THINGS THAT I AM HAPPY ABOUT

1. Fourth of July
2. Japanese and Korean soap dramas and foreign movies with English subtitles
3. Freshly cooked yellow corn
4. Water sprinklers on a hot summer day
5. Fridays

FUNNY CARTOON OF THE DAY

TODAY'S WORD

(www.joelosteen.com)

No Matter What

Today's Scripture

“I want you to know, brothers, that what has happened to me has really served to advance the gospel” Philippians 1:12 (ESV).

Today's Word from Joel and Victoria

We all could learn quite a bit from the apostle Paul. He was deliriously happy and joyous because of what Christ had done in his life. Even when he was chained and shackled in a dark prison because of his faith, Paul praised God and was excited to deliver his message of the gospel. He says in Philippians 1 that he knew he was suffering for a purpose and that he rejoiced because of the advancement of God's message even when he couldn't be out preaching the gospel. My friend, you can't defeat a person who gives God praise no matter what! And the best part is that God can work in your life the same way He worked in Paul's. God can turn some of the worst possible situations into some of the most worthwhile experiences if you have the right attitude. Praise God today . . . no matter what!

A Prayer for Today

God, I realize that You can take even my bad days and accomplish something great for Your glory. Thank You for the way You display Your power and love in my life. In Jesus' Name. Amen.

Long-Term Survival After Surgical Treatment of Patients With Takayasu’s Arteritis

CLINICAL INVESTIGATION REPORTS

http://circ.ahajournals.org/cgi/content/abstract/108/12/1474

Tetsuro Miyata, MD; Osamu Sato, MD; Hiroyuki Koyama, MD; Hiroshi Shigematsu, MD; Yusuke Tada, MD

From the Division of Vascular Surgery, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Japan. Dr Sato is presently at the Department of Surgery, Saitama Medical Center, Japan. Dr Tada is presently at the Second Department of Surgery, Yamanashi Medical University, Japan.

Correspondence to Dr T. Miyata, Division of Vascular Surgery, Department of Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. E-mail miyata-2su@h.u-tokyo.ac.jp
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Received February 6, 2003; de novo received April 10, 2003; revision received July 11, 2003; accepted July 11, 2003.

Background— Surgical interventions have been performed to ameliorate the complications of Takayasu’s arteritis. However, the efficacy of surgery to increase long-term survival has not been established.

Methods and Results— A retrospective review was performed on the survival of 106 consecutive patients with Takayasu’s arteritis who underwent surgical treatment during the past 40 years. Their ages ranged from 5 to 69 years (mean±SEM, 31.7±1.3 years). Survival was compared with the reported results of medically treated patients according to Ishikawa’s prognostic classification. There were 12 hospital deaths, and the remaining 94 patients were followed up from 8 months to 41.8 years (mean, 19.8 years). A serious long-term complication was anastomotic aneurysm, with a cumulative incidence at 20 years of 13.8%. Thirty-one late deaths were observed, and the major cause was congestive heart failure. The overall cumulative survival rate at 20 years was 73.5%. The prognostic classification by Ishikawa had little influence on the survival of surgically treated patients. For stage 3 patients, surgery seemed to increase survival; however, surgery-related complications conversely decreased the survival of stage 1 patients.

Conclusions— Surgery seems to increase the long-term survival of patients with stage 3 Takayasu’s arteritis, whereas conservative treatment is recommended for those with stage 1 or 2 disease. An anastomotic aneurysm may occur at any time after surgery, and regular follow-up using imaging modalities such as multi-detector CT, MRI, or ultrasonography at least once every several years for the rest of the patient’s life is mandatory for the early detection of anastomotic aneurysm.

TODAY'S WORD

Guard Against Bitterness

Today's Scripture
“When you go through deep waters and great trouble, I will be with you. When you go through rivers of difficulty, you will not drown” Isaiah 43:2 (TLB).

Today's Word from Joel and Victoria

Have you ever experienced something that truly tested your faith, your joy and your convictions? We're not talking about just having a bad day or having to deal with difficult people - but enduring an intense situation that rocks you to your very core. When many people face such soul-searching events, they let their happiness and joy turn into bitterness and anger. Make sure this doesn't happen to you. Don't give the evil one the victory by becoming an ineffective Christian due to lingering bitterness. Even if you're being tested, God has promised to remain faithful. He is all-powerful, and He can pull you out of your troubles at any moment. Choose to remain faithful and joyous despite your present circumstances.

A Prayer for Today

God, please help me to trust You and not give in to bitterness or anger, even in the middle of my trials. Thank You for the promise of Your never-failing love. In Jesus' Name. Amen.
Read another Word with Joel & Victoria

Comparative studies between Japanese and Korean patients: Comparison of the findings of TA

http://www.springerlink.com/content/w76u247v7263350h/

Comparative studies between Japanese and Korean patients: Comparison of the findings of angiography,HLA-Bw52, and clinical manifestations

(1) Michiyoshi Yajima1 , Ryutaro Moriwaki1, Fujio Numano1, Young B. Park2 and Young D. Cho3 Department of Internal Medicine, Tokyo Medical and Dental University, Bunkyo-ku, 113 Tokyo, Japan

(2) Department of Medicine, Seoul National University Hospital, Seoul, Korea

(3) Department of Radiology, Kosin Medical Center, 600 Pusan, Korea

Summary

A Japan-Korea cooperative survey on Takayasu arteritis has shown some differences in the features between Japanese and Korean patients with this disease. In angiographic findings, Japanese patients more frequently had lesions at the aortic arch and/or its branches (58% of 75 cases), while, in Korean patients, the abdominal aorta is the site of relatively frequent lesions (30% of 112 cases). Higher occurrence ofHLA-Bw52 was found in Japanese patients in comparison with Korean patients (46% vs 15%). The presence ofHLA-Bw52, however, might have a close association with Takayasu arteritis in Korea as well as in Japan. The complications in 126 Japanese and 88 Korean patients were also compared. The complications occurring with higher frequency in Japanese patients were aortic regurgitation, ischemic heart disease, and visual disturbances, while, in Korean patients, the more frequent complications were renovascular hypertension as well as hypertension of some other etiology.

Key words Takayasu arteritis - Aortography - HLA-Bw52 - Aortic regurgitation

Source:

Journal: Heart and Vessels
Publisher: Springer Japan
ISSN 0910-8327 (Print) 1615-2573 (Online)
Issue: Volume 7, Supplement 1 / March, 1992
DOI
10.1007/BF01744553
Pages: 102-105
Subject Collection
Medicine
SpringerLink Date
Monday, June 20, 2005

TODAY'S WORD

Relax and Let God Work

Today's Scripture

“Cease striving, and know that I am God” Psalm 46:10 (NAS).

Today's Word from Joel and Victoria

Psalm 46:10 is a great Scripture to pray daily. Turn to it and read it before you make any decision. You'll be amazed at the insight you get from waiting on God instead of striving to find the answers on your own. Don't always react on your first impulse - instead, think about what God would want from you and realize that He is in control. You'll be able to see His hand working in just about any situation when you take a step back and realize it's not your plan, but His. When you're absolutely confused, worried and don't have a clue what to do, relax for a minute and let God work. Don't let panic or worry guide your decisions when God is ready to help you.

A Prayer for Today

God, thank You for remaining in control even when I'm worried or stressed. Give me Your supernatural wisdom to make decisions that honor You and are for my good. In Jesus' Name. Amen.

LAUGHING BABIES VIDEO

Comprehensive Evaluation of Cardiovascular Complications in a Patient with Takayasu´s Arteritis

http://www.medical.siemens.com/webapp/wcs/stores/servlet/SMStandardContentView?storeId=10001&langId=-11&catalogId=-11&catTree=100001,18024,17997&pageId=53145&uCatTree=100004*3281799139*477251247
Authors:

Joon-Beom Seo, M.D.,

Tae-Hwan Lim, M.D.,

Department of Radiology, University of Ulsan College of Medicine,

Asan Medical Center, Seoul, Korea

History:

A 50-year-old female patient with a history of known Takayasu´s arteritis was presented with chest discomfort. The patient was diagnosed of Takayasu´s arteritis 20 years ago. She underwent coronary bypass graft surgery 10 years ago for diffuse narrowing of left main (LM), proximal left anterior descending (LAD), and proximal left circumflex (LCx). MSCT examination is requested by the cardiologist for evaluation of her cardiovadcular status.

Diagnosis and Comments:

ECG gated coronary CTA shows patent venous bypass graft which originates from ascending aorta and is anastomosed to distal LAD and diagonal branch [1]. Also shown is diffuse narrowing of left main coronary artery, proximal LAD, and LCx [2]. Non-gated CTA scan obtained immediately after coronary CTA without additional contrast agent shows total occlusion of left subclavian artery, and diffuse severe narrowing of left common carotid artery (LCC) [3]. The LCC originates anomalously from the right brachiocephalic trunk. Diffuse calcification of descending thoracic aorta with narrowing and dilation is also noted, which is the late manifestation of Takayasu´s arteritis. Thin slab MIP image [4] shows occlusion of left lower lobar pulmonary artery due to pulmonary arterial involvement of Takayasu´s arteritis. Also seen are tortuous bronchial arteries and many mediastinal small collaterals entering into left hilum to supply left lower lobe [5]. In the abdomen, mild narrowing of abdominal aorta with calcification at the level of renal artery origin is noted [6].

[1] VRT image shows patent venous bypass graft anastomosed to the distal LAD (arrow) and to diagonal branch (arrowhead) .

[2] VRT image shows diffuse narrowing of left main coronary artery (arrow), proximal LAD (thin arrow), and LCx (arrowhead) .

[3] Narrowing of left common carotid artery (arrow) and total occlusion of left subclavian artery (arrowhead) are seen.

[4] Sagittal slab MIP image shows total occlusion of left lower lobar pulmonary artery.

[5] VRT image shows dense calcification encircling the descending thoracic aorta (arrow) and multiple mediastinal collaterals (arrowheads) .

[6] VRT image of abdominal aorta shows mild narrowing of abdominal aorta with calcified patch at mid level. Diffuse narrowing of right external iliac artery is noted.

Siemens SOMATOM Sensation 16

Scan 1: CTA Coronary

Scan 2: Aorta

HANG ON LITTLE TOMATO

HANG ON LITTLE TOMATO

The sun has left and forgotten me
It’s dark, I cannot see
Why does this rain pour down
I’m gonna drown
In a sea
Of deep confusion

Somebody told me, I don’t know who
Whenever you are sad and blue
And you’re feelin’ all alone and left behind
Just take a look inside you and you will find

If you listen to your heart the whole night through
Your sunny someday will come one day soon to you

AFFIRMATION OF THE DAY

I meet my fear, pain or other emotions I tend to escape.
I thank the people or events that brought them up.

FUNNY CARTOON OF THE DAY

TODAY'S WORD

Go Ahead and Grow

From Joel & Victoria Osteen

joelosteen.com

Today's Scripture
“God is working in you, giving you the desire and the power to do what pleases him” Philippians 2:13 (NLT).

Today's Word from Joel and Victoria

Nothing can change God's love for you. He wants the best for you and desires for you to grow spiritually. God says in the Bible that His plans and purposes for your life are wonderful - and nothing can stop the almighty God from accomplishing great things through you! God orders certain circumstances in your life He knows will be a challenge and cause you to grow in your faith. God loves you far too much to leave you where you are. So why settle for a middle-of-the-road life when you can cross the finish line victoriously! God continually works in you to give you the power for abundant living -so believe it, receive it and use it mightily for Him!

A Prayer for Today

God, I'm so glad that You love me too much to leave me where I am. Help me to live in the obedience and victory that I know are Your desire for me. In Jesus' Name. Amen.

TODAY'S WORD

From Joel & Victoria Osteen
joelosteen.com

God is at Work for You

Today's Scripture

“I know what I am planning for you,” says the Lord. “I have good plans for you, not plans to hurt you. I will give you hope and a good future” Jeremiah 29:11 (NCV).

Today's Word from Joel and Victoria

Too often, we think God is just out there - watching and waiting for us to get things right. God is a big God, but He loves you and He wants to help bring the best things possible into your life. God is at work in your life each and every day, blessing you and preparing you for great and wonderful things that you can’t even imagine! Your entire perspective will radically change when you realize God is in your everyday experiences. Even when we are not completely faithful to Him, He is always faithful to us! Make God your hope and rely solely on Him, and He’ll faithfully work things out that will bless you, protect you and encourage you!

A Prayer for Today

God, thank You for always having my best in mind. I know that You love me and want the best for Your children. Help me to be faithful to You. In Jesus’ Name. Amen.

MUSIC VIDEO OF THE DAY: CORINNE BAILEY RAE

SCIENCE NEWS BREAKTHROUGHS IN GENETICS

http://www.hhmi.org/news/seidman20070608.html

June 08, 2007

Sensitive Genetic Analysis Reveals Vast Changes Associated with Hypertrophic Cardiomyopathy

The one-gene, one-disease concept is elegant, but incomplete. A single gene mutation can cause many other genes to start—or stop—working, and it may be these changes that ultimately cause clinical symptoms. Identifying the complete set of affected genes used to appear impossible. Not anymore.

Studying genetically modified mice, researchers led by Christine E. Seidman, a Howard Hughes Medical Institute investigator at Brigham and Women's Hospital, and her husband Jonathan G. Seidman, who is at Harvard Medical School, have identified hundreds of genes with altered expression in preclinical hypertrophic cardiomyopathy. The study, which is coauthored by colleagues at Harvard Medical School, is published in the June 9, 2007, issue of the journal Science. The discovery could help scientists define the pathways that lead to the disease and lead to the discovery of targets for early detection, prevention, and treatment.


“Some of these low-abundant molecules may be very important in altering cell biology in ways that may be part of the root cause, or a compensatory response to very early manifestations of disease.”
Christine E. Seidman

To obtain a complete picture of the genetic changes associated with the disease, the researchers developed a new gene sequencing technique called polony multiplex analysis of gene expression, or PMAGE. The technique can find messenger RNA transcripts—the directions for making a protein, spun out from the DNA of an active gene—that occur as rarely as one copy for every three cells.

To use PMAGE, researchers attach short sequences (called tags) cut from mRNAs to tiny beads. This tag is amplified, so that each bead contains millions of copies of the same mRNA tag sticking out from it like a minuscule Koosh ball. All of the beads — now called polonies (short for polymerase chain reaction of colonies) — are placed in one layer onto glass, and all of the tags are sequenced simultaneously. A computer program then matches the tags to known genes. The more tags associated with a gene, the higher the expression of that gene.

The industry standard for gene sequencing is serial active gene expression, or SAGE. "There are a couple of labs that have been dedicated to developing this technology," Seidman said, including HHMI investigator Bert Vogelstein at Johns Hopkins and George Church at Harvard. But PMAGE analysis costs between 1/20 and 1/9 of a comparable SAGE analysis, making it more appropriate for the kind of large-scale expression profiling undertaken in this study, she explained. "With SAGE, you can't afford to sequence 4 million transcripts."

Using PMAGE, the researchers compared a healthy group of mice to a group with a genetic mutation that causes hypertrophic cardiomyopathy (HCM) after about 25 weeks of age. In people with HCM, the heart muscle thickens and fails to relax normally after contraction. HCM is the most common cause of sudden death in athletes.

Seidman's group used cardiac tissue from 8-week-old mice to create two PMAGE libraries totaling 4.4 million mRNA tags. They found 706 genes that were overactive or underactive in HCM mice, compared with normal mice. Some genes already have been linked with HCM or heart development. Others are new to the scene.

Overactive genes included:

Nppa (natriuretic peptide precursor a), which encodes atrial natriuretic peptide, or ANP. This protein is an important marker for HCM.

Ctgf (connective tissue growth factor), Tgfß1 (transforming growth factor beta-1), and Postn (periostin), powerful regulators of fibrosis and collagen deposition. The early activation of these genes indicates that fibrosis is probably a primary contributor to heart dysfunction, not a reaction to other changes.

Vgll2 (vestigial-like 2 homolog) and Egr3 (early growth response-3), transcriptional regulators involved in the fetal development of the heart muscle

Nr1h3 (nuclear receptor subfamily 1, group h, member 3) and Nfkbie (nuclear factor kappa light polypeptide gene enhancer in B cells inhibitor epsilon), which have never before been linked with HCM

Underactive genes included:

Hod (homeobox-only protein) and Hand2 (hand and neural crest derivatives 2), transcriptional regulators involved in the fetal development of heart muscle

Abcc9 (adenosine triphosphate cassette subfamily C member 9), which encodes part of the cardiac potassium channel. This channel helps to regulate calcium balance. Mice who lack Abcc9 develop arrhythmias and myocardial calcium overload.

Sln (sarcolipin) and Pln (phospholamban), which regulate calcium uptake into muscle cells

"It's important that we could statistically quantify changes even in genes with very low expression levels," Seidman said. "Some of these low- abundant molecules may be very important in altering cell biology in ways that may be part of the root cause, or a compensatory response to very early manifestations of disease."

Seidman is now repeating the PMAGE sequencing using tissue from younger mice. "We want to get at the drivers of the pathology," Seidman said. "HCM largely affects structural proteins, and we don't really understand how a change in one protein affects the cascade that ultimately affects physiology. If we do this sequencing early enough, we'd like to think we'll see signals that point us to something that is fundamentally changing the whole downstream cascade."

Discovering those fundamental drivers of change could result in targeted therapies to halt HCM in its tracks, or even prevent it altogether.

"We're doing this in a mouse right now, but we have access to tissue from human patients," Seidman said. "With the deep, rich analysis we obtain from a biopsy or resection, we can jump into understanding the human biology of heart disease quite quickly."

-------------

February 27, 2005

Tailing the Cause of a Rare Heart Disease

Using genetic analyses and the translucent tail of a fish, researchers have pinpointed the underlying cause of a rare, mysterious heart disease that is preceded by hearing loss. Discovering the genetic cause of this disease provides researchers with a wealth of new ideas about the molecules involved in building the developing heart, as well as how diseases weaken heart muscle.

In an advance online publication on February 27, 2005, in the journal Nature Genetics , Howard Hughes Medical Institute investigators Christine E. Seidman and Jonathan G. Seidman and their colleagues identified the mutation that causes the disorder, dilated cardiomyopathy preceded by sensorineural hearing loss. The Seidmans and their colleagues at Harvard Medical School collaborated with researchers at University Hospital Würzberg in Germany, Massachusetts General Hospital, Children's Hospital Boston and The Wellcome Trust Sanger Institute in Britain.

“The finding that transcriptional regulation goes awry in this disorder gives us a top-down look at the molecules that must be appropriately expressed and regulated for normal function of the heart throughout life.”Christine E. Seidman

In dilated cardiomyopathy, muscle weakness causes the left ventricle to stretch. As a result, the heart becomes enlarged to the point where it can no longer pump blood efficiently. In earlier studies of patients with cardiomyopathy preceded by hearing loss, the Seidmans and their colleagues identified a region of chromosome 6 as the location of the culprit gene.

In the latest study, they sought to pinpoint the gene and identify the mutation that was responsible. A search of the human genome database identified candidate genes in the region, and subsequent tissue analysis revealed that one gene, called EYA4 , was expressed in both the heart and the cochlea of the ear. The researchers confirmed that affected people possess a characteristic mutation of the EYA4 gene, a finding which offered surprises, said Christine Seidman.

"The EYA4 gene had been implicated in hearing loss before, but in none of the patients where mutations had been characterized had there ever been an abnormality of the heart reported," she said. The Seidmans also found that the gene was expressed in adult heart tissues, which is unusual because other EYA gene family members are thought to function primarily during development.

Curiously, the gene does not code for a structural protein involved in known myocyte functions such as contraction, as is the case with other mutations that cause cardiomyopathies. Rather, EYA4 codes for a protein involved in activating other genes—controlling the copying, or transcription, of genetic information to messenger RNA that carries that genetic blueprint to the cell's protein-making machinery.

To confirm that the mutant EYA4 does indeed cause cardiomyopathy, the researchers turned to the zebrafish, whose genetic machinery for cardiovascular development closely resembles that of mammals. In their experiments with the fish, they used antisense genetic techniques to reduce the fish's production of eya4 protein and measured the resulting changes to the heart. The treated fish developed swelling of the heart ventricle that suggested cardiac dysfunction. High-speed video of the fish's beating heart—visible because the fish are translucent—indicated that the pumping function of the heart was dramatically reduced.

However, the researchers turned to the fish's translucent tail to confirm independently that blood flow was, indeed, reduced in the treated fish. "Since the cardiac imaging of zebrafish remains technically challenging," said Seidman, "we devised a means of tracking the movement of a single red blood corpuscle through the tail to assess flow. That analysis revealed a dramatically lower pumping velocity in the treated fish and provided a functional readout of heart performance," she said.

To understand the molecular mechanism by which the mutant eya4 protein might compromise cardiac function in humans, the researchers compared its function with that of other mutant forms that only caused hearing loss. They found that the mutant protein that caused both cardiomyopathy and hearing loss lacks a region necessary for the protein to attach to other proteins that help it enter the cell nucleus. Only if the eya4 protein enters the nucleus can it play the appropriate role in gene regulation, said Seidman.

"That finding suggests that this mutation causes a dramatic reduction in the amount of eya4 within the nucleus, and we presume that is what accounts for heart disease," said Seidman. "The implication of this finding is that the function of eya4 in the heart may be different than its functions in other tissues, such as the ear.”

Although the researchers' findings will not aid treatment of the cardiomyopathy immediately, said Seidman, they do offer the potential for important basic insights into the mechanisms of cardiomyopathies.

"Whenever a new disorder affecting the human population is identified, it adds new basic knowledge to the field of medicine," she said. "And sometimes rare disorders such as this one can provide very powerful insights into the biology of more common problems. In this case, the finding that transcriptional regulation goes awry in this disorder gives us a top-down look at the molecules that must be appropriately expressed and regulated for normal function of the heart throughout life."

DON'T GIVE UP

QUOTE OF THE DAY

When challenged to wait,

I learn how to wait and make good use of the time.

If no messages or directions about what to do next come up,

I am peaceful as I wait for the right timing of things.

MUSIC VIDEO OF THE DAY

Large Study Finds 12 New Disease-Related Genes

24 Genetic Risk Factors Tied to 7 Common Illnesses, British Scientists Say

LONDON - The largest ever study of genes in disease has found 24 genetic risk factors — half of them completely new — linked to seven common conditions, British scientists said on Wednesday.

It represents the biggest single haul of disease-associated genes so far, underlining an accelerating pace of discovery that will help researchers unpick the fundamental biology of major illnesses and may lead to more effective drugs.

Last week, researchers found a big batch of breast cancer genes and two months ago scientists identified a gene that contributes to obesity.

“We are just scratching the surface,” Peter Donnelly of the University of Oxford, who led the Wellcome Trust Case Control Consortium behind the project, told reporters.

“What will happen over the next couple of years, as these sorts of studies are extended, is that our understanding of the genetics of common diseases will change enormously.”

Scientists have known for years that genes, along with environmental factors, play a role in increasing the risk that people will develop problems like heart disease.

But they are still trying to work out which parts of the genome — the 3 billion sub-units of DNA in our cells — are actually responsible.

To find out more, Donnelly and colleagues from 50 research groups examined 500,000 genetic markers from each of 17,000 individuals, comparing the genomes of diseased and healthy volunteers.

Their findings, published in the journals Nature and Nature Genetics, included the discovery of four new chromosome regions containing genes that can predispose to type 1 diabetes and three new genes for Crohn’s disease, the most common form of inflammatory bowel disease.

They also found genetic links to coronary artery disease and hypertension, rheumatoid arthritis, bipolar disorder and type 2 diabetes.

New ideas for treatment

Significantly, many of the genes found were in areas of the genome not previously thought to have been related to the conditions, opening up completely new options for treatment.

In the case of Crohn’s disease, they uncovered the importance of a process known as autophagy, or “self eating,” which cells use to clear unwanted material, such as bacteria. John Todd of the University of Cambridge said this could be key to explaining the role gut bacteria play in the condition.

Scientists also, for the first time, found a gene linking Crohn’s and type 1 diabetes.
The overall increase in risk of disease conferred by the various genetic risk factors was between 1.2 and 1.5 times, suggesting routine testing is not worthwhile.

But Mark Walport, director of the Wellcome Trust medical charity, said there was a clear need for more research in even bigger projects, such as the UK Biobank scheme, which aims to test the DNA of half a million volunteers.

http://www.msnbc.msn.com/id/19074222/wid/11915773?GT1=10109

5 Things that I am Grateful and Happy

1. Good weather, the sun is out.
2. Pink Martini music.
3. Time to read.
4. Almost cleaned desk, filing stuff at work.
5. New laptop finally connected and in working order.

Cleveland Study on Takayasu’s Arteritis: Utility and Limitations of Magnetic Resonance Imaging in Diagnosis and Treatment

http://www.clevelandclinic.org/quality/outcomes/rheumaticAndImmunologic/takayasuTreatment.htm

Takayasu’s Arteritis: Utility and Limitations of Magnetic Resonance Imaging in Diagnosis and Treatment

Previous studies emphasized poor correlation of symptoms, signs and acute phase reactants with disease activity in about half of all patients with Takayasu’s arteritis (TAK). Invasive angiographic studies demonstrate vessel lumen anatomy. Sequential studies expose patients to high-dose ionizing radiation and catheter/procedure-related morbidity. Such studies do not provide qualitative information about the vessel wall. To determine the utility of vascular magnetic resonance (MR) technology in TAK patients, we previously reported (Tso E, et al. Arthritis Rheum. 2002;46:1634) our experience from 77 studies on 24 patients using ECG-gated MR images, “edema-weighted,” to evaluate the aorta and its primary branches in regard to the vascular lumen, vessel wall anatomy and vessel wall edema.

Ninety-four percent of studies, obtained when patients were thought to have unequivocally active disease, revealed evidence of vessel wall enhancement. In 81% of studies obtained during periods of uncertain disease activity, and in 56% of studies obtained during periods of apparent clinical remission, enhancement was also noted. The Westergren sedimentation rate and C-reactive protein did not correlate with either clinical assessment of disease activity or MR enhancement.

Following completion of our formal TAK-MR study, ten additional patients had MR images obtained just prior to vascular surgery procedures. In seven patients, the finding of edema on MR correlated with histopathologic proof of inflammation or vasculitis. In three patients, however, MR edema was present and inflammation absent within the biopsy, suggesting that vascular MR may not always be accurate.

This study was the first prospective analysis of the utility of recent technical advances in MR imaging in Takayasu’s arteritis. This technique can be an important supplement to the clinical and laboratory assessment of disease activity. The negative correlation we observed between ESR or CRP and MR signal intensity is similar to prior reports in which ESR was abnormal in 72% of patients during clinically active disease and was also abnormal in 44% of patients thought to be in remission.

Our observations should not be interpreted as suggesting that MR vascular imaging replace invasive angiography. Each technique has unique advantages and disadvantages. Sequential invasive angiography has been very informative in detecting new vascular lesions in TAK. It provides greater image resolution than MR in vessels other than the aorta, innominate and common iliac arteries, which makes it desirable for the preoperative planning of bypass surgery. Invasive angiography provides opportunities to record central blood pressure readings and gradient determinations in patients with vessel stenoses, allowing the clinician to assess the reliability of extremity blood pressure cuff measurements. Alternatively, the non-invasive, radiation-sparing qualities of MR and “edema-weighted” imaging techniques may lead to its preferred use for routine follow-up.

“Edema-weighted” MRI vs Invasive Angiography



A comparison of invasive angiography (A) and MR (B) demonstrates the superior resolution of the former study. The information gained from MR is considerable, and eliminates the risk of an invasive procedure and exposure to radiation.

A.

B.

Histopathologic specimen from a bypass procedure originating in the ascending aorta and inserting into the right subclavian and right carotid arteries.

Postscript

Since completion of this study, funding has been provided to the Vasculitis Clinical Research Consortium (Boston University, Johns Hopkins, Mayo Clinic and Cleveland Clinic) to further define the operating characteristics of MR, CT and PET scanning in large vessel vasculitis.

[KM McKinnon, TM Clark, GS Hoffman]

YOU GOTTA BE VIDEO CLIP

MUSIC VIDEO OF THE DAY: SEASONS OF LOVE

POSITIVE AFFIRMATION OF THE DAY

"If you believe, and if you persist, all things are possible."

Rieva Lesonsky

FUNNY CARTOON OF THE DAY

FUNNY CARTOON OF THE DAY: THE CHUBB CHUBBS

TODAY'S WORD

Fight the Good Fight

Today's Scripture

“That is why we never give up. Though our bodies are dying, our inner strength in the Lord is growing every day.” (2 Corinthians 4:16)


Today's Word from Joel and Victoria

Paul explained to the church at Corinth that giving up is not an option for a true Christian. As a follower of God, you are to fight the good fight in God’s strength and never surrender or give up. Being faithful means holding tight through tough and seemingly impossible times. Keep pushing whether you feel like it or not; keep going even when you run out of strength. Do the right thing, even when the wrong thing happens to you. In order to win the battle, you have to step out and take part in the struggle. Only after fighting the good fight can you experience the good victory that God has in store for you!


A Prayer for Today

God, thank You for giving me the strength to fight the good fight. Help me to keep my eyes on You for the endurance to keep moving forward. In Jesus’ Name. Amen.

TODAY'S WORD

From Joel & Victoria Osteen
www.joelosteen.com

Practicing Real Love

Today's Scripture

“My dear children, let’s not just talk about love; let’s practice real love.” (1 John 3:18)

Today's Word from Joel and Victoria

It’s important for you to let those special people in your life know how much you appreciate their love and faithfulness to you. It’s easy for human beings to let their love stop with words. Now loving words are certainly crucial to a love relationship, but words by themselves are not enough. The Bible says very clearly that we are to love not just by the words we say, but by the deeds of love that we do for others. There is absolutely no limit to the good things that can happen when you decide to let love be the driving force in your life. True love is so strong that the Bible says, “Many waters cannot quench love” (Song of Songs 8:7). That’s a wonderful promise that when you choose to love, your efforts will not be in vain. God will open the windows of heaven and rain down His joy, abundance and favor on you when you learn to love the way He loves.

A Prayer for Today

God, I want to live my best life for You, in love, in everything I do. Please show me the way today so that I may walk in love toward You and toward others. In Jesus’ Name. Amen.

AFFIRMATION OF THE DAY

I am still determined to be cheerful and happy, in whatever situation I may be; for I have also learned from experience that the greater part of our happiness or misery depends upon our dispositions, and not upon our circumstances. Martha Washington (1732-1802)

MICHAEL BUBLE VIDEO - EVERYTHING

FUNNY CARTOON OF THE DAY

Pink Martini Video of the Day

COOL VIDEO

Rita Hayworth singing to the Pink Martini song "Amado Mio".... cool dubbing....enjoy!

QUOTE OF THE DAY

Courage is being scared to death - but saddling up anyway.

John Wayne

FUNNY CARTOON OF THE DAY

MUSIC VIDEO OF THE DAY: THE CURE

TODAY'S WORD

From Joel & Victoria Osteen
www.joelosteen.com

Trust God’s Timing

Today's Scripture

“For the revelation awaits an appointed time; it speaks of the end and will not prove false. Though it linger, wait for it; it will certainly come and will not delay.” (Habakkuk 2:3)


Today's Word from Joel and Victoria

There’s an old adage that says, “God’s answer to your prayer is seldom early, but it is never late!” God will give you the grace you need when you’re in His timing. So if you will keep a right attitude and not allow bitterness or resentment to take hold, then at the right time, in due season, God will answer your prayers. The answer may be “No,” or something different than you think, but it will be for your best. Habakkuk 2 tells you that God has an appointed time to answer your prayers so that you receive just what you need at just the right time to live victoriously and happily. You probably have dreams that God has put in your heart; wait for His timing to bring these dreams about. Your situation will improve, but on God’s timetable, not yours!

A Prayer for Today

God, I believe You are at work in my life bringing about what You know is best for me. My desire is to be patient as I faithfully await Your answers. In Jesus’ Name. Amen.

TAKAYASU TREATMENT

In an autoimmune disease like Takayasu Arteritis, the immune system attacks and harms the bodies' own tissues. The exact cause of Takayasu's disease is unknown. Most symptoms of the disease are caused by vasculitis (an inflammation of the blood vessels). Inflammation is a characteristic reaction of the body to injury or disease and is marked by 2 phases: 1) a systemic phase (inflamed stage, fever, fatigue, weight loss, etc.); and 2) an occlusive phase (narrowing of the affected arteries).

Doctors think that an autoimmune reaction may cause the blood vessels to become inflamed, but they do not know what triggers this reaction. Under normal conditions, the immune system protects the body from diseases and infections by killing harmful "foreign" substances, such as germs, that enter the body. In an autoimmune reaction, the immune system mistakenly attacks and harms the body's own tissues. In this case, Takayasu arteritis is a chronic inflammatory condition that affects the largest blood vessel in the body (the aorta) and its branches.

Doctors usually begin treatment for Takayasu's arteritis with glucocorticoid medications, such as prednisone. If these medications alone do not work well, then stronger immunosuppressive drugs may be added, including methotrexate (Folex, Methotrexate, Rheumatrex), azathioprine (Imuran) or cyclophosphamide (Cytoxan, Neosar). Recent studies suggest that injectable etanercept (Enbrel) or infliximab (Remicade) may be helpful to control the vascular inflammation of Takayasu's arteritis when other medications fail. Blood pressure medications also may be necessary to control high blood pressure.

If Takayasu's arteritis has caused significant narrowing of an artery, the narrowed segment may need to be widened or repaired. Depending on the artery affected, this can be done in one of three ways:

- Traditional (open) surgery
- Percutaneous transluminal balloon angioplasty, in which a small balloon is inserted into the blood vessel, then inflated to dilate it
- Percutaneous placement of a stent, in which a small mesh device is placed in the artery to keep the blood vessel open

Inflamed segments of arteries may become weakened, leading to the formation of an aneurysm, or outpouching of the vessel. These may expand over time and rupture, a potentially life-threatening event; therefore, tests for aneurysm (including MRA) may be recommended for people with Takayasu's arteritis, and if an aneurysm is large or expanding, surgical repair may be recommended.

Prognosis

Symptoms usually go away in about 60% of people with Takayasu's arteritis when they are treated with glucocorticoids alone. However, symptoms return in about half of these patients. When people who have symptoms return are treated with a combination of glucocorticoids and other immunosuppressive drugs, 40% to 81% have symptoms go away again, but it's common for them to return later. Overall, about 77% of people with Takayasu's arteritis respond to some form of medical therapy.

In general, about 83% of people survive for at least 15 years after diagnosis. This figure drops to 66% for those with severe high blood pressure or significant damage to the aorta.

http://www.intelihealth.com/IH/ihtIH/WSIHW000/9339/24461.html

QUOTE OF THE DAY

Better to learn the truth, and be set free,

Than hide, and trust

to others exclusively.

TODAY'S WORD

From Joel & Victoria Osteen
joelosteen.com

Hope That Never Lets You Down

Today's Scripture
“Hope does not disappoint, because the love of God has been poured out within our hearts through the Holy Spirit who was given to us.” (Romans 5:5)


Today's Word from Joel and Victoria

Even Christians can sometimes feel hopeless and powerless to overcome adversities. Maybe you feel trapped in your job, or your marriage is in trouble and there doesn’t seem to be an answer. You may have a child who is on the wrong path. Or maybe you are single and have given up any hope of ever meeting the right person. But no matter where you are, God can turn your situation around—and it could start happening today! If you believe with all your heart that God has something great around the corner for you, then hope will take over. God’s hope is such a powerful thing that it can keep you going when practically nothing else can. That’s because God’s hope will never fail or let you down, even if everything else does.


A Prayer for Today

God, thank You for giving me never-ending hope. I confess today that I will live confidently in Your hope because I know I’ll never be let down. In Jesus’ Name. Amen.

TOP 10 LIST FOR SURVIVING TA

1. Listen to your body. If you need to cry then cry, if you need to sleep, then do so, if you need to talk to someone, seek out someone who will listen, if you need to reminisce, then take the time. It is important for the acceptance process that you go with the flow.

2. Lower expectations for yourself. You can't expect yourself to run at full capacity anymore. Give yourself a break and don't expect yourself to perform as well as you did prior to your illness. Educate others about your condition.

3. Let others know what you need from them. Don't expect others to know what you need. Communicate to family and friends how they can support you.

4. Take the time to do the things you need to do for yourself. When you feel up to it, engage in activities you feel the pull towards. It could be visiting a place you haven't been to in awhile, walks in nature, reading, bird watching, etc.

5. If you need counseling, get it. Get all the support you need. There are many support groups as well as counselors who specialize in long-term illness counseling. Don't hesitate to contact a medical and/or mental health specialist if you have feelings of hopelessness or suicidal thoughts.


6. Pamper yourself. Treat yourself well. Without breaking your budget, do things for yourself that are helpful like taking walks, being with people who are nurturing to you, soaking in long bubble baths and doing other inexpensive activities.

7. Keep a journal. Writing down your thoughts and feelings can help you to validate and work through your grief.

8. Get physical exercise. You will not be able to maintain a prior routine but accept your limitations and try to do stretching exercises as often as possible. Discuss an exercise regime with your doctor. Physical exercise can improve the way you feel.

9. Get proper diet and sleep. Maintaining a healthy diet and getting proper sleep is essential for functioning as well as you can. If you are having difficulty with either, discuss this with your doctor.

10. Be aware of others' reactions. Many people do not know how to react appropriately to your grief. Some are more comfortable than others in responding to your situation. Be aware that people have different ideas not only about illness, but about how ndividuals should react. Be true to yourself, and let others know if they say something inappropriate.

TAI CHI WORKOUT

THE BENEFITS OF TAI CHI

http://www.butyoudontlooksick.com/2007/02/the_benefits_of_tai_chi_for_th.php#more

The Benefits of Tai Chi for Those With Chronic Conditions

With my slow legs, working out is something I’ve had to forgo this past year, but since I’m usually active, I’ve wracked my brain for absolutely anything I can do to keep the juices flowing. What I came up with is the low-impact sport of Tai Chi.

Many of you may, like me, normally consider such mellow exercise a bore—I must admit that if I weren’t sick, there is no way I’d have the patience for it. But before you click on another article, scroll down to view some of Tai
Chi’s benefits.

Increased balance
Let’s face it… in our current conditions, many of us are a little off-kilter these days. A surprise hug from a toddler or an exuberant greeting from our favorite dog can send our arms in a desperate search for something to grab hold of. Tai Chi can train our muscles to respond instantaneously when we need to regain our center.

Increased blood flow
I don’t know about you, but I’ve been pretty sedentary these days. The couch has become my home during waking hours, and since my legs move so slowly I haven’t been exercising my arms much either. Tai Chi is perfect for my
condition, because you are supposed to move as if moving through water, and that is what my body does anyway. With these slow, fluid movements, I’m using my muscles in ways they aren’t normally getting used these days. At
the end of the hour, they thank me for bringing them back to life, even while asking me what on earth I’ve done to them.

Modifications
Tai Chi doesn’t need to be done by the book. In fact, my instructor teaches in various retirement communities, adjusting her routine to fit her clients’ needs. Tai Chi can be done standing up or sitting down (a feature I take
advantage of often). The movements can be big or they can be small. It can be done for a full hour or only for a matter of minutes. As someone with special needs, you are in charge of the intensity of your workout.

Socialization
Tai Chi can be done by video, but it can also be done in a classroom setting. Because I take the class with someone else, I am able to do the drive into town, and I am there for the hour with a handful of other women, gabbing and laughing and finding our “chi” in the instructor’s upstairs studio. As a freelancer who cannot work outside the home, it gives me my only set activity outside of the quiet life I live in the woods, aside from visits with friends and family.

I know Tai Chi isn’t for everyone, but I hope these benefits will assist you in finding your own exercise routine. I can’t wait for a diagnosis, so that I can be back to a more high-impact way of life, but for now Tai Chi gives me exactly what I need, and I go to bed after each lesson feeling like I helped my body in some small way.

Article written by: Shannon Luders-Manuel Butyoudontlooksick.com, © 2007

DANCE, SING, TALK YOURSELF TO SILLINESS

The Power of Silly!

http://www.butyoudontlooksick.com/2007/04/the_power_of_silly.php#more

Those of us who live with a chronic illness, deal with a lot of difficult emotions. I often find myself with feelings like frustration,boredom, loneliness, sadness, etc. For me, these emotions become their strongest at night, when I usually cannot sleep or go out. My biggest coping skills- going out for a walk or talking with a friend, are not options in the middle of the night. So, how can you alleviate these feelings when you are in your house by yourself? Dancing is one good way.

I have limited energy so I cannot dance a whole lot, but even a brief one song dance will help me out. If you cannot stand, you can still get your groove on from a seated position or even lying down. If you are sitting you can still move your head, arms, and torso. You can tap your feet, or move your legs to the music. If you are laying down you can wave your arms to the music or move your legs to the beat. Even just rotating your wrists to the music and making pretty postures with your fingers can feel good.

I am a big supporter of silly dancing. When I was still healthy and lived at home with my family, my sister and I would have these silly dancing “competitions,” where we would try to dance in the most ridiculous ways possible. It was very freeing to dance without rules or fear of judgment, and we would laugh and laugh at ourselves. This is a big stress reliever! We created dances like The Tush Push and The Worm. Dancing freely affords a wonderful opportunity to laugh at yourself! If you have pets, dancing with the dog or country line dancing with the cat can be lots of fun too. Even just dancing around them or in front of them will get you that quizzical, “What in the heck are you doing?” look, which makes the exercise all the more fun. Getting my cat’s confused gaze gives me an opportunity to laugh at how ridiculous I must look to her.

Another activity I enjoy is singing. If you are home alone you can sing at the top of your lungs and pretend you are a famous singer, belting it out for your adoring fans. Sometimes I sing and dance at the same time. Depending on my mood I might sing a real song, other times I will make one up on the spot. Sometimes I will sing a silly song about my cranky cat, or whatever comes to mind. You can make it a game and give yourself only 30 seconds to think of the next verse and it has to rhyme with the last one. It is fun to see how far you can get before getting stumped and having to start over.

I am also a big proponent of talking to yourself, talking to your pets, talking to God. Just because you look crazy, it doesn’t mean that you are! You can also write in a journal and say anything that you want to say to anyone that you want to say it to. Write a letter to that guy you like, saying everything you have wanted to say, knowing full well it will never see the light of day. You know that fight you had with your mother? Write a letter to her and get all of your feelings out on paper, then never show it to her. Writing is a good way to release those pent up emotions that you don’t know what to do with. If you are having a bad health day, vent your frustration and sadness on paper.

I have these dreams about big, messy art projects. I see myself with a giant canvas throwing paint all over it and smearing it all around with my fingers. Living in a small apartment with limited funds, I cannot actually buy a huge canvas, gallons of paint, and make a huge mess. However, I will often do smaller scale art projects. This is another way to put your emotions on paper. I like to draw, color, and paint. I suppose you could buy sculpting clay and get your emotions out by pounding it and molding it. Maybe kids finger paints are just what the doctor ordered? With my art there are no rules and no judgments. No one ever has to see it if I don’t want it to be seen. If it is just angry squiggles all over the paper, that’sokay. Sometimes if I’m mad I end up tearing holes in the paper because I am coloring so aggressively. Other times I take my time, draw a real picture, and color it in.

Drawing can help you symbolize your emotions on paper and help you figure out what you are feeling. I often have no idea what I will draw when I sit down to do it, I just let my hand and my imagination show me what needs to come out.

These are just a few ideas of ways to cope with and release those emotions you are feeling, when you are home and alone. I encourage you to be creative and fearless in coming up with new ways to express yourself. After all, no one is watching, so why not go for it? Being silly is cathartic. If you just need a release, dance, sing, make sexy poses in the mirror. No one is watching so laugh and have fun with yourself. This is truly some of the best medicine.

Written by Laura Markley © 2007 butyoudontlooksick.com

THE SPOON THEORY

Ever wondered how to explain TA chronic illness to normal people? Well, here's something I found that almost similarly describes it.

--------

The Spoon Theory

My best friend and I were in the diner, talking. As usual, it was very late and we were eating French fries with gravy. Like normal girls our age, we spent a lot of time in the diner while in college, and most of the time we spent talking about boys, music or trivial things, that seemed very important at the time. We never got serious about anything in particular and spent most of our time laughing.

As I went to take some of my medicine with a snack as I usually did, she watched me with an awkward kind of stare, instead of continuing the conversation. She then asked me out of the blue what it felt like to have Lupus and be sick. I was shocked not only because she asked the random question, but also because I assumed she knew all there was to know about Lupus. She came to doctors with me, she saw me walk with a cane, and throw up in the bathroom. She had seen me cry in pain, what else was there to know?

I started to ramble on about pills, and aches and pains, but she kept pursuing, and didn't seem satisfied with my answers. I was a little surprised as being my roommate in college and friend for years; I thought she already knew the medical definition of Lupus. Then she looked at me with a face every sick person knows well, the face of pure curiosity about something no one healthy can truly understand. She asked what it felt like, not physically, but what it felt like to be me, to be sick.

As I tried to gain my composure, I glanced around the table for help or guidance, or at least stall for time to think. I was trying to find the right words. How do I answer a question I never was able to answer for myself? How do I explain every detail of every day being effected, and give the emotions a sick person goes through with clarity. I could have given up, cracked a joke like I usually do, and changed the subject, but I remember thinking if I don’t try to explain this, how could I ever expect her to understand. If I can’t explain this to my best friend, how could I explain my world to anyone else? I had to at least try.

At that moment, the spoon theory was born. I quickly grabbed every spoon on the table; hell I grabbed spoons off of the other tables. I looked at her in the eyes and said “Here you go, you have Lupus”. She looked at me slightly confused, as anyone would when they are being handed a bouquet of spoons. The cold metal spoons clanked in my hands, as I grouped them together and shoved them into her hands.

I explained that the difference in being sick and being healthy is having to make choices or to consciously think about things when the rest of the world doesn’t have to. The healthy have the luxury of a life without choices, a gift most people take for granted.

Most people start the day with unlimited amount of possibilities, and energy to do whatever they desire, especially young people. For the most part, they do not need to worry about the effects of their actions. So for my explanation, I used spoons to convey this point. I wanted something for her to actually hold, for me to then take away, since most people who get sick feel a “loss” of a life they once knew. If I was in control of taking away the spoons, then she would know what it feels like to have someone or something else, in this case Lupus, being in control.

She grabbed the spoons with excitement. She didn’t understand what I was doing, but she is always up for a good time, so I guess she thought I was cracking a joke of some kind like I usually do when talking about touchy topics. Little did she know how serious I would become?

I asked her to count her spoons. She asked why, and I explained that when you are healthy you expect to have a never-ending supply of "spoons". But when you have to now plan your day, you need to know exactly how many “spoons” you are starting with. It doesn’t guarantee that you might not lose some along the way, but at least it helps to know where you are starting. She counted out 12 spoons. She laughed and said she wanted more. I said no, and I knew right away that this little game would work, when she looked disappointed, and we hadn't even started yet. I’ve wanted more "spoons" for years and haven’t found a way yet to get more, why should she? I also told her to always be conscious of how many she had, and not to drop them because she can never forget she has Lupus.

I asked her to list off the tasks of her day, including the most simple. As, she rattled off daily chores, or just fun things to do; I explained how each one would cost her a spoon. When she jumped right into getting ready for work as her first task of the morning, I cut her off and took away a spoon. I practically jumped down her throat. I said " No! You don’t just get up. You have to crack open your eyes, and then realize you are late. You didn’t sleep well the night before. You have to crawl out of bed, and then you have to make your self something to eat before you can do anything else, because if you don’t, you can't take your medicine, and if you don’t take your medicine you might as well give up all your spoons for today and tomorrow too." I quickly took away a spoon and she realized she hasn’t even gotten dressed yet. Showering cost her a spoon, just for washing her hair and shaving her legs. Reaching high and low that early in the morning could actually cost more than one spoon, but I figured I would give her a break; I didn’t want to scare her right away. Getting dressed was worth another spoon. I stopped her and broke down every task to show her how every little detail needs to be thought about. You cannot simply just throw clothes on when you are sick. I explained that I have to see what clothes I can physically put on, if my hands hurt that day buttons are out of the question. If I have bruises that day, I need to wear long sleeves, and if I have a fever I need a sweater to stay warm and so on. If my hair is falling out I need to spend more time to look presentable, and then you need to factor in another 5 minutes for feeling badly that it took you 2 hours to do all this.

I think she was starting to understand when she theoretically didn’t even get to work, and she was left with 6 spoons. I then explained to her that she needed to choose the rest of her day wisely, since when your “spoons” are gone, they are gone. Sometimes you can borrow against tomorrow’s "spoons", but just think how hard tomorrow will be with less "spoons". I also needed to explain that a person who is sick always lives with the looming thought that tomorrow may be the day that a cold comes, or an infection, or any number of things that could be very dangerous. So you do not want to run low on "spoons", because you never know when you truly will need them. I didn’t want to depress her, but I needed to be realistic, and unfortunately being prepared for the worst is part of a real day for me.

We went through the rest of the day, and she slowly learned that skipping lunch would cost her a spoon, as well as standing on a train, or even typing at her computer too long. She was forced to make choices and think about things differently. Hypothetically, she had to choose not to run errands, so that she could eat dinner that night.

When we got to the end of her pretend day, she said she was hungry. I summarized that she had to eat dinner but she only had one spoon left. If she cooked, she wouldn’t have enough energy to clean the pots. If she went out for dinner, she might be too tired to drive home safely. Then I also explained, that I didn’t even bother to add into this game, that she was so nauseous, that cooking was probably out of the question anyway. So she decided to make soup, it was easy. I then said it is only 7pm, you have the rest of the night but maybe end up with one spoon, so you can do something fun, or clean your apartment, or do chores, but you can’t do it all.

I rarely see her emotional, so when I saw her upset I knew maybe I was getting through to her. I didn’t want my friend to be upset, but at the same time I was happy to think finally maybe someone understood me a little bit. She had tears in her eyes and asked quietly “Christine, How do you do it? Do you really do this everyday?” I explained that some days were worse then others; some days I have more spoons then most. But I can never make it go away and I can’t forget about it, I always have to think about it. I handed her a spoon I had been holding in reserve. I said simply, “I have learned to live life with an extra spoon in my pocket, in reserve. You need to always be prepared”

Its hard, the hardest thing I ever had to learn is to slow down, and not do everything. I fight this to this day. I hate feeling left out, having to choose to stay home, or to not get things done that I want to. I wanted her to feel that frustration. I wanted her to understand, that everything everyone else does comes so easy, but for me it is one hundred little jobs in one. I need to think about the weather, my temperature that day, and the whole day's plans before I can attack any one given thing. When other people can simply do things, I have to attack it and make a plan like I am strategizing a war. It is in that lifestyle, the difference between being sick and healthy. It is the beautiful ability to not think and just do. I miss that freedom. I miss never having to count "spoons".

After we were emotional and talked about this for a little while longer, I sensed she was sad. Maybe she finally understood. Maybe she realized that she never could truly and honestly say she understands. But at least now she might not complain so much when I can't go out for dinner some nights, or when I never seem to make it to her house and she always has to drive to mine. I gave her a hug when we walked out of the diner. I had the one spoon in my hand and I said “Don’t worry. I see this as a blessing. I have been forced to think about everything I do. Do you know how many spoons people waste everyday? I don’t have room for wasted time, or wasted “spoons” and I chose to spend this time with you.”

Ever since this night, I have used the spoon theory to explain my life to many people. In fact, my family and friends refer to spoons all the time. It has been a code word for what I can and cannot do. Once people understand the spoon theory they seem to understand me better, but I also think they live their life a little differently too. I think it isn’t just good for understanding Lupus, but anyone dealing with any disability or illness. Hopefully, they don’t take so much for granted or their life in general. I give a piece of myself, in every sense of the word when I do anything. It has become an inside joke. I have become famous for saying to people jokingly that they should feel special when I spend time with them, because they have one of my "spoons".

© 2003 by Christine Miserandino Butyoudontlooksick.com

RELAXING VIDEO

MEDICAL BREAKTHROUGH IN AUTOIMMUNE DISEASES

Scientists Pinpoint Gene Behind Autoimmune Diseases

By Amanda Gardner
HealthDay Reporter
Wednesday, March 21, 2007; 12:00 AM

WEDNESDAY, March 21 (HealthDay News) -- Variations in one specific gene appear to be behind several different autoimmune and auto-inflammatory diseases.

The pinpointed region of chromosome 17, calledNALP1, could be a new target for treatment, said the authors of a study in the March 22 issue of theNew England Journal of Medicine.


"This part of the immune system may respond to triggers coming from the environment, like bacteria or viruses, and there are indications that you can turn it off. So, we're very, very hopeful that there may be drugs that allow us to do that," said the study's senior author, Dr. Richard A. Spritz, who directs the Human Medical Genetics Program at the University of Colorado at Denver and Health Sciences Center.

Spritz added, "That's not going to help people with childhood diabetes, where the damage is already complete. But, for a number of chronic autoimmune disorders, like lupus and vitiligo, if you turn off the autoimmune process, the body could repair itself."

Some 80 autoimmune and auto-inflammatory disorders, which occur when the immune system malfunctions and starts destroying normal tissue, affect between 15 million and 25 million people in the United States, particularly women.

A few of the autoimmune diseases are caused by mutations in single genes, but most appear to be more complex. Scientists suspect that some genes may predispose individuals to one or more diseases, whereas other genes may predispose individuals to autoimmune and auto-inflammatory diseases in general.

"There has been a feeling for decades that autoimmune diseases are somehow related," said Dr. Peter Gregersen, author of an accompanying editorial in the journal and director of the Robert S. Boas Center for Genomics and Human Genetics at the Feinstein Institute for Medical Research in Manhasset, N.Y.

Interactions between gene variants and environmental factors also play a role in triggering the onset of a disease.

Spritz and his colleagues have long focused on patients with vitiligo, a disorder in which pigment cells are destroyed, resulting in white patches on the skin and sometimes the hair. Individuals with vitiligo tend also to have other autoimmune and auto-inflammatory diseases, as do their relatives. But the combinations of diseases are not very consistent.

"They probably have genes that predispose more toward autoimmunity in general and not specific disorders," Spritz said.

The team did a systematic genetic analysis of 656 persons from 114 extended families in the United States and United Kingdom who had multiple autoimmune diseases, including vitiligo. This led them to a number of genetic possibilities, but the "hottest" signal was a region on chromosome 17, which had shown up previously as possibly harboring a lupus gene in families who also had vitiligo.

A closer examination revealed a collection of variations in a specific gene,NALP1.


"We don't really know which one causes the disease, but we can use the variations that we see as flags or markers of variations," Spritz explained. "These could be the ones that cause the disease or tell us about the ones that do."

But NALP1is probably only part of the picture.


"This can't be the whole story," Spritz said. "This is one of probably many genes that predispose to autoimmunity, but it looks like it may be involved in a pretty big way, which is why we were able to find it."

The gene is connected to the body's primitive immune system, which is involved with the earliest responses to outside attacks.

"It probably has a big effect, and it probably interacts in some complex way with other genes and other risk factors," Spritz pointed out. "We know a lot about this gene. It was not an anonymous gene that you would have to start from ground zero studying. We know that it's part of the surveillance system for attack by bacteria or viruses, part of the innate immune system."

"This work is really nice and elegant, and it's also provocative," Gregersen said. "It raises the issue of whether this gene might be involved in more common disorders."

He added that the research was a good example of "a successful, family-based approach to gene identification and an example of how new genes identified that way can raise new connections among different diseases."

More information

The U.S. National Institute of Arthritis and Musculoskeletal and Skin Diseases has more about autoimmune disorders.

SOURCES: Richard A. Spritz M.D., director, Human Medical Genetics Program, University of Colorado at Denver and Health Sciences Center, Aurora; Peter K. Gregersen, M.D., director, Robert S. Boas Center for Genomics and Human Genetics, Feinstein Institute for Medical Research, North Shore Long Island Jewish Health System, Manhasset, N.Y., and professor of medicine and pathology, New York University School of Medicine, New York City; March 22, 2007,New England Journal of Medicine

INSPIRATIONAL QUOTES OF THE DAY

MR. BEAN FUNNY VIDEO OF THE DAY

TODAY'S WORD

From Joel & Victoria Osteen
(joelosteen.com)

Trust God’s Strength

Today's Scripture

“The weakness of God is stronger than man’s strength.” (1 Corinthians 1:25)

Today's Word from Joel and Victoria

If you have ever struggled through a very difficult or trying time as a believer, then you probably know the supernatural strength that God has promised to give those who trust in Him. God’s strength is usually accompanied by His supernatural peace, and that should be an encouraging truth for you as you face whatever today holds! Learn to say, “God, I’m going to trust and serve You every day even when things don’t seem to be going my way.” As you wait on God, He will give you all the strength you need to fight the good fight of faith. And even when you go through difficulties, He’ll give you a supernatural peace right in the midst of those problems.


A Prayer for Today

God, thank You for holding me in Your hands. Give me strength to live within God, I know that You are strong enough for everything I will ever face. Help me to continue relying fully on You. In Jesus’ Name. Amen.

HEY YOU

HEY YOU
Don't you give up
It's not so bad
There's still a chance for us

HEY YOU
Just be yourself
Don't be so shy
There's reasons why it's hard
Keep it together, you'll make it alright
Our celebration is going on tonight

Poets and prophets will envy what we do
This could be good, hey you.

HEY YOU
Open your heart
It’s not so strange
You’ve got to teach this time

HEY YOU
Remember this
None of this is real
Including the way you feel


Refrain 1:
Keep it together
We’ll make it alright
Our celebration is going on tonight
Poets and prophets will envy what we do
This could be good, hey you.

Save your soul
Little sister

Save your soul
Little brother

HEY YOU
Save yourself
Don’t rely on anyone else

Refrain 2:
First love yourself
Then you can love someone else
If you can change someone else
Then you can save someone else

But you must first love yourself
Then you can love someone else

If you can change someone else
Then you have saved someone else

But you must first

HEY YOU
There on a fence
You’ve got a choice
One day it will make sense

HEY YOU
First love yourself
Or if you can’t
Try to love someone else

Refrain 1
Keep it together
We’ll make it alright
Our celebration is going on tonight
Poets and prophets will envy what we do
This could be good, hey you.

Refrain 2:
First love yourself
Then you can love someone else
If you can change someone else
Then you can save someone else

But you must first love yourself
Then you can love someone else

If you can change someone else
Then you have saved someone else

But you must first

CARTOON OF THE DAY

TODAY'S WORD

From Joel & Victoria Osteen
(joelosteen.com)

Trust God’s Wisdom

Today's Scripture

“I am God — I only — and there is no other like me who can tell you what is going to happen. All I say will come to pass, for I do whatever I wish.” (Isaiah 46:9-10)


Today's Word from Joel and Victoria

Many people pray very intently and seriously for things that never come to pass—then they realize later what a blessing it was that God did not answer their prayer! We can only see today, one moment at a time, but God knows how today’s situations will impact us tomorrow, next week, or even ten years from now! So many people have told us, “I’m so thankful God didn’t answer my prayer. He knew what was best for me, and now that I look back I can see how all things have worked for my good.” What a perfect example of something that is easy to forget—that sometimes the best thing that can happen to you is the exact opposite of what you want to happen. God knows the past and the future, and He always has the sequence of events in your life in perfect order. As God said in Isaiah, everything He says will come to pass, so make sure that you’re following Him.

A Prayer for Today

God, I’m so glad that You have the infinite wisdom to take perfect care of me. Give me the ability to rest in Your wisdom and not rely on my own. In Jesus’ Name. Amen.

AFFIRMATIONS OF THE DAY

ENJOY YOUR DAY!

HELPFUL MEMORY BOOSTERS FOR TAers

As we all know, one of the downsides on taking prednisone or other meds/TIAs is memory loss.

Here are a few tips to increase or at least boost or improve your memory.

From Washingtonian magazine (http://www.washingtonian.com/articles/health/3775.html)

• Doing word games, puzzles, and other mental exercises.
• Have a broad range of interests like taking a course(s), reading, attending plays.
• Physical exercise is key, too. Aerobic activity increases blood flow and oxygen in the brain
• There is also evidence that certain foods may help the brain. Deficiencies of vitamins B-12 and B-1 and folic acid have been linked to cognitive impairment—so, theory goes, foods rich in these nutrients may protect the brain. “Antioxidants may also be important, and there is a growing body of evidence that suggests fish oil may be important", says Dr. Aisen, a professor in the departments of neurology and medicine at Georgetown University.
• The Alzheimer’s Association suggests eating more• antioxidant-rich vegetables such as spinach, kale, brussels sprouts, broccoli, beets, red bell pepper, onion, corn, and eggplant,• dark-skinned fruits including raisins, blueberries, prunes, blackberries, strawberries, raspberries, plums, oranges, red grapes, and cherries,• cold-water fish including halibut, mackerel, salmon, trout, and tuna, and• nuts, such as almonds, pecans, and walnuts.
• Social interaction is another boost to brain health. According to the Alzheimer’s Association, studies have found that activities like dancing, which combines physical and mental challenge along with companionship, have the greatest benefit. Dr. Gordon, who has written books on improving memory, says that it’s not the activity that matters but doing something to keep mind and body active.

From Consumer Reports on The Best of Health.

Mental ability on some tasks varies over the course of a day by 20 or 30 percent. Here's how you can be smart all day long.

Creativity and the ability to process information peaks in the morning. It's an ideal time for writing, generating ideas, or studying subjects such as math.

Alertness peaks shortly before noon. This is the best time for tackling complex problems that require careful logic or planning but not maximum creativity.

Short term memory peaks in the morning. This is a good time to review notes for a meeting or a test early in the day.

Long term memory peaks in the late afternoon or early evening. It's a good time to soak up new information.

And some helpful tips from fellow TAer Gid:

"Ahhhh, the beauty of the bright yellow/orange post'ems. The daily ones, i.e. turn off the stove, etc. are posted with a small amt of tape to my front door.....I have begun to be very very consciencious about my appointment calendar. I carry it everywhere."