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I *highly* recommend this book to anyone interested in chronic fatigue syndrome (CFS,) its diagnosis, differential diagnosis, treatment and all other diseases that have fatigue as a major symptom.
Dr. Natelson is a professor of neurosciences at University of Medicine and Dentistry, New Jersey Medical School and director of the New Jersey Chronic Fatigue Syndrome Center. He is also a principle investigator of one of two federally funded CFS Cooperative Research Centers, along with being the medical director of the Gulf War Research Center of the Veterans Administration Medical Center in East Orange, New Jersey.
Aside from his excellent medical credentials, Dr. Natelson's presentation of what is known and not known about fatiguing illness in general and CFS in particular comes across loud and clear as ONE WHO KNOWS. This man *understands* He CARES.
In the early chapters, he does an excellent job of examining all the definitions, various terminology, and strengths and weaknesses of various research approaches.
Dr. Natelson looks at fatigue, weariness, neurasthenia, functional illness, and other fatiguing illnesses or reasons for fatigue that must be ruled out before the diagnosis of CFS is conferred. He does this in a non-jargonistic, careful, patient and easy-to-read manner. The chapters and topics are logically arranged and flow easily, and most importantly, he is not judgmental about any of the causes of fatigue.
He addresses those who have been exhausted all their lives, saying that this represents one extreme, just as the over-energetic represent another.
Dr. Natelson does an excellent job in discussing the medical causes of fatigue. He looks at chronic infection in general, then specifically as in AIDS, Lyme disease (fully recognizing the difficulties with lab tests and proper diagnosis in this disease), and tuberculosis. He looks at sleep disorders, again progressing from gen! eral to sleep apnea, restless leg syndrome.
He has quite a good outline on MS can be diagnosed, and the similar but distinctly different diagnosis of myasthenia gravis.
For MS, he says: "How does a physician make the diagnosis of MS in a patient who has not had repeated neurolgical problems separated from one another by periods of normalcy?" a frequent question. He goes on to state that the MRI becomes a diagnostic tool -- if the lesions are specific, in the "right" places and in the "right" pattern, then that "strongly suggests" MS.
But, he goes on to explicate the MRI abnormalities seen in CFS patients: Of 52 patients he studied, nine had the "tiny abnormalities" (commonly called UBOs) that were not specific enough to diagnose MS. Some time later he got in touch with 8; of those 8, three of them had doctors who had dropped the CFS diagnosis, but only two had a pattern of symptoms that pointed to MS. He postulates that patients with severe and chronic fatigue who have nonspecific MRI abnormalities may be in a different class, and may have a mild form of MS.
Of particular help, Dr. Natelson looks at the various terms and research, explaining "splitters" and "lumpers" and how these various categories have affected research. He even talks about the selection of normal controls and some of the problems.
He has several very good chapters on practical things to do, including one on understanding the doctor. I know, I know, some of us really bristle at the idea of our having to take time to understand somebody we are paying a hefty sum of money to help us!! But, this chapter gives insights into how we can better choose a doctor who WILL help, and also how to communicate more effectively with the ones who DO help. He pulls no punches with regard to how the training process, particularly in the past several years with the huge technological and information explosions in medical science, has been less than perfect! in producing the old-fashioned "physician" -- the guy or gal who holds your hand and leads you through the complexities of being sick EVEN IF he or she cannot cure you.
Dr. Natelson looks thoroughly at chronic fatigue syndrome (CFS), what it is and what it isn't, and the role of depression before or after the fact or not at all.
He encourages support groups, coaches, experimentation. He is quite aware of all the limitations presently in the care and treatment of CFS, but does offer concrete suggestions about sleep, stress and anxiety reduction, exercise (moving rather than staying in bed kind), and why the various drugs work or don't work.
Dr. Natelson mentions looking into alternative treatment and medications, with some frank discussion about the benefits and pitfalls. His guiding principle seems to be six weeks -- if *whatever* it is you are taking or doing does not show obvious improvement or benefit in six weeks, then stop. He also warns about the many false promises accompanying many of the alternative treatments and the psychological and emotional toll that takes.
In all of his treatment talk, alternative or "standard" he mentions costs and cost-benefit analysis as one of the major determining factors.
All in all, this is a no-hype, honest look at all sides of the issues surrounding CFS, with practical tips based on his experience in treating and supporting the most severely ill patients.
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Saigher McGrail is large and gentle. He is a Chicago Renaissance man in more ways than one. He lost his wife, Katrina, in a plane crash that should have also taken him. But he was sent back. He gives an interesting description of his "near-death" experience in the hospital on the night of the crash:
"Kat had also given up possession of her body. I instantly knew it. I passed through a nurse attending to Kat. Saw the nametag on the nurse's gown, Emily. She shuddered and screamed when I went inside her. I saw her leg go of the defibrillator's paddles she held for the doctor who wanted to restart Kat's stilled heart. The surgeon masks on the faces circling Kat were all moving at once. But their voices were of the physical world, where the only thing of interest to me was Kat's lifeless body. Kat's spirit was gone. Waiting for me at the chapel."
Saigher abandon's his prior calling as a clinical psychologist to start his own business, RecoveryTravel.com as a guide for people who's lives have been derailed by trauma. His client, for this tale's purposes, is Dr. Leslie Pollitte, Director of a joint university and hospital sponsored Xenotransplantation Research Program run by Minnesota University and the IGH (Inver Grove Heights) Medical Center. Her problem is that she knows there is something wrong with the research, but doesn't have the courage to track the problem herself.
Saigher, and his personal guardian angel he calls First Clue fly into danger to uncover a trail of deceit and mishandling of genetic material that is affecting the population. It is the old tale of science being compromised by financial gain. Not only does Mr. Ruark disseminate details of the coverup in an entertaining and understandable arena, he makes us laugh with Saigher's nonconformist speech, ideas and mannerisms. First Clue is a enjoyable ride, and Saigher is a hero who confuses, tantalizes, and makes us laugh.
Shelley Glodowski, Reviewer
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I currently have three anthologies of Sumerian-Akkadian literature on my shelves: Stephanie Dalley's 'Myths from Mesopotamia' (1989), Thorkild Jacobsen's 'The Harps That Once' (1987), and the present book. All three are by specialists and are designed for the general reader; all, within the limits of their shared conventional viewpoint, are excellent; and anyone with a serious interest in this remote and fascinating literature will want to have all three.
Of the three, Dalley's is the most 'technical' translation, in the sense that it has far more extensive footnotes, and that it wisely prefers to retain original terms such as "Kurnugi" (page 155), instead of offering essentially misleading equivalents such as "Netherworld" (Foster, page 78) or "Hades" (Jacobsen, page 207 ff). Her translations also seem to me to be the most vigorous, but that's just a personal feeling, and all three of these tranlations are wonderfully readable.
Foster tells us that the present book is "a selection, rearrangement, and abridgement of 'Before the Muses, An Anthology of Akkadian Literature' (Bethseda, MD : CDL Press, 1993)" (page vii). His substantial anthology is organized as follows : 1. Gods and Their Deeds; 2. Kings and Their Deeds; 3. Divine Speech; 4. Hymns and Prayers; 5. Sorrow and Suffering; 6. Love and Sex; 7. Stories and Humor; 8. Wisdom; 9. Magic Spells.
As is the case with the Dalley and Jacobsen anthologies, all texts have been provided with their own brief introductions, and all gaps and losses of text in the original tablets have been indicated in the translations, though Foster's texts are much more lightly annotated. His book opens with a short 8-page Introduction, and is rounded out with a Glossary of Proper Names, but lacks both a Bibliography and an Index.
The book has clearly been designed as a reader's edition, with minimal impedimenta in the way of notes and so on that might interfere with the reader's enjoyment of the texts. Foster tells us that those who want to learn more about these texts, or to read further in Akkadian Literature, should consult his much fuller 2-volume work, 'Before the Muses.'
The book is well-printed on excellent paper in a large clear font that might have been a bit heavier, is bound in glossy wrappers, and has one of those abominable glued spines that crack when opened. I wonder what happened to stitching?
Here, as a brief example of Foster's style, are the opening lines of his 'When Ishtar [i.e., Inanna] Went to the Netherworld,' with my obliques added to indicate line breaks :
"To the netherworld, land of n[o return], / Ishtar, daughter of Sin, [set] her mind. / Indeed, the daughter of Sin did set her mind / To the gloomy house, seat of the ne[therworld], / To the house which none leaves who enters, / To the road whose journey has no return, / To the house whose entrants are bereft of light..." (page 78).
Those with access to the Dalley and Jacobsen will find it interesting to compare Foster's version with theirs. His rhythms seem a little more stately and relaxed, a little less vigorous, and he seems less sparing of words. But, as I've indicated, all three books, though differing in flavor, are intensely readable, and we should be grateful to Professors Dalley, Jacobsen, and Foster, for the enormous labors which must have gone into them.
What I said in my review of Jacobsen applies equally here. The limits of Foster's book are the limits of the official point-of-view. Within these limits his book becomes a labor of love, a wonderfully readable literary treatment of some of the world's most ancient, fascinating and beautiful literature by a noted authority, and one that can be strongly recommended to all sensitive readers.
Readers, however, shouldn't take Foster as gospel but as something vastly more interesting, since what Ishtar/Inanna may well have been visiting was not the "Netherworld" but the mines of Africa. But to understand this you'll have to read linguist and scholar Zechariah Sitchin's 'The 12th Planet.' Only he provides a framework in which all becomes intelligible.
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Foster provides an introduction to each piece, and to sections of the longer pieces. There are gaps in most narratives, and Foster notes them. He also provides footnotes explaining the more obscure points and allusions, as well as some issues with translations. At points, it is less than a leisurely read, but Foster seems determined to present the material in plain but telling language.
I have quoted often from the book and return to it frequently. One piece, an elegy for a woman who died in childbirth, has always moved me. It is told from the point of view of the dead woman. After remembering a happy life with her husband, she says that the day she went into labor, her face "grew overcast." Despite her pleas and the pleas of her husband to Belet-illi, the goddess of childbirth, "shrouded her face" She concludes:
[All... ] those days I was with my husband,
While I lived with him who was my lover,
Death was creeping stealthily into my bedroom,
It forced my from my house,
It cut me off from my lover,
It set my foot toward the land from which I shall not return.
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Even though it is long for a picture book, A Gift From Papa Diego can be read aloud by an adult in as little as 20 minutes. If your story time is shorter than that, breaking it into segments is easy. There are several logical stopping places that provide suspense for the next reading session. A wonderful story and excellent bilingual text in side-by-side format!
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