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By Sunil Shibad If you do build a great experience, customers tell each other about that. Simply put, it is word of mouth. Word of mouth is the most powerful form of advertising. It is the most honest form of marketing, building upon peoples innate desire to share their experiences with family, friends and co-workers. Word of mouth for a brand is like a reputation for a person. You earn reputation by trying to do extraordinary things well. People notice that over time. While there are no shortcuts to generate word of mouth, you can use specific techniques to accelerate the process. Here are a few of them: Look at the customer as a friend or a family member and not as part of some vague demographic group. Develop entertaining and informative ads that can be easily forwarded. Work actively with social networks. Host discussions and message boards about your brand. Identify people who are able to influence your target customers. Inform these influencers about what your brand is all about and motivate them to spread the word. Recruit new evangelists, teach them about the benefits of your brand and encourage them to create a buzz. Set up online clubs for passionate users. Track online conversations about your brand by both supporters and detractors. Listen and respond to both positive and negative conversations. Participate honestly on online blogs and discussions. Sunil Shibad is Creative Director at The Flea, http://www.fleaglobal.com, a non-traditional communication agency. In his 14 years as a copywriter, he has worked on several blue-chip accounts. He constantly seeks ways to develop unconventional creative solutions for brands, across traditional media, new media and interactive forms of communication. He blogs at http://newnimproved.blogspot.com. Article Source: http://EzineArticles.com/?expert=Sunil_Shibad http://EzineArticles.com/?How-to-Accelerate-Word-of-Mouth-Marketing&id=153683 what is difference betwen ambien cr and ambien lorazepam med ambien bigsitecity com cheap domain zolpidem recreational

By Lance Winslow There are many ways to extend your brand-name in a franchise company. The goal is to do it is fast as possible while maintaining a strong franchise family. Often franchise systems will choose a Master franchise strategy, whereby they will sell their rights to others within a region to again sell franchises. This strategy works well for both parties and provides significant financial incentives to the Master franchise partner. However, once all the areas in territories are sold within the region of responsibility for the Master franchise agreement, then the Master franchise has less financial incentives and generally only receives a percentage of the royalties of the current franchisees. At this point often the Master franchise will wish to sell their rights back to the franchisor or to another entity. The first time I had to deal with such a situation I found it necessary to set specific limitations and stipulations all the transfer. Later I decided to include these limitations and stipulations in the Master franchise agreement prior to assigning. Below is a copy of the clause in the contracts that I came up with; 5.7 Transfer of Master Franchise Master Franchisee may not directly or indirectly sell, pledge, assign, transfer or convey any interest in the Master Franchise without the prior written consent of Franchisor. In connection with any sale, transfer or assignment of the Master Franchise, the following requirements for Master Franchisee (assignee) must be met to the full satisfaction of Franchisor as a condition to any transfer: (a) The assignee must, at the time of such assignment or transfer, be financially responsible and economically capable of performing Franchisors objectives in this Franchise Agreement and in Franchisors business development plan. (b) The assignee must expressly assume and agree to perform such obligations and sign a binding agreement with Franchisor. (c) The assignee must be trained and pass Franchisors special Master Franchise training course. (d) The assignee must be competent and subject to a thirty (30) to sixty (60) calendar day review by Franchisor before a transfer to them. (e) The assignee must run their own THE CAR WASH GUYS franchise for at least four (4) months before the transfer. (f) The assignee must own and run a company store unit for the duration of their franchise in a specifically designated area other than the Marketing Areas of their master area franchisees but in the same general region as their master area franchisees. (g) The assignee must be able to provide all on-going support items to franchisees listed in this Franchise Agreement. (h) The assignee must attend any formed franchisee organization, union or association meetings in their master area which have been officially recognized by the Franchisor, providing that the franchisees want the Master Franchisee to be there and of which their master area franchisees are a member. (i) The assignee must maintain on hand at least one regional team member and one loaner truck for every twenty (20) franchisees in their assigned master area. (j) The assignee must sign a non-competition agreement with their master area franchisees not to operate their company store in the Marketing Areas of their master area franchisees unless they have been asked to by a franchisee in case of vacation or injury. ——- ——- ——– When expanding a franchising company thru master franchising you would be well advised to consider such things. You will need to consult with a Franchising Attorney to make sure this is done correctly and in your best interests and you should ask them about these issues. I hope you will consider this in 2006. “Lance Winslow” - Online Think Tank forum board. If you have innovative thoughts and unique perspectives, come think with Lance in the Online Think Tank and solve the problems of the World; www.WorldThinkTank.net/ Article Source: http://EzineArticles.com/?expert=Lance_Winslow http://EzineArticles.com/?Mater-Franchise-Strategies-and-Transfer-Issues;-Case-Study&id=159175 ambien and birth defects ambien and eye fatigue ambien substitute ambien erfahrung

By Brian Carter Modern Living, Complex Health Problems In our post-modern industrial polluted stress-filled bad-diet culture, no one’s health is simple. We are plagued by complex long-term illnesses like lupus, rheumatoid arthritis, chronic fatigue, fibromyalgia, AIDS, even sinus problems… it may seem weird to you that I include sinus infections, but the root causes of sinus trouble can be quite complicated… Especially if they are long-term. Antibiotic Overuse Problems I hate to say it (because antibiotics are so great in some situations, and so popular overall), but antibiotics can complicate things even further - there are conditions that do not respond to them… and there are many situations in which they are not even indicated. Physicians have over-prescribed antibiotics for years… they know it, there have been studies that show it, and as a profession they’ve moved away from that. But people still want to leave the doctor’s office with a prescription, a magic-bullet. Of course, sometimes the issue is which antibiotic is the most appropriate one. They don’t all work for everything. Antibiotic Side Effects - When They’re Wrong If the sinusitis hasn’t responded to antibiotics, then either the wrong ones were prescribed, or you need to try another kind of treatment. Chinese Herbal Medicine can address the full spectrum of complaints and causes; we often treat the conditions which are not responding to conventional treatments like antibiotics. A woman wrote me about how antibiotics weren’t solving her diarrhea problem- this can happen when the disease is cold in nature. Antibiotics are cold and bitter; these qualities help it fight the dampness and heat of bacterial infections. But they are more of the same damage when the disease is cold or deficient in nature. Acupuncture and moxibustion (the warming of acupuncture points) can also be effective; some people respond very quickly… results vary depending upon a number of factors (the acupuncturist’s education, accuracy of diagnosis, frequency of treatment, and patient compliance with diet and lifestyle suggestions). Cold and Deficient If the mucus is clear or white, then it is more likely cold in nature. That fits with a Spleen-system deficiency and dampness. That would fit with the pulse she felt. You would have lowered appetite, feel fatigued, have loose stool, and possibly feel cold easily. Antibiotics wouldn’t help here, and could even make things worse. Sinus Infection Symptoms The classic acute sinusitis symptoms are nasal congestion, green nasal phlegm, facial/dental pain, eye pain, headache, and a cough at night. Some patients also complain of fever, feeling ill, bad breath and a sore throat. Chronic sinusitis is more difficult to diagnose. You can have the same symptoms above in a milder form. Chronic means long-term; it’s not usually thought of as chronic unless it’s been going on for 2 months or more. Sinus Infection Causes Sinus problems can be caused by many things- you have to think about environmental and food allergies (allergic sinusitis), chronic sinus infection, and chronic colds. Without more information, it’s hard to be specific. Sinusitis often develops after colds, and can become a chronic problem. The sinuses are very small… one of our weak points, especially for people with weakened immune systems or in the presence of irritants (once again, pollution, allergens, etc.)… she probably asked about the farms and pesticides while she was thinking about the cause of your chronic sinusitis. Mold, Fungus, and Sick Buildings And we can’t forget about mold! While some people appear to be more sensitive than others, fungus can cause fungal sinusitis. This gets into the whole ’sick-building’ topic… Mold can grow in the walls of houses and offices, and is not always easy to detect. Decongestant Side Effects Decongestants are often prescribed. They work by drying you out. Unfortunately, they don’t just dry the mucus. Long-term use of decongestants can lead to other problems, like the dry or heat types of sinus inflammation. This is why, in Chinese Medicine, we always balance an herb with other herbs- if we are drying the phlegm, we also moisten at the same time. Moisture helps the sinuses drain- you remember that Crocodile-Dundee-put-your-head-under-the-steaming-pot-thing? Likewise, there are chinese herbs whose function it is to moisten and transform phlegm. Serious Causes of Sinusitis, and Serious Solutions For those with chronic sinusitis, tests need to be done to rule out the serious things. Sinusitis can be just a simple end-of-your-cold complication, but it can also show up as part of: nasal tumors, fungal infections, and HIV or other immunodeficiency. What about the sinusitis surgery? It works from 50-93% of the time… so it can be a great help if you’re sick and tired of it, and nothing else has worked. but it’s also a super-painful process! I would see an herbalist first. Brian Carter has been making herbs and acupuncture fun and easy to understand since 1999 when he founded the Pulse of Oriental Medicine. For more about sinuses, Sinus Infection Symptoms and Information. Brian is the author of “Powerful Body, Peaceful Mind:How to Heal Yourself with Foods, Herbs, and Acupressure.” (http://www.pulsemed.org/bookpreview.htm) Brian is a medical professor and public speaker. He writes articles, blogs (http://americas-acupuncturist.blogspot.com/), and speaks on radio across the country, and has been quoted and interviewed by publications like Real Simple, Glamour, and ESPN magazines. Article Source: http://EzineArticles.com/?expert=Brian_Carter http://EzineArticles.com/?Sinus-Infection-Symptoms,-Antibiotics,-and-Alternative-Medicine&id=11780 buy ambien where mixing prescription meds- adderall zoloft xanax ambien generic ambien zolpidem 10mg generic ambien zolpidem 10mg

By Eddie Tobey There are several defenses available to people who are accused of driving under the influence. Since the prosecution has the burden of proving each and every element of the case beyond a reasonable doubt, the defendant need only create reasonable doubt in one area in order to prevail against a drunk driving charge. A person is not necessarily guilty if the machine says he is above the legal limit. There are many defenses to DUI or DWI cases, and these should be explored before even considering pleading guilty to DUI or a related drunk-driving offense. It is usually legal to drink and drive, but if the driver is under the influence then it becomes illegal. In different states, under the influence is defined differently, but generally it refers to those cases in which the driver is drunk or has taken drugs to such an extent that that his mental and physical abilities are impaired and they no longer have the ability to operate the vehicle with the caution characteristic of a sober person under the same or similar circumstances. Defense to the criminal charges may arise from different areas, and consultation with a DUI defense lawyer is critical to determine which may apply in a given case. Other defenses relate to the reliability of the chemical test results. Some people, for example, are simply not suitable candidates for breath testing due to dental problems, which trap alcohol in the mouth and create falsely high breath test results. Others suffer from medical conditions such as persistent heartburn (GERD), which can cause falsely high readings in breath tests. It takes between a millionth and a billionth of a fluid ounce of alcohol to register a .10 on the breath test machines. This is above the legal limit in every state, and can result in a criminal conviction unless fully explored by a qualified DUI or DWI defense lawyer. San Diego DUI Lawyers provides detailed information on San Diego Alcohol Treatment, San Diego Dui Laws, Driving Under The Influence, Dui And Fines and more. San Diego DUI Lawyers is affiliated with White Collar Criminal Defense. Article Source: http://EzineArticles.com/?expert=Eddie_Tobey http://EzineArticles.com/?DUI-Defense&id=233655 ambien alcohol zolpidem pill zolpidem 10mg ambien withdrawal side effect

By Mary Eule This is perhaps the most common marketing myth and must be debunked right away if you have any hope of accomplishing your business goals. A belief in this myth necessitates a view of marketing as a tactical function rather than the series of cross-functional processes, approaches and activities that it really is. Yes, advertising (marketing communications) is an essential component of your overall marketing plan, but it is not THE plan and ideally should account for only 1-2% of your entire marketing efforts. If you devote all of your attention and efforts on advertising activities (e.g. ad copy, sales channels, websites, media, etc.) youre putting the cart before the horse and are missing critical issues that may be having a negative impact on your business. Advertising should never be substituted for the marketing process as a whole. No amount of advertising is going to make up for shoddy workmanship; rude employees or an unpleasant customer experience. Its like building a house of cards it may hold up for a little while, but it most certainly will come tumbling down. Youve heard of the domino effect, yes? If all of the dominos are set up correctly then one push and they will all fall into place achieving the expected result. It all begins with that first domino it sets up the chain reaction for all the rest. Moreover, if any of the others are out of place the ones after that will not drop. This common, but vivid analogy clearly demonstrates how one element can significantly alter results. The marketing function can be broken down into two distinct parts Strategies and Tactics. Strategic marketing defines who you are It spells out how you differ from your competitors so that your prospects and customers can make wise choices. Additionally, it serves as the working foundation for your entire company. It is the content of your marketing message: what you say, how you say it, and who you say it to. Tactical marketing (Advertising, Promotions, Sales Materials, etc.) involves the communication of your strategic plan. In other words, it is the vehicle(s) for delivering your message. Strategies and tactics will be discussed in much greater detail in Chapters Three through Seven. Bottom line: You cannot advertise your way to success. If you choose to tell the public how great you are make yourself great first. The quickest way to kill a bad product, or business, is to advertise it. Classic Symptoms of a Myth #1 Believer They Ignore essential research, analysis, and planning Act like a “show horse” instead of a “plow horse” Think/Say things like, “advertising works” or “you can make a fortune on the Internet” Dont believe in giving anything away for free Mary Eule specializes in helping small and medium-sized businesses get and keep profitable customers. Formerly a Fortune 500 marketing executive; founder of two successful small businesses and award-winning speaker, Ms. Eule is President of Strategic Marketing Advisors, LLC. and co-author of a new book, “Marketing: What it Really Means and How to Make it Work for Your Business”. She holds a master degree in marketing from Johns Hopkins University. Log onto http://www.StrategicMarketingAdvisors.com for free articles, newsletter and helpful tools, tips and templates. Article Source: http://EzineArticles.com/?expert=Mary_Eule http://EzineArticles.com/?Marketing-Myth–Number-1:–Marketing-is-Just-Another-Word-for-Advertising&id=82967 buy cheap ambien online withdrawal from ambien ambien cr offer ativan affects nervous system

By Jason Hulott The size zero debate where we have seen celebrities starve themselves down to what they consider is an attractive weight is a hot topic at the moment. Appalling images of stick-thin celebrities and other figures in the public eye has sparked off a huge debate as to whether you can be a size zero and still follow a healthy diet. Many of these famous actresses and models etc insist that they eat just like anyone else and reel off a list of their daily diet that includes chicken, pasta, potatoes, salad and even the odd naughty treat such as bar of chocolate, pizza or a glass of wine And while undoubtedly there really are a small a very small minority of women who are naturally stick thin no matter what they eat, for the lollipop (ie big head on a tiny body) ladies we see in the media, they really arent following a healthy diet. Starving themselves in order to look good down to the size of a seven year old boy can have dramatic health consequences. Fasting or not eating enough food can cause periods to stop, bad skin and hair and whole list of horrifying symptoms including death. In September 2006, the 22 year old model Luisel Ramos died days after appearing on the catwalk. Newspapers reported how she was told that if she lost a significant amount of weight (she was 5ft 9in tall and weighed 7 stone when she died according to the Daily Mail newspaper) she would succeed as a model. You dont have to be stick thin in order to be fashionable. A grown woman with a body that has been starved in order to resemble that of a young boy is not attractive and is not healthy. In fact, its more important to put the right food inside your body by following a wholesome, healthy diet and nature will do the rest and youll find your ideal size. And if you are overweight or your clothes are starting to feel a bit tighter, then there are sensible diets that you can follow in order to get to your ideal weight. Missing meals or fasting are not an option. Similarly, for the naturally thin ladies among us, by following a nutritious, healthy diet, you can ensure that you keep yourself in the optimum of health. UK Diets Online provides information about all the major diet systems available. Visit now and take advantage of our special deals with Weightwatchers. Article Source: http://EzineArticles.com/?expert=Jason_Hulott http://EzineArticles.com/?Size-Zero-Versus-A-Healthy-Diet&id=548898 ambien day delivery next zolpidem dose how to abuse ativan inexpensive zolpidem

By Daniel Wadleigh The research and field results prove that there are three factors that pull people to respond to a particular business. They are logic, emotion, and both! It has been calculated in a study of 900,000 consumers in 23 markets that: one third chose where to shop based upon emotional factors, one fourth chose based on logical factors, the rest on both. What this means is that price and other rational factors like selection only won 25% of the time. It also means that emotional values like comfort, safety, convenient location, friendly people, fun, excitement, soft music, etc. only won out 33% of the time! This also means that 42% take both factors into consideration. If you only offer discounts, and your location stinks, your music is as loud, as are your people you limit yourself to 25% of the potential customer pie. Try to keep as much of a balance of safety and comfort with selection and price, as much as you can while still conforming to your image. Remember, you can’t be all things to all people, or you lose your identity. Daniel Wadleigh is a nationally published marketing consultant and has programs for start-up and existing businesses including effective web sites, e-mail/database, other non-internet ways to drive them to your website, and low cost ways to get more new customers. Go to: http://www.more-new-customers.com to get free copy of “Marketing to Men vs. Women- the 8 different responses” and a Free copy of “Market Research- 7 Questions to Ask to Start-up and 7 to Ask to Improve Any Business.” Article Source: http://EzineArticles.com/?expert=Daniel_Wadleigh http://EzineArticles.com/?Marketing-Mind-vs-Emotion&id=140569 order ambien with a prescription ambien overdose cittalopram and ativan ambien price online qoclick

By Eliza Maledevic Tired of being that woman who can’t be happy of your body? Do you hate that belly fat of yours? Who said that you could never have that supermodel body every woman is dreaming of? Did it ever cross your mind that you can be that girl who can flaunt and be confident with her figure? Here’s good news for you my friend! Feel great and boost that self-esteem that has been long lost because of your unwanted fats. Have you heard of weight loss using herbal products? Now is your chance to be one of those attractive and alluring ladies in town by trying herbal products in trimming out that belly fat. With the newest craze in weight loss advertisements you have a variety of several herbal products you can choose from that would help you increase your metabolism without endangering your health. You can try teas with green tea extract, which is rich in powerful fat burning nutrients called “catechins”. This nutrient triggers weight loss by stimulating the body to burn calories and decreasing body fats. More over, it also helps in decreasing one’s appetite thus increasing the thermo genesis of one’s body. In addition to that, this substance has also been shown to have anti-inflammatory and anti cancer properties which is very much healthy for any one who would take green tea. A good source of catechins can also be found from berries, red wine, apples and chocolate. There are also some dietary supplements that contain natural and herbal extracts that can help in weight loss. One substance known is chromium iodinate, which is also popular, as an ingredient for effective weight reduction. Chromium is an essential trace mineral for the human body. Its important in processing carbohydrates and fats, and it helps cells respond properly to insulin (the hormone, produced in the pancreas), that makes blood sugar available to the cells as our basic fuel. With the sufficient in take of chromium iodinate it speeds up the burning of calories in our bodies. By being aware of this information it would be a lot easier for any one who wishes to reduce weight naturally without worrying any harmful side effect on one’s health. We have to take into consideration as well that we can’t just rely on all the magical wonders of sculpturing our bodies by using these herbal products alone. For best results proper diet accompanied with minimal exercise could help us see the wonders of weight loss management using herbal products. So, what are you waiting for? Feel great and recover that self-esteem. Everyone has the right to be proud of his or her bodies. Start sculpturing that great body of yours and be the next hottest person in town! Use herbal remedies to have the right weight and attractive body you desire. You could also consult your doctor about your weight problem, since your doctor can definitely help you to lose your weight. Or you can tell your doctor about the herbal remedy you desire to take, for him to know and can approve about it. Article Author Eliza Maledevic from http://www.Jump2top.com, a SEO Company. Know more about Hoodia Gordinii at http://www.primeherbal.com/hoodia Article Source: http://EzineArticles.com/?expert=Eliza_Maledevic http://EzineArticles.com/?Sculpture-That-Body-with-the-Use-of-Herbal-Products&id=511393 melatonin vs ambien ativan and side effects sleeping pills order ambien zolpidem generic ambien

By KG Stiles BLACK PEPPER (Piper nigrum) - PROPERTIES & ACTIONS INCLUDE: Analgesic - pain reliever. Anticatarrhal - helps remove excess phlegm. Reduces inflamed mucous membranes of head and throat. Anti-inflammatory - controls, alleviates inflammation resulting from injury or infection Antiseptic - prevents, halts infection. Antiviral - Preventing or inhibiting viral activity Digestive - substance that promotes or aids digestion of food Expectorant - helps promote the removal of mucus from respiratory system. Stimulant - an agent that quickens the physiological functions of the body, temporarily increases body or organ function, good for convalescence, poor circulation, listlessness, good for physical and mental fatigue. Warm, mildly stimulating oil with a soft spicy aroma that’s slightly woody. Black Pepper is especially good for muscular aches and pains. A reassuring and grounding oil that neutralizes negative situations. Black Pepper increases self confidence to overcome challenges in life and aids in neutralizing negative situations. It gives strength and stamina to the body, mind and emotions and is excellent in any sports massage blend for warming and loosening the muscles before or after a sporting event. Black Pepper is beneficial for relieving tired and achy muscles from over work. Black Pepper’s antiseptic properties make it useful for easing a stuffy head, sore throat or congestion when you have a cold or the flu. Use it for soothing nervous complaints or symptoms associated with weak digestion as it stimulates the digestive juices. Black Pepper increases the ability to focus and may be helpful for memory loss and forgetfulness. Heightens alertness, assertiveness, and improves the user’s self-image. CAUTION: Use in low dilutions of less than 1% as Black Pepper can be a skin irritant. PLEASE NOTE: There are many cheap, synthetic copies of aromatic oils, but these are not recommended for therapeutic use. For best results purchase the highest quality oils you can possibly find. Use certified organic essential oils, or oils that have been tested and are pesticide free. Holistic MindBody Therapy, including pure essential oils, are gentle, noninvasive complementary forms of health care for balancing and synchronizing your body, mind and spirit and a natural, safe and effective way to enhance your health and well-being. Holistic health care may produce satisfying results where other methods have failed. Please consult with your physician regarding serious health concerns and do not attempt to self diagnose. KG has developed massage training and holistic health programs for the spa industry, health clubs and clinics, schools, resorts, as well as for individual clients. She is a MindBody Therapist and Health Educator with advanced certification and training in Bowen Therapy, BodyTalk and Aromatherapy. She is the owner of Springhill Wellness Center and the founder & director of PurePlant Essentials aromatherapy products. Click to order BLACK PEPPER PURE ESSENTIAL OIL Click to find out about KGs other fine aromatherapy products PUREPLANT ESSENTIALS. Click to learn about KGs Presentations and Workshops. More Info? Contact: KG Stiles at Springhill Wellness Center, 2520 Springhill Drive Ashland, OR USA (541) 941-7315 Mahalo! Article Source: http://EzineArticles.com/?expert=KG_Stiles http://EzineArticles.com/?Aromatherapy—Black-Pepper-Circulation-Booster&id=528051 ley organica prevencion condiciones y medio ambien when did ambien become on market buy ambien cod accepted ambien humor

By [http://ezinearticles.com/?expert=Richard_Helfant] Richard Helfant “There is nothing to fear except the persistent refusal to find out the truth.” - Dorothy Thompson One of the chapters in my recent book, “Courageous Confrontations,” describes my experience with a patient named Emma Jorgenson. Shortly after sitting down in my consultation room, she said, “I hope you can help me, Doctor. Those other doctors keep saying that my symptoms are all in my head. What seems to be bothering you, Emma? Bothering me? My problems arent just bothering me, theyre killing me. If you dont do something to help me, I am going to die. I just know it. What kind of symptoms are you having? Heaving a huge sigh, Emma shifted uncomfortably in her chair. I dont know where to begin, she said. Whenever I try to explain my symptoms to a doctor, he just rolls his eyes, and tells me its nothing to worry about. Emma hunched over, and began to well up. I reached for the box of tissues on my desk and handed them to Emma. Lets figure out how we can help you. How about starting at the beginning? I said. What was your first symptom? One night, about three years ago, I woke up with a pounding sensation in my chest. My heart was racing so fast, I thought it was going to jump out of my chest. Then I began to get nauseous and dizzy. I called Dr. Cahill, my family doctor whos also my gynecologist, and when I went in to see her the next day, she found a tumor in my tummy. She said I needed to have an operation to remove it. What did she find? A cyst on my ovary. It was nothing serious, but after the operation, the pounding and the dizziness became more frequent, so she sent me to a neurologist. Why a neurologist? Id read an article that said the three most common symptoms of brain tumors were headaches, nausea and dizziness, so I asked her to send me to a specialist. He did a bunch of scans and electrical tests, and said everything was okay. He prescribed a tranquilizer, but I knew that wasnt going to solve my problem. Did the tranquilizer help? A little at first, but then my symptoms got worse. When the pounding started, in addition to becoming dizzy and nauseous, my hands would begin to tingle and become numb. After a while, the numbness spread to my face. The whole area around my mouth would lose all feeling, except for a wired tingling sensation. I was sure I going to have a stroke. Thats when Dr. Cahill referred me to an ENT doctor. An Ears, Nose and Throat doctor? Thats right. She thought my dizziness might be due to an inner ear problem. He examined me and said he wasnt sure what was going on, but that I needed an operation to get to the bottom of it. But I was too scared. Besides, I still hadnt recovered from the ovary surgery, and my wounds werent healing right, so my gynecologist said that I could wait before having another operation. Emmas story made me wince. She had unwittingly fallen into the maze of modern medicine. Each specialist viewed her symptoms through the prism of his own specialty, ordered the inevitable battery of tests, and treated her with a pill or a procedure without having a diagnosis. Medications are the fifth leading cause of preventable death in the United States. Why did she send you to me? I told her I didnt think I had an inner ear problem, and that it had to be some kind of a heart condition. After all, how could an inner ear problem cause chest pains and shortness of breath? Chest pain and shortness of breath? You didnt say anything about that. I explained that there are several causes for chest discomfort, and each has a telltale set of characteristics. For example, in patients with pleurisy, an inflammation of the lining of the lungs, pain occurs with deep breaths. With an inflammation of the sac around the heart, called pericarditis, the pain increases when a patient lies down, and improves when they sit up and lean forward. In patients with blocked coronary arteries, the discomfort occurs during physical activity, like walking or climbing stairs. A bulging or tear in the aorta, the main artery in the body, also has characteristic features. All these possibilities and more needed to be carefully explored by delving into the nuances of Emmas chest pain, as well as her palpitations and shortness of breath. Emmas description of her chest pains did not conform to any of the common causes of chest discomfort, but it was important not to overlook other serious possibilities. In patients with pleuritis a rubbing sound can be heard with a stethoscope over the lungs during a deep inhalation. Pericarditis sounds like sandpaper being rubbed in synchrony with the heartbeat. Cardiac birth defects, diseases of the heart muscle, and valve abnormalities all provide telltale murmurs and other characteristic clues on the physical exam. Despite Emmas rapid pulse, her blood pressure was normal and her lungs sounded clear. On the cardiac exam, her heart impulse was normal, but when I placed the stethoscope under her left breast, the diagnosis immediately became obvious. When Emmas heart contracted, a series of loud clicking sounds were audible. My patient had mitral valve prolapse. The heart is divided into two sides, each having four chambers. The upper two are called atria, and the lower two are the ventricles. The right atrium and ventricle receives oxygen-depleted blood from the body and sends it to the lungs where its oxygen content is replenished. The left atrium then receives the rejuvenated blood, passing it along to the left ventricle. The powerful left ventricular chamber then pumps its contents back to the body. The atria and ventricles are separated from each other by valves. The tricuspid valve is located on the right side of the heart, while the mitral valve resides on the left. When the mitral valve opens, blood exits the left atrium, travels through the valve, and enters the left ventricle. As the left ventricle begins to contract, the valve closes, preventing blood from moving backwards into the left atrium. The mitral valve consists of two leaflets, or flaps, each in the shape of a parachute. Normally, both leaflets close in unison, but in patients with mitral valve prolapse, either the valve leaflets are too large, the chords that attach them to the heart are too long, or the connective tissue in the structure are more elastic than normal. In any case, one or both of them balloons, or flopsprolapsing into the left atrium. The characteristic click heard when listening to the heart is caused by the sound of the valve leaflet prolapsing into the atrial chamber, much like a parachute in the wind. Mitral valve prolapse is a relatively common condition, occurring in two and a half to five percent of people in the United States. It is particularly prevalent in pre-menopausal women between the ages of fourteen and forty. There has been a considerable amount of speculation about how the valve abnormalities occur, but recent research has shown that there is a genetic predisposition for the syndrome. Between twenty and fifty percent of the relatives of mitral valve prolapse patients also have the syndrome. Echocardiograms are a valuable means of evaluating patients with suspected mitral valve prolapse. The test confirms the diagnosis by demonstrating the prolapsing valve leaflets. In addition, the presence and severity of any blood leaking backwards across the valve from the ventricle to the atrium can also be detected. In Emmas case, I did not hear the telltale murmur suggesting the presence of a leak. Patients with mitral valve prolapse often have symptoms that mimic serious illnesses like heart attacks and cardiac rhythm abnormalities, but in the vast majority of women, the condition is neither dangerous nor life threatening. Most of the close relatives of patients with mitral valve prolapse who demonstrate a floppy valve on echocardiography are completely free of symptoms. The reason for the chest pains, palpitations, or shortness of breath that occur in some patients with mitral valve prolapse has never been understood. For want of a more scientific explanation, it has been hypothesized that, their nervous systems are programmed to respond excessively to stress. For unknown reasons, they are triggered to react to unthreatening circumstances as though they were dangerous. This imbalance is called dysautonomia. After putting my stethoscope in the pocket of my lab coat, I patted Emma gently on the shoulder. I have wonderful news! Your symptoms are being caused by a benign condition called mitral valve prolapse. I assumed that Emma would be relieved. Instead, the diagnosis increased her anxiety to the point where she became a shut-in. While the symptoms of mitral valve prolapse are divers and can be frighteningly severe, it is important to emphasize that for the overwhelming majority of individuals with the condition, it is neither dangerous nor life-threatening. Studies have found that increase levels of circulating adrenalin like substances account for the symptoms of chest pains, palpitations, shortness of breath, anxiety and panic attacks that plague people with the problem. The outlook for the great majority of people with mitral prolapse is excellent. My experience has been that those with debilitating symptoms gradually do feel better over time. They come to realize that their symptoms will not result in a heart attack or sudden death, and the symptoms themselves then become less incapacitating. As one of my patients said, “I just put the pains in my handbag and went about my business.” For most patients, the only treatment necessary is the use of prophylactic antibiotics before various types of surgery and dental work, but this is used only in those who have a leaking valve. Medication, particularly a group of drugs called “beta blockers” can be useful to control debilitating symptoms. Exercise, a healthy diet and relaxation techniques have all been useful in controlling symptoms. And as for Emma, she had a transformative experience that changed her life. No longer immobilized by fear, she developed a remarkable new equanimity and a new appreciation of life. It also gave her a new life purpose. Emma became a patient care counselor and an invaluable member of our health care team, using her experience as a resource to counsel our fear-ridden patients. Richard Helfant, MD, is a Harvard-trained cardiologist. His book [http://www.richardhhelfantmd.org/work1.htm] Courageous Confrontations includes this story about a woman with exaggerated fears about [http://www.richardhhelfantmd.org/work3.htm] mitral valve prolapse. Article Source: [http://ezinearticles.com/?expert=Richard_Helfant ] http://EzineArticles.com/?expert=Richard_Helfant [http://ezinearticles.com/?Mitral-Valve-Prolapse:-Truth-vs-Fiction&id=146625 ] http://EzineArticles.com/?Mitral-Valve-Prolapse:-Truth-vs-Fiction&id=146625 ambien bradycardia buy cheap ambien online buy zolpidem overnight should ambien be banned