Offering The White Glove Treatment: Treating Your Physicians with the Respect They’ve Earned

During recent years, I’ve spent a considerable amount of time waiting.

Waiting to be called into various physician’s examination rooms that is.

As I wait, I sometimes watch. People watch.

But mostly, I read.

Like everyone I know, I hate wasting time, so I bring my work along with me and get something productive accomplished as I wait for my turn.

The only thing that slows me down from working through a manuscript in record time is the people waiting around me.

All too often, I’m trying hard to concentrate but I’m hearing nothing but complaints in front of me, behind me, and on either side of me. I overhear the loud, not so subtle gripes as well as the just-above-a-whisper murmurings and I catch the oh-so-visible body language of people who feel inconvenienced and put out at having to wait their turn to see their physician.

I listen to the moans and groans. I observe the sighs and the heads shaking as their eyes narrow in distaste when they look at their watches for the umpteenth time.

And I wonder about those people.

Why didn’t they bring something (anything) to read or work on as they wait?
Why do they expect to sign in and be immediately ushered into the inner sanctum even though it’s obvious the waiting area is full to overflowing with other hurting people?
Why do they feel they deserve the white glove treatment at the expense of others?

Next, I wonder what type of greeting they’ll offer their physician when they finally (their word, not mine) enter into the examination room?

By the looks on many of their faces, I’d not want to venture into such dangerous territory.

And so it goes day in and day out in the life of our physicians. It’s an unfortunate reality that our dedicated medical professionals are fighting a losing battle with some patients before they even step into the exam room to say hello.

It’s no surprise that more and more of our brightest and most skilled men and women are opting to go into other medical specialty areas (such as research) rather than becoming a physician on the front lines of health care. Being a doctor in today’s world of entitlement can be hazardous to one’s health and I’m not talking about contracting the random virus here and there.

We hear a lot in the media today about the ever-escalating pressures physicians face in today’s turbulent times. Some of these stresses mainstream America is familiar with but other equally important factors remain in the background partially because there isn’t much doctors can do if their patients choose to not take personal responsibility for their own healthcare. The bottom line is that optimal quality of health and life cannot be achieved if patients are unwilling to meet their physicians halfway and partner together for a successful outcome.

So what does it mean to partner with your physician exactly? Partnering by its very definition implies equality, mutual respect, and working toward a common goal. Patients go to physicians for information, counsel, advice, and alleviation of pain/painful conditions. They come expecting their doctor to assemble his very best arsenal of knowledge, experience, and skills to diagnose, prescribe, fix, cure and heal them. And their physicians work overtime to meet every single one of these expectations.

Again, I wonder, isn’t it about time that patients do their part and start valuing their physicians’ commitment to them by demonstrating some simple gratitude and general courtesy? How many patients have ever put themselves in their physicians’ position? Even once?

Mostly, I suspect the majority of patients judge the success of their most recent doctor’s appointment mainly by how long they had to wait before being seen. If I’m correct, then we all need an education about the varying and diverse hats physicians wear each and every day and how these non-negotiable additional responsibilities affect you and me as patients.

Did you know that most doctors work in excess of 50 hours per week and that’s the low end of the spectrum for a physician? The truer estimate is 60-70 hours a week.
Consider this fact: before office hours even open at 8:00 or 9:00am, your physician has very likely made his rounds at whatever hospital(s) he currently has patients admitted to and generally spends about an hour attending to their special needs before seeing patients in his own office.

Next, comes the full day of examining/advising/consoling/counseling one patient after another with a brief break for lunch (if there’s time) right through the late afternoon. All the while juggling phone calls/pages/emails/texts and fielding questions from his staff, colleagues, insurance and pharmaceutical representatives. And if you think once the doors close for the day that your doctor gets to go home and relax, you’d be wrong again. Your ever diligent, hardworking doctor still has to spend hours completing patient charts and other paperwork required by the government. Oh and let’s not forget the endless hospital administrator meetings (before and after) his typically frenetic and exhausting workday. While we’re defining workday, let’s be clear that for most folks “workday” is defined as 9:00am – 5:00pm, Monday through Friday, but not so for doctors who are on rotation at the hospital, and therefore, on call, during weekends too.

When we see the other side of medicine from the perspective of our physicians more clearly, every little complaint or grudge we were nursing about that extra fifteen minute wait seems foolish, embarrassingly so. Factor in the excessive hours, demanding physical/mental/emotional workload, stresses from hospitals to staff to patients (not taking into account personal responsibilities of family/friends/home/health concerns) and then having to face a malcontent patient…or a group of them. It’s too much to ask of anyone.

Sadly, patients do more than ask, they expect, they demand, and in turn, become yet another factor that drives some good physicians out of practicing medicine…for good. But that doesn’t have to be the case. Instead of expecting the white glove treatment, why not give it instead? Certainly, our physicians have earned it.

Each of us as patients are in a position to contribute to our physicians’ well-being and happiness. How? By adhering to what I’d like to call a “patient’s code of conduct,” which by another definition means, a list of good behavioral guidelines to follow when working with your doctors.

Here’s a few suggestions for starters, but feel free to add some of your own. In any case, express your appreciation of your physician to him whenever you can, as often as you can, in every way that you can. Maybe, just maybe, your kindness will remind him why he wanted to go into medicine in the first place.

Six Effective Ways to Say, “I appreciate being your patient!”

• Thank them each and every time you enter their office.
• Listen to their counsel when they give it.
• Follow their instructions after agreeing on the best course of treatment.
• Demonstrate graciousness when having to wait longer than we’d like or expected
• Always, always see the person behind the professional demeanor.
• Give them room to have a bad day and not judge them for it (or speak poorly of them afterward.)

Copyright 2012 Michele Howe

Statistically Speaking: How Does Your Lifestyle Affect Your Health?

When I read the statistic that upwards of 80% of all visits to a doctor are lifestyle related, and in up to 90% of these incidences stress plays a significant role, I was at first skeptical, then disheartened. Like most people, when I hear about an alarming new health trend, I check myself to see if I’m part of that unfortunate national shift.

I thought back to the last couple of years and reviewed why I had visited each of my doctors during that time period. I was relieved to see that almost every appointment was either a yearly well check-up or a post-surgery consultation to assess my healing progress. Then I asked myself I had truly beaten this trend, and more important, am I healthier for having done so?

The answer wasn’t so simple. Consider that “lifestyle-related” conditions are typically thought of those such as: high-blood pressure, diabetes, heart disease, obesity, and high cholesterol related. While I can happily say I don’t suffer from any of these illnesses, I am unhappily part of the majority of individuals who deal with chronic stress.

That dismal statistic alone got me thinking about stress in general and the different types of stress each of us is subject to on a daily basis. Our bodies are built to handle acute episodes of stress, those emergency occurrences when our adrenaline pumps fast and furious through our system to cope with whatever ER situation is facing us. But chronic stress is totally different. Chronic-anything even sounds bad, doesn’t it?  Chronic stress that doesn’t let up and eats away at a person day in and day out takes a significant toll on the body, which then frequently tempts individuals to fall into unhealthy lifestyle habits. Too often we see people falling into the stress = poor lifestyle choices = more stress = unhealthy lifestyle habits = chronic health problems and compounded visits to the doctor syndrome.

As we know, these unhealthy lifestyle habits will eventually kill a person. We can see where this cycle of lifestyle stress and lifestyle habits can take us. Our daily habits, those moment-by-moment choices we make without even giving them a second thought, create a chain of health issues (good or bad) that either enhance or detract from our overall quality of life. Just as our bodies are built to handle acute episodes of stress and are no worse for the wear…our bodies can tolerate some “acute” choices of poor foods; lack of exercise; too little sleep…. on occasion. It’s the old 80/20 principle that makes setting healthy goals and living by them workable and sustainable for life.

If we aim for 100% perfection and miss our mark (and we will) it becomes physically, emotionally and mentally too burdensome to continue choosing good health options. However, if we adjust our thinking to the 80/20 plan, we tip the odds in favor of long-term success (and better long-term health.) Instead of making unrealistic demands on ourselves (and our lifestyle) it is far more effective to ease into (and stick with) reasonable dietary, exercise, and sleeping patterns. In case you need the math…it’s the 80/20 formula that works best on all fronts.

Physicians see this trend toward extremes (and extreme failure rates) in their patients every day. Either patients come in for every little ache and pain or they wait until it’s almost too late for a cure. Either/or is not a good statistical approach to live by from a medical standpoint. With any extreme thinking or lifestyle choice, it’s almost always failure waiting to happen. Where people fail most is when they adopt the all or nothing approach to health saying to themselves, “If I can’t do it right all of the time, I give up!” The fact is we can aim for the ideal, but we live in the real (world.) And in the real world, none of us can afford to give up when we fail, because fail we will. Wouldn’t it just be easier to shoot for the 80/20-success rate anyway? Statistically speaking…that’s where success lies every time.

De-stress your healthy lifestyle choices and beat the statistics: 

• Make an 80/20 plan for eating/exercising/sleeping. Write down realistic goals for all three areas and be sure to include a 20% margin for relaxing these standards and to keep life interesting and engaging. Tailor-make your healthy lifestyle to fit your lifestyle!
• Find ways to make getting healthy more fun. For many people this approach can be as simple as taking a cooking class; joining a dance class with a friend, or treating yourself to a staying up late one night a week to watch a great movie and then sleeping in the next morning. Find your sweet spots and work them to your advantage.
• Make note of specific successes you’ve had in the past by writing them down in a journal, dating each one, and then referring to your triumphs when you hit a low moment and want to give up. Get real; everyone wants to give up at times, even the fittest, healthiest folks you know have days (or weeks) when they struggle to stay at it.
• Think as kindly of yourself and your achievements as you do of others and theirs. It’s often said that the words people say to us can bring either life or death…it’s the same principle with the words we say to ourselves. Give yourself due credit for taking responsibility for your health. That is the first and most important step that many people never even consider.

Copyright 2012 Michele Howe

I had expected men to be anxious about one set of concerns and women another. Wrong. Come the night before surgery, there was plenty of agreement between the sexes on what was worth losing sleep over. Contrary to what I had previously believed true, it seems that a person’s sex; educational background, economic stability, or prior medical history has little to do with what individuals secretly fear about entering the operating room. Although each person cited a particular area that triggered his or her inner alarm to go off, there was a single common theme running through every named fear. Bottom line: it was loss of control (imagined or real.)

Though men and women cited different types of concerns that trigger anxiety, underlying each was the fear that the unexpected could occur and there would be little they could do about it. This realization is accurate in part; no one is completely (or partly) in control. What people fail to acknowledge, however, is the power they can exert when they take an active role in alleviating as many of their fears as possible. It’s the old adage, “knowledge is power.” The good news for every patient is that there are specific steps that minimize the uncertainty and reduce those pre-surgical jitters. But before that…here’s a rundown of what folks fear most.

Pre-surgical Fears: The (Not So Short) List –

1. What if I don’t wake up from the anesthesia or (worse) wake up during the procedure but I am too paralyzed to cry out for help?
2. Will I be at risk for general anesthesia complications that will result in permanent mental or physical injury and loss?
3. What happens if I experience extreme side effects from the anesthesia such as feeling nauseous and dizzy?
4. If the worst happens and I die during the operation, how will my family be consoled?
5. What if my doctor finds something he didn’t expect, how might that change my treatment plan?
6. If surgery doesn’t correct my problem, what is the next step?
7. What are the possible and most common complications?
8. How long is the recovery period?
9. How much pain will I experience and how will it be controlled?
10. Is there a significant risk for infections such as Staph and MRSA?
11. What is the success rate of my surgery and how much experience has my physician had with this procedure?
12. I want more information about the specifics steps of the surgery but I don’t feel competent about what questions to ask, can you help me?

Did your fear(s) appear on this list? If not, perhaps you have a different one (or many.) In either case, having surgery doesn’t necessarily mean that you, the patient, abdicate all control to those masked medical professionals in the OR (not if you are willing to name your fears and do a bit of pre-surgery question and answer work on your own.)
The best way to reduce your pre-surgical anxiety is to take on the role of an information gatherer well before you head to the hospital and here’s how.

Darrell Wachowiak, Director of Surgery, Flower Hospital, Sylvania, Ohio, tells patients (and their families) how to prepare for a fearless pre-surgical experience. The best part of this RX is that you don’t need a medical degree to follow these expert recommendations.

Take These Steps — Alleviate Your Pre-Surgery Stress

• The double-edged sword of trust. Patients often trust in health care in general (and in their own providers personally) and so do not ask enough questions for them to feel comfortable. Recognize that trust in your physician also means you trust him enough to communicate your doubts and fears. Your professional doctor-patient relationship must be able to bear the weight of your questions.
• Identify within yourself what you fear. People are different and have many unique and specific concerns. Some are afraid of the actual procedure while others have no fear of the procedure but are anxious that they are vulnerable or may be exposed. Ask yourself what it is that you fear, make a list, and then go after the answers.
• Ask for help in reducing “your” specific fear. Medical professionals are happy to offer reassurance and information once patients identify their fears. Staying silent (and hoping for the best) is not prudent or practical because internal stress works against the patient (and the surgical outcome.) Bring your anxieties to the light of day and providers will help you extinguish them.
• No fear is too small; no concern is too minor to be voiced. Nothing pleases a health care worker more than to know that they are putting a patient at ease and decreasing their anxiety. Hospital staff here to help and with open communication the medical community can be better prepared to treat each individual (and their fears) with all the tools at their disposal (unmasking each and every one, one concern at a time.)

On a lighter note, one final fear was expressed (which I fear is a growing one.) Fear of getting on the scale in the pre-operating area!

Copyright 2012 Michele Howe

Good for me that I had a surgeon who was willing to let me both observe one of his actual cases (and write about it). As the date approached for viewing (which had to be cleared through a number of channels including the patient herself), I excitedly told friends and colleagues about my “opportunity” as I viewed it. Surprisingly to me, most people I talked to tried to warn me off, telling me I would never (ever) voluntarily agree to another surgical procedure having watched one so like my own. I wondered about this, then decided it was too good a chance to miss no matter what conclusions I came away with after the observation.

So with a little trepidation, I entered the very same hospital waiting room where I had sat for my previous three surgeries as a patient. This time was different though. Instead of getting prepped with a gown and an IV drip of various medicines, I was escorted back to the surgical desk area where I was given a temporary ID number so that I could retrieve my scrubs for the morning from a Scrubex machine. Interesting, that. I changed into a pair of nondescript green scrubs, put on a hair net and was handed a mask to wear. Being the non-astute medical garb wearer I am, I humbly accepted help on donning all three appropriately. So much for an auspicious start.

With a curt, “Follow me,” I was taken into the operating room right in step with the patient with whom I would observe and I noticed she was still awake and chatting comfortably with nurses and technicians. Standing as near as I could to watch what was being done, and with pen and paper in hand, I took copious notes for the next two hours. Transported, that’s what it felt like…to a completely foreign world where a team consisting of an anesthesiologist, a nurse anesthetist, the orthopedic surgeon, two certified surgical technicians, and a circulating nurse performed a marvelous dance of both precision and skill. I was amazed at how seamlessly every single clinical step meshed one to another. And how every person anticipated each other’s next move and responded in a well executed rhythm all under the surgeon’s expert guidance and specific instructions. It was an experience I won’t soon forget.

After this patient was put under a general anesthetic and then intubated, I watched closely as the surgeon made his incisions using the patient’s bony anatomy to keep his orientation. I looked on as a saline solution was injected into her injured shoulder to allow better visual clarity and to help ease the movement of the arthroscope (a pen sized instrument inserted into a joint through a 1/2 inch incision). The patient received pain medication injections (even though she was unconscious); and then several scopes were inserted at the beginning of the procedure (two of these the surgeon manipulated to perform the repairs while viewing a high definition TV monitor; the third was the camera which he moved around to seek out and inspect the damaged areas).

At various junctures, miscellaneous burring, whirring, trimming (think dental equipment) drill-like instruments were applied to the troublesome shoulder areas via the scope sites, each one serving its unique purpose in the tedious corrective procedure. After approximately two hours time, the surgeon had repaired this patient’s rotator cuff (using one screw (anchor) with three sutures); performed a SAD (Subacromial  Decompression) which removed a bone spur from her shoulder blade; and did a Biceps Tenotomy (cutting the biceps tendon).

Once the surgery was completed (and the patient was sutured, cleaned up, and her newly repaired shoulder placed securely in a sling), I followed her to the Phase I recovery room (generally a 1-2 hour time period) where I learned even more about the risks and stresses of the surgery itself and how nurses carefully monitor each individual as they begin to awaken from anesthesia. The nurse attending to this still semi-unconscious patient explained the precautions taken to ensure every individual under medical care is prepared to make a full recovery.

When the patient was alert and met all the vital sign criteria, she was moved to Phase II recovery where her family rejoined her. Here, a different team of nurses answered release questions, prepared her discharge papers and offered miscellaneous creature comforts. For this particular patient, she was released to go directly home. For others, some are kept in hospital overnight or longer depending upon extenuating circumstances or their special health requirements.

On this spring morning, in this particular hospital, in just one surgical operating room, I was initiated into a world of clinical terms, medical phraseology, and complex technical procedures I had only imagined before. Perhaps the most significant takeaway I learned from my morning in the OR was that for the individuals who make this their workplace, there is no decision or movement deemed insignificant. Each of the minutest paces these medical professionals put themselves through is done with a specific purpose in mind: to ensure the safety and the healing of their patient. Humbled and honestly overwhelmed, I recognized how helpful it would be if all laypeople could witness some type of surgical procedure in order to fully appreciate the expertise of the men and women behind their ultimate physical recovery.

Changing back into my own clothing, I deposited my scrubs into the Scrubex machine for cleaning whereupon I was given “7” credits for the return. I’d like to believe I’ve come away with far more than a mere credit to my account. No doubts on that score, I know I have.

ON A NEED TO KNOW BASIS: WHAT EVERY PATIENT NEEDS TO KNOW

Dr. Christopher A. Foetisch, orthopedic surgeon at the Toledo Clinic, Toledo, OH, offers the following pre-surgical preparation recommendations. Note how the most effective pre-surgical steps women can take encompass readying both the mind and body.

BODY FACTS TO CONSIDER BEFORE SURGERY: Information to Heal Strong

• Stress, depression and anxiety prior to surgery have all been linked to poor recovery after surgery. Note also that elevated levels of cortisol; the body’s primary stress hormone, negatively affects wound healing. High cortisol levels dampen the immune response. As a result, this imbalance can delay healing while increasing the risk for wound problems such as post-surgical infections.

• Any surgical procedure places an increased demand on the body. As a result, protein and calorie needs are increased 20-50% over normal requirements. Without enough dietary protein, the body must break down muscle and organ tissue that can impair the immune system and deplete energy and strength needed for recovery.

• Exercise has a clearly demonstrated a positive effect on surgical outcomes. According to a 2005 report from the Journal of Gerontology, wound healing is 25% faster in those patients that exercised three weeks prior to surgery compared to those who maintained their normal routine. Additionally, exercise improves circulation and strength that lead to increased mobility after surgery.

HOW WE THINK: Making Your Mental Expectations Work for You

• Individuals need to embrace a “can do” attitude. Those patients who are invested in their own recovery, typically do extremely well relative to those who are apprehensive or anxious prior to surgery.
• The power of positive thinking does go a long way. Most often, if an individual thinks she will do well, she does. Flipside, when a person anticipates struggling or frets about experiencing potential problems after surgery; that individual’s recovery will be much tougher.
•  Adopt reasonable expectations. Getting well takes time and patients must be willing to commit both emotionally and physically to the recovery process to create the best environment for healing strong.

WHAT TO DO: Simple Measures to Positive Results

• Make sure to eat a balanced diet that has adequate protein intake.
• Exercise for a minimum of three weeks prior to surgery.
• Avoid pre-surgical stress and anxiety or consider delaying an elective procedure until the intense season has passed or can be more easily managed.
• Ask yourself self-check questions regarding your overall attitude toward the surgical procedure and your willingness to be fully committed to the recovery process.

Copyright 2012 Michele Howe

“People who are considering care-giving often make one primary mistake, they do not look forward enough in the process. What today is considered as minor aid can quickly escalate into constant, twenty-four hour a day care.” 

When forty-nine-year-old Renee lost her job earlier in the year, she was stunned. Immediately, she began sending out resumes. Getting a job became her job. For seven months, she landed only a few interviews despite her advanced degree and experience. Renee wondered if she’d lose her home, her credit rating, and savings in one fell swoop. Then Renee’s mom called and her fretting took an entirely different turn.

*      *      *

            Several years earlier, Renee had answered the call to move in and care for with her ailing and then increasingly frail eighty-year-old mother. That arrangement lasted about nine months. No sooner had Renee agreed to sell her home and join households to care for her mother, than her mom changed her mind. Renee’s mother decided she didn’t want anyone living with her even though she needed outside assistance. Renee tried to reason with her elderly parent, tried accommodating her in every way possible, because Renee knew it was only a matter of time before her mom’s health would deteriorate to a point where it would be dangerous for her to live alone. So after much discussion that had led nowhere, Renee moved into an apartment and eventually purchased another home for her and her children.

Life went on pretty smoothly with Renee transporting her mom to appointments, doing her shopping for her, and making certain her mother’s home was well maintained. Renee wondered if perhaps her mom might actually realize her wish to stay in her home until she passed away. Renee herself certainly preferred living in her own home.

Then Renee lost her job. Suddenly, her mother decided the perfect solution was for Renee to move back in with her again. Things would be different this time, her mom promised. I’ve changed, she told Renee. Renee wasn’t so sure; then again with the housing and job market so shaky, this might be the their best option.

Having recalled the strain of living with her mom caused Renee to think proactively on both small and large matters. She also recognized that even though her mom was giving lip service to wanting Renee back to care for her, her mom was infinitely fickle and today’s enthusiasm could very well die a sudden death once Renee settled in and the routine of daily life took over. Minute issues as how to tie the garbage bag properly or how to load the dishwasher were just a couple of irritants that had so upset Renee’s mom the first time around.

Weighing the pros and cons carefully, Renee decided to take pen to paper and begin listing areas were problematic for her mom as well as any differences in living arrangements that had caused upset for her aging mom. While making such a list was semi-depressing, Renee knew it was necessary. Once she got started, fresh questions and concerns arose too. Renee realized her mom was far less physically able to move and live safely than a few years earlier and with this deterioration, how would it affect her ability to go to work each day?

Certainly Renee had questions to get answered and challenges to overcome, but she also had the wisdom of hindsight and a clearer understanding of what it meant to enter someone else’s home (even at their request) and merge two households. It wouldn’t be easy; care taking is never that. But Renee’s goal wasn’t ease or comfort…it was taking care of someone close to her. It was a living out of that principle; treat others in the way you would want to be treated. Easy to accomplish? Rarely. Right to do. Always.

The three aspects of care giving

Emotional Considerations:

• Realize the parent you once knew and loved might be gone forever and be willing to grieve the loss of that relationship even while a parent is still alive.
• Be prepared to take control of important decision-making regarding all aspects of care even when met with some resistance by the person in need.
• Make peace with the fact that not all extended family members will step-up to assist in the way you might want and expect.

Spiritual Considerations:

• Before you enter into a care-giving situation enlist the support of friends and family who will commit to pray for you and those under your care.
• Learn how to share your faith and life perspectives without receiving the appropriate responses back from the person you are caring for.
• Be ready to journey along with your patient as they face their mortality and be prepared to listen and respond to their concerns.

Physical Considerations:

• Take good personal care of yourself as the primary caregiver by eating right, getting enough sleep and exercising daily.
• Make use of professional care-giving agencies that can offer practical assistance with hygiene, dressing, and meal support.
• Understand your personal limits before you reach them by scheduling away time regularly to recharge yourself mentally and physically.

Care-giving from a physician’s perspective:

Dr. Christopher A. Foetisch, orthopedic surgeon, Toledo, OH, offers the following observations from both a clinician’s standpoint and having served as a caregiver personally.

• Providing care for a sick individual almost always requires more time and resources than most people realize.
• Realize that the level of care can quickly change from minor to constant 24/7-hour care.
• Caregivers need to ask themselves if they are “mentally tough enough” to help with bathing, bathroom, medications and possibly dressing changes or tubes and IV lines.
• Before an individual becomes overwhelmed, decide ahead of time when the need for another arrangement will be required such as transfer to a nursing home or hospice facility.
• Plan for unexpected expenses to arise from a variety of sources.
• When caregivers begin feeling frustrated, anxious, or depressed note these as warning signs that the situation must be promptly addressed and responsibilities reduced.
• No one individual should assume the caregiver role without some form of backup, even for a short period of time.

Copyright 2011 Michele Howe

1. Define the phrase “surgical nutrition” to laypeople that may not understand what this terminology means and entails.

Surgical nutrition can mean more than one thing. It can mean optimizing nutrition for patients who are in the hospital and cannot eat themselves, such as cancer patients or stroke victims. This type of surgical nutrition involves intravenous nutrition, tube feeding and, if necessary, surgery to place the feeding tubes. However, more relevant to the general public, surgical nutrition means optimizing a person’s health and nutritional status prior to and in preparation for major surgery.

2. When we think of preparing for a major surgery (or any type of surgical procedure), how much importance should patients place on getting “prepped” nutritionally?

Studies have clearly shown people who are underweight and malnourished, protein deficient or overweight have a more difficult time recovering from surgery. Without a doubt, a healthy, well-nourished person will heal and recover much faster. The stress of surgery and the healing process that follows requires additional nutrients above and beyond what your body normally needs. You should pay close attention to your diet both before and after surgery. It is best to get the nutrients your body needs to heal from unrefined whole foods. Getting plenty of fresh fruits and vegetables, protein-rich plant based foods such as nuts, seeds and beans are also important. Essential fats also expedite the healing process and help your body deal better with surgical stress.

3. How far in advance does this preparation go (or should it ideally be lived out day by day)?

Ideally, it should be lived out day to day. However, even 2 weeks of optimizing nutrition will put your body in a better position to handle the stress of surgery and also help expedite the healing process.

4. What are the implications for patients who have not taken care of themselves prior to a surgery as far a wound healing and overall ability to regain their strength?

Complications increase (and in some cases, dramatically) as one becomes further away from being in optimal health. Also, it is much more difficult for a surgeon to perform surgery on someone who is obese. Simply losing weight will help make the surgeon’s job much easier. However, if you can’t lose weight before surgery, by adopting an anti-inflammatory whole foods diet prior to surgery can reduce post surgical inflammation reducing the risk of complications.

5. What would be the five top practical steps all people and potential patients should apply to their daily lives to live strong and healthy?

1. Exercise 3 days per week (combining cardio with resistance training). Specifically, cardio exercise is very important to improve heart and lung function and this helps your body deal better with the stress of surgery and anesthesia

2. Take multi-vitamin containing zinc & B-complex (this helps with wound healing) and a whole-foods based vitamin-C rich “green” powdered drink (such as Green Vibrance).

3. Eat more fruits and vegetables to increase the antioxidant status of your body (this helps with healing) —specifically aim to eat 1 huge serving of dark, leafy greens each day, 2-3 fruits and 2 additional vegetables.

4. Make an effort to eat more protein rich plant-based “whole”‘ foods (such as beans, nuts, legumes, seeds, “whole” soy such as tofu or tempeh) and less animal foods (such as beef, dairy, eggs, chicken, etc).

5. Aim to drastically reduce the top 4 empty calories; 1) sugar, 2) refined flour, 3) trans fats and 4) processed vegetable oils (soybean, corn, cottonseed oil, etc).

Copyright 2011 Michele Howe

Sweeping across the country as the fourth fastest growing career is the physician assistant and if your physician or specialist doesn’t have one yet, he soon will. These skilled individuals contribute to excellence in patient care in multi-faceted ways by shortening patient wait time, ordering diagnostic tests, performing therapeutic procedures, instructing and counseling patients, and sometimes prescribing medicines with their physician’s approval. In sum, a physician’s assistant makes everyone’s life better.

Not convinced? Consider this all too familiar scenario. You injure yourself and the dreaded trip to the local emergency room is required. Once you’ve been evaluated by the attending doctor and the appropriate protocol has been followed for your particular case; tests are run, x-rays taken, medicines are prescribed. You’re now handed the release forms with instructions to make a follow-up (or for further treatment) appointment with your own physician within the next few days. No problem, so far. That is, until you try to get that coveted time slot within your slim timeframe. Frequently, patients requiring quick follow-up care end up waiting much longer than is recommended, even after being instructed by the medical professionals by whom they’ve just been treated.

Sadly, scheduling backup doesn’t limit itself to the currently ill or newly injured; it’s just as widespread for the bulk of patients seeking appointments for their regular check-ups as well. Waiting an additional month or two for an annual check-up is now commonplace; yet it is not nearly so frustrating or risk-ridden as when the need to be seen by a physician is urgent and ordered by another health care professional for optimizing the healing process. Therein lies the beauty of the physician assistant’s service to patients needing either preventative or palliative care.

If and when you are placed in the position of needing immediate, non-emergency care (and one day, you will be), your most advantageous edge at getting the promptest care may well come through your physician’s trusted PA.

From the every vantage point, it only makes sense for doctors to co-labor with a physician’s assistant as their job function is both comprehensive and complementary in easing the burdensome workload of the physician as well as that of the staff. Physician’s assistants likewise communicate with respective coordinating hospital and secondary technical facilities to provide faster care to those initially skeptical, but eventually won over, highly satisfied and grateful patients.

Specifically, what does a PA offer? Perhaps first and foremost in every patient’s mind is the speed to which they are able to get an appointment. Timeliness and flexibility in patient scheduling is a primary benefit. Says Dr. Christopher A. Foetisch, orthopedic surgeon at the Toledo Clinic, “When my PA is out of town, we schedule about fifteen less patients per day.” Additionally, given that Dr. Foetisch is only in his office two days a week, his patients are able to secure prompt care through his PA who offers faster admittance to this practice’s expertise. Once in the office, patients can then be confident that the PA has access to all tests, x-rays, and prescribed medicines as well as any other pertinent medical information. The PA also confers with the doctor on the primary care plan while getting initial treatment started sooner.

So why then, after considering the above clear benefit to all concerned, do some physicians’ assistants run into initial resistance from patients? Sadly, a few patients react with a certain measure of skepticism when their doctor’s PA enters the room. Why? From a purely practical standpoint, people don’t like repeating themselves and after the nurse completes her brief survey of questions the very next person a hurting patient longs to see is his physician. But as Dr. Foetisch points out, “Patients should look at the PA as the door and not the barrier to seeing the doctor.”

Another more subtle bias that PA’s must overcome arises from the patient’s desire to be attended by someone he has built rapport and over time, trust. Most individuals select their doctors by word of mouth from someone they trust and respect. Thus, in a very real sense patients invest in their choice of doctor by way of making themselves vulnerable and open to personal questions as they subjugate themselves to his medical judgment. Once established, patients very understandably prefer their own doctor’s care to anyone else’s. And yet as the general public becomes better educated on how PA’s bring greater immediate and long-term benefits to their overall healthcare experience, they will begin thanking them for their input and expertise and welcoming their contributory role to their overall health care process. As Dr. Foetisch notes, “The reality is that there is a physician shortage and physician extenders are going to be more and more commonplace.”

Copyright 2011 Michele Howe

Since then, I started looking ahead and wondering what it would mean if I ever needed a hip or knee (or God forbid…shoulder replacement surgery). How similar would the recovery process be to my other surgical experiences? Would it take a longer or a shorter amount of time in terms of function and mobility? Are there special considerations I’d need to take into account that are unique to “replacement” surgeries versus the type of shoulder repair I’d already had? And finally, I just plain wondered, “How do they do it exactly?”

So on a recent cold winter morning, I was treated to a repeat performance of sorts. Re-entering the outpatient surgical entrance, I checked in at the surgery desk where I was given a temporary visitor tag for retrieving my scrubs for the day. And to my delight, I discovered upon swiping the identification card into the Scrubex Machine that I was already entered into this hospital’s system. Donning a pair of scrubs, shoe covers, hair net, and facemask, I was ready to learn a thing or two (and more, much more).

One of the nurses escorted me into the OR directly behind the elderly female patient whose knee was being replaced via a procedure termed, Total Knee Arthroplasty.  I stood to the side and once again watched in awe as a process of step-by-step precision unfolded before my eyes over the next two plus hours. All around me, the orthopedic surgeon, an anesthesiologist, a nurse anesthetist, two certified surgical technicians, a circulating nurse, a physician’s assistant, and even the replacement knee product sales representative, moved in and around the room expertly performing their specific tasks in turn.

Once the patient is anesthetized and prepped, and the surgical team is properly attired in hoods (helmet-like coverings with full face shields) and tents (gowns completely covering each individual from neck to feet so as to protect them and the patient) a tourniquet is positioned onto the patient’s thigh area to minimize bleeding during the operation.

Next, the knee is pulled up into a ninety-degree angle and held there by a retractable foot brace on the operating table. The surgeon marks the knee and cuts through the skin while his assistants use metal retractors to keep the area fully open as he works to inspect and evaluate the damaged area and then determine the bone resection from the femur. Once decided, the surgeon makes four angled cuts producing a box shaped femur that must be exact or the replacement knee will not fit correctly (possibly developing problems down the road).

Then he makes the tibia cut and repeats the previous process. Again, the emphasis is on producing a flush, tight fit. A temporary implant (called a femoral and tibial trial) is positioned in the patient’s knee to make certain there is 100% accuracy before placing her new permanent Cobalt Chrome replacement knee in the joint. Once the implant process is underway, the surgeon checks for symmetry and stability by releasing the foot from its brace so as to freely move the knee around. Both extension and flexion movements must be equally balanced, otherwise, more cuts are required to achieve that perfect fit. Finally, the undersurface of the patella (knee cap) is removed and replaced with a trial patellar button completing the bone cuts. When the surgeon is satisfied with the movement, he immobilizes the leg once more and using rods, pins, and the like will remove the trial components and place the permanent (three part implant-consisting of femoral, tibial and patellar components) replacement into the patient’s leg. (For accuracy’s sake, the cement is mixed prior to placing the final implants.)

As the surgical tech mixes the cement that will bond the knee to the patient’s bones, others alternately irrigate and then dry out the surrounding bony area. The surgeon deftly applies the cement in place as he positions all three parts of the replacement knee with careful precision into the patient’s leg. The entire area is then irrigated thoroughly before the surgeon and his assistant begin closing up the eight or so inch incision. The tourniquet is then deflated, removed, and the whole leg is again sanitized before special bandages are applied and the patient is readied for the Phase 1 Recovery room.

Sounds seamless and straightforward, yet it’s anything but that. Throughout this decisively complicated procedure, the surgeon is continually measuring, re-measuring, and expertly manipulating the bones, ligaments, and tissues surrounding the knee in between checking and rechecking every step and calculating how to make his patient’s replacement knee a “perfect fit” for the rest of her life. Amazing to me as an observer and essential to this patient’s future health.

Immediately following the surgery, I felt a physical letdown that left me exhausted. After all, I’d just been standing at alert for over two hours straight. I was more than ready to sit down, rest, and take a break. Then I realized this is only one case for these OR medical professionals. They frequently work from early morning into the evening hours, case after case, with little pause in between. This realization made me stop and consider how grueling their jobs are from both a mental and physical standpoint. I left the OR on this particular day feeling exactly the same way I did last spring, completely humbled and grateful for those individuals who make their career that of mending the broken and injured among us.

With pen and paper in hand, I exited the OR, changed into my street clothes and made my way back to where it all began, the Scrubex machine. I swiped my ID visitor’s card and replaced my scrubs into the Scrubex depository and suddenly doubled my “credits.”  Last spring, I had seven. Total accumulated to date: 14!

But, once again, I knew I was leaving the hospital with much more than mere Scrubex credits to my account. Far more.

Dr. Christopher A. Foetisch, orthopedic surgeon, Toledo Clinic, Toledo, Ohio Offers the Following Insights:

Total Knee Replacement

A Physician May Recommend a Total Knee Replacement Depending Upon These Factors:

• Your age
• Your activity level
• Degree of pain you are experiencing
• Level of disability caused by your knee’s condition
• Your other medical problems

Treatments Physicians Routinely Try First:

• Exercise
• Medication
• Physical therapy
• Daily lifestyle adjustments
• Weight loss
• Injection

What to Expect Following Surgery:

• Significant pain during the first couple of weeks.

• Most patients will be up and walking the next day with help of a walker/crutches.
• Physical therapy begins immediately and is intense for several weeks.
• Routine movements such as walking, standing, sitting, usually resume within a few days.
• Full recovery can take up to one year.

Life With a Knee Replacement:

• Maintaining an active lifestyle is important
• Controlling your weight will lengthen the life of your new knee
• You can resume most activities. Running and impact activities are discouraged.

Copyright 2011 Michele Howe

Although I never, ever, would have anticipated reacting in such dramatic fashion to an elective surgical procedure, I have had to face up to what happened to me during those early post-surgery weeks. If I had been privy to an outsider’s unbiased observation of my inner-emotional workings, I would have clearly declared that the woman in question (me) was undoubtedly depressed. Yet I couldn’t, wouldn’t dare, name it at the time. I was too ashamed; too humiliated by this debilitating label…in fact, I was horrified that others, including intimate family and friends, would come to the same conclusion that I secretly feared. I was not in control, rather, I was so emotionally out of control that I apprehensively worried my mind was coming unhinged.

Having never experienced such drastic fluctuations in my emotional state before, I didn’t recognize the signals of depression. True enough, I wasn’t sleeping…. enduring continual shoulder pain for weeks on end will inhibit even the soundest reposer from gaining daily needed rest. I had also stopped exercising for a solid month post-surgery, something I’ve never done in my entire adult life. This too, may have contributed to how off-kilter my body felt as it responded to this drastic change in my former daily pattern. Most significantly, most terrifyingly, it was as though someone was pinning me against the wall…and no matter how mightily I struggled, I couldn’t break free. It was in this skewed frame of mind that I unwisely, almost obsessively, began contemplating life…. my faith, my marriage, my work, my future…. for hours on end. Pondering the past, present, and future through these murky, dimly lit lenses was not a good thing. I’d sit alone with a growing inner remorse while reliving past decisions and regretting poor choices. This habit alone increased my sense of despair, my lack of hope.

Thankfully, I had outside support or I may have begun believing that my wild mental digressions into the hopeless were true. Because my family and friends continued to speak positive words of truth, accurately assessing my life, indeed my very person, I was able to heed that small, still-sane, voice in me that continued to resist these negative mind-speaks. It was a battle to be sure, one that I fought hour by hour, and often I found myself placing a desperate telephone call to a trusted friend for perspective, to vent, to question, and for prayer.

Now I can see that some of the most helpful advice I received during those darkly tenuous post-op weeks, were the suggestions to care for my physical body, to treat myself with a tender care, and to allow myself generosity of forgiveness, and time…. lots of time to rest, recover, and rejuvenate. Admittedly, I felt as though I was spoiling myself adhering to such loving counsel…but after a bit; I realized my friends were right. And so wise. My body needed a quiet period to heal…it was up to me to see that I made the right choices to allow this to happen. As I met with the surgeon after my operation, difficult as it was, I explained my emotional tailspin in brief. With a prescription for a sleep aid in hand and some fresh determination, I left the office feeling a bit more ready to proactively heal in the most “stationary” sense of the word. Sleep eventually became a blessed respite and my outlook improved dramatically. Daily exercising helped me “work out” some of the doldrums as well. I ate with authority…. meaning with full intention of building nutritious food stocks into every meal. And…I continued to lean on my family and friends, for conversation, for hugs, and for simple caring. It took a full three months before I realized I was almost “me” again. Still, every once in a while, when I grew especially tired or stressed, I felt that ominous dark cloud begin to dodge my every step. So, I would retreat a bit from life’s busyness, rest some more, and relish everyday simple joys.

Who could have foreseen that during one of the most productive and most satisfying periods of mid-life that a simple elective surgery could wreck such emotional havoc? Certainly not me. Yet countless other women have experienced the same uncontrollable response to their own “mid-life triggers” into depression. Mid-life women are all too often literally sandwiched betwixt and between their partners, children, parents, friends, and colleagues’ needs and expectations thus forfeiting their own health in the process. At some point, every woman must stand apart and carefully assess her life, both internally and externally with tempered realism. Otherwise, the sudden and frequently devastating onslaught of depression may render her incapable of functioning and feeling utterly hopeless. By exploring some common triggers that mid-life women may face if they find themselves suffering for a time with mild depression, women can move through this time of emotional tension more fully armed and better prepared.

Top Triggers

*Positive Life Stress

Karen found herself gripping the doorjamb to her apartment as she tried to decide whether to go in or stay put. She realized that entering her home meant facing “The List” the daunting visual reminder of her daughter’s upcoming wedding. Of course, Karen was thrilled that her only daughter was marrying. Still, as a single mom for long years, Karen also realized how drastically her life would change once her daughter moved out and on. Uncharacteristically for her, Karen found herself hesitant, distracted, and almost panic-stricken. But since when did I begin shrink from going home? This is nonsense, Karen decided, I need some perspective and quick before this emotional detour takes charge of me altogether.

Job promotions, weddings, vacations, even the most coveted of life’s milestones can precipitate short-term depression in mid-life women. Surprisingly, many women don’t realize how much emotional toll these beneficial experiences can take on their mental and emotional psyche. As with everything in life, balance is key. Realistic planning is also highly recommended for all women, no matter what their age or station in life.

*Negative Life Stress

Jen left the funeral emotionally adrift. She puzzled over how moved other family members had been as they said their final goodbyes to this distant relative. It was unnerving how easily Jen could turn her feelings off these past months. Maybe even a little scary if she was honest. Yet after caring for this elderly gentlemen almost entirely on her own for five years, Jen didn’t have much energy for feeling anything. Just meeting the needs of her young family and this extended family member had completely exhausted her reserves; only she didn’t yet realize it.

Family emergencies, extended care-giving responsibilities, financial upsets, unresolved relational issues, childcare dilemmas, and workplace challenges…are part and parcel of the majority of women’s daily existence. Long-term perspective is a must coupled with a strong support group of fellow travelers who can come along side with empathy, care, and unconditional acceptance, more vital now than ever before. Enlisting (and lending) anticipated help before the next major landslide of distressing events is especially crucial at this period of mid-life.

*Shifts in Health

Marisa was old enough to know better. Still, she clearly set aside her better sense when it came to taking care of herself. Busy with three teens and running a part time business from home hindered Marisa from seeing to it that she made (and kept) annual check-ups. It wasn’t until she noticed how her deeply heart pounded and how easily winded she became after performing even the simplest tasks that Marisa grew apprehensive and decided her yearly physical was well overdue. Receiving the news that she had high blood pressure, elevated cholesterol, and a recent gain of over twenty pounds about pushed Marisa over the edge until she took stock and determined to begin treating herself with the same care she offered to her family.

Sadly, many mid-life women neglect their health in both obvious and subtle ways. They avoid regular check-ups with the family doctor, gynecologist, dentist, and ophthalmologist, not recognizing how quickly most delineations from former good health can be detected and corrected. Simply showing up can make a difference. Women especially need to be checked for ever altering hormone levels, informed on how their current meds will affect their bodies and emotions, and what signs to be on the watch for according to their particular family health history.

Health-Inducing Restoratives

*Exercise, Stretch, and Sleep

Katherine, frequently dubbed the queen of spontaneity, heeded the wake-up call delivered by way of a minor stroke at age forty-three. Somewhat overweight, thoroughly inactive, this pharmaceutical rep realized she only had one life to call her own…better to handle it with care. Once Katherine received the all-clear from her doctor, she began an exercise plan in earnest and even learned the importance of regular sleep patterns which surprisingly to her, boosted her energy levels so that she could enjoy even more spontaneous activities with greater satisfaction.

As women age, regularity in habits and scheduling becomes primary. The body will respond to even the simplest minor alterations toward good health. Discover the least resistant path to consistently exercise, eat healthily, and sleep effectively and make these habits a priority.

*Realistic Expectations

Megan truly understood her tendency to perfectionism. She saw its negative results in the despondent look her young son expressed after she’d redone his morning chore more times than she could remember. Inside, Megan hated herself for feeling so internally focused on such non-issues. So she determined to let these inconsequential blips go…and instead, she concentrated on bigger, timelier matters…like hugging her child and congratulating him on a job well done.

Striving for excellence is exemplary…expecting perfection is counter-productive. All of life is riddled with imperfection, brokenness, and frailty. It is the wise woman who does what she can to make a positive difference. Wiser still, is the same woman who understands she cannot fix every thing, person, or situation…and she makes peace with that fact.

*Healthy Relationships

When Jill discovered that her father had once again dismissed her rules on several key-parenting issues while babysitting her three sons, she was livid. It shouldn’t be so difficult; she huffed, to get one adult to respect the wishes of another. So why do I continue asking Dad to watch the boys? Hmmm. Maybe I just need to sit him down a final time lay down the law and then find a replacement sitter if it happens again. What seemed like a Godsend has turned into a weekly battle of the wills.

Prudent women recognize healthy boundaries that include immediate family and close friends. Surround yourself with people who support your efforts, stand by your decisions, and are at the ready to offer assistance when required. Have the courage to distance yourself or even end ties with individuals who diminish the woman you seek to become.

Copyright 2011 Michele Howe

Preparation, schooling, and experience all weigh in on whether we are able to meet and overcome adversities. But there are some situations, those life and death matters, where no amount of pre-anything can fully ready a person to deal with the intensity and aftereffects of such highly charged moments.

Case in point. Procurement coordinator of Lifeline of Ohio, Jeffrey Blitz, encountered just such an intersection. After only four months in his position at Lifeline, Jeff (then only thirty years old) had to meet with the parents of a seven-month-old infant girl who had died from complications originating from a respiratory illness.

Two days before Thanksgiving, this young couple was traveling over the holidays when their daughter contracted an illness that took her life only five days later. Within the confines of his responsibilities, Jeff had to meet, counsel, and discuss the possibility of organ donation with this suddenly grief-stricken family. Prepared as he could be, Jeff hit an internal snag en route to the hospital to ask for permission from this suddenly much smaller family. Like anyone in his position, Jeff felt torn. How exactly do you ask a parent to donate a precious integral part of life such as an organ from one they loved so dearly? Ask Jeff; it is never easy. And yet, multiple times, week after week, this is what a procurement coordinator must do in order to pass on the gift of life.

Jeff and his colleagues continue to work within the confines of such highly emotional settings with grieving dads, moms, sons, daughters, friends, colleagues, and neighbors because they know the difference it makes, the life and death difference.  For every individual whose life ends there are countless others who are similarly struggling to survive and perhaps grieving their own loss of minimally good health and the ability to live a functional life.  Looking at it this way, we understand why Jeff does what he does, but what exactly does the process of organ donation look like step by step?

Jeff explains. Organs become “available” for donation only after a person has been officially declared “brain dead.” This legal form of death as defined in the (Uniform Determination of Death Act of 1981), cites that when, “An individual who has sustained either (1) irreversible cessation of circulatory and respiratory functions, or (2) irreversible cessation of all functions of the entire brain, including the brain stem, is dead.” Depending upon the situation and the circumstances surrounding the illness/accident of the patient, it sometimes takes between two and three days before the attending physician will do brain death testing. While most people are familiar with the term, “heart death,” “brain death” is also a legal form of death in every state.

Brain death can occur when a person suffers from a stroke or hits her head and considerable swelling takes place. Think of it as a “brain in a box.” Our brains are encased in a bony structure and when the swelling can’t be controlled, the brain has nowhere to go but into the spinal column. This is called herniation. The brain and brain stem move all the way down and cut off all the arteries so there’s no room for any blood flow back to the brain. After this happens, doctors will do testing to confirm brain death. Once brain death has been declared, the families will be approached for their consent and permission to begin the testing process for organ transplantation.

After consent is given, the procurement coordinators will initiate the process of evaluating the patient for possible organ donation. This process will include chart reviews, comprehensive types of testing for organs determining heart/lung/liver/kidney function and eventually a thirty-page patient medical/behavioral history questionnaire must be filled out before an organ is entered into the system for possible matching with an individual awaiting an organ.

The now prospective donor will have her blood pressure and heart rate monitored closely to ensure the organs stay at peak condition while awaiting a match with a recipient. Fluids and various drugs are now administered to make certain each organ is oxygenated and the organs are kept in optimal health during the transition. Jeff confers with the appropriate transplant surgeons during the entire process as well.

After all the necessary testing is completed, Jeff enters the information into the database that opens up to a 500-mile bubble radius surrounding area if no match is found in his city. He “offers” the organs to three doctors within the database one at a time and in 1,2, 3 order (usually within an hour) each surgeon will say yes or no. Jeff continues to work down his list until he has a taker. Immediately upon receiving a positive response, Jeff must then work on getting the organ to the transplant surgeon. Depending on the organ and the location of the recipient, these precious gifts are sometimes transported by air.

The organs are packaged carefully and given over to the transplant team where they take each donation and prepare it for the transplant surgery. Once the actual handover of the organ has taken place, Jeff files paperwork  and subsequent follow-ups with the donating family are scheduled. Counselors are also working with both the family of the deceased patient and the recipient of the organ to answer questions, receive support, and acting as liaison between the families and the medical staff.

Generally, the donating family will receive an update approximately six weeks after the transplant takes place. In some cases, when both families are interested in meeting, facilitators will arrange a private conference perhaps a year later. As Jeff notes, organ recipients are above all very grateful for this gift of life, but they also carry tremendous guilt knowing they lived because another person died. It takes time and lots of emotional and mental work to prepare to meet the loved ones who might still be grieving the loss of their family member, and not all recipients choose to meet, it is strictly voluntary.

While everyone longs for a happy ending, Jeff recalls this story of the seven-month old girl who died as particularly bittersweet. Because of her parents’ caring act, her kidneys gave life to a two year old and her liver was given to another infant. This little girl who passed away also had a twin brother to whom Jeff asked the parents to pass along the message in years to come, “Your sister was a hero!”  Life does indeed beget life.

What to Know About Organ Donation (and Some Facts You Probably Don’t)

• One organ donor can save up to eight people
• One tissue donor can help up to fifty people
• Approximately 104,000 people are on a waiting list with only 10,000 available donors a year
• Heart/lungs need to be transplanted within four hours
• Liver/pancreas need to be transplanted within twelve hours
• Kidneys need to be transplanted within twenty-four hours
• Eye donations may indicate only the cornea, or at other time, the whole eye
• Being an organ donor does not prohibit an open casket funeral
• Many of the donated skin grafts go to the Texas burn hospitals for wounded soldiers
• Most major religions are in favor of organ donation or leave it up to individual practitioners to decide
• Register to be an organ donor through your Secretary of State or DMV website

Copyright 2011 Michele Howe

Then, the worst-case scenario occurs. Instead of a nurse arriving to escort you into the operating room, you receive a visit from the anesthesiologist who is there to inform you that your surgery has just been cancelled. You’re shocked and your immediate thoughts wander naturally through various possible snags. Is there a problem with the surgeon? The attending staff? Some type of equipment failure?  Maybe a sudden emergency situation that’s taken priority over your scheduled procedure?

Truth is, it’s none of the above. The unhappy expression found on the faces of your doctor, his surgical team, and the surrounding hospital staff, aren’t due to anything within the realm of their control. Rather, yours. What was once an isolated event has grown into a burgeoning problem in hospitals and medical clinics across the country. In more ways than one, a patient’s weight (excessive weight, that is) is causing more surgeries to be cancelled last minute because of the potential (and frequently life-threatening) risk to the patient.

Used to be when you heard the news that you’d need to undergo a surgical procedure, a patient would necessarily consider the who, what, where, when and how’s. Today though, it isn’t the physician, nor is it an insurance company, or even the technology that’s standing in the way of some surgeries. The question being asked nowadays is a weight-related one. It is troubling that for a growing number of patients the most problematic obstacle to getting better rests solely on their shoulders (and on the rest of their body). Unfortunately, it is their own excess weight that’s holding these overweight men, women, and children hostage from overall good health and even more criminally, from receiving urgent medical care of the direst lifesaving sort.

There are some individuals who naively voice minimizing this issue of epidemic proportions [Two thirds of Americans are now either overweight (defined as a body-mass index (BMI) of 25 or higher) or obese (A 30-plus BMI)], stating that it doesn’t affect them personally. These particular obese persons believe they can be simultaneously both overweight and healthy. However, no one can convincingly argue that if sudden urgent medical care is required that the obese are on a level playing field concerning surgical risks as their normal-weighted counterparts and the statistics prove it.

The fact is, none of us can anticipate when an emergency medical situation will occur requiring immediate surgery. Nobody plans on getting into an auto accident or injured on the job, but it happens every day, in every city across our nation. And in comparatively similar fashion, a frightening number of patient casualties occur when medical professionals are forced to refuse treatment to people because the risk is simply too great pre-operatively, during surgery, and post-operatively.

If you are now numbered among the two-thirds of Americans who are overweight, you’ll want to pay particular attention to the conversation you have with your doctor before scheduling surgery of any kind.  As you sit in front of your physician and he informs you that you’ll need to undergo a surgical procedure consider closely what he’s telling you as well as what he isn’t. Your surgeon will explain that because of your excess weight you are at an increased risk for anesthesia complications, blood clots, wound problems and your rehabilitation experience will likely be more difficult and longer in duration than normal-weight persons. If you’re having a joint replacement surgery, you can almost count on the appliance wearing out prematurely as well (anyone seeing a follow-up surgery in their future?).

As if these warnings weren’t tough enough to swallow, take this solemn conversation a step further and inside the real mind workings of your doctor. What he may not tell you because it’s so discouraging to him as the medical professional whose job it is to heal you (and as the primary directive from which he operates both literally and figuratively); is what he’s seen transpire in case after case in previous obese patients under his care. As your physician is speaking, remember he’s also running a mental dialogue though his mind of how your surgery (as an obese patient) will differ from a normal-weighted patient. He, as the operating surgeon, knows the difference and you, as the patient, should too because this difference is huge.

From your surgeon’s perspective, he has no choice but to accept the additional risks and challenges of operating on someone whose very weight makes it exponentially harder to perform his job (fixing you) from a purely technical standpoint. Doctors report that they frequently encounter morbidly obese people telling them, they (the patients), are willing to accept the increased risk for complication without a thought for the difficulty that their surgeons will encounter during the procedure as well as what this increased risk for complication means to the physician as the responsible party. There appears to be a mistaken assumption among some obese patients that their weight is not a factor that might affect their surgeon’s ability to perform the intricacies required during any medical procedure. Similarly, some other patients falsely believe that their surgery can be executed with the same ease as a patient of normal weight.

Patients must also understand that weight-related health risks are alive and well even before an individual enters the operating room doors. Excess weight puts a patient at a disadvantage even before surgery is scheduled as extra fat can render some clinical tests ineffective at detecting potential and existing health problems. Amy Parham, weight loss participant on The Bigger Loser television show, remembers her wake-up call after viewing her Dexa Scan for the first time. She recognized at that moment how her extra pounds were punishing her organs and lungs hour by hour, day after day. “It was eye opening to see that the fat was not something that was not only keeping me from buttoning my smaller pants, but it was also shoving my organs around and prohibiting them from working properly. Even my lungs were so compressed I couldn’t breath well.” Parham realized that as much as she hated how fat looks on the outside, “It is the fat that we don’t see, (on the inside) that is killing us.”

Beyond the above risk complications already cited, your doctor knows that your surgical outcome may not be what you’re expecting because even with the most skilled surgeon working on your behalf, your excess weight will continue to hinder mobility and range of motion post-operatively. No matter what side of the surgery table you’re on, both doctor and patient enter the situation at a disadvantage because both are fighting to overcome weighty odds of the most costly kind. Obesity isn’t a lifestyle gamble worth playing with; it’s a risky venture whose stakes will continue to rise to life and death proportions with every pound gained. A life and death risk Parham came to understand, “I believe that many times vanity is the motivation for wanting to lose weight, but people need to wake up and realize that they are playing Russian roulette with their lives by the choices they make. I was slowly killing myself and didn’t even know it.”

The Facts on Fat and Surgical Risks -

• Obese patients suffer from more postoperative infection, thrombosis (formation of blood clots), and other circulatory organ complications.
• Overweight individuals are at a greater risk postoperatively for heart attacks (5 times higher), wound infection (1.7 times higher,) peripheral nerve injury (4 times higher), and urinary tract infections (1.5 times higher), than their non-obese counterparts. [WebMD]
• Compared to normal weight persons undergoing surgery, obese and morbidly obese patients require roughly double the dosage of intravenous antibiotics during surgery.
• There is generally an increased length of stay in the hospital after surgery, which also adds to a patient’s financial costs.

Reasons to Lose the Excess Before You Need to -

• Surgeons use smaller incisions, thus less bleeding from the operative wound in lighter patients than obese ones.
• Potential problems with anesthesia are minimized because a lesser amount is required during surgery for smaller weighted individuals.
• Postoperative rehabilitation is shorter and easier on thinner patients.
• Joint replacement hardware such as knees and hips last longer on patients of normal weight.

Copyright 2010 Michele Howe

Congratulations to my friend and CatholicMom.com family member Michele Howe on the publication of her newest book Burdens Do a Body Good: Meeting Life’s Challenges with Strength (and Soul). As I said in my endorsement of this great book, “In Burdens Do a Body Good, talented author Michele Howe and noted orthopedic surgeon Dr. Christopher A. Foetisch team up to give women a resource for those moments when life seems to be spinning out of control. Advice on dealing with a wide range of physical and emotional challenges is delivered in manner that is always accessible, practical, and inspirational. Give this book to a friend who is going through a difficult time in her life, or give yourself the uplifting gift of Michele and Dr. Foetisch’s companionship and encouragement along each day’s winding path. Their words will help you transcend some of life’s greatest challenges with positivity and good health.”

Michele has graciously offered to share a few excerpts from Burdens Do a Body Good here on the website over the next few months.  I hope you’ll enjoy them at purchase a copy of Burdens Do a Body Good for yourself or a friend – you will love it!

The Taskmaster of Time: No Time Like the Present to Change

“I have little hope for a future brought about only or primarily by human endeavors and initiatives. I have great hope for a future brought about by a God who pulls us forward by surprises and spurts, ambushing us with so-beautifuls and blessing the best out of our worst.”  Leonard Sweet in So Beautiful

Time is such a nebulous factor, one that both commands us and paradoxically submits to our whims in equal measure. We either have too much of it…as when we’re left waiting for some important (to us) event to transpire. Or, we have far too little of it as we rush headlong through each task only to get through the next one and then the next. Time, either way you look at it, is laborious. It wears us out, frays our tempers, and tempts us to take matters into our own hands. Time (at its taskmaster best) can literally bring out the worst in us. Time is not easily mastered.

Time – though each of us is given the exact same amount of it, some of us are better managers than others. Why is it that a few individuals seem to breeze through their hours and days accomplishing only a fraction of what they might have planned (if they planned at all)…and it doesn’t bother them one iota? While others, those more conscientious types, take every single item on their to-list and do not, cannot, will not, rest until every single entry is completed?  (Done with a vengeance, mind you.) Could it be even the super responsible among us inwardly know there’s something more important that just getting stuff done and we’re angry about it, because we know it’s true and still aren’t willing to give the thought of changing (ourselves, that is) the time of day? Some-times knowledge without the courage to head in a different direction is a like incessant ticking of the nearest timepiece.

Better late than never, sometimes it is best to call a timeout. Give it a rest. Stop and sit down. Close your eyes. Be silent. Be still. Then, take note. Begin to notice. Everything. Movements and moments and steps and gestures. Missing nothing. Paying attention to everything.

When we’re unable to stop long enough for even this simple exercise, it should leave us wondering what’s really at stake here? Certainly, there’s more going on than running headlong through the day only to “get things done.” When we’re consumed by merely producing, we’re missing so much more and this much more is where real life is going on. Our excuse is always the same, there will be time enough for that later on…when the work slows down, when the kids are older, when my parents don’t need my help, when my health gets better. When the worst is over. And, just when exactly, will that be?
In case we didn’t notice, there’s a never-ending list of “when’s” waiting one after the other that keep moving up on our endless to-do list of excuses. But if we’re honest, and this is the best news ever…there’s no time like the present. This precise moment is all we have, there’s no getting it back once we’ve spent it. Or squandered it more likely by being busy, busy, busy people making our grand plans, believing we’re doing everything we can to achieve our best, when in fact, all this activity just might be the worst choice we make. Eventually, every one of us needs to take to task our assumptions about life and time and how we spend them both. There’s no telling what tomorrow may bring.

Takeaway Action Thought: There’s no time to lose, literally, so do an about face turn and stop, refuse to move forward again without a focused point of action plan.

Weight Bearing Exercises for Body and Soul Health

As the pace of our lives gets increasingly faster, one season meshes right into the next, one year to another and before we realize it, decades have passed. It’s especially true of women who pass key milestones in life but they’re so pre-occupied by busyness, they forget the importance of self-care. So the question becomes, is it ever too late to begin taking better care of yourself? Are there ways every woman can make up for lost time? If so, what are they and how can women quickly implement such practices to give the most benefit in the shortest amount of time? What can women do to reverse the aging process? There are several lifestyle changes that can result in improved health and positively affect the aging process. Simple as 1, 2, 3…

• ONE: Weight loss is one of the most significant ways to peel off the years, not only will you obtain the cosmetic benefits of weight loss, but you will also receive many physical benefits. These include less stress on your joints and back, reduced risk of diabetes, improvement in blood pressure, increased mobility, and better sleep. FOCUS POINT FOR CHANGE: Concentrate on lowering fat and sugar intake for fastest results.
• TWO: Get seven to eight hours of sleep a night. Caution: too much sleep can have an adverse effect on overall health. FOCUS POINT FOR CHANGE: clock in your nighttime sleep hours, but do not nap excessively during the day. Researchers from the California Pacific Medical Center Research Institute found that elderly white women who took a daily siesta were 44% more likely to die from any cause, 58% more prone to dying from heart problems, and nearly 60% more likely to die from non-cardiovascular or non-cancer causes. Those who napped less than three hours a week showed no increased chance of death.
• THREE: Address your stress, as it is one of the biggest factors in premature aging. Stress causes the brain to produce chemicals that directly affect health negatively. FOCUS POINT FOR CHANGE: Exercise several times a week to add muscle mass and strength and also gain improved cardiovascular health. A study of 9,611 adults in Medicine and Science in Sports and Exercise showed that those who were regularly active in their 50s and early 60s were about 35 percent less likely to die in the next eight years than those who were sedentary.

Excerpted from Burdens Do a Body Good: Meeting Life’s Challenges with Strength (and Soul) Hendrickson Publishers, 2010

Read Michele’s column at: http://www.bizymoms.com/experts/michele-howe/index.html

Read Dr. Foetisch’s column at: http://www.bizymoms.com/experts/christopher-foetisch/index.html

Congratulations to my friend and CatholicMom.com family member Michele Howe on the publication of her newest book Burdens Do a Body Good: Meeting Life’s Challenges with Strength (and Soul). As I said in my endorsement of this great book, “In Burdens Do a Body Good, talented author Michele Howe and noted orthopedic surgeon Dr. Christopher A. Foetisch team up to give women a resource for those moments when life seems to be spinning out of control. Advice on dealing with a wide range of physical and emotional challenges is delivered in manner that is always accessible, practical, and inspirational. Give this book to a friend who is going through a difficult time in her life, or give yourself the uplifting gift of Michele and Dr. Foetisch’s companionship and encouragement along each day’s winding path. Their words will help you transcend some of life’s greatest challenges with positivity and good health.”

Michele has graciously offered to share a few excerpts from Burdens Do a Body Good here on the website over the next few months.  I hope you’ll enjoy them at purchase a copy of Burdens Do a Body Good for yourself or a friend – you will love it!

Waiting: Choosing Calm Over Control

What type of client, customer or patient are you? When you walk through the waiting room door does the person on the other side flinch, tense, or otherwise prepare for attack? Do you disappoint, discourage, or offer a disgruntled impression? Is every statement or question voiced one punctuated by an undergirding of subtle disrespect, disinterest or distrust? What exactly is your attitude saying about you, your words notwithstanding?It used to be that physicians had to memorize the Hippocratic oath, the most memorable line laypeople remember being, First, do not harm.” Nowadays, this pledge has been updated to make more practical sense in our modern high-tech society. Still, the underlying message remains the same. That is, one individual is making a promise to do his or her level best to help another person in need. Honestly now, aren’t we thankful that the majority of doctors and other professionals from whom we seek aid do abide by this long-standing motto? If we didn’t trust that person sitting on the other side of the desk (or across the room) to make a positive difference in our lives, we wouldn’t waste time seeking out their expertise, right?

Unfortunately, though we continue to seek out expert help from these professionals we’ve similarly begun to tote along with us an attitude of consumer elitism. Truth to tell, we’re ever-ready to assert our rights even when they’re not being compromised. We get angry when our appointment is pushed back. We feel frustrated when a promised contract doesn’t materialize. We complain and fret and moan about every little inconvenience without taking time to consider that our minor grievance could very well transform into another’s good. How so?

Consider this; the next time you’re left waiting for an hour because of an unexpected emergency and your friendly neighborhood professional begs your pardon upon greeting you…give it. Think about how you feel when your best-laid plans go wrong. We’ve all had those days when we started out on time armed with a solid plan of great intent and then we were interrupted, stalled, and thwarted. How did we feel? We were discouraged, weary, and wanted to give up. In the coming days, do yourself and everyone else a favor, hone that memory of yours that never forgets an offense against you for good of someone else and take the “oath” to keep others from harm. Purpose to never rattle someone’s already fragile emotional cage with your unrelenting demands or unrealistic expectations. Rather, tell them you understand. Tell them you appreciate their diligent service. Tell them, thank you. Guaranteed, you’ll begin to see the person behind the professional façade and we all know how terrific it feels to have someone see the “us” behind what we “do.” It can’t do any harm.

Takeaway Action Thought: Never view waiting as wasted time, these are simply opportune moments allotted for the purpose of regaining some inner stillness, calm and clarity.

Weight Bearing Exercises for Body and Soul Health:

There are only two ways to wait. We either choose to wait well or we wait poorly. If we give in to impatient thoughts and words, then we risk jeopardizing both our health and those with whom we come into contact. In a society where there is only stop and go, waiting offers a welcome in-between space to purposefully hit the pause button and to rest and reflect.  It doesn’t matter what we’re waiting for, an appointment, an apology, or an answer. It’s the conduct of our heart and minds that will make all the difference.

Waiting well:

* Lowers blood pressure; when we accept the uncontrollable as necessarily part of daily life our physical bodies take note and respond accordingly.
* Reduces inner-stress; from headaches to body aches…we just feel better when we realize we are not in control of others’ behaviors or responses, only our own.
* Makes one more productive; being forced to wait in one area allows more time and energy to invest in countless others, there is no wasted time if we use each day to its fullest.
* Allows for better decision making; rather than reacting with anger and impulsivity, we thoughtfully consider, decide, and determine taking into account all possible repercussions of our choices.
* Expands our understanding of another’s perspective; removing ourselves from the emotional intensity of the moment enables us to see a situation more accurately as time passes.
* Gives opportunity to love sacrificially; we deepen, grow, and change every time we put someone’s needs above our own, personal discomfort and all.

Waiting poorly:

* Raises blood pressure; as our mind thinks, our emotions flare, and from head to toe our bodies respond to the stress. What and how we process our thoughts and experiences does matter.
* Produces anxiety; we fret, worry, and stew…and completely forfeit the inner peace for which we so long.
* Inhibits productivity; when we focus exclusively on what we can’t have, we become completely immobilized and paralyzed, unable to be of any good to anyone or anything else in our lives.
* Increases chances of reacting impulsively; stand back, don’t react. The more frequently a person acts or speaks before thinking, the greater the potential for negative and long-lasting fallout.
* Shrinks one’s sense of proportion; when we only see our side of a situation, we’re not really viewing life as it really is. Whenever there are two people, there are two sides to every story, always.
* Robs one’s ability to grow by enduring difficulties; when we respond self-protectively or solely with self-interest, we are the ones who are short-changed most.

Excerpted from Burdens Do a Body Good: Meeting Life’s Challenges with Strength (and Soul) Hendrickson Publishers, 2010

Read Michele’s column at: http://www.bizymoms.com/experts/michele-howe/index.html

Read Dr. Foetisch’s column at: http://www.bizymoms.com/experts/christopher-foetisch/index.html

Congratulations to my friend and CatholicMom.com family member Michele Howe on the publication of her newest book Burdens Do a Body Good: Meeting Life’s Challenges with Strength (and Soul). As I said in my endorsement of this great book, “In Burdens Do a Body Good, talented author Michele Howe and noted orthopedic surgeon Dr. Christopher A. Foetisch team up to give women a resource for those moments when life seems to be spinning out of control. Advice on dealing with a wide range of physical and emotional challenges is delivered in manner that is always accessible, practical, and inspirational. Give this book to a friend who is going through a difficult time in her life, or give yourself the uplifting gift of Michele and Dr. Foetisch’s companionship and encouragement along each day’s winding path. Their words will help you transcend some of life’s greatest challenges with positivity and good health.”

Michele has graciously offered to share a few excerpts from Burdens Do a Body Good here on the website over the next few months.  I hope you’ll enjoy them at purchase a copy of Burdens Do a Body Good for yourself or a friend – you will love it!

“To deeply understand fear we must also look at ourselves and the way we interpret our situations. Those scary objects can reveal what we cherish. They point out our insatiable quest for control, our sense of aloneness.”  Edward T. Welch in Running Scared

It hadn’t been five minutes into the film before I felt something deep inside of me rebel. That “foreshadowing” device found in excellent literature that Honors English students are so familiar with as they learn to identify, separate out, and even anticipate was haunting me from the outset. It didn’t matter that I was already aware of the storyline and the satisfactory conclusion of this particular based-on-real-life tale. It still affected me, troubled me.
I couldn’t shake that insistent voice inside my head that kept saying, “This is wrong, wrong, wrong.” Throughout this film where a family was rendered homeless after a job loss, it felt obscene that it could happen in a country like ours. And yet, seeing it on the big screen ignited something that I’ve had a hard time shaking. I realized that every one of us is just a few steps from some sort of life-altering catastrophe. Your potential pitfall might be an minor illness turned terminal. Another might suffer from job loss or career replacement. Someone else might lose a spouse or child to violence. The neighbor down the road, or in the next apartment, could lose her home. You see, it doesn’t really matter how the “displacement” happens or even what form it takes. The bottom line is that every man, woman, and child needs back up, lots of back up.

This entity we term as back-up finds its form through family, friends or work colleagues who can be counted on to step up and lend a hand during those spaces of time when everything we’ve got is simply not enough. Think of offering the warm hand of friendship, offering forgiveness, offering whatever it is that someone you know needs as smart investment and not in the predatory, I’m giving to get sense. Rather, see people’s needs, really see them. Then don’t just go home and fret and worry and stew about it. Put feet to your newly acquired vision and set your hands to bringing some relief, some measure of good, where it’s most needed.

Whether or not you ever envision yourself as a person in need; the potential is always there. The problem is; ignoring it doesn’t make the risk go away and the time will come when you’re at the mercy of others. Does that frighten you? Maybe it should. It can be a terrifying reality given some people’s propensity to blindness when it comes to lending aid. Seeing is believing. We need to open our eyes and our hearts. This might equate to giving until it hurts, in our bank accounts, our time, and our talents…our treasures. Today, look around and willingly take on the role of being a back-up person for someone in need. Maybe in time, that fortunate soul will have your back when you require it.

Takeaway Action Thought: Oftentimes the best remedy to combat anxious uncertainty is to become another’s backup person.

Weight Bearing Exercises for Body and Soul Health

There are all sorts of remedies being offered for dealing with those sudden intense rushes of anxiety and those inner tugs to bolt from an uncertain situation. Truth is, for as many actual real risks to our safety, there are countless more that hover threateningly within our thoughts. In actuality, we might mentally understand that our fears of uncertainty are just that…fears founded in the uncertainty of life. Before we realize it, one undisciplined morsel of fear feeds on another and yet another until we are immobilized by what ifs. Our bodies can kick into an automatic cycle of panic that stops us from thinking rationally. The next time your body has a mind of its own and begins to react in panic, give these exercises a try.

• Take several deep breaths. Inhale slowly through your nose; exhale through your mouth. Repeat.
• Focus on tightening/relaxing one body part at a time. Methodically, work through your entire body head to toe.
• Stand up and bend over at the waist. One vertebrate at a time, slowly work up to a standing position. Repeat as needed.
• Self-massage your temples and neck using firm circular motions until you feel the tension disappear.

Excerpted from Burdens Do a Body Good: Meeting Life’s Challenges with Strength (and Soul) Hendrickson Publishers, 2010

Read Michele’s column at: http://www.bizymoms.com/experts/michele-howe/index.html

Read Dr. Foetisch’s column at: http://www.bizymoms.com/experts/christopher-foetisch/index.html

Congratulations to my friend and CatholicMom.com family member Michele Howe on the publication of her newest book Burdens Do a Body Good: Meeting Life’s Challenges with Strength (and Soul). As I said in my endorsement of this great book, “In Burdens Do a Body Good, talented author Michele Howe and noted orthopedic surgeon Dr. Christopher A. Foetisch team up to give women a resource for those moments when life seems to be spinning out of control. Advice on dealing with a wide range of physical and emotional challenges is delivered in manner that is always accessible, practical, and inspirational. Give this book to a friend who is going through a difficult time in her life, or give yourself the uplifting gift of Michele and Dr. Foetisch’s companionship and encouragement along each day’s winding path. Their words will help you transcend some of life’s greatest challenges with positivity and good health.”

Michele has graciously offered to share a few excerpts from Burdens Do a Body Good here on the website over the next few months.  I hope you’ll enjoy them at purchase a copy of Burdens Do a Body Good for yourself or a friend – you will love it!

“When we are in deep trouble we long to see some rescuer appear… Suddenly, decisively, kindness appears. And it is not the kindness of soft words or a gentle smile but a strong act of intervention, a mighty deliverance.”
Mel Lawrenz in Patterns

Where we live, how we shelter ourselves, and what our dwelling place looks like says a lot about us, some assumptions may be true, others not. Whether we even particularly like the structure of our homes or simply make do with the resources we’re given; says something too. Are we content with the present condition of our home? Or do we catch ourselves eyeing that which appears newer, maintenance-free and well, just all around more appealing than ours? Just how well do we care for and tend to that entrusted to us?
Whatever our inclination about housing and homes and the purposes these dwellings serve beyond protecting us from the elements, it must be remembered that how we live within our four walls matters. Anyone can dress up their house and make it look attractive to onlookers, but what really counts is what happens on the inside, the side no one else sees.Ever walked into a home that was beautiful on the outside, but inside was falling apart? It happens more often than we might guess and when it does, people feel unsettled, anxious, and confused when the outside and inside don’t match. Something’s just wrong with this picture.

Like it or not, every family sets boundaries for themselves and we’re not talking the brick and mortar or white picket fence type either. Rather, inside our home (and around its periphery) people live by an unseen code that determines who gets in and who stays out. There’s also a set pattern to the ways and means of our in-house interactions. Boundaries, they’re there and each one is set in something stronger than stone.

Our home-life is indeed telling; as are our expectations for those living within them. For everyone creates certain lines that won’t be crossed and each individual sets specific boundaries around themselves that are off-limits even to those closest to them. It’s safer that way, right? But not always so healthy. Boundaries are good only when they serve their purpose of offering protection, provision, and room to grow.

For individuals to thrive within the setting of hearth and home, there’s some lines that shouldn’t be crossed. Disrespect. Disregard. Discomfort. Discouragement. To name just a few. Whenever our dwellings house these unattractive detractors, it is because of neglect, and where there is neglect, the value of the home and its occupants drops markedly.

No conscientious homeowner allows potentially harmful substances to infiltrate or devalue their house. But, do we permit it from the inside out due to simple neglect? Do we aggressively protect our borders by making sure every person is treated with respect, heartfelt regard, and realizes the comfort of an encouraging kind word? It is always easier to work at keeping households in good repair than it is to tear down and rebuild after its fallen into disheveled disarray. Lawrenz reminds us that homeowners everywhere decide daily how to protect their interests. Writes the author, “Kindness is a choice, not a temperament.” Would that everyone who finds themselves within our “borders” feel protected, provided for, and may the experience always be a pleasant one.

Takeaway Action Thought: Every kitchen should display the motto, “Protection, provision, and room to grow,” and no family member should travel far from it.

Weight Bearing Exercises for Body and Soul Health: Setting boundaries and feeling safe and secure within one’s home is every woman’s reasonable expectation. Sure, women may have to attempt one or another redo or makeovers before finding the right fit for themselves, but most are pretty confident that their homes are all around safe havens. But try venturing out beyond the borders of the home routine and the world outside can feel frightening, uncertain, and unpredictable. Even when women leave their familiar surroundings for something as pleasurable as a vacation, it can feel risky. Like many choices that seem a bit chancy, simply taking some simple precautions and knowing your options helps alleviate the majority of pre-travel jitters. Be prepared, before, during and after you travel.

Before you go:

During travel:

* If you or a family member becomes ill contact the hotel concierge or someone you know locally to find out where to go for medical care. A referral increases the odds of getting optimal treatment, don’t simply go to the nearest (or most convenient) clinic or urgent care facility.

Special considerations:

* Those individuals prone to illness should consider travel health insurance before leaving.
* Medical evacuation insurance is particularly helpful for overseas travel and can be purchased for a reasonable fee.
* Refer to www.cdc.gov/travel site for specific information/warnings regarding the country you are intending to visit.

Final Word:  Despite what we read in the news, the United States does have the best medical care in the world. So given the option, do your best to get back home to be treated. As the old saying goes, “There is no place like home” truly applies to health care.

Excerpted from Burdens Do a Body Good: Meeting Life’s Challenges with Strength (and Soul) Hendrickson Publishers, 2010

Read Michele’s column at: http://www.bizymoms.com/experts/michele-howe/index.html

Read Dr. Foetisch’s column at: http://www.bizymoms.com/experts/christopher-foetisch/index.html

Once they cooled, Stacy would assist Trevor in cutting around each leaf’s outer edge before they punched holes in the top for stringing yarn and hanging on his mobile. Stacy was warned not once, but three times that morning alone, to be sure she didn’t singe either the leaves or the paper. Remember last year? Trevor had reminded her. How can I forget? Stacy thought ruefully.

What had started out as a simple afternoon extra credit science project collecting local flora had turned into a weekend long nightmare after Stacy’s daughter had a hey-day with her brother’s meticulously labeled leaves he’d left lying on the dining room table. Even though Stacy had been outside when the incident occurred, raking leaves no less, Trevor made it a point of insinuating it was Stacy’s poor disciplinary skills that caused the entire fiasco.

After a lengthy chat with Trevor, Stacy had made it crystal clear that the core issue wasn’t her parenting abilities, rather Trevor’s cavalier attitude. That discussion aside, Stacy recalled spending the better part of Saturday evening and Sunday afternoon helping Trevor resort his collection and/or gathering replacements.

Since then, Stacy continued to be amazed how different her children were in both looks and temperament. She’d had no problem figuring out her oldest two sons, but when it came to Trevor with all his fussiness and particular ways, Stacy was thrown off balance. Frequently, his speech was laced with negativity and pessimism. If he wasn’t dragging the other kids down, Trevor’s woe-is-me countenance wore Stacy’s nerves to a fine strand.

She wasn’t quite sure how to combat his defeatism other than kindly, but firmly, reminding him of the obvious blessings he enjoyed. Still, as Stacy took care to iron Trevor’s finds with attention to detail lest she ruin one or all, Stacy suddenly realized how alike people are to so many of nature’s creations. Every one of these leaves has its own style, its own signature. Some are rounded and smooth, others, rough and brittle to the touch. Not so unlike people, Stacy admitted.

But every one offers something unique to the whole collection, just like us. Lord, Stacy prayed, help me to see the beauty you’ve created in my son and to treat him as though he were the rarest of finds…because he is.

“The good man out of his good treasure brings forth what is good; and the evil man out of his evil treasure brings forth what is evil.” Matthew 12: 35

Dear Lord,

I finally get it. All this time, I’ve been missing the point with regard to my children. I believed you wanted me to take their personalities and mold them into miniature replicas of me. As if you had only created one type of person, my type. Lord, I need to ask your forgiveness. I’ve been spending countless hours trying to figure out my child’s take on life. I never seem to put my finger on where this youngster is coming from. He is so very different than me.

And now, I realize, that you simply want to me to love him as he is while setting the best example I can. Lord, in the days to come, enable me to be quiet more consistently…and learn to listen more attentively. Show me creative ways to engage my child’s heart and to lovingly bring needed encouragement as you reveal fresh ideas to me. I desire inner soul health and mental well being for my youngster, and I do not always understand the most effective ways to reach this child.

Lord, I commit my parenting to you again; I ask that you would fill me with your wisdom and vision for the future. Help me, Lord, to not become discouraged when we encounter setbacks…and we will. Bolster me for the long road ahead and give me all I require to parent in a way that honors your name with the understanding that you are watching over me, over us.

Amen

“Love God, and within the limitations He has sovereignly placed in your life at this time, do what you can.” Donald S. Whitney in Simplify Your Spiritual Life: Spiritual Disciplines for the Overwhelmed

Copyright 2010 Michele Howe

Perspective

She soon heard nothing but praises for the food and those who delivered them. Housebound most of the time, Aimee understood her parents’ gratefulness for the daily sustenance and the personal visits. Since she lived so far from her folks, Aimee was especially appreciative that others in their community were willing to give so that her mother and father could remain independent for as long as possible. Hence Aimee’s motivation for joining ranks with her town’s volunteer crew.

One of the first things Aimee learned was that promptness mattered. If she wanted to have a few extra minutes to spend with those to whom she delivered meals, Aimee had to arrive on time to pick up the meals and more important, stay on a schedule when she greeted and chatted with the recipients. This allotted Aimee no more than ten minutes per stop. Not always an easy task when those you’re visiting count your in/out stop-by as the most interesting event of their day. Mostly, she was charmed by the stories she heard and the conversation they exchanged. A few weren’t interested in chatting; they simply wanted their meal thank you very much. For these solitary souls, Aimee simply prayed.

But when Aimee met Robert she was bowled over. At eighty-six, this wheelchair bound widower was the picture of gentility. His kind demeanor was refreshing and the interest he took in Aimee’s life gratefully received. Yet every time Aimee left, she felt sick at heart because Robert would inquire about her parents who lived down south in the same vicinity where Robert had grown up.

He’d only been a local for the last five or so years when his son moved him north to be closer to family. And in that move, he’d had to give up his farm, his fishing pond, and his rolling acres of land. Aimee tried to come up with something to help her friend feel more at home but nothing seemed appropriate or even possible.

Then it came to her, why not build a small pond out back, stock it with goldfish, maybe even some lily pads and complete the setting with a miniature rock waterfall? Why not? Aimee’s husband and sons could do the work and the cost, well, she’d shop around. Delighted with her notion to bring some of nature’s goodness to Robert’s city dwelling, Aimee could hardly wait to arrive at stop number seven and propose the idea to Robert himself.

“Pleasant words are a honeycomb, Sweet to the soul and healing to the bones.”  Proverbs 16: 24

Dear Lord,

My dear, dear Lord, how can I offer my thanks for the bounty you’ve blessed me with? Each day I am astounded at your mercy, your grace. All around me I see abundant evidence of your great and glorious love for me. I thank you for giving me all that I need and so much, much more.

And as I reflect upon your provision, I must give you another thanks for my new friends. Each one is special to me. Each one holds a unique place in my heart. I cannot express how encouraged I am as I witness these older folk’s rallying despite their declining physical strength. Would that I might be so resilient and remember all the good you’ve bestowed upon me.

For this reason I now pray that you continue to help me serve these dear ones faithfully, cheerfully, and energetically. Let me use my gifts to minister to them, each one as the need arises. Lord, I pray that you never cease to remind me that we are all on the same journey through life, simply at different spots along the way. Help me to gain wisdom and perspective from those who’ve walked a bit further than I. And make my heart continually at-the-ready. Again, my heart sings for joy as I witness the very world you’ve designed for our benefit. Open my eyes every morning to its delights and for your glory.

Amen

“Life on the road requires recollection of our Love’s past deeds on our behalf and his promise of continued faithfulness to us.”
Brent Curtis & John Eldredge in The Sacred Romance

Copyright 2010 Michele Howe

They unburdened themselves of their favorite now-careworn wool blanket, a wedding gift from years past, and spread it out. Carl set their wicker picnic basket aside and they lay side-by-side faces toward the sky to cloud-gaze. Simultaneously they both sighed as they relaxed.

After a few minutes of quiet, Carl began their summer ritual game of trying to locate pictures in the clouds. There’s a buffalo, he pointed toward their left. Look, look, I see a giraffe, Trish exclaimed with delight. On and on they went until the clouds drifted by and in its place the sun shone down on their solitary watch. Getting up, Carl opened the basket and retrieved two glasses and some sparkling cherry juice, made especially from their state’s native cherries. Trish pulled out the napkins and plates and they ate a light snack of assorted cheeses, crackers, and fresh fruit.

More relaxed than she’d felt in a long, long time, Trish turned to Carl and reluctantly opened up the dreaded topic of their finances…one of the main reasons they’d gotten away for the afternoon. At her cue, Carl dug into the basket another time and found the notebook, calculator, and pen. Ok, let’s get started. Trish and Carl began listing each of their monthly expenditures and then compared the total with their monthly income. Ouch. No wonder we’ve been under so much pressure to bring in extra cash, Trish realized.

We’ve been overspending by hundreds each month. Carl and Trish then tried to brainstorm ways to cut costs…a few minor skirmishes later, both felt they’d achieved a workable budget for their family. Now, if we can just stick to our plan without getting sidetracked again, Carl spoke aloud the exact sentiments Trish was silently thinking. If we’re faithful to living under what we bring in, we’ll be debt-free within thirty-six months. Doesn’t sound so long when you put into “months” instead of years, Trish admitted.

Surely, since we’re both in agreement this time, we’ll be able to par back on our extravagant habits and retrain ourselves to enjoy life in a simpler style. Pulling her close, Carl nodded upward, the clouds had returned. What better way to begin their debt-free journey than with an afternoon of free cloud gazing?

“Do not be deceived, God is not mocked; for whatever a man sows, this he will also reap. For the one who sows to his own flesh shall from the flesh reap corruption, but the one who sows to the Spirit shall from the Spirit reap eternal life. And let us not lose heart in doing good, for in due time we shall reap if we do not grow weary.” Galatians 6: 7-9

Dear Lord:

I want to give you thanks for the special moments we shared today. It was a delightful, relaxing reprieve. One that we both needed so desperately. You know how much we’ve struggled of late to work through our money problems. It’s been a long, difficult period of months since we’ve started coming up short. And still we continued to spend!

Amazing, that the more stressed…and in debt…we became, we never stopped mindless, wasteful, and impulsive spending. Lord, I realize now that you entrust us with material wealth. It is in fact, yours alone. We are given it as a tool to use with wisdom. Please impart that much required wisdom to us now. Help us to say no to foolish purchases and selfish desires. Give us the sense to look long term and to be content with what we already possess.

I pray that each day you would speak to our hearts of your ways and teach us to make cautious choices. Place a hedge of protective restraint around our hearts so that we think twice, even three times, before handing out hard-earned cash for nonessentials. Lord, above all…open our eyes to the marvels all around us. Help us to see your world in all its majesty and realize each of us is as rich as kings as your beloved children.

Amen

“Never forget the value of time. Time heals wounds and time has a way of resolving conflicts. Decisions made in haste are often filled with regret.”

Mary Hunt in Debt-Proof Your Marriage

Copyright 2009 Michele Howe

Back in her bedroom, Beth gathered her clothes, her favorite and well-worn jeans and one of her numerous comfy t-shirts, and started the shower. Within thirty minutes Beth re-entered the kitchen and was more than ready to enjoy her first cup of coffee for the day. For the next fifteen minutes Beth could peruse the newspaper while sipping contentedly.

Unlike most people, Beth started at the back of the newspaper and worked forward. She wanted to take a quick peek at anything newsworthy or worthwhile on the television that evening, and then she checked the weather, and finally the obits and the living section where Beth was sure to find some new article of interest to her. Save the heavy news for later on, was her motto, and most days it rang true…not today.

As Beth read, she never expected to come across the name of a former employee from her workplace. Beth was stunned to read that her one time co-worker and friend, Barb, had died. Skimming the death notice for more information, Beth took note of the request for donations to the local heart center in town. Remembering Barb’s zest for life, despite her oft-frail condition, Beth felt a knot in her throat.

Eyes stinging with tears, Beth pulled herself away from the paper and left for work. Everyone has probably heard the news by now, Beth guessed. Parking her van, Beth continued to battle against the surging emotions within her. Later, Beth told herself, I’ll deal with this later. We have huge orders going out today with all the weddings and graduations this weekend.

Taking a deep breath, Beth prayed for God to help her through the next eight hours. Upon entering the florist shop, Beth instantly knew Barb’s passing was known for every one of the eight employees stood with tissues in hand, red-eyed and sniffling. Feeling her own eyes brim with tears again, Beth didn’t even try to fight it this time. Instead, Beth and her friends shed their tears and found solace in one another’s shared memories of Barb. Before the day was over, they had each had taken a hand in designing the most spectacular bouquet to be given in honor of their friend’s life.

“Remember also your Creator in the days of your youth, before the evil days come and the years draw near when you will say, ‘I have no delight in them.’”
Ecclesiastes 12: 1

Dear Lord,

I don’t really understand how to begin my prayer today. My emotions and thoughts are running in such divergent directions. I cannot think clearly. So many memories, wonderful memories, are vying for preeminence in my mind. Oh Lord, how dear this soul was to us all. How she loved life…and her with more reason than most to despair.

I am put to shame for the number of times I’ve groused about this minor inconvenience or that. As I recall the courage my friend consistently exhibited, I cannot help but give thanks for the blessing of her acquaintance. This single person gave so much to so many. Lord, would that my life will make such an impact, that my words bring such inspiration.

Will you bring the heart healing to all those who suffer now? Lend us your strength lest we fall away because of our despair. And never allow such sorrow to turn into bitterness of the soul. Rather, help each of us to put life into perspective. Remind us that you are calling us, every one, to a special purpose. Please Lord, undertake for us this day and let your love shine brilliantly through us for your glory.

Amen

“When life gets tough, when you’re overwhelmed with doubt, or when you wonder if living for Christ is worth the effort, remember that you are not home yet. At death you won’t leave home – you’ll go home.”  Rick Warren in The Purpose Driven Life

Copyright 2009 Michele Howe

For as long as she could remember, they’d planted a garden during the Memorial Day weekend and until far past Labor Day, Claire faithfully tended the seeds ‘til they grew into strapping stalks of corn, vines of ripe tomatoes, and row upon row of green beans. Too many beans, Claire frequently complained. Still, Claire wasn’t one to belabor her husband Jeff’s enthusiasm when it came to making sure they had enough for the coming winter months. It was simpler to let it pass, and give away the excess during the early fall.

As Claire got down on bended knees to pull some especially stubborn weeds by the roots, she marveled how well her crop was growing this season. You are a forgiving soil aren’t you, Claire thought, I didn’t know a lick about gardening when we first started and still you gave back in bountiful measure despite our ignorance.

Claire sighed. Would that my marriage was so resilient. Reminded of her recent struggles with Jeff, Claire felt that familiar heaviness steal over her again. I want things to be better, but sometimes we just don’t seem to agree on a thing anymore. All this bickering, Claire said, wears me out.

Sighing again, Claire finished her weeding and spied out the most succulent red tomatoes she could find. Gathering as many as she could  hold, Claire took another backward glance into her garden. Needs more work, definitely more weeding, Claire paused reflectively. Looking down at her tomato filled arms, Claire thought silently, maybe, just maybe, I need to apply the same measure of enthusiasm toward my marriage that I extend to my garden.

“Do not let kindness and truth leave you;
Bind them around your neck,
Write them on the tablet of your heart.”
Proverbs 3: 3

Dear Lord,

Thank you for demonstrating to me once again how deep and wide and rich your love is toward me. I am amazed that you used the simplest of life’s events to teach me lessons of love. Even this morning, I was reminded afresh that I put more time and effort into a mere hobby than I do my marriage. Lord, something is off-kilter here. Since when did I start believing, and indeed, acting upon the belief that accomplishment matters more than people?

For in truth, this is the way I’ve been living. I have to ask your forgiveness for allowing my heart to become so hardened that I’ve frequently chosen to give up on love. Rather than force myself to endure the hardship that solid relationships must at times endure, I’ve been guarded and self-protective.

In all honesty, I’ve used my work and play time as means of escape from the pain. But you never let me get away with expediency at the expense of truth. Eventually, stubborn woman that I am, you find a way to break through my reverie and bring light to even the darkest recesses of my heart.

I pray that beginning now, you will start a work of renewal within me. Bestow upon me your grace to love fully and without reservation. Though I’ve sowed the seeds of many poor communication habits, lend me the strength and the persistence I require to begin afresh.

I ask that you would fill our hearts with your goodness and let us experience the joy that comes from obedience to you. Day by day, never cease to remind me that you are always close by, supplying me with all I need to live a life that brings honor to your name.

Amen

“People today should only have to look at us to see what Jesus is like”. “If we fail the grace test, we fail to be Christlike. If we fail the truth test, we fail to be Christlike. If we pass both tests, we’re like Jesus.” Randy Alcorn in The Grace and Truth Paradox

Copyright 2009 Michele Howe