Incest dad, as he seems to have become known in the media, is a great teaching
moment for parents and future parents alike.  He kept his daughter in a dungeon
with no windows beneath his house for 24 years and fathered seven children
with her.  He and his wife apparently adopted 3 of them to raise as their own.

For a Full Story, Click the following link:
http://www.cnn.com/2008/WORLD/europe/05/08/austria.fritzl.ap/index.html

He is quoted as having said:  "I must have been crazy....I cared for them...."

In bits and pieces, reports of his story are as follows:

His reasons for locking her up:  she misbahaved.
His reasons for keeping her locked up:  scared he'd be apprehended.
His reasons for fathering children with her:  unclear.
His reasons for coming forward:  he took care of the family and he cared about them
  (one of the children got deathly ill and required hospitalization--he apparently
    feels he was benevolent in allowing the child medical care).  I believe he
    said something like "I could have killed her and burned her body and
    no one would ever have known".

Having had nightmares about this situation,  here are the questions that I would
think might come up in a person's mind while examining the relationships
that make up this family:

Grandchildren to grandmother--why was this OK with you?
Grandchildren to victim mother/daughter--you were powerless.  Where does that
leave me? What is going to happen to us now?  I had no idea the sky was blue.
Grandchildren to grandfather/father--why did you think this was OK? 
Daughter to mother--my having 7 children in a dungeon and giving 3 of them up
for adoption to you was the right thing to do?
Daughter to father--so you believe you are benevolent?  What now, since I have
  no knowledge of how to care for my family in the real world and I have no
  education or job skills? 

Since the stated trigger for this horrific case was the daughter's apparent
misbehavior (with parents who punish a child by locking her up, the definition of
misbehaving might need clarification),  let's have a discussion about handling
misbehaving children, especially in the teenage years. 

(Let me say ahead of time, incest and the pathology behind it, is way beyond the
scope of this entry.  Since parenting is a topic that is of interest to my readers,
I will limit the discussion to that topic alone at this point).

Let's think about all the options available for teaching a child how to behave
"properly".

How about positive reinforcement:  you do this, I'll give you that.  You don't do this,
you don't get that.

Starting young with the Parenting With Love and Logic  philosophy of life's
natural consequences and allowing children to feel them early in small doses
while they are safely at home with loving parents.

Negotiating behavior for the big things as kids get older and more capable of
independent behavior:  you can have a car but you have to pay the insurance.

Group parenting with other parents of a child's friends who can be eyes and
ears when mom or dad aren't around.

Tough Love approach:  you do this forbidden or undesirable thing, you lose
financial or some other type of support--best for older children, I would think.

The Fresh Baked Cookies approach:  have a batch of chocolate chip cookies
ready to pop in the oven as the misbehaving child is threatening to run away--
the idea is that the smell of fresh baked cookies would overwhelm the desire to flee.
Theoretically, this would work beautifully with young children.  Although this
might sound simplistic, children really like the comforts of home assuming they
are not being abused.

Get professional help if you can't figure it out.  There are resources in almost
every community for families with big incomes, little incomes, no incomes. 
Get Help.

Love them and smother them with hugs and kisses.  It has been reported that
parents tend to stop hugging and kissing their teenagers perhaps because of the
sometimes extreme emotional challenges they present.  Teenagers crave
affection like any other child and those who give advice on parenting suggest
parents simply grab them and hug them even as they squirm.  They need it.
(Teenagers request that this be done when their friends are safely out of sight).

One of my readers sent me a link to this piece by Ted Nugent.  It comes
on the heels of the piece on chronic disease.  I thought I would include it
to see what you, my readers, think about this topic.

This is, of course, one opinion among many. 

Ted Nugent lets his voice be heard.

I received this communication from Chris who works with the
Partnership To Fight Chronic Disease Blog Outreach.

Chris writes:

I wanted to make sure that you saw this Revolution Health interview with former
Surgeon General Richard Carmona.  Dr. Carmona has some interesting things to
say about the costs associated with chronic disease.

Here is the link:
http://www.revolutionhealth.com/blogs/valjonesmd/a-surgeon-generals-o-13214

Thanks.

-Chris

Partnership To Fight Chronic Disease Blog Outreach

      HAPPY MOTHER"S DAY!

It is not the cards you are dealt but what you do with them that counts.

Anonymous

                 

The cyclone that hit Maynmar has devastated the region beyond what was
initially reported.  There was a storm surge after the cyclone which
contributed to the horrible outcome.

The link below will take you to the most recent information.  Approximately
22,000 are estimated dead and 41,000 missing.  The area is difficult to reach
and aid has been slow to arrive.  Millions are without shelter.

http://www.msnbc.msn.com/id/24478247

If you would like to help,  go to one of the links below.


American Red Cross
International Response Fund
P.O. Box 37243
Washington, DC 20013
(800) HELP-NOW
http://www.redcross.org


InterAction at (202) 667-8227 or http://www.interaction.org. This link lists
multiple agencies that are accepting aid if you have a particular preference
in how to donate.

Myanmar is also known as Burma.  Click on the link to get more information
about the country.                           

Location:        

Wikipedia has a great section detailing Myanmar's history, geography, and government.
                              

Hello to my readers.

The past several days have been taken up with multiple events both in and out of town.

I have been slowly putting together information about the importance of music
in a child's life and this can be the first entry to highlight music.

Let me share with you some of the quality that children are capable of producing
given encouragement and time. 

This child is 9 years old.  She played for and won an international competition and
will be rewarded with a recital in New York.

Click the link below for the performance.
http://www.youtube.com/watch?v=HGMAm-P4vGs






This child is 11 years old.  He also played for and won an international competition. 
He will be rewarded with a recital in New York, at Carnegie Hall.

Click the link below for the performance.
http://www.youtube.com/watch?v=C90vSI2NR08

The following was forwarded to me by one of my readers.  It is priceless.

*****************************************************************

Two hillbillies walk into a bar. While having a shot of whisky, they talk about
their moonshine operation.

Suddenly, a woman at a nearby table, who is eating a sandwich, begins to
cough. And, after a minute or so, it becomes apparent that she is in real distress.

One of the hillbillies looks at her and says, 'Kin ya swallar?'

The woman shakes her head no.

Then he asks, 'Kin ya breathe?'

The woman begins to turn blue and shakes her head no.

The hillbilly walks over to the woman, lifts up her dress, yanks down her drawers
and quickly gives her right butt cheek a lick with his tongue.

The woman is so shocked that she has a violent spasm and the obstruction
flies out of her mouth. As she begins to breathe again, the Hillbilly walks slowly
back to the bar.

His partner says, 'Ya know, I'd heerd of that there 'Hind LickManeuver' but
I ain't never seed nobody do it!'

                                         

There are patients and then, there are patients you can't forget.

It has been my privilege to care for 2 such patients of mine over the past
several years.  This week, I learned again, what an impact illness can have on
a family and the lives around the person who is ill.  I also re-learned how
it looks to pass through chronic illness with grace and humor.

One of the patients is the mom.  Let's call her A.

The other patient is the daughter.  Let's call her B.

B was run over by a car when she was a young child and survived, albeit with
a number of problems, including loss of proper use of her legs, significant
brain damage, and visual problems.  She has been well cared for.  She lives
alone as an adult with her mom living right next door, available for any issues.
B is now middle aged.

B loves cats of all shapes and sizes and has a great sense of humor.  A couple
of months ago, she was confronted by a delivery man while taking her morning
walk in the neighborhood.  "Do you like what you see?" he said as he dropped
his pants and underwear in broad daylight.

She describes looking at his groin, then looking him in the eye and saying
"NO!" as she walked away.  She thought it was really hilarious that he thought
she might fall to his wiles.  He's now in jail...............

Over the past several months, it has become apparent that something is going
wrong.  After sub-specialty consultations and testing, it appears B has a
cerebellum that is shrinking significantly.  The implications are not good.
There is no treatment.

A, her mom, is now making arrangements to find ways to spend more
quality time with B while she still can.  They are two of the most jovial and
centered individuals that I see despite the illness that has challenged them
They never enter nor leave the office with anything other than an upbeat
attitude.

The last visit brought howls of appreciation from B because my nurse was
wearing a Scooby Doo shirt.  B loves Scooby Doo.  We thought we might
have to have the nurse give up the shirt for a minute there.........

What I appreciate most about these two very special people, is their close
bond and their respect for each other.  They are practical and they keep moving
forward.  "There is nothing better to do!" is the attitude.  And this in the face
of tragedy and challenge.

There are those who deserve a "tip of the hat", a standing ovation, a statue
of some kind to commemorate their lives. 

A and B will always have my gratitude and respect for their example and their
ongoing and daily laughter.  After all, the tears can fall another time.

                                   

The past couple of weeks, I've received 2 demands by insurance to
justify the use of hydrocodone for patients over the age of 64.

They say that their data indicates this medication is "not indicated/approved" for the
older population. 

This medication is a low level narcotic often used in the setting of chronic pain.
One particular patient has rheumatoid arthritis and has been on this medication
for years.  The medication controls the pain so she can perform daily activity.

So, hypothetically, a drug that has a generic formulation, that is effective, and
that relieves suffering and pain, cannot be given to this patient because she has
now become older than 64.  Or is it something more sinister, like insurance
trying to nickel and dime customers to death.........literally.

What shall we do with this patient?  Push her over a cliff in her wheelchair?

Perhaps medical insurance companies that aim for profits can explain to the
American public what people can look forward to as they get older.

I'm not talking about heart transplants.  I'm talking about a generic (cheap) pill.

Of course, Viagra is covered by the same plan.........

At the age of 99, Dr. DeBakey,  the venerable heart surgeon from Houston who pioneered
several procedures that have been life saving for heart patients, reflects on what he has
learned.

               

I've outlined the article but, for the full text from MSN by Cal Fussman, go to the link below.

http://men.msn.com/articlees.aspx?cp-documentid=6564495&GT1=32001

One of the rarest things that we do is think.

There are questions that I'd like answered. 

If world leaders were doctors, I think they would be more concerned with the welfare of people. 

In any good society, every member should be interested in the health of every other member. 

What advice would I give a doctor preparing for surgery? ....walk into the right operating room. 

I've done more than sixty thousand heart operations.... I've been fortunate in that I need
very little sleep. 

Okra is the key to good gumbo.

I'm not sure I can answer that question specifically. But ...lots of doctors took the position
that you shouldn't try it. You've got to push ahead in spite of them. I learned that lesson early.

I don't think the difference between ninety-nine and a hundred is important.

I scheduled my last operation when I was ninety. 

If you had a heart problem right now and needed an operation and I was the only doctor
around, sure, I'd do it.

The best lesson my mother taught me involves an orphanage we had in town. One Sunday...
she had put one of my favorite caps inside. I immediately protested...She told me I ought
to be glad that I could give up the cap. I never forgot that.

Being compassionate, being concerned for your fellow man, doing everything you can
to help people—that's the kind of religion I have, and it's a comforting religion. 

You can never learn enough.

It's important for a patient to go into an operation with confidence. 

The worst thing, of course is when the patient dies during the operation. You die a little
every time that happens.

There was a historian in the fourteenth century who wrote a book...the tribes that have
difficulty feeding themselves are lean and healthy, and those that have plenty of food are
fat, lazy, and unhealthy.

People often use words in a loose way that covers over what they're talking about. 

The doctor who operated on me only a few years ago was one that I trained. 

Never had a symptom. The pain came like a bullet out of the blue.
Part of me was doing a diagnosis on myself—which, as it turned out, was correct. Aortic dissection.

I was a little surprised to find myself recovering after the surgery. 

During my recovery, I played possum.  Then I'd argue with them about the therapy. 

I guess it's hard to be my doctor.

This week, an older patient came in to have a third degree burn looked at after
having spilled hot coffee on her thigh.

Initially, I thought it was a run-of-the-mill type of problem until I started talking
to her. 

She had poured herself a cup of coffee (hot, of course) and, since she sits in
a wheelchair most of the day (she has rheumatoid arthritis), she put the
coffee cup on her thigh to add the creamer and Splenda to it.  She was
steadying it with one hand and reaching for the Splenda with the other.

When she poured the Splenda into the cup of hot coffee, it began to foam.
A lot.  It foamed enough that it created a volcano effect and her hot coffee
literally exploded onto her thigh. 

She started developing blisters almost immediately.  Fortunately, her Home
Health Nurse came in at just about that time and was able to give her
First Aid right away. 

She told me that she contacted the company that produces Splenda and
they confirmed that this type of thing has been known to happen.

Another friend of hers also confirmed that a similar incident had
happened to her as well.

So, for those of you who use Splenda, you might be very careful when you
add it to a hot liquid.  Also, be very careful to keep a hot cup of anything as far
away from skin as possible while preparing the beverage.

Let your friends and family know to take great care.

If you know of any other incidents, please incude them in the comment
section of this entry.

Of all the entries I've written, the one on Diabetes and Insulin Pumps has
generated the most comments. 

To follow is more information about Diabetes and ten things a diabetic
needs to know to prevent injury to organs and to live a full and
healthy life. 

1.  There are multiple oral medications now available that can be used to
control sugar levels.  Insulin is not a necessity in adult onset diabetes.

2.  Insulin is not, as is thought by many lay people, a choice of "last
resort".  In certain cases, it is ideal and recommended.  When used
in the proper setting and in the proper pattern, it can be the best
thing for a diabetic.

3.  The ultimate goal is to control sugar levels and keep them as close
to the normal range as possible.  The lower the sugars, the less chance
of end organ damage (end organ being the heart, eyes, kidneys, blood
vessels, nerves, etc.).

4.  Diabetics that do the best eat and exercise in a regular pattern.
This poses a challenge for those who prefer a random, spontaneous
existence but can really make the difference between well controlled
or poorly controlled diabetes.

5.  A diabetic diet is the best diet for everyone actually.  Because our
society in general has developed a taste for rich, fatty foods, it seems
like a sacrifice to cut back on sugar, fat, and salt.  But, truth be told,
if everyone were on the balance of foods that diabetics should follow,
we would all be healthier and closer to our ideal weight.

6.  Remember portion control.  The trick is not only what to eat but
also how much to eat.  A quick reference is that the closed fist is a
close approximate serving size for an entree for the owner of the
fist.

7.  Always carry something that has sugar in it with you if you are diabetic. 
This might sound contradictory to the diet of low sugar but, it is very
important if you are being treated for diabetes because you might
have a too low blood sugar and need access to food instantly.  If you
have nothing to eat, you might lose consciousness before you get help.

8.  See an eye doctor (MD Ophthalmologist) regularly (at least
once per year) to prevent permanent eye damage.  Treatment for
diabetic side effects to the eyes has come a long way in the last
20 years and preventive treatment is much better than salvage
treatment.

9.  Ask your doctor or their nurse for information if you don't know.
One of the biggest mistakes diabetics make is assuming that what
is happening to them is just something they have to put up with.
Ask.

10. Be prepared to check your sugars daily, possibly several times
per day while you are becoming familiar with the treatment of
diabetes.  Learn how to operate a glucometer and write your
sugars down along with the time you checked the sugar.  When
you are still learning how to care for yourself as a diabetic, it can
also be extremely helpful to write down what you ate at a particular
meal so you can compare your intake with the sugar level that
follows.

Although everyone has probably heard about identity theft, when it happens
to someone close or to yourself, it brings a whole different perspective.

This week, an individual close to me discovered that her identity has been
stolen and that an unidentified person has been using her Social Security
Number to obtain education loans and cars and houses since she was 13 y/o.

Not unlike others, she discovered this breach when trying to get a loan
herself and had to have a credit check on file.  

When she got a copy of the credit report, she very nearly
had to be sedated as she slowly realized all the charges that did not
belong to her and as she came to terms with what had happened.

This breach can be very significant not only because it affects your credit,
but also because they can access Social Security benefits including
retirement income and start getting your money sent to them.
When it comes time for you to apply, you can find that your benefits have
been hijacked by someone else.  Even though this is theft, it can take
years to get corrected and may not ever be completely cleared. 

Experian
TransUnion
Equifax


To follow are some of the things to do if you discover identity theft:

*Notify all three credit bureaus and ask them to put an alert on your
account.  This will give you opportunity to get notification if there is
any activity on your credit and to possibly stop unauthorized activity
in the future.

*File a police report with your local precinct.

*Call the District Attorney's office and find out what they can do to
help you if criminal charges are to be filed.

*Call the Social Security Administration and alert them to the problem.
Get an appointment immediately to talk to an agent about what you
should do to protect your current or future benefits.

I had the opportunity to hear Darrell Green (former NFL star and Hall of Famer)
speak at the National Convention of the American Red Cross.  Let me say, he
is short.  But, he is a powerful short guy.

                                           

To summarize some of what he said:

Mr. Green suggests that a child needs four basic things to have a chance to
succeed in his experience.  They are:

1. To be raised by a loving adult.  This ideally, would be family (mom and dad) but
could be an aunt or grandparent or, even a foster parent.
2.  An education.
3.  Subsidized support for things the family cannot provide (schools, hospitals, etc.)
4.  A moral compass (he favors church).

To hear a celebrity of his calibur talk about the importance of children and
how they must be nurtured was truly inspirational.  Particularly so since he
comes from a disadvantaged background himself.

But more inspiring was his view of the importance of volunteerism and lending
a helping hand to those around him.  Interestingly, he reports that although
he has heard the roar of the crowd at very exhilirating times in his career,
the simple "thank you" or look of gratitude he has received from those that
he has helped is the most profoundly touching experience to him. 

Good guy.  Good message.  And, he volunteered at the American Red Cross
for years.  He credits the ARC for instilling in him a sense of volunteerism
during his formative years.

I am in Baltimore attending the National Convention of the American Red Cross. 
Having been a volunteer with this organization for a number of
years, I decided it was time to get a closer look at the inner workings and
national leadership that fuel the spirit of the thousands of volunteers that are
the American Red Cross.

Despite the negative press that has sometimes dogged the ARC, the spirit
of giving, sharing, and compassion is paramount and visible at every level in
the organization.  And, it is especially apparent with the people the ARC is
partnering with to develop ways to meet the challenges of the future.
These partners include sports celebrities, other outreach organizations,
youth and students from high schools as well as colleges, and multi-ethnic
groups.

The ARC has a proud history of volunteerism having been founded by Clara
Barton in 1881 as a way to deliver care to soldiers at war.  Since that time,
congressional charters have solidified its role in American culture and it has
become a symbol of the good in the American spirit--the spirit of giving and
of charity.

If you have not looked at the ARC recently, you might be surprised to know
that it has a congressional mandate to provide relief services to those in need
when disaster strikes but it has no funding other than through the fund raising
efforts of its staff and volunteers.  Approximately 95% of people that make up
the Red Cross are volunteers--either full or part time volunteers--who give of
their time, resources, and effort to provide what is needed.

The culture of the Red Cross and its mission of compassion spans not only
American soil but also reaches across the globe through the International
Red Cross, providing vaccines to children in Africa, and tsunami relief to those
devastated by the loss of loved ones and homes in the far east.

If you want your spirits lifted, talk to a Red Cross volunteer in your community
and you'll find that the Red Cross not only provides disaster relief but also
teaches life saving skills such as CPR and water safety. 

And, very importantly, while our troops are at war, doing the bidding of our
government on unfamiliar soil, the Red Cross provides a link of communication
and resources to soldiers and their families. 

The Red Cross also has a Holocaust Survivor's tracking unit that has helped
many people find out about their loved ones and finally have closure after
decades of not knowing.

To those who have never experienced a natural disaster or a medical
emergency, the Red Cross might seem like a distant thought.  But for
anyone who has been touched by the dedication of one of these
volunteers and the warmth they bring to their mission, the work this
organization does can be life changing. 

As one speaker said, the volunteers are not paid not because they
are of no value, but because they are priceless.

And as the American Red Cross says: change a life today, starting with your own.
Look around and see what difference you can make in the lives of those around
you in times of need.  You will probably find that the life you change most
profoundly is your own.

                                   

Barbera--Palpitations  (wonder how that one got going.....)

Shredmill--Treadmill (Hmmm)

Vanax--Xanax

Flibergator--Defibrillator

Neurotica--Neuropathy

Gore--Goiter

Nexavin--Nexium

Cadillac--Cataract

Genital Cattle Rack--Congenital Cataract

Blaupoma--Glaucoma

                                          

   
  
Since children and parenting has been the issue of the month here, I
thought I'd include a link that inspired me and continues to inspire other
people.  It is about an autistic boy and a basketball.  I will let you injoy
watching it yourself and I can tell you it is well worth your time.

  http://uk.youtube.com/watch?v=NOiEHpoKIJA

I recently took a trip from Texas to California for Continuing Medical Education.  It was
intended to be a quick in-and-out sort of affair.  To follow is the comedy it actually was--
and I mean "comedy".  Please read to the end as you will miss the best part if you don't.

Thursday afternoon: 

Finished a mass of paperwork getting ready for travel.  Saw a full load in morning clinic.
Ran home to pack at 1PM.  It is now raining and cold (in the 40's).

Drove to the airport.  Parked in Long Term Parking.  It is raining, cold and windy.  I'm
close enough to the airport I can walk.  I pull out my 2 pieces of luggage and one purse
(big) and open my umbrella.  The umbrella immediately catches the wind and flips
upside down.  I struggle and after 10 minutes of walking, I arrive, wet, cold, and
forelorn to the airport terminal.

I get to the airline counter and meet with the word "Cancelled" on all outgoing
flights for the day. 

It is Spring Break travel weekend and all flights from Thursday thru Sunday are full.

They can get me out from Dallas (connecting city) Friday afternoon which would put
me in California at 11PM missing half of the conference.  I would have to drive to Dallas.

I arrange for a flight with a different airline that allows me to attend the lectures on
Friday but it leaves from Austin.  I arrange for a friend to ride with me and drive the
car back to its original destination so that my car is at home.

Friday morning I am up at 5 AM and, without my glasses, it appears there is some
haziness in the air.  I put my glasses on.  It is snowing.  I cannot get thru to the
alternate airline because their lines are jammed with callers.  After an hour of
trying, I get through--flights are on time.  My 2 hour drive to Austin will not be
in vain.

I get to California without incident.

I attend the conference without incident.

                                    

Sunday PM, I am dropped off curbside by a friend in California.  I attempt curbside check-in.
"I can't check you in ma'am.  There is a delay in the flight and you might miss your
connecting flight.  You'll have to check in at the main counter."

At the main counter,  the attendant confirms there is in fact a delay--only 5 minutes
to catch the connecting flight.  It is not possible.  I call my husband and ask if
he would pick me up in Dallas rather than having to stay overnight and chancing
a problem coming home in time for Monday morning clinic.

I get to the gate and encounter a distinguished elderly gentleman wearing a leather
jacket with snake skin shoes, holding a cane.  He has obviously had a stroke having an
obvious loss of function of the right arm and leg.  He is limping heavily but is proud and
determined to walk using the cane--he will not accept a wheelchair.  I am
immediately aware that someone on the flight has a medical problem and might
need attention at some point.

The flight is delayed one hour longer because the third flight attendant is not there
and has been dispatched from another airport to cover our flight and is caught in
traffic--they realized she was not there as the first passenger started down the
boarding tunnel.  Now, we will be leaving 2 hours past the original flight time. 

We finally board the flight.  All goes smoothly until the pilot advises passengers that
for the next hour we will need to remain seated as storms are moving into the
Dallas area and a bumpy ride is likely.

We land without incident.  As I leave the plane (one of the last to leave as I was
seated towards the back of the plane), I encounter the gentleman who has had
a stroke, struggling up the exit ramp still declining wheelchair assistance.  He is
breathing hard. 

I inquire as to how he is doing.  "Fine but I need a bathroom!"  I offer advice as
I am familiar with the airport in Dallas and he is not.  We go our separate ways.

I call my husband who tells me he is still at least one hour away since he is
caught in traffic because of the rain.  I will do some work I have brought along
while I wait for him to arrive.

I find some airport food (haven't eaten in several hours and it is close to midnight).

                                    

I head to baggage claim.  The nice gentleman is there.  He has found his son.  They
collect his luggage.  I am waiting for the other passengers to clear out since I am
in no particular rush to get my luggage.

The nice gentleman comes over, introduces his son and sends him off to get the
car.  He then proceeds to hit on me.  I guess he has not noticed the ring on my left
finger or has chosen to ignore it.

I am tired and totally unprepared for a romantic advance from a total stranger.
My interest had been purely medical............Surreal.  I compose myself.

"I am married, sir.  Thank you for your kind offer but I am not interested."

I collect my own luggage and settle down to eat my airport food and do some
work. 

My husband calls.  He has arrived at the airport.  He is circling the terminal where
we landed.  I don't see him. He circles again.  I don't see him.

He calls.  "Don't you see me?" he asks.  No cars in sight.  I am now standing
outside under an overhang.  It is raining, windy, and cold with my luggage in tow.

I take a deep breath and look up seeking inspiration for the moment.  I realize
that even though the flight attendant had announced that our arrival was to
be at Terminal D, there must have been a last second change.  I am standing in
Terminal A.  My husband is circling Terminal D.

After an apologetic phone call to him, I see the familiar car and my poor husband
with hair standing straight up and eyes bugged out.  It has taken him 3 1/2 hours
to make a 1 1/2 hour trip.

So ends the travel comedy.  I am sure someone got a good laugh out of it.
No bitterness here you understand.  

                                           

A child's life is like a piece of paper on which every person leaves a mark.

Chinese Proverb

                                    

To follow, you will find a video link of a controversial figure in politics--Ron Paul.  
I found the speech fascinating.  These ideas are worth hearing and thinking about. 
Listen to the reasons behind the positions and you may gain a new respect for
our individual freedoms.

Dr. Paul's perspective comes from 10 Congressional terms and a career in medicine.
Do we have freedom in America today?  You decide........

http://www.worldhealth.net/p/las-vegas-conference-highlights-ron-paul-md.html

YS, one of my subscibers, ponders whether we can blame poor parenting on
"young, ignorant parents".  See Part I for the first part of the discussion.  I
reviewed a book on Divorce and The Unexpected Legacy of Divorce.

YS is obviously concerned about how we can help parents that might be
disadvantaged suggesting obligatory parenting classes, school for a
trade and being supported financially all the way.  Because divorce has
become such a big part of our society in general, I thought it might be useful
to look at this particular aspect since the impact on children is prominent.

I believe the issue has multiple facets.  Among them is the governement's
role in our lives and our own choices.  It has to be said that parents who
have more money have a better shot at good parenting.  It is easier for
them to get quality help from sitters, day care, and nannies.
So, how do we impact those that have limited knowledge and limited resources?

In the US, we seem to have come to the belief that a "right" is what we "want".
We even seem to interpret "needs" as "rights" and have come to assume that we
should have these rights regardless of whether we have earned them.  Simply by
existing, we have a "right".   We have, in turn, charged our elected officials with
the job of making sure we each get these "rights".  Many personal choices
have thus become political.  Our politicians then make choices on how to
allot the money it takes to provide these "rights".  This is one facet.  I will
tie this perspective into the current topic further down in the article.

Another facet is that our society seems to have taken the sting out of poor choices. 
That is, our Federal or State government, has systems in place that keep people
from feeling the consequences of their bad choices.  I am not necessarily
saying this is bad.  It is great to have a contingency for really bad things. 
But, consider this: in life, we make choices.  And some of them will be bad choices. 
And, it is always heart breaking to watch people live through consequences.
But, consequences are the natural result of what we think, feel, and do.  
They are not random events--at least not often.

So, as difficult as they are to watch, consequences should make us think twice
about our choices in the first place--getting married, having children, etc.

We are at least 2 to 3 generations deep in fragmented families--that is, single parents,
divorced parents, estranged parents, absent parents, etc.  In fact, it appears that
divorce happens all the time and has become part of the fabric of our society. 
We no longer think of it as a tragedy or scandal in the way it was even 3 or 4 decades
ago.

Consider this:  Wallerstein makes the comment that each child experiences
divorce "single file".  That is, there might be 15 kids in a classroom of 30 and
each of them will be thinking to themselves "why me?".  Volume does not
lessen the pain nor the impact on the individual child.  Even families who
had more than adequate finances had children with an emotional sense
of lack.

Let me be clear that divorce is not the only damaging thing that can happen
to families.  There is alcoholism, family violence, drug abuse, and any of a
number of really bad things that can exist both within intact as well as
divorced families.  So, my intention is to highlight divorce but not to assume
that it is the only problem that exists.

With regard to the "right to have children", it must be said that children should
be considered to have rights also, should they not? 

Children should have a right to good parents, good parenting, and good teaching.
They should have a right to an education and the skills to make a life for themselves.
They should have a right to a childhood unencumbered by their parents' mistakes.
They should have a right to safety, security, a full stomach, and a warm bed.

Y hypothesizes that if we provide parenting classes and pay for an education,
that parenting skills will improve.  I think these are great ideas.  The question
would be how can we implement these ideas without regulating parenting?
Who will be responsible to see that parents attend these classes, learn the
material, implement what they have learned, and who will pay for it?  How
will we measure success?

We already have a number of programs to help disadvantaged families or
parents in the US.  These programs include Housing Assistance (government pays
for housing for families that are underprivileged), Disability Income (government
pays for those who claim an impairment that keeps them from doing work),
Head Start Programs (government pays for small children to be in an educational
environment with the theory that early intervention will help kids succeed),
Medical Care for the disadvantaged (Medicaid--government pays for healthcare).

With all these programs, have we seen success in moving our society toward
prosperous and healthy families?  Or are we seeing a generation of children
who are raised in poverty and near total dependence on government?  
My observations of the family structure over the past 20 years leads me
to believe that we have fallen short in raising our children and that, despite
our support programs, inadequate parenting has become generational (observation
in my practice as well as observations of families that have been honest enough
to share their decades of experience).

What I have seen repeatedly is:  mom or dad are into drugs-or alcohol-or the
fast lane-or just not ready to raise kids but they have kids, the kids grow up poorly
attended, they themselves have children as teenagers  By this time,
mom or dad have realized their mistakes but have not acquired any more
parenting skills.  They try to help raise the grand kids on fixed incomes while
the real parents are struggling thru their own lives.  It is a family cycle that probably
requires intervention for the whole family.

Parent is a verb not a noun.  To have children may be a right but, with having
children comes responsibility that, if poorly attended, carries consequences.

In the purest sense, I believe we can blame the parents.  Parents are the ones
that have make the choice to have children--parents choose to have sex, choose
to carry a child, choose to have a child.  It is not something that happens while
they stand on a corner minding their own business.  

Consider this:  Children will grow up with food, clothing, and shelter.
But to raise them takes time, effort, and some skill.

So, what of the parents that have been poorly parented themselves--they may
not understand the importance of raising children nor where to go for information. 

Can we go to the state and federal government and ask them to solve this?
Government can do many things.  Parenting is not one of them.  That happens
in the home, one on one between a parent and a child.  There is no political
fix for this problem because it has to do with spirit, soul, and aspiration.

As Mark Twain said, "What is done to children, children will do to society".

Children are our greatest natural resource as a country and as an international
community.  It is my belief that if we pour resources into our children, we will
secure our future.  If we ignore the problem, we will also secure our future.
Which future do we want?

My own conclusion is that the solution should likely come from within our communities--
our local communities.  We have churches, schools and hospitals in almost every
community in this country.  There is some argument that churches are losing
relevance with the younger generations.  Maybe there is a point here.  Perhaps
institutional relevance should be dictated by how institutions serve our communities
rather than by which tradition or philosophy they espouse. 

Maybe churches, schools, and hospitals can become conduits of information
and centers for learning and resources for both children and adults.

A teenager talking about his father found his dad's way of doing things rather
entertaining.

He pontificated that his father was so OCD (Obsessive Compulsive Disorder)
that his dad called the disorder CDO because that put the letters in alphabetical
order.

Anyone who has had to take pills on a regular basis runs up against the problem
of remembering to take them at the right time.  It is more of a problem when the
pill is due to be taken multiple times per day.  Fortunately, the pharmaceutical
industry has developed preparations that can be taken either once or twice a
day as opposed to 3-4 times per day on many commonly used medications.

A tip for remembering to take a once-a-day or twice-a-day medication is:

Put the pill bottle right next to your tooth brush.  Assuming you brush your
teeth twice per day (hopefully you do), this will be your reminder to take your
pill at the right time.

Some patients have had to set the base of the toothbrush IN the pill bottle.
Pick up the toothbrush, remember your pill.


                                    

One of my subscribers commented as follows:

Hello Dr. Rima,

I've been subscribed to your blog for quite a while now. I thought its time for me
to come here and thank you for the good job you are doing.

I particularly like these posts of yours:

-Medication Side Effects
-Watch Your Manners
-Unfit Parents
-Parental Exercise

If you don't mind I would like to add a word or two. In my opinion, there are
some cases where you cannot put all the fault on the parents. Sometimes society
is at fault. Sometimes the grandparents are at fault. In some places the society
and families are so screwed up you don't know who to blame for it so we put all
the fault on the young ignorant parent when she or he might be a victim also.

Honestly, I do not know how such cases can be fixed. Having children is a right.
Most of these parents would not be seeking help nor advice on the Internet,etc.

Instead of taking care of the children on behalf of the parents, why aren't the
parents enrolled in obligatory parenting classes and if they are poor and
uneducated enrolled in high school or college and of course supported all the
way financially? (does this sound cheesy?)

I'm sorry for the long post.
Regards!
Y.S.

YS,  I am SO glad you posted this comment.  You have hit on a most important
topic--raising children and the impact of parenting. 

I have no idea whether you are writing from the US or outside the US but,
you make some excellent observations and comments about how to "fix" the
situation we are in.  I'd like to address one of the problems, in my opinion, that
has put us in the situation you describe--divorce.  As a physician, I have the
opportunity to observe families over many years.  Sometimes I treat the parents
and their children.  And, although this is only one aspect of the problem, I think
it needs to be said that we are at least 2 generations deep into children who
have been raised in divorced homes and, we are seeing some of the effects
on our society in general.  Children are raised with a lack of either financial
resources or relational resources--I'll explain below.  In other words, they
are not as well equipped to be parents as they might be. 

Please bear with me as I detail this topic.  It is complex.  My intention is to
highlight a problem rather than place blame.  Generally, though, if we can
shed light on why things happen as they do, we can often find a solution.  This
is my hope.

As most of us already know, the US became a "no fault" divorce country in the
1980's after much effort and lobbying to allow abused or miserable partners
to get out of horrid marriages and start a new life.  That is, our society has
decided that it is important for adults who find they have made a grave
mistake in their choice of spouse, to get out of the mistake and begin over.

Out of sheer coincidence (or maybe not), a good friend of mine recommended
a book about divorce and its effects on children about the same time that
YS made the above entry comment.

The book was The Unexpected Legacy of Divorce by Wallerstein & Blakeslee.
My friend was so adamant I read it, that she brought a copy to my office
herself.

She and I had gotten into a conversation about how children are cared for
in the post-divorce years and how parents adjust their schedules and emotions
in these situations.

I am a child of divorce and had read a lot about divorce and marriage but
this book took me totally by surprise.  Why?  Because it is completely based on
the perspective of the children--not the parents, not the grandparents, not
the attorneys, not the courts--the children.

In summary, it details the study of children over a 25 year period starting from
the day of the divorce and ending 25 years later.  Most of the children were
between the ages of 6-15 at the beginning of the study and were in their
30's to 40's at the end of the study.

What made a particular impact on me (as a doctor and as a child of divorce) is
the abiding effect of divorce on a child throughout their lives despite the best
post-divorce arrangements that our courts can provide.  The book details how
the choices our courts offer, take the parents concerns into account but, essentially
leave the children's concerns off the table.  No one actually asks the children.
There are states where there are "attorney-ad-lidum" arrangements but these
systems do not appear to mitigate the silence that the children are forced to
maintain in the divorce and its aftermath.  They look at the situation from a
"kids need both parents" viewpoint and enforce this no matter what the
circumstances--violence, drugs, alcohol abuse, emotional destruction.

Most of the distress came not during the breakup (as many people imagine) but
as children reached their adolescent and adult years.  The author posits that many
children lose the learning that happens about relationships and how to maintain
them within the boundaries of a safe, intact family.  They reach adulthood and
have to learn the social skills they have not absorbed.  Children from intact
families naturally absorb this information by being around it day in and day out.
Some were fortunate enough to end up in step families with a loving step-parent
who helped model a relationship with the child's biological parent--not many.

Also, children were generally given no explanation of what really happened (other than
the platitude "mommy and daddy cannot get along") and, in the silence, kids
are left fearing loss--because they do not understand how this happened.  That is
not to say that very young children should be lectured to about the faults of the marriage. 
It means that parents should provide their children the opportunity to ask some
perhaps painful questions and be prepared to provide very truthful answers about
these questions--this is most likely to occur during adolescence and adulthood.  

One example of the lack of information felt by kids that the author gave was that
children did not make the connection between physical violence and the divorce
even in cases where the husband was physically abusive to the wife in front of the
kids.  No one specifically explained it and they could not make the connection in
their own minds.

Additionally, joint custody arrangements commonly used across the country
caused problems for kids who were required to travel some distance between
homes for visitation and weekends.  This caused disruptions in their school and
social activities.  They ended up missing their friends at either household.  Most parents
didn't think to consider this as important.  For a fortunate few, both parents
stayed in the same community and both parents shuttled kids to activities at school
and with friends.  This helped maintain a stable environment.

But, children universally expressed anger that they had trouble planning weekend
activities because of custody sharing.  Their friends eventually gave up trying to
invite them to participate because they could not keep track of their time at home
and their time away.

When you consider that the main job of kids is to go to school and to develop social
interactions, this is highlighting a problem that is affecting kids all over the
country--all in silence because kids do not want to hurt their parents by adding
to the worries with complaints.

The relationships within the family were forever re-defined and an unexpected
consequence was that aging parents (whether mother or father) got less
attention and care in their older years.  That is, the children did not feel the
same attachment? concern? desire? obligation? to help their parents in their
late years compared to children from intact families.  This is, of course,
complicated by multiple sets of step parents and step children.

Please read this book if you are a parent contemplating divorce (which is sometimes
necessary), a child of divorce, or a parent who has been divorced.

The missing ingredient that created so much difficulty, in my mind, was that the 
parents didn't listen to their children.  They were too taken up with their own
pain and just didn't seem to be cognizant of the need to listen--even those who took
great pains to try to provide their children with stable and loving post-divorce homes.
They assumed that if the child didn't complain, they were OK or they ignored
their complaints/concerns.

I'm working on another post about the topic:  to what degree can parents
be faulted in their efforts to raise their children?

There is more information in the media this week about projections for
healthcare spending, including Medicare, and the effect of the Baby
Boomer generation as it ages.

For more specific, click on the following links:

Wall Street Journal

Health Affairs

The Washington Post

By sheer volume, the US is a unique healthcare system compared to many
countries that have been delivering medical care through federalized systems.
Our challenges are complex and there appears to be stress in every aspect
of healthcare delivery i.e. ask a pharmacist in your community what it is like
to be a pharmacist these days--short handed and not enough in the country
to cover the demand.  How will access be affected?  Who will pay for it?  How
much will they pay?  How good will the quality be?  

We live in challenging times.


 

Courage is what it takes to stand up and speak;
Courage is also what it takes to sit down and listen.

Winston Churchill