• Minimal Clinically Important Difference in the Fibromyalgia Impact Questionnaire
• Labor Day - Labour Day
• In-Depth Look at FM Medications - Trazodone
• Father's Day in Australia
• I.V. Chelation Therapy
• Preventing Fibromyalgia-Related Depression & Anxiety
• Understanding The Fibromyalgia Diagnosis Process
• Rosh Hashanah


• Varicella-Zoster Virus Infection of the Peripheral Ganglia & CFS


• Yom Kippur


• On The Lighter Side

Objective

The Fibromyalgia Impact Questionnaire (FIQ) is a disease-specific composite instrument that measures the effect of problems experienced by patients with fibromyalgia (FM). Utilization of the FIQ in measuring changes due to interventions in FM requires derivation of a clinically meaningful change for that instrument. Analyses were conducted to estimate the minimal clinically important difference (MCID), and to propose FIQ severity categories.

Methods

Data from 3 similarly designed, 3-month placebo-controlled, clinical treatment trials of pregabalin 300, 450, and 600 mg/day in patients with FM were modeled to estimate the change in the mean FIQ total and stiffness items corresponding to each category on the Patient Global Impression of Change. FIQ severity categories were modeled and determined using established pain severity cutpoints as an anchor.

Results

A total of 2228 patients, mean age 49 years, 93% women, with a mean baseline FIQ total score of 62 were treated in the 3 studies. Estimated MCID on a given measure were similar across the studies. In a pooled analysis the estimated MCID (95% confidence interval) was 14% (13; 15) and for FIQ stiffness it was 13% (12; 14). In the severity analysis a FIQ total score from 0 to < 39 was found to represent a mild effect, ≥ 39 to < 59 a moderate effect, and ≥ 59 to 100 a severe effect.

Conclusion

The analysis indicates that a 14% change in the FIQ total score is clinically relevant, and results of these analyses should enhance the clinical utility of the FIQ in research and practice.

Labor Day is a United States federal holiday observed on the first Monday in September. The holiday originated in 1882 as the Central Labor Union (of New York City) sought to create "a day off for the working man". Labor Day was outlined in the first proposal of the holiday as:

"a street parade to exhibit to the public 'the strength and esprit de corps of the trade and labor organizations', followed by a festival for the workers and their families."

Congress made Labor Day a federal holiday in 1894. Speeches by prominent men and women were introduced later, as more emphasis was placed upon the economic and civil significance of the holiday. Still later, by a resolution of the American Federation of Labor convention of 1909, the Sunday preceding Labor Day was adopted as Labor Sunday and dedicated to the spiritual and educational aspects of the labor movement.

Today, Labor Day is often regarded as a day of rest and, compared to the May 1 Labour Day celebrations in most countries, parades, speeches or political demonstrations are more low-key. Forms of celebration include picnics, barbecues, fireworks displays, water sports, and public art events. Families with school-age children take it as the last chance to travel before the end of summer.

In Canada, Labour Day has been celebrated on the first Monday in September since the 1880s. The origins of Labour Day in Canada can be traced back to April 14, 1872 when a parade was staged in support of the Toronto Typographical Union's strike for a 58-hour work-week. The Toronto Trades Assembly (TTA) called its 27 unions to demonstrate in support of the Typographical Union who had been on strike since March 25. George Brown, Canadian politician and editor of the Toronto Globe hit back at his striking employees, pressing police to charge the Typographical Union with "conspiracy." Although the laws criminalizing union activity were outdated and had already been abolished in Great Britain, they were still on books in Canada and police arrested 24 leaders of the Typographical Union. Labour leaders decided to call another similar demonstration on September 3 to protest the arrests. Seven unions marched in Ottawa, prompting a promise by Prime Minister Sir John A. Macdonald to repeal the "barbarous" anti-union laws. Parliament passed the Trade Union Act on June 14 the following year, and soon all unions were demanding a 54-hour work-week.

While Labour Day parades and picnics are organized by unions, many Canadians today simply regard Labour Day as the Monday of the last long weekend of summer. N on-union celebrations include picnics, fireworks displays, water activities, and public art events. Since the new school year generally starts right after Labour Day, families with school-age children take it as the last chance to travel before the end of summer. Some teenagers and young adults view it as the last weekend for parties before returning to school, which traditionally begin their new year the day after. FM/CFS/ME RESOURCES wishes you and your family a very Happy Labor Day!

Trazodone is used to treat depression. Trazodone is in a class of medications called serotonin modulators. It works by increasing the amount of serotonin, a natural substance in the brain that helps maintain mental balance. Trazodone is also used for people with Fibromyalgia, to control sleeping.

Before Using This Medicine

Before taking trazodone, tell your doctor and pharmacist if you are allergic to trazodone or any other medications.

Tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, and nutritional supplements you are taking or plan to take. Be sure to mention any of the following:

• anticoagulants ('blood thinners') such as warfarin (Coumadin)
• antidepressants
• antifungal medications such as fluconazole (Diflucan), itraconazole (Sporanox), and ketoconazole (Nizoral)
• cimetidine (Tagamet)
• clarithromycin (Biaxin, Prevpac)
• cyclosporine (Neoral, Sandimmune)
• danazol (Danocrine)
• delaviridine (Rescriptor)
• dexamethasone (Decadron)
• digoxin (Digitek, Lanoxin, Lanoxicaps)
• diltiazem (Cardizem, Dilacor, Tiazac)
• erythromycin (E.E.S., E-Mycin, Erythrocin)
• HIV protease inhibitors such as indinavir (Crixivan), nelfinavir (Viracept), ritonavir (Norvir), and saquinavir (Fortovase, Invirase)
• isoniazid (INH, Nydrazid)
• medications for allergies, cough or colds
• medications for anxiety, high blood pressure, irregular heartbeat, mental illness or pain
• medication for seizures such as carbamazepine (Tegretol), ethosuximide (Zarontin), phenobarbital (Luminal, Solfoton), and phenytoin (Dilantin)
• metronidazole (Flagyl)
• muscle relaxants
• nefazodone
• oral contraceptives (birth control pills)
• rifabutin (Mycobutin)
• rifampin (Rifadin, Rimactane)
• sedatives
• selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac, Sarafem) and fluvoxamine (Luvox)
• sleeping pills
• tranquilizers
• troleandomycin (TAO)
• verapamil (Calan, Isoptin, Verelan)
• or zafirlukast (Accolate)

Also, tell your doctor or pharmacist if you are taking the following medications, called MAO inhibitors, or if you have stopped taking them within the past 2 weeks:

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

Your doctor may need to change the doses of your medications or monitor you carefully for side effects.

Tell your doctor what herbal products you are taking, especially St. John's wort.

Tell your doctor if you:

• are being treated with electroshock therapy
• if you have or have ever had cancer
• if you have or have ever had a heart attack, irregular heart beat
• high blood pressure
• human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS)
• low white blood cell count
• or heart disease
• tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding
• If you become pregnant while taking trazodone, call your doctor
• if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking trazodone

You should know that trazodone may make you drowsy and affect your judgment. Do not drive a car or operate machinery until you know how this medication affects you. If drowsiness is a problem, ask your doctor about taking part of your dose at bedtime.

Ask your doctor about the safe use of alcoholic beverages while you are taking trazodone. Alcohol can make the side effects from trazodone worse. You should know that trazodone may cause dizziness, lightheadedness, and fainting when you get up too quickly from a lying position. To avoid this problem, get out of bed slowly, resting your feet on the floor for a few minutes before standing up. Talk to your doctor about eating grapefruit and drinking grapefruit juice while taking this medicine.

How To Use This Medicine

Trazodone comes as a tablet to take by mouth. It is usually taken with a meal or light snack two or more times a day. To help you remember to take trazodone, take it around the same times every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take trazodone exactly as directed. Do not take more or less of it, take it more often, or take it for a longer time than prescribed by your doctor.

Your doctor may start you on a low dose of trazodone and gradually increase your dose, not more than once every 3 to 4 days. Your doctor may decrease your dose once your condition is controlled.

Trazodone controls depression, but does not cure it. It may take 2 weeks or longer before you feel the full benefit of trazodone. Continue to take trazodone even if you feel well. Do not stop taking trazodone without talking to your doctor. Your doctor will probably decrease your dose gradually. It is important to take trazodone regularly to get the most benefit.

Your doctor may want you to have blood tests or other medical evaluations during treatment with trazodone to monitor progress and side effects.

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

CALL YOUR DOCTOR AT ONCE if you have any of these SERIOUS side effects:

• a prolonged (4 hours or longer), painful, or inappropriate erection
• an irregular heartbeat or chest pains

Other, less serious side effects may be more likely to occur. Continue to take trazodone and talk to your doctor if you experience:

• dizziness or drowsiness
• headache
• insomnia or vivid dreams
• dry mouth, upset stomach, nausea, or vomiting
• diarrhea or constipation
• tremors (shaking)
• 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 trazodone, tell your doctor if you are taking any of the following medications:

• digoxin (Lanoxin®, Lanoxicaps®)
• phenytoin (Dilantin®)
• isocarboxazid (Marplan®)
• phenelzine (Nardil®)
• tranylcypromine (Parnate®)
• warfarin (Coumadin®)

You may not be able to take trazodone, or you may require special monitoring during treatment if you are taking any of the medicines listed above.

Drugs other than those listed here may also interact with trazodone. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines, including vitamins, minerals, and herbal products.

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

In Australia, Father's Day is celebrated with much enthusiasm and joy. What is noticeable about Father's Day in Australia is its unique time of celebration. Unlike in US and several other countries where Father's Day is celebrated on the Third Sunday of June, Fathers Day in Australia is celebrated on the first Sunday of September. Hence, the date of Father's Day is never fixed.

Fathers Day celebration in Australia takes place in the same way as in several other countries around the world. Taking opportunity of the occasion, people express gratitude for father and thank them for all their care and support. Most often children gift flowers, neckties, chocolates or other gift to honor their dearest dad. Though the occasion is celebrated privately in households, several clubs and societies take initiative to organize special programmes to encourage and entertain people. Breakfast meeting for families is a common feature of Father Day celebration in Australia. Various types of games and activities are organized in such Father's Day get-togethers to strengthen the bond of love between father and a child.

The word chelation (pronounced key-LAY-shun), comes from the Greek word chele meaning "to claw" or "to bind". Chelation therapy is used as a means of purging toxic metals and minerals from the body. Practitioners of chelation therapy argue that it is an effective way of removing toxins and harmful body wastes, as well as helping to prevent or treat fibromyalgia, atherosclerosis, heart attacks, strokes, and circulation problems.

What Is Chelation Therapy?
The most popular form of chelation therapy practiced by alternative practitioners employs a drug called EDTA (ethylene diamine tetraacetic acid) administered intravenously. EDTA is approved by the Food and Drug Administration (FDA) for treatment of lead and heavy metal poisoning but not for other forms of toxicity or circulatory problems. EDTA works by attaching itself to specific minerals, which are carried out of the body via urinary excretion.

The most common and toxic heavy metals that can poison our systems and lead to fatigue and illness are iron, lead, cadmium, and mercury. Iron is by far the most common of the heavy metals that predisposes individuals to heart disease. It promotes free radical activity and thereby leads to accelerated arterial damage. Lead and cadmium are common industrial pollutants that also foster free radical activity and poison critical enzymes which repair tissue. Mercury is found in some kinds of seafood and in dental fillings. Its toxicity can depress the immune system and cause an array of symptoms. Getting the iron, lead, cadmium, and mercury out can be accomplished with chelation therapy, which both prevents and can reverse heart disease, atherosclerosis, and the other problems mentioned above.

• Angina
• Allergic Rhinitis
• Anxiety and depression
• Asthma
• Cancer
• Chronic Fatigue Syndrome
• Congestive heart failure
• Epstein-Barr virus
• Fibromyalgia
• Hepatitis C

• High blood pressure
• Influenza & Viral Infections
• Low energy and fatigue
• Macular Degeneration
• Migraine or tension headaches
• Multiple sclerosis
• Parkinson's Disease
• PMS
• Recurrent Infections

How Does Chelation Therapy Work?
For most of these metals, an intravenous solution of vitamins, minerals, and the chelator EDTA is prepared. EDTA is a substance known for its ability to pull heavy metals out of the body. This is infused into the bloodstream through a vein.

EDTA leaves the body in the same form by which it entered, but on its way out, it chelates metals and minerals from the body. Patients usually undergo between 10 and 20 chelation treatments over a period of weeks or months. Each treatment lasts several hours, during which patients can read or watch a movie.

Beyond its effects on heavy metals, chelation with EDTA also helps to remove inappropriate accumulations of calcium from tissue. Calcium gravitates to atherosclerotic plaque in blood vessels, leading to arterial narrowing and blockage. Chelation gently and gradually mobilizes calcium from plaque, restoring elasticity and flow to blood vessels.

Clif Arrington M.D., a naturopathic physician who practices Chelation Therapy states, "I have seen marked improvement in high blood pressure, angina, leg cramps and diabetic leg ulcers as well as improvement in mental alertness and memory due to improved blood flow to all areas of the body."

While controversial (chelation for cardiovascular disease reversal has few adherents among orthodox cardiologists), several thousand physicians practice chelation throughout North America and the world. Many belong to a professional organization known as the American College for Advancement in Medicine (ADAM.)

How Long Does It Last, and What Does it Cost?
A single chelation treatment usually lasts from two to four hours and costs between $50 and $100. In the first month, patients usually receive from five to 30 treatments (with 30 being most common). Patients often are advised to continue preventive treatment once a month. Patients must pay for this treatment themselves. EDTA isn't a medically accepted procedure for atherosclerosis, so insurance companies and Medicare won't reimburse for it.

Are There Any Side Effects?
Potential side effects vary depending on the IV treatment given, but are minimal with most therapies. The most common side effect is pain at the injection site (easily relieved with heat or cold compresses). Occasionally patients will experience lightheadedness or hypoglycemia symptoms. Eating and being well hydrated before IV treatments will limit the potential of experiencing side effects. Patients should bring a snack if the treatment is expected to last longer than an hour.

Testimonials for I.V. Chelation Therapy

• "I suffered from episodes of double vision, irritability, sleeplessness, chronic fatigue and inflammation. I had soreness when I exercised. I was desperate to lose weight and I was living on B12 shots. I'd been to other doctors, but nothing was helping and I was starting to think it was in my own head. My doctor first determined that I had a hormone imbalance and that my thyroid was out of whack. She also determined that I suffer from adrenal fatigue and leaky gut. She prescribed testosterone plus progesterone, six IV treatments and supplements. After one treatment, I was amazed at how much better I felt. After six weeks, I was a new person. We are still working on some things, but I feel she's fixed what was the main problem. If you would have told me a year ago, I'd feel this good, I'd say you were crazy!"


• "Nice while it lasted! I had chelation therapy before I was diagnosed with FMS about 5-6 years ago. I have to admit that at the time I was clutching at straws, trying to find a way to overcome my ill health. This treatment was recomended to me and my husband agreed to fork out the enormous sum of money I paid for several months of treatment! In the end I said enough!! "It did seem to help at the time and maybe it could have sorted me out in the end, but I couldn't justify the expense anymore. I felt very guilty about using my husband's hard earned money on something that wasn't proven!"


• "Horrifying After many tests, including high mercury content, my doctor decided that chelation would be my best route. This was his specialty, so I felt confident that he knew what he was doing. However, after my first treatment, which was also a test to see how well the test worked, I became so weak and sore that I was bedridden for a couple of days. The doctor told me that he would give me something in the IV to help with the side effects. I became even more weak after this treatment. Every muscle and bone in my body ached for days. I was bedridden and honestly thought I would die. I got a fever and rash. This is not a good therapy for someone with CFS. I think it is because our systems are already so weak. It was a terrible experience and I would not suggest that anyone with any type of CFS or fibro problems have it done."


• "I have had Fibromyalgia over 6 years and had to give up my 25 year professional career, because of it. I've been to over a dozen Doctor's, who didn't help me, plus I tried many fibromyalgia supplements, etc., with little results. I went to a 13th doctor who tested me for heavy metals. The results showed very high levels of mercury and lead. I've had 25 IV. chelation treatments (EDTA and DMPS) and am thrilled with my progress. My fibromyalgia pain, insomnia, energy level, hypoglycemia, and fibro fog have all improved. My cholesterol has dropped below 200 for the first time in 15 years, with no diet change. I thank God and My Doctor, and chelation, for my health improvements."


• "I have had fibromyalgia for about 3 1/2 years now and have put my career of 23 years on hold while I try to regain my health. I have seen at least a dozen doctors from a gastrointestinal specialist, rheumatologist, neurologist, sleep disorder specialist to an accupuncturist and chiropractor. But it was the naturopath who put squarely on the path to recovery. I am in the process of detoxifying my body and I feel the chelation treatments are working. I have completed 15 treatments so far and plan to do 30 in all as I have very high levels of lead, mercury, nickel and copper in my body. The first treatments only seemed to worsen my symptoms and pain but my naturopath explained that the embedded metals were being disturbed and removed from my bones and muscles so it was only natural that I feel discomfort. I stuck it out and perservered and I am glad I did. I am half way through and the pain is subsiding."

Depression and anxiety frequently accompany fibromyalgia (FM). If your day-to-day functioning is impaired by either of these conditions, you may need to talk to your doctor about specific medications or professional psychotherapy. On the other hand, if your symptoms are mild, and you just feel sort of blue or mildly stressed out, taking proactive measures on your own may be all you need to do to feel better. Here are some suggestions for where to start.

Look for Hidden Culprits

The first step, says Pamela W. Smith, M.D., MPH, director of the Center for Healthy Living and Longevity and author of the bestselling book, HRT: The Answers and What You Must Know About Women's Hormones, is to rule out any underlying physiological conditions that might be triggering your depression or anxiety symptoms. These might include such things as an underactive thyroid or hormonal or biochemical imbalances.

Talk to your doctor about getting tested. Often, appropriate medication can improve these conditions, and that in turn will help reduce mild accompanying symptoms of depression and anxiety. In some cases, physicians may also prescribe specific medications (usually antidepressants) to help increase levels of a brain chemical called serotonin. Serotonin, an important neurotransmitter, affects many basic psychological functions that seem to go awry in FM, including mood, anxiety, and the sleep/wake cycle.

Make Lifestyle Changes

While any type of illness puts a strain on your body's systems, chronic illnesses such as FM can drain your body of the energy it needs to function well. A healthy diet, moderate amounts of gentle exercise, and plenty of restorative sleep will not only improve your overall health but also have a corresponding positive impact on your mood and attitude.

• Diet
  According to Lynne Matallana, founder and president of the National Fibromyalgia Association (NFA), fatigue is the second most commonly cited FM symptom. Not only can this ongoing lack of energy cause patients to feel depressed, it can also lead to "self-medicating" with foods containing sugar or caffeine, eaten in an effort to counter the pervasive tiredness. Unfortunately, these choices can interfere with sleep patterns or cause "sugar highs," which are followed by increased anxiety. Instead, the NFA recommends following a healthy diet rich in low-fat and high antioxidant foods. This will help maximize your energy and alertness and minimize constant fatigue — which should help counter or reduce episodes of depression and/or anxiety. Dr. Smith also recommends avoiding alcohol, which is a depressant, and using sugar only in moderation. "FM patients, particularly those with mitochondrial and adrenal issues, report having insomnia and intense anxiety, especially if they have sugar at night."


• Exercise
  Studies have shown that exercise is linked to increased feelings of well-being in patients with FM. An individually tailored program of gentle stretching and mild exercise can be very helpful but should be done under the guidance of a physician or a personal trainer experienced in dealing with FM. If possible, schedule your exercise sessions at least five hours before bedtime. Because the body's temperature rises during a workout, allowing a proper interval between exercise and bedtime will ensure that your temperature drops before you go to bed, making it easier to fall sleep.


• Sleep
  According to a report by The National Sleep Foundation, "Studies show a growing link between sleep duration and a variety of serious health problems, including obesity, diabetes, hypertension, and depression." Some studies indicate patients with FM have trouble going into REM sleep, possibly due to muscle pain, says Dr. Smith. There is also research exploring the link between low melatonin levels and F M, which could be improved with melatonin supplements. Patients with FM should also practice healthy sleep habits. Examples from the NFA include avoiding bright lights at bedtime (since they can inhibit melatonin production) and keeping to a regular sleep schedule.

Consider De-Stressing Therapies

Practicing classic de-stressing techniques, such as prayer, meditation, yoga, breathing exercises, tai chi and qi gong, can help people with FM deal with their occasional periods of depression or anxiety. Think about signing up for a class to learn the basics, or check with your doctor about local practitioners.

Talk to a Counselor

Another approach for dealing with depression and anxiety is cognitive behavioral therapy (CBT). According to the American College of Rheumatology (ACR), CBT can help you redefine your "illness beliefs" and, through learning symptom reduction skills, enable you to change your behavioral response to pain as well as symptoms like depression.You might also want to consult a psychotherapist to determine if there are other causes, unrelated to the FM, that may be causing your depression or anxiety.

Seek Support

Perhaps the best ally in fighting depression and anxiety is to have a strong support network: friends and family members with whom you can share your feelings. Joining a FM or chronic pain support group is another good option. According to the ACR, associating with others who also have FM can be very reassuring. Depression and anxiety are often very isolating, and in a group setting, people with FM discover that they are not alone in what they are feeling, both physically and emotionally. Often, participants also hear about new coping strategies and learn the latest research results through contact with such a group. Search our Support Groups for online and offline groups near you.

If you have widespread pain, you and your doctor may wonder if you're experiencing fibromyalgia symptoms. But determining whether you do indeed have fibromyalgia symptoms isn't an easy process. It's not uncommon to spend years going from doctor to doctor and undergoing tests for conditions as varied as arthritis, depression and multiple sclerosis before reaching a fibromyalgia diagnosis.

The fibromyalgia diagnosis process can be frustrating. Here's a look at why it may take so long to go from fibromyalgia symptoms to fibromyalgia diagnosis and what you can do to make the process more efficient for you and your doctors.

Fibromyalgia Symptoms: Not always as clear

Fibromyalgia can't be easily confirmed or ruled out through a simple laboratory test. Your doctor can't detect it in your blood or see it on an X-ray. Instead, your doctor relies on your symptoms. Unfortunately, fibromyalgia symptoms may vary widely from one person to the next.

The American College of Rheumatology (ACR) guidelines direct doctors making a fibromyalgia diagnosis to test 18 points on your body for tenderness. Your doctor puts light pressure with his or her fingers on each point to see whether you feel pain. ACR criteria state that pain at 11 of the points may indicate fibromyalgia. Even that guideline is controversial, though, and some specialists question whether it's useful because fibromyalgia symptoms may come and go. You may experience pain in one area of your body, rather than over your entire body.

To further complicate the diagnosis, you may experience signs and symptoms that are seemingly unrelated to fibromyalgia. Chronic stomachaches or headaches combined with the pain you're experiencing may lead your doctor to suspect other similar conditions first.

As your doctor moves toward a fibromyalgia diagnosis, he or she may want to rule out many diseases and conditions that mimic or are related to fibromyalgia. Testing for some of these diseases and conditions may make sense to you - for instance, you may find it reasonable that your doctor wants to rule out rheumatoid arthritis, since that disease also causes pain.

But the idea of tests for other conditions may be frightening. When your doctor suggests exams and tests for conditions such as cancer, kidney problems or multiple sclerosis, you may be alarmed.

Ruling out all of these conditions may be part of your diagnosis process. Talking openly with your doctor about your fears can help you understand what he or she is looking for with each test and how each test is part of making a final diagnosis.

Diseases and Conditions Similar to Fibromyalgia

The sooner your doctor arrives at a fibromyalgia diagnosis, the sooner you can begin treatment to get your fibromyalgia symptoms under control. Here's what you can do to help yourself and your doctor during this process:

• Understand what your doctor is looking for. Ask your doctor to explain each disease and condition he or she is testing for and why. Ask for reliable sources of further information. When you better understand the diagnostic process, you'll feel less frustrated. If your doctor orders a blood test to look for lupus, ask why. Does he or she think lupus is a more likely cause of your symptoms? Or does your doctor just want to rule lupus out?


• If your doctor orders exams or sends you to a specialist for a condition that doesn't make sense to you, ask questions then, too. For example, if you're referred to a neurologist, you may wonder if your doctor misunderstood your symptoms or perhaps didn't listen to you. Ask questions to clarify the reasoning.


• Keep records of the tests and procedures you've undergone. Each time you see a new doctor or specialist, avoid having to start the diagnostic process all over again. Ask for records of the tests you undergo and the results. Sometimes there may be an advantage to having an exam or test repeated, but in many cases you may save time and money by showing your new doctor your records.


• Many times your records will be forwarded to a new doctor or specialist. But that isn't always the case. In some instances the new doctor or specialist will receive only portions of your medical records.


• Find the right doctor. Find a doctor you trust - someone who communicates well and is willing to work as a team with you. Not all doctors have a lot of knowledge about fibromyalgia, and some may even have outdated notions of the condition. If your health insurance plan allows, switch to a new doctor who is more suitable. Even if a doctor doesn't have a lot experience with fibromyalgia cases, a doctor who is interested in helping you and willing to learn more can be a good advocate for you.
  
  
  If you feel that you aren't making progress toward a final diagnosis, it may be time to find a new doctor. Contact your health insurance plan to find out what doctors you're allowed to see. Ask friends and family for referrals. Search through our Doctor Database for a doctor who treats Fibromyalgia.


• Build a good relationship with your doctor. Whether with your current doctor or a new doctor, build a good partnership. Be open and honest with your doctor about concerns you may have about the diagnosis process. Avoid coming to appointments angry or making accusations. Tell your doctor you're frustrated and ask how you can help move things along. Ask your doctor to be open about what's frustrating or puzzling about your symptoms.

As you work with your doctor, also take steps to take care of yourself so that you can cope with the uncertainty of not having a definitive diagnosis. Reduce stress by taking time for yourself. Engage in stress-free activities, such as massage and deep breathing. Eat a healthy diet with a variety of fruit and vegetables. Tell your doctor if you're having trouble sleeping.

Rosh Hashanah (literally, "Head of the Year") refers to the celebration of the Jewish New Year. The holiday is observed on the first day of the Hebrew month of Tishrei, which falls in September this year, and marks the beginning of a ten-day period of prayer, self-examination and repentance, which culminate on the fast day of Yom Kippur. These ten days are referred to as Yamim Noraim, the Days of Awe or the High Holy Days.

While there are elements of joy and celebration, Rosh Hashanah is a deeply religious occasion. The customs and symbols of Rosh Hashanah reflect the holiday's dual emphasis, happiness and humility. Special customs observed on Rosh Hashanah include; the sounding of the shofar, using round challahs, eating apples and honey (and other sweet foods) for a sweet new year.

S'lichot is a customary service observed before Rosh Hashanah. S'lichot, meaning forgiveness, refers to the penitential prayers recited by Jews prior to the onset of the High Holiday season. It is a solemn and fitting preparation for ten days of reflection and self-examination.

This article posits that infection of the peripheral ganglia causes at least some cases of Chronic Fatigue Syndrome (CFS), with a neurotropic herpesvirus, particularly varicella-zoster virus (VZV), as the most likely cause of the infection.

Virtually all CFS symptoms could be produced by an infection of the peripheral ganglia, with infection of the autonomic ganglia causing fatigue, postural hypotension, and sleep disturbances, and infection of the sensory ganglia causing sensory symptoms such as chronic pain.

Furthermore, infections of the peripheral ganglia are known to cause long-term nerve dysfunction, which would help explain the chronic course of CFS. Herpes viruses have long been suspected as the cause of CFS; this theory has recently been supported by studies showing that administering antiherpes agents causes substantial improvement in some CFS patients.

VZV is known to frequently reactivate in the peripheral ganglia of previously healthy adults and cause sudden, debilitating illness, making it a likely candidate as a cause of CFS. Moreover, many of the symptoms of CFS overlap with those of herpes zoster (shingles), with the exception that painful rash is not one of the symptoms of CFS.

A model is therefore proposed in which CFS is one of the many manifestations of zoster sine herpete; that is, herpes zoster without rash. Furthermore, re-exposure to VZV in the form of chickenpox has become less common in the past few decades; without such re-exposure, immunity to VZV drops, which could explain the increased incidence of CFS. Co-infection with multiple herpesviruses is a possibility, as some CFS patients show signs of infection with other herpesviruses including Epstein-Barr, Cytomegalovirus, and HHV6.

These three herpesviruses can attack immune cells, and may therefore promote neurotropic herpesvirus reactivation in the ganglia. The possibility of VZV as the causal agent in CFS has previously received almost no attention; the possibility that CFS involves infection of the peripheral ganglia has likewise been largely overlooked.

This suggests that the search for a viral cause of CFS has been far from exhaustive. Several antiherpes drugs are available, as is a vaccine for VZV; more research into such agents as possible treatments for CFS is urgently needed.

Yom Kippur, the Day of Atonement, is the most sacred of the Jewish holidays, the "Sabbath of Sabbaths."

By Yom Kippur the 40 days of repentance, that begin with the first of Elul, have passed. On Rosh Hashanah G-d has judged most of mankind and has recorded his judgement in the Book of Life. But he has given a 10 day reprieve.

On Yom Kippur the Book of Life is closed and sealed. Those that have repented for their sins are granted a good and happy New Year.

Since Yom Kippur is the day to ask forgiveness for promises broken to G-d, the day before is reserved for asking forgiveness for broken promises between people, as G-d cannot forgive broken promises between people.

Yom Kippur is a day of "NOT" doing. There is no blowing of the Shofar and Jews may not eat or drink, as fasting is the rule. It is believed that to fast on Yom Kippur is to emulate the angels in heaven, who do not eat, drink, or wash.

The Five Prohibitions of Yom Kippur

1. Eating and drinking
2. Anointing with perfumes or lotions
3. Marital relations
4. Washing
5. Wearing leather shoes

While Yom Kippur is devoted to fasting, the day before is devoted to eating. According to the The Talmud the person "who eats on the ninth of Tishri (and fasts on the tenth), it is as if he had fasted both the ninth and tenth." Prayer is also down played so that Jews can concentrate on eating and preparing for the fast.

On the eve of Yom Kippur the community joins at the synagogue. Men put on prayer shawls (not usually worn in the evenings). Then as the night falls the cantor begins the "Kol Nidre", it is repeated 3 times, each time in a louder voice. The Kol Nidre emphasizes the importance in keeping vows, as violating an oath is one of the worst sins.

An important part of the Yom Kippur service is the "Vidui" (Viduy) or confession. The confessions serve to help reflect on ones misdeeds and to confess them verbally is part of the formal repentance in asking G-d's forgiveness. Because community and unity are an important part of Jewish Life, the confessions are said in the plural (We are guilty).

As Yom Kippur ends, at the last hour a service called "Ne'ila" (Neilah) offers a final opportunity for repentance. It is the only service of the year during which the doors to the Ark (where the Torah scrolls are stored) remain open from the beginning to end of the service, signifying that the gates of Heaven are open at this time.

The service closes with the verse, said 7 times, "The L-rd is our G-d." The Shofar is sounded once and the congregation proclaim - "Next year in Jerusalem."

Yom Kippur is over.

A study conducted by UCLA's Department of Psychiatry has revealed that the kind of face a woman finds attractive on a man can differ depending on where she is in her menstrual cycle.

For example: If she is ovulating, she is attracted to men with rugged and masculine features.

However, if she is menstruating, or menopausal, she tends to be more attracted to a man with duct tape over his mouth and a spear lodged in his chest while he is on fire.

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