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Tuesday, March 27, 2018

Easy French Apple Pie

Prep :25 Minutes     Total : 1 Hour  15 Minutes      Serves 6
Filling :
3                 cups thinly sliced peeled apples (3 medium) 
1                  teaspoon ground cinnamon
1/4              teaspoon ground nutmeg
1/2              cup Bisquick™  mix
1/2              cup granulated sugar
1/2              cup milk
2                 tablespoons butter or margarine, melted
3                eggs
1/3              cup Bisquick™  mix
1/3              cup chopped nuts
1/4              cup packed brown sugar
3                  tablespoons firm butter or margarine

1           Heat oven to 325ºF. Spray 9-inch glass pie plate with cooking spray. In medium bowl, mix apples, cinnamon and nutmeg; place in pie plate.
2          In medium bowl, stir remaining filling ingredients until well blended. Pour over apple mixture in pie plate. In small bowl, mix all streusel ingredients, using fork, until crumbly; sprinkle over filling.
3          Bake 45 to 50 minutes or until knife inserted in center comes out clean. Store in refrigerator.

Monday, March 19, 2018

Maxy sez : Diabetes by the Numbers

Staying healthy with type 2 diabetes is a numbers game. Get the scoop on the health indicators you should be measuring and why.
By Jennifer Acosta Scott                Medically Reviewed by Farrokh Sohrabi, MD
When you have type 2 diabetes, you’ve got to know your numbers. It’s not just about blood sugar. To successfully manage diabetes, there are several measurements that you should take, or have taken, on a regular basis. Keeping track of the following numbers can help you live well with type 2 diabetes and lower your risk of complications.

Blood sugar levels. This is probably the type 2 diabetes measure you’re most familiar with. Testing your blood sugar regularly allows you to see how certain foods, exercise, and other activities affect your blood sugar levels on a day-to-day basis. Many people with type 2 diabetes need to test once or twice a day to make sure blood sugar levels are in target range. If your blood sugar is very well controlled, you may only need to check a few times a week, according to the National Institutes of Health.

The American Diabetes Association recommends aiming for a blood sugar level between 70 to 130 mg/dl before meals and less than 180 mg/dl one to two hours after a meal. To keep your blood sugar within this range, follow a healthy, well-rounded diet and eat meals and snacks on a consistent schedule. If your blood sugar is not well controlled, talk to your doctor about adjusting your diabetes management plan.

A1C level. This is a blood test, typically given at doctor's appointments, that measures your average blood sugar levels over a longer period. “It gives you a picture of what’s been going on over the past two to three months,” says Dawn Sherr, RD, a certified diabetes educator and spokesperson for the American Association of Diabetes Educators. Essentially, your A1C result shows how well your diabetes treatment plan is working.

Depending on your results, you may need to have the test from two to four times a year. For most people, an A1C level of 7 percent or less is ideal. If your A1C level is higher, you and your doctor may discuss making changes to your diabetes treatment plan. Healthy lifestyle practices, like consistent blood sugar control and regular physical activity, can help keep your A1C levels low.

Blood pressure. Monitoring your blood pressure is another important way to maintain your health. “People with diabetes are more likely to develop heart disease, and blood pressure is a big factor in that,” Sherr says.

Your blood pressure should be checked several times a year — ideally, every time you see the doctor who is treating your diabetes, Sherr says. Most people with diabetes should aim for a blood pressure of less than 140/80. To prevent high blood pressure, cut back on salt in your diet, exercise regularly, and quit smoking. Some people with type 2 diabetes may need to take medications to lower their blood pressure.

Cholesterol. This is a substance in your body with two components. Low-density lipoprotein (LDL) is known as bad cholesterol; it can build up in your arteries and contribute to heart disease. High-density lipoprotein (HDL) is called the good cholesterol and has a protective effect on your arteries. Your doctor will perform a blood test once a year to check your cholesterol levels, though you may have it checked more often if your numbers are high, Sherr says.

A test result of less than 100 mg/dl of LDL cholesterol is ideal, while HDL cholesterol should be above 40 mg/dl for men and 50 mg/dl for women. Triglycerides, a type of blood fat that can increase your risk of heart disease, should be less than 150 mg/dl for both men and women. If your cholesterol levels are outside these ranges, you can improve them by losing excess weight, exercising, and eating a healthy diet that’s rich in fresh produce and low in fat.

BMI. Short for body mass index, this is a measure that uses your height and weight to estimate how much body fat you have. Since managing weight plays a role in controlling type 2 diabetes, a healthy BMI is important.

Your doctor will probably review your BMI annually, but you can also calculate it yourself by dividing your weight in pounds by your height in inches squared, and then multiplying that number by 703. Online calculators are also available to do the math for you. A healthy BMI ranges from 18.5 to 24.9 — anything over that is considered overweight, and a BMI over 30 is considered obese.

However, the measurement may not be accurate for some people, such as those with a large amount of muscle. “The BMI score can sometimes be deceiving and not the best way to look at the health effects of someone’s weight,” says Fernando Ovalle, MD, an endocrinologist and professor of medicine at University of Alabama at Birmingham College of Medicine. In these cases, other measurements may be used, such as waist-to-hip ratio and abdominal circumference.

Microalbumin. This test measures the amount of protein, or albumin, in your urine, which helps your doctor know how well your kidneys are working. Your doctor should administer this test at least once a year.

The test compares the level of albumin with the level of creatinine, a waste product. Your albumin-to-creatinine ratio should be less than 30, according to the National Institute of Diabetes and Digestive and Kidney Diseases. To keep your microalbumin results within a healthy range, it’s important to keep your kidneys healthy. High blood pressure and high blood sugar can both damage your kidneys, so controlling those factors will go a long way toward preventing kidney problems — and many other health problems — in the future.

Tuesday, March 6, 2018

I could not resist posting this video .....You may not like Randy .... but he sure nails the important issues of the day


Canine flu warning

Image result for image of dog with soulful eyes
This is for all you sweet, kind hearted folks who melt with a soulful or sad look from a stray or abandoned dog. I know many of you have rescued dogs from climate disaster areas such as Hurricane Katrina and Harvey and hurricane Maria in Puerto Rica.  And more recently dogs rescued from the floods in China.  Many dozens of dogs were imported from China's ravaged, flooded lands and mud slides and it appears they brought something with them. It is referred to as the 'Canine flu'. We have never had any cases in Canada before.
Although there is no human risk from canine influenza, the arrival of the virus does present a few concerns for pooches and the humans who love them. Here’s what they need to know:
*The symptoms of dog and human flus are essentially the same.
*Dogs will get a fever, they’ll feel kind of run down, they’ll get a runny nose, runny eyes, and a cough.
*Some dogs also develop mild diarrhea or vomiting.
*If the flu has been reported in your area, keep your dogs away from other animals, especially if you see dogs with runny noses or eyes. Stay away from dog parks and dog walks.
*There is a flu shot for dogs, just as there’s one for humans, and it does cover the H3N2 strain diagnosed in the rescue dogs.
As mentioned, it doesn’t appear that humans can contract dog flu. But one concern flu experts have is with something called “re-assortment,” meaning the mixing together of human and dog flus.
That could happen if a dog infected with canine flu also contracted a human flu, and the two strains combined to create a new virus that was capable of infecting humans. That would be a concern  because it would create a novel virus that humans had no immunity to.
It’s really unlikely to happen, but because it’s possible, we pay close attention to it.
The public announcement below is for all who have recently adopted animals from the Orient:

Sunday, March 4, 2018

Mom Who Hadn’t Seen Son In Years Finds Out In Text Message He’s At Parkland During Shooting


A New York mother who had not seen her son in years found out he was in danger at Stoneman Douglas High School when he sent her a text message during the shooting standoff.
Julie Goffstein received this text message from her 15-year-old son while Nikolas Cruz was in the middle of his rampage:
“Hey mommy, I wanted to say hi, I wanted to talk now because there is a school shooter on my campus and we are locked down.”
“I’m safe in a closet,” her son said later, in texts reviewed by The Daily Caller. “I’m perfectly calm, to be honest this isn’t the scariest event in my life.”
Until this text message, Goffstein did not even know what high school he was attending because a Hamilton County, Ohio court had forbidden her from having any contact with her four youngest of six children for approximately 1,000 days.
Goffstein, who observes Chabad-Lubavitch Judaism, said she’s being kept away from her children by blatant religious bigotry on the part of her ex-husband and the court system.
“My children never should have been removed from their private Jewish schooling,” Goffstein said. “(James) being taken away from his mother as well as being forced to violate the religious practice in which he was raised. He has now witnessed the violence of a school massacre and has attended 6 funerals of 4 schoolmates and 2 teachers.”
Goffstein and her ex-husband Peter Goffstein married on Jan. 17, 1998.
Shortly after the birth of their first child, the couple became Chabad-Lubavitch Jews,  who strictly adhere to Jewish laws and traditions, such as keeping strict dietary laws, observing Jewish holidays, including the Sabbath, going to Jewish schools, and wearing the appropriate clothes like the Yarmulke.

Goffstein said in 2010 Peter wanted to leave the faith and demanded the rest of the family follow him; she was given an ultimatum: do as he wishes or divorce.
She chose divorce.
Julie Goffstein had been a stay-at-home mother while Peter Goffstein was the breadwinner and a judge initially gave her temporary physical custody.
“Wife is designated the residential parent and legal guardian of the minor children,” an order written by Magistrate Judge Greg Thiele on July 27, 2010, stated. “The above award is temporary only and creates no presumption in law.”
Goffstein said in Hamilton County, Ohio, where her divorce was heard, a decision is initially made by a magistrate, or junior judge, before a senior judge affirms or augments the decision.
Peter Goffstein referred to Julie’s religious belief as “extremist.”
“Mr. Goffstein also believes that ‘the Chabad movement and orthodox Judaism is a rigid, radical sect,” a custody evaluation from 2011 stated. “He simply sees his oldest two sons’ current refusal to visit him since 10-10 as being an effort by his wife to alienate them from him, attributing this to her being immersed in what he considers as extremist Judaic orthodoxy.”

Parental alienation “refers to a mental condition in which a child, whose parents are engaged in a high-conflict divorce, allies strongly with one parent (the preferred parent or alienating parent) and refuses to have a relationship with the other parent (with rejected parent or alienated parent) without a good reason,” according to Bill Bernet, a professor emeritus of psychiatry and behavioral sciences at Vanderbilt University.
Dr. Joy Silberg, who is president of the Leadership Council on Interpersonal Violence, said the term is often misused; her organization found in 2008 that approximately 58,000 children per year are forced to live in an abusive home by American family courts yearly, largely due to the false diagnosis of parent alienator to a protective parent.
Peter Goffstein argued that his ex-wife’s religious choice was alienating him: “In so doing, Mr. Goffstein cited as reasons for the change in custody Mrs. Goffstein’s religious practices and the extent to which she imposed those religious practices on the children, which he claimed alienated the children from him,” a lawsuit filed by Julie Goffstein noted.
Dr. Silberg said she’d never seen religion used as the reason for the alienation despite being exposed to thousands of cases where it was alleged.
“It never ceases to amaze how the concept of parental alienation is used in bizarre ways especially in ways to harm children,” Dr. Silberg noted.
Though it’s routinely cited in custody cases, parental alienation has thus far failed to gain widespread acceptance.
Bernet has led several unsuccessful efforts to include parental alienation into the Diagnostic Statistics Manual (DSM) with the American Psychology Association last rejecting his campaign in 2013.

Despite Peter Goffstein’s protestation, the presiding judge, John Henry Sieve, initially also sided with Julie Goffstein.
“On June 21, 2012, after evidentiary hearings on Mr. Goffstein’s motion, Judge Sieve ruled in favor of plaintiff Julie Goffstein and permitted all of the children to remain in Mrs. Goffstein’s custody,” a federal lawsuit Goffstein filed noted.
But on March 11, 2013, Peter Goffstein and his attorney, Joel Moskowitz, filed for a reallocation, or change, in custody.
Emails and voicemails to Goffstein’s and Moskowitz work email and phones were left unreturned.
Though he cited the same rejected parental alienation argument, Judge Sieve granted him a hearing.
By this point, Julie Goffstein said the divorce had left her without savings and she scrambled to find an attorney; a member of the Chabad community in her hometown paid for an attorney, Ken Flacks, but Flacks only came on two days before the hearing, which was held on March 22, 2013.
Flacks’ request for an extension was denied and Judge Sieve proceeded with the hearing.
Judge Sieve then changed his earlier order, granting custody of the four youngest children to Peter Goffstein.
Inexplicably, Sieve allowed Julie Goffstein to maintain custody of her two oldest children, thereby splitting the siblings.
A message left with Judge Sieve’s chambers was left unreturned; a subsequent email to Edward Miller, head of the office of public information at the Ohio Judicial System was also left unreturned.
A message left with Flacks’ office was left unreturned.
In their father’s custody, the four youngest stopped going to Jewish schools and attended public schools and no longer observed many of the other Orthodox traditions.
Indeed, a public education, Judge Sieve noted, was critical in his decision: “Fulfillment of their secular education requirements is quintessential to the best interest of these young children,”

Then in 2014, a magistrate judge, Paul Meyers, ended Goffstein’s alimony and reduced her child support.
As a result, Goffstein has struggled providing housing and basic needs to her two children since, with the larger Chabad community having to support her for months at a time.
She needed to move to New York, where the Chabad community has more resources, just to survive, she said.
Peter Goffstein is a Senior Vice President at Industrial Realty Group, and Julie Goffstein said he routinely makes several hundred thousand yearly.
“Are you a judge?” Magistrate Meyers asked rhetorically when reached by phone. “Then your opinion doesn’t matter.”
Moskowitz then filed a series of contempt of court motions — most of which were affirmed by Judge Sieve. As a result, what little time she had with her youngest children was reduced until all contact was removed in 2015; she has not been allowed any contact since.
Peter Goffstein moved to Florida in 2015 and has not even been required to tell his ex-wife which school her children are attending.
Goffstein said that by responding to her son during the rampage she may be in contempt of a previous order.
In fact, she’s served two stints in jail including two days last year for failing to pay part of her ex-husband’s legal bill, ordered as part of a previous contempt of court order.
In that contempt of court order, Judge Sieve found her communication with her children continued to alienate her children from their father.
“He won’t let you boys see me by myself, but hang in there” Julie Goffstein said in one email to her son deemed alienating, “I am working in federal court to get you home with mommy permanently.”
“You have been robbed of so much, I’m sorry he (their father) did this to you.” Goffstein said in a text message, also deemed alienating.

Ken Meyers is an attorney in Cincinnati and he represented Goffstein pro bono, filing the federal lawsuit referenced on her and her children’s behalf.
Myers said by the time he entered the case his options were limited with previous appeals going against Julie Goffstein.
He took the extraordinary step of suing the judge; attorneys often attract the ire of all judges when they sue a judge.
“I was threading the needle,” Myers noted, saying that because judges enjoy broad immunity, suing them is an uphill battle.
“A trial judge disagreed,” Myers noted: Sieve’s immunity was cited as a reason for the dismissal.
In the lawsuit, Myers argued that Judge Sieve’s rulings violated Goffstein’s religious liberty.
“Judge Sieve’s decisions are based on direct violations of the First and Fourteenth Amendments to the U.S. Constitution in that they impinge on the children’s right to freely practice their religion and Mrs. Goffstein’s right to practice her religion,” he said in the lawsuit. The fight continues.

Friday, March 2, 2018

Maxy sez : How Snoring Hurts Your Heart

By Dr T. Jared Bunch, MDMost of us know somebody who has suffered from atrial fibrillation, a fast, irregular heart rhythm of the upper heart chambers with symptoms like palpitations and shortness of breath. But what you might not know is how critical a good night's sleep is to keeping this heart condition under control, particularly for a person who snores.

Why Snoring Matters :
It may seem somewhat surprising, but for most people who develop atrial fibrillation, their doctor will ask about their sleep. A typical conversation for me will go like this:

“Do you snore?”
The patient will respond, “I don’t believe I snore. Maybe a bit, when I'm very sleepy.”

For a male patient, I will ask his wife, if she's with him, “Does your husband snore at night?”

She will often say, “If I don’t get to sleep before him, I can’t, because he snores so loudly.”

Or, “We sleep in separate rooms and I can still hear him.”

In some cases, “His snoring is so bad we have fortified the walls to stop them from falling down.”

My favorite response, from an elderly woman, was, “He doesn’t snore at all since I started wearing ear plugs at night.”

The disorder we physicians are looking for with this line of questioning is called sleep apnea. This is a sleep-related disorder where the body oxygen levels fall during sleep. There are two main types of sleep apnea. You can suffer from both types at the same time.

Obstructive sleep apnea: This is the most common form. It occurs when the throat muscles relax and the tissues of the throat then obstruct airflow. During partial obstruction, a person can be heard snoring. Central sleep apnea: This form is less common and often develops when other diseases may be present or with certain medications. In this disorder, the brain stops sending signals to the body muscles to breathe. This can be a completely silent problem. Sometimes spouses will notice their partner’s breaths become soft, and then absent, for short times.
How Do You Know if You Have Sleep Apnea?:
One of the most important aspects of sleep apnea is that it occurs when you are in deep enough sleep for the throat muscles and brain to relax. In this regard, the person with sleep apnea typically does not recognize that it is occurring. At times, people will awaken when the apnea becomes so severe the sleeping mind and body panic.

If anything, waking from sleep apnea suggests that it may be quite severe. Most people only recognize the side effects of sleep apnea.

Side effects of sleep apnea can include:
Feeling fatigued
Difficulty sleeping throughout the night
Needing to urinate frequently throughout the   night (even if the bladder does not seem full)
High blood pressure
Loss of concentration
Cognitive (mental) decline
Atrial fibrillation
Heart failure
Metabolic syndrome
This list of problems, many of which can be life altering, highlight the need to identify and treat sleep apnea.

When physicians check sleep patterns amongst all people with atrial fibrillation, sleep apnea can be diagnosed 30 percent to 50 percent of the time. In people who have atrial fibrillation and one or more of the side effects listed above, the chances are much higher that they have sleep apnea. In medicine, sometimes screening tests can be invasive, time-consuming, and costly. But for sleep apnea, the upfront screening tool we use in our clinic is quite simple. It is called the STOP-Bang questionnaire.
Take the 'Sleep Quiz':
The STOP-Bang questions to identify sleep apnea include:
Do you snore loudly (louder than talking or loud enough to be heard through closed doors)?
Do you often feel tired, fatigued, or sleepy during daytime?
Has anyone observed you stop breathing during your sleep?
Do you have, or are you being treated for, high blood pressure?
Is your body mass index (BMI) higher than 35?
Are you over 50 years old?
Is your neck circumference greater than 40cm (16 inches)?
Are you male?
Answering "yes" to three or more of these questions, may indicate the need for additional testing. Even if you score less than three, additional testing may be needed. This is particularly true if you are seen with a disease very commonly associated with  sleep apnea, such as atrial fibrillation.

Why Are Screening and Treating Sleep Apnea so Essential?
The simple answer is that sleep apnea is one of the greatest causes of atrial fibrillation. Not only does it cause atrial fibrillation, it worsens its severity. It does this by increasing the areas of the upper heart chambers that drive and maintain the abnormal heart rhythm.

To a patient, this increase in disease severity can be noticed when the abnormal heart rhythm no longer responds to medications, requires electrical shocks called cardioversions to restore normal rhythms, or when a seemingly successful catheter ablation procedure fails to prevent recurrent atrial fibrillation.

The importance of sleep apnea diagnosis and treatment as a means to improve atrial fibrillation treatment was reinforced in a recently published meta-analysis of atrial fibrillation patients.

The study included seven clinical trials with patients who received drug management for their atrial fibrillation as well as patients who had catheter ablation. The effect of sleep apnea treatment on abnormal heart rhythm was investigated for 1,087 of these patients.

In summary, the authors found: :Patients who were treated for sleep apnea were 42 percent less likely to have their atrial fibrillation recur.
In people who received a catheter ablation for their atrial fibrillation, those who had sleep apnea and were treated for it were, again, 42 percent less likely to develop recurrent atrial fibrillation.
In people who used medications alone for treatment of their atrial fibrillation, the same outcome was found. Those who had sleep apnea, and were treated, were 42 percent less likely to have recurrence of atrial fibrillation.
Even with our most aggressive treatment strategy for atrial fibrillation, when sleep apnea goes untreated, the approach does not work well. Untreated sleep apnea lowers overall success rates by approximately 25 percent. For example, most treatment centers will quote you success rates with ablation from 50 percent to 75 percent, based upon the type of atrial fibrillation you have. But if you have sleep apnea that is untreated, the sobering fact is that you need to consider long-term success rates of only 25 percent to 50 percent.

Many people ask me how long their medication will work, in hopes that they won't have to use a riskier medication, or undergo an invasive procedure. In this study, if the patients did not treat their sleep apnea, 63 percent had recurrence of their atrial fibrillation within a year.
What to Do About Sleep Apnea

General, if you score high on the STOP-Bang questionnaire, seek evaluation and treatment for sleep apnea. Sleep apnea is a disorder you cannot ignore. It will expose you to multiple diseases that can significantly reduce your quality of life, and in some cases, shorten your life.

If you have atrial fibrillation, regardless of how you treat it, evaluation and treatment for sleep apnea will improve how you respond and how you feel.

Finally, if you already have sleep apnea but are not being treated, these same lessons and concepts apply to you. I would encourage you to revisit treatment options with a sleep specialist. There are many different treatment options that can be tailored to your needs. If you find yourself without an acceptable treatment that you can tolerate, consider the risk factors included in the STOP-Bang questionnaire. Some of these can be modified. Those include your neck circumference, your weight, and your blood pressure.