Thursday, April 3, 2008
The first Lady of France
Bill Bonner
The Daily Reckoning
http://www.youtube.com/watch?v=flmoa2dVOSU
One of the world’s most fascinating people is surely the first lady ofFrance, Carla Bruni. She dined with Queen Elizabeth II last week. Amid allthe glamorous guests, glitzy table setting and diamonds, it was she whosparkled most. What follows has no apparent connection to our beat – money. Nor does ithave any particular connection with anything. Still, women represent halfthe human population. As poets, we are fascinated by them. As philosopherswe are intrigued. And as economists, we cannot ignore them. Mr. Sarkozy’swife is a woman, but not just any woman; she seems to us to be a kind ofüberfemale. Almost unnaturally gifted, talented, beautiful and corrupt. The trouble with economics – one of them – is that economists are almostall male. And thus they are completely incapable of understanding themotives or methods of half the population they are meant to be studying.That is why we turn our attention to Carla. She is such an extreme exampleof womanhood, perhaps we can learn something. For readers who have not followed the French press, Ms. Bruni is anextraordinary subject. The French say she is a “croqueuse d’hommes” –which is to say, a man-eater. It was she, according to the press, who hadsuch an affair with Mick Jagger that it destroyed his long marriage tothat tough, smart and talented Texan, Jerry Hall. And it was she, too, whois said to have had affairs with Eric Clapton and Donald Trump. Then, shelived with a French philosopher, Jean-Paul Enthoven, until she took afancy to his son, Raphael, with whom she had a son, Aurelien. Nor was sheparticularly demeure about the whole thing; she wrote a song called“Raphael” describing how she had fallen madly in love and had great sexwith him. She is so “properly, old-fashionedly beautiful,” writes India Knight inthe TIMES of London, “with non-inbred aristocratic features and goodbones; so beautiful that she makes everyone else look like pudding.” Not only that, she speaks three or four languages...comes from afabulously rich family...and can sing. At the Queen’s state dinner,practically every one of the hundreds of guests had seen her naked photoin the tabloids the day before. Yet, she was reportedly the most composed,most confident person there. According to reports, she is irresistible at every level – intellectually,emotionally, sexually and artistically. What’s more she lives around thecorner from your editor’s Paris apartment. “I saw her go by last night,” said a neighbor on Saturday. “She had awhole squad of police with her.” “Why doesn’t she move into the Elysee Palace with her husband?” we wantedto know. “Apparently, she likes to keep her independence.” Madame Sarkozy is like no first lady France has ever seen. Nor is she likeany first lady any country has ever seen. She says she finds monogamy“boring.” She further observed that “love lasts a long time, but burningdesire – two to three weeks.” Here is the world’s most desirable woman –married to a cad. But she is the perfect political prop...a woman whoplays her role superbly – according to the local gossip, both in publicand in private – and who otherwise goes on her way and amuses herself. What do other women think of her? Around the corner, from what we hear,they barely let their husbands out of sight. Your editor is an old-fashioned fuddy duddy; he admits it. He turns histired eyes to politics, economics and finance – and sees only frauds andmountebanks. But when he comes home at night, he is charmed. In thenewspapers, he regards the chatter on the editorial pages as all lies andclaptrap; but at home he believes every fairy tale. When his brokerproposes a hedge fund with a leveraged portfolio of private equity deals,he practically laughs in his face. But when his priest promises himeverlasting life, what reason has he to doubt? And when his daughter says,“Oh Daddy...I just dropped by the office to say hello,” he’s delighted,scarcely noticing that she leaves with $50 to buy a new pair of bluejeans. There is a place for cynicism, he says to himself, and a place to believe.Poor Carla doesn’t seem to know the difference. Still, she lives so close by. Better to keep an open mind. Besides, saysyour editor remembers that he has a couple weeks of vacation coming up... Until tomorrow,
Thursday, March 6, 2008
Easily Overlooked Lesions Tied to Colon Cancer
By DENISE GRADY from the NYTimes
Published: March 5, 2008
An easily overlooked type of abnormality in the colon is the most likely type to turn cancerous, and is more common in this country than previously thought, researchers are reporting.
»
Prevalence of Nonpolypoid (Flat and Depressed) Colorectal Neoplasms in Asymptomatic and Symptomatic Adults (JAMA)
The findings come from a study of colonoscopy, in which a camera-tipped tube is used to examine the lining of the intestine. Generally, doctors search for polyps, abnormal growths that stick out from the lining and can turn into cancer. But another type of growth is much more dangerous, and harder to see because it is flat or depressed and similar in color to healthy tissue.
Japanese researchers became concerned about these flat lesions in the 1980s and ’90s, but studies here had mixed results and American doctors tended to think that flat growths were less common and less dangerous in the United States.
The new study, to be published Wednesday in the Journal of the American Medical Association, suggests otherwise.
Some doctors in this country were already alert to flat lesions, but the findings will pose a challenge to others, because it takes a trained and vigilant eye to see the growths and special techniques to remove them. The results also mean it is especially important that patients take the harsh laxatives that many dread in advance of the test. The flat lesions, hard to find even under the best conditions, will be impossible to see if any waste is left in the bowel.
Colon cancer is the second-leading cause of cancer death in the United States, after lung cancer, with about 154,000 new cases detected and 52,000 deaths a year. It is one of the few cancers that is totally preventable if precancerous growths are found and removed; it can also be cured with surgery alone if found early enough.
People who have just had a colonoscopy should not rush to schedule another one just to look for the flat growths, doctors said.
“I don’t think people have to panic that they’ve somehow been neglected and had poor care,” said Dr. David A. Rothenberger, deputy chairman of surgery at the University of Minnesota.
But he and other experts emphasized that people should see a doctor any time they have persisting symptoms that could indicate colon cancer, like rectal bleeding or a change in bowel habits — no matter how recently they had a colonoscopy. The test is highly reliable, but not perfect, doctors say.
Some doctors who perform colonoscopy just are not good at seeing flat lesions, but may improve with training and practice, said Dr. Douglas K. Rex, a gastroenterologist and professor of medicine at Indiana University.
“I think there are people who expect everything in there to be shaped like a golf ball,” he said. “It’s not.”
Dr. David Lieberman, chief of gastroenterology at Oregon Health and Science University, who wrote an editorial accompanying the study, said: “I think there will be some surprise. There has been in general some skepticism in the United States about how common flat and depressed lesions are and how important they are. So I think this study, coming from the United States and from a good group of investigators, will be a wake-up call to a lot of physicians and will prompt people to be looking for these lesions.”
The study, of 1,819 military veterans, mostly men, found that 9.35 percent had flat lesions, and those lesions were five times as likely as polyps to contain cancerous or precancerous tissue. Depressed or indented lesions were the least common but the most risky. Together, the flat or depressed lesions accounted for only 15 percent of the potentially cancerous growths found in the study, but were involved in half of the cancers. Once the doctors spotted the flat lesions, they sprayed a bluish dye on them to see their outlines better and remove them completely.
The first author of the study, Dr. Roy M. Soetikno of the Veterans Affairs Palo Alto Health Care System said, “The message for doctors is, Here is a large amount of data showing that these precursors of cancer, always believed to be a Japanese disease, are actually a disease here, and are important, because they are much more likely to be cancerous, and doctors need to spend the time to provide quality colonoscopy.”
The message to patients, Dr. Soetikno said, is that when preparing for colonoscopy, they must follow instructions to the letter and take the hated laxatives to make sure their bowels are empty so that doctors can see the lining.
If any waste remains, flat lesions will be buried by it. Studies have shown that in about a quarter of all colonoscopies, the bowel preparation is inadequate.
Dr. Rex said that male veterans tended to have more precancerous colon growths than other groups, so the rate of flat lesions in women or the general population might not be quite as high as those in the study.
Dr. Soetikno and his colleagues started an exchange program with doctors in Japan to learn their techniques for recognizing and removing the flat lesions.
American doctors should learn from overseas colleagues more often, Dr. Rothenberger said, adding, “We tend to get very smug about our abilities.”
The quality of colonoscopy has become a delicate issue, because an article in The New England Journal of Medicine in December 2006 found that some doctors were 10 times better than others at finding precancerous polyps. A major factor in their success was taking enough time to examine the colon thoroughly, as opposed to rushing through the procedure. Doctors who miss polyps would almost certainly miss flat lesions as well because they are harder to see. The new study underscores the need for careful examinations, because the flat lesions are more dangerous.
The study also raises doubts about whether “virtual colonoscopy,” performed by a CT scanner, will ever be able to take the place of the colonoscope inserted into the rectum, as many patients had hoped. The problem is that CT scans use X-rays to reveal shapes, and find polyps because they stick out. Flat lesions are unlikely to show up in such scans.
Studies show that from 0.3 percent to 0.9 percent of patients develop colon cancers within just a few years of having a colonoscopy and polyp removal — exactly what the procedure is supposed to prevent. Some doctors think that flat lesions, missed entirely during the colonoscopy or not fully removed, may account for some of these apparent failures.
Dr. Robert Smith, the director of screening for the American Cancer Society, said flat lesions were “a vexing issue” that had provoked a lot of arguments among doctors.
“This paper shows they’re more prevalent than we believed, and also quite serious with regard to the presence of features associated with an elevated risk of cancer,” Dr. Smith said.
The difficulty facing patients is how to be sure their doctors are doing a good job. Professional groups have issued guidelines about the best way to perform a colonoscopy, but they are recommendations, not rules. The groups also urge doctors to track their own success rates at finding precancerous growths to see how they measure up to standards, but even if they do keep track, the doctors do not have to share the data with anyone. And many people are loath to ask about it. The doctor wielding the scope is the last person most patients would want to offend.
“The patient really has no way to act as an informed consumer,” Dr. Smith said. “You can’t call up a facility and say, ‘By the way, is my doctor any good?’ or, ‘Tell me who the best one is.’ ”
He added: “For some physicians there is an expectation of trust, and it is offputting to have a patient request documentation of competence. However, some physicians know patients are hearing about these issues and are not offended by questions about performance and errors.”
Published: March 5, 2008
An easily overlooked type of abnormality in the colon is the most likely type to turn cancerous, and is more common in this country than previously thought, researchers are reporting.
»
Prevalence of Nonpolypoid (Flat and Depressed) Colorectal Neoplasms in Asymptomatic and Symptomatic Adults (JAMA)
The findings come from a study of colonoscopy, in which a camera-tipped tube is used to examine the lining of the intestine. Generally, doctors search for polyps, abnormal growths that stick out from the lining and can turn into cancer. But another type of growth is much more dangerous, and harder to see because it is flat or depressed and similar in color to healthy tissue.
Japanese researchers became concerned about these flat lesions in the 1980s and ’90s, but studies here had mixed results and American doctors tended to think that flat growths were less common and less dangerous in the United States.
The new study, to be published Wednesday in the Journal of the American Medical Association, suggests otherwise.
Some doctors in this country were already alert to flat lesions, but the findings will pose a challenge to others, because it takes a trained and vigilant eye to see the growths and special techniques to remove them. The results also mean it is especially important that patients take the harsh laxatives that many dread in advance of the test. The flat lesions, hard to find even under the best conditions, will be impossible to see if any waste is left in the bowel.
Colon cancer is the second-leading cause of cancer death in the United States, after lung cancer, with about 154,000 new cases detected and 52,000 deaths a year. It is one of the few cancers that is totally preventable if precancerous growths are found and removed; it can also be cured with surgery alone if found early enough.
People who have just had a colonoscopy should not rush to schedule another one just to look for the flat growths, doctors said.
“I don’t think people have to panic that they’ve somehow been neglected and had poor care,” said Dr. David A. Rothenberger, deputy chairman of surgery at the University of Minnesota.
But he and other experts emphasized that people should see a doctor any time they have persisting symptoms that could indicate colon cancer, like rectal bleeding or a change in bowel habits — no matter how recently they had a colonoscopy. The test is highly reliable, but not perfect, doctors say.
Some doctors who perform colonoscopy just are not good at seeing flat lesions, but may improve with training and practice, said Dr. Douglas K. Rex, a gastroenterologist and professor of medicine at Indiana University.
“I think there are people who expect everything in there to be shaped like a golf ball,” he said. “It’s not.”
Dr. David Lieberman, chief of gastroenterology at Oregon Health and Science University, who wrote an editorial accompanying the study, said: “I think there will be some surprise. There has been in general some skepticism in the United States about how common flat and depressed lesions are and how important they are. So I think this study, coming from the United States and from a good group of investigators, will be a wake-up call to a lot of physicians and will prompt people to be looking for these lesions.”
The study, of 1,819 military veterans, mostly men, found that 9.35 percent had flat lesions, and those lesions were five times as likely as polyps to contain cancerous or precancerous tissue. Depressed or indented lesions were the least common but the most risky. Together, the flat or depressed lesions accounted for only 15 percent of the potentially cancerous growths found in the study, but were involved in half of the cancers. Once the doctors spotted the flat lesions, they sprayed a bluish dye on them to see their outlines better and remove them completely.
The first author of the study, Dr. Roy M. Soetikno of the Veterans Affairs Palo Alto Health Care System said, “The message for doctors is, Here is a large amount of data showing that these precursors of cancer, always believed to be a Japanese disease, are actually a disease here, and are important, because they are much more likely to be cancerous, and doctors need to spend the time to provide quality colonoscopy.”
The message to patients, Dr. Soetikno said, is that when preparing for colonoscopy, they must follow instructions to the letter and take the hated laxatives to make sure their bowels are empty so that doctors can see the lining.
If any waste remains, flat lesions will be buried by it. Studies have shown that in about a quarter of all colonoscopies, the bowel preparation is inadequate.
Dr. Rex said that male veterans tended to have more precancerous colon growths than other groups, so the rate of flat lesions in women or the general population might not be quite as high as those in the study.
Dr. Soetikno and his colleagues started an exchange program with doctors in Japan to learn their techniques for recognizing and removing the flat lesions.
American doctors should learn from overseas colleagues more often, Dr. Rothenberger said, adding, “We tend to get very smug about our abilities.”
The quality of colonoscopy has become a delicate issue, because an article in The New England Journal of Medicine in December 2006 found that some doctors were 10 times better than others at finding precancerous polyps. A major factor in their success was taking enough time to examine the colon thoroughly, as opposed to rushing through the procedure. Doctors who miss polyps would almost certainly miss flat lesions as well because they are harder to see. The new study underscores the need for careful examinations, because the flat lesions are more dangerous.
The study also raises doubts about whether “virtual colonoscopy,” performed by a CT scanner, will ever be able to take the place of the colonoscope inserted into the rectum, as many patients had hoped. The problem is that CT scans use X-rays to reveal shapes, and find polyps because they stick out. Flat lesions are unlikely to show up in such scans.
Studies show that from 0.3 percent to 0.9 percent of patients develop colon cancers within just a few years of having a colonoscopy and polyp removal — exactly what the procedure is supposed to prevent. Some doctors think that flat lesions, missed entirely during the colonoscopy or not fully removed, may account for some of these apparent failures.
Dr. Robert Smith, the director of screening for the American Cancer Society, said flat lesions were “a vexing issue” that had provoked a lot of arguments among doctors.
“This paper shows they’re more prevalent than we believed, and also quite serious with regard to the presence of features associated with an elevated risk of cancer,” Dr. Smith said.
The difficulty facing patients is how to be sure their doctors are doing a good job. Professional groups have issued guidelines about the best way to perform a colonoscopy, but they are recommendations, not rules. The groups also urge doctors to track their own success rates at finding precancerous growths to see how they measure up to standards, but even if they do keep track, the doctors do not have to share the data with anyone. And many people are loath to ask about it. The doctor wielding the scope is the last person most patients would want to offend.
“The patient really has no way to act as an informed consumer,” Dr. Smith said. “You can’t call up a facility and say, ‘By the way, is my doctor any good?’ or, ‘Tell me who the best one is.’ ”
He added: “For some physicians there is an expectation of trust, and it is offputting to have a patient request documentation of competence. However, some physicians know patients are hearing about these issues and are not offended by questions about performance and errors.”
REMEDIO PARA LA TOS - INFORMACIÓN ÚTIL SOBRE EL VICK VAPO-RUB.
Durante una conferencia sobre Aceites Esenciales, nos comentaron cómo las plantas de los pies pueden absorber aceites. Su ejemplo consistió en colocar ajo en la planta de los pies y a los 20 minutos, ¡ya se podría percibir su sabor en la boca!Algunos hemos usado el Vick Vaporub durante muchos años como remedio para muchas cosas, desde labios cuarteados hasta dedos de los pies inflamados y muchas otras partes de la piel que se puede pelar en los pliegues. Pero nunca había escuchado sobre esto. Y no lo tomes en broma, porque funciona el 100% de las veces que se hace, aunque los científicos que lo descubrieron realmente no están seguros cómo sucede.
Para detener la tos nocturna en un niño (o de un adulto, quien fue que nos lo comentó personalmente), esparza Vick Vaporub generosamente sobre las plantas de los pies y luego cubra con medias. Aún la tos más persistente, fuerte y profunda se detendrá en el término de unos 5 minutos y se detendrá para dar muchas horas de alivio. Funciona el 100% de las veces que se hace y es más efectivo en los niños, que aún las más fuertes medicinas prescritas por los médicos. Además, es extremadamente calmante y reconfortante, mientras duermen profundamente.
Acababa de sintonizar en la radio en AM y escuché un señor hablando sobre porqué las medicinas para la tos en los niños podrían causar más daño que mejoría, y es debido a la composición química de sus fuertes componentes, así que decidí escucharlo. Fue muy sorprendente saber que fuera másefectivo que los medicamentos prescritos para que los niños tomaran en las horas de la noche, y que además tenía una efecto calmante en los niños enfermos mientras dormían profundamente. Mi esposa lo comprobó en sí misma en una ocasión en que tuvo una tos muy profunda, constante y persistente durante semanas y le funcionó en un 100%.
Ella me dijo que se sentía como si una cobija tibia la envolviera, paraba la tos en unos minutos y créanme, esta era una tos profunda (increíblemente desesperante) que no se calmaba ni por segundos, y esa noche durmió sin tospor muchas horas y así fue durante cada noche que lo utilizaba. Si usted tiene hijos o nietos, distribuya este mensaje. Y si usted se llegara a encontrar enfermo, compruébelo por usted mismo y se maravillarátotalmente de ver y sentir cómo funciona.
Para detener la tos nocturna en un niño (o de un adulto, quien fue que nos lo comentó personalmente), esparza Vick Vaporub generosamente sobre las plantas de los pies y luego cubra con medias. Aún la tos más persistente, fuerte y profunda se detendrá en el término de unos 5 minutos y se detendrá para dar muchas horas de alivio. Funciona el 100% de las veces que se hace y es más efectivo en los niños, que aún las más fuertes medicinas prescritas por los médicos. Además, es extremadamente calmante y reconfortante, mientras duermen profundamente.
Acababa de sintonizar en la radio en AM y escuché un señor hablando sobre porqué las medicinas para la tos en los niños podrían causar más daño que mejoría, y es debido a la composición química de sus fuertes componentes, así que decidí escucharlo. Fue muy sorprendente saber que fuera másefectivo que los medicamentos prescritos para que los niños tomaran en las horas de la noche, y que además tenía una efecto calmante en los niños enfermos mientras dormían profundamente. Mi esposa lo comprobó en sí misma en una ocasión en que tuvo una tos muy profunda, constante y persistente durante semanas y le funcionó en un 100%.
Ella me dijo que se sentía como si una cobija tibia la envolviera, paraba la tos en unos minutos y créanme, esta era una tos profunda (increíblemente desesperante) que no se calmaba ni por segundos, y esa noche durmió sin tospor muchas horas y así fue durante cada noche que lo utilizaba. Si usted tiene hijos o nietos, distribuya este mensaje. Y si usted se llegara a encontrar enfermo, compruébelo por usted mismo y se maravillarátotalmente de ver y sentir cómo funciona.
Tuesday, January 29, 2008
NUEVO CÁNCER DE MAMAS
(Autora desconocida)
Esta es una información a tener en cuenta por nosotras las mujeres. Creo que es importante que la divulguemos entre nuestras amigas.
En noviembre, la hermana de una amiga desarrolló una erupción en su mama, similar a la que sufren las madres jóvenes que están amamantando.
Debido a que su mamografía salió limpia, el doctor la trató con antibióticos contra infección.
Después de dos tratamientos, empezó a empeorar. Su médico le mandó hacer otra mamografía y esta vez se apreció una masa cuya biopsia reveló un tumor maligno de rápido crecimiento.
Primero le ordenaron quimioterapia para reducir el crecimiento. Luego siguió una mastectomía y después un tratamiento completo de quimioterapia, seguido de radiación.....
Nueve meses después de intenso tratamiento, fue dada de alta.
Después de un año de vivir cada día al máximo posible, el cáncer le tomó el hígado.
Siguió cuatro tratamientos y decidió, finalmente, que quería calidad de vida y no sufrir los efectos secundarios de la quimioterapia.
Tuvimos cinco extraordinarios meses y ella planeó todos y cada uno de los detalles de sus días finales.
Su mensaje es el siguiente:
¡¡¡ Por favor estén alertas a cualquier cosa anormal, y sean persistentes en buscar ayuda enseguida!!!
La enfermedad de Paget:
Esta es una rara forma de cáncer de mama, y aparece en la parte exterior del seno, en el pezón, la areola.
Puede parecer una erupción, que luego se convierte en una lesión con una orilla exterior reseca.
Yo nunca hubiera sospechado que era cáncer de mama, pero era. Mi pezón nunca me pareció diferente, pero la erupción me molestaba y por eso fui al medico.
Algunas veces, me picaba y me dolía, pero fuera de eso no me molestaba. Era solamente feo y molesto, y no se aliviaba con todas las cremas recetadas por mi doctor y el dermatólogo para la dermatitis que parecía ser.
Se veían preocupados, pero no me advirtieron que podía ser canceroso. Sospecho que no hay muchas mujeres que sepan que una lesión o erupción en el pezón o una areola puedan ser cáncer de mama.
El mío comenzó como una simple roncha roja en la areola. Uno de los más grandes problemas con la enfermedad de Paget es que parecen ser síntomas inofensivos y frecuentemente se confunde con una inflamación o infección de la piel, dilatando así la detección y su tratamiento.
¿Cuales son los síntomas?
Los síntomas incluyen:
1.- Una irritación persistente, goteo y resequedad del pezón, causando comezón e irritación. (Como comenté, en mi caso no me producía mucha comezón ni tenia secreción. Sí lo sentía y tenia una costra en la orilla de un lado).
2.- Una lesión en tu pezón que no sana (la mía estaba en el área de la areola con una protuberancia en el centro del pezón).
3.- Generalmente es afectado un solo pezón. ¿Cómo se lo puede diagnosticar?
Tu médico debe hacerte un examen físico y debe sugerir una mamografía de ambos senos, haciéndolo inmediatamente.
Aún cuando la irritación y las costras parezcan dermatitis (inflamación de la piel), tu médico debe sospechar cáncer si la molestias solamente en un seno y debe ordenar, inmediatamente, una biopsia de la lesión para confirmar qué está pasando.
Este mensaje debe de ser tomado en serio y enviado a la mayor cantidad de personas posibles (parientes y amigas).
Puede salvar la vida de alguien. Mi cáncer de mama se extendió y pasó a mis huesos después de recibir megadosis de quimioterapia, veintiocho (28) tratamientos de radiación y tomar Tamaxofin.
Si esto hubiera sido diagnosticado como cáncer de mama desde un principio, probablemente no se hubiera extendido.
A todos los lectores: esto es triste. Como mujeres no sabemos de enfermedad de Paget.
Si pasando esto por e-mail, podemos hacer que otras conozcan esto, y su potencial peligro, estamos ayudando a mujeres en todos lados.
Por favor: Si puedes, perder un momento y envía esto a la mayor cantidad de personas posible, especialmente a tu familia y amigas; solo toma un momento y los resultados
Pueden salvar vidas.
Pueden encontrar más información en esta página:
http://www.cirugest.com/revisiones/cir09-06/09-06-09.htm
Esta es una información a tener en cuenta por nosotras las mujeres. Creo que es importante que la divulguemos entre nuestras amigas.
En noviembre, la hermana de una amiga desarrolló una erupción en su mama, similar a la que sufren las madres jóvenes que están amamantando.
Debido a que su mamografía salió limpia, el doctor la trató con antibióticos contra infección.
Después de dos tratamientos, empezó a empeorar. Su médico le mandó hacer otra mamografía y esta vez se apreció una masa cuya biopsia reveló un tumor maligno de rápido crecimiento.
Primero le ordenaron quimioterapia para reducir el crecimiento. Luego siguió una mastectomía y después un tratamiento completo de quimioterapia, seguido de radiación.....
Nueve meses después de intenso tratamiento, fue dada de alta.
Después de un año de vivir cada día al máximo posible, el cáncer le tomó el hígado.
Siguió cuatro tratamientos y decidió, finalmente, que quería calidad de vida y no sufrir los efectos secundarios de la quimioterapia.
Tuvimos cinco extraordinarios meses y ella planeó todos y cada uno de los detalles de sus días finales.
Su mensaje es el siguiente:
¡¡¡ Por favor estén alertas a cualquier cosa anormal, y sean persistentes en buscar ayuda enseguida!!!
La enfermedad de Paget:
Esta es una rara forma de cáncer de mama, y aparece en la parte exterior del seno, en el pezón, la areola.
Puede parecer una erupción, que luego se convierte en una lesión con una orilla exterior reseca.
Yo nunca hubiera sospechado que era cáncer de mama, pero era. Mi pezón nunca me pareció diferente, pero la erupción me molestaba y por eso fui al medico.
Algunas veces, me picaba y me dolía, pero fuera de eso no me molestaba. Era solamente feo y molesto, y no se aliviaba con todas las cremas recetadas por mi doctor y el dermatólogo para la dermatitis que parecía ser.
Se veían preocupados, pero no me advirtieron que podía ser canceroso. Sospecho que no hay muchas mujeres que sepan que una lesión o erupción en el pezón o una areola puedan ser cáncer de mama.
El mío comenzó como una simple roncha roja en la areola. Uno de los más grandes problemas con la enfermedad de Paget es que parecen ser síntomas inofensivos y frecuentemente se confunde con una inflamación o infección de la piel, dilatando así la detección y su tratamiento.
¿Cuales son los síntomas?
Los síntomas incluyen:
1.- Una irritación persistente, goteo y resequedad del pezón, causando comezón e irritación. (Como comenté, en mi caso no me producía mucha comezón ni tenia secreción. Sí lo sentía y tenia una costra en la orilla de un lado).
2.- Una lesión en tu pezón que no sana (la mía estaba en el área de la areola con una protuberancia en el centro del pezón).
3.- Generalmente es afectado un solo pezón. ¿Cómo se lo puede diagnosticar?
Tu médico debe hacerte un examen físico y debe sugerir una mamografía de ambos senos, haciéndolo inmediatamente.
Aún cuando la irritación y las costras parezcan dermatitis (inflamación de la piel), tu médico debe sospechar cáncer si la molestias solamente en un seno y debe ordenar, inmediatamente, una biopsia de la lesión para confirmar qué está pasando.
Este mensaje debe de ser tomado en serio y enviado a la mayor cantidad de personas posibles (parientes y amigas).
Puede salvar la vida de alguien. Mi cáncer de mama se extendió y pasó a mis huesos después de recibir megadosis de quimioterapia, veintiocho (28) tratamientos de radiación y tomar Tamaxofin.
Si esto hubiera sido diagnosticado como cáncer de mama desde un principio, probablemente no se hubiera extendido.
A todos los lectores: esto es triste. Como mujeres no sabemos de enfermedad de Paget.
Si pasando esto por e-mail, podemos hacer que otras conozcan esto, y su potencial peligro, estamos ayudando a mujeres en todos lados.
Por favor: Si puedes, perder un momento y envía esto a la mayor cantidad de personas posible, especialmente a tu familia y amigas; solo toma un momento y los resultados
Pueden salvar vidas.
Pueden encontrar más información en esta página:
http://www.cirugest.com/revisiones/cir09-06/09-06-09.htm
Wednesday, January 23, 2008
Food Poisoning Can Be Long-Term Problem
By LAURAN NEERGAARD
WASHINGTON (AP) — It's a dirty little secret of food poisoning: E. coli and certain other foodborne illnesses can sometimes trigger serious health problems months or years after patients survived that initial bout. Scientists only now are unraveling a legacy that has largely gone unnoticed.
What they've spotted so far is troubling. In interviews with The Associated Press, they described high blood pressure, kidney damage, even full kidney failure striking 10 to 20 years later in people who survived severe E. coli infection as children, arthritis after a bout of salmonella or shigella, and a mysterious paralysis that can attack people who just had mild symptoms of campylobacter.
"Folks often assume once you're over the acute illness, that's it, you're back to normal and that's the end of it," said Dr. Robert Tauxe of the Centers for Disease Control and Prevention. The long-term consequences are "an important but relatively poorly documented, poorly studied area of foodborne illness."
These late effects are believed to make up a very small fraction of the nation's 76 million annual food poisonings, although no one knows just how many people are at risk. A bigger question is what other illnesses have yet to be scientifically linked to food poisoning.
And with a rash of food recalls — including more than 30 million pounds of ground beef pulled off the market last year alone — these are questions are taking on new urgency.
"We're drastically underestimating the burden on society that foodborne illnesses represent," contends Donna Rosenbaum of the consumer advocacy group STOP, Safe Tables Our Priority.
Every week, her group hears from patients with health complaints that they suspect or have been told are related to food poisoning years earlier, like a woman who survived severe E. coli at 8 only to have her colon removed in her 20s. Or people who develop diabetes after food poisoning inflamed the pancreas. Or parents who wonder if a child's learning problems stem from food poisoning-caused dialysis as a toddler.
"There's nobody to refer them to for an answer," says Rosenbaum.
So STOP this month is beginning the first national registry of food-poisoning survivors with long-term health problems — people willing to share their medical histories with scientists in hopes of boosting much-needed research.
Consider Alyssa Chrobuck of Seattle, who at age 5 was hospitalized as part of the Jack-in-the-Box hamburger outbreak that 15 years ago this month made a deadly E. coli strain notorious.
She's now a successful college student but ticks off a list of health problems unusual for a 20-year-old: High blood pressure, recurring hospitalizations for colon inflammation, a hiatal hernia, thyroid removal, endometriosis.
"I can't eat fatty foods. I can't eat things that are fried, never been able to eat ice cream or milkshakes," says Chrobuck. "Would I have this many medical problems if I hadn't had the E. coli? Definitely not. But there's no way to tie it definitely back."
The CDC says foodborne illnesses cause 325,000 hospitalizations and 5,000 deaths a year. Among survivors, some long-term consequences are obvious from the outset. Some required kidney transplants. They may have scarred intestines that promise lasting digestive difficulty.
But when people appear to recover, it is difficult to prove that later problems really are a food-poisoning legacy and not some unfortunate coincidence. It may be that people prone to certain gastrointestinal conditions, for instance, also are genetically more vulnerable to germs that cause foodborne illness.
For now, some of the best evidence comes from the University of Utah, which has long tracked children with E. coli. About 10 percent of E. coli sufferers develop a life-threatening complication called hemolytic uremic syndrome, or HUS, where their kidneys and other organs fail.
Ten to 20 years after they recover, between 30 percent and half of HUS survivors will have some kidney-caused problem, says Dr. Andrew Pavia, the university's pediatric infectious diseases chief. That includes high blood pressure caused by scarred kidneys, slowly failing kidneys, even end-stage kidney failure that requires dialysis.
"I don't want to leave the message that everyone who had symptoms ... is in trouble," stresses Pavia.
Miserable as E. coli is, it doesn't seem to trigger long-term problems unless it started shutting down the kidneys the first time around, he says. "People with uncomplicated diarrhea, by and large we don't have evidence yet that they have complications."
Other proven long-term consequences:
_About 1 in 1,000 sufferers of campylobacter, a diarrhea-causing infection spread by raw poultry, develop far more serious Guillain-Barre syndrome a month or so later. Their body attacks their nerves, causing paralysis that usually requires intensive care and a ventilator to breathe. About a third of the nation's Guillain-Barre cases have been linked to previous campylobacter, even if the diarrhea was very mild, and they typically suffer a more severe case than patients who never had food poisoning.
While they eventually recover, "We don't know a great deal about what happens to those people five years later. What does 'normal' look like?" Tauxe says.
_A small number of people develop what's called reactive arthritis six months or longer after a bout of salmonella. It causes joint pain, eye inflammation, sometimes painful urination, and can lead to chronic arthritis. Certain strains of shigella and yersinia bacteria, far more common abroad than in the U.S., trigger this reactive arthritis, too, Tauxe says.
What about other patient complaints?
A variety of other organ problems might be triggered by HUS, that severe E. coli — because it causes blood clots all over the body that could leave a trail of damage, says Utah's Pavia. Among his hottest questions: HUS patients often suffer pancreatitis. Does that increase risk for diabetes later in life?
But proving a connection will require tracking a lot of patients who can provide very good medical records documenting their initial foodborne illness, he cautions.
EDITOR's NOTE _ Lauran Neergaard covers health and medical issues for The Associated Press in Washington.
WASHINGTON (AP) — It's a dirty little secret of food poisoning: E. coli and certain other foodborne illnesses can sometimes trigger serious health problems months or years after patients survived that initial bout. Scientists only now are unraveling a legacy that has largely gone unnoticed.
What they've spotted so far is troubling. In interviews with The Associated Press, they described high blood pressure, kidney damage, even full kidney failure striking 10 to 20 years later in people who survived severe E. coli infection as children, arthritis after a bout of salmonella or shigella, and a mysterious paralysis that can attack people who just had mild symptoms of campylobacter.
"Folks often assume once you're over the acute illness, that's it, you're back to normal and that's the end of it," said Dr. Robert Tauxe of the Centers for Disease Control and Prevention. The long-term consequences are "an important but relatively poorly documented, poorly studied area of foodborne illness."
These late effects are believed to make up a very small fraction of the nation's 76 million annual food poisonings, although no one knows just how many people are at risk. A bigger question is what other illnesses have yet to be scientifically linked to food poisoning.
And with a rash of food recalls — including more than 30 million pounds of ground beef pulled off the market last year alone — these are questions are taking on new urgency.
"We're drastically underestimating the burden on society that foodborne illnesses represent," contends Donna Rosenbaum of the consumer advocacy group STOP, Safe Tables Our Priority.
Every week, her group hears from patients with health complaints that they suspect or have been told are related to food poisoning years earlier, like a woman who survived severe E. coli at 8 only to have her colon removed in her 20s. Or people who develop diabetes after food poisoning inflamed the pancreas. Or parents who wonder if a child's learning problems stem from food poisoning-caused dialysis as a toddler.
"There's nobody to refer them to for an answer," says Rosenbaum.
So STOP this month is beginning the first national registry of food-poisoning survivors with long-term health problems — people willing to share their medical histories with scientists in hopes of boosting much-needed research.
Consider Alyssa Chrobuck of Seattle, who at age 5 was hospitalized as part of the Jack-in-the-Box hamburger outbreak that 15 years ago this month made a deadly E. coli strain notorious.
She's now a successful college student but ticks off a list of health problems unusual for a 20-year-old: High blood pressure, recurring hospitalizations for colon inflammation, a hiatal hernia, thyroid removal, endometriosis.
"I can't eat fatty foods. I can't eat things that are fried, never been able to eat ice cream or milkshakes," says Chrobuck. "Would I have this many medical problems if I hadn't had the E. coli? Definitely not. But there's no way to tie it definitely back."
The CDC says foodborne illnesses cause 325,000 hospitalizations and 5,000 deaths a year. Among survivors, some long-term consequences are obvious from the outset. Some required kidney transplants. They may have scarred intestines that promise lasting digestive difficulty.
But when people appear to recover, it is difficult to prove that later problems really are a food-poisoning legacy and not some unfortunate coincidence. It may be that people prone to certain gastrointestinal conditions, for instance, also are genetically more vulnerable to germs that cause foodborne illness.
For now, some of the best evidence comes from the University of Utah, which has long tracked children with E. coli. About 10 percent of E. coli sufferers develop a life-threatening complication called hemolytic uremic syndrome, or HUS, where their kidneys and other organs fail.
Ten to 20 years after they recover, between 30 percent and half of HUS survivors will have some kidney-caused problem, says Dr. Andrew Pavia, the university's pediatric infectious diseases chief. That includes high blood pressure caused by scarred kidneys, slowly failing kidneys, even end-stage kidney failure that requires dialysis.
"I don't want to leave the message that everyone who had symptoms ... is in trouble," stresses Pavia.
Miserable as E. coli is, it doesn't seem to trigger long-term problems unless it started shutting down the kidneys the first time around, he says. "People with uncomplicated diarrhea, by and large we don't have evidence yet that they have complications."
Other proven long-term consequences:
_About 1 in 1,000 sufferers of campylobacter, a diarrhea-causing infection spread by raw poultry, develop far more serious Guillain-Barre syndrome a month or so later. Their body attacks their nerves, causing paralysis that usually requires intensive care and a ventilator to breathe. About a third of the nation's Guillain-Barre cases have been linked to previous campylobacter, even if the diarrhea was very mild, and they typically suffer a more severe case than patients who never had food poisoning.
While they eventually recover, "We don't know a great deal about what happens to those people five years later. What does 'normal' look like?" Tauxe says.
_A small number of people develop what's called reactive arthritis six months or longer after a bout of salmonella. It causes joint pain, eye inflammation, sometimes painful urination, and can lead to chronic arthritis. Certain strains of shigella and yersinia bacteria, far more common abroad than in the U.S., trigger this reactive arthritis, too, Tauxe says.
What about other patient complaints?
A variety of other organ problems might be triggered by HUS, that severe E. coli — because it causes blood clots all over the body that could leave a trail of damage, says Utah's Pavia. Among his hottest questions: HUS patients often suffer pancreatitis. Does that increase risk for diabetes later in life?
But proving a connection will require tracking a lot of patients who can provide very good medical records documenting their initial foodborne illness, he cautions.
EDITOR's NOTE _ Lauran Neergaard covers health and medical issues for The Associated Press in Washington.
Saturday, January 19, 2008
New Questions on Treating Cholesterol
The New York Times
Jan 18, 2008
http://www.nytimes.com/2008/01/17/business/17drug.html?ex=1358312400&en=11b68f069a83f57c&ei=5088&partner=rssnyt&emc=rss
By ALEX BERENSON
Correction Appended
For decades, the theory that lowering cholesterol is always beneficial has been a core principle of cardiology. It has been accepted by doctors and used by drug makers to win quick approval for new medicines to reduce cholesterol.
But now some prominent cardiologists say the results of two recent clinical trials have raised serious questions about that theory — and the value of two widely used cholesterol-lowering medicines, Zetia and its sister drug, Vytorin. Other new cholesterol-fighting drugs, including one that Merck hopes to begin selling this year, may also require closer scrutiny, they say.
“The idea that you’re just going to lower LDL and people are going to get better, that’s too simplistic, much too simplistic,” said Dr. Eric J. Topol, a cardiologist and director of the Scripps Translational Science Institute in La Jolla, Calif. LDL, or low-density lipoprotein, is the so-called bad cholesterol, in contrast to high-density lipoprotein, or HDL.
For patients and drug companies, the stakes are enormous. Led by best sellers like Lipitor from Pfizer, cholesterol-lowering medicines, taken by tens of millions of patients daily, are the largest drug category worldwide, with annual sales of $40 billion.
Despite widespread use of the drugs, though, heart disease remains the biggest killer in the United States and other industrialized nations, and many people still have cholesterol levels far higher than doctors recommend.
As a result, drug companies are investing billions of dollars in experimental new cholesterol-lowering medicines that may eventually be used alongside the existing drugs. If the new questions result in slower approvals, it would be yet another handicap for the drug industry.
Because the link between excessive LDL cholesterol and cardiovascular disease has been so widely accepted, the Food and Drug Administration generally has not required drug companies to prove that cholesterol medicines actually reduce heart attacks before approval.
They have not had to conduct so-called outcome or events trials beforehand, which are expensive studies that involve thousands of patients and track whether episodes like heart attacks are reduced.
So far, proof that a drug lowers LDL cholesterol has generally been enough to lead to approval. Only then does the drug’s maker begin an events trial. And until the results of that trial are available, a process that can take several years, doctors and patients must accept the medicine’s benefits largely on faith.
“You’ve got a huge chasm between F.D.A. licensure and a clinical events trial,” said Dr. Allen J. Taylor, the chief of cardiology at Walter Reed Army Medical Center.
Nonetheless, the multistep process has worked well for several cholesterol drugs — including Lipitor and Zocor, which are in a class of drugs known as statins. In those cases, the postapproval trials confirmed that the drugs reduce heart attacks and strokes, adding to confidence about the link between cholesterol and heart disease.
Doctors generally believe that the amount by which cholesterol is lowered, not the method of lowering it, is what matters.
That continues to be the assumption of Dr. Scott M. Grundy, a professor of medicine at the University of Texas Southwestern Medical Center who was the chairman of a panel in 2001 that set national guidelines for cholesterol treatment.
“LDL lowering, however it occurs, delays development of coronary atherosclerosis and reduces risk for heart attack,” Dr. Grundy said this week. In atherosclerosis, plaque builds up in the arteries, eventually leading to blood clots and other problems that cause heart attacks and strokes.
In the last 13 months, however, the failures of two important clinical trials have thrown that hypothesis into question.
First, Pfizer stopped development of its experimental cholesterol drug torcetrapib in December 2006, when a trial involving 15,000 patients showed that the medicine caused heart attacks and strokes. That trial — somewhat unusual in that it was conducted before Pfizer sought F.D.A. approval — also showed that torcetrapib lowered LDL cholesterol while raising HDL, or good cholesterol.
Torcetrapib’s failure, Dr. Taylor said, shows that lowering cholesterol alone does not prove a drug will benefit patients.
Then, on Monday, Merck and Schering-Plough announced that Vytorin, which combines Zetia with Zocor, had failed to reduce the growth of fatty arterial plaque in a trial of 720 patients. In fact, patients taking Vytorin actually had more plaque growth than those who took Zocor alone.
Despite those drawbacks, that trial, called Enhance, also showed that patients on Vytorin had lower LDL levels than those on Zocor alone. For the second time in just over a year, a clinical trial found that LDL reduction did not translate into measurable medical benefits.
The Enhance trial was not an events trial and was not intended to study whether Zetia or Vytorin were effective at reducing heart attacks. But the growth of fatty plaque is closely correlated with heart attacks and strokes.
Without data from events trials for Zetia and Vytorin, no one can be certain if the drugs help or hurt patients. But Merck and Schering did not begin an events trial for the drugs until 2006, nearly four years after the F.D.A. approved Zetia. That trial will not be completed until 2011.
Dr. Robert M. Califf, the vice chancellor for clinical research at Duke University, and a co-lead investigator on the Zetia trial still under way, said companies should have started the trials more quickly. “Outcome trials ought to start when you know you’re going to get on the market,” he said.
On Tuesday, the American Heart Association called for the Zetia outcome trial to be completed as quickly as possible.
Merck has asked the F.D.A. to approve its drug Cordaptive, which raises HDL cholesterol and lowers LDL, without waiting for the results of an events trial. Merck has begun an events trial for Cordaptive, but data will not be available until 2013.
Merck has submitted the application for Cordaptive and has said it expects an answer from the F.D.A. before July. Doctors, patients and the drug industry will be waiting to see whether regulators are still willing to accept the theory that lower cholesterol is always a good thing.
Correction: January 18, 2008
A headline in Business Day on Thursday with an article about research involving two widely used cholesterol-lowering drugs misstated the issue raised by the results. It is whether using drugs to lower cholesterol at all costs is always medically effective, or even safe; there is no question that cholesterol itself can pose dangers.
Jan 18, 2008
http://www.nytimes.com/2008/01/17/business/17drug.html?ex=1358312400&en=11b68f069a83f57c&ei=5088&partner=rssnyt&emc=rss
By ALEX BERENSON
Correction Appended
For decades, the theory that lowering cholesterol is always beneficial has been a core principle of cardiology. It has been accepted by doctors and used by drug makers to win quick approval for new medicines to reduce cholesterol.
But now some prominent cardiologists say the results of two recent clinical trials have raised serious questions about that theory — and the value of two widely used cholesterol-lowering medicines, Zetia and its sister drug, Vytorin. Other new cholesterol-fighting drugs, including one that Merck hopes to begin selling this year, may also require closer scrutiny, they say.
“The idea that you’re just going to lower LDL and people are going to get better, that’s too simplistic, much too simplistic,” said Dr. Eric J. Topol, a cardiologist and director of the Scripps Translational Science Institute in La Jolla, Calif. LDL, or low-density lipoprotein, is the so-called bad cholesterol, in contrast to high-density lipoprotein, or HDL.
For patients and drug companies, the stakes are enormous. Led by best sellers like Lipitor from Pfizer, cholesterol-lowering medicines, taken by tens of millions of patients daily, are the largest drug category worldwide, with annual sales of $40 billion.
Despite widespread use of the drugs, though, heart disease remains the biggest killer in the United States and other industrialized nations, and many people still have cholesterol levels far higher than doctors recommend.
As a result, drug companies are investing billions of dollars in experimental new cholesterol-lowering medicines that may eventually be used alongside the existing drugs. If the new questions result in slower approvals, it would be yet another handicap for the drug industry.
Because the link between excessive LDL cholesterol and cardiovascular disease has been so widely accepted, the Food and Drug Administration generally has not required drug companies to prove that cholesterol medicines actually reduce heart attacks before approval.
They have not had to conduct so-called outcome or events trials beforehand, which are expensive studies that involve thousands of patients and track whether episodes like heart attacks are reduced.
So far, proof that a drug lowers LDL cholesterol has generally been enough to lead to approval. Only then does the drug’s maker begin an events trial. And until the results of that trial are available, a process that can take several years, doctors and patients must accept the medicine’s benefits largely on faith.
“You’ve got a huge chasm between F.D.A. licensure and a clinical events trial,” said Dr. Allen J. Taylor, the chief of cardiology at Walter Reed Army Medical Center.
Nonetheless, the multistep process has worked well for several cholesterol drugs — including Lipitor and Zocor, which are in a class of drugs known as statins. In those cases, the postapproval trials confirmed that the drugs reduce heart attacks and strokes, adding to confidence about the link between cholesterol and heart disease.
Doctors generally believe that the amount by which cholesterol is lowered, not the method of lowering it, is what matters.
That continues to be the assumption of Dr. Scott M. Grundy, a professor of medicine at the University of Texas Southwestern Medical Center who was the chairman of a panel in 2001 that set national guidelines for cholesterol treatment.
“LDL lowering, however it occurs, delays development of coronary atherosclerosis and reduces risk for heart attack,” Dr. Grundy said this week. In atherosclerosis, plaque builds up in the arteries, eventually leading to blood clots and other problems that cause heart attacks and strokes.
In the last 13 months, however, the failures of two important clinical trials have thrown that hypothesis into question.
First, Pfizer stopped development of its experimental cholesterol drug torcetrapib in December 2006, when a trial involving 15,000 patients showed that the medicine caused heart attacks and strokes. That trial — somewhat unusual in that it was conducted before Pfizer sought F.D.A. approval — also showed that torcetrapib lowered LDL cholesterol while raising HDL, or good cholesterol.
Torcetrapib’s failure, Dr. Taylor said, shows that lowering cholesterol alone does not prove a drug will benefit patients.
Then, on Monday, Merck and Schering-Plough announced that Vytorin, which combines Zetia with Zocor, had failed to reduce the growth of fatty arterial plaque in a trial of 720 patients. In fact, patients taking Vytorin actually had more plaque growth than those who took Zocor alone.
Despite those drawbacks, that trial, called Enhance, also showed that patients on Vytorin had lower LDL levels than those on Zocor alone. For the second time in just over a year, a clinical trial found that LDL reduction did not translate into measurable medical benefits.
The Enhance trial was not an events trial and was not intended to study whether Zetia or Vytorin were effective at reducing heart attacks. But the growth of fatty plaque is closely correlated with heart attacks and strokes.
Without data from events trials for Zetia and Vytorin, no one can be certain if the drugs help or hurt patients. But Merck and Schering did not begin an events trial for the drugs until 2006, nearly four years after the F.D.A. approved Zetia. That trial will not be completed until 2011.
Dr. Robert M. Califf, the vice chancellor for clinical research at Duke University, and a co-lead investigator on the Zetia trial still under way, said companies should have started the trials more quickly. “Outcome trials ought to start when you know you’re going to get on the market,” he said.
On Tuesday, the American Heart Association called for the Zetia outcome trial to be completed as quickly as possible.
Merck has asked the F.D.A. to approve its drug Cordaptive, which raises HDL cholesterol and lowers LDL, without waiting for the results of an events trial. Merck has begun an events trial for Cordaptive, but data will not be available until 2013.
Merck has submitted the application for Cordaptive and has said it expects an answer from the F.D.A. before July. Doctors, patients and the drug industry will be waiting to see whether regulators are still willing to accept the theory that lower cholesterol is always a good thing.
Correction: January 18, 2008
A headline in Business Day on Thursday with an article about research involving two widely used cholesterol-lowering drugs misstated the issue raised by the results. It is whether using drugs to lower cholesterol at all costs is always medically effective, or even safe; there is no question that cholesterol itself can pose dangers.
Sunday, January 6, 2008
La propina es tomada de varias formas
Por Verónica Martínez
Diario La Palma Newspaper
Friday, January 04, 2008
Una de las costumbres de cortesía que más controversia ha causado a través de la historia es la de dar propina.
Es así como después de haber disfrutado de una cena exquisita y de un buen servicio, luego de pagar la cuenta, se acostumbra dejar una pequeña cantidad de dinero adicional como agradecimiento al camarero por su cortesía y eficiencia.
La palabra propina proviene del latín propinare que quiere decir "dar de beber". Inicialmente, la propina era regalarle a alguien un trago como agradecimiento.
Existen muchas teorías sobre el origen de la práctica de dejar propina a cambio de un favor o un servicio, pero lo cierto es que no se sabe realmente cómo empezó. Una de ellas apunta al siglo XVII, cuando caballeros feudales comenzaron a arrojar monedas de oro a los campesinos al pasar por la calle para poder asegurar su paso seguro.
Aun así, otros afirman mucho antes de eso, en la antigüedad, cuando los romanos practicaban esta costumbre de una manera similar.
Una anécdota particularmente interesante habla del ilustre ensayista británico del siglo XVIII Samuel Johnson, quien acostumbraba reunirse en un café con sus amigos, también intelectuales y escritores. Cuentan que al entrar, siempre depositaban unos cuantos peniques en una caja con un pequeño letrero que decía en inglés: To Insure Promptness (Para Asegurar Prontitud). Por cierto, se cree que de ahí proviene la palabra tip, es decir propina en inglés, como acrónimo de aquella frase original.
Lo interesante es que la propina ha sido vista de maneras totalmente diferentes a través de la historia.
En siglos pasados, en Francia y en Inglaterra cuando no se pagaba una propina aceptable, se consideraba un insulto meritorio de agresión física.
Más tarde, los franceses se asegurarían que sus empleados recibieran una propina justa por parte de los turistas que no conocían las costumbres del país.
En muchos establecimientos, se encontraba un letrero por encima de una caja o ranura que permitía depositar unas cuantas monedas que hacía más que evidente el propósito de la misma: Merci, messieur, pour les employeés, es decir, "Gracias, caballero" (por su aporte) para (beneficio de) los trabajadores."
Por otro lado, durante muchos años, dar propina en España se consideró como un gesto ofensivo, tanto así que los camareros, entre otros de los oficios similares, solían decir "La propina afrenta al que la recibe", e incluso colgaban carteles al frente del establecimiento en cuestión que advertían "No se aceptan propinas".
Por otro lado, la clientela manifestaba lo que se convertiría en un popular refrán: "La propina envilece, empobrece y ni Dios te la agradece".
En los Estados Unidos, la propina es prácticamente obligatoria.
La regla es otorgar entre el 15 y el 20 por ciento de la cuenta como propina. Años atrás, con dejar el 10 por ciento bastaba, pero eso ya no es aceptable. Hacerlo podría ser interpretado por el trabajador como insatisfacción con el servicio. Esto se debe a que en realidad, en este país, las personas que trabajan como camareros y en otros oficios similares reciben un sueldo menor a lo que se considera el salario mínimo. Por esta razón, se les deja propina para que puedan compensar con el dinero recibido.
En España la situación es completamente distinta. Allí, la propina es realmente un gesto de cortesía, que para nada se considera obligatorio, pues es estrictamente voluntario.
Es más, en los restaurantes, por ejemplo, los camareros no "esperan" una propina. Ellos reciben sueldos justos, como cualquier otra persona que trabaje en cualquier otro oficio, y por ello no dependen de propinas para vivir cómodamente. Claro que si se les deja propina es bien recibida, pero realmente, no es requerida.
En cierta forma, esto significa que, como el servicio no depende de una remuneración económica al final de la velada, la interacción entre el comensal y el camarero es más natural y hasta más sincera.
Muchas veces, el camarero es servicial y atento simplemente porque quiere serlo y porque quiere cumplir con su trabajo y nada más.
Ahora que dejar propina no es una costumbre aceptada en todo el mundo. Según CCRA International, una guía de referencia para agentes de viajes, en Vietnam y en Argentina, se considera ilegal dejar propina.
El mejor consejo quizá, es consultar su guía de viajes la próxima vez que vaya al extranjero para evitar pasar un mal rato.
Diario La Palma Newspaper
Friday, January 04, 2008
Una de las costumbres de cortesía que más controversia ha causado a través de la historia es la de dar propina.
Es así como después de haber disfrutado de una cena exquisita y de un buen servicio, luego de pagar la cuenta, se acostumbra dejar una pequeña cantidad de dinero adicional como agradecimiento al camarero por su cortesía y eficiencia.
La palabra propina proviene del latín propinare que quiere decir "dar de beber". Inicialmente, la propina era regalarle a alguien un trago como agradecimiento.
Existen muchas teorías sobre el origen de la práctica de dejar propina a cambio de un favor o un servicio, pero lo cierto es que no se sabe realmente cómo empezó. Una de ellas apunta al siglo XVII, cuando caballeros feudales comenzaron a arrojar monedas de oro a los campesinos al pasar por la calle para poder asegurar su paso seguro.
Aun así, otros afirman mucho antes de eso, en la antigüedad, cuando los romanos practicaban esta costumbre de una manera similar.
Una anécdota particularmente interesante habla del ilustre ensayista británico del siglo XVIII Samuel Johnson, quien acostumbraba reunirse en un café con sus amigos, también intelectuales y escritores. Cuentan que al entrar, siempre depositaban unos cuantos peniques en una caja con un pequeño letrero que decía en inglés: To Insure Promptness (Para Asegurar Prontitud). Por cierto, se cree que de ahí proviene la palabra tip, es decir propina en inglés, como acrónimo de aquella frase original.
Lo interesante es que la propina ha sido vista de maneras totalmente diferentes a través de la historia.
En siglos pasados, en Francia y en Inglaterra cuando no se pagaba una propina aceptable, se consideraba un insulto meritorio de agresión física.
Más tarde, los franceses se asegurarían que sus empleados recibieran una propina justa por parte de los turistas que no conocían las costumbres del país.
En muchos establecimientos, se encontraba un letrero por encima de una caja o ranura que permitía depositar unas cuantas monedas que hacía más que evidente el propósito de la misma: Merci, messieur, pour les employeés, es decir, "Gracias, caballero" (por su aporte) para (beneficio de) los trabajadores."
Por otro lado, durante muchos años, dar propina en España se consideró como un gesto ofensivo, tanto así que los camareros, entre otros de los oficios similares, solían decir "La propina afrenta al que la recibe", e incluso colgaban carteles al frente del establecimiento en cuestión que advertían "No se aceptan propinas".
Por otro lado, la clientela manifestaba lo que se convertiría en un popular refrán: "La propina envilece, empobrece y ni Dios te la agradece".
En los Estados Unidos, la propina es prácticamente obligatoria.
La regla es otorgar entre el 15 y el 20 por ciento de la cuenta como propina. Años atrás, con dejar el 10 por ciento bastaba, pero eso ya no es aceptable. Hacerlo podría ser interpretado por el trabajador como insatisfacción con el servicio. Esto se debe a que en realidad, en este país, las personas que trabajan como camareros y en otros oficios similares reciben un sueldo menor a lo que se considera el salario mínimo. Por esta razón, se les deja propina para que puedan compensar con el dinero recibido.
En España la situación es completamente distinta. Allí, la propina es realmente un gesto de cortesía, que para nada se considera obligatorio, pues es estrictamente voluntario.
Es más, en los restaurantes, por ejemplo, los camareros no "esperan" una propina. Ellos reciben sueldos justos, como cualquier otra persona que trabaje en cualquier otro oficio, y por ello no dependen de propinas para vivir cómodamente. Claro que si se les deja propina es bien recibida, pero realmente, no es requerida.
En cierta forma, esto significa que, como el servicio no depende de una remuneración económica al final de la velada, la interacción entre el comensal y el camarero es más natural y hasta más sincera.
Muchas veces, el camarero es servicial y atento simplemente porque quiere serlo y porque quiere cumplir con su trabajo y nada más.
Ahora que dejar propina no es una costumbre aceptada en todo el mundo. Según CCRA International, una guía de referencia para agentes de viajes, en Vietnam y en Argentina, se considera ilegal dejar propina.
El mejor consejo quizá, es consultar su guía de viajes la próxima vez que vaya al extranjero para evitar pasar un mal rato.
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