From the Outside Looking In

One cannot overstate the value of a detailed skin examination in the diagnosis of systemic disorders, including infectious diseases. This precept was demonstrated in the present case.

A 41-year-old man with stage-IV T-cell-rich B-cell lymphoma presented to our emergency department reporting a 2-day history of fever, diarrhea, and malaise and a 3-week history of multiple tender, erythematous skin lesions located on his arms, trunk, and lower extremities. The lesions had been initially treated with oral clindamycin for a presumed diagnosis of cellulitis, without significant improvement. His medications on presentation included enoxaparin, erythropoietin, and filgrastim.

He had completed his 6th cycle of chemotherapy with cyclophosphamide, doxorubicin, vincristine, prednisone, and rituximab 12 days earlier. He had been admitted to the hospital 6 weeks prior for an episode of febrile neutropenia. At that time, blood, urine, and sputum cultures had been negative. He had been treated empirically with standard doses of intravenous piperacillin-tazobactam and metronidazole until defervescence and neutrophil recovery.

To read this article in its entirety, please visit our website.

-- Yasbanoo Moayedi, MD, Paul E. Bunce, MD, Shachar Sade, MD, Danny Ghazarian, MD, Wayne L. Gold, MD

This article originally appeared in May 2012 issue of The American Journal of Medicine.

Changing Demographics Worldwide

Changing US and World Demographics: Consequences for the Practice of Medicine

Demographics is a field of study in which statistical characteristics of a population are followed over a period of time. Commonly, demographic data are used in analyses involving fields such as sociology, public policy, and marketing. Characteristics that are followed often include gender, age, survival, a variety of disabilities, urbanization, socioeconomic factors, educational level, and many other variables. Demographic changes in a population can have major consequences for healthcare delivery and planning. For example, if the population in a specific country demonstrates a demographic trend for increasing numbers of geriatric individuals, this will have a major impact on the demand for inpatient hospital and rehabilitation services because this age group has a high rate of use for such services.

Recently, 2 major US periodicals have given extensive coverage to demographic changes in our country and throughout the world.(1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12) Written primarily by professional journalists, these reports are both easily understood and comprehensive. Similar trends are described in both magazines: Technologically advanced countries will continue to see dramatic increases in the percentage of their population aged 65 years or more, combined with marked decreases in per capita birth rates, so-called fertility rates. For example, Brazil, a country rapidly advancing into the category of technologically advanced, has seen a marked decrease in fertility rates, which has been ascribed to female access to education and employment combined with ease of access to contraception. In addition, female media role models are commonly portrayed as actively involved in their careers with minimal numbers of children under their care.

Many technically advanced countries are expected to experience declines in population over the coming decades because of decreasing fertility rates. Declining population growth and reduced numbers of residents are expected to be particularly challenging in countries with low immigration rates, such as Japan, where elderly individuals represent an ever-increasing segment of the population. In the United States, fertility rates are expected to remain relatively constant because of higher birth rates among new immigrant families. In most countries experiencing decreasing fertility rates, the death toll also is decreasing, with these 2 factors leading to an increased percentage of the population aged more than 65 years. Clearly, this demographic trend has major implications for healthcare distribution and financing.

To read this article in its entirety, please visit our website.

-- Joseph S. Alpert, MD (Editor-in-Chief, The American Journal of Medicine)

This article originally appeared in May 2012 issue of The American Journal of Medicine.

Golden Eye

Golden Ring in Eyes: All That Glitters Is Not Gold!

A 20-year-old man presented with progressive ascites with pedal edema. On evaluation, he was found to have cirrhosis of the liver with splenomegaly due to portal hypertension. He was nonalcoholic, and viral markers were negative. His clinical examination revealed a golden brown ring at the limbus in both eyes. He underwent a slit-lamp examination that confirmed it to be Kayser-Fleischer ring. His serum ceruloplasmin was 10 mg/dL (low) and 24-hour urinary copper was 160 μg (high). Liver biopsy could not be performed because his prothrombin time was prolonged. A combination of Kayser-Fleischer ring with low serum ceruloplasmin with increased urinary copper confirmed the diagnosis of Wilson disease. He was treated with diuretics and propranolol, and zinc therapy was initiated. He was discharged in stable condition and is on regular follow-up.

Wilson disease is caused by a mutation in ATP7B, which is the copper-transporting gene. ATP7B facilitates the transfer of copper into the Golgi apparatus, where it combines with ceruloplasmin. ATP7B protein deficiency impairs biliary copper excretion, resulting in positive copper balance, hepatic copper accumulation, and copper toxicity from oxidant damage.(1) The free circulating copper is toxic and accumulates in the liver, resulting in hepatocyte degeneration and cirrhosis. When copper-binding sites in the liver are saturated, free copper is released into the circulation and accumulates in other tissues, such as the eye, basal ganglia, and kidneys. This leads to functional derangements and clinical manifestations, such as Kayser-Fleischer ring in the cornea, sunflower cataract in the lens, tremors and rigidity, and renal tubular defects.(2)

To read this article in its entirety, please visit our website.

-- Parimal Tayde, MD, Anil Wanjari, MD, Vikram Kokate, MBBS

This article originally appeared in April 2012 issue of The American Journal of Medicine.

Ghostwriting & Misconduct

Ghostwriting: Research Misconduct, Plagiarism, or Fool's Gold?

Traditionally, personal integrity and professional accountability have guaranteed appropriate authorship of biomedical journal articles. However, recent controversies, including exposés of ghostwriting and guest authorship, have shown the fallibility of this trust.

Ghostwriting, the practice whereby individuals make significant contributions to writing a manuscript but are not named as authors, invariably goes hand-in-hand with guest or honorary authorship, whereby named authors have not contributed sufficiently to a manuscript to merit authorship. Although ghostwriting and guest authorship are prevalent, and remain as common today as they were a decade ago,(1) the actual extent of ghostwriting in biomedical journals remains unknown.(2)

These practices are thought predominantly to occur when academic investigators collaborate with industry. However, they also occur within purely academic collaborations when, for example, senior academics supervising or supporting research are included as authors, regardless of their contributions, or when junior academics are asked to draft articles for senior academics, who are then listed as first author. Increasingly, academics also are using external medical writers to facilitate manuscript writing and preparation.(3)

Nevertheless, more typically, an industry-employed or contracted writer prepares a complete draft of a review or research article for an academic partner, usually an expert in his or her field. The academic then submits the manuscript, perhaps after editing, and in turn receives an honorarium for his or her time and effort. Of note, the named academic authors rarely have access to actual clinical data for independent analysis and only participate once the manuscript has been drafted, after key decisions have already been made, including which analyses to conduct and which findings to disseminate.

To read this article in its entirety, please visit our website.

-- Xavier Bosch, MD, PhD, Joseph S. Ross, MD, MHS

This article originally appeared in April 2012 issue of The American Journal of Medicine.

Are the Solar Flares Boosting Your Cosmic Awareness?

Or, are the solar flares just bringing your old stuff to the surface?

An ordinary explosion creates a sheer energetic force of chaotic power. The shock wave from an explosion can overwhelm the senses because the body and aura become temporarily disoriented. We now have explosively shocking phenomena in our solar system, called solar flares, and they seem to be increasing in frequency and intensity lately.

The media says that the flares can affect satellites and other electrical systems. True, but what about the effect upon the living bio-electricity of your own body? In what ways are you like a satellite? And could the solar flares affect your mind, or even your soul?

Our sun's flares are activated by intensity originating from the center of our galaxy, at the galactic core. It's not something you think about generally, what with all the details of daily life, but we're becoming galactic citizens whether we realize it or not. Though our sun and our little solar system is at the edge of the Milky Way galaxy, our sun is receiving activation from the galactic core. And when you understand what is happening to our world, and know how to flow along with it, you will understand what is happening to you physically, emotionally, mentally, and spiritually.

When I tune into the consciousness of the sun, I sense that it is a vast, living being. It has a soul, and like all living beings, it gets its primary energy from the universe itself, and especially from the galactic core. And you can learn something from this, because the sun is teaching you how to connect directly with the universe, as if you were plugging into an electrical socket. But if you were just receiving fresh life energy from these solar flares, that would be easy. There is much more to these cosmic events, however...

The solar flares are transmitting a vibrantly activating higher consciousness directly from the galactic core, in the form of living plasma energy. Plasma is mysterious stuff, and it has been called the fourth state of matter -- the first three being solid, liquid, and gas. So plasma is not solid, liquid, or gas, and yet it may appear to mimic these at times. Now this plasma is fascinating because when you tune into it, it communicates with you on many levels, as if it were alive. Which it evidently is, as there is consciousness within everything in the universe -- but the intelligence of plasma is a higher level of consciousness, with special qualities...

Plasma is super-alive, or perhaps super-conscious, I'll call it, because it is capable of activating your consciousness in ways that may transcend the benefits that the solid, liquid, and gas elements can offer you. If you've spent any time with quartz crystals, and if you experienced their amazing abilities to activate your cosmic awareness, you know that crystals are definitely conscious. So multiply that, and you get a sense of how plasma can awaken your inner spiritual capacities. The sun is activated by the deep plasma life intelligence at the galactic core, and so the sun is releasing vast amounts of spiritually activating plasma into this solar system, which is having a catalyzing effect upon you.

The plasma being activated by our sun is awakening your own plasma within you, and this is changing consciousness whether people are ready for it or not. This is because plasma is one of the essential forms that your living soul has within your body. When you let yourself feel into it, you can sense how plasma may well be the life-energy body of your soul. Plasma is a flowing, vibrating, living substance, and the stronger recent solar flares are vibrating your soul body into a new level of presence and functioning. And this can feel overwhelming, because you have been acclimated to a lower level of spiritual aliveness.

The emerging super-capacities in humanity will come from their activated plasma soul-bodies. And if it were that simple, then we would all turn into super beings, and that would be that. However the challenge is that at every level of your being, your ego has hardened itself into rigid patterns, and these patterns may not ready for your emerging spiritual power. In fact, unless you understand what is happening, you might assume that your body and mind are going backwards in their development, and that's not the case at all...

When your spiritual plasma bodies activate, the vibrations shake the old patterns to the surface, and that can mean that toxins come to the surface. It can also mean that old disease patterns can surface, and this can be uncomfortable. Your practical response to surfacing toxins is to clear them out. This is important even if your lifestyle is seemingly healthy. The solar energy activations are bringing up patterns that could come from childhood diseases, family patterns, and past life patterns. So clearing toxins, releasing patterns, and embracing your spiritual awakening are keys to flowing with the changes as pleasantly as possible.

Your emotional body is also being activated by the solar flares, and as with the physical body, emotional patterns are surfacing. Many people are finding old patterns that they thought they had already released making their moody presence known. If you judge it or deny it, that won't make the old patterns go away, no matter how much you wish it would. As your plasma bodies activate, they shake the old patterns loose, just like a dog shaking water off its fur. But typically, the old patterns don't fling out of your reality quite so easily. So you'll be spending time experiencing these old emotions, and you'll have a choice to make...

Do you judge and deny the surfacing emotions, or do you befriend them, so that you can help them? Befriending them doesn't mean submitting to them or agreeing with them. You listen to them, so that the surfacing emotions know that you accept them. This makes it easier to educate them, and to gently release them. When you learn to do this layer-by-layer, you can heal your patterns more easily, because the layer-by-layer approach lets you move through the patterns gently, yet deliberately.

Your awakening soul energy is igniting the living cosmic plasma in your mental body, and this is bringing provoking thoughts to the surface. Old limiting perceptions and beliefs are up for review, and they have a characteristic tight and limiting quality to them. This distinguishes the old thoughts from the new, expansive and liberating thoughts that are attempting to emerge within your mental body. The contrast is stronger than ever, and it can be rather crazy-making to feel simultaneously that anything is possible, while also experiencing limiting childlike fears that seem to hold the ancient resonance of humanity's accumulated fears.

As your plasma energy bodies awaken, they want to express their infinite nature. And they are trying to vibrate at the higher radiant level, but it might not feel wonderful to you just yet, because the hardened patterns in your personality and ego are still resisting. And when you are only noticing the old patterns uncomfortably surfacing, you find yourself wondering when the challenges will end, and when the smoother good times will finally arrive. Here are some essential realizations that will serve you well during your spiritual awakening...

You don't have to wait until all your limiting patterns are released in order to feel the good aspects of your spiritual awakening. Just knowing that you can tap into the good vibrations now gives you the hint that you can access some enlivening spiritual realities in any given moment. If it is that simple, what exactly can you do to touch that potential? Since you are exploring the sun at the moment, just let yourself imagine this: Tune into the sun, and in your mind, go beneath the surface, and tune into its center point. Sense the sun as a living energy that you can talk with and share energy with.

Are you ready to acknowledge that whatever that vast cosmic energy within the sun is, you yourself have something very much like it within your own self? It's simple to do, but challenging for some to consider, because it helps you move beyond centuries of limited concepts. Not that recognizing your galactic essence is bad or scary -- quite the opposite -- it is a joyous recognition of your divine nature. But to the extent that your little ego feels unready, this cosmic recognition could be overwhelming for some people.

And so, recognizing your cosmic nature is up to you. And if you sense that you're probably ready, then you probably are. And if it seems like it would be too much, then relax and wait until you feel ready.

What will you find within the sun? First of all, you have been educated to perceive the sun as a ball of fiery gas. Whatever scientists will eventually prove the sun to be remains to be seen.

So be clear in your understanding that the essence you are tuning into right now is the energetic quality, or the soul of the sun. And when you tune into that divine solar essence, you discover an energy -- a living plasma energy of pure universal spirit. And, if you allow yourself to, you can start to notice a similar energy within yourself.

The solar flares are jump-starting your own internal cosmic engine, so that you can truly sense your cosmic nature. When you recognize the connection, as a real, felt sense within you, you will no longer think of yourself as a material being with an external soul. You will come to know that all your bodies, from the physical body to the soul body, are all expressions of your one integrated self, and that they express the living spark that is your divine, or higher self.

And when you let the sun, and ultimately the galactic core, energetically inform your own self of your essential cosmic nature, you will be learning from the living teacher that is within you, and that lives all around you -- your solar system, your galaxy, and ultimately the universe itself.

This frees you from the idea that this physical universe is separate from the world of spirit, or consciousness. That division was promoted for years by particular branches of science, organized religion, and the mass media, and it served their purpose of dividing and conquering humanity. When you define yourself as being a divided person, in a divided universe, you are easily manipulated.

By contrast, when you acknowledge the spiritual activation taking place with the help of the solar flares, and you own your unified living consciousness, you accept that you are one unified being, integrated with one unified universe. This lets you know yourself and your universe with a new level of empowerment, as exemplified by the film, Thrive, which presents the possibilities that life on the planet can be much more empowering and enlivening than many had supposed was possible.

The emerging energy within you is dynamically alive. It is not a static pretty picture, like a Hallmark card of spiritual niceness. It is much more amazing than that, because, being dynamic, it is a thinking, breathing, vibrating reality that is ever creating -- it is your multidimensional self. And so, the idea that you would just quietly become enlightened and float away in a cloud of bliss is unrealistic.

Your dynamic emerging consciousness doesn't want to deny the world, although as you become more conscious, your thoughts may seek to move beyond limiting energies and away from unhealthy situations. But this doesn't mean that you are denying the world -- very much the opposite -- you are releasing from limited patterns so that you can bring your creative powers to the world in even more effective ways.

This is very much what happened to me when I shifted from doing private sessions. There was a new level of possibilities to shift into, and though my ego had resisted such a shift for years, my higher self reveled in the exciting possibilities of sharing an entire lifetime's worth of cosmic teachings with a broader audience. The awakenings are not always easy, and for most they present challenges. But understanding what is happening is key to navigating through the challenges as they surface, because the deeper meaning of all these changes is that you are looking for a deeper truth, and it is emerging within you and your life.

The good news is that the spiritual activation you've been awaiting for centuries is being brought directly to you, through the catalyzing influence of the solar flares, so that you can experience the shifts within the living landscape of your own body and soul.

From now on, when you hear about solar flares, you will have the understanding to picture it in a new empowering way. You will be able to feel into what the sun, and the solar flares are sharing with your body and soul. The emerging feelings and thoughts will be seen for what they are -- shifting energies amidst a transformational process. You may have to confront some heavy old patterns, and you may feel at times that you have lost your way. But the activated energies in your emerging plasma bodies hold the wondrous potential that you have been seeking, if you let yourself learn from them.

What you had wanted from spiritual masters, from experts and authorities, and from the universe itself -- those spiritual gifts that you had hoped for -- are now emerging within you. Breathe into your awakening vibrations within, and feel the dynamism. This is really happening, and you can choose to benefit from it. You are really being awakened at every level.

Feel into this vibrant truth that is living within the sun, within the galactic core, and within your own self. Let yourself smile as you look back with understanding at your long history of spiritual studies through the centuries. Feel into the depth of your cosmic consciousness within, and recognize that you, in this moment, are the multidimensional being that you have been waiting for -- that splendid divine being who is here to bring your unique gifts into your own life, and into the lives of humanity.

Imaging & the OCD Physician

Imaging Utilization and the Obsessive-compulsive Physician

Obsessive-compulsive personality disorder (OCPD) can be defined loosely as a dysfunctional repetitive focus on detail and minutiae at the expense of logic and flexibility. There is a distinction, however, between true OCPD and OCP “trait”—which I shall define as a tendency to focus on details and strive for perfection in any given task. It is my opinion that OCP trait is an essential component of any successful physician: minute attention to details integrated into a composite view of the patient is at the root of excellence in diagnosis and therapy. There is, however, not a fine line but rather an entire “meadow” separating the disorder from the trait. And physicians who live in that large space are a major cause of over-utilization of imaging.

As there are 2 sides to every issue, let us first consider the end user—the clinician who orders imaging studies. Physicians utilize imaging to varying degrees within the same clinical context. There may be a variety of reasons, including differences in experience, knowledge (or lack thereof), institutional bias, patient demands, and all sorts of other contributing factors. But some general behaviors of individual physicians seem quite predictable to me, and personality driven. When I go in to read emergency department (ED) cases at my busy level I trauma center, or other EDs via teleradiology, I can roughly predict what kinds of studies I will or will not see based on who is staffing the ED at that time. I know when I am going to see 4 consecutive negative computed tomography (CT) studies to rule out pulmonary embolism in young patients with no risk factors; often, patients who have had negative similar studies several times before. I know when every bellyache is going to get a CT scan, every pelvic pain an ultrasound, and every extremity top-to-bottom imaging for trauma that is clearly localized to one area. And I know the nights when none of this will happen, based on a different set of emergency physicians. I am not passing judgment. Well, actually I am.

Flipping the coin, I know radiologists who have never seen a normal CT scan. They dictate 2-page reports describing in excruciating detail every dot in the lung bases, liver, spleen, and kidney; every top normal lymph node is measured, every benign ovarian cyst is described, every hedge is sat upon. To make matters worse, each of these heroic poems ends with recommendations for further imaging to include ultrasound (US) of the pelvis, US of the kidneys, magnetic resonance imaging of the pelvis, CT of the full chest, and repeat studies with additional contrast or thin-section evaluations of specific organs for the “ditzels” described. What is a well-meaning clinician to do with such generally worthless information?

To read this article in its entirety, please visit our website.

-- Robert G. Stern, MD

This article originally appeared in April 2012 issue of The American Journal of Medicine.

If We Have Grown Into a Nation of Relatives From a Nation of Families, Could the Needed Rx Be KR?

A few weeks ago, two of my cousins stopped in to visit, rather impromptu. They passed through Ohio as they were returning home to Pennsylvania. It was both a treat and very delightful to see them both, even for a few brief moments.

Both apologized for not phoning in advance, but neither was certain of their time itinerary and if a visit would even be possible before they returned home. They also didn't want to give too much advance notice because, traditionally for our family we love sharing meals together. If we know someone is planning a visit, then by the nature of just showing good manners, a meal is made readily available for their visit or sojourn during their travels.

The older generations, which I seem to firmly hold a membership within, are affectionately called "food pushers". I am not certain if the title is entirely accurate. We have descended from a long line of exceptional cooks who prepare wonderful meals that is only accentuated by good conversation and good fellowship. We, our immediate and extended family, have all grown to love each of the three rather equally. We grew up learning that the partaking of meals simply cannot occur with everyone. While food is fuel for the body, the fellowship, an intimate activity shared only between those close to one's heart and connected to another's spirit, nurtures the soul.

My cousins neither wanted me to unnecessarily expend time or energy in preparing food on their behalf just in the event the opportunity to visit couldn't occur. Yet more importantly, from their perspective, their real focus, the point that was of paramount importance, was to insure they didn't either forgo or bypass the momentarily opening for a personal exchange of family hellos, which clearly doesn't happen nearly enough or as frequent as any of us desire.

As we shared our mutual affection, I reiterated or clarified that their company is always welcome, invitations are not necessary, and arriving unannounced is totally acceptable, a privilege reserved for family and family-like friends. We exchanged our typical banter, yet I wasn't willing to relinquish this argument, {I seldom am willing, given I am slightly older} and they were remaining at the point of good manner apologies unnecessarily too long. To move us all beyond laboring on this idea and on to something really more important-kinship fellowship, I made one succinct statement. I said, "there is a difference between family and relatives." "You," I added, "are family." We all chuckled and nodded in agreement.

As you are reading this too, I imagine the sides of your mouth are also curving upwards as well. Why? The feeling many have for family members differs from those categorized as relatives. Family members come to visit. Their stay is always too short; their departure occurs too quickly. Their presence is wonderful and their absence creates a noticeable void. In contrast, visits from relatives seem to last too long. Sometimes the distance between their arrival and your desire for the visit to conclude activates a child's voice in the brain "asking is it over yet?"

Sadly, over my lifetime, I have had, and perhaps still do have some relatives intertwined among family. I am confident that this occurs more by default of a series of random unfortunate events than by some atmospheric grand design. I wondered how some earned this distinctive labeling and separate categorization. What began in humor caused me to take a little closer look at some of the differences between relatives and family. As you look at the descriptors, which are not exhaustive, tell me your thoughts as well.

The separation by title suggests that each have very different attributes that are present in one and absent in the other. Does that mean that one brings additive qualities to personal interactions; while conversely the other removes through a subtractive process desired or needed elements between two or more human beings? Does this mean that the presence of one of these groups is effortlessly fluid and the company of the other is tension laden? Does one transform physical space with their cloud covering of a sense of entitlement and the other usher in gratitude like a warm breeze?

Consider the organization of humans from a faith or creation perspective; the human race evolved through the units or groupings titled families. Consider again from a human and not necessarily a secular vantage point as one looks both out and inward, the reality is that in the absence of families, some individuals just would not be chosen. This causes a chuckle for those in the position to do the choosing or who have categorically always been chosen. However, if aligned to the other segment, it is painful for those who are excluded or included only through default.

So how does one make this delineation? On more occasions than I can recount, I have heard conversations where someone touts an expression about being connected to another as a blood relative. Similarly, we have all heard comedic lines describing relationships to someone as a second cousin, twice removed. Is it blood that defines status as either relative or family membership?

Interestingly enough, examining the blood in white blood cells or cells from the interior of the cheek will reveal if the hereditary material in one individual is the same as in another. This only proves relative relationship, a biological connection either vertically or horizontally exists. This alone isn't the definitive proof for family membership. Family is so much more. It is the kinship knitting of spirits and hearts that far surpasses positive DNA testing and presence of genetic markers. The ties that bind individuals and groups together exist and oftentimes are greater than blood connections.

Consider the unselfish and willing sacrifices, love, devotion, and commitment in the family unions of Biblical characters of Ruth and Naomi and Jonathan and David; joined together by marriage and as in-laws no less. Wow! They didn't share any similar biological markers, but did possess commonality in spiritual kinship affinity. Are these random isolated examples found only in Biblical literature? Consider polling or interviewing the hundreds of thousands or millions of individuals who experienced love, nurturing, acceptance and protection of family whose origins began with adoption.

Many would argue that they were welcomed and wanted. Many would also add their membership in these families were full, whole, unconditional and absent of restrictions even in the nonexistence of common biological markers. Consider Jaime Foxx, Faith Hill, Dave Thomas, Steve Jobs, Melissa Gilbert or even Bo Diddley; all adopted-most by strangers, some by blood related individuals-all unequivocally would argue these foundational kinship connections are truly family.

So what made us chuckle at the onset of this article that describes the inclusive group as family and the exclusionary faction as relatives? What makes it possible for us to cringe at the uncle, brother, sister, mom or dad whose persona in general or specific antics, always at group social events and holiday gatherings, which cause personal embarrassment and create retellings of these momentary exploits over and over for the next year and sometimes for years to come? What makes us justified in shunning these individuals' visits, avoiding phone calls, emotionally and physically distancing ourselves personally and sometimes professionally justified?

The justifiable evidence is really quite simple I believe; others may disagree and counter with, it is very complex. It can be summarized in a few areas, behavior, choices, disappointments and hurts-both intentional and unintentional-from things such as religious preferences, political differences, career choices, sexual and marital partnerships, alcohol usage or intolerance, etc., circumstances-sickness, physical characteristics, drug dependency, mental illness, aging, homelessness, financial insolvency, financial dependency, or financial successes sometimes becomes the boundary guidelines for exclusionary practices, avoidance, and ultimately relegation to relatives within a family caste system.

Echoing these labels silently in my head, or worst audibly through my voice, creates a void in my spirit as I empathize with the pain some must feel from the isolation and separation from families resulting from both planned and forced life choices. My own family of origin had the elements of disaster, the sprinkling of imperfection but was rooted deeply in one belief and practice: family first. My family was a collection of individuals connected to one another by blood, by friendship, persons abandoned, lost, displaced, discarded and/or forgotten. Strangers were provided shelter and given a seat at my mother's table. Transgressions were admonished; wholeness was foremost the goal, and forgiveness was served from a year round a la carte menu.

When I reflected upon my own journey through and with both my family of origin and extended members, I realized that my mother's dictated rule of family first had specific elements, a formula of sorts. There was not a formal or informal practice of relative delineation or castigation to the room of tolerance. She only displayed acceptance. No one honestly wants to just be tolerated; many desire wholehearted acceptance. So what dynamics allow or prepare individuals to treat others as and retain membership within a family? Is the recipe simple? I think it is. Here is my mother's recipe, enhanced by my aunt, and embellished over time by me.

1. Infinite supply of unconditional love.

2. Unbridled acceptance

3. Seventy times seventy application of forgiveness

4. Nonconforming unselfishly and willingly sharing responsibility for one another

Is it possible to infinitely love unconditionally, accept others without constraints, forgive in the absence of change and/or repentance AND yet willing share responsibility as someone's brother or sister keeper? Is it possible for this to be a realization other than in sitcoms and fictional families of Ozzie and Harriet of the 1960's or Claire and Cliff Huxtable of the Cosby's in the 1980's? I believe this an easily doable task. I grew up in an environment where it was not only expected but practiced.

My mom, then the reigning matriarch of our family, was quite similar to Mrs. Younger, the mother in the play Raisin in the Sun. She, like Mrs. Younger issued family edicts and accepted nothing less than compliance. Family was quintessentially important to both as was acknowledging God's dwelling presence in the home. This is evidenced in the classic line from Mrs. Younger to Beneatha and demanding recitation of "in my mother's house there is still God!" Perhaps flowing from this God foundation, also in my mother's house, each individual was valued and viewed separately from both negative behavior and choices.

While she perhaps never gave a particular name to these teachable moments and life lessons, I learned from her and my aunt that people are neither disposable nor valueless, but instead irreplaceable and priceless above all things. Looking back over our lives, I watched her repeatedly envelop people in an unconditional love without condemnation and simultaneously demonize the only the behavior but never the individual; each was always separated.

So what about the tens of 1000's and maybe the hundreds of millions relatives exiled from families? Could my mothers' love of family and quirky but extraordinary talent to reduce seemingly complex constructs to simplistic matter-of-fact how-to truths, be a bridge to reconstruct {durable sustainable} relationships and reconnect {whole healthy} families?

I think it is desperately needed. If you disagree, look at our communities that may not contain neighborhoods, the very existence of homelessness in the streets, the increasing volume of random acts of violence, free floating rage, disenfranchised, abandonment in nursing facilities, across our nation and globally, around the world. The media's local and national reporting seems to over abundantly report on the strife among us. It seems that we have turmoil in every direction we look; so many things out of order.

I am reminded of the biological classifications of both the animal and plant kingdoms in nature. Family is inserted following species and genus and prior to order. In the absence or removal of family, can order exist? Are kingdoms ever possible without families? Just using deductive reasoning, every nation around the globe originated with a collection of families evolving into neighbors, ordering and arranging into communities, then growing into kingdoms that we call countries. I didn't notice a place in either a classification of relatives. Every species has a unique and specific base to which it is connected. For animals, the clan, group or family is the source of nurturing, instruction and protection. Relatives living in isolation have neither. Have we grown from a nation of families into a nation of relatives?

In an era where people are not disposable, every hand is needed to make a change as critical changes are needed everywhere. Individual estrangement and isolation as relatives potentially can be more harmful to everyone whose life is touched by him or her. In this very imperfect world, correcting and closing the chasm of exclusion and exile, erected over time, has a high utilitarian beneficiary value throughout the "kingdom". The good news is that banishment to the isolated island of relatives does not have to conclude as terminal but can be only a temporal residency. This simply means that families can be conjointly reconciled and the relative status as outcast or outlier can be dismissed without prejudice. At the very least, consider it an Rx worth exploring. Let's call it KR--kinship redemption.

Gain Weight Quickly - 3 Hot Tips That Will Finally Help You Pack on Healthy Weight and Look Sexy

Anyone that is trying to gain weight is in a tough bind. The problem is that most people are trying to do anything but add some weight to their frame. You never hear about people want to add weight in the news. You don't read about it in magazines. You don't hear friends or family talk about it. This is why it can be so difficult to be in this situation. The worst part is, there isn't a lot of information out there for those looking to put a little extra on instead of taking it off. Today I'd like to share with you 3 quick tips that will help you finally get your start and add the weight you want.

Weight Gaining Tip #1-

The first thing you have to do is make sure you're doing the right kind of exercise. If you're doing the wrong kind of exercise you'll never be able to gain weight. The right exercise is weight training. By lifting weights you'll help your body get rid of the unwanted weight and build the right kind of weight. If you're doing cardio you'll either lose weight or you won't gain any. You have to quit doing activities or at least limit them that are designed to help people lose weight. This doesn't mean that you can't do any type of cardio but I would cut it out of your daily routine as much as possible.

Weight Gaining Tip #2-

The next tip is to be eating the right type of foods. If you're going to gain you need to make sure that you're eating a lot of food. Just because you're eating a lot doesn't mean that you can eat everything either. You need to make sure that you're still eating as healthy as possible to get the results you want. Try and eat three large meals with two to three snacks scattered in between each meal. If you find that you still aren't gaining weight, you need to add more calories to your diet or limit your physical activity.

Weight Gaining Tip #3-

The last tip is to make sure you keep track of everything you're doing so you can track your results for better success. Things that important to keep track of are what you're eating, the types of exercises you're doing and for how long, and how much you weigh each week. If you do this it will be a lot easier to see where you've been which will help you understand where you need to go. You can easily do this by getting a little notebook and dividing it into separate categories with their respective purposes.