Clinical Presentation and Investigation of Crohn’s Disease

The presentation depends mainly on the site of the disease but also on whether there is a tendency to perforate or fistulate rather than to fibrose and stricture, probably determined by genetic factors. Terminal ileal and ileocolonic disease present with right iliac fossa pain, often with an associated mass. This can present acutely, mimicking acute appendicitis or – more commonly – chronically, when symptoms may closely mimic the irritable bowel syndrome. It can also present subtly, as short stature III a child or adolescent, as weight loss with minimal abdominal symptoms or even as nephrotic syndrome due to amyloidosis.

Colonic Crohn’s disease is distinguishable from ulcerative colitis by the presence of skip lesions, rectal sparing, perianal skin tags or fistulas and/or granulomata on biopsy, but in up to one-third of cases the distinction is unclear and in this situation it is usually better not to be dogmatic about the diagnosis.

Initial diagnosis is usually made by barium studies and/or endoscopy. Radiolabelled white cell scanning may be helpful if radiological evidence of small-intestinal disease is equivocal. Serum C-reactive protein concentration is raised in about 95% of cases with active disease. Magnetic resonance scanning is very useful for evaluation of perianal fistulas and abscesses.

Extra-intestinal manifestations of the disease include erythema nodosum, episcleritis and reactive arthritis. With the exception of ankylosing s ondylitis, for which Crohn’s disease – like Ulcerative Colitis – is a risk factor, the other extra-intestinal problems usually resolve with appropriate treatmenfofthe underlying bowel disease and do not usually require specific treatment. Sclerosing cholangitis is extremely rare, particularly if colonic disease is absent.

Who is the Presenter and Who is the Audience?

Seth Godin writes, “The presenter who loves his [sic] audience the most, wins.” In the business of internet networking, in the daily communication of all of us with all of us, there is some confusion as to who is the presenter and who is the audience. When I tweet, am I tweeting you or me? If a tree falls in a forest with no one there is there a sound? Are we listening to each other? Do we have anything to say? Where is our focus? Is the goal of the market simply to perpetuate itself?

In the confusion of who is presenter and who is audience lies for each of us an opportunity. For business, for personal growth, probably for both. You really can’t have one without the other. Mindset is key, focus is key and the value we place on ourselves is the outstanding balance in the middle. I could say that the person who loves his or her audience is loved and respected in turn. If I love myself chances are that I will love you because there won’t be much of a commute between us. That’s where we get the value of all the communication strategies that are open to us. We can exchange and change in bits and bytes, in leaps and bounds.

Once upon a time it seemed to matter whether a tree fell and could be heard. With our communication portals it is almost certain someone somewhere will hear. What matters to us as entrepreneurs is that they care enough to keep going, to click, perchance to buy.

We are powerful when we take the communication possibilities offered and focus ourselves, our hearts, our truths to such a degree that we are presenters who love ourselves, our audience, our product and its persuasions to inspire the click. For us to be successful we have to inspire and delight. We need to create lightness in ourselves and each other. Is that why it seems so important to talk about every plane trip, every line we wait in every movie we see, song we hear. It’s shared experience, the trip of Life. We get to be with each other on every journey we choose to share. How cool is that? Lucky us. Let’s make it work, let’s give ourselves value. Believe in yourself, share your opportunities, make work together and play. And, don’t forget, breathe, always breathe.

Pam White is a business coach and mentor based out of Sharon, CT, that assists serious entrepreneurs in building a profitable online business with multiple incomes streams. Pam and her team have assisted hundreds of people, from doctors and lawyers to high-school drop-outs and single parents in generating profits that exceed $250K or more in their first year. For more information and to contact Pam, visit:

Parenting Time Evaluations – 4 Steps For Best Presentation of Your Case

Parenting time/custody evaluations are often difficult and invasive toward both parents of a child in a custody dispute. However, if you have a concern about the competence or fitness of your co-parent, a parenting time evaluation is one of the primary methods of getting the threat to your child evaluated. The process may include multiple interviews with each parent, psychological testing, interviews with the children if they are of age, home visits, and collateral reports from teachers, pediatricians, friends, family, and so forth. While these studies can feel invasive and difficult, there are strategies to optimize your presentation. Here are 4 ways to put your best foot forward:

1. Present your concerns in factual statements. Do not make up allegations or conjectures, but stick as much as possible to facts. To be sure, your emotions are running high over this incredibly important issue, but try to stay as rational as possible.

2. Avoid being excessively emotional. Again, this is a difficult time and a hard process. It is okay to show some emotion, just don’t cry through the whole of every session, or the evaluator could start questioning your stability.

3. Present your facts – dates, times, and events – in the context of how your spouse’s behavior affects, or could potentially affect, your children. For example, if your partner does drugs and leaves the paraphernalia lying around, you can express your concern that your children could find it. If your partner has affairs, you can explain that the atmosphere of the home is made more chaotic and emotionally unstable because of this behavior. Be sure that if you have any questionable behavior in your recent past, that you report it, as you can be sure your spouse will fill in the blanks. Just present it as it pertains to the children, and let the evaluator know you recognize it could have caused harm and that you will not continue the behavior.

4. Provide relevant updates as they occur. Evaluations can go on for many months, and there may be plenty of further incidents if your partner isn’t cleaning up his or her act. Note dates, times, and events, and provide the information promptly and concisely via email or phone as it occurs.

Are you interested in addressing your life challenges from a holistic standpoint, assessing the physical, emotional, and relationship components?

Stress Management – 7 Tips to Manage Your Stress Before Giving a Presentation

Does the very thought of giving a speech cause you stress and sends shivers down your spine. Have you ever wondered why when you give a speech your words come out fast and furious. Or when you’re describing an accident your words come quickly. So quick in fact that you have to repeat yourself because you’ve left words out and sometimes you left out entire sentences. Stress causes the rhythm of your speech to speed up and the space between your words to shorten.

This is a sure sign of being anxious. If you’re experiencing anxiety, it’s likely to have a negative impact on your presentation. While you may realize that this negative effect will only make matters worse, you’re usually not in a position to alter your state of mind. The negative effect then becomes even stronger. It’s not until you find a way to break the effect of this negative cycle that you can gain control of your speech.

The results of this quick anxious speech pattern will find you making the very mistakes that you’re desperately trying to avoid. This anxiety is unnecessary but can’t be avoided when you obsess about looking and being perfect. The harder you try the more unnatural and strained the presentation, and more mistakes you’ll make.

Seven Signs of stress before and during a speech

1. Becoming confused and jumbled when giving a speech
2. Feel constant fear of forgetting what you prepared to say
3. Breathing faster just before starting your speech
4. When you make a mistake finding it hard to concentrate
5. Feel your heart beat faster when presenting
6. Feeling so nervous while giving a speech you forget what you know

So how do you remain calm? It may not be easy but it’s doable. Here are 7 calming tips.

1. Prepare thoroughly for your presentation and speech by knowing your material well

2. Eat properly don’t be excessively hungry or full

3. Short personal routine just before the speech, such as a short prayer, 1 minute of meditation and set your intention to be a conduit of information

4. Take a deep breaths and smile just before you begin to speak.

5. If you get confused catch up you thoughts by taking a sip of water and smiling and saying something simple like “lets go on” this is an easy way to relax and catch up with your thinking.

6. Focus for a moment on a friendly face

7. Let yourself off the hook. Remember people are rooting for you and know that we are all human. So don’t beat yourself up for any mistakes. There are no mistakes only learning experiences.

And I’d like you to invite you to learn even more about how you can easily eliminate stress.