Medical Marijuana: An Insight Into a Patient’s Journey

BACKGROUND

To date, medical marijuana is legalized in the United States in 30 states including the following:

Alaska, Arizona, Arkansas, California, Colorado, Connectiut, Delaware, DC, Florida, Hawaii, Illinois, Maine, Maryland, Massachusets, Michigan, Minnesota, Montana, Nevada, New Hamshire, New Jersey, New Mexico, New York, North Dakota, Ohio, Oregon, Pennsylvania, Rhode Island, Vermont, Washington and West Virgina.

Each of these states have their own regulations and guidelines regarding use and qualifications.

Here in Florida, the Medical Marijuana Legalization Initiative, also known as Amendment 2, passed on November 8, 2016 for qualified patients under the supervision of a qualified and licensed marijuana doctor. Furthermore, this amendment passed with a total of 6,518,919 (71.32%) YES votes and 2,621,845 (28.68%) NO votes.

The federal government has classified Marijuana as a Schedule 1 drug making it illegal for doctors to prescribe marijuana to their patients. These marijuana doctors can only make recommendations for medical cannabis in compliance with the state law which can be valid up to 1 year. Patients cannot go to a pharmacy to fill a prescription for medical marijuana.

Under strict regulations, medical marijuana doctors are prohibited to be affiliated with any medical cannabis distributors or dispensaries.

Only certain patients with “debilitating ailments” are afforded legal protection under this amendment. Ailments classified under its provision include PTSD (Post Traumatic Stress Disorder), Chronic muscle spasms, Multiple Sclerosis, Seizures, Epilepsy, Glaucoma, Crohn’s Disease, Cancer, HIV/Aids, ALS (Amyotrophic lateral Sclerosis or Lou Gehrig’s Disease) and Parkinson’s Disease.

Although the above ailments were indicated as “primary debilitating conditions”, under this provision, Amendment 2 also indicated: “or any other ailment/condition of similar severity/symptoms, as determined by a physician’s opinion that the medical use of marijuana would outweigh any potential health risks”.

There are currently about 56 known and listed marijuana doctors on Florida.

More information and specifics regarding this topic can also be obtained from the website of the Florida Department of Health (http://www.floridahealth.gov) on how to become a medical marijuana patient in Florida. More in-depth information about Amendment 2 can also be found here.

PARKINSON’S DISEASE

A few months ago, I came across a video on Facebook about a man with Parkinson’s disease who was given a shot of medical cannabis. The before and after videos were quite impressive. Before the treatment, you can see this man’s significant tremors, stuttering and abnormal posturing. The after video showed a very different person. His speech was intelligible and audible. He had no stuttering, tremors and he showed very controlled movements. This man was walking and talking as any normal person would. He also shared how it has improved his quality of life.

As a physical therapist with exposure to various cultural backgrounds, I personally have mixed feelings about medical cannabis. As a healthcare professional however, it is quite an epiphany to witness one of my patient’s significant change with medical cannabis use.

Mr. J.L. with Parkinson’s Disease

For over five years, Mr. J.L. has been coming to me for physical therapy treatment off and on for problems brought on by his Parkinson’s disease. Knowing the progressive nature of the disease, I watched this gentle soul deal with the effects of this debilitating affliction. His primary physician would refer him for treatment when he starts to develop weakness, rigidity, tremors and most of all, balance problems where he reported falls at home.

We would see him for a period of about six to eight weeks each time. We worked on improving his coordination, strength, flexibility and balance for the primary purpose of keeping him safe and self sufficient at home as he lives alone. It is also to keep from falling which predisposes him to more severe injuries and complications.

The Change

About a few weeks ago, he came to the office to schedule for Physical Therapy as he was referred again by his doctor. Having worked with this patient through the years, I was trying to figure out what changed in him. I looked, and observed intently as I did my initial evaluation. He may have noticed the curiosity that was nagging me because he gave me a knowing smile. No longer able to contain my curiosity, I asked him: “Mr. J, what have you been up to?” Mr. J just laughed and asked me why the curiosity!

Well, it finally dawned on me that Mr. J. barely had no tremors on his right hand where he used to exhibit the typical pin-rolling tremors of this disease. His neck was aligned and was not shifted towards the right side. Furthermore, his speech was clearer! Another thing that struck me was that he was walking better. Not great, but he was able to turn around without having to shuffle which I have seen him do for years.

He finally shared with me that he started taking medical cannabis for over a month as recommended by his neurologist. A friend of his apparently mentioned to him a video on Facebook about a man with severe Parkinson’s disease. This man received a shot of medical cannabis and the change was visible after only a few minutes. This apparently prompted him to consult with his primary physician and then his neurologist.

The change I have seen with Mr. J after only over a month of being on medical cannabis is significant. His speech improved. His voice deeper and more audible. He had no stuttering and he had more control of his right hand from almost a non-existent tremor. He is also standing straighter. His balance and coordination have improved, even more so with the advanced balance retraining he is currently receiving.

During his therapy sessions, Mr. J could bounce a ball on the floor faster with better accuracy. We saw him throw and catch a ball in standing without anyone holding on to him. We used to have somebody stand behind and hold him as he had slow reactions and reflexive responses. His walking also improved. Just months ago, he would drag his right foot and walked with very short shuffling steps. He would lose his balance with the slightest attempt to turn around or lift his leg higher to stand on one leg.

These seemingly subtle changes in him for just about over a month of using medical cannabis has made a difference in his life. He shared that he feels more relaxed and is less anxious about falling. He can do simple house chores with more confidence and he is able to tolerate more advanced therapeutic exercises during his physical therapy sessions. He does not feel as tired and is able to do more tasks throughout the day.

Mr. J is still on this journey and wanted to share this experience and for me to tell his story. Knowing him and his background, he is not the type of person who would take marijuana indiscriminately for mere recreation and self indulgence.

About Mr. J.L.

Mr. J is originally from Central New York and has moved to Florida. He was diagnosed with Parkinson’s Disease approximately seven (7) years ago. He used to be a designer for a very prestigious Syracuse China manufacturer whose customers include the White House, 5 star hotels and prestigious restaurants. He also was a member of a Barber Shop Quartet as a tenor for the SPEBSQSA (Society for the Preservation and Encouragement of Barber Shop Quartet Singing in America) and has been on several amateur Broadway shows in New York. He was an art teacher to middle school students teaching drawing.

His life changed when he was called to ministry sometime in 1986. He became involved with a healing ministry which he revealed was mostly with people who had tumors. He has traveled abroad to expand his healing ministry. This has garnered so much attention that even the media noticed and did several coverage on his ministry. He is now retired and lives in Palm Bay Florida.

It is a privilege to know this special person who has done so much during his younger days. He has dedicated so much time and commitment to helping others. I deeply appreciate the humanitarian service Mr. J has rendered and how his ministry has touched so many lives. I consider him another unsung hero of his time.

His willingness to have me share a snippet of his story is a privilege. Moreover, to be able to work with him to further his progress and see his motivation and determination through the years is a very inspiring experience.

Mr. J.L.’s personal battle with Parkinson’s Disease.

Mr. J as he shared, was officially diagnosed with Parkinson’s Disease some seven years ago. He has been under the care of a doctor of Internal Medicine practicing in Palm Bay, Florida.

About Parkinson’s Disease

As described by the Mayo Clinic staff: “Parkinson’s Disease is a Progressive disease of the nervous system that affects movement. It develops gradually, sometimes with a barely noticeable tremor in just one hand. But while tremor may be the well-known sign of Parkinson’s disease, the disorder also commonly causes stiffness or slowing of movement.”

Subsequent effects of the disease include the following: expressionless face also known as masked facies or hypomimia and decline in speech quality that can be slurred, soft, even stuttering. These are very common in patients I have worked with. A patient’s walking ability is also affected. There is loss of arm swing from trunk rigidity, stiffness and shuffling steps from resulting incoordination.

Unfortunately, this disease is progressive and current medications are aimed to improve the symptoms but not necessarily a cure.

There are currently many ongoing researches for cure including surgery to regulate certain regions of the brain and electrostimulation.

Still, there is no standard treatment for cure at this time, as per the National Parkinson Foundation.

Additionally, medication, lifestyle modification, exercise and rest are recommended.

Medications Prescribed

Current medications prescribed include the following: Carbidopa-Levodopa, Carbidopa-Levodopa infusion, Dopamine Agonists, MAO-B inhibitors, Catechol-O-Methyltransferase (COMT Inhibitors), Anticholinergics and Amantadine. -Source: The Mayo Clinic Organization

Parkinsons and Surgery

Deep Brain Stimulation (DBS) ia procedure where electrodes are implanted in specific areas of the brain with a generator implanted in the chest area near the collarbone which sends out impulses to the brain aimed at reducing the symptoms. It is not a cure however and there are many risks and side effects involved. Both the medication and DBS will not halt the progression of the disease.

Parkinson’s and Physical Therapy

Physical Therapists get to work with these type of patients during the different stages of the disease. This is primarily because of the functional decline resulting from incoordination, dyskinesias (involuntary movements) and rigidity which makes purposeful and spontaneous movements very tedious.

These problems can make even the most basic functions as feeding, grooming and toileting very difficult. Walking becomes very unsteady. Shuffling gait is very common where it is difficult for them to make the first step (because of bradykinesia – very slow movement) but once they go, it is also very difficult to stop. Many of these patients are at a high risk for falling and a large number during the advanced stages become fully dependent for care.

When referred to Physical Therapy, patient education regarding appropriate exercises, movement strategies, task modification, gait training and fall prevention strategies are a part of the overall plan of care and functional intervention. They are also often referred to Speech Therapy for speech and feeding problems, and to Occupational Therapy for basic self care and hand or upper extremity functions.

Mr. J’s Battle

I first worked with Mr. J about 5 years ago. Although he was not on the advanced stages of the disease at that time, he already manifested the primary visible symptoms of the disease: Hand and neck tremors, masked facies, rigidity and significant incoordination. He walked very slow, was shuffling and took a long time walking even from room to room as he was unable to make quick turns. When he does turn, he tends to lose his balance and fall. His reflexes were very slow. He could hardly catch a ball or bounce it. His speech was slurred, barely audible and he had a stutter. He had difficulty getting up and down simple curbs and stairs. He had fallen a few times from balance issues.

Mr. J persevered with the physical therapy program and was always very motivated. For each of the episodes that he was referred to us through the years, he always showed improvement and always followed through with the specific exercise program we prescribed. Due to the progressive nature of the disease however, he would have a physical decline and we had to work with him again.

He shared the story of how he first noticed the change in him from Parkinson’s. Foremost he mentioned was when he was teaching drawing to middle school students in his art class in New York. He said that he was progressively having difficulty drawing and using his right hand as he had developed tremors. The rest followed including a change in his facial expression, rigidity and feeling stiff all the time.This became progressively worse through the years until his move to Florida.

Once under the care of an internist, he was prescribed Sinemet and other medications which he had taken through the years.

The last time I saw him for treatment was in early 2016 where he had significant tremors on his right hand and an involuntary twitching in his neck. His masked facies had progressed, his face almost droopy and he was walking with so much shuffling and difficulty. He was barely able to move one foot in front of the other. He also reported of falls because of worsening balance problems.

This was why when I saw him in March of this year, I saw the significant change in him which he attributed to medical cannabis.

Medical Cannabis: Capsules and Gummies

He further shared his story. Upon hearing about the potential benefits of medical cannabis for Parkinson’s disease, he consulted with his primary physician who directed him for further consult with his neurologist. His neurologist recommended trying medical cannabis due to the advancing nature of his Parkinson’s disease.

Mr. J then got started on medical cannabis capsules where he said it contained about 30 pieces of 25 mg capsules. This costed him about $80 or so including shipping. With his shipment came a sample pack of the gummies version of about 5 gummies in a pack. The capsules were bitter, according to him and he took 1 capsule daily.

He added that after taking the first capsule ever, he felt so relaxed and calm. He could move around, get in and out of bed easier, get in and out of his chair better. He also noticed that his tremors were much lesser that first time.

Mr. J stated that he liked the cannabis gummies better as it tasted much like candy and was tastier than the capsules. Even more so, the effect of the gummies seemed much faster than that of the capsules and was much cheaper. The capsules per piece costed about $3 each and the gummies would amount to about $1 a piece he added.

So as to mimic the effect of the gummies, Mr. J said he tried melting the capsule under his tongue to take off the edge of its bitterness. He also chewed regular gummy bear candy. This worked for him.

To date, Mr. J continues with physical therapy where we see him better able to tolerate and execute high level balance training tasks that he was unable to do so before. He has very little to no tremor on his right hand, he no longer exhibits the twitching on his neck, and his reflexes improved. I see this by his ability to make a turn and not lose his balance. We do not have to hold him while he catches, throws or bounces a ball to improve his protective righting reflexes necessary for him not to fall. he can lift his feet higher when walking and his shuffling is so much lesser.

Still aware of the progressive nature of this disease, it is just inspiring to see this very soft-spoken, kind-hearted, intelligent and talented individual overcome simple daily functional obstacles brought about by this debilitating and irreversible disease.

For the population afflicted with debilitating diseases, a day to day victory of being able to move about and perform tasks that seem so trivial to most of us, is a blessing.

Legalizing medical marijuana currently is, and will be an ongoing battle in congress. We all have varying stands and strong opinions about this issue. Researches are ongoing about its pros and cons. I foresee more awareness of its existence as an alternative treatment to various diseases who do not respond to conventional medicine and treatment.

As a medical professional however, it is just fulfilling to be able to witness the functional changes in Mr. J., how he is able to stay independent and self sufficient despite his impairment.

Devoted Individuals Battling Inequality Around the Globe

As I read, Mountains beyond Mountains and Strength in What Remains both written by Tracy Kidder, I could not help to think of how privileged we are here in the United States of America. These books got me thinking critically and analytically about the desperate situations of the unfortunate all over the world. These books were decisively written to those individuals around the world with the capability and aspiration to help others in dire situations. Paul Farmer, a physician and a medical anthropologist, is the main protagonist in the accredited novel Mountains beyond Mountains. Deo, a young man who survived two civil wars and strived for success and a life devoted to helping others through medicine is the character Strength in What Remains is based on. The three areas of focus are inequality around the globe on how these two physicians tackle this concern in relation to medicine. Does everyone have equal access to healthcare, like transportation, education and etc? The use of sorcery and how that might help or limit access to other westernized medicine, in communities dealing with certain diseases. Lastly, knowing that we are connected on a global scale, what changes could we the readers of these books do and implement for betterment of the globe

Mountains Beyond Mountains I gained the understanding of an important theme which is global interconnection and inequality. Even though, thanks to vast growth of technology, the world is connected on almost every stage but that does not translate to equality over borders as stated in Mountains Beyond Mountains “All suffering isn’t equal” (Kidder: 232). In this statement Farmer is illustrating that someone who lives in the third world and someone who lives in an industrialized nation do not have the same worries. The person from an industrialized nation has more access to health care, preventable medicine; physicians so, two individual living in these different worlds could not be equal when dealing with access to healthcare. For example, in a slide presented by Prof. Connie it was clear that a place that is disadvantaged like Sub-Saharan Africa accounted for half of all child mortality under the age of five in the world. The majority of the mortality of these children is not of complications that there is no cure for, but the three leading causes of death are diseases such as pneumonia, diarrhea, and malaria. These three illnesses that are the main causes of child mortality around the globe in third world are diseases that can be easily cured if better access to healthcare was provided and proper utilization of vaccines or other materials that would combat these diseases such as water, bed nets and nutrition. These are the sort of things that these two individual physicians work hard toward. An interesting Stat used by Deo, in Strength in what Remains is that of “One in five deaths caused by waterborne diseases or lack of sanitation; sever malnutrition for 54 percent of children under five”(Kidderl: 226) These are necessities for life that are for granted in the West.

In the film Yesterday it is apparent not everyone has the accessibility to medicine, finances, nor does everyone have the background knowledge needed to comprehend terms used in medicine. Even the fact that an individual has to wait such a long time in line in hopes of getting seen and still might not get seen at all that day is a lot different than that of a person living in an industrialized nation whose fears are having to wait a few hours at worst in a comfy waiting room. Also, how Yesterday’s husband John had to be forced by his employer to see a doctor because he himself could not take time off work to do so. This is a true dilemma for a lot of people around the world, they must choose whether to go to work or see a physician with whatever ailment that might be bothering them, due to job insecurity

In Strength in What Remains Deo the young man who goes through many struggles arriving at JFK with only two hundred dollars and not knowing anyone, and goes on to Columbia University then medical school. Even though Deo goes through extraordinary times surviving two genocides one in Rwanda and another in Burundi, he still manages to accomplish great things in America and goes back home to make a difference. On a trip working in hospital built by Partners in Health in a district in Rwanda the summer of 2005, Deo thought to himself “Burundi needs hospitals like this” (Kidder: 189). Deo, a young man with a lot of character and demonstartared great courage, had the idea of taking on an enormous challenge to build a hospital and bring access to healthcare for people in Burundi who are in desperate need of one.

When Deo arrived at Rukomo a town with ‘rutted roads’ and hot springs, a town that had a nice looking clinic but was ‘underequipped’ also made people pay for its services and was ruled and controlled by a Burundian pastor. Deo wanted to make a joint effort to improve the clinic but the pastor refused and Deo counter argued by making this statement. “If tomorrow you don’t have a large number of people coming to worship you, don’t be surprised. They will be sitting in their houses, in these miserable hospitals, dying. Give them something. At least that way they can show up on Sunday at your church.” (Kidder: 232) Deo, like Farmer made many efforts in any way possible to help those were disadvantaged. Deo’s goal was to make health care more accessible for those in these small towns so that they too can reap the benefits of living near a hospital that could at least help ease some of their pain. Even though Deo knew that Paul Famer an advisor for him wished that he would first finish med school before he attempted to build a clinic on his own.

Deo had many dreams and aspirations in helping underserved people in the town of Kayanza. At one point Deo pointed to a sun flower and said that ‘But the sunflower seed, as everyone will tell you, has the potential to grow into an enormous flower that is bigger and taller than any of us here’. Deo was trying to make the point that the clinic that he foresaw developing here in Kayaza had great potential of serving its people. On November 7, 2007 Deo finally got to see his dreams of opening a clinic come true with the opening of not just one clinic but three as well as a pharmacy (Kidder: 256).

Farmer on the other hand tries to bring his skills attained at a first class University Harvard to places like Haiti and other countries in the Caribbean, to battle inequality around the globe and bring access to western healthcare to these areas, while he incorporates his knowledge with any sorceries or beliefs that the natives might have about medicine. Farmer takes on such tasks in Haiti like that of curing sick people from tuberculosis (TB), and battling HIV in Haiti. In the book Mountains Beyond Mountains Farmer takes on social injustices that Haiti was struggling through. There are many great examples of Farmer’s understanding of different cultures and there equal importance of playing a role in medicine for instance. In Strength in What Remains In the book Farmer and Deo have a ‘detailed’ conversation about the hard ship Deo went through but Farmer stated “I was worried about him, but I never recommended that he see a shrink. It was hard to imagine an American psychiatrist medicating him for having survived genocide in two countries” (Kidder: 157). Farmer understands that modern medicine might not have as a big impact as sorcery medicine when it comes to certain things like mental health. Sorcery plays a big role in a lot of communities, such as in the film Yesterday when she goes to see Sangoma, the traditional healer of her village, and Sangoma tells her the cause of her illness is anger that she carries between her shoulders. Even though, it is important and a lot of times it is essential to treat someone with the advice or recommended treatment by a natural healer, but this can also cause individuals like in Yesterday to decide that maybe this is the cause of my illness. This can in return prevent someone like Yesterday from going into the clinic and seeing a physician to get what might be the correct diagnosis. With the access to healthcare being as bad as it is in these communities like of that of Yesterday this might be an alternative that might discourage them from waiting in line with a great possibility that they might not even get seen that same day.

A great example of how we are interconnected on a global scale and sacrifices that people like Farmer and Deo as well as the school teacher in Yesterday and Yesterday herself is that of an African American doctor whose name was Dziwe Ntaba who left his job in New Jersey and went to work for the clinic in Kayanza, Burundi with no pay. This is a lesson that all the people reading the book can take in, and see that there are tremendously generous people who are willing to make sacrifices so that others could receive better access to healthcare. Also, Farmer contributed to the clinic built by Deo by asking a nonprofit organization called the Solar Electric Light Fund to help Kayanza( Kidder:257).

An illustration of global interconnection I believe would be that of HIV. When the disease broke out it did not discriminate and it made everyone look over borders of what and why this disease is taking place, not just in South Africa but also in the back yard of the wealthiest nations. Since, we are all interconnected on a larger scale in this world. It is up to us to take action to make changes and take guidance from such characters like Deo and Farmer “We have to think of health in the broadest possible sense,” according to Farmer (Kidder, 2003: 91). The characters displayed great courage, moral aspiration and devotion to others in their toughest of situations. As a reader one can draw lessons from these individuals and try to follow in a similar path. Helping those less fortunate and realize that there is a world outside the boundaries of our daily lives, and that people are dying because there not receiving adequate or necessary medical needs due to lack of access to healthcare.

References:

Strength in What Remains: Tracy Kidder (2009)

Mountains Beyond Mountains: Tracy Kidder (2003)

Please, visit my site Healthstood.com to find this article and future articles that I will write in the health blog section.

My goal is to make healthstood.com a site where individuals cannot only find useful resources but, also a platform, that is easy for you to get better informed about your health. This site is stood to make it easier for people to learn about their health options. It’s designed to be a health directory to make it easier for people to find clinics, hospitals, pharmacies and health events. By, allowing you to navigate through the map to find great health options near you. You can then, read other’s reviews and make an informed decision about a your health.

We believe you are here because you stood up for your health and we want to help you keep standing up for your health and those around you by allowing you to share health events like that of walk for the cure’s as well as others that you might be coordinating or attending. We want to hear your feedback so, that other’s can know what to expect at such an event. Event listings are not limited to just walk or run organized events but, also dinners and other fundraisers. This can also, be just a meeting as long as it’s for a health cause. Please, share those events so that others can get involved or find ones that you can get involved in.

Healthstood we strive to make finding great healthcare and events easy because, here at Healthstood the importance of your health and those that you care about is understood!

A Complete Multi Faceted Approach To Nutrition And Disease

Many terms have come to define the complex symptom set and chronic disease inter-relationship that is generally recognized as the metabolic syndrome, a precursor to the modern scourge, adult- onset diabetes. Encompassing elevated lipids and glucose, high blood pressure, central adiposity and other signs and symptoms, this is the clinical manifestation of the American obesity epidemic. Nutrition texts refer to a toxic food environment.

Each quarter, I explain to students that this phrase has a dual meaning. We live in a predominantly couch-friendly, TV marketing environment that is toxic, with ads featuring highly refined foods. At the same time, we are eating food that is, in fact, toxic, adding to the metabolic burden on our bodies. Though modern medicine relies on various pharmacological therapies, reversing diabetes and obesity must focus foremost on education, prevention and lifestyle change. Diet and exercise ought to lay the groundwork with herbs, specific phytochemicals and nutritional supplements playing supporting roles.

Modern Nutrition

There is no question that our diet has changed drastically over the past 75 years. Factory food production has been geared towards corporate profits, with food preservation and refinement taking the lead, while nutrients have been stripped from the finished product. In more recent decades, greater sums of flavorings, colorings, stabilizers and preservatives have become part of factory food recipes, not to mention pesticides, agricultural – chemical residues, and of late, modified genes (GMO). The government and academic institutions have been complicit as well.

Take for example the old Department of Agriculture food pyramid with grains as the base; a recipe for diabetes. The new pyramid, laid out differently, is little improved. I advise my students to put vegetables, legumes, other plant foods, wild and grass-fed animal proteins, and some fruit near or at the base, and move grains (way) up the pyramid, if they choose to use this illustration at all. An entertaining online pursuit is perusing mypyramid.gov and then mypyramid.org, the former being, of course, the official site. The latter is a parody brought to my attention by a former student.

A decade ago, I attended an organic farming class at Rutgers, the State University of New Jersey. It took place in the Center for Advanced Food Technology and Nabisco Advanced Food Technology Institute. Clearly, industry money is influencing research, especially in an environment of financially strapped state colleges. In fact, a recent study on nutrition research out of Boston showed that four out of five studies funded by food industries were biased to show results favorable to their sponsors. In food processing, one of the first macro-nutrient components to be removed was dietary fiber, the matrix that holds plants together and incorporates key phytochemicals in its structure.

Fiber

There is a direct relationship between the inclusion of dietary fiber in meals and the bodys glycemic response to specific foods. Soluble, viscous fibers especially slow glucose absorption by slowing transit of food through the upper gastrointestinal tract. Found in legumes, citrus whites, apple skins, berries, various fruits, grains and other food, pectin, gum and mucilage can also lower blood cholesterol by binding with bile acids and aiding their excretion.

Much research is being conducted on how the body utilizes both soluble and insoluble fiber. Many think fiber goes unused. However, soluble fiber is partially broken down in the gut, yielding energy, vitamin manufacture and immune enhancement by nourishing flora and by extension, colonocytes. Insoluble fiber aids passage through the lower digestive tract and plays other roles. By eating more fibrous foods in general, we are likely to consume more health-promoting constituents in addition to phytochemicals. Lignans, for example, perform phenomenal tasks in the body though a lesser role in lowering risk of diabetes. For 75 cents per pound, one can purchase lignan-laden flaxseeds that may prevent and control breast, prostate and other cancers.

Several companies have combination formulas of powdered, soluble fiber-rich blends. These are often a considerable step in quality above commercial brands and are sometimes made without psyllium and oats, to which some individuals are intolerant/allergic. Encapsulated products are also available, though more costly, but may boost individuals adherence to a nutritional program. Powdered fiber products are invaluable for increasing overall fiber consumption and slowing glucose absorption. In fact, some individuals would get more fiber in 1 or 2 scoops of a particular fiber formula than they may get in an entire days diet. The FDAs daily value for fiber is set at 25 grams; however, few Americans consume this quantity. It is telling that traditional cultures, many of which ate 3-5 times as much fiber, had no diabetes. Compare these quantities to the average Americans daily intake of added sugar, approximately 30 teaspoons per day.

Sugar and Spice

I often ask students to consider the historic availability of sugar (and most commonly used vegetable oils). I once heard the respected herbalist, David Winston, speak of the same. Obtaining sugar was a difficult, seasonal process at best. Sugar was available certain times of the year from whole foods, fruits and vegetables, not in soda, juice, and an array of cookies and candies. It was prized and stored in the whole food matrix, dried, used to ferment, etc. The takeaway: instruct your patients and clients to step out of the box and eat whole foods rich in fiber and phytochemicals. Furthermore, we can take advice from NYU nutritionist Marion Nestle and walk the perimeter of grocery stores. The healthier foods generally live along the walls, and there appears to be less shelf-talking advertising.

Our ancestors knew there was more to spice than flavor. Cinnamon, like flaxseed, is an inexpensive food that can have profound health effects. Studies show that a gram or two per day of cinnamon may lower serum glucose, triglycerides, LDL cholesterol and total cholesterol. More than 170 million people worldwide suffer from diabetes, and for many, drugs or other forms of treatment are unavailable. It may be possible that many of these people could benefit from readily available natural products such as cinnamon, according to Don Graves, Adjunct Professor of Molecular, Cellular, and Developmental Biology from the University of California at Santa Barbara. Using advanced imaging techniques, Graves and other researchers found a proanthocyanidin compound in cinnamon that can affect insulin signaling in fat cells, thus proposing that cinnamon has insulin-like activity. This may not be news to many practitioners, but it is likely to be surprising and interesting to the average patient who has no idea that a simple kitchen spice can be so powerful.

Preliminary studies from the Japanese National Institute of Health Sciences show that chocolate may slow or prevent pancreatic carcinogenesis. Chocolate also contains proanthocyanidins and has diverse health benefits. Raw, sugarless cacao powders are available on the market. These can be mixed with chai, which usually contains cinnamon (and other phytochemical-bearing herbs), or concentrated foods such as solid extracts of berries.

Common to the Southwest, the prickly pear (Opuntia spp.) may offer promise in diabetes treatment and management. Mexicans eat the pads of this cactus, a notable source of gut-soothing mucilage, as nopalitos. The plants range is actually quite far-reaching as I have seen it on barrier islands off the Jersey Shore. In Spanish, the fruit of prickly pear is called tuna. It is rich in quercetin, a neuro-protective flavonoid common to many vegetables, fruits and herbs. Prickly pear may at least provide a demonstrative link for those with Type 2 diabetes. Traditional and available ethnic foods, including okra – another mucilage-bearing food can be used in preventing diabetes because the mucilage slows the absorption of sugars. Meal planning may include soluble fiber rich Anasazi or black beans, lima beans, or black eyed peas, along with nopalitos or okra.

Distinct medicinal food-herbs are also valuable dietary options. Herbs high in mucilage are slippery elm (Ulmus rubra) bark and marshmallow (Althea officinalis) root. Made into an unboiled tea, an infusion, the herbs thicken into a goo that provides a slimy, protective layer to the lining of an irritated digestive tract or sore throat. Moreover, diabetics should eat sources of complex sugars such as inulin found in Jerusalem artichokes (Helianthus tuberosus) instead of potatoes. Complex sugars from Helianthus and other foods, such as asparagus and salsify (Tragopogon porrifolius) digest more slowly, thus less sugar builds up in the bloodstream. These foods also fortify the lower digestive tract by nourishing gut flora.

Nutrient and Phytochemical Supplements

Prevention and management of diabetes can be enhanced with nutrients and phytochemical supplements. Alpha lipoic acid, for example, is a versatile nutrient for diabetic treatment. In addition to inhibiting glycation and therefore helping to prevent diabetic complications, such as diabetic neuropathy, lipoic acid performs other roles in antioxidant recycling and manufacture, and promotes efficient cellular energy production. For treatment purposes, 600-1,200 mg daily are recommended, while 100-300 mg daily may be recommended for prevention. Alpha lipoic acid is also helpful in treating chemotherapy-induced neuropathy and may offer hope to those with fluoroquinolone antibiotic-induced neuropathy as well.

Other nutrients critical to diabetes prevention and management are B vitamins, which are needed for metabolism of all macronutrients, and may also aid in treatment of neuropathy. Trace minerals such as vanadium and chromium play crucial roles, and few strategies for ongoing wellness are complete without additional magnesium and zinc, as they are vital to numerous enzymatic reactions and are frequently deficient in aging populations.

Generally, for those with insulin resistance, 10-40 mg of supplemental zinc and 100-300 mg magnesium are sufficient for enhancing immune response and reducing cardiovascular risk, respectively. Both minerals also contribute to bone health. Various studies show that chromium stabilizes blood sugar by enhancing insulins activity. In other studies, individuals who took additional chromium (200 mcg per day) gained muscle and lost fat in greater sums than controls. Improved body composition, body mass index and shrinkage in waist circumference (central adiposity) are directly linked to better outcomes for diabetes patients.

Many of the nutrients critical to blood sugar management are often combined in quality formulas available through healthcare practitioners. They now often contain vanadium, which decreases plasma glucose levels and has an insulin-like effect. Insulin and glucagon are not the only important hormones related to diabetes. According to Donald Yance, excess insulin in the bloodstream promotes the production of estrogen and reduces the level of sex hormone binding globulin (SHBG). SHBG is a plasma protein that binds and transports sex hormones, including estrogen and testosterone. SHBG receptor interaction depends on the occupancy of the steroid binding site. It is recommended to measure total testosterone, free testosterone, SHBG, DHEA sulfate and a thyroid panel.

Low testosterone with high estrogen can also cause an increase in fat storage. Studies have found that serum testosterone is decreased in markedly obese males. This is due to a reduction in SHBG. This can cause peripheral conversion of testosterone to estradiol, which can cause fat accumulation as well as lean muscle loss.

SHBG is also critically important to proper insulin control, as well as estrogen. A reduction in SHBG is associated with hyperinsulinism and insulin resistance. High fasting insulin levels are noted to be an independent predictor for ischemic heart disease in men. According to a recent study, low androgen levels in men correlated with increased risk of atherosclerosis. Yances Natura Health Products offers a supplement called Night Gain. It combines testosterone-boosting and estrogen-metabolizing nutrients and phytochemicals with amino acids such as arginine for cardiovascular benefits. Night Gain enhances sexual function and sleep and is helpful to both sexes, with or without insulin resistance.

Generally, I recommend 2-6 caps in divided doses in the evening. Milk thistle (Silybum marianum) offers promise in treating diabetes. In a recent study found in Phytotherapy Research, moderate dosing of roughly 600 mg silymarin daily has shown to lower various markers associated with diabetes including hemoglobin A1c (HbA1c). Using milk thistle is especially advantageous because of its protective effect upon the liver, an organ greatly stressed in obese individuals. It may also prevent prostate cancer and is currently being used for treating the disease.

Liquid herbal extracts are especially useful for diabetes management because of their relatively rapid digestion and absorption. A useful liquid formula for mild insulin resistance is Pancreaid, a product from Herbalist and Alchemist, formulated by herbalist David Winston. The blend contains dandelion root (Taraxacum off.), blueberry leaf (Vaccinium spp.), gentian root (Gentiana lutea), Devils Club root bark (Oplopanax horridus), Gymnema (Gymnema sylvestre) and cinnamon (Cinnamomum cassia). Bitters like dandelion and gentian roots have traditionally been used to normalize blood sugar levels and to help the beta cells in the pancreas to utilize endogenous insulin. Blueberry leaf, Devil’s Club and Gymnema have been used throughout the world for adult onset diabetes. Studies on Gymnema show a pronounced amphoteric effect on the Isles of Langerhans in the pancreas-nourishing, strengthening and normalizing function, according to Winstons manual, Herbal Therapeutics: Specific Indications for Herbs and Herbal Formulas.

Anthocyanins

The leaves of blueberry are not the only useful part. The pigments that come from blueberries (bilberries), black currants and other berries, as well as the skins of some vegetables anthocyanins have marked therapeutic effects. I recommend a highly concentrated 80 mg anthocyanin capsule (MEDOX Optimal) for any client with diabetes to slow the multisystemic degeneration associated with the condition.

MEDOX is a veg-encapsulated anthocyanin extract from wild Norwegian bilberries (Vaccinium myrtillus) and black currants (Ribes nigrum). MEDOX is produced in Norway by MedPalett Pharmaceuticals and the Biolink Group. Consumed in Norway and throughout the European Union as a phytoceutical sold in pharmacies and doctors offices, MEDOX is now a powerful botanical ally for Americans. Existing in a phytochemical color spectrum that moves through red to purple and deep blue, the pigments in MEDOX contain unique biological activity in humans. Few, if any other, products on the worldwide market have the intensity of color that indicates such a threshold of powerful and concentrated anthocyanins.

A unique and patented technology provides for large amounts (80 mg) of anthocyanins per capsule. The capsules are processed using chromatographic membrane technology. The special processing allows free and complete anthocyanins to quickly penetrate plasma at an affordable cost per milligram yielding sustained levels in connective tissue. The absorption and beneficial effects of MEDOX have been clinically documented at Scandinavian university hospitals and clinics.

Anthocyanins have proven efficacy for a range of modern medical problems, especially those related to the cardiovascular system, nervous system and eyes. MP865, the anthocyanin blend found in MEDOX, is also known to regulate healthy cell proliferation, blocking progression of cancer at various stages. Anthocyanins have demonstrated to be powerfully anti-leukemic. Preventing invasion of cancer by reinforcing the strength of collagen and blood vessels, anthocyanins from MEDOX induce apoptosis, organized cancer cell death. They also discourage angiogenesis and inflammation, major factors enabling cancer to spread. In this sense, MP865 from MEDOX is carcinostatic and anti-metastatic. Studies have been/are being conducted on anthocyanins and MEDOX for prostate, lung, brain, gastric, esophageal and colon cancer, though it may prove to be effective on a wide range of cancers.

Anthocyanins from bilberry are perhaps best known for the roles they play in protecting the eyes from injury related to oxidative stress and poor capillary microcirculation, such as macular degeneration and cataracts. Bilberry anthocyanins improve night vision and retinopathies. Mitigating and reversing complications related to diabetes and insulin resistance is a unique domain of anthocyanins in that they protect the blood vessels, eyes and kidneys. Furthermore, studies from Ulleval University Hospital in Norway indicate that 2 caps daily of MEDOX Optimal lowered C-reactive protein (a marker of inflammation) by 28% after two weeks. Though this study was performed on a small sample size, compare the results to 17% reduction for statin drugs, which bear considerable side effects.

Other as yet unreleased studies from Ulleval show significant decreases in resting heart rate and blood pressure after short-term MEDOX therapy. Anthocyanins (from MEDOX) are safe and effective and have no known side effects or contra-indications. In practice, I have clients pair MEDOX with blueberries (and other berries), which contain the soluble fiber, caloric and other nutritive components. In the colder months, I also recommend blueberry solid extract, a delicious concentrated paste made by Herbalist and Alchemist that clients can spread or mix in smoothies.

Anthocyanins are efficient atherosclerosis fighters through their ability to counter oxidants. Studies have shown anthocyanins to lower oxidative LDL levels, which are significant risk factors for cardiovascular diseases. Anthocyanins have a proven ability to protect the integrity of the endothelial cells lining the blood vessels. They regulate nitrogen oxide synthesis, offering further cardiovascular and erectile support. The resulting effect of taking MEDOX anthocyanins is smoother, better dilated, more flexible and stronger blood vessels.

In theory, MEDOX and anthocyanins paired with magnesium supplementation should greatly reduce risk of sudden cardiac death and stroke, thus I often recommend them in combination. The preceding interrelationships of anthocyanins’ benefits offer promise for improvement in the big picture of the diabetic tangle.

Conclusion

Patients and practitioners are looking for new ways to manage various chronic diseases, including those related to insulin resistance and diabetes. A multi-faceted approach must ultimately be part of diabetes treatment. We can start with education for prevention, diet, lifestyle modification and exercise. Supportive nutritional and botanical therapies can also play vital roles before reliance on multiple medications (polypharmacy) and more costly interventions.

What Are the Strengths and Weaknesses of a Flexible Spending Account (FSA)?

Q: My company is considering instituting a Flexible Spending Account (FSA) benefit. While it sounds good, what are the strengths and weaknesses of a FSA? Are there any special benefits to New Jersey residents?

The Problem – Determining if an FSA is Beneficial
New Jersey (NJ) ranks in the top 30% most expensive states in the U.S. for health care costs. Healthcare costs are rising 8%-10% per year and are likely to grow two to three times the rate of inflation for the foreseeable future. NJ ranks in the top 20% most expensive states for child care for pre-schoolers. Employers are shifting more child care, healthcare and insurance costs to the employees – forcing employees to evaluate FSA’s.

The Solution – Flexible Spending Account
Imagine getting over a 40% discount on your healthcare and child care costs. That is essentially what a FSA provides. Contributions to an FSA are made on a pretax basis and can be used to pay for Unreimbursed Medical (URM) and Dependent Day Care (DDC) costs.

Contributions avoid both federal income taxes (top rate 35%) and Federal Insurance Contributions Act (FICA) tax of 7.65%. Employers also avoid paying FICA taxes on employee contributions. The wonderful state of NJ is one of the only states that assess a state income tax on FSA contributions.

Unreimbursed Medical (URM) Costs
There are a wide range of items covered, including: prescribed and over-the-counter medication, eye glasses and contact lenses, crutches and hearing aids, and nicotine patches. We all know we should visit the dentist twice year for a checkup.

Unfortunately, many employers offer modest dental insurance plans, leaving employees with large out of pocket costs. Many dental insurance plans have $1,000 or $2,000 family limits and cover only “reasonable and customary” charges. In NJ, that could leave you paying $600 for a $1,000 procedure.

Dental examinations, cleanings and fillings are all covered medical costs through an FSA. While paying $600 out of pocket for a dental procedure is not easy to swallow, at least getting a 40% discount is palatable. Often overlooked FSA items include: insurance co-payments and deductibles, in vitro fertilization, and physician-prescribed weight loss programs. There is no federal limit on contributions to FSAs for URM costs.

Dependent Day Care (DDC) Costs
Two groups of dependents are permitted under DDC:
1) a dependent age 12 or under who entitles you to a personal tax exemption and
2) a spouse or other dependent that is physically or mentally unable to care for herself/himself. Qualifying expenses include: care outside of the home, dependent care center and payments to relatives (as long as they are not your dependent). One often overlooked FSA item is summer day camp that is primarily custodial versus educational. The federal limit on contributions to FSAs for DDC costs is $5,000 per year.

Use it or Lose It
Take the time to determine the qualifying expenses you expect to incur throughout the year when establishing your contribution amount. Over estimate and your unused contributions will be forfeited if you do not utilize them by the end of your employer’s plan year. Even if it means running out to the pharmacy on New Years Eve to stock up on aspirin, do not let your hard earned money go to waste. With a change in laws, starting in 2005, some employer plans allow for purchases through March 15th of the following year.

Action Steps – Utilize Your FSA
If your employer offers an FSA take the time to estimate your URM and DDC costs and contribute to your FSA. If your employer does not offer an FSA encourage them to consider one. Not only will it be viewed as a valuable benefit to attract and retain employees, but it can also save the employer taxes.

How To Become An LPN

An LPN (Licensed Practical Nurse) is a nurse who collects the medical details (blood pressure, weight, height, etc.) of a patient who enters a medical facility. In some states, they are called LVNs (Licensed Vocational Nurse). Because the details they collect are used to help diagnosis of patients, LPNs are important members of health teams.

Learning how to become an LPN is now simpler than ever. The internet, and articles like these, make it easy to learn the process.

The process to become an LPN is not very complicated. For example, if you are looking into becoming an LPN in New Jersey, you will see that the process is very straightforward; take some classes, take a test, get your license!

However, before you get started, it is important you understand that the roles of an LPN vary with states. For example, an LPN can prescribe medication in Florida, but not in Massachusetts.

The requirements will vary from state to state, as well. In most states, you must have a high school diploma before you apply for any LPN program. Technical and vocational schools offer the LVN program for a period of one year and award the successful nurses diplomas.

But in all states, demand for LPNs is high. As such, the restrictions to practice as an LPN have been greatly reduced because of the shortage of LPNs in states like Pennsylvania, Maryland and New Jersey.

The training requirements for LPNs do vary from state to state, though. Even though different states have different training requirements for LPNs, the National League for Nursing Accrediting Commission accredits programs to show that the curriculum produces adequately trained students.

Before an LVN program is accredited, the trainers must be qualified and the course must satisfy all relevant requirements fully. Most of the LPN programs in the US are advanced with both online and offline (classroom) teaching sessions.

The courses usually include instruction in the fields of biology and pharmacy. LPN programs are mostly carried out in medical centers like rehabilitation centers and nursing homes. The training process is normally supervised by a registered nurse. However, another LPN can supervise such a program, too.

An LVN program usually lasts for around 12 months based on the educational program’s guideline. In other words, it is possible to start working and get a job as an LPN 12 months after you enroll for the program.

LPNs advance their professional qualifications with ease because of their medical field experience. If you have an interest in getting a job as an LPN, it is necessary to start with an LPN program. If this is the right job for you, you will definitely not have any regrets!

Once you finish your training, the process ends with licensing. LPNs are licensed by the state after passing a special exam called the NCLEX-PN. In most states, you will need to renew this license every few years.

As part of the renewal process, it is compulsory to produce a written proof that shows nursing employment.

Anyone interested in becoming an LPN is advised to find an accredited LPN program right away. Becoming an LPN is a great opportunity to work in the medical field. Becoming an LPN gives you the responsibilities of a registered nurse, without the legal liability. It’s a great entry-way into a lucrative healthcare career!

If you’re interested in learning more about becoming an LPN, check out LPN Programs HQ [http://lpnprogramshq.com] to learn more about the process and find training in your area. If you are in MA, you should check out the page on LPN programs in MA [http://lpnprogramshq.com/lpn-programs-massachusetts-ma/].

Giving Yourself A Competitive Edge

When I was seventeen, I remember going to the “new” Cherry Hill Mall in New Jersey when it opened in 1962. Many teenagers used to go there often – then and now. Today, I sit on one of the benches while my wife shops. I look for anyone passing by older than I am. I rarely see anyone. Time passes – and a lot faster than you might expect – so the time to act in improving your future is now, not later. Here’s some of what I’ve learned that I pass on to help you or to help your sons, daughters, or grandchildren:

Focus and Specialize

While having general knowledge in your field can be useful, today is the day of the specialist. Find what interests you and laser focus on it. It’s very easy to get distracted. I made a career of doing that: customer service manager, convenience store franchisee, Congressional campaign manager, real estate broker, NJ approved real estate school director and instructor, adjunct college professor at six colleges, full time business administration faculty at Atlantic-Cape, Stockton and Camden County College, and author of seven books. Not always unrelated, but certainly not as related and as focused as it could have been – and that has consequences.

Sometimes not focusing won’t all be on you. Your job may force it on you. In law practices, attorneys can get pulled into a variety of different areas, making it more difficult to stay focused. That’s a situation not isolated to the practice of law either. While it may make focusing more difficult in these circumstances, try to identify what you want to focus on, then make any extra effort you can to do it. Time constraints can make this difficult, but otherwise the tail is going to keep wagging the dog. Just take as much control as you can to put the focus where you want it to be.

While money shouldn’t be the focus of a successful life, it surely can be an important component of it. One of my high school classmates knew he wanted to be a pharmacist. He worked in a Gloucester City pharmacy while we were at Gloucester Catholic. He graduated, went to pharmacy school, and later became the Chief Pharmacist at one of Philadelphia’s leading hospitals. He knew early on – a big advantage – and he was focused. Even though he went ahead a few years ago, I still admire the focus he had. He also made about two and a half times more annually than I’m making now, near the end of my career. Obviously, his focus paid off.

Another of our classmates was a student of “modest accomplishment”, like I was. We both would be the first to admit it. However, when he graduated he went to a fine college where he became highly motivated, subsequently went on to a lengthy post-graduate program and became a highly successful professional. It would be very safe to say he’s far exceeded the two and a half times figure above. He wasn’t focused early, any more than I was, but he surely turned that around – big time. He made the necessary changes. It made all the difference. So find something you can truly focus on, specialize as much as you are able to and go for it.

Get An Advanced Degree and/or Certifications – Or Maybe You Don’t Even Have Your Bachelor’s Yet?

If you’re talented, you may not have too much difficulty finding a good position. The question though is how far are you going to be able to go with it in the intermediate and long term?

I tell my Management students that in order to get a job, they need to create significant differential advantages over other candidates to get hired. Just saying, “I’m Jack or Jill and I have a Bachelor’s degree” isn’t going to cut it. (Especially when over 35% of NJ adults already hold Bachelor’s degrees.) I recommend that they learn to speak other languages, maintain an exceptional GPA, take foreign study programs, experience foreign travel, take online courses for improved flexibility and time management, gain relevant experience in the field they are planning to enter, and build their contacts, especially in fields and organizations they aspire to. LinkedIn is designed to help do that, but professionals should become well-versed in all major social media, to facilitate properly promoting themselves and their organizations.

(But what if you don’t even have your Bachelor’s degree or training in a skill that’s in demand? Maybe you think there isn’t any rush. You’re wrong. There is. I told you already how fast time went for me – from seventeen to seventy-three in no time. It’s not going to go any slower for you. You’ll be forty before you know it! And how much extra income are you sacrificing every year by just working at odd jobs or in a job that’s taking you nowhere? Income that could make you more independent – instead of having to just slink through life depending on your parents or others. Everyone has a valuable talent in something. You do too. Get started and find out what it is and focus on it until you’ve started your own road to success. Make an appointment at a local community college’s Advising Office. Take an interest test and listen to the advice you get. There are many options for you. You might be a late starter, but you can still be a strong finisher!)

For anyone who already has his/her Bachelor’s degree and a position, the same “distinguishing characteristics” logic above applies, except that you need to do some different things:

Getting a Ph.D can be one of them. Opportunities for promotion, the ability to teach on the university level, to do research, to get published, and to have greater credence in your field are all benefits that can emanate from this. I wish someone had told me this a long time ago. Wait… Someone did. When I was in my thirties, I thought that just by being recognized as a highly rated teacher and writing books, it would make me a tenure candidate at a four year school. Someone even told me flat out, “You’ll never go anywhere in education without a doctorate.” But I knew more, of course, just like you might think you do now with the limited knowledge you have. I never got a doctorate. While I may not have ever been promoted beyond my current modest academic rank, I ensured it by not getting one. That could be you if you don’t do what you might need to do.

This isn’t a gripe or crying over spilled milk. I made my choices. We’re bound by all the ones we made. After all, who was the one who was always there when the decisions were made?

I’m very fortunate to have the position I have and I appreciate it. This is just an attempt to get you to think about your future and to do something about it now, not when you’re past fifty, when it might be too late to make a substantive difference. Many of my colleagues have gotten their doctorates, even in their fifties. I really applaud them for it. Better late than never. But I’m sure all of them would tell you, it would have been far better to have done it sooner than later.

Obtaining a JD, a law degree, is another path. It is very true that even excellent law school graduates often have difficulty finding a position in the law, especially if they are seeking a position in private practice. However, a law degree can add prestige to a resume, and provide valuable legal, analytical and writing skills. It can also be a real plus when applying for a higher level position in your current field, or in another one. A law degree can be used in the military, business, human resources, educational administration, college teaching, and federal and state government administrative, research and analytical positions, among others.

It is almost a knee-jerk reaction for business administration majors to go for an MBA as a higher degree. If I were in that position again, I would get a JD instead. It’s a doctorate. That enables the holder to teach at the university level. It is also a more prestigious degree. MBA’s might be able to teach as adjunct university instructors, but almost never as full time faculty.

A “doctoral equivalent” for accounting majors, after a Master’s, can be to obtain a CPA. That is considered by a number of universities as the equivalent of a terminal degree in that field.

Sometimes a Master’s may do the trick. It’s very important in fields such as physical therapy, speech therapy and nursing. Similarly in nursing, it can be very wise to obtain an advanced credential as a Physician’s Assistant or Nurse Practitioner. These are what I call “intermediate professional positions”, between being a nurse and a physician. They have a strong future. Analogous to this is becoming a Paralegal, between being an attorney and a legal secretary. Just ask yourself this. If you managed a law practice or a hospital and could hire two or three of these employees for what it would cost to hire one attorney or one physician – when they perform some of the same functions – what would you do? That’s why there is only going to be continued growth in these professions.

One Master’s modification may be necessary when applying for an elementary or high school teaching position. It can often be better to get the job first with your Bachelor’s. Then after you get it, get your Master’s to make more money and have a more substantive professional credential, one that may also enable you to teach in a community college later. Normally, I would suggest getting a Master’s as soon as possible in any field, but school districts often don’t want to hire candidates with Master’s up front and strain their limited budgets. One caution: Some positions do require a Master’s to get hired, so check the job announcement carefully to determine if there is any such requirement.

Other avenues for creating strong “differentials” include obtaining fellowships, judicial clerkships, Board Certifications in the medical field, and certifications in other fields, both professional and technical. There are hundreds of computer,manufacturing and technical certifications that can be investigated too. Speak to professors in respective academic departments to advise you. It can all help. They can give you an edge in hiring, promotion and salary improvement.

Your competitors are going to have one or more of the above. You should think seriously about being more competitive yourself. Do what needs to be done. Not just what you feel like doing. Keep in mind that even successful people don’t want to do some of these things, but they do them anyway.

One of my cousins, who is the Vice-President of the Board of Directors of well known national company, previously served as CEO there and at several other national corporations. This necessitated a number of moves to Baltimore, New England, Wisconsin, Canada and many other locations for decades, as well as his having to travel throughout the world frequently. He, and his wife, knew what these jobs entailed when he took them and did what had to be done – and they did it well. That’s why he’s successful. That might not be for you, but whatever you choose to do, you have to be prepared to get the job done, whether if it’s operating an auto body shop, running a restaurant, operating a heavy rental equipment business or running a funeral home.

I’ve been a full time college professor for thirty-two years, an adjunct professor for seven years before that, and an approved real estate instructor for twenty years. I cost myself a great deal of money by not getting a law degree or Ph.D. as an educational credential. Probably at a minimum average of about $20,000 per year for thirty years – well over a half a million dollars. Do you want to lose that kind of money and lose the opportunities for promotions in your career because you lack the proper credentials? The same goes for more credence being given to much of what you might say or write. At my age, I’m not going to be making many changes. But it’s not too late for you.

Make A Change If You Need To

Its not uncommon today for workers to change positions a number of times and even career fields two or three times. This can be next to impossible for those who don’t have high level credentials and certifications. They give you flexibility. I can’t do much about that now, but you can. Please don’t think – “poor him”. Think instead “possibly poor me”, if I don’t do something about this while I’m still able to.

Sometimes when progress is stymied in a particular organization, or in your field, because a promotional path seems likely to be blocked for a long time, or there is serious difference of opinion on organizational matters or a disconnect with personalities, it might be best to make a change. Speak with some reliable mentors to get the pros and cons of doing so. Sometimes making a change can lead you to where you would do a lot better. It can make all the difference.

Finding True Happiness and Success

My Management lecture and online courses are about 70% Management and about 30% self-help in finding happiness and personal success. “Self-Management” is a necessary prerequisite to being a good manager in any field. And all fields, not just business, require management. It would benefit any student to take a Principles of Management course. I offer it, principally online. Anyone from anywhere in the world can take it through Camden County College, registering through CamdenCC.edu WebAdvisor, or through the College’s Registrar’s Office.

Success is something you need to define for yourself – and it’s not just about money. That’s one thing positive psychologists agree on.

I read a superior post on LinkedIn about a grade school teacher who sent home a message to Thomas Edison’s mother about him. His wise mother took a very negative portrayal and turned it into encouragement that produced a genius. I commented on it:

“This is an outstanding short – with a huge message. What people say to someone can provide the encouragement to discovery and success. Similarly, how many of you have heard of someone being told, “You’re not college material.” Perhaps sometimes they were right. But what about all those who got discouraged because some supposedly knowledgeable, but not too prescience or tactful “superior”, defined for them what was going to be possible in their life. Believe in yourself and possibilities. Thomas Edison’s mother did. It worked out well for him – and the rest of us too.”

We can all be Edisons in our own special way. Start building bridges to your own potential – no matter how old you are or what your station in life is now. George Bernard Shaw was asked near the end of his life, “Who would you have chosen to be if you could have been anyone else. He said, “I would be the man George Bernard Shaw could have been, but never was.” It is never too late for you to become that person.

That’s the version of yourself you should strive for every day, so you have fewer regrets at the end.”Of all the words of tongue or pen, the saddest are these: It might have been” – Rudyard Kipling. Now’s the time.

Need motivation yourself? Visit my extensive “Happiness and Success ” website at Camden County College. It will encourage you and it will help you:

Finding Happiness and Well-Being, Success, Motivation, Innovation, Reinvention and Becoming A Better You

It’s not just for college students. It’s for anyone of any age and any occupation or profession seeking real gratification, peace and contentment in their lives.

I guarantee that it will improve perspective for anyone who takes the time to read the over one hundred and ten positive psychology and self-help topics it contains. Read a few each day or at night before going to bed. I would encourage any employers to point their employees toward taking a look at it or to use the topical summaries in their own professional development courses. It’s the type of material that Chief Happiness Officers (CHO) would use. The website log-in appears below:

Happiness and Success Course Log-in:

– Go to: ccc.webstudy.com

– User Name: happiness

– Password: success

– Click Happiness, Success and Motivation Course

– Then “Timeline” on left

– Then “Expand All” at the top

– and You’re In! Scroll down to view the fifteen website segments and the many readings that can be clicked on, including two of my books. One is Your Unfinished Life. If you’re still breathing, you have one.

You don’t have to reinvent the wheel to be successful. Just pay better attention to some of the good advice you might be getting – and choosing to ignore. Far better to ignore those who tell you that you don’t have the right stuff. Be the best of what you are capable of becoming. Don’t sit rocking in a chair on a porch someday far in the future with regrets about what you could have done. Do something about it now.

Danger! Fungal Infections in Arthritis Joints From Contaminated Steroids!

The ongoing epidemic of fungal infections from contaminated steroid injections is going beyond the brain and spinal cord to include the many joints injected by arthritis specialists. The medicine, methylprednisolone acetate, is a commonly used prescription steroid for the treatment of inflamed joints. Since rheumatologists often inject joints in patients with arthritis, this presents a potential problem.

While infections in the spinal cord and central nervous system present fairly quickly following injection, it is apparent that joints injected with contaminated steroids may take several months to produce symptoms. According to Dr. Kevin McKown of the University of Wisconsin Medical Center, new cases of fungal infections in joints may present for the next six months… or even longer!

Unlike the brain, joint infections can remain indolent which leads to delay in diagnosis.

There have been at least two cases of joint infections from contaminated steroids reported to the FDA as of November 1, 2012.

Symptoms suggestive of infection include, fever, pain, increased redness, warmth, and swelling in the joint that received the injection. Since this is also a sign of a joint flare from arthritis, an infected joint may not be easy to identify.

If the infection is not recognized, the fungus can spread and lead to osteonecrosis (dead bone), a destroyed joint, and also spread to other joints via the blood stream. In its most virulent form, it may cause death.

The compounding pharmacy responsible for this outbreak is the New England Compounding Center located in Framingham, Massachusetts. It was found guilty of selling large amounts of the medication across state lines. The New England Compounding Pharmacy sold lots of their drugs to clinics in more than 23 states before being shut down by the Federal Food and Drug Administration.

So far, the two species of fungus isolated have been Aspergillus and Exserohilum.

The major problem in identifying cases is that fungal infections are slow to develop and symptoms are not always recognizable after such a long period between symptom presentation and joint injection. For example, cases of meningitis often take anywhere from one to four weeks before presentation. Joints that have been injected can take much longer.

Of the many states reported to have received the contaminated steroid preparations, there are California, Connecticut, Florida, Georgia, Idaho, Illinois, Indiana, Maryland, Michigan, Minnesota, Nevada, New Hampshire, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Virginia, and West Virginia.

Taking the Pulse of Med Management, Clinical Execs Must Review Systems and Ensure Staff Engagement

Medication management may be one of the greatest clinical challenges in senior living, where the average resident may take four to six medications a day, or more. Yet the assisted living business has earned a reputation for consistent positive performance in this arena.

“A major reason people move into assisted living is that they need help with medications, so it is a service we take very seriously,” says Maribeth Bersani, ALFA’s senior vice president for public policy. “We are training people, we are monitoring them, we are doing it safely and doing it well.”

The numbers bear it out. Looking at all medication mistakes with the exception of time errors, assisted living shows an error rate of 8.2 percent versus 10 percent in hospitals, according to Heather M. Young, Ph.D. and GNP, et al. in their paper, Types, Prevalence, and Potential Clinical Significance of Medication Administration Errors in Assisted Living.

It takes a range of best practices for assisted living providers to score consistently high in the realm of medication management.

Internal Vigilance

Some 1.5 million people receive the wrong medication or the incorrect dose each year, according to the Institute of Medicine, part of the National Academies of Science. Yet assisted living has a history of positive procedures that help ensure accurate dosing, of-ten in response to systemic causes that originate outside assisted living.

Sandi Flores, RN points to poly-pharmacy as one example. “One of the major factors is the sheer number of meds our residents are taking,” says Flores, director of clinical services for Senior Resource Group.

To keep a handle on poly-pharmacy, assisted living communities implement a range of protocols, according to a survey conducted recently for the Center for Excellence in Assisted Living (CEAL). The survey found that 74 percent of assisted living providers make sure doctors or registered nurses review lab data for residents; 68 percent use consultant pharmacists, and 67 percent use blister cards or pillow packs from primary pharmacies. This type of packaging is a safeguard to ensure residents receive correct medication dosage.

Transitions also may be an issue, a time when drugs or orders can get mishandled on their way to the assisted living community. “The biggest problem we have found is when a resident is transferred [into assisted living],” says Loretta Kaes, RN , vice president of health services for Chelsea Senior Living.

Safeguards begin with a vigilant nursing staff, Kaes says. “I want the nurses to question the orders. If you see a resident on 23 medications, I want the nurse to ask which of these drugs possibly are overmedicating,” she says. Nurses likewise make it a point to reconcile the medications as delivered against those as prescribed.

New models also are emerging. Kaes has served with the Health Care Association of New Jersey, which has developed an even more streamlined system. The group has urged doctors to communicate directly with pharmacies, reducing the possibility of error and saving the nurse one step. “Otherwise, you spend 18 hours a day trying to chase the doctor down” in search of clarification, Kaes says.

Rise of the Med Tech

One of the most promising, and most effective, evolutions in medication management has been the rise of the medication technician, or med tech for short. Also known as trained, unlicensed assistive personnel (UAP), these individuals are authorized to deliver medications, freeing nurses to pursue other tasks. The use of UAPs is allowed in virtually every state. These valuable personnel are enabled to do a variety of tasks depending on the state, and are required to attain certain types and levels of training, again varying by state.

In the realm of medication management, “UAPs generally do remarkably well with this complex task. The bulk of the medications are low risk and routine, and the risks appear to be minimal,” Young writes.

While some states are questioning the use of UAPs, a growing body of evidence suggests med techs are an effective means for assisted living to maintain its high level of medical management assurance. “Where it is allowed, which is in most states, it is working very effectively,” Bersani says.

Success lies in training, not merely an introduction to “how” things are done, but also a view toward why. “These are intelligent people, you can’t just teach them a task. You teach them the rationale behind things, and that is when you see an increase in performance,” Flores says. With an understanding of not just how but why, “people are much more understanding of proper dosing, proper timing, and so on.”

To ensure information sticks, Flores issues hands-on testing in multiple topics. The student also must make three perfect passes under supervision before being allowed to fly solo. Delivering training throughout this nationwide organization relies in part on quarterly webinars, which Flores creates.

One more winning strategy for utilizing med techs: Dress the part. Many will think it is a small point, but Flores insists that uniforms for medication aids lead directly to fewer errors. “They are recognized as being something special, and so they act like something special,” she says.

Systemic Strategies

Underlying all these basic strategies, successful administrators demonstrate a commitment to a systematic approach to medication management. To get the right drugs and dosages into the right hands at the right time, appropriate systems must be in place and safety protocols must always be consistent and repeatable.

Best systemic practices in medication management cover a lot of ground. Strategies can be incredibly detailed. A few that are absolutely worth implementing include the following:

Get stakeholders involved. Staff, physicians, and pharmacists all should have a chance to offer input into the plan, since they will be the ones to put it in practice. Transfers are crucial. Check the labels of everything coming from home or from the hospital. Read back phone orders and don’t hang up without verbal verification. If a resident is self-administering, confirm every quarter that the resident is still capable of the task. “Success comes from having the right systems and protocols in place,” Kaes says. “By constantly reviewing and observing those who dispense medications, it allows us to ensure that people are getting the right medications in the right manner.”

The biggest and broadest effort has to do with handling procedures among the staff: where and how medicine is received, stored, and dispensed. Every residence will do this differently. So long as the procedure is easy to understand and simple to implement, the “how” will matter less than the assurance that the internal system is solid. It must be repeatable, and must be repeated consistently time after time.

Some add a further step: Ongoing auditing. It’s just one more way to ensure accuracy, says Patricia Foran, president of C.O.R. Services, a consultancy to the senior housing industry.

Foran has been on the front lines, having served as a vice president at Benchmark Assisted Living prior to becoming a consultant to multiple assistant living communities. Looking at the situation from all sides, she says auditing is a significant tool in keeping errors in check.

Given the possibility of human error, “you need to have somebody to physically monitor what is going on,” she says. In Virginia and elsewhere, the executive director has to be certified in medication management, so there’s a built-in auditor. Outside consultants also can play that role.

In a typical audit, “we are literally asking people to go on a med pass, and watching how the practice is being performed. Then you finetune it each time,” Foran says. “You need to do this no less than quarterly.”

For Further Assistance…

In the best examples, assisted living residences have looked beyond their own internal resources, getting families involved for cooperative efforts in such realms as co-pays and drug availability.

“I think the families have to be really aware that their family member is in a plan that covers all their drugs,” says Jody Silva Falk, vice president of client services at Chem Rx, a pharmacy serving about 30 assisted living residences. “They need to know their formulary changes every year and they need to stay on top of that. They need to take a proactive role in what’s going on with mom’s coverage.”

In addition to family participation, combined with skillful management of the human elements within the community, technological aids can simplify and safeguard various tasks on the way from prescription to administration.

Automated medication dispensing carts secure medications and track dosing regardless of where the resident may be at the time.

Web-based prescribing facilitates the electronic creation and transmission of orders from desktop to pharmacy. Multi-alarm reminders and watches alert users when it’s time to take medications. Multi-alarm pill boxes likewise deliver an alarm while also storing pills.

Automated crushers and splitters ease dosing by reducing pills to the appropriate size.

In barcoded medication administration, a handheld device is used to scan a barcode on the resident’s wristband ID and match it against coding on the package of the medication to be dispensed.

RFID (radio frequency identification) assists with accurate medication tracking and inventory management. “[Electronic medication management tools] can be a real help if, internally, you have a good computerized system already in place-if you have electronic file maintenance and other internal systems,” says Silva K.M. Gerety, corporate director of health and wellness at Brightview Senior Living.

No one would say medication management is a walk in the park. Certainly, there are potential challenges with polypharmacy, human error, and the long chain of involvement from doctor to pharmacy to nurses or assistant. Yet assisted living continues to demonstrate its ability to rise to the challenge.

“People who come to assisted living generally are getting their medication the way they are supposed to, on time, in the right dose. This is a huge benefit to our residents,” Kaes says.

Physician Medication Dispensing – A Healthy Choice for Primary Care Practices and Patients Alike

Working on the front lines of modern health care, the primary care physician is arguably the most important physician any patient comes in contact with throughout life. Yet, more than half of primary care physicians feel they aren’t getting credit where credit is due. According to a 2007 survey done by Merritt Hawkins & Associates, 53 percent of primary care physicians said they felt like second-class citizens in the medical hierarchy.

Why? Too much work and not enough pay. The same survey showed while 83.1 percent of primary care physicians considered their practices to be very busy or even too busy, 58.6 percent of those surveyed were disappointed in their income. Many struggled with the cost of overhead, and 22 percent worried they could not sustain that overhead in the next five years.

How can primary care physicians generate more income and manage overhead more efficiently without shortchanging the patients who rely on them? The solution is physician medication dispensing.

Out with the new, in with the old

Abandoning the pharmacy concept may seem new. However, historically physicians dispensed the medications while pharmacists manufactured them. In the early to mid 20th century, things changed. Pharmaceutical companies began manufacturing and distributing medications, pharmacists began dispensing medications, and physicians prescribed medications.

Most primary care physicians currently dispense medications in the form of samples, infusions and injections. In-office dispensing allows physicians to dispense all the medications they prescribe while increasing their practice revenue.

Increased revenue

The most obvious pro for primary care practices is the opening of a new revenue stream. Physicians usually fail to realize how much time is spent each day dealing with pharmacy issues.

Each pharmacy callback costs the physician on average $5-$7 per call. A typical practice can spend $30,000 a year handling these pharmacy-related issues, all for no revenue. These issues consume 6-12 percent of physicians’ time. In-office dispensing can also improve the cost and management of overhead.

There is, of course, an initial learning curve and time investment. The process of training staff and implementing physician dispensing can be difficult, but the training process is essential for success. Successful training and implementation + time + physician leadership = increased revenue for a practice.

Space requirements for dispensing vary according to practice or clinic size. Medications must be kept in locked cabinets; typically, a five- or six-foot locked tool cabinet is sufficient for a solo practice. Medications should be kept out of patient-accessible areas. Larger practices may find it more efficient to dedicate a room entirely to dispensing.

These start-up costs are nominal. With successful training, implementation and continued use, those costs can be recouped within a few months.

Improved patient care

A simple reason for physician dispensing of medications is improved patient care. Two more compelling reasons are: 1) writing and dispensing errors are nearly eliminated and, 2) compliance rates (patients getting their prescriptions filled and taking all the medication as directed) are increased by more than 60 percent. An increased compliance rate means lower overall health care costs.

According to the Institute of Safe Medicine Practices, more than 3 million of the adverse drug events that occur each year in ambulatory care are preventable. These adverse drug events (i.e., illegible writing of prescriptions, unclear telephone/verbal orders, unclear abbreviations, unclear or inappropriate dosages, etc.) cost primary care practices thousands of dollars in overhead.

The pharmacy has to call the physician to clarify, and the physician must take the time to call the pharmacy back. More importantly, these errors cause a decrease in patients’ overall health, and a decrease in the confidence they have in their provider.

Convenience is another benefit of physician dispensing. A typical pharmacy wait time can be upwards of one hour, not including the time it takes for the patient to drive to the pharmacy after their physician visit.

The pharmacy visit time is due in large part by design. The pharmacy is oriented more for sales rather than health care Extra time in their store means more dollars and profits from the patient. Physician dispensing allows the patient to receive their medications at the point-of-care and eliminate this additional pharmacy wait time. All patients, including the elderly, disabled, and parents with sick children, are appreciative of this convenience.

Physicians who dispense are also more aware of the costs of medications. With physician dispensing, they can make the lower-cost generic and therapeutic substitutions on the spot. Traditionally, a pharmacist has to call the physician’s office to get the change made, then wait for the physician to call back to approve the change. This additional wait time (often the patient must leave and return) means the patient is not getting the medication they need when they need it. Therefore, their medication treatment is postponed.

Legal and ethical implications

Physician dispensing is fully legal in 44 of the 50 states. The states of Texas, New York, and New Jersey have placed restrictions on physician dispensing. Only three states have prohibited physician dispensing: Massachusetts, Montana, and Utah. These restrictive laws when dissected serve only one purpose: isolate the profit to the pharmacy. These laws and regulations would probably be held an illegal restraint of trade if challenged under federal law.

Each state is different in their dispensing guidelines. Some states also require an additional dispensing license, which can be obtained for a nominal fee. A qualified and reputable physician dispensing provider can assist you in these areas.

Some physicians are also concerned physician dispensing is a conflict of interest. This could be a conflict of interest, but so is a physician scheduling an office visit, ordering X-rays, lab tests, a hospital stay for a patient and surgery.

The American Medical Association (AMA) endorses the concept of physician dispensing, provided the physicians follow state and federal guidelines, and still allow their patients a choice of where to get their medications.

The overall goal of X-rays, lab tests, surgery and physician dispensing is improved patient health. Physician dispensing is clearly a necessary tool for better patient health.

A choice for your practice

Physician dispensing improves patients’ health. It increases a physician’s practice revenue. It creates higher compliance rates, which in turn lowers overall health care costs for patients and payers. It is completely safe, legal, and endorsed by the AMA. All of these benefits rally on the side of the physician. Medication dispensing is a service that should be in your practice.

The Warren County Winery Train

A single, seasonally-aged leaf, carried by the mid-September billow, floated toward the main and side tracks paralleling the Delaware River at Phillipsburg’s Lehigh Junction Station-a sign of the time, and a sign that it was time for wine-one of the many products of autumn’s harvest. But, before I reveled in the oak-hinted vintages the latest grapes had produced, I first had to access a local winery-specifically, the Villa Milagro Vineyards, located some eight miles from here in Finnesville. That experience, combined with the rails, would result in what was dubbed the “Warren County Winery Train.” But why the rails?

A glance over my left shoulder up the hill to an imposing brick building, currently painted green, indicated more. Like a full-sized, living history book, it revealed its past. It was once the Phillipsburg Union Station, and the gravel on which I stood fronting the tracks while I awaited my wine-or at least my method of getting to it-represented but a shadow of the town’s former railroad self.

“Never the twain shall meet” goes the saying, but it did here, if “twain” could be defined as “train.” Located in western New Jersey, on the edge of the region’s Lehigh Valley and on the state line (here that line is actually a river) with Pennsylvania, Phillipsburg was incorporated as a town by an Act of the New Jersey Legislature on March 8, 1861, and is today Warren County’s largest city, mirrored by its sister, Easton, across the water.

But that water, perhaps more than anything else, gave it rise. Situated at the confluence of the Delaware and Lehigh rivers, it naturally evolved as a transportation hub, linked, via the Morris Canal, to New York City’s industrial and commercial centers from the 1820s onwards, and to the west, via the Lehigh Canal.

After barge-negotiation of the waterways, products and goods were transferred to one of five major railroads, all of which also converged here: the Central Railroad of New Jersey, the Lehigh and Hudson River Railroad, the Lehigh Valley Railroad, the Delaware, Lackawanna, and Western Railroad, and the Pennsylvania Railroad. Local transportation was facilitated by five streetcar and interurban railways.

All these trains needed more than the splotch of gravel on which I stood to process passengers and products, and part of that deficiency was remedied by Union Station, located at 178 South Main Street and constructed by Frank J. Nies, architect for the Lackawanna, in 1914. It was also used by the Central.

Symbolic of the city’s great railroad era, it was the last vestige of what once encompassed a complex of stations, roundhouses, turntables, interlocking towers, signal bridges, and coal pockets. Having served as a political campaign headquarters, a pharmacy, a bank computer center, and a sporting goods store, it is occupied today by the Friends of the New Jersey Transportation Heritage Center, whose members are restoring it to its turn-of-the-20th-century splendor. Negotiation of its required tools and equipment (and resultant dust), however, still offers a glimpse of its ticket windows and waiting areas, along with an n-gauge model railroad layout and a few artifacts.

Where did all the trains go? Like numerous other US cities served either by main or branch lines, the wheels were either transferred from the rails to the roads or the skies, decreasing demand prompting service reductions until the town had closed its book on the railway era. The Lackawanna, for example, had run its last passenger train to Phillipsburg in 1941 and New Jersey Transit followed suit four decades later, in 1983.

Today, the area is only served by two such rail concerns. The first, the Norfolk and Southern, operated freight trains and accessed Phillipsburg via the former Lehigh Valley Railroad tracks, crossing the river on the Lehigh and Hudson River Railroad Bridge. The second was a tourist railroad, the Belvidere and Delaware River (Bel-Del) Railroad, operating under the Delaware River Railroad Excursions name as far as Riegelsville.

With the sheer thought of it, I could now feel the fermented liquid running down my throat, since it would transport me to the all-important vineyard. But it first had to run on the rails before I could reach that point.

II:

That railroad hardly plied smooth ones to get where it is today. Indeed, its own journey, which was characterized by obstacles and setbacks, was a circuitous one-and often without track and the rolling stock needed to use it. Then again, the situation was not as ironical as envisioned, because establishing a railroad was never its intention from the start.

Its origins lay with the New York Susquehanna and Western Technical and Historical Society, a not-for-profit educational group founded in 1988 with eight members, to restore engines and coaches and preserve New Jersey’s railroad history. With it came the first idea of establishing the previously mentioned New Jersey Transportation Museum.

Wheels first rolled, at least in the direction of its restoration destination, with the lease of a self-propelled, 1950 Budd RDC-1 (M-1) passenger car from the United Railway Historical Society intended for the museum.

Initial train operations were not its own, but paved the way (a long way) toward it. Its members, along with those of another group, staffed those undertaken by New Jersey Transit to Hawthorne for skiing purposes and Vernon in early-1990, thus providing initial hosting experience of rail-facilitated events.

After the United Railway Historical Society signed a lease for the Morris County Central engine house in Newfoundland and four former Morris County Central members themselves began work on the M-1 in July, the need for funding arose and, looking back at the revenue-generating rail rides it had hosted, the New York Susquehanna and Western Technical and Historical Society elected to extend that effort, running trips with full dining service on the Susquehanna line.

Gleaming like a gemstone just polished by a jeweler, the restored M-1, periodically rolled out of the engine house, attracted considerable interest and it operated its trial trip to Sparta on September 12, 1992. While it had only been displayed when it had been rolled out, it was now ready to wear-or, more appropriately, ride-and the public was eager to try it on-so much so, in fact, that the tourist journeys begun later that month in Whippany had culminated with an oversold one at the end of the Christmas season, necessitating an impromptu capacity increase from its existing 88 seats to 117 with temporary folding chairs and the accommodation of five children to a seat bank.

Historic and scenic tourist railroads were hardly novelties, but those operated by single, self-propelled coaches were, and capacity could not be adjusted to meet demand by coupling another car to it, simply because the society did not have one. However, a scouting trip to Tennessee yielded two-as in “two more”-an M-2 acquired by it and an M-4 purchased by some of its members.

Intending to operate its own sightseeing excursions, New York Susquehanna and Western purchased a Mikado SY steam engine from the Valley Railroad.

Despite what appeared to be increasingly green signals, the September 11 terrorist attacks abruptly turned them all red, their resultant-and prohibitive-liability insurance requirements for steam engine operations leaving the Susquehanna little choice but to sell the society the engine it could no longer afford to operate on its own track. Leasing its cars, along with those of another rail concern, it was able to inaugurate its own service, using New Jersey Transit tracks.

Funding now proved its own obstacle. Escalating New Jersey Transit movement and inspection fees left it virtually trackless. Then again, it did not own any coaches to couple to its just-acquired locomotive, even if it had the rails to do so.

The latter problem was solved when it purchased five 1950s-1960s Long Island Railroad 3/2 Pullman coaches and three 1960 ex-Metra (of Chicago) Pullman Galley bi-level ones, and these were added to the vitally important equipment roster, which now included the three 1980 Budd SPV-2000s (M-1 through M-4), the steam engine, and the previously obtained 18-ton, 1938 Plymouth locomotive.

But rail journeys were not always smooth-especially this one-and yet another company seemed imminent to write its history with its wheels in Phillipsburg, chosen location of the state transportation museum. The Black River and Western Railroad, owners of the Belvidere and Delaware River Railway and operators of its own excursion trains between Flemington and Ringoes, acquired a gas-powered Brill Model 55 motor car for this purpose.

But, unlike the many derailing events that had characterized its historical journey, this one resulted in a synergistic car-coupling and not in the hitherto-expected competitive impact. That car coupling, representing its partnership, saw it inaugurate weekend steam train service on May 1, 2004 over an initial 3.5 miles of Belvidere and Delaware River Pennsylvania Railroad branch tracks laid in 1854 and these were extended by two miles in 2006 and by another 900 feet two years after that. Society members, for the first time, graduated from coach attendants to full-fledged conductors and engineers in the process.

The sooner the train glided into the Lehigh Junction Station today, the sooner the wine would glide over my tongue.

III:

The brisk day, sending the scent of autumn to the senses, was suddenly assaulted by soot. Emerging from the natural tunnel of foliage surrounding the track and ducking under the trestle that had, only moments before, supported an elongated Norfolk and Southern freight train, a red caboose and four “Susquehanna” coaches were nudged into Lehigh Junction Station by the Belvidere and Delaware River Railroad’s signature 13-ton Mikado 2-8-2 coal-burning steam engine, #142, built by the Tang Shen Locomotive Works of the People’s Republic of China in 1989 and dubbed the Walter G. Rich after the late-CEO of the New York Susquehanna and Western.

A brief brake snag, signaled by a screech, caused the collected crowd to approach and then funnel its way through the opened door. I settled into the last car, #533-one of the Long Island Railroad coaches with walkover seats and a blue interior, and reserved for winery passengers. Only half-full, it assuredly offered sufficient space for what would be full-full-that is, the bottles of wine purchased at the vineyard.

Once again releasing a bulbous gray belch from its stack and a whistle that tore the morning’s fabric, the locomotive gave a gentle nudge to its cars, as they glided back under the trestle and settled into a rhythmic sway and clack abreast of the Mica-glinting surface of the Delaware River now visible through the right-hand windows.

Across the river, at the site of Williamsport, was the so-called “Forks of the Delaware”-or the junction of the Lehigh and Delavare rivers, itself the funneling point of the Lehigh, Delaware, and Morris canals.

At the southern edge of Raubsville, which was also on the Pennsylvania side, was the Delaware Canal’s double Ground Hog Lock–and its deepest, at 17 feet–next to which was the hydroelectric powerplant whose turbine was powered by canal-harnessed water.

Subjected to constant soot and smoke onslaughts from the locomotive, the coaches and single caboose bored their way through the arboreal tunnel, whose trees seemed equally coated in early-fall’s brown embers. Despite their lack of glitter, a rare nougat of autumn-brushed gold occasionally highlighted the collage.

Passing under the bridge that carried Interstate 78 from New Jersey to Pennsylvania, the train sliced through Carpentersville, once the location of a Bel-Del station and now little more than a hamlet formed by a scatter of vintage homes. A narrow road, as if compressed by a vice, thread its way between the tracks and the cliffs.

Rising, like two medieval monoliths beyond the third grade crossing, were two limestone kilns, once part of the almost two dozen which had graced the area and were fueled by coal, which itself had been transported by these very tracks. After locally quarried limestone had been ground into powder suitable for soil preparation and mixture with mortar, it had once again been rail-transported by the bushelful to Flemington, Trenton, and Monmouth County.

The coaches continued to sway-the very perception I expected to have after my wine, even if the train had not been in motion.

After a final burst of coal-created soot and cinders, and a last screech of the brakes, the train ceased motion, still immersed in dense foliage, now short of Riegelsville, one-time site of another Bel-Del station.

My dry throat, anticipating a vineyard oasis in what externally resembled nothing like a desert, prepared itself for lubrication, but the last mile or so of the journey, unable to be completed by the train because of still unrehabilitated tracks, required transfer to a yellow school bus. (Of course, I had forgotten to do my homework.)

Riegelsville itself was the location of one of the country’s few remaining, multi-span highway suspension bridges with continuous cables. Designed by John A. Roebling and Sons of Trenton-who themselves were the architects of the Brooklyn and Golden Gate spans-it connected Pohatcong Township with Riegelsville, Pennsylvania, and replaced the tri-span, wood-covered artery constructed in 1837 and used by foot, horse, and wagon traffic. Destroyed by a flood in 1903, it lent its piers to the current bridge, which opened on April 18 of the proceeding year.

Following the narrow, track-paralleling road and skimming the edge of the historic town, the bus shifted its way up a steep hill past a ceramic silo and threaded its way through tall cornstalks to the 104-acre Villa Milagro Vineyards, located in the Warren Hills Appellation and owned by Steve and Audrey Gambino.

Noted for its use of organic and sustainable practices to provide a protective habitat for native species of birds and plants, it produced ten varieties of grapes blended in the traditional European style to create complex wines.

An escorted tour of the fields, grapes, fermenting, and wine–making processes at last led to the tasting room, and the half-dozen varieties-from Merlots to Cabernet Sauvignons to Shirazes-accompanied by hot hors d’oeuvres finally enabled me to reach my physical and culinary destination.

Like the clinking of two glasses, my rail car, to which I had subsequently returned, seemed to toast the one ahead of it as their tensing couplings caused a momentary jolt and the smoke- and steam-emitting locomotive pushed them along the river-paralleling track for their journey to Phillipsburg in a backwards direction. With the wine I had had, at least it felt that way.