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4/26/2019

Treating prostatitis: Any cause for optimism?

 A boy’s father had to send him to the village to continue his education due to some reasons best known to him probably because he wanted his son to be familiar with their traditions and culture but on the long run, his son fell in love with a girl that almost cost them a fortune. What really happened? , what trespassed between his son and the girl?
Find out in this hilarious and emotional story “agony of chioma”
“all right reserved” this story should not be copied, shared, pirated or transformed in any form without prior permission from the author…..
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Episode 1
I couldn’t believe my ears when my dad said I was going to the village to continue my education, it was unlike my dad.
“Chief!!!! For God sake, why will Jake go to the village to continue his education” my mum exclaimed
“dad why will I go to the village, check it out I have no class in the village” I said firmly
“you all know that I am a titled man, Omeluora one of itolu Kingdom and I really love my tradition and culture. With the kind of lifestyle Jake is living he doesn’t know anything about tradition and culture and I will like him to belong, understand and know his tradition who knows he may end up being a titled man like his father” chief omeluora said as he laughed in an elderly manner
“dad what you are saying is meaningless, I don’t f-----g wanna belong to any tradition” Jake fired
“you must be stupid” chief said angrily
“chief how do you expect him to cope with things There, you know he isn’t used to local and unpleasant environments” my mum said trying to convince Chief
*woman you don’t have anything to worry about, he is staying with my mother, I will get him a driver and all that he needs, with the best school*
“well if you say so, I just hope he copes”
*so I will now be left alone* my younger sister cut in
*not at all my angel, here is lively beside I promise to take you to see him once in two weeks* my dad said
“OK am OK with that” Cindy my younger sister replied as she continued with her phone
I looked at every one in the living room as they all succumbed to my dad’s decision, I hissed and headed for my room.
As soon as I got to my room, I connected my head phone to my iPhone 6 and started playing my favorite song by LHF benzo to cool off my anger….
The next day was a Thursday, I woke up from my soft bed, muttered some prayers that I never forget to do every morning even though am an arrogant person, and headed to the restroom.
I washed my face and brushed my teeth before relaxing on my bed to play music (am a music lover).
I was still listening to my cool music when a knock landed on my door…
“come in” I said removing my head set
“food is ready” Carole our cook informed
“I will be there shortly” I muttered.
I was about living the bed when a call came into my phone oh it was Hannah my one and only girlfriend. Her family and mine are really close
“good morning sunshine”
“good morning Jake, how was your night” an angelic voice asked
“went well and yours?”
“splendid”
“that’s good”
“Jake are you coming to school tomorrow, we were asked to come copy our scheme”
I sighed before answering her
“I don’t think am resuming with you guys”
“Jake are you leaving the school for real”
“yea, my dad wants me to school in the village”
*what village??? Jake stop kidding, this isn’t April 1st” Hannah said laughing loud
“am serious, you can come over today so we would discuss things”
“sure I will by noon”
“bye angel”
“bye love”
The line went off. I left my room straight to the dining
“where the hell is Jake” I over heard my dad..
“am here” I said as I sat on my chair, they were almost done with theirs
“where have you been” my mum asked
“I was busy upstairs sorting something”
“eat your food” my mum said
My dad was fully dressed in his native attire ,an ogbu agu top, a black trouser with a red cap and his beeds, he was ready for work (that’s his normal way of dressing to work or he wears a senator attire)
“Jake I want to inform you that you are living for Enugu tomorrow morning, so you could know your new school and collect your necessary materials to resume school on Monday”
“OK” I said in a low tone “dad by the way what’s the name of this new school”
“when you get there, you will know” he took his briefcase and left the dining
I looked at him but was just silent as many things were running in my mind. Minutes later I was the only one left in the dining as I quickly rushed my tea, bread and sandwich.
FEW HOURS LATER===→♥
“ding dong” the door bell alarmed
I went to check who it was and it was no other person than Hannah
“Hannah!!”
“Jake”
“you look gorgeous”
“thanks dear”
She was putting on a dark blue gown at her knee level with a silver shoe, silver Michael kors Bag and a silver head band and the enchanting perfume she was putting on.
“how is Cindy”
“oh she is not at home, she went out with mum”
“so you are home alone”
“that’s it”
“welcome aunty Hannah, what would you like to take??” labake our maid asked
“oh nothing, am OK”
“are you sure” I asked
“yea”
,” OK let’s go to my room”
____________________
*
“so you are no longer coming to Lambert International School”
“No as a matter of fact things are beyond me, am even living for Enugu tomorrow morning and today will be the last day I will see you till further notice”
“why is your dad doing this??”
“I don’t know”

The room was silent for some minutes as I saw tears rolling down her cheek, I held her wiped off her tears and kissed her on her forehead
What?? Favour” I asked
“Promise me you won’t leave me for any village girl” Hannah said looking into my eyes
“(Smiling) why would I, am I mad. Hannah you are the only girl I love”
“that’s why I love you Jake”
We kept looking at each other, before I knew it we were already kissing, in less than few minutes we were unclad as we made love like never before.
NEXT DAY
Time check ==== 10:43am
I hugged my mum tightly as she was already missing me..
“Jake I miss you so much, I promise to see you soon” she said pecking me
I hugged my sister as tears were forming in her eyes..
“stop crying Cindy, we would see soon”
I bade them good bye as I was already missing home. Sanusi our driver helped me park my luggage into the car while we left for the domestic airport.
Thirty minutes later we arrived the airport after so much questioning from the check desk we finally boarded and about an hour later I was at enugu…
I called my dad and informed him that I was already at Enugu and he said that my unknown cousin is coming to take me. I was still waiting patiently sipping my coke when a call came in
“hello who is this” I asked
“am emeka your cousin am already at the airport, we’re are you??” he asked in a bass voice
I thought I had bass oo but this one pass me
“are you the one coming to take me”
“yes, your dad sent me”
“OK am inside the airport arrival”
“”OK” he said and hanged up
Minutes later I saw a guy, he was not that huge, he was a bit taller than I am and dark in complexion
“are you Jake??” The person asked
“yea Emeka”
“yea.. Wow this is you, I never knew you were this big”
“yea, you are my only cousin I haven’t seen tho my dad told me something about you”
“nice Jake, welcome to Enugu the rocking town”
I was a bit pissed off but I already liked the guy, he was jovial, handsome, good looking and smart he didn’t look like all this village guys,
“thanks” I said looking around the airport
He helped me with some of my luggage as we left the airport, he stopped a cab
“itolu Christ the savior road” emeka said
“the two of you”
“yes”
“3000”
We parked the luggage into the cab and zoomed off
45 minutes later
“this itolu is far oo” I said while he smiled
“it’s just an hour and forty five minutes from here”
“you enjoy long distance journey”
“not really”
“OK.. Are you still in secondary school” I asked him
“yea ss2”
Wow he was in the same class with me I thought
“wow same class”
“yea chief told me”
“did he tell you the name of my school??” I asked furious as he looked at me.
“didn’t he tell you??”
“No not at all”
“we are now in same school, almond school of Science (a-s)
“wow… That’s your school, hope the school is very conducive”
“you will like it, trust me”
“(looking at him) if you say so”
“tomorrow we would go there”
Some minutes after, we arrived at my grandma compound, I could remember it vividly because I stayed here for a Christmas holiday seven years.
We alighted as I brought out all the luggage while Emeka went inside to call grandma..
“neto chukwu, Neto chukwu” my grandmother shouted as she came out to hug me.
I can’t remember when last I was called with that name or use the name, I think junior waec though it’s my native name
“good afternoon grandma” I greeted as I hugged her
“how are you my son”
“am fine mama”
“welcome to your house”
Two girls who looked like maid came and carried my bags inside..
“Jake this is your driver, his name is kimkom he will be in charge of taking you anywhere, he is my guy” emeka said
“that’s good welcome kimkom”
“welcome sir” kimkom said
“remove the sir and call me Jake”
“OK Jake”
“funny guys”
“but how will I have a driver without car??”
“You don’t need to worry the three of us will be going to a near by village to get your car then from there we head to school”
“hmm OK”
“you people should come inside, food is ready” granny said while we all went inside.
Her chef prepared egusi soup with fufu but I opted for eba since that’s what am use to. We had eaten half way when I received an alert of one fifty thousand transfer, I knew it was my dad but I just continued with my food A new report from the Alzheimer’s Association says that as many as 5 million Americans have Alzheimer’s disease or some other form of dementia. Every 67 seconds someone in the United States develops Alzheimer’s disease or dementia. That’s 470,000 Americans this year alone.

Given that these thieves of memory and personality are so common and so feared, should all older Americans be tested for them? In proposed guidelines released yesterday, the U.S. Preventive Services Task Force said “no.” Why not? Even after conducting a thorough review of the evidence, the panel said that there isn’t enough solid evidence to recommend screening, especially since not enough is known about the benefits and the harms.

Screening means testing a seemingly healthy person for signs of a hidden disease, like Alzheimer’s or cancer.

Why is early testing for Alzheimer’s and dementia not recommended when early testing for something like breast cancer is recommended? In part it has to do with treatment. While there are effective treatments for cancer, such as chemotherapy, radiation, and surgery, so far there aren’t any truly effective approaches to stop the forward progress of dementia. While some medications can slow the progress of Alzheimer’s disease, their side effects can be damaging.

“There are certain diseases in which we know that early detection can lead to early intervention, which can stave off worse outcomes, but if you don’t have any kind of disease-modifying therapy at hand, it doesn’t make a whole lot of sense to screen people who don’t have symptoms,” Dr. Aaron Philip Nelson, assistant professor of psychology at Harvard Medical School and author of The Harvard Medical School Guide to Achieving Optimal Memory told me for an article that appears in the April 2014 Harvard Women’s Health Watch.
Testing for dementia

Checking people who have no symptoms of dementia using questionnaires, blood tests, or brain scans has long been controversial. One key sticking point is that tests available today can’t paint an accurate picture of future dementia risk. “There’s no test that can tell you that somebody is definitely going to get Alzheimer’s disease,” says Dr. Deborah Blacker, professor of psychiatry at Harvard Medical School and director of the Gerontology Research Unit at Massachusetts General Hospital.

There is one gene test, but it’s for a rare type of Alzheimer’s disease known as familial early-onset Alzheimer’s disease. It accounts for less than 5% of total cases, and typically starts before middle age. Even getting a brain scan to look for the clumps of protein known as amyloid plaques that are characteristic of Alzheimer’s disease can’t accurately predict a future diagnosis.
When you should be tested

If testing healthy adults every few years isn’t worthwhile, when does it make sense to test for dementia? When someone shows signs of memory loss, difficulty thinking, or other signs of so-called cognitive impairment, say experts. Individuals and their loved ones need to be alert to changes in memory and function. Doctors should also be aware of differences in their patients’ mental abilities. When someone has symptoms, they should get an evaluation, Dr. Blacker says.

Yet memory can naturally start to slip as you get older, and it can sometimes be hard to tell whether lapses are due to normal age-related memory loss or true mental impairment. Here’s a guide to help tell the difference
Read More »

Ease anxiety and stress: Take a (belly) breather

 The situation went over my control, being two different person to two different woman is like being in two different hell. Amaka thought that I was cheating on her, she didn’t wait for an explanation from me before she ran off with tears dripping down her face. By the way, I got nothing to explain to her. Ada on the other hand couldn’t believe her eyes. She tried to stand up, but she slipped and fell. She went faint but I quickly rush her to the hospital.
At the hospital, I sat impatiently on the floor with my heart beating rapidly like a racing horse. Everything I ever loved are now about to be shattered but I still found myself in darkness of what to do.
I summoned on James and he appeared immediately.
” My life is about getting ruin ” I said without looking at him.
” what happened? ” he asked in confusion.
” I can’t narrate anything, just go in my head and see everything yourself ” I said with a little higher voice.
Just as I finished talking, the doctor came out and I advanced towards him with speed.
” doctor how is she?” I asked with a trembling voice.
” Rest your mind she will be fine, we ran some test on her and we found out that she’s pregnant…”
” preg—what? ” I cut in the doctor.
“pregnant, she’s some months pregnant and she needs to be taken care of and also don’t let her stress herself and she shouldn’t be thinking. It’s for the health of the baby. ” the doctor said.
I went back to my sitting position, then rested my back on the wall.
” the doctor said Ada is pregnant, did you slept with her? ” James asked.
“don’t ask me foolish question, if I slept with her won’t you know, or do you think I didn’t know that you are always watching the both of us together. The doctor said that she’s some months pregnant that explains one thing. She’s carrying your baby, didn’t you slept with her when you are still alive? ” I asked trying not to let loose of my anger.
” yes I did ” he replied slowly .
” now if you will excuse me, I need to go and see her ” I said then I made my way through him.
Ada was later discharged in the evening but I got no words to say to her. I drove her to her father house then head back to my residence alone. On getting home, I met James waiting for me in the living room.
” what should we do now? ” he asked after some moment of silence.
” are you using the word ‘we’ ? I’m the only person in this mess no one can see you, no one can hear you and no one can blame you. You got me into the mess I shouldn’t have, and that’s because I helped you. I was having a normal sweet life before you came in into the picture. And everything that is happening to me is because of you James!!! Just go I don’t want to see you ” I muttered out in anger.
” I’m not leaving you until everything is solved ” he said. Just as he finished talking, i heard a knock on the door. I went to open it and Ifeoma came in.
” Ay listen to me, we need to solve this problem together ” he added. But listening to him was the last thing I ever wanted at that moment.
“chioma, what can you do to distract me from hearing someone?” I asked. Then she smiled and she began undressing herself
“no not this way… ”
“This is all I got ” she cut in then she lock her lips with mine. She wasn’t wearing a bra, cos I can feel the softness of her b----t through the tight fitted gown she wore. And just like a professional tailor she removed my d--k then began giving me a blow job which made me forget everything about James. She was so good at it that she made me almost c-m inside her mouth, but I was able to get a hold of myself. I pulled up her gown and her also found out that she’s pantless. No one needs to tell me that she came fully prepared.
I entered in into her p---y without wasting a seconds, her p---y was already wet, so my entering was so smooth. I f----d her with her back facing the wall and her leg, balanced on my shoulders. I went deep into her, I can even feel my d--k touching some end region in her p---y. I was banging her as fast as I could just to clear my head off my worries. But she was screaming as my d--k became unbearable for her to hold. Every seconds, I t----t deep into her p---y then pull out and t----t in again with force and speed without giving her any seconds to catch her breath. I separated her leg widely apart so that my whole d--k can freely enter fully into her p---y without leaving any part of it out. She was screaming as her p---y cream came rushing on my d--k. That didn’t stopped me, insted I kept banging her with every intention of destroying her p---y. It got to some point, she began frighting back with all her strength. At first she tried preventing me from having a deep penetration by using her hand to hold back my waist whenever I’m about to t----t in deeply. I got a hold of her two hands then I lock them up above her head with my left hand. Once again her p---y baceme prone to a deep penetration. After she realized how helpless her p---y was, she began trying to close her laps together. I saw this coming so I immediately lift one of her leg across my shoulder, leaving the other behind, with this, she got nothing but to watch her p---y being fired with a long ebonite rod. She began begging me to stop after an hour of non stop push in push out. But I heard her not. Screaming was not enough, so she began crying. Her p---y was as hot as an oven yet I kept banging her. She was at the edge of fainting when I pulled out and release on her p---y face. She fell like a lifeless being on the floor but I felt like, I haven’t done anything. I was thinking about going into her again when I realized I didn’t touch her boobs. My d--k regain momentum instantly, then I advance towards her spreading her leg apart for another penetration. She had no strength to fight back so I went in easily without hesitation. Just as I buried my d--k into her p---y, I took my time to do Some judgment on her b----t, Which Only serves as a catalyst to my d--k. My d--k grew harder as I suck and bite her random succulent standing boobs. My d--k was called to full action after some time, then I began bleeping her even more than the first time. She fainted after 30 minutes of hard push in and out, but that still didn’t stop me, I woke her back up with my d--k, she woke and found out that I’m still bleeping her. That day was a hell to her. I can’t really remember what happened after.
A lie can go for a thousand years, but one day, the truth will prevail.
Saying the truth was all I have left, but the truth seems crazy to hear, no one will believe me, but I know I have to let them know the real truth about myself.
Ever since then, Amaka haven’t been picking my calls and facing her parents seems like the worst thing to do. I couldn’t show my face in front of Ada again, neither could I go home to face James parents. I was alone in the living world but James was also besides me in the dead world.
” Ayo I’m sorry I dragged you into all this, I think it’s time we let the truth out, let start with Amaka, then we will move to my parents after you’ve settled in with Amaka ” James said.
I nodded then I head to her parent house. I wasn’t welcomed, but after alot of pleas I was being allowed in. I wasn’t allowed to see Amaka, I knew I dissapointed her but telling her the truth was all I needed to. I met with her parents so I began narrating everything to them. Even though they look at me in disbelief.
” papa and mama, I’m sorry. I should have let you know this before now. Believe me, I loved your daughter and I planed going more further with her into marriage, just that some things happened that I can’t really help myself out. I got this gift of sight that I can see what no one can. A ghost that looked exactly the same way I am came to me for help. The person Amaka saw me with was actually his fiancee, not mine. I was only pretending to be him ” I said. But non of my words moved them. Her father later spoke up after a while of silence.
” I’m sorry it’s too late for that, when our daughter came running at us with tears, we both think of what to do, so we sent her abroad, just for her wounds to heal, we got a call from her yesterday saying she met another man who is ready to replace you in her life. I’m sorry to break it to you. She has moved on. And I expect you to do the same. You are still welcome here anytime ” he said. Then he head inside along with his wife leaving me behind in the living room.
I never believed that Amaka has left me for good, I felt like some part of are being removed. I couldn’t eat for days. I knew she deserved better, but she didn’t wait to hear me out. I felt I lost a precious stone inside a big ocean. Getting it back will take more than a miracle.
A week after the heart break, I prepared to meet my greatest fear. But before that, I called nkechi aside and narrated everything to her. It was alot for her to take in, especially when I said I’m not her brother and her brother is dead. At first she didn’t believe me but when she see that I’m telling the truth, she had no choice than to believe me. Facing James parents was the first move then followed by Ada parent.
On the D—day, I dressed up then head to James parent house with James beside me. As I entered into the living room, I met an igbo priest sitting on the floor and making some incantations. I guessed he came for a visiting but it happened his visiting came in my favour. Immediately as I entered, I noticed some slight changes in him as he began to look at me non stop. He sense the presence of a ghost but he wasn’t sure cos he can’t see him. He fetched for a white substance from his sack, then he applied it on his eyes, then James became visible for him to see, he made a loud scream as he saw James standing beside me. He was shocked as he began to look at my face and James face.
“taboo!!!, how can you be dead and be alive at the same time? ” he asked with a shock. I calmed him down, cos he has created a scene that got everybody confused except for nkechi. After everyone is calmed, I stood up to talk
“My name is Ayo and not James, I’m not your son. Your son is dead, he’s right here beside me, the priest can testify to that” I said but, but his parents didn’t believe me. James father later voiced out after a long commotion.
” My son, have you been drinking? Don’t play with death like that, it’s not a good thing to say ”
“father he’s telling the truth, our brother is dead. He just look like him, he’s not our brother… ” nkechi said.
“nonsense!!! Will you all stop this joke!!! ” he muttered angrily.
“I’m afraid it’s no joke my friend. They are telling the truth, cos I can see a dead man here with us that look so much like him ” the priest said.
It was hard for him to believe, but when he did, he fainted and so was his wife. We rushed to them and they were being brought back.
” please tell me my son is not dead ooo, tell me he’s still alive ” that was what his mother was saying as she kept crying. He’s father on the other hand was still trying to control the shock. Chioma was wailing while nkechi kept consoling her mother with tears in her eyes.
It took the family two weeks to finally accept that there son is dead. I had no good news to tell them than to let them know that Ada is carrying their grandchild.
Due to the condition of the child inside Ada, I was told not to let her know the truth till she gave birth to the baby. It was a hard choice for me to do but I played being James till her time was up. She gave birth to a male child and he was welcomed with so much love into the world.
Finally I let her know the truth, it was really a sad moment for her as she almost cry herself to death. She pleaded for me to stay with her, but I cannot live my life being who I’m not. It’s hurt me to leave her, even both the families want me to continue being her husband. But my destiny lies not in another.
Immediately I finished my youth service, I was offered a job in the University I had my service but I declined the offer. My adventure in the east is over, it’s time I go back home.
Home sweet home, nowhere like home. I was able to get a job after 3 months of my arrival back at home. I used my father connection and I passed the test. So that got me a well payed job.
No matter how far we are into the desert, we must surely find a dwelling place when the winds come. No one can outrun the wind.
I’ve been Living a life of adventure all my life, I think it’s time I settle down and live a normal home life.
A year after I got my job, I was able to have a car of my own, but securing a good wife came as a problem to me. I bleeped all the ladies in my working place and beyond. I thought a life of adventure was easy to stop, but I was wrong One year ago today, the detonation of two improvised bombs near the finish line of the Boston Marathon killed three people, injured more than 260 others, and shattered a day traditionally filled with joy and camaraderie. Although the bombing immediately extinguished the celebration, it sparked an outpouring of extraordinary work and compassion that continues to this day.

Residents of Boston, the Commonwealth of Massachusetts, and beyond rallied to help those injured by the bombs. It is a testament to the extraordinary care and preparation by first responders and staff members at all Boston-area hospitals that only three people died.

Many of the wounded were taken to teaching hospitals affiliated with Harvard Medical School: Beth Israel Deaconess Medical Center, Brigham and Women’s Hospital, Massachusetts General Hospital, and Boston Children’s Hospital. Physicians at Mass Eye and Ear helped those suffering from serious blast injuries. During the following weeks and months, clinicians at Spaulding Rehabilitation Hospital and McLean Hospital helped others recover. (Many of these institutions are marking the anniversary with a variety of events.)

“Not one single person transported to our hospitals on the day of the bombings died,” said Dr. Jeffrey Flier, Dean of Harvard Medical School, in open letter to the HMS community. “Hundreds of hospital personnel, including some third-year HMS students who are graduating this year, responded in droves, doing what the medical profession has always been called upon to do—helping and healing, relieving suffering and saving lives. They followed their impulse to serve, to comfort and to heal.”

In an article written for Harvard Medicine News, M.R.F. Buckley describes how staff members at Harvard-affiliated hospitals responded to the bombings.

In his book Code Blue: The Making of an Emergency Physician, Dr. Michael J. VanRooyen, professor of medicine at Harvard Medical School and an emergency department physician at Brigham and Women’s Hospital, wrote about the day of the bombing and its aftermath. You can read his account here.

For a different perspective, John Hockenberry, host of the NPR Radio show The Takeaway, looks at how Boston has recovered from the bombing. He says that a recent report about the emergency response to the explosions at last year’s marathon finish line found that the city of Boston “showed strength, resilience, and even defiance in the wake of the attack.”

One year after this senseless tragedy, the healing continues. Our hearts and prayers go out to those who lost a loved one or who themselves still bear physical and emotional scars from April 15, 2013.
Read More »

Regular exercise changes the brain to improve memory, thinking skills

 The story revolves round Madison and her family, having different destinies, fate and view about life, they rally for personal interests, little did they realise they were only running round a globe.
Segregated by religion, Madison and Hassan were forced to call off their blissful relationship, it was indeed a painful quit, but they had little or no option, both families were against them-a flower can’t flourish in a dam of thorns.
Madison was an american lady whose family resided in Nigeria, hassan on the other hand was the Emir of kano’s first son.
After the painful breakup, Madison together with her family left for their home country where she discovered she was pregnant.
Nine months after which she gave birth to a set of identical twins.
The glass was already shattered! She had to raise her kids alone, without hassan’s knowledge.
She named them Michael and Gabriel, they bore her last name; Robertson.
She eventually found love again! This time, a black american.
Everything happened so fast, the got married.
Her new husband died few years into their union, she was once again left alone to cater for her mulattoes- Michael, Gabriel and Nathan.
MICHAEL ROBERTSON:
AGE: 28
PROFILE:
An american CIA who woke up one morning only to get a burn notice.
An underground crime syndicate operating in Nigeria absorbed him, knowing he was a great asset.
His skills and expertise won him the trust of his boss, love of katarina and jealousy the of a colleague.
Michael fell into a trap, a trap carved out of jealousy, he was killed in a bomb explosion, it was all a set up!
Who was the architect?
GABRIEL ROBERTSON:
AGE: 28
PROFILE:
The most naive of his brothers, a loving, caring and soft hearted fellow whose identity carved a pain in his neck.
Gabriel had the same physiological make up with Michael, even their mother always mistook one for the other.
The syndicate didn’t believe Michael was dead, Gabriel was mistaken for Michael, he had no option but to replace Michael in the syndicate.
His sole mission was to avenge his brother’s death and sell out the syndicate.
He was drowned by love, lust and power, all which he inherited from Michael’s past.
Would he be able to let go of all these and avenge Michael’s death?
Would the murderer be fished out?
NATHAN SHERWOOD:
AGE: 22
PROFILE:
Only he and Michael knew his father was assassinated!
Consumed by grieve, quest for revenge and hurts, he set out to kill everyone involved in his father’s death, he believe his step brother was murdered for a significant reason.
He later found out Gabriel was working for the same syndicate that murdered his dad
Geez! He was working with the police, would he watch the only brother he had left go to jail?

HASSAN AZZEEZ:
AGE: 52
PROFILE:
He found himself climbing up the political pinnacle, he found success at the polls, he was sworn in as the president of the republic, his people loved him, but he had enemies within!
In order to clear their coast, they planned to assassinate him.
i
t was a stormy and thundrous afternoon in the city of Kano.
The cloud was pitch black, threatening to cry. The sun found canopy under the thick cloud, warm but heavy wind blew from the south, tossing away any material that dare stand in its way.
Ranty sounds of thunder permeated the magnificiently designed room, Hassan’s heart beats weren’t helping matters, they seem to be in rythme with the thunder.
Each pump of blood pervaded fear within his being. He swallowed hard for the umpteenth time, boils of sweat tickled down his skin, defying the cold atmosphere.
Hassan paced around like someone whose wife is experiencing her maiden labour.
Its high time he let his father know about his decision to renounce islam- a religion his ancestors had practiced so faithfully.
Yes he knew it won’t be easy but the squeaky wheel gets the grease.
He stuck his legs into his slipper, took in a big gulp of air and reached for the door knob.
He turned it slowly and walked out to the hallway, heading to his father, to meet his fate.
Hassan Abdul-Azeez was first born son of the prominent Abdul-Azeez Usaini xvi the 21st century emir of kano.
The emir so much loved his son that he didn’t want anything to separate them, he had Hassan pass through western education here in Nigeria so he could teach him all there is to know about royalty, his plans was for Hassan to succeed him!
He didn’t want royalty transfered to another family.
Hassan opened the palace door with shaky hands and trembling feet. He had never felt like this before! He spent all his life in the modern palace, why was he having this strange feeling now?
His facial expression script it all, he was greatly worried.
His dad sat on the high and mighty throne with two body guards standing by his right and left respectively.
Four chiefs occupied the chairs below the throne.
The palace was well furnished, it looked nothing less of a modern palace, most of its decos were imported.
“sannun ku” he greeted breathlessly, with his head slightly bowed in respect.
“salama alaikum” the chiefs chorused, meaning “peace be unto you”
Hassan sat on one of the chairs by his right.
The Emir knew the kind of son he had in Hassan, hassan was a core introvert, he wouldn’t show in the palace by this time of the day if he had nothing important to discuss.
“is anything troubling the prince? The emir asked on noticing Hassan’s countenance.
“i request to speak with my dad….alone” came the reply from hassan.
The Emir motioned the brown horse tail he was holding.
Action speaks louder than voice, the guards and chiefs deserted the palace as commanded.
Hassan stared blankly at his dad, he was battling how best to present this to his father.
He sighed. ” father, i want to make an important request”
“go ahead son, you know i’ll do anything and everything for you” replied the king who was oblivious of his son’s request.
Hassan threw his father another quick glance; beyond the royal attaire, he saw a man who had a blazing passion for Islam and wishes all his family members to follow in is footprints.
For a moment, Hassan thought of aborting his plans, he thought against it when he remembered the promise he made to Madison.
No! He can’t afford to loss her…..
“father,,, i….i uhm…..i wish to convert to christianity” he found himself stammering.
At the drop of a hat, the tender smile Emir Abdul was wearing drifted to a heart crushing frown.
Hassan could swear he saw real fire replacing his father’s pupils.
“what did you just say?
The emir got up angrily.
Hassan’s heart skipped, he also got up. “calm down dad…..i…”
“shut up” the Emir shouted, and got into a session of loud coughs.
His heart ached badly, Hassan wished he could swallow back his words, too late to cry when the trigger is pulled.
The Emir fell to the floor helplessly, he had been managing cardiovascular attacks for the past few month now.
Hassan grew red with regret.
“Aminu!”
he screamed, a guard ran in almost immediatley.Two reports released this week shed light on the current state of type 2 diabetes in this country, and their conclusions are both promising and sobering. First, the good news: An article in The New England Journal of Medicine shows that rates of diabetes-related problems like heart attack, stroke, and lower-limb amputation are down by more than 50% over the last two decades.

Now the bad news: during the same time period, the number of people with diabetes has soared, according to a report in the Annals of Internal Medicine. In the early 1990s, 5.5% of adults had diabetes. By 2010, the number had nearly doubled, to 9.3%. That translates into about 21 million American adults living with diabetes.

Although Americans are doing a better job of controlling their diabetes, they’re falling far short at preventing it. “The major reason why the prevalence of diabetes is going up is an increase in the number of people who are overweight and obese,” explains Dr. Osama Hamdy, medical director of the Obesity Clinical Program at the Harvard-affiliated Joslin Diabetes Center and author of The Diabetes Breakthrough, a newly published book from Harvard Health Publishing.

Nearly 70% of Americans are overweight or obese. And unless something is done to reverse this trend, millions more could edge closer to diabetes.
The obesity–diabetes connection

To describe how being overweight contributes to type 2 diabetes, Dr. Hamdy uses an automotive analogy. “You have more tissue in your body, so you require more glucose [sugar]. Just as if you have a bigger car, you need more gas,” he says. Insulin—the hormone that moves glucose from the blood into the tissues for use and storage—is like the key to that car.

The more sugar that enters the blood, the more insulin is needed to drive it to its intended destination. The pancreas can pump out extra insulin to meet the need, but over time, the body becomes increasingly less sensitive to it and the pancreas eventually reaches its insulin-producing limit. “Then you get diagnosed with type 2 diabetes,” Dr. Hamdy says.

The upside is that the process can be reversed. When you lose weight, you have less tissue, which means you need less sugar—and therefore less insulin. “You become more efficient, like a hybrid car,” says Dr. Hamdy.

In his own research, he’s found that losing just 7% of your body weight can improve insulin sensitivity by about 57%—more than diabetes drugs can usually do. “What we have seen is that once people start to lose weight in the very early stages of diabetes, they can actually reverse the entire course of the disease,” Dr. Hamdy says.
Minor changes, big results

The ability to reverse diabetes might seem dramatic, but the lifestyle changes needed to achieve it aren’t. The cornerstones of diabetes prevention—diet and exercise—can be easily incorporated into even the most hectic schedule.

Take exercise, for example. “Most people don’t know that if you do short bouts of exercise it is even more efficient than if you do longer bouts,” says Dr. Hamdy. People who can’t carve out time to get to the gym could actually see greater results just by incorporating three 10-minute exercise sessions into their everyday routine.

Here’s a sample schedule:

    In the morning when you wake up, stretch for 10 minutes.
    After you eat lunch, take a brisk 10-minute walk.
    After dinner, strength train with light hand weights or an exercise band for 10 minutes.

Those three 10-minute sessions provide stretching, aerobics, and strength training—all essential components of a well-rounded workout. And if you do them every day, they add up to 210 minutes of activity a week.

An unhealthy diet can also be transformed with a couple of basic fixes. One is to divide your plate into three sections:

    Fill one with lean protein—fish, legumes, beans, tofu, or skinless chicken
    Fill another with green vegetables—spinach, broccoli, kale, or Brussels sprouts
    Fill the third with whole grains—whole-wheat bread, brown rice, quinoa, etc.

The other part of the diet fix is learning how to listen to hunger and satisfaction cues to control portion sizes. Dr. Hamdy recommends assessing your hunger based on a five-point scale:

    Starving
    Hungry
    Ok—satisfied
    Full
    Stuffed

The goal should be to sit down to a meal when you’re hungry, and stop eating when you’re satisfied.

Preventing diabetes can be done, but it takes a real commitment to change. And until more people are willing to change their eating and exercise habits—and pass those habits on to their children—the obesity and diabetes rates will continue to rise.
Read More »

4/25/2019

New drugs offer easier, more effective hepatitis C treatment

 What hurts us is what heals us
And so I wait. I wait for time to heal the pain and raise me to me feet once again, so that I can start a new path, my own path, the one that will make me whole again.
Even though I never care about yemi, but she always did silently. I thought she was a bad person, but she got a good heart I never for once imagined . I wouldn’t believe she will die protecting me.
For days I wept for her, she died in my arms after confessing sincerely from her heart to me. She made me realize love is worth fighting and also dying for.
I attended her funeral, to pay my last respect and I was surprised by the numbers of student that showed up. Even Janet was there with Elizabeth and the rest.
Janet approached me immediately she set her eye on mine.
” I’m sorry about her death, I never knew she love you ” she said.
I looked away, trying to hold back my tears.
” I got to know after she’s dead, excuse me please ” I said then I quickly move away from her.
I saw Johnson sitting on one of the tombs so I mentioned him closer.
” may her soul be in peace ” he said immediately he got to me.
” Amen, How do I battle with the death from the past ?” I asked pointedly.
” I promised to help you , but it’s seems my time as a ghost is over, My body has been found and I only got few hours before I will be drop down in the ground .” he said slowly.
“so what now? ” I asked sadly.
“I will tell you all I know, and all you got to do” he replied sharply.
” when I was still Wandering about as a ghost, I saw you talking to a tree spirit, I listened to your conversation and I heard him telling you about the death from the past, he didn’t tell you everything you need to know, but he only gave you a warning. After you are long gone, I approached the spirit in his abode, and he told me this.
Long before you were born, your ancestors from the mother’s side was born with the gift of sight. But only the female child have this gift. It is a taboo for a male child to be born with this gift. Your great grand mother had a male child with this gift. And the child was killed because the child was a taboo and an abomination. Ever since then, there has been only a female child in the family, and one out of ten or twenty have this gift. Your mother happened to be born with this gift… Unfortunately she gave birth to a male child which is you and you have the gift. She knew the risk involve, so she ran away with you. You are born with a death destiny and your mother wouldn’t want that to happen to you. Knowing fully well the pain she went through before giving birth to you.
Your father and her took you to many places just to destroy the gift. They were successful at some point but the gift can never be suppress, it’s returned after you clocked 20, now that you have the full sight, the agent of death will surely find you.
You have three moons left to Change the death destiny.
Firstly you need to know that it’s impossible to fight away death, it will surely come one day. But you can send away the commissioned one.
It’s a dangerous path, but you have to risk it, you might die in process or you can wait till death come, so make a choice. ” he said.
I took a deep breath before replying him, even though I’ve survived alot of things. I still want to live life the fullest.
” proceed ” I muttered confidently.
” travel far through the sea, till you reach the world of the mermaids, I must warn you, you have zero chance of returning. If they welcome you, make peace with them and seek for a mermaid tears…”
“wait… wait.. wait… My mission to the mermaids world is just to get their tears? ” I cut in rapidly.
” yes, it’s the tears you need” he replied.
” then I will have to do it my own way, anything more? ” I asked.
“after you’ve gotten the tears. You will need the company of a great hunter to get you mojala. Mojala is a female dear with the ability to transform into human being. At the sight of the mermaid tears, she will transform into a human. She will give you a pot of the forest water which you will take to the grave of the first male child with the same gift as yours. Place both the mermaid tears and the forest water at his grave, he will appear to you with fury, cos his death came with a great pain. He will attempt to kill you, but make sure he doesn’t. Offer him the tears and the water and his soul will vanish forever. Cos his spirit is the death hurting you around. When he’s gone, the war is over. ” he said then he disappeared before I could say a word.
” thank you ” I muttered slowly into the air.
******* ********* ********* ******** ****** *******
Back in school, When Ayokemi saw me, she flew at me as if it’s been decades since we’ve seen.
Publicly, she gave me a kiss and not minding what the students passing by might be thinking. I’m grateful joy wasn’t around.
She threw different questions at me which I couldn’t answer all. She later dragged me into her car and drove me to her residence.
She prepared pounded yam with egusi soup mixed with different encouragement that could make someone go mad salivating.
After we are done eating, we began talking and I narrated some part of my few adventures to her. I knew what her next move will be, So I made myself ready for any sexual move.
I will say the move came faster than I thought, she threw herself on me flooring me with her boobs along side with an uncontrollable kiss, a kiss I tried keeping up with, but I couldn’t. It was fast and rough. No one need to tell me how hungry she is to eat me up.
She dipped her hand into my trouser and she began robbing her hand to and fro On my yet erected d--k. Well, no dude can stand that, it arose in seconds.
I guessed she transferred the spirit into me, as I hurriedly torn apart her top. unhooking her bra will take a while, so I just drag the bra up and access her full b----t. I grabbed on the B----t, the bigger one. Woman b----t are always not the same. So I head for the bigger One which I know to be Very sensitive, I brought my head down and began sucking on the pair of b----t.
She was losing it as she began to say different sort of things. Suddenly she pushed me away and rushed forward to my prisioned d--k, I watched kneeling as she expertly handled my d--k like a car gear. I guessed she drag in at gear five cos she hurriedly entwine my d--k in her mouth. She gave me a long lasting blow job which made me almost cumming in her mouth, but thanks to the experience control, I didn’t. I balanced her in a missionary position then set her p---y on a locomotive fire. She appreciated in return by giving me a loud sexy soundtracks, meaning I’m doing a great job.
I bleep her this way for several minutes before proceeding to another f-----g level. She took charge of the situation and gave me a new f-----g style which I’ve never had before, But I do see it in a Crazy p--n video.
She walked briksy to the door, positioning her leg straightly on the door handle with her p---y widen for any kind of penetration. I felt a little more hardness on my d--k as I attack hungrily from behind. I t----t in deeply into her honey pot, not minding whether it’s hurt or not, I care less anyway, all I know is that, it goes a long way in. Cumming at this moment is an understatement, I wondered where went my c-m as I continue to bang her non stop for hours. Sometimes I love to see the champion begging. When she discovered my f-----g goals and potential. She began begging for an end, which I failed to approve, instead I positioned her for the unbeaten doggy style and entered in from behind. I guessed she didn’t see that coming. Her soundtrack began changing to yelling, a pleasurable yelling I will say. My d--k can withstand the yelling but my ears can’t. I wouldn’t want to go deaf just on f-----g a p---y, so I summoned out my c-m before she transform me to a deaf man. We both lie tiredly on the bed trying to catch our breath.
” you are a hell of a bull” she whispered.
” I will take that as a compliment ” I replied giving her a kiss.
I helped her to the bathroom and we both shower together. When night falls we hang out to a popular club house before heading back to her place to have a respectable night.
At 12 mid night, I found myself in an unknown wild Forest, in all directions came different voices and they were all echoing one word, which is death. I felt a tap on my hand which brought me back to reality, it’s a dream.
I woke up terrified, every used minute draws me closer to my death. I couldn’t sleep the whole night, my thoughts were on how to overcome the death from the past. Going to the mermaids world seems like a suicide mission to me, let alone have their tears. Doing this period an idea truck me. Perhaps I could get a help from joy, she belongs to the white witchcraft and might know a way I can get a mermaid tears.
When dawn arrived, I made myself ready then head to joy place. She demanded for a sex which I couldn’t resist, so I let her have it. After we are done, then I moved to my priority.
” do you know anything about mermaids? ” I asked.
” little I will say” she replied back with a gesture.
” you know how to get their tears? ” I threw back again.
“hell no, you can only get that from a mermaid itself, why are you suddenly asking about mermaids? ” she asked curiously.
I wanted to ignore the question, but I felt the need for her know the highlight, I wouldn’t get any help if I keep it all to myself, so I quickly summarise some part of the story to her.
” I don’t know how you can get a mermaid tears, but I know where you can find a mermaid without going to their world, On every market day, some creatures will leave their abode and transform into human and set to the market to buy things they need, part of this creatures are the mermaids. Tomorrow is another market day, an opportunity for you to see one, you can hide at the sea and wait for one to come out. ” she said.
I took a deep breath before saying my fear.
” the mermaids are they scary creatures? are they evil? ” I asked slowly. She took her eyes away not knowing how to reply me back.
” I don’t know, but don’t tag them friendly ” she let out. I thanked her and we both gisted till noon before I head back to my place.
I got home and I found Janet waiting for me at my door way.
” hi janet, you didn’t inform me that you are coming ” I said surprisedly.
” I tried your line, it’s off. So I decide to wait ” she said with a smile. I checked my phone and I found out that it’s off.
” I’m sorry Janet I didn’t know that it’s off, probably the battery is down. You shouldn’t be waiting here alone for a big head like me ” I said with gentleness.
” big head that is worth waiting for, are you going to open the door or keep on talking right there? ” she said with a wink. I quickly open the door and let her in before she throw another one .
“what should I offer you?” I asked when she’s relaxed. She stood up, head to the kitchen and survey my food stuffs, then she returned back to me with a grin on.
” I want you to cook for me” she said. At first I thought I heard the wrong thing, I didn’t know when I began laughing uncontrollably.
” I’m a horrible Cook” I said still laughing.
” that’s why you need someone like me to help you with the thing you are bad at” she said then she walk into the kitchen. I sense some things but I remain quiet. She prepared fried rice with chicken and we both ate in the same dish. The food was delicious that I wish to eat more but I couldn’t, I was trying not to be a glutton before her. So I planned to devour the remaining rice in the pot once she exit, but unfortunately Ben, mayor and ope arrived. Without even asking the three of them head into the kitchen and finish up the remaining fried rice. I felt like tearing them apart, but there’s nothing I could do in front of Janet, so I waited till she leaves before descending hell on the three of them.
Dawn arrived sooner than I expected, I remembered my conversation with joy, so I made myself ready and head to one of the biggest Ocean in town. I sat quietly by the Ocean for hours observing and watching the ocean currents, with the hope of seeing a mermaid coming out of the water. This went on for several hours, but to my greatest dismay, I didn’t even see a glimpse of fish let alone a mermaid. When I’m tired waiting, I retired and head back home.
The following day, I changed location and head to a popular river, but I found a mermaid not. This go on for weeks, but not a single mermaid came in contact. I was losing hope, I even thought of reconsidering the option of going deep into the mermaids world. I was sitting by the river one evening when I felt a tap on my shoulder. I looked back but only to see a very beautiful lady standing behind me. Her beauty are of no match to all the ladies I’ve ever see in my life. I felt lost in her beauty, as I began to stare into her eyes speechlessly. And for the first time in my life, I felt shy in front of a lady. I was dumb, I don’t even know how to start the conversation. She kept staring back at me with a lustful eyes that could drive a man totally crazy.
” Are you here for a sea watching or you are here to fish? ” she let out after the prolonged eye silence. I quickly think of an answer to give her. I can’t tell her my mission but somehow I found myself saying the truth.
” I’m just sitting hoping I will see a mermaid coming out of the water ” It was out before I realized what I said.
“really? So you believe they are real? ” she asked curiously.
” not until I see one, I only hear stories about them, anyway I’m Ayo ” I said with a smile
” I’m Erica, it’s nice meeting you ”
“the pleasure is mine ” I replied.
She took a sitting position beside me and she began staring at the ocean, and at every fast wave, she will smile ”
” I guess you are here for a picnic or something? ” I asked after I realized how lost she was with the ocean.
” tell me what you know about mermaids ” she asked.
” I don’t know much, just that they are beautiful and charming, I also heard that they are dangerous, perhaps they don’t like we humans ” I said with a shoulder gesture.
She stared at me for a while before taking her focus swiftly back.
” so what do you know about mermaids? ” I asked with a charming smile. But I got it ignored.( silent AGBELE)
I noticed some slight changes in her mood, all her beautiful smile are gone. She now focus her eye at the ocean with rage.
” you seems not comfortable with me ” I said assertively. She turned her eye at me and began staring directly into my eye as if she is reading something in my eye.
” if mermaids are dangerous as you said you should be dead by now ” she said calmly. I felt an electricity of fear running through my veins, I quickly look around and I found out that the shore is empty.
” you see down deep there ” she said pointing her finger at the ocean. I responded by a fear node.
” that’s where my home is” she said.
“you are a mermaid? ” I asked curiously.
“yes, but you won’t live to tell anyone ” she said and all of a sudden I saw her fingers growing long and sharp.
” I should have see this coming, how on hell did I not know… ”
“because you are a human ” she let out interrupting my speech.
” I’m not just not an ordinary human, I have the gift of sight, I see things, I should have see who you are when I set my eye on you ” I said with a shrinking fear. She let out a smile then she returned her fingers back in.
” I casted a spell on you, it a strong spell that blinds human, now I know why you can still see, perhaps I should pluck out your eye for dinner?” She yelled out. Her words sent a cold shiver through my veins, I could have try my luck challenging her but I knew the situation can’t be solve with violence, so I go calm and speak softly to her.
“What do you want from me ” I asked slowly. She turned her head and look at me with a lust glance.
“you are worthless to me, I should just take your life right now ” she said trowing her eyes sorrowfully away. I sense some pain in her words, I moved closer to her then hug my hand around her neck. She was surprised by my reaction as she looked puzzled.
” you ain’t scared of me are you? ” she said slowly.
“No, I’ve seen more creatures that you could ever imagine and also, not all mermaids are dangerous ” I let out slowly.
” you are just a mortal, you know nothing about supernatural world, let alone a mermaid ” she retorted. I took a deep breath and walk some steps away from her.
” I know more than I’m saying ” I said convincedly.
” I need help, I’m struck outside, I can’t go back to my world. I lost my power to an evil being, I can’t breathe underwater ,I don’t have the entry password, am lost ” she said sorrowfully . I move closer to her then pet her shoulder softly.
” how can I help you? ” I said warmly to her.
“I need the password, the longer I stay on ground the closer am I to death, please I need the password ” she said pleadingly.
” I don’t quite get it, how is the password like, is it an agglomeration of digit or patterns… ”
“it’s a diamond shell, it worth billions to you mortals of the world, but it a life to we the mermaids. I can repay you with riches if you help me get it” she cut in.
” coincidentally, we happens to have the same faith… I don’t want your riches, I want something else ” I muttered. She looked surprised as she began to wonder what I may possibly want from her.
” No mortal could refuse such a great offer of richness, what else could you desire? ” she let out loudly.
” what’s good in riches without a life, my days are numbered,very soon I will be no more, except if I get a mermaid tears, and that’s the reason why I’m here. If you promise to give me your tears, I promise to get you the life shell back. Do we have a deal or not? ” I said swiftly. It took her some minutes before nodding in agreement to my proposal.
“so where can I find the diamond shell” I asked. She dipped her hand inside her gown pocket and drew out a leather map which contains so many places and location , down in the map is a shiny spot, I wonder what the shiny spot is about, so I helped myself with a question.
“What’s that shiny Spot about? ” I asked with perplexity.
” that’s where the shell is, whenever the shell is moved, the location will change ” She replied.
” very well then, let me go get the shell for you ” I said then I made to move.
“wait, I forgot to tell you something, it’s not as easy as you think. It’s a dangerous path you might not return…”
” I’ve always been in paths full of dangers all my life, but I always survive, that’s one thing I know ” I said then I move away from her.
When I was some kilometers away from the beach, something changed in the map. I sat down and began studying the map, for hours I was there calculating directions and bearing. Then a mysterious thing began to happen, whenever I look at some certain place in the map, the region will be clear off away from the map, this continues till there’s nothing left in the map, the map was null and there’s nothing left in there. I became confused as I turned to search for Erica, but I found her standing right behind me. I wonder how long she’s been standing behind me.
” are you following me? ” I threw directly at her.
“No.. Yes… No.. Yes… I…I… have… No…where to go”
She said with her head facing down.
“thank God you are here, the map is empty? ” I let out loudly.
“really? ” she rushed towards me and snatch the map away from me. She look at it for minutes but she didn’t see anything.
“How possible!” she muttered to herself.
She looks back and she began staring at me, I wonder what she’s looking at as I began to move back slowly.
” you have the map in your head, all the map has been transferred to your head” she said slowly.
“what ?” I retorted.
” yes, I don’t know how you did it, but all the map is in your head. You have a world compass in your head ” she said with a glimpse of joy.
” what do you mean, my head is completely empty right now. There’s nothing in there ” I said rather jokingly.
” close your eyes, and imagine that you are lost ” she said.
“No, I’m not doing that. That’s madness, how can I imagine that I’m lost in an area I know fully well. ” I replied.
” just do it big head!!! ” she let out angrily.
” ok..ok ” I said then I closed my eyes, I imagined that I’m in a lost place then I opened back the eyes. I didn’t know when I exclaimed the word wow.
“Erica are you seeing this, or am I the only one seeing it” I said with excitement.
” I’m not seeing anything, what are you seeing? ” she asked.
” more than I could possibly say, I see navigations, short cuts, possibly route I never knew it’s existed, and there’s something showing me a direction, this is awesome!!! ” I shouted with an unspoken joy. I was expecting Erica to be happy as well, but her appearance seams troubled.
” don’t be too happy, I have a good news and a bad news for you ” she let out slowly. That got me perplexed as I wonder what the news Could possibly be.
“news?let me hear the bad one first” I said with a glimpse of fear.
” you are now a wanted being by all creatures in this world, either good or evil, but evil mostly ”
“and the good news? ” I cut in her speech.
” you are the only one that know the where about of the shell, which makes you a priority to me” she muttered.
” non of them are good, you just added to my life problem!!!” I yelled out angrily.
” Yea, it seems so, but we made a deal and there’s no going back” she echoed pointedly. I felt loose like an orphan, with a little hope of survival.
” I’m homeless, can you please take me in,you are all I got” she said with a pitifully voice. I wanted to decline her request but her reaction melted my heart.
“follow me” I said and she obliged happily. I was sure be ready to answer all various questions from my neighbors and friends, even with the fact that she’s a beauty.
When we got home, I prepared some noodles for her Which she ate hungrily like an ape.
“so what happens if you couldn’t get back the diamond shell within the time limit? ” I asked immediately she finished eating.
” I Will lose everything, I will be completely human ” she said drastically.
“I thought you said you will die” I rumbled.
“I will be if I’m human ” she retorted.
” it’s better we go search for it by tomorrow morning ” I said,then I helped myself with a rough sleep on the rug.
I woke up the following day at 7 am in the morning, Erica was still lost in a snoring sleep, I wonder if that’s how the mermaids sleep. I woke her up with a tap, but I was surprised when she anomalously burst into a Chuckling.
” Do you know you snore alot” she said immediately my eyes met hers.
“No, you are the one snoring!” I retorted.
“says who? I was mimicking you. That’s how you were the whole night ” She rumbled back.
“Sweet Jesus!! have you been keeping tab on me? ” are yelled loudly.
” No! You humans are found of raping, I was scared you might want to, so I stayed awake all night. ” she said with an increased high voice . Her words cooled down my nerves, I guessed she have a trust issue with some humans she has encountered it.
” OK I understand you, I’m sorry. I’m not that kind of human, so can we go look for the shell.? I said calmly, and she nodded with a smile. We had a snacks for breakfast then we head out.
I activated the mind map, then I began following the direction being shown in my head. After walking for an hour I was stopped all of a sudden by Erica.
“Do you see where you are going into!!!? ” she screamed out loudly.
” I think it’s time you open your eyes and see the real world and not just a mental map!!! ” She added more aggressively.
“where are we? ” I asked with a little confusion.
“at the entrance of a forbidden forest, no one go in there and come out ” She said with some hand demonstration.
I take a quick survey of the forest, I can see evil aroma moving dangerously in the air. Saying I wasn’t scared will be an understatement.
” so what do you suggest we do? ” I asked trying to hide my fear.
“I suggest we turn back and leave!! ” she retorted. I agreed to her suggestion then we both turn to leave. All of a sudden, I heard a distant voice calling my name. We both stopped on our track and face each other surprisely.
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3/11/2019

Low levels of HDL (the “good” cholesterol) appear connected to many health risks, not just heart disease

Burning more calories each day than you consume may have been the diet advice from the past, but that doesn’t work for everyone.  Instead, the focus should be on eating whole foods and avoiding processed carbohydrates — like crackers, cookies, or white bread. A recent review in JAMA Internal Medicine further casts a light on the shaky history of nutritional science. Before the 1980s, regulations did not require researchers and physicians to declare conflicts of interest before publishing a paper. By not announcing affiliation, research had the potential to be swayed by money and funding. That’s why it had to change.
Are fat and cholesterol the dietary “bad guys”?

A study funded by the Sugar Research Foundation (SRF) from the 1960s found that cholesterol and fat were the main contributors to weight gain and responsible for an increased risk for coronary heart disease. These results kick-started the country’s decades-long consumption of added sugar. With fat removed, food lost taste and appeal, so manufacturers added sugar to combat this. The country’s intake of sugar and processed carbohydrates went up, while our intake of fat went down. Dr. David Ludwig, a professor in the Department of Nutrition at the Harvard T.H. Chan School of Public Health, says “Overall, these processed carbohydrates are worse than the fats they replaced.”

The JAMA review from September found that the doctors involved with the study were in fact paid by the SRF. Their research was tainted due to conflict of interest. The SRF — and thus the doctors paid by the SRF — directly benefited from the results of this 1960s study, and they profited tremendously from the uptick in sugar sales, while consumers made health decisions on the basis of questionable information.
The scoop on carbohydrates

It is true that fat has more calories than carbohydrates, including sugar. But by that logic, a sugary beverage is better for you than a handful of nuts. That’s just not what the unbiased studies have shown. Looking only at calories ignores the metabolic effects of each calorie; the source of the calorie changes how you digest it and how you retrieve energy from it.

Carbohydrates have been categorized as simple or complex in the past. Dr. Ludwig says these classifications are misleading. Many doctors are pulling away from those narrow categories and moving toward the all-encompassing terms of high glycemic index and low glycemic index. An apple is a simple carbohydrate because it is digested quickly by the body, but fruit is better for you than other simple carbohydrates like chips or crackers. That’s why Dr. Ludwig views the glycemic index as a more accurate measure of a food’s value (good or bad). When something has a low glycemic index, it raises your blood sugar levels slowly, increasing your insulin levels gradually.

That’s good, because too many insulin spikes result in insulin resistance, where your body stops responding to insulin it is producing (also known as type 2 diabetes). High-glycemic foods, on the other hand, cause blood sugar levels and thus insulin to rise quickly, prompting the overproduction of insulin and fat storage. Ludwig would rather you focus on low-glycemic foods like whole-grain pasta, wheat bread, fruits, beans, and nuts. High-glycemic foods include candy, croissants, and scones. By choosing the low-glycemic foods and thus the minimally processed foods, people can lose more weight, feel fuller longer, and remain healthier.
Can you make peace with fat?

Today you can look at food differently. Counting calories alone doesn’t work because ultimately it matters where those calories come from; this matters more than the number of calories ingested. Dr. Ludwig says, “It was this calorie-focus that got us into trouble with the low-fat diet in the first place.”

So don’t be afraid to go back to fat. Just make sure it’s the healthy fats like avocado, olive oil, and nuts. Don’t cut out the fat, and don’t make a habit of eating products labeled “fat free.” It’s a relatively recent development. Whether at work, working out, watching a movie, or just about anything else, it’s as if there’s been an epidemic of dehydration that can only be warded off by constant access to water. It seems strange to me; almost no one did this a decade or two ago. Were people in the past less healthy or did they feel less well because they drank when they were thirsty or with meals, rather than throughout the day?
Water is important

Clearly, water is a necessity. Without it, a person can only survive a few days. Water serves a number of vital functions, including:

    keeping organs and tissues healthy (since every cell requires water)
    helping deliver oxygen and nutrients throughout the body
    “flushing” the kidneys and bladder which help keep them healthy
    maintaining a healthy digestion
    keeping the blood pressure and heart rate in an ideal range
    helping keep body temperature normal.

Given that the human body relies so heavily on water, it should not be surprising that our bodies have evolved to conserve and regulate it. We have intricate systems that connect the brain, the kidneys, and other parts of the body to keep our fluid status as close to ideal as possible.

For example, when fluid levels are low, the hypothalamus (in the center of the brain) sends out a signal to the nearby pituitary gland telling it to release a hormone (called ADH) that will make the kidneys hold on to water and produce more concentrated (and darker) urine. Meanwhile, the brain’s thirst center is activated and that leads people to head for the faucet. The opposite occurs when fluid levels swing toward “too much” — less ADH is released and the kidney sends more water to the bladder to be urinated away. In most people, these systems perform well to keep things running smoothly.
When things go awry

When you go for a jog on a hot, humid day or when you’re sick with a fever or diarrhea, you can lose a lot of fluid in a short time without realizing it. Young children (who cannot ask for water) or the elderly (whose kidneys and thirst centers may not function normally) may be particularly susceptible to dehydration. These are situations in which paying particular attention to water intake makes a lot of sense.
So why all the water bottles?

Outside of situations in which water levels could get dangerously out of whack, it’s usually enough to rely on thirst and a normal diet to keep your water levels where they should be.

For many, sipping water all day becomes more about habit than physiology or health. Some people try to drink a lot because they’ve been told it “dilutes out toxins” or will help them lose weight. Others monitor the color of their urine and drink enough water to keep it lighter in color.  Whether this much attention to water intake is really necessary or helpful is uncertain.
Water in the news

Research regarding how we ingest water has shed new light on the health impact of how we hydrate. For example:

    Studies have linked cola consumption with low bone density (a precursor of osteoporosis).
    Colas are highly acidic and may contribute to erosion of tooth enamel.
    Tap water (with or without home carbonation) contains fluoride that bottled water does not. That’s important because fluoride has a big impact on the prevention of cavities and is considered vital in maintaining oral health; most bottled water doesn’t contain fluoride.
    A recent study found support for the idea that drinking more water may help you maintain a healthy weight: among more than 18,000 people surveyed those who drank more plain water tended to consume significantly fewer calories.

It’s worth mentioning that there is such a thing as too much water. “Water poisoning” is not common but can be a serious problem for people with psychiatric disease, those taking certain medications or who have abnormally high levels of ADH, or others who intentionally drink excessive amounts of water. The danger comes from a low sodium level in the blood and brain swelling which may develop when the body has too much water.
What about club soda and tonic water?

Club soda and tonic water deserve special mention. Club soda has added minerals (such as sodium or potassium) for flavor; for some, the added sodium might contribute to higher blood pressure and fluid retention. Tonic water contains quinine, which gives it a slightly bitter taste (that seems to go well with gin); it contains about 120 calories per serving. The quinine can be a problem for people with heart rhythm disorders (although quinine has also been touted as a treatment for muscle cramps).
And is it true we should all drink at least eight glasses of water each day?

No one is sure where the recommendation to drink eight glasses of water per day comes from. The most plausible explanation I’ve heard is that it comes from the military. Because a day’s worth of water is heavy and difficult for a soldier to carry around, it was important to know just how much is needed; the estimate was approximately eight glasses of water/day. But keep in mind this estimate applied to active soldiers carrying heavy packs; and it included water contained in food (which can be a big contributor; carrots and broccoli are nearly 90% water).  So, the average person can drink far less than eight glasses of water per day without a problem.
And in conclusion…

Carrying water around 24 hours a day is almost certainly unnecessary. Most of us will get plenty of water if we drink when thirsty and consider the water in our foods toward the daily fluid intake. If you like to drink small amounts of water throughout the day, it’s unlikely to cause harm. But it may be a waste of money and effort; and a predictable side effect is frequent urination. After all, if you drink more than you need, your kidneys will do exactly what they’re supposed to do: get rid of the excess fluid.

Ask your doctor if there is any reason you should pay particular attention to your water intake; those taking certain medications (such as ibuprofen or related drugs) or those with certain conditions (such as kidney stones) may be advised to drink more. But for the rest of us, it may be just as well to leave your water bottle at home. Most everyone these days is aware that a high level of cholesterol is a risk factor for heart disease. For years, the thinking has been that there is “bad” cholesterol (LDL cholesterol) and “good” cholesterol (HDL cholesterol). Studies of populations (epidemiological research) have clearly demonstrated a strong association between low levels of LDL cholesterol and a lower risk of developing heart disease. LDL cholesterol reduction with drugs such as statins has been demonstrated to reduce cardiovascular risk. Thus, both the epidemiology and the randomized clinical trials support LDL cholesterol’s role as a risk factor for heart disease —  and that by lowering LDL we can lower the chances of heart attack and stroke.

With respect to HDL cholesterol, the epidemiology supports an association between high levels of HDL cholesterol and lower cardiovascular risk. However, unlike the LDL cholesterol story, recent clinical trials of drugs that specifically raise HDL cholesterol have not been shown to improve cardiovascular outcomes. Why is there this disconnect? That has been a pressing question among cardiovascular researchers.

A paper that was just published in the Journal of the American College of Cardiology sheds some light on the answer. In total, 631,762 people were studied. The authors found that low HDL cholesterol levels were associated with a number of factors that affect health, including low incomes, unhealthy lifestyles, higher triglycerides levels, other cardiac risk factors, and medical problems. Thus, the association between low HDL cholesterol and worse cardiovascular outcomes could be due to these other factors and not the low HDL cholesterol itself.

This study found that lower HDL cholesterol levels were associated with a higher risk of death from cardiovascular causes, as prior studies have shown. However, there was also a higher risk of death from cancer and other causes compared with those having average levels of HDL cholesterol. That finding makes it seem as though low HDL cholesterol isn’t just predicting cardiovascular death — which might make sense if it is really causing heart disease — but it is also predicting cancer deaths and other causes of death. And there is not a good biological explanation for why a low HDL cholesterol level should do that. The conclusion the authors reach is that low HDL cholesterol isn’t really causing any of these problems such as heart disease or cancer, but rather the underlying cause of the low HDL cholesterol, such as an unhealthy lifestyle, is the real driver of worse outcomes.

What does all this mean practically? Well, first of all, more research on the relationship between low HDL cholesterol and heart disease is still needed. There are some large clinical trials of HDL cholesterol raising drugs that are ongoing, so these studies may provide even greater insight into whether raising low HDL cholesterol protects cardiovascular health. In the meantime, it probably means that it is unlikely to be useful to take medications solely for the purpose of raising low HDL cholesterol levels. And if you have a low HDL cholesterol level, this study reinforces that exercise and a heart healthy diet are the way to go and might decrease some of the health risks seen in people with low HDL cholesterol levels.
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2/16/2019

Long-term treatment for a chronic condition

Though it seems Americans don’t agree on much, screening for cancer is an exception. Who wouldn’t support preventing or identifying cancer at an early, more treatable stage, when the alternative is pain, toxic therapies, and a shortened life? That may be why people get confused when news headlines don’t reinforce a “just do it” message. A recent example of the disconnect between public perception and medical evidence is screening for prostate cancer using the prostate-specific antigen (PSA) test. The United States Preventive Services Task Force (USPSTF), a non-governmental expert panel that produces guidelines for primary care providers, proposed new recommendations saying doctors should only order the PSA test for older men after discussing its pros and cons and eliciting preferences for screening.
Screening for prostate cancer with the PSA test: The backstory

To understand the new draft recommendation requires a brief history of this test. Introduced in the 1980s as a way to follow patients already diagnosed with prostate cancer, it began to be used to screen for new cancers. Given that the PSA is an easy blood test to perform, it was quickly adopted — without waiting for evidence that it actually worked. For many years, the USPSTF said there wasn’t enough information to recommend for or against the PSA test.

That changed in 2012 when the USPSTF released a controversial recommendation against screening. It was based in part on a large US study showing no decrease in prostate cancer deaths among men screened using the PSA test. The recommendation also reflected concern about the test causing a surge in prostate cancer diagnoses, many of which were small, low-risk cancers being treated with surgery or radiation — treatments with common side effects.

I was uncomfortable with this “don’t screen” recommendation and am happy about the proposed change. Here’s why: while the US screening trial was negative, another large study in European men showed a small decrease in prostate cancer deaths after more than 10 years of follow-up. Moreover, specialists had devised new strategies to avoid overtreating low-risk cancers.
Having a conversation about screening with the PSA test

I discuss the pros and cons of the PSA test with my patients and ask about their personal preferences for screening. I tell them that while screening can reduce death due to prostate cancer by 20%, the “bang for the buck” is small. It takes screening of over 1,000 men to prevent one death. I also highlight that the benefit of screening is years off, but the risks of treatment — impotence, incontinence, and bowel problems — occur right away.

I also emphasize the PSA test isn’t very accurate. There can be anxiety due to false positive results, meaning further testing shows no cancer. I mention the potential for diagnosing a low-risk cancer where the treatment may be worse than the disease, and that following them closely without treatment may be preferable. How much a man wants to know something like this can differ — some view it as useful information, others see it as an endless source of worry.

Finally, I share my own perspective. As a medical student in the late 1980s learning about the PSA test, my grandfather was dying from prostate cancer. He was an otherwise healthy man who had many good years left, and I wondered if the PSA test could have helped him. Because of this family history, I have decided to have the PSA test. But I’m also unsure what I would do if I didn’t have that history. The small potential for benefit must be weighed versus the risk of false positives or of finding a low-risk tumor that may never cause harm. I can see how two men without risk factors for prostate cancer could make different decisions.

So, I think the USPSTF got it right. This is a decision best made by a well-informed patient in collaboration with his doctor. The challenge in implementing this is practical: the short time I have with each patient. I could save time by simply ordering the test without a discussion. But in my role as health advisor, I need to be able to not only say when I think we should or should not do something, but also when there is a choice. And when there isn’t one right decision for everyone, my patient is the best person to make the choice that’s right for him. I can state my personal preference, but need to highlight why that may not be the right answer for him.
Screens have become so embedded in daily life that it’s hard to imagine turning them off for a whole week. Besides the fact that many, if not most, children use them for homework, they are also how we get work done, get questions answered, communicate, shop, and relax. For many families, they are also how they calm children down and keep them occupied. How do you go a day without all that — let alone a week?

I agree, that sounds hard. But as a pediatrician I’m worried about the way screens have insidiously worked their way into our lives.

According to the Campaign for a Commercial-Free Childhood (CCFC), 8 to 18-year-olds spend an average of seven hours a day on screen media. Some of that is homework, but clearly it’s not all homework. Preschoolers spend two to four hours, toddlers two hours, and a third of babies under a year are spending more than an hour watching videos every day.

It’s not all awful, of course. There is certainly high-quality educational content out there. However, children aren’t always watching that high-quality educational content. And even if they were, when you are watching a screen you are generally sedentary, not interacting with others, and relying on the screen to entertain or guide you rather than entertaining or guiding yourself.

This has implications for the health and development of children. Excessive screen time is associated with a higher risk of obesity. It can lead to poorer problem-solving and social skills, and poorer grades. It’s been linked to attention-deficit hyperactivity disorder and other behavioral problems.

That’s why I think families need to be mindful — and build some safeguards into their daily lives and family culture. Here are some suggestions:

1. Rearrange the living room so that the television isn’t the center of attention. This is a tip from the CCFC that I really like. Sure, watching TV together is fun; my family really enjoys our family movie nights. But if all the furniture faces the TV, not only is the natural tendency to turn it on when you sit down, but the message is that it’s what the living room is for — rather than talking to each other, playing a game, or doing anything else but watching TV.

2. Keep TVs out of bedrooms. They just don’t need to be there. Once it’s bedtime, laptops and phones should be out of there too; increasingly, screens are interfering with sleep, especially for teens.

3. Don’t turn on the TV during meals — and put the cell phones aside. Talk to each other instead. Family dinners have all sorts of benefits for children, from increasing their vocabulary to improving their nutrition to building better bonds between children and parents to helping keep teens out of trouble. While you’re at it…

4. Don’t have automatic screen times. So many families have the habit of turning on screens in the morning, or after school, or during dinner prep. Now, it’s not always terrible to do this; having a child watch one age-appropriate program while you do a few chores or just relax yourself can be helpful to many families. But be thoughtful about it. Does this really help? (I found that when our mornings became screen-free, things worked more smoothly, as my children paid better attention.) Is there an alternative, like engaging the child in cooking, or having them get homework done? Make sure it’s the best choice for the moment.

5. Make sure you’ve got supplies for creativity. Like paper, crayons, markers, and paints. Head to a craft store; bring your kids along and invest in some supplies for making things. Buy toys that encourage creativity and imagination, like building blocks, cars, or dollhouses. There should be lots to reach for when you are tempted to reach for a screen. Speaking of times when you are tempted to reach for a screen…

6. Pack books, small toys, playing cards, or paper and crayons whenever you head to anywhere you may get stuck waiting with your child. In my office, it seems like the only thing parents ever have on hand is their phones. There are so very many alternatives; help your child learn that.

7. Head outside. In general, children spend much more time indoors than they used to (we all do). Whether it’s heading to the park, going for a bike ride, walking around the block, or kicking a soccer ball in the back yard, make a concerted effort to make some outdoor time at least every week (every day is even better). It naturally disengages you from screens and literally engages your children with the world.Ever wonder what it would be like to be able to look at people’s entire adult lives? Not asking older people to remember, but starting with them as teenagers and tracking their health and well-being until they die? We’ve been lucky enough to do this for the past 78 years, starting in the late 1930s and early ‘40s with a group of men who agreed to be part of one of the longest studies of adult life ever done.

The Harvard Study of Adult Development has tracked the lives of 724 men from the time they were teenagers into old age — 268 Harvard College sophomores, and 456 boys from Boston’s inner city. Using questionnaires, interviews, medical records, and scans of blood and brains, we’ve monitored their physical and mental health, work lives, friendships, and romances.

Here are five of the big lessons we’ve learned about what contributes to a good life.
Lesson 1: Happy childhoods matter

Having warm relationships with parents in childhood predicts that you will have warmer and more secure relationships with those closest to you in adulthood. We found that warm childhoods reached across decades to predict more secure relationships with spouses at age 80. A close relationship with at least one sibling in childhood predicts that people are less likely to become depressed by age 50. And warmer childhood relationships predict better physical health in adulthood all the way into old age.
Lesson 2: Fostering the welfare of the next generation can ease the sting of difficult childhoods

People who grow up in difficult childhood environments (chaotic families, economic uncertainty) grow old less happily than those who have more fortunate childhoods. But by the time these people reach middle age (ages 50 to 65), those who mentor the next generation — guiding younger adults at home or at work — are happier and better adjusted than those who do not. The kind of maturation needed to nurture younger people also seems to reduce some of the sting of growing up disadvantaged.
Lesson 3: Coping effectively with stress has lifelong benefits

We all have habitual ways of managing stress and relieving anxiety. Some people tend to ignore uncomfortable facts, while others tend to face difficult issues and deal with what is unpleasant. For example, someone who is angry at his boss might “forget about it” but start missing important work deadlines. Alternatively, he might find a way to take up his concerns directly with that boss. We found that the people who cope with stress by engaging more directly with reality rather than pushing it away have better relationships with others. This coping style makes it easier for others to deal with them, which in turn makes people want to help them. They end up having better relationships and more social support, and this predicts healthier aging in your 60s and 70s. People who use these more adaptive coping mechanisms in middle age also end up with brains that stay sharper longer.
Lesson 4: Breaking bad habits earlier in life makes a difference

Watching people’s smoking habits across adulthood, those who quit earlier are less likely to develop lung disease as they grow old. They are also more likely to live longer than people who do not quit smoking or who quit later in life. Our findings differ from some studies that find no change in risk of disease and death once you’re tobacco-free for 15 years or more. Getting off the couch and starting to exercise earlier in life predicts that you’ll stay healthy longer in life, that your brain will stay sharper, and even that your immune system will be stronger.
Lesson 5: Time with others makes us happier

Looking back on their lives, people most often report their time with others as the most meaningful part of life, and what they’re proudest of. Time with other people makes us happier on a day-to-day basis, and time with a close partner buffers us against the mood dips that come with increased physical pain.

You can learn more about the study and our research at www.robertwaldinger.com and www.adultdevelopmentstudy.org. We are now studying the children of these men. Almost 1,300 of these second-generation baby boomers are participating in our study, and we hope to know more about what helps people thrive across generations. In 2015, motor vehicle accidents claimed the lives of more than 35,000 Americans. Sadly, the toll exacted by motor vehicle accidents has now been eclipsed. Data from the American Society of Addiction Medicine show that more than 52,000 of we Americans lost our lives to opioid overdose in 2015. Here in the Commonwealth, the story is even more grim; even accounting for differences in average age from community to community — younger people are still more likely to be affected than older people — the opioid overdose death rate has climbed to 23 per 100,000 residents as compared to 9 per 100,000 for the nation as a whole. The causes are numerous and a subject for another day. Similarly, approaches to solve the crisis are numerous and no one solution works for everyone who decides he or she has developed an opioid problem.
Medication Assisted Treatment (MAT)

One approach to treat people who are addicted to opioids is Medication Assisted Treatment (MAT) that combines medications to treat addiction with more traditional counseling approaches. One medication often used in MAT programs is buprenorphine-naloxone (trade name Suboxone, among others). This preparation — hereafter BN — combines buprenorphine, an opioid medication with partial activity that blunts cravings, and naloxone, an opioid overdose reversal medication that discourages abuse of the medication. When we compare groups of people addicted to opioids who are treated with and without BN, we see that those who receive the medication have a significantly higher rate of remaining free of other opioids. But how long should one continue the medication? A month? A year? A lifetime? And is it safe to continue the medication? We do not have the full answers yet, but early signals from the research indicate that not only is it safe but that longer treatment is better than shorter treatment.
Long-term treatment for a chronic condition

Many in the medical community have come to view addiction as a chronic disease. And, like many chronic diseases, it is one that can be managed but not yet cured. The thinking goes that just as those of us with high blood pressure take high blood pressure fighting medication each day for years, those of us with addiction would take addiction-fighting medication every day over years. The evidence shows that long-term proper treatment for high blood pressure lowers the risk for heart attack; evidence is now beginning to grow that long-term MAT can similarly decrease risk for relapse in those with addiction. As reported in a 2008 study in the American Journal on Addictions, patients who were successfully stabilized with a short course of BN could then be switched to long-term treatment with the medication. Forty percent of patients remained in treatment at two years and 20% at five years. When we remember that nearly half of people prescribed medication for blood pressure do not take their pills, we see that people on BN are not more likely to skip their medication than are people with better-studied chronic diseases. More importantly, though, greater than 90% of urine samples from those in the study remained free of opioids other than BN.

Long-term treatment with BN works.
How do people do without longer-term buprenorphine-naloxone treatment?

It is one thing to say that someone on a medication has a good outcome, but it is something else to prove that without the medication the person would not do well. Many advocate short-term treatment with BN. Help a person become stable and then taper off the medication. We now have evidence that this approach, however well intentioned, may be misguided. A 2014 study reported in the Journal of the American Medical Association demonstrates that over half of people who continued on BN maintenance remained free of opioids compared to just a third of those who were stabilized on BN and then tapered off. Further, far more of those treated with maintenance BN remained in the study compared to those who were tapered, suggesting that people remain committed to treatment while receiving BN.
Is long-term MAT safe?

Even if many people can be helped by extended BN treatment, it is important to consider possible side effects. Though we do not know the effects of being on BN for many decades, the 2008 American Journal on Addictions study looked for but did not find any serious adverse effects on the people treated. Earlier concerns that BN could cause liver damage also appeared to be unfounded as blood tests did not show signs of liver problems in any of the patients in the study.

More research is needed, of course, but the early evidence suggests that BN can safely help people remain off unwanted opioids over the long term just as blood pressure medication can protect people from the effects of high blood pressure. That is good news because each day off unwanted opioids is a day a person can focus on improving his or her life. Of course, buprenorphine-naloxone maintenance is not for everyone, but when it works it can work well and can give people room to breathe and rebuild their lives.
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1/14/2019

What is as an antidote to loneliness

I was called to your room in the middle of an overnight shift. There you were, breathing quickly, neck veins bulging and oxygen levels hovering despite the mask on your face. I placed my stethoscope on your back and listened to the cacophony of air struggling to make its way through your worsening pneumonia.
“We’re going to place a tube down your throat to help you breathe,” I told you.
Your eyes were pleading, scared. “We’ll put you to sleep. It’ll help you breathe more comfortably. Okay?”
You nodded. You had already told the doctors who cared for you during the day that if your breathing worsened, you would agree to intubation to allow more time to treat your pneumonia. So I called for the anesthesiologists. Minutes later, you were sedated and intubated, silenced — maybe forever.
I thought about you recently, when I read a poignant Perspective in JAMA Internal Medicine: “Saving a Death When We Cannot Save a Life in the Intensive Care Unit.” In this piece, critical care doctor Michael Wilson relates the story of a woman in the ICU who was electively intubated for a procedure and then died, without ever having had the opportunity for her loved ones to say goodbye.
Fueled by his feelings of regret over this and similar cases, Wilson argues for a different approach to intubation, which he likens to the talk a parent has with a child who is going off to war. Of course, these parents hope their children will come back safely, but they are given the chance to say what they want to say — knowing the conversation might be their last. Wilson suggests that we might build a similar pause into our protocols before intubation, lest we unwittingly deprive our patients of the opportunity for a final exchange with their loved ones. “Stealing the opportunity for meaningful last words is precisely the kind of avoidable complication that ought to be visible to us in the ICU,” Wilson writes. “My intubation checklist now includes this step.” In doing so, Wilson suggests that we might be able to “save a death” even if we are ultimately unable to save a life.
Reading this piece, I’m left with the image of Wilson’s patients — both the one who never had the chance to say goodbye, and another woman he describes who was given the chance to say “I love you” to her husband — and also of my own patients. It is too easy, in the heat of the moment, to forget that this patient before us is a person. How many times have I decided on intubation, ordered the appropriate medications, prepared for complications, but not taken pause to allow my patient to talk to a loved one?
I only took care of you for the night, as the physician on call. Though I remember your face, I do not remember your name and I don’t know what happened to you. Maybe the breathing tube came out in a day or two, and you were able to talk to your family once again. Or maybe it did not. Maybe your pneumonia worsened and you died, there in our ICU. It has been months since that night, and I can’t know. But I do wish, now, that I had paused and given you that chance.

Well, it seems as though not even a week can go by without more data on aspirin! I recently reviewed the ARRIVE trial and the implications for primary prevention — that is, trying to prevent heart attacks and strokes in otherwise healthy people. Since then, yet another large clinical trial — the ASPREE study — has come out questioning the use of aspirin in primary prevention. Three articles pertaining to this trial were published in the prestigious New England Journal of Medicine, which is an unusual degree of coverage for one trial and highlights its immediate relevance to clinical practice.

Aspirin still strongly indicated for secondary prevention

Nothing about any of the new aspirin data, including ASPREE, pertains to secondary prevention, which refers to use of aspirin in patients with established cardiovascular disease. Examples include a prior heart attack or certain types of stroke, previous stents or bypass surgery, and symptomatic angina or peripheral artery disease. In general, in patients with a history of these conditions, the benefits of aspirin in reducing cardiovascular problems outweigh the risks. Chief among these is a very small risk of bleeding in the brain, and a small risk of life-threatening bleeding from the stomach.

ASPREE study suggests no benefit from aspirin in primary prevention

ASPREE randomized 19,114 healthy people 70 or over (65 or over for African Americans and Hispanics) to receive either 100 milligrams of enteric-coated aspirin or placebo. After an average of almost five years, there was no significant difference in the rate of fatal coronary heart disease, heart attack, stroke, or hospitalization for heart failure. There was a significant 38% increase in major bleeding with aspirin, though the actual rates were low. The serious bleeding included bleeding into the head, which can lead to death or disability. Again, the actual rates were very low, but they are still a concern when thinking of the millions of patients to whom the ASPREE results apply.
Rates of dementia were also examined, and again, there was no benefit of aspirin. Quite unexpectedly, there was a significantly higher rate of death in the patients taking aspirin. This had not been seen in prior primary prevention trials of aspirin, so this isolated finding needs to be viewed cautiously. Still, with no benefits, increased bleeding, and higher mortality, at least in this population of older healthy people, aspirin should no longer be routinely recommended.
Another unexpected finding in ASPREE was a significantly higher rate of cancer-related death in the people randomized to aspirin. The prior thinking had been that aspirin might actually prevent colon cancer, though generally after many more years of being on aspirin. The ASPREE trial was terminated early due to lack of any apparent benefits. And even though five years is a relatively long period of follow-up, it may not have been long enough to find a benefit on cancer. Thus, the increase in cancer deaths may be a false finding. Nevertheless, the overall picture from this trial is not a compelling one for aspirin use for prevention of either cardiac or cancer deaths.

Should healthy people take a daily aspirin?

In general, the answer seems to be no — at least not without first consulting your physician. Despite being available over the counter and very inexpensive, aspirin can cause serious side effects, including bleeding. This risk goes up with age. So, even though it seems like a trivial decision, if you are healthy with no history of cardiovascular problems, don’t just start taking aspirin on your own.
However, there are likely select healthy patients who have a very high risk of heart attack based on current smoking, family history of premature heart attacks, or very elevated cholesterol with intolerance to statins, for example, who might benefit. Therefore, the decision to start aspirin should involve a detailed discussion with your physician as part of an overall strategy to reduce cardiovascular risk. If you are already taking aspirin for primary prevention, it would be a good idea to meet with your physician and see if you might be better off stopping.

It may not seem possible to be able to write your way to better health. But as a doctor, a public health practitioner, and a poet myself, I know what the scientific data have to say about this: when people write about what’s in their hearts and minds, they feel better and get healthier. And it isn’t just that they’re getting their troubles off their chests.
Writing provides a rewarding means of exploring and expressing feelings. It allows you to make sense of yourself and the world you are experiencing. Having a deeper understanding of how you think and feel — that self-knowledge — provides you with a stronger connection to yourself. It’s that connection that often allows you to move past negative emotions (like guilt and shame) and instead access positive ones (like optimism or empathy), fostering a sense of connection to others in addition to oneself.

Making connections is key

It’s remarkable that the sense of connection to others that one can feel when writing expressively can occur even when people are not engaged directly. Think of being at a movie or concert and experiencing something dramatic or uplifting. Just knowing that everyone else at the theater is sharing an experience can make you feel connected to them, even if you never talk about it. Expressive writing can have the same connecting effect, as you write about things that you recognize others may also be experiencing, even if those experiences differ. And if you share your writing, you can enhance your connection to someone else even more. That benefit is energizing, life-enhancing, and even lifesaving in a world where loneliness — and the ill health it can lead to — has become an epidemic.
Maybe it’s time to pay greater attention to expressive writing as one important way to enhance a sense of connection to others. Social connection is crucial to human development, health, and survival, but current research suggests that social connection is largely ignored as a health determinant. We ignore that relationship at our peril, since emerging medical research indicates that a lack of social connections can have a profound influence on risk for mortality, and is associated with up to a 30% risk for early death — as lethal as smoking 15 cigarettes a day. Social isolation and loneliness can have additional long-term effects on your health including impaired immune function and increased inflammation, promoting arthritis, type 2 diabetes, cancer, and heart disease.

How expressive writing battles loneliness

Picking up a pen can be a powerful intervention against loneliness. I am a strong believer in writing as a way for people who are feeling lonely and isolated to define, shape, and exchange their personal stories. Expressive writing, especially when shared, helps foster social connections. It can reduce the burden of loneliness among the many groups who are most at risk, including older adults, caregivers, those with major illnesses, those with disabilities, veterans, young adults, minority communities of all sorts, and immigrants and refugees.
Writing helps us to operate in the past, present, and future all at once. When you put pen to paper you are operating in the present moment, even while your brain is actively making sense of the recalled past, choosing and shaping words and lines. But the brain also is operating in the future, as it pictures a person reading the very words you are actively writing. When expressing themselves in writing, people are actually creating an artifact — a symbol of some of their thoughts and feelings. People often can write what they find difficult to speak, and so they explore deeper truths. This process of expression through the written word can build trust and bonds with others in unthreatening ways, forging a path toward a more aware and connected life.
When people tell their personal stories through writing, whether in letters to friends or family, or in journals for themselves, or in online blog posts, or in conventionally published work, they often discover a means of organizing and understanding their own thoughts and experiences. Writing helps demystify the unknown and reduce fears, especially when we share those written concerns with others.

Write for your health

As a poet, I’ve personally experienced the benefits of expressive writing. The skills it sharpens; the experience of sharing ideas, feelings, and perceptions on a page; the sensations of intellectual stimulus and emotional relief — all are life enhancing. I’d like more people to discover that expressive writing can contribute to well-being, just as exercise and healthful eating do.
I’ve documented some of the research being done in the area of healing and the arts. After reviewing more than 100 studies, we concluded that creative expression improves health by lowering depression and stress while boosting healthy emotions. So pick up a pen, and start to write creatively. For the mind and the body, writing is a strong prescription for good health.

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