The roughage of the fresh fruit and vegetables may be irritating some condition — try canned fruit and cooked vegetables. You still get nutritional value.

Also, you could have a change in stomach acidity, and the fruits become hard to digest. Remember, fruit and vegetable juices are also healthy.

Also, keep adequate protein in your diet and do strength training to keep your muscle mass as you get older. This will keep your metabolism up and lessen the storage of fat as you get older.

Take care, and please see a doctor.

Elective gallbladder surgery is done laparoscopically. If done by an experienced surgeon, the operation has a very low complication rate (about 1 percent) and a short recovery time. Unfortunately, diet and weight management are not effective in preventing further attacks or dissolving stones that are already present.

Although you have not had an attack recently, you should consult with an experienced surgeon regarding your case. This is especially important if you are young and have many years ahead of you during which these attacks could recur.

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A.Gallstones are very common among women over age 50, occurring in up to 30 percent of U.S. women in some studies. Gallstones can cause symptoms of pain in the upper abdomen (biliary colic), nausea, vomiting and fever. These attacks occur when a stone moves and obstructs the duct leading out of the gallbladder. If the obstruction lasts for more than several hours, then the gallbladder may need to be removed surgically on a semiurgent basis, because infection could set in.

A. Other problems that can result if stones make it out of the gallbladder are obstruction of the bile duct and obstruction of the pancreatic duct. These are potentially more serious problems leading to cholangitis (infection of the bile ducts leading out of the liver) or pancreatitis (inflammation of the pancreas). They may require emergency endoscopic procedures to remove stones.

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Some patients are particularly prone to recurrent depression. For individuals with a history of three or more depressive episodes, lifetime antidepressant treatment reduces the risk of additional recurrences. A structured psychotherapy program can also be helpful, but it is not as effective as the continued use of antidepressant medication for those with recurrent depression.

When Depression Becomes Life-Threatening
In several instances, patients with depression require urgent attention. If someone is having suicidal or homicidal thoughts, or psychotic symptoms (see below for examples), he or she should consult a psychiatrist at once. Patients with treatment-resistant depression or manic depression also need a psychiatrist?s care. Sometimes individuals are so depressed that they cannot “get out of bed” to perform even the most basic tasks (e.g. preparing food, showering, making phone calls) necessary to care for themselves and organize their lives. Again, it is critical that these people see a psychiatrist at once.

Keep A Close Eye on the Elderly
Senior citizens can easily become depressed as they not only battle the myriad of illnesses that come with old age, but also attempt to cope with the loss of their loved ones and peers. Elderly individuals are at the highest risk for complications and life-threatening events related to their depression. In fact, elderly white men have the highest rates of completed suicide in the United States. Also, the elderly are more likely to be impaired in their self-care and to develop a depression with psychosis (see Psychotic Symptoms section).

Elderly individuals may suffer from a major depression, while their friends and loved ones do not realize it. Their depression may be “masked” because they are not forthcoming about their low mood.

This is often the case with elderly individuals who initially complain of various physical problems (e.g. indigestion, heartburn, muscle or joint pains, and chronic headaches). Further questioning may reveal that depression is responsible for their symptoms. If one suspects that an elderly person is depressed, he or she should inquire about changes in sleep patterns, loss of appetite, difficulty concentrating or a decrease in routine activities. In these cases, the physical complaints often decrease or completely go away following treatment for depression.

Pharmacia & Upjohn
In April 2000 the U.S. Food and Drug Administration approved the first in a new class of antibiotics called oxazolidinones. The new drug, a synthetic antibiotic produced by Pharmacia & Upjohn, is called Zyvox.

Zyvox works by preventing bacteria from making the proteins they need to grow. Early trials suggest that Zyvox is effective against dangerous strains of Gram-positive bacteria such as staphylococcus, streptococcus, pneumococcus and enterococcus. In recent years doctors have depended on two powerful antibiotics to fight these infections from these bacteria: methicillin and vancomycin. Unfortunately, methicillin has been losing the fight against resistance, leaving only vancomycin as a drug of last resort. Doctors hope Zyvox will be in place in time to take up the fight if — some say “when” — vancomycin fails.

Cubist Pharmaceuticals, Inc
Cubist Pharmaceuticals has a new drug called daptomycin in phase three clinical studies. Daptomycin is a natural compound developed from a soil organism. According to Francis P. Tally, M.D., executive vice-president of Scientific Affairs for the company, daptomycin kills bacteria by destroying the cell membrane, leading to the death of the bacteria.

Cubist has just completed enrollment on a study of daptomycin, and hopes to submit a new drug application to the FDA in 2002. If all goes as scheduled, the drug should be available to physicians sometime in 2002.

Paratek Pharmaceuticals
Paratek Pharmaceuticals is looking for the key to preventing resistance with the company’s multiple antibiotic resistance (MAR) program. Michael Alekshun, Ph.D., Paratek’s MAR program manager, explains that the Paratek approach is to enfeeble the bacteria so they can’t cause infection. By not trying to destroy the bacteria, Paratek hopes to at least forestall the evolutionary process that results in resistance.

“We’ve identified mechanisms within all classes of bacteria that are responsible for how bacteria develop resistance to many different classes of antibiotics,” Alekshun said. “We’ve identified a chromosomal locus that controls multi-drug susceptibility.”

This locus is a single chromosome in a bacterium that can be turned on or off in response to threats from the environment, such as an antibiotic. When the chromosome is turned on, it shuts down the entry points that antibiotics use to invade the bacterium, and turns on pumps that remove any drug that might enter the cell. If this mechanism can be disabled, the bacteria become vulnerable to the effects of an antibiotic.

Paratek’s research is in the early stages and no date has been set for submission of a drug to the FDA.

Vertex Pharmaceuticals
Vertex Pharmaceuticals is using computer technology to search for potential candidates for new antibiotic compounds. They are targeting an enzyme called DNA gyrase. DNA gyrase has two subunits: subunit A and subunit B. According to Paul Charifson, Ph.D., who heads up antibiotic research at Vertex, other antibiotics go after subunit A.

“DNA gyrase B is novel in that it is part of the enzyme the bacterium needs to survive,” Charifson said. “We believe the drug we develop will have a slow onset of resistance because the bacteria will kill itself if it alters subunit B.”

Charifson explains how using the computer helps them search for a potential compound.

“Most antibiotics come from natural products. We’re designing an antibiotic from the very first step. We were able to determine the structure of our target [DNA gyrase subunit B]. We then screened our corporate database of compounds against the target to find a drug-like compound that could bind to DNA gyrase B.

The computer can simultaneously test thousands of compounds, as well as evaluate the fit of potential molecules. Computer techniques help us perform work that would take chemists working in a laboratory years to complete,” he said.

Charifson believes the DNA gyrase B program has strong potential to yield a breakthrough drug. The company plans to choose a critical candidate in 2001. It is too early to predict when a drug might be available to physicians.

Treatment Planning

The above concerns emphasize the importance of developing treatment strategies that address the unique concerns of adolescents. Factors that may relate to successful weight loss for adolescents include:
Personal control over weight
Recognition of barriers to weight loss
Establishing realistic expectations
Appreciation for the challenges associated with weight loss and maintenance
Willingness of parents to participate in their teens’ weight loss efforts without becoming intrusive
Realization of the barriers and challenges of weight loss implies a greater readiness to make the necessary lifestyle changes. It is important to include the adolescent in this decision-making process both initially as well as throughout the course of treatment. If the adolescent assumes responsibility for weight loss efforts, he or she is more likely to engage in the treatment process and experience positive results.

In an effort to increase his independence, Jon began work at a part-time job that required him to eat his evening meal at work. This became a significant concern to Jon because he was frequently tempted by and indulged in unhealthy foods at work. With the assistance of group members, Jon was able to identify the specific barriers to his weight loss. By gathering information and utilizing the group problem-solving process, Jon made the necessary changes in his behavior and, consequently, further enhanced his sense of self-worth and efficacy. Jon’s example also highlights the point that group members are often more receptive to suggestions from peers rather than adults (as most parents have likely experienced).

Conclusions

While adolescence is commonly a time of tremendous growth and change, issues of weight and dieting may become yet another battleground between adolescents and parents. In part II we continue our discussion on these key issues of weight management for adolescents. We also provide practical strategies that we have found useful in working with overweight teenagers and their families.

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Hesitating to take the plunge and try some soy in your diet? First, familiarize yourself with the vast array of soy products available. Several are described here. Call the companies manufacturing the products to request recipes or look in the cookbook section of a large bookstore for vegetarian cookery publications. Or, try calling the Indiana Soybean Board at (800) TALKSOY for additional information on preparing soy products and recipes.

Tofu — Sold in the produce or dairy section of your local supermarket, this white, block-shaped product will remind many of cheese in its texture, taste and consistency. Tofu is soybean curd, made by mixing hot soymilk with a coagulant.
Firm tofu: Use in stir-fry dishes, soups and stews. When mashed, it can be substituted for ricotta cheese in stuffed shells.

Soft tofu: Blend with herbs and spices for a zesty dip. Combine with melted chocolate chips for a sweet chocolate cream pie filling.

Silken tofu: Blend with frozen fruit and fruit juice for a delicious smoothie.

Tofu has a mild flavor, but will “soak up” the flavors of other ingredients in recipes, such as soy sauce, tomato sauce or pumpkin. Keep tofu stored in the refrigerator, and use by the expiration date on the package. Once opened, tofu should be used within a week. Drain off the liquid, add fresh water, and change the water daily.

Tempeh — A chewy, soft soybean cake made from fermented soybeans. This soy product can be marinated and grilled or added to stews, casseroles or chili. It has a smoky flavor and is sold in the produce or dairy section of the supermarket, or through health food stores.
Soymilk — Available in fortified versions and several different flavors, this product is sold in supermarkets in an aseptic package. Refrigerate after opening and enjoy it on cereal, in recipes, “milk” shakes and puddings. Even hot chocolate tastes great made with soymilk.
Textured Vegetable Protein (TVP) — This “ground beef imposter” can be used in place of all or part of ground beef in recipes, with little or no change in taste. Besides that, you will stretch your food dollar; you can expect to pay one-quarter to one-half of the cost of ground beef or ground sirloin. TVP is sold in a dry, granular form and needs only to be rehydrated with water prior to incorporating into chili, spaghetti sauce, tacos, sloppy Joes or even meatloaf. Get ready for a pleasant surprise when you sample this soy product!
Soy Nuts — This small, roasted peanut-like treat makes a healthful snack. Several flavored varieties are available through health food stores or catalogs.

Isolated Soy Protein Powder — The most highly refined soy protein, isolated soy protein powder is rich in protective isoflavones. It is a powder and is available at health food stores and through catalogs.

Isolated soy protein powder can be added to baked products, puddings and “milk” shakes, to enhance nutritional value.

Soy Flour — Use soy flour in place of up to one-quarter cup of flour in baked products.

After the 5 days were up he was x-rayed again and this time they found the pneumonia was gone, but due to stress his right lung had collapsed. Since he was in an intermediate care nursery they had to transfer him to another hospital because they could not handle such a high-needs baby. February 28, 2001, he ended up in the children’s hospital NICU (Neonatal Intensive Care Unit).

The first night at the NICU was a little frightening for me. This was the first night I didn’t stay with Kasey and it was a little hard to leave. The next morning the nurses decided Kasey would be best in an open bassinet so he was taken out of his incubator. The NICU was a great facility with wonderful nurses. I was happy because I was allowed to hold Kasey as much as I wanted.

Kasey stayed there for another 2 weeks. During this time he got so much better. After the first week his collapsed lung healed but it wasn’t for another week that he cleared up and saturated enough oxygen to come home.

Kasey came home on March 16, 2001. He was on medication to help with his oxygen saturation but I didn’t mind. I was just glad to have my little boy home. He was 8 lbs, 15ozs.

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After Kasey’s birth we were moved into our room to recover from the birth. We both slept and I ate, but Kasey was having problems. Everytime he tried to latch on to drink he would suck two or three times and then unlatch and gasp for air. I thought that was odd and inquired to the nurse about it. She told me that everything would be fine and said, “babies do that”. I was worried.

That afternoon Kasey woke up and started to cough up thick, black mucus. I called the nurse again and again I was told that “babies do that” and was accused this time of starving my son. I was so angry. 12 hours after his birth he still hadn’t had anything to eat so I went off in search of a different nurse and at the nursing station and found the resident doctor. She took one look at Kasey’s feet (they were blue) and took him into the ICN (Intermediate Care Nursery). There they put him on a warming table and attached heart monitors to his chest and an oxygen monitor to his foot. His oxygen saturation was at 62%. They consider 97% acceptable.

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My labour took a long time to start however, and I was allowed a small lunch at noon. The doctor told the nurses to keep turning my IV drip up and approved double the normal amount of hormones.

By 4:00 p.m. I was only 3 cm dilated and the doctor decided it was time to break my water, hoping to speed up my labour. At 6:00 p.m I was having regular contractions and by 8:00 p.m. they had progressed so far that I couldn’t handle the pain. The nurse checked me and I was still only 3 cm dilated. I had decided before my labor to use gas to relieve my pain, and take Demerol for my delivery. I decided to have some gas to relieve my pain since I wouldn’t be delivering anytime soon

At 10:00 p.m. I was still in so much pain though that I got an epidural done. It wasn’t what I wanted to relieve my pain when I first went into labour but it was WONDERFUL and I fell asleep.

At 4:00 am on February 23, 2001, I woke up and found my baby’s heart rate had dropped to 72. I called the nurse and when she came she put an oxygen mask on me and stopped my IV. She then started it back up at the lowest setting, believing that is what cause my baby’s heart to slow. She also checked my cervix. I was just under 5 cm.

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