Doctors often ask for needless tests

Here's a warning from a medical expert you won't get too often: Do not follow your doctor's prescriptions blindly and question whether you really need to undergo the diagnostic tests he or she asks for. "On many occasions, doctors ask for tests that are unnecessary. Similarly, there are drugs that have become outdated or whose efficacy isn't proven. But doctors keep prescribing them. Unless there are standard guidelines on treatment of certain illnesses, such misuse will keep happening," said Dr Kameshwar Prasad, head of the clinical epidemiology unit at AIIMS. With the number of cases involving unwarranted prescriptions of surgical procedures, diagnostic tests and medication increasing, Dr Prasad said patients must ask their doctor about the pros and cons of the treatment offered before making a decision. To create awareness on the issue, AIIMS will hold an international meet — the first of its kind in the world — where experts will discuss how standard guidelines can be evolved for treating diseases. Dr Prasad said unnecessary diagnostic tests and surgical procedures not just put additional financial burden but also affect the patient's recovery. "We are also proposing that evidence-based treatment methodologies should be emphasized in medical schools," he said. AIIMS's neurology department recently screened prescriptions of 250 brain stroke patients referred from different hospitals. Many drugs, operations prescribed without need Doctors at AIIMS who recently screened prescriptions of 250 brain stroke patients referred from different hospitals said they found more than 48% of them were prescribed a particular drug which is not approved. "Either the doctor did not know about it or he used it despite knowing that it's not effective for the condition. In both cases, the patient had to suffer," the senior neurologist said. Experts said among the most misused procedures were hysterectomy (uterus removal), caesarean section and angioplasty for artery blockage. Among drugs, the most commonly misused were vitamins, steroids and antioxidants. According to Dr Paul Glaszious, former director of Oxford University's Centre for Evidence-based Medicine, MRI and CT scan are also being overused. "Vertebroplasty - a spinal procedure where bone cement is injected into fractured vertebra - has proved to be ineffective in many studies. Still, it is being used as a treatment method in patients complaining of backache," he said. In the case of angioplasties, experts said patients were most often not given time to decide whether they need to go for the procedure or not. For every patient with a blocked artery, there are three lines of treatment open - drug treatment, angioplasty and surgery. A recent study in US showed that only 36% of patients who had undergone non-emergency angioplasty to clear a clogged artery actually met the criteria for the procedure. In 50% of the cases, there was not enough evidence to show angioplasty would help and in 14%, the procedure was definitely not required. The study was published recently in the Journal of the American College of Cardiology. In the study, researchers gathered data from more than 24,000 angioplasty patients at 58 hospitals in New York State between 2009 and 2010, and measured how well the physicians stuck to the angioplasty guidelines advised by the American Heart Association and the American College of Cardiology. Said Dr Ashok Seth, chairman, cardiovascular sciences division at the Fortis Escorts Heart Institute, "Emergency procedures are not required in most cases, except for conditions such as heart attacks and unstable angina (chest pain) where a patient has to undergo stenting or surgery within 12 hours. In my view, anybody who can walk 500 metres without chest pain or exertion can wait. Patients must think over seriously and weigh the benefits of medicine versus surgery versus angioplasty before saying yes to any one treatment." "Every hospital should conduct an audit of various procedures carried out, say in a month. This would give us much-needed data about how prevalent each procedure is, and whether it is being misused," Dr Prasad said. He also urged patients to question their doctors constantly on their line of treatment and the tests prescribed by them.

Effectiveness of the combination of memantine plus vitamin d on cognition in patients with Alzheimer disease: a pre-post pilot study

The intensified treatment of breast cancer improves survival but has a price in terms of side-effects. The main side-effects, such as vasomotor symptoms and impaired sexual functioning, are related to premature menopause due to chemotherapy and/or anti-hormonal therapy. Though for some women these symptoms are bearable, for others they have a large impact on their quality of life. The paper discusses the menopausal symptoms most frequently reported by breast cancer survivors and current treatment options. METHODS: A literature review is presented of menopausal symptoms after breast cancer and management strategies, illustrated by two cases. SUMMARY: Vasomotor symptoms can be relieved by lifestyle adaptation, acupuncture and non-hormonal agents such as venlafaxine, gabapentin or clonidine. Impaired sexual functioning can be treated by couple-based sexual counselling or psycho-educational therapy. Painful intercourse due to vaginal dryness can be alleviated by vaginal lubricants and moisturizers, but is most effectively treated by vaginal estriol. Local estriol seems safe if used for a short period (less than six weeks). Because of proven increased risk of recurrence with hormone replacement therapy (HRT), it should not be prescribed for breast cancer survivors, although exceptions could be made of selected cases of fully informed BRCA mutation carriers after ER-negative breast cancer and with severe menopausal symptoms due to prophylactic oophorectomy at a young age and (preferably) after mastectomy. CONCLUSION: The management of vasomotor symptoms and impaired sexual functioning in breast cancer survivors should focus on lifestyle and, if necessary, non-hormonal pharmacological interventions.

Results of indirect and mixed treatment comparison of fracture efficacy for osteoporosis treatments: a meta-analysis

Network meta-analysis techniques (meta-analysis, adjusted indirect comparison, and mixed treatment comparison [MTC]) allow for treatment comparisons in the absence of head-to-head trials. In this study, conditional estimates of relative treatment efficacy derived through these techniques show important differences in the fracture risk reduction profiles of marketed pharmacologic therapies for postmenopausal osteoporosis. INTRODUCTION: This study illustrates how network meta-analysis techniques (meta-analysis, adjusted indirect comparison, and MTC) can provide comparisons of the relative efficacy of postmenopausal osteoporosis therapies in the absence of comprehensive head-to-head trials. METHODS: Source articles were identified in MEDLINE; EMBASE; Cochrane Central Register of Controlled Trials (CENTRAL) via Wiley Interscience; and Cumulative Index to Nursing and Allied Health Literature (CINAHL) between April 28, 2009 and November 4, 2009. Two reviewers identified English-language articles reporting randomized controlled trials (RCTs) with on-label dosing of marketed osteoporosis agents and fracture endpoints. Trial design, population characteristics, intervention and comparator, fracture outcomes, and adverse events were abstracted for analysis. Primary analyses included data from RCTs with fracture endpoints. Sensitivity analyses also included studies with fractures reported through adverse event reports. Meta-analysis compared fracture outcomes for pharmacological therapies vs. placebo (fixed and random effects models); adjusted indirect comparisons and MTC assessed fracture risk in postmenopausal women treated with denosumab vs. other agents. RESULTS: Using data from 34 studies, random effects meta-analysis showed that all agents except etidronate significantly reduced the risk of new vertebral fractures compared with placebo; denosumab, risedronate, and zoledronic acid significantly reduced the risk for nonvertebral and hip fracture, while alendronate, strontium ranelate, and teriparatide significantly reduced the risk for nonvertebral fractures. MTC showed denosumab to be more effective than strontium ranelate, raloxifene, alendronate, and risedronate in preventing new vertebral fractures. CONCLUSIONS: The conditional estimates of relative treatment efficacy indicate that there are important differences in fracture risk reduction profiles for marketed pharmacological therapies for postmenopausal osteoporosis.

Risk of malignancies in patients with rheumatoid arthritis treated with biologic therapy: a meta-analysis

CONTEXT Concerns exist regarding the potential development of malignancies in patients with rheumatoid arthritis (RA) who are receiving biologic response modifiers (BRMs). OBJECTIVETo assess the risk of malignancy in patients with RA enrolled in randomized controlled trials (RCTs) of BRMs. DATA SOURCESElectronic databases, conference proceedings, and websites of regulatory agencies were searched for RCTs evaluating abatacept, adalimumab, anakinra, certolizumab, etanercept, golimumab, infliximab, rituximab, and tocilizumab in RA from inception through July 9, 2012. STUDY SELECTIONIndependent selection of studies included RCTs that compared the safety of any BRMs used in RA patients with placebo and/or any traditional disease-modifying antirheumatic drugs with a minimum of 24 weeks of follow-up. DATA EXTRACTIONIndependent reviewers selected studies and extracted data on quality and outcomes. Pooled estimates and 95% confidence intervals were calculated for each BRM. RESULTSSixty-three RCTs with 29,423 patients were analyzed. No statistically significant increased risk of developing malignancy was observed. Of the 29,423 patients, 211 developed a malignancy during the trial (118 solid tumors, 48 skin cancers, 14 lymphomas, 5 hematologic nonlymphomas, and 26 not specified). The incidence rate for any malignancy during the first year of therapy was very low in the BRM plus methotrexate group (0.77%; 95% CI, 0.65%-0.92%), the BRM monotherapy group (0.64%; 95% CI, 0.42%-0.95%), and the controls (0.66%; 95% CI, 0.52%-0.84%). Anakinra plus methotrexate showed lower odds compared with methotrexate alone (Peto odds ratio, 0.11; 95% CI, 0.03-0.45). No statistically significant risk was observed for specific cancer sites, although the Peto odds ratio for lymphoma was 2.1 (95% CI, 0.55-8.4) in patients receiving tumor necrosis factor inhibitors compared with controls. CONCLUSIONThe use of BRMs among patients with RA included in RCTs of at least 6 months' duration was not significantly associated with an increased risk of malignancy compared with other disease-modifying antirheumatic drugs or with placebo.

Treatment of the common cold in children and adults

The common cold, or upper respiratory tract infection, is one of the leading reasons for physician visits. Generally caused by viruses, the common cold is treated symptomatically. Antibiotics are not effective in children or adults. In children, there is a potential for harm and no benefits with over-the-counter cough and cold medications; therefore, they should not be used in children younger than four years. Other commonly used medications, such as inhaled corticosteroids, oral prednisolone, and Echinacea, also are ineffective in children. Products that improve symptoms in children include vapor rub, zinc sulfate, Pelargonium sidoides (geranium) extract, and buckwheat honey. Prophylactic probiotics, zinc sulfate, nasal saline irrigation, and the herbal preparation Chizukit reduce the incidence of colds in children. For adults, antihistamines, intranasal corticosteroids, codeine, nasal saline irrigation, Echinacea angustifolia preparations, and steam inhalation are ineffective at relieving cold symptoms. Pseudoephedrine, phenylephrine, inhaled ipratropium, and zinc (acetate or gluconate) modestly reduce the severity and duration of symptoms for adults. Nonsteroidal anti-inflammatory drugs and some herbal preparations, including Echinacea purpurea, improve symptoms in adults. Prophylactic use of garlic may decrease the frequency of colds in adults, but has no effect on duration of symptoms. Hand hygiene reduces the spread of viruses that cause cold illnesses. Prophylactic vitamin C modestly reduces cold symptom duration in adults and children.

Steven Moffat

Today marks the 50th anniversary of the first credited single release by The Beatles - who would feature in Doctor Who in stock footage in The Executioners (episode 1 of The Chase) - and if he had a time machine Matt Smith would love to see the Fab Four: "I'd go see music - the Beatles at their height, or Woodstock, or Kurt Cobain live. I'd love to see Arcade Fire in a room somewhere. And Sinatra when he was with Dean Martin." [Bust Magazine via Yahoo, 2 Oct 2012] (DWN note: Perhaps Matt got his time trip after all, if this photo that was circulated earlier in the year is to be believed!) Alex Kingston is to appear in the 10th season of NCIS as a "woman of questionable morals". The actress is to play a character named Miranda Pennebaker, and is described by series boss Gary Glasberg as someone who "deals in everything from high-end weapons sales to priceless gems. Her connections go all the way up the ladder of D.C. politics, and [Major Case Response Team leader Supervisory Special Agent Leroy Jethro] Gibbs needs her for this very disturbing, emotional case." [TVLine, 3 Oct 2012] Author and long-term fan A. L. Kennedy has expressed an interest to write for Doctor Who: "To go back to things that you are completely open to as a child, and which you allow to be very deeply part of who you are, as an artist, is to get back to that bit of yourself. And Doctor Who is very deeply there in my own work. Every crazy person, lots of the sense of humour, my viewpoint on what human beings are, absolutely. If I wasn’t going to be a writer I was going to be an anthropologist, because that was my thing: what are human beings?" The author will also be talking about Doctor Who when she appears at the Wigtown Book Festival on Sunday 7th October. [Scotsman, 1 Oct 2012] A rare opportunity to see Sarah Sutton in one of her earliest TV roles is coming up. The BFI is screening the BBC's 1973 adaptation of Alice Through The Looking Glass, which stars Sutton as the eponymous heroine, at its Southbank venue in London on Saturday 17th November as part of its Beyond the Fourth Wall – Experiments in TV Drama season. Directed by James MacTaggart, who was keen to exploit the possibilities offered by the then-new technique of colour separation overlay, the 65-minute play was the BBC's official entry to the Prix Italia competition. Also appearing in it are Geoffrey Bayldon (White Knight), Bruce Purchase (Walrus), and Stephen Moore (Haigha). Tickets go on sale to the public on Tuesday 9th October. Mark Gatiss will be at the BFI Southbank on Sunday 28th October for a question-and-answer session following a preview of his feature-length BBC Four documentary Horror Europa With Mark Gatiss, which explores European horror cinema and is a follow-up to his BBC Four series A History of Horror. Again, tickets go on sale to the public on Tuesday 9th October. The 90-minute documentary will air on BBC Four towards the end of October. Billie Piper is moving to Los Angeles with husband Laurence Fox after they both finish their current theatre stints, according to a newspaper interview with Fox, who is appearing with Arthur Darvill in Our Boys at The Duchess Theatre in London until Saturday 15th December. Piper is in The Effect at The Cottesloe, which opens on Tuesday 6th November and runs until Wednesday 23rd January 2013, meaning that for a few weeks their performances will overlap. However, Fox said the two of them didn't compete over their careers. "It's not competitive but I feel like I've got to raise my game a bit. She's really good so it would be nice if I was really good too," he said. [i, 3 Oct 2012] Meanwhile, Matt Smith and David Tennant bumped into each other at the press night for Our Boys. Also there was Billie Piper to give her support to her husband. [Mail Online, 4 Oct 2012] Comedian and TV presenter Frank Skinner has told of his failed bid to secure a role in the current series of Doctor Who. In an interview with Absolute Radio, he said: "I got my manager to phone up the Doctor Who people when I heard this series was being filmed. He never mentioned it again so I take it that he couldn't break it to me." [i, 3 Oct 2012] Comic book writer and playwright Grant Morrison, who penned stories for Doctor Who Magazine in the 1980s, told the MorrisonCon audience in Las Vegas that despite his desire to write for the show and apparent initial interest by Steven Moffat and Mark Gatiss in him doing so, nothing more had been forthcoming. "Moffat had been getting a lot of tweets from people who were saying, 'You should have Grant write Doctor Who', and I'd really love to write Doctor Who," he said. He added that a friend who had worked with Moffat and Gatiss suggested it to the pair and told him the duo wanted to hear from him. "We tried it four or five times, and he never wrote back," said Morrison. [Comic Book Resources, 1 Oct 2012 - NB: Article contains strong language elsewhere.] In a two-page feature in the new Radio Times, Steven Moffat describes how he struggled to find the proper ending for Amy and Rory. "How and why would they leave? And would they live or die? I wrote and rewrote. I had a completely different ending and threw it away. So many times over those mad few days, the fate of the Ponds changed. Alive, dead, alive, dead . . . Nothing felt right. Nothing felt inevitable." [Radio Times, 3 Oct 2012] Sheridan Smith - companion Lucie Miller to the Eighth Doctor in the Big Finish audio dramas - is the latest signing to BBC In-House Comedy's production of Mr Stink. As previously reported, the children's novel by David Walliams stars Hugh Bonneville as the eponymous tramp and has been adapted by Walliams and Simon Nye. Smith, who will play the overbearing mother of lonely 12-year-old Chloe who befriends Mr Stink, said: "David is such a brilliant writer, and the character just jumped off the page when I read it." [BBC Media Centre, 4 Oct 2012]

Doctor Who dominated the listings for the BBC iPlayer for September, with over 8 million accessing the programme at some point during the month.

Top of the list was the series opener, which has been available for almost the entire month, Asylum of the Daleks with over 2.2 million requests. It was by far the most requested programme on the iPlayer for September. The next three episodes, availble for fewer days, took the next three places in the chart with Dinosaurs on a Spaceship having 1.8 million requests, A Town Called Mercy having 1.4 million requests and The Power Of Three having 1.3 million accessing the episode. The highest rated non Doctor Who programme was Citizen Khan, which has less than half of the requests for Asylum of the Daleks with just over 1.0 million accessing the programme. The last Doctor Who episode before the mid-series break, The Angels Take Manhattan, was 7th in the list, with 0.92 million requests, despite only being available for the last 28 hours of the month. Asylum of the Daleks currently stands as the fifth most accessed programme of the year. All Doctor Who episodes are available on the BBC iPlayer until later this evening.

RELATIONSHIPS

Don`t we all come to this world as guests—constantly striving to find the golden rule of a successful rapport with everybody and everything we come across? From birth to death a person`s success or failure is measured by the kind of relationship he/ she has had with elements of this world: people. Nature and beyond it all,with the spirit behind this "relative world". But striking the right chord in a relationship often proves a hard nut to crack.

The world seems to constantly echo with a disconcerting chorus of voices, the result of frustrated relationships between parents and their children, husbands and wives, friends, siblings, in-laws, employees and colleagues—individuals disillusioned with themselves for not being able to relate successfully to their environs.

The most interesting aspect of this scenario is that, today there happens to be no dearth of methods to arrive at that elusive "success" in the act of relating.

Couples
The phenomenal flux of changes in every sphere of our lives since the last century has redefined the role of human relationships. Social revolutions such as the women`s lib, the cult of the individual, and even the human potential movement have repatterned the basic premises of relationships. A good relationship today is not one that just lasts but one that coexists with self-respect, individuality and the need to grow.

For it to thrive successfully, marriage counselors and psychologists, also, stress the need for this kind of "space" within a couple`s relationship. An individual in a marriage shouldn`t be a repository of one`s own needs and desires, in fact both the people involved should be totally committed to their relationship. They must be ready to take responsibility for themselves as well as the relationship.

How to Make Relationships Work

• Don`t try too hard to convince the other person of your love. Love and trust yourself more. This will relax your love defenses and enable you to give yourself totally to relationship.
• Don`t question the other person`s love all the time.
• Feel the oneness of the universe.Step beyond the `me first` conflicts that mar relationships. This would help you be complete within yourself.
• Don`t use your relationships to fulfill your expectations.
• Know yourself. Analyze the cause of your reactions.
• Acknowledge the other person as an individual. Grow and let grow.
• In a conflicting relationship, check where you went wrong rather than where the other person failed. Listen to each other. Communication strengthens the foundation of a relationship.
• Take the first step in working out a relationship without worrying about who is in the right. Don`t depend on any person and don`t let the other person depend on you.

Parenting
One of life`s greatest achievement is to grow and let your seeds grow. Nothing in life is more fulfilling than watching your children blossom. More so when you have to nurture, educate and guide them towards a life most suitable to them. Millions of parents do it all the time—some, with a lot of effort, some without a thought. So, what really is good parenting? Is it discipline, moral education, freedom to let your child be what he is? Or is it something more subtle, something that goes by the name of life`s lessons?

But it might be a good thing to remember that, no matter how eager or ambitious we are in shaping our children`s lives, there is a limit to what we can accomplish. Swami Vivekananda, founder of Ramakrishna Mission, uses the analogy of growing a plant to drive home the point:

"You cannot make a plant grow in soil unsuited to it. A child teaches itself. But you can help it to go forward in its own way. What you can do is not of the positive nature, but of the negative. You can take away the obstacles, but knowledge comes out of its own nature. Loosen the soil a little, so that it may come out easily. Put a hedge round it; see that it is not killed by anything, and there your work stops. You cannot do anything else. The rest is a manifestation from within its own nature."

"You cannot make a plant grow in soil unsuited to it. A child teaches itself. But you can help it to go forward in its own way. What you can do is not of the positive nature, but of the negative. You can take away the obstacles, but knowledge comes out of its own nature. Loosen the soil a little, so that it may come out easily. Put a hedge round it; see that it is not killed by anything, and there your work stops. You cannot do anything else. The rest is a manifestation from within its own nature."

BRINGING UP CHILDREN
• Teach values such as honesty, integrity, patience and self-control gradually and steadily, that too by your own example.
• Praise them openly and often, reprove secretly and seldom; reprimand the bad behavior, not your children.
• Teach them self-esteem and self-confidence (something they`ll carry for the rest of their lives).
• Restrict television watching and recreation time. Keep a watch on your children`s company.
• Try to keep alcohol and drugs away from the house, or keep them in moderation.
• Maintain a happy and loving home environment.
• Give a lot of your time to your children, both quality and quantity.
• Make humor and laughter a part of your relationship with children.
• Allow children to grow and learn through the mistakes they make.
• Hug and show feelings of love whenever possible.
• Communicate gently but clearly and firmly.

PAPA OF TINY FEET
• In a time of nuclear families in which wives also contribute to the family kitty, it is imperative that fathers too share the responsibility of bringing up a baby. Don`t view the time spent with your child as a chore. It is an integral part of your life that will help strengthen the parent-child bond.

• The keynote in approaching fatherhood is to relax. A baby is responsive to the parent`s feelings. If you are anxious, so will the baby be.

• A baby often makes demands on its mother at the most outrageous times, leaving her exhausted. At this time you can encourage her by taking on some of the tasks—such as changing nappies or waking up in the night to look after necessary chores.

• It might seem difficult to change your lifestyle that the baby`s presence would inevitably demand. You may have to say good-bye to indulgent hobbies that you have developed over the years, the partying that used to be fun. But if you allow yourself to get involved in the process of your child`s growing up—building blocks with him, doing jigsaws, and reading from picture books—you will discover a new joy, as you watch the wonder of life unfold through its eyes.

OLD V/S NEW
Current medical wisdom regarding the rearing of children, upholds some traditional Indian practices while rejecting others:

• Avoid pre-lacteal feeds like honey water, glucose or formula milk.
• Talcum powders serve no purpose and can be avoided. Soaps, if used at all should be mild.
• If your religion your child to be circumcised, postpone circumcision till a later stage and make sure that it is done by a qualified surgeon.
—Dr Promilla Butani in Parenting
• Don`t give the child any water or juices until he starts on solid food.
• Avoid applying kohl in the baby`s eyes.
• Take any ailment, even a minor fever, seriously in a newborn
• Avoid putting ear or nose-rings
• Use cotton clothes and diapers.
• After feeding, burp the child. Don`t let the child lie down face-up immediately after feeding.
• Don`t try tricks such as coating your child`s thumb with chilies to rid it of thumb-sucking habit. These are psychological problems that should be handled by a pediatrician.
—Dr Dwarkadas Motiwala

SIBLINGS:
We alternately love them and hate them, but one thing`s for sure—what would we do without them? Our companions for life, our competitors, our confidantes, our rivals, our comrades-in-arms against the whole mad world—what would we do without them? No other bond in the world can beat siblings at sharing such a unique and complex love-hate relationship!

The true worth of having had brothers and/or sisters around while we were growing up never strikes us till we are way past our childhood. The most important lesson we learn at that stage of our lives, is how to get along with individuals other than ourselves. That was also when we learnt to develop social values such as cooperation, honesty, kindness, and tolerance .

Learning such important social skills usually takes a lot of time, but they are imbibed much faster while living with brothers and sisters. Children with siblings learn how to share and resolve conflicts quite easily. And with the right kind of guidance from parents, siblings also get a lot of practice in learning how to be cooperative, supportive, and nurturing to others.

In other words, we probably turned out much better because we had that bullying older brother or the irritating younger sister__it prepared us for all the important relationships we encountered later in life.

Tips for Managing Quarrelsome Siblings
• Let siblings express their feelings.
• Try to comment only on the disagreeable behavior and avoid telling one child that a sibling is better at something.
• Try to give each sibling according to his/her individual need.
• Don`t take sides in sibling fights. Instead, try to let the children work out differences on their own.
• It takes time and persistence for you to learn new ways of treating your children and for them to learn new ways of getting along. • Don`t give up.

FRIENDS:
A friend is someone who walks in when the whole world walks out. Our friends are equity shares we earn in life. We continue to reap dividends on them throughout our lives. Yet today how many of us have shoulders to lean on outside our immediate familial relationships? In a highly competitive and result oriented world, we seem to be drifting away from each other all the time. This is not to say that the world is short of amiable individuals, but rather that we have forgotten the art of maintaining positive camaraderie. In a mad rush to keep up with the fast changing pace of urban living, we fail to nurture and care for basic ties of love and warmth that binds us all together.

Tips for Better Friendships 1. Being Fully Committed
2. Taking Personal Responsibility
3. Taking Care of Yourself
4. Being honest, and
5. Doing Your Work—will allow you to experience the love, happiness, joy, and quality of life that you deserve, and is worth your best effort!

DEATH
What is death? The final good-bye? Or a transition from one level of existence to the other? Most religions talk of an afterlife. In fact, almost all concepts of morality are based on what`s going to be meted out to us after we die. So, does that make death a moment of mourning, a sad occasion when we see our loved ones for the last time? Or is it a moment of celebration, when we prepare to break free of the mortal form and exhilarate in the communion with the eternal?
SUCCESS
  Success is what dreams are made of. Success is about making it in life. Fast cars, expensive penthouses, designer labels—in other words, high material viability is the new success mantra. Yet we see large hordes of people demanding to do more than that by trying to find a common denominator for success. No longer weighed in terms of tidy bank balances, success is now regarded as all-inclusive quotient of material, emotional and spiritual gratification. Belying Alvin Toffler`s apocalyptic cry against capitalism and urbanization, success does not remain merely a socially abrasive economic phenomenon in a highly competitive world. Today success represents a holistic and positive attitude to life.

Attitude is everything. If you think you can, you most certainly can. Success is not closeted within some kind of brick and mortar premises. It assumes the individuality of a complete act executed with perfection. Material achievements do not define life. We do not remember the sports stars for the products they endorse but the spirit of achievement they represent. In the abundance of positive attitude underlies the grandeur of a truly rewarding and rich life.

Ancient Indian wisdom believes that the most qualifying aspect of success lies in following the four Purusharthas( tenets) of life. The Purusharthas are based on the four tenets of artha (wealth,social security), kama (fulfillment of desire), dharma( principles)and moksha (salvation). Wealth or artha means earthly possessions and material gains. People usually work hard to procure such standards of success, and yet, find themselves wanting more. Desires condemned by puritans the world over, is motivating force behind all action that manifests as success. High moral credo or dharma is a life based on principles. However the crowning glory to successful life is moksha or freedom from all desires. Artha, kama, dharma and moksha patterns a rite of passage for an adult life. According to Indian thought, success depends upon the smooth transition of an individual through each of these passages.

However, the culture factor definitely influences the success expectation among a people.

Nature provides us with the very essence of life. However, the world is increasingly taking recourse to synthetic and toxic materials, which is polluting the atmosphere and curtailing human longevity. It`s about time we shifted the accent to nontoxic, nonpolluting and eco-friendlier natural habits and habitats.
The word `stress` is defined by the Oxford Dictionary as "a state of affair involving demand on physical or mental energy". A condition or circumstance (not always adverse), which can disturb the normal physiological and psychological functioning of an individual. In medical parlance `stress` is defined as a perturbation of the body`s homeostasis. This demand on mind-body occurs when it tries to cope with incessant changes in life. A `stress` condition seems `relative` in nature. Extreme stress conditions, psychologists say, are detrimental to human health but in moderation stress is normal and, in many cases, proves useful. Stress, nonetheless, is synonymous with negative conditions. Today, with the rapid diversification of human activity, we come face to face with numerous causes of stress and the symptoms of anxiety and depression.

"Nothing gives one person so much advantage over another as to remain always cool and unruffled under all circumstances."
—Thomas Jefferson

The Dyanamics of Stress
In a challenging situation the brain prepares the body for defensive action—the fight or flight response by releasing stress hormones, namely, cortisone and adrenaline. These hormones raise the blood pressure and the body prepares to react to the situation. With a concrete defensive action (fight response) the stress hormones in the blood get used up, entailing reduced stress effects and symptoms of anxiety.

When we fail to counter a stress situation (flight response) the hormones and chemicals remain unreleased in the blood stream for a long period of time. It results in stress related physical symptoms such as tense muscles, unfocused anxiety, dizziness and rapid heartbeats. We all encounter various stressors (causes of stress) in everyday life, which can accumulate, if not released. Subsequently, it compels the mind and body to be in an almost constant alarm-state in preparation to fight or flee. This state of accumulated stress can increase the risk of both acute and chronic psychosomatic illnesses and weaken the immune system.

Stress can cause headaches, irritable bowel syndrome, eating disorder, allergies, insomnia, backaches, frequent cold and fatigue to diseases such as hypertension, asthma, diabetes, heart ailments and even cancer. In fact, Sanjay Chugh, a leading Indian psychologist, says that 70 per cent to 90 per cent of adults visit primary care physicians for stress-related problems. Scary enough. But where do we err?

Just about everybody—men, women, children and even fetuses—suffer from stress. Relationship demands, chronic health problems, pressure at workplaces, traffic snarls, meeting deadlines, growing-up tensions or a sudden bearish trend in the bourse can trigger stress conditions. People react to it in their own ways. In some people, stress-induced adverse feelings and anxieties tend to persist and intensify. Learning to understand and manage stress can prevent the counter effects of stress.

Methods of coping with stress are aplenty. The most significant or sensible way out is a change in lifestyle. Relaxation techniques such as meditation, physical exercises, listening to soothing music, deep breathing, various natural and alternative methods, personal growth techniques, visualization and massage are some of the most effective of the known non-invasive stress busters.

Stress Can Be Positive
The words `positive` and `stress` may not often go together. But, there are innumerable instances of athletes rising to the challenge of stress and achieving the unachievable, scientists stressing themselves out over a point to bring into light the most unthinkable secrets of the phenomenal world, and likewise a painter, a composer or a writer producing the best paintings, the most lilting of tunes or the most appealing piece of writing by pushing themselves to the limit. Psychologists second the opinion that some `stress` situations can actually boost our inner potential and can be creatively helpful. Sudha Chandran, an Indian danseus, lost both of her legs in an accident. But, the physical and social inadequacies gave her more impetus to carry on with her dance performances with the help of prosthetic legs rather than deter her spirits.

Experts tell us that stress, in moderate doses, are necessary in our life. Stress responses are one of our body`s best defense systems against outer and inner dangers. In a risky situation (in case of accidents or a sudden attack on life et al), body releases stress hormones that instantly make us more alert and our senses become more focused. The body is also prepared to act with increased strength and speed in a pressure situation. It is supposed to keep us sharp and ready for action.

Research suggests that stress can actually increase our performance. Instead of wilting under stress, one can use it as an impetus to achieve success. Stress can stimulate one`s faculties to delve deep into and discover one`s true potential. Under stress the brain is emotionally and biochemically stimulated to sharpen its performance.

A working class mother in down town California, Erin Brokovich, accomplished an extraordinary feat in the 1990s when she took up a challenge against the giant industrial house Pacific Gas & Electric. The unit was polluting the drinking water of the area with chromium effluents. Once into it, Brockovich had to work under tremendous stress taking on the bigwigs of the society. By her own account, she had to study as many as 120 research articles to find if chromium 6 was carcinogenic. Going from door to door, Erin signed up over 600 plaintiffs, and with attorney Ed Masry went on to receive the largest court settlement, for the town people, ever paid in a direct action lawsuit in the U.S. history—$333 million. It`s an example of an ordinary individual triumphing over insurmountable odds under pressure. If handled positively stress can induce people to discover their inherent talents.

Stress is, perhaps, necessary to occasionally clear cobwebs from our thinking. If approached positively, stress can help us evolve as a person by letting go of unwanted thoughts and principle in our life. Very often, at various crossroads of life, stress may remind you of the transitory nature of your experiences, and may prod you to look for the true happiness of life.

Stress Throughout Evolution
Stress has existed throughout the evolution. About 4 billion years ago, violent collision of rock and ice along with dust and gas, led to the formation of a new planet. The planet survive more than 100 million years of meltdown to give birth to microscopic life . These first organisms endured the harshest of conditions—lack of oxygen, exposure to sun`s UV rays and other inhospitable elements, to hang on to their dear life. Roughly 300,000 years ago, the Neanderthals learnt to use fire in a controlled way, to survive the Glacial Age. And around 30,000 years, Homo sapiens with their dominant gene constitutions and better coping skills, won the game of survival. Each step of evolution a test of survival, and survival, a matter of coping with the stress of changing conditions.

Millions of trials and errors in the life process have brought men to this stage. Coping with events to survive has led men to invent extraordinary technologies, beginning with a piece of sharpened stone.

From the viewpoint of microevolution, stress induction of transpositions is a powerful factor, generating new genetic variations in populations under stressful environmental conditions. Passing through a `bottleneck`, a population can rapidly and significantly alters its population norm and become the founder of new, evolved forms.

Gene transposition through Transposable Elements (TE)—`jumping genes`, is a major source of genetic change, including the creation of novel genes, the alteration of gene expression in development, and the genesis of major genomic rearrangements. In a research on `the significance of responses of the genome to challenges,` the Nobel Prize winning scientist Barbara McClintock, characterized these genetic phenomena as `genomic shock`.This occurs due to recombinational events between TE insertions (high and low insertion polymorphism) and host genome. But, as a rule TEs remain immobilized until some stress factor (temperature, irradiation, DNA damage, the introduction of foreign chromatin, viruses, etc.) activates their elements.

The moral remains that we can work a stress condition to our advantage or protect ourselves from its untoward follow-throughs subject to how we handle a stress situation. The choice is between becoming a slave to the stressful situations of life or using them to our advantage.
 The extraordinary power of love can be overwhelming and transforming. Love is undefinable and yet all pervading.
 Despite centuries of Man`s continued existence on this planet, he has failed to conclusively solve the riddle posed by two indelible facts of human existence—Life and Death. What is Life? Religions have preached about it, philosophers have pondered over it and ordinary mortals have lived through it. But the eternal mystery of Life still eludes us.
 Swami Vivekananda, a disciple of Sri Ramakrishna Paramahamsa and founder of the Ramakrishna Mission, was a firm believer of karma yoga. During the World Parliament of Religions in Chicago in 1893, he was one of the first Indian philosophers/sages to take India`s spiritual heritage to a worldwide audience.
 What does work mean? Is it just a means to earn your livelihood? Or is it an expression of your perception of life? If so, then, while choosing your career, should you go by what`s lucrative, or by your inner instincts and aptitudes?
As a natural state of mind, tolerance indicates an ability to coexist with others, to respect alternative points of view, to neither dominate nor be dominated. It suggests both the ability to be yourself as well as allow others that freedom. It is both sturdy individuality and acceptance of other points of view.

Communication Is the Heartbeat of Relationship

If communication is indeed the heartbeat of relationship, it's little wonder that most relations are on coronary care. Once again we are confronted with another absurd reality. Our culture deprives us of the most fundamental education that we require to succeed in our relationships. Learning the subtleties and nuances of meaningful and effective communication are the cornerstones of successfully relating.
In effective communication, which incidentally is a very rare event, we need to first establish a shared meaning around the words, constructs and ideas that we are discussing and then further that meaning in a coherent flow of dialogue. Such a skill set enables relationships to thrive, businesses and organizations to be more productive and nations to create and sustain peace. What could possibly be more essential?
Shared Meaning
We take for granted that our words convey exactly what we intend them to. This is a particularly misinformed assumption. I have observed that upon deeper scrutiny, the words, let alone the concepts, tend not to be received in the way the messenger intends. By the time a few sentences have passed, we may have a totally missed communication. How often do we pause and considerately ask the other what they mean by the word or words they are using?

Although this problem is more glaring in confrontational discourse, it impacts amicable conversations as well. "You don't know how to be intimate," she exclaims. He retorts, "I don't know how to be intimate? You're so angry and cold who would ever want to be intimate with you?" In the following minutes this couple is off to the races, pushing buttons and hurling invective.
They are arguing around the word ‘intimate.' Yet, no one has bothered to share or inquire what intimate suggests. She might be referring to emotional intimacy; he might be thinking of sexual intimacy. This is a common disconnect. Yet the problem runs deeper. Let's give them the benefit of the doubt and assume they are fighting about whether he can or cannot be emotionally intimate. Have they ever discussed the concept of emotional intimacy and reached a shared meaning? This would be most unlikely.
How can we discuss or argue the virtues of something when we are speaking differing languages? When we seek to learn a new language, we must first understand what the word means when it is translated into our native language. That said the subtleties and nuances might still be different, so we need to come to appreciate these differences to communicate well. Yet, we don't bother to discern those more subtle differences when we both speak the same language. We assume the words have the same meaning for each of us. They ordinarily don't.
Coherent Communicating
Let's move this couple into the art of coherent communicating. His more proper response to her accusation might be to inquire as to what she means by the word intimate. This would require that his button not be pushed in a reactive and defensive manner, and that he respond in a balanced and sensible way. After all, his partner is upset with him. Why not find out what is truly troubling her? If he doesn't fully appreciate what she is feeling and trying to communicate, how can they ever move to resolve the emotional upset? So, in this instance, he might elect not to be right, not to prove her wrong, and try to comprehend what is stirring her upset. A more educated response might sound like, "Yikes, that feels hurtful. Please tell me what you mean by intimate and how you feel I'm failing you?" That response might actually foster a generative discussion instead of breaking down into yet another meaningless argument.
Of course, the problem lies with her as well as with him. He'd have to be very far along in his shared meaning and dialogue education to be able to reflectively inquire as to her meaning rather than simply react. To further the possibility of meaningful conversation, she might have begun with, "I'm really feeling sad and shut down that you don't share your more private thoughts and feelings with me. I feel like we're strangers just going through life together but not really connecting. Do you feel that same about me?" Imagine how differently that conversation might flow.
Language only represents thoughts, beliefs and experiences, and should not be taken as a literal or objective reality. Words don't mean the same thing to all of us. In fact, they ordinarily evoke differing connotations based upon each individual's experiences. We often end up in disagreements without clarifying what it is that we're arguing about. Just consider the confusion around the word ‘love.' One person says to the other, "I love you." The other responds, "No you don't." Are they speaking of loving one another or being in love: Eros? Is anyone clarifying? Ordinarily we aren't.
In the Greek language there are numerous words for love. The Greeks clearly appreciate the myriad nuances to this word. We need to take the time to illuminate and appreciate what the other truly means by the word. What sense does it make to argue about whether you are intimate or loving if we're talking about two different things? We must look beyond the word - the label - and find shared meaning in our communications.
When we ask one another what the word or concept means, we are in fact being very intimate and respectful. Taking the time to inquire as to what the other is truly intending to communicate honors the exchange. Sharing meaning is a precursor to an intimate exchange and opens the doorway to genuine dialogue.

Katy Perry and Russell Brand: How Do You Start Your Marriage Right So It Doesn't End Wrong?

Katy Perry and Russell Brand may have had a courtship and a wedding to remember, but that is all they'll have left now that Brand recently filed for divorce from his wife of 14 months. The pop star and the actor tied the knot during a lavish ceremony in India after knowing each other for only four months. At first everything seemed great and they appeared to thrive, even soar, despite their dissimilar backgrounds — he is a recovering drug addict and she was raised by a deeply religious Christian family. But then, as it usually does, reality set in.
So often the most challenging year of marriage is that first year — when the big issues come into play. Where should we live? Whose career should take precedence? When do we have children? How many should we have? That is when, as I discuss in my book What About Me? Stop Selfishness From Ruining Your Relationship, you make that big push away from being a "me" to working and living together as a "we." But forging that "we" can be tenuous because you are so used to living alone and thinking about yourself first; to suddenly be accountable to someone else and no longer consider what is best for me but instead what is best for us can be a shock to your system and, quite frankly, can sometimes start to feel like a sacrifice.

Page Six of the New York Post, as well as other publications, reported that Brand was pushing to settle down and start a family, while Perry wanted to focus on her career and music tour. The couple reportedly battled over this before Christmas, and then spent the holidays apart. I witness this over and over again in my practice and I always say the same thing. It is so important to discuss these defining issues with your partner before you have that expensive wedding, and before you decide to say, "I do," because without that you really don't know what you are agreeing to. Many times people start out with the fantasy and never address the reality and the expectations that brings, each thinks they will deal with it when the time comes and hope the other will go along with whatever their need is. Or if they had protested before or didn't want to do it in the past, that somehow you will get them to change their mind. But that doesn't work, as we see here and as we saw with Kim Kardashian and Kris Humphries. Hollywood couples in particular are already leading such big glittery lives that it seems they often get carried away. People talk around these decisions, thinking love is all they need.
But that fairy tale of true love is not enough. Love is a great place to start. That attraction, passion, and mutual devotion can be your diving board but you have to know what pool you are jumping into to make it work. And it has to be about pooling your resources, sharing, and becoming a team. To get there you have to lay out your individual needs and hopes before you have gone too far. Mid-dive is not a good place to realize what lies below isn't what you were expecting or what you think will make you happy in the long run.
I often think of how we take the time to plan a vacation. We decide where we want to go, where to stay, eat, and tour. You wouldn't jump into the car without any thought and head to a destination. Why would you do that with a marriage? Learn what your partner wants out of life, and what they expect from you and the home you build, before you commit to being together forever. That is the only way to ensure a happy future and continued travel together. My advice is to deal with the "me" and the "we" before you get married so that you don't have to later ask, what about me?

Beware of (Horny) Men Bearing (Empty) Promises

Men like having sex much more than they like responsibility. And women don’t mind and even like sex, but they can’t stand empty promises by men to get it from them.
I don’t know how often this occurs, but there is a not infrequent situation where a man is sure about wanting sex and may wax and wane eloquently about a wondrous future filled with romantic vacations to a woman he is pursuing in order to land her in bed. Once he has her, those promises can often fade and if the woman asks about his fulfilling what he promised, he accuses her of pressuring him and tells her to stop nagging. To compound the problem there are few things that take away a man’s desire to spend his life with a woman than her pressuring him to make good on what he promised.
However even as he resists and can become petulant about it, he may nevertheless be building an emotional dependency on her underneath. If she reaches the point, especially after her friends and family insist that he is toying with her, of delivering an ultimatum of either get engaged/married or break up and if it is not a bluff, the fear of losing her can cause that man to accede to her insistence for all the wrong reasons — not wanting to lose her vs. wanting to be with her.
Also not infrequently if the man under pressure agrees to the marriage, but feels he didn’t choose it, he can respond by withholding love and attention. And if the woman is oblivious as she becomes consumed with planning the wedding with her friends and family while the man feels like a unengaged Ken doll onlooker, he can further react by becoming even less loving.
Sadly I have seen such a switching off of desire last for decades in the man as a reaction to feeling he didn’t choose the marriage but was forced even as the couple produces children, buys a homes, etc.
Here is the real rub.  One of the worst feelings a woman can have is to feel coldness, contempt or nothing in the part of her where she is supposed to feel warmth.  Women have confided in me that a woman without warmth is not a woman (alternatively men have confided in me that a man without courage is not a man).  When men withdraw or withhold caring towards a woman or worse act sullen, petulant or complaining (since they have lost that loving feeling), it can cause a woman to lose her warm feelings towards that man.  And underneath the anger a woman may feel toward a non-loving or unloving man is a unconscious fear that she has lost her warmth, is no longer a woman and is trapped.
What’s a woman to do to prevent this very sad fate?
At any given moment when the man’s desire is waning you can tell him he is “free to leave” and that you don’t want to be with him unless he wants to be with you. Ironically, if you do that, the men worth keeping may then rediscover their desire. In fact a woman who is wise enough to never let the man feel so sure of her may have a man always desiring her. We call this being coy and it is not game playing, but rather knowing that a man feels better when he is pursuing a prize than when he is being told to do something.
What’s a man to do if he has lost that loving feeling because she “pressured” him to get married?
Realize that she didn’t put a gun to your head.  You’re the one who made the promises that you didn’t intend on keeping or did until you realized that it meant living up to a lot of responsibilities, which may have intimidated you.  Instead of pulling away and emotionally disengaging for  years or even the entirety of your marriage, tell your girl friend/fiance that the fear of not living up to those responsibilities mixed with her excitement about getting married and planning the wedding is very upsetting.  That will hopefully give her the opportunity to say to you, “I understand that and I think we can figure out and meet those responsibilities together. If you don’t want to get married or if you can’t decide until that fear goes away, I don’t think it will.  However I think every couple and every husband to be goes through this, but at least we’re talking about it.”  Just that understanding can cause you to realize why you love and want to marry to her.
I remember years ago a very touching scene when a woman was by the bed of her dying husband after being married for sixty years. In an unforgettable moment she whispered to him, “I’ve been lying to you for over sixty years.”
Half conscious he looked confused and said, “What?” whereupon she said, “Yes, for our entire life together, I’ve been mad about you and sexually crazy about you, but I never told you, because I knew you liked the chase.”
At that point he reached over to her and smiled weakly and said, “That’s one of the things I loved you for.”

How Women Fantasize About Sex

men and women both think about sex, but women go farther

Everyone's happy when the sex is good! But if the sex isn't that great, does that ruin everything? Not if you keep the big picture in mind!Do you think this cartoon is right? Do men judge their own performance more critically than women do, and are women able to enjoy sex, yet still remember what's most important in the relationship, and why she might go for him anyway?
Personally, I hope he's great in bed, and out of bed: a perfect storm.
Here's another Psych Today cartoon about dating you might like. A dog is included.

Are You with the Right Mate?

A Critical Difference

There's a difference between fighting for what you want in your relationship and being in direct control of your partner, demanding that he or she change, says Real.

Firmly stand up for your wants and needs in a relationship. "Most people don't have the skill to speak up for and fight for what they want in a relationship," he observes. "They don't speak up, which preserves the love but builds resentment. Resentment is a choice; living resentfully means living unhappily. Or they speak up—but are not very loving." Or they just complain.

The art to speaking up, he says, is to transform a complaint into a request. Not "I don't like how you're talking to me," but  "Can you please lower your voice so I can hear you better?" If you're trying to get what you want in a relationship, notes Real, it's best to keep it positive and future-focused.