The truth about death and the angel.

I have wonder and watch people dying some do struggle some just seemed to be at peace and happy, if that is a word for dying. Because, deep down no one really wants to die and why because, we as human being we don’t know what is dying and most of all is really another side or dimension or place that we are in waiting to cleanse us from our sins from a lifetime. As a true devote Catholic, I have been taught that there is a place called purgatory which is where all the souls good and bad go to be cleanse and when ready they will be taken up to heaven or paradise and we will meet our maker GOD. Well, that is all good and I believe in purgatory, the only thing is that we people here on earth don’t pray for the dead how long will it take to leave purgatory, also what angel is responsible to take us to this place.

In my research physically, I have encounter that there is such angel or identity which aren’t able to see while the act of dying take place. Only, our soul is able to see and hear this angel but, there is another angel or identity which is also there to struggle for our soul. But, what I have research the only souls that really are taken by the fallen angel or demons whatever name you want to call it, are the souls that really want to go with them, and even so the soul has to account to GOD’s will at the end of time. GOD’s angel takes the souls comfort it and release a sense of peace which is when the dead person appears serene.  

Many people struggle with fear when they approach death, or even when they simply think about dying. The fear of death is so common, in fact, that it has a name: thanataphobia. A variety of research studies have shown that the fear of death is universal among human beings worldwide. People are afraid of the suffering they may have to endure when they die, and they fear what will happen to them after death, wondering if they may go to hell or even not exist at all anymore.

But what if there’s nothing to fear about death after all? What if there is one or even a group of angels who comfort people when they’re dying and escort their souls into an afterlife?

 Throughout recorded history, people from various religious perspectives have spoken of an “Angel of Death” who does just that. Many people from all walks of life who have had near death experiences have reported that they’ve encountered angels who helped them, and people who have witnessed loved ones die have also reported encountering angels who gave their dying loved ones peace. Sometimes dying people’s last words describe the visions they’re experiencing. For example, just before famous inventor Thomas Edison died in 1931, he remarked: "It is very beautiful over there."

The Angel of Death’s personification as an evil creature wearing a black hood and carrying a scythe (the Grim Reaper of popular culture) originated from the Jewish Talmud’s descriptions of an evil Angel of Death (Mal'akh ha-mavet) who represents the demons associated with the fall of mankind (one consequence of which was death). However, the Midrash explains that God does not allow the Angel of Death to bring evil to righteous people. Also, all people are bound to encounter the Angel of Death when it’s their appointed time to die, says the Targum (the Aramaic translation of the Tankah), which translates Psalm 89:48 as: "There is no man who lives and, seeing the angel of death, can deliver his soul from his hand."

The Muslim Qur’an also mentions an Angel of Death: "The Angel of Death who is charged with taking your souls will take your souls; then you will be returned to your Lord." The Hadith tells a story that illustrates how reluctant people can be to see the Angel of Death when he comes for them: The Angel of Death was sent to Moses and when he went to him, Moses slapped him severely, spoiling one of his eyes. The angel went back to his Lord, and said, you sent me to a slave who does not want to die.  

The Christian Bible doesn’t name one specific angel as the Angel of Death. But it does say that angels are "all ministering spirits sent out to serve for the sake of those who are to inherit salvation" (Hebrews 1:14) and makes it clear that death is a holy event for Christians ("Precious in the sight of the Lord is the death of his saints," Psalm 116:15), so in the Christian view it’s reasonable to expect that one or more angels will be present with people when they die.

The Buddhist Tibetan Book of the Dead (also known as the Bardo Thodol) describes how people who aren’t yet ready to enter God's presence when they die may find themselves in the presences of bodhisattvas (angelic beings) after death. Such bodhisattvas may help and guide the deceased souls in their new state of existence.

Accounts of angels comforting dying people abound from those who have watched loved ones die. When their loved ones are about to pass away, some people report seeing angels, hearing heavenly music, or even smelling strong and pleasant scents while sensing angels around them. Those who care for the dying (such as hospice nurses) say that some of their patients report deathbed encounters with angels.

 Caregivers, family members, and friends also report witnessing dying loved ones talk about or reach out for angels. For instance, in his book Angels: God’s Secret Agents, Christian leader Billy Graham writes that immediately before his maternal grandmother died, "the room seemed to fill with a heavenly light. She sat up in bed and almost laughingly said, 'I see Jesus. He has his arms outstretched toward me. I see Ben [her husband who had died some years earlier] and I see the angels.”

When people die, angels may accompany their souls into another dimension, where they'll live on. It may be just one angel who escorts a particular soul, or it may be a large group of angels who make the journey alongside a person’s soul.

 Muslim tradition says that the angel Azrael separates the soul from the body at the moment of death, and Azrael and other angels who help him accompany it to the afterlife.

Jewish tradition says that there are many different angels (including Gabriel, Samael, Sariel, and Jeremiel) who may help dying people make the transition from life on Earth to the afterlife.

 Jesus Christ told a story in Luke chapter 16 of the Bible about two men who died: a rich man who didn’t trust God, and a poor man who did. The rich man went to hell, but the poor man got the honor of angels carrying him into an eternity of joy (Luke 16:22). The Catholic Church teaches that the archangel Michael escorts the souls of those who have died to the afterlife, where God judges their earthly lives. Catholic tradition also says that Michael may communicate with dying people near the end of their lives on Earth, helping them find redemption before they pass away.

As per the bible our souls in Matthew 10:28 “And do not fear those who kill the body cannot kill the soul. Rather fear him who can destroy both soul and body in hell. Ecclesiastes 12:7, and the dust returns to the earth as it was, and the spirit returns to GOD who gave it. Ezekiel 18:4, behold, all souls are mine; the soul of the father as well as the soul of the son is mine: the soul who sins shall die. There are words which are also, fearful and hard. GOD is merciful and does allow us to repent even in death. As, I read and search in genesis 2:7 it reads then the Lord GOD formed the man of dust from the ground and breathed into his nostrils the breath of life, and the man became a living creature. Very last in Corinthians 15:51-58, behold! Tell you a mystery. We shall not all sleep, but we shall all be changed, in a moment, in the twinkling of an eye, at the last trumpet. For the trumpet will sound, and the dead will be raised imperishable, and we shall be changed.

In my experience, life takes us in all different aspect from being happy to despair, from being a good person to someone that does not understand how in this world so many bad things happen to good people. However, I am not the best person to answer this question. However, I do know that there is a GOD, and I had the privilege to have seen and talk to a good, spiritual being called Uriel. I thought for years that I was going insane and I blurt him out of my life. But, indeed there are angels and archangels that are sent by GOD to oversee us and to help us in time of turmoil or despair. In those times, is when you know that I am not alone and there is someone watching me and whispering in my ear or a simple thought of what to do or say? When my dad passed away a year and half ago, I was there and I tried physically to revive him but, when those 30 minutes pass and my dad was not responding, I knew that he was gone and there in the room was a serene calm.

Something, did whisper tell your father to go towards GOD, tell him now. Such horrible to say but, I did struggle to say those words because; I did not want my father dead. But, the urgency was so great that I did tell my father “Dad, go to GOD, go to GOD.” His face that was in pain, and almost blue, became calm, peaceful somewhat happy, hard to say but the truth be told. I did not see angel nor did I hear music or a high pitch noise, all I heard was just that constant thing telling me to tell my dad to go to GOD that it was okay. One thing I have to say about my dad he was deeply afraid of dying and he battle death in several occasion since, 2005 and I have manage to save his life by means of my medical knowledge and from my colleagues from the hospital that they are the true earth angel saving my dad from the death.

I have witness death before in my line of work and it has not been a pleasant experience and for that I did stay away for a long time and focused myself in human services and being a psychologist. Which took me to a different route in life, dealing with the mental mind and its behaviors and feelings which that too were a challenge itself, the mental ill don’t think of death and most of the time they wish death upon themselves of others. I have seen evil in some which inside of the depth of their soul was dark and only evil spoke to them and that for me was the angel of evil not death the angel of death comes only when the time I or you have set with GOD, when we decide to come to this earth. We choose are family, friends, enemies, and countless people that cross our life.  As a devote Catholic I believe that Saint Michael has four main roles or offices. One of his roles is that he is the Christian angel of death.

In this short summary of the angel of the death, I write that I have experience of hand when death comes, and also how we are able to receive it as the human being alive, seeing death knocking at our doors. We may not want to see it or even talk about it but, the fact of the matter that there is a GOD, and he always sends his angels to watch, prepare us, for the brunt brief moment of our lives and help those that are living us for good.  When that happens please, seek immediately your spiritual senses, because GOD is always there to help us.

Thank you, for your review and time.

Dulce M. Matamoros, MS, PhD

Perseverancia

-Una sucesion de pequeñas voluntades consigue un gran resultado.
-No have falta confiar para emprender, ni tener exito para perseverar.
-Los espiritus atrevidos se encaraman prontamente a las cimas.
-El caracter es la suma de las tendencias para actuar en cierta direccion.
-El otoño da frutos; de verano es hermoso por sus frutos; la primamevera trae flores; y el invierno nos conforta con el fuego.
-Todo los hombres y mujeres pueden caer en un error, pero solo los necios perseveran en el.
-Jamas el esfuerzo desayuda a la fortuna.
-La constancia no esta en empezar sino en perseverar.
-Nuestra recompensa se encuentra en el esfuerzo y no en el resultado. Un esfuerzo total es una victoria completa.
Gracias, Dulce

Angeles y Arcangles, Guerrero de Dios, en la Tierra.

Después de la Santisima Trinidad, Padre, Hijo y Espíritu Santo, ellos Son los reyes del Universo. No existe otro poder tan grande como el de los Arcángeles, son los representantes directos de Dios. Son llamados en otras culturas, los constructores del Orden Universal, los Arquitectos del Universo, Los Siete Iluminados, etc., Tienen diferentes misiones, y definidos son sus reinos.

La palabra Arcángel se compone de un elemento prefijal que entra en la formación de palabras de origen griego con el significado de jefe, ser superior; archimandria en su adaptación romance tambien toma la forma arce, arci, archi, arc, arz, arcediano, arcipreste, arcángel, arzobispo, o bien la forma arqui: arquitectura, arquidiócesis. La palabra ángel, deriva tambien del griego "aggelo" por lo que la conjunción del elemento prefijo y la palabra ángel resulta Arcángel, el cual significa "príncipe", "principal", "ser superior", o Príncipe de los Ángeles
Los augustos Siete Iluminados por la luz de la Trinidad. Fueron ellos quienes elaboraron los mundos a las ordenes de Dios Padre. Son los Siete Misteriosos que todas las culturas mencionan con diferentes nombres. Se los denomina en India Los Siete Hijos de Aditi, tambien en otros sitios de oriente son los llamados Siete Espíritus en el Sol. En el Cristianismo y el Islam son los Siete Grandes Arcángeles.
Si bien son entidades de gran poder en espíritu, tienen a su cuidado el orden de los planetas y estos constituyen su reino, pues los 7 grandes planetas están regidos por ellos. Los planetas serian la forma exterior de su poder y algunos componen nuestro sistema solar. Pero la naturaleza real es que son los Poderosos Hijos de Dios.
Antiguamente, se reconocía que alrededor de los 7 Poderosos Hijos de Dios giraban las 12 Jerarquías Creadoras o los 12 grandes genios, que son las 12 Constelaciones del Zodiaco, de allí el basamento de la astrología mística.
El mundo fue evolucionando y cambiando sus concepciones duales de cuerpo y espíritu para quedarse solamente con lo que la ciencia moderna puede ofrecer y que es una concepción materialista carente de espíritu, por eso hoy en día no puede compararse la ciencia con la religión, ni enfrentarlas, buscarle el sentido si no se toma en cuenta que la ciencia en su afán de progresar desposeyó de todo sentido espiritual a toda cosa que estudiara. La ciencia no tiene espíritu, ese es el gran error de nuestros días. Tratar de encontrarle una explicación puramente racional a ciertos hechos espirituales es desnudar verdades para quedarse con un elemento vacío, siendo que es el espíritu que inunda e infunde poder al objeto estudiado o visto.
Por muchos años no se tomo en cuenta la verdad de los Ángeles, la historia reciente en películas e historias de ciencia ficción los evoco nuevamente y revivió su fe, pero tambien agiganto ciertas fantasías y alimento la imaginación de las personas con datos incorrectos y se trato de transferir ciertas dudas humanas a la dimensión angelical, como por ejemplo decir que los ángeles no tienen sexo, o que son todos femeninos o todos masculinos. En verdad, hay cuestiones que por simple deducción podrían asimilarse muy simplemente cuando no se conoce directamente y por experiencia propia una realidad.

Mirar el mundo desde el punto de vista tan solo material o ver solamente el aspecto físico del fenómeno que es el universo sin tomar en cuenta el espíritu que los anima a ver, es un fracaso para el conocimiento del ser humano que egoístamente cree ser la única entidad animada de alma para reconocer su alrededor, Si se tomara en cuenta que el espíritu esta presente en todo, entonces el saber adquiriría un matiz mas claro y el camino seria mas recto para llegar a los misterios mas profundos a los que el humano siempre deseo llegar, pero si cuando llegue a ciertos umbrales los despoja de su sentido espiritual y cree que por haber descubierto algo antes inexplicable, ahora se convierte en algo mas de su dominio exclusivo, entonces, sus pasos ya no le conducen adelante, sino que vuelve hacia atras una vez mas, pues esta dicho que el ego no triunfara sobre el espíritu. Mientras el ego humano quiera montarse sobre el mundo como su regidor, no habrá evolución posible ni tampoco la rueda girara a su favor.
Los santos no tienen ego, pero no carecen de fuerza o personalidad. Su presencia se hace sentir en todo momento, tanto en la tierra, como aun después de haber partido.
Los Arcángeles están cerca y siempre lo han estado. Es hora de mirar el cielo, sea de día o de noche, ellos están allí, entre las nubes o en las estrellas, sus espíritus brillan reflejando la luz divina. Orar a Dios es una perfecta manera de conocer a los ángeles.
Mi arcangel que siempre a estado a mi lado y no me avenguenza decirlo de una vez por toda es Uriel, que significa "El fuego de Dios". Representes la fuerza todopoderosa del espirity de la vida. Su atributo es una llama de fuego que represente su mision de despertar la conciencia de los seres humanos con el fuego de la verdad. Es tambien el arcangel que protege a los nacidos en el mes de Septiembre. Peude llemar un libro o pergamino. Este atributo representa su papel de observador divino de Nuestro Dios. Lleva la cuenta de los sentimientos, pensamientos y actos de los seres humanos durante su recorrido por la vida cotidina. 
A Uriel se le presente vestido de rojo o anaranjando y dorado, colores relacionados al fuego y a sus cualidades de transformacion, destruccion del mal e iluminacion espiritual. Son ademas los colores del so., el astro con el que John Milton aosica a Uriel en su obra Paraiso perdido.
Yo lo veo con colores dorados, carmelitas, y vino. Para aquellos que creen que estoy mal de la cabeza no importante para mi lo que cuenta es mi calma
Pero Dios es misericordiso, y tiene buenas intensiones para nosotros pero el ser humano no lo ve lo que esta al frente de sus ojos porque prefiere ver el mal en todo momento y personas. El mal, es un tentacion que Dios nos pone para ver si uno es digno de su misericordia y ponda hacio nosotro. Con esto digo y expreso que so Catolica, Aspotolica y Romana de Fe. Adoro a Dios, Jesus y Maria Santima y no creo que hay un infierno, si se que esta aqui en la tierra y nosotros tenemos que ser los que tomemos la decision de hacer el bien y no mires a quien. Para mi la paz y la serenidad me la un solo luegar en la tierra ese lugar es mi experiencia religiosa LA GRUTA DE LA VIRGEN DE LOURDES, en Lourdes, Francia. Para mi este lugar es mi refugio y se que ahi esta Dios, la Virgen y toda la corte celestial. Solamente, tienes que tener la mente clara, que nada te perturbes y mira hacia la gruta y encontraras lo que encuentras. Si los angeles estan a tu lado desde el dia que tu y yo decidimos de venir a la tierra por que aqui esta tu escuela y tenemos que aprender lo bueno y malo.
Los angeles nos ayudan principalmente en nuestra vida espiritual, aunque tambien nos protegen de los peligros fisicos cuando Dios los dispone asi, como en el caso de Daniel y San Pedro. En estas dos historias vemos como los angeles ayudan a Daniel y a Pedro cuando estaban presos y en peligro. Fijense que no estaban presos por haber hecho algo malo, sino por haber hecho el que Dios queria de ellos. Ojos, los angels buenos estan siempre en la presencia de Dios, pendiente de hacer todo lo que Dios les diga.
Ellos nos ayudan luchar contra loa angeles malos que los hay, que en la tierra los conocen como los demonios. Yo sinceramente, no les tengo nada de miedo por que tengo a Dios, presente dia y noche y un arcangel Uriel que me dices o me deja saber de sus presencia. Y en realidad son cobarde y intenta atrapar a uno, o para mi en mis sueños, y en una sola ocasion en carne con un pobre adolescente. Cuando un demonio nos tienta para que seamos malos o hagamos algo malo, el angel de la guarda de uno nos inspira ideas para ser buenos y saber orar que eso a los demonios no les gusta.
Buenos, espero que esta breve informacion sobre los angeles, arcangeles, la Virgen Maria y sobre todo Dios, les informe que la vida es una sola y hay que aprender y saber lo que vamos despues de este vida. Por que hay mas despues que el cuerpo fisico termina su funcion terranal.
Un saludos a todos los que leen mi articulos.
Dulce

Side effects of Lithium and Signs of Toxity.

Major side effects include nausea, diarrhea, vomiting, fine hand tremor, sedation, muscular weakness, polydypsia, edema, weight gain and a dry mouth. Adverse effects from chronic use may include leukocytosis (reversible upon discontinuation of lithium), hypothyroidism and goiter, acne, psoriasis, terarogenesis (first trimester, although the risk is very low), nephrogenic diabetes insipidus (revesible), and kidney damage.

Signs of toxicity include lethargy, ataxia, slurred speech, tinnitis, severe nausea/vomiting, tremor, arrhythmias, hypotension, seizures, shock, delirium, coma and even death. Since the toxic range is near to the therapeutic range, blood levels and adverse effects must be monitored closely. In addition, a number of other clinical lab test should be conducted at the beginning of treatment and periodically thereafter.

Clinical Lad Test for Patients Taking Lithium:
-NA (Sodium)
-Ca (Calcium)
-P (Phosphorus)
-EKG
-Creatinine
-Urinalysis
-Complete CBC
-Thyroid battery with TSH

Common Treatment Errors to Avoid.

-Lithium very toxic thus warrants close monitoring (especially in suicidal patients. Note: Suicide occur frequently not only in depressed but also manic patients). Acute dehydration can also result in toxic lithium levels.
-Poor compliance
-Discontinuation: Note: Bipolar patients need life-long treatment to avoid relapse. Patient or physician/physician assistant/ARPN, initiated discontinuation can and does result in frequent relapse. And, subsequent episodes often are more severe and may become treatment-resistant. If discontinuation must occur, it is strongly recommended that it be done gradually or a period of 6 weeks.

Dulce M. Matamoros Columbie, PhD, CMHP, PA.

Dejar de buscar y empezar a sentir....

22 de Enero, 2013

Por que digo esto, simplemente es que en nuestra vidas cotidianas siempre estamos pensando que pasara mañana y si tendre para el futuro.

Nos pasamos la vida buscando, ya se bienes materiales o respuestas espirituales. Pero buscar presupone que hay algo que no esta aqui ahora, lo que resulta frustante. El secreto es que no hay nada que perseguir.

La vida es un fin en si misma, una gran ofrenda que hay que aceptar. Vivir el presente nos permitira deleitanos a cada instante.

Ire a la raiz, significa que nunca nos parece suficiente. Lo que esta sucediendo ahora mismo en el momento presente, no suficiente para uno. Nos pasamos al vida buscando, ahnhelando y deseando otra cosa, algo mas, algo distinto a lo que ahora ocurre. Buscando algo en el futuro que nos satisfaga, no complete y nos salve. Buscando respuestas, nos asaeteamos a preguntas hasta volvernos locos.

Jamas hemos sabido descansar aqui, relajarnos completamente en lo que esta ocurriendo. Estamos sometidos a impulsos que nos empujan hacia un momento futuro en el que suponemos que las cosas iran mejor. Y, como nuestra atencion esta tan atrapada en el futuro como en su reflejo, el pasado, lo que ahora ocurre acaba reducido a un medio para alcanzar un fin, unsimple momento en una larga secuencia compuesta por muchos otros momentos. Y, como nunca estamos contentos con esto, siempre esperamos un futuro mejor.

Eso es, precisamente, lo que llamo busqueda. Y, en este sentido, todos somos buscadores, porque todos estamos buscando alfo. La busqueda se expresa de muchas formas diferentes. En el llamdo mundo material, buscamos dinero, felicidad, estatus, relaciones mejores y mas fuerte. Cosas que nos hagan sentirnos mas seguros. En el mundo material es importante saber quienes somos, hacer que nuestra vida funcione, alcanzar nuestro objetivos y satisfacer nuestra ambiciones. La busqueda se inicia para ser alguien en el mundo, hacer algo con nuestra vida antes de morir.

Por eso el mundo material suele ser tan insatisfactorio y nos orientamos tambien hacia las enseñanzas espirituales. Entonces, el objetivo cambia. Ahora queremos despertar e iluminarnos. Ya no queremos un coche nuevo sino acceder a un estado alterado de conciencia. Ya no queremos una nueva relacion sino la beatidud permanente. En lugar del exito mnundano, queremos la iluminacion, perder algo llamado ego y trascender algo llamado mente.

Pero la busqueda espiritual, como la material, sigue siendo una busqueda. Se trata del mismo movimiento mental, ose orientarse hacia un futuro inexistente. Y lo que se halla en la raiz de toda busqueda es el "YO." Quiero tner un millon de dollars o euros, en el banco y tambien quiero tener, para mi, la iluminacion espiritual. Yo, Yo, y mas Yo! En el nucleo de toda busqueda se asienta la sensacion de ser una entidad separada de la vida, separada de esto, de los demas, del mundo y la fuente. En el nucleo de toda busqueda se halla la sensacion de no estar completos, y de estar fragmentados, perdidos, alienados y, en suma, alejados de nuestro verdadero hogar.

El yo separada siempre repite el mismo mantra "No es suficiente," y esta sensacion de carencia esta tan profundamente arraigada que impregna toda experiencia, es como la sensacion de no estar en casa. En algun momento estuvimos en casa, pero ya no. Y, tanto que individuos separados, vivimos angustiados por el recuerdo difuso de una intimidad tan proxima que ni siquera podemos nombrarla.

Es como cuando, de niños, nuestra madre nos dejaba solos en la habitacion. Nos veiamos desbordados por una añoranza y una nostalgia que, pese a ser inxeplicables, se dirigian al nucleo mismo de nuestro ser. Esta nostalgia de ser una persona separada. Pero no es nuestra madre lo que añoramos. Lo que queremos es regresar a casa .Regresar, en suma, a lo que eramos antes de que todo esto comenzase.

Donde hay separcion tambien hay nostalgia, la mostalgia de acabar con la separacion, de curar la division, de poner fin a la sensacion de contraccion y de expandirnos de nuevo en la inmensidad. Jamas hemos estado separados de la totalidad. Lo unico que existe es el sueño de esa separacion. Pero siempre a pesar de ello, hemos estados buscando el camino de regreso a nuestro hogar.

Bueno, en realidad la busquedad espiritual siempre ha estado arraigada en el rechazo del momenteo presente, la busqueda de la vida siempre ha sido un movimiento de alejamiento de lo que es.
Si observamos a un niño pequeño, veremos su capacidad de sorpresa ante la vida tal cual es. Pero los adultos nos hemos alejado de esta inocencia infantial, nos convertimos en personas serias y perdidas en la busqueda, esforzandonos en tratar de ser alguien, en triunfar, en que todo sea perfecto. Pro eso siempre estamos tan agotados. Pero tras es busqueda, no obstante, todos somos niños y seguimos viendo el mundo por vez primera. Lo que ocurre es que estamos perdidos en el juego de devenir. Eso es todo lo que en realidad yo pienso de la vida y lo que transcurre en la vida.

^j^
Mil, gracias y no dejan de vivir la vida por lo mas pesada que nos venga.
Dulce Maria Matamoros Columbie, PhD.

Vivir Con Toda La Intensidad Posible. "Citas"

Revista Mente Sana y Saludable
Octobre 5, 2012
Recopilacion de Dulce M. Matamoros Columbie, Ph.D.

Citas simplemente de la vida cotidiana.

-La vida no es otra cosa que el tiempo convertido en experiencia propia.
- La gloria se da solo a aquellos que la han soñado siempre.
-Ningun camino facil te llevara a algo que merezca la pena.
-La felicidad sera constante cuando aprendas a disfrutar de cada momente de tu vida.
- No es facil decir no pero es mejor decir si para ser positivo en la vida.
-Coge el dia presented y fiate lo menos posible del mañana.
-Viver como si mañana no este, solo vale el presente por que es solo que tenemos al momento.
-No hay bien que no venga.
-Es un error vivir el presented como si solo fuera el prefacio de la bella novela del porvenir. El presente se ha de usar y gozar.
-No hay que mori por el otro sino vivir para disfrutar juntos.
-Siempre usa la imaginacion a tu favor no en contra.
-Expectativas siempres son positivas, nunca negativas.
-Meditar para cultivar la compasion en ti, en otros.
-Una sonrisa es gratis no espere que te la devuelva.
-Es facil decir no quiero discutir.
-Ten paciencia con todas las cosas, pero ante todo contigo mismo.

http://nc-cm.org/expertdulcecolumbie.htm

http://www.alltherapist.com/dulce-matamoros-columbie.html

OUR BRAIN IN SECTIONS:

OUR BRAIN IN SECTIONS:

By: Dulce M. Matamoros Columbie, PhD, PA.

Neurology Now; Retrieved 8/2/12.

Cerebral Cortex and its function: The outermost layer of the cerebral hemisphere which is composed of gray matter. Cortices are asymmetrical. Both hemispheres are able to analyze sensory data, perform memory functions, learn new information, form thoughts and make decisions.

Left Hemisphere of the brain: Sequential Analysis: systematic, logical interpretation of information. Interpretation and production of symbolic information: language, mathematics, abstraction and reasoning. Memory stored in a language format.

Right Hemisphere of the brain: Holistic Functioning: processing multi-sensory input simultaneously to provide "holistic" picture of one's environment. Visual spatial skills. Holistic functions such as dancing and gymnastics are coordinated by the right hemisphere. Memory is stored in auditory, visual and spatial modalities.

Corpus Callosum: Connects right and left hemisphere to allow for communication between the hemispheres. Forms roof of the lateral and third ventricles. Damage to the Corpus Callosum may result in "Split Brain" syndrome.

Frontal Lobe: Cognition and memory.Prefrontal area: The ability to concentrate and attend, elaboration of thought. The "Gatekeeper"; (judgment, inhibition), personality and emotional traits.

Movement: Motor Cortex (Brodman's): voluntary motor activity.

Premotor Cortex: storage of motor patterns and voluntary activities.

Language: motor speech

Impairment of recent memory, inattentiveness, inability to concentrate, behavior disorders, difficulty in learning new information. Lack of inhibition (inappropriate social and/or sexual behavior). Emotional lability. "Flat" affect. Contralateral plegia, paresis, expressive/motor aphasia.

Parietal Lobe: Processing of sensory input, sensory discrimination, body orientation.Primary/ secondary somatic area.Inability to discriminate between sensory stimuli. Inability to locate and recognize parts of the body (Neglect).Severe Injury: Inability to recognize self, disorientation of environment space, inability to write.

Occipital Lobe: Primary visual reception area. Primary visual association area: Allows for visual interpretation.  Primary Visual Cortex: loss of vision opposite field. Visual Association Cortex: loss of ability to recognize object seen in opposite field of vision, "flash of light", "stars". 

Temporal Lobe: Auditory receptive area and association areas. Expressed behavior, language: Receptive speech. Memory: Information retrieval. Hearing deficits, agitation, irritability, childish behavior, receptive/ sensory aphasia.

Limbic System: Olfactory pathways: Amygdala and their different pathways. Hippocampi and their different pathways. Limbic lobes: Sex, rage, fear; emotions. Integration of recent memory, biological rhythms. Hypothalamus.

Basal Ganglia: Subcortical gray matter nuclei. Processing link between thalamus and motor cortex. Initiation and direction of voluntary movement. Balance (inhibitory), Postural reflexes.Part of extrapyramidal system: regulation of automatic movement. 

Diagnosing Alzheimer Disease in Long-term Care Facilities

Dulce M. Matamoros, MS, PhD, PA.

July 2012

In 2011, new recommendations from the National Institute on Aging and the Alzheimer's Association created a new landscape for clinicians, patients, and families to explore Alzheimer disease (AD) Progress over the last 20-plus years, since the 1984 guidelines⁴ reorganized our way of thinking about AD, has enabled us to segment the larger universe of "related dementias" into well-defined entities. It has also given us both drug and nondrug therapies to treat the disease, at least symptomatically. In addition, we are offered preclinical scenarios and predisease states based on new biomarkers and neurocognitive studies that have helped to define the entity known as "mild cognitive impairment.

Progress in our understanding of AD has led to the creation of this 3-pronged approach to describing the disease. Biomarkers -- including neuroimaging, functional imaging, and target histochemistries (such as beta amyloid plaques and neurofibrillary tangles) -- have allowed for this redefinition^. Moreover, we have begun to better understand clinical disease states by recognizing the underpinnings of illness, including the preclinical disease burden, as well as multiple risk factors, including genetic contributions. Several compounds are now available to mark amyloid accumulation or identify neuronal degeneration. Techniques for measuring brain volume have vastly improved over the past decade, allowing us to identify neuronal loss as the most critical feature of the symptomatic disease.

As the population ages, the risk rates for AD climb, by age 85, the prevalence rate reaches nearly 50%, and patients with AD live on average an additional 7 to 10 years after diagnosis. The public health and economic implications are staggering. Nonetheless, our approach to AD and our desire to diagnose and treat it has had mixed results. More than 5.3 million Americans had AD in 2011.¹⁶ Even as far back as 2007, it was estimated that 2.55 million people were diagnosed and treated, approximately 500,000 were diagnosed but received no treatment, and almost 2 million remained undiagnosed. Although there are multiple reasons for these lapses, sophisticated screening and diagnostic testing are available but underused, even in long-term care (LTC) environment.

The Minimum Data Set, Version 3.0 (MDS 3.0), released almost 2 years ago, was significantly updated to better reflect the clinical condition of LTC-facility residents with AD, as well as their needs, expressed in resident interviews with clinicians. Many of the assessment instruments originated in clinical practice, including the importation of the Patient Health Questionnaire-9 (PHQ-9) for mood assessment. The MDS 2.0 assessment for cognition was rarely used for clinical care and decision-making. It was replaced by the Brief Interview of Mental Status (BIMS).  Although the BIMS is not a common outpatient tool for screening, it does an admirable job in the nursing home. The BIMS assesses the resident's attention, orientation, and ability to register and recall new information. Addressing these issues is part of the rationale for the Centers of Disease Control and Prevention's (CDC's) Health-Related Quality of Life initiative and has clinical and care-planning utility. LTC providers should be mindful of the BIMS and incorporate their findings, including mood and behavioral assessments, to better serve the resident.

AMDA last updated its clinical practice guideline (CPG) for dementia in 2009. The guideline focuses on resident health throughout the LTC continuum, including assisted living. As with all AMDA CPGs, it has sections on recognition, assessment, treatment, and monitoring. Treatment of the behavioral manifestations of AD is fully reviewed, including drug and nondrug interventions. The "triggers" of the behavioral manifestations of AD are also reviewed. Another CPG is devoted to delirium; however, in the context of dementia screening, delirium has long been considered a medical emergency and must be dealt with first. The CPG for delirium contains a detailed discussion of the risks and benefits of prescribing atypical antipsychotics.

Clinical guidelines have never recommended widespread screening for AD, and this remains the position of the US Public Health Service. The difficulties arise in screening a younger population with lower risk rates than a more elderly population with significantly higher risk rates. At present, no screening measure has been tested in the general population from age 65 forward to determine incidence and prevalence of AD.  One study suggested that screening was not valuable -- even in an internal medicine practice -- for patients who had already identified their need for healthcare.  Screening tests perform better when the population being tested is at risk. A screening measure works best when there is a high incidence and prevalence of disease to begin with. To assist the primary care provider, the Alzheimer's Association has outlined 10 warning signs of AD and formulated a checklist that explains the signs and lists typical age-related changes for comparison.

In LTC environments, it is important to ensure a correct diagnosis at the time of admission. However, recently hospitalized patients transferred to LTC who present with delirium may take 2 to 5 months or longer to recover from their clouded sensorium before an underlying cognitive deficit can accurately be identified. Altered mental states are addressed in 2 separate AMDA CPGs: one on delirium and another on depression in the LTC setting. Clinicians need to sort out these problems to the best of their abilities so that the specific disorder can be addressed appropriately. Depression is often prevalent in patients with early dementia who have preserved insight. Even in the nursing home, a sense of loss can cause depressive symptoms that will worsen the clinical status relating to dementia. Moreover, patients entering the nursing home often have established functional and behavioral problems, which may evolve over time.

Once delirium and depression have been ruled out, other causes of dementia can be addressed and appropriate treatment initiated. Of importance, patients should not receive acetylcholinesterase inhibitors if they do not have AD. Patients taking an acetylcholinesterase inhibitor without a diagnosis of AD should be evaluated for diagnosis, and if AD is not responsible for their symptoms, the acetylcholinesterase inhibitor should be discontinued. This is one situation where the off-label use of drugs to treat non-AD dementia has been tested and found ineffective.

The importance of diagnostic disclosure is that it provides the patient and family with a starting point for care planning. Frank discussions reduce uncertainty, provide information on the disease process, and help with staging and healthcare needs. Early communication allows families and practitioners to initiate and maintain appropriate therapies and establishes realistic treatment expectations. This also encourages planning to address financial, legal, and medical issues. With a dementia diagnosis in place, such a discussion also provides a framework for consideration of housing options and environmental supports and for developing a timeline for crossing from independence to dependence based on cognitive capacities that are preserved or lost as the disease progresses. The opportunity to address environmental changes that would benefit the patient is also touted as important in the National Prevention, Health Promotion and Public Health Council's National Prevention Strategy.

Our reluctance to pursue AD is related more to our perceived inability to treat the disease than to the sensitivity and specificity of diagnostic testing available today.^[  Among Medicare beneficiaries, up to 13% aged 65 years and older have AD and other dementias. In 2009, 68% of all nursing home residents had some degree of cognitive impairment, including 27% who had very mild to mild cognitive impairment and 41% who had moderate to severe cognitive impairment. In 2011, 47% of all nursing home residents had a diagnosis of dementia recorded in their nursing home records. Families advocate for a diagnosis, and about half of our patients welcome an opportunity to advance their understanding of AD as well. However, clinicians are reluctant to engage in such discussions because they are time-consuming, with little perceived benefit in making a diagnosis sooner rather than later.

We must acknowledge that very little has come from 30 years of AD research with regard to controlled trials of both drug and nondrug interventions. Experienced clinicians should know that the acetylcholinesterase hypothesis has been with us for over 30 years and that 3 drugs that impact acetylcholine breakdown are approved for AD therapy: donepezil, galantamine, and rivastigmine. These drugs have more utility in the early stages of disease, when we generally see cognitive decline, with modest effects in the middle or functional stages of disease, and little evidence to support the behavioral modification of AD. The glutamate receptor antagonist memantine is approved for patients with moderate to severe AD. Little information is available about the effects of nondrug interventions for patients with AD. As part of its Effective Health Care Program, the Agency for Healthcare Research and Quality (AHRQ) has conducted a systematic review of the effects of various settings and interventions in LTC on residents with dementia. The AHRQ particularly examined characteristics of care facilities including such things as organizational characteristics (population, staffing, etc), and care structures and processes. The agency's findings, including the effects of nondrug interventions and care facility characteristics, will be published later in 2012.

Patients and families often consider a diagnosis of AD a matter of black and white. This is not the case: a patient will retain as well as lose competencies. Preserving what a patient can still do -- even in a skilled nursing facility or an assisted living center -- is where much of our effort should be directed. A patient-centered approach focuses on the glass being half full, not half empty. Quality of life is measured by how well patients enjoy their lives and the environment around them, not by the frustrations that are a constant reminder of what might have been lost. What remains should be celebrated and will affect a resident's well-being.

Establishing a diagnosis allows a family to plan for the future. In this way, the number of care transitions can be reduced, better decisions can be made, and retained abilities can be better preserved. The fewer environmental transitions our elderly patients make once a diagnosis is established, the better off they generally are. This includes limiting hospitalizations, reducing hand-offs among family members, and eliminating unnecessary moves from home to an assisted living facility, memory care unit, or nursing home, when some of these steps are unlikely to be of benefit. Reducing the impact of losing a spouse, recovering from an injury, or having an intercurrent medical issue reduces the patient's ability to regain his or her former level of function. Minimizing transitions is now a goal. This philosophy of care affects a patient's well-being, especially when providers consider the patient's physical environment, the organization of the LTC facility in which the patient resides, and the psychosocial needs of the patient.

In up to 80% of cases where dementia is diagnosed, given the appropriate age of the patient and a history of disease progression that spans 2 to 3 years, the underlying cause is AD. When in doubt, confirmation that the patient has no other significant medical illnesses (such as Parkinson disease, cardiovascular disease, history of stroke) causing the decline, plus psychometric testing, use of Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR) criteria (Table), and MRI, should clinically confirm an AD diagnosis.^[59] We must be mindful not to fall into the trap of ordering cerebrospinal fluid examinations, positron emission tomography scans to detect amyloid plaques, or functional tests for mildly impaired patients, since the overlap between normal health and disease is still great. These tests distract clinicians, patients, and families from approaching AD head-on, given our good understanding of the diagnostic criteria for AD. Likewise, the clinician should avoid terms like "mild cognitive impairment," "senility," or "dementia" when a patient truly has AD.^[ Although our treatment options remain limited, an accurate diagnosis lets patient and family appropriately prepare for the future, limits care-environment transitions, and maximizes the patient's retained abilities.

Table. DSM-IV-TR Criteria for Alzheimer Dementia

1. The development of multiple cognitive deficits manifested by both: Memory impairment One (or more) of the following cognitive disturbances: Aphasia Apraxia Agnosia Disturbance in executive functioning 2. The cognitive defects in each cause severe impairment in social or occupational functioning and represent a major decline from a previous level of functioning. 3. The course is characterized by gradual onset and continuing cognitive decline. 4. The cognitive deficits are not caused by any of the following: Other central nervous system conditions that cause progressive deficits in memory and cognition (eg, cerebrovascular disease, Parkinson's disease, Huntington's disease, subdural hematoma, normal-pressure hydrocephalus, brain tumor) Systemic conditions known to cause dementia (for example, hypothyroidism, vitamin B12 or folic acid deficiency, niacin deficiency, hypercalcemia, neurosyphilis, HIV infection) Substance-induced conditions 5. The deficits do not occur exclusively during the course of a delirium. 6. The disturbance is not better accounted for by another mental disorder (for example, major depressive disorder, and schizophrenia).

DSM-IV-TR = Diagnostic and Statistical Manual of Mental Disorders, 4th ed, text revision; HIV = human immunodeficiency virus, adapted from the DSM-IV-TR. 2000: 154-158.

Too often, to soften or avoid a time-consuming interchange with patient and family, the practitioner will give the patient an incorrect diagnosis of mild cognitive impairment. Mild cognitive impairment has its own diagnostic criteria. It is not to be confused with the DSM-IV-TR criteria that we currently use to define dementia and AD. We must also realize that a firm diagnosis of AD can be made based on the clinical criteria. That is what DSM-IV-TR is for -- waiting for an autopsy to confirm an AD diagnosis is just an excuse. Patients and families, as well as clinicians, may need to be reminded that pathologic criteria used in the research setting are not necessary to confirm the diagnosis of AD and move forward with clinical care. In LTC, we should make an accurate, factual diagnosis; discuss the risks and benefits of treatment with both drug and non-drug interventions; waste little time on the staging of disease (residents are in a LTC facility because they are already experiencing functional and behavioral decline); and provide compassionate, comprehensive care to the patient and the family.