Worksheets

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WorksheetsIn This Appendix

^ Making a list of prescription drugs

Worksheets^ Comparing Part D plans to make your final cut

^ Seeing how Medicare Advantage health plans measure up to one another

•bInding the best drug plan among scores of possibilities — when each W One has its own costs and benefits and is different from the next — can be a nightmarish prospect. But it doesn’t have to be a nightmare in practice. In Part III, I explain how you can whittle those choices down to a manageable few — by first deciding whether you want to receive your healthcare from traditional Medicare or from a Medicare Advantage plan and then by comparing Part D plans head-to-head according to what they charge for the drugs you take (and other factors that may be important to you).

Using checklists and notes of point-by-point comparisons to track the info you’re compiling can help you more clearly see the differences between the plans you’re considering so you can make that final cut — down to one. This appendix has three worksheets designed to help you do just that.

Worksheet 1 Is essentially your master list. It provides an organized way of jotting down complete information on all the prescription drugs you take. This is the list you need to make before you can compare Part D plans properly, as explained in Chapter 10.

Worksheet 2 Is the tool to use after you’ve searched the online Medicare Prescription Drug Plan Finder (or had someone do this for you), as explained in Chapter 10, and reduced your number of drug-plan options to a shortlist of three or four that seem best. You can use this worksheet to finalize your choice among either stand-alone prescription drug plans (PDPs) or Medicare Advantage health plans that cover drugs (MAPDs).

Worksheet 3 Is a checklist to use when considering Medicare Advantage plans for their health costs and benefits, as explained in Chapter 9, after you’ve reduced these plans to a shortlist of the three or four that seem best for you.

Worksheet 1 is the essential list you must make before comparing Part D plans, as explained in Chapter 10. For each of the drugs you take, write down its exact name together with any other words or letters that follow the name (for example, verapamil HCR ER), its dosage (120 mg, 2.50 ml, and so on), and how often you take it (one pill a day, one bottle a month, and so on).

WorksheetsWorksheet 1 Your Personal List of Prescription Drugs

Full Name of Prescription Dosage How Often You

Drug Take Drug

1_

2_

3_

4_

5_

6_

7_

8_

9_

H)_

11 12 13 14 15 16 17

Worksheet 2 is designed to be used with the online Medicare Prescription Drug Plan Finder, found at Www. medicare. gov. The plan finder tool provides answers to the following questions, as I describe in Chapter 10.

Worksheet 2

Comparing Part D Plans Point by Point

Suggested Questions to Answer for Each Plan

Plan 1 Plan 2 Plan 3 Plan 4

WorksheetsDoes this plan cover all of my drugs? (Yes or no)

What will be my total estimated out-of-pocket costs over the year at Retail pharmacies Under this plan? (Dollar amount)

What will be my total estimated out-of-pocket costs over the year under this plan’s Mail-order service? (Dollar amount or N/A if mail order not offered)

What will my total estimated out-of-pocket costs be over the year under this plan if I choose available Lower-cost drugs? (Dollar amount)

How many of my drugs come with any restrictions: prior authorization, quantity limits, step therapy? (for example, 1 PA, 2 QL, 0 ST)_

Will I fall into the coverage gap under this plan? (Yes or no)

Does this plan cover any of my drugs in the gap? (Yes or no)

Does this plan use pharmacies that are convenient for me? (Yes or no)

What are this plan’s ratings for customer service? (POor, FAir, GOod, VEry GOod,

EXcellent)

Will this plan cover my prescriptions when I’m away from home? (Yes or no)

WorksheetsYou can use Worksheet 3 to compare Medicare Advantage health plans After You’ve decided to receive medical benefits from an MA plan rather than traditional Medicare (as explained in Chapter 9). This worksheet focuses only on medical care. You can get most of the answers by comparing Medicare health plans online at Www. medicare. gov. You may have to ask plans or providers for answers the online tool can’t provide. (To compare these plans’ drug benefits, use Worksheet 2.)

Worksheet 3 Comparing Medical Benefits in Medicare

Advantage Plans

Suggested Questions to Plan 1 Plan 2 Plan 3 Plan 4 Answer For Each Plan

Will the providers (doctors, hospitals) that I prefer accept this plan? (Yes or no)

Will this plan allow me to go to out-of-network providers for a higher co-pay? (Yes or no)

Will this plan cover my nonemergency healthcare needs outside of its service area? (Yes or no)

What will my fixed costs (monthly premium, annual deductible) be in this plan? (Dollar amounts)

Does this plan put a limit on my out-of-pocket expenses in a year? (Dollar amount) Are any services excluded from this limit? (Yes or no)

What will I pay to visit my primary care doctor in this plan? (Dollar amount or percentage)

Suggested Questions to Plan 1 Plan 2 Plan 3 Plan 4 Answer For Each Plan

What will I pay to visit a specialist in this plan? (Dollar amount or percentage)

What will I pay to stay in a hospital in this plan? (Dollar amount or percentage)

What are this plan’s ratings for quality of care? (pOor, FAir, GOod, VEry GOod, EXcellent)

Does this plan offer benefits for vision, hearing, or dental care? (Yes or no for V, h, Or D)

Does this plan offer preventive care (screenings, scans, tests) that meets my needs? (Yes or no)

Does this plan cover physical exams? (Yes or no)

Appendix B

  • Автор: Анкар
  • Категории: Appendixes

Ten Complementary Medicine Tips for Healthy LivingIn This Chapter

^ Identifying ten tips for healthy living

^ Determining how therapies can help you achieve great health

Ost of the complementary therapies covered in this book contain precious nuggets of self-care advice for optimising health.

Ten Complementary Medicine Tips for Healthy LivingIn this chapter, I extract ten of the best, simple, self-care tips from these therapies that can help put you on the road to the best of health.

Be Aware

The traditional medical systems of China, India, Tibet, and Japan, as well as early European Nature Cure (see the chapters in Part II of this book for more about all these), all advocated body awareness and living in tune with the seasons. This awareness means getting to know your body well, being observant of changes, and learning how to read and interpret body signs of health and disease, such as in tongue and face analysis and urinalysis.

Ten Complementary Medicine Tips for Healthy Living

You’ve probably heard stories of people sometimes proving to be a better judge of what was wrong in their own bodies than their doctors, specialists, or even expensive diagnostic equipment.

Of course, in many cases early medical detection and treatment is accurate and effective. Yet developing the skill of body awareness, and learning to fully trust it, is surely good for your health – and in some rare cases may even turn out to be life-saving.

M

Ten Complementary Medicine Tips for Healthy LivingTake a look at the self-diagnosis skills described in Chapter 2 to help you increase your body awareness.

Remember to always seek medical advice if you have a cause for concern.

Well

Ten Complementary Medicine Tips for Healthy LivingPractitioners of nutritional medicine are passionate about helping you to optimise your digestion and nutritional status by eating well.

Decide today to move away from consuming junk food, burgers, sugary foods, saturated and hydrogenated fats, and excess alcohol, tea and coffee and to replace these with lots of healthy whole grains; fresh fruit and vegetables; oily fish and lean meats (if not vegetarian or vegan); nuts, seeds, pulses; and even seaweeds, sprouted seeds, and grasses. And don’t forget to add plenty of essential fatty acids from plant, nut, and seed oils (or fish oils if you eat oily fish) and oodles of water for adequate hydration.

For more comprehensive nutritional tips, go to Chapter 12.

Boost Immunity

Boosting your immune system is probably one of the best ways of staying healthy. We are all constantly exposed to bacteria and viruses, but if your immune response is good, you’ll be most able to dispel these or render them harmless.

Herbalists have a range of herbs that they recommend to support the immune system. One of the most popular is the plant echinacea (also known as the purple coneflower), which you can take in tablet or liquid tincture form (available from health food shops). Echinacea has been shown to raise white blood cell count and reduce the likelihood of getting a cold or decrease its duration and severity if you already have one.

Other ways to boost the immune system include regular intake of bioflavonoids and other nutrients (see Chapter 26) or treatments such as acupuncture (more about this in Chapter 9).

For more on echinacea and other great herbal medicines, go to Chapter 11.

Balance Those Bones

Structural alignment and posture are also key to health. Years of bad habits such as balancing phones between the ear and shoulder, hours spent hunched over games consoles or computers, always carrying bags on one side of the body, sports injuries, and so on all take their toll on the bones, muscles, ligaments, and tendons. Gradually, the full range of movement of joints can be lost, wear and tear can occur, and repetitive strain is also a possibility.

Osteopaths and chiropractors can help rebalance the body and increase the range of movements as well as recommend exercises for practising at home to help maintain improvements. Therapies such as the Alexander Technique and Pilates can also help to improve posture and flexibility.

Give your body an indulgence and have one of these treatments, and learn some of their exercises to practise yourself everyday. For more on osteopathy and chiropractic, check out Chapters 14 and 15, while you can find details of the Alexander Technique and Pilates in Chapter 16.

Breathe

Ancient yogic sages have claimed over centuries that breathing is the key to life. They argued that each person has a finite number of breaths and that when you’re stressed or angry your breath becomes shallower and more rapid, which means that your lifetime’s supply will be used up more quickly!

This theory is unproven but it’s certainly true that when you’re relaxed and happy your breath is more relaxed and full and you breathe at a slower rate using your diaphragm more rather than restricting breathing mainly to your upper chest. On the other hand, lots of activities today, such as computing and gaming, which often involve stooped postures and intense concentration, lead people to hold or restrict their breathing, and thereby decrease the oxygen supply to the body.

Naturopaths and yoga practitioners recommend practising deep breathing in the fresh air every day in order to relax the body and oxygenate the tissues. Naturopaths also recommend taking air and sun baths for around 15 minutes daily whenever possible because moderate, sensible sunlight exposure facilitates the production of Vitamin D in the body and allows air to circulate around the body, which helps promote healthy skin.

Resolve to increase your breathing awareness from today and to get in some good full breaths of fresh air whenever and wherever possible. For more about naturopathy, read Chapter 13 and for more on breathing exercises check out Chapter 18.

Ten Complementary Medicine Tips for Healthy LivingMove It!

We all know that exercise is good for us but, as in all things, getting a balance is important. Overtly physical or aerobic exercise can increase oxygenation of the tissues and lead to the production of feel-good chemicals – the Endorphins - in the brain. However, overdoing it can lead to long-term damage of joints and tissues, cell death, and even exercise addiction!

In Oriental medicine, the emphasis has been predominantly on therapeutic rather than aerobic exercise, with a focus on stretching, breathing, and coordination. Exercises such as yoga, T’ai chi, And Qi gong May look simple but they require stamina, precision, and good breath and muscle control. They are also said to facilitate the flow of ‘vital energy’, known as Qi Or Ki.

Research has also shown that these exercises can have profound health benefits; for example, medical yoga treats such conditions as asthma, irritable bowel problems, and more.

Incorporating these types of exercise into your regular exercise routine can therefore be very helpful. Resolve to start discovering one of these therapeutic movement systems this year, or to deepen your practice, or learn a new form if you’re already competent in one. For more about these movement therapies, check out Chapter 16.

Rest and Sleep Well

Ten Complementary Medicine Tips for Healthy Living

You cannot be in the best of health without incorporating adequate rest into your lifestyle and getting good sleep.

Famous politicians such as Winston Churchill and Margaret Thatcher are well known for having perfected the art of cat-napping in order to cope well with their busy lives and demanding schedules. Fatigue and insomnia (inability to sleep at night and wakefulness during the night) can grind you down, making it impossible to function effectively and leading to irritability, impatience, burn-out, and a myriad of health problems.

Oriental medicine practitioners advise you to build brief rest periods into every day; my Qi gong Teacher in China always argued that taking short rests enables you to achieve more – not less – in your day overall. Acupuncturists also have a great remedy for insomnia using the acupoint Heart 7. This point is located on the inside of the wrist in the groove in line with the little finger when the hand is bent inwards. Clinical and research evidence suggests that massaging or applying pressure to this point can help facilitate a good night’s sleep.

For more about acupuncture, see Chapter 9; for relaxation therapies head to Chapter 18.

De-stress

Moderate stress is actually good for you. It can stimulate the brain and lead to improved performance, production, and so on. But too much stress can set you on a downward spiral of anxiety, fatigue, burn-out, and stress-related disorders.

Psychological therapies such as psychotherapy, counselling, and hypnotherapy can make a difference by helping to identify areas of major stress and providing new coping strategies.

In the realm of self-care, even using positive affirmations and visualisations can make a difference. Many leading sports people now use these techniques to cope with pre-match nerves and to bring out their best performance.

Ten Complementary Medicine Tips for Healthy LivingEmploying these techniques in everyday life is easy to achieve by increasing awareness of negative self-talk and then replacing such statements with healthier alternatives. For example, mental messages such as ‘I’m useless at this’ and ‘I’m never going to finish this on time’, which can rack up stress, may be replaced with repetition of ‘I am capable of doing this’ and ‘I will be able to finish this on time’.

Ten Complementary Medicine Tips for Healthy Living

Homeopathic remedies (available over the counter and from qualified homeopaths) are also popular with some people to ease the strain. For example, the remedy Passiflora 30c is said to help to switch the mind off and reduce mental anxiety. Flower remedies are believed to increase mental positivity (check out Chapter 22) while some aromatherapy oils such as lavender and lime can be wonderfully relaxing and uplifting when you add them to bath water or room burners (more on aromatherapy in Chapter 19).

For more about homeopathy, see Chapter 10. Information about positive affirmations and creative visualisation is in Chapter 23.

Create and Express Yourself

Expressing yourself creatively is sometimes ignored as an aspect of health and seen more as a luxury or a leisure pursuit to be fitted in when time allows. Yet music, art, and drama therapies are established therapies that have been shown to be helpful for all types of people with various types of health problems.

Drama therapy, for example, can help adults work out emotional issues, sand play therapy can help children to non-verbally express their feelings about problem situations within their family, and art therapy has been successfully used in prisons enabling inmates to have an outlet for feelings of aggression and frustration.

On a more mundane level, incorporating some sort of creative activity into your daily life can be relaxing and enjoyable and can help you to release daily stresses. Just look at all the celebrities who’ve taken up knitting for this purpose! You also gain the satisfaction of looking at your finished ‘masterpiece’ and sharing it with others.

If you don’t already then why not have a go incorporating sketching, painting, pottery, sewing, knitting, music playing, singing, amateur dramatics, or whatever turns you on into your life. Being creative is healthy and fun too! For more about creative therapies, take a look at Chapter 23.

Satisfy Your Soul

Health in body, mind, and spirit means paying a little attention to your spiritual needs too. For some doing so may mean following a particular religion but for others ‘soul satisfaction’ may be achieved through meditation, or through feeling a connection with ‘universal energy and love’.

This satisfaction can come just through a special moment, meeting eyes with a loved one, catching sight of a beautiful flower, sensing the awesome power of nature, or through healing therapies.

Healing therapies such as Reiki claim to connect you directly with ‘universal energy’, thereby facilitating the body’s own inherent healing power, while spiritual healers claim to channel ‘divine energy’ into the body. Many people enjoy these therapies and say that they lead to experiences of a deep sense of spiritual peace, calm, and well-being.

Try to find at least a few moments at the start and end of each day to ‘tune in’ and nourish your soul or find a personal or group spiritual activity that can have this effect on a regular basis. For more about healing therapies, visit Chapter 20.

In This Chapter

^ Assigning Cis – And Trans – Configurations

^ Reflecting on enantiomers and diastereomers

W^tow About this: Two organic molecules have identical chemical formulas. Each atom in Ґ m One molecule is bonded to the same groups as in the other. They’re identical molecules, right? Wrong! (Mischievous chemistry gods point and snicker.) Many organic molecules are Isomers, Compounds with the same formula and types of bonds, but with different structural or spatial arrangements. Who cares about such subtle differences? Well, you might. Consider thalidomide, a small organic molecule widely prescribed to pregnant women in the late 1950s and early 1960s as a treatment for morning sickness. Thalidomide exists in two isomeric forms that rapidly switch from one to the other in the body. One isomer is very effective at combating morning sickness. The other isomer causes serious birth defects. Isomers matter.

Isomers can be confusing. They fall into different categories and subcategories. So, before committing your brain to a game of isomeric Twister, peruse the following breakdown:

Structural isomers Have identical molecular formulas but differ in the arrangement of bonds.

Stereoisomers Have identical connectivities — all atoms are bonded to the same types of other atoms — but differ in the arrangement of atoms in space.

• Diastereomers Are stereoisomers that are Not Non-superimposable mirror images of each other. Two types of diastereomers exist: Geometric isomers (or Cis-trans isomers) Are diastereomers that differ in the arrangement of groups around a double bond, or the plane of a ring. Conformers And Rotamers Are diastereomers that differ because of rotations about individual bonds (we don’t cover them in this book because they’re beyond the scope of general chemistry).

• Enantiomers Are stereoisomers that Are Non-superimposable mirror images of each other.

Chapter 21 neatly handles structural isomers, describing how to recognize and name them appropriately. This chapter focuses on the trickier category: stereoisomers.

Picking Sides with Geometric Isomers

Geometric isomers Or Cis-trans isomers Are a good place to start in the world of stereoisomers because they’re the easiest of the stereoisomers to understand. In the following sections, we explain how isomers relate to alkenes, alkanes that aren’t straight-chain, and alkynes (see Chapter 21 for an introduction to these structures).

Alkenes: Keen on cis-trans configurations

Straight-chain alkanes are immune from geometric isomerism because their carbon-carbon single bonds can rotate freely. Unsaturate (or add another bond to) one of those bonds, however, and you’ve got a different story. Alkenes have double bonds that resist rotation. Furthermore, the Sp2 Hybridization of double-bonded carbons gives them trigonal planar bonding geometry (see Chapter 5 for an introduction to hybridization). The result is that groups attached to these carbons are locked on one side or the other of the double bond. Convince yourself of this by examining Figure 22-1.

Figure 22-1:

Cis And Trans Isomers of an alkene.

H3C

3 ^\

CH

YC=C\

H3C

H

/C = C\

H CH

In Figure 22-1a, the carbon chain continues along the same side of the carbon-carbon double bond. Both methyl (-CH3) groups lie on the same side of the unsaturation. This is called a Cis Configuration. In Figure 22-1b, the carbon chain swaps sides as it proceeds across the double bond. The methyl groups lie on opposite sides of the unsaturation. This is called a Trans Configuration.

Naming Cis-trans Isomers is simple. Attach the appropriate Cis – Or Trans – Prefix before the number referring to the carbon of the double bond (refer to Chapter 21 if you don’t know how to name alkenes). For example, Figure 22-1a is Cis-2-butene, while Figure 22-1b is Trans-2-butene.

A)

B)

H

Alkanes that aren’t straight-chain: Making a ringside bond

Although straight-chain alkanes happily avoid isomerism by rotating merrily about their single bonds, the four bonds of sp3-hybridized carbons assume tetrahedral geometry. Detailed representations like the one shown for methane in Figure 22-2 reveal this geometry. In the structure of methane, the bonds depicted as straight lines run in the plane of the page. The bond drawn as a filled wedge projects outward from the page. The bond drawn as a dashed wedge projects behind the page. These filled and dashed wedge symbols are known as Stereo bonds Because they’re helpful in identifying stereoisomers.

Figure 22-2:

Stereo bonds in methane.

C

HH

»H

H

When alkanes close into rings, they can no longer freely rotate about their single bonds, and the tetrahedral geometry of sp3-hybridized carbons creates Cis-trans Isomers. Groups bonded

To ring carbons are locked above or below the plane of the ring, as shown in Figure 22-3. The figure depicts two different versions of trans-1,2-dimethylcyclohexane. In both versions, the adjacent methyl substituents are locked in Trans Positions, on opposite sides of the ring.

The upper set of structures shows the plane of the ring as seen from above and highlights the Trans – Configuration of the methyl groups with stereo bonds.

The lower set of structures shows the same rings rotated 90 degrees downward and toward you.

H, C,

CH, ____• ,

CH CH,

,

CH CH,

Figure 22-3:

Two isomers of Trans-1,,-Dimethylcy-clohexane.

H3C

3

CH CH,

H3C

3

CH CH,

CH

The Trans Configuration of the methyl groups is most clear in the lower structures. The front-most methyl group is highlighted with explicit hydrogen atoms to emphasize its position above or below the plane of the ring. (Astute readers may ponder, if both are Trans, Why are they different? The answer to this mystery lies in the upcoming "Staring into the Mirror with Enantiomers and Diastereomers" section.)

Alkynes: No place to create stereoisomers

Alkynes also contain carbon-carbon bonds that can’t rotate freely. However, the Sp Hybridization of the carbons in these bonds leads to linear bonding geometry. The two-carbon alkyne, ethyne, is shown in Figure 22-4. Each carbon locks three of its valence electrons into the axis of the triple bond. Each has only one valence electron remaining with which to bond to hydrogen. No Cis-trans Isomerism is possible in this scenario.

Figure 22-4:

No iso-merism is possible at

The triple H-CC-H

Bonds of alkynes, such as ethyne.

Q. Draw the structure of Cis-3-hexene.

A. The name helpfully informs you that

You’re dealing with a six-carbon alkene, and that the double bond occurs between the third and fourth carbon atoms. The Cis – Prefix tells you that the carbon chain continues along the same

Side of the double bond, as drawn in the following figure:

HH

/C=C\

H3C

3

CH

CH

CH

1. Name the structure shown in the following figure:

/

CH, CH3

,3

H3C C H, C H,

CH2 CH2

22

/ \

H3C

3

2. Draw the structure of Trans-2-pentene. Solve It

H

Solve It

3. Draw the Cis- And Trans – Isomers of 3-heptene.

Solve It

4. Can geometric isomerism occur across the first and second carbons in a chain? Draw the structure of 1-butene. Are different geometric isomers possible across the double bond in this molecule? Explain why or why not.

Solve It

Staring into the Mirror with Enantiomers and Diastereomers

Geometric isomers are really just prominent types of Stereoisomers, Compounds that differ only by the arrangement of groups in space. Geometric isomers belong in the category of Diastereomers, Stereoisomers that aren’t non-superimposable mirror images. This section introduces a devilish category of stereoisomers called Enantiomers, Isomers that Are Non-superimposable mirror images of each other. Telling the difference between enantiomers and diastereomers can take some practice. You can practice here.

Getting a grip on chirality

Not all mirror images are superimposable on one another. This fact is so fundamental that it may have escaped your attention. If you doubt the truth of it, just try this: Extend your fingers and thumbs so that each hand makes an L-shape. (You’ve just synthesized two L-shaped molecules — well done.) Now, try to orient your L-shaped hand-molecules so both palms face upwards and so your fingers and thumbs all point in the same directions. . . At the same time. It can’t be done without serious injury. That’s because your L-shaped hand-molecules are Chiral, Meaning they have the property of non-superimposability with their mirror images. Molecules must be chiral in order to be enantiomers.

Carbon atoms can be chiral, too. When sp3-hybridized carbons bond to four different groups, those carbons have chiral geometry and can form Chiral centers Within molecules. Compare the two molecules shown in Figure 22-5, remembering to visualize the projections of the stereo bonds drawn as wedges (see the earlier section "Alkanes that aren’t straight-chain: Making a ringside bond" for more details). Rotate the molecules in your mind, trying to superimpose them. Although this is potentially a safer experiment than trying to superimpose your hands, it stands no greater chance of success. Chirality is what it is.

Figure 22-5:

Each carbon center bonds to the same set of four different partners, but these two chiral carbon atoms are not superim-posable.

Br

Cl

Cl

C

Br F

Molecules with chiral centers are often — not always — chiral. Chiral molecules often — always — possess chiral centers. Chiral centers are important enough that you should understand what they are and seek them out.

Not

C

F

Depicting enantiomers and diastereomers in Fischerprojections

Chains of tetrahedral carbon atoms show up so frequently in organic molecules that chemists have devised shorthand methods for drawing their structures. One such method is the Fischer projection. Fischer projections are a simple way to condense the three-dimensional reality of tetrahedral carbon onto a two-dimensional page.

.jjSiJj^ff In a Fischer projection, a bonded chain of tetrahedral carbon atoms is depicted as a vertical «Ґ\ line. Horizontal lines represent other bonds projecting from these central carbon atoms.

Each intersection between lines represents one carbon atom. Vertical lines symbolize bonds that project away from you. Horizontal lines represent bonds that project toward you. Examples of two molecules drawn as Fischer projections are shown in Figure 22-6.

Figure 22-6′

Enantiomers of 2-bromo-3-chlorobu-tane drawn as Fischer projections.

CH,

-Cl

- Br

CH

Cl Br

CH

CH

Fischer projections are convenient, but you have to be careful when using them to visualize bonds to make decisions about whether something is chiral.

First, you can only rotate these structures In the plane of the page. Don’t try to rotate them out of the page, or they’ll lose all their meaning.

Second, Only consider one carbon center at a time. If you try to simultaneously visualize the three-dimensional bonding of two adjacent carbon atoms on the vertical chain, you’ll only get yourself into trouble, and you may well burst a blood vessel.

With those caveats in mind, take a closer look at the two structures in Figure 22-6. Do you see how no amount of sliding or rotating them in the plane of the page can superimpose them? That’s because these two molecules are enantiomers.

Compare that situation with the one presented by the two molecules shown in Figure 22-7. Do you see how rotating one of the molecules 180 degrees in the plane of the page allows you to superimpose the two? That’s because these two molecules are diastereomers.

H

H

Figure 22-7′

Diastereomers of 2,3-dichlorobu-tane drawn as Fischer projections.

CH

Cl

Cl

CH

Cl Cl

CH

CH

H

H

You protest — how can it be? Both sets of molecules contain chiral centers! That’s true, but remember: Not all molecules with chiral centers are themselves chiral. In fact, a special term exists for these chiral-but-not-chiral molecules. They are called Meso compounds. Many meso compounds pull off this trick by having an internal plane of symmetry. In other words, they are their own mirrors. Narcissistic little buggers.

Q.

In the structures shown in the following figure, fill in the missing substituents so the two molecules become enantiomers.

H, C -

3

CH2CH2CH3

, , 3

-CH, CH,

CH2CH3

,3

A. To make the two molecules enantiomers, simply fill in the missing pieces so the

Molecules are mirror images of each other, as shown in the following figure. The pre-existing substituents guarantee that no pesky Meso Symmetry lurks in the shadows.

H3CH2C -

3 ,

H3C

3

CH2CH2CH3

, , 3

CH2CH2CH3

, , 3

-CH2CH3

, 3

CH

CH2CH3

, 3

CH2CH3

, 3

Redraw the structure shown in the following figure as a Fischer projection, identify the chiral centers, and draw the corresponding enantiomer.

OH O

! II

HO CH C

\ / \ / \ CCH OH

II I

OOH

SotVe It

6. Which of the structures in the following figure are enantiomers?

CH2CH3

, 3

H3CH2C -

3 ,

CH

CH

■OH H3CH2C -

3 ,

H

OH

CH2CH3

, 3

A)

H

H

H

CH2CH3

, 3

OH OH

CH2CH3

, 3

HO HO

CH2CH3

, 3

CH2CH3

, 3

B)

Solve It

7. Which of the structures in the following figure are Meso Compounds?

A)

C)

H HO H

H

Br -

CH2OH

OH H

OH

CH2OH

COOH

OH OH

COOH CH

Br H

CH3

OH H OH

OH OH

Br H

CH2OH

H

OH H

CH2OH

COOH

COOH CH

H Br

CH3

B)

Solve It

8. Identify the structures in the following figure as geometric isomers, enantiomers, or Meso Compounds. Name any geometric isomers (including Cis – Or Trans – Designations), identify all chiral carbon atoms, and draw any internal planes of symmetry.

A)

H

\

C

CC

,CH2CH2CH3

H3C

3

CH

OH OH

CH3

OH OH

CH

CH3

CH

H’Si

F

CH

II ^xV——- Si.

COOH H — C— NH

COOH

H N C H

H

H

B)

C)

D)

H

Solve It

Answers to Questions on Stereoisomers

D 4-methyl-frans-4-nonene. The structure contains a nine-carbon parent chain, with a double

Bond occurring between carbon atoms 4 and 5. The main chain swaps sides of the unsaturation as it proceeds. The molecule is also substituted at the fourth carbon with a methyl group.

Mb 7Vans-2-pentene is a five-carbon alkene with the double bond occurring between the second and third carbon atoms. The parent chain proceeds along opposite sides of the carbon-carbon double bond, as shown in the following figure:

H

H3C

3

,CH..CH3

/ \

H

MM The Cis – And Trans – Isomers of 3-heptene differ only in the orientation of the carbon chain about the double bond, as shown in the following figure:

HC

3

Cis

CH CH

/ \ HH

CH

/ CH

Trans

H

CH

H3C

3

\ / C^=C

/ \ ■ CH2 H

CH3

3

CH

MM Consider the structure of 1-butene, shown in the following figure:

H

\ / C^=C

/ \ HH

CH2CH3

23

The chain terminates at the double bond. The first carbon atom is bonded to two identical hydrogen atoms. No unique substituent group lies Cis Or Trans To the continuing parent chain.

EM This is partially a trick question. (Hey! At least we admitted it.) Although the structure has

Chiral centers, proper drawing of the Fischer projection (pay attention to stereo bonds!), seen in the following figure, makes it clear that the compound is Meso. The molecule has an internal plane of symmetry.

CO2H

-OH – OH

CO2H

MM The two structures shown in Figure A are enantiomers, Although they don’t appear to be at first glance. To make the enantiomeric relationship more obvious, rotate one of them 180 degrees in the plane of the page. The two structures in Figure B are not enantiomers. In fact, this is a Meso Compound.

MM The structures shown in Figures A and B are Meso Compounds. The structures shown in

Figure C are not Meso. Although the structures in Figure A don’t have an internal plane of symmetry, the two are superimposable mirror images. The structures in Figure B have an internal plane of symmetry and, in fact, are the same compound. The two structures in Figure C are non-superimposable mirror images, and are therefore enantiomers.

MM The structure in Figure A is a geometric isomer, Frans-2-hexene. The pair of molecules

Shown in Figure B are different orientations of a Meso Compound with two chiral centers and an internal plane of symmetry, as shown in the following figure. The plane cuts the molecule in half, across the bond connecting the second and third carbon atoms. The pair of structures in Figure C are enantiomers. The chiral center in this case isn’t carbon! Rather, it’s silicon, which sits right below carbon on the periodic table, and also bonds with tetrahedral geometry. The pair of molecules shown in Figure D aren’t isomers at all, But are simply different orientations of the amino acid glycine. The central carbon of the projection bonds to two identical hydrogen atoms, so no isomerism is possible.

CH,

CH,

■ OH

■ OH

OH OH

CH

CH

H

H

H

H

Ten Inventive Ways to Give Massage as a GiftF you really want to get on somebody’s good side, here’s a little secret:

*C Give them a massage gift. You don’t necessarily have to give the massage yourself (in some cases this could even be inappropriate), but you do have to put forth the effort to create the massage gift, arrange for it, pay for it, and so on. You may be surprised at how incredibly warm a reception your gift receives. Massage, ultimately, is always a gift for the person who’s receiving it. Even if you’re paying for it yourself, there’s something very special about the physical act of receiving the massage. It’s natural to respond as though it were a gift. The giver works so hard, on such an intimate level, that you can’t help but feel connected to him, and grateful. Try some of the suggestions that follow to accentuate this quality of the massage you offer to others.

Spa gift certificates

Purchase a gift certificate that’s good at over 700 great day spas in the U. S. and give it to a deserving individual. To order your certificate, call 888-SPA-WISH, and make sure to check out the coupon in the back of this book, because it gets you a discount! Way cool.

The massage birthday gift

Ten Inventive Ways to Give Massage as a Gift

For that special someone’s birthday, your anniversary, or any other special occasion, hire a professional massage therapist to come over as a surprise gift. This could lead to some major gratitude immediately following the massage, so make sure you have a bottle of champagne chilled just in case.

The spa date

With so many spas around these days, it’s possible for many people to get away to one for a night or two. Arrange in advance for a "spa date" on which both of you get multiple massages by a pro. Pack a good book, a bathing suit, and you’re all set.

In This Chapter

► Creating great massage gifts

The royal treatment at home

Drop the kids at grandma’s house and head home to cook your partner’s favorite meal, arrange flowers, light candles, and warm the aromatherapy oil. Then put the skills you attain from this book to good use by giving a great massage. This is good for major brownie points in your favor.

B&B and massage

Take a trip to a quaint and charming little bed & breakfast and trade massages with your partner in this new, romantic environment.

Ten Inventive Ways to Give Massage as a Gift

LeaVe a tittle rub behind

When you’re a houseguest, leave behind a massage gift certificate from a local massage therapist to show how much you appreciate your host’s hospitality.

Massage for charity

Buy a gift certificate from a local massage therapist and offer it as a door prize for your church or community club auction.

Wedding day rub

Buy a massage for (or better yet, give a massage to!) a friend who is getting married. I received a massage on my own wedding day and have given massages to friends on theirs. You can always manage to make that extra hour appear on the big day, no matter how hectic things seem to get, and it really helps to calm the nervous bride or groom.

The massage economy pack

Negotiate with a local massage therapist to purchase a whole series of massages at a discount, and then share them with your partner, family, friends, business associates, and anyone else you can think of.

\lou’re the gift

After you read this book, offer free massages to all of your friends and each person in your family. Do this even if you think you’re not "good enough" at giving massage yet. If you give from your heart, people may respond accordingly. It’s the gift that counts, not the wrapping.

Chapter 24