By Q. Charles. University of Rhode Island. 2018.
Classi- cally buy 15 mg prevacid, a patient with stress urinary incontinence reports leakage of urine with sneeze buy prevacid 15mg low price, cough, or activities such as lifting, jogging, or brisk walking. The patient with urgency incontinence commonly reports accompanying urinary frequency and often is classiﬁed as having an “overactive” bladder. It is important to be aware that there may be overlap of these two broad categories, an example of which is illus- trated by Case 1. Though this patient leaks urine with cough and sneeze, it is the urgency and urge incontinence following stroke that is interfering most with her activities of daily life. Detrusor hyperreﬂexia commonly is seen in cases of suprapontine cerebral disorders such as cerebrovascular accident (Table 37. Though bladder neck suspension would address the stress component of this patient’s incontinence, what she really needs is anticholinergic therapy to control her detru- sor hyperreﬂexia. In patients with stress urinary incontinence, options for management include Kegel exercises, biofeedback, and operative suspension of the bladder neck. There are a variety of techniques for bladder neck suspension, and, in most cases, a pubovaginal sling pro- cedure is performed. Male Patient In the male patient with incontinence, it is important to rule out retention with urinary overﬂow incontinence. Retention of urine can be ruled out by measuring the postvoid bladder urine residual volume either with ultrasound or, more commonly, with bladder catheterization. Incontinent male patients may suffer from detrusor hyperreﬂexia with resultant urgency incontinence. Men with injury to the urinary sphincter show failure to store urine and a stress incontinence pattern. One must be cautious in the male patient not to induce urinary retention iatrogenically by weakening the detrusor too much. Risk of retention is due to the higher detrusor voiding pressure required in men to overcome the resistance of the prostatic urethra. Operative interventions include bladder neck injection with bulking agents such as collagen or implan- tation of artiﬁcial urinary sphincter. Hematuria Hematuria may be gross (visible to the naked eye), as in Case 2, or microscopic and can present alone or in combination with other symp- toms. In Case 2, the patient experienced a traumatic event, resulting in gross hematuria. When pain is present, its location may point to the source of bleeding, indicating the importance of the patient history. Malignancy of the urinary tract is most common in smokers and in those over 40 years of age. It generally is recommended that, after the physical examination is performed, the patient provide urine for analysis and bacterial culture as well as for cytology testing for cancer cells. Renal ultrasound is desirable given its safety and lack of need for contrast injection. In the nonacute setting, ofﬁce ﬁberoptic cystoscopy is performed to inspect, under direct vision, the urethra, including the posterior prostatic urethra, and the bladder. Urine efﬂuent from the left and right ureteral oriﬁces is assessed for evidence of bleeding. Cystoscopy in the operating room under anesthesia is reserved for those with an abnormal ﬁnding on ofﬁce ﬁberoptic cystoscopy and for those with gross bleeding requiring clot evacuation and fulguration. At the time of cystoscopy in the operating room, bladder biopsy, endoscopic tumor removal, retrograde pyelogram of the upper tracts, and ureteroscopy to evaluate the ureter and renal pelvis may be performed. Patients with gross hematuria may require hospitalization, prompt evaluation, and treatment for hemodynamic instability, signiﬁcant drop in blood count, or inability to evacuate urinary tract (i. The ﬁnding of gross blood at the penile meatus, as in our case study, requires evaluation of the urethra with retrograde urethrogram to rule out the presence of a urethral disruption. In the event that a urethral disruption is documented, urethral catheterization of 37. Ureteral and renal pelvic injuries from external trauma: diagnosis and management. The use of indwelling ureteral stents in managing ureteral injuries due to external violence. In performing retrograde urethrogram, contrast is injected into the penile urethra under ﬂuoro- scopic guidance via a catheter placed in the fossa navicularis; 3cc of saline placed in the retention balloon of the catheter provides an adequate seal. In the absence of contrast extravasation indicating that the urethra is intact, a Foley catheter may be passed into the bladder. To rule out bladder perforation as a source of hematuria, a cys- togram is performed. Contrast is instilled into the bladder under gravity via a Foley catheter, and a maximum of 400cc is instilled. Extravasation of instilled contrast from the bladder indicates bladder perforation. Perrotti kidneys are assessed to conﬁrm blood ﬂow and rule out renal parenchymal fracture. By far the most common is bacterial cystitis, representing an inﬂammation in the bladder secondary to a bacterial infection. Bacterial cystitis may be accompanied by urinary frequency, dysuria, urgency, and foul- smelling or cloudy urine. It is preferable to obtain urine analysis and culture at the time of antibiotic initiation, though many patients are treated empirically. Commonly used ﬁrst-line agents are Macro- dantin and Bactrim, and success rates are approximately 60% and 75%, respectively. Though required length of therapy remains poorly deﬁned, it generally is agreed that 3 days is too short and 10 days probably unnecessary and associated with complications such as yeast vaginal overgrowth. In patients with persistent symptoms following antibiotic therapy, careful reevaluation of the urinary tract is required, starting with urinalysis and culture. In the evaluation of patients with recurrent urinary tract infection (see Algorithm 37. In patients with no discernible etiology, some success has been seen when bowel dys- function (i. Complicated infections are those associated with temperature elevation above 101°F, structural abnormalities of the urinary tract, resistant organisms, or renal insufﬁ- ciency. Some patients have lingering bladder discomfort after infection has been treated appropriately. Algorithm for the evaluation of patient presenting with lower urinary tract in fection.
There are some things which can only be learned by experiment cheap prevacid 15 mg with visa, and I would urge every one to some effort in this direction discount 15mg prevacid free shipping. You have your own bodies, and though you may value them highly, it will do little harm to test some medicines upon your own person. There is nothing in medicine that I would not test on my own person, if I was engaged in studying its action. Very certainly if the physician has occasion to take medicine for any disease, he should carefully note its effects from hour to hour. Let us call this the second method of studying remedies, it is the Homœopathic method, though employed to some extent by all classes of physicians. It gives most excellent and reliable results, and we can not afford to dispense with it. The third method is by carefully studying the effects of remedies administered for disease. This study can only be made to advantage where notes are kept, when care is used in the diagnosis, and when single remedies, or remedies that act in the same way, are employed, It is true that we can carry something in our memories, and by repeated observations facts will become familiar, but it is not a good plan to trust the memory too far. There are two things we want to know - the expression of disease, and the action of remedies - and in so far as we can, we want to associate them together. We may keep a record of cases with but little writing, if we have a plan to commence with. One word will sometimes express the condition of disease, it will rarely require more than a line. Now when giving remedies we may note nearly as briefly the reason why we have selected the remedy. Pulse small, frequent - Aconite; pulse frequent, sharp - Rhus; veins full - Podophyllum; tissues full, œdematous - Apocynum; muscular pain - Macrotys; nervous, free from fever - Pulsatilla; periodicity - Quinine; dull, stupid, sleepy - Belladonna; pain of serous membranes - Bryonia; dusky coloration of surface or mucous membranes - Baptisia; mucous membranes deep red - Acids; mucous membranes pale - Alkalies; feeble heart - beef-tea; strong circulation, high temperature - boiled milk. I give examples as my memory recalls them, but I think that the majority can have a record in about as many words. We do not want to write a book for other persons, but to make such notes as will enable us to recall the entire history of the disease, with its expressions that have suggested the use of the remedies employed. The reader will see that the record of the effect of the medicine can be easily kept. A 0 will tell the story of no effect, and a group of half a dozen adjectives will note the more important influences that we wish to record. In making a study of our working materia medica, it is well to note the advantages of carrying remedies, and of extemporaneous prescription at the bedside. The advantages are threefold - to the physician, to the patient, and to the friends. To the physician in that he learns his remedies better, and prescribes with greater certainty. To the patient, that the remedies are given in less doses, are promptly administered, and are not admixed with unpleasant vehicles, and are of more certain value and action. I have no special love for retail druggists, and many unpleasant experiences have shown me that it is quite possible to procure the poorest drugs in the market from them, and that it is quite uncertain what you will get in any given case. Of course there are many exceptions, but this is applicable to the druggist in ordinary, who makes it a rule to buy cheap, and sell dear. I need not say that a contract between physician and druggist, by which the former receives a percentage on prescriptions, is a very small species of swindling, and unworthy the profession. Patients will soon recognize the advantage that comes from a well filled medicine case, and will pay their bills more promptly if they are not bled by the druggist. Talking about bleeding, I have seen, time and again, a poor family saddled with an expense of from thirty cents to a dollar and a half a day for weeks, and for drugs that were useless, or in quantities much larger than were necessary. Recently I counted on the mantel of a patient, seven four-ounce, two six-ounce, and three two-ounce bottles, with three boxes of powders, all of which had been procured in seven days for a child four months old. As regards the form in which medicines are dispensed, I greatly prefer fluids, as they are easily measured, miscible with water, which is the best vehicle, are readily absorbed by the stomach, and hence of quicker and more certain action. The physician carrying his medicine in fluid form will soon learn that the small dose is not only as good but better than the old doses, and that with the majority of drugs given for direct action, the standard gtt. Prescribed in water in this way, medicines are not unpleasant, and the child will take them without objection. In dispensing, we have them bring one or two glasses half full of water, and a teaspoon, and prepare the remedy before the patient. The child takes its medicine without trouble, and indeed I do not recollect when I have had a case where the child required to be forced to take it. Using but small quantities of the stronger tinctures, an ordinary pocket case will carry enough for a very large practice. The pocket case I am using contains twenty-four four-drachm vials, and sixteen two-drachm vials, is of Eastern manufacture, and cost $3. It can be carried in the overcoat pocket, is sufficiently thick to sit upright in the buggy or on the table, corks all up - no unimportant matter in carrying fluids. The first row of twelve vials contains the essentials of practice - the remedies in common use - Veratrum, Aconite Gelseminum, Lobelia, Belladonna, Rhus, Bryonia, Nux, Ipecac, Phytolacca, Asclepias, Macrotys, and we will give these a first consideration. This remedy is employed to slow the pulse, and is especially indicated when it is full and strong, the large pulse being the prominent feature. The deep red stripe down the center of the tongue - marked - is a characteristic symptom, and calls for Veratrum. Fullness of tissue - not contraction - is found in cases where Veratrum gives its best results. It is a remedy in erysipelas with full tissue and bright color, both locally and internally, and in chronic disease with full pulse and increased temperature. This remedy is employed to slow the pulse and is especially indicated when it is small. It is the child’s sedative, and is employed in the entire range of fevers and inflammations. It exerts a special influence on the throat and larynx, and is thus used in the treatment of quinsy and croup, being the most certain remedy for the latter we possess. It exerts its most marked influence on mucous membranes, and is thus used in acute disease of bronchial tubes or intestinal canal. In irritative diarrhœa, and in sporadic dysentery, we use it with the best results. This is the remedy for irritation of the nerve centers, marked by flushed face, bright eyes, contracted pupils, and increased temperature, The dose will vary from the fraction of a drop to five to ten drops.
Change in bowel habits is the second most common complaint cheap prevacid 15mg visa, with patients noting either diarrhea or constipation purchase 30 mg prevacid otc. Eisenstat eralized peritonitis, or, if walled off, it may present with obstruction or ﬁstula to an adjacent structure, such as the bladder. Staging Staging systems are important for predicting outcomes, selecting patients for various therapies, and comparing therapies for like patients across institutions. For a tumor to be considered as an inva- sive cancer and staged, it must penetrate through the muscularis mucosa. Several classiﬁcation systems are utilized, including the Dukes, which is based on the extent of direct extension, along with the presence or absence of regional lymphatic metastases for the staging of rectal cancer. Dukes’ A lesions are those in which the depth of pene- tration of the primary tumor is conﬁned to the bowel wall. Dukes’ B lesions have primary tumor penetration through the full thickness of the bowel to include serosa or fat. Although not initially described, it became accepted by common practice to add a fourth category for distant spread (D) outside the resected specimen. Diploidy is cor- related with good prognoses; aneuploidy is correlated with poor prog- noses. Preoperative Staging for Colorectal Cancer The general physical examination remains a cornerstone in assessing a patient preoperatively to determine the extent of the local disease, disclosing distant metastases, and appraising the general operative risk. Special attention should be paid to weight loss, pallor as a sign of anemia, and signs of portal hypertension. In addition, a complete workup should include the investigations listed in Table 25. Cancer of the Colon Natural History Surgery remains the cornerstone of treatment for colorectal cancer, but it has inherent limitations imposed by the biology and stage of the tumor as well as its location. Ultimately, 50% of patients who undergo curative resection develop local, regional, or widespread recurrence. Operative management is discussed brieﬂy below, and additional ther- apies, based on pathologic ﬁndings, are outlined in Algorithm 25. Cancer of the Cecum, Ascending Colon, or Hepatic Flexure For lesions located in the cecum or ascending colon, a right hemi- colectomy to encompass the bowel served by the ilii-colic, right colic, and right branch of the middle colic vessels is recommended. For lesions involving the hepatic ﬂexure, a more extended resection is indi- cated, including the right colon and proximal and midtransverse colon, including both branches of the middle colic artery. Cancer of the Splenic Flexure Splenic ﬂexure lesions require removal of the distal half of the trans- verse colon and the descending colon. Cancer of the Sigmoid Colon Sigmoid lesions are treated by removal of the sigmoid colon. Subtotal colectomy is the treatment of choice for patients with syn- chronous lesions at different sites. If synchronous lesions are located in the same anatomic region, a conventional resection may be performed. Colon and Rectum 465 Cancer of the Rectum Rectal cancer has traditionally been treated with abdominal perineal resection, which removes the whole rectum and anus. More recently, the low anterior resection and local excision with and without radi- ation have gained popularity. Both preserve continence and can result in equal 5-year survival rates in properly selected patients. Cancer Arising in a Colon Polyp A colorectal polyp is deﬁned as a mass that protrudes into the lumen of the colon. Nonneoplastic polyps are without dysplastic features and include mucosal, hyperplastic, inﬂammatory, and hamartomatous (including juvenile) polyps. There is now a general consensus that most colon cancers arise from preexisting polyps. The lifetime risk of an adenoma transforming into a malignancy is estimated to be 5% to 10%, and the time for trans- forming is estimated to be 5 to 15 years. Less than 2% of adenomas smaller than 1cm harbor a carcinoma, whereas the percentage increases to about 10% in adenomas between 1 and 2cm and 50% in adenomas larger than 2cm. Colonoscopy and complete polypectomy are cura- tive in patients with carcinoma in situ, as these lesions appear to have no potential for metastases. Sessile and pedunculated polyps illustrating Haggitt’s classi- ﬁcation of levels of invasion. Eisenstat Therapy for Metastatic Colorectal Cancer Of 100 patients with colorectal cancer, roughly 50 are cured by surgery, 15 develop local recurrence, and 35 develop blood-borne distant metas- tases. The organs most frequently involved with metastases are the liver, the lung, the bone, and the brain. Up to 15% of patients present with liver metastases at their initial operation, and 30% of patients undergoing apparently curative resection already have hepatic metas- tases that are not evident to the surgeon at the time of operation. Patients with disseminated disease beyond the scope of surgical resection are eligible for chemotherapy. Therapy for Local Recurrent Colorectal Cancer Of all colorectal cancer recurrences, 70% occur within 2 years of oper- ation. Local recurrences vary between 1% and 20% for colon cancer and between 3% and 32% for rectal cancer. Many patients are eligible for surgical therapy of localized recurrence, but this should always be considered in conjunction with options for chemotherapy. The condition is characterized by the development of hundreds to thousands of colonic adenomatous polyps and an extreme risk of colon cancer. Polyps occur at a mean age of 16 years, and almost all affected persons exhibit adenomas by age 35 years. Seven percent of untreated individuals have cancer by age 21, 50% by age 39, and 90% by the age of 45 years. The average age of colon cancer diagnosis is 45 years, and the lifetime risk of colon cancer is 80% in gene carriers. Screening not only should be directed at the colon but also at the pancreas, breast, cervix, ovary, and bladder. Colonoscopic surveillance should be performed every other year until 30 years of age and annually thereafter.
Gotz buy 30 mg prevacid, “Characteriza-¨  Clinical and Laboratory Standards Institute prevacid 15 mg discount, “Performance tion of the importance of Staphylococcus epidermidis autolysin standards for antimicrobial disk and dilution susceptibility and polysaccharide intercellular adhesin in the pathogenesis of test: M2-A9. Performance standards for antimicrobial sus- intravascular catheter-associated infection in a rat model,” Te ceptibility testing,” Tech. Greenberg, “Te involvement of cell-to-cell Complementary and Alternative Medicine,vol. Gotz,¨ “Activity of gallidermin on Staphylococcus “Resistance of bacterial bioflms to disinfectants: a review,” aureus and Staphylococcus epidermidis bioflms,” Antimicrobial Biofouling,vol. Stewart, “Reduced glucopyranose on bioflm formation by Staphylococcus aureus,” susceptibility of thin Pseudomonas aeruginosa bioflms to Antimicrobial Agents and Chemotherapy,vol. Gilbert, “Changes Shindo, “Antimicrobial susceptibility of Staphylococcus aureus in the biocide susceptibility of Staphylococcus epidermidis and and Staphylococcus epidermidis bioflms isolated from infected Escherichia coli cells associated with rapid attachment to plastic total hip arthroplasty cases,” Journal of Orthopaedic Science,vol. Antimicrobial activity of novel 1-methyl-3- rapid determination of antibiotic susceptibilities of bacterial thio-4-aminoquinolinium salts,” Folia Microbiologica,vol. Deighton, “Antibiotic susceptibility of coagulase-negative 4-aminoquinolinium chlorides,” Acta Poloniae Pharmaceutica: staphylococci isolated from very low birth weight babies: com- Drug Research,vol. Woodmansee, “Activities of daptomycin and vancomycin alone and in combination with rifampin and gentamicin against bioflm-forming methicillin-resistant Staphylococcus aureus isolates in an experimental model of endocarditis,” Antimicrobial Agents and Chemotherapy,vol. Shanks, “AzaSite inhibits Staphylococcus aureus and coagulase-negative Staphylococcus bioflm forma- tion in vitro,” Journal of Ocular Pharmacology and Terapeutics, vol. AboZahra, “In vitro activities of three kinds of antibiotics against Staphylococcal bioflm and planktonic cultures,” African Journal of Microbiology Research,vol. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Tose results showed that the diferent test systems and the mixed infection with particular genotypes of M. Twenty- positive isolates were included in this study which were isolated in fve microliter of 0. In this study of all the total 1412 culture positive incubated for an additional 2 days. Results for determining drug susceptibility in the L-J agar proportion from our genotyping analysis showed that 10 paired isolates method in this study (Table 4). Te isolates ahpC further confrmed one patient (number 18) with mixed with particular genotypes, such as Spoligotype International infection by the heterogeneous genotypes (Table 4). Cangelosi, “Drug susceptibility testing of Mycobacterium tuberculosis: a neglected problem at the turn of the century,” International Journal of Tuberculosis and Lung Authors’ Contribution Disease,vol. Scarparo, Zaoxian Mei and Zhaogang Sun contributed equally to this “Current perspectives on drug susceptibility testing ofMycobac- work. Acknowledgments  Chinese Anti-Tuberculosis Association, Protocols for Tubercu- Te authors thank the Beijing Bio-Bank of Clinical Resources losis Diagnosis in Laboratory, Chinese Educational and Cultural on Tuberculosis and the Outpatient Department of Tian- Publisher, Beijing, China, 1st edition, 2006. References Shinnick, “Association of specifc mutations in katG, rpoB, rpsL and rrsgeneswithspoligotypesofmultidrug-resistantMycobac-  J. Gumbo, “Meta-analysis terium tuberculosis isolates in Russia,” Clinical Microbiology and of clinical studies supports the pharmacokinetic variability Infection, vol. Locht, “Variable human minisatellite-like regions in the and cause disease,” Journal of Clinical Microbiology,vol. Kim, “Drug-susceptibility testing in tuberculosis: methods and reliability of results,” European Respiratory Journal,vol. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Antibiotic resistance in bacteria is a global problem exacerbated by the dissemination of resistant bacteria via uncooked food, such as green leafy vegetables. New strains of bacteria are emerging on a daily basis with novel expanded antibiotic resistance profles. In this pilot study, we examined the occurrence of antibiotic resistant bacteria against fve classes of antibiotics on iceberg lettuce retailed in local convenience stores in Rochester, Michigan. In this study, 138 morphologically distinct bacterial colonies from 9 iceberg lettuce samples were randomly picked and tested for antibiotic resistance. Among these isolates, the vast majority (86%) demonstrated resistance to cefotaxime, and among the resistant bacteria, the majority showed multiple drug resistance, particularly against cefotaxime, chloramphenicol, and tetracycline. Tis implies that iceberg lettuce is a potential reservoir of newly emerging and evolving antibiotic resistant bacteria and its consumption poses serious threat to human health. Te use of antibiotics as on green leafy vegetables and the increasing occurrence of growth promoters in the agriculture industry is particularly foodborne pathogens on fresh produce is worrying. In 2011, 3842 human infections in Germany poultry are excreted as biologically active metabolites which with enteroaggregative hemolytic E. IntheUnitedStates,spinachgrowninMonterey been detected in animal waste, aquaculture, wastewater, river County, California, infected with E. Similarly, there was 2 BioMed Research International an outbreak of Shiga-toxin-producing E. Te ∘ inNetherlandsandIcelandin2007,whichresultedinatleast lettuce samples were stored at 4 C and processed for bacte- 50 illnesses , and an outbreak of Shigella sonnei associated riological analysis within 24 h of purchase. Te samples were with iceberg lettuce in Europe in 1995 which resulted in over processed by frst removing the outer leaves and then weigh- 100 confrmed cases of shigellosis . Of particular interest ing 25 g of each sample and placing it in a sterile stomacher to our study is the outbreak of E. Te stomacher bag with shredded romaine lettuce purchased in Michigan and was sealed and kneaded in a stomacher at 150 rpm for 20 min. Te increasing prevalence of foodborne Te resulting wash was then serially diluted 4 logs in 0. Antibiotic powders cases are generally treated using beta-lactam antibiotics were purchased from Becton Dickenson. Single isolated In recent years, a growing number of studies have shown bacterial colonies with distinct colony morphology and pig- the emergence of bacterial strains resistant to beta-lactams ment production were randomly selected, picked, purifed, ∘ and the main underlying mechanism is the production of andstoredat−80 C for further analysis. Biochemical Identifcation and Antibiotic Susceptibility tion with multidrug resistance (defned as resistance to three Testing. Te bacterial isolates from iceberg lettuce were or more classes of antibiotics) . Some of these results were presented at the 52nd Intersci- ence Conference on Antimicrobial Agents and Chemother- 2.
He presents nationally and internationally on new developments in the assessment and therapy of emotional disorders purchase 30mg prevacid mastercard. Smith generic prevacid 30 mg with visa, PhD, is a clinical psychologist and adjunct faculty member at Fielding Graduate University. She specializes in the assessment and treatment of adults and children with obsessive-compulsive disorder, as well as personal- ity disorders, depression, anxiety, attention-defcit hyperactivity disorder, and learning disorders. She often provides consultations to attorneys, school dis- tricts, and governmental agencies. She presents workshops on cognitive ther- apy and mental-health issues to national and international audiences. Smith is a widely published author of popular and professional articles and books. Elliott and Smith have written Borderline Personality Disorder For Dummies, Obsessive-Compulsive Disorder For Dummies, Seasonal Affective Disorder For Dummies, Anxiety and Depression Workbook For Dummies, Depression For Dummies, Hollow Kids: Recapturing the Soul of a Generation Lost to the Self-Esteem Myth, and Why Can’t I Be the Parent I Want to Be? They are members of the Board of Directors of the New Mexico Psychological Association and affliated training faculty at the Cognitive Behavioral Institute of Albuquerque. Their work has been featured in various periodicals, includ- ing Family Circle, Parents, Child, and Better Homes and Gardens, as well as popular publications like the New York Post, The Washington Times, the Daily Telegraph (London), and The Christian Science Monitor. They’ve com- mitted their professional lives to making the science of psychology relevant and accessible to the public. Smith and Elliott are available for speaking engagements, expert interviews, and workshops. Dedication We dedicate this book to our growing, changing families — Brian, Alli, Sara, and Trevor. Authors’ Acknowledgments We’d like to thank our excellent editors at Wiley: Project Editor extraordi- naire Vicki Adang, Acquisitions Editor Michael Lewis, and masterful Copy Editor Christy Pingleton, as well as our agents Elizabeth and Ed Knappman. Scott Bea from the Cleveland Clinic for reviewing our work and making insightful suggestions. We also wish to thank our publicity and marketing team, which includes David Hobson and Adrienne Fontaine at Wiley. Thanks to Trevor Wolfe and Kate Guerin for keeping us up on pop culture, social media, blogging, and tweeting on Twitter. We want to thank Deborah Wearn, Pamela Hargrove, Tracie Antonuk, and Geoff Smith for their continued interest. Brad Richards and Jeanne Czajka from the Cognitive Behavioral Institute of Albuquerque, thanks for including us on your affliated training faculty. Finally, we are especially grateful to our many clients we’ve seen, both those with anxiety disorders and those without. Publisher’s Acknowledgments We’re proud of this book; please send us your comments at http://dummies. Some of the people who helped bring this book to market include the following: Acquisitions, Editorial, and Media Composition Services Development Project Coordinator: Patrick Redmond Project Editor: Victoria M. Adang Layout and Graphics: Ashley Chamberlain, (Previous Edition: Norm Crampton) Joyce Haughey, Christine Williams Acquisitions Editor: Michael Lewis Proofreaders: Laura Albert, Evelyn C. Gibson (Previous Edition: Natasha Graf) Indexer: Steve Rath Copy Editor: Christine Pingleton (Previous Edition: Esmerelda St. Clair) Assistant Editor: Erin Calligan Mooney Senior Editorial Assistant: David Lutton Technical Editor: Scott M. Bea, PsyD Editorial Manager: Michelle Hacker Editorial Assistant: Jennette ElNaggar Cover Photos: iStock Cartoons: Rich Tennant (www. At the time, we wondered how the audi- ence would react to a book with a title like Overcoming Anxiety For Dummies. But we were surprised and gratified at the overwhelmingly positive responses we got from the majority of readers who contacted us. People all over the world e-mailed us to say that they had found this book to be one of the most comprehensive and accessible books on anxiety they had ever read. Some told us that for the first time in their lives, anxiety no longer dominated their lives. We were also thrilled to discover that many counsel- ors, therapists, and psychologists reported using the book as a supplement to psychotherapy sessions for their anxious patients. When our editors approached us about updating Overcoming Anxiety For Dummies, we took some time to think about what had happened in the world since we wrote the first edition. As we reflected on this issue, we realized that the world has changed a lot in the nine years since the first edition appeared on bookshelves. Because of these growing, emerging sources of worry, we felt a need to include information in this book that addresses them. For example, some airport security areas now have equipment that takes a virtual naked picture of you as you enter. We’ve suffered through what’s cur- rently called the Great Recession, and at the time of this writing, it’s unclear where the world economy is headed. People worry about getting jobs, keep- ing jobs, and fragile dreams of retirement. The globalization of economies and travel have made the spread of pandemics faster and potentially more deadly than ever. The spread of nuclear weapons continues, and worries abound about war, crime, and terror. But just as we don’t want to become victims of terror, we can’t let ourselves become vic- tims of anxiety. We realize that some anxiety is realistic and inescapable; yet, we can keep it from dominating our lives. Even under duress, we can pre- serve a degree of serenity; we can hold onto our humanity, vigor, and zest for life. Because we believe in our collective resilience, we take a humorous, and at times irreverent, approach to conquering anxiety. Instead, we present a clear, rapid-fire set of strategies for beating back anxiety and winning the war against worry. First, we want you to understand just what anxiety is and the different forms it can take. Second, we think that knowing what’s good about anxiety and what’s bad about it is good for you. Finally, we cover what you’re probably most interested in — discovering the latest techniques for overcoming your anxiety and helping someone else who has anxiety. For example, if you really don’t want much information about the who, what, when, where, and why of anxiety and whether you have it, go ahead and skip Part I.