Kids With Autism - Risperdal and Similar Psychotropic Drugs May Produce Negative Responses

Jean Genet, a brain researcher and an autism survivor himself, truly believes that psychotropic drugs (i.e. Risperdal) can produce negative responses for the child over time. Although it is a stimulant drug which is known to fight ADHD, it is not immune from negative consequences. This is why kids with autism should be given better forms of treatment if possible.

What psychotropic drugs do is that they use the central nervous system's energy as a fuel to the responses that they produce. However, the time it takes to entirely use this energy is relative to the child. The more active the child is, the faster the consumption of this energy will be.

If you want to detect when the psychotropic drug is about to exhaust the energy of the child's central nervous system, you can do so by observing how aggressive the child's behavior is. If s/he cannot sleep easily, lacks appetite and is unusually depressed, then the energy has most likely been used up. And since kids with autism are usually very on-the-go, it is easy to detect this behavior.

They say that when the symptoms of energy loss begin to surface, you need to increase the dosages. But then again, the symptoms will only become worse.

Jean Genet feels it is highly essential to closely observe how the child responds to the drugs that s/he takes and this should be done with your doctor in order to monitor the doses too.

Genet also recommends a gluten essential in the neutralization of the consequences of psychotropic drugs. Also, corn and soy should be removed from the child's diet.

Yeast must be injected in the diet, as it can reduce hyperactivity and sudden tantrums. Melatonin is good as well. It can induce better sleep. Allergy testing is likewise recommended, as it is important to monitor the responses to whatever the child takes in. Kids with autism need to have their diet closely monitored.

Be sure you are one of his/ her watching eyes.

And if you have never heard of chelation therapy, you should consult your doctor about it. It is a non-evasive way of assisting the child's body to remove the toxins which are brought about by taking psychotropic drugs.

Lastly, for the child's emotional growth to come full circle, remember that the basics of discipline still follow. Calmly delineate what is right and wrong and never forget to be a role model to your kids.

Celiac Disease Blood Test

When a patient has symptoms suggestive of celiac disease or CD, the physician will request a celiac disease blood test, also called a celiac blood panel. Since other diseases may have similar symptoms, it is important to conduct the proper testing to diagnose or rule out celiac sprue disease.

Common Celiac Disease Symptoms

The most common symptoms prompting the blood test include: Anemia, diarrhea, malnutrition, abdominal pain, weight loss, joint pain, fatigue and weakness. A celiac blood panel may also be ordered for patients who have a family history of gluten intolerance or other autoimmune diseases.

Diagnosing Celiac Disease

Physicians often follow three steps to diagnose CD - a complete physical examination that includes bloods tests and, in some cases, a duodenal biopsy taking samples from different areas of the small intestine. A gluten-free diet is usually put into place. If the symptoms are alleviated and the small intestine returns to normal, the confirmation of CD is made.

It is common for patients with CD to experience lactose or gluten intolerance. A celiac disease blood test may be combined with other tests such as allergy evaluation for gluten allergy symptoms. AGA, Anti-tTG, and EMA tests may also be ordered to screen compliance with a gluten-free diet. This analysis helps to determine how effective the treatment is since the levels will fall once gluten is eliminated from the diet. There are several other tests ordered to help determine the extent of the disease and if any other organs are involved.

Celiac Sprue Disease Blood Tests

- CBC (Completed blood count) for anemia - CMP (Comprehensive metabolic panel) to verify protein, calcium, and electrolyte levels as well as to the condition of the liver and kidneys - ESR (Erythrocyte sedimentation rate) - CRP (C-Reactive protein) to assess inflammation - Stool fat, to evaluate malabsorption (Difficulty digesting or absorbing nutrients from food) - Vitamin B12, D, and E levels to measure any vitamin deficiency.

This disease has no current cure, but it can be managed effectively with dietary restrictions of gluten. It is important that you see your physician if you are experiencing any of the symptoms noted above to begin a treatment regimen.

Natural Remedies For Babies and Toddlers

Being a nurse I have had the common habit of having 'every' drug in the cupboard for health problems or emergencies! However, in the last few years I've become aware of alternate ways of dealing with symptoms and problems and I'm now more likely to 'think outside the square' and search for a 'natural' alternative such as chiropractic, Cranio-sacral therapy, herbal, Bach flowers, food intolerances, vitamins and minerals rather than an over the counter drug.

I love the nature of my work and the individual challenge that each baby presents to me. While common issues and problems appear consistently in general age/ developmental stages, I still look at each baby in as an individual and make sure that I am dealing with a routine or strategy issue and not a health problem. Sometimes parents want me to solve the sleeping issue when there is a genuine medical reason for the problem but more often the child presents with a history of 'survival' strategies that mum and dad put in place and we need to work on a new plan that "gives mum and dad their life back". Let's look at some common issues and how we can deal with them.

Pain, Reflux, Colic, Bedwetting.
I am often referring the generally unsettled, reflux, colicky babies, babies who protest at floor play, babies unable to hold their head up independently and older children who are bed-wetter's to a paediatric chiropractor for spinal checks. Remember that the spine channels the nerves around the body to the organs, so it makes sense that if the spine is out of alignment (from the birth process, a fall or physical trauma) that there may be a nerve being pinched that is causing pain or unwelcome sensations in the body (hence the reflux, colic, headache, sore neck, unstable bladder etc).

This group also respond well to homeopathic remedies such as Brauer's 'colic relief' and 'stomach calm'.

Unexplained night time alertness and food reactions.
Then there is the increasing number of children who are in a fantastic, organized daily routine, eating and playing well, consistent parenting and communication but they are waking up in the middle of the night, looking and acting like they have had 12 hours sleep! Or the children with eczema, skin rashes and other reactions after eating.

I refer all of these children to an immunologist for allergy testing. While this may seem extreme or unusual, with the changes to our food sources and the colouring, preservatives and additives in our foods a lot of our children are not coping. Unfortunately the usual treatment for eczema is a prescription cream and bucket loads of expensive lotions for during and after the bath. But doesn't it make sense to look for the source of the eczema or the possible diet related night waking rather than waiting for the child to 'grow out of it' or mum and dad to go insane and send the child off to boarding school! Many children are reportedly reacting to the preservatives in the bread they are eating or the salicylates, amines and yeast etc even in the fruits, vegetables and salads they are eating or not receiving the right amounts of vitamins or minerals in their diet. Yes they are healthy foods!

Mums, if you are feeling that your body isn't feeling 'normal' or you suspect that you may be going through early menopause due to your symptoms, have your hormone levels checked and do some research.

Anxious, stressed or emotional babies.
For the babies who are anxious and appear stressed or have unusual separation anxiety (remembering that children reflect the parent's emotions) I refer mothers and babies to a Cranio-sacral therapist or a homeopath. Cranio-sacral therapy is a gentle light-touch therapy to align the malleable bones of the cranium (skull) with the rest of the spine down to the sacrum and pelvis. This therapy encourages the body's natural healing mechanisms to improve the function of the central nervous system and deepen the sense of relaxation.

A homeopath offers Bach flower remedies to counteract your symptoms and help your health return to a state of balance. Looking at the cause of your ill health rather than just treating the symptoms.

Tip:

Handy Natural 'alternatives' that I recommend

To stop a dry cough in babies and adults

For babies over three months Rub INFANT Vicks Vapour Rub generously on the soles of your babies feet and cover with socks. For children over two years and adults rub the normal Vicks Vapour Rub generously on the soles of your feet and cover with socks. Reapply when you feel it has worn off. Don't know how it works but it does. (Remember that some coughs are due to a runny nose running down the back of the throat and this is difficult to stop until the nose stops running).

Anxious, Unable to sleep, In pain, Injured??
Rescue Remedy is a 'Bach Flower' homeopathic preparation widely used as a spray or a dropper bottle and applied under the tongue or rubbed on the wrist. Use on any age. It works by instantly relaxing the nerves and calming the mind. No Maximum doses, use as needed. I keep a spray bottle in my medicine cabinet and in my handbag.

Want to keep mozquitoes away?
Listerine mouthwash! Purchase a spray bottle from the gardening section of your supermarket and pour in the Listerine straight, not diluted. Mozzies hate it apparently and it's safe to spray everywhere.

(C) 2008 Natalie Ebrill All Rights Reserved Worldwide.

Skin Tests Used to Find Causes of Allergy

One of the biggest problems with having pets in the home is the fact that so many people suffer an allergic reaction to them. Though when the allergy first appears it may not be obvious as to what is the cause and all possibilities need to be looked at before being certain that it is due to the pet. This can be a serious problem for the health of the person suffering from the allergy and possibly the thought of having to remove the pet from the family is one that is unbearable. The next steps would be to seek medical advice so that the real cause can be found.

If the allergy is displaying itself on the skin of the patient the then one of the many tests that are used in finding the cause is the skin test. This is usually done after a careful history of the patient has been made to find out if there is any pattern or family history of the allergy, or the likelihood of it occurring just after the pet appeared. It may sound horrifying to the sufferer of the allergy but it is very effective at finding out exactly what substance is making their body react in such a debilitating way. Of the skin allergy tests there are two types, the epidermal and the percutaneous.

Epidermal Skin Allergy Tests

The epidermis is the skin that we all see, the outer layer of our skin that gets exposed to the world and protects us from it. The first type of these is simply the Patch Test, in which suspect substances are placed against the skin and held next to it by a patch. The patch when removed about 20 minutes later will show if the epidermis has reacted to the substance and displaying any skin allergy.

Another is the Friction Test, which is useful with substances like animal hair, where it is rubbed over the forearm about 10 times to see if a reaction takes place.

Percutaneous Skin Allergy Tests

Percutaneous in this case means getting underneath the outer layer of skin and applying the substance there. This is not so bad as it sounds but requires the skin to be pricked or scratched to be able to do it effectively. The first of these tests is the Prick Test, where the substance is placed upon the skin and with something similar to a needle the skin is pricked to see if a reaction forms. There should be no bleeding; it is not a deep prick but just enough to get underneath the surface. The results of this should be seen after about 15 minutes when the substance is washed away.

Another form is the Scratch Test, where the skin is scratched, again not enough to cause any bleeding and only about 5mm long. The substance may be made into a solution to enable it to have contact with the skin, but then it is given time to see if a reaction takes place.

The final skin test here is the Intradermal Test, though this is one that can be difficult to interpret. This is where a very small sample of the substance is made into a solution and injected with a small syringe and needle. This is not the same as having an injection because it is only done just under the surface of the skin, just enough to produce a tiny bump, about 3mm on the surface. This test may take a lot longer to get the results from, in some cases over weeks but is used only in specific situations where any of the other tests above cannot work. If a reaction has taken place the area where the substance was injected will flare up.

These are the most common types of skin test used and many of the simpler epidermal ones are likely to show where the allergic is coming from. It may be the case in pet allergy that the exact cause of the allergy is found and some remedy or solution will be recommended rather than the undesired removal of the pet.

Eosinophilic Esophagitis - Diagnosis and Treatment of Allergic Or Eosinophilic Esophagitis

How is eosinophilic or allergic esophagitis diagnosed?

It is first suspected by the classic history and the appearance of the esophagus on endoscopy of multiple rings or constrictions that result in the esophagus looking like that of a cat's esophagus. This is called felinization of the esophagus or ringed esophagus. Other visual signs may be whitish spots, long furrows or a lining that looks like crepe paper and is very easily torn.

The definitive diagnosis is made by the finding of an abnormal number of eosinophils in esophageal biopsy tissue. The number of eosinophils considered abnormal is debated between >15-25 eosinophils per high power field (400x) with most authorities agreeing >20 as being diagnostic. The esophagus normally contains no eosinophils. It has been long accepted that chronic acid reflux commonly can be associated with 5-10 eosinophils per high power field in the lower esophagus but this finding higher in the esophagus should raise likelihood that eosinophilic esophagitis is present.

Why is it important to diagnose eosinophilic esophagitis and distinguish it from acid reflux esophagitis?

Acid reflux esophagitis usually responds to acid blocker medications like histamine 2 blockers ranitidine (Zantac), cimetidine (Tagamet), famotidine (Pepcid) and proton pump inhibitors like omeprazole (Prilosec) or esomeprazole (Nexium) whereas eosinophilic esophagitis often does not get better with these medications. Acid reflux injury to the esophagus can result in narrowing or constriction of the lower esophagus causing a food sticking sensation. This can be treated by a stretching of the constriction known as esophageal dilation that is usually safe and highly effective. Eosinophilic esophagitis also may result in constrictions of the esophagus but the stricture or rings are usually multiple, located higher in the esophagus and carry a high risk of tearing or puncturing the esophagus if dilation is attempted before treatment with steroids. There does not seem to be an association of cancer of the esophagus with eosinophilic esophagitis like there is with acid reflux. However, eosinophilic esophagitis can be chronic and difficult to treat.

How is eosinophilic esophagitis treated?

Identification and elimination of problem allergy foods is the mainstay of treatment. Foods that show positive allergy testing are eliminated. In some people a strict elimination diet is recommended. Rarely, a diet of only basic amino acid proteins in a liquid (elemental diet) is required. Temporary relief can be achieved with steroids. Systemic (oral prednisone) works but has the potential side effects of steroids on the rest of the body. Topical steroids applied directly to the surface that have little or no absorption into the blood stream are preferable. The nasal steroid, fluticasone propionate, has been used successfully. It is sprayed in the mouth and swallowed twice daily. The mouth should be rinsed out followed by spitting out rather swallowing the water. No eating or drinking for 30 minutes is recommended. A few studies have reported response to mast cell stabilizer disodium cromoglycate (Cromolyn), leukotriene inhibitor montelukast (Singulair), immunomodulators such as aziothioprine (Imuran), or monoclonal antibody against IL-5 mepolizumab.

Eosinophilic esophagitis: What role do foods play and what is the diet treatment?

Food allergy plays a major role in the cause and treatment of eosinophilic esophagitis, hence the alternative term used allergic esophagitis. Most patients will be found to have one or more food allergies when adequate testing is done. Skin prick allergy testing or blood tests (RAST, IgE food antibodies) can be negative but patch skin testing or intradermal testing may be positive. Sometimes, elimination diet with re-challenge is the only way to implicate a problem food. In most patients a personal and/or family history of allergic disorders (atopy) such as allergic rhinitis (hayfever), asthma, eczema, atopic dermatitis, or food allergies is noted.

What are the most problem common foods associated with eosinophilic esophagitis?

In descending order, the most common foods reported in the largest series were, milk, egg, soy, corn, wheat, beef, chicken, potato, oats, peanuts, turkey, barley, pork, rice, green beans, apples, and pineapple. Elimination of foods that test positive on allergy testing is the cornerstone of treatment of eosinophilic esophagitis. However, sometimes allergy testing is negative or inconclusive. It it then that an elimination diet is necessary and a pre-elimination diet food symptom diet diary is very helpful.

Can Autism Be Cured

This is an enquiry that every mum or dad of an Autistic child will ask at some point. The answer is no. There is no treatment for Autism. While you may notice ads for books, or items that promise a remedy for Autism, they're misleading you. Autism has no cure. There are a great deal of treatments that can make troubled with Autism easier.

Here are a few of the treatments that help with Autism.

Therapies

There are several sorts of therapies that can assist with the treatment of Autism. Occupational, physical, behavioral, speech, music, sensory, drug, play, and lots of other types of therapy can make a big difference in the life of an Autistic child. The therapies will not cure your kids Autism. They will just help teach them various ways of addressing it.

Alternative Remedies

Natural and alternative treatments are on the rise. These may include the application of herbs in place of prescription drugs. The herbs do not have the side effects located in traditional conventional medicines. Vitamin and supplements are being discovered to help in treating Autism. Always notify the doctor of any natural products you are applying with your child. Some herbs can have interactions with prescription medications. Remember again these herbs and vitamins are not cures. They are just to help with some of the symptoms of Autism.

Nutritional Methods

Some people go to the diet plan when dealing with Autism. They eradicate particular foods that might result in sensitivities. Some of the foods the remove from the diet program are Gluten, dairy, and artificial dyes. The idea behind this method is that taking out the meals that create sensitivities will remove the behavior problems. You may have your youngster tested for food allergies. Ask your child's physician about allergy testing. This will allow you to know if your child maybe having behaviors as a result of a food allergy. It will likewise give you a concept of which foods to eradicate from their dietary plan.

There is no cure for Autism, but there are lots of treatments that can help with a few of the symptoms. When trying a new remedy only try one at a time. This will allow you to know if it is helping or not. Allow enough time for the treatment to work. Usually two or three months is enough time to tell if a new treatment is working. There will be no miracle remedies that give instant results. If you are employing a herbal or vitamin remedy inform the physician. They have to be aware of the things you are trying. Herbs and minerals can lead to reactions with other medicines. It is essential that the treatment team be kept informed and on the same page. This will make your kids outcome a good one.

Do not waste your cash on goods that claim to cure Autism. If there was a cure available it would be told to you by your physician, in place of some guy on a late night infomercial. Carry on help your child by treating the symptoms of Autism. This will help your youngster have a better life.

Can Food Allergies Be The Cause Of Your Chronic Muscle And Joint Pain?

When it comes to back pain, there are dozens of causes. Your chances of getting an accurate diagnosis increase when you are informed of all possible causes. One often-overlooked cause of chronic muscle and joint pain is diet.

Allergies and Pain

A food allergy is present when your immune system perceives a component of the food, usually the protein, as a threat and attacks it with the inflammatory response. Allergies differ from intolerances, which are digestive rather than immunological reactions.

Histamine is an inflammatory substance released during an allergic reaction. The inflammatory response attempts to block off threats from the rest of the body, kill the threat and promote healing. In the case of an allergic reaction, however, the inflammation caused by histamine is excessive and attacks the body itself. Any of the body's muscles and joints can become inflamed during an allergic reaction, resulting in pain and soreness.

If you have a food allergy you're unaware of, you may be in a state of chronic reaction. This can be the source of your chronic muscle and/or joint pain.

How To Identify And Rule Out Allergies

Of course, there are many other causes of muscle and joint pain. If you have chronic muscle or joint soreness that is not attributable to repetitive use, overexertion or poor posture, diet could be a factor.

Arthritis is a main cause of joint pain, and many forms of arthritis involve joint inflammation. Diet may not be the sole cause of arthritic joint pain, but identifying any food source that may increase inflammation in your body can help relieve pain.

One simple way to identify if you have a food allergy is to participate in the "elimination diet," which requires removing the suspected food from your diet for a week. If symptoms reside, you likely found the food you're allergic to. This can be confirmed by reintroducing the food back into your diet and seeing if symptoms reappear. Keeping a dietary diary is a great way to help you identify food allergies. Keep track of what you eat and the presence and severity of your pain.

Knowing the most common food allergens will help to narrow down your experiment. The most common are milk, egg, soy, wheat, shellfish, seafood, tree nut and peanut allergies. First, identify which of these allergens features prominently in your diet. Check food labels, as many store-bought foods contain soy, tree nuts, wheat and dairy.

Blood tests can be done to identify allergy-related immune substances in your blood. A blood sample is taken and different foods are used to test its reaction in a lab. Blood tests are not always accurate when looking for food allergies, however. Making dietary changes and monitoring their impacts are your best diagnostic tools.

Dietary changes may be the answer to resolving your chronic back pain. Eliminating common allergens from your diet can help resolve inflammation in both muscles and joints.

Methods of Allergy Testing Your Doctor Might Recommend

If you think that you may have an allergy, but you are uncertain of the specific allergen causing this allergic reaction, your doctor may suggests a variety of allergy testing to diagnose your condition. The different types of allergy tests identify a variety of allergens.

Since many tests work better than others depending on your specific allergy, it is recommended that you make sure you are familiar with the various kinds of allergy tests prior to making an appointment with your doctor. The basic tests fall into three areas: Scratch tests, elimination tests, and blood tests.

Scratch Tests

The scratch tests are the most common of the allergy tests that are done. This test consists of placing a small amount of the suspected allergen onto the surface of the patient's skin, and then making a scratch or prick to allow the substance to penetrate the skin. The site is then observed closely for indication of an allergic reaction.

Swelling, redness, or itching are signs that an allergic reaction has occurred. A result can often be detected in as little as twenty minutes using this type of testing. The other advantage to this kind of test is that many different allergens can be tested together. This makes this method especially useful if the allergen is unknown, airborne, or a food allergy.

Elimination Diets

If a food allergy is suspected, the elimination diet may be performed. A variety of foods that are potential allergens are eliminated form the diet for several weeks. Each food is then gradually added back to the person's diet, with attention being mad to see which of the selections of food is causing the allergy symptoms to return.

This method of allergy testing works best with mild allergic reactions. However, it can pose a potential danger to patients who have severe, anaphylactic allergies. If there is a severe allergy suspected, a third method of allergy testing is preferred to ensure the safety of the patient. Thus, a life-threatening substance is not placed into the system of the allergy sufferer.

Blood Tests

The last type of allergy testing is the blood test, commonly called the RAST test. This is performed in the laboratory and uses blood that has been drawn for the patient. The blood is examined for presence of immunoglobulin antibodies. These will indicate if the body is producing an allergic reaction. Elevated levels of IGE's can tell your doctor if you are allergic to certain types of allergens. This method is not always accurate or precise as are the other methods. Should your doctor decide to have allergy testing done, he will examine your family medical history and tell you when to stop your medications.

Curing Acne

Curing acne is effective and economical in the long term when done naturally and holistically. Curing acne naturally from the inside out with diet and practical lifestyle changes is far more effective than simply trying to cure acne overnight with topical treatments. Curing adult acne internally is also possible with this approach - it's not just for teenagers.

Curing acne naturally involves taking into consideration the multiple organ systems in the body that contribute to it. First understand how acne arises so you can treat the underlying cause. Curing acne holistically involves using a multi-pronged approach to correct the internal imbalance.

Curing acne holistically requires supporting the large intestine (colon), kidneys, lungs and skin which are all organs of elimination that get rid of waste material and toxins. If one or more of the internal organs is not functioning optimally due to an internal imbalance, the other organs try to compensate so curing acne from the inside out is the key. Therefore skin problems like acne, eczema, psoriasis are often the body's way of trying to balance itself when the internal organs have an imbalance. This is why curing acne internally is the key.

Curing acne requires addressing the following issues:

1) Digestive tract

Constipation which blocks toxin elimination as well as recycling of "bad estrogens" implicated in hormone-related acne.The use of antibiotics will destroy the "good bacteria" such as lactobacillus in the gut. These microbes are needed to ensure gut health as well as to indirectly prime the immune system (which helps prevent autoimmunity among other things). Candida overgrowth in the gut can compromise the immune system which is often due to antibiotics killing off the good bacteria. Curing acne internally requires improving the health of the digestive tract.

2) Nutrition

Poor nutritional health due to a highly processed food diet (the detoxification organs need different types of vitamins and minerals to function optimally). Food allergies such as those to milk, saturated fats, sugar, caffeine, aspartame, red meats, soy, wheat etc that can cause "leaky gut" which can also cause autoimmunity and lethargy. A high glycemic index diet (refined carbohydrates like white bread, pastries, cakes) affects the immune system adversely by increasing inflammation which is the underlying cause of acne. Curing acne naturally requires an acne cure with diet.

3) Hormones

The increase in sex hormones at puberty causes excess production of sebum which causes pores to be clogged. High glycemic index foods cause a spike in the hormone insulin which increases a substance known as IGF-1 which in turn increases sex hormones that increase the secretion of sebum (oil) in the skin leading to breakouts. The stress hormone cortisol leads to a cascade of events that end up in an overall reduced sensitivity of the body to multiple hormones including insulin as well as to an increase in inflammation. Curing acne holistically requires taking into account the underlying hormones as well.

Solutions for curing acne naturally

1) Ensure proper elimination through atleast one bowel movement per day- ensure that you get enough water (8-10 glasses of water) and fibre in the diet ideally through vegetables but if not, use a fibre supplement (psyllium or citrus pectin). Check with your doctor whether you need more exercise and whether you may have hypothyroidism that can cause constipation.

2) Check your home and work environment for toxins - household cleaners, chemical fumes from plastics, treated wood or carpets in the home, additives in cosmetics, leaching from cooking utensils.

3) Replenish the good bacteria in the digestive tract by taking probiotics that are manufactured to ensure the number of live bacteria as well as viability after passage through the acidic environment in the stomach.

4) Remove any food allergies by checking with your doctor regarding food allergy testing. Then remove those offending foods and find alternatives so you don't fall back into the old habits of offending foods. Your local healthy grocery store is a good place to look for healthy alternatives such as gluten-free bread or non-dairy milks such as rice milk or almond milk.

5) Heal the digestive tract to eliminate "leaky gut" through supplements like glutamine and slippery elm tea.

6) Support the liver which is the main organ of detoxification. Burdock, milk thistle and dandelion root tea from the garden (provided the area is relatively free of toxic materials and no pesticides are used on lawns in the vicinity).

7) If a hormonal imbalance is suspected (low energy, anxiety, depression, insomnia, sudden weight gain, body hair growth in women, Polycystic Ovary Syndrome, irregularities in the menses cycle) consult your doctor for laboratory testing.

Some topical natural acne treatments are tea tree oil, turmeric and white willow bark. Curing acne naturally involves addressing the excess of inflammatory cytokines from the immune system and a TH1/TH2 imbalance (different cell types of the immune system) that lead to inflammation.

Curing acne involves promoting toxin elimination, healing the lining of the digestive tract, supporting the liver and normalising hormonal imbalances in order to ultimately reduce inflammation - the underlying cause of acne.

This is provided as information only and is not meant to diagnose or treat any health condition. Consult your doctor before making any changes to your health regime.

Environmental Control - The Best Treatment For Allergies

Three basic treatment options exist for allergy sufferers:

1. Allergy Medication

2. Immunotherapy (Allergy Shots)

3. Environmental Control

What Is Environmental Control?

Environmental control requires a bit of work on your part - it's not quite as easy as swallowing a pill or getting a shot - but it is the most effective treatment for allergies. If you can control your environment and avoid your allergens, then you will not experience allergy symptoms. It's that simple!

Environmental control may involve frequent vacuuming with a HEPA-filtered vacuum cleaner, encasing your mattress and pillows with special allergy relief bedding, running an air purifier, wearing a mask, or placing a dehumidifier in your basement. Your environmental control plan depends on the specific allergens to which you are allergic.

What Causes Allergy Symptoms?

Allergy symptoms appear after a sensitive individual is exposed to allergens. The most common allergens are proteins from plants and animals (although some people may be allergic to certain chemicals). Once an allergen makes its way inside the body, it sets off a chemical chain reaction within the immune system of sensitive individuals. This chain reaction, which includes the release of histamine and other inflammatory chemicals, leads to allergy symptoms - sneezing, watery eyes, congestion, etc.

How Do I Discover My Specific Allergens?

Before you can formulate an environmental control plan, you must know the substances that cause your allergy symptoms.

You should visit an allergist or ENT physician for allergy testing. In the most common method of allergy testing, an allergy technician pricks the skin with a tiny needle to insert a small amount of the allergen. If the patient is allergic, then the site of the skin prick will become red and swollen.

As another option that's more cost-effective and convenient, you can use MyAllergy Test in your own home. This easy-to-use kit allows you to collect a sample of blood (using a finger stick lancet) and send it to a lab for allergy testing. MyAllergy Test shows if you're allergic to timothy grass, bermuda grass, mountain cedar, short ragweed, mold, milk, egg whites, wheat, cat dander, and dust mites. If you want more extensive testing, you should make an appointment with an allergist.

Once you know your specific allergens, then you can start implementing environmental controls to help you avoid exposure to your allergens.

Dust Mite Allergy

Like villains in a microscopic sci-fi movie, dust mites are everywhere. They can live inside automobiles, deep within carpet fibers, and on furniture. Since dust mites feed on dead human skin, they tend to hang out where the shed skin collects: in the fibers of your bedding, mattress, and pillows. That's why it's vitally important to encase your bed with allergy relief bedding, also known as dust mite encasings. These encasings will keep dust mites from invading your bed. See the Allergy Relief Bedding Buying Guide to learn more.

You should also vacuum frequently with a HEPA-filtered vacuum cleaner. Vacuuming alone will not suck up all the dust mites, but it will take away their food. To kill dust mites in carpet, use anti-allergenic carpet powders and sprays. We also recommend using anti-allergenic laundry detergents and additives to kill dust mites and denature allergens in your laundry, especially if you normally wash your laundry in cold water. (Water must be very hot in order to kill dust mites, but you can kill them in a cold water wash by using de-mite laundry additive or Allergen Wash.)

If you have a dust mite allergy, you should monitor your relative humidity. Dust mites like warm, humid environments, and they cannot thrive if you keep the relative humidity below 50 percent. Monitor your humidity with a humidity gauge. If necessary, you can lower the humidity in your home with a dehumidifier.

Finally, although an air purifier won't eliminate the actual dust mites, it will eliminate excess dust in your home. To reduce dust mite populations, it's important to keep your home free of dust and clutter. If you can, replace carpet with hardwood floors and low-pile area rugs.

Stuffed animals also harbor dust mites. You can kill dust mites on small items like stuffed animals by placing them out in the sun for several hours or by putting them in the freezer over night. Or, you can buy washable toys like Gund Stuffed Animals.

Mold Allergy

As with dust mites, it's impossible to get rid of every single mold spore in your home. They're everywhere! However, using environmental control measures, you can greatly reduce the number of mold spores in your home and thereby reduce the frequency and severity of your allergy symptoms.

Like dust mites, mold requires a warm, humid environment for growth. Monitor the humidity in your home with a humidity gauge, and keep the humidity below 50 percent using a dehumidifier.

For protection while you're sleeping, Allergy Armor allergy relief bedding features a special antimicrobial finish that prevents mold growth.

Use M-1 Sure Cote Mold & Mildew Resistant Sealant to clean up mold around your home and prevent future growth. AllerMold and Vital Oxide are two additional household cleaners that are effective against mold but safe for your family and the environment.

Be careful when cleaning mold! If the growth is significant, you'll want to wear a mask, along with gloves and goggles.

HEPA air purifiers and HEPA vacuum cleaners also capture mold spores and remove them from your environment.

Pet Dander Allergy

We've already discussed several products that will help you avoid pet dander in your home; these products include allergy relief bedding, air purifiers, and HEPA vacuum cleaners. Allergy Armor Ultra bedding, for instance, blocks animal dander from your bed. Other products specially made for pet allergies include the Dyson DC17 Animal vacuum and the Austin Air Pet Machine air purifier.

If you own a pet, we also offer items to help you keep your pet's dander to a minimum, including the Pet Brush vacuum Attachment and Ecology Works Pet Allergy Shampoo. See all Pet Allergy products for more suggestions.

Of course, if you're severely allergic to a specific animal, the best advice is to stay away from that animal. If you cannot avoid spending time with an allergenic animal, try avoid touching your face, and wash your hands (or better yet, shower) as soon as possible. And keep all pets out of your bedroom!

Pollen Allergy

The main problem with pollen allergy is that you can't go outside and vacuum up all the pollen, nor can you stick an air purifier in your backyard and expect it to have any affect on the pollen level. When dealing with a pollen allergy, it's best to wear a mask outdoors. Watch your local pollen count and try to stay inside when the pollen counts are high. Once you get inside, shower as soon as possible.

Indoors, you can use HEPA vacuums and air purifiers to capture pollen grains. Be aware that pollen will find its way inside your home any time a door opens or window opens. If you want to get some fresh air without the pollen, put a Safeguard Window Filter on your window.

Sinus and nasal irrigation products also work well for pollen allergy sufferers because the saline washes away pollen grains in the nasal passages. The SinuPulse Elite is the world's most advanced nasal irrigation system, but a simple neti pot works well, too.

Testing And Treatment For Gluten Intolerance Symptoms

What is gluten intolerance? How do I know if I have it? How do you treat it? What is the prognosis? All good questions that I hope to help you answer here. As gluten intolerance becomes better known in the medical community as well as the general population, people are starting to question their symptoms and suffering that doesn't seem to be helped by other treatments. Gluten intolerance has gone under the radar for some time, but that is changing.

Gluten intolerance can be known as Celiac Disease or Non-Celiac Gluten Sensitivity (NCGS). Celiac Disease is an inherited autoimmune disease in which the lining of the small intestine is damaged from eating gluten and other proteins found in wheat, barley, rye, and possibly oats. The villi in the small intestines become flattened. When they are flattened they can no longer function properly. They are responsible for absorbing minerals and nutrients. When they can't function, malnutrition and vitamin deficiency occur. Once that happens, the scene is set for you to develop a whole list of other health concerns, some of them very serious. You can develop anything from gas, bloating, diarrhea, and vomiting, to more serious conditions such as anemia, bone disease, growth delay in children, nosebleeds, seizures, and dental enamel defects and discoloration.

There is a test that can be done if gluten intolerance is suspected. Your physician will do a blood test, which is a complete blood count, (CBC), to see if anemia is present. The test can show an increase in alkaline phosphate which means there may be some bone loss. There may be low cholesterol and albumin levels which could mean malabsorption of nutrients. There could be a mild increase in liver enzymes or detect antibodies. If the blood test comes back with positive results, your physician will then order an upper endoscopy to retrieve a biopsy from the small intestine, otherwise known as the duodenum. Genetic testing is available to see who is at risk of developing Celiac disease. An endoscopy with enteroscopy of lower section of the intestine will show flattening of the villi. After the initial blood work and biopsy a follow up of those tests will be ordered several months after the diagnosis and treatment given. Normal results of those tests will confirm the diagnosis.

There is a treatment for gluten intolerance. Unfortunately, it is a gluten free diet that can be difficult to follow at first. The gluten free diet gives the villi time to heal. You must refrain from consuming any food or beverage that contains wheat, barley, rye or oats. Be sure to read all your labels carefully. Check for hidden grains. Wheat and barley are found abundantly in the American diet. Be sure not to start the diet before you are tested because then the test results will not be accurate. Your physician may prescribe a vitamin and mineral supplement. If you decide to see a dietician to help you get started, be sure you see one who specializes in gluten intolerance and Celiac disease.

Using NAET as a Treatment for Autism

In November of 1983 in an effort to cure herself of debilitating health conditions, Dr Devi S. Nambudripad developed Nambudripad's Allergy Elimination Technique.

Working on the premise that all health conditions are brought about by allergens, she used a selection of different forms of alternative treatments to reduce or eliminate the allergen thereby removing the illness.

Kinesiology is used to determine the presence of the allergen by a form of muscle testing, if the person is allergic to the item placed on their skin, their muscles are weaker.

Accupuncture or Accupressure is used to resolve the imbalance in the body by removing the energy blockages in the Meridian thereby bringing the body back to a state of homeostasis.

This treatment can and has been used on multiple illnesses brought about by allergens including Autism.

A case study in 2005 with a group of 60 Autistic children, 30 of which were treated with NAET, of the 30 treated, 23 of the children with Autism improved so much that they were able to be rediagnosed and lost their Autistic label and were able to attend mainstream classes in a regular school after receiving 50 treatments for allergen removal in a 12 month period.

It can be used to assist with other health conditions brought on by Autism such as constipation or leaky gut syndrome.

For the severely Autistic child a surrogate can be used to facilitate the treatments whereby, so long as the surrogate is touching the skin of the Autistic child, the accupuncture or accupressure can be performed on the surrogate and the child with Autism will be effectively treated.

After the treatment is performed, the Autistic child will need to be kept away from the allergen for between 24 to 30 hours to allow them to clear it.
This can present a difficulty for parents of a child with Autism who insists on a regimented meal plan and won't eat a varied diet.

Sometimes for more severe or stubborn allergies, the Autistic child may need to go through the same treatment for the same allergen more than once.

Dr Nambudripad has written a book, Say Goodbye To Allergy Related Autism, published in soft cover in 2006 in which she shares detailed reasoning for her theories and case studies from Autistic children who were helped by her allergy removal technique.

Dr Nambudripad holds regular seminars where she trains others in the NAET practice.
There are registered NAET practitioners all around the world.

With so much at stake regarding recovering the child from Autism, this is one treatment that should not be ignored.

Learning to Live with Sensory Processing Disorder Successfully

I've spent thousands of dollars on Occupational therapy for my son who has had Sensory Processing Disorder and ADHD. I believe in Occupational Therapy and who knows where we'd be if we didn't have the OT. But I've found how to integrate it into our life, and save us some money.

My son loved OT and I know the many benefits that he received from it. But it didn't come without a struggle. Each session was $60 per half hour, or $120 an hour. I loved seeing him thrash around in the mats, swinging on the swings or spinning, running and jumping. I knew that he was getting mental benefits as well as physical and we continued the work at home by doing jumping on the trampoline, wheel barrels and crab crawls. But the money I was spending without being reimbursed started to cut into other things I wanted to do for my son. For instance, I wanted to get him allergy testing, but that $1300 for the test was something I'd have to save for, so we cut out OT.

I've made hundreds of little changes in our lifestyle over the past year and a half since I became somewhat educated about my child's needs. It truly has been a series of trying something and seeing if it worked, and trying another to see if that worked. Some days, it seems we have moved forward several steps, but then we can take several steps backwards in one day, or one giant, dramatic episode.

Here are a few things I've learned about my son. I need complete structure in the house and with his routine. He gets up at a certain time, eats, bathes and does story time every day and every night. We have to plan far in advance to do something out of the ordinary, and the whole house has to be set up to accommodate that. That means, if we have cub scouts or basketball practice, then the house has to be clean before he gets home and I will focus 100% of my time on him before he goes. If we have a play date, the date wraps up at exactly 5PM so I can get home and get dinner on the table by 6:15 and have him in the tub by 7PM. His bedtime is strictly 8:30 and there is no negotiating.

I've learned that I have to spend more time with him in the afternoon. I get all of my work and chores done during the day around my work, so when he gets home, I play with him and part of that play is his OT. He jumps on the trampoline, we box, wrestle, go hunting for treasures in the yard or go for a walk. The afternoon routine always consists of homework and exercise.

I have learned that TV and play dates with other kids are rewards. For good behavior, he can watch a cartoon. He does not get to plop down in front of the TV whenever he wants or turn on the computer. He has to do his home work and gets to play with friends if he has good and we usually plan these play dates. We do this so there is not much stimulation and there isn't a lot of chance where he can get over stimulated.

All throughout the morning and day and evening, I rub Jeremy's muscles. I scratch his back and affectionately massage his legs, arms or feet. In the bathtub I scrub him with a washcloth and he always makes sure that I get under his armpits! That wash cloth takes the place of the OT brush and the massage he gets throughout the day must help too. He doesn't seem to complain about it because I tell him we want to warm up his muscles and keep him in shape.

I have asked Jeremy to help me get in shape so we do push ups together, crab crawls and bear crawls. We race each other and we compete. In the evenings or in the mornings, I have my husband wrestle with Jeremy or have Jeremy try to push my husband over by pushing his hands against my husbands' hands. This helps with the upper body strength and is similar to wall push ups. The wrestling is good for his body as well and acts like the mats in therapy.

Bath time used to be the worst time of the day. Getting him in and out of the tub was a literal nightmare. I dreaded it for the hour before bath time. Now, I give him choices. He can stay in the tub for the whole time or he can get out and watch 15 minutes of TV. He has choices to make and it doesn't matter to me which choice he makes, it is up to him. He usually gets out the tub to watch a few minutes of TV. I have stopped screaming for him to get out of the tub. I simply give him a choice of two things: tub or TV. If he chooses to stay up for longer than he is supposed to, then he loses a play date with friends the next day. If he gets in bed on time, then he gets a special reward and I'll make a special play date for him the next day if I'm able.

We've experimented with no dairy, magnet therapy, supplements and tae kwan do. We've done allergy testing, toxin testing and are hoping to do Mind mapping in the near future. My goal is to get him off of any type of ADHD medication. We'll keep doing different therapies until we've found the magic potion of what works for him. We regularly read healing scriptures and the Psalms in the Bible.

We are on a journey together and I'm definitely not "there" but I have learned a few things along the way. I've learned that my child needs me to keep him comfortable and needs me to structure his life. I've learned that yelling isn't the answer and that building up his body is a process but it's one that is worth the effort. I've learned that putting him first above everything else has worked for me. My career is on hold. Marketing is on hold. Moving ahead with dream projects are on hold. Jeremy has my complete and full attention at the moment.

I've never worked so hard in my life. I don't even eat sugar or drink alcohol much anymore because it might affect my mood and I just don't have time to slow down. I do many of my workouts at home with hand weights, pushups and lunges because I know I need to be strong for this journey.

My son has made me into a better person. His challenges that he had early on due to a premature delivery has made us all work harder in our life. But I see a remarkable person developing right in front of me. He's smart about nutrition and exercise. He understands the value of hard work. He sees that when he eats well and exercises that people comment positively on his body. He has such in depth knowledge of historical bible characters from the cartoons, that he often shares pearls of wisdom with me from the leaders of the Bible. He understands that everyone is a little bit the same like that we all have skin, eyes and hair, and that we're all a little different, in our attitudes, beliefs and actions.

I feel honored to have a child that has had challenges in life out of the gates. He changed my attitude of entitlement to one of hard work and commitment and devotion. I would never give up the last several years of incredible struggle and learning that we've gone through. Now I know what it takes for him to have a good day. It takes muscle work, good food to feed his body, reading to him, being with him and loving him.

Sensory Processing Disorder is a situation that can cause families to be in crisis and have chaos. When the kids are whiney and uncomfortable and mom and dad aren't sleeping, the whole family life is turned upside down. There is hope though, and I hope one day I'll be able to say that all of my discoveries are things that worked over the long haul, but for right now, they seem to, and I'm going to continue to integrate our OT, healthy eating and nurturing of my son into our daily routine.

After all, I've never met another person who I thought was more worth it... than my son.

Grandparents Use DNA Analysis to Prevent and Treat Inherited Diseases for Future Generations

Why is DNA Analysis important to me?

Knowing your family's genetic history may someday save your life or that of someone you love. Based on state-of-the-art genetic technology, a unique DNA Profile can be generated for you to keep for years to come. DNA Storage for up to 25 years is available for future genetic testing, upon your request. What better gift can a loved one leave behind?

What role does DNA have in Funeral Service?

The purpose of this article is to familiarize Funeral Directors about DNA activities, and related areas. Realizing that this technology is what we as caregivers are used to discussing, is a field that is of concern to many of our clients and their families. The vast spectrum of DNA can give us insight on the value it can play in our community. In a series of articles, we would like to give you a basic knowledge about the different but related studies involving DNA.

It takes three generations to determine predisposition to most of the genetic inherited diseases / disorders. It is now known that families should store DNA for future use. Banking specimens containing DNA from the same Family provides invaluable information for the health of current and future offspring. We as Funeral Directors have an opportunity to make a Family aware that such a service is available. After burial, retrieving DNA can be expensive. Obtaining DNA after cremation is much more difficult. The success rate of recovering DNA within the first year of cremation is approximately 50%. Offering storage and or profiling DNA of the deceased, gives Funeral Directors a Unique opportunity to offer a Service that can have a lasting impact on those we serve. If you as a Funeral Director do not see the need for this service, it does not mean that families do not need this service. Statistics tell us that families place a tremendous amount of trust in their Funeral Director. This is because we care so deeply in what we do. Informing a Family of their options, while guiding them through the most difficult times in their life is a responsibility that a Funeral Director accepts and excels in.

It is our hope that Funeral Homes throughout the United States will contact us and give us their input as to the value of DNA in a Funeral service.

Why we firmly believe in what we do.

At the National Funeral Directors Association meeting in October 2001, we outlined all the reasons for the value of DNA storage such as paternity/inheritance, genealogy, missing persons, forensic issues; identification of hereditary disorders, congenital birth defects; predisposition to allergies, mental, metabolic, cardiovascular, bleeding/clotting disorders, genetic cancers, microbial diseases. The potential does not end with the above. Rapidly evolving technologies in cloning pets, stem cell/gene therapy are currently being done, all to improve the quality of life.

Recently we had four interesting success stories...

1. A 62-year-old female dies of complications resulting from Breast Cancer. The deceased women leave 2 daughters and 1 granddaughter. During a "Pre-Need Consultation", the woman elected to have her DNA profiled and the sample banked.

2 years later; one of the daughters is diagnosed with the same Breast Cancer as the Mother. The second daughter has her DNA profiled and compared to the mothers. It is determined that the second daughter does not have the same genetic structure as the mother that would pre-dispose her to the cancer. However, the Granddaughters DNA is profiled and it is determined that she possesses the same genetic disorder as the Grandmother. Pharmacogenomics and gene therapy are begun to prevent the cancer in the granddaughter before it develops.

2. The mother of a Divorced son was interested in identifying the granddaughter's father. Was he her husband were her son? We identified her son is the alleged father. This was a "Paternity" issue.

3. The three sons of the deceased lady came to request identification of their mothers remains between two occupants of a gravesite that had collapsed. She passed away seven years ago, so the atypical specimen sources were bone marrow and vertebrae. Procedures were laborious, but we identified their mother. Her remains can now be transferred to another site. This is "Profiling".

4. A friend's baby presented with what appeared to be a Bleeding tendency at 3 months of age. The baby was admitted to Children's Hospital, Cincinnati, extensively treated but expired at age 8 months. An autopsy revealed universal capillary involvement (small blood vessels) by a clotting abnormality resulting in damaging complications in vital organs such as heart, liver and spleen. This leaves a Protein called von Willebrand factor and is coded by a Gene called ADAMSTS 13. The parents are currently being tested for "Mutations" in order to know who transmitted to the gene. The baby's DNA is currently in storage it doesn't matter who stores DNA in life and in death provided it is properly collected and stored because although it's stable, it can be contaminated and it can disappear during purification; this complicates genetic testing. Before the advent of Pharmacogenomics, astute clinicians treating HIV patients relied on drug resistance testing to predict outcomes; complementary to resistance testing his current genotyping, which includes identifying mutations, associated with resistance. In the not-too-distant future, the combination of drug resistance testing and pharmacokinetic testing will provide a better idea of in-vivo relevance of resistance data. Stored DNA lasts forever; it will provide an endless source for multiple testing that will hopefully improve clinical outcomes.

Pharmacogenomics

The terms "Pharmacogenomics" and "Pharmacokinetics" are sometimes used interchangeably to describe the analysis of genes involved in drug response.

Pharmacogenomics is more inclusive; it refers not only to the effects of individual genes, but also to complex interaction between genes from every part of the genome affecting drug response.

Pharmacogenomics is an aid to diagnosis and prognosis. Routine diagnosis is not always straightforward. A patient does not always come with textbook type symptoms of the disease. In some cases, a single gene variation has been shown to be responsible for disease, and a Genetic test for this scan confirms the diagnosis as in cystic fibrosis and Huntington's disease. Sometimes more than one gene is involved, such as to Breast Cancer genes, Alzheimer's Disease genes, and susceptibility to Migraine genes. The most likely publicly visible contribution of Pharmacogenomics to improved health care would be delivery of a number of drugs coupled to diagnostic tests based on genetic markers for head and neck, pancreatic cancers, and solid tumors.

Pharmacogenomics classifies patients into responders and non-responders to particular therapeutic options. Breast cancers that over express a Protein for the herceptin genes are candidates for monoclonal antibody therapy. The cholesterol-lowering drug PRAVACHOL works according to the number of copies of the transfer protein gene. HIV Phenotyping is an important and practical adjunct to the treatment of AIDS.

Pharmacogenomics can save lives lost to adverse drug events, the 6th leading cause of death in the US. A blood test now enables physicians to tailor a certain drug dosage to their patient's genetic profiles. However, the cause and effect association remains unknown. Implementation of rapid automated DNA genotyping capabilities still, over time, provides individual genotypes of patients. Clinical data that is properly collected and managed identifies patient subpopulations at risk for adverse events, while allowing others to continue to receive the benefits of pharmaceutical therapy.

Pharmacogenomics and Gene Therapy

Mutation is a change of DNA sequence leading to aberrant or absent expression of the corresponding protein. It is the mutation, not the gene that causes predisposition to disorder/disease. Polymorphism is the quality of existing in several different forms. Sequencing of parts of the genome has demonstrated that some of these polymorphisms are in genes whose functions are important in responses of individual patient to therapy. The pathologist will need to profile common polymorphisms in patients who are beginning therapy for common diseases such as diabetes, hypertension, cancer and infections. The laboratory definition of the genotype/phenotype will determine the specific drug and doses suitable for him. This puts the pathologist in a more definitive position to determine appropriate therapy than traditional predictions of disease behavior based on morphology of lesions (microscopic patterns) or cultural characteristics of infectious organisms. The lab also monitors the success of gene therapy. After a gene is introduced, the tissue where the gene is inserted (i.e.: Transgenic Monkey or Mouse) must be active and should be monitored for normal expression of the introduced gene and normal structure and function of the gene product. The lab must also monitor the "integrating transfected genes" such that integration allows both normal gene expression and does not produce abnormal function or structure of the patient's other genes. In summary, molecular pathology is permeating and penetrating, as was immunopathology 20 years ago. "Immunopathology" an example of which is vaccine therapy is nothing new, a German/Austrian vaccine "UKRAIN" is supposed to destroy cancer cells through APOPTOSOS (programmed cell death) without attacking healthy cells. The US now has "GLEEVAC" with identical results. It also has been proven that in breast cancers there are genetically divergent CLONES that account for different microscopic components resulting in different responses to therapy.

Future Direction

As the human genome Project continues to uncover important disease genes (especially those for common disorders) at an ever increasing rate and technologies for high-speed DNA sequencing and multiplex mutation detection continued to improve, we can anticipate diagnostic molecular genetics assuming a far more dominant role in public health and preventive medicine. The advance of DNA "CHIPS" containing thousands of probes may someday allow extensive genotyping and lifetime disease prediction for thousands of disorders from a single drop of blood. Also, a poster on Human Genome Landmarks in the US Department of Energy, identifies a whole gamut of diseases/disorders with the corresponding position of the defective gene! Against these promising advances will have to be weighed ethical issues, especially in the field of gene therapy. Whatever the ultimate balance reached, there's no doubt that molecular genetics will be the driving force behind an ever greater proportion of evidence based medical practice in the 21st century and virtually every patient whether healthy or ill will feel the impact.

The impact of DNA storage on clinical practice
Evidence based medicine is the gold standard for the 21st century.

What do we do that contributes to the practice of this medicine? What specific examples and daily living indicate that storing DNA is a "Must"?

The event of 9/11 mainly profiling and identifying the deceased was laborious and expensive on federal funds despite which only approximately 2000 persons have been identified. One does not realize the importance of the death certificate without which burial cannot be accomplished until death occurs! Soldiers "missing in action" cannot be declared dead until their bodies are found and identified.

An article in USA Today concerned a "Mystery killer" that involved a young couple; studies failed to give a definitive answer despite autopsy and numerous laboratory tests. Since chances that the suspected disease that clinically presented to be contagious (plague) proved negative on repeated testing. Had DNA been stored, further testing may have led to the diagnosis and cause of death

A TV program about a Serial killer in Juarez Mexico led to more than 200 missing women and "no leads". Profiling and storing of DNA when these women were newborns would have helped identify the remains that took months to surface. The women after being raped were doused with gasoline and burned! The problem is ongoing.

Although Chandra Levy was missing for a year before the body was found, DNA is stable, and after profiling samples from her remains she can now be laid to rest. Since degraded DNA is difficult to purify, tests on her remains are ongoing to hopefully identify the killer. The FBI in USA Today declared, "there still are no clues to the killer". Samples are from her remains such as hair, teeth, bone; even old blood can still be stored and tested along with a Suspect's samples until results are conclusive.

A complex disease such as Parkinson's disease and the genes whose polymorphic forms can increase any person's risk but not necessarily cause it is the second most common in a Neuron-degenerative disorder. Parkinson's disease has neither a Polygenic (multiple genes) or multifactoral (genes and environment) cause. Over the past few years, debate has occurred between Parkinson's disease having a Genetic component or is just secondary to environmental influences. To evaluate the possible genetic component, open quote gene mapping" is the way to go. The availability of data from the Human Genome Project is opening new possibilities in studying common diseases such as Parkinson's disease. The multitude of molecular techniques and statistical tools applied to this data now allows us to potentially move medicine from a "reactive" discipline to one that can prevent disease. However, once found, how these "susceptibility genes" will be used in the future remains to be seen.

A newborn (the 3rd child) was diagnosed to have a "Rare protein allergy". Surgery was successful the baby is now seven years of age and healthy. Two other siblings are healthy. Storing this baby's DNA would have enabled testing of future siblings for mutations related to this rare congenital predisposition to allergies.

At three months of age a Baby presented with a Bleeding disorder; she was admitted, traded and died at the Children's Hospital in Cincinnati. The baby's profile showed a defective ADAMSTS 13 gene. The parents are being tested for this "mutation" and the baby's blood, buccal smears, and hairs are stored.

Will everyone be gene type early in life to prevent disease that they are at risk for? How will this affect employment/applications for competitive educational opportunities? Wolf farm code genetic genotyping be routine to determine patients with the risk for side effects or variability in efficacy? If the patient refuses typing will third-party payers is still pay for medications and/or treatment? Someday mandatory DNA storage and testing in life and death will enhance the quality of life and improve clinical outcomes because increasing knowledge of genetic variations sheds light on the role of genetic and environmental factors and disease susceptibility, aggression and therapeutic response.

Specialists can now screen eggs for the faulty gene that closes early onset Alzheimer's disease, enabling women who carry their rare disorder to avoid passing it on to their children.

FDA approved GLEEVEC has been very effective in chronic myelogenous leukemia and rare (stromal) stomach cancers; causes of relapse do so because they have developed mutations that alter GLEEVEC's target site in the leukemic cells, a Phenomenon well known to infectious disease clinicians. Just as microbes developing drug resistance mutations, so do cancer cells.

Summarizing the future of cancer treatment: in the past, pathologic diagnosis was based on histology. In the future it will be based on molecular profiling of tissue both that the genetic and proteinomic level. In the past, therapy was chosen by disease category. In the future, combination therapy will be aimed in tailored to individual patient profiles or classes of profiles. Select, monitor, and reevaluate.. that's hope for the future!

Kinesiology Is Becoming A Widely Used Discipline

Kinesiology is quickly becoming one of the most widely used tools in identifying health disorders and treating individuals successfully. Being overweight or even obese is one of the most common "disorders" in the US today. Kinesiology is becoming more common with medical professionals such as dentists, chiropractors, orthopedic specialists, nutritionists, herbalists, therapists and nutritionists. The science has become the solution to numerous medical conditions that have baffled natural and western medicine.

Kinesiology is based on proper testing of the body's functions and various balances, and not necessarily treating the symptom of the disease or imbalance. Understanding the root cause of human movement and function is becoming much more effective than simply treating conditions as they arise.

As millions of Americans continue to combat the effects of obesity, Kinesiology remains a science that is dedicated to educating and impacting future generations. The impact of an active lifestyle has long been recognized as beneficial, but Kinesiologists are now documenting not only the "why" but also the "how do we achieve this". Kinesiology is being drawn into the education curriculum of many schools; initially to define sport-oriented problems, then to help prevent sports injuries. Curriculums are taking advantage of the discipline by assessing the nutrition provided students and the various physical and mental activities confronting students. In turn this expansion is further increasing the demand for professionals experienced in Kinesiology based methods.

Kinesiology professionals test and document feedback of an individual's various imbalances, and decide which methods are needed to return and optimize the balance thus improving the individual's health. By monitoring the resistance of muscle groups after the application of pressure (muscle testing) practitioners can accurately pinpoint various imbalances. Conventional medical practices are being questioned as the general conscious of the population moves away from treating illness and more towards preventing illness and injury.

Kinesiology has had a tremendous impact of the health and fitness industry. By documenting optimum performance with studies and clinical trials the various aspects of exercise the professionals and clinicians have helped challenge some long-time held beliefs. A primary example is what causes muscle soreness after intense exercise. Muscular soreness, even pain, was thought to occur due to the build-up of lactic acid in the muscles. Kinesiologists assisted in discovering the soreness was most probably due to micro-tearing of muscles.

The impact on fitness workouts has been dramatic in the last 10 years or so. To reduce the unpleasant soreness, greater emphasis has been placed on warm-ups immediately prior to workouts. Almost as important is the focus on warming up the same muscle groups being exercised in the fitness workout. Fitness bootcamps have wholeheartedly embraced the effectiveness of this scientific discipline. By using kinesiologic principles in everyday fitness bootcamp workouts, the efficiency of bootcamps soared. Some clinical studies indicate that fitness bootcamp workouts may be as much as nine (9) times as effective as other routines. This allowed the fitness bootcamp model to literally explode throughout the entire country in 10 to 15 years.

Walgreens, CVS, and Rite Aid - What RE Investors Should Know

There are 3 major drugstore chains in the US: Walgreens, CVS, and Rite Aid. Below are some key statistics about the 3 major drugstore chains as of 2012:

1. Walgreens ranks first with market cap of $28.51 Billion, $72.2 Billion in 2011 total revenue ($45.1B from prescription revenues), and an S&P rating of A. According to Walgreens, 75% of the US population lives within 3 miles from its stores. In April 2010, it acquired 258 Duane Reade drug stores in New York Metropolitan area which brings a total of 7841 drug stores Walgreens operates as of February 2012, including 137 hospital on-site pharmacies.

2. CVS ranks second with market cap of $56.56 Billion, $107.1 Billion in revenue ($40.5 Billion from CVS prescription revenues and $16.1B from its Caremark prescription mail order revenue), and an S&P rating of BBB+. As of December 31, 2011, CVS operates 7404 drug stores.

3. Rite Aid ranks third (fourth, behind Walmart in terms of prescription revenues) with market cap of $1.49 Billion, $26.1 Billion in revenue ($17.1B from prescription revenues), operates 4714 drug stores as of February 2011 and has an S&P rating of B-.

Investors purchase properties occupied by these drugstore chains for the following reasons:

1. The drugstore business is very recession-insensitive. People need medicine when they are sick, regardless of the state of the economy. Both rich and poor people in the US have access to medicine. Some even argue that low-income people use more medicine due to free or low-cost drugs offered by government-assisted programs. So the tenants should do well during tough time and have money to pay rent to landlords.

2. The drugstore business has a good prospect in the US:

繚 People are living longer and need more medicine to sustain longevity, e.g. Actonel for osteoporosis, Aricept for Alzheimer's symptoms. Older people tend to use more medicine than younger ones as they often have more medical problems. As the 78 million baby boomers are getting closer to retiring age starting from 2008, the drugstore chains anticipate the demand for medicine to increase in next 20 years.

繚 The drug market continues to expand as the US population continues to grow. More and more Americans suffer from various diseases. The number of Americans suffers from seasonal allergies doubled in the last 15 years to 37 million people per Fortune magazine. They spent $5.4 Billion in 2009 for allergy drugs. As their waist lines balloon (75% of Americans are forecasted to be either overweight or obese by 2020), more Americans are diagnosed with diabetes, along with high cholesterol at younger and younger ages. In addition, doctors also recommend treating various diseases sooner than later due to better understanding about the diseases. For example, doctors now prescribe antiretroviral drugs for patients soon after infected with HIV virus instead of waiting for the infection to become AIDS. More doctors combine insulin with oral medicines to treat type-2 Diabetes instead of just oral medicines alone. All these factors increase the size of the drug market.

繚 Advance in genetic engineering has introduced various new genetic DNA testing kits which allow the genetic diagnosis of vulnerabilities to inherited diseases and disorders. Genetic testing is currently the highest growth segment in the diagnostics industry. Some of these genetic tests will probably transform into direct-to-consumer testing kits available in drug stores in the near future.Upon FDA approval, these new products will potentially bring in additional revenue for drug stores.

繚 Using a new method of tailoring molecules called structure-based design; drug companies come up with new medicines that they might not have discovered otherwise, e.g. Xalkori by Pfizer to treat lung cancer.

繚 The passage of Health Care Reform Bill on March 23, 2010 provides insurance coverage to an estimated 33 million more American. This is a great present to the drugstore industry.

繚 There are new drugs to treat previously untreatable illnesses, and new diseases, e.g. Viagra for men's unhappiness, Avastin for colon cancer, Herceptin for breast cancer,. The new medicines are very expensive, e.g. a year's supply of Avastin costs about $55,000. Eli Lilly has sold about $4.8 billion of Zyprexa in 2007 for schizophrenia and yet most people have never heard of this medicine.

繚 There are existing drugs now approved to treat new illnesses and thus increase their sales revenue. For example, Lyrica was originally intended to treat pain caused by nerve damagein people with diabetes. It is now approved by FDA to treat Fibromyalgia which affects 5.8 million Americans per WebMD.

繚 Big advances in genetics, biology and stem cells research are expected to produce a new class of drugs to treat diabetes, Parkinson's and various rare genetic disorders. For example the new drug Ilaris from Novartis targets genetic causes of an inherited disorder that there are only 7000 known cases worldwide. However, Novartis hopes to gradually broaden its drugs to a blockbuster drug to more common disorders caused by similar genetics.

繚 Technology and modern life introduce and require new products, e.g. pregnancy test kits, Lamisil for stronger clearer toe nails, Latisse for longer & thicker eyelashes, Propecia for male hair loss, Premarin for menopausal symptoms, diabetic monitors, electronic toothbrushes, contact lenses, lenses cleaners, diet pills, vitamins, birth-control pills, IUDs, nutrition supplements and Cholesterol-lowering pills (Americans spent nearly $26B in 2006 on Cholesterol medications alone per IMS Health, a Connecticut-based consulting company that monitors pharmaceutical sales.)

繚 Before the customers can get to the medicine aisles or pharmacy counters, they have to pass by chocolates, sodas, digital cameras, watches, toys, dolls, beers and wines, cosmetics, video games, flowers, fragrances, and greeting cards. Drug stores hope you use the one-hour photos services there. The stores also carry seasonal items, e.g. Halloween costumes, and "As Seen on TV" merchandise, e.g. Shamwow. As a result, customers buy more than their prescriptions and medicine in these drugstores. CVS reported that non-pharmacy sales represented 30% of the company's total sales in January of 2007. The figure for Walgreens is 34% and 37% for Rite Aid. Many pharmacy locations are in effect convenience stores especially ones that are in residential or rural areas. And so Walgreens hopes that customers also pick up WD-40, and screwdrivers at its stores instead of at Home Depot; Thai Jasmine rice, and fish sauce to avoid a trip to Safeway or Kroger Supermarkets. During the recession, sales of these non-drug items are down as customers buy what they need and not what they want. Walgreens tries to reduce the number of items by 4000. It also introduces its own private label which has higher profit margins.

繚 There are more and more generic medications on the market as a number of enormously popular brand-name blockbusters lose their 20-year long patents, e.g. Lipitor (best selling drug in the world to lower cholesterol) in 2010, Viagra (you know what it's for) in 2012. Drugstores prefer to sell generic drugs to customers due to higher profit margins than the brand-name medications.

繚 Many people are addicted to pain killers, e.g. Hydrocodone/Oxycodone. Per the DEA in 2012, there are 1.5 million American addicted to cocaine but 7 million addicted to prescription drugs.

繚 This author estimates that at least 10% of the dispensed prescription drugs are not used at all and sit idle in the medicine cabinets. They are eventually expired and thrown away.

3. These companies sign very long-term NNN leases, guaranteed by their corporate assets. This makes the investment in the underlying property fairly low risk, especially for Walgreens with a S&P "A" rating. In fact, these properties are sometimes referred to as investment-grade properties. Once the drugstore chains sign the lease, they pay the rent promptly and timely. This author is not aware of any properties leased by one of these drugstore chains in which the tenants failed to pay rents. Even when the stores are closed due to weak sales (Walgreens closed 119 stores in 2007), these companies may sublease the properties to other companies, e.g. Advance Auto Parts and continue to pay rents on the master leases.

繚 A typical Walgreens lease consists of 20-25 year primary term plus 8-10 five-year options. During primary term and options, there will be no rent increases in most of the leases. This is the main disadvantage of investing in Walgreens drugstores.

繚 A typical CVS lease consists of 20-25 year primary term plus 4-5 five-year options. The rent is normally flat during the primary term and then there is a 2.5%-10% rent increase in each 5-year option.

繚 A typical Rite Aid lease consists of 20-25 year primary term plus 4-8 five-year options. The lease often has a rent increase every 5-10 years.

Investment Risks

Although the pharmacy business in general is recession-insensitive, there are risks involved in your investment:

1) The main downside about investing in pharmacies is there is little or no rent bump for a long time, e.g. 20-50 years, especially for Walgreens. So the rent is effectively reduced after inflation is factored in. This is one of the main reasons these properties do not appeal to younger investors, especially when the cap rate is low.

2) The 3 drugstore chains now have a new formidable competitor, Walmart. Walmart sells prescription drugs in more than 4000 Walmart, Sam's Club and Neighborhood Market stores in 49 states. As of 2012, Walmart is the third largest drug retailer with $17.4B in prescription sales, just ahead of Rite Aid with $17.1B in prescription sales. The retail giant is known for launching in 2006 a highly-publicized $4 generic prescription drug program which now sells 350 generic medications for a 30-day supply. The actual number of medications is less as the medications with different strengths are counted as different medications. For example, Metformin 500 mg, 850 mg, and 1000 mg are counted as 3 medications. Walmart probably makes very little profits on these medications if any. However, the marketing campaign--created by Bill Simon, the President and CEO of Walmart US, generates a lot of publicity for Walmart. Walmart hopes to draw customers to its stores with other prescriptions where it has higher profit margins. In an unscientific survey with just one brand-name prescription of Lyrica, this author finds the lowest price at Costco, the highest price at Walgreens and Walmart at the middle. Other drug chains try to counter Walmart in different ways. Target now offers the same 350 generic medications for $4 for a 30-day supply. Walgreens has a Prescription drugs club with membership fee which offers 1400 generic medications for as little as $1/week. CVS says it will match any offers from its competitors.

3) Chief Business Correspondent Rick Newman from US World & News Report predicted that Rite Aid might not survive in 2009. Rite Aid is still around in 2012. The prediction seems to go away in 2012 as Rite Aid as it was able to refinance the long terms debts and sales revenue has increased.

4) Drugs are also sold in thousands of supermarkets, Target stores, and Costco warehouses. However, there are no drive-through windows at these stores or Walmart to conveniently drop off the prescriptions and pick up medicines. Customers will not be able to pick up their prescriptions during lunch hour or after 7PM at Target stores or supermarkets. They need to have membership to buy medicines at Costco. Others may not fill their prescriptions at Walmart because they don't want to mingle with typical Walmart customers who are in lower income brackets. And some baby boomers don't want their prescriptions filled at Target or Walmart because there are no comfortable chairs for them to sit down and wait for their medicines.

5) Drugs retail business to some degree is controlled by the Pharmacy Benefits Managers (PBMs). Customers normally get prescription coverage from their health insurance companies, e.g. Blue Cross. These PBM manage prescription benefits on behalf of the insurance companies. In 2012 Walgreens lost a contract valued at over $5 Billion with Express Scripts, a major PBM. Walgreen revenue was immediately fallen in the first quarter of 2012 as Express Scripts customers cannot fill their prescriptions at Walgreens. The PBMs are also in the drugs retail business via mail orders which do not require leasing expensive retail spaces. The prescription mail orders currently capture over 20% market share of the total prescription revenue. Should customers change their prescription purchase habits to mail orders (there is no such evidence in 2012), it could have negative impact to the business of drugstore chains.

6) Many leases in areas with hurricanes and tornadoes are NNN leases with the exception of roof and structure. So if the roof is damaged, you will have to pay for the expenses.

7) The tenant may move to a new location down the road or across the street when the lease expires. This risk is high when the property is located in small town where there is low barrier for entry, i.e. lots of vacant & developable land.

8) The tenant may ask for rent concession to improve its bottom line during tough times. The possibility is higher if the tenant is Rite Aid and if the store has low sales revenue and/or higher than market rent.

9) More Americans are walking away from their prescriptions, especially the most expensive brand-name medicines. This may have negative impact on the sales revenue and profits of drug stores and consequently may cause drug store closures. According to Wolters Kluwer Pharma Solution, a health-care data company, nearly 1 in 10 new prescriptions for brand-name drugs were abandoned by people with commercial health plans in 2010. This is up 88% compared to 4 years ago just before the recession began. This trend is driven in part by higher and higher co-pays for brand name drugs as employers are shifting more insurance costs to their employees.

Among 3 drugstore chains, Walgreens and CVS pharmacies in general have the best locations-at major intersections while Rite Aid has less than premium locations. Walgreens tends to hire only the top graduates from pharmacy schools while Rite Aid settles with bottom graduates to save costs. When possible, all drugstore chains try to fill the prescriptions with generic medications which have higher profit margins.

1) Walgreens: the company was founded in 1901 by Charles Walgreen, Sr. in Chicago. While the company has existed for more than 100 years, most stores are only 5-10 years old. This is the best managed company among the three drugstore chains and also among the most admired public companies in the US. The company has been run by executives with proven track records and hires the top graduates from universities. Due to its superior financial strength--S&P A rating-- and premium irreplaceable locations, properties with leases from Walgreens get the highest price per square foot and/or the lowest cap rate among the 3 drugstore chains. In addition, Walgreens gets flat rent or very low rent increases for 20 to 60 years. The cap rate is often in the low 5% to 6.5% range in 2012. Investors who buy Walgreens tend to be more mature, i.e. closer to retirement age. They are looking for a safe investment where it's more important to get the rent check than to get appreciation. They often compare the returns on their Walgreens investment with the lower returns from US treasury bonds or Certificate of Deposits from banks. Walgreens opened many new stores in 2008 and 2009 and thus you see many new Walgreens stores for sale. It will slow down this expansion in 2010 and beyond and focus on renovation of existing stores instead.

2) CVS Pharmacy: CVS Corporation was founded in 1963 in Lowell, MA by Stanley Goldstein, Sidney Goldstein, and Ralph Hoagland. The name CVS stands for "Consumer Value Stores". As of 2009, CVS has about 6300 stores in the US, mostly through acquisitions. In 2004, CVS bought 1,200 Eckerd Drugstores mostly in Texas and Florida. In 2006, CVS bought 700 Savon and Osco drugstores mostly in Southern California. And in 2008 CVS acquired 521 Longs Drugs stores in California, Hawaii, Nevada and Arizona for $2.9B dollars. The acquisition of Long Drugs appears to be a good one as it CVS did not have any stores in Northern CA and Arizona. Besides, the price also included real estate. It is also bought Caremark, one of the largest PBMs and changed the corporation name to CVS Caremark. When CVS bought 1,200 Eckerd stores, it formed a single-entity LLC (Limited Liability Company) to own each Eckerd store. Each LLC signs the lease with the property owner. In the event of a default, the owner can only legally go after the assets of the LLC and not from any other CVS-owned assets. Although the owner loses the guaranty security from CVS corporate assets, this author is not aware of any incident where CVS closes a store and does not pay rent.

3) Rite-Aid: Rite Aid was founded by Alex Grass (he just passed away on Aug 27, 2009 at the age of 82) and opened its first store in 1962 as "Thrif D Discount Center" in Scranton, Pennsylvania. It officially incorporated as Rite Aid Corporation and went public in 1968. By the time Alex Grassstepped down as the company's chairman and chief executive officer in 1995, Rite Aid was the nation's largest drugstore chain in terms of total stores and No. 2 in terms of revenue. His son, Martin Grass, took over but was ousted in 1999 for overstatement of Rite Aid's earnings in the late 1990s. Rite Aid is now the weakest financially among the 3 drugstore chains. In 2007, Rite-Aid acquired about 1,850 Brooks and Eckerd drugstores, mostly along the East coast to catch up with Walgreens and CVS. In the process, it added a huge long term debt and is the most leveraged drugstore chain based on its market value. The integration of Brooks and Eckerd did not seem to go well. Revenue from some of these stores went down as much as 20% after they change the sign to Rite Aid. In 2009, Rite-Aid had over 4900 stores and over $26 Billion in revenues. The figures went down in 2010 to 4780 stores and $25.53 billion in revenue. On January 21, 2009 Moody's Investor Services downgraded Rite Aid from "Caa1" to "Caa2", eight notches below investment grade. Both ratings are "junk" which indicate very high credit risk. Rite Aid contacted a number of its landlords in 2009 trying to get rent concession to improve the bottom line. In June 2009, Rite Aid successfully completed refinancing $1.9 Billion of its debts. In 2012, Rite Aid benefits from Walgreens contract problem with Express Scripts. Same store sales increased 2.2%, 3.2%, and 3.6% for January, February and March of 2012, respectively. Rite Aid is still losing money in fiscal year 2012 which ended in March 3, 2012. However, it is losing less, $0.43 per share in 2012 versus $0.64 per share in fiscal year 2011. The company expects better outlook in fiscal year 2013.

Things to consider when invested in a pharmacy

If you are interested in investing in a property leased by drugstore chains, here are a few things to consider:

1. If you want a low risk investment, go with Walgreens. In stable or growing areas, the degree of safety is the same whether the property is in California where you get a 5.5% cap or Texas where you may get a 6.5% cap. So, there is no significant advantage to invest in properties in California as the property value is based primarily on the cap rate. In 2012, the offered cap rate for Walgreens seems to come down from 7.5%-8.4% in 2009 to 5.5%-6.5% for new stores.

2. If you are willing to take more risk, then go with Rite-Aid. Some properties outside of California may offer up to 9% cap rate in 2012. However, among the 3 drug chains, Rite Aid has 10.5% chance of going under in 2010. Should it declare bankruptcy, Rite Aid has the option to pick and choose which locations to keep open and which locations to terminate the lease. To minimize the risk that the store is shuttered, choose a location with strong sales and low rent to revenue ratio.

3. Financing should be an important consideration. While the cap rate is lower for Walgreens than Rite Aid, you will be able to get the best rates and terms for Walgreens.

4. If you are not a conservative investor or risk taker, you may want to consider a CVS pharmacy. It has BBB+ S&P credit rating. Its cap rate is higher than Walgreens but lower than Rite Aid. Some leases may offer better rent bumps. On the other hand, some CVS leases, especially for properties in hurricane areas, e.g. Florida are not truly NNN leases where landlords are responsible for the roof and structure. So make sure you adjust the cap rate down accordingly. Some of the CVS locations have onsite Minuteclinic staffed by registered nurses. Since this clinic idea was introduced recently, it's not clear having a clinic inside CVS is a plus or minus to the bottom line of the store.

5. All 3 drugstore chains have similar requirements. They all want highly visible, standalone, rectangular property around 10,000 - 14,500 SF on a 1.5 - 2 acre lot, preferably at a corner with about 75 - 80 parking spaces in a growing and high traffic location. They all require the property to have a drive-through. Hence, you should avoid purchasing an inline property, i.e. not standalone and property with no drive-through windows. There is a chance that these drugstores may not want to renew the lease unless the property is located in a densely-populated area with no vacant land nearby. In addition, if you acquire a property that does not meet the new requirements, for example a drive-through, you may have a problem getting financing as lenders are aware of these requirements.

6. If the pharmacy is opened 24 hours a day, it is in a better location. Drugstore chains do not open the store 24 hours day unless the location draws customers.

7. Many properties may have a percentage lease, i.e. the landlord can get additional rent when the store's annual revenue exceeds a certain figure, e.g. $5M. However, the revenue used to compute percentage rent often excludes a page-long list of items, e.g. wine and sodas, tobacco products, items sold after 10 PM, drugs paid by governmental programs. The excluded sales revenue could account for as much as 70% of store's gross revenue. As a result, this author has seen only 2 stores in which the landlord is able to collect additional percentage rent. The store with a percentage rent is required to report its annual sales to the landlord. As an investors, you want to invest in a store with strong gross sales, e.g. over $500 per square foot a year. In addition, you also want to check the rent to revenue ratio. If the figure is in the 2-4% range, the store is likely to be very profitable so the chance the store is shut down is low.

8. It does not matter how good the tenants are, avoid investing in declining, e.g. Detroit and/or low-income areas or small towns with less than 30,000 residents within 5 miles ring. In a small town, it may be the only drug store in town and captures most of the market share. However, if a competitor opens a new location in the area, revenue may be severely affected. In addition, the tenant can always moves to a new location down the road when the lease expires since there is low barrier to entry in a small town. These properties are easy to buy now and hard to sell later. When the credit market is tight, you may have problems finding a lender to finance these properties.

9. Many properties have an existing loan that the buyer must assume. If you have a 1031 exchange, think twice about buying this property. You should clearly understand loan assumption requirements of the lenders before moving forward. Should you fail to assume the existing loan (assuming an existing loan is a lot more difficult than getting a new loan), you may run out of time for a 1031 exchange and may be liable to pay capital gain.

10. With few exceptions, drugstore chains do not own the stores they occupy for several reasons. Here are just a couple of them:

- They know the pharmacy business but don't know real estate. Stock investors also don't want Walgreens to become a real estate investment company.

- Owning the real estate will require them to carry lots of long term debts which is not a brilliant idea for a publicly-traded company.

11. About 10% of the drugstore properties for sale and typically CVS pharmacies require very small amount of equity to acquire, e.g. 10% of the purchase price. However, you are required to assume an existing fully-amortized loan with zero cash flow. That is, all of the rent paid by the tenant must be used to pay down the loan. The cap rate may be in the 7-9% range, and the interest rate on the loan could be attractive in the 5.5% to 6% range. Hence, the investor pays off the loan in 10 to 20 years. However, you have no positive cash flow. This requires you to come up with outside cash to pay income tax on the rental profits (the difference between the rent and mortgage interest). The longer you own the property, the more outside cash you will need to pay income taxes as the mortgage interest will get less and less toward the end. So who would buy this kind of property?

- The investors who have substantial losses from other investment properties. By acquiring this zero cash flow property, they may offset the income from the drugstore tenant against the losses from other investment properties. For example, a property has $105,000 of rental profits a year, and the investor also has losses of $100,000 from other properties. As a result, the combined taxable profits are only $5,000.

- The uninformed investors who fail to consider that they have to raise additional cash to pay income taxes.

Out of the Box Thinking

If you put too much weight on the S&P rating of the tenants, you may end up either taking a lot of risks or passing up good opportunities.

1. A Good location should be the key in your decision on which drug store to invest in. It's often said a lousy business should do well at a great location while the best tenant will fail at a lousy location. A Walgreens store that is closed down later on (yes, Walgreens closed 119 stores in 2007) is still a bad investment even though Walgreens continues paying rent on time. So you don't want to blindly invest in a drug store simply because it has a Walgreens sign on the building.


2. No company is crazy enough to close a profitable location. It does not take rocket science to understand that a financially-weak company like Rite Aid will make every effort to keep a profitable location open. On the other hand, a financially-strong Walgreens will need justifications to keep an unprofitable location open. So how do you determine if a drug store location is profitable or not if the tenant is not required to disclose its profit & loss statement? The answer is you cannot. However, you can make an educated guess based on the store's annual gross revenue which is often reported to the landlord as required by the percentage clause in the lease. With the gross revenue, you can determine the rent to income ratio. The lower the ratio, the more likely the store is profitable. For example, if the annual base rent is $250,000 while the store's gross revenue is $5M then the rent to income ratio is 5%. As a rule of thumb, it's hard to make a profit if this ratio is more than 8%. So if you see a Rite Aid with 3% rent to income ratio then you know it's likely a very profitable location. In the event Rite Aid declares bankruptcy, it will keep this location open and continue paying rent. If you see a Rite Aid drug store with 3% rent to income ratio offering 10% cap, chances are it's a low risk investment with good returns and the tenant will most likely to renew the lease. The weakness of corporate guaranty from Rite Aid is probably not as critical and the risk of having Rite Aid as a tenant is not really that significant.


3. Drug stores with new 25 years leases tend to sell at lower cap, e.g. 6-7% cap on new stores versus 8.0-8.5% cap on established locations with 5-10 years remaining on the lease. This is because investors are afraid that the tenants may not renew the leases. Unfortunately, lenders also have the same fear! As a result, many lenders will not finance drug stores with 2-3 years left on the leases. The fact that drugstores with new leases have a premium on the price means they have potential of 20% depreciation (buying new at 6% cap and selling at 7.5% cap when the leases have 8 year left). Some investors will not consider investing in drug stores with 5-10 years left on the lease. They might simply ignore the fact that the established stores may be at irreplaceable locations with very strong sales. Tenants simply have no other choices other than renewing the lease.