Waitangi Day commemorates a significant day in the history of New Zealand. It is a public holiday held each year on the 6th of February to celebrate the signing of the Treaty of Waitangi, New Zealand's founding document, on that date in 1840. The Treaty made New Zealand a part of the British Empire, guaranteed Mãori rights to their land and gave Mãori the rights of British citizens.

Public Holiday
Waitangi Day was proposed as a public holiday by the New Zealand Labour Party in their 1957 party manifesto. After Labour won the election they were reluctant to create a new public holiday, so the Waitangi Day Act was passed in 1960 making it possible for a locality to substitute Waitangi Day as an alternative to an existing public holiday. In 1963, after a change in government, Waitangi Day was substituted for Auckland Anniversary Day as the provincial holiday in Northland.

New Zealand Day
In 1971 the Labour shadow minister of Mãori Affairs, Matiu Rata, introduced a private members' bill to make Waitangi Day a national holiday, to be called New Zealand Day. This was not passed into law. After the 1972 election of the third Labour government under Norman Kirk, it was announced that from 1974 Waitangi Day would be a national holiday known as New Zealand Day. The New Zealand Day Act 1973 was passed in 1973.

This article was requested by one of our readers. The term "polyarthritis" means inflammation of more than one joint. (Technically, the term "oligoarticluar arthritis" is used when 4 or fewer joints are inflamed.)

Patients with inflammatory polyarthritis (i.e., inflammation in more than 4 joints) are a diagnostic and management challenge. When symptoms are of recent onset, the range of possible diagnoses is great. Certain viruses including those that cause rubella, and mumps, human parvovirus B19 and some enteroviruses can cause acute polyarthritis; however, these viral arthritides normally subside within 6 weeks without sequelae. The prodrome of acute hepatitis B infection and infection with the Lyme disease agent, Borrelia burgdorferi, may include polyarthritis. The former is recognized by the ensuing hepatitis, while the latter requires a high index of suspicion (i.e., a history of tick bite or a typical rash on a patient from an endemic area) and often involves only 1 or 2 large joints.

In patients who are under 50 years of age with joint pain and swelling lasting longer than 6 weeks the diagnoses to be considered include rheumatoid arthritis, psoriatic arthritis, other seronegative spondyloarthropathies and SLE. In patients over 50 years of age, crystal-induced synovitis should also be considered. Osteoarthritis may also cause considerable inflammation in the affected joints. For most of these conditions specific therapies aimed at controlling inflammation, preserving range of motion in the joint and preventing joint damage are successful in decreasing morbidity and improving quality of life.

The patient with symptoms in many joints requires a detailed history and physical examination. If there is morning stiffness lasting more than 30 minutes or stiffness after sitting, the joint complaints are likely to be caused by inflammation; a convincing history of joint swelling confirms the presence of inflammation. The physician should record the onset and progression of symptoms and the distribution of joints affected. A history of psoriasis in the patient or a family member is an important clue to the possibility of psoriatic arthritis. The physician should also inquire about a history of iritis or inflammatory bowel disease, both of which are associated with seronegative spondyloarthropathies. A recent episode of infectious diarrhea or genitourinary infection are clues to possible Reiter's syndrome. Does the patient have symptoms suggestive of SLE (e.g., photosensitive or malar rash, alopecia or pleurisy)? Is there a past history of acute episodes of arthritis or gout? Are the joints tender or swollen? Is movement limited? The choice of laboratory tests that may help depend on the differential diagnosis.

The typical patient with rheumatoid arthritis has inflammation in the wrist and MCP or metatarsophalangeal (MTP) joints, or both, that persists beyond 6 weeks. Among patients under 50 years of age more women are affected, but after age 50 incidence is equal for men and women. Morning stiffness and inactivity stiffness are almost always present, and swelling of affected joints is clear with careful examination. The condition may be episodic at the onset, but within weeks to months the symptoms become persistent and more disabling. A positive rheumatoid factor test supports the diagnosis; however, as many as 30% of those affected have negative test results. Specificity increases with consistent results on more than 1 test and with high titre. The presence of antinuclear antibodies at a low titer may be associated with more severe seropositive rheumatoid arthritis. If the patient has had active polyarthritis for more than 1 year, joint erosion may be seen on radiographs of the hand or foot.

Useful laboratory tests for patients with recent onset inflammatory polyarthritis may include complete blood count, erythrocyte sedimentation rate, rheumatoid factor test, aspartate aminotransferase (AST) test, creatinine level and urinalysis. Erythrocyte sedimentation rate is an inexpensive measure of disease activity in those with rheumatoid arthritis; however, the test is not diagnostic and rates are not elevated in all patients affected. A positive test result for rheumatoid factor is helpful but not essential to confirm the clinical impression of rheumatoid arthritis in the setting of symmetrical inflammatory polyarthritis. If the arthritis has lasted more than a year, the physician should consider taking radiographs of the hands and feet.

The importance of diagnosing rheumatoid arthritis cannot be overemphasized — early intervention with DMARDs has been shown to improve long-term outcomes, and once joint damage has occurred erosion and joint instability are irreversible. If rheumatoid arthritis is mild and in its early stages many rheumatologists favour using hydroxychloroquine because it is safe and convenient. If control is suboptimal after 2 months, additional DMARDs are often prescribed. A recent study reported some efficacy with minocycline for patients with early seropositive rheumatoid arthritis. However, long-term efficacy data for patients treated with minocycline are not available, and radiographs show that damage progresses at the same rate as in placebo-treated patients.

If a patient has moderate or severe rheumatoid arthritis, especially if the rheumatoid factor is positive, methotrexate may be the preferred DMARD. Methotrexate is relatively convenient and well tolerated. Sulfasalazine is safe as a second-line agent and can be used in combination with methotrexate and other DMARDs. Many new DMARDs and biologic agents are becoming available.

There is frequently a delay between the presentation of polyarthritis and the confirmed diagnosis, and there is always a delay before a prescribed DMARD has the expected benefit. When optimal DMARD therapy or a combination of DMARDs does not control synovitis, low-dose prednisone can provide symptom relief, acceptable low toxicity and joint protection. Bisphosphonate, either cyclical tidronate or daily alendronate, reduces the risk of steroid-induced osteoporosis and should be prescribed prophylactically when the daily dose of prednisone is 7.5 mg or more.

Patients with active rheumatoid arthritis should be assessed by a rheumatologist on a regular basis, and clinical and laboratory evaluations should be repeated to measure the efficacy and toxicity of treatment. The aim of therapy is to minimize pain, stiffness and joint swelling; retard joint damage; and reduce future disability.

Patients with SLE (female:male ratio is about 10:1) frequently present with polyarthritis - typically a peripheral polyarthritis with symmetric involvement of both small and large joints. The physician should question the patient in detail about symptoms that reflect multisystem involvement, particularly photosensitivity, unexplained rashes, malar rash, pleuritic chest pain, history of seizures, oral ulcers, hair loss, Raynaud's phenomenon, fevers and sweats. Deformities including subluxation at the MCP joints, ulnar deviation, "swan neck" and boutonniere deformities (Jaccoud's arthropathy) may develop in about approximately 15% of patients with SLE, but these are not associated with joint erosion.

If, on the basis of the history and the physical examination, SLE is suspected the physician should order an antinuclear antibody test; this is a useful screening test because a negative test result will virtually exclude SLE. If the test is positive and there is clinical suspicion of multisystem disease, the physician should consider further serologic tests and refer the patient to a rheumatologist. For SLE patients without serious internal organ involvement hydroxychloroquine is the drug of choice because it has been shown to improve disease control, prevent flares and improve long-term outcomes. Arthritis and pleurisy respond to NSAIDs. Steroid medications may also be required in low and moderate doses either intermittently or continuously. Immunosuppressant drugs are required for those with serious internal organ involvement (e.g., cerebritis or glomerulonephritis).

Diseases such as primary Sjögren's syndrome, polymyositisdermatomyositis, limited and diffuse scleroderma and mixed connective tissue disease may also manifest as polyarthritis. Primary Sjögren's syndrome may be extremely difficult to differentiate from rheumatoid arthritis when the main feature is polyarthritis. Prominent muscle weakness is a clue to myositis, and patients with scleroderma almost always have sclerodactyly and Raynaud's phenomenon. Mixed connective tissue disease may present with features of rheumatoid arthritis in conjunction with those of other connective tissue diseases.

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 Ambien.

Ambien is a sedative, also called a hypnotic. It affects chemicals in your brain that may become unbalanced and cause sleep problems (insomnia). Ambien is used to treat insomnia. This medication causes relaxation to help you fall asleep and stay asleep. Ambien may also be used for purposes other than those listed here.

Before Using This Medicine

Ambien will make you fall asleep. Never take this medication during your normal waking hours, unless you have a full 7 to 8 hours to dedicate to sleeping.

You may be more likely to have amnesia (forgetfulness) if you cannot get a full 7 to 8 hours of sleep after taking Ambien. You may also be at an increased risk of accident or injury if you attempt to drive or operate machinery after taking Ambien without having enough sleep time afterward.

Ambien can cause side effects that may impair your thinking or reactions. You may still feel sleepy the morning after taking the medication. Until you know how this medication will affect you during waking hours, be careful if you drive, operate machinery, pilot an airplane, or do anything that requires you to be awake and alert.

Do not drink alcohol while you are taking Ambien. It can increase some of the side effects of Ambien, including drowsiness.

Do not take other medicines that make you sleepy such as:

• cold medicine
• pain medication
• muscle relaxants
• medicine for depression or anxiety

You may have withdrawal symptoms if you stop taking Ambien after taking it over several days in a row. Do not stop taking Ambien suddenly without first talking to your doctor. You may need to use less and less before you stop the medication completely.

Ambien may be habit-forming and should be used only by the person it was prescribed for. Ambien should never be shared with another person, especially someone who has a history of drug abuse or addiction. Keep the medication in a secure place where others cannot get to it.

What To Discuss With Your Healthcare Provider

Do not use this medication if you are allergic to Ambien. Ambien tablets may contain lactose. Use caution if you are sensitive to lactose. Ambien will make you fall asleep. Never take this medication during your normal waking hours unless you have a full 7 to 8 hours to dedicate to sleeping. You may be more likely to have amnesia (forgetfulness) if you cannot get a full 7 to 8 hours of sleep after taking Ambien. You may also be at an increased risk of accident or injury if you attempt to drive or operate machinery after taking Ambien without having enough sleep time afterward.

Before taking Ambien, tell your doctor if you are allergic to any drugs, or if you have:

• kidney disease
• Liver disease
• Lung disease such as asthma, bronchitis, emphysema, or chronic obstructive pulmonary pulmonary disease (COPD)
• A history of depression, mental illness, or suicidal thoughts
• A history of drug or alcohol addiction

If you have any of these conditions, you may not be able to use Ambien, or you may need a dosage adjustment or special tests during treatment. This medication may be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. Ambien can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby. The sedative effects of Ambien may be stronger in older adults. Accidental falls are common in elderly patients who take sedatives. Use caution to avoid falling or accidental injury while you are taking Ambien. Do not give this medicine to anyone younger than 18 years of age.

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. Follow the directions on your prescription label.

Ambien comes with patient instructions for safe and effective use. Follow these directions carefully. Ask your doctor or pharmacist if you have any questions. Take z olpidem only if you are able to get a full night's sleep before you must be active again. Never take this medication during your normal waking hours, unless you have a full 7 to 8 hours to dedicate to sleeping.

Take Ambien with a full glass of water. Ambien is for short-term use only. Tell your doctor if your insomnia symptoms do not improve, or if they get worse after using this medication for 7 to 10 nights in a row. Do not take Ambien for longer than 4 or 5 weeks without your doctor's advice.

You may have withdrawal symptoms if you stop taking Ambien after taking it over several days in a row. Do not stop taking Ambien suddenly without first talking to your doctor. You may need to use less and less before you stop the medication completely.

Withdrawal symptoms include:

• Behavior changes
• Stomach pain
• Muscle cramps
• Nausea
• Vomiting
• Sweating
• Anxiety
• Panic
• Tremors, and seizure (convulsions).

Insomnia symptoms may also return after you stop taking Ambien. These symptoms may seem to be even worse than before you started taking the medication. Call your doctor if you still have worsened insomnia after the first few nights without taking Ambien.

Do not crush, chew, or break an extended-release tablet. Swallow the pill whole. It is specially made to release medicine slowly in the body. Breaking the pill would cause too much of the drug to be released at one time. Store Ambien at room temperature away from moisture and heat.

Precautions While on this Medicine

Ambien can cause side effects that may impair your thinking or reactions. You may still feel sleepy the morning after taking the medication. Until you know how this medication will affect you during waking hours, be careful if you drive, operate machinery, pilot an airplane, or do anything that requires you to be awake and alert.

Do not drink alcohol while you are taking Ambien. It can increase some of the side effects of Ambien, including drowsiness. Do not take other medicines that make you sleepy such as:

• cold medicine
• pain medication
• muscle relaxants
• medicine for depression or anxiety

Avoid taking Ambien during travel, such as to sleep on an airplane. You may be awakened before the effects of the medication have worn off. Amnesia (forgetfulness) is more common if you do not get a full 7 to 8 hours of sleep after taking Ambien. Take Ambien only if you are able to get a full night's sleep before you must be active again.

If You Miss A Dose

Since Ambien is usually taken as needed, you may not be on a dosing schedule. Never take this medication if you do not have a full 7 to 8 hours to sleep before being active again. Do not take extra medicine to make up a missed dose.

In Case of Overdose

Seek emergency medical attention if you think you have used too much of this medicine. An overdose of Ambien can be fatal when it is taken together with other medications that can cause drowsiness.

Symptoms of a Ambien overdose may include:

• sleepiness
• confusion
• shallow breathing
• feeling light-headed
• fainting
• coma

Side Effects

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

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

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

• Worsening sleep problems
• Depressed mood, thoughts of hurting yourself
• Unusual risk-taking behavior, decreased inhibitions, no fear of danger
• Aggression, feeling agitated
• Hallucinations, confusion, loss of personality

Continue taking Ambien and talk to your doctor if you have any of these less serious side effects:

• Daytime drowsiness;
• Dizziness, weakness, feeling "drugged" or light-headed
• Weakness, lack of coordination
• Amnesia, forgetfulness
• Headache
• Vivid or abnormal dreams
• Diarrhea, nausea, vomiting
• Muscle pain
• Blurred vision

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 Ambien, tell your doctor if you are using any of the following drugs:

• itraconazole (Sporanox®)
• rifampin (Rifadin®, Rimactane®, Rifater®)
• imipramine (Janimine®, Tofranil®)
• fluoxetine (Prozac®, Sarafem®)
• sertraline (Zoloft®)
• narcotic pain medications
• muscle relaxers
• seizure medications
• anti-anxiety medications

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

There may be other drugs not listed that can affect Ambien. 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.

I hope this article has been helpful. Next month our focus will be on Pamelor.

Valentine's Day or Saint Valentine's Day is a holiday celebrated on February 14 in Canada, Mexico, the United Kingdom, France, and Australia. It is the traditional day on which lovers express their love for each other by sending Valentine's cards, presenting flowers, or offering candies. The holiday is named after two among the numerous Early Christian martyrs named Valentine. The day became associated with romantic love in the circle of Geoffrey Chaucer in the High Middle Ages, when the tradition of courtly love flourished.

The day is most closely associated with the mutual exchange of love notes in the form of "valentines." Modern Valentine symbols include the heart-shaped outline, doves, and the figure of the winged Cupid. Since the 19th century, handwritten notes have largely given way to mass-produced greeting cards. The sending of Valentines was a fashion in nineteenth-century Great Britain, and, in 1847, Esther Howland developed a successful business in her Worcester, Massachusetts home with hand-made Valentine cards based on British models. The popularity of Valentine cards in 19th-century America was a harbinger of the future commercialization of holidays in the United States.

According to the Greeting Card Association, an estimated one billion valentine cards are sent each year, making Valentine's Day the second largest card-sending holiday of the year. (An estimated 2.6 billion cards are sent for Christmas.) Approximately 85 percent of all valentines are purchased by women.

We would like to wish all of our readers a very happy Valentine's Day!

Objectives:
This paper reviews the existing theoretical models explaining task persistence in chronic pain, pointing at its strengths and weaknesses.

Findings:
For chronic musculoskeletal pain, purely biomedical models appear insufficient. The prevailing Fear-Avoidance model postulates that catastrophic misinterpretations of pain give rise to fear of pain, subsequently leading to a cycle of avoidance of activity, disuse, and disability. For pain disability associated with task persistence and overuse often seen in patients with fibromyalgia, cognitive behavioral mechanisms have been a neglected area in pain research and are just beginning to be scrutinized. One promising theoretical model is the so-called Mood-as-Input model, which predicts that task performance results from the interaction between current mood and certain stop-rules.

The novel feature of the Mood-as-Input model is that the effects of mood on task performance are dependent on motivational context variables [As-Many-As-Can [AMAC] and Feel-Like-Discontinuing [FLDC] contexts]. In the AMAC context, negative mood signals the individual that not enough progress on the task has been made, leading to continuation with the task. In the FLDC context, the opposite pattern is found. A negative mood here signals that continuing with the task is no longer appropriate, thereby disengaging from the task. Thus, with different stop-rules, the same mood can have different motivational effects.

Conclusions:
The literature suggests that the Mood-as-Input model may provide a framework to enhance our understanding of disability both due to avoidance behavior and activity overuse. Suggestions for further research in this novel area are made.

U.S. Presidents Day, officially known as Washington's Birthday, is a federal holiday in the United States and is celebrated on the third Monday of February. It is also the official name of a concurrent state holiday celebrated on the same day in a number of states.

Although it has become known as a great weekend for sales, especially on cars, there's a lot more to the holiday. Presidents Day was originally designated in honor of George Washington's birthday and is still legally called "Washington's Birthday." The first president of the United States was born on February 22, 1732.

The first attempt to create President's Day occurred in 1951 when then the "President's Day National Committee" was formed by Harold Stonebridge Fischer of Compton, California, who became its National Executive Director for the next two decades. The purpose was not to honor any particular President, but to honor the office of the Presidency. It was first thought that March 4, the original inauguration day, should be deemed President's Day. However, the bill recognizing the March 4th date was stalled in the Senate Judiciary Committee (who had authority over national holidays), who felt that, because of its proximity to Lincoln's and Washington Birthdays, 3 holidays so close together would be unduly burdensome. During this time, however, the Governors of a majority of the individual states issued proclamations declaring March 4 to be President's Day in their respective jurisdictions. Later on, the Washington's Birthday holiday would concurrently become known as President's Day.

By the mid-1980s, with a push from advertisers, the term "Presidents' Day" began its public appearance. Although Lincoln's birthday, February 12, was never a federal holiday, approximately a dozen state governments have officially renamed their Washington's Birthday observances as "Presidents Day", "Washington and Lincoln Day", or other such designations. However, "Presidents Day" is not always an all-inclusive term.

• More About George Washington
• More About Abraham Lincoln

When shopping the grocery store for healthy foods, the Nutrition Facts panel and other health claims on packaged food can be helpful tools. But how do you know these labels are guiding you to make the healthiest and most nutritious choices for you and your family?

Government Regulation of Nutrition Facts and Claims in America

The Food and Drug Administration (FDA), along with the US Department of Agriculture (USDA) and the Department of Health and Human Services (HHS), is responsible for setting the guidelines for healthy eating in America. This includes the regulation of the FDA's Nutrition Facts panel and of any nutrition claims that manufacturers display on the packaging of food and beverages sold in the US.

The Nutrition Facts panel was initially developed by the FDA to make consumers aware of the nutrients and calories in the foods and beverages they buy and, ultimately, to help shoppers make more-healthful choices for themselves and their families. The panel is required to list the amount of calories, fats, cholesterol, sodium, carbohydrates, fiber, sugars, protein, vitamins, and minerals per serving, as well as the serving size and number of servings per container. Still, food labeling at the FDA and USDA remains a work in progress, with revisions being made as scientists uncover important nutritional revelations.

Revising Nutrition Facts

To help protect consumers from misleading claims, the FDA and USDA made a significant change to the Nutrition Facts panel requirements in 1994. The departments created guidelines for the use of such terms as "healthy," "light," "reduced sodium," and "low fat" (and variations on these terms) as part of the Nutrition Labeling and Education Act. Before this provision, a food or drink that contained no fat or sodium could have been labeled as "healthy" - even jelly beans or soda.

In 1994, the FDA declared that in order to be deemed "healthy," a food or beverage must be low in fat (including saturated fat), sodium, and cholesterol, and also contain at least 10 percent of the recommended daily value of either vitamin A, vitamin C, iron, calcium, protein, or fiber.

Even big brands with the word "healthy" in their names, such as Healthy Choice, were obliged to conform to the FDA's new labeling laws. The FDA also currently regulates terms - including "low," "reduced," "high," "free," "lean," "extra lean," "good source," "less," "light," and "more" - that may be used to describe a given nutrient.

In January 2006, in an effort to help consumers make more heart-healthy choices, the FDA began requiring manufacturers to list trans fat - that is, trans fatty acids - on the Nutrition Facts (and some Supplements Facts) panels. This addition was the result of scientific research showing that consuming trans fat can increase the risk of coronary heart disease by raising low-density lipoprotein (LDL) levels, often referred to as "bad cholesterol." Saturated fat and dietary cholesterol also increase LDL, but they have been listed on food labels since 1993.

Global Nutrition Labels

In a September 2008 Consumers and Nutrition Labeling global report by the Nielsen Company, Deepak Varma, senior vice president of Nielsen Customized Research, concluded that both the rise in obesity and the fact that heart disease is the number-one killer worldwide puts increasing pressure on governments and the food industry to better educate people about what they're eating. "The urgent need for clear and educational labeling has become one of the most debated and controversial topics in recent years," says Varma.

Nielsen's survey suggests that consumers are vulnerable to advertising when it comes to food. While 26 percent of global shoppers look at nutrition labels and scrutinize foods that they perceive as being "nonhealthy," they do not examine the foods that they consider to be "healthy" in the same way.

Worldwide, Americans are the most likely to understand the information on the Nutrition Facts panel (67 percent as compared with the global average of 45 percent, according to Nielsen's survey). But American consumers also appear to be the least inclined to use that information to their benefit. And while the sales of many health and wellness products may be on the rise in America - particularly those that boast "no trans or saturated fats" or claim to contain flax, hemp seed, or probiotics - obesity is also still on the rise.

Getting the Most Out of the Nutrition Facts Panel

Despite any perceived failings in the FDA's nutrition-labeling system, it remains the primary system in the US. The FDA and USDA, along with the HHS and other governmental regulatory agencies, will continue to update the Nutrition Facts panel and other dietary guidelines for Americans and to regulate health claims based on scientific research and consensus panels.

The following are a few tips for getting the most out of the FDA's Nutrition Facts panel:

• Pay attention to portions, and make sure you're eating the right amount based on the actual serving size.


• Count calories to help manage your weight; make sure not to take in more calories than your body burns or you will gain weight.


• Limit saturated and trans fats, cholesterol, and sodium to reduce your risk of chronic diseases.


• Be sure you're getting enough dietary fiber, vitamin A, vitamin C, calcium, and iron in your diet - daily.


• Use the Percent Daily Value (%DV) to determine how much the nutrients per serving are contributing to your total daily diet. You can also compare %DVs of similar products to see which is higher or lower in nutrients and, therefore, which one is better for you (for instance, if one cereal has 40%DV of iron while another has 100%DV).


• Read the ingredients list to learn more about what the package contains. For instance, you may want to choose foods that contain fewer preservatives or you may be seeking more whole grains. The ingredient listing is also important if you or someone in your family has food allergies.

There are many different ways to manage stress. These are among the simplest and most effective, arranged in a simple format. I urge you to try as many as you can, keeping an open mind, so you can have a collection of techniques that are the most effective for you. You'll also find resources below to help you incorporate healthy changes and create a lower-stress lifestyle.

• Feel Better Now
• Take Care of Yourself
• Maintaining Right Attitude
• Creating Right Atmosphere
• Resources for Busy People
• Healthy Habits

Feel Better Now

If you want to lower your stress level in a matter of minutes, these techniques are all relatively fast-acting. Use them as needed to feel better quickly; practice them regularly over time and gain even greater benefits.

• Breathing Exercises
• Meditation
• Reframing With a Sense of Humor
• Music
• Progressive Muscle Relaxation (PMR)

• Yoga
• Exercise
• Guided Imagery / Visualizations
• Journaling
• Cognitive Restructuring: Finding Perspective

Take Care of Yourself

When we're stressed, we don't always take care of our bodies, which can lead to even more stress. Here are some important ways to take care of yourself and keep stress levels lower.

• Healthy Eating
• Better Sleep
• Exercise

• Hobbies
• Good Nutrition
• Healthy Sex Life

Maintaining The Right Attitude

Much of your experience of stress has to do with your attitude and the way you perceive your life's events. Here are some resources to help you maintain a stress-relieving attitude.

• Optimism
• Being In Control
• Overcoming Perfectionism
• Using The Law of Attraction
• How To Be Happier
• Positive Affirmations

• Maintaining a Sense of Humor
• Mindfulness and Stress Relief
• Letting Go of Stressful Thoughts
• Letting Go of Anger
• Tips on Having Fun

Creating The Right Atmosphere

Your physical and emotional surroundings can impact your stress levels in subtle but significant ways. Here are several ways you can change your atmosphere and less your stress.

• Soothing Environment
• Music
• De-Cluttering

• Aromatherapy
• Positive Energy
• Create a Home Spa

Resources for Busy People

Many stressed people are busy people - people who may have more stressors in their lives (because they have more activity in their lives), and less time to devote to stress management. If you're a busy person, these resources can help you to manage stress efficiently in a short amount of time, and eliminate some of what's causing you stress in the first place.

• Ongoing Stress Reduction Resources
• Time Management
• Finding Time
• Prioritizing
• Best Stress Relievers for Busy People

Healthy Habits

Certain routines can help buffer you from stress; if you adopt a few of them, you can more easily manage stress without it becoming severe. The following are some healthy habits you may want to adopt, along with resources to make it easier to make them a lasting part of your life.

• Morning Habits
• Habits for Better Sleep
• Choosing The Right Habits
• How To Stick With New Habits
• E Courses

In the Western Christian calendar, Ash Wednesday is the first day of Lent and occurs forty-six days (forty days not counting Sundays) before Easter. It is a moveable feast, falling on a different date each year because it is dependent on the date of Easter. It can occur as early as 4 February or as late as 10 March.

Ash Wednesday gets its name from the practice of placing ashes on the foreheads of the faithful as a sign of repentance. The ashes used are gathered after the Palm Crosses from the previous year's Palm Sunday are burned. In the liturgical practice of some churches, the ashes are mixed with the Oil of the Catechumens (one of the sacred oils used to anoint those about to be baptized), though some churches use ordinary oil. This paste is used by the minister who presides at the service to make the sign of the cross, first upon his or her own forehead and then on those of congregants. The minister recites the words: "Remember (O man) that you are dust, and to dust you shall return", or "Repent, and believe the Gospel."

In the Roman Catholic Church, ashes, being sacramentals, may be given to any Christian, as opposed to Catholic sacraments, which are generally reserved for church members, except in cases of grave necessity. Similarly, in most other Christian denominations ashes may be received by all who profess the Christian faith and are baptized.

In the Roman Catholic Church, Ash Wednesday is observed by fasting, abstinence from meat, and repentance, a day of contemplating one's transgressions. The Anglican Book of Common Prayer also designates Ash Wednesday as a day of fasting. In other Christian denominations these practices are optional, with the main focus being on repentance. On Ash Wednesday and Good Friday, Roman Catholics between the ages of 18 and 59 are permitted to consume only one full meal, which may be supplemented by two smaller meals, which together should not equal the full meal. Some Roman Catholics will go beyond the minimum obligations demanded by the Church and undertake a complete fast or a bread and water fast. Ash Wednesday and Good Friday are also days of abstinence from meat (for those Catholics age 14 and over), as are all Fridays in Lent. Some Roman Catholics continue fasting during the whole of Lent, as was the Church's traditional requirement, concluding only after the celebration of the Easter Vigil.

A lot of people - even doctors - want to lump fibromyalgia (FM) and chronic fatigue syndrome (CFS/ME) together, believing they're different manifestations of the same underlying problem.

While it's true that the symptoms are remarkably similar, these conditions aren't the same. The top researchers of both syndromes point to numerous differences that should not be ignored.

Similarities Between FM & CFS/ME

• Pain
• Fatigue
• Sleep disorders
• Irritable bowel syndrome symptoms
• Chronic headaches
• Association with Temporomandibular Joint Syndrome (TMJ)
• Cognitive or memory impairment
• Dizziness
• Impaired coordination

However, those are largely surface similarities. When we talk about pain, most of us (including health-care workers) don't have a good vocabulary for different types of pain. When you look deeper, you discover that FM is linked to pain states such as hyperalgesia (pain amplification) and allodynia (pain from a typically non-painful source). CFS/ME, meanwhile, is associated with muscle aches like what you get with the flu. Also, not everyone with CFS/ME has pain.

We also have woefully poor language for describing fatigue, but here again, research shows that people with CFS/ME have unique fatigue states. The same has not been found about FM, and not everyone with FM has fatigue.

The types of unrefreshing sleep are vastly different, as well. People with CFS/ME may sleep most of the time, yet never feel rested. So far, researchers have been unable to identify any actual sleep disorders in CFS/ME, but they have found abnormal sleep patterns. FM, on the other hand, is generally characterized by one or more recognized sleep disorders as well as abnormal sleep rhythms. In many, the sleep disorders pre-date FM. Generally, those with FM get very little sleep.

When it comes to exercise, which causes symptom flares or "crashes" in both conditions, studies link the reaction to different physiological processes, including low growth hormone in FM and abnormal heart rhythms and lactic acid processing in CFS/ME.

The presence of central sensitization puts these conditions in the same overall category, but it's not unique to these illnesses.

Differences Between FM & CFS/ME

• Greater immune dysfunction in CFS/ME
• Abnormal nerve response in FM
• Stress-system (HPA axis) abnormalities predominantly from the adrenal glands in CFS/ME and the hypothalamus in FM
• FM patients have abnormal levels of a cellular chemical called substance P (which transmits pain signals), this level appears to be normal in CFS/ME patients.
• CFS/ME patients often have high levels of a cellular antiviral enzyme called RNase L, while the level is normal in FM patients.
• CFS/ME diagnostic criteria include low-grade fever and sore throat, FM criteria do not.
• The onset of FM frequently is traced to a physical or emotional trauma. The pain of FM usually gets better with heat and massage, while CFS/ME pain doesn't.
• Elevated pro-inflammatory cytokines in CFS/ME, and sometimes elevated anti-inflammatory cytokines in FM.

In addition, leading researches of both FM and CFS/ME say that subgrouping is the future. Many of them believe that FM and CFS/ME are themselves umbrella terms for similar but distinct conditions.

Last week was my birthday and I didn't feel very well waking up on that morning. I went downstairs for breakfast hoping my wife would be pleasant and say, 'Happy Birthday!', and possibly have a small present for me.

As it turned out, she barely said good morning, let alone 'Happy Birthday'. I thought...well, that's marriage for you, but the kids....they will remember.

My kids came bounding down stairs to breakfast and didn't say a word. So when I left for the office, I felt pretty low and somewhat despondent.

As I walked into my office, my secretary Jane said, 'Good Morning Boss, and by the way Happy Birthday!'

It felt a little better that at least someone had remembered.

I worked until one o'clock, when Jane knocked on my door and said, 'You know, It's such a beautiful day outside, and it is your Birthday, what do you say we go out to lunch, just you and me.'

I said, 'Thanks, Jane, that's the greatest thing I've heard all day. Let's go!'

We went to lunch. But we didn't go where we normally would go. She chose instead at a quiet bistro with a private table. We had two martinis each and I enjoyed the meal tremendously.

On the way back to the office, Jane said, 'You know, It's such a beautiful day...We don't need to go straight back to the office, Do We?'

I responded, 'I guess not. What do you have in mind?'

She said, 'Let's drop by my apartment, it's just around the corner.'

After arriving at her apartment, Jane turned to me and said, 'Boss, if you don't mind, I'm going to step into the bedroom for just a moment. I'll be right back.'

'Ok.' I nervously replied.

She went into the bedroom and, after a couple of minutes, she came out carrying a huge birthday cake ... Followed by my wife, my kids, and dozens of my friends and co-workers, all singing 'Happy Birthday'.

And I just sat there....On the couch....Naked.

If you are suffering from Fibromyalgia (FM) and/or CFS/ME, you are probably experiencing a number of uncomfortable side effects. From muscle pain to chronic headaches, FM and CFS/ME patients often experience a plethora of symptoms, many of which make it difficult to function on a day-to-day basis.

You may also be finding that your memory just isn't what it used to be before you were diagnosed. You may be forgetting where you put your keys or your favorite shirt, or you may be having difficulties remembering plans that you made just a few days ago.

Are You Losing Your Mind?

If you are experiencing problems with your memory, you may be wondering if you are losing your mind. These cognitive disruptions can be very distressing, particularly if you are used to being able to remember detailed information at the drop of a hat. But it is important to know that you are not alone. In fact, a large percentage of FM and CFS/ME patients experience problems with their memory, and this is often referred to as "fibrofog." Fibrofog can leave you feeling as if you are in walking around in a haze, and can cause a number of worrisome symptoms. Common symptoms include:

• difficulty remembering details
• difficulty remembering new information
• difficulty finding the right words to express yourself
• problems identifying the meanings of similar words
• confusing similarly shaped numbers

Are Your Memory Problems Real?

Those around you may be telling you that your memory problems are just a figment of your imagination. But recent studies now reveal that memory problems with FM and CFS/ME seem to go hand in hand.

A study performed at the University of Michigan in 2002 examined the cognitive abilities of fibromyalgia patients and healthy controls. Involving 69 patients, this study required participants to perform a variety of cognitive tests. Upon completion of the study, fibromyalgia patients were found to perform more poorly on all of the tests when compared to healthy controls of a similar age. Additionally, fibromyalgia sufferers performed at about the same cognitive levels as people who were more than 20 years older than them. This study suggests that the memory loss is a true symptom of fibromyalgia. But are these memory loss symptoms caused by FM and CFS/ME, and if so, what can you do about it?

Use Learning Strategies

Though memory loss can be quite upsetting, it doesn't have to be a fact of life when it comes to FM and CFS/ME. There are few things that you can do to help improve your memory while retaining control over your symptoms. Learning strategies are a great way to help your brain remember information and details. They simply provide you with a more organized way of storing and retrieving information. Some effective learning strategies include:

• Focus on what you're trying to remember. Take time to think about what you need to remember, whether it's a list of names, chores, or items to buy. Spending a few moments actively processing your thoughts can make it easier to recall what you need to remember in the future.


• Link your list. Try to remember several things or ideas at once by linking them together in your mind. If you want to memorize your grocery list, for instance, connect the items you need together with a specific image or action in your head. Imagine you're in your laundry room holding a container of detergent, then walk into your kitchen to get some bread and milk, then move to the bathroom to replenish the toilet paper.


• Personalize your list. Organize lists into short, manageable sections, and try to connect items to something that's easier for you to remember. Improve memory by linking lists of numbers, for example, to personally relevant dates like your birthday or interesting historical dates.


• Create a visual image. If you're trying to remember someone's name, visualize an object that will help remind you in the future. Think of summer for a woman named June or a cat for someone named Catherine.


• Create an acronym. Train your brain to remember items in a specific sequence by creating a word to represent the objects. Try using the first letter of each item on your shopping list to form a word. For instance, MOST can stand for milk, oranges, soap, toilet paper.


• Use all of your senses to help improve memory. Afraid you're going to forget your next hair appointment or dinner with a friend? Verbally list your appointments out loud and then think about the softness of your hair after a salon visit and the aroma of the food at your favorite restaurant to help solidify the dates in your mind.


• Write it down. Even if you don't actually use your list or a note to remind you of an appointment, simply writing the information down will help your brain retain it.


• Create a rhyme. How did you learn the alphabet or the number of days in each month when you were little? You probably learned them with the help of a song or rhyme. Try doing the same thing with names, appointments, and lists.


• Make it manageable. Organize a long list into shorter lists that are easier to remember. Instead of trying to remember a dozen different items, create four mini-lists with only three things you need to remember from each.


• Be positive. Don't doubt yourself - our brains can often do more than we realize. Regularly practice these tips to help improve memory, and you'll be amazed by how much more you can remember.

Exercise Your Brain

Just as your body needs exercise, so does your brain! There are a number of other ways you can strengthen your memory. Try these strategies and exercises to keep your brain and memory sharp:

• Be organized. Keep lists and notes, and maintain an appointment book.


• Challenge your mind and body. Try new physical and mental activities like yoga, ballroom dancing, tai chi, or chess.


• Play mind games. Do crossword puzzles, read as much as possible, and play games like Scrabble or sudoku.


• Keep yourself guessing. Stimulate your brain by taking an unusual route to work or by using your opposite hand to do simple activities like placing your key in the door, putting on makeup, stirring your food, or brushing your teeth.

Avoid Certain Medications

Unfortunately, certain medications appear to impact directly on memory. By identifying which of your medications affect your cognition, you can help to lessen your cognitive difficulties. Medications that are known to affect memory include:

• benzodiazepines
• tricyclic antidepressants
• first generation antihistamines (such as Benadryl)

If you are taking any of these medications and they appear to be affecting your memory, talk with your health care provider. They may be able to suggest an alternative medication.

Beating Memory Loss

Forgetting things can make you feel flustered and disorganized. But regular workouts for your mind can improve memory and boost your overall brain power. Once you figure out which memory tips work best for you, it's possible that you'll never forget a name, birthday, or that last item on your grocery list ever again.

FEBRUARY 2010

MARCH 2010

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