You’re probably aware of whether you tend toward a type A or type B personality, since those labels are part of our lexicon. What you may not know, however, is that there is a third type — type D — and it’s not a great category to find yourself in. The D stands for distress, and a growing body of research links this personality type with a variety of health risks and even early death — so it may be especially important for these inhibited and gloomy folks to do everything they can to lighten up.

Remember Eeyore — the sad, self-conscious donkey character in Winnie-the-Pooh? To my mind, he is a perfect illustration of the type D personality. He always expected the worst and therefore, that’s what he usually got. Traits associated with this personality type include social inhibition, a negative self-image, depressed mood, hostility, tension, chronic anger and a tendency to overreact to stressful events.

Type D & Death Risk

It’s already known that having this type D personality elevates risk for people who have had heart attacks, cardiac bypass surgery and/or stent implants. In new research from the University of Tilburg in the Netherlands, scientists set out to determine the impact of these characteristics on people with a common condition called peripheral artery disease (PAD), a circulatory problem in which narrowed arteries reduce blood flow to the limbs. People who have PAD have four to five times greater risk for heart attack and stroke.

Researchers asked 184 patients (average age 65) diagnosed with PAD to fill out a 14-item personality questionnaire to assess character traits, such as negativity and social inhibition. They rated statements such as “I would rather keep people at a distance” and “I often find myself worrying about something” as false or true on a scale of zero to four. During the next four years, 16 patients (9%) died — six of cardiovascular disease, seven of cancer and one each from emphysema, pneumonia and acute pancreatitis. After factoring in other variables such as age, gender, diabetes and kidney disease, investigators learned that those with type D personalities were more than three times as likely to have died as those who were Type A or B.

How Distress Raises Risk

There are numerous pathways linking this particular personality type with poor health outcomes, I learned from study coauthor Johan Denollet, PhD, a professor of medical psychology at Tilburg University. Some are physical, other behavioral. For instance, Type D individuals tend to…

• Experience chronic anxiety and negativity. Living in such a state has a variety of physical effects on your body, none beneficial. Chronic stress drives up levels of inflammatory proteins called cytokines, which leads to increased oxidative stress and contributes to disease. The adrenal glands respond to stress by pumping out cortisol, the hormone that helps us meet perceived threats. Having high and prolonged levels of cortisol in the bloodstream causes serious problems, including blood sugar imbalances, reduced immunity, slower wound healing and increased abdominal fat.

• Have poor health habits. Research has shown that people with type D personalities often neglect their health by eating improperly, not having medical checkups and being sedentary.

• Are unlikely to be proactive in seeking medical care. Perhaps because they are unable to express their emotions and are tense, insecure and uncomfortable in social situations, type D individuals are often slow to seek the medical help they need. In one study, type D patients with chronic heart failure experienced more cardiac symptoms and worried more about them than other people but, paradoxically, were less likely to discuss them with health-care professionals. Other research demonstrates that heart failure patients with “inadequate consultation behavior” face a six-fold increased risk for impaired health.

What Can Help

Generally speaking, you can’t change your personality — but if you recognize these traits in yourself or a loved one, there are plenty of things you can do to address the issues and minimize the impact on your health. For example, Dr. Denollet notes that type D personalities are more likely to experience anxiety and depression — and points out that these can be managed to a significant degree with counseling and/or medication. Other strategies include…

• Adopting healthier lifestyle behaviors, such as better diet and regular exercise.

• Participating in programs or counseling to conquer addictions, such as smoking or alcohol abuse, or to improve social skills and learn to relax.

• Using techniques such as guided imagery, breathing exercises, meditation, tai chi and yoga to help manage stress and mood and learn to control anger and hostility.

While you can’t change who you are, if you have a type D personality, you can take these concrete steps to make yourself healthier and, I’llbet, happier.

Source(s):

Johan Denollet, PhD, professor of medical psychology, Tilburg University, Tilburg, The Netherlands.

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Do you worry that coffee could harm your health? Relax. Studies suggest that, when consumed in moderation — meaning two to four eight-ounce servings daily — coffee may in fact be good for you.

It is not clear whether the benefits come from coffee itself or its caffeine. Even decaffeinated coffee may have some caffeine, and there is limited research on other caffeinated beverages, such as tea. Per cup, coffee has about 100 mg of caffeine… black tea has about half as much. Studies show that coffee may…

• Reduce risk for some cancers. An analysis of nine studies found that drinking two cups of coffee daily lowered liver cancer risk by 43%. Coffee also may protect against colorectal cancer.

• Help prevent diabetes. Among 200,000 study participants, those who drank four to six cups of regular or decaffeinated coffee daily were 28% less likely to develop type 2 diabetes than people who drank two cups or less daily.

Possible reason: Chlorogenic acid, an antioxidant in coffee, slows sugar’s release into the bloodstream.

• Protect memory. In a study of 7,000 seniors, women who drank more than three cups of caffeinated coffee or six cups of caffeinated tea daily had less memory loss than women who drank two cups or less.
• Prevent gallstones. In a study of 80,000 female nurses, drinking two or more cups of caffeinated coffee daily cut gallstone risk by about 20%.

Why: Caffeine may aid the digestive fluid bile, reducing formation of cholesterol crystals that become stones… and stimulate gallbladder contractions, flushing away crystals.

• Lower Parkinson’s disease risk. In the nurses’ study, women who drank one to three cups of caffeinated coffee daily were 40% less likely than nondrinkers to develop Parkinson’s, a movement disorder caused by loss of brain cells.

• Improve physical performance. The amount of caffeine in two to five cups of coffee boosts endurance… helps the body burn fat instead of carbohydrates… and eases muscle soreness.

Reassuring: Coffee drinkers are no more likely to have heart attacks or chronic high blood pressure than nondrinkers. Coffee oils can raise cholesterol, but paper filters remove these oils. Coffee doesn’t appear to increase risk for ovarian or breast cancer. Some women say coffee worsens premenstrual syndrome and fibrocystic breast disease (benign breast lumps), but research does not support this.

Cautions: Both regular and decaf coffee can cause digestive upset. Caffeine can trigger migraine or cause insomnia. Animal studies suggest that at high doses, caffeine may weaken bones by blocking calcium absorption. Moderate amounts of caffeine do not impair fertility or cause birth defects, but consuming more than 200 mg daily may double miscarriage risk — so limit caffeine to 100 mg per day while pregnant.

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Bottom Line/Women’s Health interviewed JoAnn E. Manson, MD, DrPH, a professor of medicine and women’s health at Harvard Medical School, and chief of the division of preventive medicine at Brigham and Women’s Hospital, both in Boston. She is one of the lead investigators for two highly influential studies on women’s health — the Harvard Nurses’ Health Study and the Women’s Health Initiative. Dr. Manson is the author, with Shari Bassuk, ScD, of Hot Flashes, Hormones & Your Health (McGraw-Hill).

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Hospitals advertise constantly these days and, by and large, the ads don’t say much that you need to pay attention to. But if you notice that a nearby hospital promotes itself as a “stroke center,” do take note — a new study from the University of Toronto reports that being treated at a stroke center vastly reduces your likelihood of suffering serious permanent disability from stroke.

What’s a Stroke Center?

Here in the US, a hospital that wants to be certified as a “primary stroke center” by The Joint Commission must meet very specific criteria, including team training for staff. With stroke, time is everything. At stroke centers, everyone — from the ambulance staff responding to 9-1-1 calls all the way through the doctors and nurses working in the emergency room — expedites diagnosis and treatment to be sure patients who would benefit from the clot-busting drug tissue plasminogen activator (tPA) get it in time to help.

I called Ralph L. Sacco, MD, MS, professor and chairman of neurology at Miller School of Medicine, University of Miami, and now the incoming president of the American Heart Association, and he reiterated how important it is to know in advance how to deal with a stroke emergency. “For every minute we delay treatment and dispensing tPA, millions of brain cells die,” Dr. Sacco said. “The recommended window for successful treatment is four and one-half hours — but within that time and before the drug can be given, the symptoms of stroke have to be recognized, 9-1-1 called, the patient taken to a hospital, and a CT scan performed. That’s not a lot of time to work with.”

How You Can Be Prepared

“Learn which primary hospitals are certified for stroke treatment and which are not,” Dr. Sacco advised, noting that there are stroke centers in most urban areas. Look online, at www.strokecenter.org/strokecenters.html, where you can click on your state to find a list of primary stroke centers accredited by The Joint Commission.

Refresh your memory on the warning signs for stroke, from The American Stroke Association:

• Sudden numbness or weakness of the face, arm or leg, especially on one side of the body.

• Sudden confusion, trouble speaking or understanding.

• Sudden trouble seeing in one or both eyes.

• Sudden trouble walking, dizziness, loss of balance or coordination.

• Sudden, severe headache with no known cause.

Another quick way to test is to have the person smile. If one side of the face droops, stroke may be suspected.

Finally, remember that it is always best to call 9-1-1 immediately if you suspect stroke in yourself or a companion. Research has shown that people who walk into an emergency room on their own may be treated with less urgency. A trained emergency team responding to a 9-1-1 call not only can get you to the right hospital, but also can start some treatment right away and help speed you through the admission process.

Source(s):

Ralph L. Sacco, MD, is chairman of neurology, Miller Professor of Neurology, Epidemiology, and Human Genetics at the Miller School of Medicine, University of Miami. Dr. Sacco will serve as president of the American Heart Association for the 2010-2011

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Do you know zilch about zinc? Let’s rectify that, as this essential trace element is vital to your health and well-being. According to some reports, as many as 12% of Americans may have a zinc deficiency, a figure that may rise to as much as 45% in people over age 60. Among the important functions of zinc in our bodies — it boosts the immune response… protects cell membranes from harmful oxidants and structural damage… repairs DNA… and supports nearly 100 different enzymes that regulate the chemistry of cells and organisms.

Regular Daily Health News contributor Mark Stengler, NMD, told me that zinc is also helpful in stabilizing blood glucose… contributes to neurological function… and helps the formation of testosterone, thereby potentially boosting sexual function. (So the reputation of oysters as an aphrodisiac has a scientific basis — they have more zinc than any other food.) And, of particular interest to the older population, says Dr. Stengler, is that zinc helps prevent or reduce the damage of age-related macular degeneration, a leading cause of blindness in adults over age 60.

Why Do We Lack Zinc?

Our ability to absorb zinc may decline with age. On top of that, many older folks take medications known to deplete zinc, in particular thiazide diuretics and ACE inhibitors (used to control blood pressure) and acid-suppressing medications. Additionally, having a digestive disorder that prevents proper nutrient absorption — such as irritable bowel syndrome (IBS) or Crohn’s disease — can contribute to deficiency. And since animal products are a primary source of zinc, eating a vegetarian diet can also mean that you don’t get enough.

With so many people at risk, you’d think there would be good tests to measure zinc levels, but alas, the only ones available are not sensitive enough to be useful — so it is important to be aware of deficiency symptoms. Severe deficiency causes severe problems (such as rashes, chronic diarrhea and night blindness), but that’s rare in developed countries. Lower level deficiency is far more common, but its symptoms can be troublesome, too — including depression, a loss of appetite and libido, and frequent colds and other infections.

Zinc and Colds

When you get a cold or respiratory infection, supplementing with zinc can help relieve your sore throat and shorten your suffering, a benefit that has been demonstrated in many studies. This has made zinc-based cold fighters, including the Zicam Cold Remedy line, quite popular. There was considerable concern last year when the FDA issued a warning about use of Zicam products delivered nasally (its gels and sprays). These are no longer being sold, and according to Dr. Stengler, Zicam lozenges are safe (a daily dose — six lozenges — has 80 mg of elemental zinc). Dr. Stengler likes even better lozenges that contain 15 mg to 25 mg of elemental zinc, and in particular the brands Bluebonnet and LifeExtension. At the first sign of a cold, have one every two hours away from meals, since zinc supplementation may also interfere with the absorption of iron and calcium, and competes with copper for uptake from the gut. Note: Zinc may hinder absorption of antibiotics, so if you’re on them, be sure to use it at least two hours before or after the time you take the drug.

For Health in General

The zinc Recommended Daily Allowance is 11 mg a day for men and 8 mg for women. You can obtain this much from food (see below), but if you have signs of deficiency or are not eating a zinc-rich diet, Dr. Stengler says 15 mg per day is generally a good supplemental dose. The upper limit for a zinc supplement is 40 mg — too much zinc has been associated with prostate cancer. Pregnant and nursing women should not take zinc unless instructed to do so by a doctor.

Zinc-rich foods include…

• Beef
• Crab
• Turkey
• Oysters
• Liver
• Dairy including milk, yogurt and cheddar cheese
• Cashews, almonds, peanuts
• Crimini mushrooms
• Spinach
• Pumpkin seeds

For most people at most times, he says, eating a varied, healthful diet and taking a daily multivitamin with zinc should be sufficient to prevent deficiency.

Source(s):

Mark A. Stengler, NMD, a naturopathic medical doctor and leading authority on the practice of alternative and integrated medicine. He is editor of Bottom Line’s Natural Healing newsletter, author of The Natural Physician’s Healing Therapies (Bottom Line Books), director of the La Jolla Whole Health Clinic in La Jolla, California, and adjunct clinical professor at the National College of Natural Medicine in Portland, Oregon. To learn more about his work, visit www.drstengler.com and www.lajollawholehealth.com.

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Warren Buffett ranks as one of the greatest investors of all time. Over more than three decades, his Berkshire Hathaway Inc. has purchased dozens of stocks and businesses. During that time, the company has outperformed the Standard & Poor’s 500 Index by a wide margin. Buffett achieved his record by following a disciplined investment strategy. He waits years for stocks to sell at discounts. Buffett does not hesitate to hold cash if nothing meets his exacting standards.

Seeing his record, many investors seek to mimic Buffett’s style. When the master buys a stock, the imitators also make the purchase. While there is much to learn from Buffett, those who seek to copy him should beware. Buffett’s approach is difficult to implement, and even the master himself has made mistakes while using the strategy. Some trademark Buffett tactics that most investors should avoid…

Mistake: Holding a concentrated portfolio. Academics have long argued that investors should own a wide variety of stocks and other assets. That way, if some holdings fall, others may rise. Buffett understands the scholarly research, but prefers to hold “concentrated” positions, keeping big stakes in just a few industries. Altogether, Berkshire derived one-fourth of its revenue and half its profit from one industry — insurance.

Buffett’s success can be traced to his concentrated approach. But most investors should tread more carefully. In fact, Buffett says most investors should diversify extensively. Many part-time investors should stick with mutual funds. A sound approach is to buy an index fund, such as one that tracks the S&P 500. While funds may never outpace the best stock pickers, the index trackers never finish at the bottom of the standings.

Mistake: Buying nothing but cheap stocks. Stocks are often thought of as being from one of two categories — growth stocks, which have growing earnings and price multiples that are higher than average… and value stocks, which have little or no earnings growth and relatively low prices. Buffett does not fit neatly into any one camp. His portfolio includes some stocks that may be considered “growth” and others that fit into the value category.

Some investors may want to follow his example of holding growth and value. By owning both, you can diversify a portfolio because growth and value sometimes move in different directions. But for long-term investments, I prefer putting more than 50% of assets in value stocks. According to research by Eugene Fama, PhD, professor of finance at the University of Chicago, and Kenneth French, PhD, professor of finance at Dartmouth, value stocks tend to outperform growth over long periods. The best performance comes from stocks that are in the cheapest 10% of the market as indicated by their price-to-book ratios (p/b). This is the share price divided by the book value, a measure of a company’s assets minus its liabilities. Fama and French found that during the 27 years ending in 1990, the cheapest 10% of stocks returned 21% annually, compared with the most expensive 10%, which returned 8% annually.

Mistake: Investing only in big companies. Because his company is huge, Buffett finds it more convenient to buy big companies. Otherwise, to put Berkshire’s assets to use, he would need to own a great many small companies and it would be difficult to watch so many as closely as he would like. The result would be an unwieldy portfolio that would be too hard to manage. But ordinary investors should hold at least some small-company stocks. According to Fama and French, the smallest stocks in the market produce the biggest returns. During the 27-year study, the smallest 10% of stocks grew more than six times, while the largest 10% returned less than half as much.

Mistake: Favoring losers. As a value investor, Buffett often buys unloved stocks, picking up shares that have fallen. He shuns growth stocks that have been embraced by the markets. But investors seeking to build diverse portfolios should include at least some growth stars as short-term holdings.

When stocks have climbed for six months, they have tended on average to continue climbing for the next 12 months, according to a study by Narasimhan Jegadeesh, PhD, professor of finance at Emory University, and Sheridan Titman, PhD, professor of finance at the University of Texas.

Investors who take advantage of the short-term moves of growth stocks must be prepared to trade quickly. Studies indicate that after 12 months, the growth stars begin to lag.

Mistake: Holding for life. After buying a stock, Buffett holds it indefinitely. If the shares climb sharply, he still won’t sell. And if the company doesn’t show earnings growth, he still hesitates to sell. Buffett often refrains from selling because he believes that it is difficult to tell the right time for unloading a stock. Rather than making mistimed moves, he holds.

Because most investors, especially those near retirement age, can’t wait the decades that Buffett is prepared to wait, they can’t be so patient. Expensive shares with shaky earnings can deliver disastrous short-term results.

Before buying a stock, Buffett estimates its intrinsic or fair value. This requires projecting the company’s cash flow into the future and then “discounting” it to the present using an appropriate interest rate that takes the risk of the investment into consideration.

Measuring fair value precisely isn’t easy, but there are ways to estimate when a stock’s price has become too rich. Start by comparing the stock’s p/b to those of the company’s competitors. If the stock commands a relatively high multiple, then it could be priced above fair value. Additional check: Compare the stock’s current p/b to those from the past. When a stock’s p/b exceeds its typical historical level, it is another sign that the price may be too high.

Mistake: Sticking with what you know. Buffett prefers buying companies that are easy to understand. Until recently, he bought only US companies. He still has very little international diversification.

Unlike Buffett, most investors should use more international diversification. Their portfolios should include shares from the emerging markets of Asia and Latin America. Overseas markets don’t always move in lockstep with Wall Street.

For convenience, consider owning foreign shares by buying mutual funds or American Depositary Receipts (ADRs), foreign issues that trade on US exchanges.

Do Buy Utilities Like Buffett

Until recently, Buffett rarely bought utilities. Now he’s beginning to invest in power companies. You should, too. Utility companies should be a core holding in most investors’ portfolios.

Reasons: The best utility companies can generate steady cash flow. Companies with strong cash flows are able to pay their bills and invest in expanding their businesses. Many utility companies also provide solid dividends. These can provide investors with steady income, an important consideration during times when share prices are falling and portfolios are not producing capital gains.

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Bottom Line/Retirement interviewed Vahan Janjigian, editor, Forbes Growth Investor, 60 Fifth Ave., New York City 10011. 12 issues. $197/yr. He is author of Even Buffett Isn’t Perfect (Portfolio). From its inception October 6, 2000, through December 31, 2009, the Forbes Growth Investor model portfolio returned 74.78%, compared with -20.87% for the S&P 500.

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Sheila Buff
When was the last time you bought a really good-tasting tomato from the grocery store? Weather permitting, you can grow a bumper crop of your own, much more delicious tomatoes this year and use them for salads, sauces and other recipes — and give them to grateful friends. Almost anyone can do it, even if you don’t have enough space for a garden. How to go about it…

CHOOSE THE RIGHT VARIETIES

The typical garden catalog might offer 10 to 20 tomato varieties — a specialty catalog might offer several hundred.

Not every tomato variety will grow well in every garden, but there are some stalwart varieties that are easy to grow, disease resistant and produce large crops of delicious tomatoes just about anywhere. Some top choices found in catalogs and garden centers…

• Small fruits — cherry tomatoes. Riesentraube, Sugary, Sun Gold (yellow), Sweet 100.

• Medium fruits — salad or slicing. Better Boy, Big Boy, Box Car Willie, Celebrity, Early Girl, Flammé (orange), Lemon Boy (yellow), Matina, Paul Robeson (black), Sioux.

• Large fruits — beefsteak. Brandywine varieties, German Johnson, Goliath, Mortgage Lifter.

Most tomato varieties will do reasonably well anywhere, but if you have a short, cool growing season — or a long, hot, and humid one — choose varieties that are best for your area.Good medium-sized red choices for short seasons — Early Girl, Jetsetter, Stupice. Good medium-sized red choices for long, hot seasons — Homestead, Porter’s Pride, Solar Fire, Sunmaster.

PLANT METHODICALLY

Tomatoes like good soil with lots of organic material (humus) in it, a fair amount of room, and plenty of warmth and sunshine.

Tomatoes hate the cold, so plant them after the last frost for your area (check with your local county extension or farm bureau to find the date for your area). Also, choose a spot that will get at least six hours of full sun every day.

If you grow your own seedlings, start the seeds indoors about six to eight weeks before the last frost date in your area.

Space the seedlings two to three feet apart (in all directions) or one plant per pot if you are using containers. Dig a planting hole six to eight inches deep or more — it should be deep enough to hold the roots and the stem of the seedling up to the first set of true leaves (not the small rounded leaves closest to the roots). Planting deeply helps your tomato plants develop strong roots, which will help them flourish.

Place a stake by each plant now, so you won’t disturb the roots later on when the plant is bigger. As the plants get taller, tie them loosely to the stakes with string or twist ties. This keeps fruit and foliage off the ground, making it easier to find and pick the tomatoes — and also keeps the branches from breaking under the weight of the fruit.

To keep down weeds, insects and plant diseases, and to help conserve moisture, cover the soil around the plants with a thick layer of organic mulch, such as dead leaves, grass clippings, straw, shredded newspaper — or use black plastic sheeting or landscape cloth.

Tomatoes in soil that has been enriched by organic gardening methods don’t usually need added fertilizer. If your soil isn’t as good, your tomatoes may need some help. Apply natural fertilizers, such as compost tea (soak a shovelful of compost overnight in a gallon or two of water, then pour off the water around the plants) or fish emulsion, available at any garden center, when the seedlings are first planted, again when the first blossoms appear and again when the first fruits start to turn light green. If you want to use a manufactured fertilizer, Miracle-Gro for tomatoes has the best mineral balance.

WATER DEEPLY AND OFTEN

The true secret of growing perfect tomatoes is watering them deeply and often. The best way to water is with soaker or drip hoses along the bases of the plants. These get the water down to the roots without wetting the foliage and fruit, where it can cause mildew and other diseases.

Tomatoes need to be watered on a regular basis. Check the moisture level every few days by digging down a couple of inches. If the soil is dry below the surface, you need to water.

Tomatoes need roughly two to three gallons of water applied per plant per week — more if it’s very hot and dry, less if it’s been rainy. If you use soaker hoses, let the hoses run for two to three hours. To hand water, gently apply about a quart of water around the base of the plant, let it soak in and then repeat once or twice more.

If your tomato plants start looking badly wilted or yellowed even though you’ve been careful about watering regularly, chances are a tomato disease is at work. Once these problems turn up in your garden, they’re there for good. Avoid them in the future by selecting resistant varieties. Resistance to the most common tomato diseases is indicated by these letters after the variety name on the seed packet or label on the container (if you bought seedlings)…

• A stands for Alternaria arborescens fungus.

• F for Fusarium wilt.

• N for nematodes (tiny worms that attack roots).

• T for tobacco mosaic virus.

• V for Verticillium wilt.

Check with your local county extension agent or farm bureau to find out more about specific tomato diseases in your area and for help identifying what’s hurting your plants.

HARVESTING YOUR CROP

For best flavor, pick your tomatoes when they’re still two or three days away from being fully ripe. Let them finish ripening indoors on a countertop away from direct sun. Homegrown tomatoes will often have some green at the stem end even when they’re ripe. They may also still have some green on the shoulders. Pick them anyway — by the time they turn completely red, if left on the vine, they will be overripe. Most important of all: Never put tomatoes in the refrigerator! Their taste and texture will be ruined.

TOMATOES FOR SMALL SPACES

No space for a garden? If you have a balcony, patio, porch or a sunny window, you can still enjoy homegrown tomatoes.

The secret is to choose a variety designed for container growing. These varieties are all small, compact plants with small fruits that will grow well in pots or even hanging baskets. The most popular variety is called, unsurprisingly, Patio. Other container favorites include Florida Basket, Red Robin and Sprite. For really small spaces, try Tiny Tim — the plants grow to only 18 inches — or Micro-Tom, the world’s smallest tomato variety. These plants grow to only eight inches. For tomatoes in containers…

• Use the largest container possible for the space.

• Pick the sunniest spot.

• Protect the plants from wind by putting them in a sheltered spot or putting a windproof screen around them.

• Fertilize as needed.

• Water often, daily if necessary. Plants in containers dry out quickly. Check the soil daily for moisture.

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Bottom Line/Retirement interviewed Sheila Buff, author of several books on gardening, natural history and the outdoors, including The Great Tomato Book (Burford Books). Ms. Buff lives in Milan, New York. www.sheilabuff.com.

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Zindel Segal, PhD, CPsych
Centre for Addiction and Mental Health

Suffering from depression is very different from being sad. Sadness is a normal part of life. Depression is a constellation of psychological and physical changes that persist, unrelenting, for a minimum of two weeks — and often much longer.

One of every eight women and one of every five men will suffer at least one bout with serious depression at some point in their lives. Genetics seem to predispose some people to depression, though life events can be a factor as well. Seniors who experience losses in physical functioning and social networks can be especially susceptible to bouts of depression.

For those affected, depression often becomes an ongoing issue — those who have faced it once have a 40% chance of experiencing an episode in the future and those who already have had multiple episodes face up to an 80% chance of additional recurrences.

Depression is most commonly treated with medication that regulates the brain’s chemistry and with professional counseling, which helps people take effective action in the face of the low motivation and pessimism that often define depression.

Exciting new tool: In the last decade or so, a new technique has been shown in studies to help sufferers head off depression before it takes hold. The technique is called mindfulness — paying attention to the present moment, without judgment, in order to see things more clearly.

LIFE ON AUTOMATIC PILOT

Mindfulness can prevent depression from taking hold of us because the alternative — our usual state — is that we operate on “automatic pilot.” Our minds are elsewhere as we perform mundane activities. Example: You’re taking a shower, but wondering what’s waiting in your e-mail.

If we let it, this automatic pilot also will select our moods and our emotional responses to events — and the responses it chooses can be problematic. For instance, if you make a minor misstep in some area of your life, your autopilot might select as your emotional response feelings of anger, failure and/or inadequacy, even though the event might have been completely inconsequential.

Because your mind is not paying full attention to the situation, you might not grasp that the negative feelings are greatly out of proportion to what’s really going on. You only know that you feel bad. When these negative feelings persist, they can pull you into the downward spiral of depression.

Example: A friend mentions that one of the stocks in his portfolio has turned a profit. Your investments have not been as successful, and your autopilot selects inadequacy as your primary emotional response. This may sound like an overreaction, but in someone who is prone to depression, these feelings can expand into a full-blown episode.

Mindfulness can be an antidote to automatic pilot. By becoming more aware of the world around us, we experience life directly, not filtered through our minds’ relentless ruminations. We learn to see events for what they are rather than what our autopilot might turn them into. That helps us to derail potential episodes of depression before they have a chance to take hold. It typically takes two weeks or longer for depression to fully sink in, so there is often plenty of time to stop the process.

BECOMING MINDFUL

Learning to be mindful involves more than simply paying attention. You must reorient your senses so that you experience a situation with your whole mind and heart and with all of your senses.

Try it out: Pick up a raisin. Hold it, feel it, examine it as if you had never seen anything like it before. Explore the raisin’s folds and texture. Watch the way light shines off of its skin. Inhale its aroma. Then gently place it on your tongue. Notice how your hand knows exactly where to put it. Explore the raisin in your mouth before biting. Then chew once or twice. Experience the waves of taste and the sensation of chewing. Notice how the taste and texture change as you chew. Once you swallow, try to feel the raisin moving through your digestive system.

Keep it up: Practice the following three steps every day to make mindfulness a regular part of your life — and episodes of depression less likely…

1.Focus on your breath. Focusing your attention on your breath is perhaps the simplest, most effective way to anchor your mind in the moment. You think only of this breath. You can do this anytime, anywhere.

2.Watch your thoughts drift by like clouds. See them, acknowledge them, but do not attempt to reason them away. Some people attempt to use logic to escape depression. They tell themselves, My life is pretty good — I should be happy. This just leads to troubling questions like If my life is good, why am I so unhappy? What’s wrong with me?

It is also tempting to try to push negative thoughts away so that you don’t have to deal with them at all. Unfortunately, the thoughts are still there even if you refuse to acknowledge them.

Better: When you feel bad, reflect on what is bothering you. Try to uncover the original thought or event that set off your bad feelings. Then view it as just a thought, something independent from you even though it has popped into your head. Do not dismiss it, though. Even if the thought or the event that caused it was trivial, the feelings it has prompted are real and significant.

Next, notice any physical sensations that you are experiencing. Does your throat feel tight? Is your mouth dry? Are there butterflies in your stomach? Just as you are learning to watch your feelings float by, watch these physical sensations in a detached way. If you can learn to spot the onset of these sensations, you will be able to identify the early signs of depression sooner — and head off the bad feelings before they take root.

3.Take action. Ask yourself: Does this thought have any merit? Is it connected to negative thoughts that I have had in the past? What can I do to make myself feel better about this issue?

Example: You feel depressed about your work life even though you are doing fine in your job. When you reflect on these negative thoughts, you realize that they began recently, when you learned that your brother received a promotion. You feel left behind because it has been some time since your last promotion.

What actions could you take to allay these negative feelings? Perhaps you could speak with your supervisor about your job performance and your prospects for future promotions… or contact a headhunter to remind yourself that you have other options.

With any problematic thought, identifying it quickly and taking some positive action is often enough to head off depression.

Important: Learning the mindfulness approach can be useful for preventing future bouts of depression — not for combating an episode that is already under way. When people are in the midst of depression, they typically cannot concentrate sufficiently to practice mindfulness. It is better to use the technique between episodes of depression so that it becomes a natural part of your thought process.

WHERE TO FIND HELP AGAINST DEPRESSION

For information about depression and links to local support, contact…

• National Institute of Mental Health, 866-615-6464, www.nimh.nih.gov.

• National Alliance on Mental Illness, 800-950-6264, www.nami.org.

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Bottom Line/Retirement interviewed Zindel Segal, PhD, CPsych, the Morgan Firestone Chair in Psychotherapy at the University of Toronto, and head of the Cognitive Behavioural Therapy Unit at the Centre for Addiction and Mental Health, both in Toronto, Canada. He is a coauthor of The Mindful Way through Depression: Freeing Yourself from Chronic Unhappiness (Guilford).

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Russell K. Portenoy, MD
Beth Israel Medical Center

Every day, 36 million Americans take an over-the-counter (OTC) painkiller, usually acetaminophen (Tylenol), ibuprofen (Advil, Motrin) or aspirin.

We take those medications to stop a headache… ease an arthritis flare-up… soothe a sore shoulder after a weekend of yard work… or relieve any one of the everyday aches and pains that inevitably disrupt our lives.

But do you know which painkiller to take first for maximum effectiveness and safety?

Here are the latest guidelines…

HOW painkillers WORK

All three of the most common pain relievers — acetaminophen, ibuprofen and aspirin — reduce the production of cyclooxygenase (COX) enzymes. These enzymes play a key role in the formation of prostanoids, biochemicals that sensitize the nerve fibers that produce pain and trigger inflammation.

What you may not know: There is no “best” OTC painkiller for every pain problem. That’s because not everyone responds to pain relievers in the same way — none of these drugs works consistently for everyone or for every type of pain.

You may find that ibuprofen relieves your headaches, but it may do nothing for your spouse, who swears by aspirin when his/her temples start to throb.

Even if ibuprofen works for both your and your spouse’s headaches, the amount each of you needs for pain relief may be different — and the amount that one person needs may cause a distressing side effect that never troubles the other. How can you determine the right drug and dose for you, and you alone? Follow the three-step plan below.

Important: This self-care plan is best for relief of mild-to-moderate acute pain, such as a toothache or headache. It is not appropriate for chronic pain. Long-term use of any painkiller should be monitored by a doctor because of the risk for side effects. All dosages listed are for adults. Also, don’t use products that combine two or more of these ingredients, such as Extra-Strength Excedrin, which includes acetaminophen and aspirin. Combination products have not been proven to work any better and may have an increased risk for side effects.

START WITH ACETAMINOPHEN

Because there’s no way to tell which OTC painkiller will work best for you, it’s sensible for most people (though not all) to start with the safest — the one that decades of clinical use has shown poses the lowest risk for side effects. That drug is acetaminophen.

Starting dosage: 500 milligrams (mg) to 1,000 mg.

Maximum dosage: Two extra-strength 500-mg capsules, four times daily. If you take acetaminophen repeatedly over many days, don’t exceed 4,000 mg a day.

Warning: The biggest risk from acetaminophen is liver damage, which can occur when more than the maximum dosage is taken. Don’t use acetaminophen at any dosage without a physician’s supervision if you have a liver disease, such as hepatitis C, or a history of heavy drinking (three or more drinks a day). Although ibuprofen generally would be preferred over the other painkillers in these cases, all painkillers have added risks for people who have liver disease or who are heavy drinkers.

If you haven’t been drinking heavily for several months, it is probably safe to use acetaminophen unless there is a history of liver damage.

NEXT, TRY IBUPROFEN

If acetaminophen doesn’t relieve your acute pain, switch to ibuprofen or one of the other nonsteroidal anti-inflammatory drugs (NSAIDs), such as naproxen (Aleve) or ketoprofen (Actron).

Starting dosage: 200 mg to 400 mg.

Maximum dosage: Use of more than 2,400 mg daily requires monitoring by a physician because high dosages can cause serious side effects.

Precautions: Like all NSAIDs, regular use of ibuprofen can damage the gastrointestinal tract, causing problems ranging from heartburn to bleeding ulcers. Other possible side effects…

• Kidney damage, with swelling of the legs, worsening of high blood pressure and/or kidney failure.

• Risk for blood clots, which increase the likelihood of angina, heart attack and/or stroke. If you have unstable angina (not effectively controlled with medical care), PAD (narrowing of the arteries in the legs) or have had a heart attack, a transient ischemic attack or a stroke, or have otherwise been diagnosed with cardiovascular disease, do not take ibuprofen regularly. The more severe the circulatory disease, the greater the need for caution with ibuprofen. Acetaminophen is probably the better choice, but talk to your doctor.

ASPIRIN IS the LAST choice

If acetaminophen and ibuprofen don’t work, you can try switching to aspirin, with the understanding that aspirin is the most likely of these drugs to cause side effects in most people.

Starting dosage: Two 325-mg tablets.

Maximum dosage: Do not exceed 4,000 mg daily.

Precautions: The greatest risk with aspirin is bleeding ulcers.

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What’s scarier — dying of cancer or paying for cancer treatment? It sounds like the punch line to an unfunny joke, but in fact, Americans are divided about half and half when asked to answer that question, according to a recent survey commissioned by the Community Oncology Alliance (COA).

Even if you have what you consider to be good health insurance, the financial burden on cancer patients can be overwhelming, notes Deborah E. Hoffman, MSW, LCSW, associate director of the Shapiro Center for Patients and Families at Dana-Farber Cancer Institute (www.dana-farber.org) in Boston. Most insurance policies have significant limitations, yearly caps and lifetime maximum payouts that can create financial disaster. Even middle-class professionals are not immune from the pressure. In 2007, three out of four Americans who filed for bankruptcy cited medical expenses as a key factor even though most had health insurance and were well-educated, owned homes and held good-paying jobs… and that number has been going up, not down.

However, there is help to be had. An increasing number of medical institutions are realizing that financial help for patients can be nearly as important as medical help. At Dana-Farber, for example, cancer patients are now offered free financial coaching from the Financial Planning Association of Massachusetts (www.fpama.org) to help figure out how to handle medical costs, debt and other issues.

Ask For Help — It’s Available

While not every medical center is equipped to offer full-service counseling such as that offered by the Dana-Farber program, most do have specialists on hand to help you overcome the daunting financial obstacles that accompany cancer – a list of challenges that may include how to cover the cost of required treatment versus available coverage… unexpected out-of-pocket expenses, often including the need to travel some distance for treatment… how to afford complementary and alternative treatments that are often not covered by health insurance… lost income, etc. Though it can be difficult to focus on anything but how to get better, the best strategy is to begin looking at treatment costs as soon as you can after diagnosis — or ask a capable family member or friend to do so. Follow these steps to help stay on top of cancer costs…

• Meet with your hospital’s designated professional (the title may be something like “financial information officer” or “resource specialist”) to discuss your practical concerns. He/she will be familiar with what’s available to help with your financial burden. It’s important to neither overstate nor understate your financial health, as some assistance is based on need.

• Ask your insurer to assign you to a case manager. It’s usually easier to call a particular person with your questions about billing and coverage than to shuttle from one person to another each time you call.

• Learn the details of what your health plan will pay for and what it won’t cover. For example, take note of the amount of your deductible (what you must pay before your coverage kicks in)… the covered length of any hospital stays (some pay for only 30 days, others for more)… annual or lifetime coverage limits (most plans have such limits on what they pay toward treatment for specific health conditions)… co-pays (the cost you are expected to cover at each visit)… and whether or not you are covered by another policy, such as your spouse’s, and if so what are the different percentages each insurer will cover.

• Stay in close touch with your insurer. Even if the firm denies a claim or says it will not cover a particular treatment, keep asking… and ask your doctor to call on your behalf, too. The first answer isn’t always the final answer — for instance, if you’ve been denied coverage for a type of treatment, it may help if you’re able to provide evidence from your physician that it is most effective for your type of cancer.

• Explore supportive programs and possible no-cost services. Depending on your income, you may be eligible for free or low-cost drugs from pharmaceutical companies or treatment from providers. Cancer institutes such as Dana-Farber also have access to donor funds to help strapped patients with hidden cancer costs, such as paying for transportation, gas, parking and meals associated with hospital visits. Also, many private and hospital foundations provide assistance with treatment costs as well. Ask your specialist to outline the possibilities.

• For particular types of cancer, these organizations may provide additional financial support:
  

  The Leukemia & Lymphoma Society
  800-955-4572
  www.lls.org

  The CancerCare Co-Payment Assistance Foundation
  866-552-6729
  www.CancerCareCopay.org

  The HealthWell Foundation
  800-675-8416
  www.healthwellfoundation.org

• Maintain your liquidity. The standard financial advice to pay off credit card balances may not be the right path for those who have cancer. It’s an expensive disease to treat, and during this time, it might make sense to make only minimum payments and keep higher credit lines available to pay bills.

• See a financial professional. A financial planner can assist you with matters like budgeting, debt management, estate planning and insurance. If you have extensive credit card debt, a credit counselor can help you bundle three or four credit card payments into one monthly amount and, depending on your circumstances, negotiate for smaller or suspended payments.

• Get a patient advocate. The nonprofit Patient Advocate Association (www.patientadvocate.org or 800-532-5274) offers free case-management services to help resolve insurance and financial difficulties.

Source(s):Deborah E. Hoffman, MSW, LCSW, associate director, Shapiro Center for Patients and Families, Dana-Farber Cancer Institute, Boston, Massachusetts.
Bottom Line’s Daily Health News

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Truth #1 – It is going to take some work on your part to succeed. If you have done some research into tax lien certificates and tax deeds you may have heard some so called “gurus” bragging about how easy it is to make a fortune. While it is easier and safer than many investments, it doesn’t come without some work on your part. You need to learn about the business and you need to invest some of your time to succeed. The good news is that with less work than most traditional investments you can get substantially higher returns while exposing yourself to less risk.

Truth #2 – There are hidden treasures for those that are persistent. You’ve heard the stories I’m sure. An investor buys a tax lien certificate at auction, the owner doesn’t redeem, and the investor ends up with 25 acres of land for the low price of 68 dollars.

First let me say that these sorts of things do happen and more often than you think. I personally know the gentlemen who bought the previous piece of land for 68 dollars. But you can be sure that it did not happen the first time at the auction. With some persistence and a little bit of experience you can get better at finding the jackpots.

Truth #3 – Most properties at auction do have real value. There are a lot of reasons that a property can end up at auction. The common misconception is that most of the properties do not have any real value. True – there are properties on the auction that seem worthless, and to many, they are – but to the creative investor they are literal gold mines.

Think outside the box. Put your mind to work and you’ll discover that there are a lot of things you can do with the property that no one else wants. By being creative you give yourself an advantage over 99% of the people at the auction. Now cash in on it!

Invest some time and money into the business and you will discover that there are huge returns waiting.

For more Investing tips & info visit:
http://www.bruisedonion.com/guide/investing/

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