Shankha Twyana is the Nepal Eye Bank’s manager and first technician by Joel Addams

While it has been an uphill battle, many Nepalis now believe that donating one’s corneas (the thin, clear front portion of the eye) can be much more beneficial to them in the next life, an idea that was not always in vogue in Nepal.  With a country that is 80% Hindu and about 20% Buddhist, many in previous generations were not interested in donating their corneas, believing that they would be blind in the next life.  This has changed somewhat as corneal extractions by these eye bank technicians have moved from the hospitals to the sites where families bring their loved ones for cremation:  the Buddhist Temples and the Hindu Temples.  There is the intersection of medicine and religion, when families are met by these three men to discuss — in the middle of the funeral — if they would consider making the donation of their loved one’s corneas.  It can be a tense and intense time, where some families are willing and understanding, others can be rude and quite angry.

Bhola Khitri was the second technician at the Nepal Eye Bank (and still loves his green tea) by Joel Addams

It doesn’t help, either, if you look too young when approaching families about such a major donation.  The young Bala, the newest of the technicians, is in his mid-twenties and as most Nepalis do, he looks a bit younger.  There’s no scorekeeping when it comes to successful approaches to families, but Bala and I were turned down many, many times when approaching families.  The authority of the more elderly and therefore wiser (?) individual may be what is preventing a higher success rate for the technician, but he pushes ahead, knowing that he is doing a good thing.  So many people are waiting for corneal transplants in Nepal and the tissue is never enough to meet the demand currently.

The Nepal Eye Bank technician Bala by Joel Addams

I’ve provided a few images of these three gentlemen.  May they continue well on their way!

If you’d like to support any of these great institutions, I can think of none better who run more efficiently and effectively as they do:

TBI (Tissue Banks International, Baltimore, Maryland)
Himalayan Cataract Project (Burlington, Vermont)

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Come see two of my pieces from my series Marked Trees at SPIN8: Put at Tree On It Friday, June 29, 2012, 5:00 – 9:00p.m. at HCP Houston Center for Photography, 1441 West Alabama, Houston, Tx 77006

HCP is partnering with Trees for Houston for their annual summer party Tickets are under 21 – Free, $15 – HCP and Trees for Houston Members, $20 – Advance online tickets, $25 – At the door.

There will be food from Good Dog Hot Dog, beer from Real Ale Brewing and music from Gracie Chavez!

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We start, not by disagreeing with the enactivists, but by agreeing with them up to, but excluding agency.  Let’s discard the assumption that the lived body is the locus of experience.  That should get the party started.

Then we wait for someone to cry foul.  We take their argument, whatever it is, and we examine its agential commitments, and associated mentalese. There is no test one can do to distinguish between the tumblebot and the goldfish without presuming some locus of agency.  There will be many domains of relative autonomy though.

Take whatever ‘mind’ is offered, and call it the P-world.  The domain of present experience.  Identify the P-world in a variety of ways: Umwelt, milieu, consciousness.  The P-bomb is, of course, that the P-world does not exist.  It is a construct that allows the discussion of a world.

What’s the endgame?  Do we no longer draw the boundary at the species?  Is this the way to realize that we are the natural world?  We are the world we see.

Furthermore, once one has chosen to identify a given domain as agentive, one creates a blindspot.  Behind that, we must explain with non-observable constructs, like the shallow tinker toys of mechanistic psychology.

We’re excited to meet providers and share information about how a zVision unified worklist can benefit private practices and hospital networks.

If you’d like to meet with us, send us an email at sales [at] clariomedical.com. For more information about the HCP: Radiology & Imaging show, click here.

In an effort to save media dollars, there is a trend for marketers to rely solely on their sales force to promote new programs. The idea being that a sales rep will detail an HCP on a new program, provide them with patient materials and ask the HCP to promote it to their patients.

As a marketer, I have seen this approach fail over-and-over again. Since November, I have personally seen three programs (from two different pharma companies) promoted solely using this tactic. Each program experienced extremely low response and was deemed a failure.

The results are not too surprising. For two years I personally carried a bag for a large pharma company. If my efforts as a rep didn’t directly result in an NRx, I wasn’t going to spend one second of my small window of time with the doctor talking about anything other than my portfolio of products.

Simple Solutions for Budget-Conscious Brand Marketers:
When paid media is tight, look to non-paid channels to promote your program and help drive response:

Dedicated Email Blasts:
Email promotion can be very effective, even more so when you utilize a dedicated email blast. Keep the messaging simple, showcase the value and make sure your email is optimized for mobile and desktop email clients.

Website Promotion (Mobile and Desktop):
Take advantage of traffic being generated through your paid channels (SEM, Display, etc). Like email, keep the messaging simple and focused on the value of the offer.

SEO:
Once you include the promotion on the website(s), don’t forget to update your SEO keywords, description, etc.

Adherence Program:
Assuming the content is relevant, promote your new program through existing medication reminders, education, etc. of your adherence program.

In-Office Collateral:
Add a call to action to patient education materials, in-office brochures and other types of collateral.

When looking to promote a new program, be sure to include non-paid channels to the mix. It has proven to be an easy and cost-effective way to drive response and help increase ROI.

Chris Crichton
VP, Mobile Health
@chrisjcrichton

10. Abdominal bloating

Hormonal changes in early pregnancy may leave you feeling bloated, similar to the feeling some women have just before their period arrives. That’s why your clothes may feel more snug than usual at the waistline, even early on when your uterus is still quite small.

9. Heightened sensitivity to odors

If you’re newly pregnant, it’s not uncommon to feel repelled by the smell of a bologna sandwich or a cup of coffee, and for certain aromas to trigger your gag reflex. Though no one knows for sure, this may be a side effect of rapidly increasing amounts of estrogen in your system. You may also find that certain foods you used to enjoy are suddenly completely repulsive to you.

8. Nausea or vomiting

For some women, morning sickness doesn’t hit until about a month after conception, though for others it may start a week or two earlier.  And while morning sickness is most prevalent in the a.m., it’s not just in the morning.  Nausea gravidium, the big official name for nausea and vomiting associated with pregnancy, can be a problem morning, noon, or night.  And while some lucky mamas get to skip this part of the pregnancy experience, an estimated 50-75% percent of all women experience some degree of nausea and vomiting.

About half of women with nausea feel complete relief by the beginning of the second trimester. For most others it takes another month or so for the queasiness to ease up.

 7. Frequent urination

Shortly after you become pregnant, hormonal changes prompt a chain of events that raise the rate of blood flow through your kidneys. This causes your bladder to fill more quickly, so you make more trips to the ladies room.  This symptom may start as early as six weeks into your first trimester.

Frequent urination will continue – or intensify – as your pregnancy progresses. Your blood volume rises dramatically during pregnancy, which leads to extra fluid being processed and ending up in your bladder.  As your pregnancy progresses, you little bitty will become less little bitty and will start to put more pressure on your bladder.

6. Fatigue

You should start to feel more energetic once you hit your second trimester, although fatigue usually returns late in pregnancy when you’re carrying around a lot more weight and some of the common aches and pains make it more difficult to get a decent night’s sleep.

5. Tender, swollen breasts

One of the early signs of pregnancy is hypersensitive breasts caused by rising levels of hormones. The soreness and swelling may feel like an exaggerated version of how your breasts feel before your period. Your discomfort should diminish significantly after the first trimester, as your body adjusts to the hormonal changes.

4. A missed period

If you’re usually pretty regular and your period doesn’t arrive on time, you may decide to do a pregnancy test before you notice any of the above symptoms. But if you’re not regular or you’re not keeping track of your cycle, nausea and breast tenderness and extra trips to the bathroom could be pregnancy before you realize you didn’t get your period.  That being said, some women actually experience these symptoms and it’s simply a part of what they go through during their period.

3. Implantation bleeding

Very early in pregnancy, even before you realize you’re pregnant, you may have some spotting that lasts for only a day or two. There’s no way of knowing for sure why this happens, but it may be caused by the fertilized egg burrowing into the wall of your uterus – a process that starts just six to seven days after fertilization.  Because of this spotting, coupled with a lack of the typical early pregnancy signs, some women don’t recognize they’re pregnant until later in their pregnancy when they have more definitive pregnancy signs.

2. Your basal body temperature stays high

If you’ve been charting your basal temperature and you see that your temperature has stayed elevated for 18 days in a row, you’re probably pregnant.

And finally …

1. The proof: A positive home pregnancy test

In spite of what you might read on the box, many home pregnancy tests are not sensitive enough to reliably detect pregnancy until about a week after a missed period.  Yes, you might get a positive pregnancy test a few days before your missed period (I did with both of my children), but chances are you will not.  So if you decide to take a test earlier than your missed period date and get a negative result, don’t get discouraged and try again in a few days.  And if you still get a negative result and suspect you may be pregnant, talk to your health care provider.

Once you’ve gotten a positive result, make an appointment with your practitioner.  Congratulations!!!!

Bithionol

Chlorofluorocarbon propellants

Halogenated salicylanilides

Vinyl chloride

Zirconium-containing complexes

Chloroform

Methylene chloride
Not being a chemist, I didn’t recognize most of them. Considering both countries gave them the boot, lets just agree that they’re the bad guys.  However, the FDA listed two “restricted ingredients” that were both all on the banned list of the UK. Those ingredients being Mercury and Hexachlorophene. 

Besides the 354 ingredient difference, it’s odd unto why the FDA would look into these two ingredients and not ban them entirely. Ive researched each of their functions, as well as their hazards. Click the links for more info as well.

Mercury: The only heavy metal that is in liquid form. It is predominately used in mascara as a preservative and prevent bacteria growth. Cosmetic companies are allotted up to 65 parts per million of mercury in their products in order to be deemed as “safe”. What the risk? There are several. For starters, there’s infertility. Mercury lowers zinc levels, which in turn lower progesterone levels. Progesterone is needed to bring a pregnancy to term. Low zinc levels will also lower testosterone levels–sorry guys. Mercury can cross the placental barrier, endangering the unborn child for birth defects and neuronal defects (AKA-learning disabilities). I wont even go into autism and the contraversies that surround it. Moreover, mercury rapidly depletes the immune system. In 2008, Minnesota became the first state to ban mercury in cosmetics, giving it a tougher standard than the FDA. For more information related to ban/phase out states: Click here.
Hexachlorophene (HCP): A disinfectant widely used in toothpastes and acne soaps and creams due to the efficiency of it’s odorless, powder form.  However, due to its powder form it is easily inhaled and massively irritating to the lining of the lungs, creating an asthma-like allergy. Already have asthma? Watch out! MCP can also cause nerve damage that may lead to blindness with consistant exposure.

The super multivitamin.

For a mother’s health, and the health of her baby, she is advised to take so-called ‘prenatal vitamins’ during pregnancy. Prenatal vitamins are specially formulated multivitamins that make up for any nutritional deficiencies in the mother’s diet.  The super multivitamin.  If you suspect you might be pregnant or are trying to get pregnant, it’s in the best interest of your health and your unborn baby’s health to start taking your prenatal vitamins and to continue taking them throughout your pregnancy.

What makes them different from regular multivitamins?

Prenatal vitamins have extra folic acid, iron, and calcium, which are all important minerals and supplements during your pregnancy.

Folic acid can reduce your risk of having a baby with a serious birth defect of the brain and spinal cord, called the ‘neural tube.’ A baby with spina bifida, the most common neural tube defect, is born with a spine that is not closed. The exposed nerves are damaged, leaving the child with varying degrees of paralysis, incontinence, and sometimes mental retardation.

Neural tube defects develop in the first 28 days after conception, before many women realise they are pregnant. Because about half of all pregnancies are unplanned, the Department of Health recommends that you take 400 micrograms of folic acid each day while you are trying to conceive, and should continue taking this dose for the first 12 weeks of pregnancy. . A woman who has had a prior child with a neural tube defect should discuss the appropriate dose of folic acid with her doctor before her next pregnancy. Studies have shown that taking a larger dose (up to 4,000 micrograms) at least one month before and during the first trimester may be beneficial.

There are natural sources of folic acid: green leafy vegetables, nuts, beans, and citrus fruits. It is also found in many fortified breakfast cereals and some vitamin supplements.

Calcium during pregnancy can prevent a new mother from losing her own bone density, as the fetus uses the mineral for bone growth.

Iron helps both the mother and baby’s blood carry oxygen.

While a daily vitamin supplement is no substitute for a healthy diet, most women need supplements to make sure they get adequate levels of these minerals.

Not all vitamins are created equal.

No, you don’t necessarily need to take the prenatal your OB prescribes you.  You can take over the counter ones, but be careful in selecting them.  Look for vitamins containing the ingredients listed below.

• 400 mcg of folic acid
• 400 IU of vitamin D
• 200 to 300 mg of calcium
• 70 mg of vitamin C
• 3 mg of thiamine
• 2 mg of riboflavin
• 20 mg of niacine
• 6 mcg of vitamin B12
• 10 mg of vitamin E
• 15 mg of zinc
• 17 mg of iron

My prenatal makes me nauseated.  What do I do?

Unfortunately, your prenatal vitamin can make you feel a little queasy.  It’s believed to be related to the level of iron.  Some prenatal vitamins contain up to 30 mg of iron, which can be difficult to stomach.  If you have trouble stomaching your prenatal, try the following:

• Take your prenatal vitamin with food or before bed.
• Consider taking a food-based prenatal vitamin, which are typically easier on the stomach and easier to digest than mineral based vitamins.
• Chewable or liquid vitamins are also an option.
• If it’s the size of the vitamin that’s causing the problem, again, chewable or liquid vitamins are available.  You can also get prenatal vitamins without calcium that are much smaller and easier to swallow.  However, you would have to take a separate pill to get your extra necessary calcium.
• If all else fails, consider talking to your HCP about taking a prenatal that doesn’t have iron in it, at least during your first trimester when you’re typically your sickest.  You can try to eat foods high in iron (such as dark leafy greens) to make up for the lack of iron in your prenatal.  If this doesn’t work, continue to talk with your HCP until you find something that works for you.

Beware of constipation.

That extra iron in your prenatal, on top of making you nauseated, unfortunately can cause constipation.  Constipation is already common enough during pregnancy, and the extra iron is only going to add on to it.  Constipation in pregnant women is thought to occur in part due to hormones that relax the intestinal muscle and by the pressure of the expanding uterus on the intestines. Relaxation of the intestinal muscle causes food and waste to move slower through your system.

Let me tell you something.  Everything’s worse when you’re pregnant.  Even constipation.  Many moms complain of a heavy achey pressure in their pelvis and become concerned about their pregnancy.  Constipation is quite the culprit.

Preventing and treating constipation.

Prevention and treatment of constipation involve much of the same thing. Here are a few things that you can do to help prevent constipation from occurring or treat it if you are already experiencing it:

• Eat a high fiber diet: Ideally, you will consume 25 to 30 grams per day of dietary fiber from fruits, vegetables, breakfast cereals, whole grain breads, prunes and bran.
• Drink a lot of fluids: Drinking plenty of fluids is important, particularly with your increase of fiber. Drink 10 to 12 cups of fluids each day.  I can’t tell you how important staying hydrated is. It is the combination of a high fiber diet and lots of liquid that best help you eliminate your waste. Sweat, hot/humid climates, and exercise may increase your need for additional fluids.
• Exercise routinely: If you are inactive, you have a greater chance of constipation. Walking, swimming and other moderate exercises help the intestines work by stimulating your bowels. Schedule exercise three times a week for 20-30 minutes each.
• Over-the-counter remedies: There are over-the-counter products such as Metamucil which may help soften your bowel movements and reduce constipation. Always speak to your health care provider before using over-the-counter medications.  Your HCP may even prescribe a stool softener, such as Colace or Docusate, if the constipation becomes enough of a discomfort.
• Reduce or eliminate iron supplements: Iron supplements may contribute to constipation. Good nutrition can often meet your iron needs during pregnancy. Taking smaller doses of iron throught the day rather than taking it all at once can reduce constipation. Talk to your health care provider about checking your iron levels and recommendations to manage iron intake during pregnancy.

Do not!

Do not take laxatives.  Laxative pills are NOT recommended for the treatment of constipation during pregnancy because they might stimulate uterine contractions and cause dehydration.

Mineral oils, such as castor oil, should NOT be used during pregnancy because there is an increased reduction in nutrient absorption.  And if you drink enough castor oil, you might trigger the same problem laxatives can cause.

1. Make a visit with your HCP (health care provider) before becoming pregnant.
2. Start making good food choices now and start exercising (providing your HCP approves).   A healthy fit start to pregnancy usually makes for an easier pregnancy.
3. Again, exercise!  By starting an exercise program now, you lower your risk of miscarriage, start a habit that will help you stay in shape during your pregnancy, and has even been proved to help reduce labor complication and length of labor.
4. Trying to conceive?  Track your menstrual cycles.  Not every woman has the standard 28 day cycle.  Some average closer to 31.  Using an ovulation calendar, which can be found all over the world wide web, you can get a fairly accurate idea about when you’re ovulating and are most likely to conceive.  But don’t stress if you don’t get pregnant right away.  Only an estimated 25% conceive within their first month of trying.  Most couples will experience conception within the first 12 months of trying, although for some it may take up to 18 months. Most practitioners will not intervene in the conception process unless it has been more than 12 months since the couple actively began trying to conceive.  Give it time.
5. Start doing your research.  Educate yourself. Ask friends and family, read books, google stuff.
6. Check out a book about pregnancy.  My personal favorite, The Pregnancy Countdown Book.  The information is brief, too the point, and presented in the most conversational way.  It breaks your pregnancy down into weeks as opposed to months.
7. Stop the bad habits, especially smoking.
8. Take your prenatal vitamins.  There are a wide range of prenatal vitamin options to choose from, and you can easily get them over the counter.  If prenatal vitamins are hard on your stomach (or just hard to choke down) consider taking a children’s chewable multivitamin.
9. Practice good dental hygiene, such as brushing your teeth daily.  Try to make a dental appointment before getting pregnant. That way, your teeth can be professionally cleaned, your gum tissue can be carefully examined, and any oral health problems can be treated in advance of your pregnancy.  Why, you ask, is this important?  Pregnancy causes hormonal changes that increase your risk of developing gum disease, which in turn, can affect the health of your developing baby.
10. Do you have cats?  Stop changing the litter box.  Leave that to your significant other.  There is a slightly nasty parasite, toxoplasmosis, that could potentially be found in the cat’s fecal matter.  If exposed while pregnant, the parasite could result in miscarriage, early delivery, poor growth or stillbirth. A child born with this parasite may get eye problems, convulsions or mental disabilities. However, some infected babies do not develop anydisease at all.  So, avoid the kitty litter.
11. Avoid any other potentially harmful chemicals or substances.  Act pregnant.  Think pregnant.  Harmful substances include illegal substances, alcohol, or chemical exposures.    Now, if you have a drink and later find out you were pregnant, don’t fret.  It happens, and usually there aren’t any long term effects.
12. Once you find out your pregnant, relax.  Take it easy.  Rest when you can.  The first trimester can be exhausting as your body is working in overdrive to develop your little one.  Rest, rest, rest!
13. Announce your pregnancy when you are ready.  Some people like to wait until week 12(ish) or after their HCP has been able to doppler the baby’s heartbeat, at which point in time the risk of a miscarriage has dropped significantly.  Others announce minutes after their positive pregnancy test.  Neither is right or wrong.  It’s your baby.  Share the news when you feel comfortable.
14. Don’t be disappointed if everyone doesn’t exude uncontainable excitement about your pregnancy.  Maybe you tell your girlfriend, who, while excited for you, is also a little bummed or even jealous that she’s not having a baby.  You never know.  Just remember, while your family and friends might not react the way you envisioned them reacting to you announcing your pregnancy, most of the time they are really happy for you and will later share your excitement.
15. Consider starting a pregnancy journal or even a blog.  You will remember the big things (the day you first hear your baby’s heartbeat, your first ultrasound, etc.), but the little milestones could fade from your memory quickly.  There’s this thing called “pregnancy brain.”  Pregnancy brain is a condition that affects expectant mothers, usually during the first and third trimesters. Sometimes known as placenta brain or baby brain drain, the condition is usually characterized by short-term memory loss or forgetfulness. Some medical experts say thatpregnancy brain is a myth, but evidence shows that many women have experienced this condition.  Bottom line, you’re not going to remember every moment of your pregnancy, and it might be a fun project to jot down the little things.  Like the first time a stranger congratulated you on your pregnancy and wished you well, or the day you went from looking like maybe you’ve just gained weight and now look like you’re expecting.
16. Hydrate!  This important throughout the pregnancy for an abundance of reasons.  Drink 6-8 eight ounce glasses of water per day.  Not sodas, tea, or coffee.  Water.
17. Keep your prenatal appointments with your midwife or doctor and be certain to communicate any concerns you might have to them.   Keeping your scheduled appointments when help to ensure any problems that you might have are hopefully caught early and treated appropriately to ensure an uncomplicated as possible pregnancy.
18. Write your questions, comments or concerns for you HCP down because inevitably, when you have your appointment, you will forget them.
19. Be prepared for nausea, heartburn, constipation and some major fatigue.
20. Consider taking prenatal classes throughout your pregnancy.
21. Bump up your calorie intake to approximately 300 during your second trimester and 500 extra calories per day during your third.
22. Take a tour of your birth facility options (hospital or birth center).  Obviously, if you plan for a home birth, you can skip this step.
23. Be aware of preterm labor signs and symptoms.  They can be pretty vague (i.e., back pain or pelvic pressure), but error on the safe side.
24. Planning for a natural childbirth?  Get prepared!  Take classes, read books, develop a plan and make sure you have a strong support system.
25. When decorating your little one’s nursery, leave the painting to someone else if possible.  There are paints that are low VOC (volatile organic compounds), but it’s still better to let someone else do the painting when possible.  Ensure adequate ventilation (i.e., open the windows, etc) and stay out of the nursery until it’s aired out.
26. If your BFF just had a baby, see if she’ll let you babysit for a little so you can get some first hand new born experience.
27. Thinking of breastfeeding?  Take a class to help you prepare for the realities of breastfeeding your newborn.  It can be a learning process for you and your baby, so be prepared for ups and downs.
28. Leg cramps?  Be prepared for potentially breath-taking cramps in your legs.  They are not fun.  They hurt.  Try extending and flexing your foot before getting in and out of bed to stretch the legs.
29. Even if you have to slow down exercising with your growing belly, continue exercise if your HCP approves.  There are plenty of studies indicating moms who stayed fit during their pregnancy had easier and shorter labors and easier and shorter recoveries.
30. Have a birth plan.  There are lots of examples on line of what you can include in your birth plan.  Your plan may be to get an epidural as quickly as possible.  It might be to labor with minimal medical interventions.  Develop your plan early on in your pregnancy and make sure to share it with your HCP and your support persons.  You want everyone to be on board with your plan to help facilitate the best possible delivery for you.
31. Even if you know you want an epidural as soon as your physically able to get one, prepare to feel contractions.  You never know what’s going to happen once you’re admitted.  Some doctors won’t write for epidurals until “active” labor (3-4 centimeters, broken water and/or cervical change).  Some hospitals only have one anesthesiologist that may be tied up in another case.  There are conditions in which epidurals aren’t an option (some blood clotting disorders and medications, deviations in the spinal cord, HELLP syndrome).  There are IV pain medication options, but they don’t necessarily make you pain free.   Again, even if the plan is for an epidural, it’s in your best interest to have some breathing/coping skills down before you go into labor.
32. When you pack your hospital bag, make sure you have your insurance cards, picture ID, any pre-registration forms, your camera, phones, chargers, and birth plan.  There are plenty of websites out there with printable checklists for packing your hospital bag.
33. Get familiar with the signs and symptoms of labor and be prepared for these signs and symptoms to go on for…a while.  A potentially really long while.  Days.  Some times weeks.  Early labor, unfortunately, can last a long time.  If this happens, don’t get discouraged.  Your baby will come when he/she is ready.
34. Enjoy your pregnancy while it lasts.
35. Don’t feel bad if you’re miserable and “just want this over with”.  That doesn’t mean that you love your baby any less than the woman next to you talking about what a wonderful experience pregnancy is.  Pregnancy can be tough and it’s not all rainbows and sunshine every day.  You won’t be pregnant forever, and your baby is well worth the wait.

I love this book. It's great for a laugh.