Relationships are being developed between the healthcare and health club industries, and there is an opportunity for you to benefit financially from the changes in how healthcare is delivered in the U.S.

Whether you are ready or not, in the coming years, health clubs will no longer be in the health club business, they will be in the healthcare industry.

The healthcare system has been in a state of change for the past two decades. This transformation has forced healthcare providers to refocus their business strategy from sick care to prevention, especially in the areas of early disease diagnosis and intervention, aggressive rehabilitation, fitness programming and alternative medical care.

These changes have motivated the rethinking of how healthcare should be delivered in a way that is attractive to the consumer/patient. One way to deliver healthcare services is in the user-friendly club environment.

A “coach,” in the context of athletics or as a provider of private lessons (acting coach), originated in university slang out of “stage-coach” (one who carries you along). The word “positive,” in the context of facilitative learning, is characterized by affirmation (to strengthen). Thus, when the words “positive” and “coach” are combined, yet another definition of facilitator is produced: a person who carries participants along, strengthening them in the process.

Throughout the group cycling class, facilitators should:

* Demonstrate a reasonable, flexible and caring attitude.

* Create a state of mutual respect to make participants feel safe and unthreatened.

* Demonstrate friendliness, consideration and enthusiasm.

* Demonstrate a strong understanding of thesubject.

* Create a low-stress learning environment.

* Present “key points” of information, as needed.

* Demonstrate effective skills and techniques.

* Help participants develop effective skills and techniques.

* Help participants enjoy the class.

Three principles for facilitation.Experience has demonstrated that when facilitators keep three basic principles in mind, learning is easier and remains enjoyable for participants and thefacilitator.

1.Do not hover.During class, the facilitator should circulate among the class, but shouldnot linger or “hover.” Instead, the facilitator should move around the room using appropriate praise and reinforcing correct skill. This positive coaching will help strengthen the participant’s self-confidence. Facilitators should prevent participants from repeating incorrect procedures. Corrections of skills by the facilitator should be done in a supportive manner.

2. Do not step over the edge.This principle applies primarily to facilitators with credentials beyond the basics. Having facilitators with special training and experience canoffer a wonderful perspective; however the downside is that it is easy for them to “step over the edge” (i.e., ride beyond the class’ fitness level or use undefined terminology). If instructors step over the edge, the club risks losing its participants.

3.Know there is no one way.Facilitators have or have not been certified in a particular group cycling program, and they have unique and distinctive differences in style and presentation. However, the use of standard techniques and terminologies will provide consistency and safety.

Facilitator checklist. Group cycling instructors should use the following guidelines:

1. They should arrive 10 minutes early to class to greet everyone and learn theirnames. They should also make an effort to learn two names each week, and vow to learn something more about someone in every class.

2. Always introduce themselvesand explain or describe what their goals are for the class.

3. Always ask, “Is this anyone’s first class?” or “Does anyone have an injury or limitation I should be aware of?”

4. Review proper form and technique. Facilitators will enhance participants’ execution of the exercises, plusincrease their kinesthetic awareness.

5. Make eye contact with every person at least once during the workout. This lets participants know that the instructor is aware of their existence and is watching their form.

6. Arm class members with knowledge. Instructors should offer fitness tips, explain why theyuse certain positions, tempos and phrases, and help particpants to execute correctly.

7. Change their routine and music regularly. This helps the facilitator and the class to achieve a more bal-anced workout.

8. Be a “coach” instead of an instructor. This allows the facilitator to personalize the program for all participants’ needs, and tooffer modifications when necessary.

9. Be consistently positive, upbeat and professional. There is no room for mood swings.

10. When possible, instructors shouldlet participants know ahead of time when they won’t be there to teach a class.

11. On holidays, use special music and create a differentmood. Use props whenever possible, and show participantsappreciation for their loyalty.

12. Always thank your participants. Facilitators should let class members know that they appreciate the time and effort it took for them to attend the class.

Some of you may not experience difficulty conceiving when you make your decision to become a mother. But, if you have taken time out of your busy schedule to visit us, it is likely that you are concerned about the many issues and choices involved in conception. Because conception can sometimes be more difficult than expected and because without intervention it can sometimes take as long as a year to get pregnant, some of you may even be wondering What’s Wrong. And many of our visitors are often very anxious or confused about the reproductive process and the mechanics of The Female Body. I want to step back and take a moment to address these and other concerns that many of you are experiencing. I want to start with what it means to begin the journey toward motherhood.

If you feel a breast lump or mass see your doctor, who will examine your breasts carefully.
For normal breast tissue nothing need be done. Fibrocystic changes can be treated as above.

For a possible cyst or a fibroadenoma, one option is to measure the lump and have you return for an examination after you next period. If the lump is gone, it was probably a cyst.

If the lump is still there your doctor may recommend an ultrasound, which helps tell a cyst, which contains fluid, from a fibroadenoma, which is solid. Your doctor may also recommend needle aspiration of the mass. In this procedure, a needle is inserted into the mass and an attempt is made to withdraw fluid that would indicate a cyst. Mammograms are rarely done in adolescents because their breasts are so dense.

If aspiration of the mass can’t be done or no fluid comes out, or if the mass is hard, getting bigger, hurts a lot and is causing you and your family a lot of anxiety, then the mass can be surgically removed. Be sure to see a surgeon experienced with breast surgery in adolescents and learn about the risks and benefits of the procedure.

Breast Discharge
Breast discharge in adolescents may provoke anxiety but rarely indicates breast cancer.

One type of discharge is a milky discharge known as galactorrhea. Causes of galactorrhea in adolescents include:
pregnancy
breast manipulation (physical activity, sexual stimulation)
trauma
medications
thyroid problems
pituitary tumors
central nervous system tumors

See your doctor if you have any type of breast discharge.

Nipple Problems

Jogger’s nipple — This is caused by friction during jogging or sports. The nipples get irritated and sore. Common treatments are lubrication with petrolatum and protection with an adhesive bandage. A soft cotton bra without a seam in the cup may also help.

Nipple eczema — This is a type of dry, scaly rash involving one or both nipples. A good moisturizer and mild topical steroid treats the eczema. An antibiotic is needed if the area gets infected.

An internet drugstore may present you private manner to buy prescription medicines, often at a more inexpensive rate. No prescription online pharmacy are especially suitable in case you do not drive or live in a rural area.

Lack of breast development — This may be due to a health problem; an endocrine (hormonal) problem; a rare condition called amastia or radiation therapy involving the chest.

Breast hypertrophy — Also known as excessive breast growth, this can cause back pain, breast pain, shoulder pain, poor posture, rashes under the breasts and psychological concerns. Breast reduction surgery is an option after breast growth is complete.

Tuberous breasts — These breasts have narrow bases and very large nipple-areola complexes. Plastic surgery can be done for cosmetic reasons.

Significant breast-size differences — This may indicate an underlying problem, such as a cyst or a mass. A doctor can determine if this is the case. If no underlying problem is found, one option is to use bra padding or a bra insert for the smaller breast. Another option is plastic surgery. This can be considered once breast growth has finished.

If you are considering any type of breast surgery, be sure to see a plastic surgeon who has experience with that particular procedure in women your age. Learn about the risks and benefits of any surgery before you proceed.

Infections
Bacteria that enter small cracks or breaks in the skin cause breast infections. These can occur from:

• breast-feeding
• plucking or shaving hairs around the areolae
• sexual play
• nipple eczema
• trauma to breast skin

In breast cellulitis the skin is red, tender, warm and swollen. It is treated with an antibiotic and warm compresses.

A breast abscess is a collection of pus, which usually requires incision and drainage in addition to an antibiotic and warm compresses.

Yeast infections may occur under large breasts and appear as bright red rashes. A topical anti-fungal cream is used to treat it.

Seek medical care right away if you think you have a breast infection.

Lumps and Bumps
Breast cancer is extremely rare in adolescents. Since adolescent breasts are normally dense, firm and nodular, most of the lumps girls feel in their breasts are normal breast tissue or fibrocystic changes.

Fibrocystic changes are cyclic or menstrual-related breast changes. Symptoms include breast pain or discomfort the week before menstruation. Breasts are usually tender and feel granular due to small microcysts, which may merge into a larger cyst that can be felt as a mass. The cysts may go away then recur with successive menstrual cycles.

Treatment includes a well-fitting support bra and nonsteroidal anti-inflammatory prescription medication. Oral contraceptives may be used for more severe cases.

Of all breast masses that are surgically removed in adolescents, the most common type is the fibroadenoma. Cancerous tumors are one of the least common types removed in adolescents.

Why men lose their hair: We know of several reasons why men lose their hair. Some people may experience severe hair loss following an illness or major surgery. While the person undergoing the hair loss may feel that the amount is excessive, the hair loss is the result of a certain event. Usually the hair that is lost grows back.

Adverse reactions to medications can also cause hair loss. Most chemotherapy agents as well as some anticoagulants are well-known to cause hair loss. In these cases, once the use of the medication ceases, the hair usually grows back. Hair loss may occur as the result of using anti-depressants or taking too much vitamin A.

Hormonal imbalances, thyroid conditions and some fungal infections are some of the more common causes. Furthermore, it could be a symptom of an underlying condition, such as lupus or diabetes. Because there are so many potential causes, the specific cause of hair loss can be difficult to identify, so it is wise to check with your doctor as soon as possible.

Treatment for Hair Loss

Research continues to find a way to slow the loss of hair or to actually regrow it. At this point, generic Propecia and Rogaine are the two medications that are approved for treatment of male pattern baldness. The FDA has approved each of these medications.

Propecia, available by prescription only, is an effective treatment for male pattern baldness. It reduces the levels of dihydrotestosterone (DHT) in the body, a substance that causes reduced growth of hair. It is known that Propecia interferes with the hormonal process that results in hair loss. Although Propecia cannot help men regrow all their hair, it can slow the loss of hair.

Side effects: All drugs have side effects, and Propecia is no different, although only minor effects have been reported. Propecia is not known to cause any common side effects. But severe side effects may occur, including allergic reactions (hives, rash, itching, chest tightness, labored breathing, and swelling of the face, mouth, tongue or lips), breasts that are enlarged, painful or tender or that have nipple discharge, testicular pain or erectile dysfunction.

If you experience any of these symptoms after taking Propecia, obtain medical help immediately.

Ways to purchase Propecia on the Internet

Although Propecia (finasteride) is available by prescription only, it is not necessary to go to the doctor in order to purchase the medication. So ordering Propecia on the web is more efficient and cheaper.

A new and different class of drug is Effexor. It’s similar to the SSRIs in that it keeps mood balancing chemicals in the body’s system longer. A third class is Wellbutrin. “It’s the same drug as Zyban, which is prescribed to help people stop smoking,” Guthrie said. It affects mood and movement.

“Initially, prescribing medication is a bit hit or miss,” Guthrie said. “We know they all work. By knowing each drug’s side effects, we can narrow it down. And by knowing what other prescription drugs without a prescription a patient is taking, we can narrow it down a little more. Then after we see how you do, we can tailor it even further.

“But remember, it usually takes a couple of weeks for the drugs to fully enter your system,” she said. “And it may take that long before you to notice a change or an improvement. Some say these medications wake them up, while others say they narrow their mood swings.”

Other treatment includes psychotherapy or talk therapy, which may be effective in treating mild to moderate depression, Stotland said.

This involves talking with a trained mental health professional to help learn better ways of handling problems. Work is generally done over a short-term course with a specific number of sessions, Stotland said. For example, in cognitive/behavioral therapy patients work at changing the negative behaviors and styles of thought that may contribute to their depression. “This focuses on the here and now, which we have the power to change,” she said.

Interpersonal therapy focuses on learning to deal more effectively with other people and working to change relationships that can cause depression or make it worse.

“For many people, a combination of both medication and psychotherapy is best,” Stotland said. “Depression is a serious illness — so take it seriously. It’s a disease that must be treated. If you feel guilty or hopeless, remember it’s all part of the disease. Get help — and don’t give up. Keep going to someone until they make you better.

“By nature, women are loathe to take care of themselves,” Stotland added. “So tell yourself you’re doing it for your family — your husband, your children, your mother, your sister — then do it.”

Cognitive — this includes low self-esteem, negative thinking patterns, pessimism, excessive worry and/or the feeling that you have little control over your life.

Genetic — those with a family history of chronic depression are at increased risk for depression. Clinical depression, however, may occur in people without a family history of the illness.

Situational — hard life events like divorce, financial problems, death of a loved one, a move and/or a significant loss may contribute to depression.

“The biggest misconception about clinical depression is that you can get over it by force of will,” said Dr. Nada Stotland, chief of psychiatry at Illinois Masonic Medical Center in Chicago. “It’s a disease — a chemical imbalance — and once it’s started, it can’t be healed without treatment. It makes you feel hopeless and helpless — like nothing can be done to help.”

But it can be treated. Once diagnosed, clinical depression is one of the most treatable of all mental illnesses. Only a qualified health professional, however, can make an accurate diagnosis and prescribe treatment. As with most illnesses, the earlier treatment begins the more effective it can be.

Depression Treatments
The most commonly used treatments are medication and psychotherapy, or a combination of both. Medications have come a long way in their ability to effectively treat clinical depression. Until the late 1980s there were only two classes of cheap prescription drugs available — tricyclic antidepressants and monoamine oxidase (MAO) inhibitors.

“And they weren’t always well tolerated,” said Dr. Sally Guthrie, an associate professor in the College of Pharmacy at the University of Michigan in Ann Arbor. She also has an appointment with the university’s department of psychiatry. For example, the tricyclic antidepressants often caused a feeling of sedation, dry mouth, constipation, weight gain and diminished sex drive. And MAO inhibitors often caused dizziness and interactions with over-the-counter drugs, such as cold medications.

“That’s really all we had until the late 1980s when Prozac was introduced,” Guthrie said. “But today there are an awful lot more medications to choose from and we’re able to tailor — or fine tune — medications for patients’ specific needs and to allow these medications to co-exist with other prescription medications patients might be taking. This is especially helpful since it’s very common to suffer from more than one illness at a time.”

“I had this real sense of being stuck,” said Mendelson, 47. “I remember spending nights and weekends so depressed just sitting in a chair for hours, wondering, `Is this ever going to pass?’” Off and on for almost 20 years she tried various types of psychotherapy — but no medications. Then four years ago, Mendelson was diagnosed with clinical depression as well as obsessive-compulsive disorder and post-traumatic stress disorder — both anxiety disorders.

“I was so relieved,” she said. “I’d always felt that if only I tried harder or if only I had a better character, I could overcome my feelings and be well. I was so happy to learn that there were names in medical books for what I was feeling. Now I knew that I had an illness — a chemical imbalance in my brain — and it could be treated like any other medical illness.”

Today, Mendelson takes the antidepressant Paxil and is a member of a support group. “I was so grateful when the medication kicked in. I felt more in control and happier. It helps level my playing field and helps me enjoy my life,” she said.

Mendelson has become an advocate and activist for mental health. Her goal is to help end the stigma of mental illness as a dark and shameful secret rather than a treatable disease. She also recently married. “Life is better that it’s ever been,” she said. “Because I’m recovering, I can be the person I always wanted to be. I always had that glimmer of hope. Now I’m trying to help others realize there’s help on the other side.”

Mendelson is not alone. In fact, she’s one of the millions of women affected by clinical depression each year. Researchers say women are twice as likely as men to experience clinical depression and 1 in 4 women can expect to develop it during their lifetime. In addition, untreated clinical depression can also increase a woman’s risk for heart disease and hypertension — especially among black women, studies say.

Early ejaculation is a trouble that frustrating many couples. Fortunately, there is info out there that may help out you to stop you premature ejaculation issue.

After three weeks without improvement, I got a shot in the shoulder that helped for a week. After three more weeks of physical therapy, I went back for a checkup and found I had lost more range of motion.

The doctor now says I have adhesive capsulitis. What is this, and how does it happen? I did not injure the shoulder by any physical activity — it just started hurting. I am to begin aggressive range-of-motion therapy. Is this the best plan? I have only had one X-ray and no MRI.

T.P.

A.Adhesive capsulitis involves shrinkage of the capsule of the shoulder, which results in limited range of motion. Initially when a patient comes to me with shoulder pain, I take a detailed history, perform a physical examination and often take X-rays.

Apparently your orthopedist initially thought you had rotator cuff tendinitis. The rotator cuff is a group of four muscles that surrounds the shoulder joint, forming a cuff that aids in range of motion of the shoulder and helps provide stability. If you did have rotator cuff tendinitis, physical therapy is an appropriate first step.