Depression can lead to several other conditions that are particularly harmful to arthritis patients. One is insomnia. Almost every day I speak to a large number of people who complain about their inability to sleep well. Pain is one reason — it’s hard sometimes to get into a comfortable sleeping position. Medications are another. But depression is, according to people that I talk to, a major cause of sleeplessness. And if the body doesn’t get enough restful sleep, all kinds of trouble follow. Sleeplessness increases pain and depression in a vicious cycle that sometimes seems overwhelming and impossible to break.

If you experience chronic insomnia, I urge you to talk to your doctor about this. I do have an ulterior motive. I think it’s important for more doctors to recognize the peripheral symptoms and maladies that come along with rheumatoid arthritis. But I also believe that in talking to your doctor, you may be able to find a solution — or at least something to help alleviate your sleeplessness. There are new drugs on the market today that are much milder than older sleeping pills, which really knocked you out for the night.

A second condition that depression can lead to in chronically ill people is obesity. It’s well documented that some people overeat when they are depressed, and when you combine overeating with the difficulty that arthritis patients have exercising, you often end up with a significant weight problem. This, too, is a vicious cycle, because carrying too much weight in turn hurts the joints even more, especially those in the hips, knees, ankles and feet. The more your knees or feet hurt, the less likely you are to try to exercise.

There is no easy answer for this condition, but a couple of things can help. The basic equation is to eat less and move more. Try to examine your reasons for overeating. If you are eating because of a mental state, such as depression, sometimes you can stop yourself just by thinking about the motivations behind that midnight snack. You can at least try to substitute healthier snacks for more fattening ones, such as celery sticks or fat-free yogurt rather than cookies and candy bars. Don’t try to start a radical diet, but try to watch your fat intake and calories and eat healthier in general. Add fruits and vegetables to your diet, which help fill you up, and be sure you get enough protein, which helps to quell those cravings.

As for moving more, the most important thing is to start slowly. I would highly recommend you join one of the Arthritis Foundation’s aquatic exercise programs. Many communities have them; just check with your local AF chapter. If your chapter doesn’t offer such a program, you may be able to find one in the community, such as at the local YMCA. As a last resort, you can practice your own water exercise program by jogging lightly or swimming in a local public pool, a neighbor’s pool, or a pool at a health club or YMCA.

One of the well known benefits of exercise is a decrease in depression, caused by the release of serotonin, a brain chemical that imparts a sense of well-being. Some of the antidepressant medications doctors prescribe for people with depression work by affecting the brain’s serotonin levels.

Exercise is a “natural antidepressant,” in a way. It really does make you feel better, and in the long run, you will see even more benefits as you trim some weight and take a little pressure off your joints.

The feature article on depression in our Arthritis Library gives a number of other great tips on combating this debilitating condition. If you have any tips of your own, I urge you to visit the drkoop.com message boards and leave your ideas for others to read.

Inspect fire extinguishers and recharge as necessary.

Grade soil to channel water away from the house.

Review procedures for shutting off electrical, water, and gas sources into the home.

In the fall, have a chimney sweep inspect and clean all fireplaces and chimneys. You can find a chimney sweep in the Yellow Pages.

Check for loose or exposed electrical wires and replace them.

Inspect exterior wood for decay and insect damage, including splintering, splitting, and holes. If you have a termite protection service, ensure that they inspect and report to you.

Powerwash vinyl siding and unfinished wood such as decks. Protect wood surfaces by painting and sealing.

Check and replace weather stripping around doors and windows. Caulk as needed. Check windows and screens for damage.

If you have an automatic ice maker, check the line and connections for leaks.

Clean out the dryer exhaust vent. You can use a leaf blower to blow out the lint. (Cleaning out the lint trap after every use is also recommended.)

Inspect roof shingles. Replace damaged or missing shingles yourself, or call a roofer.

Prune tree limbs that grow too close to the house.

Inspect washing machine hoses and dryer ventilation hoses. Refer to manufacturer’s guidelines.

Check weather strip on bottom of garage door. Replace as needed.

Check sweep on bottom of exterior doors. Replace as needed.

Check home for settling, especially cracks around doors, windows, and junction of walls, floors, and ceilings.

Check kitchen range for proper anchor against tipping.

Twice annually

Inspect caulking around sinks, tubs and showers, toilets, and tiles. Repair cracked or dried out caulking. Clean mildew from grout and caulk.

Replace batteries in smoke alarms. A good time to do this is in conjunction with the changeover to and from Daylight Savings Time.

Have systems serviced before seasonal use — air conditioning in spring, heating in early fall.

Inspect exposed plumbing areas. Check for dampness, drips, and leaks.

Clean gutters and inspect downspouts. Replace any lost screws and gutter supports. Check pitch with water to assure proper drainage.

Vacuum dust and lint from under refrigerator. Check the door seal by closing it on a strip of paper. If the seal doesn’t provide some resistance when you pull out the paper, consult the manufacturer’s recommendations for replacement.

Several times a year

Check the electrical system by tripping circuit breakers and grounding circuit fault interrupters several times a year.

After wet weather, check for dampness or leaks in basement or below-ground areas of the home.

Hold a family fire drill — especially with children. Review exit route, smoke avoidance procedures, and assembly areas.

Check for roof leaks in attics — discoloration on sheathing and rafters. Consult a roofer at first sign of leak.

Monthly

Inspect and test smoke and fire alarms.

Change filters in HVAC system.

Check washer hose connections and replace at first sign of deterioration. (Be sure to turn off water to washer whenever leaving home for an extended absence.)

Always

Check the storage of all flammable and poisonous liquids for safety. Don’t store flammables near a water heater or any other sources of fire. Make sure the lids on all gasoline containers are tightly secured, and inaccessible to young children.

If appliances produce a tingling sensation or slight shock when touched, disconnect immediately and replace.

Also call in an electrician if you frequently experience blown fuses or tripped breakers, or have light switches or outlets that work intermittently.

A flat development just as kitchen remodel project is a great, successful method to increase price to your home and modernize room which you and your family use, see every day.

Most people with fibromyalgia — up to 90 percent — have major sleep problems. They may be light sleepers and wake easily during the night. However, it is difficult to tell whether sleep deficiency is a cause or an effect of fibromyalgia. For some people, the fatigue of fibromyalgia is more bothersome than the pain. Many people with fibromyalgia do not experience the deepest level of sleep, reached when delta waves flood the brain. In the brains of those with fibromyalgia, research has suggested, short alpha waves tend to barge in and interrupt the delta wave phase. Perhaps as a reaction to reduced sleep, people with fibromyalgia report difficulty concentrating. They often call these mental lapses “fibro-fog.”

In 1975, one researcher produced fibromyalgia-like symptoms among a healthy group of college students when he prevented them from getting deep sleep for three nights in a row. After they returned to regular sleep patterns, however, they quickly recovered. Interestingly, the athletes in the group didn’t suffer the symptoms of fibromyalgia.

About one-quarter of people with fibromyalgia are clinically depressed, although many others say they feel down or anxious. As with sleep problems, researchers do not know whether depression is a cause of or reaction to fibromyalgia. Given the role of certain neurotransmitters such as serotonin in depression, sleep regulation and pain processing, it is no surprise that all three symptoms are reported.

Doctors have also found that fibromyalgia often co-exists with other conditions, including chronic fatigue syndrome, irritable bowel syndrome and interstitial cystitis. People with fibromyalgia often complain of migraine headaches and temporomandibular joint dysfunction, or TMJ.

People with musculoskeletal diseases such as rheumatoid arthritis may develop fibromyalgia if their joint pain results in poor quality sleep.

Fibromyalgia may get worse with stress or poor weather conditions, but it is not a progressive disease. Occasionally, patients with fibromyalgia have a full recovery. In most cases, however, the symptoms improve with treatment and education about the condition.

Peer pressure — Teens like to talk about sex: who’s doing it, who’s not. The reality is, not everyone is doing it. In a 1999 survey of U.S. high-school teens, only half of ninth through 12th graders reported ever having sex. That’s not everybody.

Partner pressure — One partner in a relationship may put pressure on the other to have sex. Part of your evolving sexuality is learning to say no to any type of sexual activity you don’t want to do.

The media — The media bombards you with unrealistic sexual situations and images. Television shows and movies glorify sex while managing to ignore the risks of unprotected sex. Sex is also used to sell just about everything, even to teens like you.

The body-mind gap — Your body may be ready to have sex but your mind may not. It takes a lot of emotional maturity to deal with a sexual relationship. You just don’t have that maturity at age 13.

The pleasure-reality gap — Your desire for sexual satisfaction may get in the way of good judgment. Example: You have sex without a condom simply because you don’t have a condom nearby. Normally you know to use condoms, but you get so caught up in the heat of the moment that you take the chance of getting pregnant or getting an STD just to satisfy your sexual urge.

Pornography — Pornography is readily available in our society. As an adolescent, you may not have the emotional maturity and perspective to deal with pornographic images.

Sexual abuse — Unfortunately, sexual abuse of children and adolescents is all too common. Sexual abuse can have a tremendously negative impact on your sexuality and on your ability to have a satisfying sexual relationship.

Sexual assault — Sexual assault of adolescents, especially young women, is also common. One type of sexual assault — date rape — has received a lot of attention because of its rising incidence. The physical and psychological effects of sexual assault can be devastating.

Choosing what you need from the nearly 30,000 available supplements can make anyone’s head spin. Who knows what to take? You do—thanks to our expert-approved data by Allison Sarubin, R.D., author of The American Dietetic Association’s Health Professional’s Guide to Popular Dietary Supplements. Pinpoint your profile to learn how to get your nutrients. Fall into more than one category? Follow all of the advice, but don’t double up on any vitamins.

Take: A multivitamin and a calcium supplement.

Take Extra: Vitamin C (250 milligrams on top of your multi). Choose a multi that has this added C or pop a separate vitamin C supplement. Your multi will take care of your B6 and folic acid needs.

Eat for Extra Credit: C-rich fruits and veggies such as oranges, berries and spinach.

If You Are a Vegetarian or Vegan

You May Be Missing: calcium, Vitamin B12, zinc and iron. These nutrients are abundant in meat and dairy foods.

Take: A multivitamin and a calcium supplement.

Take Extra: Nothing (your multi covers it), but vegans should check with a nutritionist to make sure they’re consuming enough iron and zinc, since these are found primarily in animal products.

Eat for Extra Credit: Soy milk fortified with zinc and B12. Eat brown rice and seven-grain bread to get more zinc, and consume plenty of beans and mushrooms for iron power.

If You Exercise Daily

You May Be Missing: Vitamins C and E and the mineral selenium. These nutrients may help your body deal with the stress that working out five or more times per week can create, although more studies are necessary to decide the extent of the impact.

Take: A multivitamin and a calcium supplement.

Take Extra: Vitamin C (250 mg on top of your multi) and Vitamin E (200 to 400 international units on top of your multi). Choose a multi that has this extra C and E, or take them as separate supplements. Your multi will cover your selenium needs.

Eat for Extra Credit: C-rich fruits and veggies such as grapefruit, cantaloupe, cabbage and dark, leafy greens.

Now people can order medications without prescriptions. We may offer you the largest range of effective and safe medicines. Every one of our pills only the highest quality and have indications to application and contraindications.

A multivitamin may be useful during the disease’s active periods when your appetite is poor, but excessive doses of vitamins can have serious side effects. Avoid supplements that promise to cure lupus; they are bogus. In general, a diet low in saturated fats and full of fruits and vegetables is preferable. Your doctor may suggest that you avoid dairy products if your kidneys have been affected. Fish oil and flax seed have been shown to have some benefits for lupus.

Personal Habits
Avoid smoking and secondary smoke. Moderate amounts of alcohol are recommended, although excessive alcohol may damage the liver and certain medications require that no alcohol be consumed. Get a full night’s sleep and, if your body calls for it, take a nap during the day. Plan your day so that you do the most difficult tasks when your energy level is highest.

Controlling Flare-ups
Here are some tips to help you avoid lupus flare-ups:
Exposure to sun or ultraviolet light can trigger flare-ups, causing rashes or other symptoms. When you must be in the sun, wear a broad-brimmed

hat and clothing made of tightly woven fabric. Sun block with a high SPF is always required.
Avoid crowds and individuals where you might be exposed to infections.
Keep emotional stress to a minimum.
If you decide to become pregnant, close medical supervision is required, as pregnancy may trigger flare-ups.
Do not take antibiotics without supervision. Sulfa drugs can intensify sensitivity to light.

A trip to the dentist may require medication beforehand to avoid infection. Use only hypoallergenic cosmetics. Cosmetics with alpha hydroxy acids may cause greater sun sensitivity and have been reported to cause severe

redness, swelling, burning, itching and bleeding.
Oral contraceptives modify the amount of estrogen in your body and should be supervised. The same is true for estrogen creams.
Surgery may trigger flare-ups.
Monitor your mind and body, and report changes to your healthcare team.

That may be easier said than done, especially for those who are experiencing the depression that can accompany lupus. It often helps to think of yourself as a model for others, and let your behavior show them the way to handle a challenging situation. Everyone in your family and work circle is influenced by your diagnosis. Sensitivity to the changes the disease brings to their lives may assist in balancing your new situation.

Private counseling and support groups can be sources comfort and practical support. Although your future is less certain, do not be afraid to plan ahead, while taking into consideration your new reality. Remember that a person with lupus can live a normal life span, but it is up to the individual to charge that life span with its meaning and vitality.

Management of lupus is a team effort and the patient is an important part of that team. Your healthcare team will customize your medications to minimize symptoms, prevent flare-ups and minimize long-term damage to your body. Your role is to give clear, accurate feedback about your body and its response to medication, to take responsible precautions against flare-ups, to educate yourself about lupus and its treatment, and to keep your mind and body in optimum condition. Because lupus flares and subsides and appears in different organ systems, and because the medications can affect your body in unpredictable ways, your treatment plan may change many times. A person with lupus must develop patience with the unexpected and understand that the medications may need frequent adjustment.

Medications

Always take your medication as prescribed. Never modify it without consulting your healthcare team. For many of the drugs you may be taking, the smallest modification can result in negative side effects.

Tell your healthcare team if you are taking vitamin or herbal supplements. Many of them can interact with medications.

Exercise
Your body will tell you how much exercise it can tolerate. Joint pain and fatigue may make exercise difficult, but people with lupus should stay as fit as possible. Moderate exercise is safe, but those with lupus should not expect it to ease their joint pain or fatigue. Daily exercise is important to avoid stiffness and muscle weakness, even during flare-ups.

When Frank Heart needed someone to direct hardware design and implementation for the IMPs, he called on fellow Lincoln Lab alumnus, Severo Ornstein. After he left BBN in 1976, Ornstein went to Xerox PARC, where he worked on the high-speed PC prototype, Dorado, and on the first laser printers. In 1984, he retired from PARC and with his wife, former PARC scientist Laura Gould, co-founded Computer Professionals for Social Responsibility, dedicated to fighting nuclear war and arms proliferation. Like many computer professionals, Ornstein also has a keen interest in music. His father, Leo Ornstein, was a well-known modernist composer of the early 20th century. Himself a pianist, Ornstein lives in Northern California, organizes chamber music concerts, and republishes his father’s works.

Dave Walden, 57

Another Lincoln Lab alumnus, Dave Walden was a member of Frank Heart’s IMP guys team, and co-wrote the operating code for the IMPs. During his 26 years with BBN, Walden was involved in developing TCP/IP and telnet, a program that lets users log on to remote hosts. He is currently editor in chief of the Center for Quality of Management Journal and holds a faculty appointment at MIT.

Vint Cerf, 56

As a grad student in 1969, Cerf assisted in the installation of ARPA’s first IMP at UCLA, and was present the day that the first messages were sent from host to host. While at ARPA in the 1970s, Cerf co-developed the transmission-control protocol/Internet protocol (TCP/IP) with Bob Kahn. TCP/IP are the primary protocols used for transmission of data on today’s Internet. Cerf served as founding president of the Internet Society from 1992 to 1995. In 1994, he rejoined MCI (which he had left in 1986, after four years there), where he oversaw the first commercial email service to be connected to the Internet. Today, Cerf is senior vice president for Internet architecture and technology and at MCI WorldCom. In his spare time, he works on his pet project, the Interplanetary Network (IPN), which will connect deep-space probes with researchers on Earth via an Internet-style network (see “Cerf’s New Turf,” Aug. ’99, p149).

Jon Postel (1943-1998)

As a grad student at UCLA, Jon Postel helped install the first IMP in 1969. Later, with Craig Partridge and Paul Mockapetris, Postel co-invented the domain name system, which identifies computers and gave us the familiar suffixes .com, .org, and .net. He became a major player in the Internet community and headed the Internet Assigned Numbers Authority, which controlled the domain name system. Postel died in October 1998. He was 55.

Arpanet: A civilian network

Paul Baran, 73

If the myth that the Arpanet was a top-secret military command-and-control network designed to withstand a Soviet nuclear attack was anyone’s fault, it was unwittingly Paul Baran’s. While working for Rand Corporation in the early ’60s, Baran wrote papers on what we now know as packet switching and distributed networks. In them, he described such an impervious network; Arpanet, however, was never intended as a military network, but as a method by which researchers could share computing power at a distance, and Baran was never directly involved with the Arpanet project. As an entrepreneur, Baran is today involved in a number of companies working in wired and wireless networking in the Silicon Valley. In 1986, Baran founded mobile data provider, Metricom, and in 1992, founded Milpitas, Calif.-based cable-modem-maker, Com21, where he currently serves as chair.

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While a graduate classmate of Larry Roberts at MIT in the late ’50s and early ’60s, Len Kleinrock wrote the first papers on the underlying principles of what later came to be known as packet switching-the idea that data could be chopped up, sent over wires by various routes, and be reassembled at their destination-a central technology of today’s Internet. The parceled data was sometimes called “data blocks,” a term later dropped in favor of “packets,” coined by British networking pioneer, Donald Davies. Having joined the faculty of UCLA in 1963, Kleinrock was on the team that laid out the original specification for the Arpanet four years later. He also helped develop the interface between the Sigma-7 host computer and the first IMP, unpacked at UCLA on Labor Day weekend 1969, and oversaw transmission of the first host-to-host message, on Oct. 29. Kleinrock established and ran the Network Measurement Center, which ran experiments to test the behavior and outer limits of the network. He is still on the faculty at UCLA and is leading research and development at nomadic computing technology provider, Nomadix.

Bob Kahn, 60

At Bolt Beranek and Newman (BBN, now GTE Internetworking), the Cambridge, Mass., contractor that built much of the Arpanet’s equipment, Bob Kahn helped design and construct the IMPs. He organized the first public demonstration of the Arpanet in Washington, D.C., in October 1972. That same year, he was made director of IPTO. Kahn is co-inventor (with Vint Cerf) of TCP/IP, the lingua franca of today’s Web. Kahn also pioneered development of radio and satellite packet data networks to link computers wirelessly. After 13 years with ARPA, Kahn founded the nonprofit Corporation for National Research Initiatives in Reston, Va., to provide leadership and funding for research and development of the National Information Infrastructure. He is CNRI’s CEO and he served on the Presidents Advisory Council on the National Information Infrastructure.

Douglas Engelbart, 74

What didn’t Douglas Engelbart invent? Engelbart pioneered the mouse, hyperlinks, windows, and a score of other essentials. When Bob Taylor announced plans to build the Arpanet in 1967, Engelbart was thrilled. He volunteered to start the online Network Information Center (NIC), which would track all the network’s resources. As a result, his SDS-940 computer in the Augmentation Research Center at SRI was chosen to be the second host in the Arpanet. Engelbart developed NLS (for online systems) for storing and retrieving electronic documents. Later, in 1977, Cupertino, Calif.-based Tymshare bought the rights to NLS and renamed it Augment. Engelbart followed his progeny. In 1984, Tymshare was in turn bought by McDonnell Douglas. After retiring from the aerospace company in 1989, Engelbart founded the Bootstrap Institute, dedicated to improving the performance of organizations. He lives in the San Francisco Bay Area and continues as head of the Fremont, Calif.-based Institute.

Frank Heart, 70

A computer systems engineer, Frank Heart managed the team, which came to be known as “the IMP guys,” that designed and built the IMP subnetwork computers at BBN. Also on the IMP guys team were Ben Barker, Bernie Cosell, Will Crowther, Jim Geisman, Bob Kahn, Severo Ornstein, Hawley Rising, Truett Thach, Marty Thrope, and Dave Walden. Heart remained with BBN until his retirement, working largely in biomedical, network technology, physical sciences, and logistics computing. When he retired in 1994, he was president of BBN’s systems and technology division. The secret to Arpanet’s success, Heart says, was that “Despite the fact that it was supported by the Department of Defense, it was entirely unclassified. People could just get on and try it.”

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In his long career, Bob Taylor has had a hand in the creation of just about every major technology that today’s Net surfer takes for granted, including the personal computer, local area networks (LANs), asynchronous transfer mode (ATM) networking, desktop publishing, and search engines. Between 1966 and 1969, Taylor was director of IPTO, where he initiated and secured funding for Arpanet experiments and hired a reluctant Larry Roberts away from MIT’s Lincoln Laboratory to get it under way. Like Licklider, Taylor came to computers while studying psychoacoustics in the ’50s. Taylor was a polymath, who majored in psychology, with minors in mathematics, English, philosophy, and religion. Taylor left ARPA in October 1969, just before the network went live. A year later, he founded and managed the computer science lab at Xerox’s Palo Alto Research Center (PARC). Later, he oversaw the building of Digital Equipment Corporation’s Systems Research Center in Palo Alto, the lab that created the AltaVista search engine. He retired in 1996 and today lives on the San Francisco peninsula. “From my point of view,” he says, “technology advances proceed at a rather stately pace.”

Larry Roberts, 61

Without Larry Roberts, there would doubtless be some kind of email today, but it would probably be an unmanageable mess. Roberts wrote the first electronic-mail manager for the Net’s first (and still most) killer app. That alone would elevate Roberts to the pantheon, but it was only his last act at ARPA, and a mere bagatelle. Roberts joined ARPA in 1966. He designed and wrote the Arpanet’s original specification and oversaw the project until he left ARPA in 1973. Later, he founded Telenet, the world’s first commercial packet data communications company, bought by GTE in 1979 and later spun out to Sprint. Between 1983 and 1993, Roberts served as CEO of a packetized facsimile and ATM equipment company called NetExpress. From 1993 to 1998, he was president of ATM Systems, a division of Connectware. Today, Roberts is president and CEO of a Palo Alto, Calif.-based ATM and IP switching company called Packetcom. When asked if he knew where the Arpanet experiment would lead, Roberts says, “I really believed it would take over the telephone network and communications. But I really didn’t envision the kind of ecommerce we have today.”

Wes Clark, 72

During a 1967 ARPA workshop in Ann Arbor, Mich., Bob Taylor presented his scheme for a network of research computers to his fellows. One of the problems such a network faced was how to get the different machines to communicate seamlessly despite their technical differences. According to Katie Hafner and Matthew Lyon’s history, Where Wizards Stay Up Late, Taylor was outlining his plan when a note was passed up from someone in the crowd. “You’ve got the network inside out,” it read. It was from Wes Clark, a former Lincoln Laboratory engineer who in the 1950s had worked on the TX-0 and TX-2 computers, then considered state of the art. After the presentation, Clark proposed a sub-network of identical computers that would handle routing and other functions. That way, each computer-whether a TX-2 or Sigma-7-had only to be configured to deal with one other type of computer. Thus the idea for the interface message processors (IMPs) was born. “I would give Wes Clark more credit that any other single person on the technical side,” says Taylor. Clark has been a consultant since 1972. He is currently a principal and co-founder of Clark Rockoff & Associates in Brooklyn, New York.

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