Review of Oxford Messed Up by Andrea Kayne Kaufman Facing OCD

[Note: In celebration of love, life and hope, Andrea Kayne Kaufman will be offering the Ebook edition for $ .99 on Amazon from May Day thru Cinco de Mayo - May 1-5.]


When Grant Place Press contacted me about reviewing Oxford Messed Up by Andrea Kayne Kaufman, little did I realize the connections I would find with my own life.  The protagonist, Gloria Zimmerman, is traveling to Oxford to study feminist poets, and struggles with OCD.

I have a degree focused on feminist poets.  Reading poems written by these women, and writing my own poems gave me strength to deal with depression, OCD and other pain.   I was a very serious young woman, who didn't know she had OCD, but knew that I was often scared about symptoms in my body, and trying to be perfect.  Gloria knows she has OCD, but attempts to keep herself together with rituals, Klonopin, and Van Morrison's music.

Van Morrison's music is a source of strength to both Gloria, and her "loo-mate" Henry Young(the other protagonist who has had many traumas in his life).   As a girl, I  remember sitting on the floor going through my parents record collection, trying to understand what a Moondance was, and mesmerized by the album.

I was intrigued that one of the recommendations on the back of the book came from Susan Richman from OCD Chicago, a chapter of the International OCD Foundation.  Oxford Messed Up does indeed explore Exposure and Response Prevention Therapy(ERP), the standard for treating OCD, and is the only novel for the adult market that I've ever come across that does.

Henry is the catalyst for Gloria's ERP, and this shows the importance of rapport for willingness to do Exposures.  If I hadn't trusted my ERP therapist, I wouldn't have done any of the Exposures he suggested.  I believe that family and friends are often on the frontlines of working on Exposures with the ones they love who have OCD, and that self-help has been very important for many sufferers, especially Jonathan Grayson's book Freedom from OCD, and his model of GOAL support groups.

At the same time, though, I was ambivalent about Henry's quick study of ERP, and how unrealistic this might be.  I was able to suspend disbelief because I remembered reading somewhere that ERP, even incompletely done, can be better than years and years of talk therapy. I only wish more therapists were  quick as Henry--like the 6 or 8 of them I saw before I found Leonard, who actually specializes in OCD and was expert in Exposure Therapy, rather than asking me to simply avoid my triggers or use logic to make it all go away.  I would imagine a novelist's dilemma would be how to portray a series of ERP sessions with a therapist, in a way that would make good fiction.  

Gloria has contamination OCD, which I don't have, and which gave me a brief flash of disappointment, because this is the stereotype of people who have Obsessive Compulsive Disorder.   But she also has perfectionism, a mandate to be a "Superstar,"  which I identify with, and I liked that Kaufman showed how perfectionism can underlay everything, and that this may be slower to respond than other aspects of OCD.  If patterns have been in place for a lifetime, through family culture, personal history, combined with genetic heritage, that simply habituating to the "dirty world" isn't enough, and that compassion, love, understanding and hope are crucial to regaining a life that has been ordered by taking as few risks as possible, and trying to earn the love of others.  

I recommend Oxford Messed Up for it's improvisational dialogue both internal and external, for an inside look at the OCD thought process while facing fears, for the importance of hope, and of "fatalistic optimism"(as the characters describe the music of Van Morrison).

In celebration of love, life and hope, Andrea Kayne Kaufman will be offering the Ebook edition for $ .99 on Amazon from May Day thru Cinco de Mayo - May 1-5.

Avastin Lucentis Update 49 A Follow up on Infections from Intravitreal Injections

In my last posting (Avastin/Lucentis Update 48), I wrote about the problems with Avastin injections, that appeared to be caused by non-sterile/non-aseptic techniques during re-packaging Avastin from 4 ml bottles into much smaller doses (0.05ml) in tuberculin syringes.

A colleague, who is a compounding pharmacist, pointed out to me that other things can cause contamination of the eye during intravitreal injections besides using non-aseptic techniques during aliquoting and re-packaging of Avastin into injectable syringes.

He sent me a copy of a report from Medscape Medical News that was published online following a meeting of the American Academy of Ophthalmology and Middle East Africa Council of Ophthalmology 2010 Joint Annual Meeting, held during last year’s AAO Meeting.

Here are excerpts from that report:

Intravitreal Injections Expose Patients to Streptococcus More Often Than Eye Surgery

Kathleen Louden
October 20, 2010
Medscape Medical News

Streptococcus is isolated much more frequently from endophthalmitis cultures after intravitreal injection (IVI) of antivascular endothelial growth-factor agents than after ocular surgery, results of a meta-analysis show.

Ophthalmologists should consider using additional sterile techniques during these injections to prevent exposing patients to the sight-threatening complication of streptococcal endophthalmitis, said study author Colin McCannel, MD, associate professor of ophthalmology from the Jules Stein Eye Institute at the University of California at Los Angeles.

"If we can prevent some of the worst cases of endophthalmitis, I think it's worth the effort," Dr. McCannel told Medscape Medical News.

To confirm his impression that reports of Streptococcus organisms seemed more frequent than should be expected after IVI, Dr. McCannel analyzed the American medical literature from 2005 through 2009. He found 16 articles that reported the causative organism in post-IVI endophthalmitis. As expected, endophthalmitis was rare, occurring in 54 of 105,531 injections. Only 26 were culture-positive, according to the abstract. Most of the causative organisms were coagulase-negative Staphylococcus, he said.

However, cultures yielded Streptococcus organisms 30.8% of the time (8 of 26), which Dr. McCannel said is "3- or 4-fold higher" than the incidence reported in the literature for acute postoperative endophthalmitis. The postoperative incidence of streptococcal endophthalmitis ranges from 0% after vitrectomy to 8.2% to 9% after cataract surgery, he reported.

Likely Source of Infection

This finding led him, he said during an interview, to do "some detective work" to try to find the possible source of these streptococcal infections. He found several studies in the anesthesia literature reporting streptococcal meningitis after dural puncture, a procedure that, according to Dr. McCannel, has a working distance between physician and patient similar to that of IVI. Analysis found that the causative organisms in most of those cases came from the treating physician's oral flora, which was aerosolized during talking.

Consequently, the Centers for Disease Control and Prevention in Atlanta, Georgia, recommended in 2007 that spinal procedure operators wear a surgical mask during the procedure (MMWR Morb Mortal Wkly Rep. 2010;59:65-69).

Ophthalmologists "often have to give directions to the patient during injections, and sometimes there is small talk," Dr. McCannel said. "The patient's eye is probably being showered with these microscopic droplets. We may be contaminating the injection field or the needle."

Recommendations

If other studies validate his findings, the ophthalmic community should decide whether to recommend wearing a surgical mask during IVI, he said. He told the audience that he does not wear a mask because "it would be burdensome to take it on and off" during the brief injections.

Another precautionary strategy that Dr. McCannel suggested was to avoid talking, coughing, or sneezing during the injections. He said he asks his ophthalmic technicians to instruct the patient before the procedure that "the injection is not the time to ask questions" and to refrain from talking. If he needs to instruct the patient, he said he speaks away from the patient.

A panelist at the session who did not participate in the study, Joan W. Miller, MD, said in an interview that the study findings have the potential to change clinical practice. Dr. Miller, professor and chair of ophthalmology at Harvard Medical School in Boston, Massachusetts, said she will consider changing her IVI techniques to try to prevent the spread of Streptococcus.

"Not talking on the [injection] field is probably sufficient precaution," she told Medscape Medical News.



My friend, the compounding pharmacist, went on to say,  “I wish we had more visibility into what [really] happened in TN and FL and the pharmacies that prepared those compounds. It is even more critical that physicians look to do their diligence when choosing a pharmacy to provide these sterile compounds to patients. Because of our strict quality control and assurance procedures we have created an environment that focuses on quality.”

“As you may be aware OMIC, the ophthalmology insurance carrier, has been recommending to physicians that the best practice is to seek out compounding pharmacies that have been accredited by PCAB, the Pharmacy Compounding Accreditation Board.  Being accredited by PCAB gives confidence to physicians and consumers that products are prepared in accordance with the United States Pharmacopeial Convention's standards. Chapter 797 of the USP clearly outlines the facility, environment and testing necessary to provide sterile compounded products.  Without an accreditation body like PCAB, there is no reliable third-party verification that a pharmacy meets the USP 797 standard.”

Easy Ideas To Keep Up A Smart Exercise Routine

By Yandy Roman

Choosing to work on your fitness and improving your health is an admirable goal. You need to make sure you have got the right advice to help you start out so you avoid discontentment or injury. Use the guidance in this post to help you increase your fitness level the safe and straightforward way.

A method to stay healthy when working out is to do all that you can to prevent neck injury. Never apply yourself without correct guidance and information. Always use proper form when performing any type of strength building exercise. Be certain to stretch your neck correctly before and after the workout.

To cut back your soreness following an exercise session, be totally certain to perform sufficient cool down exercises. This cool down period allows your muscles to loosen up and relax after your workout is over and signals to your body that the workout is over. Failure to cool down properly after exercising may cause further soreness and even cramping to occur.

Try one or two situps, and other exercises that encourage a full range of motion. These types of exercises keep your body flexible, which becomes important as you age and need to be able to reach things you drop on the floor. Just make sure that you do not have your ankles bound when you do those sit-ups, though!

To have a healthy body it is really important to have a good quantity of sleep. The body needs to sleep to renew, this should not be taken lightly. Sleeping for eight hours maintains the body's healthy immune system, helps the individual manage stress better. So be certain to get a good amount of sleep daily.

When strength coaching, the rest you take between sets, will determine how your muscles will develop. If you are looking to develop muscles and get chunky, your rest time between sets should be longer. If you are looking to build endurance and get leaner, more chiseled muscles, then your rest time should be shorter.

A great way to help get fit is to be really certain of your targets. A lot of people want to put on muscle and get rid of fat at the exact same time. Doing both at the exact same time is not practicable. By knowing exactly what you want, you'll find the right exercise and diet program for you.

A good tip for healthier living is to perform strength coaching. Strength coaching keeps your muscles powerful and healthy. Having more muscle bulk is a great way to manage your weight because the more muscle you have, the more calories you can consume. This is due to the fact that the additional calories will go to the muscle instead of the fat. Strength coaching is also beneficial in forestalling osteoporosis.

It's critical to get the right information when trying to boost your fitness level. Bad info can be discouraging and may lead to injury. Use the fitness guidance you have just read to work on and to meet your fitness targets. This is an investment in you yourself, so get all the information you will need to succeed.

About the Author:

If you are looking for the best Crossfit Fort Lauderdale has to offer then you need to stop by Crossfit Muscle Farm. Our location is also convenient for those in search of Crossfit Pompano Beach, Crossfit Wilton Manors, Crossfit Deerfield Beach, or Crossfit Plantation. Come by today and see what you have been missing!

Coming Up With Essential Oils Guide

By Nancy Gardner

Even though essential oils are referred to as oils, they are not real ones. They lack fatty acids which are needed for a product to be said to be proper oil. They have been several definitions for oils. One if the definition refers to oil as a plant constituent which highly concentrated and has potent cosmetic and medicinal qualities. Another one refers to these oils as the plant soul and life force. The discussion below offers essential oils guide.

A lot of them have high levels of antifungal, antibacterial and antiviral characteristics. That is why they are a good addition in cleaning solutions made at home. The great ones for use in cleaning include lemon, rosemary, grapefruit, lavender, eucalyptus, tea tree and lavender. It is important to determine their degree of purity. The pure ones should evaporate without leaving behind a ring when placed on a construction paper. If a ring is left on evaporation, then the products contains some impurities.

The size of their molecules is very miniscule. That is why their absorption into the skin is very good. Therefore, many products used for care of the skin contain the oil to soften, nourish and heal the skin. They do not have the tendency to accumulate inside the body. They are quickly metabolized completely and this makes them superior over the other body care products.

Research reports have demonstrated that essential oil derived from rosemary improves the performance of brain. Smelling of the oil has been associated with better memory and high performance in the various tests taken. The smelling of oil extracted from lavender or rosemary also causes a feeling of relaxation.

Essential oils do not mean the same as fragrance oils. The use of terms like perfume, fragrance or fragrance oil means something synthetic. Do not confuse this with essential oil because these ones are natural.

They can not be patented. That is why they are not found in drug stores. For this reason, rarely do medical practitioners include them in their prescriptions to substitute conventional drugs. On the same note, many of the drug companies are not interested in researching about them. This limits the scientific knowledge touching on them and much of the data available concerning them is a result of experimentation and personal use from ancient times.

Very large quantities of plants are needed for production of essential oil. Four thousand pounds of the Bulgarian roses are required for production of just a pound of these oils while to produce the same amount of essential oil from Bulgarian roses one hundred pounds of a plant are needed. Given the concentrations they are supposed to have, many plants will have to be used to realize production of quality products.

Use of these oils in their original concentrations is discouraged. This is because skin reactions may result. They need to be diluted using butter, waxes, alcohol and other measures used in dilution. Nevertheless some are safe to use without possibly diluting them. However, a number of them have been tested and proven to be safe for use without been possibly diluting them. The list includes sandalwood, rose geranium, German chamomile and tea tree. More research is advised to get well informed.

About the Author:

You can visit www.theessentialoils.net/ for more helpful information about Coming Up With Essential Oils Guide.

Whats Up with Yoga Pilot Studies

by Nina and Ram

Photographing Chard by Melina Meza

Okay, this is going to be a really boring post for most of you. But I really think it needs to be done because there is an important scientific issue we need to address. You see, we've received a lot of inquiries (and even, I have to say, flack) about the sample sizes in some of the yoga studies we have written about on the blog. Some of those inquiries have been public in the comments section and others have even come in through my private email. So I'm just going to bite the bullet and get it over with.

In Ram’s post More on Yoga for Brain Strength: Neuroprotection, he wrote about a study in which the sample size was very small (just 14). This was also true in his post Rapid Cellular Changes Triggered by Yoga (just 10) as well as many of the studies we have written about in the past. And some of our readers have asked, if the sample size is so small (under 100), how can we take the results seriously? Aren’t the results basically meaningless? Or, at least shouldn’t we take them with a large dose of salt?

I turned to Ram for a response. Before I tell you what he said, I want to be sure you all know that Ram is a Research Associate Professor at the Buck Institute for Research on Aging. He has a Ph.D. in Neuroscience, and his research there is focused on aspects of age associated with neurodegenerative diseases with an emphasis on Alzheimer’s disease. So we trust his scientific judgment.

Now here's Ram's response: he says that he disagrees with the claim that we need to dismiss these studies or take them with a huge dose of salt because:

1. The studies were published in peer-reviewed journals, which means that the reviewers saw merit in the findings and suggested that the study be published.
2. What is a good sample size? There is no set standard. The rule of thumb is that it is better to have a large sample size to minimize systemic errors and standard deviations, unless the results happen to be too significant to ignore in a small sample size like in these particular studies.
3. These are not clinical trial studies; these are a pilot study and pilot studies generally employ small sample size.
4. If changes between two sets of paradigms (in this case yoga group vs. control) are highly significant with very minimal variation, the results are not only meaningful but they override the small sample size.
5. Such studies where the results are highly significant with very minimal variation, not only can be successfully replicated, but they can be implemented for a larger trial.

I hope that settles the issue for now. We'll continue to publish posts about these interesting pilot studies, and because we'll continue to include the sample sizes used, you are free to draw whatever conclusions you like.

I’d like to add my own note to this. One reason why many yoga studies are so small, and often never progress beyond the pilot study stage is that funding for science is at an all-time low here in the U.S. (Most of the larger studies are conducted, for obvious reasons perhaps, in India.) More support for the National Science Foundation and the National Institutes of Health will not only allow there to be more studies on the benefits and mechanisms of yoga but will also enable continued work on other critical health problems, and this will be of value not only people in the US but people worldwide as well. (Yes, I am married to a scientist.)

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