Chess recommends considering the following:

Is the physician (or if a laser technician is doing the work, the physician in charge of the facility) highly qualified in the use of the Q-switched lasers?

Is the physician board-certified by the American Boards of Medical Sub-Specialties in dermatology or plastic surgery?

Does the doctor have different types of Q-switched lasers in the practice to cover the different colors? Are they owned by the doctor, or rented for a day or two a month?

How much training does the doctor or technician have in the use of these lasers? How many tattoo removals has he or she done?
“A laser technician who is not a physician but has treated thousands of tattoos over a period of years is probably going to be more expert at doing it than a physician who rents a laser once a month and has done it 20 times over a two-year period,” Chess said.

If you choose to have a piercing, make sure the needles are sterilized before use. Thoroughly clean the area after it’s pierced, and use antiseptics and lotions to help the healing process.

Redness or heat may indicate an infection and you may have to remove the jewelry to clear things up.

He is the director of the fellowship training program in gastroenterology as well as the director of gastrointestinal endoscopy at the Datrmouth-Hitchcock Medical Center.

His clinical interests include therapeutic gastrointestinal endoscopy and diseases of the liver and pancreas. He currently is a principal investigator in several clinical studies evaluating new treatments for patients with chronic Hepatitis C infection.

The following exercises can be done in a very full bathtub. You will likely want to do them in a sitting position.

Safety First
Be sure to exercise before soaping up so the tub surfaces are not too slippery. A rubber tub mat or non-skid tape or decals also might be appropriate.

It’s a good idea to have a handrail installed so you can have something to hold onto when you’re exercising and while getting in and out of the tub. It’s also wise to have someone within calling distance while you’re in the tub, in case you need help.

Toe curls
With feet immersed, curl your toes and hold. Then relax. Repeat.

Pedaling
Point the toes of one foot toward your face while pushing the toes of the other foot away from your face. Reverse feet and repeat.

Knee bends
With your back straight and your head up, bend one knee and move it toward your body. Wrap your arms around the knee and pull it close to your chest. Alternate with the other leg. (If you have had knee or hip replacement, bend the knee only. Do not pull it.)

Ankle Circles
With feet slightly apart, raise them an inch or so off the tub floor. Point your toes inward, then outward.

The cultural soup in which we operate is constantly changing as well. Raising a child in the 1950s, ’60s, ’70s, ’80s and ’90s were different experiences because of the changing historical context. Our parents did not have many of the material, educational and cultural opportunities we have, but neither did they have the choices, dilemmas and pressures we face going into the new millennium. The quickly accelerating Information Age introduces products, ideas and influences into our lives and our children’s lives at a rate that can make our heads spin. The amount of material we process while trying to keep abreast of new information is astounding. We are bombarded with information and conflicting advice. Sometimes it’s liberating, and sometimes it is paralyzing.

A media executive recently pointed out that we now face a unique historical situation. The Information Age represents a revolution manifested in dramatic alterations in technology, communication, commerce, education and culture. The computer is the center of the revolution. It is the first period in which the young know more than the older generations and are leading the way! Witness the relative ease with which youngsters use computers, navigate the Internet, establish Web sites, consult for adults and launch companies.

In my family therapy practice, individuals, couples and families consult with me about many different problems. I feel privileged when they share their stories with me in their quest to understand and change their lives. I join them for a while on their voyage to make things better or to cope with things in their lives that cannot be changed.

I believe in the power of stories. We are by nature story makers. Stories help us to understand our world, define our identities and create visions of preferred ways of being. I believe that we learn from each other’s stories — from our parents, siblings, children, friends, and even stories we hear about strangers.

Stories can shape, encourage, inspire and heal, both in the telling and the hearing. In short, I believe that stories have the power to transform.

Each parent and child is an expert and source of meaningful stories worth sharing.

In this column, I would like to create a space for people to share not only their parenting questions and dilemmas, but also, to share their parenting anecdotes and stories. Readers can form a kind of parents’ circle — a cross between a traditional column and a chat room. Through e-mails and chats, we could each serve as links in the chain as we offer our ideas, thoughts and experiences. We could also consult with our children and share their perspectives on our most difficult issues. The column could provide support and encouragement — a place to honor and celebrate our accomplishments and efforts

“Alendronate significantly reduced the risk of clinical fractures among women with osteoporosis,” write a team of researchers led by Dr. Steven Cummings of the University of California, San Francisco. Their findings are published in the December 23/30 issue of The Journal of the American Medical Association.

In their 4-year study, the researchers examined rates of fracture and changes in bone mineral density in over 4,400 postmenopausal women with low bone density. All study subjects received either weekly Fosamax therapy or (an inactive) placebo.

The authors report that “compared with placebo, treatment with alendronate increased average bone mineral density at all measured sites.” For example, they found that mean lumbar spine density rose by 8.3% in the Fosamax group, compared with just 1.5% in those receiving placebo.

In women with full-blown osteoporosis, Fosamax therapy reduced the risk for bone fracture.

However, drug therapy “did not significantly affect risk of clinical fracture in those with higher (non-osteoporotic) bone mineral density,” the researchers report.

They also found that, compared with placebo, Fosamax therapy reduced risks of smaller, ‘pre-osteoporotic’ vertebral fractures (only discernible on x-ray) by 44%. These ‘radiographic fractures’ are often predictors of later osteoporosis and disabling fracture.

Fosamax had no significant side effects compared with placebo, the investigators report.

In an editorial, Dr. Robert P. Heaney of Creighton University in Omaha, Nebraska, writes that women with low bone mineral density or a prior history of fracture after age 40 years are among those “most likely to benefit” from treatment with Fosamax.

Heaney points out that, for patients with less-severe deficits in bone density, drugs without a prescription such as selective estrogen receptor modulators, hormone replacement therapy, calcium, and cholecalciferol may be effective treatment alternatives. Because some of these therapies reduce risks for other illnesses (such as heart disease) “it makes sense to use an agent that offers multiple benefits,” he said.

The California study was supported in part by a grant from Merck Research Laboratories of Rahway, New Jersey, a division of the pharmaceutical company that makes Fosamax.

Eastin encouraged school districts to use the data to examine their physical education programs and plan improvements. “It is critical that schools see this as important, and incorporate programs that provide students with the knowledge and abilities needed to maintain active and healthy lifestyles,” Eastin said.

With the percentage of overweight young people doubled since 1980, San Diego County Office of Education physical education and health coordinator Mary Blackman said, “People should be becoming outraged. The whole nation should be pulling together and saying ‘Wow, we should be getting our kids active.’”

The state scores are slightly up from two years ago: 20 percent of students were fit two years ago, compared to 23 percent currently. Fitness scores were generally higher in high-income areas than in less-affluent ones. The state official who oversees the fitness testing said that students in low-income areas may not be able to afford to join recreational leagues, may live in apartments without a play area and may be unsupervised after school while their parents are working.

Blackman’s suggestions for improvements in physical activity include the following: Increase the number of safe places for physical activity. Focus more on nutrition in school. Reduce the size of physical education classes. Offer more after-school physical activities for students who are not on school teams.

And there is proof that such changes can make an impact on students’ physical fitness: In one San Diego County school staffed with full-time physical education specialists, fifth-graders reached all fitness standards at nearly double the county average. The school credits the school’s facilities and the student’s high participation in recreational sports leagues for this achievement.

Is there a perfect diet? No. In general, you should reduce the saturated fat and cholesterol in your diet. Keep in mind that animal products are the biggest sources of saturated fat and cholesterol. Select leaner cuts of meat if you are a meat eater and remove all visible fat. Minimize your intake of dairy products, such as eggs, cream and cheese. As much as possible substitute fruits, vegetables and grains. Your doctor can help you set specific daily goals or refer you to a nutritionist to plan a comprehensive dietary program. Here is what the American Heart Association recommends:

Keep your total fat intake to less than 30 percent of total calories.
Limit saturated fat to less than 10 percent of total calories.
Limit your cholesterol intake to no more than 300 milligrams per day.
Does a heart-healthy diet mean tasteless food? No! There are dozens of books on nutrition and diet that can teach you on how to prepare interesting and delicious recipes. Keep in mind that long-term success in changing your eating habits will not come from following a structured and tasteless diet, but rather from changing your relationship to food. Think about the importance of your health and the joy you get from a fit, well-tuned body. There may be some truth to the old axiom “we are what we eat”.

Alcohol in Moderation
Studies suggest that the more you drink the less your likelihood of cardiac problems. This is probably due to the fact that wine and other alcoholic beverages raise the level of protective HDL cholesterol in the blood, although other factors may be important, too. However, drinking alcohol is associated with noncardiac illness, and for that reason many doctors are reluctant to suggest that their patients indulge in alcohol. For those who do enjoy a drink and who do not suffer from any alcohol-related illnesses, doctors generally recommended no more than one or two drinks per day.

Don’t Smoke
Evidence indicates that smoking is a strong risk factor for angina and heart attack. The 1989 Surgeon General’s report concluded that smoking increases the risk of cardiovascular death by 50 percent. If you do smoke, you should realize that the risk of tobacco-related illness — including cardiovascular disease — falls rapidly after quitting.

What should you do if you are a smoker and you have been diagnosed with angina? Nicotine is highly addictive and quitting can be quite difficult, but people successfully quit all the time. Take advantage of the fact that your motivation may never be stronger. Talk with your doctor about which method might suit you best.

Current approaches include nicotine replacement systems (patches, gum and inhaled nicotine), antidepressant medications, behavioral techniques including hypnosis and structured cessation programs.

Control Your Blood Pressure
Blood pressure has often been called the “silent killer” since it rarely announces itself with symptoms, but silently causes damage to various organs throughout the body. It is a potent risk factor for heart disease and angina. If you are already being treated for high blood pressure, take your medications and make sure your condition is well controlled. Remember that there are many nonpharmacological methods to lower blood pressure, including weight loss, limiting alcohol consumption, exercising regularly, reducing salt intake, increasing your intake of calcium and potassium, stopping smoking and relaxation exercises.

Stay Active
Studies have shown that people who are physically active are healthier and live longer. Even people with coronary artery disease can benefit from starting an exercise program. Aim for at least 20 to 30 minutes of moderate activity daily, or at least several times a week. Rapid walking, bicycling or swimming are beneficial.

Because exercise may induce angina, you may need to modify the type of activity you choose and the way you approach it. In general, rapid, intense activity is more likely to bring on symptoms than gradually increasing activity. When exercise induces angina, you should slow or stop until the symptoms subside. Most doctors will agree it is safe to resume activity, though they might recommend a slower pace.

Keep in mind that digestion puts an added demand upon the heart. You will be more likely to get angina when exercising after a large meal. Weather can be a factor, as well. Many people find angina occurs far more frequently in cold weather. Talk with your doctor about an ideal exercise program and determine a target heart rate. In some instances, your physician will observe your response to exercise on a treadmill before prescribing a home exercise program. Most exercise programs shoot for a heart rate between 50 percent and 85 percent of the maximum rate for a person of your age.

Some medications, particularly beta blockers, will prevent your heart rate from increasing in a normal fashion. If you are taking such medications, your doctor will usually recommend a lower target heart rate. A quick formula for determining your maximum heart rate is to subtract your age from 220. A 50-year-old would have a predicted maximum heart rate of 170 beats per minute. Thus, the target heart rate during exercise should be between 85 and 144 beats per minute.

Manage Stress
You may be upset to learn you have angina and coronary artery disease, and understandably so. But do not let that worsen the situation. There is no reason to feel helpless or to give up. Learn about your disease and put that knowledge to work for you.

Think about whether chronic stress is a factor in your life. Try to determine whether it may have contributed to the development of coronary disease. Remember that stress takes a toll on the body in insidious ways.

It interferes with sleep, it leads to altered eating habits, it blunts our immune system, and, in many ways, it contributes to illness. Among the most detrimental forms of psychological stress are anger and hostility.

What can you do about stress? There are many methods you can use on your own, and all of them can be learned through books and other commercially available material. Among these are meditation, self-hypnosis, exercise and progressive muscular relaxation. For patients with severe stress and anxiety, professional counseling may be helpful.

In the study, researchers observed the link between asthma and obesity in more than 1,300 children (between the ages of 4 and 9) living in urban neighborhoods. They found that nearly 20 percent of the children were obese, and that these children had considerably more wheezing problems than their non-obese peers, including two extra weeks of wheezing per year. The obese children were also 8 percent more likely to visit a hospital emergency room, and 6 percent more likely to be prescribed with oral steroids to ease asthma than non-obese children.

Urban children may have a higher risk for obesity and aggravated asthma symptoms due to the lack of safe areas for them to exercise. Previous research has shown that many urban children are forced to stay inside their homes because of the limited number of safe areas for them to play and exercise, and therefore, may be more likely to be obese than children living in suburban or rural areas. Researchers believe that regular exercise may help children to control their asthma symptoms and reduce their weight.

If your facility is located in an urban area, consider offering children in your neighborhood the opportunity to work out in your facility during slow periods, such as after school.

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