A group of researchers from Indiana University, working in collaboration with scientists at Eli Lilly, the drug company which patented and markets raloxifene, published their study in the Dec. 11 issue of the Archives of Internal Medicine. The results support previously published work that shows that raloxifene reverses mineral loss from bone in older women, and also lowers blood cholesterol levels.

They followed two separate groups of post-menopausal women for three years. The total number of study patients was 1,145, and they ranged in age from 45 through 60. The study patients were divided into four separate groups: an inactive placebo control, and those who received raloxifene at doses of 30 milligrams, 60 milligrams or 150 milligrams. They were evaluated every three to six months for bone mineral density (BMD) at the spine, hips and total body; bone metabolism or turnover; and blood lipid (fat and cholesterol) levels.

The results confirmed that raloxifene was effective in slowing, and even reversed, the loss of calcium that leads to the development of osteoporosis. While those receiving the placebo had a diminution in BMD in the lumbar spine of 1.3 percent over the study period, those receiving the active drug at a dose of 30 milligrams had an increase of 0.7 percent, those who received 60 milligrams had an increase of 1.3 percent, and those who received 150 milligrams of raloxifene sustained an increase in their BMD of 1.2 percent. The effects at other skeletal sites were similar. Importantly, there was no increase in serious side effects among those who took raloxifene compared to those who received only placebo. The only difference between the active vs. the placebo groups was in the frequency of hot flashes, which occurred in 25 percent of those on the drug, and in 18 percent of those on placebo.

As for cholesterol levels, those receiving raloxifene had a reduction in total cholesterol of 6 percent to 8 percent, and a reduction in the “bad” cholesterol, LDL, of 7 percent to 12 percent, with the greater reductions associated with the higher dose.

Studies involving estrogen and tamoxifen, a SERM the U.S. Food and Drug Administration approved for the prevention of breast cancer, have shown a higher rate of uterine abnormalities, including cancer, in those taking these prescription drugs without a prescription, probably due to their stimulating effect on the uterine lining cells. While prior studies have not shown that raloxifene has this effect, there were no special evaluations done to assess this problem in this study. No such cases were observed. Also, one preliminary study has shown that raloxifene may exert a protective effect against the development of breast cancer. No analysis for this effect was done in this study. Prior studies have shown that raloxifene might increase the risk of clots in the leg veins, called deep vein thrombophlebitis. There was one such case (out of 860 patients) in the raloxifene group, but this was not felt to be a significant finding.

This study confirms previously reported work showing that raloxifene has a protective effect against osteoporosis, and a beneficial effect on blood cholesterol levels. Prior research has also shown that raloxifene use leads to an actual decrease in bone fractures, a result that this study did not directly address, but which seems likely if BMD rises. Again, the lowered lipid levels may predict a reduced rate of heart disease in those on the drug, but this effect cannot be assumed. There is a major trial now ongoing, the Raloxifene Use for the Heart (RUTH) trial, which is designed to assess this very outcome. There is also a trial underway comparing raloxifene with tamoxifen in the prevention of breast cancer, the STAR trial (Study of Tamoxifen and Raloxifene). The results of both these trials are eagerly awaited to help assess the role of raloxifene in prevention of heart disease and breast cancer. Meanwhile, its place as an agent useful in the prevention and treatment of osteoporosis seems assured at this time.

Raloxifene is called a SERM because it mimics some of the effects of the female hormone estrogen, while opposing other estrogen effects. Raloxifene has been shown to have estrogen-like effects on bone, where both substances tend to protect bone from the loss of calcium that causes osteoporosis. Osteoporosis is a disease common in older women, partially due to lack of estrogen, and is responsible for bone fractures, especially in the spine, hip and forearm.

Other studies suggest that over 15 percent of adolescents suffer, at one time or another, from major depression.  The course of depression in adolescents is characterized by protracted and frequent depressive episodes.  The disorder is associated with high rates of suicide, psychiatric and medical hospitalization, as well as impairment of work, family and social lives.

Despite conflicting evidence of their benefit and high incidence of cardiovascular complications, tricyclic antidepressant drugs have for many years been used to treat depression.  Newer drugs called selective serotonin reuptake inhibitors (SSRIs) have been developed with the hope that they will offer a more effective and safer alternative for treating depression.  These drugs have been used, largely successfully, in treating depression in adults for over 10 years.  They include fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil).

Martin B. Keller, M.D., of the Department of Psychiatry and Human Behavior at Brown University, and 21 other researchers from across the U.S. and Canada compared the effects of paroxetine and imipramine (a tricyclic antidepressant) to placebo in treating adolescent patients with major depression.

The study, which was conducted at ten medical centers in the U.S. and two in Canada, consisted of 275 adolescents, ages 12 to 18, who were diagnosed with major depression.  Each participant underwent a series of 6 tests to establish a baseline score for the severity of depression.  Subjects were then randomly assigned to one of three groups.  One goup received paroxetine pills (up to 40 mg/day); one received imipramine pills (up to 300 mg/day); and one received placebo.  The doses varied for individual cases as deemed necessary by research clinicians.  Each group took its assigned pills for 8 weeks.  At the completion of the eighth week of treatment, the researchers administered the same regimen of tests used to establish the baseline depression scores and compared the change in scores in the paroxetine and imipramine groups to the placebo group.

The researchers found that after treatment, 66.7 percent of the paroxetine group showed significant improvement in HAM-D scores (the primary measure of depression).  Only 58.5 percent of the patients who took imipramine saw such improvement.  Unlike paroxetine, the effect of imipramine was not statistically significant compared to the placebo group in which 55.2 percent of patients improved.

Similarly, 65.6 percent of the patients on paroxetine achieved a score of “very much improved” or “much improved” on another test of depression. Again there was no significant difference between the imipramine and placebo group, in which 52.1 percent and 48.3 percent of patients, respectively, achieved these scores.

The researchers found that the paroxetine group achieved statistically significant improvements over the placebo group on four of the six parameters used to measure depression, and “tended toward statistical significance” on the other 2 measures.  Conversely, the response to imipramine was not significantly different from that for placebo for any of the tests.

More imipramine patients (31.5 percent) than paroxetine patients (9.7 percent) withdrew from the study due to adverse effects during treatment. Approximately one-third of the adverse effects from imipramine were cardiovascular complications.  The most common adverse effects of paroxetine, namely headache, dizziness, and nausea, were less serious.

This is the first study to compare benefit of an SSRI and a tricyclic antidepressant with placebo in treatment of major depression in adolescents.  The authors say that the “study demonstrates that treatment with paroxetine results in clinically relevant improvement in depression scores.  The SSRIs are the medications of choice for treatment of major depression in adolescents because they are the only agents that have been shown to be efficacious in this population; they have a safer side-effect profile than other antidepressants, particularly in overdose, and they can be administered once daily.”

An internet drugstore may present you easy manner to obtain over-the-counter, prescription pills, frequently at more available rate. Online pharmacies are particularly convenient in case you live in a rural area or do not drive.

• If your request results in turf battles or your healing professionals are unable to treat your decision with respect, you may need to find people who are more willing to be open to cooperating with each other.

• Although you may not be completely satisfied with certain aspects of orthodox medicine, don’t dismiss its advantages. Be sure you give objective consideration to diagnostic testing, inoculation, surgery, and chemical control of symptoms while you’re assessing what’s best for you. It doesn’t make sense to throw out the baby with the bath water.

• Remember that herbs, vitamin supplements, and other natural substances are not free of side effects and require careful monitoring, especially in large doses. They are often not tested or regulated by the Federal Drug Administration

• If your ailment is related to stress or to predominantly psychological factors, consider alternatives to biomedicine. Biofeedback, psychotherapy and psychotherapeutic hypnosis, meditation, and various forms of exercise may be safer and provide relief more effectively than drugs. Chronic illness, pain, and the side effects of treatment such as chemotherapy may also respond to these kinds of therapies.

• Consider the addition of non-traditional elements such as positive imaging to surgical procedures. They may reduce discomfort and speed healing. Enlist the help of your surgeon in these efforts.

• Utilize the many sources of information about all kinds of medicine available on-line, in library reference sections, and through commercial databases. Hook up with groups of people whose concerns reflect yours. Don’t reinvent the wheel! In recent years our resources for health care have been enriched by the addition of many alternatives. You can influence your health care by choosing from those available to you, but it’s up to you to be sure that they really do complement each other.

However, did you know that CVD is actually a term used to indicate a collection of conditions or risk factors that have a detrimental effect on the heart and vascular system? These risk factors or conditions associated with CVD include; elevated blood pressure, cholesterol, blood homocysteine levels, blood lipoproteins levels, diabetes and free radical damage. Sounds a little more complicated now than just cholesterol levels, doesn’t it?

The two most common dietary factors associated with cardiovascular disease are fat and cholesterol. However, recent data suggests arterial plaque development has several other contributing factors, which highlights the point that focusing primarily on dietary intake of fat and cholesterol alone may not be sufficient to prevent CVD in some people.

While medical science has identified some genetic causes of this condition, the majority of risk factors for cardiovascular disease are associated with diet, nutrition and lifestyle. Some of these factors include consumption of salt, saturated fats, polyunsaturated fats, and hydrogenated or partially hydrogenated oils.

To understand the role diet has in the development of CVD, let’s first outline the process of arterial plaque development (the process of developing clogged arteries). Essentially, the process of arterial plaque development is related to Low-Density lipoproteins (LDL). These fat-protein molecules attach to the endothelial arterial walls and become oxidized or glycosylated. This process of oxidizing LDL is capable of damaging the arteries and initiating the process called atherosclerosis. Once the arterial walls are damaged, plaque builds up and eventually obstructs the artery. In the case of a coronary or heart-supplying artery, you have a heart attack. So, controlling this plaque formation process is seen as the key to prevention and treatment of CVD.

The issue with trans-fatty acids is they actually block an enzyme that would normally help metabolize cholesterol and remove it from the body. Which means, eating modified polyunsaturated fats actually increases your serum cholesterol, not the other way around. In fact, in a study cited in Nutrition Reviews , individuals who consumed the most trans-fatty acids (an average of 5.7 gm/day) were found to be 50 percent more likely to develop cardiovascular disease than individuals who consumed the least (2.4 gm/day).

The moral of this story is that margarine and other trans-fatty acid-containing foods may be cholesterol-free, but they inhibit the body’s ability to eliminate cholesterol, which may actually increase your serum (blood) cholesterol instead of lowering it. So is there any fat okay to eat? Most research on the subject indicates that monounsaturated olive oil appears to be the healthiest dietary fat/oil and is part of the much-publicized Mediterranean diet.

Salt is another dietary factor that impacts cardiovascular disease. Approximately 60 percent of hypertensives (those with high blood pressure) are “salt sensitive” according to an article in the Journal of the American College of Nutrition . In these individuals, increased salt (sodium chloride) sends their blood pressure through the roof! However, many people who are avoiding the salt shaker in an attempt to reduce their salt intake may be missing the enormous amount of “hidden salt” added to fast foods and processed foods. So, to adequately reduce your salt intake, a reduction in fast foods is also in order. In addition, check the label of all processed foods to determine how much salt you are actually eating.

Potassium is another component of the CVD prevention program worth mentioning. Although having no direct correlation to cholesterol, adequate potassium levels appear to play an important role in the prevention of cardiovascular incidents, (which is a nice way of saying heart attacks and strokes).

Regardless of any food supplements you may be taking to reduce your risk for CVD, a healthy whole-food diet remains your best defense. In fact, a healthy diet alone may be enough to prevent or reduce the risk of developing this disease. Epidemiological studies posted in the Journal of the American College of Nutrition clearly show that a higher consumption of fresh fruits and vegetables (rich in phytochemicals) is associated with a reduced risk of cardiovascular disease. In addition, the reduction of salt (for salt sensitive individuals) and appropriate use of monounsaturated olive oil will go a long way in maintaining a healthy cardiovascular system.

Now, many reading this article may have trouble eating the five fruit and vegetable servings per day recommended for optimal health and prevention of CVD. If this is you, taking a few food supplements may help you make up where your diet leaves off.

While there are many food supplements that are useful in maintaining cardiovascular health and preventing disease, only a few seem to have benefits that are specific to CVD prevention. These are: magnesium, vitamin E and C, Coenzyme Q1O, and Garlic.

A story in Natural Health Resources reports that magnesium deficiency has been associated with an increased incidence of atherosclerosis, hypertension, strokes, heart attack and diabetes.

Vitamin E has been shown to play a powerful role in the prevention of heart attacks because it can reduce platelet adhesion (clot formation) and prevent oxidation of LDL cholesterol. (Please note that dosages over 400IU of Vitamin E may cause blood thinning and prolonged bleeding. Those taking blood thinners such as Coumadin® should consult their healthcare professional before taking this supplement).

Vitamin C can also have an effect on cardiovascular disease. In a study cited in the American Journal of Clinical Nutrition , individuals consuming vitamin C at two to three times the RDA had improved lipid profiles, corresponding to a reduced risk of cardiovascular disease.

Coenzyme Q10 is involved in the production of energy at the cellular level and is also a key nutrient for the heart. Current theory suggests a significant portion of congestive heart failure may be due, at least in part, to a coenzyme Q10 deficiency.

Lastly, while not a vitamin or mineral, garlic is an herb that appears to benefit those with cardiovascular disease. According to an article in the British Journal of Clinical Pharmacology garlic is effective in lowering elevated serum cholesterol and triglycerides and inhibits platelet aggregation, which may help prevent a heart attack or stroke.

Although food supplements are beneficial to the cardiovascular system and help to reduce or prevent the development of CVD, a diet rich in fresh fruit and vegetables is still the best means of prevention. Food supplements are very useful and even necessary at times, but they can only do so much if your diet is poor.

As cardiovascular disease is predominately related to lifestyle, it is within the power of each of us to make the lifestyle changes today that will ensure we have a healthy and strong cardiovascular system tomorrow. Prevention is the key and a diet rich in fresh fruits and vegetables is a good start on the road to a healthy heart.

Such cells contain no active telomerase, an enzyme required to maintain chromosome stability in dividing cells.

In contrast, most cancer cells have an unlimited ability to undergo cell division, and these “immortal” cells almost always contain measurably active telomerase, which they produce continuously.

“We are successfully exploiting this difference between normal cells and cancer cells to detect the presence of cancer cells in the prostate gland,” says Richard E. Beltz, PhD, emeritus professor of biochemistry, School of Medicine.

Dr. Beltz is a member of a research group that recently published several in a series of articles on its research in the professional journal Urologic Oncology. The first article is titled “Detection of telomerase activity in prostatic fluid specimens” .

George R. Prout Jr., editor in chief of the journal, commented on the article, saying “The article entitled ‘Detection of telomerase activity in prostatic fluid specimens’ by Wang et al. is a very clever paper, and the results strongly suggest that we’ll be using this in the clinic in the not too distant future.”

A second article, “Telomerase activity in sextant needle cores from radical prostatectomy specimens,” Urologic Oncology has also been published and a third in the series is being prepared.

Scientists contributing to the research and preparation of the journal articles include individuals from the School of Medicine department of biochemistry and the Loma Linda University Medical Center department of surgery’s division of urology.

“Our studies have shown that telomerase assays [measurements] performed on prostatic fluid could play an important role in the detection of prostate cancer,” Dr. Beltz explains. “Unfortunately, the method we employed for measuring telomerase activity requires radioactive material and apparatus that are not suitable for clinical laboratory use.”

The challenge, he continues, is to develop a new telomerase assay method, which is usable in a clinical setting and is comparable to or better than the original method in accuracy and precision.

“A second challenge,” Dr. Beltz adds, “is to investigate other urogenital fluids, more easily obtainable than prostatic fluid, as potential clinical specimens for prostate cancer diagnosis. Research is now proceeding along these lines.”

“He continues research as an active emeritus professor in collaboration with George Javor, PhD, professor of biochemistry,” indicates Clifford Herrmann, PhD, associate professor and acting chair, department of biochemistry/microbiology, School of Medicine. “A poster describing some of their results was presented at the May, 2006, meeting of the American Society of Microbiology.”

In addition to lecturing to medical students through the years, Dr. Beltz has served as facilitator in the problem-based learning setting with small groups of first-year medical students.

Blood glucose is typically measured by pricking the finger with a small, but very sharp lancet several times each day to obtain blood samples. A small drop of blood is applied to a test strip, which is then inserted into a glucose meter that determines blood glucose levels. Monitoring blood glucose levels may seem like a simple procedure, but it is never a pleasant experience.

Fortunately, science and technology have come to the rescue with a new and improved method of glucose monitoring. Developed by Cygnus under the trademark name “GlucoWatch”, this bit of technology may allow people with diabetes to check glucose levels more frequently without as much discomfort as the finger-stick method. Worn around the wrist, the GlucoWatch is designed to measure glucose using a disposable Autosensor. The sensor measures glucose via contact with the skin after receiving a small electric current. Within the sensor is an enzyme, which releases hydrogen peroxide when it reacts with collected glucose. Hydrogen peroxide generates an electronic signal, which is then interpreted as a blood glucose value based upon previous calibration with the pinprick method. The Autosensors are good for 12 hours after calibration, and can detect up to three glucose readings per hour. Cygnus expects to launch the GlucoWatch in early 2001 pending FDA approval. Although the GlucoWatch is not meant to replace the traditional method of glucose monitoring, it may reduce the number of times diabetics need to draw blood samples.

Unfortunately, needle-sticks do not end there for people with diabetes. Insulin is given via injection to people with Type I diabetes because their pancreas does not produce enough (or none at all!) to facilitate glucose’s entry into cells. Even those with Type II diabetes may eventually require insulin injections as the disease progresses. Diabetics may require multiple injections throughout the day. I cannot think of even one person who enjoys being given a shot, much less two or three each day.

Are injections the only way to administer insulin? Isn’t there some sort of an insulin pill for people with diabetes? The problem is that insulin needs to arrive intact in the bloodstream in order to be effective. Insulin cannot be taken by mouth unless it is protected from digestion because it is a protein. Similar to a hamburger, proteolytic enzymes, rendering it useless, would break down a simple insulin pill.

However, scientists have come up with some interesting ways to get around this problem. Several different modes of drug delivery are currently under investigation, one of which is an “insulin inhaler”. Together with Pfizer, Inhale Therapeutic Systems has developed an insulin delivery system (similar to an inhaler) that allows dry insulin to be absorbed by alveoli in the lungs. Alveoli are small air sacs covered by a very thin layer of cells and surrounded by blood capillaries. Aerosolized insulin is easily absorbed by alveoli, whose total surface area is over 100 square meters in the adult.

According to findings presented at a conference of the European Association for the Study of Diabetes held in Jerusalem, researchers at the University of Vermont College of Medicine reported that inhaled insulin was as effective as injected insulin in their two-year study. Study participants did not appear to suffer any lung damage. Inhale Therapeutic Systems’ inhaleable insulin is currently in Phase III clinical trials.

With the advent of insulin inhalers and non-invasive blood glucose monitors, quality of life for people with diabetes may well be improved. If you or someone you know has diabetes, ask your doctor for more information about the latest options in diabetes care.

Smokers who strongly associated coffee with smoking may find themselves changing their coffee habit upon quitting smoking. Instead of drinking four, six or more coffees per day, they may decide to cut down when they quit, because of the strong association they made between smoking and drinking coffee. Others may decide that to quit smoking they have to cut out coffee altogether. Without realizing it, they thus may also initiate caffeine withdrawal. Headaches do accompany caffeine withdrawal for a few days.

Some people may decrease coffee but without realizing it, they increase their soft drink intake. Many soft drinks contain caffeine. Examine and evaluate your caffeine intake, as the results may surprise you. If you end up ingesting more caffeine, you may be initiating restlessness and insomnia. Many people do this and complain of insomnia, of waking during the night, something that didn’t happen when they were smoking.

A certain amount of stress accompanies smoking cessation. Quitting is a major life change after all, and the urges to light up, by themselves will bring about stress and anxiety. Stress and anxiety can induce headaches.

A change in diet can also come about during this time without realizing it. Quitters may reward themselves by eating foods that gratify. Bulky foods can cause constipation, and constipation can cause headaches.

What can be done?
The usual headache pills bought over the counter are fine. However, taking analgesic (pain-relieving) headache medication should be combined with the following actions:

# Deep breathing:
Deep breathing brings more oxygen to your system and may help your headache. Place both hands on the upper abdomen and breathe in deeply through your nose, making sure your upper cage rises and your upper body straightens up. Hold it for a count of five and then exhale though your mouth. Do this often throughout the day. It will add oxygen to your system and may really help. A walk outdoors in the fresh air will get more oxygen to your brain. Many people relate that a walk in the evening really makes a difference.

# Relaxation techniques:
Along with deep breathing, try taking a warm relaxing bath. Pamper yourself, and create a relaxing atmosphere with lead-free candles and music if it helps to relax you. This will help reduce the stress factor causing the headache. Trying some meditation techniques will add positive impact to reduction of stress. Some people play with marbles or Chinese balls to help reduce the stress from ‘restless fingers’ that no longer have a cigarette to handle.

# Attention to Digestive changes:
It’s most important to drink lots and lots of water! Water helps to clean out those cigarette toxins from the body, and we now know that cigarettes add some 4000 toxins, including formaldehyde and arsenic and other scary things. Rinse them out of your system with water; it helps to clear the digestive tract. Quitting smoking means that nicotine is not longer being introduced into your body. Nicotine stimulated the system, including the metabolism. Therefore by cutting out nicotine, the metabolism will slow down. Quitters will feel the difference, and quitters aged forty-five and up may find some noticeable changes in their digestive system. They may feel more sluggish and constipated, and thus more headachy. Fiber should be increased in the diet. An oat bran cereal will add a lot of fiber and help to reduce constipation. Some people sprinkle some bran flakes into the sauces they make. You can add some in stir-fries without anyone noticing it. By reducing cheeses and bulk-causing foods, this will help a great deal as will fat reduction in the diet.

Many people notice a change in their digestion around the age of forty-five. Pay attention to your body. If cheese is a problem, pay attention to that and cut down the amount you eat.

If you’re not the breakfast type, and some people are not, why not try an evening snack of bran cereal, or if you don’t like bran cereal by itself, you can add it to a bowl of your favorite type. You can slip oat bran flakes into your favorite recipes and meals too. Eat fruit every single day. An apple in the morning and in the evening will add fiber to your diet, not to mention all kinds of good nutrients. We have to pay attention deliberately and consciously to increasing fiber, and increasing grains, vegetables and fruit in the diet.

Negative self-talk and rationalization can bring us back to smoking once again. Having come this far, it’s vital to really keep taking positive measures and doing really positive actions. We can so easily listen to negative self-talk. Success involves positives and striving to eliminate negatives.

Above all, don’t think that this will last. The initial headache should pass in a few days and be greatly diminished if you follow the above tips.

After a drug has been developed in a laboratory, it must undergo many strictly controlled tests before it can be sold to the public at large. It can only be considered for human trials after it has been proven through preclinical trials that it can be beneficial.

If animal trials have yielded positive results for a drug, it must then be submitted to the IND (Investigational New Drug) and the FDA (Food and Drug Administration) before human trials can begin. Once they are sufficiently satisfied that the drug has potential and the levels of toxicity have been determined, they will be permitted to test the drug on humans.

During the first phase of clinical trials, safety and toxicity levels are investigated using human volunteers. At first, the drug is tested on a small group of volunteers — approximately 20 to 80 subjects. If the drug in question is thought to be extremely toxic, as is the case with certain cancer medications, it will then only be given to those who already suffer from the ailment.

The second phase of the trials will investigate the quantities of the drug that can be safely given to patients so that dosage levels can be determined. Approximately 100- 300 people will be involved in these trials, which can be conducted in several clinics and take place over a period of one to two years.

During the third phase, the drug is tested on a broader scale, involving 1000 – 3000 volunteers. The drug will be given to individuals who are afflicted with the disease and the outcomes will be compared with those of other existing drugs. Normally this phase lasts 2-4 years and provides the most useful results with regard to the drug and its effects. During the third phase, a control group of volunteers will be given a placebo. This is done to compare the effects that the drug has on those who have the disease but do not receive treatment.

If the drug is shown to be safe and effective, a new drug application is submitted to the FDA. Once the FDA approves the drug, it can be distributed. Every two years, the drug must undergo more safety tests. Once the results of the first 3 phases have been collected, the drug is approved and phase 4 begins. Phase 4 examines the general use of the drug and any side effects which may become apparent after an extended time of usage. The effectiveness of various forms of the drug will be investigated as well as how various dosage levels can affect its efficiency.

Once a drug is available on the market, it is continually tested and improvements are made for as long as it remains on the market. From the time a new drug is conceptualized until it reaches the market, it can take as long as 20 years. Millions of dollars are spent by the multi-billion dollar medical research industry to develop each drug in an effort to improve our health.

Pain—the Great Inhibitor

Pain—relentless and unpredictable—is an obvious obstacle to sexual enjoyment. Not only does it make certain positions difficult and/or impossible, pain also limits desire, sexual response and function. Equally inhibiting, though, is poor self-image. Few of us with RA remain physically unscathed. Many of us have visible deformities; some of us have surgical scars. In a country that bases an almost impossible standard of beauty on youth, health and strength, it is no wonder that many of us feel “sexless”.

So Why Bother?

Because sex is the life force! It is our greatest intimacy, that which links us to humanity; it is how we show our love and vulnerability to each other. Orgasm releases endorphins, reducing pain and stress, relieving fatigue and depression, making us feel alive and desirable. And making love with our partners is a way of reassuring each other, of letting him or her know that we still find them attractive. It’s joyful, rewarding and free. Sure, you could conceivably live without sex. You could live without laughter, too, but why would you want to?

“Lowered Expectations” v. Redefined Expectations

Recently, I came across an article on RA and sexuality in which the author suggested that if you have RA, you should “reduce your expectations”, sexually speaking. Although I’m sure the author meant well, I felt like screaming. Reduce our expectations? Why? Haven’t we reduced enough of our expectations? Granted, if your expectations are based on gratuitous media images in which trapeze acts, hurling each other into walls and being double-jointed in general seem to be the norm, then perhaps you might want to reduce your expectations. The rest of us, though, should be able to use a little creativity and redefine—rather than “reduce”—our expectations.

Redefining Our Sexuality

Physical Obstacles

Obviously, if you are in the midst of a five-alarm flare you should postpone lovemaking until your symptoms subside. On the other hand, it probably isn’t necessary to wait until you are pain-free before making love (for some of us, that would be a very long wait). In fact, sex—like exercise—may be just what you need to relieve moderate stiffness and pain. Here are a few ideas you can use to prepare your body for lovemaking:

* Try to limit extra activity
Postpone extra chores or errands for another day or delegate a few of them to your partner.

* Plan sex for the time of day you feel best…and time your medications accordingly.
Some of us feel stiffness in the mornings; others feel fatigue at night. You know better than anyone when your peak time is…and how to time your medication for maximum comfort.

* Trade spontaneity for anticipation
True, spontaneous sex might be harder to pull off. But don’t discount the fun of anticipation! (e.g. catching each other in the hallways and whispering, “Just two more hours until you-know-what!”)

* Take a warm bath or shower beforehand
Better yet, take one together!

* Warm up with range of motion exercises
Yoga, tai chi, qui gong, Pilates or any range of motion exercise recommended by your doctor or physical therapist will reduce stiffness and enhance enjoyment.

* Create a relaxed atmosphere
Put the kids to bed, turn on the answering machine, light some scented candles, and—if your medication allows you—have a glass of wine.

* Incorporate massage into your foreplay
Scented, flavored massage oil can be warmed and worked into stiff muscles. Therapeutic and erotic!

* Develop subtle signals for your partner
Use a light tap or tug to let your partner know if he or she is hurting you…by the same token, let them know when something feels good, as well.

Positions

It is possible that some positions will cause too much discomfort, but instead of seeing this as yet another limitation, treat this as an opportunity to add some spice to your love life! Buy a copy of the Kama Sutra or Alex Comfort’s Joy of Sex . Experiment with oral sex and marital aids. Arrange pillows to support sore joints.