How to Negotiate Hair Transplant Costs

Over 60% of men will have some sort of hair loss in their life time which they will seek medical attention for. In over nine out of ten of these cases the most prominent factor contributing to the loss of hair is a genetic condition known as male pattern baldness. This problem, with the medical name Androgenic Alopecia, can affect both men and women and is passed down through the generations from either the mother’s side of the family, the father’s, or both.

When a man suffers balding due to this problem his hair follicles (the roots) are attacked by a naturally occurring hormonal substance called DHT. This DHT actually renders the hair follicles incapable of producing keratin, the hair shaft material. At this point the only hope for hair in the balding area is have a hair transplantation procedure performed at a hair restoration clinic. This is fairly expensive but the price can be negotiated down. With the current economic conditions most clinic are operating below capacity and are willing to give discounts to get new patients. If you have been considering hair transplant as the solution to your baldness then this is a great time to get it done.

The first key to negotiating a good price is to let the other party know it is too much. When they give you the cost look shaken and say that is more than you expected. This sets up the stage for the tactics to come. Most people are reluctant to do this part and thus they start off with a week hand when it comes down to the end of the negotiating game.

Next, ask if there is anything that can be done to make it more affordable. Maybe they can cut down on the number of grafts and give you about the same coverage. After this you can ask if they offer free financing. If you are going to borrow the money the fact that they will offer to give you an interest free loan can be worth a lot.

By this time you have often times received discounts but don’t stop there. Offer 15% less than their bottom offer. If they say no then thank the clinic representative and stand up from the table. Say it just doesn’t seem doable. You will be surprised at how many people find one more offer when you are walking out the door.

Outsourcing Your Online Business

Watching the better quiz shows on the TV is a favorite pastime of mine. One thing that strikes me, and others I'm sure, is that some questions which I can not even hazard a guess at are answered by some contestants with ease, while other questions to which I immediately know the answers receive a blank look in The studio. The reason is obvious, when it comes to general knowledge nobody can know everything about everything. It is the very nature of general knowledge; Nobody, regardless of how clever they are, can know the answer to every question.

It is true in life that no individual can be good at everything. Kevin may be a great cook whilst Susie can not even boil an egg without burning the house down. On the other hand, Susie may be a brilliant musician whereas Kevin is tone deaf. We all have our skills and our areas of incompetence; Our strengths and our weaknesses. That is the nature of things.

This is just as true in the sphere of internet marketing as anywhere else. Although the basic strategy for running an online business is straight-forward there are lots of different skills to apply to a successful project. Very few people feel totally confident in every area, especially in the early months of starting up a business. One person may be good at the technical side and poor at copywriting while another may be the complete opposite. This is where outsourcing your online business comes into its own. This article will give you ideas as to what and how to outsource.

So, what is outsourcing? Companies such as "Upwork" and "Fiverr" offer outsourcing services and will take on work which you, as a marketer, are less happy with. For a very small financial outlay you can find professionals through such companies who will do the tasks which you feel unhappy with. If you need to have a website built, they can help. If you need a sales letter written, they will do the work for you. If you need articles written, email follow-up sequences created, rebranding work done, keywords searched, etc. Etc. It can all be outsourced to experts who will do the work for a small fee. So, by outsourcing you will leave yourself the time to work on the things you can do well. It's a no-brainer really! Ideally, internet marketers should absolutely aim to do all these different tasks themselves but this takes time. Let outsourcing take the pressure off, especially when you are new to the business. If this were an expensive option then it might be better to struggle through yourself; – but it is not expensive so why not use it!

Another aspect of outsourcing is the use of Fulfilment Houses. These are companies who will deal with all the product processing. They will produce, pack and send out your DVDs, printed reports, etc. For a small fee per item, thus relieving you of the time commitment, time which you can then spend on developing new products and planning your next campaign. The profit margins in internet marketing are so big that the cost of outsourcing online business will hardly be noticed.

To summarize, if there are aspects of your internet marketing business which you do not feel you have the skills to fulfill yourself then outsource it. Find expert professional help which is readily available to do the work for you. The cost is very small, especially in the light of the internet marketing profit margins, so use it. The benefits in having this work done professionally will, almost certainly, be reflected in your sales.

Pulsatile Tinnitus – What Beat Are You Marching To?

Tinnitus comes in several different noise packages, with pulsatile tinnitus being one that is not so common. With general tinnitus symptoms, the sufferer deals with noises that are continuous, such as: hissing, roaring, clicking, ear ringing and other such variations. One thing to keep in mind is that tinnitus is not a disease, but rather a symptom of some underlying condition. It is therefore important to find out what is causing the irritating sounds.

The causes of tinnitus fall into three main categories: hearing damage due to loud noises; hearing damage due to stress or anxiety; and hearing damage due to allergies and sinus problems. There are also two main forms of tinnitus: subjective tinnitus and objective tinnitus.

Subjective Tinnitus: This is where only the one suffering from tinnitus can hear the noises, and the sounds are continuous. But, there is no external evidence of the sounds he/she is hearing, it is completely “subjective”. This is the most common type of tinnitus and almost 50 million Americans deal with it in some form.

Objective Tinnitus: The noises that the person with objective tinnitus hears can also be heard by their doctor, through a special medical instrument.

Pulsatile tinnitus, also known as vascular tinnitus, would be classified as objective tinnitus. It gets its name from the fact that the sounds are not continuous but rather come in “pulses”, keeping rhythm with your heartbeat. This is usually due to the restriction of blood vessels in and around the ear, or even by poor blood circulation. This restriction makes it more difficult for the blood to get through it and disrupts the normal smooth flow resulting instead, in a pulse like flow. That is why some people refer to it as pulsating tinnitus.

Hypertension, or high blood pressure, could also be a potential cause of pulsatile tinnitus, as could any number of factors that alter the regular, or normal, blood flow in and around the ear. One quite common culprit could be an inner ear infection or inflammation, which causes an elevation and thus a disruption, in the blood flow.

Some sounds associated with Pulsatile Tinnitus Are:

  • Clicking
  • High pitched sounds
  • Swooshing or swishing
  • Blowing sounds
  • Low pitched humming, booming or thumping
  • Single rhythmic beats

Pulsatile Tinnitus Treatment

The treatment for pulsatile tinnitis must concentrate on the improvement of blood flow throughout the capillaries and blood vessels. This is done by isolating, and then dealing with, the underlying conditions that are causing the disruptive flow to start with. You could take the conventional, or medical, route for treatments or try any number of alternative tinnitus remedies that offer relief to the sufferer without the bothersome, and sometimes dangerous, side-effects of the drug-based therapies.

1. Conventional Treatment of Pulsatile Tinnitus:

This is through the use of drugs that work to improve the blood flow, which in turn reduces or alleviates the annoying symptoms of pulsatile tinnitis. These drugs are inclusive of those that help reduce hypertension and a spectrum of antibiotics that fight inner ear infections. Angioplasty surgery is sometimes used to un-block the restricted blood vessels, thus improving the flow dramatically and doing away with the “pulse” or “beat” symptom of pustule tinnitus.

2. Alterative Pulsatile Tinnitus Treatment:

For those who shy away from high-potency drugs or invasive surgery, there are many, valid, natural or homeopathic remedies that can bring relief for pulsatile tinnitus sufferers. They also deal with the underlying issues, but without the negative, and sometimes dangerous, side-effects of prescription medications, and of course, without having to go through the trauma of tinnitus surgery.

Here Are Some Alternative Treatments For Pulsatile Tinnitus:

  • Herbal remedies
  • Dietary supplements
  • Homeopathic medicine
  • Exercise
  • Lifestyle adjustments
  • Change of diet
  • Tinnitus retraining therapy

Utilizing an all-encompassing “holistic” approach, by combining the best remedies from each of these alternative treatments packaged together, will offer you the best chance of getting rid of your pulsatile tinnitus once and for all…

How to Defeat the Effects of Pepper Spray

Whenever you are stuck in a serious situation or just goofing off with friends, coming in contact with pepper spray is something more and more people are faced with today. This link with agent has very powerful effects. Here are just a few tips to counter the effects of pepper spray.

How to Defeat the Effects of Pepper Spray in Four Steps

Step 1 – Do Not Panic – The worst thing you can do is panic. Never panic! Whatever you do, do not rub the affected area. Pepper spray is both a physical and mental attack. It makes you physically blind and makes you think you are suffocating at the same time. From the moment your hits with pepper spray in the eyes stopped taking deep controlled breaths and stay calm. Another side effect is snot draining out of your nose. Again not something to be alarmed about.

Step 2 – Rinse with Water – From the moment you are hit with pepper spray asks somebody close by your guide you to the nearest water supply. There, rinse your eyes thoroughly with running water preferably through a hose for 10 to 15 minutes. Even though you will feel an immense amount of burning on your eyes keep grimacing and force your eyes open to allow the water to get in.

Step 3 – Blow Air – Next step is to hold a fan in front of your open eyes, preferably a hand-held fan. It is the second most important step that will help you overcome the traumatic experience. False your eyes open and allow the air to blow onto your eyes. It will most definitely hurt but after a few minutes of pain you will be able to open your eyes and see again.

Step 4 – Treat the Skin – The Painful pepper spray liquid will now be out of your eyes but it will not be out of your skin yet. Simply, gently and carefully rinse your face off with soap and water. Your eyelashes and hair might also still contain the harmful liquid. So, it is advised to take a shower and completely remove everything.

Compensatory Movement Patterns

When a machine moves, stress on the moving components will deteriorate or wear out the machinery. If the alignment of the specific segments or moving parts is not ideal then the machine will eventually break down. In contrast to machinery, stress on the moving segments of the human body is necessary and graded stress can actually improve the strength of the involved tissues-two of the advantageous characteristics of the human body. There are upper and lower limits that determine whether or not it will be beneficial to the health of the tissues. Any loss in the precise movement can begin a process that can induce changes that can cause micro trauma to macro trauma in the involved tissues. I will try to give you examples of common movement impairment syndromes that will create faulty mechanical wear and tear which eventually leads to pain or dysfunction.

 

Over-Stretch Weakness

 

Muscles can become weak when they’re maintained in a lengthened position, particularly when the stretch occurs over periods of prolonged rest. For example, the development of elongated dorsiflexor and shortened plantar flexor muscles in the patient confined to supine bed rest with the sheets exerting a downward pull on the feet, causing an additional force into plantar flexion, therefore lengthening the dorsiflexor muscles. Another example is the prolonged stretch of the posterior gluteus medius that occurs while sleeping on your side. A woman with a wide pelvis with her uppermost leg positioned in adduction, flexion and medial rotation will test weak in hip abduction, extension and lateral rotation. The resultant lengthening of the muscle can produce postural hip adduction or an apparent leg length discrepancy in a standing position.

Sleeping in a side-lying position with the lower shoulder pushed forward pushes the scapula into abduction and tilted forward. This position can stretch the lower trapezius and possibly the rhomboids. The top shoulder can also be susceptible to pull the scapula into the abducted, forward position as well, especially if the thorax is large. This sleeping position can cause the humeral head in the glenoid to migrate towards a forward position.

Characteristics of muscles with over-stretched weakness include:

 

1. Postural alignment controlled by the muscle indicates the muscle is longer than ideal.

 

2. Muscle tests weak throughout its range of motion and not only in its shortened position.

 

An over – stretch weakness can also be caused by a strain from trying to lift a heavy object. Remember, strain is a minor form of tear in which the filaments of the muscle have been stretched or stressed beyond their physiological limit resulting in disruption of the Z-lines to which the actin filaments attach. These disruptions alter the alignment of the myofilaments which interferes with the tension-generating ability of the contractile elements. Muscle weakness occurs and in many instances, pain when the muscle is palpated or when resistance is applied during muscle contractions. For example, if the upper trapezius is strained, weight of the shoulder girdle itself might be excessive for the muscle. The shoulder’s pull on the muscle causes it to elongate and the muscle is unable to heal. A strained muscle might actually be under constant tension even when it appears to be at its normal resting length. Typically, a strained muscle is unable to support itself against gravity when positioned at the end of its range. Furthermore, the muscle is unable to maintain its tension at any point of the range when resistance is applied.

When a muscle becomes elongated and weak, then it’s contribution or tension-generating capabilities will change and another muscle will have to take over, creating a compensatory movement pattern. This will eventually become the normal pattern which then causes health problems down the line. Therefore, stretching might not always be optimal to alleviate muscle spasm or pain. Stretching and placing excessive force demands on the muscle is contra-indicated if it is strained. It is the length of the muscle and the presence of pain that act as guides to whether the muscle is merely weak from atrophy or weak form strain.

Traditionally, the emphasis is placed on stretching the muscles that have shortened, but equal emphasis has not been placed on correcting muscles that have lengthened. Lengthened muscles will not automatically shorten when stretching the antagonist. A client who demonstrates Lower-Cross Syndrome might have an exercise program that stretches the hamstrings, however, this does not concurrently shorten the lengthened muscles such as the lumbar back extensors. It would be prudent to shorten the elongated muscle while simultaneously stretching the shortened muscle. This is especially important when the lengthened muscle controls the joint that becomes the site of the compensatory motion as a result of the limited motion caused by the shortened muscles. For example, during forward bending, excessive lumbar flexion can occur as a compensatory motion because of shortened hamstrings. The best intervention would be to stretch the tight hamstring muscles but also shorten the back extensor muscles as well.

 

Altered Recruitment Patterns

A person with shoulder pain has excessive shoulder elevation during shoulder flexion to 90 degrees as compared to a person without shoulder pain. The elevation is present even after the patient no longer experiences the pain. Runners who tend to keep their weight posterior-closer to the rear than to the front of the foot show they use the hip flexor strategy, which also involves an excessive use of the tibialis anterior muscle, leading to shin splints. In contrast, runners who keep their weight line forward can be observed to use more push off with their ankle plantar flexor muscles.

The upper trapezius muscle, which is the upper component of the force-couple that controls upward rotation of the scapula can be more dominant than the lower trapezius. Muscle testing might show a weakness of the lower trapezius or the serratus anterior. One might notice excessive shoulder elevation when abducting the arm. Muscle strengthening might not necessarily change the pattern of recruitment. Instructing the client in correct performance of shoulder motion using a mirror is as important as the strengthening exercises you might prescribe.

An individual with an exaggerated swayback posture who stands in hip joint extension has diminished contour of the gluteal muscles, suggesting a weakness in these muscles. The hamstrings will usually take up the slack in hip extension. The hamstrings are extremely susceptible to an overuse syndrome when they are dominant because of the inadequate participation of the abdominal, gluteus maximus or even rectus femoris, as well as the lateral rotators of the hip. 

The TFL (tensor fascia latae) and rectus femoris muscles are more dominant than the iliopsoas muscle hip flexion. In this situation the client will show excessive hip medial rotation. The person usually has a swayback posture.

The TFL, anterior gluteus medius and gluteus minimus muscles are more dominant than the posterior gluteus muscle in the action of hip abduction. When abducting, the client will substitute with medial rotation and flexion of the hip.

The extensor digitorum longus muscle is more dominant than the anterior tibialis muscle for the action of ankle dorsiflexion. The client will extend the toes as the initial movement of dorsiflexion instead of ankle motion.

 

The hamstring muscles are more dominant for the action of knee extension. In walking or running, once the foot is fixed on the ground the hip extension action from the hamstrings contributes to extension of the knee. Hip extension to assist in knee extension is commonly used by the person who has weakness of the quadriceps muscles. To reenforce the knee extension action, the person flexes the trunk slightly to use gravity to further contribute to the knee extension movement. A similar pattern is seen in the runner who uses the hamstrings for knee extension control. He or she will bring the knee backward toward the body rather than bring the body up to the knee as when climbing stairs.

When asked to perform finger extension, many individuals will demonstrate a small degree of wrist flexion. This type of compensatory movement pattern occurs most frequently with individuals who perform a lot of repetitive wrist flexion such as typing. As a result of this position of wrist flexion movement, the position of flexed joint and the anterior position of the flexor tendons reduce the carpal tunnel space, which can result in carpal tunnel syndrome.    

 

In summary, the mechanical stress on tissues arising from movement impairment syndromes can cause a wide variety of injuries. The various injuries implicated can be degenerative changes in cartilage and joints, ligament strains, joint inflammation, myofascial strains, myofascial tears, tendinitis, bursitis, neuropathic pain from entrapment and compression and adhesions are a few examples. The better you get at muscle testing and identifying these compensatory movement patterns, the better you’ll be able to keep your clients from injury.

10 Ways to Save Nature

Your mother is always forgiving, but do not take her for granted. If you commit hundred crimes she may throw you out. Same applies to Mother Nature. She is no longer ready to accept any more human atrocity.

Mother Nature has been demonstrating her anger in various ways like global warming, climate change, flash floods and droughts, cloud bursts and water scarcity, earthquakes and many more in varied magnitudes. Humans, selfish as ever in their ways, fail to understand or do not want to understand.

Pollution has been the major cause of nature’s wrath since industrial revolution two hundred years ago. Thanks to fossil fuel burning like that of coal, oil and natural gas in big factories, heavy urbanization leading to tremendous motor vehicle traffic, steady annihilation of greenery and natural resources, commercialization of forests and parks and such a chain of follies our mother is gasping for breath.

Now trying to think about saving nature we must understand the basics. First, the ozone layer which protects us from the harmful rays of the sun. This gas in beneficial if it resides in the stratosphere, if it comes down to the earth’s surface it starts adding to global warming. Chemical gases and pollution are harming the ozone layer to a point of consternation.

Second, the greenhouse gases. If these gases remain at normal level our earth is kept comfortably warm for all the inhabitants. But the enhanced greenhouse emission caused by excessive human activities is not normal and it leads to abnormal warming with results in higher sea levels, more rainfall and floods and severe droughts too. Most of these harmful greenhouse gases damage the ozone layer.

Third, the global warming which is a result of the mix of damaged ozone and enhanced greenhouse effect. Melting of glaciers follow leading to fluctuations in climate and natural disasters. Apart from this, if such pollutants are allowed to perforate the ozone there will be 19 million more cases of cancer and 129 million more cases of eye cataracts, scientists warn.

Lastly, our depleting reserve of precious natural resources like water, wildlife, marine world and of course trees and forests. Green plants are ideal for absorbing harmful gases and a green cover contributes directly to Mother Nature’s eco balance.

With this basic knowledge we can now list out the ten ways to save our mother planet-the only place in the endless universe where we can still live happily.

Love Trees: Always keep a habit of planting trees be it your locality or society campus or even your living room. Initiate and organize tree planting campaigns with your fellow residents.

Love Animals: Let the animals be part of the natural habitat or the wild. Never buy or eat exotic and endangered animals or patronize products made out of animal parts.

Love the Three R’s: You should put the mantra in your heart-reduce recycle and reuse. Reduce your requirements to exactly what you need. This will result in reduced garbage and your combined action can relieve pressure on the municipal authorities to dispose garbage. You perhaps know that your garbage while broken into pieces produces harmful greenhouse gases. Reuse all items that are still working or can be repaired. Recycle all products like newspapers, plastic and glass items and scraps by selling them in the nearby junkyard.

Dispose of Garbage Properly: Try to separate your organic waste from other non-perishable waste. You can have a compost pit maybe in your back garden or terrace to deposit all your organic waste and finally make it into a fertilizer the utility of which you would know soon. Never allow your waste to smell bad, because foul-smelling waste means release of greenhouses gases into air.

Be a Farmer: Do not get scared. It is not so difficult. You can do it in your backyard or even in your terrace with permission or cooperation of your neighbors. Apart from plants and flowers you can also start cultivating vegetables for which your compost fertilizer would come very handy. Remember, such practices are no longer novelties.

Stick to Local Products: Get all your required products from your locality as far as possible. This will prevent transportation and packaging which in turn will contribute to less burning of energy thus preventing release of harmful gases.

Identify Your Polluting Acts: Some of the things you use could be polluting agents. Your car, refrigerator, foam blowers, fire extinguishers and others pollute environment if overused. So be moderate in their use.

Do not be a Thrower: Never indulge in throwing things out of your windows or your balconies. This could include anything from garbage pieces to broken scientific products like thermometers, barometers and others that contain mercury. Mercury is poisonous and so harmful.

Household Chores: Always be devoted to your cherished household chores. Prevent wastage of water, save electricity whenever possible, do not burn plastic or waste, do not use colored plastic bags which are already banned in many countries, walk to the local market with your normal cloth bag and so on. Set examples and you will definitely have followers.

Be Aware and Spread Awareness: Be a part of all community campaigns for environment protection in your society, locality and city. Oppose any attempt to construct buildings or super markets in public grounds or parks. Oppose any attempt to cut trees or shave off hillocks. Oppose malpractices by others even if s/he is your best neighbor or friend. Follow international conferences on greenhouse emission rules and other environmental issues and share your knowledge with others.

If all of us join hands we can still save nature and our mother planet.

Exercise For Eyes – Tips On How To Use Glasses With A Vision Improvement Program

As a consumer you want to have the assurance that solutions to your problems are simple,convenient and hassle free. After all, why pursue a solution that makes your life more complicated than it has to be? This applies to your eye health as well. This issue should be examined from both sides. Because sometimes there are allowances that need to be made. These are a positive means to an end when it comes to weaning yourself off of glasses.

This is an important aspect of an eye exercise program that is frequently overlooked. Paying attention to the correct protocol in terms of knowing how to wean yourself off of glasses, can significantly speed up the progress of your vision improvement program.

For example, in cases where you have a strong prescription, it is not recommended that you discontinue your glasses immediately. Doing this puts the eyes under stress and tension. This is caused by straining to see while you are waiting for your vision to improve. Get a weaker prescription that gives you 20/40 visual acuity that will still allow you to see clearly enough to drive.

Straining to see without glasses can actually slow down your progress. Here are some tips on how to use your glasses in conjunction with your eye exercise program. The key is to use your glasses as little as possible. Use them only when it is absolutely necessary to perform important tasks. By all means apply common sense.

For instance, if you need them for driving,use them for driving only. However, if you can perform a task without them don’t use them. For example,if your phone rings take them off. If you are going on a trip and you are not the driver at the wheel take them off. If you are watching t.v sit a little closer to the t.v set. Choose the closer seat at the movie theater if you are nearsighted. If on the other hand, you are farsighted make sure that your reading room has proper lighting.

This is because prolonged frequent and unnecessary use of glasses can weaken your eyesight. These tips may seem like a hassle but which would you prefer? Straining to see without glasses which slows down your vision improvement or making a relatively simple adjustment to wearing a weaker prescription that speeds up your vision improvement significantly?

Weaker prescriptions are necessary as they help you to wean yourself off of your glasses gradually until they are no longer needed. Why is this important? It’s important for 3 reasons: It makes it easier to perform all your daily activities hassle free.2A weaker prescription will significantly reduce the stress and tension in your eyes that is caused by straining to see.3 It will give your eyes just enough room to improve naturally on their own thereby speeding up your progress.

Taking these necessary steps will speed up the rate of your vision improvement progress. You will also significantly reduce the period of time it takes to see complete improvement and These are outcomes that are all favorable to your vision.

Effects of Drug Abuse on the Liver

Drug abuse and its effects, while considerably less well-known than the effects of alcohol abuse, can wreak equally harmful havoc on the liver. When you think about it, it’s very simple. The liver is responsible for breaking down all things ingested or absorbed into the bloodstream and filtering out the toxins so the body can absorb the healthy nutrients that remain. This normal function for this organ becomes problematic when we start putting extreme amounts of toxins into our bodies, essentially making the liver work overtime to remove all of the poison so it doesn’t have adverse effects on the rest of our system. And as you can probably guess, there are not many things out there that can cause the buildup of toxins in the body the way that drug abuse can.

Heroin and the Liver

Heroin has its most profound effect on the liver through the illness of hepatitis. Hepatitis basically means the swelling and inflammation of the liver most often due to a viral infection. People can get hepatitis from using heroin regardless of the method of ingestion. Many heroin addicts get hepatitis through snorting the drug as it’s never cooked in this form. It’s also extremely common for heroin addicts to pass hepatitis from one party to another through the practice of sharing unclean needles. Hepatitis B is the most common and can be the most severe form of the virus to affect heroin addicts and others who engage in intravenous drug abuse. This is because this particular virus is generally transmitted via blood and the severity of it is linked directly to the physical health of the sufferer before they contracted the disease, and heroin addicts are notoriously malnourished and generally unhealthy.

Inhalants and the Liver

The effects of inhalants on the body in general somewhat resemble the effects of alcohol abuse. What happens here is when the various chemical vapors are inhaled, the body is immediately starved of oxygen, causing each organ in the body to work that much harder to restore it back to healthier levels. Chronic inhalant abuse can cause significant damage to the liver, which depending on the longevity of the drug abuse will determine if the organ can recover at all after prolonged abstinence. Carbon tetrachloride specifically, which was commonly used as a dry cleaning solvent and refrigerant has such a strong association with liver damage that it is actually used to induce liver disease in animal models.

How to Study for and Pass the Internal Medicine Boards

As the ABIM internal medicine certification exam approached, we received a large number of emails from our subscribers asking for suggestions on the best way to study for the boards. The truth is there is no one path to success though there are certainly ways to increase your likelihood of passing. Regardless of whether you are preparing for board certification or trying to achieve maintenance of certification (MOC), the best tried and true overall method is to “study early and study often.” Below we lay out possible strategies and tactics (in no particular order) for passing the ABIM board exam:

1. Know the basics of the internal medicine board exam

This is obvious but a lot of people simply don’t review this prior to starting their exam preparation and instead rely on their ABIM study source of choice to provide the information.

  • Review the ABIM exam blueprint and understand the topics covered on the exam
  • A large percentage (33%) of the exam is comprised of Cardiovascular Disease, Gastroenterology, and Pulmonary Disease
  • Over 75 percent are based on patient presentations – most take place in an outpatient or emergency department; others are primarily in inpatient settings such as the intensive care unit or a nursing home.
  • While it’s not a big part of the exam, be prepared and expect to interpret some pictorial information such as electrocardiograms, radiographs, and photomicrographs (e.g., blood films, Gram stains, urine sediments).

2. Use the in-training exam as a starting gauge

If you are a resident, the Internal Medicine in-training exam is a good starting point to see where you stand. It’s simply that – a barometer of where you stand. It will give you an idea where you may be weak and where you may be pretty strong. It will also give you an idea of how you compare with your peers. Don’t alter your ABIM study plan simply based on it but it does give you an early metric of the areas you need to focus on.

3. Get a study guide to prepare for the ABIM exam

It’s important to have a good study guide that is tailored for the exam. Some of the more popular and effective guides we’ve come across are the MedStudy Internal Medicine Board Review books and Harrison’s Principles of Internal Medicine Board Review.

4. Join a study group

Study groups, if utilized properly, are particularly effective because they allow you to learn from your colleagues and other exam takers. Oftentimes, people will form study groups with their colleagues (ideally limited to 3-4 people) at their residency program. Tactics to use in ABIM study groups may include:

  • Focus on a new internal medicine category by week. For example, focus one week on cardiology and the next on pulmonary care. The exam can be broken into a dozen or so categories (see the ABIM exam blueprint). The majority of the subspecialty questions on the Internal Medicine board exam will focus on cardiology, gastroenterology, and pulmonary care. However, do not neglect the other areas as the ABIM wants to ensure that internists have a broad base of medical knowledge.
  • Test each other with internal medicine questions you have written yourself. We are firm believers in the philosophy that the best way to learn is to teach. If you help others learn, your knowledge of medical concepts will be greatly strengthened.

We recognize that joining a study group is often not feasible – especially for those no longer in residency programs where everyone is preparing the boards. Fortunately, we live in a digital age where being part of a study group is much easier. You can connect with colleagues through Skype, Google hangout or a number of other channels. One of our favorite approaches is to remain informed and learn through the power of social media – in particular Twitter. In a previous post, we highlighted excellent Twitter handles to follow for ABIM exam review as you prepare for certification. If Twitter is not your cup of tea, you can also connect with colleagues through the Knowmedge ABIM community on Google+. Regardless of what approach you decide, studying alongside others preparing for the same exam is a great motivational tool for success.

5. Get a question bank that fits your personal needs

What is the value of an Internal Medicine question bank? This is a discussion near and dear to our heart, of course. Question banks have become a popular tool because they bring together a lot of material in a question format and help create a test taking environment. There are a lot of question banks to choose from – so what should you look for in an ABIM qbank?

  • High quality ABIM-style questions in a format similar to the exam: The exam is mostly filled with clinical vignettes and has straightforward questions as well. At a minimum, your ABIM exam question bank should have both of these types of questions. Quantity is important – but the quality of the questions and explanations is much more important.
  • Detailed explanations that review why the incorrect choices were wrong: A question bank that does not provide you detailed explanations is probably not worth the money and time spent. As you review questions, you will inevitably get some wrong – your choice of ABIM question bank should detail why your choice is incorrect and the reasoning behind the correct choice.
  • Ability to track your personal performance: Your choice of ABIM qbank should be able to tell you your performance overall and by category. Most – not all – question banks provide you a dashboard broken down by category. The Knowmedge question bank has gone an additional step to break the categories into subcategories as seen on the ABIM exam blueprint. This allows you to review your strengths and weaknesses at a granular level. Knowing you are weak at cardiovascular disease is great – knowing you are weak at arrhythmia questions is more valuable.
  • Add-ons – Notes, Lab values, Highlighting: Depending on how you study, these may be valuable features.

ABIM exam questions straight talk:

  • No question bank – not MKSAP, not Knowmedge, not any – knows what will be on the actual ABIM exam. Based on the ABIM Blueprint, you can make assumptions on what are the most high-yield areas to study. The point of a question bank is not to give you the exact questions that will be on the exam – it is to hopefully teach you concepts you may see on the exam and how to reason through what you don’t know immediately.
  • High-quality ABIM exam review questions can be found in many places – question banks are not the only place. There are study guides, books, and even free sources. So don’t simply base your decision on question bank on the questions. In addition to the quality of the questions, what truly differentiates one ABIM exam question bank from another is whether it will truly help you build a broad base of knowledge and help you retain information for the exam. If you are not comfortable reading a bunch of text – it won’t matter how great the questions are. If you are not an audio-visual learner, the Medstudy or Knowmedge videos won’t do anything for you (As clarity, the Knowmedge qbank contains text and audio-visual explanations for this exact reason). If you are an “old-fashioned” learner that prefers printouts – USMLEWorld is definitely not for you – those who have used them are well aware their software will block you from taking print screens or copying of their content. In short… don’t follow the herd – each one of us learns differently and you need to pick the best method for you.

6. Consider whether a review course is right for you

There are pros and cons to taking a review course for your ABIM exam prep. The pros are that it gives you a serious dose of review in a short period of time. It gets you focused if you weren’t focused and some courses are absolutely excellent – we know some internists are ardent supporters of some of the professors that teach these courses. The three most popular independent courses we are aware of are:

  • Awesome Review by Dr. Habeeb Rahman – The best known and most popular independent course. Dr. Rahman has a very unique style of teaching and accompanies his lectures with his own videos. During this six day course (Sunday – Friday), Dr. Rahman provides students his own set of notes and questions to practice.
  • iMedicineReview by Dr. Shahid Babar – This three day course (Friday, Saturday, Sunday) course comes with a set of 1,500 review questions.
  • Unique Course by Dr. Satish Dhalla – A six day course (Monday – Friday) taught by one of the Top Internists in the Nation as selected by U.S. News

The cons of a review course are that they are expensive (Often over $1,000 plus hotel stay) and can be inconvenient to travel to and from. Regardless of whether you attend a review course or not, it cannot replace the pre and post-course study time that is needed. It is complementary to study time and does not replace it.

7. Review our suggested ABIM test taking strategies

The ABIM exam questions are not intended to trick you – they are intended to challenge your knowledge and ability to bring together your understanding of many different concepts and topics. Below are some of the tactics you can use as you are practicing questions and/or taking the actual ABIM exam:

  1. For clinical vignettes, read the question (last line) first and then go back and read the scenario. This way you’ll know what to look for as you are reading the scenario.
  2. Try to answer the question even before seeing the answer choices.
  3. Pay attention for keywords that can clue you in on an etiology or physical exam.
  4. Watch for key demographic information – Geography, ethnicity, gender, age, occupation.
  5. The ABIM test is not intended to be tricky but we are all human so we miss keywords sometimes – such as “least likely” – pay attention to these.
  6. If you are challenged by a longer clinical vignette, note the key items and develop your own scenario – this may trigger an answer.
  7. Most internists we’ve spoken with say time is generally not an issue – but be aware that it is a timed exam and that you have approximately two minutes per question.

We cannot stress enough the mantra “study early and study often.” The exam is challenging but it can be conquered with diligence and proper preparation.

8. Understand and be prepared for ABIM test day

  • Be prepared and confident. No matter how you have chosen to study, on test day – confidence is critical!
  • Get a good night’s rest – last minute cramming and staying up late is only going to stress you out more.
  • Get there early – don’t risk getting caught in traffic. It’s much better to be a little early than be aggravated in traffic.
  • Take an extra layer of clothing. The last thing you want to do is be uncomfortable and cold because someone decided to turn on the air conditioner too high.
  • Test day is long! Be mentally prepared for it. From registration to the optional survey at the end, the day will be 8-10 hours long (depending on whether you are certifying for the first time or taking the maintenance of certification exam).
  • Keep some power snacks with you to take during break time.
  • Review the ABIM exam day schedule so you know exactly what to expect.

That’s a basic overview of how to study for and pass the ABIM board exam. As mentioned, there is no secret sauce or method to this – you simply need to have a broad base of knowledge. There is no substitute for studying early and studying often! If you are preparing for the ABIM Boards, we wish you well – we’re here to help so let us know if you have any questions! Happy studying!

A Massage Therapy Business – How to Make Six Figures in Your Massage Therapist Business

This article discusses if and how a massage therapist really can make six figures in their massage therapy business.

Truthfully, the median income for massage therapists is below $50,000 per year. Many earn much less than this. This is predominantly because many choose to work part time. But what about the entrepreneur who wants a full time massage therapy business and wishes to make a 6 figure income?

How To Make Six Figures From Your Massage Therapist Business

Well most massage therapists have a base rate that equates to around a dollar per minute, so an hour massage would be around $60. Mind you, I’ve seen much higher, in 2002 I stayed at an upmarket resort in Fiji that charged $250 USD per hour for a massage! But let’s use $60 per hour for this example.

6 x 1 hour massage per day, 6 days per week, 48 weeks per year. This is certainly ‘do-able’. 2 treatments in the morning, 4 in the afternoon / evening, 6 days per week with 1 month off per year for holiday, and you’re making a 6 figure income. $103,680 to be exact.

While a business like this would certainly take time to establish, it’s absolutely achievable. This leads us to 2 further questions:

1. How to make six figures in your massage therapy business while working less than this?

2. For the very ambitious – how to make even MORE than this in your massage therapist business?

1 – How To Work Less And STILL Make Six Figures In Your Massage Therapy Business?

While this work load would not be an issue for some, for others, the thought of averaging 6 x 1 hour massages per day, 6 days per week is a bit too much for their liking. So to make the same amount while working less, it’s simple, substitute some of your massage revenue with a different kind of revenue that you can still make in your massage business.

For example, let’s say you want to do 6 less massages per week. Instead of 6 per day, you want to average 5 per day. Or maybe you want to work 5 days per week rather than 6. You need to find a substitute revenue earner to bring in $360 per week.

The easiest way, sell products, here are some ideas:

· Massage oils

· Massage books

· Massage videos

· Massage pillows and rollers

· Yoga and Pilates products

· Massage novelty products – like mugs and t-shirts

You can also run a course once per month teaching massage for home use. You can specialise in a particular massage niche like:

· Face and scalp massage

· Back, neck and shoulder massage

· Couples massage

· Massage for infants

If you have just 10 people paying $200 for an all day, or weekend course, that’s $2000.

2 – How To Make Even MORE Than 100K Per Year From Your Massage Therapist Business?

When you get to a six figure income level, you may find you are so enthused with your business that you just don’t want to stop, your entrepreneurial genes kick in and you want to increase your income even further.

Of course you can add all the things I mentioned above, sell products, run courses, but there’s also another major strategy… leverage.

Leverage Your Massage Therapy Business

This means leverage your time. If you are doing 6 massages per day, all you need to do to triple your income is do 18 massages per day, except of course you couldn’t physically do it!

But if you are at this level of business expertise, you could certainly scale up your marketing to increase your clientele, and employ other massage therapists. Imagine having 1, 2 or 3 other massage therapists working for you and you keeping 50% of what they make. That’s the power of leverage.

This may seem a daunting strategy, but when you have established a successful massage therapy business and have accrued some business skills and entrepreneurial talent, leveraging your business in this way can take your income to a completely new level that you may have once thought impossible for you.

I hope these ideas on how to make six figures from your own massage therapist business have given you food for thought and inspired you to set higher goals for where you want to take your business. Other successful massage therapy businesses are doing it and reaping the benefits, why not you too?

Food For Penis Enlargement – Can 3 Sex Foods Help Grow Your Penis?

This article aims to give an honest view on whether food for penis enlargement really does make any difference or not.

Is there any natural food for making your member bigger?

While there are not any foods to eat that will actually cause bigger penile growth, your diet can have an effect on your penis enlargement efforts and even your erection strength. That said, foods we eat can influence penis enlargement because, the nutrition is the deciding factor of correct blood flow. Your erections will be bigger and more powerful than usual if your circulatory system is in good working order and if the blood vessels are allowing more blood to pass through the penis.

The main thing to look for in food is for those ingredients in food that will increase your blood flow. The substances contained in these foods are called vasodilators and they work by relaxing the smooth muscles making up the walls of blood vessels.

Some examples of really good foods are seafood, salmon, tuna. Eggs, milk, liver and green vegetables like broccoli, carrots, sweet potatoes and tomatoes are also very beneficial in your diet.

A healthy diet for your body will be healthy diet for your penis. If you eat fatty type foods that lead to clogged arteries, not only will your heart will suffer, your manhood will also. The penis depends on blood flow to enlarge it and it will not reach its full size if the arteries that supply it are blocked.

96% of men said that dietary supplements along with the correct diet actually did the trick!

100% natural herbal pills have easy to obtain formulas and active natural ingredients. They are commonly known as male enhancement pills. Using one of the most effective and well-known herbal penis enlargement pills on the market with food for penis enlargement and a healthy lifestyle will significantly improve your male enhancement results.

What to do next?

– Fill your grocery trolley with lots of fruits and vegetables, lean meats such as fish and grains like whole wheat or oats. Stay away from processed sugar white flour products and fast foods.

– Take a quality multivitamin and mineral supplement daily.

– Consider using the number one most successful, fast acting herbal supplement for a few months.

– Quit smoking. Studies have shown that smoking may lead to a smaller penis size this habit has a lot to do with decreased blood flow.

7 Homemade Detox Drinks for Weight Loss

These homemade detox drinks for weight loss are a natural way to melt the fat fast. Detoxification removes toxins and helps you reach your weight loss goals in a relatively short period of time. So naturally it’s a good idea to detox your body on a regular basis.

It’s important to note, if you plan on drinking only detoxification drinks for more than a few days, make sure your current health status allows you to change from your normal diet to a detox diet. Before doing any kind of long-term or drastic detox you should consult with a doctor.

With that said, here are 7 homemade detox drinks to help you lose weight:

  1. Tea: Tea is a natural detox drink that expels toxins from your system. Dandelion tea, green tea, peppermint tea, and ginger tea are especially effective in supporting weight loss. Drink 3-5 cups of tea daily to support your weight loss efforts.
  2. Cranberry Juice: Cranberry juice enhances the body’s metabolism, which is essential to converting fats into energy instead of excess weight. Along with eating plenty of fruits and vegetables, drinking cranberry juice is a very effective way to lose weight. Plus, this detox drink also helps clear nicotine and alcohol from your system in just about four days. Drink at least 32 ounces of 100% natural organic cranberry juice every day.
  3. Cabbage Juice: Cabbage is very effective for detoxifying your liver. And because your liver is responsible for the detoxification of your body, it is an essential part of your detox and weight loss plan. If you have a juicer, juice up some cabbage, carrots and pears for a deliciously refreshing detox drink.
  4. Cabbage Broth: For a satisfying hot drink, simmer a head of cabbage along with carrots, onions and a pinch of salt, then strain and drink. You can also add other vegetables to pack more nutrients into this hot detox drink, which is very effective for detoxifying your liver.
  5. Cucumber and Lemon: This might seem like a surprising combination, but the effects of these two ingredients was tested by professional nutritionists and found to be a very effective detox and weight loss drink. All you have to do is use a blender to mix 1 cucumber sliced into tiny pieces and the juice half a lemon. Drink at least 2 times per day. This detox drink boosts your metabolism, which is essential for losing weight quickly, and you’ll notice how it loads you with energy.
  6. Master Cleanse Lemonade: This is probably the most popular detox drink for weight loss in the industry. It was made famous by celebrities like Angelina Jolie and Beyoncé Knowles because it is an extremely effective detox drink for weight loss and for improving your skin complexion. This is a perfect homemade detox drink to lose weight fast. Mix lemon juice, organic maple syrup and a dash of cayenne pepper into a 10 oz. glass of water. Sip on this drink all day for best results.
  7. Salt Water Cleanse: At the start of your detox, you might want to do a salt water detox to cleanse your digestive system and prepare your body for weight loss. Do this on a day when you have plenty of time to stay home near the bathroom as it will run through your body very quickly. Mix 1 to 2 tablespoons of natural sea salt into one quart of lukewarm water. Do not use table salt; it will not have the same effect. Stir or shake until the salt is dissolved. Drink and then relax. Most people report a bowel movement within 30 minutes to two hours and several more may follow. Once you have cleansed your system, restore it by eating yogurt to replenish the beneficial bacteria in your digestive tract, drink juice, and eat fresh, soft-cooked and steamed fruits and vegetables.

In addition to these detox drinks, make sure to eat lots of veggies, fruits and whole grain foods that fill you up and give you the best chance for quickly losing weight.

There’s a Snake In The Yard! What to Do (and not do) When You See a Snake

First, don’t kill nonvenomous snakes. Any given area can only support a fixed number of snakes. If you kill the nonvenomous snakes that leaves a food supply that could support a population of venomous snakes.

Remember to stay a safe distance from the snake. Snakes usually strike about 1/2 their body length, but they can strike farther. You also don’t want to trip and fall on the snake.

80% of bites occur when someone tries to catch or kill a snake. The safest thing you can do if you see a snake is to leave it alone. (It’s probably protected by law anyway.)

85% of bites in the United States occur on the hand and forearm. 50% involve a victim under the age of 20. 70% of bites in the United States involve alcohol consumption.

If you have a snake in your yard, either call someone trained in their removal or stand at a safe distance and spray it with a garden hose. Snakes hate that and will leave quickly.

Step on logs rather than over them. Snakes coil beside logs in the “Reinert Posture” and might mistake your leg for a predator or prey.

Watch where you put your hands and feet. Do not reach under boards with your fingers.

Snakes can be handled safely with proper tools and training, but do NOT risk trying to handle venomous snakes if you have not been professionally trained. There are things that no website can teach you about how to handle venomous snakes safely.

You can minimize the appeal of your yard to a snake by 1. cutting the grass, 2. picking up debris, and 3. Controlling rodents. If there is no food or shelter the snake will soon leave for better hunting grounds.

The safest thing to do if you see a snake is to LEAVE IT ALONE. Most bites occur when someone is attempting to capture or kill a snake.

If you are bitten by a snake, seek immediate medical care from a licensed and experienced physician. According to the Centers for Disease Control, the first aid for snakebite consists of:

“Do remain calm – Remember that there is an excellent chance for survival, and in most cases there is plenty of time.

Do suck and squeeze – as much venom as possible directly from the wound. Venom is protein and can be taken orally with no ill effects.

Do remove jewelry – Swelling can progress rapidly, so rings, watches and bracelets can be a real problem.

Do mark the time – The progress of symptoms (swelling) is the most obvious indicator of the amount of envenomation.

Do keep the stricken limb below the heart.

Do get to a hospital as quickly as possible – Anti-venom serum is the only sure cure for envenomation, and because some people are allergic to horse serum it should only be given in a fully equipped medical facility.

In case of a Coral bite, do pull the snake off immediately – Corals’ fangs are relatively small, and they have to work at getting venom into the wound. Therefore, the faster the snake is removed the less venom is injected.

Do attempt to identify the offending snake – Positive identification in the form of a dead snake is helpful, if convenient, but no time or safety should be wasted since the symptoms will give medical personnel an accurate diagnosis.

Do get a tetanus shot.

Don’t cut the wound – This almost always causes more damage than it’s worth.

Don’t use a tourniquet – This isolates the venom in a small area and causes the digestive enzymes in the venom to concentrate the damage.

Don’t use alcohol orally – it speeds the heart and blood flow and reduces the body’s counter-acting ability.

Don’t use ice – Freezing the stricken limb has been found to be a major factor leading to amputation.”

Remember, snakes have their place in the ecosystem and were around long before we arrived. We are the visitors in their garden. Snakes are quite capable of defending themselves, but are reluctant to do so. If you follow a few common sense rules you can minimize an already very small risk of snakebite during your outdoor adventure.

Health – Entering a Hospital

A hospital is driven by the goal of saving lives. It may range in size and service from a small unit that provides general care and low-risk treatments to large, specialized centers offering dramatic and experimental therapies. You may be limited in your choice of a hospital by factors beyond your control, including insurance coverage, your physician’s hospital affiliation, and type of care available.

Before entering a hospital, you should be aware of possible dangers. Well-known hospital hazards are unnecessary operations, unexpected drug reactions, harmful or even fatal blunders, and hospital borne infections. The Institute of Medicine recently identified three areas in which the health-care system, in general, and hospitals and their staff, in specific, often fall short: the use of unnecessary or inappropriate care (too many antibiotics), underused of effective care (too few immunizations or Pap smears), and shortcomings in technical and interpersonal skills . The greatest single danger that a hospital presents is infection, which is largely preventable.

What can lay people do to ensure proper and safe care while in the hospital? The following guidelines should be considered.

If you have a choice of hospitals, inquire about their accreditation status. Hospitals are subject to inspection to make sure they are in compliance with federal standards. Policies implemented in 1989 require the release of information on request to state health departments regarding a hospital’s mortality rate, its accreditation status, and its major deficiencies.

Before checking into a hospital, you need to decide on your accommodations. Do you want to pay extra for a single room? Do you want a nonsmoker for a roommate? Do you need a special diet? Do you need a place to store refrigerated medicine? If someone will be staying with you, will they need a cot? You should try to avoid going in on a weekend when few procedures are done. When you get to your room, you should speak up immediately if it’s unacceptable.

You need to be familiar with your rights as a patient . Hospitals should provide an information booklet that includes a Patient’s Bill of Rights. The booklet will inform you that you have the right to considerate and respectful care; information about tests, drugs, and procedures; dignity; courtesy; respect; and the opportunity to make decisions, including when to leave the hospital.

You should make informed decisions. Before authorizing any procedure, patients must be informed about their medical condition, treatment options, expected risks, prognosis of the condition, and the name of the person in charge of treatment. This is called informed consent. The only times hospitals are not required to obtain informed consent are cases involving life-threatening emergencies, unconscious patients when no relatives are present, and/or compliance with the law or a court order, such as examination of sexually transmitted diseases. If you are asked to sign a consent form, you should read it first. If you want more information, you should ask before signing. If you are skeptical, you have the right to post pone the procedure and discuss it with your doctor.

Authorization of a medical procedure may be given nonverbally, such as an appearance at a doctor’s office for treatment, cooperation during the administration of tests, or failure to object when consent can be easily refused. This is called implied consent.

You need to weigh the risks of drug therapy, x-ray examinations, and laboratory tests with their expected benefits. When tests or treatments are ordered, you should ask about their purpose, possible risks, and possible actions if a test finds something wrong. For example, the injection or ingestion of x-ray dyes makes body structures more visible and greatly facilitates a physician’s ability to make a correct diagnosis. However, dyes can cause an allergic reaction that ranges from a skin rash to circulatory collapse and death. Finally, you should inquire about prescribed drugs. You should avoid taking drugs, including pain and sleeping medication, unless you feel confident of their benefits and are aware of their hazards.

When scheduled for surgery, prepare for anesthesia. In rare cases general anesthesia can cause brain damage and death. One cause of such catastrophes is vomiting while unconscious. To reduce the risk, refuse any food or drink that may be offered by mistake in the 8 hours before surgery.

You need to know who is in charge of your care and record the office number and when you can expect a visit. If your doctor is transferring your care to someone else, you need to know who it is. If your doctor is not available and you do not know what is happening, you can ask for the nurse in charge of your case.

You should keep a daily log of procedures, medicines, and doctor visits. When you get your bill, compare each item with your written record. Insist on an itemized bill.

You should stay active within the limits of your medical problem. Many body functions begin to suffer from just a few days’ inactivity. Moving about, walking, bending, and contracting muscles help to clear body fluids, reduce the risk of infections (especially in the lungs), and cope with the stress of hospital procedures that add to the depression and malaise of hospitalization.

You should be alert. Throughout your stay, you can keep asking questions until you know all you need to know. According to some experts, the biggest improvement in health care has not been technological advances; it’s been patients asking questions. The more questions, the fewer mistakes and the more power patients have in the doctor-patient relationship

Selecting a Health-Care Professional

Choosing a physician for your general health care is an important and necessary duty. Only physicians are discussed here, but this information applies to the selection of all health-care practitioners. You must select one who will listen carefully to your problems and diagnose them accurately. At the same time, you need a physician who can move you through the modern medical maze of technology and specialists.

For most people, good health care means having a primary-care physician, a professional who assists you as you assume responsibility for your overall health and directs you when specialized care is necessary. Your primary-care physician should be familiar with your complete medical history, as well as your home, work, and other environments. You are better understood in periods of sickness when your physician also sees you during periods of wellness. Finding a primary-care physician, however, may be difficult. Of the 700,000 doctors in the United States, only 200,000 (less than 30%) are in primary care.

For adults, primary-care physicians are usually family practitioners, once called “general practitioners,” and internists, specialists in internal medicine. Pediatricians often serve as primary-care physicians for children. Obstetricians and gynecologists, who specialize in pregnancy, childbirth, and diseases of the female reproductive system, often serve as primary-care physicians to women. In some places, general surgeons may offer primary care in addition to the surgery they perform. Some osteopathic physicians also practice family medicine. A doctor of osteopathy (DO) emphasizes manipulation of the body to treat symptoms.

There are several sources of information for obtaining the names of physicians in your area:

Local and state medical societies can identify doctors by specialty and tell you a doctor’s basic credentials. You should check on the doctor’s hospital affiliation and make sure the hospital is accredited. Another sign of standing is the type of societies in which the doctor has membership. The qualifications of a surgeon, for example, are enhanced by a fellowship in the American College of Surgeons (abbreviated as FACS after the surgeon’s name). An internist fellowship in the American College of Physicians is abbreviated F ACP. Membership in academies indicates a physician’s special interest.

All physicians board certified in the United States are listed in the American Medical Directory published by the American Medical Association and available in larger libraries. About one fourth of the practicing physicians in the United States are not board certified. This may mean that a doctor failed the exam, never completed training, or is incompetent. It could also mean that the doctor simply has not taken the exam.

The American Board of Medical Specialists (ABMS) publishes the Compendium of Certified Medical Specialties, which lists physicians by name, specialty, and location. Pharmacists can be asked to recommend names.

Hospitals can give you names of staff physicians who also practice in the community.

Local medical schools can identify faculty members who also practice privately.

Many colleges and universities have health centers that keep a list of physicians for student referral.

Friends may have recommendations, but you should allow for the possibility that your opinion of the doctor may be different.

Once you have identified a leading candidate, you can make an appointment. You need to check with the office staff about office hours, availability of emergency care at night or on weekends, backup doctors, procedures when you call for advice, hospital affiliation, and payment and insurance procedure.You should schedule your first visit while in good health. Once you have seen your doctor, reflect on the following: Did the doctor seem to be listening to you? Were your questions answered? Was a medical history taken? Were you informed of possible side effects of drugs or tests? Was respect shown for your need of privacy? Was the doctor open to the suggestion of a second opinion?

10 Suggestions for Themed Role plays to Spice up Your Bedroom

10 Suggestions Cop and Bad Guy/Girl,

Doctor and Patient, Arabian nights, Stripper and Customer, Maid/servant, Naughty schoolgirl/boy, The innocent, Boss and Employee, Hooker and customer,The stranger

Cop and Bad Guy/Girl

In this scenario, figure out who gets to be who. You can have any female or male combination that you’d like, so long as you keep a straight face and a pair of handcuffs handy. The partner playing the cop role may want to knock on the bedroom door and holler out, “Police, open up!” When the bad guy/girl answers the door, they can deny anything that they’re accused of. But in order to be thorough with his/her job as a cop, they may have to handcuff and perform a thorough strip search. And this means EVERYWHERE a weapon just might be found. Fun things to use include a cop uniform and a badge, handcuffs (of course), and even a play gun for effect. The bad guy/girl can plead for their innocence and offer to do ANYTHING to get out of the charges…and their clothes for that matter.

Doctor and Patient

Much like the cop scenario, partners get to choose roles to play. The doctor or nurse can also perform a very thorough examination of every part of the patient. Perhaps the doctor is trying to make sure that the patient can still have an orgasm, or a few. You can use a lab coat and a stethoscope for the doctor part. And those cold ends of the stethoscope can help to perk up a lot of places on the body, as well as the heart. And what if the insurance doesn’t cover the appointment? There’s sure to be something that the patient can work something out…

Arabian nights

For a more ethnic and exotic role play, you can set up your own harem. This works out well with a male in the power position and the women as a part of the harem. Perhaps the woman has to perform for the man as he wishes her too— belly dancing and all. Or perhaps she is new to the harem and needs a little training as to how the master wishes her to behave and please him.

Stripper and Customer

Of course, many of the readers will automatically think that the woman will be in the stripper role, but this isn’t always necessary. Men can strip just as well. The customer can make sure that the stripper works for it. Perhaps a private show is in order if the stripper isn’t as pleasing as the customer had hoped. Wearing some provocative lingerie at this point is completely appropriate– along with high heeled boots or shoes is a great touch.

Maid/servant

While the issues of who gets to serve who is a little interesting. Women are always wonderful in the little French maid outfit, but what about the men? Well, they can always be the boy toy at the command of their woman. Have them do inane things, but make sure that they’re in the skimpiest of outfits. Lots of bending over and sexual favors are mandatory.

Naughty schoolgirl/boy

If you’ve ever had a detention or just had to stay after school, you hoped that there was a way to make it more tolerable. Well, now you can live out that fantasy. No longer do you have to write your name over and over. The teacher can come up with other ways to work off the offense. And of course, the teacher will need some coercing into the ‘punishment.’

The innocent

This role play works best with the woman in the innocent position, but men can be there as well. The person who is the innocent needs to unaware that they are being sexy. Perhaps they can wear something overly provocative, like a body stocking, under their clothing and when the other one finds this, they can ‘teach’ them about how to please someone or something else that they can do.

Boss and Employee

Most people have had the fantasy about their boss or a coworker, so why not bring that into the bedroom as well? Perhaps there’s been a bed performance review or something that has gone wrong, so the employee at fault needs to find a way to correct their actions. On the other hand, perhaps the employee can talk to the boss about being promoted and offer to help with the process.

Hooker and customer

This role play is much like the stripper, but you can be a little more saucy and risky with it. Perhaps you can have the woman walk the street near the house one night in a provocative outfit, short shorts etc and be ‘picked up’ by the man as though she were a prostitute. There would be a discussion of what services could be rendered as well as payment.

The stranger

Like the prostitute role play, you can take this one out of the bedroom. Arrange to meet each other in a certain bar, but then pretend to pick one of the other up. Play it off as though you know nothing about each other. And then go home and find out everything that you can.

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