It is easier to understand how organic disease states (identifiable diseases arising from a specific organ in the body) such as gastroesophageal reflux disease (GERD), peptic ulcer disease or malignancy can cause abdominal pain. In these conditions, acid and pepsin, a digestive enzyme, injure the lining of the bowel and irritate nerve fibers, causing pain. It is less clear how patients without recognizable abnormalities develop their symptoms. Functional bowel disease (diseases that are not associated with organic disease states) may result from abnormal contractions in the bowel, an increased sensitivity to stretching of the bowel wall (decreased compliance), a hyper-sensitivity of the bowel to normal functions or gastric acid, and psychological conditions such as anxiety and abuse syndromes.

There is much controversy regarding the association between a gastric (stomach) infection by an organism called Helicobacter pylori (H. pylori) and dyspepsia. While H. pylori is known to be a major cause for peptic ulcer disease and, therefore, a direct cause for dyspepsia, its relationship to pain in the absence of ulcer disease is not clear. Other documented causes of dyspepsia related to ulcer disease are the use of non-steroidal, anti-inflammatory medications such as aspirin and rare conditions characterized by an overproduction of gastric acid (acid produced in the stomach) such as Zollinger-Ellison syndrome.

It is important to realize that functional dyspepsia is a diagnosis of exclusion, which means that possible organic causes have been ruled out. When diagnosing patients, physicians also need to consider other rare causes of abdominal pain.

These include diseases of certain organs including the pancreas, gallbladder and liver, as well as very unusual causes such as lung clots, heart attacks or aneurysms of the aorta. These latter conditions, however, are generally associated with long-standing, waxing and waning discomfort. Usually there are other symptoms that lead the physician to consider these other diagnoses.

Definition and Location
Dyspepsia is generally defined as persistent or recurrent abdominal pain that is centered in the upper abdomen and is usually present for more than four weeks. Associated symptoms forming part of this complex include a sensation of bloating, nausea, burping and early satiety (a feeling of fullness that occurs soon after eating). Symptoms usually develop after meals, but this is not an absolute association.

Dyspepsia must be differentiated from gastroesophageal reflux disease (GERD) in which symptoms result from the passive movement of the stomach contents into the esophagus, or swallowing pipe connecting the back of the throat to the stomach. The cardinal symptom of GERD is heartburn, or pain that occurs behind the sternum (breastbone) and rises up into the chest. Dyspepsia should also be distinguished from functional bowel disease (disease resulting from carrying out normal bowel functions and not associated with identifiable diseases from specific organs of the body) of the lower portions of the bowel. Finally, dyspepsia needs to be distinguished from hepatobiliary pain (pain arising from the liver and gallbladder) in which the location is usually more to the right side and more constant.

Dyspepsia has sometimes been classified into subgroups: 1) ulcer-like dyspepsia in which the primary symptom is pain, 2) motility-like dyspepsia in which the primary symptoms may be bloating, fullness and gas distention of the abdomen, and 3) reflux-like dyspepsia, in which the primary symptom is similar to that of heartburn. However, there is a significant overlap between these subgroups and many patients remain unclassifiable. Therefore, sub-group definitions of dyspepsia have not been useful from a clinical point of view.

Who Gets Dyspepsia?
Dyspepsia is extremely common, but tends to come and go in spurts. There is no difference between the percentage of men and women that are affected by this condition. Up to 10 percent of the population will experience the new onset of dyspeptic symptoms each year, while approximately one-third of patients lose their symptoms over time. Dyspepsia is a waxing and waning phenomenon with symptoms occurring regularly for up to months at a time followed by long intervals without symptoms.

Precise quantification of the prevalence of dyspepsia is limited because only about half of the population seek medical care and many patients medicate themselves with over-the-counter therapies.

Understanding Your Body
The process of digestion begins when one chews food and it mixes with saliva in the mouth. The food then travels down the esophagus. Several minutes after the food reaches the stomach, it is mixed with secretions and enzymes to break down the food. In normal digestion, the stomach wall is coated with mucus to protect it from secretions and enzymes. If the mucus coating fails, acid secretions and the digestive enzyme pepsin can eat a hole into the lining of the stomach resulting in a gastric ulcer. The stomach then empties its contents into the first part of the intestines, called the duodenum. Meals can be transported to the duodenum within a few hours of ingestion: carbohydrates empty the fastest, with proteins emptying more slowly and fatty foods the slowest. The intestine produces some of its own secretions and obtains secretions from outside organs to assist in the process of digestion. The broken down food continues to move through the twisting and turning intestines with the aid of wavelike muscular contractions. During its journey, nutrients are absorbed into the blood vessels or lymph vessels. Finally, the unwanted waste materials are expelled through the rectum as feces or stool.

When you look at an arm that has sustained a rupture of the biceps, the muscle often looks like a bulge of the biceps closer to the elbow. Some people refer to this as a Popeye muscle. As time goes by, this area of muscle does atrophy (waste away) to some degree, and the arm then develops a more normal appearance. As far as your question of whether the torn issue will rebuild and look normal again, a rupture of the biceps at the shoulder typically does not heal, as the tendon tends to retract from its normal position. However, though the arm may not return to its normal appearance, it usually does improve over time.

Patients who are concerned with cosmetic issues can discuss surgery with their doctor. Unfortunately, there are no current techniques to reattach the biceps tendon back to its original insertion site. One technique that has been tried involves making a keyhole in the humerus (upper arm bone) just below the shoulder. The tendon then is bunched up, stuffed into the keyhole and locked into position. This helps restore more normal tension to the biceps, but functionally does not seem to give significant increase in strength.

F.F.

A.Rupture of the tendon of the biceps muscle can occur at either the shoulder or at the elbow. At the shoulder, there are actually two heads to the biceps tendon. The short head originates from a bone called the coracoid, which juts forward from the shoulder blade, and the long head runs up through the shoulder joint, inserting on top of the socket of the shoulder joint. This long head of the biceps tendon is the one that typically ruptures at the shoulder.

A. In general, a rupture of the biceps tendon from the shoulder is treated non-operatively. A rupture of the biceps tendon at the elbow is generally treated with surgical repair. Based on your question, I assume that your husband sustained a rupture of the long head of the biceps tendon at the shoulder joint.

Many accidents happen at work, home so it is extremely significant to be ready and also to protect your friends and children. Buy appropriate, reliable, safe individual first aid cabinets from a wide assortment of specialize first aid supplies.

There are many fad-diet pitfalls. Sacrificing a major food group for another, or whittling down food choices to only salad and water will not work for very long. The secret to long lasting weight control lies in finding permanent lifestyle changes that promote a reasonable weight and good health. If you are an emotional overeater, you may be using food as a coping mechanism — develop other skills to handle stress, perhaps with the help of a therapist or nutrition counselor.

Unit 3: The ABC’s of Dieting Right
Learn to make the best food choices in any given situation — Pass on the fried chicken legs and french fries in the lunch line. Look for lean protein foods, simple vegetable dishes and low-fat starches — choose the baked potato over the fries. Drink at least two glasses of skim milk a day. Take some fruit back to your room for an afternoon or evening study snack.

Don’t skip meals — If you can’t get to the dining hall before your first class, keep some low-fat cereal bars and juice in your room. This way, you can wake up your metabolism and get your body burning calories. Breakfast is also an opportunity to eat nutritious foods.

Stock your room with healthy alternatives — It is so easy to get take-out food delivered to the dorm. Resist this temptation to pig out and turn to a well-stocked cupboard of low-fat soups, oatmeal, popcorn, canned fruit, low-fat peanut butter and crackers, and pretzels. If you have a refrigerator, you can keep yogurt, pudding snacks, low-fat cheese, fresh fruit, carrot sticks, lean lunchmeats and bread. Fat has 9 calories per gram vs. protein’s 4 grams and carbohydrates’ 4 grams, so keep the fat content in mind as you select foods.

Watch your portions — Even if the food can’t be low fat, eat less of it! Do you normally load up your plate and go back for seconds on fried shrimp night at the dining hall? Can you eat one less piece of pizza than you normally do?

Watch out for those beer calories. Instead, try a nonalcoholic beer — it has fewer calories. Try to take up space on your plate with some vegetables or a salad. It’s another way to reduce the number of calories on your plate.

Get moving — Exercise burns calories, makes you feel good, burns off stress and can be fun. Join the intramural basketball program, find an aerobics class on campus, take a run every afternoon before studying. You also need to develop a strength-training program to develop muscles — muscles increase metabolism as well as admiring glances. Find out where the weight equipment is on campus and learn how to use it.

These basics will earn you an A in the Improved Body Major. Why not come home from college at summer break with an expanded intellect and fit

physique!

With so much diet hype and nutrition misinformation, no wonder our impressionable youth take silly and drastic measures, and sometimes put their health at risk to lose weight.

For many college freshmen, the college meal ticket gives them a new opportunity to make food choices without Mom’s influence. Imagine all you-can-eat — at every meal! Many of the foods offered and preferred are fried, heavily sauced, or contain cheese and butter. Even salad bars can be fattening if you select the mayonnaise- and oil-laden salad mixtures. And then, there are the unlimited desserts.

We can’t only look at the dining hall menu. Late-night pizzas, junk-food snacks in the dorm room and those drinking parties — all subtract points from the diet-quality grade. And students who participated in high school sports may not be getting the same level of exercise in college.

So what are the weight loss and healthy eating basics your college student needs to know? Here is a course syllabus with some suggestions.

Unit 1: The Truth About Weight Control
Weight management has a lot to do with plain old math. If you eat more calories than you expend being alive and active, you will store those extra calories as fat. To lose weight, increase calorie expenditure and decrease calorie intake.

A poorly balanced diet may leave you hungry, cause you to lose muscle mass or even sacrifice your health. So, check out the food pyramid on the back of your cereal box and get the basic food groups into your diet every day.

The fats, sweets and alcohol are extras that are not necessary for good health. Work to improve your fruit and vegetable consumption — those may be hard to find on a college campus.

A deficit of 3,500 calories will produce a weight loss of 1 pound. So, by just starving yourself for three days on that fad diet, you won’t significantly or permanently change your weight. Take 500 calories a day out of your diet (for example, the two pieces of pizza at your nighttime break), and you will lose a pound a week. Add 500 calories of exercise a day and another pound will disappear.

We spent hours together in the basement of an apartment complex in the north Bronx, all screeches and giggles, pretending to run from a monster rumored to be hiding there. Other days, we idled away hours at the swing in the woods by the Hudson River, sailing over the treetops together on the well-worn rope. When we grew older, and more rebellious, we huddled together in the schoolyard, sharing gossip, secrets and cigarettes.

Having friends came as easy then as our tired inside jokes.

Friendships are as precious to me now as ever. Kicking around with one of my pals is akin to an adult version of time-out, a quiet place to sort out the swirl of life. But long gone are the days when I could turn up at someone’s house and expect to have hours of fun. Friendship, I’ve discovered, like most of my relationships, takes a lot of work. Without some effort those wonderful ties can unravel.

Take it from me — I know. After years of juggling the demands of my career, marriage and daughter, I found that I had let some of my friendships go to seed. It wasn’t intentional. But I have to shoulder some of the responsibility because I failed to make a real go of it. As it happens, I was the one who suffered.

It’s easy to put friends second. Part of the problem is that they usually understand. Instead of gossiping — or commiserating — over coffee, we share a brief telephone call and promise to get together. We leave voice mail messages and then don’t talk again for weeks. Forget about having a couple of glasses of wine together, or going for a long hike.

Tired from work, intent on staying on top of the kids’ dance lessons or homework, committed to doing something with my beloved husband (so that we don’t grow apart), I make vague plans with my friends that are never fulfilled. My loss.

A handful of my childhood friends and I have managed to stay in touch through the years. Two of my best friends from high school live only about 50 miles east of me. But the traffic between our homes can turn what should be a 90-minute drive into a three-hour, clenched-fist ordeal. For all we get to see each other these days, they might as well be living on the other side of the world. Meanwhile, my best friend from second grade lives only 3 miles from my apartment in Manhattan. Sure, it’s only a 15-minute subway ride away, but finding a mutually convenient time to sneak away from our children and job responsibilities often seems as challenging as proving Fermat’s Last Theorem.

Still, I’ve learned that maintaining my friendships is not only worth the hassle; it’s crucial to my happiness and well-being. Besides, even with my harried schedule, I get a little bounce from staying connected to the friends I love.

Not surprisingly, an extensive body of medical research shows I’m not alone. A large-scale study over nine years in Alameda, Calif., found that the death rates among people with lasting relationships, like spouses and friends, were markedly lower than those among people without these relationships. Another well-known study conducted by Duke University Medical Center a few years back found that heart patients who lacked social supports were 3 times as likely to die within five years of diagnosis than patients with a spouse or other close friend.

“Having and keeping friends is absolutely necessary for healthy living,” said Sheenah Hankin, a Manhattan-based psychologist who specializes in relationships and personality disorders. “It’s important because we humans are small-group animals, and that group cannot be confined only to kids and husbands.”

So, then, how do you strengthen these precious ties? Follow some basic principles. Make time for outings with friends the same way you make time to do laundry or exercise. If you haven’t seen your friends in a while, put off something else. Let the dust accumulate a little if it means having time to hook up with a friend. Let your family eat out instead of fussing over dinner.

Get out of your normal routine and take the first step to get together. It may seem like you’re the one making all the effort, but in time you’ll probably find that a good friend comes through, and it may not be in ways that you expect.

I’m constantly amazed at how resilient good relationships are. Two of my best friends from high school have taken distinctly different paths through life than I have — they live in the suburbs of Long Island; I’m a city maven. But we always find so much to talk about and share when we get together. And we do it as often as we can.

In the summer, my daughter and I make regular trips out to Long Island’s Jones Beach to meet Hannah and Joan and her two children. Sometimes we spend the night at Joan’s house. During the off-season my pals make the long trek into Gotham to visit me.

Another of my friends uses e-mails to help boost our connection when it starts to fade. Sometimes weeks pass when we haven’t spoken, and I’ll check my e-mail to find that she has sent me an interesting women’s health bulletin or a spicy joke.

No, it’s not the same as getting together and sitting down to chat, but given our hectic lives, sending an e-mail has the virtue of taking less time than a phone call. And it works surprisingly well in sending the larger and more important message: I’m thinking about you.

And that’s really all it takes.

“Acmegidgetscomp’nyhowc’nId’recyercall,” it doesn’t bother me a bit to say, “I’m hearing impaired. Could you back off and take another run at
that, only more slowly?”

I said hearing impairment is the least considered of the disabilities. We get no ramps and curb cuts, no white canes, wheelchairs or crutches. But finally we are getting some legal recognition. Nowadays we see more service dogs besides just guide dogs for the blind. Some dogs are trained especially to alert their owners to certain, specific noises. If the owner’s name is called; if the smoke detector goes off; a doorbell, phone, or alarm; dropped keys, etc.

Other dogs are trained to help people with severe physical handicaps. There may be other kinds of service dogs. All these special dogs and their owners have legal entrance to any public building or conveyance, and they should not be petted by strangers.

Commonly, hearing impaired people with service dogs are rousted, hassled, and sometimes treated as though they are trying to get away with something illegal. They have enough problems without the humiliation of having to deal with people ignorant of the law respecting service dogs.

Severely hearing impaired and deaf people never go to movies. What’s the point? But one good thing we’re seeing more of is captioned movies. I went to my first the other day, “One Good Thing.” It is a good movie, but so much of the dialogue was whispered that even those with good hearing would have missed it without the captioning. Often you could not even see the actor’s face. Even if I had not been hearing impaired, I would have been grateful for the captioning. In only one brief scene was captioning in the center of the screen, across the actor’s face.

It was a totally delightful experience. Next time you would like to see a movie, but you hesitate because it is marked, “Captioned for the deaf,” go to it anyway. You might be surprised at how much more you get with the captioning. Also, you would be helping to persuade the industry to produce more.

Hearing disability sometimes causes great emotional trauma. If we practice being observant, and when we deduce that another person is hard of hearing, use just a little consideration-in a group try to draw the withdrawn person in; face her and speak plainly-we will make life a little smoother for everyone.

Most people do not comprehend that some among them do not hear well. There are a couple of reasons for the unawareness.
Many people refuse to admit that they are hard of hearing. They bluff or fake it in groups and conversations, nodding and smiling to cover the fact that they can’t hear. When required to respond, they often give an answer to what they guess the other person has said, even though the embarrassment of giving a ludicrous answer can be far greater than that of wearing a hearing aid and asking others to face you and talk more slowly.

Another reason for unawareness is that hearing aids are often hardly noticeable, especially if hidden by long hair. Purveyors of hearing aids contribute to the shame of hearing impairment. Some of them advertise that their instruments are so small they can hardly be seen.

Why people will wear glasses that wrap from ear to ear across the whole front of their faces, but refuse to wear unobtrusive hearing aids, is beyond me. Impaired hearing is more prevalent than poor eyesight.

One third of those who are older than age 65 are hearing impaired. However, it is not a problem just for ancient citizens. Many middle-aged people, young adults and even children have hearing loss, sometimes severe.

More than 5 million people wear hearing aids. Even so, the average person waits seven years after signs of hearing loss appears before doing anything about it. Only one third of hearing aid wearers have a T coil, a built-in device that allows them to use their hearing aids while using the telephone.

Just as corrected vision is never as efficient as proper, unaided 20/20 vision, so hearing enhanced with modern, high-tech devices is never as good as the healthy, original hearing mechanism nature designed for us. But in most cases, faulty hearing can be greatly enhanced by aids that are customized to the wearer’s individual needs.

My wife’s right ear is severely impaired and cannot be helped by a hearing aid. However, she wears a small, molded device with a transmitter in it, which transmits sounds and speech on her right side over to her hearing aid in the left ear, which has a tiny receiver.

It makes a huge difference to her when she’s with other people.

We need to be aware. Notice if another is wearing hearing aids. Speak directly to them, and don’t cover our mouths with our hands. We all speech read to a small extent-watch the speaker’s face and mouth. Hearing impaired people do it more than those with normal hearing. It eliminates having to stop mentally, and guess whether a person said, “My son is coming,” or “Someone is running.”

Strafaci started out marketing his 800-square-foot facility to doctors and chiropractors, telling them that he was available to train people who could benefit from exercise, but for one reason or another, wouldn’t like working out at a typical gym. The referrals he received turned out to be almost exclusively for older adults, especially those recovering from strokes, andjoint replacement surgery or other injuries. Strafaci hired a person experienced with geriatric training, and his fitness center took off. “Most of our clients are seniors who feel more comfortable with people of their own nature,” he says. “They fit into two categories: seniors with no exercise historywho, because of the recent HMO changes, don’t have access to an exercise professional; and those who are post-rehab and don’t have long-term access to an exercise professional.”

The concept was simple: to offer a service that addresses the growing change in the wellness industry, a change that reflects the growing older adult population in America. Strafaci aims to help his clients reach their full fitness potential, instead of just treating their individual injuries: “Our approach is holistic. Instead of treating the specific area, we look at their total functional condition, taking their injury into account,” he says.

After a physician referral, a client comes to Strafaci’s facility for a training assessment. The client then takes a six- to eight-weekpersonal training class made up of six orseven other participants. The classes are a combination of flexibility, cardio and strength training. Clients can also, if they choose, sign up for individual training sessions. “We don’t send them home to exercise,” says Strafaci. “We put them in a class setting and they love it. We have a waiting list to join.” The one-on-one assessment and resultant training serves to increase the confidence and comfort levels of the new exercisers, says Strafaci. “They absolutely love to be together in a group setting,” he says.”They are anxious to go to class.” Program participants tend to plan their days around their classes, often heading to lunch after with their classmates.

Strafaci currently has about 45 clients per day, and employs four trainers. Ninety percent of his clients are referred by physicians, and clients pay per class or per training session. In April of 2001, Strafaci expanded his facility to 2,000 square feet, adding a 1,200-square-foot group-training room, including changing rooms. The center’s maingoal, says Strafaci, is to improve functional levels. His motto is,
“Seniors with special needs need special fitness classes.”

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