Sex 101: Drugs

Building a website that will be considered a �traffic worthy site' is essential for your site's success. A traffic worthy site is developed for more than just the human, however. It also needs to be developed for the search engines along with their spiders and crawlers. That is why a sound web design is crucial for driving traffic to your site. So, what is involved in building a traffic worthy site you ask?
First of all, you must perform a thorough research into what constitutes your company's keywords.

SEO. Everywhere we turn anymore it seems we hear about search engine optimization (SEO for short). SEO consists of keyword optimization. SEO also is utilized by both search engines automatically and humans manually. Each time a visitor types in their word of choice into the search engine (known as search utilization), sites pop up containing that word. See the importance of knowing your keywords?

It is estimated that more than 86% of all human visitors arrive at websites via search engines. Recent statistics have shown that Google is the top pick search engine. Can you see how search engine optimization is of utmost important for your site's success?

A top ranking in the search engines can bring you highly targeted traffic. These particular visitors are essential for your success. You offer a certain product. Visitors are searching for that particular product and come across your site. You offer something they are seeking. Therefore, search engines are sending you pre-qualified customers.

Google indexed 8 billion pages. Google uses bots (also known as spiders and crawlers.) It's important for marketers to know how spiders crawl around your web page and site.

Search engine crawlers are your best visitor. Giving the crawler unlimited ability to move around your website and page is essential for your search engine ranking.

Your website must be spider (search engine) friendly if you want any traffic from the search engines. The search engine spider does not read your website the way humans do. The spider reads HTML (web page source code). If your site does not contain it, or uses it poorly, the spider will give up.

Furthermore, spiders love text content. They do not care about JavaScript at all. Sites containing a multitude of images and no ALT tags may not be indexed properly for the spiders. The site may be appealing to the eye, but the bot spiders do not care. They will lose interest in your site. So, when designing your site, you must convince your web developer of incorporating some structural design that promotes search engine friendliness.

A smart web developer will see what their site looks like to search engines. A Lynx viewer (text mode web browser) is great for this. This viewer also make one's site friendly for the vision impaired who regularly search the net. Yes, there are millions doing this.

Designing your website for your human visitors should be first priority. A balancing act between human and search engine visitors is a tricky one, but needs to be accomplished.

Practice good SEO, but not at the expense of your visitors' viewing experience.

It's also important to note that web browser standards are not yet fully integrated. For instance, a site that looks good in Window's Internet Explorer may not look good in the Mozilla based Firefox or Netscape. Developers must be knowledgeable about cross browser design for their website's success. Plus, with the multitude of hand held devices provide another issue. These hand held devices display information differently and developers must be conversant in W3C formatting. Google-backed Firefox is quickly eating up Window's Internet Explorer browsing turf. Developers must keep abreast of these changes.

Never use a word processor to design your website. Word processing software is notorious for containing a variety of hidden messy codes which are not search engine friendly.

Search engine 'bots' are your most important visitors. You must accommodate and entice them. By properly designing your website, you will gain respect with them. This respect, in turn, increases both your targeted visitors and sales.

The subject of bringing traffic to your website is immense. This article touches upon only a few of the ways you can succeed in this area. You can only benefit by knowing how to build a traffic-driven website.

Common contractors budget a variety of factors as they oversee a building's design, including finances, materials and timetable. They also should ensure compliance with a wide range of regulatory requirements, by enviromentally friendly criteriato legal business practices. One of the most significant concerns a general contractor must control, especially in the building industry, is protection.

Fully, the federal govt considers construction protection a significant concern. In 2006, more than 59% of all federal inspections carried out by the Occupational Safety & Health Administration (OSHA) nationwide, 22,891 inspections in all, took area in the construction sector. OSHA conducted an additional 27,672 state inspections at design jobsites.

Over the past few years, incidents involving vehicles or equipment have been the most important source of construction workplace accidents in Texas. Fall dangers as well account for a high percentage of the mishaps that take place. Other hazards that result in jobsite accidents include electrical shock and trapped-betweens and falling things.

The tactic to sustaining a safe jobsite and reducing the danger from these and many similar problems is a 3-pronged technique of arranging, training and inspections.

Designing: Ceasing Mishaps Prior to They Occur

Designing forward enables people to see plus steer clear of mishaps earlier than they take place. “Our job crews perform a pre-task arranging every day,” said Rae Arora, Safety Director for Amalgam Dev. Construction. “Ahead of work commences, we determine the duties to be performed and discover problems, then get rid of them or engineer them out. This procedure takes place before the task begins and repeats each and every early morning until it's accomplished. The planning varies by place because each one jobsite shows its own different dangers, but the general process of continuing designing stays the same.

“On a additional certain level, we have a official safety plan,” Arora said. “The plan is totally recorded and made available to everyone involved in our projects. This ensures our operations stay within OSHA standards and formalizes our policies so everyone, from our staff to our subcontractors to our clients, knows our standards and procedures ahead of time.”

Security Education

Training is the second important aspect of the prosperous safety plan. “We do wide-ranging training for the people,” said Arora. “All of our people in the field has accomplished the OSHA 30-hour course, has been trained in first aid and disaster reaction, and has earned CPR certification. Even our administrative employees, from our receptionist to our CEO, have been prepared in first aid and CPR.”

Training is available by way of a wide range of sources. For services that are correctly staffed, a great deal of the training is done in-house. Consultants are available to address more specialized academic needs, like stormwater administration and enviromentally friendly education. Industry associations, like the AGC, ACI and TCA, also offer teaching packages and direction. In particular, QUOIN (the north and east Texas chapter of AGC) performs and coordinates training programs and helps companies produce and implement protection programs. QUOIN has led step for safety teaching to include periodic security stand-downs around the state and local education marathons that offer OSHA 10-hour training on tohundreds of people at a time.

The most shocking resource for protection education is - the competition. “If another general service provider is doing education that one of my guys needs, I'll get him into that class,” said Arora. “I've done the identical for other firms as well. In safety there is no player. The work crew on another corporation's site today could without difficulty be in ours next month. By elevating protection information on more companies' jobsites we ultimately improve our own as well.”

One explanation constant teaching is important is due to the ever-evolving aspect of personal defensive supplies (PPE). Sellers continuously bring out brand new as well as enhancedPPE in response to identified requirements in the industry or as a result of evolving OSHA standards, and contractors must stay existing on what is available.

“PPE changes all the time,” said Rae Arora. “OSHA's requirements change regularly and gear giants continually innovate to meet those revisions. The PPE that was fully compliant last year may not be today. For example, a few years ago there was no these thing as retractable lanyards for drop safety. Given all the different positions workers needed to be to get the job done, in many conditions the standard harness didn't be enough. So these people come up with the retractable lanyard, one that produces an instant stop inside two inches of the start of the fall, to reply to that require. OSHA adjustments a constraint, makers interact with new PPE and contractors are expected to stay on top of this.”

Instruction as well enables workers to identify future developments in compliance. Rae Arora considers that in the moving calendar months OSHA will focus on enforcing the wellbeing section of their ordinances, like how long people are exposed to chemical compounds such as chromium or lead. He anticipates that OSHA will regulate the proper apply of PPE further stringently as well. By education frequently, a contractor can tackle these changes proactively.

Security Inspections

Adhering to on the heels of arranging and instruction, the third aspect of the successful safety program is to self-inspect. Superintendents and safety representatives go around the jobsite many occasions a week, observing function procedure, documenting procedural violations and possibilities problems, and applying remedial activity. Frequently, these kind of inspections result in procedural modifications that are integrated into the day-to-day pre-task planning.

Benefits of a Superior Construction Safety Program

Clearly, implementing the successful safety program requires a great deal of work at all levels of the project. The results are well worth the effort.

“Our safety program is a benefit from an operational standpoint as well,” Arora added. “We haven't suffered a time-lost unpleasant incident in more than five years. Workers come to our jobsites, trusting that we perform a secure work environment, and that increases morale. We have a track record for security, which probably establishes a expectation in our workers' minds that we won't tolerate something less than safe job procedures. In that sense the program is self-perpetuating. Most importantly, on a moral level we want our workers to be safe. We want them going home in the same condition they came to work in. Our safety program provides cost benefits, marketing advantages, operating and efficiencies, and it is fundamentally the right thing to do.”

According to Arora, the biggest question to preserving a safe jobsite is mindset. “Getting folks to identify the inherent risk of working on a building site is a big part of what I have to do every day,” he said. “It's easy to cut corners on safety. It's easy not to put on the reflector vest or harness, not put up the railing on the scaffolding. For the safety program to be a success we have to overcome that complacency.

Introduction

After almost two thousand years of independence in the Hawaiian islands, and two centuries after the arrival of Captain James Cook and foreigners, the original pure-blooded native population has gone from about 400,000 (possibly 1,000,000) to about 5,000-7,000 (1-3). This signifies a greater than 98% decrease in the pure blooded Hawaiian population over the last two centuries. The current part-Hawaiian population exceeds 400,000 in the United States (4). Tragically, a 1987 document stated that the pure blooded Native Hawaiians are predicted to become extinct by the year 2044 if current (1980’s) mortality trends persist (5). It is already established that Native Hawaiians or kanaka maoli have remarkable morbidity and mortality (6). However, the relative lack of a current easily accessible comprehensive article on the topic of Hawaiian health and documented authors’ recommendations was noted by the author of this paper. Hence, this paper provides an epidemiological and high-risk health review of Hawaiians until the year 2003. It also addresses the practical question “What can clinicians, patients, and researchers do about it?”

Methodology

A literature review was done in search of information applicable to Hawaiian health published until the year of 2003. Appropriate journals, books, and magazine articles were utilized. Hawaiian words and diacritical marks were checked using a reliable internet Hawaiian dictionary resource (7).

The term “Native Hawaiian” in this article implies that one can link their genealogy or heritage to Hawaiians or Kanaka Maoli in the Hawaiian Islands before Western contact.

Results

High morbidity of Hawaiians compared to non-Hawaiians in Hawai‘i

In 2000, Native Hawaiians had higher prevalence rates compared to non-Hawaiians for asthma and diabetes (8). The asthma prevalence rate was 139.5/1,000 and state total rate was 86.5 per 1,000 in Hawaii. The diabetes prevalence rate was 49.0 per 1,000 for Hawaiians and 45.9 per 1,000 for the state total (8). The Japanese ethnic group had the highest diabetes prevalence at 67.7 per 1,000. Hawaiian rates for arthritis (38.3 vs. 71.7), high lipids (85.6 vs. 133.1), and hypertension (116.7 vs. 144.2) were lower than some state totals.

High mortality of Hawaiians

Low life expectancy

Since the early 1900’s, Hawaiians and part-Hawaiians have reported the lowest life expectancy at birth for both genders combined, compared to Caucasians, Chinese, Filipinos, and Japanese. In 1990, the Native Hawaiian life expectancy was 74.27 years old with the Hawai‘i state total at 78.85 years of age (9).

Elevated total and specific causes of death

Native Hawaiians have the highest reported rates of all cause mortality. From 1980 to 1990, the full and part-Native Hawaiian all cause standardized mortality rate increased from 642 to 755 per 100,000 (10). Compared to non-Hawaiians in Hawai‘i, Native Hawaiians have greater than twice their total mortality rate. All ages’ standardized mortality in 1990 was highest in Native Hawaiians for heart disease, malignant neoplasms (cancer), stroke, all accidents, diabetes (10) and asthma (11-12). Full-blooded Native Hawaiians’ mortality rates are worse than part-Hawaiians (10).

Cancers
Cancer is another major health problem for Native Hawaiians. From 1995 to 2000, the Native Hawaiian male and female total cancer mortality rates per 100,000 were higher compared to Hawaii’s state total cancer mortality rates (13).

Breast cancer

Over the last few decades, the incidence of Native Hawaiian female breast cancer has increased, while the mortality rate has decreased. Still, breast cancer incidence in Hawai`i was the highest in Native Hawaiian women (162.4/100,000) from 1995 to 2000 compared to the state total which was 128.3/100,000 (13) . Even after adjustment for breast cancer risk factors, one cohort of Native Hawaiian women had a relative risk 65% higher than Caucasians (14). Native Hawaiian women also reported the highest breast cancer mortality rate at 31.0/100,000 (58% higher) versus the total state rate of 18.1 per 100,000 (13). Another study suggests that Native Hawaiian females have significantly lower breast cancer survival rates and the worst stage status and metastases status compared to all other groups (15). In the Hawai`i 2001 Behavioral Risk Factor Surveillance System (BRFSS), Native Hawaiian females were reported to have the same prevalence rates for mammography screening compared to other ethnicities (16).

Cervical cancer

Native Hawaiian female cervical cancer incidence rates have decreased over the last three decades, but from 1995 to 2000 they still reported the highest incidence rates compared to state total, 13.5/100,000 and 10.1/100,000 (13), respectfully. For all ethnic groups in Hawai‘i, cervical cancer mortality rates have declined. However, over the last three decades, Hawaiians, Chinese, and Filipinos appeared more likely to have an invasive cancer stage at time of diagnosis (13). In 2001, the BRFSS showed that Native Hawaiian women had the lowest prevalence rates (based on the previous 3 years) in Hawai`i for having had a Pap smear test (16).

Colorectal cancer

Over the last three decades, the Native Hawaiian female colorectal cancer incidence rates increased,
while there was no significant change for Hawaiian male incidence or mortality rates (13). From 1995 to 2000, colorectal cancer mortality was highest in Native Hawaiians for both males and females (13). Native Hawaiians may have the lowest colorectal cancer survival rates, even though they received more chemotherapy and radiation treatments compared to other ethnic groups (17). In 2001, Native Hawaiians 50 years and older reported the lowest percent of ever having had a fecal occult blood test, ever having had a sigmoidoscopy or colonoscopy, and having had a sigmoidoscopy or colonoscopy within 5 years. However, in the previous year (2000) Native Hawaiians reported the highest fecal occult blood testing percentage compared to all other ethnicities in Hawai‘i (16).

Lung cancer

From 1995 to 2000, Native Hawaiian males and females reported the highest lung and bronchus cancer incidence and mortality rates compared to the total state rates. Native Hawaiian females have lung cancer mortality rates about twice the state total, 48.2/100,000 and 24.8/100,000 respectfully. And Hawaiian males have a 50% higher lung cancer mortality rate compared to the total state, 75.9 and 50.6 respectfully (13). In one small study (Hinds et al) of 132 Native Hawaiian female lung cancer patients, smoking by Hawaiian females was significantly more contributory toward getting lung cancer compared to other groups in Hawai`i (18). Another small pilot study of 45 Native Hawaiian cancer survivors showed that improved access to care and utilization of cultural values with education and services may improve quality of life and survival status (19).

High-risk behaviors and cancer

About 68% of all cancers are thought to be due to the maladaptive habits of tobacco use, drinking excessive alcohol, and a poor diet (20). Being overweight or obese are proven to be linked to cancer deaths. A study of over 900,000 adults followed for ten years showed the overweight cohort to have increased risk of death from cancer of the esophagus, colon, rectum, liver, gallbladder, pancreas, kidneys, non-Hodgkin’s lymphoma, and multiple myeloma. The obese cohort had higher mortality from cancer of the stomach, and prostate. The postmenopausal obese group had higher cancer rates of the breast, cervix, ovaries, and uterus (21).

Behavior Risk Factors among Native Hawaiians

A search of the literature reveals a high prevalence of behavioral risk factors among Native Hawaiians. Curb and colleagues found one group of Native Hawaiians on a rural island to have frequent risk factors for cardiovascular disease with poor control and awareness about them (22). BRFSS has reported on the prevalence of behavioral risk factors in Hawai`i among the 5 major ethnic groups, including Native Hawaiians. From 1986 to 1993, 56% of Native Hawaiians had a sedentary lifestyle. This was similar to the Hawai‘i state total of 55.5% (23). Out of 576 Hawaiians profiled in 1991, 63.4% had chronic alcohol use and binge drinking that was twice the state total (n=1,984). Hawaiians also had a 10% higher prevalence of marijuana use and smoking tobacco compared to the Hawaii state total in 1991 (24). Native Hawaiian behavioral risk data in 1993 reported 46% to be overweight, 20% had acute and chronic alcohol intake, and 27% were smokers (25). This was from a relatively small sample size of 341 (12%) Hawaiians out of a total of 2,155 (25). In a 1990 publication, Native Hawaiians also reported having the lowest use of seatbelts compared to other ethnicities in Hawai’i. (26).

BRFSS data in Hawai'i reports that these high risk cardiovascular and cancer trends continue in 2002 (n=approximately 750 surveyed for Native Hawaiians). In the 2002 BRFSS report, Native Hawaiians 18 years and older reported higher (compared to Hawai'i state total) percentages for current smoking status, overweight/obese body mass index greater than 25, never to nearly always using seatbelts, not having healthcare coverage, sub optimal physical activity, and heavy drinking (16).

In regard to obesity, genetics possibly play a role for one rural male and female (30 years old and older) Native Hawaiian population (n=567, cross-sectional), as seen in the dependant relationship of increased percentage of body mass index, and increased waist to hip ratio with the increased percentage of Hawaiian blood quantum. This conclusion was made even after adjustment for calorie intake, activity level, and age (27).

Hawaiian youth

In regard to Native Hawaiian adolescents, recent mental heath and high-risk behavior statistics are disturbing. Data from 2000 shows a progressive increase in drug use and the highest rates of substance abuse among Native Hawaiians youth, grades 6 to 12. This includes use of tobacco, alcohol, marijuana, cocaine and methamphetamines (28). 

One study found that Native Hawaiian adolescents have a high rate of suicide attempts, which appears dependently related to a higher Hawaiian cultural affiliation (29). Hawaiian adolescents who are more culturally Hawaiian attempt suicide more than those with less cultural affiliation. In 1990, Native Hawaiians aged 15 to 29 years old reported the highest suicide rates (30) In one study, Hawaiian adolescents were found to have significantly elevated psychiatric symptomatology (especially females), family adversity problems, and less family support (31-32). Furthermore, the 2000 Hawai`i Student Alcohol, Tobacco, and Other Drug Use Study reported that Native Hawaiian high school seniors had the highest percentage for suspension from school, being drunk at school, and violence (28).

Crime and violence

Native Hawaiians are over represented in prison. Of the prison inmate population in Hawai‘i in 2000, 39% were Native Hawaiians. This is disturbing as Native Hawaiians make up approximately 20% of the total state population (33). Also in 2000, Native Hawaiians reported higher rates of aggravated assault, burglary, motor theft, arson, property fraud, and forgery, and were over represented as murder victims and known offenders (34).

Remarkable Hawaiian subgroups

Mahus (may mean transgender, a very feminine male, homosexual, and/or bisexual) appear to be a critically high-risk subgroup of Native Hawaiians in regard to drug abuse and violence. One study of over 100 Native Hawaiian mahus reported that 74% were smokers, 31% admitted to illegal drug use (excluding marijuana), and 50% were involved with violence (35).

Availability of health insurance

After identifying high-risk Native Hawaiian behavior and subgroups, access to care also needs to be addressed. Now let us look at availability of healthcare coverage. In Hawai‘i, Native Hawaiians (ages 18-65 years) reported the highest percentage of non-health insured status at 10.3 percent, versus Caucasian 8.6%, Filipino 6.4%, Japanese 3.3% in 2001 (36). According to Hawai'i's BRFSS report in 2002, the percentage of non-insured Native Hawaiian adults increased to 15.2% (16).

Summary

It is established that Hawaiians have remarkable morbidity, mortality, and high prevalence of risk factors for cancer and cardiovascular disease. But what can clinicians and researchers consider or support in order to improve the health status of the Native Hawaiian community?

This next section summarizes many recommendations from various authors, which specifically relate to Native Hawaiian health. Many recommendations are cross-cultural and deal with health disparity issues of Native Hawaiians. However, they may also be applicable to other groups as many are universal. Utilizing these recommendations, clinicians and healthcare providers are encouraged to be aware of cultural influences that are unique to this population or traditionally oriented individuals and groups.

1. Kekuni Blaisdell M.D. suggests revitalizing the culture, language, and spirituality of Hawaiians. He also recommends regaining “inherent sovereignty and self determination,” and arresting factors that exploit and undermine Hawaiians. This recommendation includes denying materialism and returning to more traditional ways (37).

2. Access and kuleana to 'aina and sovereignty are cited by many as essential to wellness of the Hawaiian people (37-42).

3. Healthcare providers need to appreciate that ‘olelo (the word) is very important and influential to Hawaiians (43), and that they need optimism and honesty in their medical discussions. Communicating with proper and familiar layman’s terminology is required. In one study of Native Hawaiian women, only about 50% knew the definition of a “PAP test” (44). The teaching of medical concepts using analogies of things from Hawaiian culture seems to be a practical idea. Taro or kalo  was the staple food of Hawaiians of old and symbolically represents the family or relatives. The taro fields need a group effort in order to allow proper nutrients and irrigation (or circulation) for an  optimial  harvest. Likewise, people and their families need to optimize nutrients and their circulation in order to attain wellness. And like taro cultivation, if a habit of holistic care is initiated and maintained, any hard and tedious productive work can reap great rewards.

4. Hawaiians can enhance their health and mana (divine power) by reinstating the culturally relevant idealistic ways of eating natural foods, maintaining daily physical activity, meditating, and not abusing substances or committing offenses. A program called Uli‘eo Koa is a pilot program that uses culturally appropriate methods to improve diet, as well as physical and spiritual wellness (45-46). Specific culturally appropriate physical activity recommendations for Native Hawaiians might include the hula (traditional and contemporary Hawaiian dancing), lua (Hawaiian martial arts), working in the taro lo‘i (taro or kalo field), surfing, hiking, and swimming in the ocean, among many others.

5. Native Hawaiians need to be recruited into medicine in order to address their under representation in the health care field. There is a discrepancy of the current 5% Native Hawaiian physician population to the 20% Hawaiian state total  population (47). Native Hawaiian rural communities are areas in dire need of culturally competent providers.

6. Cultural competence needs to be taught in health professions schools (48-50). Analogous to mnemonics taught to medical students as a memory tool, remembering the Hawaiian na piko ‘ekolu and na'au concepts could ensure a culturally sensitive, thorough, and systematic awareness in clinical interactions with traditional patients.

The na piko ‘ekolu (three navels or centers) and na‘au (”gut emotions,intuition) concepts can be organized by location, symbolism, and it's representation in time (43,45-48). 

The head/crown or Manawa/Po‘o PIKO (fontanelle) relates to one’s spirituality or ‘aumakua/ancestors and the  past.  Our  navel or Waena PIKO signifies the family, earth, and current “umbilical ties”. The navel or waena piko involves the present.
The lower abdomen or NA'AU signifies our  “Gut emotions”, intellect, and intuition and involves the present time.
Our genital area or Ma‘i PIKO signifies our offspring and the future.  A healer would be reminded of holism if they could visualize the location of these cultural concepts when with the patient. Applying these Hawaiian cultural concepts would incorporate the importance of the body, mind (psychology and parapsychology), spirit, nature or environment, , intellect, culture, community, and family relationships.

Also, it may be appropriate to use cultural terms, like mana (divine power) and pono (correct and true nature), etc., when having clinical discussions with Hawaiian patients. It is well known that spirituality is an essential part of Hawaiian culture and daily life (51). The integration of mutually respectful spirituality and religious beliefs can be complimentary. If appropriate to the individual patient and their beliefs and needs, clinicians might even consider saying a prayer with the patient and family, or recommend praying when patient takes their medication. Furthermore, providers and patients might benefit from incorporating dream-work and respecting other spiritual or cultural forms of communication and beliefs (52-53). These alternative resources are not only essential, but also affordable and may be culturally appropriate. Ho‘oponopono (traditional conflict resolution method) is also a resource for the Native Hawaiian community that may even help them with academic difficulties and addictive behaviors. Psychological counseling in a university setting is found to correlate with better academic outcomes (54). Like ho‘oponopono, the alcoholics anonymous twelve step group support program acknowledges a higher power, involves group support, and then emphasizes forgiveness and appropriate behavior (55). Identifying or incorporating this similarity to ho‘oponopono may increase acceptance of this established rehabilitation program by Native Hawaiians. In order to exhibit respect and support for the Native Hawaiian community, clinicians may consider inquiring about and referring patients to traditional Kahuna healer training and practices (53), like la’au lapa’au, lomilomi, and ho‘oponopono, when deemed appropriate.

7. The association with Hawaiian cultural affiliation and adolescent Native Hawaiian suicide attempt rates (29) needs to be intensively studied and addressed.

8. In order to optimize outcomes, the family, community and cultural peers of Hawaiian patients need to be involved with clinical endeavors. The use of lay facilitators may help the Native Hawaiian population, as seen in the breast and cervical cancer program done in Waianae (56). For example, clinicians or researchers may encourage or emphasize family or peer participation with clinic visits, treatment plans, and research activities.

9. A special effort to help and understand special subgroups of Hawaiians, based on gender (57), age (58), sexual orientation (35) and HIV status (59) is indicated. Another special subgroup are the Hawaiians who live outside of Hawaii (60).

10. The participation, research, and behavior of Native Hawaiians in clinical trials for cancer and other disorders could be better understood (61-64). Appropriate outreach, access, and professional support may help Native Hawaiian women with breast cancer health practices, as found in a ten year study (65).

11.Health care providers can spend extra time with Native Hawaiian patients, make house calls if needed, and frequent phone calls to facilitate respect, bonding, rapport, and trust (66).

12. Clinicians and researchers may recognize and address socioeconomic issues, access to care problems (19, 67), and the distrust of Western medicine (68-69).

13. In order to facilitate a connection and communication with native ancestors or ‘Aumakua, themselves (or higher self), others (people and other living creatures) and nature, a meditative state can be of value to both the healer and patient. Hawaiians need to learn how to meditate daily (70). Rest and relaxation were also part of traditional Hawaiian healing instructions (44). Also, in order to be prepared for patient interactions, healers need to be relaxed, free of personal negative or judgmental thinking, and biased expectations (71-73).

14. We need to reinstate the federal census quantification of pure Hawaiians and standardize ethnic definitions for prevalence, mortality, and populational data. It does not make sense that the federal government would stop quantifying how many pure Native Hawaiians currently exist. Furthermore, the recent grouping of “Pacific Islanders” with statistical data is very ambiguous, and will not allow comparison with past data nor allow more specific statistics on Hawaiians or other Polynesians. Any definition of “Native Hawaiian” should allow or imply an objective genealogical connection to Hawaiians living before Western contact in the Hawaiian Islands.

15. And finally, Native Hawaiian healthcare providers can be role models and encourage indigenous youth to pursue medicine and other health related fields.

Limitations

Limitations to this paper includes: limited or minimal data, some studies were with small sample sizes and that may underestimate or exaggerate rates, and lack of consistency and confusion on the definition of a “Hawaiian” over time and with different organizations. 

Hawaiian language experts were not consulted for this paper and diacritical marks were not available due to font limitations. Please see section on methodology.

Conclusion

In short, Hawaiians and non-Hawaiians are challenged to have koa (courage) and work together to get the goal of wellness accomplished. For both the patient and healer, understanding and enhancing mana (divine power), pono (true nature), and lokahi (unity) are required to succeed. One traditional Hawaiian healing secret is to have lokahi of the body, mind, nature, and spirit (71). Many Native Hawaiian healing ways are timeless, universal, and relevant in modern times. Following the advice of the Native Hawaiian Biennial Healing Conference in 2002, we need to know that “We are Hawai‘i”, and “We need to perpetuate the breath, the knowledge, and the life”. Furthermore, “We need to stand proper, stand connected, and stand in harmony” (74).

Acknowledgements

The supportive encouragement and advice provided by Kim Ku’ulei Bernie of Papa Ola Lokahi, and Douglas Massey MD on this paper was greatly appreciated. 

The anonymous critique by a few Hawaiian health specialists was also extremely helpful and informative.

The authors’ accept full responsibility for any errors.

There was not financial support for this paper.

References

1. Kirch PV. Legacy of The Landscape: An Illustrated Guide To Hawaiian Archeological Sites. Honolulu, Hawaii: University of Hawaii Press; 1996.

2. Schmitt RC. Historical Statistics of Hawaii. Honolulu, Hawaii: University Press of Hawaii;1977. 

3. Stannard DE. Before the Horror: The population of Hawaii on the eve of western contact. Honolulu, Hawaii: University of Hawaii Press;1988. 

4.United States Census Bureau. Census 2000. Summary file 1; 2000.

5. Miike, L. Current health status and population projections of Native Hawaiians living in Hawai‘i. Washington D.C.: Office of Technology Assessment, U.S. Congress; April, 1987.

6. Hope BE, Hope JH. Native Hawaiian health in Hawaii: historical highlights. Californian Journal Health Promotion. 2003; Special Issue December 31, 1: 1-9.

7. Pukui M, Elbert S. Hawaiian Dictionary. Honolulu, Hawai‘I: University of Hawai‘i Press ;2003. Available at: www.wehewehe.org . Accessed June 2004.

8. Hawaii Department of Health Office of Health Status Monitoring. Honolulu, Hawaii; 2000. Table 4.7.

9. Hawaii Department of Health Life expectancy in the state of Hawaii 1980 and 1990. Honolulu, Hawaii: Research and Statistics Report; 1996, 63: 18-33.

10. Braun KL, Look MA, Yang H, Onaka AT, Horiuchi BY. Native Hawaiian mortality 1980 and 1990. American Journal Public Health.1996, 86(6): 888-889.

11. Massey DG, Fournier-Massey G, Hope BE. Asthma in Hawaii: A tradition of excess mortality. Journal of Asthma. 1997, 34(2): 113-117.

12. Hope B, Massey D. Hawaiian materia medica for asthma. Hawaii Medical Journal. 1993, 25(6):160-167.

13. Hawaii Tumor Registry. Cancer Research Center of Hawai‘i. Honolulu, Hawaii, University of Hawaii, 1995-2000. Tables 5,12,14,16,18,21. Available at: www.hawaii.gov/health/statistics/other-reports/cancer2003-04.pdf . Accessed June 2004. 

14. Pike M, Kolonel L, Henderson BE, Wilkens LR, Hankin JH, Feigelson HS, Wan PC, Stram DO, Nomura AM. Breast cancer in a multiethnic cohort in Hawaii and Los Angeles: risk factor-adjusted incidence in Japanese equals and in Hawaiians exceeds that of Whites. Cancer Epidemiology Biomarkers Prevention. 2002, 11:795-800.

15. Meng L, Maskarinec G, Wilkens L Ethnic differences and factors related to breast cancer survival in Hawaii. International Journal Of Epidemiology. 1997, 26(6):1151-1158.

16. Hawaii State Department of Health. Community Health Division, Behavior Risk Factor Surveillance System, United States Center for Disease Control and Prevention, Honolulu, Hawaii; 2001. Tables 13,15,17. Available at: www.hawaii.gov/health/statistics/other-reports/cancer2003-04.pdf . Accessed June 2004. And Available at: www.state.hi.us/doh/stats/surveys/2002/state02 . Accessed September 2004. 

17. Pagano IS, Morita SY, Dhakal S, Hundahl SA, Maskarinec G, Time dependant ethnic convergence in colorectal cancer survival in Hawaii. BMC Cancer. 2003, 3(1):5.

18. Hinds M, Stemmermann G, Yang H, Kolonel L, Lee J, Wegner E. Differences in lung cancer risk from smoking among Japanese, Chinese, and Hawaiian women in Hawaii. International Journal Cancer. 1981, 27(3):297-302.

19. Braun K, Mokuau N, Hunt G. Ka‘ano‘i M, Gotay C. Supports and obstacles to cancer survival for Hawaiis’ native people. Cancer Practice. 2002, 10 (4):192-200.

20. Doll R, Peto R. The causes of cancer: Quantitative estimates of avoidable risk of cancer in the US today. Journal of National Cancer Institute.1981, 66:1193-1208.

21. Calle S, Rodriguez C, Walker-Thurmond K, Thun M. Overweight, obesity, and mortality from cancer in a prospective studied cohort of US adults. New England Journal of Medicine. 2003, 348(17):1625-1638.

22. Curb J, Aluli N, Kautz J, Petrovitch H, Knutsen SF, Knutsen R, O‘Conner HK, O‘Conner WE. Cardiovascular risk factor levels in ethnic Hawaiians. American Journal Of Public Health. 1991, 81(2):164-167.

23. Hawaii Department of Health Behavioral Risk Factor Survey. Hawaii’s Health Risk Behavior 1986-1993. Honolulu, Hawaii:1993, table 6.79.

24. Hawaii Department Health Alcohol And Drug Abuse Division. Hawaii Behavioral Health Survey: 1991. Executive Summary. Honolulu, Hawaii: 1991, Table 6.91.

25. Hawaii Department of Health Behavioral Risk Factor Survey. Hawaii’s Health Risk Behavior 1993. Honolulu, Hawaii: 1993, table 6.75.

26. Chung C, Tash E, Raymand J. Yasunobu C,Lew R. Health Risk Behaviors And Ethnicity In Hawaii. International Journal Of Epidemiology. 1990, 19:1011-1018.

27. Grandinetti A, Chang H, Chen R, Fujimoto WY, Rodriguez BC, Curb JD. Prevalence of overweight and central adiposity is associated with percentage of indigenous ancestry among Native Hawaiians. International Journal Obesity Related to Metabolic Disorders. 1999, 23:733-737.

28. Hawaii Department of Health Alcohol and Drug Abuse Division. “The 2000 Hawaii Student Alcohol, Tobacco, and Other Drug Use Study”. Native Hawaiian Data Book. Office Hawaiian Affairs. Honolulu, Hawaii: 2002. Available at: www.oha.org/pdf/databook_6_02.pdf . Accessed June 2004.

29. Yuen, N, Nahulu, L, Hishinuma, E, Miyamoto, R. Cultural identification and attempted suicide in Native Hawaiian adolescents. Journal Of The American Academy Of Child And Adolescent Psychiatry. 2000, 39(3):360-367.

30. Goerbert, D, Birnie,K. Injury disability among Native Hawaiians.Pacific Health Dialog.1998, 5(2):253-259.

31. Goebert D, Nahulu L, Hishinuma E, Bell C, Yuen N, Carlton B, Andrade N, Miyamoto R, Johnson R. Cumulative effect of family environment on psychiatric symptomatology among multiethnic adolescents. Journal Adolescent Health. 2000, 27(1):34-42.

32. Makini G, Andrade N, Nahulu L, Yuen N, Yate A, McDermott J, Danko G, Nordquist C, Johnson R, Waldron J. Psychiatric Symptoms Of Hawaiian Adolescents. Cultural Diversity In Mental Health. 1996, 2 (3):183-191.

33. Hawai‘i Department of Public Safety Correctional MIS. Honolulu, Hawaii: 2001. Available at: www.oha.org/pdf/databook_6_02.pdf . Accessed June 2004.

34. Hawai‘i Attorney General: Crime Prevention And Justice Assistance Division Research And Statistical Branch. Honolulu, Hawaii: 2002. Available at: www.oha.org/pdf/databook_6_02.pdf . Accessed June 2004.

35. Odo C, Hawelu A. Eo na Mâhû o Hawai‘i: the extraordinary health needs of Hawaiis’ mâhû. Pacific Health Dialog. 2001, 8 (2):327-334.

36. Hawai‘i Department of Health. Hawai‘i Health Survey. Office of Health Status Monitoring. Department of Health. Honolulu, Hawai‘I: 2001, Table 4.7.

37. Chen, M. Guest Feature: Introducing Richard Kekuni Akana Blaisdell, MD. Asian American And Pacific Islander Journal Of Health.1994, 2: 171-179.

38. Dudley M. Man, Gods, And Nature: A Hawaiian Nation I. Honolulu, Hawai‘i: Na Kane O Ka Malo Press;1990. 

39. Dudley M, Agard K. A Call For Hawaiian sovereignty: A Hawaiian Nation II. Honolulu, Hawai‘i: Na Kane O Ka Malo Press;1990. 

40. Geoffroy A. The polynesians of Hawai’i: surviving a biological, political, and cultural genocide. Universite de La Reunion, Faculte des Lettres & Sciences Humaines. France,1993. Available at: http://www2.univ-reunion.fr/~ageof/text/74c21e88-144.html . Accessed October 23, 2003.

41. Gon S, Snow J, Gregory M. Health and land stewardship: a Hawaiian perspective. 2000. Available at: http://www.hoolokahi.net/healthland.htm. Accessed July 13, 2003.

42. Oneha MF. Ka mauli o ka ‘oina a he mauli kanaka: an ethnographic study from an Hawaiian sense of place. Pacific Health Dialog. 2001, 8 (2): 299-311.

43. Pukui M, Haertig E, Lee C. Nana I Ke Kumu. (Look To The Source): Volume 1 & 2. Honolulu, Hawai‘i: Hui Hanai;1972. 

44. Banner RO, DeCambra H, EnosR, GotayC, Hammond OW, Hedlund N, Issell BF, Matsunaga DS, Tsark JA, A breast and cervical cancer project in Native Hawaiian community: Waianae cancer and research project. Preventive Medicine. 1995, 24(5): 447-453.

45. Hughes CK. Uli’eo Koa- Warrior preparedness. Pacific Health Dialog. 2001, 8 (2): 393-400.

46. Leslie JH. Uli’eo Koa Program: incorporating a traditional Hawaiian dietary component. Pacific Health Dialog. 2001, 8 (2): 401-406.

47. Else I. Native Hawaiian physician location and service to the underserved in Hawaii. Pacific Health Dialog. 2001, 8 (2): 312-321.

48. Cadman E. John A. Burns School of Medicine: a rebirth. Pacific Health Dialog. 2001, 8(2):244.

49. Kagawa-Singer M, Kassim-Lakha S. A strategy to reduce cross-cultural miscommunication and increase the likelihood of improved health outcomes. Academic Medicine. 2003, 78: 577-587.

50. Palafox N, Buenconsejo-Lum L, Ka‘ano‘i M, Yamada S. Cultural competence: a proposal for physicians reaching out to Native Hawaiian patients. Pacific Health Dialog. 2001, 8 (2): 388-392.

51. Handy E, Pukui M. The Polynesian Family System In Ka‘û, Hawaii. Rutland, Vermont: Charles E. Tuttle Company, Inc.;1972. 

52. McDermott J, Tseng W, Maretzki T. People And Cultures Of Hawai‘i: A Psychocultural Profile. Honolulu, Hawai‘i: John A. Burns School Of Medicine And University Of Hawai‘i Press;1980. 

53. Nani‘ole J, Meyer M. (Ka maka o ka ihe laumeki-The point of the barbed spear : Native Hawaiian epistemology, and health. Pacific Health Dialog. 1998, 5(2): 357-360.

54. Broderick S. Student Health, Student Success. Community College Journal. 2003, August/September:10-15.

55. Watson-Wade TA, Culture-specific treatment curriculum for substance abusing Hawaiians (and other non-Western peoples). California Institute of Integral Studies. Available at: www.h3online.org/c11/Tamara/substance.htm . Accessed April 19, 2003.

56. Matsunaga DS, Enos R, Gotay CC, Banner RO, DeCambra H, Hammond OW, Hedlung N, Ilaban EK, Issell BF, Tsark JA. Participatory research in a native Hawaiian community program. The Wai‘anae Cancer Research Project. Cancer.1996, 78 (7 suppl):1582-1586.

57. Nunez A. Multicultural considerations in women’s health. Medical Clinics Of North America. 2003, 87(5): 939-954.

58. Fernandes R, Sweet N, Casken J. Kupuna Program: A Solution To The Health Problems Facing Native Hawaiian Elderly? American Public Health Association Conference Presentation. 2000, Abstract #15775

59. Ka’opua L. Treatment adherence to an antiretroviral regime: the lived experience of Native Hawaiians and kokua. Pacific Health Dialog. 2001, 8 (2): 290-289.

60. Ka ‘Uhane Lokahi. Native Hawaiian Health And Wellness Summit And Island ‘Aha: Issues, Trends, And General Recommendations. Honolulu, Hawaii: Papa Ola Lokahi;1998. 

61. Hughes CK, Tsark J, Kenui C, Alexander G. Cancer research studies in Native Hawaiians and the Pacific Islanders. Annals Epidemiology. 2000, 10 (8): S49-60.

62. Ka‘ano‘i M, Braun K, Gotay C. Oncologists’ knowledge, attitudes and practices related to cancer treatment clinical trials. Hawaii Medical Journal. 2002, 61(5): 91-95.

63. Makini G, Hishinuma S, Kim S, Carlton B, Miyamoto R, Nahulu L, Johnson R, Andrade N, Nishimura S, Else I. Risk and protective factors related to Native Hawaiian adolescent alcohol use. Alcohol & Alcoholism. 2001, 36 (3):235-242.

64. Mau M, Glanz K, Severino R, Grove J, Johnson B, Curb JD. Mediators of lifestyle behavior change in Native Hawaiians: initial findings from the Native Hawaiian diabetes intervention program. Diabetes Care. 2001, 24(10): 1770-1775.

65. Tsark JU, Braun KL. Ten-year changes in breast cancer knowledge, attitudes, and practices in Native Hawaiian women. Pacific Health Dialog. 2001, 8(2): 280-289.

66. Wergowske G, Blanchette P. Health And Health Care Of Elders From Native Hawaiian And Other Pacific Islander Backgrounds. 2003. Available at: http://www.stanford.edu/group/ethnoger/nativehawaiian.html . Accessed September 12, 2003.

67. Blaisdell-Brennan HK, Goebert D. Health care utilization among women on O‘ahu: implications for Native Hawaiian women. Pacific Health Dialog. 2001, 8 (2): 274-279.

68. Au C. Cultural factors in the preventive care: Asian-Americans. Primary Care: Clinics In Office Practice. 2002, 29 (3). 

69. Humphry J, Reinhardt T. Disease management: the interface between Hawaiian health and the Western health care system. Pacific Health Dialog. 1998, 5(2): 370-374.

70. Harden M. Voices Of Wisdom: Hawaiian Elders Speak. Kula, Hawai‘i: Aka Press;1999. 

71. Naone KL. Mai Iluna Mai (It Comes From Above). Honolulu, Hawaii: Kumu A‘o and The Hawaii Community Foundation; 2002.

72. Kahalewai N. Hawaiian Lomilomi Big Island Massage. Mt. View, Hawai‘i: Island Massage Publishing;2000. 

73. Gutmanis J. Hawaiian Herbal Medicine. Kâhuna La‘au Lapa‘au. Honolulu, Hawai‘I: Island Heritage; 1976.

74. Native Hawaiian Biennial Healing Conference. Compassion Is The Healer. Honolulu, Hawai‘i; 2002. Available at: www.waimanalohc.org/hc02/information.htm . Accessed November 20, 2003. 

By Bradley E. Hope MD (last revised 07/03/2006)

Brought to you by www.freemedicaltextbook.com
& http://www.avanafildrug.com/

A medical school loan will most likely be the most expensive loan that is taken out by a college student. Besides the traditional four years of college, there will be anywhere from four to eight more years of what could be considered post-graduate education before you earn your M.D. degree.

For this reason, careful consideration will need to be given to the type of medical school loan that you apply for, and where you apply for the loan. This is especially important because of the fact that most student loans require that repayment begin within six years of the original loan date, and you may still be taking courses.

There is, however, one very good option for obtaining a medical school loan. It's a little tricky, but it can be done, and this is how: Find a hospital that offers tuition reimbursement or loan forgiveness in exchange for your commitment to work at that hospital or one of its affiliates for a specific number of years.

Doing so may require you to accomplish a few preliminary goals first, as well as make some major changes. For instance, you may find it feasible or necessary to go ahead and obtain your pre-medical college degree first. Or, you may have to relocate to an area where an extremely large, very prestigious hospital (such as the Mayo Clinic, to give an example) is located.

These can be some pretty heavy decisions to make. However, if you look at them as goals to be reached, or a means to an end, it may make it easier for you.

So, with these things in mind, go ahead and look into the option of a “commitment-required” medical school loan by deciding first if you need to go ahead and get your “preliminary” degree. If you feel you should, take the steps to do that.

Then, do your research, and find a hospital that offers a medical school loan, and apply for admission to that hospital's medical school. When you are accepted (you want to think positively, here), be the best medical student you can be.

Once you have earned your medical degree, you may come to realize that the major decisions you had to make (earning your preliminary college degree, relocating, and fulfilling your commitment) have just turned out to be the best decisions you ever made. This will be especially true when you realize the success and pleasure that comes from having reached your goal of becoming a medical professional.

Brought to you by www.freemedicaltextbook.com
& http://www.avanafildrug.com/

Www.Avanafildrug.com

The expression “rock your world” was coined by the actor Jamie Foxx when he was a character actor in the role of Wanda on In Living Color, long before he became an Oscar winner for the movie Ray. Well having my world rocked is exactly what happened when after four months of dizziness, ringing and roaring in the ears, extreme ear pressure and fullness of the ears, imbalance, nausea, and three falls as a direct result of vertigo attacks (a sensation of movement when there is no movement), I finally got the diagnosis that I would need to begin a treatment plan for what physicians were certain was Meniere’s Disease.

Meniere’s Disease also called idiopathic endolymphatic hydrops is a disorder of the inner ear. Very difficult to diagnose, to date the cause of the disease is unknown contributing to the treatment of Meniere's Disease to be even more difficult. Theory is that the probable cause is from an abnormality in the fluids of the inner ear. Usually only one ear is involved though in my case both ears were involved. Statistically this disease starts between the ages of 20 and 50 years of age. Men and women are affected in equal numbers. Treatment for Meniere's Disease is done somewhat on an experimental based on an individuals' previous medical condition and their current state of health and symptoms.  

People diagnosed with Meniere’s Disease experience vertigo that lasts anywhere from 20 minutes to two hours or longer, sometimes days. When experiencing these attacks, one is unable to perform activities that are otherwise normal to work or home life. Usually following an attack sleepiness follows for hours. Intermittent hearing loss also occurs early in the disease and though hearing loss occurs, the ears do become particularly sensitive to loud sounds. The fullness and ringing in the ears comes and goes intermittently. At this point in the illness treatment for Meniere's Disease is focused on stabilizing the patients' balance and eliminating any pain and discomfort associated with the condition.

My doctors were very honest throughout this process in telling me that treatment for Meniere’s Disease is an ongoing experimental process. The process would begin with conservative treatment before considering surgery as a last and final alternative. After unsuccessfully having tried conservative treatment with drugs to attack viral and bacterial infections including a battery of steroids, diuretics, anti-vertigo medications, and high blood pressure medications, the next step was to schedule an audiometric examination with an Otolaryngologist. This particular test would show mild hearing loss and extreme negative pressure in both ears. Having established a base line, this procedure was done on each visit to determine if there was any further hearing loss. Further treatment with steroids and diuretics was continued however there was no improvement. I was then referred to another doctor who performed an ENG to evaluate balance function. This test would show permanent balance damage to the right ear. I was then sent for an MRI to insure there were no neurological problems. The MRI was negative. This doctor then referred me to another special at U.C.S.D. Medical Center where the Balance Center is located. Doctors at this location are the local experts in the field. He too wanted to continue along a conservative path and so we experimented with several medications and a restrictive salt intake diet combined with exercise and a controlled diet.

Being proactive, I changed my diet completely. I removed all salt and eliminated all fast and processed foods. I at that point was taking only Hydrochlorothiazide (a diuretic) and Klor-Con M20 Tabs to supplement my potassium. I had even learned to stabilize when an attacks occurs to focus on one thing, to stare continuously until the balance was regained. Improvement wise things progressed moderately. Where the vertigo attacks occurred every day several times a day, they eventually started to decrease in numbers. I continued with a diet high in fiber and protein, fresh fruits and vegetables, no red meat, no pork, no fast foods and no caffeine. I was becoming satisfied with my progress and keeping a journal to chart the increase or decrease in attacks, and then it happened. As I got ready to go to bed one night, a vertigo attack came on as I was getting up from the sofa to go to bed causing me to lose my balance. I tried to catch myself but when you experience vertigo you have no control. After it was over, there was blood everywhere. In trying to catch myself I had stabbed myself in my leg with my fingernail. After having made progress the way that I had, this was frustrating and depressing leaving me with feelings of helplessness.

The next week I saw my doctor. It was explained to me that there was a procedure that I could try that had been successful for some patients being treated for Meniere's Disease. Again the procedure was experimental. Since the permanent balance damage was in the left ear, a surgeon could go in and puncture the eardrum several times, and inject Prednisone. It would be a few weeks before I would experience some relief but it would be worth it, or so I was told. I agreed that moment on the spot, and it was done that day -– while I was awake. Since I had driven myself, with the exception of the Lidocaine injection in my eardrum, they would not be able to administer any pain medication. The pain I experienced the hours following the surgery, the next few days and weeks was excruciating. I swore off any further procedures or surgeries. Eventually things did improve. This procedure in actuality relieved a lot of the pressure issues I had in my ears. The vertigo attacks are not as frequent, however I am very regimented in terms of my routine. I am now only taking the diuretics and the potassium supplements. Rigorous exercise is recommended to eliminate the body of excess fluids, so I run daily. To calm myself from the agitation associated with the disease (it’s hard to ignore ringing and roaring in your ears) I practice Yoga and Pilate's and I meditate daily. I am on a very strict diet that is low carbohydrate, high protein, fresh fruits and vegetables, oatmeal daily, lots of fluid, and no caffeine.

As a result of Meniere’s Disease I have had to curtail my driving to a minimum so as not to injure others. It is the responsible thing to do. I don’t swim as it could jeopardize my safety. I listen and pay attention to all signals my body sends. Vertigo attacks usually give a signal. The ears ring, and then they become full, afterward all control is lost until the attack ceases. I have learned by exerting control in the areas that I can and in being responsible and proactive for my health. By approaching it in this manner I am able to eliminate a lot of the negativity associated with the disease. I have been told unless the vertigo attacks become more severe I will not have to have further procedures done. Should it become further disabling, surgery at that point would be recommended. Based on research it has been determined that even though necessary, most of the surgeries are considered destructive. My hope is that this is not a path I will have to take in the future. I do however plan to continue to be proactive in doing my part to keep my health stabilized. One way of doing so is by being active in several Meniere’s Disease support groups to get feedback from others with the same diagnosis.  If you suspect you are suffering from  Meniere's Disease or other balance related conditions, contact your physician to determine the best course of treatment for your situation. Acknowledging there is a problem, and making an appointment to see your physician are the first steps to recovery, so don't wait. 

Brought to you by www.freemedicaltextbook.com
& http://www.avanafildrug.com/