Teenagers With High Blood Pressure? What?

twhbpJerrod was tall, muscular, and the best center fielder his high school baseball team ever had. So he didn’t give a second thought to the routine physical he had to have before the season.

“You’re generally in good shape,” said Dr. Parsons, “but your blood pressure is high. Well have to measure it again in a mountain or so.”

There was a moment of silence. Then Jerrod told the doctor it couldn’t be. Fifteen-year-olds don’t have a high blood pressure, especially healthy 15 years old like he was. Adults have high blood pressure, especially overweight adults like his dad and his grandfather. “Besides,” he said, “I’m not sure what high blood pressure means.”

The doctor explained that blood pressure is the force of a person’s blood against blood vessels, especially the arteries. It is expressed in two numbers.

The first number is the systolic pressure–when the heart is contracting. The second number is the diastolic pressure–when the heart is resting. In adults, blood pressure covers a range, and 120/ 80, or 120 over 80, is considered to be within normal range. Many people have blood pressure readings that are lower, and that is still normal. Anything over 10/90 is considered high blood pressure, or hypertension.

In children and adolescents, high blood pressure is defined in a different way. That’s because blood pressure in preadults increases with age. What’s normal for a 14-year-old would be high for a 6-year-old. So, high blood pressure in young people occurs when the pressure is above the 95th percentile for the person’s age and sex. That means that 95 percent of young people of the same age and sex have lower blood pressure. If blood pressure is between the 90th and 95th percentiles, it’s considered high normal.

Using this guideline, the National Heart, Lung and Blood Institute defines severe hypertension as more than 144/92 for adolescents ages 13 to 15 and more than 150/98 for adolescents ages 16 to 18.

An Early Start

Dr. Parsons said that hypertension, while much more common in adults, is a disease that originates in childhood. Until recently, experts thought that high blood pressure in children and adolescents was a sign of some other underlying problem. That’s called secondary hypertension. The most common underlying condition involves kidney function. Secondary hypertension is more common in children than in adults, but it’s still rare.

Doctors now know that a high reading can be a sign that a young person is developing essential, or primary, hypertension. That’s the most common type. It accounts for 95 percent of all hypertension and is present in more than one of four American adults. In children, essential hypertension is present more than a half the time when the blood pressure is elevated. The total incidence of hypertension in children has been placed at between 1.6 percent and 4.6 percent of the population.

Experts don’t understand the cause of essential hypertension, although they have isolated some risk factors–including obesity and a family history of high blood pressure. Research is ongoing to discover human genes that may make a person likely to develop hypertension. One research team has reported a gene that may affect blood pressure by influencing the way the body uses sodium. Medical experts have long warned that a high-salt diet may increase blood pressure. But only half of high-blood pressure patients seem to be affected by the amount of salt they eat. The discovery of the gene may explain why.

Jerrod was upset to hear that high blood pressure may be hereditary. “I guess there’s no way out. I’m just programmed to have it,” he told Dr. Parsons.

But the doctor explained some things that brightened the outlook. First, he hadn’t even completed his examinations of Jerrod’s blood pressure. A diagnosis of hypertensions is made only after three separate blood pressure readings done at different times. In patients without a history of elevated blood pressure, doctors recommended that blood pressure be measures once a year.

Second, heredity is not the only thing that influences blood pressure. Environmental factors are important, too–diet, weight, smoking, stress, exercise. Jerrod has a lot of control over these kinds of things.

In fact, when doctors treat hypertension, they begin by trying to modify these lifestyle factors. Only if that fails to bring the pressure under control do physicians prescribe the drug.

Lifestyle Choices

Diet. Lowering salt intake is only one dietary approach to controlling blood pressure. It’s also important to cut down on fats. A high-fat diet may contribute to high cholesterol, a waxy substance that becomes deposited in artery walls. Blood pressure increases when it must travel through narrowed vessels.

Some research suggests that potassium can lower blood pressure. It’s present in such foods as potatoes, bananas, and cantaloupe. Calcium has also been mentioned as a blood pressure regulator, but the research is sketchy.

Weight. Obesity, defined as weight that is 20 percent higher than normal, is probably the most common factor connected with essential hypertension, according to Dr. Michael Horan of the Heart, Lung and Blood Institute. The effects of excess weight on blood pressure can be seen in children as young as 2 years old.

Tobacco and other drugs. Smoking can aggravate high blood pressure by constricting blood vessels. So one of the first treatment approaches in smokers is to quit. Hormones pills may increase blood pressure. So may large amounts of caffeine taken by people who drink a lot of coffee or colas, or who use “stay awake” products.

Exercise. Exercising is one of the best ways to lose weight, control cholesterol buildup, and lower blood pressure. Regular aerobic exercise seems to be the best–at least 20 minutes three times a week. Power weight lifting may not be recommended since it can increase blood pressure. Participation in sports seems to be all right, except in cases of severe hypertension, but the final decision must be made with your physician.

Stress. In adults, studies have shown that stress management can reduced blood pressure. Treatment may include counseling to increase coping skills and such stress reduction techniques as deep breathing.

Drug Therapy

Most doctors try to control blood pressure without drugs, but if lifestyle changes don’t work, medication is the second line of defense. There are several types of drugs to control high blood pressure. Some work to remove excess fluid from the body. Some help dilate the blood vessels so that blood flows more readily. Others modify certain chemical reactions in the body. If one drug isn’t effective, or causes a bad reaction, others can be tried.

High blood pressure is a lifelong condition. So far, there’s no cure, but there are many ways to control it and even to prevent it. We know now that it’s a disease that starts in childhood. So you’re not too young to begin a healthy lifestyles and keep it from occurring at all.

The Measure of the Pressure

Blood pressure is measured with a device called a sphygmomanometer (sfig-mo-me-nam-et-er; sphygmo means pulse; manometer is an instrument for measuring the pressure of gases or liquids). The sphymomanometer consists of an inflatable band wrapped around the upper arm to compress the artery, and an attached manometer. The technician will be wearing a stethoscope.

When you’re having your pressure, sit in a comfortable position. The technician will wait a few moments until you get over your initial anxiety. In fact, blood pressure is often taken twice, and the second reading is sometimes lower because the patient is more relaxed.

Your arm will rest on a surface at heart level. The cuff will be wrapped around your upper arm and inflated. Then pressure within the cuff is released. As the pressure decreases, a clear tapping sound begins, which is heard through the stethoscope. This is the systolic blood pressure, which estimates the highest pressure of blood flowing through the arteries.

As the cuff is further deflated, there is a murmur of blood flow through the artery narrowed by the cuff. Then, still using the stethoscope, the sounds become crisper and more intense. As the cuff pressure decreases further, there are low-pitched, muffled sounds. The last phase is the disappearance of all sounds. That’s when diastolic pressure — as the heart rests — is measured.


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War On Drugs: Still Relevant?

wodYou’ve probably seen videotapes of drugs “busts” on evening television, especially if millions of dollars or huge quantities of illegal chemicals were seized. In fact, it’s longer shocking for the evening news to show three police officers unloading bales of confiscated marijuana from trucks or displaying tables loaded with cocaine for the TV cameras.

These scenes gives us a glimpse of the vast, invisible empire of drug dealing. The sun never sets on this illicit enterprise that feeds South American coca harvesters while it ruins the lives of drugs users around the planet. From Asian poppy fields, where opium is collected, to the hidden laboratories that convert it to heroin, to the streets of your hometown, drugs are big business. Very big business–dealing with enormous profits.

From “Miracle” Drugs to a Major Menace

The drug trade is nothing new. Chinese workers who were brought to the West to build railroads are said to have been an early source of opium. And the “secret ingredients” of many “medicines” widely advertised and sold to the public in the 19th century? Opium or cocaine.

James A. Inciardi, author of The War on Drugs, writes that drugs use in the 1900s was so common that the 1897 Sears Roebuck catalog included ads for hypodermic kits that enabled buyers to inject morphine. No one really knows how many 19th-century Americans were drug-dependent, but records from that time indicate that drug use was common, Professor Inciardi writes. In those days, though, the dangers of these drugs were virtually unknown. Some experts of that time thought of opium products and cocaine as miracle drugs. The chemical compound diacetylmorphine was first marketed under the brand name “Heroin.” And historians write that even the Coca-Cola of that time contained cocaine. Only later did the dark side of these drugs become apparent.

Today, we fight back with drug education and laws to prevent and punish drug abusers and sellers. We know that illegal drugs are dangerous. We’ve learned about the hazards.

The U.S. Food and Drugs Administration closely regulates the contents and sale of prescription drugs. Pharmacists dispense them and advise customers on how they should be taken; physicians observe patients for possible side effects. There are no such safety measures with illegal drugs. A drug buyer never knows the drug’s potency or how it has been manufactured.

How Agencies Combat the Illegal Drug Trade

Thousands of people are involved in the illegal drug trade. Some foreign armies reportedly protect drug lords; drug organizations intimidate national leaders, court systems, and police. But thousands more people are fighting the sales land use of illegal drugs.

Arrests in American cities may follow months of cooperation between foreign governments and U.S. agencies, including the FBI, the CIA, the Drug Enforcement Agency, the Immigration and Naturalization Service, branches of the military, the Internal Revenue Service, and the Bureau of Alcohol, Tobacco and Firearms. These agencies attempt to coordinate their investigations, and huge databases and high-tech networks have been established to allow them to exchange information on drug organizations and dealers. An FBI computer, for example, is used to scan and identify fingerprints transmitted electronically by other law enforcement agencies.

Working with Other Countries

To coordinate all the agencies involved in the war on drugs requires the cooperation of many countries. It also means that huge law enforcement agencies must learn to work together closely. Sharing information is of great importance, since plans involve everyone from the local police to the Department of Defense. At the same time, political leaders must be careful to preserve relations with other countries.

The FBI is an excellent example of the fight against drugs. The FBI plan calls for catching the “big fish.” This involves gathering intelligence, intercepting drugs imports, seizing the belongings of the biggest drug operations, and constantly coordinating with other agencies.

In addition, the FBI receives CIA information on foreign drug sources, works with the Coast Guard and the Customs Service to catch drug traffickers entering the United States, and uses financial wizards to track down “money laundering” schemes. Money laundering is a way of making drug money look like it came from legitimate sources. But if experts can untangle the financial tricks used to hide the money source, they can often follow the money to a drug organization’s leaders.

Electronic eavesdropping is another technique, among many, that agents can use to understand inner workings of a drug organization.

In recent years, laws have been changed to allow law enforcement agencies to confiscate drug money and use it for future investigations.

Experts estimate that U.S. citizens spent $52 billion on illegal drugs during a recent one-year period. The U.S. Department of Justice estimates that more than 1 million people were arrested for drug crimes in 1991, the most recent statistics available.

The illegal drug trade is a major threat to the United States. It affects our economy, our people, and the future of our children. It’s a war worth fighting–and one we have to win.


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Injuries Take A Toll On Us All

itatouWhat do you and Olympic gymnast Shannon Miller have in common? You and basketball star Michael Jordan? You…and tennis veteran Jimmy Connors?

Injuries. Getting hurt. Twisting it, pulling it, spraining it, breaking it. Now granted, our injuries don’t make the evening news. But whether we sprain an ankle on the pro tennis circuit or just jogging through the back yard, it hurts … and we want it fixed, pronto.

And that’s the other thing we have in common with today’s sports stars – the treatment we receive for injuries. Breakthroughs in orthopedic treatment of injuries to the joints, bones, muscles, ligaments, and tendons (many discovered by specialists in “sports medicine”) have altered treatment of nonathletic injuries as well.

“Everything that’s been learned in treating injuries at the elite athletic level is filtering down to the rest of us,” says Marjorie Albohm, associate director of Indiana University’s International Institute of Sports Science and Medicine. She notes that while athletes and nonathletes show different patterns leading up to an injury, they often wind up in the same place, needing the same sort of treatment.

“The athletic population most often tends toward acute injury, often involving the ligaments,” says Albohm. “In the nonathletic group, we see more ‘overuse’ injuries”. Repetitious activity using certain muscle groups or body areas can eventually flare up into an acute condition–one that requires the same treatment an athlete would receive.

Who treats injuries involving the bones, muscles, ligaments, and tendons? It’s all considered a part of the field of orthopedic medicine. And while orthopedic surgeons possibly are the most visible members of this specialty, an injury may call for the expertise of therapists, trainers, and “rehab” specialists in many different health care settings.

“Orthopedic medicine is a specialty that tends to change very slowly,” says Al Negelberg of the American Academy of Orthopedic Surgeons. If also, the past decade set an unusually dizzy pace for this “slow” corner of medicine. Let’s look at just some of the recent breakthroughs that could have an effect on the care of your next injury.

Honey, I Shrunk the Operation!

Bottom line… what’s the biggest overall benefit of recent advances in orthopedic treatment of injury? Dr. David Holden, an orthopedic surgeon whose emergency surgery kept gymnast Shannon Miller in the running for Olympic medals (see the story on page 11), says it’s being able to “get people moving very quickly” after an injury.

“We have a saying in orthopedics that motion is life,” Dr. Holden told us. “Muscle atrophy (deterioration) and scarring from some of the things we used to do were so bad that no matter how good the surgery was, the person didn’t get that flexibility back. Muscles atrophy in a matter of days, and you lose ground quickly.

“The difference today is that we are now able to do surgery to a point that lets people get into rehabilitation-and moving-very soon after the injury. And the biggest factor in that is how much arthroscopic surgery came along in the decade of the ’80s.”

Below, a look at “what’s new in orthopedics:

Arthroscopic Surgery

The idea sounds like a special-effects movie. Take one TV camera, shrinks it down to less than bite-size, add flexible strands of glass to produce intense fiber-optic light, and presto … you have a surgical kit that can operate in the tiniest of quarters and avoid making more than a Band-Aid-size incision.

Arthroscopic (the word comes from arthro “joint” and scope “view”) techniques got their start at the knees, where (relatively speaking) there’s plenty of room to operate. Older, “open” surgery techniques required at least a month on crutches and opened the body to infection. With an arthroscope and microsurgical instruments, a surgeon can repair torn cartilage and ligaments, remove bone chips, smooth out rough spots-and generally have the patient up and walking after only a weekends recuperation.

Today, fiber optics also makes it possible to use laser beams to cut and seal tissue. Tiny laparoscopes are used to view and repair back tissue leaking from a ruptured disk. And surgeons are using arthroscopic techniques to work on smaller and smaller joints: ankles, toes, a joint of the jaw that is less than one-tenth the size of the knee.


Joint replacement techniques have improved with the discovery of better materials to be used as full or partial replacement of the diseased or injured joint.

More than 150,000 total hip replacements are performed each year in the United States, according to Harvard Medical School’s Dr. Stuart Kozinn. In a complete replacement, the entire ball-and-socket joint is replaced by an artificial one, known as a prosthesis, that combines metal alloys and high-density plastics.

Traditionally, hip replacements used acrylic cement to hold the prosthesis in place. This worked well for older, less active patients. But one study of younger patients found that the cement loosened in 50 percent of cases after 10 years of use.

The solution? A cementless implant. A prosthesis is fitted into the femur (upper leg bone). Its porous or rough surface allows natural bone growth to attach itself to the implant in much the same way that a healing callus forms when a bone is fractured. Because the rate of new bone growth varies, recovery time for a cementless implant can be longer–but the patient can expect to lead a more active life after surgery.

What’s in the works?

Researchers are experimenting with ways to stimulate bone growth through use of electromagnetic fields and other methods. And the future also holds the possibility of human-donor hip transplants.

Diagnostic Tests and Scans

More high-tech stuff: Though not widely used yet, CT scans and computer programs can now map the precise shape of a needed implant and design a custom job (one size fits YOU) to replace an injured joint.

But some experts think the greatest breakthrough in diagnostic testing has been the use of MRI-magnetic resonance imaging.

“That’s a big advance,” says Albohm. “MRI can do soft-tissue evaluation, and that adds a key piece of information to what the physician knows. It was first very important in things like evaluating muscle strains among athletes, but the technology is now filtering down to the rest of us. In many cases, MRI can mean avoiding surgery altogether, because the physician doesn’t have to do anything invasive just to find out what’s going on in there.” For patients with soft-tissue injuries to tendons, ligaments, and muscles, MRI is fast becoming a first step to knowing whether surgery is really necessary.

What Else? Biofeedback…and More

A patient injured in a fall uses a computer-designed orthotic device placed inside the shoe to change the angle of an injured ankle and foot and promote faster healing.

A race walker carries a portable monitor that calculates whether certain pressure points on the foot are receiving too much or too little force.

A computer analysis suggests ways to improve technique … and reduce the chances of leg fatigue and injury.

These are just two current uses of the science of biomechanics — a way of analyzing the human body as a living machine reacting to forces outside and inside the body.

Only recently, sophisticated biofeedback devices were sort of thing you’d find only at places training world-class athletes- for instance, the US Olympic facility in Colorado Springs. Among the biofeedback programs in use: high-speed speed filming and video imaging, force platform studies, scanners that can “read” movement from light-emitting diodes (LEDs) attached to an athlete’s body, computer-designed “stick figure” replications of an athlete’s motions, and so on.

Today, however, many home exercise machines (stair climbers, etc.) are equipped with some similar measuring devices that will monitor pulse rate, oxygen consumption, and other factors. Look for more and more feedback equipment in use among casual athletes or nonathletes-to help prevent and heal many types of orthopedic injuries.

What’s the last word in orthopedic treatment? Just ask. Whether you’ve been injured at home, in an accident, or participating in athletic activity, chances are the there’s more than one way to treat your injury. Ask questions about what can be done- and be sure your injury is helped along by recent advances in orthopedics.

Normally, it might not have felt like such an emergency. A local high school freshman walks into the emergency room after a fall that dislocates her elbow. We can fix that.

But this high school freshman was a world-class gymnast on the road to Barcelona. The fall that injured Shannon Miller’s happened just five weeks before the U.S. national championships, and only a few months before the Summer Olympics. She didn’t have any time to waste.

“Shannon had what we call a fracture dislocation,” Dr. David Holden told us. “She was doing a relatively easy maneuver and just landed a little awkwardly on her arm. She slipped along the mat, and the force dislocated the elbow. In the process, a good-size bone chip was broken off, too. Normally when you dislocate your elbow, you tear the ligaments- but in her case, the bone was weaker than the ligaments, and the bone chip that tore away was where the ligaments attach to the elbow.”

Dr. Holden immediately repositioned the elbow in the emergency room to reduce Shannon’s pain. But that was only part of the problem.

“Now we had a loose, unstable elbow, and some choices to make. I talked to her parents and coaches about it. We could treat the injury conservatively- as it would have been [treated] 10 years ago, or today by someone who doesn’t deal with sports injuries. That is, we could immobilize the arm in a cast for five or six weeks.

“I felt that would be a disaster for her-no way she’d be back in time to complete at the nationals or in Barcelona.” (Russian coaches said a gymnast on their team with a similar injury took more than a year to recover before she could complete again.) “And too,” he adds, “the stiffness after a fracture dislocation can be severe. A gymnast can’t afford to lose the extension of her arm-and I knew if we put it in a cast, she’d never straighten that elbow out again.”

Shannon’s parents and coaches agreed that surgery was really the only choice. Dr. Holden operated that night.

“We were lucky in that the ligaments weren’t torn. I used a small fragment screw to place the bone chip back onto the bone. That immediately stabilized the elbow, and we were basically able to get her into therapy right away and never had immobilize the arm at all. She had an excellent trainer, and her coach was extremely good at bringing her along without pushing to hard.”

The combination of high-tech surgery, therapy, and Shannon’s determination paid off. Barely more than a month following her surgery, she placed first on balance beam in the U.S. championships. And in the summer, she blasted past more highly touted U.S. gymnasts to take the Olympic silver medal in the all-around competition at Barcelona.


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Changing Your Email? It Ain’t Easy!

cyeOF ALL THE PROMISES MADE TO CONVINCE US TO SPEND LONG HOURS AT A KEYBOARD WHILE LOOKING INTO A small, fuzzy screen, e-mail has delivered best. It has permanently benched us from the unproductive game of phone tag and saved the lives of countless trees. It has also played a significant role in our somewhat successful attempt to dam the flood of information coming at us. We, like millions of e-mail users, have come to rely on it. The relationship remains quite rosy, until we have to change our e-mail service provider.

Maybe you need to change providers because you live outside of a major metropolitan area and the monthly long-distance fees or toll calls to a local node for America Online or CompuServe are killing you. Maybe your Internet service provider (ISP) went out of business, or you’ve moved to an area where it doesn’t have a local number. Maybe you’ve finally become too frustrated with your provider’s service. Whatever the mason, you’ll suffer even more disappointment trying to make the switch. We’ve got some ideas to ease the pain that we’ll tell you about, but they’re far from perfect.

Two entrepreneurs who’ve experienced much frustration are Daniel and Dennis Murphree, who build custom computers in Tilton, New Hampshire. The father and son spend about 100 hours a month using e-mail and browsing the Web to order parts for their company, Agape Computers, and to stay in touch with customers.

Their original provider, America Online, was a long-distance call away. They decided to try a local ISP to cut costs and saw huge savings in their monthly bills. Unfortunately, the Murphrees had problems with the service’s reliability from the outset. They left the ISP when it suddenly hiked its fees. They didn’t see an improvement with their new ISP, and after a few more months of lost communications, they switched again. The two are understandably cautious about whether their new ISP will meet their needs. Changing providers four times in one year cost their business dearly. They’ve no idea how many customers didn’t get through to them with all the switches.

In a Perfect World The Murphrees, and you, shouldn’t have to suffer. After all, it is electronic mall so it should be simple for e-mail providers to add a few lines of code and forward mail from your old address at jsmith@abc.com to your new one at jsmith@xyz.com. It should be, but it isn’t.

The problem is that your old service provider has to initiate the forwarding. Neither the major online services nor most ISPs offer this option. Although CompuServe leaves your mailbox open for 60 days after you cancel your account, it won’t forward your mail. You’ll still have to go back in and grab it. One ISP we spoke with said it might forward a subscriber’s e-mall if he left on amicable terms, such as moving or being transferred. But if a subscriber left because of unhappiness with the service, forwarding would not even be considered.

Since there is no forwarding, you’re looking at dumping all of your business cards, stationery, and collateral materials, as well as changing any ads or listings you’ve painstakingly selected for reaching your target markets. You’ll also have to worry about what clients will think when their e-mails to you come back with the online version of “Return to Sender: Address Unknown.”

Keep Two Accounts If you have to change your e-mail provider or are just fed up with its service, you need to take some temporary measures to keep from losing communications with valuable contacts. First, send a message to all your contacts with your new e-mail address. Then, keep both your old e-mail account and your new one for three months. This ploy should pay for itself with the first piece of new business that you would have otherwise missed.

E-mail software such as ConnectSoft’s E-Mail Connection and Global Village’s FocalPoint can access more than one account and collect all your messages in a single in-box. You simply inform all the users who are still sending messages to your old account that you now have a new address.

All of your messages may have to begin with the line, “Please send all replies or correspondence to jsmith@xyz.com.” This can be tedious, but some programs such as the Macintosh application Claris Em@ailer will automatically send a canned response to any messages coming from your old e-mailbox.

Never Again No matter what ISPs may wish, you should be able to change providers without losing your client correspondence. If you’re ready to switch, there are two options that will prevent you from losing e-mail in the future.


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Get Those Expenses Straight!!

gtesWhen translator Benno Groeneveld first struck out on his own, he didn’t bother to invoice clients for business calls. Why not? He didn’t have the time to sort through every call he made when his statement-arrived. But within no time, Groeneveld’s monthly phone bill skyrocketed to $200 (of which $150 was client-related). So when the St. Paul, Minnesota, businessman discovered his long-distance carrier offered call coding–which automatically categorizes client calls by account–he signed up. “For me, it makes a difference in what I charge,” he says.

Tracking out-of-pocket costs is a blight everyone faces–whether you have to document expenses for individuals or the IRS. But it’s a necessity: Overlooked financial outlays and lost receipts add up to mega-dollars down the drain, and late-paid expenses cause cash flow catastrophes. Take Joe Ely, an agricultural debt adviser in Indiana whose out-of-state client visits average $250 apiece. If he were to misplace only one set of receipts a month, he’d lose $3,000 a year.

Thanks to new products, software, and services (and some old-fashioned organizational systems), staying on top of expenses doesn’t have to be a nightmare. By choosing the right solutions, you can claim everything you’re entitled to–without wasting hours wading through receipts. The trick is to find the method that works best for you during each of the three expense steps: collecting receipts, entering amounts, and invoicing.

Step 1: Gathering Proof of Payment
No client will reimburse your expenses without validating that you’ve spent the money. Whether you purchase an airline ticket to San Francisco or buy a salami sandwich, you need to show that you shelled out money. Credit card purchases are naturally easier to duplicate and keep track of each month because you get a statement (although many companies now require cash-register receipts as well), but cash expenses are most often overlooked. “Start expensing as soon as you take money out of your wallet,” insists Cincinnati organizer Stephanie Denton.

To account for cash, she suggests keeping a pen on hand to note the client name and project on the back of, say, each taxicab receipt that’s handed to you. Or tuck a notepad or personal digital assistant (PDA) in your briefcase to log such small costs as magazines, food, or other essentials. For road warriors, Denton recommends securing a mileage book on the dashboard, along with a pencil (pens freeze in cold weather). Then, as soon you get back to your office, immediately file your paperwork. Indiana adviser Ely, for instance, keeps an envelope with the name of the month on the comer of his desk.

For telephone costs, take a tip from translator Groeneveld and enlist your phone company to collect your expense information by subscribing to call coding. Offered by the big three carriers, call coding requires only that you punch in a two- or three-number code with each long-distance call. Sprint (800-877-4646), for instance, sells call coding for $5 per month for an unlimited number of long-distance calls. And, for no extra charge, you can add the service to your calling card (if you travel internationally, however, you have to ask for operator assistance). And AT&T’s Call Manager (800-566-2464) plan is free.

Although your monthly phone statement will be arranged with calls broken out and subtotaled by code–saving you countless hours of mindless work–call coding doesn’t yet import information into your PC. You still have to enter the subtotals yourself.

Step 2: Expense Entry
Even if you’re an expense receipt pack rat, you may skip this vital step–inputting your money outlays into your accounting system. The key to saving time, however, is to let suppliers and technology systems do most of your legwork, so all you have to do is download data to your desktop.

If you’re often on the go, PDAs with Pocket Quicken, such as the Apple Newton MessagePad 130 (800-538-9696, www. apple.com; $799), help tally your expenses immediately. Unlike old-fashioned paper logbook entries, which have to be re-entered back at the office, certain PDAs import data directly to your desktop Quicken. Who wants to waste time with double data entry when you can grow a business?

To shave even more hours off your accounting paperwork, consider banking electronically. If you use Quicken 5.0 or higher, for example, you can download your expense information from more than 41 banks, American Express, or Quicken’s own credit card, and print out your costs receipts with each client invoice. Other financial institutions that offer electronic services include Wells Fargo and Security First Network Bank, Neither requires you to call a special phone number or buy additional software to tap your account.

Step 3: Streamline invoicing With Software
Once you’ve entered your expense information into your computer, simplify the process by using programs that are designed to track payment. For instance, ExpensAble 2.0 from Intuit (800-816-8025; Win 95, Win; $49.95) is created for people who travel and have an expense account. It’s an intuitive invoicing program that prompts you for expenses you might have forgotten. It’s even able to sort out complex hotel bills in seconds. What’s more, it imports information from a PDA and offers an assortment of invoice styles for different types of companies. Unfortunately, business owners who bill for expenses that fall outside ExpensAble’s preset categories may find the program doesn’t meet all their needs.

For those who bill by the hour, Timeslips Deluxe 7.0 helps tally your time–and expenses. But if all you need is a simple expense program, Timeslips is too complicated to master for the occasional out-of-pocket cost. If that’s the case, check out Xpense-Pro from Lumtron Technologies (815-568-2602; Win 95, Win; $40).

Cincinnati consultant Denton swears by Quicken to help monitor her costs. For $39, the personal finance program can sort your expenses by both category (type of expense) and class (your client). Then, with all expenses coded by client, Quicken’s report function will produce an itemized list in seconds. Although the program doesn’t include invoice forms, you can import client reports into your word processor. But, adds Denton, many clients accept a Quicken report (perhaps with a brief cover sheet) as an invoice.

On the other hand, West Los Angeles small-business owner Donna McMillan prefers to use QuickBooks. Once you’ve entered your expense data, the program automatically imports it into one of several invoice forms, and then tracks it as accounts receivable.

Even better, QuickBooks helps speed up your payment process–the whole reason you’re expensing in the first place. “A reminder screen will list your outstanding accounts receivables,” McMillan says. “And it’ll sit there until you tell the program you’ve deposited the check.”


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Mailing Lists – How We Hate Them!!!

tlgEverybody knew Wait, the neighborhood butcher when I was growing up. Walt, in turn, knew everybody. He knew that my mother ordered a pot roast for Sundays. He knew that Mr. Schlampp wanted fish on Fridays, and that Mrs. Levine bought kosher food. He knew our addresses and phone numbers, when the grandkids were coming home to visit, our birthdays and our paydays, and whose charge accounts were in arrears. Walt’s customer database was in his head.

Wait used his database for marketing. He called us if he had a particularly nice roast. He did not call Mr. Schlampp to offer him meat on Fridays, nor did he offer pork chops to Mrs. Levine. He cheerfully acknowledged his customers’ new cars, new dresses, and new hairdos and, as a result, probably got more business.

Because he was a friend and neighbor, we didn’t mind Walt using some of the details of our lives to better his business. Although Mrs. Brown next door suspected him of having a heavy thumb on the scale, for the most part we trusted Walt.

Consumers have no such trust in the companies that collect, sell, and trade their personal information today. Nor do they trust the automated robots that vacuum up the electronic crumbs from the “cookies” (files that keep track of all they see and do online on a hard disk).

As operators of small businesses in the computer age, we capture a lot of information about our customers in our own computer databases. We can also buy information about potential customers, whether our businesses operate locally, across the country, or even overseas. The lists can be as broad as every household in a certain city or as focused as all the credit cardholders who live in the three most affluent zip codes in a town, have teenaged children, and have charged at least $1,000 in Colorado between November and February.

If I were a travel agent, I’d want to send a brochure or two to the folks in that latter group. If I were the recipient of the travel brochure, perhaps I would think, “At last! A piece of interesting and potentially useful junk mail.” At least, that would be my first thought. But as with so many things in the computer age, second thoughts are sure to follow. Junk mail, the direct marketing industry is fond of saying, is simply mail that is sent to the wrong person. Someone, somewhere, would find the same piece of mail to be valuable. The problem is matching the right piece of mail with the right recipient.

In the discussion of junk mail that appeared in this space last month, the focus was on unscrupulous business operators who flood the Internet or U.S. Postal Service with messages, hoping that, out of the thousands that are sent, a few will land in receptive hands. This shotgun approach, known on the Internet as spamming, is widely reviled. But the opposite tactic–the laser4ike targeting of specific messages for specific individuals–is as appealing to businesses as it is troublesome on privacy grounds.

Database marketing is based on the increasing availability of information about individuals, made possible by computer records. There are now more than 1,500 commercially maintained mailing lists in the United States, ranging from relatively simple lists containing just a few snippets of data, similar to the information found in a phone book, to massive lists of tens of millions of consumers, including detailed records on health, finances, and spending habits.

Each of us has been captured in a computer file somewhere. The files grow when we enter school, sign up for a birthday party at the ice cream store, enter a contest, send off for a magic kit, get a Social Security number and a driver’s license, apply for a credit card, join the army, make a phone call, fill out a warranty card, register to vote, buy a house, order a sweater from a catalog, and so on. The lists are getting ever more detailed, and the latest trend is to consolidate multiple lists into a giant master file.

The Internet and the World Wide Web hold the promise of gathering even more finely detailed information on users, keeping track of what Web pages they view, how long they tarry over specific advertisements, and whether they purchase anything online. Most of the big database companies now use sophisticated software to analyze these lists, fine-tuning them to sift out those households most likely to respond favorably to certain products.

Viewed in a positive light, the precision of database marketing is appealing to any business that wants to gain new customers and make the most effective use of marketing budgets. It’s also a benefit to consumers who are more likely to receive useful mail.

Viewed in a negative light, these precision-targeted lists are cause for concern on privacy grounds. These unseen computers know far more about us than Walt the butcher ever did–or wanted to.

If you’re considering the use of such targeted marketing pitches, whether gleaned from your own customer database or taken from lists purchased from brokers or other companies, you have an obligation to use the information responsibly (for more on this subject, see “Direct Your Pitch” in this issue”). Businesses that gather consumer information from Web-browser cookie files need to set clear policies on the use–and protection–of that consumer data. Many states have laws restricting the uses of public databases, but even the big database companies say the rules are confusing.

In fairness to the direct marketing industry, abuses of consumer databases are rare compared with the vast amount of data being traded among companies. But database abuses are growing, and one of these days consumers, and perhaps the government, are likely to demand greater controls over the information being gathered and sold.

Those of us who run home-based businesses should be even more sensitive to the concerns over targeted direct marketing. Let’s face it: A lot of us work from home because we don’t want anyone looking over our shoulders. As business owners, we need to make effective use of the latest technologies, but we also need to stand up for the right to privacy, to use the available information responsibly, and to safeguard the data we gather from customers. If a business intends to sell or trade its customer databases, it has an obligation to inform customers and give them the right to opt out of the list.


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No Need For Windows? Er, Maybe…

tlgNearly every profession has been transformed in some way by technology, and graphic design is no exception. The drafting table has been replaced by the desktop computer, which performs some of the most exacting-and formerly messy–tasks. In addition, where light-filled workspaces used to be considered a necessity, that same light now tends to drown out images displayed on a large-screen monitor–the graphic designer’s most important tool.

That’s what Washington, D.C.-based graphic designer Lloyd Greenberg discovered when he moved his home office from upstairs to downstairs to make room for his new baby. Thanks to some creative lighting design, Greenberg was able to move comfortably from a large room with a nine-foot ceiling and seven-foot windows with southern exposure to a dark unfinished basement with a seven-foot, eight-inch ceiling.

To make the space work, Greenberg had to move the furnace and radiators, take out a column, add a beam, and erect plasterboard walls. But it was the halogen and fluorescent lighting Greenberg installed that made the most difference. Greenberg used long-lasting, low-wattage fluorescent bulbs in 20 standard recessed light cans (fixtures that also can burn incandescent bulbs) throughout the studio and a bank of color-correcting fluorescent lights.

Several high-intensity halogen lights provide task lighting at two workstations. Feeling the need to compensate for his subterranean setting, Greenberg installed 150-watt floods, which warmed up the studio even before the repositioned furnace was vented. But in the end Greenberg discovered that he needed much less, not more, light than he had been used to having in his upstairs studio.

Indeed, the degree of illumination is perhaps the most important change from the studios of five or 10 years ago, when artists craved great expanses of natural sunlight as well as total darkness for photostat-making and other darkroom activities. Now, studio lighting is subdued so as not to interfere with monitor brightness, and darkroom activities are performed with such computer photo applications as Adobe Photoshop.

Only a stray shaft of afternoon daylight now enters Greenberg’s studio through front and rear doors and windows. Ambient lighting in the studio is on dimmer switches, complementing the art- and book-lined walls and the faint strands of classical music Greenberg listens to while he works.

Greenberg, who has been doing all of his work on computers since 1992, says his office now requires not only less light but less space. “When I started as a graphic designer,” Greenberg explains, “we needed space with a lot of light and room to spread out. But since I made the switch to working on computers, I probably use a quarter of the space I did before.”


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High Tech Hotels Make Vacationing Smart

hthmInstead of making hotel rooms feel like luxurious versions of home, innkeepers today are trying to make rooms more like your office. “Historically, hotels have [offered] business centers,” explains Gary Hamilton, professor of law and operations at the School of Hotel & Restaurant Management at California State Polytechnic University in Pomona. “But now everybody has laptops, so the nature of business has fundamentally changed again.” Hamilton explains that to survive, hotels now have to provide accommodations that offer the very technology that would otherwise cut into the hotel’s business by keeping potential travelers in their offices.

The new Cyber Suite in the Los Angeles Westin Century Plaza represents the high end of hotel high-tech. The Cyber Suite features plasma-screen TVs with high-speed Internet access, real-time videoconferencing, a multimedia computer with wireless mouse, a CD stereo system to blow any hi-fi nut’s mind, a videodisc player, cell phone service on and off ‘ hotel property, and a voice-activated “butler in a box” to work lights, doors, and more– all for a hefty $2,000 a night.

That’s a little rich for most travelers’ pocketbooks. But moderately priced hotels are accommodating business guests with increased in-room technology offerings as well. Radisson’s Business Class program offers free phone access, no fax surcharges, a computer workstation, and computer hookup. At Hilton Garden Inns, a middle-marker hotel group with 25 hotels and 100 planned by the year 2000, rooms feature desk space for portable computers, electrical outlets and phone jacks at desk height instead of at baseboard level, and two telephones with dataports. “Midpriced hotels currently offer the greatest development opportunity for Hilton,” says James Abrahamson, senior vice president of franchising. “Our research shows there’s increased demand by travelers for [in-room technology].”

High-speed Internet access is also gaining in hotel rooms. The Fourth Communications Network of San Jose, California, is currently installing high-speed Internet access through hotel room PCs and TVs in more than a dozen chains, including Holiday Inns, Embassy Suites, and Hiltons.

Finally, look for hotel rooms featuring standalone, fully dedicated, high-speed Internet access systems–similar to ATMs–which are debuting nationwide from Atcom/ Info in partnership with Microsoft. Oakland, California’s Claremont Hotel and,Washington, D.C.’s Renaissance hotels are up to ISDN speed with this system, and “many major hotel companies are talking to Atcom about testing installations,” reports Michael Mahoney, director of hospitality consulting services at Coopers & Lybrand LLP in Los Angeles.

Trying to juggle work and family is especially hard when your home is your workplace. In Hew to Raise e Family and a Career Under One Reef (Bookhaven Press; $15.95), author Lisa Roberts combines real-life experience with practical advice on what it takes to launch and nurture a business and family at the same time, in the same place. Roberts explores the impact of working at home on children, marriage, the household, and the individual. To help you cope, she provides exercises and suggested readings, and lists outlets where you can seek support in your quest for the perfect balance of a combined work and family life.


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