Post-Marketing Pharmacovigilance For Well-Established Drugs

Even if a drug has been prescribed for many years within the European Union, there is still a need for pharmacovigilance work to develop the knowledge base around the product. During the pre-marketing phase, the drug will have been subjected to clinical trails according to EU drug safety laws. An application will have been made for a Marketing Authorisation to allow the drug to be sold within the EU. This will have been carefully considered by regulators, and the drug will only have been placed on the market should that authorisation have been duly issued. Nonetheless, the possibility for unanticipated adverse reactions is still present, even with such apparently 'well established' drugs.

Pharmaceutical Drugs Could Contain Excipients Which Invoke A Reaction

When the patient receives a prescription or over the counter drug (for example, as a tablet or capsule), it often only contains the active chemical component (the drug) as a small component of the total volume. The remaining volume consists of excipients, substances which in theory do not produce any effects. They may be present to give the tablet, capsule or other preparation its distinctive form, colour, flavour and so on. They may be added as preservatives, as dilutants, and so on. They can vary between dose strengths and formulations of the very same drug.

Pharmaceutical companies may manufacture thousands of products for which the composition and quantity of excipients used varies from product to product. The company may change suppliers for those excipients, and/or vary formulations over time. It is possible for an adverse reaction to occur with excipients, for example, lactose intolerance, or allergies or the effects of sugar in diabetic patients, etc. In previous years, there have been instances where changes to the formulation of a particular well established product have resulted in increased amounts of the active drug being absorbed by the body.

Placebos And Associations With Suspected Adverse Reactions

In the past, there have been some adverse reactions reported within clinical trials where there was an association suspected with placebos. The (EU) Clinical Trial Directive 2001/20/EC, April 4, 2001 refers to placebos within its list of 'investigational medicinal products'. Accurate and timely reporting of adverse reactions suspected to be associated with the taking of a placebo applies to clinical trials which take place during the post-marketing phase. Typically such reactions occur due to an allergy to one or more of the excipients contained within the given placebo. The same can be said for those that occur with excipients in medicinal products which contain active ingredients which may also be the cause of allergic reactions.

Problems Can Arise Even With Generic Drugs When Manufactured By Differing Pharmaceutical Companies

An important point note about generic drugs is that they will have originally been marketed as a patented formula by one particular pharmaceutical company. After sufficient time has elapsed for the patent to expire, the drug can then by made by other companies as a generic, providing the correct clinical trials are conducted according to the relevant drug safety laws prior to (and after) release onto the market. Should an adverse reaction be suspected to be associated with taking a generic formula, it is the company who made the particular generic in question who must report it to the regulatory agencies, rather than the company who held the original patent. Since there can be problems associated with excipients, cases can arise where an association is suspected with the formulation of the generic, or other aspects of its manufacturing process.

New problems can arise with 'old products'

There are numerous examples of even very serious adverse effects which have taken many years to be identified. It could have been that the rarity of the occurrence of these adverse effects meant that suspicions were not initially raised in connection with taking the particular product. Examples here include the identification of heart valve disease associated with certain types of drugs prescribed to combat obesity, or heart rhythm disturbance associated with certain non-sedating antihistamines. There have also been other instances where it has taken many years for the development of the adverse reaction, such as the development of certain types of cancer.

For the above reasons pharmacovigilance is still crucial for pharmaceutical companies, professionals, patients and the public even when a drug has been prescribed in routine practice for many years within the EU and elsewhere. It is important to note however, that the information contained here still cannot be considered as an exhaustive list of all eventualities nor as any form of formal or informal professional advice.

Allergies - Allergy Shots

In this article we're going to discuss a common form of battling allergies with the use of allergy shots and how allergy shots work to build up a person's immunity to outside allergens.

A growing number of people who suffer from allergies and not finding the relief that they want from antihistamines are turning towards allergy shots to hopefully put and end to their dreaded sneezing, wheezing, itching and misery.

So exactly what are allergy shots? Allergy shots actually contain a very small amount of whatever it is that you're allergic to. If you have multiple allergies, such as a combination of indoor and outdoor allergies, then two shots are actually given. One for the outdoor allergies and one for the indoor allergies.

How do allergy shots work? Well, in theory it's actually very simple. Allergy shots help your body fight the allergen that is bothering you. When you get shots of the allergen itself your body makes antibodies to the allergen. These antibodies help block the effects of the allergen itself. Your symptoms become less severe because the antibodies block the way your body reacts to the allergens. After taking enough of these shots over a long period of time you might start to get relief from your symptoms. This relief should last for a very long time.

Many kinds of allergies can be battled with allergy shots. They work very well with allergies to pollen, or what is commonly called hay fever. They also work for eye allergies, bee sting allergies, and even some drug allergies. In many people, allergy shots can greatly improve asthma symptoms. Most people will get allergy shots after they have exhausted every other option.

Unfortunately, not everyone can get allergy shots. If you have severe asthma or a heart problem you should not get allergy shots. Also, if you take a beta blocker for a heart condition you shouldn't take allergy shots. Children under five years of age should also not get allergy shots. Also, you shouldn't start allergy shots if you are pregnant.

If you decide, along with your doctor, to get allergy shots, he will first have to give you an allergy test to determine what allergies you have. This test in effect is actual treatment as some of each allergen has to be injected into you in order to do the test. After the results are in, a vaccine can be made which can then be given on a weekly or biweekly basis or for whatever interval the doctor thinks is necessary.

Once you start taking your shots you will at first have to take them every week or every other week. After about 6 months most people can go on what is called maintenance and get shots once each month. This usually continues for about 3 to 5 years until eventually most people no longer need to take shots because their immunity has been built up enough to the allergens.

Allergy shots are normally not harmful but some people do have reactions to them. If you should have a severe reaction the doctor will usually keep you in his office for about 20 minutes each time you get your shot so that if you have a reaction he can give you something to counteract it.

Dog Allergies Are More Common Than We Suspect

It may come as a surprise to some people that dogs do indeed suffer from dog allergies. There are many different kinds of allergies affecting man's best friend and many different sources that can cause adverse physical reactions:

Food

Dogs that tend to suffer from itchy skins are often allergic to the soy, wheat or corn products in the dog food. Dog owners should rotate the different dog foods on the market in order to pinpoint which ones are causing the itching.

Mold

Another food related cause can be mold which is found growing on the grain particles in the dog food. Molds are known for producing toxic immune system suppressants called mycotoxins. This will cause dogs to scratch their skin frequently since they are more vulnerable to these uncomfortable elements.

Mold spores are also found in unventilated kitchens and bathrooms. Mold growth can be controlled by keeping the humidity level down in the home as well as keeping the mold level down by regular cleanings. Mold and mildew can grow wherever it is dark and damp such as in ventilation ducts, air conditioning and fan filters as well as in electronics.

Cats

Dogs may also be allergic to cats. Cats emit allergens called feld-1 that is found in their skin. When these are released, they tend to stick to many surfaces sometimes for as long as a decade. This can be controlled by giving the cat periodic baths which prevents this allergen from being released into the environment.

Top of the line air filters are also effective in picking up the allergens. The filters will need to be washed or replaced on a regular basis to keep the allergen levels low. Sprinkling tannic acid on the floor and carpets is also effective in minimizing the potency of the feline allergen.

People and Other Animals

Dogs can also be allergic to people since people, too, give off allergens in the form of dandruff, or other animals. In these cases, it may be helpful to give the dog allergy shots. Outdoor pollens may also cause reactions in some dogs that have not been exposed to certain allergens at an early age when the immune system is still building in strength.

Often pets and their owners are allergic to the same things. No one knows the reason for this but it does occur. Shampoos containing tea tree oil have been proven to provide temporary relief but often they cause additional skin irritation. It helps to ask the veterinarian if the dog can be administered the same remedies that work for their human owners.

Tracking down the cause of dog allergies is a trial and error process. The veterinarian can subject the dog to the scratch test where different pollen extracts are injected into the dog to ascertain which naturally occurring pollens are negatively affecting the dog. It is a good idea to be patient when trying to pinpoint the cause for the dog allergy.

How Probiotics Help Alleviate Allergy Problems

Scratching

Food allergies, the response to the high level of grains in dog food, causes itching which in turn causes mild to severe scratching. At the same time, the dog food is lacking the natural enzymes that your dog's stomach needs to fully digest the food. Probiotics help your dog's intestinal track to accept the food and absorb the needed nutrients into the body.

Dry and flaky skin

Red, blotchy or dry, flaky skin can be a sign of your dog not getting enough needed nutrients from his food. Probiotics can help dogs to absorb the vital nutrients they need from their food and crowd out an overgrowth of bacteria in the body. It also helps the dog eliminate wastes and toxins in the body, resulting in an overall healthy skin and coat.

Excessive Shedding

Excessive shedding can be caused by allergies, age or poor digestion. Of course, dogs can be expected to shed but excessive shedding can be greatly reduced by introducing probiotics into the digestive system

How to Cure Any Phobia Without Prescription Drugs or Therapy

A phobia is an intense fear that causes you to avoid the feared thing or endure it with unbearable mental pain. Additionally, a phobia is an irrational fear, in that most people either don't fear the same thing that you do or fear it to a much lesser degree. Some examples of common phobias are the fear of public speaking, dating the opposite sex, heights, spiders, closed spaces, crossing bridges or tunnels, going to the dentist, swimming in the ocean, flying in planes, and being in a crowd of people.

Classical Conditioning

One of the most powerful techniques used for curing phobias is called classical conditioning. Simply put, classical conditioning involves pairing a particular feeling with a particular event over and over again until the feeling and event become automatically associated with each other.

Let me give you an example. Let's say that whenever you give a public speech, you feel intense fear. However, you wish to feel intense calm, whenever you give a public speech. How do you accomplish this?

First Step: First you must find something that makes you feel intensely calm - something like two or three shots of whiskey.

Second Step: Then whenever you give a public speech, you drink two or three shots of whiskey just before going onstage. You will undoubtedly feel calm during your public speech.

Third Step: After giving many public speeches under the influence of whiskey, you will automatically associate giving public speeches with feeling calm. Once this happens, you will be able to calmly give public speeches - without drinking whiskey beforehand! Mission accomplished, your phobia is cured!

Sedatives

You say, "Wait a minute! If my supervisor catches me drinking alcohol on the job, I'm history!" Good point. In many workplaces, drinking alcohol is taboo and those found committing the taboo may suffer serious consequences. Luckily, there are other sedatives that are more socially acceptable.

Some examples of socially acceptable sedatives are Remeron, Xanax, Thorazine, Risperdal, Benadryl, Lunesta, and Rozerem. All of these sedatives need to be prescribed by a physician, except for Benadryl. And taking any one of these sedatives is more discreet than drinking alcohol, since it doesn't leave your breath smelling and your eyes red.

Okay, so which sedative should you choose? Upon researching each sedative, you see that each of them works differently, producing different types of sedation. You end up choosing Benadryl, since it is the easiest to obtain (no physician's prescription needed) and it sedates effectively.

Benadryl (Diphenhydramine Hydrochloride)

Benadryl (diphenhydramine hydrochloride) is an antihistamine that is used to relieve allergy symptoms. It is also used as a sleep aid, due to its sedative effects. Benadryl sedates by blocking histamine from its receptor sites. Histamine is a neurotransmitter that promotes alertness, arousal, and allergy symptoms. By blocking histamine, the opposite occurs.

Another way Benadryl sedates is that it inhibits the re-uptake of serotonin. Serotonin is a neurotransmitter that calms the brain. Neurons release serotonin to send calming signals throughout the brain, but then the neurons need to reabsorb serotonin to turn off the calming signals. Benadryl interferes with this turning-off process.

Phobia Cure

Now that you have a sedative that can be bought over-the-counter, is very affordable, works quickly, and sedates effectively, you are ready to cure your phobias. Pick a phobia. Fear of dating the opposite sex? Okay let's cure it.

First Step: Strike up pleasant conversations with potential dates, and ask them if they would like to get together with you to do something fun (e.g., bowling, dinner, movies, swimming, etc.). To reduce the chance of rejection, only ask potential dates who already know you and have expressed some interest in you. A good hunting ground is your workplace or any other populated place that you visit often.

Second Step: Take 25-50 mg of Benadryl (diphenhydramine hydrochloride) a half hour before going on the date. If you must drive a motor vehicle, be careful - Benadryl may cause drowsiness! Your date may drink alcohol, but you may not; because Benadryl increases the intoxicating and sedating effects of alcohol. The sedating effect of 25-50 mg of Benadryl lasts 4-6 hours.

Third Step: Go on many dates, taking 25-50 mg of Benadryl a half hour before the start of each date. Eventually, you will automatically associate feeling calm with going on dates. Once this happens, you will be able to calmly go on dates - without taking Benadryl beforehand! Mission accomplished, your phobia is cured!

Warnings, Drug Interactions, and Common Side Effect

When using any drug, some common sense is needed. Even though Benadryl (diphenhydramine hydrochloride) is a very safe drug with minimal side effects, I advise you to check with your physician and pharmacist to see if it is okay for you to use Benadryl as prescribed here.

To avoid adverse drug or medical interactions, always read the container label of any drug that you take. Benadryl enhances the effects of alcohol, sedatives, and tranquilizers. Additionally, taking Benadryl tablets and applying Benadryl cream or ointment enhances the effects of each other. If you have glaucoma, an enlarged prostate gland, or breathing problems, Benadryl may worsen your condition.

Since Benadryl may cause drowsiness, be very careful while driving or operating hazardous equipment. To reduce your chances of becoming too drowsy, don't exceed 50 mg per dose, don't take more often than every 4-6 hours, and don't take more than six doses within a 24-hour period of time.

Discussion

Therapy and prescription drugs can be very expensive, especially if you don't have health insurance. Oftentimes the poorest members of society have to live with mental health problems such as phobias. Affording the best health care, the rich rarely have to live with phobias or other mental health problems. Thus, mental health relates to financial health. However, there is an alternative way to cure mental health problems such as phobias. This way involves using an effective self-help technique with an affordable over-the-counter sedative.

How to Relieve Sinus Pressure: Learning to Feel Better

Until you have experienced true sinus pressure you have no idea how painful it can be. Many people find that sinus pressure can range from mildly annoying to incapacitating because of the pain. There are countless people all around the world that are dealing with the pain that is associated with sinus pressure and many assume, wrongly, that they have to live in pain and wait for the pressure to resolve itself, but this simply is not the case.

If you want to feel better you may need to get to the bottom of why you are experiencing such pressure. For many people it is a sinus infection and for other people it is caused by allergies that could be treated to do away with the pressure. Either way, there are treatment options that can reduce the amount of pressure or pain and overall suffering that many people around the world are experiencing.

Relieving sinus pressure may be as simple as getting antibiotics that will treat the underlying infection that is causing the pain. Allergy medications or allergy shots can help to treat different allergies so that the suffering can be stopped. When the pressure remains and there doesn't seem to be one specific trigger, there are some other options to consider.

For many patients it is as simple as using sinus rinse. There are special solutions that can be mixed with sterile water and applied with a squirt bottle or netty pot that will clear out the sinuses by removing any mucus or irritants from the sinus passages. For many people this can simply be done daily to relieve any and all irritants and therefore removing any and all sinus pressure on a regular basis.

There are other simple practices that can help you deal with sinus headache relief. Many people assume that simply staying in bed will do the trick, but in some cases you need to move around. In fact, it has been found by many patients that when you run or get moving that the sinus pressure will relieve itself as the passages naturally open up to allow for ideal blood oxygenation.

Another great option is to take showers. If you take hot showers when you are suffering from a sinus headache it can help to open up the sinuses and relieve pressure. This may be a temporary solution, but it can help you get the relief that you need to help prevent the anger and frustration that often accompanies sinus pressure that you cannot relieve simply.

If you find that you really need to lie down to relieve pressure, this can help. The best thing that you can do is to lay down on a supportive pillow, preferably one that has been made for support. Then, lay facing the side of your face/sinus that is not filled with pressure. When you do this it can help to equalize the pressure in the sinuses and may bring you some relief until medications have a chance to kick in, or in an effort to combat the pressure at all.

Sinus pressure relief can be sought in many different ways. If you haven't had luck with medications or you just want to try to go as natural as possible, you may just find that these simple but natural remedies really do work to provide you with the sinus headache relief that you need to feel better.

Nasal Polyposis

What is nasal polyposis?

It is the growth of a soft painless and noncancerous mass lining the nasal cavity and paranasal sinuses. They result from chronic inflammation caused by conditions such as allergies, asthma, recurrent infectious, hypersensitivity to certain drugs and or certain immunologic diseases.

Before continuing, a little history...

Nasal polyposis was first reported by the Egyptians over 4000 years ago. They are considered the pioneers in the diagnosis and treatment of this condition as they were thoroughly familiar with the nasal anatomy and due to the mummification approach take took place in that time. Samuel of Egypt, was first described as a patient. It is said that he had a polyp so great that it hung down the back of his nasopharynx and "strangled" the patient!

However, it was Hippocrates who coined the term polyp considering that it resembled a "marine polyp" (has a flat base, are soft and the body is shaped like a tube). Hippocrates was even the first to describe the surgical procedure for resection of the polyps or the "polypectomy"

What are the symptoms of nasal polyposis?

They come in different sizes. When they are small they may not cause any symptoms. However, when they are large or even giant, they can give very severe symptoms such as difficulty in breathing, changes in smell and taste, nasal congestion, nasal voice or permanent, postnasal discharge, presence of abundant hyaline mucus, pain in the upper dental arch, tightness in the forehead and malar region (also known as the cheek), snoring and recurrent infections.

When should you visit the otolaryngologist (physician in charge of looking at diseases of the Ears, Nose and Throat (ENT))?

You must go to your doctor if symptoms persist for more than 10 days. Symptoms of chronic sinusitis and nasal polyposis are very similar to those of many other conditions or diseases, including the common cold. It is advisable that you go to see your doctor if you feel that you have one or more of the above symptoms.

Who is affected by polyps?

Polyps can occur at any age but are by far more common in people over 40 years and tend to be more common in men than in women. In rare causes they are also know to affect children under the age of 10 years. They can form anywhere in the nose but typically occur first in the ethmoid cedillas but are most common in the area where the sinuses are "drained", this place is better known as osteomeatal complex.

What are the risk factors?

The risk factors for developing polyps in the nose could be from any situation that involves the chronic inflammation of the nasal mucosa, such as allergy.

The diseases associated with nasal polyposis frequently are: Asthma, Allergy to aspirin (acetylsalicylic acid) or nonsteroidal antiinflammatory drugs, better known as NSAIDs (ibuprofen, naproxen), allergic fungal sinusitis, cystic fibrosis (a genetic disorder resulting from the production and secretion of abnormally thick, sticky mucus) and Churg-Strauss syndrome (a disease that causes inflammation of blood vessels). There are also hereditary genetic diseases that can make us more likely to develop nasal polyposis.

However, in many cases, nasal polyposis is of an unknown cause but cases are known of nasal polyp formation preceding the development of asthma or sinusitis.

What are the potential complications?

They are varied and can range from sinusitis to obstructive sleep apnea, to asthma exacerbations, dissemination of the infectious process to the eye or even to the development of meningitis.

How are they diagnosed?

The nasofibroendoscopa is a very useful tool to the otolaryngologists that is easy and painlessly and allows direct and detailed visualization of the nose and sinuses with a camera.

Similarly, the CT scan of the nose and paranasal sinuses may help assess more accurately the location and extent of the polyps in deeper areas of the sinuses and allowing the extent of mucosal inflammation to be assessed. Also it allows us to know if there is obstruction of either side within the nasal cavity and thus it is best option to decide and plan treatment for the patient.

There may also be other diagnoses studies that can be used such as allergy tests, and if polyps are found in the nasalesen of a child then a specific diagnostic test for cystic fibrosis should be carried out. It is important that treatment is multidisciplinary, i.e. several specialists should be consulted with in order to offer the best treatment and the gain best result for the patient.

Normally, depending on the size of polyps, our first approach is to treat the polyps with medication. Corticosteroids (nasal sprays) are the first line treatment because they help us to reduce inflammation. This treatment can reduce the size of polyps and sometimes even eliminate them altogether. Other times, we can accompany oral and injectable corticosteroids if they do not get the desired effect with the nasal spray. Also, occasionally we have to prescribe antihistamines to control the allergic process as well as antibiotics to treat chronic or recurrent infections.

Surgical treatment for nasal polyposis

The surgery is performed when despite medical treatment, polyps do not get smaller or disappear. The type of surgery depends on the size, the number and location of polyps.

There are 2 surgeries that can be performed. The first of them is the polypectomy (Hippocrates, the father of Rhinology, was the first to do it), which is used in small or isolated polyps that can be completely removed with a suction device or a microdebrider. The second is endoscopic sinus surgery (which uses a camera that magnifies the nasal structures). It is reserved to remove large polyps and to correct sinus problems that promote inflammation and the development thereof of polyps.

Although surgery is associated with a significant improvement in most patients it may be less effective in those with a combination of polyps and asthma or those with polyps, asthma and hypersensitivity to aspirin ( Triad Sampter described this in 1969 in Sampter and Beer).

Reoccurrence

Unfortunately, nasal polyps tend to recur if the underlying cause is not treated or controlled. Therefore, both the otolaryngologist and allergist and sometimes even the inmunologist must maintain tight control of the patient because they must address the factors mentioned above in order to offer the patient a better quality of life.

Stayin' Alive at 55

When I was 5 years-old I was in first grade and fully energized by those of my age together in the playground where a hierarchy of order was made plain by class, color, and wealth. It was the beginning of abuse by bullies who were stronger and lean compared my to husky size from my mother never allowing anyone leaving the table unless all the food was eaten, and she cooked for an army. I learned that mass hysteria was easily accomplished on the playground. I watched a mentally retarded brother manipulate my adult parents with ease. I learn the subtle art of psychology without even realizing it.

When I was 10 years-old I was beaten many times in the school yard and to and from home. My hormones kicked in early and I began to lift weights and body build. A short time later those same bullies, who were expelled from the school system for beating me, wouldn't come near me. A few years later in Catholic school the pastor sexually abused me and many others, a long buried event that only came up when I was writing a novel and I used that experience when writing the key element of the main female character. As an altar boy, I learned that praying was not a substitute for action to solve my problems. I had to act or allow myself to become merely fodder for those who were sadistically stronger. I learned to question all authority be it religious or otherwise. I watched as my intransigent brother was put into an institution for threatening my two infant brothers. I watched as my mother blamed my father for it. I grew up quickly because of their rift caused by pure manipulation. I learned to hide fear well.

When I was 15 years-old I was a high school starter in football as a center, odd as I was the smallest guy on the team, and then attempted wrestling due to a coach's pressure. I hated it, and got out by exaggerating an injury. I had become a bonafide athlete. I threw discus and ran track, and girls now became an attractive force of nature, but I knew there was danger in paradise. I learned how to play drums. I learned that although I had a far superior education in Catholic school, emotionally there was a vacuum inside. I sought acceptance and allowed myself to be used for that purpose. I felt like the poor boy at grand banquet and didn't deserve to be there. I learned that I had to begin an ongoing process, to rely on me, to love myself before I could go further. I learned how hard that really was.

When I was 20 years-old I drove a forklift, made a bunch of money, went to Jamaica by myself, didn't come back when I supposed to and was fired by Scott Paper. I then went back to college after dropping out after the first semester with the college being on the Boardwalk in Atlantic City due to a construction strike, and earned a degree in music two and a half years later. I gained strength from adversity. I came from knowing nothing about music to graduating in Who's Who in American Colleges in a very short time. The immersion of myself into knowledge and technology at that time made it the most incredible part of my life. I learned that I possessed incredible passion and it made me go for the seemingly impossible as I truly began to believe in the spirituality of a force within me. I studied the subject of religion voraciously, and cared not about what anyone else thought of me. I learned I had the power within to do incredible things when I surrendered to that force and allowed the energy to flow through me. I learned to be vulnerable and to accept failure as a temporary setback to success, and then realized that it was an inevitable part of it. I learned that listening was more important than talking, that being smart was being secure in being smart, without having to prove it or impress anyone else.

When I was 25-years-old and ready for a career after graduation in 1977 the recession and the "gas crisis" made for a harsh time and I shoveled coal at the local utility company and my rental home in the farm area of South Jersey was burglarized and we lost everything that my girlfriend and soon-to-be wife had owned. We lived in a tent on a friend's property for the summer. My favorite Uncle was able to secure for us an old chauffeur's quarters behind a former mansion that was now being used as an American Legion Hall for $90 a month in Pleasantville, N.J. We began to play music in the clubs in and around Atlantic City. I enjoyed the night life and playing great music for appreciative audiences the experience was soul satisfying but paid comparatively little. I learned not to depend on anyone but myself in all matters and that certain old friends were best left as such when they become toxic. I realized that the pain I went through as a child now made me better able to handle the bitter parts of life that I could not change.

When I was 30 years-old I was now working for a casino as an Audio Technician and learned my trade both from books and being on the job. It was a new age of growth for the area with the incredible expansion of casinos, but like anything, greed begets greed and the corporate structure killed the golden goose. The political and corporate stupidity was constantly at work and I learned that what "appears to be" is much more important that "what is." I watched my father die over a few months. I learned to accept my mortality and cried for the time back. I saw what seemed so much time wasted and was bitter, I still hadn't learned the understanding and enlightenment to be at peace with it.

When I was 35 years-old I was now married for some time and had bought a house in the country with way too much grass to cut and I developed severe allergies that would not be discovered or even checked until 5 years later. It was a time of false bliss, of thinking that possessions and money could bring happiness. My move to the Taj Mahal nine months early to prepare for the opening was to be the beginning of both "The Donald's" and my demise in that era of the 90's. Chasing corporate dollars was a pastime and not really a career that was fulfilling although it provided just enough comfort to not take a chance and remain safely in the corporate cradle. I learned that physical pain is never understood by anyone but those who have been through similar pain. Headaches got worse and workloads were excessive. I learned to have trust in but a few key fellow workers. I learned that one must proactively terminate a threat before it cannot be overtaken regardless of the personal circumstances. I learned brutal bloody coldness from the very best management that Donald Trump offered.

When I was 40 years-old my health worsened, the headaches went unabated and my high school football-worn knees could barely handle the constant humidity of the East Coast. Without work I went into depression and then my left arm went numb from a C-4 nerve impingement that no one figured out for 8 months. By that time my marriage was asunder, I was out of a job and I went to Las Vegas with less than $1000 and searched for work while I knew my wife at the time would not go with me. My divorce soon followed when Merv Griffin called and needed an Entertainment/Technical Director for his new place in Mesquite, NV. Of course, greed got to those owners as well and they went belly-up. It was when I moved to Las Vegas that I was diagnosed as having bubble-boy allergies. The severe headaches and cysts were keeping me in misery, and I was put on allergy shots for the next six years.....this after two futile operations back East without even testing for allergies and two more operations in Las Vegas. I worked both at the Sahara showroom AND the Stratosphere (pre-opening) full time and made bank to make up for the losses of those previous years. I learned that the world when confronted by the truth always looked the other way and offered trite solutions to complex problems because they really didn't want anyone to know anything that could take their corrupt advantage away. I learned that living in the now was the most important thing to understand. My past was unchangeable, the future not here yet. I began to understand the wisdom of the past leading to what was the "now" and the inevitability of what could only be, based on choices that I made.

When I was 45 years-old I had been working at the Tropicana in Las Vegas and ran audio for the Folies Bergere and then after 3 years completely revamped and operated their Convention Services Technical Department. After much turmoil from the past, I would marry a woman that I knew for over 24 years and had her band booked many times in Atlantic City at the Taj Mahal and other places. The irony was that her band would have played for my first wedding but they weren't available, but I did book them for my brother's first wedding......her family was from a place 20 minutes from my New Jersey childhood home....I met her in Las Vegas at the Riviera lounge one night.....so it is indeed a small world. A few years later an emergency operation was done on my skull to stop infection from reaching my brain and holes were drilled into the area above my eyes to drain the poison, like I needed two holes in my head. Obviously, it worked. I watched as my mother died at age 67. I learned that the number of people I could really trust, I could count on one hand, as my father predicted and warned me 30 years earlier. I never gave up on myself.

When I was 50 years-old I planned a big birthday bash and made out the invitations with a picture of a man in a wheel chair on an IV, and being tended to by a nurse. Little did I know that I would be in a hospital fighting for my life because of an emergency operation for a spinal infection. I did in fact flat line and die, but was given a choice to fight and come back to the pain and bittersweet experiences of life, and I took it, despite the painless beauty of that afterworld experience. The nerve damage disabled me but I took this as just another challenge that life has doled out for me since I was that beaten-up child. I learned that love does truly conquer all and the love I had for my wife brought me back to the land of the living so that I could tell her and others that I was alright on that "other side." Despite the best efforts of the doctors and the hospital, I survived and checked myself out after 5 weeks in intensive care. I also learned "patient do thy own research" and don't trust "practitioners." Irony upon irony was that I had already written a Near Death Experience in my novel 10 years earlier that paralleled my real experience. I learned to laugh at death, to embrace life's preciousness and I allowed the epiphany of living, in its own right, to saturate my every action. I finally published my novel, I opened a restaurant with my brother, and I took chances without fear of the consequences. I was finally free to be who I always was and dared to do things without fear and was supported by those who cared without judgment of success or failure.

Now I have now turned 55 years-old and I am happy to be alive despite the paralyzation and pain from the surgeries and I know that life itself is all that counts. There is much more to my life than these highlights, there is no describing the passion, the intense work and rewarding outcomes, the dreams that became reality and the dreams that still live on. It is the how that is much more important than the what I have done. There is no great secret to how to live your life other than to survive and make lemonade from lemons. Those of weak minds do not survive and cannot be stable unless they begin to realize- this is it, this is not a rehearsal. You get one chance and only one chance, so why care about what anyone else thinks? I have learned that relying on pure hope without the effort of one's self is an invitation for disaster, but in the overall human existence, it is the singular most powerful emotion that brings us the strength to face another day, then another, and then another.

Now on the day of the First of November, I'll raise a glass for my diabetic-ridden ass, to drink to the thoughts on my special birth-day of celebrating my life, my wife, and for my parent's sacrifice to have brought me into this world, and lastly for the suffering and sacrifice to all those who are brave enough to have offspring in this world of unknowns. To my nieces and nephews and to all others, I leave you with this: Do what makes you happy and in the words of Joseph Campbell, "always follow your bliss." Anything less and you have no one else to blame for your misery. Accept the pain and deal with inevitable and then rejoice for your existence every day.