much harder.

Due to advances in medicine, a lot of procedures that earlier required a hospital stay can now be performed on a same-day basis. What this means is that outpatient coding is a lot more prevalent than inpatient coding.

Another factor to consider when choosing between inpatient and outpatient coding is that employment opportunities may be more for outpatient medical coders as they can find jobs in a variety of healthcare settings that include hospitals, physician offices, diagnostic labs, outpatient care centers, nursing care facilities, etc.

On the other hand, most inpatient coding jobs are limited to large hospitals though inpatient medical coders may also find employment with long-term care facilities or health insurance companies.

Medical Coding Training

Like mentioned earlier in the article, there may be some differences in the coursework of an inpatient medical coding training program and an outpatient medical coding training course. However, a large part of the curriculum remains the same for both inpatient and outpatient coding.

Most medical coding training programs include courses in different coding systems (ICD, CPT, etc.), healthcare reimbursement process, medical record types and formats in addition to topics like medical terminology, pharmacology, anatomy, etc. that provide students a thorough understanding of the clinical world.

Aspirants can also choose a medical billing and coding training program that provides them the skills for both inpatient and outpatient coding. However, it’s important to remember that most medical coding professionals start their careers as outpatient coders and then move up the ranks to inpatient coding.

Now that you know what the two jobs involve, it’s for you to pick the one that suits your career goals and temperament better.

Plunked by Michael Northrop – Youth Baseball, Self-Confidence, and Elementary School-Aged Challenges

Jack Mogens is a sixth grader at Tall Pines Elementary School. It’s late March as he begins his sixth season playing Little League baseball for the Tall Pines Braves.

Jack gets “plunked” on the side of his head while batting on Opening Day. The hit shakes his confidence to the point where he’s now afraid of inside pitches.

Compounding Jack’s challenge is the “revenge pitch” he takes during the team’s following practice. His nemesis, Kurt “Malfoy” Beacham, heard him talking smack about him in school; and throws a pitch, hitting him in the ribs.

Nightmares haunt Jack, where a faceless pitcher is throwing balls at him, while glued to the batter’s box. His anxiety builds, forcing him to feign injury to avoid playing in next weekend’s game.

“Family emergency” is Jack’s excuse as to why he missed Saturday’s competition. His teammates and buddies aren’t buying it in the cafeteria Monday morning. Jack finds his deceptions becoming harder to conceal.

Depressed, Jack unexpectedly coins the phrase, “open to mopin” when Andy Rossiter, (his best friend since second grade) questions his attitude.

Andy helps Jack save face with his buddies after missing Saturday’s game. Their ultimate connection occurs at the Tall Pines Family Pharmacy while thumbing through comic books.

In an awkward moment of silence and avoided eye contact, Jack knows he owes Andy an explanation why he missed Saturday’s game. When Andy asks, he exposes himself emotionally and admits his fear of getting hit by the ball. Andy affirms his feelings by responding, “Everyone is a little scared of the ball sometimes.” It’s a poignant display of emotions between two boys; not often encouraged in today’s society.

Northrop has a talent for crafting narrative relatable to middle school-aged children: “but don’t even pretend you’ve never faked a fever or blamed the cat for breaking something or anything like that. Don’t even pretend to pretend.” He also addresses doing homework and riding the school bus: “Right on cue, the bus pulls up, and its doors open. Shut up and get in it says.”

Jack enjoys a loving relationship with his parents. They attend all of his games; and watch Major League Baseball together at home.

Even so, he sometimes frets over their parental control. Regarding his computer access: “Mom and dad have so many filters on this thing, it’s a wonder anything gets through. Like St. Paul the Apostle could send me a personal email telling me to study hard, and it would end up in the spam folder.”

Collecting Major League Baseball cards with his father is one of the duo’s favorite pastimes. Viewing his dad’s most prize-possessed rookie card, Cal Ripken, Jr., Jack shamefully realizes that Ripken Jr. would never fear inside pitches or let his team down. Baseball bobbleheads, a row of baseballs, and a big poster from the Baseball Hall of Fame in Jack’s bedroom also provide him an a-ha moment.

Jack’s emerging sexuality is evident in his awareness of the team’s shortstop, Katie Bowes: “She glances up and I look down fast. I don’t think she saw.”

What kid doesn’t have a favorite pet that’s part of their being? Jack has his in Nax, a black Labrador retriever. Nax sleeps at the foot of Jack’s bed; and knows when he’s happy or upset.

Baseball language complements Plunked, including “ducks on the pond” (two men on base with two outs).

Well-written literature transcends time. The release of Plunked this March however, complements the start of Little League and Major League Baseball, making it an ideal read for any sports-minded kid.

If you’re an educator looking to assign, or suggest a book for your middle school-aged boys, Plunked is it. If you’re a parent anticipating your child’s summer reading assignment, or support reading in your kids (especially boys), you’ll hit a home run with Plunked.

To view excellent literature, written for grade school children and young adults, including author interviews and give-aways, visit: http://www.scholastic.com/kids/stacks/?lnkid=stacks/nav/home/main.

Short and Long Term Effects of Alcohol, Marijuana and Cocaine Abuse on Human Body

Drug abuse is one of the major health concerns in United States today. Drugs affect various parts of human body and impair their normal functioning. People know that drug abuse is very dangerous, but many of them don’t know its exact effects. It is very important to understand the short and long term effects of drugs and alcohol abuse on human body to stay away from them. Here we will discuss about some of the effects of commonly abused drugs such as Alcohol, Marijuana and Cocaine.

Before discussing about the short and long term effects of these drugs, here is a brief overview on each drug.

Alcohol
Alcohol is among the most abused drugs in America. According to National Survey on Drug Use and Health (NSDUH), more than half (51.9 percent) of Americans or 130.6 million people, aged 12 years or more were current alcohol drinkers in 2009. Alcohol is legal but a dangerous central nervous system depressant. It can be as potent as many other illicit drugs of abuse. The main problem with alcohol is that many people often do not realize that they are getting addicted to it.

Marijuana
Marijuana is the most commonly abused illicit drug in America. NSDUH states that there were 16.7 million Marijuana abusers in 2009. It has similar effects as stimulants, depressants and hallucinogens. Marijuana smoke contains more carcinogens than tobacco smoke, creating a higher risk of lung diseases.

Cocaine
Cocaine, a strong stimulant to the central nervous system and is highly addictive. In 2009, there were 1.6 million current cocaine users aged 12 years or old.

Short term effects
Alcohol: Alcohol intoxication causes behavioral changes, impairs brain function and motor skills, alters ability to learn and remember and reduces sensitivity to pain. Alcohol intake also affects vision, narrowing down the visual field, reducing resistance to glare and decreasing the sensitivity to colors. Very high doses of alcohol can cause death. Alcohol if taken with other illicit drugs can produce life threatening effects.

Marijuana: Short term effects of Marijuana include substantial increase in the heart rate, bloodshot eyes (reddening of eyes), dry mouth and throat. Marijuana use also increases body temperature, appetite and drowsiness. Marijuana impairs the ability to drive a vehicle or work on a machine as it affects concentration, reaction time and coordination.

Cocaine: Immediate effects of Cocaine use include elevated blood pressure, dilated pupils, stuffy nose, heart and respiratory problems. Crack, a freebase form of Cocaine causes dilated pupils, increased pulse rate, elevated blood pressure, insomnia, loss of appetite, hallucinations, paranoia, and seizures. In some cases, Cocaine use can lead to death by cardiac arrest. Cocaine user may experience anxiety, restlessness, twitches, tremors, spasms, coordination problems, chest pain, nausea, seizures, respiratory arrest, and cardiac arrest. In some rare cases, first time use of cocaine can also cause sudden death.

Long term effects
Alcohol: Consuming large quantities of Alcohol for longer periods can lead to permanent brain, liver, pancreas and stomach damage. It may also lead to malnutrition, high blood pressure, lower resistance to diseases and gastro-intestinal problems. Heavy alcohol can cause cancer to vital organs such as esophagus, stomach, liver and pancreas.

Marijuana: Long term Marijuana abuse can reduce short term memory and ability to perform tasks requiring concentration and coordination. It can cause respiratory problems, lung damage, and even cancer.

Cocaine: Long term Cocaine users risk heart attacks, respiratory failure, strokes, seizures, nausea and abdominal pain, irregular heartbeat, chest pain and headaches.

Apart from causing harm to one’s health, drug abuse impacts abusers’ interpersonal relationships, deteriorates financial condition and reduces the ability to work. Therefore, it is very important to stay away from drugs.

Raynaud’s Disease – Ayurvedic Herbal Treatment

Raynaud’s disease is a condition which causes narrowing of the arteries, leading to numbness and coolness in the fingers, toes, tip of the nose and ears. This condition is more common in colder climates; and women are more likely to have Raynaud’s disease than men. While the cause of this condition is unknown, it is believed that blood vessels over-react to cold temperatures and stress and go into spasms, thereby causing the symptoms. Primary Raynaud’s, without any underlying medical condition, is called Raynaud’s disease. Secondary Raynaud’s is due to some other problem like scleroderma, lupus, rheumatoid arthritis, repetitive trauma, smoking, injuries and medications.

The Ayurvedic treatment of Raynaud’s disease is aimed at reducing the number and severity of attacks, preventing tissue damage and treating any underlying condition. To prevent the spasm of the arteries, medicines from the ‘Rakta-Prasaadak’ category are used in this condition. These include Saariva (Hemidesmus indicus), Manjishtha (Rubia cordifolia), Chopchini (Smilax china), Suranjaan (Colchicum luteum)), Mundi (Sphaeranthus indicus), Khadeer (Acacia catechu), Guduchi (Tinospora cordifolia), Haridra (Curcuma longa), Daruharidra (Berberis aristata), Mahamanjishthadi Qadha, Saarivasav, Arogya-Vardhini, Panch-Tikta-Ghrut-Guggulu and Kaishor-Guggulu.

To prevent an over-reaction of the blood-vessels to stress, medicines like Brahmi (Bacopa monnieri), Jatamansi (Nardostachys jatamansi), Shankhpushpi (Convolvulus pluricaulis), Vacha (Acorus calamus) and Sarpagandha (Raulwofia serpentina) are used. From this category of medicines, the herb Mandukparni (Centella asiatica) deserves special mention, since it not only reduces stress, but also improves blood circulation in the extremities, thereby reducing spasm, and preventing or healing ulcers.

Treatment of the underlying condition in secondary Raynaud’s condition is equally important, in order to reduce symptoms and prevent further complications; however, in such cases, more prolonged treatment needs to be given. It is important for all people with Raynaud’s disease to adopt suitable life-style changes, and avoid known precipitating factors.

Why Nutrilite Double X Vitamin-Mineral-Phytonutrient is Right For You!

In part 1 of this series we discovered that the Nutrilite Double X Vitamin/Mineral/Phytonutrient:

  • is made from plant concentrates.
  • includes free radical fighters – with broad and targeted power.
  • offers true enzyme defense.
  • provides real energy, all day.

Let’s explore in detail what all of this really means to you and your family.

Plant concentrates

It appears that many multivitamins offer the standard array of vitamins and minerals, many at 100% of the Recommended Daily Intake (RDI).

So what makes Double X different?

Double X adds phytonutrients from plant concentrates, way more than other multivitamins do. Double X includes 12 vitamins, 10 minerals, and 20 plant concentrates. No other multivitamin comes close.

Free radical fighters – with broad power.

You’ve heard about them in the news: free radicals are rogue oxygen molecules that attack your healthy cells, steal an electron, and begin a chain reaction of instability and damage.

Free radicals are everywhere, generated by air pollution, sunshine, X-rays, pesticides, car exhaust, cigarette smoke, even breathing and exercise.

Science now knows that by increasing our intake of free radical fighters, called antioxidants, we can defend ourselves – right down to our cells – against this constant attack.

Health Canada has adopted a way to measure the raw power of antioxidants to help fight the good fight. This measure is called the oxygen radical absorbance capacity (ORAC). It measures how well the antioxidants mop up free radicals. It is recommended that we all get between 3,000 and 5,000 ORAC units daily, preferably from whole, fresh fruits and vegetables. But the average person only gets between 1,200 and 1,640 ORAC units a day.

The Double X multivitamin/mineral/phytonutrient delivers an average of over 3,000 ORAC units in each daily serving.

Free radical fighters – with targeted power.

In extensive testing of over 100 different plant concentrates, Nutrilite scientists identified 20 plant concentrates that would be included in the Double X formula.

These included plant concentrates that targeted and protected against five specific categories of free radicals.

  1. Hydroxyl – Pesticides, pollution (out performed competition)
  2. Peroxyl – Aging, X-rays (out performed competition)
  3. Peroxynitrite – Smoke, exhaust (out performed competition)
  4. Superoxide – Cellular metabolism (out performed competition)
  5. Singlet Oxygen – Exercise, UV rays (equaled competition)

Hydroxyl, peroxyl, peroxynitrite, superoxide, and singlet oxygen are 5 harmful free radical categories implicated in many health disorders.

Free radicals are generated by compounds found everywhere, from breathing to sunshine, from X-rays to car exhaust, from air pollution to pesticides and cigarette smoke. We’re always under attack, but with Double X, we can help our bodies fight free radicals.

Enzyme defense.

Plants have natural mechanisms to help protect themselves against harmful pests or unfavorable growing conditions. Similarly, there are some naturally occurring compounds in the foods we eat every day that can be mildly harmful to humans. The human digestive system, therefore, develops enzymes to protect itself from these harmful compounds. These enzymes help our body differentiate between the good and bad compounds.

Double X contains cruciferous plant nutrients, such as broccoli and kale, that help produce Phase 2 enzymes. In fact, lab tests show that Double X assists the body’s natural production of Phase 2 enzymes. These enzymes break down the harmful compounds that enter our body by making them water soluble. Once these compounds are water soluble, they exit the body more quickly.

Real energy, all day.

Double X helps you unlock energy stores and metabolize carbs with B vitamins and concentrates from apples, alfalfa, basil, and acerola cherries. If you want sustained energy that lasts all day, not just a fast jolt, choose Double X.

Could you eat all this?

Even if you already eat a diet rich in fresh, whole, natural foods, you may not be getting everything you need. Why not? Because in order to get the vitamins and minerals your body needs, at the recommended levels, you’d have to eat a mountain of food every day. In fact, here’s just some of what you’d have to eat, daily, to get some of the nutrients found in Double X:

  • Vitamin E of 33 T. of peanut butter
  • Vitamin C of 7 cups of cantaloupe
  • Folic Acid of 6 cups of baked beans
  • Thiamine of 3.3 lbs. of pork loin
  • Riboflavin of 7.75 quarts of low-fat milk
  • Niacin of 1.5 chicken breasts
  • Vitamin B6 of 22 bananas
  • Magnesium of 4.2 cups of peas
  • Vitamin B12 of 4.2 lbs. of ground beef

Well now you know what I know. Enjoy your Nutrilite Double X Vitamin/Mineral/Phytonutrient.

See you on the Beaches of the World,

Kevin McNabb

Sleep Deprivation – The Hidden Danger Of An Enlarged Prostate

Sleep, interrupted: It’s so basic that we don’t think about it much, but a good night’s sleep is a major contributor to quality of life.

If you have an enlarged prostate or you’re suffering from an adult bladder control problem, then missing out on sleep may be the furthest thing from your mind. However, sleep deprivation can have nasty effects all on its own.

What does sleep deprivation have to do with prostate health? Good question. Non-cancerous prostate health problems frequently focus on various urinary issues, such as increased frequency or a very urgent need to urinate. Oddly enough, these issues very often crop up at the most inconvenient of times, when you’re trying to sleep.

If you don’t think sleep deprivation is a serious business, then think again. It’s been used as a method of interrogation and even torture. Menachem Begin, who was the Prime Minister of Israel from 1977 to 1983, was once held prisoner in Russia by the KGB and subjected to sleep deprivation as an interrogation tactic.

“In the head of the interrogated prisoner, a haze begins to form,” said Begin. “His spirit is wearied to death, his legs are unsteady, and he has one sole desire: to sleep… Anyone who has experienced this desire knows that not even hunger and thirst are comparable with it.”

Now, let’s be honest: urinary incontinence doesn’t cause the sort of sleep deprivation used by the former KGB. But it’s no picnic.

Very often, lack of enough sleep may result in aching muscles, blurred vision, dizziness or a weakened immune system. In severe cases it can even lead to clinical depression, cardiovascular disease, general confusion and even hallucinations.

A study performed by the University of Chicago Medical Center in 1999 showed that sleep deprivation can have a particularly deleterious effect on the body’s ability to metabolize glucose. In turn, this can lead to type 2 diabetes.

Even more worrying, sleep deprivation may have an effect on brain function. Studies done on animals seem to suggest that sleep deprivation leads to an increase in stress hormones. These hormones have been known to slow down or even bring to a halt the process of neurogenesis in adults, the method by which new brain cells are created.

Comprehensive prostate health treatment should include some way to lower the frequency of night time urination. By increasing flow, you’ll get up less and feel better in the morning.