Thoughts, Dreams, and Emotions…

A friend can mend a broken heart
Wednesday, 15 April, 2004, 23:38 GMT
Love seems to help mend a broken heart. Having a really close relationship with another person, whether they be close friend, lover or relative, can halve the risk of suffering ongoing heart attacks, researchers suggest today.
Doctors in Manchester who monitored 600 people for a year after they suffered a heart attack found patients with someone they could confide in were only half as likely to have another heart attack as those with no one close to turn to.
The link remained after taking account of the severity of the original heart attack, the previous history of heart disease, and age.
Those without a close relationship were more likely to drink heavily, use illegal drugs, and to have had a previous heart attack, suggested the research, reported in the medical journal Heart. They were also more than twice as likely to have been separated from parents during childhood.
The screening of the patients, three-quarters of them men and with an average age of 60, included patients’ assessments of their mental health before their heart attack as well as their personal histories.
About one in four of those screened had been depressed before their heart attack, but, in contrast to the findings of some previous research, they were no more likely to have another attack or die.
The authors speculate that the loss of parents early in life may reduce the chances of forming intimate relationships in adulthood.
“Alternatively, those who do not have a close confidant may delay seeking treatment for myocardial infarction [heart attack] or may be less likely to adhere to treatment afterwards,” the authors say.
However, heart specialists should not ignore depression, they say. Other research had shown that depressed people were less likely to give up smoking after a heart attack.
The researchers, from Manchester royal infirmary and Manchester University’s department of psychiatry, were supported by the Medical Research Council and the British Heart Foundation.
Belinda Linden, head of medical information at the BHF, which provided �160,000 for the study, said: “A close relationship, whether it be lover, friend or relative, is obviously a potentially vital source of social support, which can play an important role in both preventing coronary heart disease and enhancing recovery from attack.”
Source: Guardian Unlimited

Human warmth ‘can protect heart’
Having a very close relationship with another person may be the best medicine for people who have had a heart attack, research suggests.
Scientists have shown that a strong bond – whether it be with a friend, lover or relative – can halve the risk of further heart attacks.
The researchers, from Manchester Royal Infirmary, believe having somebody to talk to helps people cope better. The research, based on a study of 600 patients, appears in the journal Heart. The volunteers who took part in the study were screened three to four days after having had a heart attack. They were also monitored for a further 12 months to assess their risk of further attacks or death. About one in four of those screened had been depressed before having their first heart attack – suggesting state of mind may influence risk. However, despite findings from previous research, these patients were no more likely to have a further heart attack or to die than the patients who were not depressed. But the researchers found that patients who had a close friend or relative in whom they could confide had half the risk of those without such a confidant. This was the case even after taking account of the severity of the heart attack and other risk factors.
Patients without a very close relationship were more likely to drink heavily, to use illegal drugs, and to have had at least one previous heart attack before admission. The finding echoes a previous study by the University of Chicago which found that lonely people’s cardiovascular systems worked differently to those of people who were not lonely, in ways which put them at higher risk of heart disease.

Stress response
Lead researcher Professor Francis Creed told BBC News Online that a variety of factors seemed to increase the risk of recurrent heart attacks. These included smoking, heavy drinking, little exercise, and poor diet – but also depression and lack of social support. He said that stress and depression tended to make the heart beat faster, and keep the body in a more aroused state. He said: “We think that people who have no close confidant may react to stress in a more pronounced fashion. “This is potentially dangerous, as in the post-heart attack phase the heart is more susceptible to arrthymias [disrupted rhythms].”
The researchers also found that people without a very close relationship were twice as likely to have lost both parents during childhood as patients who enjoyed a very close relationship with another person. They speculate that separation from parents during childhood might adversely affect the chances of forming an intimate relationship as an adult.
Belinda Linden, of the British Heart Foundation (BHF) which co-funded the research, said: “This research is helping us to understand how important such psychosocial factors can be in preventing further cardiac events. “A close relationship – whether it be a lover, friend or relative – is obviously a potentially vital source of social support, which can play an important role in both preventing coronary heart disease and enhancing recovery from a heart attack.”
Source: BBCnews

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Easter Sunday
How glorious it would be if we could help folks see that our Heavenly Father has built into each Sunday a greeting of its own: �Good morning glory, good morning grace!�
The first day of the week, each Sunday, rolls around every seven days. It punctuates each week with a reminder that our Savior �was handed over to die because of our sins, and he was raised from the dead to make us right with God.� (Romans 4:25) The Supper we share when we meet together on Sunday (Acts 20:7), the Lord�s Day (Revelation 1:10), isn�t just about remembering his death, but also about anticipating his coming again and about living as his presence as the Body of Christ in the world until that day arrives. (1 Corinthians 10:17; 11:23-26) Jesus� resurrection from the dead, and our weekly reminder of his victory over death, means that our lives are not lived in vain (1 Corinthians 15:56-58) and that we are freed from the power of death to destroy and to produce fear (Hebrews 2:14-18). Our Lord�s resurrection guarantees our own, and ensures our reunion with those of faith who have gone before us. (1 Thessalonians 4:13-18)
So what�s the point? Well, actually I want to leave you with two.
First, Easter isn�t about getting dressed up and going to church once a year to celebrate the resurrection of Jesus in the springtime. Instead, Easter is a mindset, a lifestyle. It is about living with the firm conviction that death has ultimately been defeated and Jesus has given us �new birth into a living hope.� (1 Peter 1:3) Easter is about living daily with our minds focused on things above, knowing that Christ will come and enable us to share in his glory. (Colossians 3:1-4) We are the resurrection people of God. Life is ours. Not even death can take it from us. Second, to give us our booster shot for glory, God gives us Sunday every week. This first day of the week, the day the early church called the Lord�s day because it was the day of his resurrection, is our weekly time to awaken and cry out to each other: �Good morning glory, good morning grace!� Just as the dawn gave the crushed disciples the gift of the empty tomb and the presence of a living Lord, we too celebrate that our Lord lives and our life and future are bound up with him!”

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Good Friday
The passion week of the Easter season is here, and I am so grateful for this wonderful time to reflect on what Jesus did for us. He suffered every step of the cross with us in mind. He loved us and willingly took every stripe for us. He shed His precious blood for us. May this week be a time of constant reflection in your heart and soul as you remember the incredible gift of God � His Son’s sacrifice for our salvation.
Roy Lessin has written a beautiful message of Jesus’ purpose and passion for us
He Saw You
What an incredible journey Jesus made; what an overwhelming expression of love He undertook; what an awesome purpose He had in mind. You were on His heart. When He left His home in heaven, He saw you; When He became a man on earth, He was seeking you; When he stretched out His hands upon the cross, He was reaching out to you; When He returned to His Father, He was preparing a place for you. You are the sheep He has come to shepherd, to guide, to feed, to protect, to shelter, and to carry. You are the one He calls His own.
– Roy Lessin

The surgery professor met “The Nutty Professor,” and together they hatched a plan to help people in pain waiting to see the doctor.
What if comedian Jerry Lewis asked Emory’s, Dr. Scott Boden if patients in chronic pain had a waiting room where they could laugh instead of cry or wince? Where lovely ladies and gentlemen could watch old “Honeymooners” episodes or Abbott and Costello or even “The Nutty Professor” and “Cinderfella”?
Boden was one day away from signing off on the final plans for Emory University’s new Orthopaedics & Spine Center, which will be dedicated officially today. With one little squiggle mark, Boden tore down a wall between two offices on the blueprint, and the Jerry Lewis Healing Theater, which may be unique among doctor’s offices waiting rooms, was in the works.
Today, the 78-year-old comic legend, who’s suffered his share of back problems, will be at the official grand opening of the Emory Orthopaedics & Spine Center, of which the healing theater-waiting room is a centerpiece.
“I met Jerry about a year ago, and we just sort of hit it off,” said Boden, an orthopedics professor and director of the center. “And he mentioned he’d always dreamed of one day having a waiting room that would be a cheery place, sort of a ‘laughter is the best medicine’ sort of thing. And we just worked it out. It’s just amazing.”
However, the $12 million free-standing clinic is about far more than the theater of Emory Healthcare. It signifies a new entrance by Emory into the Atlanta orthopedics market and orthopedics research. It’s not solely academic, either. Orthopedics is the fifth-largest moneymaker from surgeries for hospitals, according to the American Academy of Orthopaedic Surgeons.
The specialty, which treats bones, joints, and muscles, is expected to grow even more as baby boomers age; the AAOS predicts about 7 percent a year shortly.
“It’s a fascinating thing. If you look at my grandparents’ age, they just accepted aging. But now, baby boomers are not willing to slow down,” said Dr. Michael Schaufele, a physiatrist, or nonsurgical orthopedist, at Emory. Obesity, too, is playing a role in the growth of the specialty, the doctors said, as excess weight causes back and joint problems throughout the body.

Large clinics like Peachtree Orthopedic Clinic and Resurgens have long been leaders in metro Atlanta, and Piedmont Hospital’s orthopedic staff numbers are more than 30. “I think it will create some closer competition, but we’re up to the challenge,” said Nina Montanaro, Piedmont Hospital spokeswoman.
The Emory clinic will have 26 doctors, Boden said. Its features will be a sports medicine clinic with a special, private waiting room for celebrity athletes, filmless x-rays, and a spine center. Boden expects a surge in patient visits, from 65,000 at Emory’s former location on North Decatur Road to 100,000 patients at the new clinic this year.
Many will wait in the theater, with 15 red-leather stadium-style seats, a carpet with Lewis’ likeness woven into it, and a plasma-screen TV to show old comedies. Pictures of the world’s most excellent comics hang on the walls. There’s also an option for people who don’t want to watch the scheduled feature; four carrels behind the stadium seats will have small, private screens where patients can choose a film.
“This is not intended to be a shrine to Jerry Lewis; it’s a place of laughter and healing for anyone,” Boden said. Even though the center will be officially dedicated today, doctors have been seeing patients in some departments since Dec. 29.
Jay Knox, 38, of Avondale Estates, has been to the clinic twice for chronic neck and back pain. “It’s incredible,” Knox said. “This is my second time with this, and it is so nice to go in, park right there, and not have to go from place to place. And the waiting room chairs are incredible. Wow, I can’t believe I don’t have to sit in chairs that will make my back feel worse.”
Source: The Atlanta Journal-Constitution ajc.com

How to Reduce Your Risk of Heart Disease and Alzheimer’s
Jan. 14
It is one of the greatest fears of growing old: losing your memory to Alzheimer’s disease.
An estimated 4.5 million Americans have the disease and the number is growing. But who are those most at risk? Researchers are now discovering a direct link between Alzheimer’s and heart disease.
This link between brain damage and heart damage was discovered during a series of autopsies more than 20 years ago. While working in the Kentucky medical examiner’s office, Larry Sparks was checking brain tissues looking for early signs of Alzheimer’s disease. He noticed that those who had the telltale plaques of Alzheimer’s had one thing in common: “I took the slides � and put them into two piles, those with heart disease and those without heart disease. And all the plaques and tangles showed up in the pile with heart disease,” said Sparks, who is now a scientist with Sun Health Research Institute in Arizona. That finding, for the first time, suggested heart disease could be a forerunner of brain disease. “The link between heart disease and Alzheimer’s disease is growing in strength every few months,” said Bill Thies, the scientific director of the Alzheimer’s Association. “And we predict it will continue to grow.”
“I’m not surprised that there’s a relationship,” he said. “The heart is the organ that supplies essential elements to many parts of the body, and the brain is just one of the first.”

Risk Factors
A series of studies has revealed that the very same risk factors for heart disease also put people at greater risk of developing Alzheimer’s.
In one study, people with high cholesterol in their 40s and 50s were three to five times more likely to become demented in their 60s and 70s. “We found that excess cholesterol in the blood,” Sparks told ABCNEWS, “leads to increased cholesterol in the brain and that increased production of cholesterol in the brain promotes production of plaques.”
High blood pressure � above 140/90 � also increases the risk of Alzheimer’s by damaging blood vessels. “They become more stiff and this may lead to a decrease in the nutrients that can get to the brain and feed cells in the brain,” said Lenore Launer, chief neuroepidemiologist at the National Institute on Aging. Moderate smoking � 10 to 20 cigarettes a day � according to some research, can double or triple the chances of becoming demented. “With every cigarette you smoke, there’s probably an increased risk,” Launer told ABCNEWS. And preliminary Obesity research suggests the more overweight you are at 70 years of age, the greater your Alzheimer’s risk. The good news, researchers say, is that this is the first set of risk factors they’ve identified that people can actually do something about. Medications and lifestyle changes that have been used to promote heart health may actually protect brain health as well.
Source: ABCnews.com

Dieters seek alternatives to ephedra: Side effects of many substitutes unknown, FDA warns
Updated: 5:46 p.m. ET Jan. 12, 2004
People who think ephedra helped them lose weight are looking to new ingredients with names like guarana, bitter orange and green tea extract to replace the soon-to-be-banned dietary supplement.
There’s little proof yet that ephedra alternatives actually burn pounds, and scientists warn that some come with health considerations of their own, including an ephedra mimic that might interact dangerously with medicines the dieter also swallows.
“There are a number of, quote-unquote, `ephedra substitutes’ on the market now where even less is known about potential side effects,” Food and Drug Administration Commissioner Mark McClellan cautioned in an interview last week.
The FDA will pull ephedra off the market soon and wants consumers to stop immediately using the herbal stimulant, which is linked to 155 deaths and dozens more heart attacks and strokes.
Many consumers are ignoring that advice. There has been a run on remaining ephedra supplements since FDA’s warning two weeks ago, even though studies show ephedra helps people lose only a few pounds more than dieting alone.

Users eye ingredients
Still, as January ushers in postholiday diets, Americans are turning to the burgeoning ephedra-free market, too. Topping the lists of new ingredients are caffeine-containing supplements, some that deliver the buzz of at least three cups of coffee in one dose. Not all mention caffeine on the label; consumers may have to learn herbal aliases such as guarana and green tea to ensure they don’t get caffeine jitters by taking multiple supplements.
The ingredient drawing the most attention is bitter orange, which McClellan says the FDA is monitoring closely because it contains synephrine, a stimulant chemically similar to ephedra.
Also called citrus aurantium, the peel of this very sour “Seville orange” is found in some foods like orange marmalade.
“It’s not as potent as ephedra unless you take it in much higher doses,” says Mark Blumenthal of the American Botanical Council.
But some scientists note that synephrine can increase blood pressure and constrict blood vessels, as ephedra does, and question whether using it with caffeine could worsen those effects the way taking ephedra with caffeine does.
“There’s not really a reason to think citrus aurantium will be safer,” says Dr. Adriane Fugh-Berman of Georgetown University, an expert on herbal supplements.
More worrisome, she says, is that bitter orange could interact dangerously with prescription or over-the-counter drugs.
Why? It’s related to a longtime warning against taking medications with grapefruit juice. Grapefruit contains a natural chemical that inhibits one of the body’s drug-metabolism routes so that some medicines build up to dangerous levels, and bitter orange contains even more of that drug-boosting substance, says Fugh-Berman.
Studies to date show bitter orange inhibits metabolism of at least two drugs, the popular over-the-counter cough medicine dextromethorphan and the prescription blood-pressure drug Plendil.
As for shedding pounds, there’s no evidence in people yet that it works.

Other ephedra alternatives:
Green tea extract. Green tea typically contains less caffeine per cup than coffee, plus many antioxidant vitamins.
Caffeine itself can be a mild appetite suppressant, and proponents say there may be other substances in green tea that could slightly speed calorie burning. There’s no evidence yet that green tea causes weight loss, but Fugh-Berman calls the possibility interesting and says the substance probably is harmless.
Guarana, used in a popular Brazilian soft drink, contains two to three times as much caffeine as coffee, Blumenthal says. Other caffeine-containing supplements are kola and mate.
Garcinia, also called hydroxycitric acid. A Journal of the American Medical Association research review found no good evidence of weight loss.
“Starch-blocking” pills promise to help starchy foods pass through the body with less calorie absorption. Most are made with kidney-bean extracts not thought to be harmful. Supplement giant Metabolife International cites a small study that found users dropped slightly more weight than regular dieters, but the research has not been published.
Old-fashioned fiber works on the same principle and can fill people up so they eat less, notes Fugh-Berman. But she says it’s impossible to get as much fiber in a pill as from a glass of Metamucil, made with the soluble fiber psyllium.
Bladderwrack, an herb that contains a lot of iodine, which could cause or worsen thyroid disease, notes a recent supplement review by University of Montana pharmacists. Germany, which strictly regulates herbal medicines, lists bladderwrack as unapproved, citing the health risk and lack of evidence that it burns pounds.
Source: The Associated Press

Time For A New Pediatrician?
NEW YORK, Jan. 10, 2004
One of the best ways to ensure your child stays healthy is to have a good pediatrician.
The Saturday Early Show‘s Dr. Mallika Marshall provided some advice on finding the right doctor for your child and deciding when it may be time to choose a new one.
After parents, your child’s doctor is one of the most important people in his or her young life. A pediatrician is the guardian of your child’s health. Marshall says there are many chronic conditions that start in childhood and if you don’t have a good doctor, these illnesses may not get detected, which could spell long-term trouble for the child. Marshall says to switch if you are in any way unhappy with your pediatrician. And when initially looking for one, be very selective.
Marshall suggests you look for the following qualities when choosing a pediatrician:
Good Talker: Your pediatrician will probably be leaving you with instructions once the exam is over. Marshall says it’s very important that your doctor speak in a way that you can easily understand and that he or she uses terms that are recognizable. The doctor’s advice will be of no use if you can’t make out what was said.
Patient Disposition: In today’s world of managed care, doctors are busier than they have ever been. That said, Marshall says you want a pediatrician who will sit and listen to your concerns and not rush you out of the examining room. Marshall advises that you make a list of topics you would like the doctor to address. The list will make you better prepared to make good use of your time with the doctor.
Strong Support Staff: Doctors rarely work alone. They are often part of a larger practice, which includes nurses, practitioners and various other staff members. Marshall says often you will spend more time with the support staff than you will with the doctor. So make sure these people are competent and that you get along with them.
Easily Accessible: Children don’t just get sick Monday through Friday between the hours of 9 a.m. and 5 p.m. You need a doctor who can tend to your child when there is an emergency over a weekend or on a holiday. This doesn’t mean your doctor will be at your beck and call. But a good pediatrician will either help you directly or refer you to another competent medical professional during these off hours.
Qualified Partners: There will be times that your child may get sick while your regular doctor is away. You want to make sure that the other doctors in the practice are just as qualified and are also as easy to deal with on a personal level. There is nothing worse than being a parent of a sick child and having to deal with an unfamiliar doctor who is not considerate of your concerns.
Marshall says to switch pediatricians as soon as you no longer feel comfortable having your child under your current doctor’s care. While it may take a little time to find a new doctor, she says it will be well worth the effort.
And she says one of the best ways to find a good pediatrician is by asking friends who can give you a first-hand account of how the doctor works. Another good person to check with is your obstetrician. And you can always get a recommendation from your hospital. Before you begin going to the new doctor, Marshall recommends scheduling a short “meet and greet,” so that everyone is on the same page.
Source: cbsnews.com

A Very Special Brain
Jan. 7, 2004
The brain, the most complex of all organs, defines us in more ways than we can even think about. There are about 35,000 genes in the brain, and if only a few of those are missing, the result can be devastating and fascinating.
Williams Syndrome is a rare birth defect in which about 20 genes are missing. Six years ago, correspondent Morley Safer reported on people diagnosed with Williams Syndrome. Their stories were so fascinating that 60 Minutes II decided to go back to see how they�re doing.
But first, here�s a look back at 1997 in this 60 Minutes classic.
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Gloria Lenhoff remembers more than 1,000 songs, yet she can�t add 5 plus 4. Michael Williams can play almost anything, yet he can�t go out the door without getting lost. Meghan Finn studies music in college but can�t tell left from right.
60 Minutes met these remarkable people at a music camp in Massachusetts — people with profound disabilities but with an equally profound passion for music. They often have unusual, almost elfin features. Their IQs average in the 60s, but they have the social skills of talk show hosts, what�s been called �cocktail party personalities.�
To a stranger, any sense of their handicap quickly disappears, and one is overwhelmed by their friendliness and openness.
�Music is a huge part of my life. To me, music is like soup. Music comes down to your throat. It feels so warm. So music is like soup. It tastes good,� says Meghan.
Gloria says she can sing in 25 languages: �I could sing in Macedonian, Korean, Yiddish, you name it.�
Among the things that seem to be common among people with Williams is extremely sensitive hearing. It�s remarkable. They can even hear whispering.
But part of that really sensitive, acute hearing is a negative reaction to loud noises. For example, thunder sounds like a cannon going off to Meghan: �Just shot off, right next to our house, and it made me cry so hard.�
For the most part, they are among the happiest people you�ve probably ever met. And they can�t stop smiling. But are they really happy most of the time?
�Yes, I am,� says Bob. �I am, too,� adds Jason Dennis.
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Michael Williams had always known he was different, but he only learned last year that his condition had a name. For the first time, at the music camp, he met other people just like him.
�Somehow, I felt that I fit in,� says Michael, who is most comfortable at the piano. But as a child, his parents never dreamed that he would be capable of handling the complexities of the instrument.
�My other kids had piano lessons. He didn�t, we didn�t think he could do it. After they went out to play, he would sit down � for hours on end, for days on end. And all of a sudden, one day he played a song,� says Frank Williams, who admits he was devastated when his son was born and he clearly wasn�t normal.
But that changed a long time ago. �We were blessed,� says Michael�s father.
�The opportunity to study an individual with Williams Syndrome is exciting. It provides a window on brain development,� says Dr. Barbara Pober, who runs a Williams Syndrome clinic at the Yale University School of Medicine. �We can learn an awful lot about what it means to have a handicap from folks with Williams Syndrome.�
And what it means to be shunned and isolated. Last year, Meghan tried living in a college dorm. While she did make a few friends, her mother, Liz Costello, says she had a rough time: �She doesn�t fit in. She knows she doesn�t fit in. That�s very hard.�
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Since that story first aired, we�ve learned more about Williams Syndrome. Most people who have it are not only using different parts of their brain when they listen to music, they�re using more of it than the rest of us. And they are more engaged emotionally.
Michael Williams is still most comfortable at the piano. 60 Minutes II caught up with him in September performing at a retirement home in upstate New York.
We also went back to see some of our Williams friends when they got together for one last time at that music camp in Massachusetts. Ben, a very grown-up 17-year-old, plays the drums. Gloria has made two CDs, and now sings in 30 languages. Jason is playing the drums and working part-time at a video store.
And Meghan is living in California, and attends regular classes at a local college, where she�s learned to ignore people who make fun of her. �I�m not gonna be pushed or shoved or anything like that � because nothing�s gonna pass me by. I�m a tough woman,� she says.
And, we met two new faces, both pianists and composers: Tori, 22, and Alec, 18. Alec was barely two months old when his mother, Lori Swaezey, sat him down next to her while she played a jazz piece on the piano.
�When I came to a certain whole note in the piece, he matched the note, and just sang, �Ooh.� I looked at him and he smiled like crazy and was kicking his legs,� recalls Swaezey. �I couldn�t believe it. I knew there was some very spooky connection with music at that point.�
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While there�s no question that those 20 missing genes can have a devastating effect on the lives of people with Williams, it also seems to create an undeniable bond among them.
�When I�m with, like, all of these people that are around me right now, I feel like I fit in,� says Tori. �I feel safe. All these guys have taught me not be negative and you know, I�m just happy.�
And they have remained positive through tremendous adversity. In Ben�s short life, he�s already been through five major surgeries to correct heart and spinal problems � problems that can be common for people with Williams. His mother, Terry Monkaba, told Safer that music got him through a very tough, young life.
�From when he was very small, music was the thing that calmed him down. And music is what taught him to walk. He didn�t walk, he marched to music when he was 4-and-a-half,� says Monkaba, who admits it�s been difficult for them as a family. �Benjamin has a two-years younger brother who has really been angry for many years because he was cheated out of a regular brother. So it makes family life, you know, very difficult.�
When we last met Dr. Pober, she was running a Williams Syndrome clinic at Yale. In June, she left for further genetic study, but her connection with Williams patients remains strong. Since our first story, the human genome project has been completed. Geneticists now know that most people with Williams are missing the same 20 genes. And they think they know why they are so engaged by music.
�There was a very recent study that had individuals with Williams Syndrome listen to music, and then had controlled individuals listen to music and compared the areas of the brain that were activated,� says Pober. �Folks with Williams Syndrome activated more brain areas and not the same area that you or I would activate. So, it was an overall greater activation � The underlying differences could explain why persons with Williams Syndrome are so much more connected to music. Seem to respond to music differently.�
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The great tragedy of Williams, however, is that they know they�re ill. �They�re smart enough to know they�re different. And that is a great hardship for most adolescents and adults,� says Pober.
In Meghan�s case, her mother says she�s accepted that she will never have children, but still has great anxiety about being alone.
�She said to me a couple of years ago, �You know, mom, I just wanna have someone that I can grow old with, too. And have somebody, you know,�� says Liz Costello. �And so, she has a friend who has Williams Syndrome who�s, she�s engaged to be married. And she said, �Part of me is so happy and the other part of me is so sad �cause I don�t have anyone.� But you know, who knows what the future�s gonna bring? You know, who knows?�
Last summer, with her mother looking on, Meghan recorded a song for her own CD. �I sometimes ask myself why are we going through this CD thing, but boy, it�s magical. It�s just magical,� says Meghan�s mother.
�She has a disability. She�s not a savant. There are many things she can�t do, she won�t be able to do. But you know, she has something that when she sings, people love to listen to her.�
Source: cbsnews.com

Pneumonia: What Lurks in the Lungs
Jan 6, 2004
Now that fear of the flu has reached SARS-like proportions, it’s time to remember that influenza season is also pneumonia season. In fact, some pneumonias can be caused by the flu, or follow an influenza infection. Pneumonia is an infection of the lungs that most commonly affects older people but can also affect children and younger adults. While pneumonia caused about 62,000 deaths in the United States in 2001, it can usually be treated with antibiotics.
And a preventative vaccine exists for pneumococcal pneumonia, the most common type of pneumonia. But like the flu vaccine, this year there is a limited supply of pneumococcal conjugate vaccine.
Below, pneumonia researcher Michael Fine, M.D., a professor of medicine at the University of Pittsburgh and director of the VA-Pittsburgh Center for Health Equity Research and Promotion, discusses the different types of pneumonia and why prevention or early treatment is best.

What is pneumonia?
It’s an infection of the respiratory tract that is typically characterized by a broad array of signs and symptoms. The infection is usually termed community-acquired pneumonia to differentiate it from that acquired in the hospital.
The lungs are comprised of very tiny sacs called alveoli. This is where the oxygen that we inhale comes into contact with circulating blood through capillaries, or tiny blood vessels, and where the oxygen is exchanged. In pneumonia, those tiny sacs become filled up with infectious material.

Who is at highest risk for pneumonia?
Among adults, risk increases with age. So the older you are, the greater the likelihood to get pneumonia. If you’re a smoker, you have a slightly greater increased risk because smoking diminishes the lung’s capacity to fight infection.
Anyone who is a drug abuser or an alcoholic, who has impaired levels of consciousness that can affect the gag reflex, would be at increased risk because they can inhale their own throat secretions. Patients who are immunocompromised for one reason or another, whether they’re taking systemic corticosteroids for something like asthma or if they’re receiving chemotherapy or radiation therapy for cancer, would be at increased risk.

What are common symptoms?
The symptoms can really be divided into two categories: typical respiratory symptoms and nonrespiratory symptoms. Respiratory symptoms would include cough, coughing up mucus, shortness of breath and chest pain. A less common respiratory symptom would be coughing up blood.
Then there are a variety of nonrespiratory symptoms, the most common of which�and probably the number-one symptom overall�is fatigue, which is present in about 90 percent of patients. You can also get headache, muscle aches, abdominal pain, fever and chills.
And, it’s possible to be asymptomatic, but quite unlikely. But frequently, in the elderly, the symptoms are subtle. For example, patients who are older may not have a severe temperature. They also may have more atypical symptoms, such as abdominal pain, rather than classic pulmonary symptoms.

What is meant by walking pneumonia?
That’s a lay term and it refers to a mild case, perhaps in a younger person, that can safely be treated in the outpatient setting.

What causes pneumonia?
We usually think of infectious causes and, within that category, there are both bacteria and viruses. In adults we think bacteria first because it’s more prevalent.
Within the types of bacteria, there are the bacterium called Streptococcus pneumonia, which causes pneumococcal pneumonia, and then there’s one called Haemophilus influenzae. These are probably the first and second-most common causes. Haemophilus influenzae may be more common in smokers and patients who have underlying chronic emphysema or bronchitis.
Viruses probably account for 20 percent to 25 percent of community-acquired pneumonia in adults. And in children, there’s a much greater likelihood that the pneumonias are caused by a virus than a bacteria.
The influenza virus can cause pneumonia, though not frequently. And following influenza, patients also become more susceptible to developing bacterial pneumonia.
And then there are a variety of less common organisms that cause pneumonia such as Mycoplasma, Legionella and Chlamydia. There are many other causes that are probably infectious but we can’t uncover what the actual agent is.

Is it possible to have the bacterial and viral pneumonias at the same time?
Yes, it’s possible to have bacteria and a virus or two types of bacteria at one time. Probably 10 percent to 15 percent of infections are due to that type of bacterial co-infection.

Do the symptoms vary depending on the types of pneumonia you have?
Traditional wisdom said yes, but in fact when people have looked at that, it’s really impossible to differentiate the cause of the pneumonia based on the symptoms.

How is pneumonia usually diagnosed?
The diagnosis requires the presence of some of the clinical symptoms. And then in adults, the gold standard is to obtain a chest X-ray and to find a shadow called an infiltrate on the chest X-ray.
When you take an X-ray of the lungs, usually the air shows up as a very dark, almost black, space on the chest X-ray. When the lungs become filled up with this infectious material, it looks white on the X-ray and that’s what’s called the infiltrate.

Do you think that chest X-rays are being done as often as they should be?
Unfortunately, if you’re a physician practicing in the community, particularly in a rural setting, there may not be access to X-rays. So I think there may be a tendency in certain parts of the country to treat with antibiotics based on symptoms without ever formally establishing the diagnosis. So I think we may be under-utilizing chest X-rays to make the diagnosis.

How is pneumonia spread?
Most cases of pneumonia that are bacterial in origin are not necessarily transmitted from person to person. These bacteria actually reside in people’s normal respiratory tract systems: in their throats, their pharynx, their nose. Everybody has a small content of material from the throat that gets into the lungs, and then normally the person’s defense mechanism sweeps that out. But sometimes the body isn’t able to defend against that and that’s when the infection starts.
Some types of viral pneumonia, however, can be transmitted by droplets, so if you cough or breathe on someone, they are transmittable. But most cases of bacterial pneumonia are not passed from person to person that way.

How is pneumonia treated?
In adults, it’s typically treated with antibiotics. For patients who are healthy enough to be treated in their own homes, usually we treat them for seven to 10, sometimes up to 14 days with antibiotics by mouth.
About one million of the four million cases nationally require hospitalization. Patients in the hospital typically get a course of intravenous antibiotics. The duration of that course of intravenous antibiotics really depends upon their response to therapy. Once their vital signs begin to normalize and their temperature begins to come down and they have adequate oxygen in their blood, then we switch them from intravenous to oral antibiotic therapy.

What happens if pneumonia isn’t treated?
What happened before the advent of penicillin and antibiotics is that many patients got better without treatment. But those who were immunocompromised or either aged or very young or frail often died from pneumonia. Even now, with antibiotics, the average mortality rate is probably somewhere between 5 percent and 15 percent.
The average age of an adult with pneumonia is in the 60s. So many of these patients have additional underlying medical illnesses that pneumonia often makes worse.
For example, if the oxygen doesn’t reach the tissues and someone has heart disease, it can lead to cardiac complications. People with pneumonia can also develop secondary respiratory failure and respiratory complications and complications of their kidneys or their liver.

How long is someone usually sick with pneumonia?
We actually have done long-term studies and found that patients may still be fatigued a month later. And probably a quarter to a half of patients may even be fatigued up to 90 days or more.

How is pneumonia prevented?
There are several ways to prevent pneumonia. Number one is to try to get people to stop smoking. Number two, there are several vaccines, specifically the flu vaccine, because during flu season the incidence of pneumonia goes up because you can have a post-influenza bacterial infection.
There’s a vaccine against pneumococcus, the number-one cause of pneumonia in adults. And that’s generally recommended for patients who are over the age of 65 or higher-risk patients, patients who would be immunocompromised for one reason or another who are less than age 65.

Are many pneumonias resistant to antibiotics?
One of the things that we have to be concerned about in this country is the overuse of antibiotics. One of the reasons that it’s so important to establish an accurate diagnosis of pneumonia is that for many other things that mimic pneumonia such as bronchitis, there’s no good evidence that antibiotics improve patient’s outcomes. But they do increase resistance to certain organisms.
In this country, over the past 10 to 15 years, we’ve seen a tremendous growth in resistance among Streptococcus pneumoniae or pneumococcus, the number-one cause, as well as Haemophilus influenzae, to penicillin and cephalosporin types of antibiotics that were traditionally used to treat these types of infection.

Do you see any solution to this problem?
The solution is to try to make an accurate diagnosis, and only treat infections when you’ve made an accurate diagnosis. We do have newer, stronger antibiotics that are available now that can be used for those situations. But it’s hard to know ahead of time when a patient will be infected with a resistant strain.

At what point should someone go to the doctor or the emergency room?
Anyone who has a cough-related illness with fever or shaking chills; anyone who has a cough-related illness with symptoms of wheezing or shortness of breath; and anyone who has a cough-related illness with or without fever who’s immunocompromised, extremely elderly, or pregnant, should be in touch with their doctor.
Source: ABCnews.com