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LAist catches Executive Chef Sascha Lyon in the kitchen at Delphine in the new W Hotel on Hollywood Boulevard. Lyon comes to LA with a pedigree, previously of Balthazar, Pastis and his own New York restaurant, Sascha. He brings with him bold flavors from the Mediterranean, specifically the South of France.

His goal is to offer affordable and accessable seafood in a non-seafood restaurant. So no captain's wheels, glass floats or netting on the walls. The decor is a little more Barbarella meets a millionaire (but cheats on him with Moondoggie.) The chef is all about consistency in the food while promoting a good time, and the W is definitely all about a good time. The joint was jumping on a Thursday night, and a number of partiers were enjoying pissaladiare and cocktails at Station, the comfortable patio area. The perfect place for a cuddle.

I love this seafood stew for being both simple and complicated at once. Few of us can achieve that dichotomy without substantial artifice, but this dish stumbles into it without effort. As my Marseilles cousin said to me when I described the recipe, “These are not the mussels of Marseilles.” Perhaps not in the traditional sense, but I've taken the essences of Marseilles that inspire me—the seafood, the pastis, the saffron, the garlic—and bubbled them into a light, spicy dish that is both warming and weightless.

The dish takes, from beginning to end, perhaps twenty minutes. The subterranean perfume of anise wafts up from the subtle, but present, pastis and fennel. The floral saffron and hot chilies add further depth of flavor to what is otherwise a simple pot of seafood. The clams leach their signature briny liquor, and add a sweet emphasis and contrast of texture to the quotidian mussels. It's a pot of mussels taken to new Provençal heights. And if you want to make this moules frites, I suggest you try it with sweet potato fries and some good crusty bread. Use the shells to spoon the hot broth into your mouth like a suppertime elixir—it's bright, fresh, and life-giving.

About the author: Kerry Saretsky is the creator of French Revolution Food, where she reinvents her family's classic French recipes in a fresh, chic, modern way. She also writes the The Secret Ingredient series for Serious Eats.

Marseilles-Style Spicy Mussels and Clams

- serves 2 to 4 -

Ingredients

2 tablespoon olive oil
3 shallots, finely diced
4 cloves garlic, sliced
1/4 fennel, thinly sliced
1/4 teaspoon chili flakes
1/2 cup grape tomatoes, halved
1/4 cup pastis
1/2 cup dry white wine
1/4 teaspoon saffron
1 pound mussels
1 pound little neck clams
1 tablespoon butter, very cold
2 tablespoon fennel fronds, chopped
1 tablespoon chervil, chopped

Procedure

1. In a wide risotto pan, heat the olive oil over medium to medium-low heat and add the shallots, garlic, fennel, and chili flakes. Sauté until translucent, fragrant, and tender—about 5 minutes.

2. Add the tomatoes, and sauté another 3 minutes.

3. Add the pastis, and reduce.

4. Add the wine, and reduce.

5. Add the saffron, the mussels, and the clams, and raise the heat to high. Cover, and steam the seafood until it opens—about 5 minutes. Shake in the cold butter to make the sauce creamy.

6. Toss in the fennel fronds and chervil and serve immediately.

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People gets sick once in a while. It's waited. That's why people have sick time at job. That's why there are doctors and insurance organizations. However there are a few basic things to be sure you be in principal perfect health. You should wash your hands. In general, not enough they do this. When taking the restroom. Investigations have been done and a shockingly low percentage of men and women wash their hands after using the lavatory or before meals.

I always tell you: Drink liquid. Water cures all sickness. Dehydration is the guilty of many common indisposition like headaches and even bloating. Eight cups of liquid is the minimum so make sure you're getting at least that much. Think that fruits and vegetable juices count towards your daily dose of hydrating beverages. Exercise. Physical activity does not have to mean hours on the treadmill sweating away to exhaustion. Physical activity can be as simple as walking across the parking lot to the grocery store or doing housework. That's true! Airless get off calories intake! The more active in general you are the more exercise youare getting. Consider getting a pedometer. Passometer's have shown that men and women who wear pedometer's are more active than those who do not.

There are varieties of tips available on weight loss if you go through health magazines regularly. Some of these tips actually work, and others don't. Those of them suggesting pills, weight loss supplements and fad diets usually don't work. Exercise and Diet are those tips that work most of the times. However, the weight loss industry is ridden with myths and deceptive information, and people often tend to twist the truths, either because of their own advantage or out of plain ignorance. In this article three such weight loss myths are discussed.

First Myth: Relying on Cardio exercises alone will help you lose weight: Even though it is true that cardio exercises can help you loose fat, it is not true that this is the only type of weight loss exercise available. Another good and effective option is aerobic workout. As a matter of fact, the amount of fat you will lose doing either cardio or aerobics is almost same. On the other hand, weight lifting is better than both cardio and aerobics, in the sense that it not only helps you burn fat during the workout, but even after that!

Second Myth: Instant reduction of fat is possible: This is not at all true and I am sure that any weight loss expert will agree to this. Under any conditions you cannot force your body to reduce fat instantaneously no matter what type of workouts you perform. If you do only crunches and leg lifts frequently in the hope of reducing belly fat, you will notice that instead of reducing your belly fat, you will reduce the muscle mass that resides beneath the abdomen. For this purpose you should eat a healthy diet that would speed up your metabolic rate and burn up your excess fat, instead of just focusing on crunches and leg lifts alone!

Third Myth: A rapid cut down on the intake of calorie reduces your body fat: This myth has tempted many obese persons to undertake crash dieting. In the hope of losing those extra pounds, people generally undertake a crash dieting programme; least realizing that crash dieting harms their bodies instead of helping them. The fact is that when you are fasting or starving, your body realizes that you are going to kill it and then it goes into the starvation mode. The metabolic rate of the body is slowed down while in the starvation mode and the muscles are burnt (instead of fat, which is kept in reserve) for producing energy. This way, you don't lose much fat at all; if anything, you lose your valuable muscles. You will gain extra weight more than you had previously once you return to your normal diet!

I sincerely hope that this article has successfully brought the real weight loss truths before you!

The Mayo Clinic Diet: Eat Well, Enjoy Life, Lose Weight. 254 Pages. Good Books. $25.99.
The Daily Beast’s William Boot reviews bestsellers to see which, if any, are readable. This week: The Mayo Clinic Diet.

Book: The Mayo Clinic Diet
Authors: The weight-loss experts at the Mayo Clinic
Pages: 254
Readable pages: 254
Sample line: “Carbohydrates, fats, protein…oh my!”

Listen up, fatso: The Mayo Clinic Diet is the best-selling diet book in America. It’s not because of the weight-loss prescriptions, which are rather obvious (“eat a healthy breakfast”). It’s because of the book’s writing, the happiness-enriched prose that can make even the girthiest among us feel like a swimsuit model. It’s the feel-good book of the year.

“This diet is not a fad,” writes the Mayo Clinic’s Dr. Donald Hensrud, a handsome, Charlie Crist-looking figure. What Hensrud and his team want is to make your diet as unobtrusive as possible. There will be no humiliations as in NBC’s The Biggest Loser. The Mayoites urge you to “find your eating place”—the part of house you’d like to diet in. “The cool thing about burning calories,” they write, “is that the possibilities are almost endless.”

In an introductory lesson, the Mayoites suggest that you, the dieter, try to estimate half a cup of dry cereal—the point being that you’re probably eating more food than you think. Now, I know of no one, outside of a Kellogg’s executive, who would feel threatened by the outcome of this exercise. But the authors feel moved to add, “If you overestimated, don’t feel discouraged.”

Every diet promises comfort—no calculators, no food scales, etc. But The Mayo Clinic Diet is beatific in the extreme. The authors may work for one of the most cutting-edge medical facilities in the world, but they address the reader as if he or she had never before been in a supermarket. “Common opinions hold that vegetables and fruit don’t have much flavor or that they all taste the same,” they write. Held where, in kindergarten? Elsewhere: “Lettuce or fresh spinach is generally the foundation of a healthy salad.” Still elsewhere: “Keep in mind that you don’t need to like all varieties of vegetables and fruits, just some of them.”

The first section—called “Lose It!”—told me I could lose six to 10 pounds in two weeks. The advice is hearteningly intuitive. I should eat whole grains, fruits, vegetables (not all of them, just some of them). I should exercise 30 minutes a day. I should cut out sugar and snacks, and I shouldn’t eat while I watch TV. Flipping the pages, I kept waiting for the provocative angle, the hook that made The South Beach Diet or Atkins’ New Diet Revolution so memorable. But it never came, nor did any command I couldn’t perform while sitting in the business class section of Virgin Atlantic. The authors later say that this part of the book is “kind of like a boot camp.”

As the book moves from “Lose It!” to “Live It!”—aka, Week 3—a few hard numbers begin to appear. I should lose one to two pounds per week; I should eat 500 to 1,000 fewer calories a day; I should eat one-quarter of the Snickers Bar I find lying around Beast headquarters instead of the whole thing. There is plenty of smart advice: My daily serving of protein, for instance, should be no bigger than the size of a deck of cards.

The author of a diet book must be a gentle psychologist. Anyone who has picked up the thing has done so because they feel bad about themselves, because their vow to run a mile every morning has become a brisk walk to the pastry shop. The Mayo Clinic Diet tries the gentle approach. It’ll cite a “negative attitude” (“Exercise is painful and boring”) and contrast it with a “new attitude” (“I’ll call a friend to go walking and enjoy the beautiful day”). I’m guessing that most of us fall somewhere between clinical depression and unbearable happiness—and even that makes us feel better.

The Mayoites have performed a kind of provocative stunt here: they’ve done nothing provocative. They’ve put some brightly colored jogging shorts on some age-old wisdom. And one more thing: The Mayo Clinic Diet makes a bid to be the official diet of the Obama administration. The book is chock full of helpful hints called “Yes, I Can!” This is a diet for an optimistic age, for those who still believe in the audacity of hope.

Read it? Yes.

Previously reviewed William Boot:

U is for Undertow by Sue Grafton
I, Alex Cross by James Patterson
The Help by Kathryn Stockett
Noah’s Compass by Anne Tyler
Committed by Elizabeth Gilbert

Plus: Check out Book Beast, for more news on hot titles and authors and excerpts from the latest books.

William Boot covered the war in Ishmaelia and wrote the Lush Places column for The Daily Beast. He now reviews bestsellers.

For more of The Daily Beast, become a fan on Facebook and for more books coverage follow Book Beast on Twitter.

For inquiries, please contact The Daily Beast at editorial@thedailybeast.com.

Losing weight and getting fit preoccupied Americans in 2009:

• Nearly one out of two American women, including high school girls, were on a diet.

• Over 40 billion was spent on branded diet plans.

• Children as young as 9 to 11 years old were sometimes or very often dieting.

Yet an epidemic of obesity continues to affect more people than ever before:

• Less than a third of adults enjoyed normal weight.

• Children were two to three times more likely to be overweight today than they were 30 years ago.

Can we begin to reverse these worrisome trends in 2010?
We can if we update our old views with new ways to look at fitness in the coming year.

Old View: It's hopeless! Efforts to lose weight are inevitably doomed to fail. Even if a person manages to lose weight, he or she will eventually regain the weight and add back even more.

New View: You can do it! Strategies for making healthier choices involving diet, physical conditioning and improved self-care are available to you and can be learned. Championing this view is Kelly Brownell, Ph. D., who heads the LEARN Program for Weight Management at Yale University. And thanks to widespread access to the Internet, peer counseling in online communities is expanding. Internet support may include food and exercise diaries, weekly counseling, online weight-loss lessons and motivational phone calls.

Old View: Thin is in! Most individuals, especially women, seek to lose weight because they have internalized the media's ultrathin ideal.

New View: Healthy is in! Health is replacing vanity as the primary reason for pursuing fitness and weight loss. In 2009, researchers reported that four healthy habits could reduce or eliminate 80 percent of major medical problems: eating a healthy diet, not smoking, exercising regularly and maintaining a normal body weight. This insight, combined with rising medical costs, is triggering a focus on fitness.

Old View: If you are fat, you are a bad person. Obesity is a personal problem caused by a lack of willpower.

New View: Obesity is a disease that is treatable. The cost of providing medical care per person has skyrocketed from $356 in 1970 to $8,160 in 2009. Moreover, in 2009, the cost of treating obesity-related medical problems reached $147 billion. Given these costs, obesity has become a public health concern requiring a multifaceted community-based approach. In response, community leaders in Albert Lea, Minnesota, implemented a comprehensive lifestyle program to improve the health and longevity of the city's residents. To increase employee productivity and reduce health insurance costs and absenteeism, corporate wellness programs are proliferating.

Old View: Low-fat diets are required to lose weight. Eating fat makes a person fat. To lose weight, a dieter needs to stick with low- or no-fat foods.

New View: Total calories actually determine weight. The total calories consumed by a person, whether from carbs, fats or proteins, determines weight. Since the goal is a balanced diet, the Mediterranean diet, which includes healthy fats, is recommended by the Mayo Clinic and the American Heart Association as a nutritionally sound and healthy eating plan. Nuts, which until recently were on dieters' “do not eat” lists, are making a comeback because of their health benefits, especially almonds, walnuts, cashews, pecans and macadamia nuts. Momentum is growing for mandating information on the caloric content of fast foods and food products.

Photo courtesy of everystockphoto.com

Old View: Medical intervention is needed. Weight-loss drugs or bariatric surgery can solve the problem of surplus pounds for many people, and advances in medicine can address obesity-related problems such as cardiovascular disease, diabetes, stroke and cancer.

New View: A healthy lifestyle is the best way. Prevention, rather than treatment of obesity-related medical problems, will move to the forefront because of the rising cost of medical insurance and healthcare. While the number of bariatric surgeries will continue to skyrocket, family physicians will increasingly write exercise prescriptions in lieu of drug prescriptions.

Old View: Ignore overweight children. Children who are overweight will outgrow their chubbiness, so kids' surplus pounds can be ignored.

New View: Help overweight children now! Dr. Robert Murray, chair of the American Academy of Pediatrics Council on School Health, is alarmed that nearly half of kids and teens are overweight or obese and, as a consequence, children's life expectancies are lower than their parents'. Treating childhood obesity is a serious medical problem that if ignored will place the child at risk for heart disease, diabetes and other serious medical conditions.

Old View: Don't ask, don't tell. Asking employees to modify their unhealthful behavior is an invasion of privacy and violates employees' right to choose their own lifestyle.

New View: Offer help, incentives and access to experts. In 2008, medical insurance premiums reached a record $15,609 for a family of four. Employers are proactively seeking to reduce costs (medical insurance, workers' compensation claims and absenteeism) by restructuring benefit programs. In increasing numbers, employees are being offered incentives to quit smoking or lose weight. They face penalties if they refuse to change habits that drive up the cost of healthcare.

Old View: Hard-core exercise one hour daily. Going to a gym daily for a 60-minute workout on a treadmill and resistance equipment is the best way to exercise.

New View: Diversity, fun and enjoyment. Thanks to popular television programs, dancing for fitness is back, particularly Zumba, a one-hour workout that fuses Latin rhythms with calorie-burning dance movements. Exergaming, such as Wii and Dance Dance Revolution, continues to grow in popularity with young and old alike. Michelle Obama has made the Hula-Hoop popular once again. The use of technologically sophisticated feedback gadgets, from pedometers to heart monitors, will expand. To attract members to the gym during tough economic times, more fitness centers will offer cardio cinema so members can watch a movie while exercising.

Will we continue to get fatter until 2018 when, according to research by Kenneth Thorpe, PhD, of Emory University, 40 percent of us will be obese (and another 33 percent overweight)?

If we are to succeed in reversing the obesity trends and mounting medical care costs, we'll have to find new approaches. And the more readily we learn from the past and update our understanding of the complex nature and causes of obesity, the more quickly we can successfully move into a healthy future.

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Weight Loss Tracker also has a social networking aspect where you can share your progress with your friends and comments on each other’s status.

Features:

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• Keeps track of calories consumed or points associated with a weight loss program.
• Keeps an exercise log of when you exercised and the type of activity.
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• Has a convenient iGoogle gadget option.
• Similar Tools: CaloriesPerHour, Ideal Body Weight Calculator, WeightMirror. and also see related article “6 Great Free Weight Loss Resource Sites“.

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Ok, Skippy, my first instinct was to respond to you in a really sarcastic way. I've quelled that urge. However, I would respectfully ask you to consider that your not needing your health insurance rests on a HELL OF A LOT more than your being a “healthy and fit vegan.” Namely, luck. I could eat better, it's true. But even if I ate better, I still would have needed, really needed, my health insurance this last year. a) I have a mental illness. Not a super-serious one, but one that requires meds and a therapist. b) I sprained my ankle and broke my foot (separate occasions). That's thousands right there. c) Other reasons, that aren't my “fault” that I have needed health insurance in the past and will need it again in the future: hearing impairment. propensity to get sinus infections. heavy periods.

So, maybe, Skippy, your health is due to your own great habits. But what is far more likely is that you're lucky. Should someone pay you for that? I don't think so. Health insurance is a lucrative industry right now, but the basic idea is a good one: we pool our resources, so that when any one of us has a hard time, that one won't be shit out of luck.

I'm not for or against corporate health incentives, per se. I think helping people with gym memberships is probably a good idea, because it shouldn't cost an arm and a leg to work out. Helping people quit smoking might be nice, but punishing those who already do probably has more to do with luck than you might think (class, for example, has a big impact on whether or not you pick up smoking, as does whether or not your parents smoke).

It's like Ted Kennedy said about George HW Bush (paraphrasing): “He was born on third base and thought he hit a triple.” (Talking about class privilege, not health, but it's an apt analogy). Good health is 90% luck. So try to have a little compassion for those of us with less luck. I know I have more luck than most, which is why I think Whole Foods sucks on this particular issue.

weight loss exercise

There are many different diet and weight loss methods on the internet. Do a google search and you'll literally find hundreds. Some are pretty complex and most involve instating some very boring routines into your life. As I was eating lunch today, I looked down and there was my dog with its eyes all shiny bright eyeing my pizza intently. As I stared at my dog I thought to myself, now there's a weight loss program that would actually be not completely terrible. I'll call it the “Get-a-Dog-Diet-and-Weight-Loss-Program”. Am I serious? Halfway. There is some logic to this idea, despite what seems like absurdity at first. Think about it though, all gimmicks aside, we all know that the only way to lose weight is to eat smaller portions that the western world has taught us and to exercise more than the western world has made necessary. A dog will help you on these things.

The dog always wants some of your food so if you give in and give it a bite here and bite there, you, yourself, will be consuming fewer calories. You'll also be making a good connection with your dog who will like you even more than before. Just don't share your chocolate with the dog. The downside to this is your dog might follow you around even more than previously.

As for exercise, if you play with you dog like you should, you will get more exercise. Play tug-of-war with a rope, chase the dog around, or throw a ball. It's all terrific exercise. Take your dog for long walks. Walking with a dog is less boring that just wandering around by yourself.

If you are anti-social and don't have an exercise buddy, get a dog. They love to walk. Small dogs, terriers and toys, are always energetic. So, not only will you have a walking partner, you'll have one that's always happy to go further. They are also more alert than the average human, so the ability for a stranger to sneak up on you is decreased. However, be aware, dogs will also bark at squirrels and their own shadows so on that note they aren't the best warning system but they are still better than humans at paying attention to the world around them.

The more you play with the dog and walk them, the more exercise you'll be doing and the more likely you are to be losing a little weight without realizing it. Even if you aren't the playful type, you'll still be running after the dog when it steals your favorite pen to devour or runs off with your shoes. So get a dog, in fact get several dogs. It'll be a more entertaining, or at least motivating, way to lose weight.

But all these dogs will cost money to keep you might say? Sure, but their not more than other weight loss methods. You can take that 30 bucks you'd spend on a gym membership and put it to buying their food. Take the 50 dollars you'd spend on some useless exercise equipment with a “as shown on TV” sticker, which let's face it, once you get it you'll use it once and then put it a corner to collect dust and mold, instead put that money towards your dog's rabies shots and heartworm prevention chews. As for the cost to obtain your dog, dogs are only costly if you buy a purebred puppy. You can usually find mixed breed puppies being given away for free, or you can search the local pound and find an adult dog for cheap.

So if you don't have a dog, but think you could stand having one, get one. It's good exercise for you. If you already have a dog, spend more time with it and give it more of your food. It's bound to help you lose a little weight and also you'll have gained a friend. The secret to weight loss is life changes. If you really don't mind hitting the treadmill and feeling like a hamster, then you can follow all those exercise routines online. Personally, I think it's more effective to get something in your life that makes you active. A pet is one way. However there are hundreds of other alternatives. You could also join a sports group or take dance classes. Find something you like to do that makes you active. These are much more meaningful changes to your life than hanging out at home counting reps of odd exercises that put you through motions you never use in real life.

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Everyone in the world has been affected by the most annoying occurrence known to man… hiccups. They show up at the most awkward times and make a nuisance of themselves when you try to talk, sleep, or eat. But what exactly are hiccups? Why do we get them? And most importantly, how do we get rid of them?

Hiccups or sometimes called hiccoughs, are involuntary spasms of the diaphragm that repeats several times a minute. The diaphragm is the dome-shaped muscle that is at the bottom of your chest. The diaphragm almost always works perfectly. When you inhale, it pulls down to help pull air into the lungs. When you exhale, it pushes up to help push air out of the lungs. But sometimes the diaphragm becomes irritated. When this happens, it pulls jerks down, which makes you suck air into your throat suddenly. When the air rushing in hits your voice box, you're left with a big hiccup.

A lot of times, hiccups can happen if you eat too fast, eating too fast causes you to swallow air along with our food causing a case of the hiccups. Also, eating too much fatty foods, eating very hot or spicy foods or drinking too much can irritate the diaphragm and result in hiccups. Laughing vigorously or coughing can trigger hiccups as well. Some medical conditions such as hysteria, personality disorders, laryngitis, multiple sclerosis, meningitis, peptic ulcers, low sodium, low potassium, low calcium, high glucose, emotional stress, smoking, sudden temperature changes, stomach inflammation, and indigestion can also cause hiccups.

A case of the hiccups is rarely a medical emergency, however if your case of the hiccups is frequent and last more than 3 hours, or if they interfere with your daily life such as your sleeping patterns and you have any abdominal pain or you spit up blood when hiccupping, you really should seek medical attention. Any disease or disorder that irritates the nerves that control the diaphragm such as pleurisy or pneumonia or a stroke or tumor affecting the hiccup center in the brain can cause a medical emergency. If you have recently had abdominal surgery, hiccups can be present. Doctors have prescribed medications suck as Lioresal and Dilantin, both have been successful to get rid of those annoying hiccups. A last resort for ridding hiccups has been surgery to disable the phrenic nerve, but like I said that is a last resort.

Hiccups are common and normal in newborns and infants. During the first few months, babies will hiccup at regular intervals, this is quite normal and is nothing to be alarmed about, and you may notice hiccups to be present particularly when the baby gets excited or just after feeding. Much has to do with the relative immaturity of the baby's internal organs. Frequent burping during feeding may decrease the instances of the hiccups. Hiccups for babies can last anywhere fro a minute or so up to an hour at a time but they do not harm the baby in any way.

The most known case of the hiccups was from Charles Osborne, he began hiccupping in 1922 while slaughtering a hog and they continued for 68 years until he died of complications from ulcers in 1991. Despite his conditions, he was able to lead a normal life, marry twice and have eight children.

A lot of home remedies exist for getting rid of hiccups. Here are some things that you can try:

Hold your breath.

Drink a glass of water quickly.

Have someone try to scare you.

Use smelling salts.

Pull hard on your tongue.

Place half a teaspoon of dry sugar on the back of your tongue.

Bite into a wedge of lemon.

One shot of apple vinegar.

Rub the soft part of the pallet on the inside of your mouth for 20-30 seconds.

Chew up and swallow one large marshmallow.

The reason that these remedies are thought to work is that carbon dioxide build-up in the blood will stop hiccups, which is what happens when you hold your breath. If the vagus nerve that runs from the brain to the stomach is stimulated, hiccups can also be alleviated (this is what is happening when you drink water or pull on your tongue).

All in all, this annoying reaction can be resolved by one of the hundreds of home remedies that are out there, if none of them work for you…patience is a virtue.

IMPORTANT NOTE: ALWAYS READ THE ENTIRE LABEL TO MAKE SURE THE MEDICINAL HERBAL PRODUCT DOES NOT CONTAIN SOMETHING THAT YOU MAY BE ALLERGIC TO AND WON'T MIX WELL WITH OTHER MEDICATIONS YOU'RE TAKING.

Little known facts

Black cohosh or cimicifuga racemosa is a member of the Ranunculaceae. The plant is commonly found from such eastern North American areas as Ontario all the way down to Georgia, and as far west as Missouri. Black cohosh can grow up to 2.5 m tall.

American Colonists would use black cohosh to treat yellow fever, malaria, fevers, and bronchitis.

It's Latin name, Cimicifuga means, “bug repellent.”

Since it was great for curing snake bites, Native Americans called this magic potion, “snakeroot.”

Medicine manufacturer, Lydia Pinkham made the herb famous when she marketed it as a vegetable herbal compound.

Black cohosh was also well-known as a “baby in a bottle.”

True effects

I have felt so much better since I started taking black cohosh. The amounts of benefits cohosh have on the human body are almost endless. I wish I could name or describe any specific symptom I've experienced. All I know is how great I felt. I went from feeling “blah” to feeling purer, healthier, and more energized. All of this happened within a day of taking the herb.

The herbal medicine effects such vital organs as the lungs, heart and stomach directly. Black cohosh will lower your heart rate and raise your pulse. Black cohosh will equalize your blood circulation.

Black cohosh is especially good for getting rid of mucus in the bronchial tubes.

Being an excellent and safe sedative, black cohosh is great to treat epilepsy.

Black cohosh will help your kidneys, liver, spleen and lymphatic system in the secretion process.

Two more important notes: If you take too much black cohosh, you can get a headache in the base of your skull. While it is safe to take in the final weeks of pregnancy, black cohosh should not be taken in the beginning.

Disorders, irritations, ailments, and bodily systems treated by Black Cohosh

Angina

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Arthritis – In case you don't know what it is by now, let me clarify. Arthritis is when there is serious damage to joints in the body. There are certain kinds of arthritis; rheumatoid arthritis for example can be an autoimmune disease where the body will literally be attacking itself.

Asthma – This should be self-explanatory. But in case it isn't, in case you don't know what it is exactly, I'll tell you. Asthma is a chronic disease of the respiratory system that constricts a person's airway. Common symptoms of asthma are wheezing, and coughing.

Bedbugs – Tiny, blood-sucking insects that are commonly found in torn mattresses, between floorboards and under the edges of wallpaper can grow to about 5 millimeters long with a reddish body.

Bee stings

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High blood pressure – This should be self-explanatory. But let's get into it for argument's sake. High blood pressure or hypertension is when the pressure in your blood in chronically elevated. This can lead to heart attacks, heart failure, and strokes.

Bowels – Your bowels or intestines are extremely long canals in your belly that can be host to any number of diseases; such as, Gastroenteritis or inflammation of the intestines, Ileus or blockage of the intestines, Ileitis or inflammation of the ileum and of course, Colitis.

Chronic bronchitis – To explain bronchitis, you'll have to know what the bronchus or bronchi are. The broncus is one of two tree-branch-like pipes (trachea) that are used to transfer air to and from the lungs. Bronchitis is simply an inflammation of mucous membranes in those pipes.

Childbirth – This should be self-explanatory.

Cholera – An acute infectious and deadly disease that causes severe diarrhea, vomiting, cramps and a great loss of fluids.

Chorea – Disorders commonly affiliated with convulsive movements of the limbs, face and head. The types of chorea are as follows; acute (afflicting mostly children), hereditary (degenerative disorder of the brain), and senile (chorea as it attacks the elderly).

Convulsions – This should be self-explanatory. In case you don't know what it is, let me tell you. Convulsions are involuntary contractions of the muscles or a series of contractions in which your body is jerking.

Coughs

Diabetes – A disorder in which the body can no longer metabolize insulin, carbohydrates, fats and proteins. Severe conditions require frequent shots of insulin.

Diarrhea – Do we have to describe this ailment? Okay, if we must, we must. Diarrhea is the softening and liquefying of bowel movements. For infants, this ailment can be very dangerous.

Digestive disorders

Dropsy – Accumulation of clear fluids in bodily tissues or cavities, and an obsolete term to describe many other fluid retaining states is dropsy.

Dysmenorrhea – The ladies should know what this is. But in case no one does know what dysmenorrhea is, let me explain. Dysmenorrea is painful menstrual periods caused by a functional disturbance or say, something like tumor or an infection.

Epilepsy – A chronic neurological disease in which a person can lose consciousness, and seize in which there is violent convulsions.

Estrogen deficiency – Estrogen is simply the female sex hormones. Formed within the ovaries, estrogen is vital for maintaining a woman's every secondary sexual characteristic.

Fevers – This should be self-explanatory. But for the sake of argument, let's go into it anyway. It's when the body temperature goes rises above the normal 98.6 degrees Farhenheit.

Gallstones – Caused by a defect in the composition of bile, stones will form in the gallbladder.

Headaches

Heart palpitations

Hormone balancer – Hormones are glandular chemical secretions from an organ or part of the body. They are carried through the bloodstream to organs or parts of organs. Hormones can stimulate or retard an organ's function.

Hot flashes

Hysteria

Insect bites

Kidney ailments – Kidneys are the bean-shaped organs used to regulate acid-based concentrations and water balances in the tissues. But this significant organ can be host to any number of diseases or disorders. Problems include scarred kidney tissue, degeneration, abnormally placed kidneys, floating kidneys, stones, and blood deficient kidneys.

Every kind of inflammation

Insomnia – Simply put, if for whatever reason you just can't fall asleep or stay asleep, you're suffering from insomnia.

Liver – The liver is a mult-purpose and extremely helpful organ, but it can be host to a number of diseases and disorders; such as, Hepatitis or inflammation of the liver, Cirrhosis or the formation of fibrous tissue inside the liver, Gilbert's syndrome or the genetic disorder of the bilirubin metabolism, and Glycogen storage disease II which leads to progressive muscle weakness.

Lumbago – Simply put, lumbago is backache in the lumbar region.

Lungs – The pair-shaped organs in your chest are a necessity for breathing, but they can be host to any number of deficiencies and diseases. You can get black lung or coal miner's, you can get lung cancer, a rheumatoid in your lung, fluid in a lung (pulmonary edema), and lungs marked by honeycomb-shaped cysts.

Malaria – Malaria is simply an infectious disease of several different types. One type is so severe, a child could be playing in the backyard in the early afternoon and be dead by bedtime. Malaria could be one of the scariest infectious diseases I've ever heard of. How it works is by the malaria parasite entering the liver, from there, they spread, invading blood cells from which to reproduce. The cell is completely gone at this point. This cycle continues until the parasite reaches the brain.

Measles – An acute contagious, viral disease that can lead to red spots on the skin, and inflammation of the mucus membranes in the respiratory tract.

Menopause – Mostly a condition for women, commonly occurring between 45 and 50 years old, menopause is the death of menstruation. Symptoms include hot flashes, headaches, and vulvar discomfort.

Menstrual problems – Menstruation is when blood discharges from the uterus. It usually occurs every 4 weeks and lasts from 3 to 5 days in women. In typical menstruation cycles, this process is preceded by ovulation.

Nervous disorders

Neuralgia – Having severe pain along the course of a nerve is neuralgia. The only other form is trigeminal or a facial pain usually located near the nerve of the same name.

Pain

Paralysis – If you lose control of all your muscular functions, you're paralyzed.

Pelvic disorders – Your pelvis supports the spinal column, but this essential bone in your body can be host to any number of disorders and deficiencies. You can have a pelvis that is too small or too big. Symptoms vary depending on the severity of each case.

Poison antidote

Poisonous bites – Poisonous bites can come from insects and snakes.

Rheumatism – A term that best describes disorders of the heart, bones, joints, kidneys, and lungs. A symptom of Rheumatism is back pain.

Skin disorders

Smallpox – This dangerous, viral infectious disease incubates within 12 days. In the beginning of the virus, symptoms can include headaches, fevers, pains, and vomiting. Then those minor symptoms disappear only to bring about much worse conditions; such as, pustules breaking out on the face, hands and feet. This can lead to scabs. It's only after three weeks that the disease hits its end, leaving behind permanent scarring – also called “pock marks”. Just hope you never catch this nasty bug.

Snake bites – There are all kinds of poisonous snakes, including the rattler, the asp, and the cobra. But, of course you already knew that.

Sores – An open skin legion of many different types and origins, including bed sores, canker sores, cold sores and pressure sores.

Sore throat

Spasms – If your muscles are contracting and you can't control it, those are spasms.

Spinal meningitis – In order to describe spinal meningitis, we must talk about what spinal and meningitis mean exactly. Spinal is simply in relation to your spine or vertebral column. Meningitis is the inflammation of those membranes covering your brain and spinal cord.

Syphilis – An infectious STD (sexually transmitted disease) that can cause small ulcers around the genitalia, skin eruptions, mucous patches and fevers.

Tuberculosis – A deadly disease that primarily attacks the lungs. Just hope you never catch this bug.

Typhoid fever – Typhoid or typhus is an acute infectious and contagious disease marked by high fever, severe headaches, and a rash. This nasty bug is usually transmitted by body lice.

Uterine problems

Whooping cough – Also called, Pertussis, whooping cough is when you've got a severely hacking cough and you let out a “whoop” when you take another breath.

Worms – An example of a worm is the parasitic flatworm.

Herbal First Aide

No home should be without this recipe for an herbal first aide kit.

You must have Aloe Vera. The gel from the plant's leaves will help in relieving pain, and healing burns and cuts. Believe me, I know this works.

Also, you should have Arnica. Another healing gel that will take the blue out of bruises.

Take Calendula. When taken as a tea, this dry leaf will help clean cuts.

For indigestion, anxiety and insomnia, take some Chamomile in tea form.

You should most definitely take Echinachea if you want to treat the flu or the common cold.

Gingerroot is great for relaxing the stomach, killing nausea, and putting an end to motion sickness.

Keep a bottle of Witch Hazel handy to stop infections, and heal minor burns and rashes.

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The Herb Book by John Lust
The Prescription for Nutritional Healing by Phyllis Balch
Back to Eden, 2nd Revised Edition by Jethro Kloss & Promise K. Moffet
Children's Herbal Health by Deanne Tenney
Green Pharmacy Herbal Handbook by James Duke, Ph.D
Encyclopedia of Natural Medicine by Michael Nurray, N.D.
Herbally Yours by Penny C. Royal
A Modern Herbal by Mrs. Grieve
Desk Reference to Nature's Medicine by Steven Foster and Rebecca L. Johnson

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If you are having trouble building muscle, try using some of these techniques to trick your body into growing:

1) Work your legs. The leg muscles are the largest muscle group in your body and working them stimulates more testosterone than any other muscle(s). Try adding a few sets of lightweight squats at the beginning of your workout, this extra boost of testosterone can stimulate more muscle growth for the rest of your body. ( You shouldn't be neglecting your legs either, make sure to do upper and lower body workouts. )

2) Increase the weight/reps. Don't go into the gym everyday doing the same weight and amount of reps because your body reacts best to change. Does going to work everyday and doing the same thing make working a lot easier, probably not, it's the same for your body. Try changing up your sets to include heavier weight or more reps to stimulate that extra bit of muscle growth.

3) Creatine. If you are taking it, stop taking it, and if you are not taking it, start taking it. Creatine gives your muscles some extra energy while you work out, giving you an edge when trying to build muscle. Although, just like any supplement and exercise, your body does get used to the extra creatine after a while, so it is best to use creatine in cycles such as 4 to 6 weeks at a time, then taking a 2+ week break. Though, this may not be the optimal routine to use, this is what has worked best for me.

4) Stop counting reps. You don't always have to be a robot and do an exact number of reps. Try working your muscle to failure and doing more than one exercise without resting between sets (this is called a superset and it is an advanced technique, do not try this if you are a new to the gym).

5) Are you getting enough protein? It is recommended that you get at least 1g of protein for every lb. of body weight.

6) Take a break. Your body can be overworked, and this will not let your body make the steady gains that you want. Try taking a few days off from the gym and let your body recover.

7) Work other parts of your body. I know it makes sense that if you want to build biceps, you should work your biceps, and that is true! However, it sometimes helps to focus on another body part for a while and then come back to the area where you are looking to improve on.

These tips can give you that extra boost that you are looking for to get out of that “plateau”. I have incorporated all of these into my workouts and have successfully made steady gains. All of the statements above have come from experience in the gym and advice from friends and other gym-goers. For more information on specific topics, try researching the topic and learning as much about it as you can. Try molding your own workout routines to fit your needs and your body.

For more great tips for building muscle, be sure to check out my other articles.

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Apple's chief executive Steve Jobs announced that the company's annual revenues are now beyond $50 billion, but indicated that even more is in the pipeline to get excited about.

“If you annualize our quarterly revenue, it's surprising that Apple is now a $50+ billion company,” Jobs said. “The new products we are planning to release this year are very strong, starting this week with a major new product that we're really excited about.”

Apple sold 3.36 million Macs, including more than 2.1 million notebooks. That represented 33% growth in Mac sales, compared to an industry-wide 17% growth in PCs reported by IDG. Desktop sales reached 70% growth year over year thanks to the popular new iMac models. Apple's COO Tim Cook detailed even greater growth rates in Mac sales internationally.

It also sold 21 million iPods and 8.74 million iPhones, a record number of new mobile devices for the company. Apple retained roughly 70% market share in the global MP3 market with iPods; growth in the iPod touch reached 55%, while iPhones amounted to a 100% increase in sales over the previous quarter, comparing very favorably to Canalys' data showing industry smartphone growth at around 30%.

The “major new product” Jobs alluded to is expected to be a tablet-form factor device to be announced on Wednesday at the scheduled press event. Company executes speaking during today's earnings announcement explicitly avoided any comment on what the company might release on Wednesday, even dodging the question of whether any new products in the pipeline might contribute to Apple's future earnings.

As the company outperforms both its PC and smartphone competitors and maintains dominance over the entire MP3 market, the uncertainty of whether Apple will be able to successfully deploy a tablet-sized device (given the history of failure dogging that category of products) seems less of a risk than many observers have suggested.

Apple's confidence in launching a new, larger mobile device appears to be based on its years-long head start in releasing usable multitouch interface technology that customers have snapped up enthusiastically, in addition to the tight integration between its iTunes business and its mobile device hardware.

While jobs and the economy are at the forefront of all Americans’ minds, Congress has the ability to create jobs, raise federal revenues, and boost the economy at the end of their fingertips —without any expense to the taxpayer. This could all be achieved simply by permanently repealing the death tax.

At a lecture at the Family Research Council, Dick Patten, the President of the American Family Business Institute, presented a compelling case for repealing the death tax. The death tax is a costly burden for small family-owned businesses. According to President Obama, small business “created roughly 70% of all new jobs in the past decade.” And yet the death tax punishes growth of these job producers by making it difficult for them to succeed after the death of their owner. A study by Prince and Associates showed that “the need to raise funds to pay estate taxes” was cited by 98% of respondents as the reason for failure of such firms.

The death tax has been on a path towards elimination since 2001, thanks to the 2001 and 2003 tax cuts. Those cuts abolished the tax for 2010, but only for one year. The tax comes roaring back to life in 2011 at its rate and exemption levels prior to the cuts. Now Congress must decide whether to repeal the currently dormant tax permanently, or to allow it to resume in 2011 at its pre-tax cut levels: 55 percent on estates worth over $1 million. Hanging in the equation are jobs and economic growth.

The decision should be an easy one given the facts. Patten outlined studies done by former director of the Congressional Budget Office Douglas Holtz-Eakin, Ph.D and Stephen Entin, President of the Institute for Research on the Economics of Taxation show that while reinstating the death tax would cost 500,000 jobs, repealing it altogether would actually create 1.5 million jobs—almost half of President Obama’s not yet reached goal of 3.5 million jobs under the $800 billion stimulus bill.

What is more, unlike the President’s failed stimulus plan, repealing the death tax would have no net cost. Rather, federal revenues would rise were the death tax to permanently expire. Entin shows that fully repealing the death tax would decrease revenues for the federal government by $19.2 billion a year, relative to 2009 rates. However, revenues from other tax collections would increase as a result, to a total of $42.4 billion. Together, this means that repealing the death tax would create a net federal yearly revenue gain of $23.3 billion, more than doubling the revenue created by the death tax. Congress could then cut income tax rates for all taxpayers to make sure there is not a net tax increase.

Many wrongly see the tax as a mode of redistribution from the wealthy to the not-so-wealthy. But in reality, the death tax punishes middle and low-income Americans by discouraging new hiring and stifling new growth.

The United States has the third highest death tax in the world. All other western countries tax estates well below what we do. Furthermore, in Heritage’s recent publication of the Index for Economic Freedom, all of the countries that ranked more economically free than the United States did not have a death tax at all. The choice is clear: repeal the death tax and protect American prosperity by ensuring jobs and economic growth at zero cost to the taxpayer, or allow the tax to continue to lead us down the road towards economic decay.

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Recent studies have found that atypical antipsychotics used to control agitation in aggressive alzheimer patients (chemical straightjacket) have unacceptable risk.

At 5 to ten times the cost of the old standby thorazine,recent comparative studies show the diabetes inducing zyprexa class of drugs are only borderline better in controlling symptoms.

I took zyprexa starting in 1996 the year the FDA approved it, which was ineffective for my condition and gave me diabetes.

Zyprexa is the product name for Olanzapine,it is Lilly's top selling drug.It was approved by the FDA in 1996 ,an 'atypical' antipsychotic a newer class of drugs without the motor side effects of the older Thorazine.Zyprexa has been linked to causing diabetes and pancreatitis.

Zyprexa, which is used for the treatment of psychiatric disorders, such as schizophrenia and bipolar disorder, accounted for 32% of Eli Lilly's $14.6 billion revenue last year.

Did you know that Lilly made nearly $3 billion last year on diabetic meds, Actos,Humulin and Byetta?

Yes! They sell a drug that can cause diabetes and then turn a profit on the drugs that treat the condition that they may have caused in the first place!

I was prescribed Zyprexa from 1996 until 2000.
In early 2000 i was shocked to have an A1C test result of 13.9 (normal is 4-6) I have no history of diabetes in my family.

All the psychiatrist I've interviewed and the information on line presents zyprexa as a worse offender than the other Atypicals such as seroquel.My doctor has stopped prescribing zyprexa altogether.

The PDR classifies zyprexa as 'severe' for causing weight gain and diabetes and seroquel as 'moderate'.

Of course the 50 year old Thorazine didn't cause diabetes and is many times cheaper but it could cause tardive dyskinesia.

Where Eli Lilly's negligence comes in,is their KNOWING and not informing consumers (black box warning) until the FDA demanded it.

Lilly's incentive not to readily disclose is they had billions coming in from state medicaid scripts.
– –
Daniel Haszard http://www.zyprexa-victims.com

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The bladder

The bladder is a hollow organ in the lower abdomen. It stores urine, the liquid waste produced by the kidneys. Urine passes from each kidney into the bladder through a tube called a ureter.

An outer layer of muscle surrounds the inner lining of the bladder. When the bladder is full, the muscles in the bladder wall can tighten to allow urination. Urine leaves the bladder through another tube, the urethra.

Understanding bladder cancer

Cancer is a group of many related diseases. All cancers begin in cells, the body's basic unit of life. Cells make up tissues, and tissues make up the organs of the body.

Normally, cells grow and divide to form new cells as the body needs them. When cells grow old and die, new cells take their place.

Sometimes this orderly process goes wrong. New cells form when the body does not need them, and old cells do not die when they should. These extra cells can form a mass of tissue called a growth or tumor.

Tumors can be benign or malignant:

• Benign tumors are not cancer. Usually, doctors can remove them. Cells from benign tumors do not spread to other parts of the body. In most cases, benign tumors do not come back after they are removed. Most important, benign tumors are rarely a threat to life.

• Malignant tumors are cancer. They are generally more serious. Cancer cells can invade and damage nearby tissues and organs. Also, cancer cells can break away from a malignant tumor and enter the bloodstream or the lymphatic system. That is how cancer cells spread from the original (primary) tumor to form new tumors in other organs. The spread of cancer is called metastasis.

The wall of the bladder is lined with cells called transitional cells and squamous cells. More than 90 percent of bladder cancers begin in the transitional cells. This type of bladder cancer is called transitional cell carcinoma. About 8 percent of bladder cancer patients have squamous cell carcinomas.

Cancer that is only in cells in the lining of the bladder is called superficial bladder cancer. The doctor might call it carcinoma in situ. This type of bladder cancer often comes back after treatment. If this happens, the disease most often recurs as another superficial cancer in the bladder.

Cancer that begins as a superficial tumor may grow through the lining and into the muscular wall of the bladder. This is known as invasive cancer. Invasive cancer may extend through the bladder wall. It may grow into a nearby organ such as the uterus or vagina (in women) or the prostate gland (in men). It also may invade the wall of the abdomen.

When bladder cancer spreads outside the bladder, cancer cells are often found in nearby lymph nodes. If the cancer has reached these nodes, cancer cells may have spread to other lymph nodes or other organs, such as the lungs, liver, or bones.

When cancer spreads (metastasizes) from its original place to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the primary tumor. For example, if bladder cancer spreads to the lungs, the cancer cells in the lungs are actually bladder cancer cells. The disease is metastatic bladder cancer, not lung cancer. It is treated as bladder cancer, not as lung cancer. Doctors sometimes call the new tumor “distant” disease.
Bladder cancer: Who's at risk?

No one knows the exact causes of bladder cancer. However, it is clear that this disease is not contagious. No one can “catch” cancer from another person.

People who get bladder cancer are more likely than other people to have certain risk factors. A risk factor is something that increases a person's chance of developing the disease.

Still, most people with known risk factors do not get bladder cancer, and many who do get this disease have none of these factors. Doctors can seldom explain why one person gets this cancer and another does not.

Studies have found the following risk factors for bladder cancer:

• Age. The chance of getting bladder cancer goes up as people get older. People under 40 rarely get this disease.

• Tobacco. The use of tobacco is a major risk factor. Cigarette smokers are two to three times more likely than nonsmokers to get bladder cancer. Pipe and cigar smokers are also at increased risk.
• Occupation. Some workers have a higher risk of getting bladder cancer because of carcinogens in the workplace. Workers in the rubber, chemical, and leather industries are at risk. So are hairdressers, machinists, metal workers, printers, painters, textile workers, and truck drivers.
• Infections. Being infected with certain parasites increases the risk of bladder cancer. These parasites are common in tropical areas but not in the United States.
• Treatment with cyclophosphamide or arsenic. These drugs are used to treat cancer and some other conditions. They raise the risk of bladder cancer.
• Race. Whites get bladder cancer twice as often as African Americans and Hispanics. The lowest rates are among Asians.
• Being a man. Men are two to three times more likely than women to get bladder cancer.
• Family history. People with family members who have bladder cancer are more likely to get the disease. Researchers are studying changes in certain genes that may increase the risk of bladder cancer.
• Personal history of bladder cancer. People who have had bladder cancer have an increased chance of getting the disease again.

Chlorine is added to water to make it safe to drink. It kills deadly bacteria. However, chlorine by-products sometimes can form in chlorinated water. Researchers have been studying chlorine by-products for more than 25 years. So far, there is no proof that chlorinated water causes bladder cancer in people. Studies continue to look at this question.

Some studies have found that saccharin, an artificial sweetener, causes bladder cancer in animals. However, research does not show that saccharin causes cancer in people.

People who think they may be at risk for bladder cancer should discuss this concern with their doctor. The doctor may suggest ways to reduce the risk and can plan an appropriate schedule for checkups.
Symptoms of bladder cancer

Common symptoms of bladder cancer include:

• Blood in the urine (making the urine slightly rusty to deep red),

• Pain during urination, and
• Frequent urination, or feeling the need to urinate without results.

These symptoms are not sure signs of bladder cancer. Infections, benign tumors, bladder stones, or other problems also can cause these symptoms. Anyone with these symptoms should see a doctor so that the doctor can diagnose and treat any problem as early as possible. People with symptoms like these may see their family doctor or a urologist, a doctor who specializes in diseases of the urinary system.

Diagnosis of bladder cancer

If a patient has symptoms that suggest bladder cancer, the doctor may check general signs of health and may order lab tests. The person may have one or more of the following procedures:

• Physical exam — The doctor feels the abdomen and pelvis for tumors. The physical exam may include a rectal or vaginal exam.

• Urine tests — The laboratory checks the urine for blood, cancer cells, and other signs of disease.
• Intravenous pyelogram — The doctor injects dye into a blood vessel. The dye collects in the urine, making the bladder show up on x-rays.
• Cystoscopy — The doctor uses a thin, lighted tube (cystoscope) to look directly into the bladder. The doctor inserts the cystoscope into the bladder through the urethra to examine the lining of the bladder. The patient may need anesthesia for this procedure.

The doctor can remove samples of tissue with the cystoscope. A pathologist then examines the tissue under a microscope. The removal of tissue to look for cancer cells is called a biopsy. In many cases, a biopsy is the only sure way to tell whether cancer is present. For a small number of patients, the doctor removes the entire cancerous area during the biopsy. For these patients, bladder cancer is diagnosed and treated in a single procedure.
Treatment for bladder cancer

Staging

If bladder cancer is diagnosed, the doctor needs to know the stage, or extent, of the disease to plan the best treatment. Staging is a careful attempt to find out whether the cancer has invaded the bladder wall, whether the disease has spread, and if so, to what parts of the body.

The doctor may determine the stage of bladder cancer at the time of diagnosis, or may need to give the patient more tests. Such tests may include imaging tests — CT scan, magnetic resonance imaging (MRI), sonogram, intravenous pyelogram, bone scan, or chest x-ray. Sometimes staging is not complete until the patient has surgery.

These are the main features of each stage of the disease:

• Stage 0 — The cancer cells are found only on the surface of the inner lining of the bladder. The doctor may call this superficial cancer or carcinoma in situ.

• Stage I — The cancer cells are found deep in the inner lining of the bladder. They have not spread to the muscle of the bladder.
• Stage II — The cancer cells have spread to the muscle of the bladder.
• Stage III — The cancer cells have spread through the muscular wall of the bladder to the layer of tissue surrounding the bladder. The cancer cells may have spread to the prostate (in men) or to the uterus or vagina (in women).
• Stage IV — The cancer extends to the wall of the abdomen or to the wall of the pelvis. The cancer cells may have spread to lymph nodes and other parts of the body far away from the bladder, such as the lungs.

Treatment

Many people with bladder cancer want to take an active part in decisions about their medical care. They want to learn all they can about their disease and their treatment choices. However, the shock and stress that people often feel after a diagnosis of cancer can make it hard for them to think of everything they want to ask the doctor. Often it helps to make a list of questions before an appointment. To help remember what the doctor says, patients may take notes or ask whether they may use a tape recorder. Some patients also want to have a family member or friend with them when they talk to the doctor — to take part in the discussion, to take notes, or just to listen.

The doctor may refer patients to doctors who specialize in treating cancer, or patients may ask for a referral. Treatment generally begins within a few weeks after the diagnosis. There will be time for patients to talk with the doctor about treatment choices, get a second opinion, and learn more about bladder cancer.

Getting a second opinion

Before starting treatment, a patient may want to get a second opinion about the diagnosis, the stage of cancer, and the treatment plan. Some insurance companies require a second opinion; others may cover a second opinion if the patient requests it. Gathering medical records and arranging to see another doctor may take a little time. In most cases, a brief delay does not make treatment less effective.

There are a number of ways to find a doctor for a second opinion:

• The doctor may refer patients to one or more specialists. Specialists who treat bladder cancer include surgeons, urologists, medical oncologists, radiation oncologists, and urologic oncologists. At cancer centers, these doctors often work together as a team.

• The Cancer Information Service, at 1-800-4-CANCER, can tell callers about treatment facilities, including cancer centers and other programs supported by the National Cancer Institute.
• People can get the names of specialists from their local medical society, a nearby hospital, or a medical school.
• The American Board of Medical Specialties (ABMS) has a list of doctors who have met certain education and training requirements and have passed specialty examinations. The Official ABMS Directory of Board Certified Medical Specialists lists doctors' names along with their specialty and their educational background. The directory is available in most public libraries. Also, ABMS offers this information on the Internet at http://www.abms.org. (Click on “Who's Certified.”)

Preparing for treatment

The doctor develops a treatment plan to fit each patient's needs. Treatment depends on the type of bladder cancer, the stage of the disease, and the grade of the tumor. (The grade tells how closely the cancer cells resemble normal cells. It suggests how fast the cancer is likely to grow. Low-grade cancers usually grow and spread more slowly than high-grade cancers.) The doctor also considers other factors, including the patient's age and general health.
Methods of treatment

People with bladder cancer have many treatment options. They may have surgery, radiation therapy, chemotherapy, or biological therapy. Some patients get a combination of therapies.

The doctor is the best person to describe treatment choices and discuss the expected results of treatment.

A patient may want to talk to the doctor about taking part in a clinical trial, a research study of new treatment methods. Clinical trials are an important option for people with all stages of bladder cancer. The section on “The Promise of Cancer Research” has more information about clinical trials.

Surgery is a common treatment for bladder cancer. The type of surgery depends largely on the stage and grade of the tumor. The doctor can explain each type of surgery and discuss which is most suitable for the patient:

• Transurethral resection: The doctor may treat early (superficial) bladder cancer with transurethral resection (TUR). During TUR, the doctor inserts a cystoscope into the bladder through the urethra. The doctor then uses a tool with a small wire loop on the end to remove the cancer and to burn away any remaining cancer cells with an electric current. (This is called fulguration.) The patient may need to be in the hospital and may need anesthesia. After TUR, patients may also have chemotherapy or biological therapy.

• Radical cystectomy: For invasive bladder cancer, the most common type of surgery is radical cystectomy. The doctor also chooses this type of surgery when superficial cancer involves a large part of the bladder. Radical cystectomy is the removal of the entire bladder, the nearby lymph nodes, part of the urethra, and the nearby organs that may contain cancer cells. In men, the nearby organs that are removed are the prostate, seminal vesicles, and part of the vas deferens. In women, the uterus, ovaries, fallopian tubes, and part of the vagina are removed.
• Segmental cystectomy: In some cases, the doctor may remove only part of the bladder in a procedure called segmental cystectomy. The doctor chooses this type of surgery when a patient has a low-grade cancer that has invaded the bladder wall in just one area.

Sometimes, when the cancer has spread outside the bladder and cannot be completely removed, the surgeon removes the bladder but does not try to get rid of all the cancer. Or, the surgeon does not remove the bladder but makes another way for urine to leave the body. The goal of the surgery may be to relieve urinary blockage or other symptoms caused by the cancer.

When the entire bladder is removed, the surgeon makes another way to collect urine. The patient may wear a bag outside the body, or the surgeon may create a pouch inside the body with part of the intestine.

Radiation therapy (also called radiotherapy) uses high-energy rays to kill cancer cells. Like surgery, radiation therapy is local therapy. It affects cancer cells only in the treated area.

A small number of patients may have radiation therapy before surgery to shrink the tumor. Others may have it after surgery to kill cancer cells that may remain in the area. Sometimes, patients who cannot have surgery have radiation therapy instead.

Doctors use two types of radiation therapy to treat bladder cancer:

• External radiation: A large machine outside the body aims radiation at the tumor area. Most people receiving external radiation are treated 5 days a week for 5 to 7 weeks as an outpatient. This schedule helps protect healthy cells and tissues by spreading out the total dose of radiation. Treatment may be shorter when external radiation is given along with radiation implants.

• Internal radiation: The doctor places a small container of a radioactive substance into the bladder through the urethra or through an incision in the abdomen. The patient stays in the hospital for several days during this treatment. To protect others from radiation exposure, patients may not be able to have visitors or may have visitors for only a short period of time while the implant is in place. Once the implant is removed, no radioactivity is left in the body.

Some patients with bladder cancer receive both kinds of radiation therapy.

Chemotherapy uses drugs to kill cancer cells. The doctor may use one drug or a combination of drugs.

For patients with superficial bladder cancer, the doctor may use intravesical chemotherapy after removing the cancer with TUR. This is local therapy. The doctor inserts a tube (catheter) through the urethra and puts liquid drugs in the bladder through the catheter. The drugs remain in the bladder for several hours. They mainly affect the cells in the bladder. Usually, the patient has this treatment once a week for several weeks. Sometimes, the treatments continue once or several times a month for up to a year.

If the cancer has deeply invaded the bladder or spread to lymph nodes or other organs, the doctor may give drugs through a vein. This treatment is called intravenous chemotherapy. It is systemic therapy, meaning that the drugs flow through the bloodstream to nearly every part of the body. The drugs are usually given in cycles so that a recovery period follows every treatment period.

The patient may have chemotherapy alone or combined with surgery, radiation therapy, or both. Usually chemotherapy is an outpatient treatment given at the hospital, clinic, or at the doctor's office. However, depending on which drugs are given and the patient's general health, the patient may need a short hospital stay.

Biological therapy (also called immunotherapy) uses the body's natural ability (immune system) to fight cancer. Biological therapy is most often used after TUR for superficial bladder cancer. This helps prevent the cancer from coming back.

The doctor may use intravesical biological therapy with BCG solution. BCG solution contains live, weakened bacteria. The bacteria stimulate the immune system to kill cancer cells in the bladder. The doctor uses a catheter to put the solution in the bladder. The patient must hold the solution in the bladder for about 2 hours. BCG treatment is usually done once a week for 6 weeks.
Side effects of bladder cancer treatment

Because cancer treatment may damage healthy cells and tissues, unwanted side effects sometimes occur. These side effects depend on many factors, including the type and extent of the treatment. Side effects may not be the same for each person, and they may even change from one treatment session to the next. Doctors and nurses will explain the possible side effects of treatment and how they will help the patient manage them.

The NCI provides helpful booklets about cancer treatments and coping with side effects, such as Radiation Therapy and You, Chemotherapy and You, and Eating Hints for Cancer Patients. See the “National Cancer Institute Information Resources” and “National Cancer Institute Booklets” sections for other sources of information about side effects.

Surgery

For a few days after TUR, patients may have some blood in their urine and difficulty or pain when urinating. Otherwise, TUR generally causes few problems.

After cystectomy, most patients are uncomfortable during the first few days. However, medicine can control the pain. Patients should feel free to discuss pain relief with the doctor or nurse. Also, it is common to feel tired or weak for a while. The length of time it takes to recover from an operation varies for each person.

After segmental cystectomy, patients may not be able to hold as much urine in their bladder as they used to, and they may need to urinate more often. In most cases, this problem is temporary, but some patients may have long-lasting changes in how much urine they can hold.

If the surgeon removes the bladder, the patient needs a new way to store and pass urine. In one common method, the surgeon uses a piece of the person's small intestine to form a new tube through which urine can pass. The surgeon attaches one end of the tube to the ureters and connects the other end to a new opening in the wall of the abdomen. This opening is called a stoma. A flat bag fits over the stoma to collect urine, and a special adhesive holds it in place. The operation to create the stoma is called a urostomy or an ostomy.

For some patients, the doctor is able to use a part of the small intestine to make a storage pouch (called a continent reservoir) inside the body. Urine collects in the pouch instead of going into a bag. The surgeon connects the pouch to the urethra or to a stoma. If the surgeon connects the pouch to a stoma, the patient uses a catheter to drain the urine.

Bladder cancer surgery may affect a person's sexual function. Because the surgeon removes the uterus and ovaries in a radical cystectomy, women are not able to get pregnant. Also, menopause occurs at once. Hot flashes and other symptoms of menopause caused by surgery may be more severe than those caused by natural menopause. Many women take hormone replacement therapy (HRT) to relieve these problems. If the surgeon removes part of the vagina during a radical cystectomy, sexual intercourse may be difficult.

In the past, nearly all men were impotent after radical cystectomy, but improvements in surgery have made it possible for some men to avoid this problem. Men who have had their prostate gland and seminal vesicles removed no longer produce semen, so they have dry orgasms. Men who wish to father children may consider sperm banking before surgery or sperm retrieval later on.

It is natural for a patient to worry about the effects of bladder cancer surgery on sexuality. Patients may want to talk with the doctor about possible side effects and how long these side effects are likely to last. Whatever the outlook, it may be helpful for patients and their partners to talk about their feelings and help one another find ways to share intimacy during and after treatment.

Radiation therapy

The side effects of radiation therapy depend mainly on the treatment dose and the part of the body that is treated. Patients are likely to become very tired during radiation therapy, especially in the later weeks of treatment. Resting is important, but doctors usually advise patients to try to stay as active as they can.

External radiation may permanently darken or “bronze” the skin in the treated area. Patients commonly lose hair in the treated area and their skin may become red, dry, tender, and itchy. These problems are temporary, and the doctor can suggest ways to relieve them.

Radiation therapy to the abdomen may cause nausea, vomiting,diarrhea, or urinary discomfort. The doctor can suggest medicines to ease these problems.

Radiation therapy also may cause a decrease in the number of white blood cells, cells that help protect the body against infection. If the blood counts are low, the doctor or nurse may suggest ways to avoid getting an infection. Also, the patient may not get more radiation therapy until blood counts improve. The doctor will check the patient's blood counts regularly and change the treatment schedule if it is necessary.

For both men and women, radiation treatment for bladder cancer can affect sexuality. Women may experience vaginal dryness, and men may have difficulty with erections.

Although the side effects of radiation therapy can be distressing, the doctor can usually treat or control them. It also helps to know that, in most cases, side effects are not permanent.

Chemotherapy

The side effects of chemotherapy depend mainly on the drugs and the doses the patient receives as well as how the drugs are given. In addition, as with other types of treatment, side effects vary from patient to patient.

Anticancer drugs that are placed in the bladder cause irritation, with some discomfort or bleeding that lasts for a few days after treatment. Some drugs may cause a rash when they come into contact with the skin or genitals.

Systemic chemotherapy affects rapidly dividing cells throughout the body, including blood cells. Blood cells fight infection, help the blood to clot, and carry oxygen to all parts of the body. When anticancer drugs damage blood cells, patients are more likely to get infections, may bruise or bleed easily, and may have less energy. Cells in hair roots and cells that line the digestive tract also divide rapidly. As a result, patients may lose their hair and may have other side effects such as poor appetite, nausea and vomiting, or mouth sores. Usually, these side effects go away gradually during the recovery periods between treatments or after treatment is over.

Certain drugs used in the treatment of bladder cancer also may cause kidney damage. To protect the kidneys, patients need a lot of fluid. The nurse may give the patient fluids by vein before and after treatment. Also, the patient may need to drink a lot of fluids during treatment with these drugs.

Certain anticancer drugs can also cause tingling in the fingers, ringing in the ears, or hearing loss. These problems may go away after treatment stops.

Biological therapy

BCG therapy can irritate the bladder. Patients may feel an urgent need to urinate, and may need to urinate frequently. Patients also may have pain, especially when urinating. They may feel tired. Some patients may have blood in their urine, nausea, a low-grade fever, or chills.

Nutrition

Patients need to eat well during cancer therapy. They need enough calories to maintain a good weight and protein to keep up strength. Good nutrition often helps people with cancer feel better and have more energy.

But eating well can be difficult. Patients may not feel like eating if they are uncomfortable or tired. Also, the side effects of treatment, such as poor appetite, nausea, or vomiting, can be a problem. Foods may taste different.

The doctor, dietitian, or other health care provider can suggest ways to maintain a healthy diet. Patients and their families may want to read the National Cancer Institute booklet Eating Hints for Cancer Patients, which contains many useful ideas and recipes. The “National Cancer Institute Booklets” section tells how to get this publication.
Rehabilitation

Rehabilitation is an important part of cancer care. The health care team makes every effort to help the patient return to normal activities as soon as possible.

Patients who have a stoma need to learn to care for it. Enterostomal therapists or nurses can help. These health care specialists often visit patients before surgery to discuss what to expect. They teach patients how to care for themselves and their stomas after surgery. They talk with patients about lifestyle issues, including emotional, physical, and sexual concerns. Often they can provide information about resources and support groups.

Followup care

Followup care after treatment for bladder cancer is important. Bladder cancer can return in the bladder or elsewhere in the body. Therefore, people who have had bladder cancer may wish to discuss the chance of recurrence with the doctor.

If the bladder was not removed, the doctor will perform cystoscopy and remove any new superficial tumors that are found. Patients also may have urine tests to check for signs of cancer. Followup care may also include blood tests, x-rays, or other tests.

People should not hesitate to discuss followup care with the doctor. Regular followup ensures that the doctor will notice changes so that any problems can be treated as soon as possible. Between checkups, people who have had bladder cancer should report any health problems as soon as they appear.

Support for people with bladder cancer

Living with a serious disease such as cancer is not easy. Some people find they need help coping with the emotional and practical aspects of their disease. Support groups can help. In these groups, patients or their family members get together to share what they have learned about coping with the disease and the effects of treatment. Patients may want to talk with a member of their health care team about finding a support group.

People living with cancer may worry about caring for their families, holding on to their jobs, or keeping up with daily activities. Concerns about treatments and managing side effects, hospital stays, and medical bills are also common. Doctors, nurses, and other members of the health care team will answer questions about treatment, working, or other activities. Meeting with a social worker, counselor, or member of the clergy can be helpful to those who want to talk about their feelings or discuss their concerns. Often, a social worker can suggest resources for help with rehabilitation, emotional support, financial aid, transportation, or home care.

Materials on coping are available from the Cancer Information Service (1-800-4-CANCER) and through other sources listed in the “National Cancer Institute Information Resources” section. The Cancer Information Service can also provide information to help patients and their families locate programs and services.
The promise of cancer research

Doctors all over the country are conducting many types of clinical trials. These are research studies in which people take part voluntarily. Doctors are studying ways to treat bladder cancer and prevent it from coming back. Research already has led to advances in these areas, and researchers continue to search for more effective approaches.

Patients who join clinical trials have the first chance to benefit from new treatments that have shown promise in earlier research. They also make an important contribution to medical science by helping doctors learn more about the disease. Although clinical trials may pose some risks, researchers take many steps to protect their patients.

Patients who are interested in joining a clinical study should talk with their doctor. They may want to read Taking Part in Clinical Trials: What Cancer Patients Need To Know. This NCI booklet describes how treatment studies are carried out and explains their possible benefits and risks. NCI's Web site at http://cancer.gov provides general information about clinical trials. It also offers detailed information about specific ongoing studies of bladder cancer by linking to PDQ®, NCI's cancer information database. The Cancer Information Service at 1-800-4-CANCER can answer questions and provide information from the PDQ database.

Doctors are studying surgery, radiation therapy, chemotherapy, biological therapy, and combinations of these types of treatment. Another approach under study is photodynamic therapy, which uses drugs that start to work when exposed to light. After the cancer cells absorb the drug, the doctor shines a special light inside the bladder through a cystoscope. The drug becomes active and kills the cancer cells.

Doctors also are studying whether large doses of vitamins or certain drugs may prevent bladder cancer from coming back after treatment.Bladder Cancer At A Glance

• While the exact cause(s) of bladder cancer is not known, risk factors have been identified.
• The most common warning sign of bladder cancer is blood in the urine.
• The diagnosis of bladder cancer is supported by findings of the medical history and examination, blood, urine, and x-ray tests, and confirmed with a biopsy (usually during a cystoscope exam).
• Treatment of bladder cancer depends on the growth, size, and location of the tumor as well as the age and health of the patient.