This wasn’t one of those weeks. I can only think that I didn’t eat enough during the week, which is entirely possible.

Exercise was impossible — no time and my asthma has become worse.

I wish I could have provided a more upbeat and productive report, but this is real life, right? Little steps….

Sharon’s Reply
Dan,

I am surprised at 4 pounds in one week! Have you tried your scale more than once? You could be so busy that your aren’t eating much. In order to stay at your weight, you need to eat about 2500+ calories a day. Maybe you just aren’t consuming many calories. Some people eat more when stressed; others eat less. Are you feeling all right? No excessive thirst or urination? ( A quick weight loss can be a symptom of medical problems also — not to alarm you).

I am glad to see the little steps. Do you think you could write a note each day about your food choices? How hungry were you? What factors influenced your eating that day? If I could just get you to think about healthful eating each day, you will stay on track. You don’t need restrictive dieting to lose weight, but you do need to be attentive. And, in your case, you need enough protein to preserve muscle and protect your immune system.

Have a good week!

Sharon

Armand’s Reply

Dan,

I’m sorry to hear you had another tough week that kept you from exercising. Sometimes you get in a cycle where it seems nearly impossible to get back into your desired routine. The longer it goes, the more difficult it can become to get out of. I am recommending that you just pick the day that you will start exercising again and put it on your calendar. Whether it is first thing in the morning before work or at the end of the day to help wind down, you are going to start exercising again on that chosen day — no matter what! Try that and let me know how it goes.

As far as your asthma is concerned, I know it can make exercising difficult; however, exercise is also beneficial to people with asthma. In fact, studies have shown that physically fit people with asthma have fewer attacks and need less medication. I would suggest you read my article on Exercise & Asthma in the Fitness Files section of the Fitness Center in drkoop.com, if you haven’t already.

I look forward to hearing from you next week. Hope you have a much better week! Good luck.

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The art is the ability to develop rapport and gain each client’s trust, which is necessary to make things happen. When exercise professionals are given tools and a structure, but encouraged to be creative in providing for each situation, they feel a part of each individual’s success, as well as that of the overall fitness center.

Summary

Fortunately, we are in a business in which our members’ success is our success. As we move into the 21st century, we have come to know that exercise is not a fad, but rather an integral part of wellness for the general population.

People will come to you in the hopes of integrating regular exercise into their lives. Alone, many will fail. When you use the available research-based information, though, you can greatly increase their chances of success; progressively and intelligently nurturing the exercise habit. I encourage you to start developing a plan for supplying helping techniques to your clients, large scale. It’s an important business move, as well as a humane one.

By this definition, an ecologist is a scientist specializing in the study of such relationships. But the cores of most environmental advocacy organizations do not consist of scientists proficient in that field. The philosophy of most environmentalist groups is, in effect, that endangered species deserve protection and that, because there are billions of humans, humanity does not qualify for protection.

In the United States and in nearly all other democracies, environmental laws are established primarily to protect humans. For example, wildlife-preservation laws serve to maintain gene pools, which are potentially useful to human therapeutics. Although every civilized society has accepted avoidance of unnecessary harm to nonhuman animals as an ethical obligation, no society is willing to compare human lives to the lives of other organisms.

Conclusion
In this century, poverty, ignorance and environmental protection are the greatest challenges to the world community. Public education with three focuses — literacy, the sciences and critical thinking — is necessary for the elimination of poverty.

The elimination of ignorance and poverty is necessary for efficient protection of the environment. Excessive allocation of resources to deal with one of the three challenges will probably further complicate dealing with the other two.

Optimal allocation of resources requires that the scientific and engineering communities — with their peer-review and consensus processes — participate in policy development. The role of advocacy groups for any cause — including fighting poverty, promoting education and protecting the environment — is to convince the electorate that their goals must be met and that their respective strategies for achieving these goals are sound. But ignorance should not be promoted, even incidentally, for any cause. Therefore, every scientific or engineering aspect of advocacy-group goals and related strategies belongs exclusively within the purview of the scientific and engineering communities.

In a scientific statement in the combined Jan. 2/9 edition of Circulation, a journal of the American Heart Association, a panel of ASA experts published a comprehensive list of risk factors for stroke and made recommendations for stroke prevention.

Larry Goldstein, M.D., director of the Duke Center for Cerebrovascular Disease and head of the Stroke Policy Program at the Center for Clinical Health Policy Research, chaired the writing group that drafted the ASA’s statement and guidelines. He described stroke as “a major, but underappreciated healthcare problem in the United States,” adding that “[m]ost people don’t realize that stroke is the third leading cause of death in the country. It is also one of the leading causes of disability among adults. Studies show that many people view a major stroke as being a condition worse than death.”

The ASA statement, which reviewed the most up-to-date evidence, classified risk factors for stroke according to their potential for modification and further distinguished between risks by the level of scientific certainty behind them. The authors asserted that “the best approach to reducing the burden of stroke remains prevention.” Preventive measures focus on modifiable factors. “Importantly,” Goldstein added, “we are learning more about how to prevent stroke.”

Non-modifiable risks included age (risk of stroke doubles every 10 years after age 65), sex (stroke is more common in men), race (higher stroke occurrence in blacks) and family history (parental history of stroke increases risk). The risk associated with these factors cannot be reduced.

Conversely, modifiable factors can be altered to reduce risk of stroke. Well-documented modifiable risk factors include smoking, high blood pressure, diabetes and atrial fibrillation (irregular contraction of upper heart chambers). Sickle cell disease, a genetic disorder, also increases the likelihood of stroke, but its proper treatment, especially in children, significantly reduces the associated risk. Of these factors, smoking and high blood pressure put the most people at risk.

Quitting cigarettes can cut a smoker’s risk in half in one year and reduce it to the level of nonsmokers in five years. The authors urged smoking cessation for all active smokers. Goldstein warned, “[t]here is probably an increase in risk from passive smoking (being exposed to cigarette smoke) as well.”

“Hypertension [HBP] is one of the important treatable conditions that can lead to stroke,” Goldstein said. High blood pressure can increase a person’s risk of stroke by up to four times. “It is called a ‘silent killer’ because people don’t know they have it unless it’s checked regularly. Treatment significantly decreases stroke risk,” according to Goldstein. Since many Americans have high blood pressure but are unaware of it, the authors recommend regular screening for high blood pressure (at least every two years) and appropriate management as prescribed by a physician.

Other potentially modifiable factors listed in the statement, which were less well-supported than those described above, included obesity, physical inactivity, poor diet or nutrition, alcohol and drug abuse, oral contraceptive use, and hormone replacement therapy. To further reduce risk of stroke, the authors advise people to avoid illicit drug use, reduce weight if overweight, exercise for 30 minutes daily, eat a healthy diet with five daily servings of fruits and vegetables, avoid second-hand tobacco smoke, and limit alcohol consumption to one (women) or two (men) drinks daily.

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One of the great challenges of the 20th century no longer exists: Because of the development and large?scale production of weapons of mass destruction, it is likely that humankind has seen its final world war. No developed democracy would risk wholesale destruction of its citizens and infrastructure. While a few countries that possess such weapons may be willing to use them as more than deterrents, the world community actively seeks to promote democracy in those countries. Further, there is a concerted worldwide effort to prevent the use of such weapons. Regrettably, civil wars and ethnic and sectarian conflicts continue to kill multitudes, degrade the environment and bring misery to millions. But the gravest problem of recent centuries — extensive multinational wars — has apparently been solved.

Ignorance
Precisely where society-wide education was first attempted is unknown. China, Greece, Spain and Middle Eastern countries had institutions of learning in ancient times. Probably the first documented law mandating education for all children was established in Strasbourg, France, in 1598. Today, all industrialized countries — indeed, the overwhelming majority of nations — have laws that mandate public education. The thrust of public education has long been two?pronged: to teach children to read and write, and to provide them with basic instruction in literature, mathematics and other subjects, such as history, geography and art.

Despite enormous progress in world education, ignorance continues to be an important global problem. There are two major reasons for this:
The difference between a society’s desire for public education and its ability to provide it can be vast. Although worldwide literacy has improved significantly in recent decades, a large segment of the population cannot read or write.
Fighting illiteracy is not enough. Ignorance does not necessarily include an inability to read or write, and certainly illiterates are not necessarily ignorant. The faculty of reason is what chiefly distinguishes humans from other species. Literacy facilitates not only communication but also reasoning; it increases the probability of obtaining information and, therefore, the probability of making informed, reasonable decisions. But even the most compelling speakers and writers are not necessarily reasonable.

Thus, the thrust of public education, traditionally two-pronged, must be expanded to include a third “prong”: critical thinking, the lack of which undercuts efforts against poverty and environmental degradation.

Poverty

Some believe poverty is a problem only for those countries in which it persists, but it has an impact on virtually every nation. Improvements in communication technology have enabled citizens of all developed countries to be fully aware of human misery. Widespread famine is recurrent despite superabundant food production.

Recognizing poverty as their primary problem, many countries have set up aggressive development programs with the sole objective of increasing their populations’ standard of living. But, in many cases, local education cannot meet development-program needs with respect to numbers of skilled workers. Environmental-protection needs are given short shrift.

How can one convince a poverty-stricken parent whose child is sick or hungry that protecting the environment is important? Destitute people have little or no desire to protect the environment. There is a misconception within the environmentalist community that technological development and environmental protection are inherently incompatible. Apparently, many environmentalists neglect the equivalence between poverty and exposure to the most toxic pollutants. They also neglect poverty’s causal relationship to environmental problems, such as the large-scale destruction of flora and fauna, soil erosion and water pollution.

These classes are rapidly gaining the attention of exercisers because just about anybody can participate. Class participants don’t need to worry about running into someone else or being embarrassed if their fitness level is not as great as someone else’s; an athlete can easily work next to a beginner. All a person needs is the ability to sit on the bike, adjust the tension to fit their own workout pace, listen and have fun with a group of people.

For these reasons, many men and women who don’t participate in traditional group exercise activities are getting involved, creating a possible new revenue center for clubs. Group exercise cycling classes are currently being taught in a host of facilities across the nation.

While most refer to this type of class as “Spinning” (a federally registered trademarked program by Mad Dogg Athletics), group exercise cycling is the more appropriate term, as new programs are continually being introduced. The fact that so many of these programs are being introduced may be one more reason for clubs to consider group cycling as a viable new profit center. However, several factors should be considered to make this program a success, including equipment, staff training, bike placement and setup, class length and whether to charge members an additional fee to participate.

That’s the label for software programs that secretly collect information and send it to a company via your Internet connection. And you’re not aware what’s going on.

What can it report? A company could learn details such as Web sites you are visiting, pages you are looking at, software installed on your personal computer, the contents of data files — the possibilities are endless.

The spyware issue has been with us for some time. RealNetworks, whose software many people use to access audio and video on the Internet, got in trouble last year when it was discovered that its RealJukebox program had a spying feature.

Users were shocked to learn it silently collected information about the music they liked and secretly uploaded that data to RealNetworks. For some people, that was extreme Big Brother behaviour.
RealNetworks removed the “feature” and apologized.

Although the concept of spyware isn’t new, some of the recent Internet buzz suggests that the problem is getting worse. A report at the Privacy Forum (http://www.vortex.com/privacy), for example, says
that once again, RealNetworks has released software that fits the category. The forum says a “download helper” tells the firm all about the files you are getting on-line.

There was also a recent uproar about an innocuous little program called Comet Cursor that collected information about your Web activities and sent it to the software’s developer. Netscape was also
found to have implemented a “feature” that reported your Internet browsing activities back to it.

Also on the Internet, it recently has been reported that popular software such as Cute FTP, Abe’s MP3 Finder and PeopleSeek 98 feature a module that sends you ads while you use the programs, and reports back about which ones you click on.

It gets worse. Uninstall one of these offending programs, and a spyware module stays behind. When you read about this spyware program (grc.com/oo/aureate.htm), you’ll be convinced that this capability allows the company that developed it to do anything it likes to your computer.

Imagine the day when you’ll download a simple program from the government that lets you do your taxes. Unknown to you, the program could be scanning your hard drive, grabbing accounting records from any of the well known financial programs installed on your machine. Then it could upload them to the tax authorities.

Farfetched? People were shocked when they heard about the Big Brother database that Ottawa maintains on every one of us.

To learn about software and methods that allow you to determine whether unauthorized programs are running on your machine, look at OptOut.

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Gov. George W. Bush has been running television ads in a number of primary states saying that he is “A Reformer With Results.”

One of the results he points to is that, “Under Governor Bush, Texas enacted some of the most comprehensive patient protection laws in the nation.”

It is true that Texas enacted one of the toughest patient protection laws in the United States back in 1997 while Bush was governor. But did he pass a patient rights bill or did he merely stand by while the Texas legislature passed a bill he simply let become law? On patient rights, was he a “reformer with results”?

In May 1997, the Texas legislature passed a patient rights bill that, among other things, allowed Texans to sue managed care entities, including HMOs, for medical decisions that negatively affect a patient’s health.

In Texas, when the legislature passes a bill and sends it to the governor, the governor has three options. He can sign it into law, veto it, or do nothing and allow it to become law. Bush took the third course and simply let the patient rights bill become law.

In a one page statement on May 22, 1997, announcing his decision to simply let the bill become law, Bush said, “Given the choice between doing nothing and doing something to address a significant problem that impacts the health of thousands of Texans, I have concluded the potential for good outweighs the potential for harm.”

Today, Bush is taking credit for the law, including the right-to-sue provision, and saying the law “allowed patients who have been harmed the right to seek legal action because Texas law includes a strong, independent review process and lawsuit reforms designed to encourage quick, out-of-court resolutions instead of costly litigation.”

But when Bush signed the bill he was not so confident that the legislature had written the best possible legislation. At the time, Bush said he withheld his signature from the bill to signal “the need to carefully monitor its effects to make sure that the benefits do in fact outweigh any unintended consequences.”

In his letter, Bush was concerned that the bill had the potential to drive up healthcare costs and increase the number of lawsuits against physicians and other healthcare providers. “I hope my concerns are proven wrong,” he said.

In letting the bill become law, Bush raised policy concerns many other people have raised regarding the details of the patient rights debate. But, his role was clearly not one of taking the lead in reforming patient rights in Texas. It is clear from the record that he stood by while the legislature worked out the details. He expressed some reservations about parts of the bill, and then simply let it become law.

Real reformer? On patient rights, he was a real observer.

“Kids should not get recurring urinary tract infections, and if they do, the chances of them having a urinary tract abnormality are high — up to one in 10 children with a UTI will have a more serious problem,” says Ferrer.

Among the most common problems is a condition called vesico-ureteral reflux, a backward flow of urine caused by a faulty valve in the tubing that connects the bladder to the kidneys. Studies show this can be the case with up to 50 percent of children with recurring UTIs.

“We pick it up because the child develops a urinary infection — it’s silent until they do have a UTI,” says Dr. Russell Steele, a pediatric urologist at the Louisiana State University School of Medicine and Children’s Hospital in New Orleans.

Additionally, says Steele, “It’s not uncommon to pick it up in one child who has a UTI, and then examine their brothers and sisters and discover they have it, too.”

Left undiagnosed, a faulty valve can lead not only to chronic infections, but also to serious kidney damage. The good news: For some children, all that’s necessary is a regimen of continuous, low-dose antibiotic therapy and time for a natural growth spurt.

“As these children grow, their bladder increases in size and the seal closes on its own,” says Ferrer. The antibiotic controls the recurring UTIs and helps guard against subsequent kidney infection.

If growth doesn’t solve the problem, or if breakthrough infections continue while waiting, a simple surgery to seal the valve can help.

Other abnormalities linked to UTIs include blockages or defects somewhere in the system between the urethra and the kidney.

“Anywhere from 5 to 10 percent of kids with a UTI will have some obstructive lesion in their urinary tract,” says Ferrer, adding that most respond well to surgery, particularly when they are treated early on.

What To Do
Experts say if your child is running a fever, be on the lookout for subtle signs of a urinary tract infection, including grunting or groaning right before or right after urination; a stronger-than-normal urine odor on the diaper; and, in a toddler who is toilet trained, a reluctance to go to the bathroom, or wetting accidents. Another clue: If your child urinates and then wets himself a short time afterward, it may indicate he is holding back urine because of pain.

Other symptoms can include abdominal tenderness or pain around the pubic bone, as well as general lethargy, vomiting, diarrhea and a lack of appetite.

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If you’re like most parents you probably think “ear infection” or maybe “teething.” But according to the American Academy of Pediatrics (AAP), a child with an unexplained fever — and no other obvious symptoms — could have a urinary tract infection, or UTI. And while it’s generally not a diagnosis that crosses a parent’s mind, studies show it’s an option no mom or dad can afford to ignore.

“Up to 1 percent of all boys and 3 percent of girls — tens of thousands of children — have at least one symptomatic urinary infection during the first 10 years of their life. If left undiagnosed, it can lead to some serious complications,” says Dr. Fernando Ferrer, a pediatric urologist at the Brady Urological Institute at Johns Hopkins Medical Center in Baltimore. Those complications, he says, can include a potentially life-threatening kidney infection or a serious urological impairment requiring immediate care.

Despite the seriousness of the problem, experts report that pediatric urinary tract infections are often overlooked — not only by parents, but also by doctors.

Indeed, the AAP became so concerned about the potential for undiagnosed UTIs, it issued a set of guidelines in 1999 covering diagnosis, treatment and follow-up care, particularly for children between the ages of two months and two years.

“We needed to remind people that the diagnosis needs to be considered. Because if you don’t think of it, you don’t make it . . . it’s not a diagnosis that finds you,” says Dr. Kenneth Roberts, professor of pediatrics at the University of North Carolina and co-author of the AAP guidelines.

How an Infection Occurs
Urinary tract infections are often caused by the bacterium escherichia coli or E. coli — a germ commonly present in the colon. Due to poor bathroom hygiene or sometimes during a diaper change, the germ can make its way to the urethra — the tube that carries urine out of the bladder. Once there, an infection known as urethritis can occur. If the germ ascends to the bladder, cystitis is the diagnosis.

And infections that go all the way to the kidney are called pyelonephritis.

In general, a girl is far more likely to develop a UTI, since her urethra is short, and the passage to her urinary tract unprotected.

Interestingly, however, if you look at just the first year of life, a boy is more vulnerable, particularly if he is uncircumcised. The reason: the extra foreskin can harbor germs, a problem that sometimes diminishes as the genitals grow, experts say.

When diagnosed in the early stages, both urethritis and cystitis respond well to antibiotics — usually a week or less of treatment can do the trick.

Delay the diagnosis, however, and pyelonephritis sets in, often causing high fever, pain and the potential for serious kidney damage.

“If the infection escapes the tract and gets up to the kidney, that infection causes a scar and a scar in the kidney is dead renal tissue that won’t work,” says Ferrer. According to the National Institutes of Health, children who experience kidney damage can grow up with a 23 percent increased risk of high blood pressure and 10 percent greater risk of fatal kidney failure.

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