Build Muscle – How Overtraining Affects Your Ability to Build Muscle

If you are currently trying to build muscle, there is no doubt you are performing intense weight lifting sessions in the gym. If you aren’t, you’re likely not getting the results you’d like to be.

Bodybuilding is a very physically demanding exercise on the body and as such, will recover more time to recover from than other activities such as a jog, a swim, or a game of basketball.

The thing to remember with bodybuilding is that when you build muscle, you are actually tearing down your body, so that it will build itself back up. If time is not given to allow this process to take place, where do you stand? Your body is technically ‘broken’ and you won’t be seeing any muscle weight gain then.

Now, apart from not going, how else does overtraining affect you? This is not a simple issue that should be overlooked. If proper care is not taken immediately when you realize this may be occurring in your body, you could be out of the gym for months trying to recover.

Here is what it will do to you.

Decreased Testosterone Levels

If your body is not recovering between your workout sessions, your testosterone levels are going to decline. Since the body is focused solely on trying to overcome the great stimulus you are subjecting it to, it’s certainly not going to be trying to increase a hormone that is related to building, and creating a new life (since, testosterone is after all, a sex hormone).

Increase Fat Gain

Yes, that’s right. If you overtrain yourself long enough, you could be setting yourself up for an increase in fat storage.

The reason for this is because when overtraining sets in, there is a tremendous stress on the body and in response to this, cortisol is released.

This cortisol causes the body to store more body fat, especially around the abdominal region, therefore rather than gaining any muscle, you might just end up gaining more body fat.

Decreased Immune Response

Another problem that occurs with overtraining is your immune system will start to suffer and weaken.

This will put you at risk to experience colds and diseases more easily – and potentially more frequently as well, thus, not only will this take you out of the gym itself, but you may just jeopardize your health if you let it go on long enough.

Muscle Mass Loss

Finally, the last critical thing that happens when you overtrain that is the enemy of anyone out to build muscle is that you will suffer a loss of muscle mass.

So, just as you spent the last year work hard to gain those precious ten pounds of muscle, if you then start going too hard on your program, lifting too much and too frequently, you may just end up kissing

that muscle away.

This is such a hard concept for bodybuilders to grasp since common sense says the harder you work, the better you do, but there is a very fine line between doing enough and doing too much.

Making sure you don’t cross this line is going to mean the difference between you developing an amazing body and you looking mediocre, despite spending years in the gym.

Important Points to Ponder Before Buying a Health Insurance Plan

A health insurance plan is an essential part of financial planning in this era of skyrocketing medical costs. Medical inflation has been aggravating at its full spree which makes it all the more important to buy a Health Insurance plan which could sponsor the hospitalization and medical treatment bills or expenses.

It is important to evaluate and look for the following parameters to get a best health plan for you and your family.

1. Check for the Waiting Period Clause

You must be feeling care free after taking an insurance, but your health insurance comes with a waiting period clause for specific conditions. There is an initial period clause which says that any hospitalization claim will not be admissible in first 30 days of the policy commencement apart from accidental hospitalization.The pre-existing diseases or conditions are also not covered immediately after you purchase a policy.There is a waiting period ranging from 2 years to 4 years as per the plan conditions in the industry. Also, there are certain surgeries and treatments like hernia, cataract, joint replacement, etc. which can be treated after a specific waiting period of 1 or 2 years.

So,it is important to check the waiting period clause before you finalize the health plan.

2. Check for Sublimits

There are certain capping or sublimits in your health plan which says that the specific kind of expenses are paid by the insurance company upto a specific limit and beyond that the insured or customer has to bear them at his own. For example: Room rent charges are capped on per day basis for different health plans. Some health plans also come with a mandatory co-pay where the portion of the admissible claim is to be borne by the insured and the remaining is paid by the insurance company.

Check for the sublimits in your health plan to avoid any last minute surprises at the time of claim.

3. Check for Network Hospitals

The insurance companies offering health plans have certain empaneled network hospitals with whom they have a tie up. Any hospitalization or treatment taken in the mentioned or specified network hospital list is done on the cashless basis subject to policy conditions.

Check for the list of network hospitals of insurance company and ensure you have network hospitals of the insurer near your place of residence in case of any emergency hospitalization. Also, a treatment in non-network hospital may not offer cashless treatment and some insurers have a co-pay clause if you take a treatment in non-network hospital.

4. Check for the Claim Process

Different insurance companies have different claim procedures. Some settle or administer claims through Third Party Administrators (TPA’s) and some have their own in house claim settlement unit to foster quick and hassle free claim processing. Also, check the claim settlement ratio of the insurer you intend to buy a health plan from to have a clear picture on the number of claims settled by the insurer.

It is important to have a handy information on claims procedure to have a smooth and hassle free treatment in the times of hospitalization.

5. Compare & Buy Online

It is important to take a right buying decision which can be done by comparing the available health insurance plans online. You can compare the price, key features, policy benefits, value added benefits, eligibility, exclusions,etc. of multiple health insurance plans to make a right informed choice of your own without any interference of the agents. Buying online health insurance plan is a hassle free process which required least documentation and quick policy processing. There are certain online portals which will enable you to make an easy comparison and will assist you in choosing the right Health insurance plan.

Online buying of the health plan is economical as companies offer discounts on premium for buying a policy online. The reason for an insurance policy to be cost effective if bought online is because the intermediary cost of the premium component is removed. When there is no intermediary in between, Co.’s save on the commission and policy issuance cost, which the Co. transfers it to the customers.

Do evaluate your need and make a right buying decision by checking the above stated parameters.

Panic Disorder and Anxiety in the Teenage Years

The teenage years are a developmental stage typified by huge bodily, cognitive, societal and emotive transformation. This time of life indicates an evolution towards autonomy as new societal acquaintances away from the direct relations are recognized and merged and personal objectives and ambitions get focus. For a few, though, troubles with panic and anxiety might show themselves during the teenage years, bringing about major suffering and getting in the way of the important development tasks of this age. Luckily, a great deal of new information has been added concerning the character and handling of panic and other anxiety disorders during the teenage years.

Though disagreement has been present concerning the degree to which panic attacks and panic disorder happen in kids and young people, a lot of scientific researchers and practitioners now have the same opinion that panic doesn’t merely exist previous to maturity, but that it frequently starts during the teenage years. In fact, 40-60 percent of young people tell of panic attacks, whilst about 1 out of 100 young people faces panic disorder, a disorder typified by unexpected, unforeseen blasts of strong anxiety. Panic is therefore a comparatively widespread yet often misinterpreted occurrence of the teenage years.

A panic attack is described in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders. (DSM-IV; American Psychiatric Association, 1994) as an unexpected incident of strong terror, anxiety, or uneasiness which is associated with as a minimum four of the following physical or cognitive symptoms rising in strength inside 10 minutes (attacks having less than four symptoms are designated as “limited-symptom attacks”):

  • Palpitations/pounding heart
  • Sweating
  • Trembling or shaking
  • Sensations of shortness of breath or smothering
  • Feeling of choking
  • Chest pain or discomfort
  • Nausea or abdominal distress
  • Dizziness or light-headedness
  • Derealization or depersonalization
  • Numbness or tingling sensations
  • Chills or hot flashes
  • Fear of losing control or going crazy
  • Fear of dying

Three kinds of panic attacks have been recognized:

  • Unforeseen or uncued panic attacks are not linked with a situational activator and therefore happen suddenly or “out of the blue”
  • Situationally-bound or cued panic attacks nearly each time happen right away upon contact with, or expectation of, a situational activator (e.g. an adolescent feels a panic attack each time she is requested to talk before a group)
  • Situationally-predisposed panic attacks are more liable to happen upon contact with a situational cue, but do not at all times happen right away upon contact (e.g. an adolescent is more liable to have a panic attack at the movies, however, he does not at all times have a panic attack under these circumstances or he might feel a panic attack an hour into the movie)

These three kinds of panic attack might happen across an assortment of anxiety disorders. A teenager has to feel recurring unforeseen panic attacks to be given a diagnosis of panic disorder, though situationally-predisposed panic attacks are widespread in this disorder too. Situationally-bound panic attacks are for the most part characteristic of societal and specific phobias. A number of young people might feel infrequent panic attacks in the absence of an anxiety disorder.

In the majority of cases, though, young people feeling a panic attack portray experiences of imminent disaster and a strong wish to flee.

Non-clinical panic attacks are those that happen in persons who are not looking for cure. They seem to be a quite widespread feeling of the teenage years. New investigations have looked at the occurrence and character of non-clinical panic by requesting young people to complete surveys or dialogues concerning their occurrences of panic.  The following deductions can be extracted from this investigation:

  • Panic is a comparatively widespread feeling in the teenage years (36-63 percent of the teenage society samples tell of panic attacks)
  • Girls tell of feeling more panic attacks than young men
  • American young people tell of somewhat more panic attacks than Australian young people
  • The incidence and gravity of panic attacks are straightforwardly connected to anxiety, depression and stress, and are inversely connected to communal backing

King et al. (1993, 1996) have carried out two investigations meant to examine panic attacks in Australian young people. In both investigations, young people were requested to complete a panic attack survey which incorporated queries on the subject of incidence of panic attacks and linked symptoms, in addition to circumstances in which panic happened. The initial investigation looked at 246 13 to 15-year-olds and 288 16 to 18-year-olds. Of the whole sample, 43 percent told of feeling a panic attack sometime in their lives, though the majority felt just a small number of symptoms (e.g. limited symptom attacks).  The most widespread symptoms were:

  • Thumping heart (endorsed by 71 percent of panickers)
  • Trembling or quivering (53 percent)
  • Sweating (38 percent)
  • Sickness (34 percent)

Unforeseen panic attacks were told of by 21 percent of pubescent panickers. Lastly, young people who had felt panic attacks told of more elevated intensities of general anxiety, depression and terror than did non-panickers. Domestic issues were a significant factor too, with pubescent panickers telling of a smaller amount of household backing and additional family-associated stress and strain when weighed against their peers who had never felt a panic attack. It is vital for experts who work with young people to be responsive to such hazards and the part they might play in the occurrence of panic attacks during the teenage years.

Young people with panic disorder feel recurring, unforeseen panic attacks followed by as a minimum one month of unrelenting anxiety about having added attacks, fret about the connotations or costs of the attacks, or a major alteration of conduct connected to the attacks. For example, an adolescent with panic disorder might be anxious that she is losing self-control or “going crazy”, or she might think that the physical symptoms of the panic attacks are the consequence of a grave sickness.

A lot of teenagers with panic disorder progress to agoraphobia, described as anxiety about being in circumstances from which flight may be hard (or awkward) or assistance may not be promptly obtainable if the victim were to feel a panic attack. Young people with agoraphobia characteristically keep away from such circumstances, or will go into them only with a “safe person”, for example a close relative. In fact, a lot of young people with panic disorder start to keep away from an assortment of circumstances, for example cinemas, classrooms, stores, public transportation and being unaccompanied, for terror of having a panic attack.

As said by DSM-IV, there is a great deal of unpredictability in the age at the start of panic disorder, though it characteristically starts between the late teenage years and the mid-30s (though more than a few cases have their start in childhood). There is some implication that the late teenage years are the first peak for the start of panic disorder, which highlights how vital it is that adults working with young people be responsive to warning signs suggestive of the occurrence of panic disorder during the teenage years.

Whilst panic disorder and its linked avoidance can be exceptionally incapacitating for young people, other kinds of anxiety can bring about substantial suffering and intrusion in a person’s life during the adolescent years too. These other anxiety disorders often coexist with panic disorder in the teenage years, and panic attacks, as explained above, might happen in any of them.

  • Social Phobia gravely damages an adolescent’s capability to partake in societal behaviors that are significant workings of the teenage years, involving going to social gatherings and school parties with acquaintances, encountering new folks and courting.
  • Obsessive-compulsive Disorder might lock young people up into a forlorn world where they feel imprisoned by invasive feelings and rites that are frequently hard to comprehend and talk about with peers.
  • Young people affected by generalized anxiety disorder feel unmanageable concern that might cause trouble unwinding and touchiness, once more bringing about major suffering and getting in the way of relations.
  • Specific Phobias might lead a teenager to keep away from particular   circumstances they are afraid of, for example dogs, elevations or aircraft, once more limiting behavior (e.g. an adolescent with a specific phobia of flying might not be capable of joining a significant school or club excursion).

Social phobia in young people is typified by substantial anxiety in and evasion of societal or performance circumstances (e.g. courting, social gatherings, school productions) because of doubts about negative response or off-putting assessment. When confronting a circumstance they are afraid of, young people with social phobia will nearly always feel instant anxiety, which might take the shape of a situationally-bound or situationally-predisposed panic attack. Symptoms that are characteristically felt in societal or performance circumstances consist of a thumping heart, trembling, sweating, belly pain and blushing.

Young people with social phobia frequently feel strong discomfiture and terror that others will believe they seen anxious, “strange”, or unintelligent. When talking before others or having a chat, they might be anxious that their anxiety will seem palpable, with others becoming aware that they are trembling or having trouble expressing themselves. Even fundamental behavior for example eating, drinking or writing publicly might be kept away from owing to terror of humiliation. Social phobia characteristically starts in the mid-teens, brings about major suffering and gets in the way of every day behavior and societal relations.

The three-component model offers a supportive plan for recognizing, measuring and caring for panic and anxiety. Rather than describing anxiety as one overarching thing, this representation takes into account:

  • The physical component
  • The cognitive component
  • The behavioral component

All of these components are significant factors in the start, continuation and handling of anxiety. Young people will feel these components in a different way, depending on the character of their anxiety. For a few, actions (e.g. keeping away from common behavior in the vein of school parties) appear to be the leading component, bringing about the majority of the suffering and interfering. Others might feel extreme concern in which anxious feelings take center stage. Young people with panic disorder frequently recognize the physical sphere as the vital component, owing to the somatic character of a lot of panic symptoms (e.g. racing heart, faintness). But generally, all three components are there and interrelate with one another to make a cycle of panic or anxiety.

Conveniences Do Cost Money

You get home and check the mail and low and behold your credit card statement is in. Attached to it is a piece of paper that catches your eye. There is a convenience check attached. It could be for any amount like $300, $500, or maybe even $1000. The wheels in your head start spinning. There are so many things you could use the money for. You think about a fishing trip or some new gear or maybe even a present for your wife.

Woh, you should stop right there and put some thought into this check that you’re holding in your hand. Remember it is called a “convenience check”. In short for the most part all one of these checks work out to be are cash advances on your credit card. If you know anything about cash advances on credit cards then you know with them they usually carry many extra fees and unfortunately this is usually not understood by consumers.

I just want to show you a few types of fees that most credit card companies charge for cash advances on credit cards.

1. In addition to the normal interest charges you will be usually charged a 2-4 percent fee for the cash advance. So on a 1000$ convenience check you will pay an extra 20-40$

2. Something else that is quite common with cash advances are higher interest rates. Cash advances are usually charged at 18% or higher even if you have a low interest credit card. Something else is that most credit card companies only apply a small amount of your monthly payment towards the cash advance. Many companies require that you pay down the balance of purchases first before putting payments towards the higher interest advances. If you only pay your minimum you will be paying for a long time to get that advance paid off.

3. When you purchase items you usually have 30 days to pay off that purchase before you have to start paying interest on it. This is usually not true with cash advances. Quite often you will start paying interest immediately on any cash advances or when a convenience check is cashed.

4. Your credit card company has to disclose any terms that are involved with the convenience check so it is you the consumer who should be reading the fine print. If you can’t find any details on your statement anywhere then you should call your credit card company to find out any details.

There are two reasons that credit card companies charge these rates. One is to process the fees which are associated with the cash advance and secondly it is to cover all the loans that are defaulted on. So yes many times the faults of other people are passed on to the consumer.

In no way am I knocking the credit card companies. They are in the business to make money. It is up to you as an individual to make all your own decisions. The card companies are offering you this check but by all means you do not have to use it.

Dale Mazurek

The Era Of Minidisc

The MiniDisc (MD) was first introduced to the market by Sony in 1992 as a replacement to the audio cassette. Developed during the late 1980’s, MD used a magneto-optical system to store data recorded in real-time on a rewritable medium. The data could be randomly accessed allowing for quick seek-time and easy editing relative to the linear access of cassette mediums. The data was encoded and stored in a compressed format called Adaptive Transform Acoustic Coding (ATRAC). The ATRAC compression rate of 292kbps, called SP, allowed for 60, 74, and 80 minutes of music to be stored on a disc that could hold 20, 25, and 28 minutes of music in CDaudio quality, .WAV format.

The first MD machine was the MZ-1 recorder, which retailed for approximately 750 usd. It had line-inputs for optical, RCA audio single-line, and microphone. It’s line-outputs were for headphone and optical, but the optical line-out was an option that was discontinued from later releases of portable MD units. Sony licensed MD technology to other companies and soon Kenwood, Panasonic, Sharp, and others were releasing their own MD units, both recorders and stand-alone players. To further the integration of MD as the replacement medium for cassette, Sony offered the first home MD deck, MDS-101, and the first in-dash car unit, C670RDS, in 1994. Throughout the 90’s and into the next decade, MD ruled supreme as the medium for portable audio and recording in East Asia but never developed a mainstream following in North America and Europe.

In 2000, Sony introduced a new encoding method, MiniDisc Long Play (MDLP), that had two formats LP2 and LP4. LP2 extended the capacity of an 80 minute disc to 160 minutes by recording data at a compression rate of 132kbps and LP4 extended the capacity of an 80 minute disc to 320 minutes using 66kbps. Both SP and LP2 used separate stereo coding with discrete left and right channels while LP4 used joint stereo coding.

In 2002, Sony introduced NetMD, which allowed for the transfer of music files from computer to MD via USB connection. The software, SonicStage (SS), quickly developed a bad reputation for freezing systems, the occurrence of errors with operations successfully performed minutes earlier, restrictions on the number of times a file could be checked out, and requiring large amounts of system resources for operation. While SS, now called SonicStage CP (SSCP), has become a user-friendly and streamlined program, the memories of its first release and update are still recalled by product reviewers and DAP users when considering new Sony equipment.

The marketing by Sony also caused resentment among new users to MD via NetMD. On their websites and on the product boxes, Sony stated that NetMD could play MP3 files. What Sony failed to clarify was the MP3 file had to be imported into SS and recoded into ATRAC before it could be transferred to MD. The importing and recoding added time to complete the transfer to disc and decreased the quality of the original MP3 file.

Retailers of NetMD products also added to the negative sentiment by selling the product on merits that it did not have. Not being familiar with NetMD, many retailers erroneously informed customers that files could be transferred from the NetMD unit to the computer. Based upon this information, users would transfer files to an MD disc and erase the source file from their computer thinking it was available for reloading at a future time. The two-way transfer of files between computer and MD did not come about until the release of Hi-MD.

In 2004, Sony revamped the MD product line with the introduction of Hi-MD. This new format introduced 1GB disc memory, backwards compatibility with non Hi-MD discs, the ability to use Hi-MD as a USB connected drive, and the ability to upload ATRAC files encoded in Hi-MD file formats. For the field-recorder, the greatest improvement was the ability to record files in an uncompressed format called Linear PCM, which could easily be re-encoded into CD quality .WAV files. Unfortunately, no other companies opted to release Hi-MD portable units but Onkyo added Hi-MD to a series of home shelf stereos and mini-component systems. While Hi-MD has never found it’s way into home or car decks, companies such as Marantz, Teac, and Kenwood continue to release MDLP capable decks for such situations.

The latest release of a portable MD unit was the Hi-MD recorder, MZ-RH1, in April, 2006. This unit expanded upon the upload capabilities of the first Hi-MD units by allowing the upload of files encoded in the pre-Hi-MD file formats. This could be a sign that Sony wants to free itself of the MD legacy by allowing users to move all their data off MD and into their computer.

Regardless of Sony’s next move, the MD format has many adherents, both casual and diehards. The ability to copy music from external sources, in real-time, without being reliant on a computer keeps many radio users in the fold. With the variety of units and blank disc styles made available over the past 15 years, collectors have evolved who enjoy using their gear and displaying their collection on the internet and in person to anyone willing to look. Casual users of portable audio, field and radio recordists’, and collectors will keep MD alive even if manufacturers release no further products. MD is a format that requires a bit more personal attention than just downloading from an online music store and this creates a connection with the music and the medium which can’t be replaced by drop-and-drag digital audio players.

Symptoms of a Pregnant Cat – Know What to Do

When owning a cat, it is important to know what the symptoms of a pregnant cat are. When a cat becomes pregnant, pregnancy symptoms are initially noticed at approximately the three week stage of pregnancy. The average gestation period for cats is 63 days.

Listed below is a basic timetable of pregnant cats to enable you to detect the symptoms of a pregnant cat.

o Week 3

The nipples of your pregnant cat will begin to enlarge and be pinkish in color. There will be no signs of swelling in her belly during this period.

o Week 4

It is during this week that your cats belly will begin to swell slightly. The swelling will also be more apparent in her nipples. Your cats’ appetite will also begin to increase.

o Week 5

It is advised by many cat experts that you consult your vet for a growth formula. This will satisfy the increased diet of your pregnant cat.

o Week 6

It is by this point that the pregnancy of your cat becomes obvious. The symptoms of a pregnant cat will now include changes in her behavior. She will begin moving around with great care. Stretching and twisting actions will also be avoided by her, and if she generally ventures outdoors, you may find that she will prefer to remain indoors. Her appetite will also continue to increase throughout the sixth week.

o Week 7

The largest symptoms of pregnant cats are their behavior. She will undoubtedly begin to show signs of excitement. This behavior is referred to as “quickening”, and it the stage of the cat pregnancy when the fetus begins to move. She will roll and stretch and begin her search for a place to give birth. For this reason, it is advised to keep your cat indoors to ensure that she does not make her nest outdoors.

o Day 61

Labor can begin as early as 61 days after conception and as late as 70 days.

The symptoms during labor will include:

o Stage 1

Your cat will begin to show signs of restlessness, and begin either growling or purring rhythmically. This behavior can last for a few hours or as much as 24 hours.

o Stage 2

She will now begin with the contractions. The contractions may initially be once every 30 minutes or even longer. The contractions will then gradually begin to become more frequent until just before the first kitten is born. The contractions will then occur every 30 seconds. The cat may continue to growl and repeatedly
lick her vaginal area to stimulate the arrival of the remaining kittens.

It can take as long as 24 hours before all of her kittens are born, especially if she is having a large litter. Four is the typical size of a litter for a cat.

Therefore, recognizing the symptoms of pregnant cat is of great importance, to ensure that she remains healthy during the complete process.

What You Need to Know About the Blueberry Extract

Got love for Blueberries? Well, they are extremely nutritious and is one of the world’s most potential sources of the antioxidants. While the Blueberry extract is sold in the form of a supplement that is natural in nature. Due to its enormous list of health perks, the blueberry extract is always praised as a highly rich source that inhibits oxidation. These antioxidants are the anthocyanins. Moreover, they are compounds that are meant to reduce the inflammation and even guard us against heart diseases and cancer.

Why is the Blueberry Extract Used by a lot of People?

The Blueberry Extract is used for medical purposes to prevent and treat the following conditions:

• Heart Disease

• Alzheimer’s Disease

• Age-related Macular Degeneration

• Diabetes

• High Cholesterol

• High Blood Pressure

• It also provides with anti-aging advantages.

The Blueberry Juice Benefits

The research on the benefits of blueberry extract was not done so much, but from how much was done, we know that it has a lot of perks that would help us a lot. The benefits include:

1. High Blood Pressure – By consuming the Blueberry Juice, it can easily keep the blood pressure under a check that would help prevent the high blood pressure issues in a person’s body. It has also been said to reduce oxidative stress, that is a major cause in heart attacks.

2. Alzheimer’s Disease – The extract can prevent the Alzheimer’s Disease by shielding the brains from the toxic effects of the amyloid-beta. It is a substance that helps to form plaques in the brain that causes this disease.

3. Diabetes – The blueberry extract is an excellent aid for diabetes as it helped to lower sugar levels.

4. Cancer – There are a few studies that proved that the blueberry extract might help fight against the breast cancer. This is done by slowing the growth of cancer cells in the body.

Safety of the Extracts

There isn’t much about the long term use, but if you are using the blueberry extract to manage diabetes, you need to take caution while consuming it along with your diabetic medications.

Alternatives to Extract

There are many natural things that hold anthocyanins. They include the acai, bilberry, chokeberry, elderberry, and tart cherries. You can also take in whole blueberries or any other types of berries like grapes, pomegranates, etc.

Where To Find The Blueberry Extract

You can get them online in a huge variety. Visit today! Plant Nat is a 12 years blue berry extract manufactory. They have the Independent laboratory, excellent doctoral technical team and raw material production base. So they can control the quality from the source.

Life Cycle Of Indoor Black Molds and Associated Health Problems

Molds are invisible organisms that reproduce by spreading spores. Molds, often called as mildew, are parts of environment and they play crucial role in maintaining the balance of ecosystem. Molds decompose organic materials to form simpler compounds and elements. They grow on dead leaves, trees, wood and collect their nutrition from these matters thus enabling recycling of nutrients around the ecosystem. Molds and mildews are the lowest level members of Food Pyramid.

Molds are practically everywhere inside and outside your home. Being microscopic organisms, molds are not visible to human eyes unless they colonize. Molds grow on almost any surface including uncovered food, dead organic matters etc. Water and humidity are necessary for molds to grow and amplify.

Lifecycle of Molds:

Spores get spread with air, dust particles, or any other container and start growing as soon as they get humid surface, food and right temperature. The Hyphae, a threadlike structure, secretes enzymes that decompose the contaminated organic material to obtain nutrition. Then the molds start growing mycelium – the main part of mold body.

Under suitable environmental conditions like light, air, water and nutrition black mold starts growing spores within the hyphael cells. The spores, after reaching maturity, are released in the air. Mold spores can remain inactive for years and wait for suitable environmental condition to grow.

When these spores start invading your home and spore count in air becomes higher than that of outdoor, chances of forming mold colony inside home become higher. Even if the spores get a small open watery surface in any dark place, they stuck on it, germinate and mold formation begins. Unlike spores and single mold body, mold colonies are visible to naked eye. Molds when infect a surface leave black stains and that is the reason molds are often referred as black mold.

Apart from the spots and discoloration of the surface, one can recognize the presence of molds from its pungent odor. This odor helps people spot the Molds if they had chosen a hidden place to grow in. Inspect places close to water source or where water can leak out making the surface wet.

Possible Health problems and remedies:

Living in a room with black molds could lead to health problems to human beings and pets. Higher spore count in the air cause breathing trouble, asthma and more serious health threats. Some species of molds are toxic; they produce mycotoxins which have adverse effects to human health. Both adults and children can suffer from various health problems including nausea, headache, fatigue, watery eyes, excessive sneezing, irritation of skin, eyes, lungs etc. Even dead mold bodies may lead to difficulties in breathing and skin rash.

The quantity of black molds and mildew that leads to health issues varies for different individuals. Being ubiquitous, molds are everywhere. But when they spread in great number inside a covered space problems begin. Black dots on walls, carpet, drywall and the typical musty odor signal considerable mold growth which can be removed with the help of mold cleaners.

The very first step is to open the windows and let air flow inside the rooms so that spores are taken out with air current. With adequate sunlight humidity decreases and the growth of molds is arrested. If the condition is worse, consult an inspector and professional mold controllers.

Benefits of a Kitchen Exhaust Fan

The kitchen is one of the most common places of get together in many homes. It is a place to loosen up and bond with family and friends. Therefore, the kitchen should be cozy and convenient. But from all the warm images that the kitchen may present, there is something hidden that lingers, its pollution!

Kitchen can be the main source of pollutants in a home. Think all the grease, smoke, unwanted odors and moisture produced during cooking. Pollutants that stick to the walls, ceilings, carpets, furniture, and upholstery may require frequent cleaning and all the effort and expense it entails. But having an exhaust fan system will get rid all of these problems.

A good, reliable kitchen exhaust fan system is what you need especially if you are fond of cooking frying and broiling foods. Cooking methods often produce evident particles as well as an unseen mist of greases that can cover the surfaces of your kitchen if they are not vacuumed and exhausted to the exterior of your home. And, without an effective kitchen exhaust fan, air inside will be packed with dangerous contaminants and disease-causing agents released into indoor air.

Cooking releases excess moisture in the air and make indoor air very humid. If not ventilated properly and adequately, it can decrease the quality of indoor air and may lead to a number of problems like asthma, allergies, skin rashes, headaches and nausea and other breathing disorders.

It can possibly cause formation of fungus, mold spores, and mildew that may cause severe health problems. Home furniture may be warped due to excess humidity. Wall paints may crack and peel.

There are wide selections of products in the market that will keep your kitchen well ventilated. It may cover a choice of kitchen range hoods, kitchen exhausters and kitchen fans. All these products are well designed to keep the air inside your home fresh and the atmosphere comfortable.

Kitchen range hoods can furnish an attractive look and be functional additions in your kitchen. It can drive out heat, smoke, moisture and odors fast and directly. These kitchen range hoods are available in different designs and colors. This type can also provide cook top lighting and some models even offer a selection of light levels like a subtle nightlight.

Kitchen range hood are installed directly over the range to trap the heated air, smoke, moisture and gas fumes while a fan exhaust it through duct work to the exterior of the house. It has a filter that traps grease that can be easily removed and cleaned. This type of kitchen ventilator must be with the same width as the cooking surface. It serves and sets up directly over it at a height of at least 18 to 30 inches from your burners.

You can have it installed. Most of it comes with free service installation when bought. Otherwise, you can do it yourself by following the instructions in the manual.

Whatever type of exhaust fan you decide to install in your kitchen, it will definitely improve the air inside, as well as the overall environment inside your house.

Baby Allergies – What Triggers Them

Do you often see rashes on your babies' skin? Babies have very sensitive and delicate skin. It is because of this that parents should be very careful when introducing new things to these cute little ones. Everything around them should be baby-friendly and this includes mother's breastfeeding clothes.

Because baby allergies are quite common, as parents it is helpful to learn the common things that trigger baby allergies. Listed below are 5 of them.

Fabrics

This reflects to most "adult" fabrics like wool, silk, nylon, woven synthetic, and others that are not soft enough for the skin of your baby. A more baby-friendly option is cotton. This along with other natural fabrics is soft, breathable, and more resistant to fire. When choosing for your baby's clothing and your breastfeeding clothes, they should be 100 percent cotton.

Perfume

Intense scent could have the reason why your baby experiences difficulty in breathing. Strong oils and chemicals can trigger allergic reactions. Check that the items used by your babies are perfume-free. And avoid using perfume as much as possible.

Pets

Do you have pets that go in and out of the house? Pet dander can trigger skin irritations as well as wheezing, sneezing, coughing and itching. Pet fur on the other hand collections pollen and dust. These allergens are blamed for asthma. So keep your furry little pals from your baby.

Detergent and Fabric Softeners

Brands with strong chemicals are not advisable to use for washing babies clothes as they are harsh on the skin of your baby. Find mild and unscented brands when choosing detergent and fabric softeners instead.

Latex

Latex products like rubber mats have protein substances and the body reacts to it. Your baby may experience redness and itchiness after playing or changing nappies when using rubber mats.

What You Should Do

Baby allergies can ease up over time as their immunity strengnthens. Did you know that breastfeeding strengthens baby immunity? But while your baby is still in the hyper-sensitive phase of his or her life, you should be extra careful with materials and other elements that come into contact with your baby.

As your baby's skin is sensitive, it is important that you take extra care in introducing things to your cute little bubs. If you see rashes on the skin or some changes in his or her behavior, you could have given or use something your baby is allergic to. Use baby-friendly items including the clothes you wear for nursing.

Crystal Meth and the Gay Community

In recent years, crystal meth has become the drug of choice in the gay men’s party scene. Like the mainstream use of crystal meth, this trend spread from west to east – San Francisco to New York and Vancouver to Toronto. At “PNP” parties (shorthand for “party and play” – meaning sex and drugs), crystal meth, known as “tina,” increases energy and reduces sexual inhibition. The superhuman feeling that often comes with a crystal meth high means the sex is often unprotected.

The dangerous mix of crystal meth and unprotected sex got the world’s attention in February 2005 when it was revealed that a New York City man who is a frequent crystal meth user and had unprotected sex with numerous other men contracted a highly virulent strain of HIV. The virus with which he is infected is resistant to three out of the four classes of commonly used HIV drug treatments, and is so fast-acting that it progressed from initial infection to full-blown AIDS within three months.

If you are gay and looking for a drug rehab with an addiction treatment component specifically for the gay population, you might want to look at www.lakeviewfreedomrings.com [http://www.lakeviewfreedomrings.com/]. This particular center seems to have a medical component capable of managing the medical problems associated with crystal meth addiction and a staff sensitive to the needs of the gay population.

What is crystal methamphetamine?

Methamphetamine is a chemical stimulant that is similar to amphetamine, but creates a much stronger effect on the central nervous system. In low doses, it can be used to treat ADD, narcolepsy and, for short periods of time, obesity. It became a common street drug known as “speed” in the 1960s, usually taken in pill form, but lost popularity after a number of incidents that spread the warning that “speed kills.”

“Meth” was not a drug of choice through much of the 1970s and 1980s. In the late 1980s, a smokable, crystal form was created, perhaps in Asia, and then surfaced in California in the 1990s. It has increased in popularity among drug users in the past decade-and-a-half.

How does crystal methamphetamine work?

Methamphetamine releases high levels of dopamine in the brain, a neurotransmitter that is associated with pleasurable or rewarding experiences.

After it is taken in oral form, the user experiences increased wakefulness and physical activity, and decreased appetite. For some people, even low doses can be addictive.

With higher doses of crystal meth, especially if it is smoked or injected, the user immediately experiences an intense “rush” (also called a “flash”) that causes intense pleasure but only lasts a few minutes. Users can become addicted and dependent quickly, needing more and higher doses as the addiction progresses. One of the other reasons people continually return to crystal meth use is found in the “crash”. When the effects of the crystal meth high wear off, it leaves the person feeling so low, they want to return to the previous state of elation.

In high doses, crystal methamphetamine causes irritability, insomnia, confusion, hallucinations, anxiety, paranoia and increased aggression. In even higher doses, hypothermia and convulsions can cause death.

When the body is stimulated by crystal methamphetamine, the drug can cause irreversible damage. The increased heart rate and blood pressure damage blood vessels in the brain, which can cause strokes, or irregular heart beat, which can cause cardiovascular collapse and death. By vastly increasing the release of dopamine, methamphetamine appears to damage brain cells, eventually reducing the amount of dopamine available to the brain, causing symptoms similar to Parkinson’s disease and severe depression, or both.

Treatment for Crystal Meth Addiction

In almost every case, treatment for crystal meth addiction should occur in an inpatient drug rehab or addiction treatment program. The intense cravings that are associated with discontinuing the use of crystal meth are best managed in a medical detox unit on the drug rehab. In conjunction with these cravings, there are ussually a number of medical problems associated with crystal meth addiction that are best dealt in drug rehab. Most drug rehab’s have their own detox unit’s and physicians which are capable of managing the medical and psycholobgical issues associated with detox from crystal meth.

Love Yourself

Do I come first or my family or the rest of the world?

If you think your family, then you will be very surprised to know it's not because when you work extremely hard day and night, week in week out exceeding the normal work hours by over 60 plus.

And in the forefront of your mind is your family (partner, kids) with deep love in your heart for them, ever you will burn out and break down. (Your depression will start slowly)

As the time passes you by and all your children have grown up with wisdom and knowledge,

Their financial structure has been set by your hard work over the years by sacrificing your youth health you ever reach old age.

Your children will fly away like birds to find their place in the big wide world and leaving you all alone in your home.

"Your inner voice calls out"

Do this or do that? Fulfil this dream and that dream constantly torturing you and when least expected your aspirations from the past will step in and remind you of all the things you have not done or yet to be done.

However, the saddest thing will be that you will have no more energy and strength to do anything because of old age.

And the world will pass you by while you're sitting at home lonely and miserable.
You come first?

"You must love yourself before you love another, by accepting yourself and fully being what you are, your simple presence can make others happy."

You simply organize your life around your own timetable, fulfilling all of your old dreams to your new dreams and aspirations.

Do the things you love and do the things that make you happy, have one day specifically for only you and your close friends, because they bring enjoyment and fulfillment to your life, and though you will be in touch with the world?

Must;

1) Have one day for relaxation
2) Live in the present and focus on the future.
3) Be organized

It sounds good but can I really do it?

Yes off course you can just by organizing your entire week, next a month after that the entire year.

If you study any successful person in the world, you will come to realize the key fact that they were extremely organized.

Monday to Sunday you have 168 hours in the week, minus your work and sleeping hours you are left with all the free hours to do whatever you want.

Intern you will find Time for yourself, family, friends and relaxation.

You and your time are extremely precious?

The beautiful world was your servant when you entered it. The trees produce oxygen for you so you live healthy; The earth produces beautiful fruit and vegetables for you to eat.

And the animals are your servants, some you eat others use as transport and others you keep as pets.

You are so unique and precious no one has your finger prints in the entire world, which means there will never be another person like you in this world ever again.

So you have one life, one chance, one shot to be the best you can be.

Remember when you love yourself and are happy everything around you becomes happy and full of positive energy.

Like your family, friends and the rest of the world, so I hope you realize one very important fact that "you come first".

Inspirational Children's Story – Shadowflower and the Garden of Time – Part 1

In the Garden of Time there lives a flower called Shadowflower. No one knows how she got her name. All the bees are drawn to this flower for its sweetness and the way it sends out rhythms that dance on the wind. Birds sing more deeply and more beautifully when in the presence of this flower. All the little flowers, especially one called "Bright Spirit" sit at the feet of this season old flower and love to hear the story of how she got her name.

When all is quiet in the Garden of Time and the birds have ceased singing and the bees have stopped buzzing the flower that loves its own shadow begins the story of how it got its name.

Shadowflower takes a deep breath and remembers a time that once but has gone forever but is forever returning. She looks into the faraway sky and far beyond the time when her life was not as it is now. She returns to the time when in the Garden of Time she was rootless. She returns to a time when she lay in a bed that was low and devoid of any nourishment. She lay in a bed where there was little light for most of the day, everyday. There was no feeling of opening to the sun. There was only the feeling of shaving away from the light. Shadowflower felt so sad. In her sorrow she called out to the Gardener of the Garden of Time but it seemed he did not care or could not hear.

But the Gardner of the Garden of Time is not just any Gardner. He is the Gardner who comes from beyond time. He only comes into the Garden of Time when those who call really want to come out of the shadow into the light. Otherwise there is little that he can do to add nourishment to the soil or create an opening for the sunlight. So it was that Shadowflower called and called and called. Her roots began to get dry and hard and this caused her much pain. Finally she thought that she would simply go and lie in the Sun and that would end of all her sorrow and suffering.

So one very bright day Shadowflower began to uproot herself. As she was doing this the Gardener came over and came and said, Beloved of my heart what are you doing? "Shadowflower covered her eyes." The light around the Gardener came over time seemed brighter than she had ever seen before and it stung her eyes. Shrank away.

"Who are you?" She asked defensively. She had never seen this man before. She feared that even she felt very bad that he would think she was a weed. That would have been the last straw to end up being rolled up by the roots and being thought one was something as abnoxious as a weed.

"I am the Gardener beyond Time and this is my Garden. You are one of my Beloved Creations." You have been calling me and I am here to help you in any way that you care to ask me to do so, "advised the Gardner Beyond Time.

Shadowflower wanted to say, "Well you took your time coming." She wanted to tell this Gardener beyond Time person that she had been calling and calling and that now it was too late. She wanted to say like but she resisted.

"Let me help you Beloved Creation," requested the Gardener.

This only served to irritate Shadowflower even more. "Who does he think he's calling 'Beloved Creation. I'm no creation of his. I created me all by myself with some help from the soil. I've never even seen him before." Yet Shadowflower sensed something more. It was in the sound of the voice. There was such tenderness in this voice that she forgot her pain.

"OK you want to help me do you?" Asked Shadowflower with not just a little bitterness in her voice. "If your so helpful then explain to me why I have why all this shadow around me and what I did to deserve it. I've been a good flower all my life. Pain at my roots and I do not know how I can get it to go away. " At this the flower began to weep and all the petals around her sad face began to shake up and down.

The Gardener from beyond Time remained silent until she had stopped sobbing. He left it a moment and said, "Are you sure that you want to know the reason why you are in so much shadow?"

"Of course I want to know," replied Shadowflower who was feeling that this Gardner from Beyond Time was far beyond anything she had ever met before. For one thing he appeared to listen to her in a way that no one ever quite listened to her. She appeared, despite her irritation with him drawn to share her heart that felt shrunken and unalive.

"OK then," replied the Gardener from Beyond Time. "The reason why you live in shadow is because it's the Law."

"It's the Law," Responded Shadowflower. "Is that it. Your telling me that the reason is because of the law."

The Gardner from Beyond Time replied quietly, "Yes, Beloved of Creation."

Shadowflower began to shake. "Well let me tell you that you are real good to hear. That makes me real real happy to know that its because of the Law. At least now I can rest in peace knowing that all this suffering, all this pain is all this horror is because Of the Law. Gee thanks you do not know how good you have made me feel. " This was all said with sarcasm and anger. "

When she had finished venting Shadowflower shouted, "I am not your Beloved of Creation."

The Gardener from Beyond Time remained silent. This was always the way those in shadow responded to the answer he got them. He knew that you had to let them shake up and down and go bright red and have their breathing change and their angry words be heard before you could explain them to the Law.

Shadowflower took a deep breath. Then she took another. She sat down on the ground and tucked her dry roots into the dry earth. This caused her some pain. The Gardner from Beyond Time came and touched her dry body and in an instance she felt, for one joyous moment, pain free.

Whoh, thought Shadowflower. Whoh. This feels so good. You are a real Gardner. She remembered what her mother had taught her and she said, "Thank you."

"Your welcome, Beloved of Creation." Then the Gardner from Beyond Time smiled and said, "Sorry, you asked me not to call you that."

"It's OK you can call me that if you want. You seem to think its true and to be honest I can do with someone who thinks I am the Beloved of Creation. I certainly do not feel very Beloved. Feel very lovely. " Shadowflower began to cry again but this time there felt some release in crying. This time there was crying but it did not feel painful or pain filled.

Shadowflower sat quietly and felt the soil beneath her roots. It felt good and she just wanted to be there for a while. The Gardner beyond Time sat on the ground before her and let her be. After a time Shadowflower asked, "This Law," and then she explained. She was not sure if she wanted to know more but so far the results of conversing with the Gardener beyond Time had been more than she could have hoped for.

The Gardner beyond Time let her proceed at her own pace. "This Law, she began again," Tell me more about it. "Then Shadowland`s mother popped into her head as all good girl's mothers tend to do when they are tying to assert them. Then Shadowflower said reluctantly," Please. "

"This Law is Our Law," replied the Gardner beyond time.

This only set Shadowflower off on another of her rants. "Just wait a minute," she said slowly at first. Then the rant began to gather speed, "Just you wait one God damn minute there buddy. Did I hear you right or was it a bee buzzing in my ear? Law. '

"Yes that is true, Beloved of Creation."

"OK Mr Gardener beyond Time or whoever call you yourself, just answer me this question. When was I ever consulted about this Law, you call our Law. I want to tell you I do not ever remember being consulted about any such Goddamn law And let me tell you more. I do not think very much of a Law that makes good people like me suffer for no reason. I do not think very much of a law like that at all.

Shadowflower was panting. She was up off the ground. She was now stamping her roots. Strange to say that there was no pain in the movement where previously there had been little or no movement at all. She suddenly looked down and saw what she was doing. She started to leap up and down.

"Hey look at me, I can dance," she said. And so she did. She forgot the rant about Our Law and she went dancing there and then and it seemed that a lot of shadows left her face and flew off into the light.

The Gardener from Beyond Time watched her and a soft light fell from his face. He loved the dance. He loved the dance of his creation. Nothing cave him more joy than the dance of the light that he had created in all his Beloveds.

"OK friend," Shadowflower said. "I do not know what game your playing with me but it sure feels good." I'm going to take a chance on you. You seem to be able to pull some strings in this garden of Time and I think you might well be Able to help me. I'm not sure if I agree with all you`re going to show me but heck look at me I'm dancing. "

And so it was that Shadowflower went of dancing and when she returned she learned the Law.

To read Parts II and III see below

Differentiated surgical tactics in patients with colic polyps and polyposis

Modern approaches to surgical treatment of patients with colic polyps and polyposis (CPP)
Although the discussion on possibilities of conservative treatment of colic polyps, in particular -by taking non-steroid anti-inflammatory drugs, aspirin, therapeutic enemas with celandine juice, is still going on [12,14,21,25], majority of specialists [2,3,4,8,12,14,19,21,24] adhere to the opinion, that the only adequate method of treatment of the disease is surgery, and the main reason for that is cancerous transformation of the polyps. 
There are numerous publications on the issues of surgical treatment of diffuse colic polyposis. As far back as in 1923 году G. Pennington expressed the opinion, that the only radical treatment of diffuse colic polyposis is colectomy with permanent ileostoma. Until recent times the single-stage operations like colproctectomy, subtotal colectomy were treated as unsafe for patients due to significant shifts in homeostasis caused. For this reason number of authors preferred multi-step operations [18, 19, 21,]. However the recent studies demonstrated, that in this case 63,4% patients develop complications, lethality rate reaches 19,4% [21, 24], and risk of neoplastic transformation in the remaining parts of colon remains high. This makes impossible to perform the next step of surgical intervention due to increased extent of cancerous process or presence of remote metastases [1,2,3,18]. V.D.Feodorov and А.М. Nikitin [19,24] studied the results of multi-step (93 patients) and one-step (174 patients) operations.
Postoperative complications have been observed correspondingly in 63,4 и 39,1% of patients, lethality rate comprised 19,4 и 9,7%. Over recent years colorectal surgeons in such cases tend to perform sphincter-preserving operations. There are two trends: one – colproctectomy and forming the enteric reservoirs [2.3,12,19,21]; the second – using the method of endoscopic polypectomy for sanation of the remaining parts of colon before surgery and in consequent periods of observation [4.5,9,11,13,15]. 
After the report of Doniec J.M. in 2003 about usage of high frequency current during fibrocolonoscopy in treatment of colic polyps, regardless to their localization, the coagulation method became widespread. The experience to date allows holding it safe and highly efficient in CPP cases. [4, 6, 9, 26]. 
Number of authors [4, 11, 15, 16] think, that active case finding and timely removal of polyps significantly reduces the risk of development of colon cancer in 99.5% of examined patients.  
In 1983 Bergmann U. et al. for the first time implemented the method of transanal removal of benign rectal tumors using transanal endoscopic microsurgery (ТЕМ).
It is possible to remove neoplasms of lower and medium parts of rectal ampulla together with sub-mucosal layer, using specially designed operating rectoscope with three-D optics using up to four microsurgical instruments. This method provides adequate lateral resection line in case of benign tumors, and in case of malignant ones allows to expand the extent of intervention up to segmental or even to circular resection of the lesion site of the organ across to whole mass of enteric wall with formation of end-to-end anastomosis. The main application point of the method is treatment of “large” (more than 3 cm in diameter), trailing and malignant villous tumors, because electric coagulation in such cases leads to unsatisfactory results. [22,23].
Spreading of polyps through the entire gastro-intestinal tract, grave condition of patients complicates both diagnostics and choice of surgical tactics. Some authors [17.19, 21, 24] propose combination of both endoscopic and open surgery, depending on the character of the lesion and clinical course of the disease. Its important to note, that regardless to the progress in surgical treatment of CPP, the complications and fatality rates remain high enough and amount to 4-40% [17,21,24]. Multi-step operations lead to highest number of complications and lethality. Complications often occur at colectomy with abdominoanal proctectomy with pulling-through the ileum to anal canal, as well as at subtotal colectomy with ileorectal anastomosis. So, there occur: strictures of the pulled-down bowel (2.8%) и ileostomic fistulas (1.2%) [19,21,24]. Ileus, which occurs in about 3,3% patients, is the main cause of lethality at such operations. The main cause of lethality of patients in the long term is progression of cancer (24,1%). 
Thus, the choice of tactics and method of surgical treatment in CPP remains the issue of the day. Surgical tactics has to be differentiated and individual, depending on the character of the disease and the level of involvement of colon. Timely diagnostic and prognosis of course of CPP is a prerequisite for development and choosing the most effective differentiated surgical tactics. 

Objective
Development of differentiated surgical tactics in patients with CPP based on utilization of advanced complex of diagnostics and prognosis of the risk of malignization of colic polyps. 

Materials and methods
There are analyzed results of diagnostics and treatment of 183 patients with CPP, who were treated at Republican Coloproctology Research Center (RCPRC) and Republican Oncology Research Center (ROCR) of the Ministry of Health of Uzbekistan in 1998-2008. The patients were divided into 2 groups. The 1st (comparison) group consisted of 81 patients, in which the traditional examination and surgical treatment methods were used. The 2nd (main) group consisted of 102 patients in which there were applied the newly developed methods of complex diagnostic and differentiated surgical tactics. The main group consisted of 60 males (58.8%) and 42 females (41.2%), and the comparison one of 52 (64,2%) males и 29 (35,8%) females (Table 1). 

Table 1
Distribution of patients by sex and age
Age of patients (years) Main group Comparison group
Males Females Total Males Females Total
Abs. % Abs. % Abs. % Abs. % Abs. % Abs. %
Under 20 3 2,9 4 3,9 7 6,8 2 2,5 0 0 2 2,5
20-29 10 9,8 15 14,7 25 24,5 16 19,7 5 6,2 21 25,9
30-39 12 11,8 2 2,0 14 13,7 3 3,7 2 2,5 5 6,2
40-49 9 8,8 14 13,7 23 22,5 12 14,8 7 8,6 19 23,4
50-59 13 12,7 7 6,9 20 19,6 11 13,6 13 16,0 24 29,6
60 and older 13 12,7 0 0,0 13 12,7 7 8,6 3 3,7 10 12,3
Total 60 58,8 42 41,2 102 100,0 51 63,0 30 37,0 81 100,0
Average age 45,6±1,92 37,1±1,85 42,0±1,41 42,3±2,17 44,0±2,63 42,9±1,68

Average age of patients in the main group made 42.0±1.41 years, in the comparison group – 42,9±1,68 years, i.e. patients of the two groups were comparable by age and sex. 

The clinical forms of CPP in patients are presented in the Table 2.  
Table 2 
Distribution of patients by clinical features, n=183
Clinical forms Main group Comparison group
Solitary polyps 33 19
Multiple polyps 18 27
Diffuse leasons 43 28
Out of them Peuts-Jegher’s syndrome 9 2
Malignant polyposis 8 7
Distal part of intestine 70 65
Left side 12 6

Subtotal 3 4
Total 17 6
Villous polyps 14 9
Ademonatous 35 22
Adenopapillomatous 27 18
Hyperplastic 10 11
Proliferative 5 9
Cancer in citu 11 13
Complications
Posthemorragic anemia 22 31
Cachexy 7 2
Strictures 6 3
Chronic colonic ileus 7 11
Malignization 10 5
Toxic dilatation of colon 2 1
Acute colonic ileus (intussusception) 3 5
Bleeding from rectum 35 32
Colonic perforation 1 1

The main group had more severe clinical features than the comparison one (Table 2). 

Substantiation of the algorithm of the differentiated surgical tactics
We developed the complex of diagnostic and prognostic criteria for evaluation of disease severity and risk of malignization of CPP. There were identified 4 malignization risk groups – minimal, moderate, significant and high risk. On the basis of published data and on our own experience we developed the algorithm of differentiated surgical tactics in patients with CPP depending on the malignization risk group. (Picture 1). 
1 group – minimal malignization risk, includes patients with preclinical phase and initial disease symptoms, with solitary adenomatous and villous polyps no bigger than 5-8 mm, less than 10 items in total, in most cases with involvement of rectum only, that is why there were used transanal and endoscopic methods of surgical treatment.
2 group – moderate malignization risk, includes patients with multiple proliferating and hyperplastic polyps with size not exceeding 15mm, up to 50-100 pieces in total, mainly with involvement of rectum and distal parts of sigma. We, as the majority of modern authors, adhere to tactics of dynamic [7, 20] endoscopic bipolar electrocoagulation of these polyps. 
While performing the endoscopic polypectomy we were guided by the following criteria:
1) Excision has to be started from the most proximally located adenomas, to avoid traumatizing the eschar formed after coagulation during sometimes unavoidable multiple insertions of endoscope.;
2) One should not try to remove all the polyps in one step, depending of their quantity and size the polyps, the aim of the endoscopic intervention can be fulfilled in several steps with removal of 20-30 polyps in one session.;
3) First of all one should remove the biggest and suspicious in terms of malignization polyps, in which the electrocoagulation is performed on the level of basement of the pedicle with subsequent histological examination of not less than 3-4 of them, capturing into microscopic section all parts of the polyp (basement, peduncle and head);
4) All patients have to be kept under observation by the specialized facility; intervals between check-ups should not exceed 6 months. 
3rd group – significant malignization risk. There are included patients with diffuse polyposis, initial presentations of Peuts-Jeghers, Trucot, Gardner syndroms, with polyps sized between 15-30 mm, 100-500 pieces in total, of adenopapillomatous, proliferative, and dysplastic nature. In this group there is implemented two-step radical surgery tactics. During the 2nd step, if necessary, there were performed reconstructive operations. In these patients, depending on the character, level and extent of lesion there are performed either one-step resections of the involved parts of colon, or combination of resection with unloading ileostomy. The second variant is usually used as urgent operation in weak patients with significant weight loss. In several months – after stabilization of their condition – reconstructive operation with closure of the ileostomy is performed. 
In number of cases, when other organs of gastro-intestinal tract are involved – intestine, stomach or gallbladder – the simultaneous operations are performed in those cases where general condition of the patient allows. 
In the group 4 – high malignization risk, which includes patients with total diffuse polyposis of colon, intestinal polyposis of gastrointestinal tract (Peuts-Jeghers, Trucot, Gardner syndromes), malignant polyps or transformation from cancer in situ into adenocarcinoma – there are used 3 variants of surgical tactics. 
If there are gastric polyps –endoscopic bipolar electrocoagulation of gastric and colonic polyps has been performed as the 1st step. On the second step there were performed radical extended operations on colon with lymphodissection, and on the 3rd stage – reconstructive operations.
In case of polyps of intestine the first radical extended operations are performed on intestine and colon, and roughly in 1 year after that – reconstructive ones.
In case if there is no polyps in stomach and intestine the two-step tactics is used – radical extended operations on colon as the first step and reconstructive operations after 1 year as the second step. We propose the algorithm of differentiated surgical tactics in patients with CPP (picture 1). 
Picture 1.  
ALGORITHM OF DIFFERENTIANTED SURGICAL TACTICS IN PATIENTS WITH COLIC POLYPS AND POLYPOSIS

Results of treatment
The Table 3 shows the types of operations performed in the main and comparison groups. One can see that the groups are comparable by the character and volume of operations.  
Table 3
Types of operations in patients with CPP
Type of operation Main group, 
n=85 Comparison group, n=73
Transanal polypectomy 29 (34,1) 19 (26,0)
Total colectomy, ileostomy 9 (10,6) 4 (5,5)
Abdomino-anal proctectomy with pull-down of proximal parts of colon to anal canal 22 (25,9) 15 (23,3)
Sub-total colectomy with colorectal anastomosis 1 (1,2) 1 (1,4)
Abdomino-anal proctectomy, colostomy 4 (4,7) 13 (17,9)
Hartmann’s operation 3 (3,5) 2 (2,7)
Left hemicolectomy with transverso-rectal anastomosis 1 (1,2) 2 (2,7)
Duhamel’s operation with colorectal anastomosis – 1 (1,4)
Abdomino-perineal extirpation of rectum, colostomy – 2 (2,7)
Laparotomy, enterotomy, proctotomy, polypectomy, resection of intestine, side-to-side anastomosis 1 (1,2) 2 (2,7)
Sigmoid colectomy with colorectal anastomosis (CDH-29 or CDH-31 apparatus) 1 (1,2) 4 (5,5)
Total coloproctectomy, disinvagination of intestine, ileostomy 0 (0%) 1 (1,4%)
Preventive double-barrel ileostomy 1 (1,2) –
Operation of DeLorme 1 (1,2) –
Operation of Miculicz 1 (1,2) –
Reconstructive operations 11 (12,9) 5 (6,8)

In 25 patients there are performed simultaneous operations. Abdominoanal proctectomy with pulling down of proximal parts of colon to anal canal was combined in 5 patients with removal of ovarian cysts, hysterectomy, echinococcectomy and Bilroth 1 partial gastrectomy. Left hemicolectomy with transverse-rectal anastomosis in 2 patients was combined with cholecystectomy and ureterolythotomy. Right hemicolectomy with ileotrasversoanastomosis in 4 patients was combined with ovarian cyctectomy and echinococcectomy. Sigmoid colectomy with colorectal anastomosis in 3 patients combined with Kummel’s posterior rectopexy and amputation of uterus. Sub-total colectomy with colorectal anastomosis in 2 patients combined with appendectomy and ovarian cystectomy. Total colectomy with ileorectal anastomosis in 5 patients combined with cholecystectomy, gastric resection and herniotomy. Sigmoid colectomy with colorectal anastomosis in 4 patients combined with appendectomy, ovarian cystectomy and metrofiromectomy. Reconstructive operations in 4 patients combined with cholecystectomy, gastric resection and herniotomy. In 4 patients gastric resection and in 1 patient cholecystectomy have been performed due to Peuts-Jegher’s syndrome (diffuse polyposis of stomach and gallbladder). 
The data we brought confirm the correctness of the chosen surgical tactics and indicate the need to improve the methods of early diagnostics of CPP. In Table 4 there are shown the results of treatment of main and comparison groups. As it is seen, recovery rate in the main group was significantly higher than in the comparison one – 83,5±3,7% and 65,7±5,2%, and the rate of relapses was significantly lower – 1,2±2,2% и 12,3±3,5% accordingly. 
Таблица 4. 
Results of surgical treatment of patients with CPP in the comparison groups

Treatment outcome Main group, n=85 Comparison group, n=73
абс. % абс. %
Recovery 71 83,5±3,7* 48 65,7±5,2
Improvement 8 9,4±2,8* 12 16,4±4,2
No change 1 1,2±1,2 4 5,5±2,4
Worsening 1 1,2±1,2 – 0±0
Relapse 1 1,2±2,2* 9 12,3±3,5
Fatal outcome 3 3,5±2,0* – –
Footnote * – Differences between the indicators of main and comparative group are statistically valid (Р<0.05).

At the same time, one should note, that there were no fatal outcomes in the patients of comparison group, whereas in the main group 3 patients (3,5±2,0%) died due to cardiac failure (2) и ileus (1). Cardiac failure was a cause of death of 1 patient with multiple polyps, who undergone reconstructive operation and 1 patient with diffuse polyposis after simultaneous operation. Ileus was a cause of death of 1 patient with diffuse polyposis, who undergone radical (abdominoanal proctectomy, subtotal colproctectomy, single-barrelled ascendostomy) operation. As seen, fatal outcomes in the main group were attributed to severe baseline condition, and in 2 out of 3 cases they occurred after expanded reconstructive operations. 
Conclusions
1. In patients with colonic polyps and polyposis the differentiated surgical tactics should be applied, using both endoscopic and radical operations, taking into account the extent and character of involvement, as well as the risk of malignization. 
2. In order to choose differentiated surgical tactics in these patients 4 groups of severity of lesion and malignization risk have to be distinguished on the basis of criteria we developed earlier. 
3. Application of the developed algorithm of differentiated surgical tactics allows improving the treatment outcomes significantly, particularly to increase recovery rate and reduce the rate of relapses several times. 
4. As necessary the operations on colon have to be complemented by operations on other gastrointestinal tract organs (stomach, intestine, gallbladder etc.).
5. There is a need in further development of surgical tactics, preoperative preparation, anaesthetic and resuscitation management in patients with colonic polyps and polyposis, especially in the 3rd and 4th risk groups, in debilitated patients and in cases of urgent operations. 

References:
1. Axel Е.М., Davidov M.I., Ushakova T.I. Malignant neoplasms of gastrointestinal tract: main statistical indicators and trends. //Modern oncol. – 2001. – №4. – P.141-145. 
2. Barsukov Y.A., Knysh V.I. Modern opportunities of treatment of colorectal cancer //Modern Oncol. – 2006. – V.8, №2. – P.7-11.
3. Short-term and follow-up outcomes of sphincter-preserving operations with forming colonic J-shaped reservoir. /Vorobyov G.I., Odariuk T.S., Tsarkov P.V. et al. //Surgery. – 2000. – №6. – P.41-47.
4. Program of active case finding, early treatment and case monitoring in patients with precancerous lesions and early cancer of colon. //Probl. Coloproctol.– 1998. – P.154-155.
5. Veliev T.P. Endoscopic treatment of villous polyps in elderly age patients with co-morbidity. //Materials of the 1st Congress of CIS coloproctologists. – Tashkent, 2009. – P.224.
6. Videocolonoscopy and chromoscopy in diagnostics of flat adenomas of colon. /Zaikin S.I., Agadzhanian V.V., Levchenko T.V. et al. // Russian J. Gastroenterol. Hepatol. Coloproctol. – 2009. – №1. – P.66-70.
7. Galimov O.V., Rylova T.V., Khanov V.O. Endoscopy in diagnostics and treatment of gastric polyps //Herald of Surgery – 2008. – V.167, №5. – P.65-67.
8. Knyazev M.V. Is reduction of colorectal cancer morbidity possible? //”Attending Physician” М.: 2003 № 2 – P. 31-34.
9. Pobedinskiy A.A. Role of colonoscopy in diagnostics and treatment of colonic cancer. International conference “Adaptation-compensatory mechanisms of regulation of organism functions in modern ecologic conditions”. – Gomel, –2000.
10. Adler G., Fiocchi C., Vorobiev G.J., Lasebnik L.B. Inflammatory Bowel Disease-Diagnostic and Therapevtic Stratigies// Falk Symposium 154. – 2007. – P.237. 
11. Akemi Ito. Indications and limitations of endoscopic surgery on colorectal tumors Digestive Endoscopy,V12, 2000, s16
12. Bond J.H. Polyp Guideline: diagnosis, treatment, and surveillance for patients with colorectal polyps //Amer. J. Gastroenterol. –2000. – Vol.95, №11. – P.46–54.
13. Bories E, Pesenti C, Monges G, Lelong B, Moutardier V, Delpero JR, Giovannini M. Endoscopic mucosal resection for advanced sessile adenoma and early-stage colorectal carcinoma. Endoscopy 2006; 38: 231-235  
14. Cherkasov M.F. Opportunities of screening method in colorectal cancer case finding. // Actual issues of Coloproctology., Moscow, Medicine, 2006
15. Ming-Yao Su, Chen-Ming Hsu, Yu-Pin Ho et al. Endoscopic mucosal resection for colonie non-polypoid neoplasma// Ann. J. Gastroenterol.-2005. –Vol. 100. –P.2174-2179. Endoscopic mucosal resection for colonic non-polypoid neoplasms /Ning-Yao Su, Chen-Ming Hsu, Yu-Pin Ho et al. //Amer J. Gastroenterol. – 2005. – Vol.100. – P.2174-2179.
16. Nakajima T. Problem of total colonoscopy for mass screening of colorectal cancer //Dis. Colon. Rectum. – 2004. – Vol.47. – P.1052.
17. Ismailkhodjaeva Sh.U. Исмаилходжаева Ш.У. Specific patterns of course and treatment of diffuse family colonic polyposis with Peuts-Jeghers sydrom : Ph.D. dissertation abstract – М., 1998. – 24 p.
18. Melnik V.M. Poyda A.P. Method of surgical rehabilitation of patients after colectomy with extirpation of rectum. //Annals of surgery. – 2005. – №5. – P.49-52.
19. Nikitin A.M. Surgical treatment of diffuse colic polyposis: Doctoral dissertation abstract. – М., 1981. – 284 p.
20. Polyposis gastrica: endoscopic treatment or dynamic observation? /Sotnikov V.N., Dubinskaya T.K. Sotnikov A.V. et al. //Surgery. – 2007. – №1. – P.38-42.
21. Intestinal polyps and polyposis /Rivkin V.L., Kiryanov I.V., Nikitin A.M., Lukin V.V. – М.: Medpractice, 2005. – 254 с.
22. Transanal rectectomy with mesorectumectomy /Eropkin P.V. Tssarkov P.V. Peresada I.V. et al. //Surgery. – 2000. – №3. – P.25-29.
23. The device for endoscopic resection of mucosa in flat adenomas of colum. / S.I.Zaikin, V.V.Agadzhanian // Endoscopic surgery – Moscow, 2009 – P.12-16
24. Feodorov V.D., Dultsev Y.V. Main forms and stages in development of diffuse colic polyposis //Arch. Path. – 1983. – №6. – P.54-58.
25. Aspirin or events tumors in a murine model of familial adenomatous polyposis /Mahmound N., Dannenberg A., Mestre J. et al. //Surgery. – 1998. – Vol.124, №2. – P225-231.
26. Endoscopic mucosal resection for early colorectal neoplasia: pathologic basis, procedures, and outcomes / Repici A, Pellicano R, Strangio G, et al // Dis Colon Rectum. – 2009. – Vol.52, N 8. – P.1502-15.

Panic Attack Relief – Four Helpful Tips

For those of us who suffer from panic attacks and other anxiety disorders, it is easy for us to become discouraged and think there is no panic attack relief in our future. While there are probably not any over-night solutions (contrary to some of the articles and sales pitches I've seen), there are reliably easy steps you can take to help get you life back in control.

First, get to your family doctor as soon as you can for a check-up to make sure there are not any underlying medical issues that are contributing to your anxiety and panic.

Second, come to an understanding of what anxiety and panic attacks are all about. Believe it or not, most anxiety related symptoms are totally under your control. You can control what you think about and how you respond to those thoughts. It may take some time to bring your thoughts under control to get some relief, but it can be done. Just do not get frustrated if progress is slow.

Third, try to understand that there are people, events and things in your life you can not control. Try to not dwell on these issues. For example, you can not change what you did or what happened to you yesterday or last month. Try your best to forget about the past and focus on the future. Some parts of your future can be controlled, but your past is gone forever. Do not dwell on your past mistakes or think too much about what you could have done differently. Obviously, we need to learn from our mistakes so we do not repeat them in the future, but we do not need to be preoccupied with how things turned out – we need to spend more time improving our processes so our results will be Better next time. Just working with this simple idea can provide some panic attack relief.

Fourth, try to find ways to calm yourself in situations where you feel panic and anxiety coming on. One of the most important things I can do is to mentally give in to my anxiety. Sometimes the act of giving in to my attacks can actually bring relief. I used to tense up and make matters worse when I felt panic was going to be an issue. Now when I do not try to fight off an attack I find it easier to start to calm myself down and avoid a full blown attack.

There are many different methods you can use to help calm yourself down. It's important to use some of these methods every day and not just when you feel extra stress or anxiety.

One thing to try is some breathing exercises. Many of us never fully exhale in any given day, so take three very deep breaths and then exhale just as deeply. Make sure each breath is taken in a measured and deliberate fashion and protract the exhaling as well. You should do this breathing exercise several times each day.

You can also try meditation. You can find some programs that teach meditation or you can just try sitting calmly several times each day and focus your thoughts on pleasant sensations or times in your life. I went on a 10 day cruise on a 30 foot sailboat through the Bahamas several years ago and enjoyed some of the most relaxing times of my life. I particularly remember sleeping on deck one night and waking up the next morning to the sound of waves slapping the side of the boat and a fantastic panoramic view of the ocean. I can remember being very calm and relaxed. When I'm feeling stressed I still can think of my sailboat trip and get some much needed relief.

Try some of these tips and see if they will help you like they've helped me.