A cancer diagnosis can often be directly linked to your family medical history, your lifestyle choices, and your environment. You can't control your family medical history, and only some aspects of your environment are up to you. But lifestyle choices like diet, weight, activity level, and smoking are yours to manage.

"Preventive measures are so heavily underutilized by people. And yet they work. Everything in moderation really works," says Richard R. Barakat, MD, chief of the gynecology service at Memorial Sloan-Kettering Cancer Center in New York City.

While the overall odds are that two out of three women will never get cancer, 700,000 women were diagnosed with cancer in 2008, most with one of the following types:

1. Breast Cancer
Breast cancer accounted for 26 percent of all female cancer cases and 15 percent of the 272,000 female cancer-related deaths that year. A woman's odds of getting this cancer: 1 in 8.

2. Lung and Bronchus Cancer
Lung and bronchus cancers accounted for 14 percent of female cancer cases and 26 percent of all deaths. A woman's odds of getting this cancer: 1 in 16.

3. Colon and Rectal Cancer
Colon and rectal cancers accounted for 10 percent of all cancer cases and 9 percent of all deaths. A woman's odds of getting this cancer: 1 in 19.

4. Uterine Cancer
Uterine cancer accounted for 6 percent of all cancer cases, and 3 percent of all deaths. A woman's odds of getting this cancer: 1 in 41.

5. Non-Hodgkin Lymphoma
Non-Hodgkin lymphoma accounted for 4 percent of all cancer cases and 3 percent of all deaths. A woman's odds of getting this cancer: 1 in 53.

As you learn about the common risk factors for each of these cancers, you can take steps to correct the ones within your control.

Breast Cancer Risks

Risk factors for breast cancer, the most common cancer among women, include:

• Age: Two of three women with invasive breast cancer are 55 or older.


• Family history: Your risk is doubled if your mother, sister, or daughter has had it.


• Race: White women are more susceptible than African-Americans, although African-American women are more likely to die from breast cancer, partly because their tumors may grow faster.


• Dense breast tissue


• Previous radiation treatment to the chest


• A greater than average number of menstrual periods (starting before age 12, reaching menopause after age 55)


• No pregnancies, or having your first pregnancy after the age of 30


• Taking birth control pills: The level of risk goes back to normal 10 years after stopping the pill.


• Past treatment with the drug diethylstilbestrol (DES), once used to prevent miscarriage


• Post-menopausal hormone therapy: Avoiding this treatment decreases your risk of breast cancer.


• Not breastfeeding


• Being overweight and having a high-fat diet


• Lack of exercise


• Drinking heavily: University of Oxford researchers who studied 1.3 million women over a seven-year period found that moderate drinking — as few as one to three drinks per week — puts you at higher risk for breast cancer.

Lung and Bronchus Cancer Risks

A look at the percentages of deaths among people diagnosed with this form of cancer shows just how deadly lung cancer is, at close to the reverse of breast cancer statistics. Most striking is our ability to lower those numbers: 80 percent of all lung cancers in women (and 90 percent in men) might be avoided if people didn't smoke; smokers are 10 to 20 times more likely to get lung cancer than nonsmokers. Family history also plays a part. Other risk factors include exposure to:

• Second-hand smoke
• Radon gas
• Arsenic
• Tar
• Soot

Besides following an exercise plan and a healthy diet, limiting your alcohol intake can also help keep lung cancer at bay.

Colon and Rectum Cancer Risks

More than 90 percent of colon cancers occur in those 50 and older. Risk factors include:

• A personal or family history of colorectal cancer, polyps, inflammatory bowel disease
• Inactivity
• Smoking
• Heavy drinking
• Low-fiber, high-fat diet that includes lots of processed meat, few fruits & vegetables

Early detection is a lifesaver, especially when it comes to colon and rectum cancers. It usually takes 10 to 15 years for abnormal cells to grow in the colon, which means if you have regular colonoscopy screenings to look for polyps and remove them before they become abnormal, you can stay on top of this deadly disease.

A new study from the National Institutes of Health also found a promising connection between calcium and dairy food intake and a lower risk of colon cancer. This study, which tracked 200,000 men and 200,000 women over a seven-year period, is significant because it used a larger population sample to support smaller studies with the same findings.

Uterine Cancer Risks

Hormonal changes, particularly related to estrogen, play a significant role in your risk for uterine cancer, also known as endometrial cancer. Risk factors include:

• A greater than average number of menstrual periods
• No pregnancies
• Taking estrogen therapy
• Obesity and having a high-fat diet
• Past or present use of tamoxifen for breast cancer
• Some kinds of ovarian tumors
• Polycystic ovarian syndrome
• Age
• Diabetes
• A family history of colon cancer
• A personal history of breast or ovarian cancer
• Some cases of endometrial hyperplasia, a thickening of the uterine lining

Using birth control pills over a period of time, but ultimately having multiple pregnancies, can help decrease your risk.

Non-Hodgkins Lymphoma Risks

This disease, which can show up in your lymph nodes, spleen, tonsils and adenoids, thymus gland, or bone marrow, attacks the body's lymphatic system, which is part of the immune system. Risk factors include:

• A weakened immune system, especially if related to long-term infection or organ transplant
• Age: Most cases occur in people 60 or older
• Exposure to certain chemicals, especially insecticides and herbicides
• Obesity
• Autoimmune diseases

There are no known prevention methods for Non-Hodgkins lymphoma , other than to avoid diseases that cause immune deficiency; the most preventable of these diseases is HIV.

Making all the lifestyle improvements you can, most of which involve simple changes to your diet and exercise habits, will go a long way toward improving your health and helping to reduce your risk of cancers common to women.

Labour Day commemorates the achievements of the Australian labour movement. The celebration of Labour Day has its origins in the eight hour day movement, which advocated eight hours for work, eight hours for recreation, and eight hours for rest.

On April 21, 1856 Stonemasons and building workers on building sites around Melbourne, Australia, stopped work and marched from the University of Melbourne to Parliament House to achieve an eight hour day. Their direct action protest was a success, and they are noted as the first organized workers in the world to achieve an eight hour day with no loss of pay, which subsequently inspired the celebration of Labour Day and May Day.

The Labour Day public holiday varies considerably between the various states and territories. It is the first Monday in October in the Australian Capital Territory, New South Wales and South Australia. In both Victoria and Tasmania, it is the second Monday in March (though the latter calls it Eight Hours Day). In Western Australia, Labour Day is the first Monday in March. In both Queensland and the Northern Territory, it is the first Monday in May.

In April we did an article on Medications Used to Treat Fibromyalgia. We thought it might be helpful for you to learn more about these medications. This month we will take an in-depth look at Flexeril®.

Flexeril is a muscle relaxant. It works by blocking nerve impulses (or pain sensations) that are sent to your brain. It is used to treat pain, tenderness, and limited motion caused by muscle spasms. This medication is used together with rest and physical therapy for short-term treatment (2 to 3 weeks). Flexeril may also be used for purposes other than those listed here.

How To Use This Medicine

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor.

Take each dose with a full glass of water. This medication is usually taken three times each day for a period of 2 to 3 weeks. Do not use Flexeril for longer than 3 weeks unless your doctor has told you to.

Do not stop taking Flexeril suddenly if you have been taking it for longer than 1 week. Stopping suddenly may cause nausea, headache and general discomfort.

This medication can cause you to have unusual results with certain medical tests. Tell any doctor who treats you that you are using Flexeril. Store Flexeril at room temperature away from moisture and heat.

Discuss With Your Doctor

Do not take Flexeril if you have used an MAO inhibitor such as:

• isocarboxazid (Marplan®)
• tranylcypromine (Parnate®)
• phenelzine (Nardil®)
• selegiline (Eldepryl®, Emsam®)

within the past 14 days. Serious, life-threatening side effects can occur if you take Flexeril before the MAO inhibitor has cleared from your body.

Do not use Flexeril if you have recently had a heart attack, or if you have:

• Heart Rhythm Disorder
• Congestive Heart Failure
• Heart Block
• Overactive Thyroid

Before using this medication, tell your doctor if you have:

• Problems with Urination
• Enlarged Prostate
• Glaucoma
• Liver Disease

If you have any of these conditions, you may not be able to use Flexeril, or you may need a dosage adjustment or special tests during treatment.

This medication is not expected to be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment.

It is not known whether Flexeril passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

Do not give this medication to a child younger than 12 years old. Older adults may be more sensitive to the side effects of this medication.

If You Miss A Dose

Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at the next regularly scheduled time. Do not take extra medicine to make up the missed dose.

In Case of Overdose

Seek emergency medical attention if you think you have used too much of this medicine. An overdose of Flexeril can be fatal.

Symptoms of a Flexeril overdose may include:

• drowsiness
• fast heartbeat
• tremors or shaking
• slurred speech
• confusion
• nausea
• vomiting
• hallucinations (seeing things)
• chest pain
• seizure (convulsions)

What To Avoid

Flexeril can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert. Avoid using other medicines that make you sleepy such as:

• cold medicine
• pain medication
• muscle relaxers
• medicine for seizures, depression or anxiety

They can add to sleepiness caused by Flexeril. Avoid drinking alcohol, which can increase some of the side effects of Flexeril.

Side Effects

Get emergency medical help if you have any of these signs of an allergic reaction:

• hives
• difficulty breathing
• swelling of your face, lips, tongue, or throat

Stop using Flexeril and call your doctor at once if you have any of these SERIOUS side effects:

• Fast, Pounding, or Uneven Heartbeats
• Chest Pain or Heavy Feeling
• Pain Spreading to the Arm or Shoulder, Nausea, Sweating
• General Ill Feeling
• Sudden Numbness or Weakness, Especially on One Side of The Body
• Sudden Headache, Confusion, Problems with Vision, Speech, or Balance
• Feeling Light-Headed, Fainting
• Confusion, Weakness, Lack of Coordination
• Nausea, Stomach Pain, Low Fever, Loss of Appetite
• Dark Urine, Clay-Colored Stools, Jaundice (yellowing of the skin or eyes)
• Seizure (convulsions)
• Unusual Thoughts or Behavior, Hallucinations (seeing things)
• Easy Bruising or Bleeding, Unusual Weakness

Continue using Flexeril and talk with your doctor if you have any of these less serious side effects:

• Dry Mouth, Increased Thirst
• Blurred Vision
• Drowsiness, Dizziness, Tired Feeling
• Feeling Nervous or Irritable
• Heartburn, Loss of Appetite, Stomach Pain, Nausea, Vomiting
• Muscle Weakness
• Diarrhea, Constipation, Gas
• Sore Throat, Cold Symptoms

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

Drug Interactions

Before taking Flexeril, tell your doctor if you are using any drugs that make you sleepy such as:

• alcohol
• cold medicine
• pain medication
• muscle relaxers
• medicine for seizures, depression or anxiety

Medications that can increase drowsiness caused by Flexeril include:

• amitriptyline (Elavil®)
• citalopram (Celexa®)
• clomipramine (Anafranil®)
• desipramine (Norpramin®)
• escitalopram (Lexapro®)
• fluoxetine (Prozac®, Sarafem®)
• fluvoxamine (Luvox®)
• imipramine (Tofranil®)
• nortriptyline (Pamelor®)
• paroxetine (Paxil®)
• sertraline (Zoloft®)
• meperidine (Demerol®)
• morphine (MS Contin, MSIR®)
• propoxyphene (Darvon®, Darvocet®)
• hydrocodone (Lorcet®, Vicodin®)
• oxycodone (Percocet®, Percodan®)
• fentanyl (Duragesic®)
• codeine (Tylenol #3®)
• prescription cough medicines
• phenobarbital (Solfoton®, Luminal®)
• amobarbital (Amytal®)
• secobarbital (Seconal®)
• chlorpromazine (Thorazine®)
• fluphenazine (Prolixin®)
• mesoridazine (Serentil®)
• perphenazine (Trilafon®)
• prochlorperazine (Compazine®)
• thioridazine (Mellaril®)
• trifluoperazine (Stelazine®)
• diazepam (Valium®)
• alprazolam (Xanax®)
• lorazepam (Ativan®)
• clorazepate (Tranxene®)

If you are using any of these drugs, you may not be able to use Flexeril, or you may need dosage adjustments or special tests during treatment.

There may be other drugs not listed that can affect Flexeril. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

We hope this article has been helpful. Next month our focus will be on Gabapentin.

Thanksgiving, or Thanksgiving Day on the second Monday in October, is an annual holiday to give thanks at the close of the harvest season. Although some people thank God for this bounty, the holiday is mainly considered secular.

The history of Thanksgiving in Canada goes back to an explorer, Martin Frobisher, who had been trying to find a northern passage to the Pacific Ocean. Frobisher's Thanksgiving was not for harvest but homecoming. He had safely returned from a search for the Northwest Passage, avoiding the later fate of Henry Hudson and Sir John Franklin. In the year 1578, he held a formal ceremony, in what is now the province of Newfoundland and Labrador, to give thanks for surviving the long journey. The feast was one of the first Thanksgiving celebrations in North America, although celebrating the harvest and giving thanks for a successful bounty of crops had been a long-standing tradition throughout North America by various First Nations and Native American groups. First Nations and Native Americans throughout the Americas, including the Pueblo, Cherokee, Cree and many others organized harvest festivals, ceremonial dances, and other celebrations of thanks for centuries before the arrival of Europeans in North America. Frobisher was later knighted and had an inlet of the Atlantic Ocean in northern Canada named after him — Frobisher Bay.

At the same time, French settlers, having crossed the ocean and arrived in Canada with explorer Samuel de Champlain, also held huge feasts of thanks. They even formed 'The Order of Good Cheer' and gladly shared their food with their First Nations neighbours.

After the Seven Years' War ended in 1763 handing over New France to the British, the citizens of Halifax held a special day of Thanksgiving. Thanksgiving days were observed beginning in 1799 but did not occur every year. After the American Revolution, American refugees who remained loyal to Great Britain moved from the United States and came to Canada. They brought the customs and practices of the American Thanksgiving to Canada. The first Thanksgiving Day after Canadian Confederation was observed as a civic holiday on April 5, 1872 to celebrate the recovery of the Prince of Wales (later King Edward VII) from a serious illness.

Starting in 1879 Thanksgiving Day was observed every year but the date was proclaimed annually and changed year to year. The theme of the Thanksgiving holiday also changed year to year to reflect an important event to be thankful for. In the early years it was for an abundant harvest and occasionally for a special anniversary.

After World War I, both Armistice Day and Thanksgiving were celebrated on the Monday of the week in which November 11 occurred. Ten years later, in 1931, the two days became separate holidays, and Armistice Day was renamed Remembrance Day.

On January 31, 1957, the Canadian Parliament proclaimed: "A Day of General Thanksgiving to Almighty God for the bountiful harvest with which Canada has been blessed - to be observed on the 2nd Monday in October."

Chronic fatigue syndrome (CFS) is characterized by chronic, medically unexplained fatigue associated with effort and stress intolerance, widespread pain, and impairment in sleep and concentration.

Although this constellation of symptoms is highly prevalent in clinical practice, the pathophysiological mechanisms underlying CFS are poorly understood. Current evidence indicates similarities in symptomatology, and possibly etiology and pathogenesis, between CFS and depression. Additionally, there is significant overlap between CFS and fibromyalgia for which antidepressants have shown consistent efficacy. Data regarding antidepressant treatment of CFS is less copious and less uniformly positive, such that antidepressant use in CFS remains controversial.

The current review aims to summarize available data related to antidepressants and other psychotropic agents in CFS to provide a platform for clinicians to make decisions in their treatment of this challenging syndrome.

We identified relevant studies through a PubMed literature search with a combination of the following search terms: 'fatigue,' 'depression,' 'antidepressant,' 'etiology' (e.g., 'neurobiology,' 'neurotransmitter,' 'genetic'), 'diagnosis,' and 'treatment' (e.g., 'antidepressant' plus the specific name).

In addition, studies were also identified via the reference sections of retrieved articles. The authors thoroughly reviewed major findings from the scanned literatures and eventually synthesized them, providing summary, interpretation, and future directions.

If you have the flu, spend a few days in bed, and you'll likely feel better. Fibromyalgia (FM) is different. Symptoms are eased, never cured, and there is no one "remedy" that works for everyone. For these reasons, fibromyalgia patients should develop a personalized treatment plan to minimize flare-ups and the severity of symptoms.

Identify your symptoms

Widespread, chronic pain is a hallmark of FM. It's diagnosed by the presence of tenderness in 18 specific points of the body, with at least 11 of those 18 spots being abnormally tender, even when mildly touched. Fatigue, sleep, and memory and concentration problems (often called "fibro fog") also are common symptoms of FM. You might also experience restless legs syndrome (RLS), irritable bowel syndrome (IBS), painful menstruation, depression, dry eyes, anxiety or headaches. Make sure you work with your doctor to treat all of your ailments. Click here for more information about FM symptoms.

Find the Right Medications

To date, Lyrica, Cymbalta and Savella are the only medications approved by the U.S. Food and Drug Administration (FDA) to treat FM pain. Tricyclic antidepressants often have been found to be the most efficacious medications for FM, especially since sleep and fatigue problems respond well to some antidepressants. But other painkillers, from over-the-counter ibuprofen to prescription-only narcotics, also are prescribed. Click here for more information about the medications used to treat FM.

Talk to your doctor about what will give you the greatest relief with the fewest side effects. Because there are so many medications to choose from, you may need to use trial and error to help determine which is best for you. If antidepressants don't work, you may need to incorporate sleep aids or muscle relaxants into your treatment plan.

Explore Alternative Treatments

Odds are if you have fibromyalgia (FM), you have heard about alternative treatments that may help you feel better. In fact, 90 percent of FM patients have reported trying such alternative therapies as massage, acupuncture, dietary supplements or chiropractic treatment to ease their symptoms.

While research has yet to prove that all alternative therapies work in treating FM, there is a lot of evidence that supports acupuncture as a successful treatment. Using super-thin needles, acupuncturists stimulate various pressure points to provide pain relief. Some studies show that electroacupuncture, in which an electric current is pulsed through a needle, is more effective than the traditional method.

Many people with FM find different alternative methods effective. And like mainstream FM treatments, what works for one person might have no effect on another. Bottom line: You have to shop around to see what is best for you. Here are some other options:

Massage: Massage therapists work on the muscles and soft tissue of the body to alleviate pain, muscle spasms and stress. However, the National Center for Complementary and Alternative Medicine reviewed research about the effectiveness of treating FM with massage and found that the benefits are only short-term.

Cognitive behavioral therapy: Often called CBT, cognitive behavioral therapy has been shown to be among the most effective non-medication treatments for FM. CBT helps change the way you think about pain with the goal of changing the way your body responds to pain, thus making the pain less severe. It may also help improve sleep.

Though studies on the following methods have been deemed insufficient by some medical experts, they are still widely used by people with FM, with varying degrees of success.

Myofascial release therapy works to stretch, soften, lengthen and realign connective tissue to ease pain.

Chiropractic treatment manipulates the spine into proper alignment, helping to boost immune system function and reduce pain.

Dietary supplements magnesium and SAM-e are often used to treat FM. SAM-e is a naturally occurring compound in our bodies that helps in the production of dopamine and serotonin, which regulate mood and control the pain response. Preliminary research has shown evidence that SAM-e supplements may work to keep symptoms in check, but further study is needed. Magnesium is helpful in hundreds of ways, like converting food into energy, strengthening the immune system, and maintaining normal nerve and muscle function. Some researchers believe that a deficiency of this mineral contributes to FM symptoms, though research into its efficacy has been inconclusive.

Finding the alternative treatment that works for you will require some experimentation. Ask your doctor for recommendations and be sure to tell him or her which treatments you already are using. This is especially important with dietary and herbal supplements since they can interact with other medications and possibly cause side effects. Click here for more information about treatments for FM.

Make Healthy Changes

Stress reduction, a healthy diet and regular exercise can reduce FM flare-ups, so lifestyle changes should be a part of your treatment plan. Sleep also is crucial for managing symptoms. Devising a treatment plan will require coordinating with your primary care doctor and/or a rheumatologist, physical therapist, naturopathic physician (if you use one) and other health professionals. Make sure everyone on your health care team is aware of your plan, and consult your doctor before making adjustments. To find a doctor near you that treats FM visit our Doctor Database.

Diet and Exercise Can Calm Fibromyalgia Symptoms

A healthy diet and regular exercise are essential to anyone who wants to feel well. For someone with fibromyalgia (FM), those two things play a critical role in helping to reduce pain, increase energy and improve quality of life.

Studies have shown that walking, strength training, stretching exercises and swimming in a heated pool can alleviate FM symptoms. Regular exercise appears to enhance the body's response to stress, which often triggers symptoms. It also improves endocrine function to help the body better process pain and regulate sleep patterns.

Here are the keys to an effective exercise program:

• Start slowly. Begin with gentle stretching, walking, bicycling or swimming.


• Create a routine. Exercise should be a regular part of your life. Schedule time for it on your weekly calendar and take advantage of small opportunities to exercise throughout your day, such as using the stairs instead of the elevator.


• Have fun with it. Yoga, Pilates, strength training, tai chi, bicycling, walking, jogging, low-impact aerobics or swimming all are recommended. Mix it up so you won't get bored.

While exercise is one of the most proven ways to battle FM, the jury is still out on the issue of nutrition. A balanced diet can help increase your energy level and reduce your risk of other health problems, but more research is needed before experts can identify if specific foods affect the risk of flare-ups. Many people with FM, however, have reported a reduction in symptoms by avoiding certain things, such as caffeine and alcohol. Experiment by cutting foods from your diet that seem to intensify your symptoms. To maintain your health, though, make sure your diet remains well-balanced.

Improving your diet can make you healthier and may even reduce your pain and fatigue. Add that to a regular exercise regimen and you may be on the road to more pain-free days.

Manage Stress, Manage Fibromyalgia

When you have fibromyalgia (FM), stress has a powerful grip on your life. It can cause the disease to flare-up, resulting in shooting pains, extreme fatigue, and cognitive problems like confusion and memory loss—often called "fibro fog." In fact, many people report that a traumatic event brought on their first symptoms of FM, leading some researchers to speculate that stress can actually trigger the disease. The National Institute of Arthritis and Musculoskeletal and Skin Diseases currently is funding research into whether FM is caused by a breakdown in the way the body responds to stress.

Stress is known to trigger flare-ups in people with FM, so restoring calm to your everyday life can help reduce your symptoms. Here are some coping techniques that can help you have more pain-free days.

Identify Your Stressors: Analyze your day and look for potential stress hot spots. For example, some people don't mind sitting in traffic, but others fume as they creep along during rush hour. If you feel hurried to get out the door on time every morning, consider waking up earlier (and going to bed earlier to compensate). If talking on the phone to a certain family member is stressful, consider changing to an email-only relationship. Figure out which situations you can control and make the necessary adjustments to make your days easier.

Develop Coping Techniques: Much of life's stress is unavoidable, but you can learn to react to it while keeping your calm:

• Schedule time to relax or meditate every day. The more you do it, the better you'll get at relaxing. Then, when you experience a sudden stressful situation, such as a heated discussion with your boss, you'll know how to take a few minutes afterward for deep breathing exercises or a short walk.


• Don't dwell on the past. One component of stress involves regret over things we could have done differently. Live in the moment and focus on what you need to do now to control your illness.


• Request accommodations at work. If your FM makes mornings difficult, ask to work from 10 a.m. to 6 p.m., for example, instead of from 9 a.m. to 5 p.m. If sitting at your desk all day leaves your body aching, ask for a better chair or for regular breaks so you can walk and stretch.


• Find support. Talk to others who have FM to share coping strategies and encouragement during your bad days.

Managing stress will not cure your FM, but it can help you gain some control over your symptoms. Allow yourself to relax and your body will thank you.

Disturbed sleep is a common symptom of Fibromyalgia (FM), and now research indicates that it may also be an underlying cause of this painful muscular condition.

A study at the University of Washington found that when 12 healthy women were deprived of deep, restorative sleep three nights in a row, they developed increased musculoskeletal pain as well as overall discomfort and fatigue - classic symptoms of FM. In some cases, chronically disrupted sleep appears to lead directly to FM, especially in people with a family history of the condition.

"Sometimes mothers who are up night after night with colicky babies go on to develop FM," says Dr. Stuart Silverman, clinical professor of medicine and rheumatology at Cedars-Sinai Medical Center UCLA. More often, poor sleep is part of a cascade of FM-precipitating events. "If you have chronic pain, which then disrupts your sleep, you may develop a phenomenon called central sensitization - increased sensitivity to pain signals in the brain, and that can be a pathway to FM," explains Dr. Silverman.

Pinpointing Sleep Issues

If you are at risk for FM or even newly diagnosed with it, identifying sleep problems and getting regular rest becomes all the more important in becoming symptom-free. If the quantity or quality of your sleep isn't what it should be, start by talking to your doctor, who may refer you to a sleep specialist.

"We try to find the causes of a person's interrupted sleep," says Dr. Ana Krieger, sleep specialist at New York's Weill Cornell Medical College, "so we may ask patients to keep a sleep diary or come to a sleep center so we can observe them overnight."

Experts find there are certain conditions that commonly rob people of the rest they need. And when these disorders are effectively treated, sleep problems improve. Among the most common sleep-related problems are:

• Restless Legs Syndrome. Many people with FM have restless legs syndrome, (RLS), a neurological disorder that causes a powerful urge to move your legs when you're sitting or lying down. This can interrupt your sleep repeatedly. Lifestyle changes may help, such as avoiding cigarettes, alcohol, and caffeine, all of which can aggravate the symptoms. Moderate exercise during the day and relaxation techniques at bedtime may also calm your restless limbs. If these strategies aren't enough, there are medications that help reduce RLS symptoms.


• Sleep Apnea. If your sleep partner complains that you snore, or you wake unrefreshed even though you're getting enough sleep, the culprit may be sleep apnea, a condition where breathing stops for short periods when you lie down. This can happen 20 to 30 times an hour, each episode waking you, but so briefly that you don't remember it in the morning. Sleep apnea not only leaves you drowsy during the day, but, left untreated, it can increase your risk for high blood pressure, heart attack, and stroke, and some research suggests that it may be related to FM as well. Treatment involves weight loss if obesity is the cause, and using an artificial breathing device called a CPAP (continuous positive airway pressure) machine when you sleep.

Following Good Sleep Hygiene

In our 24/7 world, getting the rest you need can be a challenge. "We think of sleep as a luxury, so we're busy up to the minute we go to bed, but it takes a while for the body to shut down," says Dr. Krieger. You can set the stage for a good night's sleep with simple changes to your lifestyle and bedtime routine.

• Watch what you eat and drink. Avoid heavy eating for at least 2 to 3 hours before going to bed, and limit your caffeine intake to the morning only.


• Keep to a regular schedule, both bedtime and wake time, and stick to it — even on weekends.


• Limit daytime naps. Although you may feel very tired, sleeping during the day often will make it harder to fall asleep at night.


• Wind down at night by taking a warm bath, reading, or listening to soothing music.


• Learn to relax. If you have difficulty falling asleep, try a relaxation technique such as meditation or deep breathing.


• Create a sleep-promoting environment. Keep your bedroom dark and cool, and use a fan or "white noise" machine to block noise, if necessary.

Bottom Line: If you have chronic sleep problems, it's important to get them diagnosed and treated. Sound sleep will not only give you the energy to carry out daily activities, it could help you avoid developing FM.

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"While women typically experience tenderness or pain in at least 11 of 18 tender points, men may have only six places in the body that are tender, and they aren't as painful as those in women patients," says Tarvez Tucker, M.D., a fibromyalgia expert and associate professor of neurology at the University of Kentucky in Lexington. The reasons for these gender differences aren't completely understood, but there are several theories why women suffer more than men.

The Estrogen Connection

Because fibromyalgia peaks in women during the reproductive years, female hormones are believed to play a role in the higher incidence and severity of the disorder. Many women complain that fibromyalgia pain is worse just before and during their periods. This may be due to hormone fluctuations — estrogen plummets right before menstruation and begins to rise again after a woman's period is over.

"Estrogen is believed to be protective against pain," says Dr. Tucker. "It's very high during pregnancy, probably to protect women from the pain of childbirth." But in menstruating women, estrogen levels fluctuate during the month, which can worsen fibromyalgia symptoms as levels dip.

It's also thought that men more effectively release endorphins, natural substances in the brain that activate its pain-killing receptors. Research suggests that women, in general, have lower thresholds to pain than men, which may relate to these endorphin and hormonal differences.

Role of Testosterone

Men have a small amount of estrogen, but it doesn't fluctuate throughout the month the way it does in menstruating women.

"It's the changes in estrogen levels that seem to trigger a higher sensitivity to pain," says Dr. Tucker. Additionally, the male hormone testosterone may be protective against pain. "Clinical experience has shown that men with [the] highest levels of testosterone are the least prone to fibromyalgia,"

Says Patrick Wood, M.D., a fibromyalgia researcher and chief medical advisor for the National Fibromyalgia Association. Women have this hormone too, but only in a small amount compared to men. Some researchers theorize that testosterone may protect men from experiencing as much fibromyalgia discomfort, as well as fewer migraines or other pain conditions that are more common in women.

A Hidden Disorder in Men?

Though fibromyalgia symptoms are less intense in men, many still suffer from the disorder. Moreover, some experts believe that the incidence in men may be higher than the numbers indicate. Because fibromyalgia is typically considered a woman's syndrome, male sufferers may be overlooked.

"There's a notion among physicians that fibromyalgia is only a female problem, so it's not a diagnosis that's often considered in male patients," says Dr. Wood.

Additionally, men tend to see doctors less often than women, especially for generalized pain complaints "Many men believe that going to a doctor for vague, hurt-all-over pain is being a little bit of a wimp," notes Dr. Tucker. Rather than being seen as less manly, they don't seek diagnosis and treatment.

Fortunately, awareness of fibromyalgia is increasing both in the public eye and in medical circles, so it's becoming increasingly common for doctors to pick up on fibromyalgia symptoms in male patients. Properly diagnosed, all its sufferers can find relief. Several medications are now approved for the treatment of fibromyalgia in both men and women.

The modern holiday of Halloween has its origins in the ancient Celtic festival known as Samhain (pronounced sow-in). The festival of Samhain is a celebration of the end of the harvest season in Gaelic culture, and is sometimes regarded as the "Celtic New Year". Traditionally, the festival was a time used by the ancient pagans to take stock of supplies and slaughter livestock for winter stores. The ancient Gaels believed that on October 31, the boundary between the alive and the deceased dissolved, and the dead become dangerous for the living by causing problems such as sickness or damaged crops. The festivals would frequently involve bonfires, where the bones of slaughtered livestock were thrown. Costumes and masks were also worn at the festivals in an attempt to mimic the evil spirits or placate them.

Irish immigrants carried versions of the tradition to North America in the nineteenth century. Other western countries embraced the holiday in the late twentieth century. Halloween is celebrated in several countries of the Western world, most commonly in Ireland (where it originated), the United States, Canada, Puerto Rico, the United Kingdom, and occasionally in parts of Australia and New Zealand.

United States & Canada

The main event for children of modern Halloween in the United States and Canada is trick-or-treating, in which children disguise themselves in costumes and go door-to-door in their neighborhoods, ringing each doorbell and yelling "trick or treat!" to solicit a gift of candy or similar items. Upon receiving trick-or-treaters, the house occupants (who might also be in costume) often hand out small candies, miniature chocolate bars, nuts, loose change, soda pop, stickers, or even crayons and pencils.

Other common Halloween activities include ghost tours, bonfires, costume parties, visiting "haunted houses", carving Jack-o'-lanterns, reading scary stories and watching horror movies.

Puerto Rico

Halloween is largely celebrated, particularly by children of a young age, always chaperoned, otherwise it is unadvisable for little kids to leave the house. Young teens take to throwing Halloween parties (mostly to have a reason to throw a party; costumes and candy aren't usually remembered). Celebration of the holiday out on the streets asking for candy has declined.

Ireland

All over Ireland, huge bonfires are lit. Young children in disguise go trick-or-treating, they are warmly received by their neighbors with gifts of fruit, miniature chocolate bars, loose change, peanuts and of course sweets for the "Halloween Party". Some homes will put up decorations including Halloween lights. Children have the week off from school for Halloween, and it is common for teenagers and for college students to spend weeknights out and about with friends, pranking and causing mischief, if not trick-or-treating themselves, and perhaps even "egging" (throwing eggs at houses), drinking alcohol, and setting off fireworks.

England

In England, trick-or-treating does occur, although the practice is regarded by some as a nuisance or even a menacing form of begging. In some areas, households have started to put decorations on the front door to indicate that trick-or-treaters are welcome, the idea being that trick-or-treaters will avoid a house not participating in the custom. Tricks currently play a less prominent role, though Halloween night is often marked by vandalism such as soaping windows, egging houses or stringing toilet paper through trees. More serious vandalism often occurs in the form of damage caused by fireworks. The holiday's date being close to the English celebration of 'Bonfire Night' on November 5th, which is traditionally celebrated with fireworks displays, means that those who do with to cause more serious mischief find them to be easily attainable.

Each year approximately 1.3 million people received letters from Social Security denying their claim for disability benefits that included the following or similar statement;

"We realize that this condition keeps you from doing any of your past work, but it does not prevent you from doing other jobs which are less demanding. Your overall condition does not meet the basic definition of disability as defined by Social Security."

If your claim has been denied and you're stuck in the appeals cycle, there's hope. You can file a winning second claim and receive benefits as early as three to four months. The steps to filing a second claim are:

Step 1: Have a denial date from the second appeals level on the first claim signed by an Administrative Law Judge (ALJ)

After you've been denied at the second level of appeals by an administrative law judge, a new claim can be filed. The second claim is processed and may be approved while your first claim waits to be heard at the Appeals Council (AC). The waiting period at the AC level is between two months and two years. While the first claim is waiting to be heard at the AC, you could be receiving monthly disability checks.

Step 2: Contact the Appeals Council, the third level of appeals, to confirm your waiting period is longer than six months

You need to know if you have the time to file a new application. If your case will be heard in six months or less then it isn't worth filing second claim. To find out when your case is scheduled just call the local Social Security office and ask for the Appeals Council phone number. Call the AC office and ask when your case will be heard. If your court date before the AC is between six months and two years or more then filing a second claim is a viable option.

Step 3: Confirm you are still eligible for benefits

When you file a second claim, by law the second claim must have a new starting date (onset date, Section 2, question E of the application). The new date is the day after the ALJ's decision. In order for your second claim to be valid with a new starting date, it's essential that you're still eligible and that your "disability insurance" is still in effect.

To find if you're still eligible, contact your local Social Security Office and ask them for the "last date insured". If the last date insured is after the new starting date, the day after the ALJ's decision, you can file a second claim.

Step 4: Make changes, improvements to your first claim

In order for the second claim to succeed, there must be changes or improvements to the first application or there is no reason to file a second claim. Improvements such as additional medical or non-medical evidence, thorough and detailed responses to questions, supplemental forms or questionnaires can make the difference between success and failure. The second application must unequivocally establish your disability. If you didn't include medical evidence with your first claim, now is the time to do it. More than likely your doctors have ordered additional tests or studies since you filed your first claim. This is considered new medical evidence that could be added to a second claim.

Many claimants answer the application's questions with short and simple responses that are unfortunately insufficient to prove the limitations of a disability. The majority of denials are because the claimant did not establish that they are incapable of working at the most basic of jobs. It's mandatory to convince Social Security that your disability is severe enough to significantly limit basic physical or mental work activities.

Step 5: Consider the pros and cons of submitting a second claim

Finally, there are risks in filing a second claim that need to be considered and weighed against the benefits of doing so. If the second claim is approved, you'll receive monthly cash benefits while the first claim waits to be heard at the Appeals Council. The AC can make a number of decisions: they can approve both claims, deny both claims or send the claims back to the ALJ. If the Appeals Council sends the first claim back to the ALJ for consideration, the instructions include a statement that vacates the second claim. Both the first and second claim are sent to the ALJ for a determination. If the ALJ ultimately denies both claims then the claimant runs the risk of having to pay back the benefits that were paid when the second claim was approved.

On the positive side, the Appeals Council is influenced by the new evidence in the second claim and frequently upholds the approved determination of the second claim. If the Appeals Council approves the first claim, you'll receive back benefits from the onset date of the first claim. In addition, with an earlier effective date, based on the first claim's approval, you'll receive Medicare sooner if not immediately.

It's a balanced choice that only you can make. If you are confident that the second claim proves your disability and inability to do the simplest jobs, then the risk is minimized and you have everything to gain by filing a second claim.

About The Author

Trudi Aviles is a passionate advocate for disabled adults filing for SSDI benefits. Before becoming disabled with CFIDS/FM she wrote technical training manuals for working adults. She applied her skills of strategic analysis, research and writing when completing her SSDI application. The process took six months but she won her benefits in three months. Distressed by the number of people denied benefits the first time they applied, 64%, she was determined to make a difference in the SSDI's culture of denial. Trudi has written a book entitled, Win Your Disability Benefits Now. It is a step-by-step, question-by-question guide to writing winning answers on the SSDI application. This book is her contribution to help others win their benefits the first time they apply. For more information about Trudi, her book, tips and techniques visit SSDI-Help.

A new supermarket opened near my house. It has an automatic water mister to keep the produce fresh. Just before it goes on, you hear the sound of distant thunder and the smell of fresh rain.

When you pass the milk cases, you hear cows mooing and you experience the scent of fresh mown hay.

In the meat department there is the aroma of charcoal grilled steaks.

When you approach the egg case, you hear hens cluck and cackle, and the air is filled with the pleasing aroma of bacon and eggs frying for breakfast.

The bread department features the tantalizing smell of fresh baked bread & cookies.

However, I don't buy toilet paper there any more.

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