Choices/Decisions Part I

The issue of choice has been an interesting topic this week. On Monday I posted a research study, which suggests that Choice Doesn’t Always Mean Well Being for Everyone. In response to that article, I received an e-mail recommending that I check out the presentation by psychologist Barry Schwartz on the Paradox of Choice, at the TED Conference.

Schwartz premise is that increasing choices ultimately results in making us confused and even reduces the chance that we’ll make a choice in the first place- it produces paralysis, rather than liberation. With more options to choose from, the more dissatisfied people are with their selection. It's easy to imagine that you could have made a different choice that would have been better. And what happens is this imagined alternative induces you to regret the decision you made, and this regret subtracts from the satisfaction you get out of the decision you made, even if it was a good decision. The more options there are, the easier it is to regret anything at all that is disappointing about the option that you chose.

Adding options to people's lives can't help but increase the expectations people have about how good those options will be. And what that's going to produce is less satisfaction with results, even when they're good results.

While I understood Schwartz’s frustration with an overwhelming set of choices in breakfast cereals, electronics and other material things I wasn’t so sure I agreed with his comments about health care.

It is no longer the case in the United States that you go to the doctor, and the doctor tells you what to do. Instead, you go to the doctor, and the doctor tells you, well, we could do A, or we could do B. A has these benefits, and these risks. B has these benefits, and these risks. What do you want to do? And you say, "Doc, what should I do?" And the doc says, A has these benefits and risks, and B has these benefits and risks. What do you want to do? And you say, "If you were me, Doc, what would you do?" And the doc says, "But I'm not you." And the result is -- we call it "patient autonomy," which makes it sound like a good thing. But what it really is is a shifting of the burden and the responsibility for decision-making from somebody who knows something -- namely the doctor -- to somebody who knows nothing and is almost certainly sick and thus not in the best shape to be making decisions -- namely the patient.

I disagree with Schwartz’s last statement. The doctor has one set of information about the patient, often in the form of test results and exams. Compare this to the patient and their family, who knows the patient's likes and dislikes as well as their beliefs and their ability to make changes etc. Ultimately, since it’s the patient that has to live with the decision rendered, why shouldn’t they be responsible for the choice?

However, this is just my viewpoint so I decided to do a survey of friends and colleagues, all of whom either are living with a chronic condition and/or are in the medical field. I asked about what level of choice they wanted in their healthcare, as well as how they went about making healthcare decisions for themselves. Needless to say, this is a biased sample and so findings can’t be generated much beyond the people that responded. Still the results were interesting.

Long story short, respondents wanted to make the choice about their health care. However, they wanted the assistance of a trusted medical provider and they didn’t want too many options, particularly ones that are conflicting.

I think making the decisions should still be a dialogue. Most important is for the patient to know consequences or possible outcomes. I have no problem with a physician making a strong case for a choice but ultimately I think a patient must decide if competent….. Two areas of physician in charge modality worry me: excessive testing and excessive end of life intervention….

I am most certainly in that very small group of “affluent educated westerners” who benefit from choice. I take my responsibility to monitor and be in charge of my own health care very seriously. There have been times when I have been really too sick to make any choices, and I try to choose doctors who will a) allow me to be a full partner in my health decisions and b) I would trust with my life if I am unable to hold up my end of that partnership.

I see my nurse practioner as a partner in health so to speak...she has suggestions; I consider them...if she has strong feelings about a particular issue, I listen more closely...However, I want to be in charge of my own health decisions. I believe as I age, this will be more important. Most doctors, at least, seem to see death as the enemy (at least in my experience), and are fairly quick to suggest stuff to ward off death regardless of whether that's a smart thing to do or not. …. I respect the knowledge and experience of my medical caregivers, and want their input, and want to know how strongly they feel about particular treatments, but I want to be the one to make the decisions. Perhaps once I’m older and possibly feeble minded, I will be more content to let them have more input and influence...

I probably wouldn't stay with a doctor who didn't involve me in the decision making process. But the patient has got to be informed.

To the question of how people go about making health care choices, there was a general consensus that getting information from a reliable source was very important. With the Internet, there are a host of options, some of which are just plain “snake oil.” There is also the possibility of “information overload.”

One person noted that the need for a quickly made choice is much different to one where you have time to think about the impact. The range of information provided indicates the complexities of making a choice. It is easy to see why, with more options being presented, the more complex the decision making becomes for the patient and ultimately why some patients just throw up their hands.

Several people recommended looking at complementary and alternative therapies as one of the choices and one respondent was very clear that cost and impact on her spouse were very important considerations. I suspect that cost is a much bigger factor than this survey would indicate. I also think that location of treatment and time away from work and family also plays in to decision making.

I ask a lot of questions and try to get as much information as I can. I consult with other patients and/or doctors, I read books and serious stuff on line (not chat room whining), all so that I understand the various factors at work.

I try to get as much information as possible, but in the end, many of my health choices boil down to gut instincts about what is right for me. I try to be very quiet and listen to my inner wisdom. Ultimately, I am looking to heal and this is not always an option with western medicine. So many doctors are satisfied to shoot for “remission” with drugs whose toxic side effects are “within acceptable limits”. I work very hard at reaching for the possibility of something much better than that….and to this end I turn over every leaf and follow every little trail I find. I listen to other patients and read as much as I can.

I don’t think there is one formula for health care decisions. So much depends on the circumstances.

I usually wait till the very last minute I can tolerate the pain to have bone and nerve stuff done. I usually feel I have to give my body the best chances possible, PT etc. to heal itself.

I make my health care decisions based mostly on cost and the impact my treatment is going to have on my husband. He works a second job just to make sure that I have health insurance and can pay for the medications I need every month. Even with insurance, my co-payments run as high as $500 per month! Because my husband works so many hours and is under the additional stress of worrying about my health, I tend to minimize the intrusions that my treatment is going to have on our (limited) time together so he doesn't have to bear any further burdens than he already does. For that reason, I have steered clear of some clinical trials and drug regimens that may cause me to have side effects that would cause him to worry even more than he already does.

I suppose I'd advise someone to look at a holistic approach to making any decisions and to be sure to include a place for alternative therapies that will bring them a sense of well-being and relaxation, and I think a psychotherapist is essential. Even if you don't think you need to talk to someone it can be extremely helpful, particularly if you need an advocate or assistance in sorting through various courses of treatment.

Take A Break: Make a “King Cake”

I grew up with a mother that celebrated every possible holiday she could. A frustrated artist in some ways, my Mom’s outlet was to introduce her children, as well as her students (she taught 3rd grade) to all kinds of traditions. There was green oatmeal on St. Patrick’s Day and Chinese food for Chinese New Year. We received our Christmas stockings on Dec. 6, St. Nicholas Day and celebrated Mardi Gras the day before Ash Wednesday.

Outside of Christmas and Easter, February was a very busy month for my Mom. She used Black History Month, Mardi Gras, Chinese New Years and Valentine’s Day to make a very dreary time quite a lot of fun. In honor of my Mom, the next three Take a Break Wednesdays will be crafts and ideas to celebrate the February holidays.

If you live in New Orleans, you have been eating King Cake since January 6 (Epiphany-Feast of the Three Kings). Based on a European tradition, the oval cake symbolizes the unity of faiths. Decorated with purple, green and gold (yellow) sugars, a small baby is tucked into each cake. The baby symbolizes the baby Jesus, and the Three Kings search for the child.

There are different customs about what it means to “find the baby” in your slice-my Mom used a bean or a penny instead of a baby. In some places, the baby means you host the next party, or you purchase the next King Cake. Since my husband is a Cajun and zydeco fiddler, the Mardi Gras parties are generally at our house. We have started the tradition that if your slice has the baby you are responsible for bringing the King Cake for next year’s party.

The thought of a plastic baby being baked in a cake doesn’t seem like a very healthy idea. Instead, just shove it into the cake after it’s baked and cooled. You’ll probably want to do it before you ice it.

There are a variety of recipes for King Cake on the web, and you can certainly order a box mix from New Orleans. However, the simplest way is to make the cake using a tube of cinnamon rolls.

You can make individual ones, by taking each roll and rolling into a hot dog shape, and making an oval. You can also pinch the dough together, roll it out so everything is connected, and then turn into one large oval. You can also divide the sheet into three lengths, braid and then shape into an oval. Follow the cooking directions on the can.

After it’s cooled, use the icing that comes with the can (or make more if you prefer) and decorate with purple, yellow and green sugars. These are easy to make. Pour some sugar into a bowl; add a drop or two of food coloring and mix. Let dry before sprinkling for best results. Of course you can divide the icing into three bowls and color accordingly.

Babies can be purchased at a craft, party store or any place that sells baby shower favors. As they say in Cajun country Laissez le bon temps rouler Let the Good Times Roll!

An Ill Father, a Life-or-Death Decision

In keeping with my weekend post, as well as yesterdays, the following article appears today in the New York Times. The idea of choice, and who gets to make it, looms large in health care, most particularly where chronic disease is at play.

New York Times
January 26, 2010
CASES
An Ill Father, a Life-or-Death Decision

By ALICIA von STAMWITZ
I am utterly spent by the time my father lands in the emergency room, shortly after 1 a.m. on a cold January night.

We have been through the drill so many times that when the nursing home calls to tell me the ambulance just left, I do not even bother to phone my siblings, who live in other states. I leave a note on the kitchen counter for my teenage children, grab the small bag I’ve already packed for these occasions and speed to the hospital on quiet streets.

In the E.R., I greet my father with a kiss. He is propped in a sitting position on the gurney, struggling to breathe. His eyes are closed and he does not respond to my voice or presence, but I take his hand in mine as I position myself opposite the medical team. I answer their questions in the clipped shorthand I know they prefer, eliminating pronouns and adjectives.

“Sixty-nine years old.”

“Bipolar alcoholic.”

“Yes, two open-heart surgeries.”

“No, can’t speak much since his last stroke, but his mind is fine.”

The doctor does not cut me off, so I add: “His liver is also shot, but that’s not because of the drinking only. It’s because he really tried to beat the bipolar illness and faithfully took his lithium.”

The doctor explains what I already know: my father’s heart is weak, his kidneys are failing and his lungs are filling with fluid. For the second time in six months, he needs to have a tube inserted in his windpipe.

I nod, waiting for him to continue listing procedures and tests. Instead, he takes a small step back from the gurney and asks, “Does your father have a living will?”

I freeze. No emergency room doctor has asked me this before. I answer, evenly, yes. “Do you have durable power of attorney?” Yes.

Visibly relieved, he looks me in the eye and gently but pointedly asks: “Does your father want us to employ extreme measures” — he pauses one heartbeat for emphasis — “knowing that he is not likely to improve?”

The two nurses flanking the doctor look at me kindly.

I smother my rising panic. I must stay calm. I need to think. The doctor has given us an opening, a chance to consider our options.

I know what I want: I want to stop the insane cycle of hospitalizations and heroic life-saving treatments. It is not helping my father. He is getting sicker. He is dying. And I am exhausted beyond belief. I have no energy for family or friends, and my career has suffered. I want my life back.

I am acutely tempted to answer, “Of course not — my father would not want heroic measures.” But I hesitate because I know it might not be true. In the past, he has wanted everything possible done. This night is different, but I do not know if his answer would be different.

I look at my father. It is hard to tell if he is conscious. No one else is looking at my father. Everyone is watching me closely.

Finally, I say out loud the only thing I know to be true. “In the past, my father has asked that everything possible be done.”

Then I bend over my father and ask him in a clear, strong voice: “Daddy, do you want to be intubated again? Squeeze my hand if you want to be intubated.” I wait, but he does not squeeze. Instead, he surprises us all by nodding his head. He is weak, but the nod is unmistakable.

One nurse grunts and rolls her eyes dramatically. The other mutters, “Oh, brother — here we go again,” and shoves a stainless steel instrument cart closer to the gurney. The doctor, more professional, remains impassive as he suggests I leave the room. “It is difficult to watch this procedure. Most patients struggle and flail, so we will have to use restraints.”

Yes, I know. I kiss my father on the cheek, tell him I will be back soon and head to the waiting room.

What the doctor and nurses do not know, what I hesitate to admit even to myself, is that I almost gave them the answer they wanted: the reasonable one. But I would have been terribly wrong.

My father never really recovered. He could never again breathe without a respirator, he never left the hospital bed, and he eventually needed dialysis and a feeding tube. Six months later he died of heart failure.

I suppose my father’s decision was a mistake. But it was his mistake to make, not mine. My role was to support my father, no matter what, and to tell the truth, no matter how hard.

Choice Doesn't Always Mean Well-Being for Everyone

Choice Doesn't Always Mean Well-Being for Everyone

ScienceDaily (Jan. 24, 2010) — American culture venerates choice, but choice may not be the key to happiness and health, according to a new study in the Journal of Consumer Research.

"Americans live in a political, social, and historical context that advances personal freedom, choice, and self-determination above all else," write authors Hazel Rose Markus (Stanford University) and Barry Schwartz (Swarthmore College). "Contemporary psychology has proliferated this emphasis on choice and self-determination as the key to healthy psychological functioning."

The authors point out that this emphasis on choice and freedom is not universal. "The picture presented by a half-century of research may present an accurate picture of the psychological importance of choice, freedom, and autonomy among middle-class, college-educated Americans, but this is a picture that leaves about 95 percent of the world's population outside its frame," the authors write.

The authors reviewed a body of research surrounding the cultural ideas surrounding choice. They found that among non-Western cultures and among working-class Westerners, freedom and choice are less important or mean something different than they do for the university-educated people who have participated in psychological research on choice.

"And even what counts as a 'choice' may be different for non-Westerners than it is for Westerners," the authors write. "Moreover, the enormous opportunity for growth and self-advancement that flows from unlimited freedom of choice may diminish rather than enhance subjective well-being."

People can become paralyzed by unlimited choice, and find less satisfaction with their decisions. Choice can also foster a lack of empathy, the authors found, because it can focus people on their own preferences and on themselves at the expense of the preferences of others and of society as a whole.

"We cannot assume that choice, as understood by educated, affluent Westerners, is a universal aspiration, and that the provision of choice will necessarily foster freedom and well-being," the authors write. "Even in contexts where choice can foster freedom, empowerment, and independence, it is not an unalloyed good. Choice can also produce a numbing uncertainty, depression, and selfishness."

Adapted from materials provided by University of Chicago Press Journals, via EurekAlert!, a service of AAAS.
Journal Reference:

University of Chicago Press Journals (2010, January 24). Choice doesn't always mean well-being for everyone. ScienceDaily. Retrieved January 25, 2010, from http://www.sciencedaily.com /releases/2010/01/100119121430.htm

When is it time to say “enough?”

Seven out of ten people in the United States will ultimately die from a condition they have lived with for a long time. Some conditions require daily regiments, such as a person with diabetes needing insulin injections. Others may need weekly or monthly chemotherapy. Many manage quite well on their own, some need help with certain activities, and others need round the clock care.

It is not uncommon for a person living with a chronic condition, or those who care for them, to talk about how if x, y or z happens they wouldn’t want to live or they’d have to consider other options than care at home. When x, y or z actually does occur, many will have adjusted to changes along the way and may not even realize they have reached a particular benchmark.

Regardless of how you are affected by chronic disease, there are times when “enough is enough.” For some it’s a very clear decision and they don’t waiver from it. For others, it’s not a simple process. They may be concerned about disappointing the people in their lives, including the medical team, a shorter life expectancy, side effects, finances, quality of life and/or fear of dying.

The decision reached can also be about finally doing treatment because the pain or discomfort of symptoms is unbearable. No matter what the “enough” is, below are some ways to make the decision making process more manageable.

• Be honest with yourself and medical providers. Ask them for their assistance in making decisions. Keep in mind that the decision(s) ultimately rest with you, so listen to yourself.

• Assess as accurately as possible what the situation is.

• Use “decision making” tools
-The Ottawa Decision Guide
- Decision Aids by Health Topic
- Decision Aid Library
-Informed Medical Decisions

• Seek outside help in making the decision. This could include talking to a therapist, counselor, shared decision specialist (many hospitals now have such programs in place), a social worker, a trusted friend or colleague, or a member of the faith based community.

• If you are a caregiver, recognizing the need to take care of yourself first is important. If you can’t take care of yourself, you wont be in shape to help others.

• Caregivers are often placed in a position to make the “enough call.” A very useful resource, which can be downloaded for free or purchased, is Hard Choices for Loving People. Hard Choices covers the most common medical treatment decisions faced by those who are living with a life-threatening illness. CPR (resuscitation efforts), artificial feeding, hospitalization of an ill person and shifting to a hospice approach are all considered in depth. Besides these most common treatment decisions, there are sections on ventilators, dialysis, antibiotics and pain control. Also, at the end of the chapters on CPR, Artificial Feeding and Comfort Care/Hospice there is a section on making these treatment choices for children. This book is not just for the elderly but for anyone facing a life-threatening illness. The author Hank Dunn has served as a full time nursing home chaplain at the Fairfax Nursing Center and as a staff chaplain for the Hospice of Northern Virginia (now Capital Hospice).

• If you are a friend, it can be upsetting and confusing if someone you care about stops treatment. A good resource to consider is When Someone You Love Decides to Stop Treatment from Cancer.Net

Take a Break: Save and Read Quotes

Take a Break: Save & Read Quotes

How often do we come across a passage in a book, magazine or even on a blog that we find touches us in someway? If you don’t have a place to write, type, pin (as in Pinterest) or copy those quotes, start today. Every so often, take a look at the quotes that inspired you at one time. It could be just the jolt you need to think in a new more positive direction.

This past week, I’ve been working on a 1930s project with a group of school children. While reading about Eleanor Roosevelt, I couldn’t help but be impressed not only with her life, but also her wisdom. Two quotes that struck me were:

About the only value the story my life may have is to show that one can, even without particular gifts, overcome obstacles that seem insurmountable if one is willing to face the fact that they must be overcome; that, in spite of timidity and fear, in spite of a lack of special talents, once can find a way to live widely and fully.”

You gain strength, courage and confidence by every experience in which you really stop to look fear in the face. You must do the thing you think you cannot do.

Emergency Preparedness

This week I received a phone call from someone that I have worked with for many years. Living with a variety of chronic conditions, she was watching and reading about the struggles in Haiti after the earthquake. Like many people with chronic illness, she is not in a position to be making monetary contributions, but wants others to know who is doing what and where they might want to consider donating.

There was another important issue for her. If a natural disaster struck, how could she help the people in her building, many of whom are elderly or living with a significant disability? She pointed out that it had been a long time since she had taken anything like a basic first aid course. What could she do?

To address her concerns, below are some suggestions on how to prepare for a disaster.

• Keep in mind the airline attendants instructions, “in the event of an emergency, put the oxygen mask on yourself first before helping children and others around you.” Make sure you are okay first, so you are in the best possible shape to help others.

• Ready. Gov: Prepare. Plan. Stay Informed This government website provides information on setting up:
- A basic survival kit.
- A plan so that family and close friends know how to contact one another and what you can do in different situations. There are online family planning tools you can use to make this easier.
- Be informed. Learn more about possible risks for your community and how you can prepare for them.

• Talk to your neighbors about how to work together in case of an emergency. Find out what emergency plans are in place where you live, work, play, pray and go to school.

• Learn how to shelter in place: This means how to take immediate shelter regardless of where you are.

• If you have pets, make sure your plan includes them.

• CDC’s Emergency Preparedness and Response: Addresses specific hazards, such as bioterrorism, chemical emergencies, radiation emergencies, mass causalities, natural disasters and severe weather, and recent outbreaks and incidences

• Learn basic first aid and CPR-Contact your local Red Cross Chapter

Palliative Care is For Everyone

Recently, I was acting as an advocate for someone living with cancer, who became very upset upon learning they were being given “palliative” radiation versus a “curing” regiment. The doctor explained that they didn’t think the patient was strong enough for a “curing” regiment and the cancer would return. However, the palliative treatment could reduce the pain, improve quality of life, and possibly even extend it. This was not what the patient wanted to hear. In fact, out of earshot of the doctor, this person voiced their dislike of the “P” word.

Palliative Care is not hospice. Another way to think of Palliative Care is comfort care. This specialty has all sorts of ways to improve day-to-day living by reducing pain, fatigue, stress, nausea etc. It doesn’t matter what your diagnosis is, whether it’s a chronic condition or a terminal one, what treatment plan you are on or how old you are. Palliative Care can be a wonderful asset at any stage and at any age.

Dr. Elaine Schattner, who writes from the experience of a patient (she had breast cancer) and an oncologist, has written an interesting article “Palliative Care Needs a New Spin.” Many people, doctors included, are ill-informed about this essential branch of medicine. As a result, it's rarely discussed, undervalued and underused.

The purpose of palliative care is to make patients feel better -- by managing pain, emphasizing nutrition and providing assistance in daily life. The goal is not, necessarily, to cure disease, but instead to help people cope with any chronic medical disorder.

I think that palliative care matters now more than ever. That's because medical advances have expanded patients' care choices to such a point that health care decisions can overwhelm individuals caught up in the immediacy of an illness. In a specialist-driven system that aims to eradicate disease, sometimes we overlook the simpler need to alleviate patients' discomfort and distress.

Get Palliative Care suggests the following ways to “get Palliative Care:”

The first step is to talk to your own doctor. Most of the time, you have to ask your doctor for a palliative care referral to get palliative care services. Whether you are in the hospital or at home, a palliative care team can help you. Following are some tips to help you talk to your doctor:

• Tell your doctor you are considering palliative care and ask what palliative services are available in your area. Obtain a list of providers for your state by going to http://www.getpalliativecare.org/providers

• Ask your doctor to explain your illness as well as past, current, and future treatments and procedures.

• Explain to your doctor what quality of life means to you. This list may include being able to spend time with loved ones, having pain and other distressing symptoms aggressively treated, the ability to make your own decisions for care and your preferred location of treatments (home vs. in the hospital).

• Be sure your doctor is aware of any personal, religious, or cultural beliefs, values, or practices that are important to consider in your care and treatment decisions.

Take a Break: Watch a Feel Good Movie

There is nothing like watching a “feel good” movie to improve one’s spirits. Below is a list of some of my favorites, as well as others that come highly recommended. Some of these films are old enough that you can stream them on your computer. To find out what’s available, type the name of the film plus “streaming” in Google.

• Miyazaki’s films: Particularly Howl's Moving Castle and Spirited Away.  Others include Castle in the Sky. These are anime films.

• Amelie

• A Fish Called Wanda

• When Harry met Sally

• Ferris Bueller’s Day Off

• Many of Woody Allen’s movies, particularly Radio Days 

• The Full Monty

• The Princess Bride

• Slumdog Millionaire

• Julie and Julia

• O Brother, Where Art Thou?

Healing versus Cure

This past weekend I happened to stumble across a quote from Jon Kabat-zinn about healing. Healing implies the possibility for us to relate differently to illness, disability, even death, as we learn to see with eyes of wholeness. Healing is coming to terms with things as they are.

I was curious about what others had written on this topic and found an interesting sampling on-line:

Bernie Sigel MD Waging a War Against Cancer Versus Healing Your Life When our minds and bodies are involved in a battle and a war our response is one of protection. That means we are prepared to run for our lives as our blood is diverted to parts of our brain and bodies, which help us to escape. Stress hormone levels are elevated and immune function is suppressed during this time. When we are involved in healing and see life as a labor pain of self-birthing then the side affects are diminished and our body is reprogrammed to grow and heal as the stress level is reduced and immune function enhanced.

Patrick Quanten MD Healing versus Curing When we heal people, we very often notice that the disease does not disappear. Yet, somehow we have the feeling that we did help that person. Healing is not about "curing diseases"; healing is about "making whole". In healing no one is fighting anything or anybody. There are no bugs or mystery causes to be destroyed. Healing is not about destroying; healing is about making whole. A person, an animal, a country or culture can be made whole without overcoming all illness and discomfort. Even Nature has its own discomforts, its own pains and anxieties, but none of it imbalances the structure. "Evil" and "goodness" are human concepts, which colour our world in good and bad. These concepts do not help us to live a more whole live as they separate the seeds from the husks, the active ingredient from the impurities, the "me" from the "them". It is this separation that creates the harmful situation we are now desperate to find a cure for. Healing brings together all those differences in a whole; it delivers the normal state.

Landis Vance Healing vs.Cure Vance is a writer, professor and former hospital chaplain. She is living with cancer and post polio syndrome. For me it isn't about hope - what do I hope for? To be rid of these conditions - not gonna happen. To have a good day? Some will be good and some not. It's about living in the moment, fully, with the negative and the positive and allowing each its rightful measure. Perhaps healing is acceptance in some way - not acceptance as in caving in to doom - acceptance as in here you are - you are what you are- not more and not less.

My psychology professor had a wonderful way of expressing this. 'Greet each thing that overwhelms you thus: "There you are. Please come in and let's have tea."' Or another expression: "There you are. Have a seat on the bus. You can journey with me but you're not driving!"

So What’s a Serving Size?

Less than a quarter of American’s eat the recommended five servings of fruits and vegetables daily. A new study, published in the January 2010 American Journal of Public Health, found that by logging onto a special website, people increased their consumption of fruits and vegetables. While that sounds terrific, there is an underlying question- what constitutes a serving? Does a cup of fruit juice count as a serving? (Yes, if it’s 100% fruit). What about a potato or sweet potato? (Sweet potato yes, a regular baked potato not so much.)

While the United States Department of Agriculture (USDA) has set a general recommendation of five servings daily of fruits and vegetables, a closer examination of Mypramid.gov shows that serving amounts can differ depending on your age, whether you are pregnant, have a particular health condition, and other variables.

Back to what constitutes a serving size. The USDA goes by 1 cup (the kind used in recipes) measures. In general, 1 cup of raw or cooked vegetables or 100% vegetable juice, or 2 cups of raw leafy greens can be considered as 1 cup from the vegetable group. One cup of fruit or 100% fruit juice, or 1/2 cup of dried fruit can be considered as 1 cup from the fruit group.

Learn more about specific vegetables, and what constitutes a serving size, by going to http://www.mypyramid.gov/pyramid/vegetables_counts.html# For fruits, go to
http://www.mypyramid.gov/pyramid/fruits_counts.html

Other websites to check out:

Fruits and Veggies Matter

Fruits and Vegetables: Do you Get Enough from the American Cancer Society

MyPyramid

Dietary Guidelines from the USDA

Take a Break: Plant Something

The first weeks in January can appear pretty drab, particularly after the holiday decorations have been put away. Indoor plants are a great way to decorate your house, bring the outdoors in and brighten your mood.

January is sale month, so look for bulbs, such as paper whites, that you can grow in small containers with a few stones. Many plant kits from the holidays are half price or even less.

Herbs in window boxes or clay pots not only brighten a kitchen but can also provide a fresh addition to soups, stews and other foods. Depending where you live, you may even want to consider starting some plants from seeds that can be transplanted as the days warm.

Resources:

Plant Care for Indoor House Plants

Growing Herbs in Containers

Forcing Bulbs for Indoor Beauty in Winter

New Health Rule: Quit Worrying About Your Health

JANUARY 4, 2010, 6:09 PM
New York Times

By TARA PARKER-POPE
Stuart Bradford

Have you had your five to nine servings of vegetables today? Exercised for an hour? Cut back on saturated fat and gotten eight hours of sleep?

Dictating the rules for healthful living has become a cottage industry, with Web sites, talk shows and books (and health columns like this one) devoted to the dos and don’ts of staying healthy.

But when it comes to achieving these goals, many of us feel we are falling far short. Whether you’re a busy parent who can’t find time for exercise, a chronic dieter struggling to lose 20 pounds or a multitasker who gets by on six hours of sleep, it is virtually impossible to follow the rules.

Now Dr. Susan M. Love, one of the country’s most respected women’s health specialists, offers a new rule: stop worrying about your health.

In the new book, “Live a Little! Breaking the Rules Won’t Break Your Health” (Crown), Dr. Love makes the case that perfect health is a myth and that most of us are living far more healthful lives than we realize.

Dr. Love, a clinical professor of surgery at the David Geffen School of Medicine at the University of California, Los Angeles, says that failing to live by the various health rules is a major source of stress and guilt, particularly for women. For most of us, “pretty healthy” is healthy enough.

“Is the goal to live forever?” she said in a recent interview. “I would contend it’s not. It’s really to live as long as you can with the best quality of life you can. The problem was all of these women I kept meeting who were scared to death if they didn’t eat a cup of blueberries a day they would drop dead.”

The book, written with Alice D. Domar, a Harvard professor and senior staff psychologist at Beth Israel Deaconess Medical Center, explores the research and advice in six areas of health — sleep, stress, prevention, nutrition, exercise and relationships. In all six, they write, the biggest risks are on the extremes, and the middle ground is bigger than we think.

“Everything is a U-shaped curve,” Dr. Love said. “There may be times in your life when you’ve gotten too much of this or too little of that, but being in the middle is better, and most of us are probably there already.”

Take the issue of sleep. Most people believe that it’s best to get at least eight hours a day. But the studies on which this belief is based look at how much men and women sleep under ideal conditions — silence, darkness and no responsibilities other than taking part in a sleep study. These studies tell us how much people will sleep when they have nothing else to do, but they don’t tell us anything about how much sleep we really need on a daily basis or what will happen if we get less.

A 2002 report in Archives of General Psychiatry tried to address those issues by comparing sleep habits and mortality risk. The study found that people who slept seven hours a night were the least likely to die during the six-year study period. Sleeping more than seven hours or less than five increased mortality risk. It wasn’t clear from the study whether more or less sleep increased risk or whether an underlying health problem was affecting sleep habits, but the findings did call the old “eight hours” rule into question.

The reality is that individual sleep needs can vary. Some people need very little while others need more than the average. “The issue of sleep causes a lot of guilt by women,” Dr. Love said. “We need to be more realistic. If you’re sleepy all the time, you’re not getting enough sleep for you. If you’re fine on six hours, don’t worry about it.”

Likewise, while exercise is important, many people don’t place enough value on the fitness that comes from everyday tasks like lifting and chasing children, lugging groceries and cleaning house.

And there is nothing magic about losing weight. People who are obese or underweight have higher mortality rates, but people who are overweight are just as healthy as those of normal weight — and sometimes healthier. “The goal is to be as healthy and have as good of a quality of life as you can have,” Dr. Love said. “It’s not to be thin.”

Health experts agree that moderation is important and that people should not panic about their health habits. But Dr. Elizabeth Barrett-Connor, professor of family medicine at the University of California, San Diego, cautions against interpreting a relaxed health message as an excuse to overeat or stay sedentary. “I think the problem is the slippery slope,” Dr. Barrett-Connor said. “In the process of translating this message simply to the masses, they may feel they’ve been forgiven. They shouldn’t feel like they’re sinning, but they shouldn’t feel like this is a license not to try to do better.”

Miriam E. Nelson, director of the John Hancock Research Center on Physical Activity, Nutrition and Obesity Prevention at Tufts University, who has read the book, says it may help people realize that it is easier to be healthy than they thought. “There is a large part of the population that doesn’t do anything because they’ve been overwhelmed,” Dr. Nelson said. “This book could get them interested because it’s not so complicated anymore.”

Dr. Love said she and Dr. Domar decided to write the book because many people seemed to have lost sight of what it meant to be healthy. “The point of this is to use your common sense, and if you feel good, then you’re fine,” she said. “The goal is not to get to heaven and say, ‘I’m perfect.’ It’s to use your body, have some fun and to live a little.”

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For Success, Spread out the Resolutions

So while we’re on the subject of New Year’s, how good are any of us at keeping resolutions? Jonah Lehrer has written a very interesting article in the Wall Street Journal on this topic. “Most of us assume that self-control is largely a character issue, and that we would follow through on our New Year’s resolutions if only we had a bit more discipline. But this research suggests that willpower itself is inherently limited, and that our January promises fail in large part because the brain wasn’t built for success.” In order not to overtax the brain, the latest neuroscience suggests spreading resolutions out over time. You can read Blame It on the Brain at the Wall Street Journal website.

Keeping the Happy in Happy New Year

Keeping the Happy in Happy New Year

For the next several days, “Happy New Year” will be the most frequent form of “hello” on the planet. But what do we mean when we wish someone a “happy” New Year? Does it imply that the previous year sucked?

What do we mean by happiness? Is it the same as contentment? The ability to thrive? Well being? If you are living with a serious illness, does it mean you can’t be happy?

According to Daniel Gilbert, Harvard professor of psychology and author of "Stumbling on Happiness," "Happiness is the thing that all human beings are looking for. Each decision we make in our lives is based on what will make us happier." The problem, Gilbert says, is that we have no "road map" to happiness, and for whatever reason, people don’t know what will make them happy.

PBS is about to air a three part series, starting January 4, called “This Emotional Life.” The series will be addressing three key scientific concepts of happiness:
• You can’t be happy alone
• You can’t be happy all the time
• You can be happier than you are.

The third episode, “Rethinking Happiness,” explore(s) the latest research on the activities and qualities that foster them, such as meditation, compassion, forgiveness and altruism. We also share the remarkable stories of resilient individuals that scientists are studying to learn more about us all, including a man who overcame an abusive childhood to become a renowned surgeon and a Vietnam veteran who survived torture, solitary confinement and seven years as a POW, yet emerged emotionally unscathed. Understanding why some people have the ability to bounce back after disaster strikes, while others do not, sheds light on how all of us can lead happier, more fulfilling lives.

The film ends by coming full circle to the understanding that it is the quality of our relationships — with friends, family and the larger community — that ultimately defines our happiness.

Even though I’ve been following the literature for years on this topic, 2009 seems like a banner year for “happiness” related research, blogs, books and other activities This is just a sampling of what’s now available on-line:

Positive Psychology Center at the University of Pennsylvania

Authentic Happiness, part of the University of Pennsylvania program

Positive Psychology News Daily

The Happiness Project:

The Woman’s Day Happiness Project

Deepak Chopra’s 7 New Ways to Happiness

While PBS is trying to understand American happiness, the BBC conducted a study to “Make Slough Happy.” Six happiness specialists developed 10 things people could do to make themselves happier-improve their sense of well-being. They then tested whether this worked by studying 50 volunteers who were taught how to use the “happiness manifesto” (see below). These 10 ideas covered four general areas, physical, relationships, work and community. Not every strategy worked for every person, but at the end of the experiment, “We produced more change than we expected. Generally, people misjudge what makes them happy, particularly in relation to materialism. The pursuit of money is not the way to wellbeing or joy. The take-home message is that you, yourself, can make so much difference to your happiness.”

The Happiness Manifesto
• Plant something and nurture it

• Count your blessings - at least five - at the end of each day

• Take time to talk - have an hour-long conversation with a loved one each week

• Phone a friend whom you have not spoken to for a while and arrange to meet up

• Give yourself a treat every day and take the time to really enjoy it

• Have a good laugh at least once a day

• Get physical - exercise for half an hour three times a week

• Smile at and/or say hello to a stranger at least once each day

• Cut your TV viewing by half

• Spread some kindness - do a good turn for someone every day

Regardless of health status, these are simple measures you can try. At least one of the volunteers for the Slough project had significant health issues, yet found that Manifesto offered him a new way to live his life. In follow up interviews, this volunteer continues to practice the Manifesto and continues to find it improves his sense of well being.