Kamis, 20 Oktober 2011
AJM Editor-in-Chief previews the November 2011 issue (video)
AJM Editor-in-Chief Joseph S. Alpert, MD, previews the November 2011 issue of The Journal, which is now available on our website.
Selasa, 18 Oktober 2011
Severe Circadian Hypertension in a Young Man
A 19-year-old white man with no prior health problems presented at an employment physical examination with markedly elevated blood pressures of 234/132 mm Hg. The primary doctor initiated treatment with the alpha-beta blocker, labetalol, 200 mg daily and amlodipine, 10 mg daily. The young man denied neurologic or cardiac symptoms and there was no history of drugs of abuse or use of tobacco or alcohol. His family history was unremarkable for secondary forms of hypertension or cardiovascular disease.
To read this article in its entirety, please visit our website.
-- -- Patrick Campbell, MD, Kanwar P. Singh, MD, Gregory Schuchard, MD, Koyal Jain, MD, William B. White, MD
This article originally appeared in October 2011 issue of The American Journal of Medicine.
To read this article in its entirety, please visit our website.
-- -- Patrick Campbell, MD, Kanwar P. Singh, MD, Gregory Schuchard, MD, Koyal Jain, MD, William B. White, MD
This article originally appeared in October 2011 issue of The American Journal of Medicine.
Minggu, 09 Oktober 2011
Habit of Wealthy People
Probably the first thing that comes to mind when you begin reading an article with this title would be 'spend less', 'save', 'invest', and the like. While these are good things to do, and arguably if you do these you'll amass some amount of money, the above activities are the results of habits, they're secondary to the sorts of basic things this article will discuss. What this article will discuss are more properly the habits of effective people- people who are happy, dynamic, and good at what they do, whatever it is. These are all small, but profound things that come together to make the big things happen more quickly and with greater ease.
Stop Complaining- Complaining is not just annoying to other people, it is harmful to you. huh? Complaining is the strategy we use in order to get other people to solve our problems for us, and what's more, usually it's the strategy we use to make other people feel bad for us. What complaining does for us is to attract people who want to feel bad for you, repel people who won't tolerate that sort of behavior, locks you into a dependency paradigm, and it rewards you for giving up. If you complain effectively, people will come to you and give you attention- it worked when you were a baby, right? The problem is that when complaint becomes a habit, when your first strategy in the face of adversity is to give up and complain in the hopes that other people will come to either solve your problem for you or console you, it means that your habit is to impose on anybody who will let you. Complainers like to describe people who aren't interested in being imposed upon as 'selfish' or 'insensitive', and often are the same people who equate selfishness with bad moral character- after all, if they can't manipulate these people by complaining, they must be bad, right? When you complain, you rob yourself of initiative, you shut your imagination down, and you stop looking for solutions to your problem on your own. Instead of becoming larger than your problems, you become smaller, and in order not to feel miserable about it, you complain in order to get some self-validation. As soon as you bring self-validation into it, you get your ego involved, which only complicates things- at that point you have to choose between being right and being happy, and your ego is very motivated to be right. Instead of finding a way to overcome your problem, you'll settle for feeling righteous about how unfair your life is.
How to know you're getting good at not complaining-
• You look for constructive things to do about a problem first
• big problems start to look a lot smaller, or even un-noticeable
• drama? what drama? The interesting parts of your life are the positive things, rather than the negative ones.
• You don't take adversity personally
• People stop coming to you with their complaints, and start coming to you with good news instead.
Stop Worrying- Worry occurs in your imagination, not in reality. Worry is the process by which you torture yourself with past could've-beens and future what-ifs- both of which are, by virtue of their imaginary status, impossible to address in the present. They are separate from reality, and separate in time, from anything you can control- all you can control is yourself, in the present. If, with your present self, you choose to worry, all you accomplish is to take yourself out of reality for the duration of your trip. If your worry is about something that may happen in the future, ask yourself two questions- 1) is there anything I can do about it now? If so, get to it, and 2) isn't this a problem I'll be able to deal with when it comes up? If your worry is about something that could've happened in the past, ask yourself whether it's relevant in any way to the present or future, and how can you apply questions one and two above to it?...at that point, you can drop the subject, resolved, until the next time you need to deal with whatever it was that bothered you enough to worry. Worry is a function of fear, and fear is your subconscious's way of telling you that it is uncomfortable with something- and your subconscious will make you miserable until the problem goes away... but the problem is that worrying doesn't solve anything. The quickest way (indeed, the only way) to resolve something that bothers you is to act in the present, in reality, outside the context of your fear. Inside it's context... you could wrestle with it forever, and it will only make you unhappy and powerless.
"We can't solve problems by using the same kind of thinking we used when we created them." -Albert Einstein Worry traps you in the context of your fear- in your imagination, out of reality, without a means of actually solving the problem that's got you all worked up. Worry is the stick your subconscious uses to jerk you around, to tell you there's something wrong- it is NOT THE SOLUTION TO THE PROBLEM. I've been told earnestly by a friend that if he didn't worry about the future, the future would be a disaster. A friend of mine told him that worrying doesn't actually *do* anything- it just makes you unhappy now. Upset, he insisted that if he didn't worry, how could he know that he'd behave appropriately in the future? My friend suggested that the only time he'd be able to do anything about it would be when the future arrived... but that when it did arrive he might miss it because he'd still be worrying about an even more distant future instead of behaving well in the present. Sure enough, he got mad at my friend and didn't understand the lesson. I walked away from that conversation with an interesting thought- I don't know that I'll behave appropriately in the future- that is the meaning of freedom. When the time comes, I'll probably do the right thing- out of choice, not because I've tortured or brainwashed myself into it.
How to recognize you're getting good at not worrying:
• You solve problems as they come up
• You procrastinate a lot less than you used to
• You're happier and more free
Get over being selfish- It's a basic truth that you have needs, and a simple way of defining needs is 'what you require in order to fulfill your purpose'. If you're a carpenter, you need your tools or else you can't do carpentry, and it's impossible for you to do the good things you do that make life better for other people. You have many purposes, and therefore many needs- you are someone's child, someone's friend, someone's parent perhaps- all of these roles confer responsibilities upon you, and fulfilling these responsibilities is arguably part of your purpose in life. If you fail to get your own needs met, you cannot effectively serve those purposes. Getting your needs met is an absolutely moral endeavor, because it establishes your own ability to contribute to the lives of others. Being selfish doesn't mean taking more than your share- that's what the complainers would have you think- they want you to feel bad about not meeting their needs before yours. Being selfish is not the opposite of being generous, it is the pre-requisite of being generous. What being selfish does is allow you to fulfill your potential- it allows you to discover, and to express the values that define your purpose in life. It allows you to filter out demands of you that are unreasonable, it allows you to attract positivity and position yourself in a way that everything you do makes you happy, including giving. If you're positioned in your life to get happiness out of everything you do (I get a lot of satisfaction out of giving gifts, it makes me happy, it's a selfish act) then you become motivated to do more- and in doing more, more people benefit from you, it's as simple as that. At the same time, you free yourself to reap the benefits of everything you do- and you realize your ability to fulfill your purpose in life. "Our deepest fear is not that we are inadequate, our deepest fear is that we are powerful beyond measure. It is our light, not our darkness, that most frightens us. We ask ourselves, who am I to be brilliant, gorgeous, talented, fabulous? Actually, who are you not to be? You are a child of God. Your playing small doesn't serve the world. There's nothing enlightened about shrinking so that other people won't feel insecure around you. We are all meant to shine, as children do[...] it's in everyone. As we let our own light shine we give others permission to do the same; as we're liberated from our own fear, our presence automatically liberates others." -Marianne Williamson Your first responsibility, before all others, is to meet your own needs. Until then, you're not only cheating yourself, you're cheating everyone around you of the benefits that you could have offered to the world, had you realized your potential. If your needs are not met, you cannot be happy, free, ethical, moral... because these are the values that express who you are after they are met. If you don't have what you need in order to be you, you can't do that. For this reason, it is profoundly immoral to neglect your potential, just as it is to ask another to do so. If you are unprepared to serve yourself, you cannot serve others. Make yourself happy, and you will attract people who are, or want to be, happy. Accept that you cannot make anyone else truly happy- only they can do that, by following the same selfishness principle. Create within yourself what you want to attract from without- it works in no other way, and it starts with being selfish.
How to know you're getting better at being selfish:
• Your 'wants' are few.
• Your friends are happier
• You attract more people to you
• More and more of what you do makes you happy
Get over being right- Maybe another way of saying this is 'Quit serving your ego and train your ego to serve you.' Who is the boss here, after all? This one is fundamentally important, because mastering this concept is key to personal freedom, happiness, and being an effective person. If it's your mission in life to validate all of your current beliefs, to prove yourself right at all costs, you are truly the servant of your own ego and you'll resist changing your mind, your beliefs, your opinions, your self, even in light of compelling new information. If you're unwilling to change your mind, you're unwilling to learn, grow, evolve, or adapt to your world, and this can become punishing, because your ego is a demanding thing- it needs a little stroking, and it'll take what it can get- even if it means putting the blinders further on and settling for feeling good about being 'right' when you don't get your way....but what is 'right', anyway? Being 'right', correct, proper, etc. is a subjective judgment you make when you process your observations of the world through the filter of your beliefs, habits, and values... but it is not an absolute, it's just what works for you. There are no facts, only interpretations. -Friedrich Nietzsche...so if being 'right' is subjective, what's the big deal?...the big deal is that your pride is involved, because you've identified personally with an external thing- in other words, you've made it about you personally when it's not about you. It gets in your way, makes it difficult to listen to what other people have to say, makes it difficult for you to surrender to truth as it comes to you, makes it impossible for you to mutate at will. Your pride and your ego are very good things, but they're only good insofar as they serve you- not the other way around- and one of the easiest ways to avoid serving them is to get over your desire to be 'right' about everything, so you can get to work on solving the real problems you'll face in your life, and become your future self with grace and elegance.
Ways to know you're getting over your desire to be right:
• You argue less
• You go weeks without complaining or blaming
• Your happiness lasts longer and is fuller
• You feel capable of being happy effortlessly
Tolerate nothing- If you mean to harm yourself, so they say, it makes no sense to torture yourself with small annoyances- go big or go home....and if you don't mean to harm yourself, why are you putting up with all the torture? Of course, we don't mean 'be intolerant' in the sense of the term that would have you closed-minded or unwilling to accept new or differing ideas or perspectives- that would be an obstacle to your ability to grow and evolve. Instead, the imperative 'tolerate nothing' is a call to root out your cynicism about all the little things in life that aren't perfect, and to help you get clear that you can have it all. At the same time, the call to 'tolerate nothing' does not suggest that the problems you face are bad or wrong- they are simply what is so for you- and rather than viewing them in the context of right or wrong, it's much more constructive to view them in the context of choice. Many of us tolerate the small things that plague us in our daily lives because we're simply unconscious to the fact that we have choice around them- that is, we're honestly convinced that 'this is just how life is'. Often what's underneath this is the fear that if we deal with this one, the next one could be bigger and scarier. In truth, the size of the 'problem' that stops you is precisely the size of YOU- or, said another way, the size of the problem that stops you is how big you declare yourself to be relative to it. In life, there will always be problems. It is part of the human condition to be confronted by challenge, to identify personally with adversity and in a sense, to be defined as a being by the scope of the challenges we take on. Another important idea is that we're here to learn and grow as we become our future selves- and solving problems is the way we learn from our world. What's more, it feels good to solve them. To be human is to have problems, and the question you want to ask yourself is this: are the problems you have right now worthy of you? Are they a fitting expenditure of your life? Most people go through their lives trying to get rid of problems, or at best, trying to make their problems as small as possible. Effective people expand themselves by taking on problems that cause them to grow, develop, learn.
Ways to know you're getting good at tolerating nothing:
• You solve problems before you worry about them
• Problems become lighter, easier to deal with, and much more interesting.
• Solving problems, even substantial ones, becomes no big deal
Surround yourself with success- Each of us lives our lives within a variety of communities and social contexts. Success in the abstract (that is, any sort of success, it needn't be limited to the financial sort) is a social function, and it is accomplished within the context of community. Part of surrounding yourself with success is merely in recognizing the successes around you- indeed, there's plenty, the sky is raining soup, as it were- and in becoming attuned to this success. If you said you'd take out the garbage and you did, you succeeded! 99% of your life is a success. Another component of surrounding yourself with success is in actively generating the community within which you will realize your success (again, we're talking about success in the abstract- it could be having a great relationship, learning to throw a curve ball, or running a profitable business)- and in generating community, what you generate is the space within which you and others create the results by which you will be measured. Of course, community is a cooperative effort- to exist, it requires multiple people operating at this level, and one of best ways to choose these people is to look at the kinds of results they've been generating. Surrounding yourself with people whose results match the kinds you're hoping to generate is a good way to generate this space- and what's more, these are the best people to learn from- who better to ask about throwing a curve ball than someone who can do it? It's not necessary to dump your 'loser' friends in order to succeed- after all, they each have their own successes as well (very few people are completely unremarkable)- but consider that if their perspective/filters/outlook are causing them to produce results you don't want for yourself, that the community you share with them may not be the best one to seek success in.
Ways to know you're getting good at surrounding yourself with success:
• The drama in your communities becomes much less
• The gossip in your communities becomes about all the great things going on
• You get into the habit of celebrating the little things
Don't fear failure- In order to succeed, first you have to try. If your fear of failure is greater than your desire to succeed, odds are good that you won't try, and therefore cannot succeed. Fear is an illusion we create in order to avoid pain, and at it's root is generally a morbid fantasy that if we don't avoid (whatever it is we're afraid of) that we'll end up experiencing pain of some sort, abandonment, or death. Of course, if we follow out the chain of logic that connects the two, we'll discover that it's a little ridiculous. What's the worst that could realistically happen, and how much of it is in your head? Again, this becomes an exercise in spotting how much your ego rules you. The idea here is to become the person whose ego serves them- because your ego is an incredibly powerful and amazing part of you- but it can be a cruel master if you choose to serve it.
How to know you're not afraid to fail:
• You accomplish more
• You don't notice that you're trying more things
• Your world becomes much larger and richer
• Nothing is a big deal
Treat your body right- Your body will treat you as you treat it- so it's vital that you get out with it and keep it healthy. What's more, exercise reduces stress, helps you rest better, sharpens your mind, lengthens your life, and improves its' quality. If you smoke, do what it takes to quit. If you're clinically overweight or have other health challenges, do what it takes to manage your health- you only have one body, and using it as it was meant to be used makes it feel better, last longer, and look better. With exercise, your body becomes stronger, your energy levels go up, your bones become stronger... and with an active sense of play, exercise can be just plain fun....but it doesn't necessarily follow that more is better. Too much can be worse than not enough- it can lead to injuries and other health problems.
Ways to know you're doing it right:
• You feel better all the time
• You sleep well and wake up refreshed
• You need less sleep
Do Nothing "Because you Should"- The word 'should' confers a duality- it distinguishes what you want to do from what you think is the right thing to do- meaning that if you govern yourself with 'shoulds', what you're creating is a conflict within yourself. Instead of simply wanting to do the right thing (the elegant path), when you govern yourself with 'shoulds' you create and empower a separate part of you to tell you that you shouldn't do what you want- and this part of you operates by making you feel guilty and miserable. The word 'should' is the weapon of your negative ego- that's the part of you whose job it is to belittle and control you... when the purpose of your life is to grow, be happy and free, and to express your higher purpose in life. We empower our negative ego in order to balance out our 'positive' one's faults- for example, if your ego gets a lot of validation out of spending lots of money on status symbols, the negative ego's job would be to make you feel guilty over spending more than you can afford. The entire reason for empowering our 'negative ego' is because we resist changing the positive one- but this is a path of self-conflict and wasted energy. Instead of creating a separate entity to fight us and make us feel dumb and guilty, we can simply become the person who wants to (rather than 'thinks they should') do what is best for themselves. The key here is in allowing reality, rather than your ego, to guide the way you adapt to your world. Mutate at will. This has nothing to do with principles- by all means, be true to your values- but don't mistake your values for your concept of 'self'- as soon as you do that, your ego is engaged and you're on the hook. For example, in this case (where you're driven to keep up with the joneses by your concept of self) it's really tempting to believe that without being ahead of the joneses, you would cease to be you- but that's just not true.
Stop Complaining- Complaining is not just annoying to other people, it is harmful to you. huh? Complaining is the strategy we use in order to get other people to solve our problems for us, and what's more, usually it's the strategy we use to make other people feel bad for us. What complaining does for us is to attract people who want to feel bad for you, repel people who won't tolerate that sort of behavior, locks you into a dependency paradigm, and it rewards you for giving up. If you complain effectively, people will come to you and give you attention- it worked when you were a baby, right? The problem is that when complaint becomes a habit, when your first strategy in the face of adversity is to give up and complain in the hopes that other people will come to either solve your problem for you or console you, it means that your habit is to impose on anybody who will let you. Complainers like to describe people who aren't interested in being imposed upon as 'selfish' or 'insensitive', and often are the same people who equate selfishness with bad moral character- after all, if they can't manipulate these people by complaining, they must be bad, right? When you complain, you rob yourself of initiative, you shut your imagination down, and you stop looking for solutions to your problem on your own. Instead of becoming larger than your problems, you become smaller, and in order not to feel miserable about it, you complain in order to get some self-validation. As soon as you bring self-validation into it, you get your ego involved, which only complicates things- at that point you have to choose between being right and being happy, and your ego is very motivated to be right. Instead of finding a way to overcome your problem, you'll settle for feeling righteous about how unfair your life is.
How to know you're getting good at not complaining-
• You look for constructive things to do about a problem first
• big problems start to look a lot smaller, or even un-noticeable
• drama? what drama? The interesting parts of your life are the positive things, rather than the negative ones.
• You don't take adversity personally
• People stop coming to you with their complaints, and start coming to you with good news instead.
Stop Worrying- Worry occurs in your imagination, not in reality. Worry is the process by which you torture yourself with past could've-beens and future what-ifs- both of which are, by virtue of their imaginary status, impossible to address in the present. They are separate from reality, and separate in time, from anything you can control- all you can control is yourself, in the present. If, with your present self, you choose to worry, all you accomplish is to take yourself out of reality for the duration of your trip. If your worry is about something that may happen in the future, ask yourself two questions- 1) is there anything I can do about it now? If so, get to it, and 2) isn't this a problem I'll be able to deal with when it comes up? If your worry is about something that could've happened in the past, ask yourself whether it's relevant in any way to the present or future, and how can you apply questions one and two above to it?...at that point, you can drop the subject, resolved, until the next time you need to deal with whatever it was that bothered you enough to worry. Worry is a function of fear, and fear is your subconscious's way of telling you that it is uncomfortable with something- and your subconscious will make you miserable until the problem goes away... but the problem is that worrying doesn't solve anything. The quickest way (indeed, the only way) to resolve something that bothers you is to act in the present, in reality, outside the context of your fear. Inside it's context... you could wrestle with it forever, and it will only make you unhappy and powerless.
"We can't solve problems by using the same kind of thinking we used when we created them." -Albert Einstein Worry traps you in the context of your fear- in your imagination, out of reality, without a means of actually solving the problem that's got you all worked up. Worry is the stick your subconscious uses to jerk you around, to tell you there's something wrong- it is NOT THE SOLUTION TO THE PROBLEM. I've been told earnestly by a friend that if he didn't worry about the future, the future would be a disaster. A friend of mine told him that worrying doesn't actually *do* anything- it just makes you unhappy now. Upset, he insisted that if he didn't worry, how could he know that he'd behave appropriately in the future? My friend suggested that the only time he'd be able to do anything about it would be when the future arrived... but that when it did arrive he might miss it because he'd still be worrying about an even more distant future instead of behaving well in the present. Sure enough, he got mad at my friend and didn't understand the lesson. I walked away from that conversation with an interesting thought- I don't know that I'll behave appropriately in the future- that is the meaning of freedom. When the time comes, I'll probably do the right thing- out of choice, not because I've tortured or brainwashed myself into it.
How to recognize you're getting good at not worrying:
• You solve problems as they come up
• You procrastinate a lot less than you used to
• You're happier and more free
Get over being selfish- It's a basic truth that you have needs, and a simple way of defining needs is 'what you require in order to fulfill your purpose'. If you're a carpenter, you need your tools or else you can't do carpentry, and it's impossible for you to do the good things you do that make life better for other people. You have many purposes, and therefore many needs- you are someone's child, someone's friend, someone's parent perhaps- all of these roles confer responsibilities upon you, and fulfilling these responsibilities is arguably part of your purpose in life. If you fail to get your own needs met, you cannot effectively serve those purposes. Getting your needs met is an absolutely moral endeavor, because it establishes your own ability to contribute to the lives of others. Being selfish doesn't mean taking more than your share- that's what the complainers would have you think- they want you to feel bad about not meeting their needs before yours. Being selfish is not the opposite of being generous, it is the pre-requisite of being generous. What being selfish does is allow you to fulfill your potential- it allows you to discover, and to express the values that define your purpose in life. It allows you to filter out demands of you that are unreasonable, it allows you to attract positivity and position yourself in a way that everything you do makes you happy, including giving. If you're positioned in your life to get happiness out of everything you do (I get a lot of satisfaction out of giving gifts, it makes me happy, it's a selfish act) then you become motivated to do more- and in doing more, more people benefit from you, it's as simple as that. At the same time, you free yourself to reap the benefits of everything you do- and you realize your ability to fulfill your purpose in life. "Our deepest fear is not that we are inadequate, our deepest fear is that we are powerful beyond measure. It is our light, not our darkness, that most frightens us. We ask ourselves, who am I to be brilliant, gorgeous, talented, fabulous? Actually, who are you not to be? You are a child of God. Your playing small doesn't serve the world. There's nothing enlightened about shrinking so that other people won't feel insecure around you. We are all meant to shine, as children do[...] it's in everyone. As we let our own light shine we give others permission to do the same; as we're liberated from our own fear, our presence automatically liberates others." -Marianne Williamson Your first responsibility, before all others, is to meet your own needs. Until then, you're not only cheating yourself, you're cheating everyone around you of the benefits that you could have offered to the world, had you realized your potential. If your needs are not met, you cannot be happy, free, ethical, moral... because these are the values that express who you are after they are met. If you don't have what you need in order to be you, you can't do that. For this reason, it is profoundly immoral to neglect your potential, just as it is to ask another to do so. If you are unprepared to serve yourself, you cannot serve others. Make yourself happy, and you will attract people who are, or want to be, happy. Accept that you cannot make anyone else truly happy- only they can do that, by following the same selfishness principle. Create within yourself what you want to attract from without- it works in no other way, and it starts with being selfish.
How to know you're getting better at being selfish:
• Your 'wants' are few.
• Your friends are happier
• You attract more people to you
• More and more of what you do makes you happy
Get over being right- Maybe another way of saying this is 'Quit serving your ego and train your ego to serve you.' Who is the boss here, after all? This one is fundamentally important, because mastering this concept is key to personal freedom, happiness, and being an effective person. If it's your mission in life to validate all of your current beliefs, to prove yourself right at all costs, you are truly the servant of your own ego and you'll resist changing your mind, your beliefs, your opinions, your self, even in light of compelling new information. If you're unwilling to change your mind, you're unwilling to learn, grow, evolve, or adapt to your world, and this can become punishing, because your ego is a demanding thing- it needs a little stroking, and it'll take what it can get- even if it means putting the blinders further on and settling for feeling good about being 'right' when you don't get your way....but what is 'right', anyway? Being 'right', correct, proper, etc. is a subjective judgment you make when you process your observations of the world through the filter of your beliefs, habits, and values... but it is not an absolute, it's just what works for you. There are no facts, only interpretations. -Friedrich Nietzsche...so if being 'right' is subjective, what's the big deal?...the big deal is that your pride is involved, because you've identified personally with an external thing- in other words, you've made it about you personally when it's not about you. It gets in your way, makes it difficult to listen to what other people have to say, makes it difficult for you to surrender to truth as it comes to you, makes it impossible for you to mutate at will. Your pride and your ego are very good things, but they're only good insofar as they serve you- not the other way around- and one of the easiest ways to avoid serving them is to get over your desire to be 'right' about everything, so you can get to work on solving the real problems you'll face in your life, and become your future self with grace and elegance.
Ways to know you're getting over your desire to be right:
• You argue less
• You go weeks without complaining or blaming
• Your happiness lasts longer and is fuller
• You feel capable of being happy effortlessly
Tolerate nothing- If you mean to harm yourself, so they say, it makes no sense to torture yourself with small annoyances- go big or go home....and if you don't mean to harm yourself, why are you putting up with all the torture? Of course, we don't mean 'be intolerant' in the sense of the term that would have you closed-minded or unwilling to accept new or differing ideas or perspectives- that would be an obstacle to your ability to grow and evolve. Instead, the imperative 'tolerate nothing' is a call to root out your cynicism about all the little things in life that aren't perfect, and to help you get clear that you can have it all. At the same time, the call to 'tolerate nothing' does not suggest that the problems you face are bad or wrong- they are simply what is so for you- and rather than viewing them in the context of right or wrong, it's much more constructive to view them in the context of choice. Many of us tolerate the small things that plague us in our daily lives because we're simply unconscious to the fact that we have choice around them- that is, we're honestly convinced that 'this is just how life is'. Often what's underneath this is the fear that if we deal with this one, the next one could be bigger and scarier. In truth, the size of the 'problem' that stops you is precisely the size of YOU- or, said another way, the size of the problem that stops you is how big you declare yourself to be relative to it. In life, there will always be problems. It is part of the human condition to be confronted by challenge, to identify personally with adversity and in a sense, to be defined as a being by the scope of the challenges we take on. Another important idea is that we're here to learn and grow as we become our future selves- and solving problems is the way we learn from our world. What's more, it feels good to solve them. To be human is to have problems, and the question you want to ask yourself is this: are the problems you have right now worthy of you? Are they a fitting expenditure of your life? Most people go through their lives trying to get rid of problems, or at best, trying to make their problems as small as possible. Effective people expand themselves by taking on problems that cause them to grow, develop, learn.
Ways to know you're getting good at tolerating nothing:
• You solve problems before you worry about them
• Problems become lighter, easier to deal with, and much more interesting.
• Solving problems, even substantial ones, becomes no big deal
Surround yourself with success- Each of us lives our lives within a variety of communities and social contexts. Success in the abstract (that is, any sort of success, it needn't be limited to the financial sort) is a social function, and it is accomplished within the context of community. Part of surrounding yourself with success is merely in recognizing the successes around you- indeed, there's plenty, the sky is raining soup, as it were- and in becoming attuned to this success. If you said you'd take out the garbage and you did, you succeeded! 99% of your life is a success. Another component of surrounding yourself with success is in actively generating the community within which you will realize your success (again, we're talking about success in the abstract- it could be having a great relationship, learning to throw a curve ball, or running a profitable business)- and in generating community, what you generate is the space within which you and others create the results by which you will be measured. Of course, community is a cooperative effort- to exist, it requires multiple people operating at this level, and one of best ways to choose these people is to look at the kinds of results they've been generating. Surrounding yourself with people whose results match the kinds you're hoping to generate is a good way to generate this space- and what's more, these are the best people to learn from- who better to ask about throwing a curve ball than someone who can do it? It's not necessary to dump your 'loser' friends in order to succeed- after all, they each have their own successes as well (very few people are completely unremarkable)- but consider that if their perspective/filters/outlook are causing them to produce results you don't want for yourself, that the community you share with them may not be the best one to seek success in.
Ways to know you're getting good at surrounding yourself with success:
• The drama in your communities becomes much less
• The gossip in your communities becomes about all the great things going on
• You get into the habit of celebrating the little things
Don't fear failure- In order to succeed, first you have to try. If your fear of failure is greater than your desire to succeed, odds are good that you won't try, and therefore cannot succeed. Fear is an illusion we create in order to avoid pain, and at it's root is generally a morbid fantasy that if we don't avoid (whatever it is we're afraid of) that we'll end up experiencing pain of some sort, abandonment, or death. Of course, if we follow out the chain of logic that connects the two, we'll discover that it's a little ridiculous. What's the worst that could realistically happen, and how much of it is in your head? Again, this becomes an exercise in spotting how much your ego rules you. The idea here is to become the person whose ego serves them- because your ego is an incredibly powerful and amazing part of you- but it can be a cruel master if you choose to serve it.
How to know you're not afraid to fail:
• You accomplish more
• You don't notice that you're trying more things
• Your world becomes much larger and richer
• Nothing is a big deal
Treat your body right- Your body will treat you as you treat it- so it's vital that you get out with it and keep it healthy. What's more, exercise reduces stress, helps you rest better, sharpens your mind, lengthens your life, and improves its' quality. If you smoke, do what it takes to quit. If you're clinically overweight or have other health challenges, do what it takes to manage your health- you only have one body, and using it as it was meant to be used makes it feel better, last longer, and look better. With exercise, your body becomes stronger, your energy levels go up, your bones become stronger... and with an active sense of play, exercise can be just plain fun....but it doesn't necessarily follow that more is better. Too much can be worse than not enough- it can lead to injuries and other health problems.
Ways to know you're doing it right:
• You feel better all the time
• You sleep well and wake up refreshed
• You need less sleep
Do Nothing "Because you Should"- The word 'should' confers a duality- it distinguishes what you want to do from what you think is the right thing to do- meaning that if you govern yourself with 'shoulds', what you're creating is a conflict within yourself. Instead of simply wanting to do the right thing (the elegant path), when you govern yourself with 'shoulds' you create and empower a separate part of you to tell you that you shouldn't do what you want- and this part of you operates by making you feel guilty and miserable. The word 'should' is the weapon of your negative ego- that's the part of you whose job it is to belittle and control you... when the purpose of your life is to grow, be happy and free, and to express your higher purpose in life. We empower our negative ego in order to balance out our 'positive' one's faults- for example, if your ego gets a lot of validation out of spending lots of money on status symbols, the negative ego's job would be to make you feel guilty over spending more than you can afford. The entire reason for empowering our 'negative ego' is because we resist changing the positive one- but this is a path of self-conflict and wasted energy. Instead of creating a separate entity to fight us and make us feel dumb and guilty, we can simply become the person who wants to (rather than 'thinks they should') do what is best for themselves. The key here is in allowing reality, rather than your ego, to guide the way you adapt to your world. Mutate at will. This has nothing to do with principles- by all means, be true to your values- but don't mistake your values for your concept of 'self'- as soon as you do that, your ego is engaged and you're on the hook. For example, in this case (where you're driven to keep up with the joneses by your concept of self) it's really tempting to believe that without being ahead of the joneses, you would cease to be you- but that's just not true.
Jumat, 07 Oktober 2011
Men and Sexual Fanatsy
The integrity of sperm DNA is essential for the transmission of the father's gene contribution. Tests which show an increased fraction of sperm DNA fragmentation often correlates to other sperm pathologies such as poor motility, count and morphology. Most reproductive endocrinology clinics do not test for this often hidden pathology even when the patient presents with poor sperm parameters.
As in all areas of medicine, there is internecine battling going on between physicians as to the meaning and the effect of this issue on male fertility. Some doctors completely disagree with its relevancy as a contributor to male infertility; some physicians accept its contribution but don't know what to do with the findings; others think that the only real detriment to the quality of sperm rendered by DNA fragmentation is the sperms inability to penetrate the egg and they think that injecting the sperm into the egg (ICSI) effectively deals with the problem. It does not.
DNA fragmentation has a far reaching effect on fertility and surpasses the mere diminished ability of sperm to penetrate egg.
Some studies show that with higher percentages of fragmentation there are increased correlations in spontaneous abortions. The proportion of patients with abnormal sperm DNA integrity is higher in couples with spontaneous miscarriage. This is not surprising as a good embryo is nothing other than the combination of a good egg with a good sperm and sperm with DNA fragmentation is not good sperm.
In sperm without DNA fragmentation the DNA is protected from damage while being transported through both the male and female reproductive tracts; if there is damage to the DNA then impaired fertility is an obvious consequence.
Causes are many and varied ranging from genetic anomalies to reactive oxygen species due to white blood cell (leukocyte) infiltration), as well as vericoceles. As DNA repair systems are less active in the later stages of sperm production, sperm with fragmented DNA can readily reach the ejaculate.
Men that have sperm DNA fragmentation greater than 30% are typically infertile.
Treatment options Antioxidant therapy
Antioxidants 'scavenge' reactive oxygen species and can, in some instances, reduce sperm DNA fragmentation percentages. A n anti oxidant compound which has been shown to be effective in some instances is composed of lycopene 6mg, vitamin E 400IU, vitamin C 100mg, zinc 25mg, selenium 26 mg, folate.5 mg and garlic (available in pill form)1000 mg. This should be taken once daily.
Acupuncture and Herbs
Acupuncture with its ability to stimulate blood which transports oxygen and nutrients to the testes, while carrying debris away from the testes may also be an effective treatment.
Many herbal medicines also have high antioxidant properties and should be included in the treatment regimen. Combining antioxidant therapy as described above with acupuncture and herbal medicine can potentially increase fertility outcomes in men with high percentages of DNA fragmentation.
Smoking cigarettes and marijuana have been shown to contribute to sperm DNA fragmentation. Elimination of these mitigators may also help to normalize sperm.
As in all areas of medicine, there is internecine battling going on between physicians as to the meaning and the effect of this issue on male fertility. Some doctors completely disagree with its relevancy as a contributor to male infertility; some physicians accept its contribution but don't know what to do with the findings; others think that the only real detriment to the quality of sperm rendered by DNA fragmentation is the sperms inability to penetrate the egg and they think that injecting the sperm into the egg (ICSI) effectively deals with the problem. It does not.
DNA fragmentation has a far reaching effect on fertility and surpasses the mere diminished ability of sperm to penetrate egg.
Some studies show that with higher percentages of fragmentation there are increased correlations in spontaneous abortions. The proportion of patients with abnormal sperm DNA integrity is higher in couples with spontaneous miscarriage. This is not surprising as a good embryo is nothing other than the combination of a good egg with a good sperm and sperm with DNA fragmentation is not good sperm.
In sperm without DNA fragmentation the DNA is protected from damage while being transported through both the male and female reproductive tracts; if there is damage to the DNA then impaired fertility is an obvious consequence.
Causes are many and varied ranging from genetic anomalies to reactive oxygen species due to white blood cell (leukocyte) infiltration), as well as vericoceles. As DNA repair systems are less active in the later stages of sperm production, sperm with fragmented DNA can readily reach the ejaculate.
Men that have sperm DNA fragmentation greater than 30% are typically infertile.
Treatment options Antioxidant therapy
Antioxidants 'scavenge' reactive oxygen species and can, in some instances, reduce sperm DNA fragmentation percentages. A n anti oxidant compound which has been shown to be effective in some instances is composed of lycopene 6mg, vitamin E 400IU, vitamin C 100mg, zinc 25mg, selenium 26 mg, folate.5 mg and garlic (available in pill form)1000 mg. This should be taken once daily.
Acupuncture and Herbs
Acupuncture with its ability to stimulate blood which transports oxygen and nutrients to the testes, while carrying debris away from the testes may also be an effective treatment.
Many herbal medicines also have high antioxidant properties and should be included in the treatment regimen. Combining antioxidant therapy as described above with acupuncture and herbal medicine can potentially increase fertility outcomes in men with high percentages of DNA fragmentation.
Smoking cigarettes and marijuana have been shown to contribute to sperm DNA fragmentation. Elimination of these mitigators may also help to normalize sperm.
30 Articles in Press available on AJM website
The American Journal of Medicine regularly publishes accepted and corrected manuscripts on our website in advance of the actual publication date. There are currently 30 case reports, clinical research studies, and other types of articles on AJM's website.
Check out Dr. Joseph S. Alpert's video about articles in press above and related articles here.
Rabu, 05 Oktober 2011
Incremental Weight Loss Improves Cardiometabolic Risk in Extremely Obese Adults
Very obese adults can improve their cardiometabolic risk under primary care weight management. In this study, weigh loss correlated significantly with improvements in fasting plasma glucose, triglycerides, high and low-density lipoprotein cholesterol, uric acid, alanine aminotransferase, lactate dehydrogenase and high-sensitivity C-reactive protein.
Abstract
Objective
Excessively obese adults often acquire many metabolic disorders that put them at high risk for developing type 2 diabetes mellitus and cardiovascular disease. We investigated the hypothesis that cardiometabolic risk in a primary care cohort of 208 excessively obese adults (body mass index 40-60 kg/m2, 48 with type 2 diabetes mellitus) would deteriorate with additional weight gain and improve incrementally beginning with 5% weight reduction.
Methods
Further analysis of the Louisiana Obese Subjects Study of excessively obese patients enrolled and followed during 2005-2008 is reported.
Results
Weight loss correlated significantly with improvements in fasting plasma glucose, triglycerides, high- and low-density lipoprotein cholesterol, uric acid, alanine aminotransferase, lactate dehydrogenase, and high-sensitivity C-reactive protein. Most parameters deteriorated with weight gain and progressively improved with 5% or more weight loss. Except for low-density lipoprotein cholesterol, all risk factors significantly improved with≥20% loss of body weight. Among patients who had not been diagnosed with type 2 diabetes mellitus and had normoglycemia at baseline, median fasting plasma glucose increased significantly (13%) with stable or gained weight at 1 year, but did not change significantly with reduced weight. Although glucose levels did not change significantly in patients with type 2 diabetes mellitus who gained weight, a decline beginning after 5% weight reduction culminated in 25% glucose reduction with≥20% weight loss. Resting blood pressure declined independently of weight change.
Conclusion
Very obese adults can improve their cardiometabolic risk under primary care weight management. Incremental success may help motivate further therapeutic weight reduction.
To read this article in its entirety, please visit our website.
-- -- William D. Johnson, PhD, Meghan M. Brashear, MPH, Alok K. Gupta, MD, Jennifer C. Rood, PhD, Donna H. Ryan, MD
This article originally appeared in October 2011 issue of The American Journal of Medicine.
Abstract
Objective
Excessively obese adults often acquire many metabolic disorders that put them at high risk for developing type 2 diabetes mellitus and cardiovascular disease. We investigated the hypothesis that cardiometabolic risk in a primary care cohort of 208 excessively obese adults (body mass index 40-60 kg/m2, 48 with type 2 diabetes mellitus) would deteriorate with additional weight gain and improve incrementally beginning with 5% weight reduction.
Methods
Further analysis of the Louisiana Obese Subjects Study of excessively obese patients enrolled and followed during 2005-2008 is reported.
Results
Weight loss correlated significantly with improvements in fasting plasma glucose, triglycerides, high- and low-density lipoprotein cholesterol, uric acid, alanine aminotransferase, lactate dehydrogenase, and high-sensitivity C-reactive protein. Most parameters deteriorated with weight gain and progressively improved with 5% or more weight loss. Except for low-density lipoprotein cholesterol, all risk factors significantly improved with≥20% loss of body weight. Among patients who had not been diagnosed with type 2 diabetes mellitus and had normoglycemia at baseline, median fasting plasma glucose increased significantly (13%) with stable or gained weight at 1 year, but did not change significantly with reduced weight. Although glucose levels did not change significantly in patients with type 2 diabetes mellitus who gained weight, a decline beginning after 5% weight reduction culminated in 25% glucose reduction with≥20% weight loss. Resting blood pressure declined independently of weight change.
Conclusion
Very obese adults can improve their cardiometabolic risk under primary care weight management. Incremental success may help motivate further therapeutic weight reduction.
To read this article in its entirety, please visit our website.
-- -- William D. Johnson, PhD, Meghan M. Brashear, MPH, Alok K. Gupta, MD, Jennifer C. Rood, PhD, Donna H. Ryan, MD
This article originally appeared in October 2011 issue of The American Journal of Medicine.
Senin, 03 Oktober 2011
Weight and Weight Change—Think About the Context
While obesity has been linked to multiple risk factors for cardiovascular disease and risk for type 2 diabetes and its complications, several epidemiologic studies have suggested that patients with excess weight may not have higher rates of (cardiovascular) mortality. Two articles in this issue of The American Journal of Medicine and one in the September issue demonstrate how the question of an “obesity paradox” can be very tricky to answer.
To read this article in its entirety, please visit our website.
-- -- Stuart R. Chipkin, MD, diabetes and metabolism specialty editor, The American Journal of Medicine
This article originally appeared in October 2011 issue of The American Journal of Medicine.
Here are links to the three research studies referenced in Dr. Chipkin's editorial.
Incremental Weight Loss Improves Cardiometabolic Risk in Extremely Obese Adults
The Obesity Paradox and Weight Loss
Weight and Mortality Following Heart Failure Hospitalization among Diabetic Patients
To read this article in its entirety, please visit our website.
-- -- Stuart R. Chipkin, MD, diabetes and metabolism specialty editor, The American Journal of Medicine
This article originally appeared in October 2011 issue of The American Journal of Medicine.
Here are links to the three research studies referenced in Dr. Chipkin's editorial.
Incremental Weight Loss Improves Cardiometabolic Risk in Extremely Obese Adults
The Obesity Paradox and Weight Loss
Weight and Mortality Following Heart Failure Hospitalization among Diabetic Patients
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