Takers don’t know another way to get through life. In this sense, they truly need the givers. But the givers don’t necessarily have to be victims of these out-of-control takers. They need to learn to say no.

Recently, when I was complaining to two very wise women friends about people who had imposed upon my hospitality, they gave me some excellent advice that I am more than happy to pass along to fellow givers. A person I barely knew had asked in several ways to invade my home for a couple of days. The names and specifics have to remain my secret. I didn’t know how to refuse her requests and so I acquiesced, regretting it from that moment.

“Whenever someone asks you for more than you can or want to give,” my friend Patricia told me, “all you have to say is, ‘That wouldn’t work for me.’ Don’t explain, don’t apologize, just use that phrase.”

I was so struck by the perfection of such a response that I was speechless for a moment. It fulfilled all my requirements: I could refuse without being rude or making up some lie or excuse to avoid doing something I didn’t want to do and the person making the request had no right to ask of me. It set limits on the other person in a polite but firm way. And it would surely save me from the resentment I had felt in the past from just giving in to over-the-top requests.

My other friend, Ellen, assured me that goodness and kindness did not require self-sacrifice. I needed the reminder. Patricia’s mantra of “That wouldn’t work for me” had freed me of some ugly obligations as easily as a knot coming undone.

Takers would have a lot harder time of it if givers just took a stand.

So now I’m ready. The next time someone asks for something totally out of the question, I can smile sweetly and say, “That wouldn’t work for me.” And I know I always will hear the delighted giggle of my friend Patricia whenever I invoke her magic words.

A.Generally, patients with benign strictures (those not associated with cancer) respond well to dilation. However, repeat procedures may be required, usually at infrequent intervals. It is important that patients who receive dilation also take acid-suppressive medications to aid in proper healing and reduce the risk of stricture recurrence. In a patient who does not respond well to dilation, several factors must be considered, including whether the method being used for dilation is aggressive enough and whether cancer has been ruled out (strictures caused by cancer tend to be harder to treat). To answer your specific question, there is really no limit to the number of dilations that can be done.

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B.J.

A.Doctors refer to the procedure used to “enlarge the esophagus” as esophageal dilation. In this procedure, an esophagus narrowed by scarring (strictures) is literally stretched open. Most strictures are a result of the inflammation caused by long-standing gastroesophageal reflux disease (GERD). Other causes of strictures in the esophagus include tumors, radiation to the chest, ingestion of caustic substances (typically in a suicide attempt) and certain medications (including chemotherapeutic agents).

A.Patients with strictures experience difficulty swallowing solid foods and the sensation that food is “sticking” in their chests. Esophageal strictures are usually diagnosed during an endoscopic or barium examination of the upper GI tract.

There are several different methods that can be used to perform esophageal dilation through an instrument called an endoscope (a flexible tube that carries a viewing device and other surgical tools down the throat). One method involves using a set of tapered cylinders to gradually enlarge the diameter of the esophagus. This system is effective for very severe and tight strictures, in which multiple endoscopic dilating sessions may be needed. Certain strictures are mild and may only require widening with a larger, more flexible cylinder.

Finasteride is used for healing specific kinds of androgenic alopecia, baldness, hair loss in men. Cheap propecia works by decreasing the quantity of the hormone dihydrotestosterone also known as DHT in the organism.

The most common causes include:

Bacteria — If untreated, bacterial pneumonia can sometimes result in death, particularly in people with emphysema and other chronic lung conditions. It can spread to other parts of the lung and the bacteria may invade the bloodstream, causing sepsis.

Viruses — Most people with viral pneumonia can recover with bed rest and adequate medical care. However, there is no drug therapy available for this form of infection.

Fungi — Certain fungi can cause a mild form of pneumonia in otherwise healthy people. However, in people with AIDS or other immune system disorders, those same fungi can cause severe reactions. One of the most common causes of pneumonia in people with AIDS is Pneumocystis carinii, which researchers believe is a fungus. This serious condition is usually treatable with antibiotics, though occasionally steroids, such as cortisone, are needed as well.

Finding the Right Spa for You
Whether you’re interested in a quick tune-up, a relaxing day or a lengthy vacation, there’s a spa to meet your needs, Walker says. “In just the same way you can choose a hotel at any price point, you can also choose a spa experience to fit your needs,” she said.

You just need to figure out what they are. That’s extremely important when you consider that one person’s ideal spa experience of hiking, fitness and health-conscious spa cuisine might be a nightmare for the person picturing a totally pampered experience with gourmet foods and wines.

The International SPA Association categorizes spas in the following manner:

Day spas offer a variety of professionally administered services and skin, hair and nail treatments to clients on a half-day or day-use basis.
Club spas are primarily fitness facilities that offer a variety of professionally administered services on a day-use basis.
Medical spas provide comprehensive medical and wellness care in an environment that integrates spa services as conventional and complementary therapies and treatments.

Mineral spring spas offer on-site sources of natural mineral, thermal or seawater used in hydrotherapy treatments.
Cruise ship spas provide professional administered spa services and fitness and wellness components. Cuisine may include spa (health-conscious) cuisine options.

Destination spas provide lifestyle improvement and health enhancement through professionally administered spa services, fitness, educational programming and on-site accommodations. Spa cuisine is served exclusively.

Resort/hotel spas are located within a resort or hotel and provide professionally administered spa services, fitness, and outdoor sports or activities and/or wellness components. Cuisine may include spa cuisine choices.

Within those categories, spas may offer the following areas of concentration or focus:

Fitness may include sports, fitness classes, weight loss or healthy lifestyle programs, and invigorating body treatments.
Stress management introduces stress reduction, relaxation techniques and strategies for feeling more in balance and control.
Peace of mind pursues a spiritual journey of introspection and reflection through medication, yoga, tai chi and chi gong to achieve serenity,

understanding and self-acceptance.
Pampering and pleasure is designed to indulge the senses with massage, facials, mud and aroma baths in a relaxing atmosphere.
Health and wellness explores health, healthy lifestyles and dealing with medical issues and concerns.
The variety of services and treatments offered at spas can be confusing for the first-timer. Bruce Schoenberg, owner of Oasis Day Spa in New

York City, advises his first-time guests to start out with something pretty traditional. “I usually suggest a basic Swedish massage,” he said. “The masseuse uses long, smooth, easy strokes that lengthen the muscle.

It’s relaxing and feels great and it provides a good foundation for experimenting with other more unusual types of massage.

“After you’ve tried traditional techniques and begun to learn what you like, you’re more ready try anything that captures your imagination,” Schoenberg said.

A big fan of facials and massage, Metz often visited the Georgette Klinger Skin Care Salon in Chicago but had never before experienced a half-day of total indulgence at a day spa. Her birthday treats and treatments included lunch, a South-Asian combination abhyaga and shiro dhara massage, a botanical blend facial, a paraffin manicure and lava pedicure.

“It was just wonderful. And at the end of it all, I was a very relaxed rag doll,” Metz said. “I believe once you’ve experienced all this, there’s no going back.”

A Health and Wellness Phenomenon
She’s probably right. Metz is one of millions of American women — and men – who have embraced the spa experience. They have transformed a ritual pleasure formerly partaken of by a small segment of pampered “ladies-who-lunched” and their executive “husbands-who-clubbed” into a stress-beating health and wellness phenomenon that’s sweeping the country. According to a recent survey conducted for the International SPA

Association, about 95 million people visit spas each year.

“The spa industry has exploded,” said Lynne J. Walker, executive director of the International SPA Association. “Men and women are working harder and earning more discretionary income. And they’re realizing they need to spend some time on themselves, for themselves.

“The spa experience is part of a healthy lifestyle,” Walker added. “It’s preventative therapy — a good way to maintain your health and help you be all you can be for yourself and for those important to you. It’s your time to relax, reflect, revitalize and rejoice.”

Jane Hand agrees. A Westchester County, N.Y., elementary school principal and confirmed spa devotee, she knew she was hooked during her first professional massage several years ago at Gurney’s Inn Resort and Spa in Montauk on New York’s Long Island. “I went with some girlfriends. Our husbands were going fishing, so we decided to go to a spa,” Hand said. “I was a total novice. I really didn’t know what to expect. But during that massage — during that moment in time — I was sure massage was just the best thing in the entire world.”

Soon her husband caught her enthusiasm and the two began incorporating spa treatments into their vacations. But Hand’s spa indulgences aren’t limited to vacations. “Every six weeks or so I like to drive to a nice town with a friend for a spa outing at a pretty place. Then we have lunch and do some shopping. I have it down to a science,” she said. “It’s just a great day.”

In between outings, Hand occasionally books an appointment for a facial at a day spa near her school after a particularly trying day at work or before a PTA meeting in the evening.

“Just for a quick tune-up,” Hand said. “I love a facial. It’s tremendously relaxing, temporal and fleeting — and it does great things for my skin.”

Newly wed Amy Caruso knows firsthand how a spa experience can positively affect your attitude and appearance. She had her first spa experience just before her wedding day. “I was so stressed out with wedding preparations that I decided to treat myself,” she recalled. She had a Vichy shower at Serenity Spa’lon in Cincinnati, Ohio. The package also included a body wrap, a facial mask, massage, aromatherapy and a soothing shower.

The rise of human capital and of the Net Generation has huge implications for these social conditions. While we will likely still see very wealthy people, there is already growing pressure for knowledge workers to share in the wealth they create.

Because of its growing importance, human capital has great power. It also is more mobile and volatile than traditional capital. I remember working for a consulting company whose CEO would say, “Our assets leave on the elevator every night.” Increasingly, that is true for a majority of the work force.

Knowledge workers, especially N-Geners, will be positioned to demand a share in the wealth they create because they have the option of doing it themselves-of being entrepreneurs. They have grown up in the interactive world creating their own Websites, collaborating, criticizing, authenticating, and creating value. They also have a powerful new platform for entrepreneurship-the Net-that enables independent entrepreneurs to have many of the advantages of large companies without the main liabilities.

Management will have to treat them well. As a generation they are smart, confident, mobile, and connected, engaged in knowledge work and endowed with an unprecedented capacity for creating wealth and innovation. To perform effective knowledge work, they must be motivated and collaborate well. Unlike with production machines or blue-collar workers, management cannot simply turn up the speed, to say “Management wants twice as many innovations per month.”

Most important, firms will be forced to develop new ways to compensate employees based on the value they create. This will include a profound democratization of corporate ownership. Even leading opponents of the measurement and recording of intellectual capital on balance sheets believe that the rise of knowledge work requires new approaches to retaining people. As merchant banker John Rutledge has said. Rutledge argues that the issue is how to hold people together in an organization long enough to achieve its objectives. Companies can’t “own” human assets, they can only rent them, so he says companies will have to ensure that these people “own the income streams created by their own efforts.”

At the beginning of 1998, in a late-night barroom conversation at the World Economic Forum in Davos, Switzerland, Tom Stewart, a member of Fortune’s board of editors, pointed out to me that half of the shares of Microsoft were purchased with traditional capital-money-and the other half with intellectual capital. People acquired wealth in exchange for their knowledge and work. In discussing the Net Generation, Stewart mused that in the future employees should be treated as “investors of intellectual capital.”

It’s true. Effective knowledge workers are investing their intellectual capital in the firm. They give of their ideas, creativity, know-how, and energy, and, as in the case of Microsoft, increasingly they will be positioned to share in the wealth they create. Their fresh thinking could enable firms to retain their most precious assets and sustain innovation and wealth creation, not to mention bring a little more social justice into the economy.

Furthermore, because customer information and knowledge become part of human capital, customers need to share in the wealth they create. Expect customers to begin demanding value, including cash payments (digital microcash) for their information knowledge. You provide information about yourself that, with your permission, is sold to others? You receive a share in the transaction. You contribute to a product evaluation? You receive compensation for it.

Our internet shop it’s a place in which you will quickly and easily buy international calling cards online. You can make long distance phone calls to any region or country to the parents, partners, friends.

More than half of all injury deaths involve motor vehicles or firearms. Guns kill nearly 40,000 Americans a year and wound hundreds of thousands more — a number that continues to climb.

Half a million people a year are hurt riding bicycles. Nearly 20 million people a year incur an injury at home that sends them to a doctor or limits their activity for at least half a day.

Too many people each year get sunburns, which can lead to skin cancer.

To protect your skin outdoors, wear a sunscreen with an SPF of at least 15 and wear a wide-brimmed hat every day to block ultraviolet rays. Use bug spray with 10 percent to 15 percent DEET to keep ticks and mosquitoes at bay.

Protect yourself at home, at the office, on the road and even while you’re out enjoying a sunny day. Be aware of what’s happening around you, and be careful out there.

Here are some tips from Wahida Karmally, registered dietician and diabetes educator, and John Zrebiec, clinical social worker for the Joslin Diabetes Center and moderator of an online chat group for people with diabetes:
See a diabetes educator and a dietician for realistic tips on nutrition, exercise and monitoring your blood sugar levels.

Join a diabetes support group, either in person or online, and read diabetes magazines.

Utilize your healthcare team. Keep in touch with your doctor, and go as often as you feel you need to. Ask for referrals or advice, especially if you’re getting off track.

Set realistic, achievable goals.

Ask yourself what change you’re ready to start with, then take small steps to realize that goal. For example, start by having smaller portions during one meal a day or adding vegetables at dinner.

Learn how to season and to prepare your foods to satisfy your taste buds.

Think about an activity you enjoy, such as tennis or walking, and ask a friend to join in the exercise.

Avoid problems when possible. For example, if you have a tendency to overeat, don’t hit that all-you-can-eat buffet and tell yourself you won’t eat too much. And don’t sit down for a meal or go to parties hungry, which will also cause you to overeat.

Be on the planning committee for work parties to be sure foods you can eat are included, or offer to bring a dish you like.

Plan ahead. Keep healthy snacks at work so you won’t be tempted to hit the vending machine. Prepare and freeze meals for weeks when you know you’ll be too busy to cook.

Most of mishaps happen at home or work so it is very significant to become prepared and also to care for your children, friends, family. Buy appropriate and reliable industrial first aid kit from a large assortment of specialize first aid supplies.

Developed by Dr. Mark Stearns and a research team at Medical College of Pennsylvania-Hahnemann University in Philadelphia, it is soon to get a major clinical trial. If it proves to be as useful and reliable as it appeared to be in smaller-scale studies Stearns and his associates have done, it could be on the market in about a year.

The test uses a technique called DNA-gene array technology to search for a protein called PSTF-1 in a urine sample. Stearns and MCP-Hahnemann surgery professor Daniel Rukstalis found the protein in cancerous prostate tissue and in the urine of prostate cancer patients. They did not find it in specimens from patients who had benign prostate hyperplasia — an enlargement of the prostate gland — but did not have cancer.

They suspected that it was evidence of a chromosome break, an event related to the cancer’s development, and could be a unique marker for prostate cancer or, in technical terms, a transcription factor. Their studies so far, with a relatively small patient population, appear to confirm that.

Stearns, Rukstalis and Dr. Youju Hu, a pathology professor at MCP-Hahnemann, believe that PSTF-1 testing will not only turn out to be what Stearns called a new “gold standard” in diagnosis, but will also be useful in tracking prostate cancer growth when doctors have decided that the cancer is an early, low-grade type and their best course is watchful waiting to see whether or when more aggressive treatment has become necessary.

PSA testing only indicates that prostate cancer may be present, and the test can return what is called a false negative, meaning that it failed to detect the presence of cancer. About half the time, Stearns said, PSA tests yield a false positive, meaning that they found indications of prostate cancer when there were none present.

A doctor’s digital rectal examination of the prostate, the traditional test, is more reliable, but at present the only certain confirmation of a diagnosis is a biopsy, removal of tissue to be examined by a pathologist.

The PSTF-1 test, Stearns said, has correctly indicated 90 percent of the time whether or not a patient had prostate cancer. Besides being both specific and sensitive, he said, it is non-invasive, requiring no blood or tissue samples, and will be quite inexpensive once it is on the market. He said he believes similar urine tests can be developed for bladder and kidney cancer.

If it gains approval following clinical trials, Stearns said it would be marketed in kit form so that any medical laboratory can perform the test. A patent has been applied for.