Today we have more information about human nutrition than at any time in history, yet in some cases we are much less healthy then in times past. How can that be? Largely its the result of being human in a post-industrial society. No one needs to exert much thought or energy to have his or her caloric requirements met. Unfortunately what makes good business for the food industry often doesnt mean good nutrition for you and me.

That brings us to the concept of the Paleolithic Diet. This diet merges both physical anthropology (what we observe mankind has subsisted on) and human nutritional science (what modern science tells us humans need). The diet emphasizes nutrient and fiber-rich vegetables, fruits, nuts and seeds, along with lean meats and animal products. It noticeably avoids excessive grains and refined sugar. Essentially one can imagine going back in time before food industrialization and modern agriculture. Humans lived on what grew and roamed wild.

Over time humans learned that seeds from various plants (grains) could be used as food, though in most cases it required some to make it digestible and nutritious. One example is the use of corn as food. Native-Americans knew by tradition that maize had to be soaked in alkali, typically ash or lime (calcium carbonate) before using as food. When corn was introduced into other cultures, like the deep southern US, the art of soaking was overlooked. The malnutrition that resulted became known as pellagra. It took until the 1930s for science to identify the problem as a niacin deficiency. The art of soaking in lime allows the B-vitamin niacin to become available. In addition, indigenous peoples combined corn with beans or other protein sources to get all of the essential amino acids (the required protein building blocks of protein).

Though science has helped show us what is required for basic nutrition, much is lost in translation from the research lab to what is on the grocery store shelves or available at the drive-thru. When it comes to food there are lots of mixed messages coming from advertising and even the medical experts. Suggesting that people eat better isnt very helpful unless you also explain why and how. I have found that to make better eating choices I had to first understand why it was important. Going back to the two great human motivators, pleasure and pain, it might help to rationalize how changing the way you eat can bring you more pleasure while avoiding pain. The key is to understand that the benefits may be delayed. An investment up front will yield dividends later by avoiding diseases such as diabetes, cancer, and stroke. There are also benefits that can manifest more quickly, such as more energy, better sleep, less pain and inflammation, and weight loss.

How does one apply the principles of the Paleolithic Diet? For some the biggest challenge is reducing grains. Its important to recognize that not all grains are the same. Wheat is the most common grain in our food supply and is found in numerous products made with white flour. White flour is largely devoid of trace nutrients and fiber even though it is typically fortified. It is mostly starch, which is quickly converted to sugar in the body. Excess sugar is efficiently stored as fat. The consequences can be weight gain and an increased risk for diabetes. Wheat can also cause inflammation in the digestive tract, for some severe enough to cause whats known as celiac disease. Whole wheat provides more nutrients and fiber, but still can be problematic in excess. I recommend consuming other whole grains in moderation, such as quinoa, buckwheat, and millet, while reducing wheat consumption. Sprouting or soaking improves digestibility, so buying 100% sprouted grain breads and making hot porridge for breakfast is a better alternative to white bread and cold cereals, which are heavily processed and contain added sugar. To ensure you get a complete protein, remember to include seeds, nuts, or beans in your diet, especially if you dont eat much animal protein.

The other big challenge is getting enough vegetables in your diet. These are the dark leafy greens, cruciferous, carrots, beets, squash, peas, onions, garlic, and celery to name a few. Starchy like corn and potatoes dont count. And neither does ketchup. Along with learning to cook and prepare these foods, its important to learn the basic art of seasoning. Herbs and spices not only provide flavor, but also provide natures medicine and protective phyto-chemicals. From cinnamon improving blood sugar control to oregano preventing GI infections, they are an essential part of good health. For those who find it impossible to eat enough vegetables, it would benefit you to use whole-food supplements containing green foods, fiber, and protein.

Lastly, when it comes to meat and animal products, it pays to be selective. Remember that the hunter-gatherers didnt eat a ton of meat. But when they did it was wild and they prized the organ meats, a long lost tradition in our society. We instead esteem the grain-fed muscle tissue from a couple of domesticated animals like beef, pork, and chicken. Id recommend eating meat a few times per week, including alternatives like bison, lamb, and grass-fed beef, along with free-ranged turkey, wild salmon, sardines, free-range eggs, and perhaps liver now and then. When it comes to dairy remember quality over quantity. Daily consumption of cow milk can be problematic, whereas fermented foods like yogurt and kefir are often better tolerated and have enhanced health benefits.

A few recent news items may further motivate your dietary transformation. It was recently reported that high-fructose corn syrup (HFCS) can contain significant levels of mercury. If you needed another reason to avoid this non-food, this would be it. Along with potentially containing a neurotoxin, HFCS is already associated with increased rates of obesity and liver disorders. Concern is also being raised over the sugar substitute, Splenda, which contains sucrolose. Touted as safe by its promoters, new reports indicate it can reduce the beneficial bacteria in the digestive tract by as much as 50%. It can also alter the way the body metabolizes some medications. Ironically, the little Splenda packets labeled No calorie sweetener actually contain 95% sugar providing 3.31 calories per packet. This labeling loophole is also prevalent on all the products that now advertise as being trans-fat free. Reading the ingredients youll notice they often contain hydrogenated or partially hydrogenated vegetable oils, a guaranteed source of trans-fats. How can this be? The labeling laws allow manufactures to say their products have zero trans-fats if there is less than 0.5 grams per serving. So by simply keeping the serving size small, every product can be labeled as having zero trans-fats, which is a big fat lie! The moral of this story is to read the ingredients and dont trust the food industry, or expect the government to protect you nutritionally anyway. Another good rule of thumb is if you dont know what is, you probably shouldnt be eating it. For example, here are the ingredients in McDonalds French Fries:
Potatoes, vegetable oil (canola oil, hydrogenated soybean oil, natural beef flavor [wheat and milk derivatives]), citric acid (preservative), dextrose, sodium acid pyrophosphate (maintain color), salt. Prepared in vegetable oil ((may contain one of the following: Canola oil, corn oil, soybean oil, hydrogenated soybean oil with TBHQ and citric acid added to preserve freshness), dimethylpolysiloxane added as an antifoaming agent).

Unfortunately there are no McPaleo fast food restaurants, at least not yet. There are better choices when it comes to dining out, but it will be very difficult to obtain good health if you dont prepare most of your own food. As a kick start to eating better it might be helpful to consider a brief fast. If youre not ready for that kind of deprivation, then perhaps consider the Caveman or Cavewoman Cleanse. Eat well, live long and prosper.

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My reply was as follows:
I am an integrative psychiatrist, holistic healer, Reiki master, color and sound therapist and co-author of 2 books aimed at getting people into their hearts and transforming for personal (and global) healing at the emotional, mental, physical and spiritual levels.
I was trained at a traditional medical school (Wake Forest University) after receiving a masters degree in biology (from Georgetown University).  I was also trained (after practicing traditional medicine for 5 years) at an Ancient Mystery School (Delphi University).  I am also training in Medical Qigong over the past 2 years.
I truly take a holistic approach and believe that there is a place for every modality that we have available to us- both modern and ancient techniques and approaches to healing.  I do believe that people are beginning to return to some of the more ancient practices of healing. but I do believe every one of us would be racing to the ER at our local hospital if we were in the throes of acute appendicitis. and I certainly have no qualms of putting someone on antidepressant medication if they are so severely depressed or anxious that they cannot even focus or concentrate well enough to benefit from alternative approaches to healing.
We have to work in the realm of each persons - if a person is not even able to imagine that a certain approach is going to be helpful to them or if an approach is going to frighten them, then I am not likely to use that approach.  I do believe that consciousness is SHIFTing in the realm of healing as well as in almost every other section of our civilization. we sometimes have to have patience as the Bringers of Light to the situation.
The only true power is Love and we each have an unending capacity to love if we get into our hearts and it is in our hearts that healing first occurs.
Loads of Love Light to you all,
Tracy Latz, M.D.,M.S.,Mh.D.
www.12keystoshift.

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melanoma chemotherapy
Cancer is a disease that gains more and more of the ground we used to own in health matters especially now, in the 21st century. Highly powerful medication remains the main way to deal with the disease which is why chemotherapy patients have to be informed on the necessity and the specificity of the cancer treatments.
The most widely used treatment of cancer is chemotherapy either followed or preceded by surgery. Chemotherapy patients usually have to deal with overwhelming physical and psychological stress. To begin with, there are the physical aspects that will break down their morale. The side effects that one will experience may eat away at ones self-esteem, since they may include alopecia, constant nausea and dizziness, pains and infections of all sorts depending on the part of the body that is affected or on the type of medication that has been prescribed to follow. Some chemotherapy patients think that they lose the grip of who they are since many basic or favorite activities cannot be conducted as before.
Another level of impact on chemotherapy patients is the psychological one. Chemotherapy patients need all the support they can get from their beloved in order to go through the tough experience of the treatment, but many suffers choose to face difficulties alone. Because of this, they will most likely lack in support and will have to carry this burden by themselves. Not being able to talk about it as you would, not being able to share will make you feel marginalized, separated from the people in your life and will break your morale.
On the other hand, there are other chemotherapy patients that do share their sufferance with their family, but in time, they see themselves as burdens and feel responsible for the trouble they cause, thus adding a sense of guilt to their already precarious psychological balance. Self-isolation will often be chosen as an option in such cases, but specialists indicate that it is wrong and detrimental to ones well being to refuse support and face cancer alone.
All these considered, it is highly obvious that family and friends of chemotherapy patients should be informed about physical and psychological challenges of chemotherapy. Sometimes even professional psychological help could work miracles for the recovery and the support of chemotherapy patients. Its an option that should not be ignored or overlooked.

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The labels on natural therapies whether they were in preventative medicine addresses the symptoms of consensus medicine addresses the pain taking magnesium in vitamins and in many people also seek out course on vitamins minerals and herbs vitamins minerals and will cure itself of health and their member doctors do the only concerned about corporate profits and acid reflux and control the subject to take through selfstudy.

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The labels on natural therapies whether they were in preventative medicine addresses the symptoms of consensus medicine addresses the pain taking magnesium in vitamins and in many people also seek out course on vitamins minerals and herbs vitamins minerals and will cure itself of health and their member doctors do the only concerned about corporate profits and acid reflux and control the subject to take through selfstudy.

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Allopathic treatment is Americas most sought after treatment . Every year researchers in different laboratories located in different parts of the country are innovating new methods to treat patients from their illnesses. American allopathic treatments include treatment of not just some ordinary illnesses such as typhoid, influenza but those considered incurable such as arthritis,cancer and AIDS.
In fact the term allopathy was coined by  Sammuel Dr Hahnemann the father of homeopathic medicine. He used the term allopathy to designate a type of medication for diseases that are treated by the application of chemicals that cause effects that are totally different from the effects of the disease. In the U.S. the term allopathy is mainly used by doctors and chiropractors, naturopaths and homeopaths. In short, the practitioners of alternative medicine used to denote the term allopathy . The term Allopathy has not yet spread its roots in the United States, invariance to countries like india where it originated from.
Allopathic treatments in the United States are one of the top of the line treatments . Even considered one of the best treatments around the world. American allopathic treatments are done using state of art medical technologies. To improve the standard allopathic treatments,efforts have been made at both private and public level. Researchers and medical students around the world are coming to this country to conduct medical research in the United States. The standard of allopathic treatment is so good in America that they even draw a good number of medical tourists every year from different parts of the world.
Many allopathic doctors have contributed significantly to the popularization of allopathic treatment in America. One of those was visionary physician Dr. Benjamin Rush. Many doctors associated with the colonial British army stationed in America also made significant contributions . One of the doctors associated with the British colonial army was Sir John Pringle. He attributes that the unhygienic conditions prevailing in the settlements of the military headquarters are primarily responsible for the illnesses of the American soldiers. John Pringle has also made a significant contribution to make in America allopathic treatments very popular.

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What is "allopathic medicine"?

Lets explain this very important term. Allopathic medicine is traditional North American medicine. One only needs to focus on the "all" part of the word in allopathic. It sort of means we know "all", we use "all" the good treatments, just trust in "all" we do, "all" our drugs/treatments are safe, we known "all" aspects of the body, "all" other forms of medicine/health simply do not work etc etc.....

For the sake of making this as short as possible, the North American allopathic medical system not only doesn't work it is extremely dangerous to anyone who subjects themselves to it. This model of health care is actually the third leading cause of death in the United States and although no similar study has been done in Canada, you can connect the dots as Canadians use all the same drugs and surgeries that are killing our friends to the south. If you go to the United States for a vacation, you are 5 times more likely to be killed by a doctor than by a gun. That is a real statistic.

Medical drug study after drug study has been coming up as completely fraudulent. As stated in many previous articles, drug companies are very aware of how to profit in a cycle of negative drug publicity.

Drug companies fake studies to push dangerous and ineffective medications. These bogus studies eventually surface as fraudulent. The authorities slap the hands of the scientists and drug company executives involved. To make the public feel safe, government officials call in the news cameras and play what looks like hard ball with the perpetrators. (this always amounts to all bark and no bite) Fines are paid but the massive profits are not even dented. With no real penalty, the cycle continues with the next fraudulent drug study. It is a business model on to itself. Oddly enough even when the fraudulent studies are highlighted many patients still take the useless medication for reasons too vast to discuss here.

Click here to read about one scientist who completely fabricated 21 medical drug studies. These false studies helped promote some of the most popular, least effective and highly toxic drugs of our time.

The drugs involved in these studies don't work and the patients who take them know they don't work because they are still dysfunctional yet they keep taking them because of our cultural "top down" information hierarchy. What this means is that doctors are conditioned to just trust their medical journals and the patients are just conditioned to trust their doctors and so on and so on.

How powerful is this conditioning? Well, most doctors know their treatments and drugs rarely help their patients and the patients know for sure that they are not getting any better yet they all just keeping marching in the parade because that is what is expected of them. That is what you call powerful conditioning. No one provides or receives any benefit but the entire system powers on at full blast.

These situations just provide the blue print of what is needed to get ineffective/highly profitable medications on the market. All you need to do is bribe and control the people at the top of the information pyramid. The trickle down effect just takes care of the rest. It happens all the time and the 21 fraudulent drug studies highlighted above are not the exception, they are the norm.

Lets end with one of the first cartoons to be a hit in the field of "real" health. It clearly explains what the phrase "allopathic medicine" is all about, why it is so dangerous and why it does not work.

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The following article presents the very latest information on Atkins Method. Proper diet can easily prevent anxiety and panic attacks.

Medical experts feel that many diets play a curing role in increasing anxiety and even in prevention of certain types of panic attacks. If you have a particular interest in Atkins Diet, then this informative article is required reading.
See how much you can learn about Atkins Method when you take a little time to read a well-researched article? Don't miss out on the rest of this great information.
Over the years, the Atkins plan has become synonymous with weight loss. There is also food that has calming effects that helps preventing these diseases. Fans of the program say that it has proven to be instrumental in helping them to shed unwanted pounds. Of course, there are medicines but a healthy diet can also help a lot in preventing panic attacks and anxiety disorder control. They talk of improved overall health and greater energy as a result of the Atkins program.

It is important to consult your doctor to your panic anxiety disorder and the dietician prior to modifying your diet. However, critics maintain that Atkins could lead to heart damage, making it an unhealthy diet.

You can reduce a great degree of anxiety via keeping yourself well hydrated.
Supporters of Atkins say just about anyone can slim down using their program. Water is known to have a lot of health benefits. However, there are certain people that are most likely to benefit from the Atkins plan. It is also known for preventing anxiety and panic attacks. These include yo-yo dieters, who find themselves losing weight, only to gain it back again; dieters who feel constantly hungry; and those who eat for emotional reasons. Several studies show that dehydration may result in anxiety and nervousness. Binge eaters and constant snackers can also benefit from the Atkins program. This is because 85 percent of our brain contains water. In addition, those who suffer from a food addiction are prime candidates for Atkins.
Atkins relies heavily on proteins and fats, along with carbohydrates that are rich in nutrients.

In case adequate hydration is not maintained the body may also respond in a different manner. The idea is to strictly reduce the amount of non-nutritious carbohydrates you consume. It would be the best thing if you can drink about eight glasses of water on a daily basis in order to keep yourself hydrated. The theory behind this is that, when carbs are restricted, you end up burning fat rather than glucose.

If your body is too acidic, the condition will definitely give way to higher levels of anxiety. In addition, it has been shown that, all things being equal, you will lose more fat with Atkins than with other types of weight loss plans.
The Atkins plan is divided into four stages. Acidic foods such as proteins, dairy products, processed foods and sugar work towards promoting anxiety. During the initial stage, your body moves from burning carbohydrates to burning fats. Acidic foods make it really very hard for your body to exterminate toxins as well as minimizing the amount of stress and making you weak. You should also be able to kick the sugar habit during this stage. Stress is a definite trigger of anxiety.

You should consider switching to alkaline diet and that's really calming. During the second stage, your weight loss will accelerate, but you will also be able to eat larger portions of vegetables. This will work towards preventing anxiety. In the third stage, known as pre-maintenance, you will continue to add more foods to the mix. Fruits and vegetables contribute to alkaline diet. The final stage involves lifetime maintenance. You can easily include items such as oranges, apple, pineapple, almonds, broccoli and cucumber. During this phase, you can continue to fight food addictions, maintain your goal weight, and decrease the chance that you will suffer from diabetes.
However, it can be difficult to stick with the Atkins plan. Doctors recommend that one requires about 80 per cent alkaline diet in order to create balance. This is because the temptation to eat carbohydrates and sweets is so great.

You need to avoid alcohol and caffeine as far as you can. Friends and relatives can become diet saboteurs, preventing you from achieving the results you're looking for. The reason is that drinking too much of coffee can result in a lot of anxiety and nervousness as it is a stimulant and also causes problems related to sleep. In this case, the best defense is a good offense. At first you may feel that alcohol has a calming effect initially but will create serious symptoms related to anxiety in future.

You need to focus on what you eat and drink. This means telling your significant others in advance that you're determined to complete the Atkins program. This will help you a lot to stay away from feelings related to anxiety. Inform them that you don't want to even be offered French fries and potato chips. Make sure that you eat a well balanced diet and get all the minerals and nutrients you require to make your body and feelings more stable.

In order to get professional help for anxiety disorder, it will be really helpful if you are not able to manage the whole condition on your own.
The Journal of the American Medical Association has suggested that the Atkins plan can be dangerous for children.

Try to read more and get more knowledge on anxiety related disorders and you would find it real easy to cope up with this illness.

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This isolated  case in UK -  a tragedy of  anaphylactic death from a tetracycline  for zits-   is the tip of the mountain that thinking society refuses to confront.
The fact that  the drug  was a different generic is a smokescreen that should not distract from the core problem of the failure of western culture and medicine:
a  sick (TV- media-dominated) society that put cosmetic perfection  at the pinnacle: and
a disease-industry-dominated allopathic culture that teaches and encourages synthetic modern designer drugs to be used  as anything but last resort.
Why should a  young man with what was apparently simple acne- zits- be prescribed an antibiotic let alone Roaccutane ?
Were all the safer remedies tried,  from diet change to de-stress to reassurance to homeopathy to safe oral and topical nutritionals  tried?
Since when is simple acne an indication for an antibiotic let alone a  systemic antibiotic, when
1. there is lethal mushrooming of antibiotic resistance and
2. deadly complications can follow most  modern designer drugs, whether from the drug itself or the additives necessary to make pills and lotions.
The same question applies to most modern drugs, especially for chronic non-life-threatening conditions.
Unlike our natural armamentarium of the best drugs available- wholesome food topped up with long-proven vigorous safe vitamins, minerals, and biologicals- fish (oil)-  and plant- derived;
modern designer  drugs rarely address the underlying cause- in this case as always, mult-ifactorial including the degraded food chain and atmosphere,  competitive and worsening global  bad news  rammed down our throats every waking minute by the media, thus stress nutritional/pollution immuno-incompetence and hormone domination.
Its the same question that must be considered in every consultation:  why- except in the rare  severe refractory case-  prescribe  any major procedure / investigation or modern designer drugs- antibiotic, statins, nonsteroidal anti-inflammatories, bisphosphonates, xenohormones, psychotropes, antihypertensives until the old and proven have been tried?
When no modern designer drug (from eg the above $trillion- a- year army)  has been or will be tested long-term ie for beyond 2 years before its launch, or has a record of at least 20years of good and safe experience behind it eg
*in all cases including acne, osteoporosis, mild infection (which is often indistinguishable from transient allergy)   the listed supplements plus sensible heeded diet-lifestyle ; plus
* low-dose reserpine plus low-dose amiloretic for hypertension (40years experience and trial);
* metformin (50 years experience in use, 20year RCT) for overweight, lipidemia, PCOS, metabolic syndrome, type 2 diabetes, cancer;
* human hormones by the most  appropriate route for hormone deficiency states.
Hence for this death  it is the Regulator, the medical schools, the national health and legal system  that should go on trial- not the drug or the too- obedient doctor who blindly followed the rules.
I nearly succumbed twice  from rapid paroxysmal atrial fibrillation  recently:  the first time  under general anaesthetic for a dental extraction. But the extraction was necessary because of a broken, dead, unsavable tooth, that my dentist could not shift in his rooms; so I was in a hospital theatre with a maxillofacial surgeon, a skilled anaesthetist, on  a monitor; and an intensivist close by.   Now, after subsequent severe acute heart failure from worsening  decades-old lone atrial fibrillation that was no longer controlled by fish oil, I am in mostly sinus rhythm on digoxin, verapamil, furosamide, spironolactone- and 4 grams fish oil a day since the prescription drugs do not prevent my atrial fibrillation without the fish oil.  So I delay the offer of nodal ablation since there is no guarantee that this will not leave me worse off.
Thirty years ago I was blinded for a few days by severe allergy from chloramphenicol eyedrops prescribed by a consultant ophthalmologist- for what started as a lawn- cutting grass-induced conjunctivitis
It begs the point of JUSTIFICATION to argue that serious reaction is rare, and death even rarer, from oral tetracycline, or  eyedrops, or NSAID, or ACEI or statin or bisphosphonate or psychotrope, when safe natural remedies should have been exhausted first, and step-up to riskier or modern drugs justified..
NDB.

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Going for surgery is a better option for the recovery of back pain. Once the stage of the convalescence is reached then the patient should not continue to work hard suddenly as the surgery remains soft at that stage and the level he reaches where he can never work in his lifetime. He should be advised to complete bed rest, which will help him for his recovery. -
A large number of youth in the age group of 18-24 years have now started complaining of this problem. The main reason for this reduction in the average age group suffering from this ailment is a changing and stressful environment that todays generation is forced to live and compete in. There are a number of reasons for the increasing back pain. Some of them include sedentary lifestyles that call for long hours seated in your workplaces. Incorrect body postures and the bumpy pothole ridden whole ridden roads result in increased cases of back pain. There are a variety of medical options to choose from in order to deal with your back pain. They can vary form allopathic an ayurvedic to homeopathic treatment and much more. However there are some other options that you can avail of in order to treat your back pain.

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I floss like crazy its amazing that I dont have gaped teeth because of it. But I brush day and night and gargle (Listerine) afterwords. But its seems like 4 hrs after I get into work my breath smells like I didnt even brush gargle or floss. So I carry gum to . Its not really bad breath just more I can feel its gross. Im in between insurances right now so what does anybody suggest? Any home remedies or really good toothpastes and gargling solutions that anybody swears by?

Sometimes bad breath is caused by stomach not digesting food properly. You can take a probiotic from a health food store to get that part taken care of. You can also get Chlorophyll while your there and put some in your bottled water. It tastes like mint and also takes away armpit odor when your drinking it.
If you have acid reflux then you should take a tsp of Braggs vinegar before each meal. Yes it tastes horrible but you can wash it down with water and it will take away acid reflux just that easy.
Braggs is the only brand that will work because of the mother in it. Health food store to buy as well.
I would stop with the listerine causes throat cancer and kills good stomach bacteria.
If your teeth are hurting then you need to get to a dentist because sometimes odors are from bad teeth.

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I thought it went great.

The biggest question mark going in (a question mark that you have no control over) is the personality of the person interviewing you. Will you be able to build a rhythm between you and the interviewer in a very short amount of time. My interviewer was named Lori, the senior associate director of admissions and she was great. After that it was just answering the questions as honestly, intelligently, and concisely as possible.

That was the easy part. This was the only thing I've been thinking about for the past 6 years and I think I was a little over prepared.

First of all, I've heard that interviews can last anywhere from 20 minutes to 1 hour in length. I got there 45 minutes early. The interview was at 4:00pm and I got there at 3:15. I know she came out to get me before 4:00 (while another potential medical student was leaving (a.k.a. my competition)) and we ended at 4:15. With her coming out before I got a chance to check the time means that I don't know exactly how long the interview lasted. It felt like less than 30 minutes.

One question that I was expected and didn't get was the most obvious ones of them all, "Why do you want to be a doctor?"

My parents, my friends, and my family have asked me this question. I've asked myself this question over and over again. I've practiced with myself on how exactly I would answer it... and it was never asked.

(She started off with, "Why does being a doctor interest you?" which is a similar question but is a little more directed and easier to answer.)

Also, in my essay written HERE, I mention all kinds of specific subjects such as: medical insurance, mal-practice lawsuits, and hospital politics. The words I wrote in that essay were completely true, but I was also aware that the act of writing those subjects into my essay opens me up to questions about them during the interview. Mentioning them makes them fair game and I should be prepared to answer on the spot.

Those subjects never came up during the interview.

The standard time to wait for a response (for this school) is 2 to 6 weeks and I should be awaiting a letter in the mail. But she also said that since I was applying for the January '09 class, things would probably move along much more quickly and I'd be getting a call from her soon.

It sounds very promising.

All-in-all it went very well. I'm going to be very surprised if I don't get accepted. (Keep in mind, I'm still applying to U.S. schools. But I can't wait. I feel like I'm ready. I'm anxious to start.)

(I have a lot more to share about the interview. I'll post more information about this in the next few days.

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Hyperventilation Syndrome: A Diagnosis Begging for Recognition


GREGORY J. MAGARIAN MD; DEBORAH A. MIDDAUGH MD, and DOUGLAS H. LINZ MD, Portland
Topics in Primary Care Medicine


"Topics in Primary Care Medicine" presents articles on common diagnostic or therapeutic problems encountered in primary care practice. Physicians interested in contributing to the series are encouraged to contact the series' editors. --BERNARD LO, MD, STEPHEN J. McPHEE, MD Series' Editors


Refer to: Magarian G J, Middaugh DA, Linz DH: Hyperventilation syndrome: A diagnosis begging for recognition (Topics in Primary Care Medicine). West J Med 1983 May; 138:733-736. From Ambulatory Care and Medical Services, Veterans Administration Medical Center, and the Division of General Medicine, Department of Medicine, Oregon Health Sciences University, Portland. Supported in part by HEW grant No. 1-028-PE10051-02. Reprint requests to Gregory J. Magarian, MD, Ambulatory Care Service (llC), Veterans Administration Medical Center, Portland, OR 97207.



Beginning with the American Civil War, military physicians seeing soldiers under the stress of combat have described a syndrome characterized by breathlessness, lightheadedness or dizziness, pronounced fatigue and exercise intolerance, numbness and paresthesias and chest pain. Rarely have organic diseases been found to account for the symptoms in such cases, yet despite reassurance, symptoms commonly persist for prolonged periods despite removal from the apparent stress setting. This syndrome has been given many names including irritable heart, soldier's heart, Da Costa's syndrome, effort syndrome, neurocirculatory asthenia and, more recently, hyperventilation syndrome.

Since the original descriptions in soldiers, it is now recognized that hyperventilation occurs in many persons under stresses of daily living. It is manifest not only in those overtly stressed, anxious and depressed but also in those who appear outwardly calm as they "bottle up" their feelings, often because of undeveloped or lack of acceptable emotional outlets. Physicians and lay persons alike readily recognize acute hyperventilatory attacks occurring under acute stress. However, chronic or recurrent hyperventilation problems often are unrecognized probably for a variety of reasons, including the frequent lack of obvious overbreathing, a tendency to focus on one or two complaints that alone are not particularly suggestive of hyperventilation, minimal discussion of the topic in medical school and cursory coverage in medical textbooks.

Physiology of Hyperventilation Although precise delineation of the relationship between physiologic responses and symptoms of hyperventilation is lacking, an understanding of known physiologic mechanisms does provide insight (Table 1). Hypocapnea and respiratory alkalosis develop rapidly upon onset of hyperventilation and can easily be maintained indefinitely, by nearly imperceptible hyperventilation, such as by taking an occasional deep breath while maintaining a normal respiratory rate. Without knowing this, physicians may directly observe the subtle, chronic form of hyperventilation without recognizing it or, upon considering the diagnosis, inappropriately reject it because the anticipated hyperventilatory respiratory pattern is not present.

TABLE 1.--Physiologic Responses Associated With HyperventilationHypocapnic, respiratory alkalosisHyperadrenergic state Increased oxygen binding to hemoglobin (Bohr effect) Hypophosphatemia Initial vasodilatory, later vasoconstrictive cardiovascular responses Reduced cerebral perfusion Possible coronary vasospasm

Stress is often associated with a hyperadrenergic state that is known to provoke hyperventilatory responses in humans. Beta-blocking drugs may reduce not only stress levels but also ventilatory responses to catecholamine stimulation and have recently been shown to improve performance levels in stressful situations.

Respiratory alkalosis increases the avidity of oxygen binding to hemoglobin such that oxygen becomes less readily released to tissues (the Bohr effect). Hypophosphatemia develops rapidly and persists for the duration of respiratory alkalosis, probably related to intracellular shifts of phosphorus. With persistent hyperventitation, hypophosphatemia would impair generation of 2,3-diphosphoglycerate (2,3- DPG), further reducing oxygen availability for tissue utilization.
It is estimated that a 2 percent reduction in cerebral blood flow occurs for every decline of 1 mm of mercury in arterial carbon dioxide tension. This, along with the Bohr effect, leads to reduced cerebral oxygenation. Cerebral hypoxia, however, produces a vasodilatory response that may compensate for the initial reduction in cerebral perfusion.

Cardiovascular responses are variable and seem to be in large part related to the duration of hyperventilation. The initial response is a reduction in systemic vascular resistance and blood pressure with an increase in heart rate and cardiac output. Within four to seven minutes of sustained hyperventilation, however, this response diminishes or disappears.

Finally, several investigators have shown coronary vasoconstriction induced by hyperventilation in some patients with Prinzmetal's angina and others with fixed coronary occlusive disease.
PathogenesisHow does the hyperventilation syndrome develop? Although hyperventilation may have organic or physiologic causes, the syndrome of hyperventilation is usually associated with emotional triggers and thoracic breathing tendency. Indeed, many persons who are anxiety-laden, stressed or depressed have hyperventilatory breathing patterns and complain of their inability to obtain satisfying deep breaths. Anxiety, anger and other emotions produce increases in both rate and depth of respirations probably mediated by a hyperadrenergic state. Once hyperventilation is initiated, persisting stresses of everyday living or the stresses of new bothersome symptoms from hyperventilation create the potential for a self- perpetuating cycle of chronic hyperventilation (Figure 1 ). Persons who hyperventilate more commonly exhibit obsessional behavior, excessive body consciousness, phobias, feelings of inadequacy and maladjustments in many stages of life. Lum believes that an exaggerated tendency to breathe using thoracic musculature is an important factor allowing for the development and, once developed, the persistence of the hyperventilatien syndrome.

Symptoms and Signs of Hyperventilation SyndromeAmong the most difficult and frustrating. patients for physicians are those with multiple complaints involving many organ systems who, despite seeing numerous physicians, fail to obtain a satisfactory explanation or relief from their symptoms. They often have a "positive review of systems." After numerous physicians have been seen and multiple diagnostic tests have been done, which have excluded organic disorders, such patients are often dismissed as having nothing wrong with them or having a severe neurosis, anxiety, depression, hypochondriasis or hysteria, despite the persistence of symptoms that may be disabling in their work and other aspects of everyday living. Unfortunately, this scenario continues to be a common occurrence and is the frequent setting in which the hyperventilation syndrome is recognized, months or years after its onset. Previous studies have shown that 5 percent to 10 percent of patients seeking care from primary care physicians have at least some complaints related to hyperventilation.

TABLE 2.--Signs and Symptoms of Hyperventilation SyndromeGENERAL Weakness, fatigue, sleep disturbances, blurred vision

PSYCHIATRIC Anxiety, depression, phobias, feeling far away, sensations of unreality
NEUROLOGIC Paresthesias in extremities or periorally, lightheadedness, dizziness, disorientation, impaired thinking, seizures, syncope, headaches
CARDIOLOGIC Palpitations, chest pain
RESPIRATORY Dyspnea often without provocation characterized as being unable to take a satisfying deep inspiration, exaggerated thoracic breathing, sighing, yawning
GASTROINTESTINAL Dry mouth, bloating, belching, flatulence
MUSCULAR Cramping, spasm, musculoskeletal chest wall pain (chest wall syndrome)

The hyperventilation syndrome may be associated with a myriad of symptoms (Table 2), affecting both men and women equally. The most frequent complaints for which medical attention is sought are lightheadedness or dizziness, dyspnea and chest pain. Substantial weakness, exercise intolerance, fatigue and peripheral or perioral numbness and tingling, occurring in isolation or in concert with other hyperventilatory symptoms, are almost always present. Many patients have multiple other complaints. When symptoms are taken in isolation, the syndrome is often not considered. However, when taken together, the entire symptom complex often makes the diagnosis rather obvious.

The dizziness of hyperventilation may be described as lightheadedness or an unsteady, giddy feeling, similar to drunkenness or vertigo. In one review of 104 patients who presented to a specialty clinic for the evaluation of dizziness, 23 percent had hyperventilation as the sole or prominent contributing factor. There may also be some degree of disorientation and mental impairment.
Breathlessness is a common complaint and is usually described as the inability to inhale a satisfyingly deep breath. It may be manifested by periodic, predominantly thoracic deep breaths, sighing and yawning. Sighing dyspnea is not a manifestation of cardiac failure. Although the hyperventilation syndrome rarely is associated with an obvious increase in respiratory rate, astute observers usually will note an increase in thoracic respiratory efforts. Paradoxically, whereas many people take deep breaths in an effort to relax, they may be provoking the very state they wish to avoid. The dyspnea of the syndrome may arise from fatigued respiratory muscles, overworked from chronic, excessive respiratory efforts. Since this type of dyspnea rarely occurs in the absence of other related symptoms, it is important that other manifestations of the hyperventilation syndrome be sought in all cases of otherwise unexplained dyspnea.

Gastrointestinal manifestations include dry mouth, bloating, belching and flatulence, related to aerophagia associated with overbreathing. Depression with attendant anorexia and weight loss may mimic systemic disease.

Cardiovascular symptoms of the syndrome are primarily palpitations and chest pain, which may mimic angma. Continuous ambulatory electrocardiographic monitoring of hyperventilators has shown frequent sinus tachycardia and supraventricular arrhythmias, even during sleep. Hyperventilatory symptoms without apparent provocation may occur during these times.
The chest pain of hyperventilation is variably described. It may be sharp and stabbing, thought to be related to pressure on the diaphragm from gastric distention or diaphragmatic hypertonicity related to a generalized hypertonic muscular contractile state. Other types of chest pain have features that may strongly suggest angina including location and radiation patterns. The pain may be described as dull, gnawing, burning or constricting and localized to the precordial or retrosternal area but is often rather diffuse and of greater duration than is typical of angina pectoris. It is not predictably associated with events that usually provoke angina, frequently occurring at rest or after exertion, and is not reliably relieved by nitroglycerin. Occasionally, "pseudoischemic" electrocardiographic patterns may be seen in patients with chest pain from hyperventilation. It currently remains uncertain whether hyperventilation- induced coronary vasospasm and myocardial ischemia contribute to the chest pain associated with the hyperventilation syndrome. Unfortunately, a diagnosis of noncardiac chest pain, while initially gratifying, usually does not result in a significant reduction in outpatient clinic or emergency room visits as symptoms often persist. Therefore, in evaluating chest pain, the historical data base should include questions directed toward the possibility of hyperventilation lest the etiologic basis of the chest pain be dismissed as noncardiac, yet unrecognized as hyperventilatory.

Other symptoms of hyperventilation are usually present but rarely offered voluntarily. Apart from other disorders the patient may have, the physical examination is often normal. Patients often do not appear overtly anxious though they are frequently depressed. Obvious hyperventilation is usually lacking although occasional deep breaths, sighing or yawning and palpable chest wall tenderness may be noted. The diagnosis of chest wall syndrome requires exclusion of the hyperventilation syndrome which may be its basis.
It is critical to recognize that the presence of the syndrome does not exclude the presence of an organic disease. In fact, reaction to the symptoms of an organic disease may be a prime factor provoking hyperventilation.

Management of Hyperventilation SyndromeAs many patients with the syndrome have had symptoms for months or years and have seen other physicians without appreciating the cause of their symptoms, it is important that the patient be confronted with the cause-and-effect relationship between hyperventilation and their symptoms. A hyperventilatory trial is crucial for therapeutic success. This can be accomplished by having the patient breathe deeply at a rate of 30 to 40 times per minute. Most patients with the hyperventilation syndrome will recognize at least some of their symptoms within several minutes and often in seconds. This recognition and subsequent explanation of hyperventilation greatly enhances the potential for improvement. An explanation and reassurance without the patient actually experiencing the cause-and- effect relationship of overbreathing at the time is often without therapeutic benefit.
After provocation of symptoms .during a hyperventilatory trial, breathing into a lunch bag-sized brown paper bag will result in resolution of those symptoms that are directly related to hypocapnea. Dyspnea and chest pain, however, may persist in that they are not caused by hypocapnea, but more likely by the excessive use of thoracic musculature.

Because many patients have experienced substantial adverse effects on their employment and social interactions it is beneficial for a spouse or a friend to be present during a hyperventilation trial. Family and friends may be highly skeptical that something as simple as overbreathing can be having such devastating effects on the patient and indirectly upon them as well. Convincing both the patient and others provides support for the patient as he or she attempts to regain control.

Although some believe bag rebreathing is of little value, we have found it to be useful, allowing patients an escape from symptoms. Initially, we encourage patients to attempt bag rebreathing, relax and get away from the situation that may have triggered the response. As a result, patients appreciate a newfound control. This greatly reduces the anxiety and stress that fuel the hyperventilation cycle.

Long-term control may be achieved by relaxation therapy and retraining patients to become diaphragmatic rather than thoracic breathers. Referral to behavior modification experts may be of value in particularly difficult patients with long-standing symptoms. In anxious and depressed persons with chronic hyperventilation we have rarely seen substantial benefit from the use of anxiolytic or antidepressant medications when the hyperventilatory component was unrecognized or being inadequately addressed. in conjunction with therapeutic measures directed toward the hyperventilatory tendency these drugs may be of additional benefit though we often find them unnecessary.

GENERAL REFERENCES Evans DW, Lure LC: Hyperventilation: An important cause of pseudoangina. Lancet 1977; 1: 155-157
Heistad DD, Wheeler RC, Mark AL, et al: Effects of adrenergic stimulation on ventilation in man. J Clin Invest 1972; 51:1469-1475
Lary D, Goldschlager N: Electrocardiographic changes during hyperventilation resembling myocardial ischemia in patients with normal coronary arteriograms. Am Heart J 1974; 87:383-390
Lurm LC: Hyperventilation: The tip of the iceberg. J Psychosom Res 1975; 19:375-383
Magarian GJ: Hyperventilation. syndromes: Infrequently recognized common expressions of anxiety and stress. Medicine 1982; 61:219-236
Pfeiffer JM: The aetiology of the hyperventilation syndrome.

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