Monthly Archives: June 2021

“But” vs “And”

Two three–letter words: “but” and “and.” In grammatical terms, they are called conjunctions. They bridge two clauses of a single sentence together. In communication (and negotiation), these words are subtle manipulators of exclusion or inclusion. Generally speaking, “but” excludes, denies, discounts or in some way rejects the previous clause. For example, the statement “she is a very productive employee but she can be a bit demanding” is subtly different than “she is a very productive employee and she can be a bit demanding.” In the first example, the “but” tends to convey a negation of the first clause of the sentence in favor of the second clause of the sentence. In the next example, the “and” tends to convey an inclusion of the first clause along with the second clause.

Take another example: “Yes I understand you need to meet with me before tomorrow’s meeting but my schedule is packed full” vs. “I Yes I understand you need to meet with me before tomorrow’s meeting and my schedule is packed full.” In this example, by using “and” instead of “but” the speaker not only avoids negating the initial clause but also conveys to the listener that his/her concerns about needing to meet are acknowledged.

Using “and” is also a much softer way to say no. For example, the typical “yes, but” can easily be replaced with “yes, and.” For example, the request “We need to purchase new computers” can be responded to with “yes I know, but we can’t until next year” or “yes I know, and we can’t until next year.” The “and” does not negate the “yes” whereas the “but” does tend to convey a sense of canceling out that which preceded the “but.”

The use of “but” is extraordinarily common. In fact, few people actually recognize the subtle influence of using but. If you were to consciously attempt to change “but” to “and” in your speaking, you will notice how odd it feels. But, it is a worthwhile exercise if for no other reason than to become more comfortable with the ability to switch from one to the other. However, there can be a more important reason: using “and” instead of “but” can positively influence dialogue. When using “and” instead of “but” there is a sense of inclusion and acceptance even if the conclusion is a denial or refusal.

Try it out over the next several days. Listen to others’ sentences and when you hear “but” change it in your own mind to “and.” Then, start listening to your own sentences. When you hear yourself about to say “but” change it to “and” but remember one thing…oops…and remember one thing…

Understanding the Different Classes of Firewalls

For the enforcement and the tight control of security and the flow of traffic within and given network or between networks, the firewall is one very important piece of software and also hardware that is entrusted with these functions. An understanding of how the firewall is able to achieve its functions through the capabilities a firewall is able to provide. These are the capabilities which determine the type of firewall to be sourced to meet a certain and specific set of security needs.

Most of the firewalls will work through the packet filtering method which is one of the most effective methods of implementing security for the network through validation of data packets. The validation of the data packets is usually based on a number of factors which are the destination and the source internet protocol (IP) addresses, protocol, type of service, the source and the destination ports and port numbers, the differentiate services code point, the time range and a host of other parameters associated with the internet protocol header. These criteria are usually tested and matched for all individual packets so as to guarantee or deny these packets. This packet filtering comes about or rather is implemented through the use access control lists (ACL) which are found on switches and routers. The ACl has the advantage of being very fast when coupled with the application specific integrated circuit. Having seen these features of the packet filtering firewalls, the most obvious strong point for this type of firewall is that it is most common and can be found in about every component of the network. The packet filtering firewall is found in switches and routers as mentioned earlier, the wireless access points, the virtual private network aggregators are other devices on the network which use this type of firewall. The downside with the packet filtering firewall is that it is static and has been exploited by hackers who channel suspicious traffic through the TCP 80 port which grants unobstructed access.

The proxy firewalls also called the application firewalls work on a more complex model which can be explained by the Open System interconnection (OSI). This model seeks to explain the   transmission  of information from one computer to another application on a second computer. The information is passed through layers to make sure security is not compromised. The information according to the OSI model is passed through seven different layers starting with the application layer (7th layer) which is usually the interface in the form of programs used on the computer. The next layer is the presentation layer which is the translator between systems and converts the application layer information to a format acceptable to various different systems. Encryption is done in this layer.

The session layer is the fifth and manages service requests between computers. The transport layer provides reliable ordering and communication of data by preparing the data for delivery to the network  transmission  control protocol. The third layer is the network layer at which data is referred to as packet and this layer is responsible for routing and IP addressing. The data link layer handles the reliability of data which at this point is referred to as a frame. Finally, the first layer is the physical layer which is now composed of the devices which we can see as well as their electrical characteristics. The application firewalls work at layer seven which is the application layer just as the name suggests and they give a buffer often acting on behalf of a client. It is also patches easily in case vulnerabilities are identified. The only disadvantage is that they are slow in the manner that they handle data and traffic.

The next type of firewall is the reverse proxy firewall which will work in a similar manner to the application firewall. The difference lies in that the reverse proxy firewalls are deployed for the servers and not clients as in the case of application servers. The effectiveness of this firewall lies in the reverse proxy understanding how the application behaves and the intelligence to do away with problems like the buffer overflow.

A last form of firewall is the packet inspection firewall which takes care of session information and is even able to perform deep packet inspection to enforce compliance and scan for viruses all the time making sure that operation speed is superb.

These are the basic types of firewalls and which are chosen dependent on security needs and on to which many features have been added by different security vendors to make them better adapted for use.

Finding Gas Scooter Parts

From time to time pretty much any vehicle will break down or have mechanical issues and need to be fixed – that’s a given. This is true of electric or gas scooters and motor bikes. This can get expensive, especially if you have to pay for both the parts and the labor. If you are mechanically inclined, you might be able to fix a lot of problems on your own, as long as you know what is wrong with your scooter and what parts are needed to fix it.

There are many ways to get gas scooter parts. You can always go the easy route and take the bike to a mechanic, who will be able to both get the necessary parts and fix the bike. This is probably the most expensive way to go however. You can also go to a parts store and see if they have whatever you need. They may or may not have it, but most times they will be willing to order it for you.

The easiest thing to do might just be to go on the internet and order the part from the comfort of your own home. There are a number of websites that sell scooter parts, and most make it easy for you to locate just the right part. They allow you to search by the part or by the make and model of your bike so that you can make sure you choose the right thing. You might have to pay a shipping charge, but if you find the parts on sale somewhere you could end up saving money even with the shipping.

Whether you need a starter or a part for your   transmission , you can find what you are looking for on the internet. Even if you don’t have one of the new models of gas scooters or electric bikes, you are likely to be able to find what you need with a little bit of searching. Searching the internet is much easier than going to a lot of different parts places looking for what you need, so this is probably the best way to go if you want to purchase the parts to do a repair on your own.

Heartburn Can Be Easily Cured

Do you suffer from heartburn, reflux or burping? Perhaps you rely on a medicine to help settle your tummy. I have written on digestive disorders on several occasions previously, but this time I would like to write specifically on a little bacterium called Helicobacter pylori. Helicobacter pylori bacterial infection is recognised as the most prevalent bacteria to infect the human population in the entire world. You may well identify the following problem, and if you do, don’t despair. It actually is possible to free from heartburn, reflux or a low grade queasiness, which affects so many people.

Helicobacter is a clever little bug

In 1982, when Australian Dr. Barry Marshall identified a new bacterium called Helicobacter pylori (HP) as an infectious agent responsible for peptic ulcer disease, it completely transformed medicine’s understanding of the microbiology and disease of the human stomach. Your stomach is protected from its own gastric juice by a thick layer of mucous that covers the stomach lining. HP takes advantage of this protection by actually living in the mucous lining. Once this clever little bug is safe in this mucous, it is able to fight the stomach acid that does reach it with an enzyme it possesses called urease. Urease converts urea, of which there is an abundant supply in the stomach (from saliva and gastric juices), into bicarbonate and ammonia, which are strong (alkaline) bases. This creates a cloud of acid-neutralizing chemicals around the H. pylori, protecting it from the acid in the stomach. This cloud is also part of the reflux and burping process that occurs, which many HP people complain of.

Contributing to the protection of HP is the fact that the body’s natural defenses cannot reach these bugs in this mucous lining of the stomach. The immune system will respond to an HP infection by sending “killer T-cells”, (white blood cells), and other infection-fighting agents. However, these potential H. pylori eradicators cannot reach the infection, because they cannot easily get through stomach lining. They do not go away – the immune response just grows and grows over time. White cells die and spill their destructive compounds onto cells lining the stomach lining. More nutrients are sent to reinforce the white cells, and the H. pylori can feed on this. Within a few days, gastritis and perhaps eventually a peptic ulcer results in the lining of your tummy. And of course, the person who suffers is often blissfully unaware, takes an antacid or an acid-blocking drug long-term, and continues to eat and drink foods which only aggravate the healing process long term. So they go back to the doctor, only to be told to stay on the medicine. After a few years, the person resigns themselves to the fact that they will always require this “medicine” to cure their condition. Yeah right, and Alice lived happily after in Wonderland.

To confirm that HP caused the gastritis and peptic ulceration, Marshall swallowed cultures of the bacteria and contracted gastritis (inflammation of the mucus membrane of the stomach). He then underwent endoscopy (internal examination of the stomach), and provided biopsies from which the suspected bug was re-isolated.

Changing medical belief and practice takes time. For nearly 100 years, scientists and doctors thought that ulcers were caused by lots of stress, spicy foods, and copious alcohol. Treatment involved bed rest and a bland and boring diet. Later, researchers added stomach acid to the list of causes and began treating ulcers with antacids when they became fashionable.Unfortunate for poor Barry, nobody believed him. In fact, he was actually treated with ridicule and disdain when he first proposed the idea that a bacteria actually lived the hostile environment of the stomach. Before 1982, the accepted medical paradigm was “no acid, no ulcer”, and that stomach ulcers only occurred when excess acid damaged the stomach wall and that all treatment should be aimed at reducing or neutralising all that bad acid. Surely you remember the advertisements on TV with the man drawing on his tummy with a felt tipped pen, telling you that the acid has to “stay down there”. These commercials generally came on after dinner, the time when your tummy is most likely to play up, I can’t help but thinking how many of those sufferers possibly have an undetected H.pylori infection. There is still a lot of drug promotion regarding this acid reflux problem. Unfortunately, many such patients today are still seen as having “too much stomach acid”, and treated with antacids or stomach-acid blockers as front-line therapy, when in my clinical experience actually the opposite applies, they don’t have enough or have an infection which needs sorting. Gastric juice is composed of digestive enzymes and concentrated hydrochloric acid, which can readily digest food or kill microorganisms. Low levels of stomach acid increase the chance an organism’s survival. It used to be thought that the stomach contained no bacteria and was actually sterile, and it took an Aussie GP to prove all the world’s experts wrong.

It seems pretty silly to treat the acid problem perpetually, without enquiring into actually why this burping, reflux and upper abdominal discomfort is occurring in the first place. Albert Szent Györgyi, (1937 Nobel Laureate in Physiology and Medicine) said that: “Discovery consists of seeing what everybody has seen and thinking what nobody has thought.” Today it is an established fact that most cases of peptic ulcers and gastritis, diseases that affect millions of humans worldwide, result from this HP infection, and not “too much acid” in the stomach at all.

“Discovery consists of seeing what everybody has seen and thinking what nobody has thought.” Albert Szent Györgyi

HP infection and prevalence

H. pylori is believed to be transmitted orally. Did you wash your hands? Many researchers believe that HP is transmitted orally by means of fecal matter through the ingestion of tainted food or water. In addition, it is possible that H. pylori could be transmitted from the stomach to the mouth through gastro-esophageal reflux or belching, all common symptoms of gastritis. The bacterium could then be transmitted through oral contact.

HP infection remains a huge problem, is extremely common and infecting more than a billion people worldwide. It is estimated that half of the American population older than age 60 has been infected with H. pylori at some stage and the economic effect of ulcer disease in the US (as measured back in a study of 1989 data) showed that the illness cost then nearly $6 billion annually. ($2.66 billion for hospitalisation, not including doctor ‘s fees), outpatient care ($1.62 billion), and loss in work productivity ($1.37 billion).

One in five Aussies and Kiwis have HP, according to Dr. Barry Marshal, infection usually persists for many years, leading to ulcer disease in 10 % to 15% of those infected. H. pylori is found in more than 80% of patients with gastric and duodenal ulcers. You can imagine what this common complaint in NZ and Australia is costing, in terms of medication, doctor’s visits and lost productivity at work. Early research on HP characterised much of the work to come, the data that emerged from the study of all these samples was quite unexpected. It showed that HP is actually a common bacterial agent and that an amazing 30-50% of the world’s population are colonised with it.

How do you know if you have the HP bug?

The infection manifests differently in different individuals. In some people, it produces more acid in the stomach, and ulcers may result. In others, stomach acid suppression or complete lack (which we call achlorhydria) may result, and these people may be at a greater risk of gastric cancer. It is unclear why some people respond one way or the other.

Typical manifestations of a Helicobacter pylori infection:

· Nausea, or a low-grade feeling of being queasy. Could be vomiting.

· Avoidance of chilli, garlic or a specific food which “does not agree” with your tummy.

· Bloating worse after meals. Feeling worse after meals or certain foods.

· Recurring abdominal pain, intestinal cramps.

· Peptic or duodenal ulcers (over 90% of all cases have HP)

· Burping, this can be pretty bad. The person may have developed a reputation!

· Heartburn, and perhaps reliant on Quick-Eze or Gavascon, Losec, etc.

· Diarrhea or constipation after several years of infection.

· Disturbed sleep, perhaps waking up with a hollow feeling or heartburn. I have known some patients to prop up the head of the bed with a few bricks even.

· Symptoms worse at night, or worse lying down.

· Vitamin B12 deficiency. Have your practitioner test for this, you may well be deficient.

· Altered appetite, some times you may feel like eating, other times you don’t.

· After being infected for several years, you may have develop mineral deficiencies which can lead to a myriad of health problems.

· Helicobacter pylori is implicated in Hashimoto’s thyroiditis.

· Migraine headaches (40% of migraine sufferers are positive, and eradication subsides the headaches).

· Acne rosacea. Helicobacter pylori is suspected of causing rosacea (eradication of HP often results in a significant reduction in rosacea symptoms).

Is it any wonder how an ailing stomach is supposed to do its job, i.e., digesting and absorbing foods efficiently when a bacterial infection is causing such dysfunction? Your doctor may have initially prescribed a medicine such as Losec, Gavascon or Mylanta for your stomach, serving to block acid or dilute it. How is your tummy supposed to work at all now? Then you go back and complain that the symptoms are unchanged. What then? You can see what I mean, after many years of this infection you can feel quite unwell. I see one person or more each week like this, and have done so for many years. When I wrote an article to our local newspaper several years ago regarding HP, I received nearly ten calls. And almost al these patients had a HP infection, all were on either Losec, Quick-Eze, Gavascon or Mylanta.

Conventional HP Therapy

Please note that it is extremely important to obtain an accurate diagnosis before trying to find a cure of your heartburn or reflux. Many stomach or digestive diseases and conditions share common symptoms: if you treat yourself for the wrong illness or a specific symptom of a complex disease, you may delay legitimate treatment of a serious underlying problem, yes even stomach cancer. In other words, the greatest danger in self-treatment may actually be self-diagnosis. Always work with your health-care professional, preferably one who is experienced in gastrointestinal disorders. If you do not know what you really have, you simply can not treat it!

I have always had a great concern regarding the extensive use of antibiotic drugs required to treat HP infected individuals. The conventional medical clearing of HP from the stomach requires therapy from 10 to 14 days with multiple drugs. My concern is that prolonged or recurrent antibiotic treatment alters the normal microbial population of the entire gastrointestinal tract, eliminating many beneficial bacteria as well as HP, allowing the sufferer to develop a gut environment which may contain bugs like Candida albicans, proteus, or a whole host of other undesirables. You get rid of one problem, only to create yet another.

Triple Therapy

The use of only one medication to treatH. pylori was never recommended by Dr. Marshall. At this time, the most conventional treatment is a 2-week course of treatment called “triple therapy”. It involves taking two antibiotics to kill the bacteria and either an acid suppressor or stomach-lining shielding drug. Two-week triple therapy reduces ulcer symptoms, kills the bacteria, and prevents ulcer recurrence in many patients – but the recurrence can be as high as 75%. Complete eradication is difficult, I have had many patients who have come to me after having had triple therapy many years ago with average to poor results, and were placed on an acid blocker for many years after.I do recommend this for some resistant cases, and have been know to send some patients to a GP for triple therapy, then follow-up with natural treatment for 6 weeks. I have found that some patients may find triple therapy complicated because it involves taking 3 kinds of drugs, and as many as 20 pills a day. Also, the antibiotics and bismuth drugs used in triple therapy may cause side effects such as nausea, vomiting, diarrhea, dark stools, metallic taste in the mouth, dizziness, headache, and yeast infections, particularly in women.

HP Testing

The diagnosis of H. pylori infection has traditionally involved endoscopy with biopsies of the stomach’s mucosa. There are three ways to test for HP currently in NZ. To be honest, I only occasionally authorise a HP test these days, and generally have a “gut feeling” a person has this bug once they come into my room and complain of the above mentioned symptoms. Common sense – the patient will soon tell you if they are or are not improving, and it only takes about three to four weeks to really know what is going on. Just because the test results come back negative, you could still have this bug. You know me by now, please don’t get paralysis from analysis! If you feel significantly better after a HP treatment whether it be pharmaceutical or natural – you probably have HP regardless of what the test results say. Remember – up to one in five New Zealanders have this infection, so the odds are reasonably high you have it.

· The Urea Breath Test method of diagnosis relies on the Urea reaction being present, as mentioned earlier. This is a sound test – 90 – 95% successful in picking up the HP bug.

· Blood tests measuring HP antibody levels have been developed. However, these tests have suboptimal sensitivity and specificity (85% and 79%).

· Stool tests for antibodies – again, many factors can affect the outcome of this test, stay with breath testing. Many experts say that the fecal antigen test is bullet proof, but in my experience I have seen many “false negatives” with testing. That is, the results come back all ok, but the patient responds dramatically after HP treatment.

Natural HP Eradication

No clear indications exist for specific treatment of each and every individual case of HP associated gastritis. I have found the following treatments to be effective, and employed many different therapies over the years. Here are some treatments which I have found to work in various HP cases. Remember, recurrence rates are quite high, so you may want to persist with treatment until you feel much better, then hang in there for a few more months (lower grade treatment) to be absolutely sure. I recommend treatment in blocks of 6 weeks, then wait 2 -3 weeks, then another 6 week period of treatment. A good clinical tip for you: always treat this infection by taking something with meals, and also something in-between, or away from foods. This is designed to really drive the “kill” treatment home, and lets the treatment have access to the HP bugs in the gut with as well as away to some extent from foods and gastric juice involvement. I have a saying in my clinic: persistence breaks resistance. Remember Winston Churchill? – never give in, never give in, never give in.

· Manuka honey, which has high levels of hydrogen peroxide and has been shown in studies to be active against H. pylori. Go for the Comvita high UMF factor Manuka honey.

· Propolis works really well for some, but is dismal for others.

· Vitamin B12 – get this checked in your blood! You may well be deficient here.

· After antibiotic treatment is finished, (triple therapy) it makes sense to rebuild the gut flora with lactobacillus species. They won’t cure the condition, however. (A 2002 trial demonstrated that a mixed acidophilus preparation failed to eradicate the H. pylori infection in the patients upon whom it was tried).

· DGL (deglycyrrhizinated licorice) – you can get this in capsules or liquid.

· Aloe Vera helps to heal the mucous lining of the gastrointestinal tract.

· Berberine is found in the herb Goldenseal, and it may be used as a natural herbal antibiotic.

· Eat grapefruit seeds, for some this is very effective long term. The extract is even better.

· Digestive enzymes may also be useful – especially with achlorhydria (low stomach acid)

· Gum mastic is a natural substance from the sap of the Mediterranean evergreen tree, Pistacia lemniscuses. Mastic gum has been shown to be effective in protecting the digestive system, healing peptic and duodenal ulcers, and eradicating H. pylori from the gut. I use this a lot, and give two capsules twice daily in between meals.

· Bismuth. It displays anti-inflammatory action (due to salicylic acid) and also acts as an antacid and mild antibiotic. Don’t freak out – It can also cause a black tongue and black stools in some people who take it, when it combines with trace amounts of sulfur in their saliva and gastrointestinal tract. This discoloration is temporary and absolutely harmless.

My favourite HP treatment regime? I would have to say gum mastica between meals, and with meals a preparation of Bismuth,deglycyrrhizinated licorice, grapefruit seed extract and goldenseal. I often recommend aloe vera and activated charcoal as well.

Do you get that annoying heartburn, and want to try and find a cause and ultimately a cure? Consult your naturopath or nutritional-friendly doctor who can check you out carefully and thoroughly and who will actually treat the cause, not the symptom. They should generally recommend a course of treatment and a specific diet designed for the individual, with promising results for many patients. And what a relief, to be free of heartburn, bloating and that “awful feeling in the tummy” again!

Hansens Lepresy

Since the beginning of time, Hansen’s disease has been recognized as a problem. Reported in Egypt in as early as 1350 BC, Lepresy is the oldest disease known to man; this is according to the Guinness World Records. Frequently, Lepers have lived outside of society. This is partly due to the fact that for a long time the disease was believed to have been caused by a divine, often times associated with demons, curse or punishment. This idea changed in the middle ages, when people started to believe that lepers are loved by God, and that it is humans that have cursed them

Another reason for secluding the Lepers what that in the past it was believed that leprosy was highly contagious. If was even taken to the extent that leprosy could be spread by the glance of a leper or an unseen leper standing upwind of healthy people. Today we know that the disease is much less contagious than we once believed in the past. Lepresy is caused by a mycobacterium that will multiply at a very slow rate. The disease mainly affects the skin, nerves, and mucous membranes. The organism has never been grown in cell culture, because of the difficulty that is involved with doing so. This difficulty is as a result of the fact that the organism is an obligate intra-cellular parasite. This means that it lacks many necessary genes for independent survival. This is also evident and provides proof for it having such a slow rate of replication.

Uncertain today, is the method of   transmission  of Hansen’s disease. Many people believe that it is spread person to person in respiratory droplets. What we do know though, is that most of the population is naturally immune to the disease. The disease is chronic, and often times patients are classified as having paucibacillary, which is a form of multibacillary Hansen’s disease.

The Roles and Responsibilities of the Members of a Family

The family is a basic unit of the society which consists of the husband, wife and their children. Each of these members has their assigned roles and responsibilities. Within a family, everyone assumes these roles. Talking about these roles and responsibilities, it is important to note the following key points:

• One of the most important responsibilities of a family is raising a child. It is the most challenging responsibility because the child has to be raised from childhood till he/she is old enough to take care of him/herself.

• The family is also expected to educate and transmit the societal norms and culture to its offspring and also give them a position or status in life.

• The family provides emotional, psychological moral and material support to members.

• The family has to ensure provision of.physical security in terms of food, clothing, shelter and other needs to its offspring or other dependent individual members of the family e.g grandparents. However, tradition still believes in assigning specific roles to each family member.

Examples of roles and responsibilities of each family member include:

Father

• Provision of food, shelter and money for the family

• Making important decisions.

Mother

• Preparing food and keeping the house in order

• Nurturing and raising the children, teaching the children morals and values

It is important to note that the above roles and any other traditional roles assigned to either parent could be performed by any of the parents. Indeed, both parents are to compliment each other in the performance of all these functions.

Children

• Obeying their parents

• Assisting in performing household chores, particularly in the kitchen, garden, laundry, washing the car etc

• Living up to family expectations

• Getting good grades in school

Each of these roles is accorded a status. The status assigned to a particular role within the family reflects the values and beliefs of that family. The higher the status assigned to a role, the greater the authority, privileges and reward accorded to that role.

Dirofilariasis – The Deadly Heartworm in Dogs

When a dog is suffering from heartworm, it means that they are infected with a roundworm commonly known as heart worm. The organism is actually Dirofilaria immitis, a parasite. This worm is transmitted by mosquitoes and will infect your dog’s blood, heart and lungs. Left untreated, the disease is fatal.

Causes

Heartworms are spread through mosquitos that carry the infective heartworm larvae. The larvae enter the dog’s body through the mosquito bite wound and travel through the dog’s body to the heart. This process will take approximately six months.

Once the heartworms are living inside your dog, the adults will release immature heartworms (microfilariae) into the bloodstream of the dog. When a mosquito bites an infected dog, it will become a carrier of these microfilariae and infect the next dog it bites.

If a dog lives in a high risk area for heartworm, without preventative treatment it will almost certainly contract heartworm disease. Although heartworm is mainly endemic in tropical and subtropical areas, it is not limited to these areas. Heartworm has been identified in all 50 US states and is found worldwide.

Symptoms of Heartworm

Heartworm disease can be diagnosed by your veterinarian through a blood test. There are three classes of heartworm, and the symptoms vary from no visible symptoms to extreme ill health. It is difficult for a dog owner to identify heartworm in their pet.

The symptoms of heartworm include but are not limited to an occasional or more regular coughing, reduced canine activity or an intolerance to exercise, anaemia, fainting, chronic heart failure, labored breathing and high blood pressure.

The severity of heartworm disease will depend on the severity of the infestation, the duration of the disease and the response of the dog. All dogs are different in the way their bodies cope with the heartworm infestation.

Diagnosis

If your vet suspects your dog may have heartworm they can conduct a blood test, carry out an electrocardiograph (can reveal heart rhythm disturbances), a urine analysis or x-rays. They are looking for damage to or enlargement of the heart and associated arteries.

Treatment

Initially your dog will be hospitalized, and receive a dose of adulticide which will kill the adult heartworms. Depending on the severity of the infestation your dog may need to be hospitalized for a longer period. In some cases surgery may also be required to remove adult worms from the heart and jugular vein.

After the adult worms have been killed, treatment must be ongoing with a monthly dose of prophylaxis to kill eggs and larvae which have not been killed by adulticide.

You should be aware that the treatment for heartworm can be deadly. Even mild to moderate cases of heartworm will have a considerable impact on your dog. It is not an easy treatment for your dog, and should not be considered light heartedly.

Prevention

Heartworm disease is completely preventable through a regular dose of prophylaxis which is a preventative heartworm medication. Your veterinarian will be able to assist you with the appropriate medication and dosage to suit your dog.

If your dog does contract heartworm and has been successfully treated, you should take care to administer the monthly dose of prophylaxis as advised by your vet – reinfestation can easily occur especially in high risk areas.

A Fragile Lifeline: Lessons I Learned Answering The Aids Hotline

Dial 1-800/AIDSNYC

Every Monday and Wednesday morning, promptly at 10 a.m., I leave behind

my daily life and turn to volunteering as an AIDS Hotline counselor at New York

City’s GMHC [Gay Men’s Health Crisis], the nation’s largest social service

agency for AIDS.

For the next four hours, my co-volunteers and I sit in front of a bank of

constantly-ringing telephones, talking to men, women, and teens who call in

from across the nation with urgent questions about AIDS, the ravaging disease

that has left 13.9 million people dead worldwide.

After almost 20 years, a whole generation, families are still facing the

heartache of tending the sick, while scientists continue to be confounded by

this stubborn, ravaging virus.

Although the federal government currently spends$4 billion per year on

AIDS research, and $15 billion worldwide, there is no cure in sight for the viral

infection and no vaccine available. Small wonder that the GMHC AIDS Hotline,

the nation’s first, is flooded with more than 40,000 calls each year.

Listening to callers 8 hours each week, I often think the Hotline is actually a

direct link to the soul of callers–an anonymous forum that allows each to

reveal secrets and fears that they might otherwise never discuss with anyone.

A Morning in May

This is the way it began: “Good morning, GMHC AIDS Hotline, can I help

you?”

“Yes…I have a question…[hesitantly] My son…he’s 21…and he just found

out…he’s HIV-positive [voice breaking] I’m…..alone, divorced. And I need some

help…someone to talk to…”

“Of course….happy to talk to you…it sounds like this has been devastating

for you….”

“It’s terrible. He told me two nights ago….he’s…he’s so young….I don’t

want him to die. He’s my only child….why did this have to happen?” [crying]

Her son, she explains, had sometimes neglected using condoms, convinced

he wouldn’t contract HIV infection from his female partners.

“How could he be so stupid?” she now asks angrily. “Why didn’t he know

how to protect himself? I don’t understand. What am I going to do?”

We talk for 35 minutes, and by the end of the conversation, I notice I’m

barely breathing. The distraught woman’s anguish is palpable. Her situation is

every mother’s worst nightmare.The life of her child is in jeopardy and she

feels helpless and afraid. I can’t imagine anything worse.

During the call, I do my best to employ the GMHC Hotline protocol of “active

listening,” which involves using silence, empathy and gentle probing with

open-ended questions. I’m also having my own emotional reaction to the panic

in her voice, and I’m worried about whether I’m doing enough.

Toward the end of the clal, when she exclaims: “I don’t want my baby to

die,” my heart plummets: “I know….I understand that, but there is hope,” I tell

her. I find myself on the verge of tears.

The Bad News

This mother’s story is too common. According to the Centers for Disease

Control in Atlanta, Ga., 40,000 Americans (half of them under 25) are newly

infected with the AIDS virus each year. Unprotected sex and intravenous drug

use remain the principal modes of   transmission .

“Teenagers,” notes AIDS activist Elizabeth Taylor, “are being very hard hit.”

She refers to the three million adolescents who contract a sexually-transmitted

disease annually.

“Heterosexual teenage football players who are healthy and drink milk can

get it too!” says the 71-year-old actress, who has singlehandedly raised $150

million for AIDS research. “But teens are very ignorant and feel invincible. They

believe there’s an invisible shield protecting them from the virus, when it’s

actually aimed right at them.”

Taylor believes in addressing the problem head-on: “Tell your teenage son:

‘Maybe a condom doesn’t feel as good, but if it saves your life, it’s better than

being six feet under.’ Intelligence must replace random sex.”

Although a new generation of AIDS-fighting medications is prolonging the

lives of thousands, nearly half of the 900,000 people infected with HIV in the

U.S. cannot afford these drugs. Since the virus was discovered in l981, 410,800

Americans have died from AIDS-related complications, and the disease has left

13.9 million dead worldwide.

Who Calls a Hotline?

Not long ago I took a call from a 15-year-old boy living in a small town who

said he feels guilty about his sexual attraction to other boys and is scared to

discuss this with his parents. I ask him if there’s a school counselor or relative

he might talk to, but he says he’s too afraid to confide in anyone.

Being a teenager is hard enough, I thought, without the pressure of

keeping this kind of secret. I felt angry and saddened that this child can’t

comfortably discuss his feelings with his own parents.

I encourage him to call the Gay Community Center Youth Program in a

nearby city. In the meantime, I assured him that he could call our Hotline

anytime, that we’d be there for him.

This call was typical of the many we get from teenagers,whispering from

their parents’ homes, confiding their blossoming sexual feelings and concerns.

Our Hotline also receives calls from married men who phone from their offices,

worried about extramarital sexual encounters; gay men suffering side effects

from medications; mothers caring for a sick child or grieving for one lost to

AIDS; even health care professionals themselves confused and requiring

burnout support.

One particular morning, I’m struck by the number of single women who

turn to our hotline for help. At 10:15 a.m. a distraught young woman calls,

explaining that she had been dating someone “very charismatic,” after a two-

year period of sexual abstinence.

“At first we used condoms and I was taking the pill to avoid pregnancy,” she

says. But after her partner assured her he was HIV-negative, the couple began

having unprotected sex. A few months into the relationship, she recounts, his

behavior became “unpredictable,” until he finally admitted he was sleeping with

other women and was addicted to heroin. Now she has to withstand the

“terror” of waiting 3 months before getting an HIV antibody test. To help her

cope, I give her the names of three terapists in her area. The call lasts 43

minutes.

At 11:15 a.m. I take a call from a woman who is breathing heavily.

She says that four months earlier she’d had a brief affair with a limousine

driver, “not out of passion, but because I felt lonely. This was so totally unlike

me,” she continues. “I come from a traditional Orthodox Jewish family…”

Although they used condoms, and she has since tested negative for HIV, she

feels deeply ashamed, and has stopped seeing him. And because she has both

a persistent vaginal yeast infection and a rash on her neck, she’s convinced she

must be infected by HIV.

Although rashes, high fever, swollen lymph glands, heavy night sweats, sore

throat, or other flu-like symptoms may indicate HIV, they can just as easily

accompany the common cold or flu, or other type of infection. I encourage her

to seek medical help and counseling, but the calls ends on a down note. “I

must have it [AIDS],” she moans. I’m exasperated because it doesn’t sound

that way to me, yet I can’t get through to her. The call lasts 22 minutes.

It’s 11.38 a.m. when a well-spoken woman, who says she’s an attorney,

calls from her office, asking for the names of anonymous testing sites. At first

very businesslike, she calmly takes down all the information. I ask her why

she’s considering a test. Total silence. Then she begins to cry: “I….I can’t

talk….I’m sorry…you see, I have swollen lymph glands….[crying]….And my

doctor wants to rule out HIV…I feel overwhelmed…” Then, abruptly: “Where

can I send a donation?” She thanks me and hurries off the phone after just 3

minutes.

These were one-time callers, but, as in any epidemic, an element of panic

prevails, and our hotline also attracts an army of “chronic” or repeat callers

who are intensely fearful no matter how benign their risk, many revealing

continued misconceptions and paranoia about a disease that can be effectively

prevented. We do our best to help them, but often they’re impervious to

counseling.

Most poignant are calls we get from AIDS patients, phoning from their

hospital beds, attempting to navigate the exhausting labyrinth of insurance

and health care matters. One man, in hospice care, said he craved

companionship and missed the “good old days” when he was handsome and

healthy.

That call was a tough one for me as just the day before a close friend of

mine, Joe, who had battled HIV for 16 years, had finally succumbed. Although

at the end Joe was a mere skeleton, he was nonetheless at peace. “I’ve done

what I wanted to,” he told me on our last visit. An avid gardener, he insisted

on a final trip to his country house to see his garden one last time. For a

moment the caller’s reality and the memory of my deceased friend blurred in

my mind and I was overcome. Time for a break.

Face to Face

One of the most and unique services GMHC offers is called “A-Team

Counseling,” a one-time, in-person session that’s free and anonymous.

Recently, I was on an A-Team counselling a 26-year-old HIV-infected

mother from the Midwest. She had traveled to Manhattan by bus to find her

estranged boyfriend, who, she recounted tearfully, had kidnapped her 7-year-

old son. Disheveled, painfully thin, the woman was a disturbing sight. She’s

learned that the two had already returned home where the boyfriend was, and

the child put in his grandmother’s custory. custody of his grandmother.

Meanwhile she’d run out of money for the return trip, been refused a loan by

her family, lost her ID, gone hungry and spent two nights on the street.

Fortunately, this woman was registered at a local AIDS organization in her

town. I telephoned her caseworker and persuaded him to buy her a one-way

Greyhound bus ticket for $115.00. I also gave her subway tokens, a basket of

food, juice and coffee. Smiling shyly, she thanked me for caring.

Shaking hands good-bye with this woman was a bittersweet farewell. What

will happen to her? I wondered will her health deteriorate or improve? Will she

gain control of her life and be able to provide for her son? I’ll never know. One

thing I do know: She’d appeared with the sorrow of a difficult life in her eyes,

but when she left, she was elated at the thought of being reunited with her

child. It seems that with faith and a helping hand, almost anything is possible.

* * * * *

10 BIGGEST MISCONCEPTIONS ABOUT AIDS AND HIV

(This list would probably be most effective when presented in a vertical chart,

the misconception on the left, the correct answer on the right.)

1)The AIDS virus can be transmitted through saliva, sweat, tears, urine or feces;

also through deep kissing.

1) HIV can ONLY be transmitted through four bodily fluids: blood, semen,

vaginal secretions and breast milk–and can also be transmitted from a mother

to her child before birth, during birth, or while breast feeding. The exchange

of saliva through kissing is no-risk, unless the saliva has blood in it and both

you and your partner are bleeding in the mouth simultaneously.

2) HIV may also be transmitted through casual contact with an infected person.

2) You can’t get infected from toilet seats, phones or water fountains. The virus

can’t be transmitted in the air through sneezing or coughing. You can’t get

HIV from sharing utensils or food or from touching, or hugging. HIV dies after

being exposed to the air. Therefore, touching dried blood on a shaving blade, a

toothbrush or a bathroom counter top is no risk. In any case, unbroken skin is

impermeable, like a rubber raincoat, and cannot absorb the virus whether it’s

alive or dead.

Blood transfusions and medical procedures in the U.S. are safe. Giving blood is

completely risk-free. The chance of getting HIV from dentists or other health

care providers is too low even to measure.You can’t get it from mosquitoes or

other insect or animal bites.

3) Oral sex is just as risky as vaginal or anal intercourse.

3) Although not 100% risk-free, oral sex is considered a low-risk

activity,except if: you have bleeding gums, recent dental work, open sores such

as a herpes lesion, any cut, blister, or burn in the mouth, or if you’ve just

brushed or flossed your teeth. Also, oral sex with an infected woman is riskier

if she is having her period, since menstrual blood can contain HIV. Overall,

latex barriers, (such as condoms or dental dams) used during oral sex reduce

the  transmission  of not just HIV, but other sexual transmitted diseases.

4) Animal skin, latex and polyurethane condoms are all equally effective in

preventing HIV infection and you can use ANY lubrication on the condom

desired.

4)Only latex or polyurethane condoms may be used, as HIV can pass through

an animal skin condom. With latex condoms, only water-based lubricants–like

K-Y jelly or H-R jelly–may be used. No lubricants with oil, alcohol, or grease

are safe.Petroleum jelly,Vaseline, Crisco, mineral oil, baby oil, massage oil,

butter and most hand creams can weaken the condom and cause it to split.

However, with polyurethane condoms, petroleum-based lubricants can be

used.

5) Women have to rely on men using condoms during intercourse to protect

themselves against HIV.

5) Women may employ the “female condom,” a plastic sheath that can be

inserted in their vaginas and used for protection against HIV. It can be inserted

up to 8 hours before sex, has rings at both ends to hold it in place and can be

lubricated with oil-based lubricants that stay wet longer. In addition, women

can carry conventional condoms for their male partners’ use.

6) If a woman is HIV-positive, her offspring will automatically be born infected

with HIV.

6) With no medical treatment taken, about 25% of HIV-positive women will

give birth to infants who are also infected. However, the use of anti-HIV

medications has resulted in a significant decrease of mother-to-child

 transmission  of HIV in utero and during delivery to less than 5%. (NYT 10/19/

99].

7) AIDS is fundamentally a gay disease contracted by white males.

7) Recent data compiled by the Centers for Disease Control and Prevention

indicate that young gay Hispanic and African-American men and heterosexual

women are the fastest growing segment of the population being infected with

HIV. Women now account for 43% of all HIV infected people over age 15. [NYT

11/24/98] African-American and Hispanic women account for more than 76%

of AIDS cases among women in the U.S.

8) Heterosexual men are not really at risk for contracting HIV, even if they

don’t use condoms.

8) The inside opening of the penis is composed of highly-absorbent, sponge-

like mucous membrane tissues, which can provide a route for HIV-infected

vaginal secretions or blood to enter the bloodstream. Proper condom use

protects men from infection.

9) The AIDS epidemic is largely over because new AIDS medications like

protease inhibitors and others have turned AIDS into a chronic, not a terminal

disease.

9) In the U.S., AIDS is the fifth leading cause of death for people 25-44 years

old. Roughly half of all those infected with HIV in the U.S. are not receiving any

medications or medical care. AIDS now kills more people worldwide than any

other infection, including malaria and tuberculosis.[NYT 11/24/98] In 1998

alone, 2.5 million people died of AIDS worldwide. 13.9 million people have

died since the virus was discovered in 1981.

10) If you think you’ve been exposed to HIV through unprotected sex, you can

take an HIV antibody test 2 weeks later and get an accurate result.

10) The standard “window” or waiting period remains a full 3 months. However,

because the widely-used HIV antibody tests (The ELISA and Western Blot) have

become so sensitive, about 95% of people will procure an accurate result 4-6

weeks after a possible exposure to the virus.

* * * *

[Note:The information stated above was reviewed for medical accuracy by Dr.

Todd J. Yancey, an infectious disease specialist practicing in New York City and

affiliated with New York Presbyterian Hospital, NY, Cornell Campus.]

THE CHILD LIFE PROGRAM

“Mommy takes a lot of medicine and Mommy’s really tired sometimes and she

can’t take you to the park as much as she used to. It’s not that I don’t love

you…and that I don’t want to…but Uncle Jack’s going to take you to the park

today.” –A mother living with AIDS, a client at GMHC, talking to her 6-year-

old son.

In New York City alone, 28,000 children have been orphaned by AIDS since the

epidemic began [NYT 12/13/98]

GMHC’s unique Child Life Program serves HIV-infected parents and their

children–who may, or may not, be infected with the virus. “We help families

strengthen their ability to cope, relieve the pressure of parenting with support

services, and teach parents how to talk to their kids,” says Child Life Program

Coordinator Alison Ferst. “Unfortunately, should a parent or child be sick

enough to be facing death, we also help them walk through it with grace and

dignity—as opposed to feeling alone, isolated and frightened.

“We also encourage sick parents to make stable legal plans for their

children who may be left behind,” adds Ferst, “and to have disclosure

conversations with the children in advance, so you don’t have a child standing

at her mother’s funeral, not sure where she’s going next.”

When an HIV-infected Mom arrives at GMHC to have lunch, attend a support

group, consult with a lawyer, or access the acupuncture clinic, she can leave

her children in a spacious playroom, decorated with fanciful murals and a giant

tree hand-painted by the famed children’s story writer and illustrator, Maurice

Sendak, who donated his art. [see photos] The program provides: child-

sitting, nutrition services, a food pantry, art and magic classes, and

recreational trips–church picnics, seasonal apple-pumpkin picking,

amusement parks, zoos, museums, beaches. Also: homework help sessions,

holiday parties, hospital visits, summer sports and weekly support groups for

HIV- positive parents and their HIV-negative children.

This unique program also features: Cooking classes for kids who sometimes

prepare meals for sick parents; Pediatric Buddies, GMHC adult volunteers who

play with sick children and also assist with family chores; Fun With Feelings

Support Group, Friday Evening Family Time, Birthday parties, and a Holiday Gift

Drive.

“Children infected or affected by AIDS,” concludes Ferst, “want to be like

other kids: They want to play with their friends, want to know that someone

will always take care of them, want to know they’re not alone, and often

wonder if it’s their fault when Mom or Dad gets sick.” These children need a

helping hand and any of us can provide one.