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Triggering A-Fib at the Dentist: My Post-Ablation Experience
A while back we published a warning by Dr. Sam about how your dentist's use of local anesthesia containing epinephrine can trigger your A-Fib. I have another warning to add.
My Dental Cleaning After Catheter Ablation
I was reminded of Dr. Sam's post when I visited my own dentist three days after having my recent catheter ablation (my Atrial Fibrillation returned after 21 years of being A-Fib free).
Upon hearing of my medical procedure, my long-time dentist, Dr. Dave Famili, didn't want to use the typical ultrasonic type of dental cleaning because it could distrupt my heart rhythm. So, they didn't use anything electronic. Instead, they did a manual cleaning only, and all was good.
For my chart, he also requested the name and contact information for my EP, Dr. Shepal Doshi, in case he needed to be contacted.
Update Your Medical Records
From my first-hand experience, I remind you to be sure to inform your dentist and other healthcare providers when you have a procedure for your Atrial Fibrillation.
Use of Epinephrine Could Trigger Your A-Fib
Another concern at the dentist is the use of Epinephrine (Epi or Adrenalin). It is one of the drugs EPs can use when completing a catheter ablation—they try to trigger A-Fib to check that their ablation scars for working. So any local anesthesia with Epinephrine (Epi) potentially can trigger A-Fib.
Local anesthesia (with Epi or Adrenalin) is used by dentists, dermatologists, emergency room personnel and others.
At the Dentist: A retired MD wrote to caution A-Fib patients that local anesthesia containing epinephrine can trigger your A-Fib.
Dr. Sam writes: "I had to have a dental implant and bridgework requiring that I have local anesthesia several times. The dentist uses local anesthesia with Epinephrine (Epi or Adrenalin) to numb your mouth.
My EP said he thought it would be OK to use. So I had it, and within 30 minutes I was in A-Fib which lasted about 20 minutes and then I went back into NSR.
From then on I requested that my dentist use only local anesthesia without Epi, and I had no more A-Fib episodes. Dentists like to use local anesthesia with Epi because it lasts longer and reduces bleeding locally.
I found very little info online about this, and no studies had been done about dental anesthesia with Epi & A-Fib."
Tell Your Doctors: Epinephrine Containing Products Can Trigger Your A-Fib
At the Opthamologist: The drops that the eye doctor uses to dilate your eyes are similar to Adrenalin. Ask for an alternative.
At the Dermatologist: Local anesthesia containing epinephrine is used by your doctor to numb skin and reduce bleeding when they remove cysts, limpomas, moles, skin cancer spots, etc. and to close lacerations. Tell them your concern about triggering your A-Fib.
Your GP and at the Emergency Room: Doctors use local anesthesia with Epinephrine to sew up wounds and/or to do small surgical procedures requiring local anesthesia, because it reduces bleeding locally and lasts longer. Remind your GP and discuss your A-Fib with emergency room caregivers. Express your concern about the use of Epinephrine. Ask for an alternative.
Are You Allergic to Medications? As a Caution Include Epinephrine
Medical staff routinely ask if you are allergic to any medications.
Tell your doctors you have Atrial Fibrillation and discuss your concern that the use of local anesthesia with Epinephrine may trigger your Atrial Fibrillation.
You might want to add Epinephrine as a medication you are allergic to in your medical records along with an explanation.
Early-Onset A-Fib linked With Family History
Blacks and Hispanics/Latinos with A-Fib have higher rates of complications and even death as a result of A-Fib. This is despite research which shows that Blacks and Hispanics/Latinos are less likely than Whites to develop Atrial Fibrillation.
Although research of A-Fib in minority populations has been limited, researchers think they have unlocked one bit of the mystery.
Thanks to the development of a large, diverse registry of patients at the University of Illinois at Chicago, researchers have been studying A-Fib in minority populations.
This study is unique because most prior studies on family history and A-Fib relied on data from mostly White populations, leaving doctors with little research to guide personalized treatment in minority communities.
A-Fib Registry of Blacks, Hispanics/Latinos and Whites: Of the 664 patients enrolled in UIC's A-Fib registry at the time of the study, 40 percent were white, 39 percent were black and 21 percent were Latino, according to Dr. Dawood Darbar, professor of medicine and head of cardiology at the UIC College of Medicine.
Early-onset A-Fib refers to those younger than 60 years old when diagnosed.
Early-onset A-Fib refers to those younger than 60 years old when diagnosed.
Link with Early-Onset A-Fib diagnosis: The researchers found that there was a family history of A-Fib in 49 percent of patients who were diagnosed with early-onset A-Fib (EOAF), that is, in patients younger than 60 years of age―compared with only 22 percent of patients diagnosed with A-Fib later in life.
Monitoring First-Degree Relatives: This is the first research-based evidence that supports increased monitoring (even including genetic testing) of families who have first-degree relatives with early-onset A-Fib (EOAF) as a preventive measure against complications including strokes.
When broken down by race, the chance of a patient with early-onset A-Fib having a first-degree relative with the condition was more than two-and-a-half times more likely for Blacks and almost 10 times more likely for Latinos, compared with only two-and-a-half times more likely for Whites.
While more research is needed, these findings have important implications for identifying family members at risk for atrial fibrillation
"Many people with A-Fib do not know they have the condition until they present to the emergency room with a stroke," said Dr. Darbar.
Hispanics/Latinos with early-onset A-Fib are almost 10 times more likely to have a first-degree relative with A-Fib.
Hispanics/Latinos with early-onset A-Fib are almost 10 times more likely to have a first-degree relative with A-Fib.
What this Means to Patients
For patients diagnosed with early-onset A-Fib, a family history of A-Fib was found in 49 percent of patients. This research holds true across all three races, Whites, Blacks and Hispanics/Latinos.
If you have early-onset A-Fib (EOAF), that is, if younger than 60 years old when diagnosed, your family members should be monitored for A-Fib as a preventive measure against complications including stroke. This is especially true for Hispanics/Latinos.
Causes: How Do You Get Atrial Fibrillation? What Triggers A-Fib?
Expanding your understanding of A-Fib is a core mission here at Atrial Fibrillation: Resources for Patients (A-Fib.com). In that effort, one of our core content pages is 'Causes of A-Fib'.
(A 'core page' answers one of the basic questions you [and your family] have about developing or being diagnosed with Atrial Fibrillation.)
Review of Causes and Triggers
Expand or fill in any gaps in your understanding of A-Fib. Our basic review of the various causes of Atrial Fibrillation covers: Heart Problems, Alcohol Consumption, Severe Body Distress, Mental Stress, Being Overweight and Genetics.
After the list of causes, we then review some of the Triggers that can bring on your A-Fib. We cover: Food-Related Triggers, Sleep Apnea, Mechanically-Induced A-Fib, Physical and Gender Characteristics, Aging and 'No Known Cause'. Go to What Causes A-Fib?
The Pursuit of Knowledge
The more you understand about Atrial Fibrillation, the better you can cope with your symptoms—and the better you can strive to Seek Your Cure!
The Effect of Diet & Nutrition on Your A-Fib: My Top 5 Articles
Many patients wonder if eating or avoiding the right foods might lessen or improve their A-Fib symptoms. While we don't know of any diet to "cure" your A-Fib, you might consider the "DASH" eating plan recommended by U.S. National Heart, Lung and Blood Institute which reduces the risk of developing cardiovascular disease.
The following articles may answer some of your A-Fib-related questions involving diet and nutrition:
1. Caffeine: "Is drinking coffee (tea, colas, other products with caffeine) going to make my A-Fib worse or trigger an A-Fib attack?"
2. Diet: "Is a whole food or organic diet helpful for patients with Atrial Fibrillation? Is there any research recommending one or the other?"
3. Personal A-Fib story: "No Way Am I Having an Ablation! But Diet and Meds Disappoint—A-Fib Free After Ablation" by Saul Lisauskas
4. Nutrition: "Why are doctors so opposed to nutrition as a way of helping A-Fib. I tried to talk with my doctor about magnesium and other nutritional supplements. 'There's no proof that they work,' was his response."
5. Holistic Approach: "I want nutritional counseling and a more integrated approach to my A-Fib treatment plan. How do I find a doctor with a more "holistic" approach?"
Be a Sleuth: Keep an Episode Diary
To determine if certain foods or beverages may be triggering the number and duration of your A-Fib attacks, start by keeping a log or diary. When an episode occurs, note the day & time, duration and what you were doing, eating or drinking.
As you collect data, scrutinize your log entries for patterns and specific triggers. This may lead you to lessen or eliminate certain foods or beverages or even activities that appear to trigger your A-Fib. You may want to share your log with your doctor.
More About Stroke and Dementia…Link to Artificial Sweeteners
It's commonly assumed that both sugar–sweetened and artificially-sweetened soft drinks have been linked to cardiometabolic risk factors, which increase the risk of cerebrovascular disease and dementia.
But results from the well-known Framingham Heart Study Offspring indicate otherwise.
Researchers studied 2,888 participants over 45 years old for incidents of stroke, and 1484 participants over 60 years old for incidents of dementia. Adjustments were made for age, sex, education (for analysis of dementia), caloric intake, diet quality, physical activity, and smoking.
Risks of Ischemic Stroke, All-Cause Dementia
Researchers found that higher recent-intake and higher cumulative-intake of artificially sweetened soft drinks "were associated with an increased risk of ischemic stroke, all-cause dementia, and Alzheimer's disease dementia."
But results were not the same for sugar! Sugar-sweetened beverages were not associated with a higher risk of stroke and dementia.
What Patients Need To Know
The bad news: For those of us worried about an A-Fib stroke and dementia, we need to avoid artificially-sweetened beverages.
The (somewhat) good news: The same warning doesn't seem to apply to sugar-sweetened beverages. (This doesn't necessarily mean that sugary drinks are healthy or good for you.)
For more about Dementia: see A-Fib and Dementia: My Top 5 Articles.
Can I Prevent Familial A-Fib with Diet? Supplements?
I've posted a new Frequently Asked Question and Answer about A-Fib that runs in families:
"Both my uncles and my Dad have Atrial Fibrillation. I'm 50 years old and so far I don't have A-Fib (yet), but I'm worried. How can I avoid developing A-Fib? Can dietary changes help? Or lifestyle changes?"
A-Fib does run in families and is called Familial A-Fib. Research says you have a 40% increased risk of developing A-Fib yourself. And the younger your uncles and dad were when they got A-Fib, the more likely you are to develop A-Fib. So, you are correct to be concerned about getting A-Fib.
My answer covers:
• What can someone with A-Fib in the family do to avoid getting A-Fib?
• Is there a diet to prevent A-Fib? The Mediterranean diet? A whole-food organic diet?
• What are the causes of A-Fib that can be controlled?
• Do mineral deficiencies cause A-FIb?
• What are the vitamins and supplements known to improve your overall heart health? (I take these myself to help stay A-Fib free after my 1998 catheter ablation which isolated only one of my pulmonary vein, common at the time.)
Read my full answer at FAQs: Can I Prevent Familial A-Fib with Diet? Supplements?
FAQs: Can I Prevent Familial A-Fib with Diet? Supplements?
FAQs Coping with A-Fib: Diet & Lifestyle
"Both my uncles and my Dad have Atrial Fibrillation. I'm worried. How can I avoid developing A-Fib? Can dietary changes help? Or lifestyle changes? I'm 50 years old and so far I don't have A-Fib (yet), "
A-Fib does run in families and is called Familial A-Fib. Research says you have a 40% increased risk of developing A-Fib yourself. And the younger that family member was when they got A-Fib, the more likely you are to develop A-Fib. So, you are correct to be concerned about getting A-Fib.
Note: Most heart health eating plans aim to improve the 'plumbing' of the heart, whereas A-Fib is primarily an 'electrical' problem.
A Heart Healthy Diet and Lifestyle
While there's no "Atrial Fibrillation diet" proven to prevent, stop or cure A-Fib, anything that improves your overall heart health might indirectly affect developing A-Fib.
Start with a 'heart healthy' diet and healthy lifestyle. There are lots of on-line resources and books about eating healthy for your heart.
• The U.S. National Heart, Lung and Blood Institute recommends the "DASH" eating plan which reduces the risk of developing cardiovascular disease;
• A Mediterranean diet may reduce the risk of atrial fibrillation, according to a article by Case Adams, a board-certified Naturopath;
• A whole-food organic diet is "preferred" for A-Fib patients, states Naturopathic doctor (ND) Dan Carter. But he doesn't claim that this diet will prevent or cure A-Fib.
For more about a whole food or organic diet, read my FAQ answer.
A-Fib Causes: Some are Under Your Control
The four main causes or co-morbidities of A-Fib are sleep apnea, obesity, hypertension and diabetes. If you have any of these conditions, it's important to get them under control.
Binge drinking has been known to start one's A-Fib, as well as smoking and excessive stress or anxiety. Avoid these as much as you can. (Also, many patients develop A-Fib post-surgery due to sudden low levels of magnesium.)
Dehydration can contribute to A-Fib. Too much alcohol or caffeine and too little water can alter the fluid levels in your body. Consume an adequate amount of water especially on hot days and when exercising.
Vitamins, Supplements and Herbs
Several vitamins, supplements and herbs have been shown to reduce or eliminate A-Fib symptoms. Magnesium and Potassium deficiencies are prevalent among A-Fib patients, as well as Calcium overload. Read more on our Mineral Deficiencies page.
For a list of 7 other vitamins and supplements known to improve your overall heart health, see my article: 'Natural' Supplements for a Healthy Heart'. (I take these myself to help stay A-Fib free after my 1998 catheter ablation which isolated only one of my pulmonary vein, a common treatment strategy at the time.)
What This Means to Families of A-Fib Patients
With A-Fib running in your family, you have a 40% increased risk of developing A-Fib yourself. And the younger your uncles and dad were when they got A-Fib, the more likely you are to develop A-Fib.
The younger your uncles and dad were when they got A-Fib, the more likely you are to develop A-Fib.
While there's no diet to prevent A-Fib, you can get control of co-morbidities such as obesity, sleep apnea, diabetes and high blood pressure. And you can avoid lifestyle choices like binge drinking, smoking, excessive stress and anxiety that increase your odds of A-Fib. (If you have surgery, ask your doctor about Magnesium IV post-op).
Above all, choose a healthy heart lifestyle, exercise, don't overindulge and eat well.
Back to FAQs: Coping with Your A-Fib
Last updated: Monday, June 18, 2018
Women with A-Fib: Mother Nature and Gender Bias—Or—Get Thee to an EP ASAP
by Patti J. Ryan, August 2015
Several studies have established that the symptoms and consequences of A-Fib are more profoundly felt in women.
Mother Nature and A-Fib Symptoms in Women
Females tend to develop A-Fib at a later age than men. They are also more likely to seek medical attention, are usually more symptomatic, and have higher heart rates. A-Fib tends to affect their physical quality of life more severely. Women suffer more from A-Fib related anxiety which in turn increases the risk of being misdiagnosed as panic disorders.
Women have a lower incidence of A-Fib than men. While men as a group develop A-Fib twice as often as women, there are twice as many females as males in the age group with the highest percentage of A-Fib, mainly because women live longer than men. Around five times as many males undergo catheter ablation than females.
Cardiovascular mortality rates are 2.5-fold greater for women with A-Fib. Women have a 4.6-fold higher rate of stroke. Post menopausal women are especially at risk for a stroke. The estrogen deficiency that comes with menopause causes a weakness in the arterial walls and an increase in proinflammatory molecules in the brain called cytokines. A-Fib is the most frequent cause of disabling stroke in elderly females.
Remember: you don't have to live with A-Fib! Seek your cure.
What can you do about it? As a female with A-Fib, you may have more symptoms, quality of life issues, and are at greater risk of an A-Fib-related stroke. But you don't have to live with A-Fib. As soon as practical, get a referral to a heart rhythm specialist (an Electrophysiologist (EP)—a cardiologist with a specialty in electrophysiology). Early diagnosis means less damage to your heart and more treatment options.
Drug Therapies for Women with A-Fib and Risk of Stroke
Women fail more antiarrhythmic drugs therapies than men. Women don't do well on some antiarrhythmic drugs (estrogen may prolong the QT interval). (Women have a longer QT interval than men.) When treated with antiarrhythmic drugs, women are more likely to have life-threatening adverse events. Women with A-Fib have about the same stroke risk as men, though they are less likely to receive anticoagulation.
Antiarrhythmic drug therapy in women with hypertension is associated with more major cardiovascular events. (Some research indicates that women may have more hypertension than men, 55.2% vs 40%).
What this means to patients: "Drugs don't cure A-Fib but merely keep it at bay," says heart rhythm specialist, Dr. Dhiraj Gupta. Antiarrhythmic drugs only work for about 50% of patients, and often stop working after a period of time. Many can't tolerate the side effects.
Don't spend a year in A-Fib trying different medications or combinations of medications only to find none work for you. In addition, anticoagulants, like warfarin, for your increased stroke risk, have their own health risks. Don't live a life on medication. Seek your cure.
Differences in Catheter Ablation for Females with A-Fib
Women, in general, have smaller cardiac chambers so that catheter manipulation is more of a challenge (40.6 mm on average for women vs 44.6 mm for men). (However, since research data shows there is a significant delay in referral for ablation in women, it is feasible that they may have larger left atrial sizes due to remodeling, making this a moot point.)
Run, don't walk to the best heart rhythm specialist (an electrophysiologist) you can find.
Females have more non-PV triggers and have lower ablation success rates.
Females tend to have more ablation complications like pericardial tamponade, vascular complications, and bleeding.
What can you do about it? Don't delay. "Run, don't walk" to the best heart rhythm specialist (an electrophysiologist) you can find, advises former A-Fib patient Sheri Weber. A-Fib is a progressive disease. Consult an EP after your diagnosis. Don't wait for your A-Fib to get worse. (A-Fib rarely gets better.)
Gender Bias Also Plays a Role
Women are referred to A-Fib specialists three times less often than men. Men with A-Fib are managed more aggressively (such as more cardioversions) prior to seeking a catheter ablation.
Women often have developed a larger left atrium because of being referred to EPs later in their treatment plan than men (60 months for females vs 47 months for males).
Women are referred to A-Fib specialists three times less often than men.
Women are referred for catheter ablation less frequently and later into their treatment plan than men. When referred, they are older on average than men (61.6 years old vs 56.9 years old for men).
Consequently, they have more complex symptoms, and their procedure success rate is lower with more complications.
What can you do about it? When you go to your GP or cardiologist with your A-Fib symptoms or complaints, anticipate gender bias! Don't let it deter you. A-Fib is a progressive disease. Don't waste time. Don't let your A-Fib worsen over time by remodeling or enlarging your heart. Request a referral to a heart rhythm specialist―an electrophysiologist (EP). Until you consult an EP, you may not be getting the best and most up-to-date A-Fib treatment advice. You deserve nothing less.
Don't just take your meds and get used to being in A-Fib.
Why is there Gender Bias in the Treatment of Women with A-Fib?
In many cultures and societies, doctors are more conservative in their treatment of women with A-Fib. Some doctors, concerned with safety, may be reluctant to perform or recommend any invasive procedures in women.
Social and family pressures may delay medical consultation and treatment ("I can't be sick. My family needs me.") Access to health care may be limited for some women.
And, of course, there's plain ol' bias by male doctors against female patients. "Your symptoms are all in your mind." or "Just take your meds and get used to being in A-Fib." (These are actual quotes from A-Fib.com readers about their doctors' advice.)
What can you do about it? Be prepared for your doctor appointment with a list of questions or concerns. Don't leave until you have answers. Don't be afraid to 'fire' your doctor. Get a second, or third opinion. Find a doctor who will partner with you to find your cure or best outcome. (For help, use the Finding the Right Doctor for You resources on A-Fib.com.)
Good News: EPs Less Likely to Have Gender Bias
Research indicates female gender bias tends to disappear when a woman sees an electrophysiologist (EP), particularly concerning catheter ablation. This suggests that treatment bias may be more at the primary care level, i.e., your GP or general cardiologist.
What this means to patients: It's reassuring to be in the care of someone who regularly treats A-Fib patients. A-Fib is an electrical problem. Don't waste you time. Don't settle for just 'managing' your A-Fib. See a heart rhythm specialist, an electrophysiologist, a cardiologist who specializes in the electrical function of your heart. An EP will discuss all your treatment options. EPs want to free you from the burden of A-Fib.
About the Author: Patti J. Ryan is editor of A-Fib.com and regularly contributes her writing and graphics expertise. She is also publisher of Beat Your A-Fib: The Essential Guide to Finding Your Cure by Steve S. Ryan, PhD (BeatYourA-Fib.com), an Amazon.com Top 100 Seller in two health-related categories.
Shallenberger, Frank. The Connection Between Stroke and Frailty – And How to Avoid Both, Second Opinion, February 2020, Vol. XXX, No.2, p. 1.
VIDEO: Atrial Fibrillation—A Conversation with Dr. Steve S. Ryan
Resources & Links
Video Interview: Steve S. Ryan, PhD, Author of Beat Your A-Fib
Host Skip E. Lowe interviews Steve S Ryan, PhD, about Atrial Fibrillation. Topics include A-Fib symptoms, causes, cures and Dr. Ryan's book, Beat Your A-Fib – The Essential Guide to Finding Your Cure. Skip E. relays his own experiences with A-Fib. Dr. Ryan warns about incorrect A-Fib information found on the internet and in print media. Recorded in W. Hollywood, CA. 14:53 min.
About Steve S. Ryan, PhD: An advocate for patients with Atrial Fibrillation, Dr. Ryan is publisher of the patient education website 'Atrial Fibrillation: Resources for Patients' (A-Fib.com), author of the award-winning book, 'Beat Your A-Fib: The Essential Guide to Finding Your Cure' (BeatYourA-Fib.com) and known as The A-Fib Coach for his one-to-one mentoring of A-Fib patients.
Return to Videos Featuring Steve S. Ryan, PhD
Last updated: Tuesday, April 21, 2015
Research: Catheter Ablation Reduces Stroke Risk even for Higher Risk Patients
Catheter Ablation Reduces Stroke Risk Even for Higher Risk Patients
by Steve S. Ryan, Last updated: March 24, 2018
In a study of nearly 38,000 people, patients with A-Fib who had a catheter ablation had about as many strokes as the people without A-Fib, while people on just medication had about twice as many strokes. (This isn't a surprising finding. If you no longer have A-Fib, by definition you can't have an A-Fib stroke.)
But what is surprising is that even patients at greater risk of stroke had a reduced stroke risk after catheter ablation. "Across all CHADS2 profiles and ages, A-Fib patients with ablation had a lower long-term risk of stroke compared to patients without ablation." Even those at higher risks of stroke had a reduced risk of stroke.
Catheter Ablation Reduces Stroke Risk to That Of A Normal Person
And, more importantly, if someone had a catheter ablation, stroke risk decreased to that of a normal person. "A-Fib ablation patients had similar long-term risks of stroke across all CHADS2 profiles and ages compared to patients with no history of A-Fib…Freedom from A-Fib was the strongest predictor of stroke-free survival."
Warfarin Not Needed After Successful Catheter Ablation
Some patients after a catheter ablation are still put on warfarin-for-life depending on their CHADS2 score. But research indicates that "A-Fib patients after ablation with moderate to high risk CHADS2 scores in which warfarin was discontinued do not show a higher risk of stroke compared to those in which warfarin is continued."
Editor's Comments:
This study is medical breakthrough news, similar to another important study in which a successful catheter ablation reduced by 60% the expected rate of cardiovascular mortality. (See Live Longer—Have a Catheter Ablation.)
For anyone who has had a successful catheter ablation or who is thinking of having one, this study also is a game changer!
Even if you are at a theoretical high risk of stroke (high CHADS2), you don't have to be on warfarin for the rest of your life after a successful catheter ablation. A successful catheter ablation reduces your stroke risk to that of a normal person (though obviously normal people do have strokes).
We already know that a catheter ablation significantly improves our well being. We certainly feel healthier in sinus rhythm. Few other medical procedures produce such a dramatic and nearly immediate improvement in our quality of life. This study confirms the long-term benefits of catheter ablation even for people who are sicker.
We don't have to live a life on meds! A-Fib can be cured by a catheter ablation. And when you are made A-Fib free, not only do you feel better, but your risk of stroke is reduced to that of a normal person! This is terrific news for the A-Fib community.
Return to Treatments for A-Fib
Last updated: Saturday, March 24, 2018
FAQ: Natural Therapies & Holistic Treatment for A-Fib
FAQ: Natural Therapies & Holistic Treatment
Many A-Fib patients have questions about treatment alternatives such as naturopathic doctors, complementary or integrated medicine as well as mind/body practices (such as chiropractic, acupuncture, yoga and meditation).
1. Holistic approach: "How do I find a doctor with a more "holistic" approach? I want nutritional counseling and a more integrated approach to my A-Fib treatment plan?
2. Complementary Medicine: "I've read that yoga and acupuncture are considered 'Complementary Medicine'. What is that? How does it relate to conventional medicine?"
3. Naturopathic Medicine: "A dietitian friend referred me to a Naturopathic doctor. What is naturopathic medicine? Are they 'real' physicians?"
Related question: "Have any A-Fib.com readers reported success working with a Naturopathic doctor? Anyone controlling their A-Fib with supplements?"
4. Vagal: "What is the 'vagal maneuver'? I've heard it might help me during an A-Fib episode. What is it and how is it done? Is it safe?"
5. Diet: "Is a whole food or organic diet helpful for patients with Atrial Fibrillation? Is there any research recommending one or the other?"
6. Chiropractic: "Do A-Fib patients find chiropractic adjustment useful? If so, what are their results? In the past, I've found it helpful for other ailments. Could it help with my A-Fib symptoms?"
7. Yoga: "I do Yoga. It relaxes me and helps with my stress level. Is there any evidence on Yoga helping with other A-Fib symptoms?"
8. Acupuncture: "What's the research on acupuncture and Atrial Fibrillation? I'm willing to try it if it will help ease or reduce my A-Fib episodes."
9. Natural blood thinners: "Have there been any tests comparing natural blood thinners to the new anticoagulants (NOACs) in terms of efficacy and speed of onset?"
"Most people use non-mainstream approaches along with conventional treatments. The boundaries between complementary and conventional medicine overlap and change with time." ∼ US National Institutes of Health
If you find any errors on this page, email us. Y Last updated: Saturday, February 11, 2017
Return to Frequently Asked Questions
FAQs Understanding A-Fib: Questions from Patients
FAQs: Understanding Atrial Fibrillation
Atrial Fibrillation patients often have loads of "Why?" and "How?" questions. Here are answers to the most frequently asked questions by patients and their families. (Click on the question to jump to the answer.)
1. Causes: "Why does so much Atrial Fibrillation come from the Pulmonary Vein openings?"
Related Question: "Why do older people get Atrial Fibrillation more than younger people?"
Related Question: "What causes Paroxysmal A-Fib to turn into Persistent (Chronic) A-Fib?"
Related Question: "A-Fib and Flutter—I have both. Does one cause the other?"
2. Hereditary: "Is my Atrial Fibrillation genetic? Will my children get A-Fib too?"
3. PSVT: "Is Atrial Fibrillation (A-Fib) different from what doctors call Paroxysmal Supraventricular Tachycardia?"
4. Adrenergic/Vagal: "What is the difference between "Adrenergic" and "Vagal" Atrial Fibrillation? How can I tell if I have one or the other? Does it really matter? Does Pulmonary Vein Ablation (Isolation) work for Adrenergic and/or Vagal A-Fib?"
5. Heart Condition: "How do I know if I have an enlarged left atrium and what does it mean, if it is? What is the size of a normal left atrium?
Related Question: Fibrosis: "How can I determine or measure how much fibrosis I have? Can something non-invasive like a CT scan measure fibrosis?"
Related Question: Stiff Heart: "I've heard about 'stiff heart' or diastolic dysfunction. When you have A-Fib, do you automatically have diastolic heart failure? What exactly is diastolic dysfunction?"
6. Stem Cells: "I've read about stem cells research to regenerate damaged heart tissue. Could this help cure A-Fib patients?"
7. EF: "What is the heart's ejection fraction? As an A-Fib patient, is it important to know my EF?"
8. Anesthesia: "I read that the local anesthesia my dentist uses may trigger my A-Fib. Why is that?"
9. Treatment Options: "My surgeon wants to close off my LAA during my Mini-Maze surgery. Should I agree? What's the role of the Left Atrial Appendage?"
Related Question: "My cardiologist recommends a pacemaker. I have paroxysmal A-Fib with "pauses" at the end of an event. Will they stop if my A-Fib is cured? I am willing, but want to learn more about these pauses first."
Related Question: "My EP won't even try a catheter ablation. My left atrium is over 55mm and several cardioversions have failed. I am 69 years old, in permanent A-Fib for 15 years, but non-symptomatic. I exercise regularly and have met some self-imposed extreme goals. What more can I do?
10. Cure Rate: "I have paroxysmal A-Fib and would like to know your opinion on which procedure has the best cure rate."
If you find any errors on this page, email us. Y Last updated: Saturday, June 16, 2018
FAQs Newly Diagnosed with A-Fib: Cause
"Did I cause my Atrial Fibrillation? Am I responsible for getting A-Fib?"
Most likely not.
We all remember our first attack of A-Fib—the shock, fear, confusion, the sense of something wrong in our body that we can't control and the rushing to a doctor and/or emergency room.
Often there's a tendency to blame ourselves, to feel guilt. We ask ourselves "What did I do—or not do—that caused my A-Fib?"
In general we are not responsible and didn't cause our A-Fib. It's different from a life-style related condition (like liver failure due to alcohol abuse).
Those newly diagnosed need to think of A-Fib as fate or karma or a life accident—rather than something we bring on ourselves. In life sometimes bad things happen to good people through no fault of their own. Think of A-Fib that way.
We need to keep saying to ourselves, "I am not responsible for my A-Fib. I did not cause my A-Fib," like a chant or mantra whenever we start feeling guilt or blame for our A-Fib.
Go back to FAQ for the Newly Diagnosed A-Fib Patient
Last updated: Monday, June 18, 2018
FAQs from Newly Diagnosed Patient
Frequently Asked Questions by Newly Diagnosed Patients
Newly diagnosed Atrial Fibrillation patients have many questions about living with A-Fib. These are answers to the most frequently asked questions by patients and their families. (Click on the question to jump to the answer)
1. Cause: "Did I cause my Atrial Fibrillation? Am I responsible for getting A-Fib?"
2. Severity: "My doctor says I had an attack of Atrial Fibrillation. How much trouble am I in?"
Related Question: "Is Atrial Fibrillation a prelude to a heart attack?"
Related Question: "Can I die from my Atrial Fibrillation? Is it life threatening?"
3. Anomaly? "Could my Atrial Fibrillation go away on its own? I don't want to take any medication. Can I just wait and see?"
Related Question: "Is it possible to have a single Atrial Fibrillation attack and not have any others? I had a single episode of A-Fib and was successfully converted in the ER with meds."
Related Question: "How can I tell when I'm in A-Fib or just having something like indigestion?"
4. Sex/Exercise: "Should I cool my sex life? Can I exercise if I have Atrial Fibrillation? Should I exercise?"
5. Driving: "Can I drive my car if I have Atrial Fibrillation?"
6. Nutrition: "Is drinking coffee (tea, colas, other products with caffeine) going to make my Atrial Fibrillation worse or trigger an A-Fib attack?"
Related Question: "Is there a diet I could follow which would cure my Atrial Fibrillation?"
7. Medical ID: "Should I carry a wallet card or a medical ID? I have A-Fib and take Coumadin (warfarin). In case of an A-Fib emergency, what information should I include?"
8. Coping: "I have a lot of stress at work. Does this stress cause or trigger my Atrial Fibrillation?"
Related Question: "I live in fear of my Atrial Fibrillation. I never know when I'm going to get an A-Fib attack or how long it will last. How do I deal with the anxiety?"
Related Question: "Is there anything I can do to get out of an Atrial Fibrillation episode? How do others deal with their episodes?"
9. Specialist? "Should I see a cardiologist for my Atrial Fibrillation and not just my primary care doctor? (He wants to prescribe medication.) Should I also see an A-Fib specialist?"
10. Cure? "Is Atrial Fibrillation curable? Or can you only treat or control it? Should I seek a cure?"
11. Disability Benefits? "Can I get government social security disability benefits if I have Atrial Fibrillation?
If you find any errors on this page, email us. ♥ Last updated: Monday, October 2, 2017
Return to Frequently Asked Questions
What Causes Atrial Fibrillation?
What are the Causes of A-Fib?
It's estimated as many as 5.1 million people in the U.S. have A-Fib. By the year 2050, the number will be 12-16 million. Each year there are over 340,000 new cases in the US. A-Fib is the most common heart arrhythmia. In the U.S. people over 40 have a one in four lifetime risk of developing A-Fib.
Worldwide the number of cases is estimated to be 33.5 million or 0.5% of the world's population. A-Fib has rightly been called an emerging epidemic.
Risk Factors: HOW DO YOU GET A-FIB?
Heart Problems
If you've had other heart problems, this could lead to diseased heart tissue which generates the extra A-Fib pulses. Hypertension (high blood pressure), Mitral Valve disease, Congestive Heart Failure, coronary artery disease, and obesity seem to be related to A-Fib, possibly because they stretch and put pressure on the pulmonary veins where most A-Fib originates. Coronary artery disease reduces blood flow and oxygen (stagnant hypoxia) which can trigger A-Fib. Coronary artery disease reduces blood flow and oxygen (stagnant hypoxia) which can trigger A-Fib.
Coronary artery disease reduces blood flow and oxygen (stagnant hypoxia) which can trigger A-Fib.
A lot of A-Fib seems to come from uncontrolled high blood pressure. Many EPs recommend that all hypertension patients get a home BP monitor and aggressively work at controlling their blood pressure. Hypertension is high among people with A-Fib, about 70% to 90% based on randomized clinical trials of DOACs (Direct Oral Anticoagulants).
About 25% to 35% of stroke survivors experience atrial fibrillation; Up to 40% of patients get A-Fib after open heart surgery. "Pericarditis"—inflammation of the pericardium, a sack-like membrane surrounding the heart—can lead to A-Fib.
Alcohol Consumption
Heavy drinking may trigger A-Fib, what hospitals call "holiday heart"―the majority of A-Fib admissions occur over weekends or holidays when more alcohol is consumed. No association was found between moderate alcohol use and A-Fib. (Heavy drinking reduces the ability of cells to take up and utilize oxygen [histotoxic hypoxia] which in some people may produce or trigger A-Fib. [Thanks to Warren Stuart for this insight.]) See the personal A-Fib story by Kris: "Binge Drinking Leads to Chronic A-Fib, Amiodarone Damages Eyesight" pp. 144-150 in my book, Beat Your A-Fib.
See the personal A-Fib story by Kris: "Binge Drinking Leads to Chronic A-Fib, Amiodarone Damages Eyesight" pp. 144-150 in my book, Beat Your A-Fib.
But if you already have A-Fib, even moderate use may trigger an A-Fib attack, "…people with atrial fibrillation had almost a four and a half greater chance of having an episode if they were consuming alcohol than if they were not. (Thanks to David Holzman for calling our attention to this article.)
Otherwise healthy middle-aged women who consumed more than 2 drinks daily were 60% more likely to develop A-Fib.
Steve Walters writes "that red wine brings on A-Fib attacks for him, but not beer, white wine, or cordials. Has anyone else had similar experiences with red wine?" E-mail: bicwiley(at)gmail.com.
Neville writes that "taking a heavy dose of Magnesium/Potassium tablets and bananas for breakfast kept him out of A-Fib during a golfing weekend with significant drinking." He uses the same strategy to get out of an A-Fib attack. email@example.com
Severe Body & Mind Stress
Severe infections, severe pain, traumatic injury, and illegal drug use can be a trigger. Low or high blood and tissue concentrations of minerals such as potassium, magnesium and calcium can trigger A-Fib. Thyroid problems (hypothyroidism), lung disease, reactive hypoglycemia, viral infections and diabetes.
To learn the impact of anxiety and emotional stress on A-Fib, see Jay Teresi's personal story "Anxiety the Greatest Challenge"
Extreme fatigue, anxiety and emotional stress can trigger A-Fib. (Even "minor" stress may trigger A-Fib. Harlan writes that something as simple as watching an emotional or scary movie or TV show may trigger his A-Fib.)
Smoking can trigger A-Fib. Smoking reduces the ability of the blood to carry oxygen (anemic hypoxia). Smoking cigarettes raises the risk of developing A-Fib even if one stops smoking, possibly because past smoking leaves behind permanent fibrotic damage to the atrium which makes later A-Fib more likely.
Being Overweight
As we put on pounds, our risk of developing A-Fib increases. In recent studies overweight adults were 39% more likely, and obese adults 87% more likely, to develop A-Fib than their normal-weight counterparts.
Health problems linked to obesity, like high blood pressure and diabetes, can contribute to A-Fib. And obesity may put extra pressure on the pulmonary veins and induce A-Fib. Left atrial hypertension is a common finding in obese patients.
See the personal story and VIDEO by Susan Klein: My Family's A-Fib was Misdiagnosed for Years.
See the personal story and VIDEO by Susan Klein: My Family's A-Fib was Misdiagnosed for Years.
According to Dr. Dan Roden of Vanderbilt University, genetic research may become important to A-Fib patients. He postulates that "Lone A-Fib" (A-Fib without a known cause) may actually be caused by genetics.
We've had reports that A-Fib can be triggered by antihistamines, bronchial inhalants, local anesthetics, medications such as sumatriptan, a headache drug, tobacco use, MSG, cold beverages and eating ice cream, high altitude, dehydration, and even sleeping on one's left side or stomach. One person writes that hair regrowth products seem to trigger his A-Fib.
I used to include caffeine (coffee, tea, sodas, etc.) in this list, but some research suggests that coffee and caffeine in moderate to heavy doses (2-3 cups to 10 cups/day) may not trigger or induce A-Fib. Coffee (caffeine) may indeed be antiarrhythmic and may reduce the propensity and inducibility of A-Fib both in normal hearts and in those with focal forms of A-Fib.
But we are all different. If coffee triggers your A-Fib, consider switching to decaf.
Possible Food-Related Triggers
Chocolate in large amounts may trigger attacks. Chocolate contains a little caffeine, but also contains the structurally related theobromine, a milder cardiac stimulant.
Another reader writes that the natural sweetener and sugar substitute Stevia seems to trigger her A-Fib.
GERD (heartburn) and other stomach problems (like H. pylori) may be related to or trigger A-Fib. If so, antacids and proton pump inhibitors like Nexium may help your A-Fib. A report from England suggests that the veterinary antibiotic "Lasalocid" found in eggs and poultry meat may cause or trigger A-Fib.
Sleep Apnea
Recent research indicates sleep apnea (where your breathing stops while you are sleeping) may contribute to A-Fib, probably by causing stress on the Pulmonary Vein openings and/or by depriving the lungs and body of adequate oxygen supply (Hypoxemic Hypoxia).
Over 25 million Americans currently have sleep apnea, but 80% of these people don't know they have it.
In one study of patients with A-Fib, 43% had sleep apnea. (An additional 31% had "central sleep apnea/Cheyne-Stokes respiration" which is a different type of sleep apnea.)
If you have A-Fib, it's wise to have yourself checked for sleep apnea. You can do a "quick" check of how much oxygen is in your blood with a Pulse Oximeter, such as the Contec Pulse Oximeter for about $30 from Amazon.com and in drug stores. A reading below 90% would indicate you need to have a sleep lab study.
Gail writes that "both her sleep apnea and her A-Fib were cured by a CPAP [Continuous Positive Airway Pressure] breathing machine." (E-mail her: gail(at)bonairwine.com.)
To learn more, see Sleep Apnea: When Snoring Can Be Lethal and Sleep Apnea: Home Testing with WatchPAT Device and the Philips Respironics
Mechanically Induced A-Fib
Be careful if you work around equipment that vibrates. Certain frequencies and/or vibrations may possibly trigger or induce A-Fib. (If anyone has any info on how or why high frequencies and/or vibrations may possibly affect A-Fib, please email me.) Don Thompson describes how working on an oil drilling rig with a vibrating plate "a shaker" caused him to go into A-Fib. See Don Thompson Story.
Isabel Pichardo writes that the vibrations from riding in her husband's Mini Cooper trigger her A-Fib for long periods.
Michael writes, "I had an A-Fib attack right after using a tens device on my shoulder close to my heart. I'm sure this set it off. Within 30 minutes after the tens treatment, I was in A-Fib. I was feeling very well with no stress. It had been 10 years since my last A-Fib attack."
Jerry writes that "high powered magnets, such as the N50, may trigger A-Fib due to the electromagnetic fields they generate." (If you have any info on this, please email me.)
Physical and Gender Characteristics
Men get A-Fib more than women. But women may have more symptoms.
Men get A-Fib more than women. But women may have more symptoms.
Men get A-Fib more than women. But women fail more antiarrhythmic drugs therapies than men and may have more symptoms. For more see my article: The Facts About Women with A-Fib: Mother Nature and Gender Bias.
A-Fib is associated with aging of the heart. As patients get older, the prevalence of A-Fib increases, roughly doubling with each decade. 2-3% of people in their 60s, 5-6% of people in their 70s, and 8-10% of people in their 80s have A-Fib. Approximately 70% of people with A-Fib are between 65 and 85 years of age.
This suggests that A-Fib may be related to degenerative, age-related changes in the heart. Inflammation may contribute to the structural remodeling associated with A-Fib.
No Known Cause
But in many A-Fib cases of Paroxysmal A-Fib (around 50%), there is no currently discernible cause or trigger (called "Lone" or "Idiopathic A-Fib"). (Some research suggests that inflammation may initiate Lone A-Fib.)
Explore Treatments for A-Fib
Regardless of the cause of your A-Fib, we make it easy to explore the various treatments for Atrial Fibrillation. Both short-term and long-term approaches aim to control or eliminate the abnormal heart rhythm associated with A-Fib. Go to Treatments.
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Return to A-Fib.com home
If you find any errors on this page, email us. Y Last updated: Saturday, April 25, 2020


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The below is posted at Daily Nous.
What should be the relation of a philosophy department to the country it is in? For example, is there a sense in which a philosophy department in America ought to be distinctly American, tied more closely to the history, culture and identity of America than to that of other countries? Or should the fact that the department is in America be irrelevant to the philosophical work that is done in the department?
I will call the former view, that the department ought to be distinctly American in some sense, nationalism. And I will call the latter view universalism.
So according to nationalism, philosophy departments in, say, America, Mexico, India, Germany, Egypt and so on, though they will have a great deal of similarities and points of overlap, nonetheless will be different in their philosophical projects since they are interwoven with their home countries in different ways. According to universalism, however, philosophy departments in different countries ought to be the same in terms of content, since philosophy departments ought to transcend the contingent fact of their location.
A couple of clarifications. First, nationalism in the sense I am talking about is distinct from patriotism. The difference between a nationalist and a universalist isn't who loves their country more. A universalist can be as patriotic as a nationalist. The difference is about the philosophical relevance of the country the department is in to the work of the department.
Second, much work done in philosophy departments is obviously universalist. Logic, philosophy of physics, philosophy of biology, internalism versus externalism—for these it makes no difference whether one is in America or Brazil or South Africa. For that matter, if one is working on Spinoza or Shankara or Avicenna with the aim of understanding the content and historical conditions of their work, then too it is irrelevant what country one is in. So the issue between nationalism and universalism isn't whether philosophy projects can be universalist. The issue is whether philosophy departments ought to also have distinctly nationalist projects which are more tied to the concerns, culture and history of the country the department is in.
At first blush, it might seem that universalism is the clear way to foster diversity in philosophy departments. If departments adhered to nationalism, wouldn't that reinforce the structural privileges and biases of the country the department is in? The universalist argues that in order to think critically about the assumptions of a country, it is essential to adopt a universal perspective where people reflect on themselves not as Americans or French or Israelis, but simply as people. That the task of philosophy is to foster such universalism.
I would suggest, however, that universalism actually stifles conversation about diversity. For it replaces philosophical debate about the identity and direction of a country with a sharp dichotomy between local, unphilosophical discourse and universal, philosophical discourse. In the process, any view other than universalism is set up from the get go as something backward, insular and what is to be overcome.
This stifling of debate is experienced from at least two sides in America. First, from the side of proponents of cultural Eurocentrism. If someone says, "American philosophy departments should focus more on European philosophy since it captures the traditional culture of America," this is not racist or automatically intolerant. Racists might say such a thing, but that doesn't mean racism is the only way of saying it. A philosophical Eurocentrist is a nationalist, in the sense I defined above, who has a particular view about what nationalist projects philosophy departments should contribute to. This is a legitimate view in conceptual space which ought to be taken seriously, both for its potential merits and because a great many people intuitively find it compelling. Nothing is gained by dismissing it without reflection.
A similar stifling of debate can be experienced by proponents of non-European traditions. In America, this is most obvious in the case of African-American philosophy. Since African-Americans can lay a great claim to America (as people who were an essential part of it from its foundation), universalism is not necessary to argue for the inclusion of African-American philosophy in philosophy departments. Embracing nationalism is more than sufficient for that. The idea that African-American philosophy can only be defended from a universalist perspective uncritically reinforces the assumption that America as a nation is fundamentally Eurocentric. But this assumption is exactly one of the main issues at stake, and can only be resolved by explicitly doing, what one might call, the philosophy of America (What it is? What it has been? What it ought to be?).
For example, is Black Lives Matter philosophically significant? What about the alt right? Saying "yes" doesn't require agreeing with these movements. It requires just the idea, which is patently true, that these movements sharply raise questions related to the philosophy of America. These movements are attempts to articulate different, competing visions of America. Philosophy departments can help in better articulating these visions, and so help foster more productive and rigorous discussion between them.
Ultimately, this is the limitation of universalism. To foster diversity, we need philosophy departments to engage more, not less, with issues distinctive to the nations they are in. Though Black Lives Matter has movements in other countries, it cannot be evaluated simply as a global phenomenon. In its American, founding manifestation, it is a distinctly American movement, with people, pro and con, trying to grapple with the history of race relations in America. The unique American element of the movement is not a detriment to its philosophical interest, as universalism would imply. Rather, it is of great importance for honestly addressing the philosophical questions particular to the identity of America.
Let me end with a historical speculation. Prior to World War II, American pragmatism, especially in its Deweyean form, was unabashedly nationalist. Just as Dewey made no sharp distinction between science and philosophy, he made no sharp distinction between politics and philosophy. It was treated as entirely natural that part of the project of philosophy departments in America would be to foster the flourishing of America – including debating what America, and its flourishing, meant.
After World War II, however, universalism became more the norm in American philosophy. Like Dewey, Quine blurred the boundary between science and philosophy; but unlike Dewey, Quine reinforced a sharp separation between politics and philosophy. On the Quinean worldview, philosophers, like scientists, are trans-national thinkers, interested only in universal truth, and not in particular identities such as what country one lives in. Nor was this only an analytic attitude. A continental thinker like Marcuse blurred the boundary of politics and philosophy, and made a big cultural impact in America. Yet the politics at issue was trans-national, of the common situation of countries in late capitalism.
Why did this shift happen in America in mid-20th century? My guess is that with the civil rights movement and the end of colonialism, the concept of nationalism in philosophy departments in America became conflated with the concept of racist white nationalism in American culture. The conflation is psychologically and historically understandable. But intellectually it has been disastrous, especially for discourse about the direction of America. Philosophers in America need to resist this conflation and create spaces for debating alternate nationalistic visions, for academic philosophy and America more broadly. They would then be at the front lines of healing the divisions in the country.

subset: commoncrawl


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by Cross Woodfield
So i have just been thinking lately about words…
Like in women's studies we learn to call ourselves "women" because it's more empowering than calling ourselves "girls".
But I like the word "girls" wayyyyy more…it's
a. less frumpy
b. more fun
c. more feminine
d. more youthful
We also learn that words like "lovely" and "coy" that are gendered feminine can be regressive in terms of feminism because they connote submission and a game-playing-with-boys type of feel.
What do y'all think?
Can words empower us, or do we feel empowered enough to use whatever words we want?


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*Actual prices may vary
Priscilla relentlessly pursues Clare's destruction, while Deneve and Helen remain just as determined to protect her. But when the combined form of Luciela and Rafaela attacks, Clare and her cohorts are pulled into the twisting mass. Meanwhile, in Rabona, Miria heads east to destroy the Organization. She encounters Rubel and his secret weapons: mysterious warrior twins who may be Alicia and Beth's successors, as well as the Organization's number 10—a deadly fighter who can read Miria's mind.
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- отправил Feb 14, 2016Indoor Spec. ?It is outdoor use.After the first rain after a few days from using it, dropping Cover was full of Tank and Seat water droplets. Water will also enter from the gap between Seat and Rear cowl and the cl...Прочитайте больше
- отправил Nov 29, 2015Clearly, it is better not to buy.I have been buying and began to break down around the year and a half. It is the most durable among Bike Cover purchased so far (Cover of 5000 yen Class or less). I thought that the best Cover was dec...Прочитайте больше
- отправил Jun 10, 2013It purchased together with the Motorcycl...It purchased together with the Motorcycle and one year has already passed.
Although a fall is not seen for the moment, the water repellence of the Cover does not have the durability of the place of t...Прочитайте больше


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After working here for over 41 years, our most tenured employee at EHD, Ed Eshleman knows a thing or two about EHD and what makes it special. Throughout his time here, Ed has been an account executive, a marketing manager for our branches, an in-house underwriting program manager and now the Exton Commercial Lines Manager and Assistant Vice President. The hallmarks of Ed's personality are his kindness, and his drive to "always treat everyone the way [he] would want to be treated."
Ed explained his passion for EHD, "I'm a second generation employee, following in my father's footsteps. At the completion of one more year at EHD, [I] will have passed his number of years of service."
While not working, Ed enjoys spending time with his wife and two daughters, watching sports and going on vacation with his family. His lifelong love though, is golf. In fact, he said, "My wife surprised me with a trip to Arnold Palmer's Bay Hill Club in Orlando, FL for a couple rounds of golf to celebrate my 60th birthday!"
Ed Eshleman is a team player who takes pride in representing our company. No matter the situation, he is always fair and humble. Ed's extensive experience in the insurance industry makes him a valuable resource to colleagues and clients alike. Throughout the 41 years he has spent here, Ed has seen many changes come to pass, both big and small. One thing we hope never changes, though, is his valued presence in this company and his exceptional dedication.


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The Wedding Venue – Lillibrooke Manor
This beautiful wedding was held in Lillibrooke Manor, Maidenhead. It's a gorgeous Tudor house settled in the most stunning grounds. It provided the perfect setting for the wedding celebrations of Abbie and Mitch, who came together with their families to throw one epic party.
The Details
This one was brim full of personal touches. Our gorgeous bride even spent her train commute to work cross stitching table plans and table decorations – what a trooper. I love personal details that weave through wedding days. The little touches added by the couple that you know that have had hours of love and patience poured over them to make the day unique and therefore extra special. This wedding day was absolutely jam packed with smiles, family, friendship and love.
The Couple
These two love birds are perfect for each other. Both utterly gorgeous, kind, thoughtful and so very much in love. It was a pleasure to be with them for their big day and watching them laugh, smile and share those tiny personal moments that are caught through a lens. I can't thank them enough for allowing us to share their day with us. So here we are! THAT dress, those sharp suited boys, "Team Bride", the setting, the sunset – simply perfection.
Have a look at some of the sneak peeks here…
I think you'll agree that these two are absolutely gorgeous and the whole wedding was just divine. We laughed the whole day and we felt incredibly welcommed, in conclusion I now declare we are part of the family. The fun we had with group shots, smoke bombs, coloured flash guns, confetti and dirty page boys knees all came together to make an unforgettable day and that's without mentioning the most epic cake.
Thank you Abbie and Mitch, you absolute stars!
To see more of my weddings please click here


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Escape to Westfield
Escape to Westfield
As a New Yorker and mother of two girls, escaping for a day out—and maybe a drink—is often what is needed. Lately, my choice has been Westfield World Trade Center. Being able to find my favorite stores in one spot is ideal. Every girl loves a new pair of shoes (Stuart Weitzman!) and a great new moisturizer (Rituals!) to make her feel like new. Of course, I can't forget the hubby and kids, so a stop for some goodies at Dylan's Candy Bar is a must.
After that, I have earned a seat at Eataly for a plate of burrata and a glass of cabernet sauvignon. Besides being the mecca for food and shopping Westfield will be introducing an exciting art exhibition that will run from June 23rd to July 23rd. Up Close: Michelangelo's Sistine Chapel will be a limited-time exhibit of Michelangelo's most iconic work. Many of his famous and well known paintings will be reproduced in their original sizes. Since I have had the opportunity to see some of these amazing works of art when I visited Florence I for one am excited to take the whole family here to see this can't-miss new exhibit! And, New Yorkers won't be the only one to see these magnificent pieces of art! The show will be traveling to Westfield's across major cities. To get the full list click here: https://www.westfield.com/upclose/upcoming-events


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– Father Denys Lloyd
Most Catholic churches have Stations of the Cross in the form of paintings or sculptures placed at intervals inside the church. The idea developed from pilgrimages to Jerusalem and the Holy Land in the medieval period. The Stations usually depict fourteen scenes on Jesus' journey to Calvary culminating in his death on the cross. At Sheringham a fifteenth station, the risen Christ, appears on the reredos. Giles Gilbert Scott's sketches for the Stations and the frames can be seen in a collection of his designs for St Joseph's in the British Architectural Library at the Victoria and Albert Museum in London. The Stations were ordered from the workshops of Ferdinand Stuflesser I at Ortisei, then part of the Austro-Hungarian Empire, and completed in 1914. They were loaded into the hold of a freighter bound for England. When they failed to arrive the parish priest, Fr Carter, asked a number of people to investigate their whereabouts but to no avail. He was greatly surprised when the shipment arrived after the end of the 1914-18 War. The German freighter carrying them had been interned in the port of Genoa for the duration.
The Stations were spaced around the walls of the church with plaques naming the donors. They were re-positioned when the church was extended in 1934.
During Lent Stations of the Cross services follow Jesus' journey. These webpages should enable the devotions to be made anytime and anywhere using photographs of the beautiful Stations at St Joseph's to assist mediation. The booklet which forms the basis for these pages is available for sale.
Booklet dedicated to Abbot Aelred Sillem, Abbot of Quarr Abbey
on the Isle of Wight
from 1964 until 1991
In the Name of the Father, and of the Son, and of the Holy Spirit. Amen.
The Way of the Cross of Jesus is the royal way of the Church. Following closely in the footsteps of the Master, we make our pilgrimage of faith, to reach the glory of the resurrection.
Holy and merciful Father, grant that we may follow the Way of the Cross in faith and love, so that we may share in Christ's Passion and, together with him, attain the peace and joy of your kingdom. We ask this through Christ our Lord.
Prayers to be said before each Station
V. We adore you, O Christ, and we bless you;
R. Because by your holy Cross you have redeemed the world.
Prayers to be said after each Station
I love you, Jesus my love, above all things;
I repent with my whole heart for having offended you.
Never permit me to separate myself from you again.
Grant that I may love you always,
Then do with me what you will.


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5 Best Moments in NCAA Tournament History
With March Madness and the NCAA Basketball Tournament ready to begin, we're almost certain to witness some stunning upsets and amazing game-winning shots that happen year after year. With that certainly being on the horizon, let's take a look at the top five moments in NCAA Tournament history that will leave you ready for more unforgettable moments this year.
5. John Wooden Goes Out With 10th NCAA Championship
Before Duke, North Carolina and Kentucky, there was UCLA; the original college basketball dynasty and the man behind it all was Head Coach John Wooden. Between 1964 and 1973, he guided his team to 9 National Titles with his 10th and final one in 1975, after which he walked away from the game. Not a bad way to go out.
4. Magic vs Bird
It was 1979 and two of the future Hall of Famers were battling it out like they would in the NBA for years to come. Magic came out on top this time around, but as you know from history, Bird would get him back in the professional ranks.
3. Michael Jordan, North Carolina
1982 National Championship
Before Michael Jordan would go on to win multiple titles in the NBA, he was coming alive in college basketball, with his career being punctuated by sinking the game-winning shot in the 1982 National Championship.
2. Christian Laettner, Duke
1992 NCAA East Regional Final
There was only 2.1 seconds on the clock, but for Laettner, that was all that was needed as Grant Hill launched the ball three-quarters of the distance of the court to Laettner who proceeded to turn around and hit a jumper as the time expired.
1. NC State Upsets Houston
With Akeem Olajuwon and Clyde Drexler on the same team, there didn't seem to be any way that the Houston Cougars would lose. NC State felt otherwise as there were able to knock off the Cougars in the 1983 National Championship Game with a game-winning dunk as the final buzzer sounded.


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Our collection of picture books featuring Black and Indigenous people and People of Color (BIPOC) is available to the public. *Inclusion of a title in the collection DOES NOT EQUAL a recommendation.* Click here for more on book evaluation.
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Mexico 1
Whiskers, tails, and wings
Retells animal folktales from five indigenous peoples of Mexico, including the Tarahumara tale in which a puma meets a grasshopper, and provides information on the culture of each indigenous people.


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Rocky Hwasta
Carpenter, United Brotherhood of Carpenters and Joiners of America, Local 373 (retired)
Cleveland, Ohio
"I enjoy a challenge," says Rocky Hwasta, a retired carpenter from Cleveland, Ohio. During her 30-year career, Rocky was challenged physically by her work, and mentally by unwelcoming colleagues. Now that she has retired, she has set her eyes on a new challenge: helping more women succeed as tradeswomen.
When Rocky started a pre-apprenticeship program in 1985, she was a single mother with three young children. Although she had a bachelor's degree from Ohio State, her job as a counselor paid only $7 an hour and did not provide benefits. When she began searching for better paying opportunities, someone mentioned to her that there as an upcoming test for the carpenters' union. Of the 250 applicants, only the top twenty-five scorers would be admitted to the program. Rocky earned the top score, securing not only a position in the program, but also a better life for her and her family.
Although her position in the program was well-earned, Rocky was not able to rest on her laurels. "The guys weren't exactly welcoming," she says. Rocky managed to win over some of her colleagues by demonstrating a stellar work ethic. "You're always being watched, so you need to show them you can do the work," says Rocky. She proved herself by learning to read blueprints, doing side work, and taking classes. When she would occasionally encounter a helpful male colleague, they did not always have the most professional of intentions. Rocky describes how some of the men were genuinely concerned for her safety, but others tried to use their "help" as an opportunity to try to date her. "That was a fruitless endeavor for them," says Rocky with a chuckle.
Rocky's hard work paid off, allowing her the opportunity to work on a variety of projects over her 30-year career, including big projects like bridges and commercial construction and smaller ones like residential decks. "I have a lot of pride in what I do. Working for this many years, you have to have good mechanical skills, something that not every woman or man has." Rocky's skills and tenacity helped her work her way to leadership positions, both in management, as a foreman, and as president of her local. "I was really proud of becoming a foreman," says Rocky. "It's great when a contractor sees that you're smart, efficient, and can motivate others. "
Now that she is retired, Rocky uses her ability to motivate others to bring more women into the trade. She speaks at schools and job corps programs, helping to inspire the next generation. Her advice to aspiring tradeswomen: "Get union-trained for the skills, wages, and benefits, and get a mentor." A mentor, Rocky says, can not only help tradeswomen develop strong mechanics, but mentors can also help women navigate the other challenges of the job, like saving to prepare for inevitable layoffs. She also advises women to attend the Women Building California and the Nation conference. The conference, she says, "gives you such a great feeling that you're not alone and that there are more women going through the same things as you. " (The Women Building California and the Nation conference is happening this weekend.)


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Zak Stevenson has more than 20 years of experience in the field of technical production. He has provided technical direction and taught technical theatre courses at Southern Utah University, UNC Greensboro and Alma College (Alma, Mich.). Professionally, he has worked for numerous companies, including the North Carolina Shakespeare Festival and ten seasons at the Utah Shakespeare Festival.
Stevenson is a member of the U.S. Institute for Theatre Technology (USITT) and has served on panels for the national conference and presentations for the southeast region master classes. He served as the technical coordinator for Region VIII Kennedy Center American College Theatre Festivals in 2007 and 2008, as well as establishing guidelines for the first region VIII award for Student Technical Director in 2007.
- International Alliance of Theatrical Stage Employees (IATSE), Local 635 (Winston-Salem, N.C.); served as call steward for Local 274 (Lansing, Mich.) and Local 635
- ETCP certified rigger (arena); actively rigs with Locals 635 and 574 (Greensboro, N.C.) and Local 322 (Charlotte, N.C.)
- American Welding Society (AWS)
- American Institute of Steel Construction (AISC)


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Ocean Lu Program Leader, Instructor, Economics, Statistics, UT Business
Office: CBA 225B • Email: email@example.com • Phone: 250-370-4162
Ocean Lu became a part of the department of Economics, Finance and UT at Camosun College in 2010, and she holds a Master's degree in Economics with a focus on Econometrics. Prior to joining Camosun teaching team, Ocean was working as an Economics Analyst, Population Analyst and Senior Statistical Officer at BC STATS with the Government of British Columbia. The extensive research background that Ocean received from working for BC government allows her to provide many real-life examples and projects to the students in economics and statistics.
Born and raised in China, Ocean Lu arrived in Canada in 1999, and began her studies at college level. Ocean Lu is very passionate about international education, and seeks every opportunity to reach out to students who experience cultural, language and social difficulties. In her spare time, Ocean also thrives in another profession as a certified Chinese dance instructor teaching Beijing Dance Academy Chinese Dance Graded Examination Syllabus, and she is running a successful dance academy and very actively involved in the local Chinese communities.


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Spring has arrived, and with it some big decisions for your school. It's time to start thinking about what yearbook publishing company you should use this year.
We want you to know that you are not alone when it comes to your yearbook project. There are a lot of resources available to you, that we are happy to share.


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The monstrous female is a tricky beast. Within the realm of '60s and '70s body horror cinema, she manifested inside the shadows of what she was not: a fetishised image of womanhood, all prim and proper, constructed by the male gaze. The male directors who blacklisted the destructive forces of her rage are to be held responsible for nurturing this stereotype as much on-screen as in the real world, for the two were inevitably strung together: the death drive and bloodlust of female vampires, witches, and werewolves superimposed onto the internalised fury of the mute housewife.
Auto Italia and writer-researcher Harman Bains collaboratively navigate the history of the monstrous female across the sub-genre of body horror and exploitation film in the exhibition "Nature of the Hunt", on show at the East London project space until 3 September 2017. Spanning a "disembodied survey" of 20th century (s)exploitation cinema, the exhibition hones in on themes of violence, vengeance, sadomasochism, schizophrenia, shame and hysteria that inform both Eastern and Western imaginings of the female monster: from the soft-core pleasure chambers of Japanese pinku eiga ("pink film") pros including Kôji Wakamatsu, to the psychosexual obsessions of South Korean Ki-young Kim's housemaids and the campy vampires of Jesús Franco.
From the street, seven weapon-wielding women can be seen posing side-by-side in a blow-up poster of the Taiwanese action-adventure "Golden Queen Commando" (1982). This playful prop appropriately conceals the more subversive film essay playing on loop in the darkened back room of the gallery. Clocking in at under half an hour, the video offers a collage of scenes from around two dozen exploitation films. Bains' own voice weaves in intermittently over the muted clips to offer a larger analysis of the social and cultural symbolism of these films and question their underlying motives. Through Bains' unwavering criticism, the hysteria of these monstrous women develops an emotional vulnerability, morphing from villain to victim – all while their bodies convulse and evaporate, imploding into abject potions of blood, slime, and fear: the torturous and nebulous power structures of the patriarchy.
Is there any way out of this stereotype of the raging female, whose origins and psychosexual neuroses are simultaneously feared and invalidated by the male gaze? Is it possible to subvert the phallocentric understandings of the feminine penchant for violence, as driven by unfulfilled desire? In a sub-genre characterised by this deep-rooted misogyny, is there any space to re-claim the agency of the female monster?
Essentially, yes. The game is changing, Bains suggests during our discussion of the monstrous female's contemporary on-screen descendants: from Iranian-American director Ana Lily Amirpour's vampire western, "A Girl Walks Home Alone at Night" (2015), to this year's most talked about vegetarian-turned-cannibal from French director Julia Ducournau's "Raw" (2017).
But why vampires in particular? Because there is nothing more powerful and threatening than a female monster who can reproduce without the other half, Bains explains. In choosing her victims, the female vampire is free to select women as much as men; furthermore, she often keeps on these mothers, daughters, wives as reformed companions—"seducing the daughters of the patriarchy."
Finally, the vampire confuses the division of human and animal: "crossing the animalistic desire of wanting to empower attack with the human desire to not." For the female vampire, biting (and transforming her victim into a mirror image of herself) is as revolutionary as an act of sexual pleasure as it is an act of self-love. "Female vampires [like 'Girl Walks Home…'] are so beyond the realm of being abused," Bains explains. "She forms her own identity through her own being."
While today's vampire reclaims her emotional agency as a political metaphor, the female directors of the '70s and '80s who willed her into existence were not so lucky. "This ability was largely denied to female directors of body horror cinema, from Italy to Japan," Bains tells me, referencing the exceptional cases of Barbara Peeters and Doris Wishman, who were only able to lay claim to this sub-genre through their filmmaker husbands.
But as the monstrous female continues to subvert the male gaze, there is a positive kickback in today's film culture: a new empowerment of the female director. We can begin to ask how she wants to represent the female on screen—and through all manifestations of womanhood, fur and fangs aside.


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Making Disciples, Raising Up Saints & Transforming Communities for Christ
by Elizabeth Coldiron, Capital Episcopal Youth Network, Trinity Cathedral, Sacramento The Capital Episcopal Youth Network was formed in the fall of 2014, when youth leaders from churches in and around the Sacramento area came together to create opportunities for youth to serve, learn and grow together- all while having fun! In 2015, the holiday weekends of Martin Luther King Day and Presidents' Day were the times these Episcopal youth served together for Sierra Service Project's Weeken...
by the Capital City Preachers Group The Capital City Preachers Group is pleased to announce that our guest speaker for the January 25th meeting will be the Rev. Dr. Linda Lee Clader.
by The Lay Preachers Group The Lay Preachers Group is an informal group sponsored by the Capital Deanery for licensed lay preachers and for those who are seeking information to become licensed or those already working to become licensed preachers. Our group meets bimonthly on Saturdays from 9:45 a.m. to 12:00 p.m.
by the Ven. Beatryce "Cookie" Clark, Archdeacon of the Episcopal Diocese of Northern California The Rev. Cindy Long, RN, deacon at St.
by the Rev. Dcn. Cindy Long, RN, St.
article by the Rev Deacon Cindy Long, RN, and photos by her husband, Mark --both of St. Matthew's, Sacramento On June 22, 2011 the congregation of St. Matthew's Episcopal Church, Sacramento welcomed many to our farewell celebration in honor of the Reverend Lucinda Ashby, who has accepted a call to be the Canon to the Ordinary of the Diocese of Idaho.
© 2013 The Episcopal Diocese of Northern California.
Designed by: Element Fusion


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Mendelsohn, Daniel. WAITING FOR THE BARBARIANS: ESSAYS FROM THE CLASSICS TO POP CULTURE. New York City, NY: New York Review Of Books, 2012. Hardcover. First Edition/First Printing. Unpaginated. As New/As New.
The author's second collection of critical essays. One of Daniel Mendelsohn's finest achievements. The First Hardcover Edition. Precedes and should not be confused with all other subsequent editions. Published in a very small and limited first print run as a hardcover original only. Presents Daniel Mendelsohn's follow-up to his ground-breaking "How Beautiful It Is And How Easily It Can Be Broken" (2008) . Mendelsohn knows how to come up with great titles; "Waiting for The Barbarians" is ironic, referring to one of his specialties, Classical literature, and to its barbaric adaptation by modern sensibilities (such as, but not necessarily limited to, Hollywood movies) . "Brings together twenty-four of his essays, each one glinting with verve and sparkle, acumen and passion, on a wide range of subjects, from 'Avatar' to the poems of Arthur Rimbaud, from our inexhaustible fascination with the 'Titanic' to Susan Sontag's 'Journals'. Trained as a Classicist, Mendelsohn moves easily from penetrating considerations of the ways in which the classics continue to make themselves felt in contemporary life and letters (Greek myth in the 'Spider-Man' musical, Anne Carson's translations of Sappho) to trenchant takes on pop spectacles, none more explosively controversial than his dissection of 'Mad Men' " (Publisher's blurb) . Written in effortless, impeccable prose with a paradoxical mix of wit and ardor, this is a "must-have" title for Daniel Mendelsohn collectors. This copy is very prominently and beautifully signed in black pen on the title page by Daniel Mendelsohn. This title will become a contemporary classic. This is one of very few signed copies of the First Hardcover Edition/First Printing still available online and is in especially fine condition: Clean, crisp, and bright, a pristine beauty. A very scarce signed copy thus. Winner of the National Book Critics Circle Award in 2007 for "The Lost". One of the finest living American writers. A fine copy. (SEE ALSO OTHER DANIEL MENDELSOHN TITLES IN OUR CATALOG). ISBN 1590176073. $70.00