By Cheryl Kaye Tardif
What is Pulmonary Hypertension?
Pulmonary hypertension is a rare, serious and incurable lung disorder that affects how blood flows from the lungs to the heart. It is categorized in two ways: primary, meaning there is no obvious cause; and secondary, in which a cause is known, such as bronchitis or emphysema. Primary pulmonary hypertension (PPH), also referred to as pulmonary arterial hypertension (PAH) and more recently, idiopathic pulmonary arterial hypertension (IPAH), causes increased blood pressure in the pulmonary artery, a blood vessel that carries oxygen-poor blood from the right ventricle of the heart to the lungs.
Increased blood pressure can have serious results. The muscles within the walls of the arteries may tighten, causing the arteries to constrict. The walls of the pulmonary arteries may thicken. Scar tissue may form, causing the arteries to become increasingly narrow. Tiny blood clots may form within the smaller arteries, causing blockages. In more serious cases, when the right ventricle no longer functions properly, progressive heart failure occurs, leading most often to death.
Symptoms:
Symptoms of PPH frequently occur over a period of time, making the condition difficult to diagnose. Although most of the symptoms relate to breathing issues, such as shortness of breath and hyperventilation, other symptoms may include:
• Extreme fatigue
• Dizziness or fainting
• Weakness of the body
• Racing pulse
• Chest pain
• Swelling of legs and hands
• Coughing up blood
• Bluish discoloration of lips and skin (cyanosis)
Diagnosing PPH:
PPH is regularly misdiagnosed in routine medical examinations since its symptoms can be confused with other more common conditions. These conditions must be ruled out first, along with secondary pulmonary hypertension disorders. Unfortunately this means that PPH is usually diagnosed after the appearance of many of the symptoms, and by that time the disorder is likely to have progressed to a more serious stage.
Tests to diagnose PPH include:
• X-ray of the chest
• Electrocardiogram
• Echocardiogram
• Cardiac catheterization
• Blood tests
• MRI
• Pulmonary function tests
• Connective tissue serology
• Perfusion lung scans
In most cases, the cause of primary pulmonary hypertension is unknown, yet could be attributed to genetic or familial predisposition, immune system disease or drug/chemical exposure. A number of drugs, such as cocaine, amphetamines and the diet drug Fen Phen (taken off the market in September 1997) have been linked to causing PPH.
Treatment:
PPH requires proper medical diagnosis, treatment and follow-up. Most treatment regimes require drugs that help lower blood pressure, or affect the blood, blood vessels, lungs and/or heart. In recent studies, Viagra (Sildenafil) has been found to improve the condition of PPH. It is awaiting approval for use as a treatment for PPH.
Other drug therapies may include:
• Anticoagulants
• Calcium channel blockers
• Diuretics
• Endothelin receptor antagonists
• Prostacyclin analogues
Since every patient responds differently to drug combinations, amounts and types of drugs must be carefully monitored and often changed. For patients who do not respond to drug therapy, the other alternatives are heart-lung or lung transplantation. However, transplantation can lead to complications that could result in death.
Statistics:
The Montefiore Medical Center states that the first recorded case of primary pulmonary hypertension occurred in 1891. Each year in the United States, an estimated 500 to 1,000 new cases are diagnosed, most of them women between the ages of 20 and 40. However, both genders and any age can develop PPH. According to the American Lung Association, there were 3,065 deaths attributed to PPH in 2000. It can also be a genetic disorder―familial primary pulmonary hypertension―passed on by a parent. If a parent is known to have PPH, genetic counseling is recommended. According to Ronald J Oudiz, MD, “IPAH is responsible for approximately 125-150 deaths per year”.
Life expectancy:
Before 1990, the diagnosis of PPH was virtually a death sentence, with little hope of prolonging life. Since then, with the advances in new treatments and drug therapies, patients with PPH may have an increased life expectancy. Untreated, the survival rate is about 68% at one year, 48% at three years, and 34 % at five years, according to the University of North Carolina at Chapel Hill Pulmonary & Critical Care Medicine. With treatment, life expectancy can increase on average 3-5 years.
Follow-Up Treatments:
As with any disease, a diagnosis of pulmonary hypertension requires counseling for all involved―the patient and family. Having all the facts and knowing what treatment options are available and what lifestyle changes to make are vital to the continued health of the patient. For more information, please visit the National Heart Lung and Blood Institute or any of the other resources for heart and lung care.
Cheryl Kaye Tardif has worked in the past as a journalist and book editor. Currently, she is the author of three novels: The River, Divine Intervention and the bestselling novel Whale Song, a novel that includes a character with PPH. Cheryl spent over a month researching PPH and this article is the result of her findings. Besides PPH, Whale Song deals with many controversial and emotional issues, including the assisted death of a loved one.
For more information on Cheryl and Whale Song, please visit http://www.whalesongbook.com.
Saturday, August 4, 2007
Friday, August 3, 2007
Early Onset Alzheimers: A Family In Crisis
By Carol D. O’Dell
At first, Irene* kept forgetting her cat Waldo’s name. She didn’t think too much about it, chalked it up to menopause. Then she forgot how to get home from the grocery store and drove around for nearly three hours before a policeman stopped her—for driving too slow. She didn’t mention the incident to either of her two daughters until something about the police ride home and the tow truck accidentally slipped out in conversation.
Irene visited her family physician who referred her to a neurologist. She was diagnosed with early onset Alzheimer’s disease at the age of 52. Her family was devastated. At first, neither she nor her two daughters talked about it. She was given Aricept, a common Alzheimer’s drug and took her daily dose even though she said she felt dizzy and complained of nausea. She seemed more clear-headed and her daughters welcomed the slight improvement. They made plans to change their mother’s living arrangements since neither of them lived nearby. They worried about her cooking meals or attempting household chores. Both daughters agreed to care for mom six months out of the year.
Divorced, Irene then began taking turns living with her two daughters—one on the east coast, the other the west. Adjusting to not being the woman of the house wasn’t easy. Depression loomed. Each daughter found an adult day care for when mom stayed with them—to give her something to do during the day. Her daughters continued to work and share the responsibility of “mom.” They felt their mom was too young to enter a full-time care facility, and they wanted to make the most of time they had—taking vacations, and finishing scrapbooks and just being together every chance they could. They got “the button” as Irene called it, in case she fell or needed immediate care. They learned all they could about home care for Alzheimer’s.
Home Treatment in Early Stages from OurAlzheimer’s.com at www.healthcentral.com
Telling the Patient. Often doctors will not tell patients that they have Alzheimer's. This is a family decision. If a patient expresses a need to know the truth, it should be disclosed. Both the caregiver and the patient can then begin to address issues that can be controlled, such as access to support groups and drug research.
Mood and Emotional Behavior. Patients display abrupt mood swings and many become aggressive and angry. Some of this erratic behavior is caused by chemical changes in the brain. But it may also be due to the experience of losing knowledge and understanding of one's surroundings, causing fear and frustration that patients can no longer express verbally.
The following recommendations for caregivers may help soothe patients and avoid agitation:
• Keep environmental distractions and noise at a minimum if possible. (Even normal noises, such as people talking outside a room, may seem threatening and trigger agitation or aggression.)
• Speak clearly. Most experts recommend speaking slowly to a patient with Alzheimer's disease, but some caregivers report that patients respond better to clear, quickly spoken, short sentences that they can more easily remember.
• Use a combination of facial expression, voice tones, and words for communicating emotions. (One study suggested that patients may have difficulty in recognizing the meaning of facial expressions, particularly those signaling sadness, surprise, and disgust.)
• Limit choices (such as clothing selection).
• Offer diversions, such as a snack or car ride, if the patient starts shouting or exhibiting other disruptive behavior.
• Simply touching and talking may also help.
• Maintain as natural an attitude as possible. Patients with Alzheimer's disease can be highly sensitive to the caregiver's underlying emotions and react negatively to patronization or signals of anger and frustration.
• Showing movies or videos of family members and events from the patient's past may be comforting.
Irene enjoyed adult day-care for a time but as she began to wander, her daughters had to hire home health care. It was difficult to find a good match. Irene grew combative. Each daughter worried not only mom’s quality of care, but of the rising cost as well. Irene did not have long term health care insurance.
Irene is now 62 and in a memory loss unit. Her dementia is advancing quickly.
Her medication has been changed. She’s now taking Nameda.
Irene’s west coast daughter decided to move to the east coast to oversee her mother’s care. She is now divorced and lives with her sister. She has two children, ages 5 and 9. She no longer takes the grandchildren to see their grandmother, hoping they’ll remember the good times. Irene is angry and belligerent some days, and others, she seems to have adjusted. The two daughters are grateful they have each other—for shared responsibility and emotional support.
Common Alzheimer’s Medications:
The first four drugs belong to a group of drugs called Cholinesterase Inhibitors. They delay the break down of acetylcholine in the brain. Acetylcholine helps communication between the nerve cells and is important for memory.
Aricept, Exelon and Razadyne are most effective in the early stages of Alzheimer’s disease. This group of prescription drugs has been shown to have some modest effect in slowing the degeneration of cognitive symptoms. The drugs can also reduce the behavioral problems that are exhibited in people with Alzheimer’s. When the drugs work well they can significantly improve people’s quality of life. Benefits, if they occur, should happen within a few weeks.
Namenda (memantine)
Nameda is a N-methylD-aspartate (MNDA) antagonist It acts on another neurotransmitter (transmitter of nerve messages) called glutamate. The drug shields the brain from glutamate which contributes to the death of brain cells in people with Alzheimer’s disease.
Effective in moderate to severe forms of Alzheimer’s disease, improving the day to day life of the person with Alzheimer’s disease, and by implication the life of the care givers. Improvements should be seen within a few weeks.
Alzheimer’s Medication information is from www.aboutAlzheimer’s.com
It’s been ten years since Irene’s original diagnosis of early onset Alzheimer’s disease. Irene doesn’t recognize her daughters anymore, but they check on her every day either by phone call or visit. She’s losing her ability to speak, which is sometimes just gibberish. She’s still mobile and is often restless and agitated. She walks aimlessly in the halls, common Alzheimer’s occurrence. Both sisters attend a caregiver’s support group to cope with their guilt, stress, and sorrow. They worry. Is early onset Alzheimer’s genetic? We’ll discuss this issue in a follow-up article.
Sidebar:
WARNING SIGNS OF ALZHEIMER'S
Memory loss
Difficulty performing familiar tasks
Problems with language
Disorientation to time and place
Poor or decreased judgment
Problems with abstract thinking
Misplacing things
Changes in mood or behavior
Changes in personality
Loss of initiative
*Irene is a fictitious name, but this story is based on a real family’s struggle with Alzheimer’s.
At first, Irene* kept forgetting her cat Waldo’s name. She didn’t think too much about it, chalked it up to menopause. Then she forgot how to get home from the grocery store and drove around for nearly three hours before a policeman stopped her—for driving too slow. She didn’t mention the incident to either of her two daughters until something about the police ride home and the tow truck accidentally slipped out in conversation.
Irene visited her family physician who referred her to a neurologist. She was diagnosed with early onset Alzheimer’s disease at the age of 52. Her family was devastated. At first, neither she nor her two daughters talked about it. She was given Aricept, a common Alzheimer’s drug and took her daily dose even though she said she felt dizzy and complained of nausea. She seemed more clear-headed and her daughters welcomed the slight improvement. They made plans to change their mother’s living arrangements since neither of them lived nearby. They worried about her cooking meals or attempting household chores. Both daughters agreed to care for mom six months out of the year.
Divorced, Irene then began taking turns living with her two daughters—one on the east coast, the other the west. Adjusting to not being the woman of the house wasn’t easy. Depression loomed. Each daughter found an adult day care for when mom stayed with them—to give her something to do during the day. Her daughters continued to work and share the responsibility of “mom.” They felt their mom was too young to enter a full-time care facility, and they wanted to make the most of time they had—taking vacations, and finishing scrapbooks and just being together every chance they could. They got “the button” as Irene called it, in case she fell or needed immediate care. They learned all they could about home care for Alzheimer’s.
Home Treatment in Early Stages from OurAlzheimer’s.com at www.healthcentral.com
Telling the Patient. Often doctors will not tell patients that they have Alzheimer's. This is a family decision. If a patient expresses a need to know the truth, it should be disclosed. Both the caregiver and the patient can then begin to address issues that can be controlled, such as access to support groups and drug research.
Mood and Emotional Behavior. Patients display abrupt mood swings and many become aggressive and angry. Some of this erratic behavior is caused by chemical changes in the brain. But it may also be due to the experience of losing knowledge and understanding of one's surroundings, causing fear and frustration that patients can no longer express verbally.
The following recommendations for caregivers may help soothe patients and avoid agitation:
• Keep environmental distractions and noise at a minimum if possible. (Even normal noises, such as people talking outside a room, may seem threatening and trigger agitation or aggression.)
• Speak clearly. Most experts recommend speaking slowly to a patient with Alzheimer's disease, but some caregivers report that patients respond better to clear, quickly spoken, short sentences that they can more easily remember.
• Use a combination of facial expression, voice tones, and words for communicating emotions. (One study suggested that patients may have difficulty in recognizing the meaning of facial expressions, particularly those signaling sadness, surprise, and disgust.)
• Limit choices (such as clothing selection).
• Offer diversions, such as a snack or car ride, if the patient starts shouting or exhibiting other disruptive behavior.
• Simply touching and talking may also help.
• Maintain as natural an attitude as possible. Patients with Alzheimer's disease can be highly sensitive to the caregiver's underlying emotions and react negatively to patronization or signals of anger and frustration.
• Showing movies or videos of family members and events from the patient's past may be comforting.
Irene enjoyed adult day-care for a time but as she began to wander, her daughters had to hire home health care. It was difficult to find a good match. Irene grew combative. Each daughter worried not only mom’s quality of care, but of the rising cost as well. Irene did not have long term health care insurance.
Irene is now 62 and in a memory loss unit. Her dementia is advancing quickly.
Her medication has been changed. She’s now taking Nameda.
Irene’s west coast daughter decided to move to the east coast to oversee her mother’s care. She is now divorced and lives with her sister. She has two children, ages 5 and 9. She no longer takes the grandchildren to see their grandmother, hoping they’ll remember the good times. Irene is angry and belligerent some days, and others, she seems to have adjusted. The two daughters are grateful they have each other—for shared responsibility and emotional support.
Common Alzheimer’s Medications:
The first four drugs belong to a group of drugs called Cholinesterase Inhibitors. They delay the break down of acetylcholine in the brain. Acetylcholine helps communication between the nerve cells and is important for memory.
Aricept, Exelon and Razadyne are most effective in the early stages of Alzheimer’s disease. This group of prescription drugs has been shown to have some modest effect in slowing the degeneration of cognitive symptoms. The drugs can also reduce the behavioral problems that are exhibited in people with Alzheimer’s. When the drugs work well they can significantly improve people’s quality of life. Benefits, if they occur, should happen within a few weeks.
Namenda (memantine)
Nameda is a N-methylD-aspartate (MNDA) antagonist It acts on another neurotransmitter (transmitter of nerve messages) called glutamate. The drug shields the brain from glutamate which contributes to the death of brain cells in people with Alzheimer’s disease.
Effective in moderate to severe forms of Alzheimer’s disease, improving the day to day life of the person with Alzheimer’s disease, and by implication the life of the care givers. Improvements should be seen within a few weeks.
Alzheimer’s Medication information is from www.aboutAlzheimer’s.com
It’s been ten years since Irene’s original diagnosis of early onset Alzheimer’s disease. Irene doesn’t recognize her daughters anymore, but they check on her every day either by phone call or visit. She’s losing her ability to speak, which is sometimes just gibberish. She’s still mobile and is often restless and agitated. She walks aimlessly in the halls, common Alzheimer’s occurrence. Both sisters attend a caregiver’s support group to cope with their guilt, stress, and sorrow. They worry. Is early onset Alzheimer’s genetic? We’ll discuss this issue in a follow-up article.
Sidebar:
WARNING SIGNS OF ALZHEIMER'S
Memory loss
Difficulty performing familiar tasks
Problems with language
Disorientation to time and place
Poor or decreased judgment
Problems with abstract thinking
Misplacing things
Changes in mood or behavior
Changes in personality
Loss of initiative
*Irene is a fictitious name, but this story is based on a real family’s struggle with Alzheimer’s.
Saturday, July 7, 2007
Dream Interpretation for Self-Knowledge
By Jeremy Spiegel, MD
Dreams, said Carl Jung, are “letters we send to ourselves.” Properly interpreted, dreams are an invaluable tool for self-knowledge.
Scientists have proposed many reasons for why we dream. Sigmund Freud, over one hundred years ago, concluded that dreams display the dreamer’s deep unconscious wishes seeking fulfillment in the theater of the mind. Decades later Jung found that the meanings of dream elements exist on multiple levels, often linked to universal patterns, or archetypes. More recently, the late Francis Crick, co-discoverer of the DNA molecule, suggested that dreams help clear the brain of “obsolete data files,” making room for the storage of more current, practical information. All these scientists agreed that “downloading” the content of dreams and interpreting their often-mysterious symbolism is enlightening.
When interpreting a dream, first look at how it unfolds, noting its contents. You will likely discover some of the intrapsychic special effects Freud describes in Interpretation of Dreams, especially condensation, displacement, repetition, and wish fulfillment.
Condensation is a distillation of two or more beings or ideas from waking life into one image, frequently manifesting as a composite human being. For example, suppose you dream of someone who combines the qualities of a belligerent client you treated and your boyfriend of five years. In the dream, the client-boyfriend creeps up from behind you and bites your neck. You reach to touch the wound but feel nothing. Even so, your colleagues surround your assailant and force him into five-point restraints, whereupon he explodes with rage, unleashes a volley of expletives, and is dragged away kicking and screaming. Later, you learn he has died from a stroke. You experience horror, which rapidly gives way to a welcome feeling of liberation. Focusing on the condensation, you uncover the dream’s meaning: you must free yourself from your controlling boyfriend, whose emotional manipulation has had an injurious effect on you, preventing you from effectively caring for your clients and yourself.
Displacement occurs when dream content involves a feature or action unrelated to the dreamer’s waking focus or life circumstances. For example, say you dream about antique wallpaper even though in reality all your walls are painted. The wallpaper is peeling and impossible to patch. The more the wallpaper separates from the wall and the more you try to smooth it back on, the more holes are revealed in the surface behind it. Reflecting later, you realize the peeling ancient wallpaper represents your increasingly desperate attempts to cover up the “holes” in your life. Perhaps for many years you’ve been in denial about the need for a “repair” in your “home”—that is, in displacement-speak, a need for healing in your psyche and your life.
Repetition involves the reappearance of a dream element, either in the same dream or in recurring ones, and often in different formats, such as imagery, language, and wordplay. For example, suppose an empty bag of saline solution keeps showing up in your dreams. First you see it between the cushions of a love seat, then next to the milk carton in the refrigerator, and later dangling from the rearview mirror of your car—which, you notice, is running on empty. Upon later reflection, you suspect that the bag’s recurrence in your dream symbolizes the depletion of your resources and an unexpressed wish to quench your emotional dehydration. It also occurs to you there might be wordplay at work: the solution is to refuel yourself.
Wish fulfillment discloses a desire the dreamer may or not be aware of and provides the satisfaction of that desire in dreamtime. For example, say you are a local branch manager recently promoted to regional sales director. The first week on the job you dream you are overseas struggling with a foreign language and discouraged about your inability to communicate. Then you pull a red button from your pocket and press it. Feeling something “click” in your head, you suddenly unleash a stream of clear communication in the heretofore unfamiliar language. Your dream expresses—and satisfies—your desire to master your new job responsibilities.
If ignored or left uninterpreted, the dream elements of condensation, displacement, repetition, and wish fulfillment can leave you in psychic tumult, awash in disturbing sensations long after waking from your dream. Over time, unintegrated dreams can lead to self-defeating attitudes or actions.
By contrast, the more you practice dream interpretation, the greater your self-awareness and the better your ability to function mindful of, rather than ruled by, the hidden agendas of your unconscious. Interpreting your dreams can help you access and reinforce your true self. Ultimately, you can learn to dispel the tension and anxiety found in disturbing dreams and use the passion of exhilarating dreams to enhance your waking energy. You can decide which elements, themes, and resulting insights you want to hold on to in your waking life—which shells from your psychic sea you wish to keep.
Releasing Nightmares
Just as you can keep positive aspects from your dreams, so you can dispense with dream elements that undermine or frighten you. The “nightmare rehearsal technique” originated with patients “rehearsing” trauma-related dreams in front of a therapist, and gained popularity after British psychiatrist Isaac Marks used it in 1978 to successfully relieve a woman’s fourteen-year recurrent nightmare.
For example, suppose you have a recurring nightmare of your car careening out of control, smashing into another automobile and killing a mother and her two small children. To release this nightmare, revise it in your imagination. Go back in time to the moment when you began losing control of the car. See yourself regaining control and bringing your vehicle to a smooth stop. In your mind’s eye, watch as the mother and her two children serenely drive by your car, completely unharmed. Picture yourself driving on to your destination, safe, calm, and in complete control.
After revising the dream in your imagination, “rehearse” the revised dream sequence before bed. As a result, the nightmare will cease because the new, emotionally nourishing content reflects your conscious wish fulfillment, simultaneously decreasing your anxiety and enabling confidence to spring from your true self.
At-a-Glance Guidelines for Dream Interpretation
• Place pen and paper near bed.
• Write down your dream content.
• List the people, objects, and actions appearing in the dream.
• Note the intrapsychic special effects appearing in the dream.
• Free associate to your dream.
• Select the insights worth keeping.
• If your dream is a nightmare, revise it and rehearse the new rendition.
* * *
Jeremy Spiegel, MD, practices general adult psychiatry in Portland, Maine, where he lives with his wife and three children. A graduate of Princeton University and Dartmouth Medical School, Dr. Spiegel treats patients in his private practice, as well as in a mental health center where he works with the homeless and consults for the Maine Department of Human Services.
This article was excerpted and adapted from the forthcoming book, The Mindful Medical Student: A Psychiatrist’s Guide to Staying Who You Are While Becoming Who You Want to Be, by Jeremy Spiegel, MD. For more information, contact Elizabeth Wolf, Blessingway Authors’ Services, ewolf@blessingway.com.
Dreams, said Carl Jung, are “letters we send to ourselves.” Properly interpreted, dreams are an invaluable tool for self-knowledge.
Scientists have proposed many reasons for why we dream. Sigmund Freud, over one hundred years ago, concluded that dreams display the dreamer’s deep unconscious wishes seeking fulfillment in the theater of the mind. Decades later Jung found that the meanings of dream elements exist on multiple levels, often linked to universal patterns, or archetypes. More recently, the late Francis Crick, co-discoverer of the DNA molecule, suggested that dreams help clear the brain of “obsolete data files,” making room for the storage of more current, practical information. All these scientists agreed that “downloading” the content of dreams and interpreting their often-mysterious symbolism is enlightening.
When interpreting a dream, first look at how it unfolds, noting its contents. You will likely discover some of the intrapsychic special effects Freud describes in Interpretation of Dreams, especially condensation, displacement, repetition, and wish fulfillment.
Condensation is a distillation of two or more beings or ideas from waking life into one image, frequently manifesting as a composite human being. For example, suppose you dream of someone who combines the qualities of a belligerent client you treated and your boyfriend of five years. In the dream, the client-boyfriend creeps up from behind you and bites your neck. You reach to touch the wound but feel nothing. Even so, your colleagues surround your assailant and force him into five-point restraints, whereupon he explodes with rage, unleashes a volley of expletives, and is dragged away kicking and screaming. Later, you learn he has died from a stroke. You experience horror, which rapidly gives way to a welcome feeling of liberation. Focusing on the condensation, you uncover the dream’s meaning: you must free yourself from your controlling boyfriend, whose emotional manipulation has had an injurious effect on you, preventing you from effectively caring for your clients and yourself.
Displacement occurs when dream content involves a feature or action unrelated to the dreamer’s waking focus or life circumstances. For example, say you dream about antique wallpaper even though in reality all your walls are painted. The wallpaper is peeling and impossible to patch. The more the wallpaper separates from the wall and the more you try to smooth it back on, the more holes are revealed in the surface behind it. Reflecting later, you realize the peeling ancient wallpaper represents your increasingly desperate attempts to cover up the “holes” in your life. Perhaps for many years you’ve been in denial about the need for a “repair” in your “home”—that is, in displacement-speak, a need for healing in your psyche and your life.
Repetition involves the reappearance of a dream element, either in the same dream or in recurring ones, and often in different formats, such as imagery, language, and wordplay. For example, suppose an empty bag of saline solution keeps showing up in your dreams. First you see it between the cushions of a love seat, then next to the milk carton in the refrigerator, and later dangling from the rearview mirror of your car—which, you notice, is running on empty. Upon later reflection, you suspect that the bag’s recurrence in your dream symbolizes the depletion of your resources and an unexpressed wish to quench your emotional dehydration. It also occurs to you there might be wordplay at work: the solution is to refuel yourself.
Wish fulfillment discloses a desire the dreamer may or not be aware of and provides the satisfaction of that desire in dreamtime. For example, say you are a local branch manager recently promoted to regional sales director. The first week on the job you dream you are overseas struggling with a foreign language and discouraged about your inability to communicate. Then you pull a red button from your pocket and press it. Feeling something “click” in your head, you suddenly unleash a stream of clear communication in the heretofore unfamiliar language. Your dream expresses—and satisfies—your desire to master your new job responsibilities.
If ignored or left uninterpreted, the dream elements of condensation, displacement, repetition, and wish fulfillment can leave you in psychic tumult, awash in disturbing sensations long after waking from your dream. Over time, unintegrated dreams can lead to self-defeating attitudes or actions.
By contrast, the more you practice dream interpretation, the greater your self-awareness and the better your ability to function mindful of, rather than ruled by, the hidden agendas of your unconscious. Interpreting your dreams can help you access and reinforce your true self. Ultimately, you can learn to dispel the tension and anxiety found in disturbing dreams and use the passion of exhilarating dreams to enhance your waking energy. You can decide which elements, themes, and resulting insights you want to hold on to in your waking life—which shells from your psychic sea you wish to keep.
Releasing Nightmares
Just as you can keep positive aspects from your dreams, so you can dispense with dream elements that undermine or frighten you. The “nightmare rehearsal technique” originated with patients “rehearsing” trauma-related dreams in front of a therapist, and gained popularity after British psychiatrist Isaac Marks used it in 1978 to successfully relieve a woman’s fourteen-year recurrent nightmare.
For example, suppose you have a recurring nightmare of your car careening out of control, smashing into another automobile and killing a mother and her two small children. To release this nightmare, revise it in your imagination. Go back in time to the moment when you began losing control of the car. See yourself regaining control and bringing your vehicle to a smooth stop. In your mind’s eye, watch as the mother and her two children serenely drive by your car, completely unharmed. Picture yourself driving on to your destination, safe, calm, and in complete control.
After revising the dream in your imagination, “rehearse” the revised dream sequence before bed. As a result, the nightmare will cease because the new, emotionally nourishing content reflects your conscious wish fulfillment, simultaneously decreasing your anxiety and enabling confidence to spring from your true self.
At-a-Glance Guidelines for Dream Interpretation
• Place pen and paper near bed.
• Write down your dream content.
• List the people, objects, and actions appearing in the dream.
• Note the intrapsychic special effects appearing in the dream.
• Free associate to your dream.
• Select the insights worth keeping.
• If your dream is a nightmare, revise it and rehearse the new rendition.
* * *
Jeremy Spiegel, MD, practices general adult psychiatry in Portland, Maine, where he lives with his wife and three children. A graduate of Princeton University and Dartmouth Medical School, Dr. Spiegel treats patients in his private practice, as well as in a mental health center where he works with the homeless and consults for the Maine Department of Human Services.
This article was excerpted and adapted from the forthcoming book, The Mindful Medical Student: A Psychiatrist’s Guide to Staying Who You Are While Becoming Who You Want to Be, by Jeremy Spiegel, MD. For more information, contact Elizabeth Wolf, Blessingway Authors’ Services, ewolf@blessingway.com.
Thursday, July 5, 2007
Exercise or Play?
By Carol D. O'Dell
I spent a good deal of my childhood up a dogwood tree high above the earth imagining the wicked queens in their fortresses unable to penetrate my lofty perch. My cat Charlie and I would hide in the azalea bushes, his large disk eyes staring wildly at me. I had to hide him from the evil spies in the cars that cased my neighborhood seeking to kidnap the world’s most valuable cat and his diamond collar that held valuable secret codes.
I could swing high, higher, higher than all the other neighborhood kids. I’d swing so high the chains slackened their taut pull and wobbled indecisively, and then I’d push off and leap—suspend—and land two flat feet on soft sand. I did it! The highest I’d ever been! I’d try it again even though most attempts resulted in a mouthful of dirt, which I can still taste to this day. Apparently, my mother never looked out the window when I did this because if she did, she would have scolded me and then ordered Daddy to dismantle my swing-set.
That’s how I played as a child. What about you?
Now that I’m in my mid-forties, no one asks me to come out and play. But they should. Adult are preoccupied with stress, jobs, weight loss, bone loss, sleep loss, and we’ve forgotten the key. We follow the rules, or at least know the rules and warnings we’re not following. And a lot of numbers are rolling around in our heads: What your BMI score, your cholesterol score? Do you know your HDL and LDL levels? You better. Include omega fatty acids in your diet but avoid trans-fats. Don’t forget, thirty minutes a day of exercise that raises your heart rate and be sure to eat whole grains. Lots of whole grains.
No one will argue about the benefits of exercise. It’s a key component to weight management and can have a profound impact on many diseases such as cardio-vascular disease and diabetes. According to Fitness Today Magazine, there are six exercise goals:
• Muscular Size, Strength and Endurance
• Bone Strength
• Cardiovascular Efficiency
• Enhanced Flexibility
• Body Leanness
•
• Increased Resistance to Injury
But exercise can’t help us if we can’t stick to a routine. Ken Hutchins outlines the differences between exercise and play in his Super Slow Exercise Guide:
Exercise Recreation
Logical Instinctive
Universal Personal
General Specific
Physical Mental
Not Fun Fun
The differences are mostly mental. Many forms of exercise and play overlap. Attitude is everything. So how about listening to good ole’ mom? Go outside and play.
Play is a happy word. Play conjures up playgrounds, backyards, swing sets, swimming pools and baseball fields. Every child plays, or should. Every child plays differently. Some are naturally team sport player, others are runners, gymnasts, dancers, tree climbers, others love to roll down hills, build snow men, join swim teams, play with their pets, make mud pies. Every family has their own play history as well. Some families are hikers, touch football families or like mine, water gun families. We chase each other for hours, hide behind sheds and cars. Attack. Squirt. Run. Duck. Scream. We play for hours. We play after dark. We forget we’re hungry or tired. Or old.
Adults need to play. Ditch the exercise routine and dip back into those childhood memories and remember what kind of kid you were and how you liked to play.
What’s Your Play Style?
Were you an explorer? Then go for a hike. Team player? Take up karate or adult soccer. Loner? Join the Y and do laps or find your Zen state in tai-chi. Did you like to climb trees? Go rock climbing. The point is, you can still play, still be you, and you’ll find that by tapping into your play history you’ll stir up some great memories, rev your endorphins and never look at your watch in hopes that you’re workout’s almost over.
Why is play so much fun? Play engages a different side of our brain. The classic text The Handbook of Psychology by Jaan Valsiner and Kevin J. Connolly states that the most widely acceptable working definition of play is that it has “no apparent immediate purpose.” The text also states that play can resemble more serious behaviors and can include “exaggerated motions and vocalizations.” Anyone who’s ever watched or participated in a rousing game of beach volleyball can attest to there being plenty of “exaggerated motions and vocalizations.”
Many psychologists, behaviorists and anthropologists have noted that humans in all societies and throughout history play. Animals such as dogs, cats not only play, but they play with us in a wonderful exchange and can be both exhilarating and comforting well into our senior years. It’s also apparent that birds and marine mammals such as dolphins play. Scuba divers have observed that some species of fish also seem to play.
Play can be easy, challenging or engaging. Time and place begin to fade. We can play by ourselves, with our pets, with family and friends. Play can be hard, sweaty or dirty. Play can be quiet, loud, rowdy or easy. Play does more than merely release endorphins and give us a natural high. It’s good for our souls.
Me? I was and still am the bicycle queen. In my mind, I was an Air Force Pilot flying in an out of enemy lines. Zoom downhill on my bike--faster, faster, get my hips just right, lean, lean a little to the left, tilt, hold it, hold it, let one hand go, balance, let go of the other…no hands! Wind in my face, trees whiz by, wave to old lady Darcy, jump the creek, lean, lean, turn the curve. Do it again.
Carol has been published in numerous publications and is the author of Mothering Mother: A Daughter’s Humorous and Heartbreaking Memoir. She rides her bike in her neighborhood most mornings and let’s go of one hand.
Sources:
Fitness Today Magazine, June 2005.
The Handbook of Psychology by Jaan Valsiner and Kevin J. Connolly
http://www.relaxationexpert.co.uk/RecreationVSExercise.html
http://www.superslow.com/articles/exercise_vs_recreation.html
I spent a good deal of my childhood up a dogwood tree high above the earth imagining the wicked queens in their fortresses unable to penetrate my lofty perch. My cat Charlie and I would hide in the azalea bushes, his large disk eyes staring wildly at me. I had to hide him from the evil spies in the cars that cased my neighborhood seeking to kidnap the world’s most valuable cat and his diamond collar that held valuable secret codes.
I could swing high, higher, higher than all the other neighborhood kids. I’d swing so high the chains slackened their taut pull and wobbled indecisively, and then I’d push off and leap—suspend—and land two flat feet on soft sand. I did it! The highest I’d ever been! I’d try it again even though most attempts resulted in a mouthful of dirt, which I can still taste to this day. Apparently, my mother never looked out the window when I did this because if she did, she would have scolded me and then ordered Daddy to dismantle my swing-set.
That’s how I played as a child. What about you?
Now that I’m in my mid-forties, no one asks me to come out and play. But they should. Adult are preoccupied with stress, jobs, weight loss, bone loss, sleep loss, and we’ve forgotten the key. We follow the rules, or at least know the rules and warnings we’re not following. And a lot of numbers are rolling around in our heads: What your BMI score, your cholesterol score? Do you know your HDL and LDL levels? You better. Include omega fatty acids in your diet but avoid trans-fats. Don’t forget, thirty minutes a day of exercise that raises your heart rate and be sure to eat whole grains. Lots of whole grains.
No one will argue about the benefits of exercise. It’s a key component to weight management and can have a profound impact on many diseases such as cardio-vascular disease and diabetes. According to Fitness Today Magazine, there are six exercise goals:
• Muscular Size, Strength and Endurance
• Bone Strength
• Cardiovascular Efficiency
• Enhanced Flexibility
• Body Leanness
•
• Increased Resistance to Injury
But exercise can’t help us if we can’t stick to a routine. Ken Hutchins outlines the differences between exercise and play in his Super Slow Exercise Guide:
Exercise Recreation
Logical Instinctive
Universal Personal
General Specific
Physical Mental
Not Fun Fun
The differences are mostly mental. Many forms of exercise and play overlap. Attitude is everything. So how about listening to good ole’ mom? Go outside and play.
Play is a happy word. Play conjures up playgrounds, backyards, swing sets, swimming pools and baseball fields. Every child plays, or should. Every child plays differently. Some are naturally team sport player, others are runners, gymnasts, dancers, tree climbers, others love to roll down hills, build snow men, join swim teams, play with their pets, make mud pies. Every family has their own play history as well. Some families are hikers, touch football families or like mine, water gun families. We chase each other for hours, hide behind sheds and cars. Attack. Squirt. Run. Duck. Scream. We play for hours. We play after dark. We forget we’re hungry or tired. Or old.
Adults need to play. Ditch the exercise routine and dip back into those childhood memories and remember what kind of kid you were and how you liked to play.
What’s Your Play Style?
Were you an explorer? Then go for a hike. Team player? Take up karate or adult soccer. Loner? Join the Y and do laps or find your Zen state in tai-chi. Did you like to climb trees? Go rock climbing. The point is, you can still play, still be you, and you’ll find that by tapping into your play history you’ll stir up some great memories, rev your endorphins and never look at your watch in hopes that you’re workout’s almost over.
Why is play so much fun? Play engages a different side of our brain. The classic text The Handbook of Psychology by Jaan Valsiner and Kevin J. Connolly states that the most widely acceptable working definition of play is that it has “no apparent immediate purpose.” The text also states that play can resemble more serious behaviors and can include “exaggerated motions and vocalizations.” Anyone who’s ever watched or participated in a rousing game of beach volleyball can attest to there being plenty of “exaggerated motions and vocalizations.”
Many psychologists, behaviorists and anthropologists have noted that humans in all societies and throughout history play. Animals such as dogs, cats not only play, but they play with us in a wonderful exchange and can be both exhilarating and comforting well into our senior years. It’s also apparent that birds and marine mammals such as dolphins play. Scuba divers have observed that some species of fish also seem to play.
Play can be easy, challenging or engaging. Time and place begin to fade. We can play by ourselves, with our pets, with family and friends. Play can be hard, sweaty or dirty. Play can be quiet, loud, rowdy or easy. Play does more than merely release endorphins and give us a natural high. It’s good for our souls.
Me? I was and still am the bicycle queen. In my mind, I was an Air Force Pilot flying in an out of enemy lines. Zoom downhill on my bike--faster, faster, get my hips just right, lean, lean a little to the left, tilt, hold it, hold it, let one hand go, balance, let go of the other…no hands! Wind in my face, trees whiz by, wave to old lady Darcy, jump the creek, lean, lean, turn the curve. Do it again.
Carol has been published in numerous publications and is the author of Mothering Mother: A Daughter’s Humorous and Heartbreaking Memoir. She rides her bike in her neighborhood most mornings and let’s go of one hand.
Sources:
Fitness Today Magazine, June 2005.
The Handbook of Psychology by Jaan Valsiner and Kevin J. Connolly
http://www.relaxationexpert.co.uk/RecreationVSExercise.html
http://www.superslow.com/articles/exercise_vs_recreation.html
Tuesday, June 5, 2007
My Daddy’s Heart
By Carol D. O’Dell
The italicized portions of this article are excerpts from Mothering Mother by Carol D. O’Dell
“Carol, come to the hospital.”
I knew from Mama’s voice, the exhaustion, and the flat lack of hope, that Daddy had had another heart attack. This was his fourth: the one he had when I was thirteen, and two in the three years I had been married. It happened in the middle of the night. He grabbed Mama’s hand and clutched so tight she thought her bones would break.
I raced to the hospital, hoping and praying I would make it in time. Being newly married and having two young daughters had left me with little time to sit outside on warm summer nights and talk to him the way I had as a child. I wanted to make up for that lost time. I needed a good, long conversation about the stars, sitting next to Daddy, his legs crossed in the too-small lawn chair, both of us falling quiet, thinking.
Mama and I sat with Daddy in the drab hospital room day after day, waiting for the doctors to decide what to do. We knew we didn’t have much longer.
I turned towards Daddy, the mound of his body under the sheet and thin blanket, and I began to doze, dreaming about the times when I was a little girl and my Daddy would come home from work. I’d hide and giggle and wait for him to find me.
The year was 1985. I was 24 years old, newly married with two young daughters. My Daddy’s heart had worried Mama and me for more than ten years. It started with chest pains, and then I watched him gasp for air, stop every few feet and hold onto a chair, or a tree, or the door jamb. Wherever we were, he had to stop. Then came the nitro-glycerin tablets popped in his mouth like Tic Tacs. I worried. My own heart ached for him. He was the strongest, sweetest man in the world to me. But I also witnessed him continue to salt his food, make poor choices of fried and fatty foods, and do little, if any exercise. As much as I loved him and as much as he loved Mama and me, his actions didn’t show it. Habit was stronger than resolution.
“Where’s my little sweety-pie? I know she’s hiding. Could she be under the table? Behind the couch? In the closet?” He started the game even before he got his coat off.
I giggle, giving myself away, and in my dream I am four.
“Is she in the pantry? Is my little sweety-pie behind the door?”
I opened my eyes and looked at Mama. A loose strand of hair fell from her French twist, her teased front collapsing. I noticed the gray hairs in with the red ones, hanging in her eyes. She let them, too tired to care.
“I don’t know why the Lord allows us to be separated from each other in our old age. It seems cruel to spend a whole lifetime together only to be torn apart when we need each other the most. I don’t understand.” She got up and tucked the blanket under his chin, running her fingers through his hair.
“At least I have the assurance we’ll be together again.”
Heart disease continues to ravage our loved ones. We’ve made much medical advancement in 22 years and still, the statistics are staggering. Over 80 milllion Americans have one or more forms of cardiovascular disease (CVD). Eight million will suffer a myocardial infarction (acute heart attack). The good news is that the numbers are dropping due to education and an arsenal of preventative measures. Cholesterol blocking drugs are plentiful. The artery and valve replacement surgery my dad endured followed by many m
onths of recovery is now down to weeks. And yet, one thing remains: personal responsibility.
I drove home sometime after midnight and kissed my daughter’s soft toddler cheeks while they slept. My arms ached to scoop them up and rock them on that black, rainy night. I’d caught only snippets of them these past few weeks. I needed to do mommy things—take them to the park and feel my hand on their backs as I pushed them on the swing. I rubbed their chubby fingers until they stirred and left before I woke them.
I stripped down and crawled into bed beside my husband, Phillip. He held a pillow in his arms where I was supposed to be. I kissed his back and neck until he woke and turned over, whispering inaudible words as he drew me to him. We made love, silent, with our eyes closed. I drifted off to sleep, only to wake to the telephone.
“This is the nurse on sixth tower. Your father’s had another heart attack.”
Phillip drove me to the hospital, our girls asleep in their car seats, their heads drooped to one side. I pulled the visor down and looked at their cherub faces in the mirror.
They probably won’t even remember their Papa.
The world blurred. Every streetlamp, every lighted billboard zoomed by, and I noticed each one as if important.
I prayed for time.
Daddy sat on the side of the bed; his thin hospital gown did little good to cover this massive man. He glanced at me as I entered, then looked down to the floor. His hands, on his knees, braced his body.
The oxygen cord wrapped over Daddy’s ears and into his nostrils, irritating him. He adjusted it again and again. I couldn’t believe that after yet another massive heart attack he could still be sitting up.
Phillip stepped in front of me and held my mother in his arms. I knelt in front of Daddy, afraid to touch him and break the immense concentration he needed to control the pain.
“I want ya’ll… to promise me one thing,” he said with ragged breath. “I want you to promise… me… to be good… and… take care of… each other. Promise.”
Daddy passed away February 10, 1985.
This Father’s Day, make a promise to your family and to yourself. Take responsibility. Go for annual check-ups. Choose lean meats, veggies and fruits. Walk every night. Break a sweat. Go for the 94% fat-free popcorn, pretzels and frozen low-fat yogurt for treats. Start with the simple things. Do it first for yourself. And for those who adore you.
Take it from me--a daughter who misses her Daddy every single day.
Statistics are from http://www.americanheart.org.
The italicized portions of this article are excerpts from Mothering Mother by Carol D. O’Dell
“Carol, come to the hospital.”
I knew from Mama’s voice, the exhaustion, and the flat lack of hope, that Daddy had had another heart attack. This was his fourth: the one he had when I was thirteen, and two in the three years I had been married. It happened in the middle of the night. He grabbed Mama’s hand and clutched so tight she thought her bones would break.
I raced to the hospital, hoping and praying I would make it in time. Being newly married and having two young daughters had left me with little time to sit outside on warm summer nights and talk to him the way I had as a child. I wanted to make up for that lost time. I needed a good, long conversation about the stars, sitting next to Daddy, his legs crossed in the too-small lawn chair, both of us falling quiet, thinking.
Mama and I sat with Daddy in the drab hospital room day after day, waiting for the doctors to decide what to do. We knew we didn’t have much longer.
I turned towards Daddy, the mound of his body under the sheet and thin blanket, and I began to doze, dreaming about the times when I was a little girl and my Daddy would come home from work. I’d hide and giggle and wait for him to find me.
The year was 1985. I was 24 years old, newly married with two young daughters. My Daddy’s heart had worried Mama and me for more than ten years. It started with chest pains, and then I watched him gasp for air, stop every few feet and hold onto a chair, or a tree, or the door jamb. Wherever we were, he had to stop. Then came the nitro-glycerin tablets popped in his mouth like Tic Tacs. I worried. My own heart ached for him. He was the strongest, sweetest man in the world to me. But I also witnessed him continue to salt his food, make poor choices of fried and fatty foods, and do little, if any exercise. As much as I loved him and as much as he loved Mama and me, his actions didn’t show it. Habit was stronger than resolution.
“Where’s my little sweety-pie? I know she’s hiding. Could she be under the table? Behind the couch? In the closet?” He started the game even before he got his coat off.
I giggle, giving myself away, and in my dream I am four.
“Is she in the pantry? Is my little sweety-pie behind the door?”
I opened my eyes and looked at Mama. A loose strand of hair fell from her French twist, her teased front collapsing. I noticed the gray hairs in with the red ones, hanging in her eyes. She let them, too tired to care.
“I don’t know why the Lord allows us to be separated from each other in our old age. It seems cruel to spend a whole lifetime together only to be torn apart when we need each other the most. I don’t understand.” She got up and tucked the blanket under his chin, running her fingers through his hair.
“At least I have the assurance we’ll be together again.”
Heart disease continues to ravage our loved ones. We’ve made much medical advancement in 22 years and still, the statistics are staggering. Over 80 milllion Americans have one or more forms of cardiovascular disease (CVD). Eight million will suffer a myocardial infarction (acute heart attack). The good news is that the numbers are dropping due to education and an arsenal of preventative measures. Cholesterol blocking drugs are plentiful. The artery and valve replacement surgery my dad endured followed by many m
onths of recovery is now down to weeks. And yet, one thing remains: personal responsibility.
I drove home sometime after midnight and kissed my daughter’s soft toddler cheeks while they slept. My arms ached to scoop them up and rock them on that black, rainy night. I’d caught only snippets of them these past few weeks. I needed to do mommy things—take them to the park and feel my hand on their backs as I pushed them on the swing. I rubbed their chubby fingers until they stirred and left before I woke them.
I stripped down and crawled into bed beside my husband, Phillip. He held a pillow in his arms where I was supposed to be. I kissed his back and neck until he woke and turned over, whispering inaudible words as he drew me to him. We made love, silent, with our eyes closed. I drifted off to sleep, only to wake to the telephone.
“This is the nurse on sixth tower. Your father’s had another heart attack.”
Phillip drove me to the hospital, our girls asleep in their car seats, their heads drooped to one side. I pulled the visor down and looked at their cherub faces in the mirror.
They probably won’t even remember their Papa.
The world blurred. Every streetlamp, every lighted billboard zoomed by, and I noticed each one as if important.
I prayed for time.
Daddy sat on the side of the bed; his thin hospital gown did little good to cover this massive man. He glanced at me as I entered, then looked down to the floor. His hands, on his knees, braced his body.
The oxygen cord wrapped over Daddy’s ears and into his nostrils, irritating him. He adjusted it again and again. I couldn’t believe that after yet another massive heart attack he could still be sitting up.
Phillip stepped in front of me and held my mother in his arms. I knelt in front of Daddy, afraid to touch him and break the immense concentration he needed to control the pain.
“I want ya’ll… to promise me one thing,” he said with ragged breath. “I want you to promise… me… to be good… and… take care of… each other. Promise.”
Daddy passed away February 10, 1985.
This Father’s Day, make a promise to your family and to yourself. Take responsibility. Go for annual check-ups. Choose lean meats, veggies and fruits. Walk every night. Break a sweat. Go for the 94% fat-free popcorn, pretzels and frozen low-fat yogurt for treats. Start with the simple things. Do it first for yourself. And for those who adore you.
Take it from me--a daughter who misses her Daddy every single day.
Statistics are from http://www.americanheart.org.
Wednesday, May 2, 2007
Tennis? Water Aerobics? Poker in the Lounge? Modern Retirement Communities Bring Seniors to Life
By Belinda Hulin
Jacksonville travel writer Judith Martin isn’t planning to retire anytime soon. But between trips to research Barcelona architecture and Alabama barbecue, the 60-year-old divorcee has already started shopping retirement communities.
“It’s a way of making sure you can stay active,” says Martin. “Everybody starts slowing down eventually. If you live alone, there’s a lot of effort that goes into maintaining your existence. Living in a retirement community means you don’t have to worry about the cooking, shopping and housekeeping. You can reserve your energy for the things you want to do.”
Continuing care retirement communities—developments that offer everything from single family homes with minimal services to full-scale nursing care—are one of the hottest segments of the U.S. housing market. Generations-removed from your grandmother’s “old folks home,” these well-manicured campuses seduce active seniors with a siren’s promise of carefree living, resort-quality amenities and, when needed, easy access to medical services and daily assistance. As Martin notes, “It’s all the things you have at a great hotel--the pool, the tennis court, the dining room, the salon, the car service and the housekeeping—plus someone to help when your knees give out.”
A well-chosen retirement community can be an investment in ongoing mental health, as well as shelter. Today even mid-sized cities with a young demographic are likely to support several large retirement communities as well as smaller, more specialized senior complexes. Some may be affiliated with religious groups, while others cater to seniors with common interests. In the greater Philadelphia area, many retirement communities are affiliated with the Religious Society of Friends. Fleet Landing in Atlantic Beach, Florida attracts retired military personnel. There are retirement communities nestled into larger housing developments, so seniors can live near adult children or middle-aged friends, as well as retirement communities on college campuses, near artist colonies and near medical centers.
Such communities, as noted by the U.S. Department of Health and Human Services, have gained popularity because they provide a “continuum of care.” Able-bodied seniors make the decision to move to a house, condo or apartment in such a development while they’re still active, with the promise of being assured a spot in one of the onsite assisted living or nursing care units when and if that becomes necessary. A confluence of sociological and demographic trends has fueled the growth. First, there are Census Bureau estimates that the country’s elderly population will increase 65-percent by 2025. Combine that with the fact that people are living longer and—with adult children following their careers to far-flung places—are less likely to live near extended family.
“My children live in Canada, Colorado and Washington State,” says Winnie Young, an active 81-year-old resident of Vicar’s Landing in Ponte Vedra Beach, Florida. “If anything happens to me, my children don’t have to hop on a plane right away. That’s one of the things that I thought about before moving here. Also, when you’re living alone in a house, you think you’re going to be able to hire all sorts of people to take care of the things that need to be done, for both you and the house. Well, even if you can find people to reliably provide those services, the services keep getting more and more expensive.”
Young, a widow, gave up a house with a swimming pool in the exclusive Sawgrass community to move to Vicar’s Landing. Moving to a small apartment required “purging” her belongings to a manageable collection, but Young says she has no regrets. “I was tired of taking care of everything,” she says, adding that she loves the camaraderie of her community. “When you’re a single woman, it becomes more and more difficult to entertain and as a result, it becomes more difficult to socialize. Now, I can easily invite two couples to join me for a drink at our bar. And I’ve made the most wonderful friends here. I recently came back from visiting my brother in Michigan. A car picked me up at the airport, when I got here someone brought my bags to my apartment and I walked into the dining room. Well, it was as if I had this big extended family just waiting to greet me and find out about my trip. I absolutely love it.”
Of course, such convivial convenience comes at a price. Retirement communities have a wide range of payment structures, but most require an initial buy-in plus monthly fees. Some offer all-inclusive monthly payments, while others operate on a fee-for-service basis. Entrance fees can range from less than $10,000 to $500,000 depending on the age and health of prospective residents, as well as the size and style of housing they prefer, and the location and general amenities of the complex. Retirement communities that operate on a strictly fee-for-service basis offer some plans with no set monthly fees, however charges for home health care visits, dining room meals and housekeeping can add up. Average monthly fees for most retirement communities range from $1,000 to $4,000. Smaller digs in independent living units command a lower rate than more elaborate housing or accommodations in assisted living or nursing care buildings.
According to a recent Wall Street Journal article, residents in retirement communities generally have modest annual incomes from pensions or investments, but a net worth of more than $150,000. Residents generally sell their homes to fund retirement community entrance fees and to supplement investment accounts.
“Affording a retirement community can be tricky,” says Martin. “Most of us need our assets to generate income to live on in our old age. If you take a big chunk of that money to buy into a retirement community, that pretty much guarantees you’ll have less money to live on and do all the things you want to do.”
Both Martin and Young say people should give thought to moving to a retirement community while they’re still young enough to enjoy all the amenities and before they need all the life-care services. “I think people tend to wait too long to make these decisions,” says Martin. “They move after they’re disabled or need serious care, and they can’t take advantage of all the fun things these places offer. If you move to a retirement community because you’re forced to, that can be depressing. You want to enjoy your golden years, not feel like you’re waiting to die.”
[A version of this story originally appeared in Jacksonville Homebuyer Magazine.]
For more from this talented writer, click here.
Jacksonville travel writer Judith Martin isn’t planning to retire anytime soon. But between trips to research Barcelona architecture and Alabama barbecue, the 60-year-old divorcee has already started shopping retirement communities.
“It’s a way of making sure you can stay active,” says Martin. “Everybody starts slowing down eventually. If you live alone, there’s a lot of effort that goes into maintaining your existence. Living in a retirement community means you don’t have to worry about the cooking, shopping and housekeeping. You can reserve your energy for the things you want to do.”
Continuing care retirement communities—developments that offer everything from single family homes with minimal services to full-scale nursing care—are one of the hottest segments of the U.S. housing market. Generations-removed from your grandmother’s “old folks home,” these well-manicured campuses seduce active seniors with a siren’s promise of carefree living, resort-quality amenities and, when needed, easy access to medical services and daily assistance. As Martin notes, “It’s all the things you have at a great hotel--the pool, the tennis court, the dining room, the salon, the car service and the housekeeping—plus someone to help when your knees give out.”
A well-chosen retirement community can be an investment in ongoing mental health, as well as shelter. Today even mid-sized cities with a young demographic are likely to support several large retirement communities as well as smaller, more specialized senior complexes. Some may be affiliated with religious groups, while others cater to seniors with common interests. In the greater Philadelphia area, many retirement communities are affiliated with the Religious Society of Friends. Fleet Landing in Atlantic Beach, Florida attracts retired military personnel. There are retirement communities nestled into larger housing developments, so seniors can live near adult children or middle-aged friends, as well as retirement communities on college campuses, near artist colonies and near medical centers.
Such communities, as noted by the U.S. Department of Health and Human Services, have gained popularity because they provide a “continuum of care.” Able-bodied seniors make the decision to move to a house, condo or apartment in such a development while they’re still active, with the promise of being assured a spot in one of the onsite assisted living or nursing care units when and if that becomes necessary. A confluence of sociological and demographic trends has fueled the growth. First, there are Census Bureau estimates that the country’s elderly population will increase 65-percent by 2025. Combine that with the fact that people are living longer and—with adult children following their careers to far-flung places—are less likely to live near extended family.
“My children live in Canada, Colorado and Washington State,” says Winnie Young, an active 81-year-old resident of Vicar’s Landing in Ponte Vedra Beach, Florida. “If anything happens to me, my children don’t have to hop on a plane right away. That’s one of the things that I thought about before moving here. Also, when you’re living alone in a house, you think you’re going to be able to hire all sorts of people to take care of the things that need to be done, for both you and the house. Well, even if you can find people to reliably provide those services, the services keep getting more and more expensive.”
Young, a widow, gave up a house with a swimming pool in the exclusive Sawgrass community to move to Vicar’s Landing. Moving to a small apartment required “purging” her belongings to a manageable collection, but Young says she has no regrets. “I was tired of taking care of everything,” she says, adding that she loves the camaraderie of her community. “When you’re a single woman, it becomes more and more difficult to entertain and as a result, it becomes more difficult to socialize. Now, I can easily invite two couples to join me for a drink at our bar. And I’ve made the most wonderful friends here. I recently came back from visiting my brother in Michigan. A car picked me up at the airport, when I got here someone brought my bags to my apartment and I walked into the dining room. Well, it was as if I had this big extended family just waiting to greet me and find out about my trip. I absolutely love it.”
Of course, such convivial convenience comes at a price. Retirement communities have a wide range of payment structures, but most require an initial buy-in plus monthly fees. Some offer all-inclusive monthly payments, while others operate on a fee-for-service basis. Entrance fees can range from less than $10,000 to $500,000 depending on the age and health of prospective residents, as well as the size and style of housing they prefer, and the location and general amenities of the complex. Retirement communities that operate on a strictly fee-for-service basis offer some plans with no set monthly fees, however charges for home health care visits, dining room meals and housekeeping can add up. Average monthly fees for most retirement communities range from $1,000 to $4,000. Smaller digs in independent living units command a lower rate than more elaborate housing or accommodations in assisted living or nursing care buildings.
According to a recent Wall Street Journal article, residents in retirement communities generally have modest annual incomes from pensions or investments, but a net worth of more than $150,000. Residents generally sell their homes to fund retirement community entrance fees and to supplement investment accounts.
“Affording a retirement community can be tricky,” says Martin. “Most of us need our assets to generate income to live on in our old age. If you take a big chunk of that money to buy into a retirement community, that pretty much guarantees you’ll have less money to live on and do all the things you want to do.”
Both Martin and Young say people should give thought to moving to a retirement community while they’re still young enough to enjoy all the amenities and before they need all the life-care services. “I think people tend to wait too long to make these decisions,” says Martin. “They move after they’re disabled or need serious care, and they can’t take advantage of all the fun things these places offer. If you move to a retirement community because you’re forced to, that can be depressing. You want to enjoy your golden years, not feel like you’re waiting to die.”
[A version of this story originally appeared in Jacksonville Homebuyer Magazine.]
For more from this talented writer, click here.
Thursday, April 5, 2007
A Question of Attitude
By Sharon Moran
The issue of nursing in public is a source of constant debate. The resulting outcome of such debates demonstrates that many Americans are misinformed at best and at worst breast-phobic. Who could forget the Super Bowl display when Janet Jackson bared all, exposing her breast and part of her nipple? Despite the near hostility that is directed towards many nursing mothers, the reality is that the overwhelming majority of nursing mothers are conservative in their demeanor when nursing in public. In fact, nursing in public is so easy for veteran moms that in many cases people are usually not even aware if a mother is nursing or if the infant is simply sleeping.
It’s easy to see the impact that negative attitudes towards nursing in public have on breastfeeding rates. About 30% of new mothers in the U.S. never nurse their babies despite widespread evidence indicating breastfeeding as the preferred method of infant feeding. Of the 70% of new moms who choose to breastfeed, only 17% are still nursing at the 6-month mark, and a mere 8% reach the American Academy of Pediatrics recommendation of nursing for at least one year. The U.S. has the lowest breastfeeding initiation rate of all industrialized nations. In countries such as Sweden, over 90% of new moms breastfeed. One contributing factor to such a wide variation in breastfeeding rates across continents involves cultural attitudes. Many new moms in the U.S. never even attempt breastfeeding when their babies are born simply because of the perceived fear that they might one day have to nurse in public. The U.S. clearly needs a radical shift in the misguided priorities and gender biases inherent in the negative perception that nursing is abnormal or borderline obscene.
Certainly those individuals opposed to nursing in public offer what they believe are reasonable alternatives. The most common suggestion offered to breastfeeding moms is to feed a nursing baby in a nearby bathroom. Another popular suggestion is that a nursing mother should offer a nursing baby pumped breast milk in a bottle while in public places. There are at least a dozen reasons why feeding expressed breast milk is not viewed as a suitable choice by a committed breastfeeding mother, and for obvious reasons I won’t even touch the suggestion about “dining” in a restroom. One major issue with expressed breast milk is the possibility of contamination of the pumped milk, particularly on hot days. Also, even if a nursing mom fed a bottle of pumped breast milk, in the absence of actually nursing her infant, she will still need to pump at some point which really doesn’t solve the problem because when out in public she would be relegated to the bathroom to pump.
If the sight of a nursing mother is so uncomfortable to those who would love to ban breastfeeding in public places, I have to wonder what such individuals think of scantily-clad models on the magazine covers at the grocery checkout. Are these images as equally offensive and repelling? All too often in our nation another nursing mother is forced to a leave public place due to outdated attitudes that harm infants simply for the sake of ensuring that males will still be able to view breasts solely as sex objects. If men were biologically equipped to breastfeed (in some cultures males have actually nursed and generated a limited milk supply), I’m fairly confident that you would not see one bottle of infant formula in a public place. Breastfeeding would be viewed as the biologically preferred, health-affirming process that it is, rather than be viewed as overtly sexual and indecent. Men would have no qualms or hesitation about nursing in public. They would do it with the same nonchalance and ease they have when “readjusting.” Women, on the other hand, suffer from the “disease to please” which causes them to focus too heavily on what others think. Rather than be concerned for themselves or their babies, they are concerned with the outdated, borderline Puritanical attitudes of everyone else. I’m not advocating complete dissent from social etiquette guidelines. Rather, our social etiquette rules should give them same consideration and accommodation to breastfeeding moms as we do moms who bottle feed. Ban nursing in public places, and you have to ban bottle feeding as well.
On the countless occasions I nursed my child in public, I never once bared any visible skin whatsoever. I have easily revealed far more wearing expensive designer dresses than I ever did as a mother nursing in public.
As a teen, I was never offended at the site of a nursing mother, regardless of how rare it was to see a nursing mother. (To date, I have only seen about two dozen mothers nursing in public, all were modest, so I really have no idea what anti-breastfeeding citizens are complaining about.) I often wondered, at the naïve age of fifteen, why nursing mothers didn’t simply “plan better.” That was before motherhood, obviously, when I lacked the maturity to realize exactly what is involved with successfully nursing an infant. Infants nurse literally around the clock. Breast milk is digested very differently than infant formula, so a nursing infant often needs to nurse for an hour with perhaps as little as ten to twenty minutes in between feedings. Unless every new mom is expected to adhere to a sentence of house arrest, nursing in public is eventually unavoidable.
Admittedly, I did vow I would never nurse in public, and I made those statements as late as third trimester of pregnancy. Then reality set in when I became a mom, and I realized that nursing should not be viewed as such a negative, indecent event. I have absolutely zero responsibility for Hollywood’s success in sensationalizing breasts as sexual objects, and I don’t intend for the provincial attitudes that have resulted to unduly influence my parenting decisions. As a dedicated mother, I was undeterred from nursing in public and not about to let the misplaced logic of a small minority of reincarnated Puritans dictate what is best for my baby’s health and well being. It’s pretty obvious our nation is headed for serious trouble when Playboy and pornography are considered mainstream and the sight of a nursing infant is considered perverse. I have no issue with adult pornography or immodest attire, but if you’re going to dress in a revealing manner, don’t be offended by a mother nursing her infant or toddler.
I urge those who find nursing in public distasteful to undo their tightly-buttoned, overly-starched collars. Breastfeeding is normal. I realize a drastic shift in cultural attitudes will need to occur for nursing in public to become the societal norm, but my hope is that one day the mere sight of a nursing mother in public will be viewed as exactly what it is and has been for thousands of years-normal.
For more from this talented writer, click here.
The issue of nursing in public is a source of constant debate. The resulting outcome of such debates demonstrates that many Americans are misinformed at best and at worst breast-phobic. Who could forget the Super Bowl display when Janet Jackson bared all, exposing her breast and part of her nipple? Despite the near hostility that is directed towards many nursing mothers, the reality is that the overwhelming majority of nursing mothers are conservative in their demeanor when nursing in public. In fact, nursing in public is so easy for veteran moms that in many cases people are usually not even aware if a mother is nursing or if the infant is simply sleeping.
It’s easy to see the impact that negative attitudes towards nursing in public have on breastfeeding rates. About 30% of new mothers in the U.S. never nurse their babies despite widespread evidence indicating breastfeeding as the preferred method of infant feeding. Of the 70% of new moms who choose to breastfeed, only 17% are still nursing at the 6-month mark, and a mere 8% reach the American Academy of Pediatrics recommendation of nursing for at least one year. The U.S. has the lowest breastfeeding initiation rate of all industrialized nations. In countries such as Sweden, over 90% of new moms breastfeed. One contributing factor to such a wide variation in breastfeeding rates across continents involves cultural attitudes. Many new moms in the U.S. never even attempt breastfeeding when their babies are born simply because of the perceived fear that they might one day have to nurse in public. The U.S. clearly needs a radical shift in the misguided priorities and gender biases inherent in the negative perception that nursing is abnormal or borderline obscene.
Certainly those individuals opposed to nursing in public offer what they believe are reasonable alternatives. The most common suggestion offered to breastfeeding moms is to feed a nursing baby in a nearby bathroom. Another popular suggestion is that a nursing mother should offer a nursing baby pumped breast milk in a bottle while in public places. There are at least a dozen reasons why feeding expressed breast milk is not viewed as a suitable choice by a committed breastfeeding mother, and for obvious reasons I won’t even touch the suggestion about “dining” in a restroom. One major issue with expressed breast milk is the possibility of contamination of the pumped milk, particularly on hot days. Also, even if a nursing mom fed a bottle of pumped breast milk, in the absence of actually nursing her infant, she will still need to pump at some point which really doesn’t solve the problem because when out in public she would be relegated to the bathroom to pump.
If the sight of a nursing mother is so uncomfortable to those who would love to ban breastfeeding in public places, I have to wonder what such individuals think of scantily-clad models on the magazine covers at the grocery checkout. Are these images as equally offensive and repelling? All too often in our nation another nursing mother is forced to a leave public place due to outdated attitudes that harm infants simply for the sake of ensuring that males will still be able to view breasts solely as sex objects. If men were biologically equipped to breastfeed (in some cultures males have actually nursed and generated a limited milk supply), I’m fairly confident that you would not see one bottle of infant formula in a public place. Breastfeeding would be viewed as the biologically preferred, health-affirming process that it is, rather than be viewed as overtly sexual and indecent. Men would have no qualms or hesitation about nursing in public. They would do it with the same nonchalance and ease they have when “readjusting.” Women, on the other hand, suffer from the “disease to please” which causes them to focus too heavily on what others think. Rather than be concerned for themselves or their babies, they are concerned with the outdated, borderline Puritanical attitudes of everyone else. I’m not advocating complete dissent from social etiquette guidelines. Rather, our social etiquette rules should give them same consideration and accommodation to breastfeeding moms as we do moms who bottle feed. Ban nursing in public places, and you have to ban bottle feeding as well.
On the countless occasions I nursed my child in public, I never once bared any visible skin whatsoever. I have easily revealed far more wearing expensive designer dresses than I ever did as a mother nursing in public.
As a teen, I was never offended at the site of a nursing mother, regardless of how rare it was to see a nursing mother. (To date, I have only seen about two dozen mothers nursing in public, all were modest, so I really have no idea what anti-breastfeeding citizens are complaining about.) I often wondered, at the naïve age of fifteen, why nursing mothers didn’t simply “plan better.” That was before motherhood, obviously, when I lacked the maturity to realize exactly what is involved with successfully nursing an infant. Infants nurse literally around the clock. Breast milk is digested very differently than infant formula, so a nursing infant often needs to nurse for an hour with perhaps as little as ten to twenty minutes in between feedings. Unless every new mom is expected to adhere to a sentence of house arrest, nursing in public is eventually unavoidable.
Admittedly, I did vow I would never nurse in public, and I made those statements as late as third trimester of pregnancy. Then reality set in when I became a mom, and I realized that nursing should not be viewed as such a negative, indecent event. I have absolutely zero responsibility for Hollywood’s success in sensationalizing breasts as sexual objects, and I don’t intend for the provincial attitudes that have resulted to unduly influence my parenting decisions. As a dedicated mother, I was undeterred from nursing in public and not about to let the misplaced logic of a small minority of reincarnated Puritans dictate what is best for my baby’s health and well being. It’s pretty obvious our nation is headed for serious trouble when Playboy and pornography are considered mainstream and the sight of a nursing infant is considered perverse. I have no issue with adult pornography or immodest attire, but if you’re going to dress in a revealing manner, don’t be offended by a mother nursing her infant or toddler.
I urge those who find nursing in public distasteful to undo their tightly-buttoned, overly-starched collars. Breastfeeding is normal. I realize a drastic shift in cultural attitudes will need to occur for nursing in public to become the societal norm, but my hope is that one day the mere sight of a nursing mother in public will be viewed as exactly what it is and has been for thousands of years-normal.
For more from this talented writer, click here.
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