Strategies and Resources for Teens with Chronic Conditions

 

I was prompted to write this post after reading an article about a Mom’s response to her teenage daughter’s diagnosis with sudden onset multiple sclerosis (MS). As I’ve been working on this, I’ve had to wonder why it’s taken me so long to address this topic, as I spent quite a few years working with kids with HIV/AIDS, as well as having a son diagnosed with a chronic condition when he was a teen. Hmmm. One can speculate.

View this as a work in progress. While both the “Getting What You Need Checklist”  and Healing the Whole Person: Ways to Increase Well-Being are relevant for teens, by and large these are not handouts that would not appeal to them. In time, with a group of teens to lead the way, we will have versions of both of these documents for adolescents living with chronic conditions. Until then, this post will be more useful to parents, providers, teachers and adults who are working with adolescents.

Estimates are that about 2 million Americans  (6%) between the ages of 10-18, have a chronic condition that limits their activities of daily living. The most common are asthma, other chronic respiratory tract disease, musculoskeletal disorders and heart disease. Mental health issues can also appear during these years as the brain and body rapidly develop. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1071594/

Ask any parent of an adolescent and they can tell you “it’s the best of times, it’s the worst of times.” The hormonal roller coaster alone can take the entire family on what feels like an out of control ride. Throw a chronic condition into the mix and it can be a very tough road.

Below are strategies and resources to help try and map a steadier course for all involved

• Find a provider who works with teens if at all possible. Doctors, physician assistants and nurse practitioners that specialize in Family Medicine are often adept at this. Whether they have been trained in working with adolescents or not, one of the most helpful approaches is going to be: clear explanations in language they can understand, easy as possible treatment regiments to follow, and using specialists only when needed.

• Meet the teen “where they are at.” They network completely different than many adults, so providers need to understand that texting their cell phone to remind them of office visits, taking meds etc. maybe more effective than phone calls to home. Teens need an “e-prescription.” Give them links to good on-line resources-information about their condition, stories from teens who are living with similar chronic conditions and support groups. The parents also need their own e prescription.

• Teens live life at a “tweeter length.” Short information is best. Even though their text messages and tweets are full of OMG, LOL, etc. (here’s a link to help with translation of text and chat room abbreviations) avoid using them. As my youngest e-mailed my husband, when he wrote IME (in my experience) “don’t do that again.” It’s their jargon and they prefer to keep it among themselves.

• The brains of adolescents are different. While adults look at them as being impulsive and self-absorbed, this is normal behavior for a growing and developing brain. Watch Sarah-Jayne Blakemore’s TED talk, “The Mysterious Workings of the Adolescent Brain.” 

• Let Go. While all parents have their respective issues about “letting go,” there are unique challenges for the parent of a kid with serious health issues. Regardless, adolescents need to be encouraged to be independent, take care of their own health issues and develop their own set of coping skills. More than one adolescent has told me over the years, “I’m fine. I can do this, but she (and occasionally he or they) don’t trust me. “ The older they become, the more important it is to let them go to their medical appointments alone and form their own relationship with their care team. By the time they are 18, they  get to call the shots, so they need the skills sets to make the best possible choices.

Camps that are designed specifically for kids with special needs are a great place for starting the “letting go” process. See resources section for camp listings.

• School issues and self image are huge for this group regardless of health status. Looking different or having special needs compounds this problem and then some.   While there are lots of platitudes written about this “Encourage adolescents to share their concerns related to their body and how it may be affected by their illness or treatment” real concrete suggestions are needed.

When I was running Twin States, an organization for families dealing with various health conditions, we held a Family Camp and finally added a Kids Camp. The latter was the best thing we could do for our kids that were living with various health issues. As the kids aged, they became counselors in training and eventually counselors. It didn’t matter if the health conditions were the same they understood the isolation that comes from “being different.” Check the resource section below for a list of camps.

Helping adolescents connect to others who are experiencing similar issues is important. They can do this on-line or in person. If the medical  provider can’t offer information about groups, contact the local chapter of your condition specific organization (e.g. American Diabetes Association). If there is nothing out there that meets the need, start a Facebook page, chat room, blog or whatever format feels right for you.

• The human is very social, at all ages, but particularly at adolescents. Bottom line-don’t go it alone. See the resource section for on-line support groups for teens.

•  Compliance with medical regiments, sticking to diets etc. are an issue no matter what your age. Yes, teens that have to be on special diets because of diabetes, celiac’s or another condition can have a hard time when out with friends or in other situations. The idea that you have to adhere to this the rest of your life, can be overwhelming and challenging for teens (like it isn’t for adults).

Having a son who became symptomatic with Celiac’s disease as a freshmen in college gave me some first hand experience in how difficult it is for them and a family. My son took to calling himself a “glutard,” and referring to his food as “freak food.” Through trial and error he has become an excellent cook and even I’m finding I prefer the cookies and pies that I make from nut flours and oats over those made from wheat flour. In short, it takes trial and error and a belief that it will be ultimately okay.

• Sibs have needs too. Younger and older siblings can be as impacted by a brother and sister with a significant illness just like parents, grandparents etc. Check out Sibling Support Project http://www.siblingsupport.org/ and if your community doesn’t offer Sibshop, http://www.siblingsupport.org/sibshops/find-a-sibshop consider becoming a facilitator.

• Living in the present and mindfulness are important and there is currently a study Mindfulness Based Stress Reduction (MBSR) and teens. To learn more about this approach for helping teens with various types of health issues, go to Mindfulness Based Teen Program Pilot Phase. 

RESOURCES

Camps for Children/Adolescents

• The Hole in the Wall Gang Camp: Held at the Camp’s 344-acre facility in Ashford, Connecticut, Camp’s signature summer program consists of eight, weeklong sessions for seriously ill children aged 7-15, and one session for the siblings of children with serious illnesses. The camp is free with its primary catchment area being the Northeast. Other programs are offered through out the year. 

• Hero’s Journey: A seven-day course of personal challenges, Wilderness First Aid and backcountry living at Camp for young adults aged 16-18 whose lives have been impacted by a chronic or life-threatening illness. Five sessions run per summer. 

• Camps for Kids with Cancer 

• The Consortium on Children’s Asthma Camps 

• Camps for Children with Diabetes 

• Camps for Children with Special Needs 

On-line Support Groups for Teens

• Internet Support Networks: Suggestions for a Safe and Sound Experience  Item 5 includes various on-line groups to consider.

• Daily Strength 

• Self Help Group Sourcebook Online Resources for Teens 

Learning From Other Teens

• Finding Our Way: Stories from teens who are part of the Darmouth STAR (Steps Toward Adult Responsibility) program. 

Other Resources

• Dealing with a Chronic Condition: Site includes information for teens and parents. 

• Family Voices: Family centered care for all children and youth with special health care needs and/or disabilities 

Take a Break: Chocolate Leaves and Other Projects

Fall is so gorgeous in Vermont, particularly the vibrant shades of red and orange, so today’s “take a break” is all about going outside and collecting leaves from your neighborhood. There are so many ways that you can use these leaves, but since I adore chocolate in all forms, my first suggestion is making chocolate leaves.

 While traditionally lemon leaves are used for this, how many of us are fortunate to have lemon leaves in our yards? However, as long as the leaves are free of pesticides and non toxic, you can use them for this project. Rose and grape leaves are fine. So before you start this project, check with your state’s garden hotline to make sure the leaves you are using are safe. Greener leaves that have pronounced veins work best for this project.

To get started wash and dry the leaves carefully.

Melt chocolate. You can use a water bath or place the chocolate in the microwave for 30 second bursts so that it doesn’t burn. “Paint” the chocolate onto the back side of the leaf, you can use your finger,  and place on wax or parchment paper to dry. I generally put them in the refrigerator. Once hardened, peel holding onto the stem. Store the leaves in the refrigerator until ready to use.

You can use white chocolate and add a little bit of food coloring to obtain the reds, yellows and oranges of fall. While there are specific colorants you can purchase for white chocolate, regular food coloring, with a little bit of oil, works. The colors are not going to be a bit muted with this technique. 

One idea for a terrific dessert is to take a chocolate leaf, place a single berry (such as a strawberry, raspberry or blackberry) with a smidge of whipped cream. How elegant!

For more tips, watch the video How to make chocolate leaves. 

Some other leaf projects:

Paint on Leaves: The leaf is your canvas. Just about any leaf will do, but the bigger the better. Unfortunately, you wont be able to really paint them right away, but you can begin the process.

Step 1: Place leaves with their stems between paper, under books or bricks, and let dry and flatten.

Step 2: Once dry, soak them in water, so they will become soft and pliable.

Step 3: Paint with acrylics.

Step 4: Consider framing.

Painting on Leaves GHCA. 

Cut patterns into dry leaves: Use the same process above for leaf preparation, and then gently cut out designs. For inspiration, check out Lorenzo Duran’s amazing leaf cuts 

Preserving Leaves 

Make Roses from Maple Leaves: I did this last fall and the results are amazing. 

Change Happens: Gaining a Better Perspective on It

As a kid when something happened we didn’t like, particularly if it was something you really had no control over, it was common for adults to say, “It’s like the weather. Don’t like it?” Wait a bit and it will change.”

The knowledge that changes can and will continually happen, can be comforting. It can also be terrifying and cause considerable fear and anxiety. There are times we become frustrated with how slow a change is coming and other times, it seems like we are trying to ride life with the brakes on in an effort to keep things constant.

Whether the change is good (your blood work comes back with excellent results), bad (you have a flare in your chronic condition), outside your control (the doctor you like is leaving the center where you receive your care), it’s a normal part of life (the transition from summer to fall), or it’s major (the death of a loved one) adjustments need to be made. Sometimes it’s easy and other times it feels like it will knock you to the ground.

Good or bad, change is a source of stress, and stress, while having both good and bad components, can have major implications for someone with a chronic condition.

In 1967, Thomas Holmes and Richard Rahe examined the medical records of over 5,000 subjects as a way to determine whether stressful events (all involving change of one sort or another) might cause illness. Research indicates a correlation between a high score on the Holems and Rahe Stress Scale and illness. 

While an interesting tool to gage how changes in your life could be impacting your health, note that this stress scale is weak in certain areas. They list the number one stressor as being death of a spouse, but don’t list the death of a child at all. There are also cultural differences, let alone individual variations. Still it’s an interesting way to see what might be contributing to your emotional well being. A score of 300 suggests a very high risk of becoming ill.

So what does it take to get to 300? Let’s take the scenario of Jane, not a real person,  who happens to be living with multiple sclerosis (MS). At Christmas (12), she is having difficulty sleeping (16) because she just moved into a condo (28) due to a divorce (73). To make things even more difficult, her mother is sick (39) and she’s started a new job (39). Even though the job pays more, Jane is worried about making payments on her new mortgage (31), since she alone will be responsible for it.  Her former mother-in-law, who she once really liked,  is sending nasty e-mails (29)-“How could you be so mean to my son!” The new job requires longer hours (20) with more responsibilities (29) and consequently Jane’s diet consists of a bagel for breakfast and little else until dinner time, when she pigs out uncontrollably (15). To top it off, Jane got a speeding ticket (11), because she overslept and was rushing to get to work on time. While she doesn’t normally stay out on “school nights,” she had a late dinner with her best friend Paula, whom she normally talked to almost daily. She hadn’t seen her in a month because of all the changes in her life (18). So if my math is correct, Jane has a stress score of 360 and chances are quite high that a flare of her MS will be greeting her in January.

Using Jane as the example, here are some ways to deal with change so it doesn’t make you sick

• The serenity prayer is a good one to keep in mind. “Grant me the serenity to accept what I cannot change, the courage to change what I can, and the wisdom to know the difference.” Jane can’t change that it’s Christmas or that her Mom is sick. However, she can change how she reacts to them. For example, instead of trying to be the most devoted daughter possible, she can work with a sibling to set up a “Lotsa Helping Hands” website so family and friends can help with appointments, rides, meals etc.

• The courage to change is huge for some, while others are totally addicted to it and can’t stand it if things are constant for too long. While there are all sorts of stress scales out there, doing something like the Holems and Rahe Stress Scale can help you recognize there are reasons for why you may be feeling so overwhelmed.

 In Jane’s case, of the more than 10 stress factors in her life, half are things she could change- she has a choice in whether she takes a new job and the host of new responsibilities that goes with it, stays out late when she knows she has to work the next day, doesn’t adhere to a healthy diet, doesn’t stay connected to friends and makes a large purchase-the condo- when she’s unsure of her finances. For the remaining stressors, she may or may not have choices in their happening-such as the divorce itself or an irate mother-in-law, but again she does have choice in how she responds.

• An outsider might view Jane’s life and say, “what chaos.” However, if we asked Jane’s best friend Paula, she might reply, “Oh that’s Jane. The more drama and chaos the happier she is. She wouldn’t know what to do if she wasn’t having a fight with someone or didn’t have some crisis to deal with.” Interestingly, her other close friend Anne has a totally different take. “I haven’t heard from her in months and I know she’s under a lot of unusual stress. That’s just not like her.” Regardless of what makes Jane tick, she’s clearly on over load and heading for a major flare of her MS, with significant consequences on multiple fronts.

• To reduce the impact of change and drama in life, consider the following:

-       Identify the stressors-What can you change? How can you respond differently to those you can’t change?

-       Maintain social relationships. Even if it’s just a few e-mails, stay connected and surround yourself with people who are positive and upbeat. Eliminate or minimize contact with “energy vampires,” those people who drain you of spirit and energy.

-       Laugh

-       Stick to a healthy routine (Eat regularly and be mindful of food choices; Exercise, even if it’s a 10 minute walk three times a day; Sleep between 6-8 hours each night and take naps when you need them.

-       Get professional help if you need it

-       Read Healing the Whole Person: Ways to Increase Well-Being  as there are lots of tips that might be helpful.

Don’t hesitate to remind yourself that change is a normal part of life and that you have dealt with it quite successfully before and you will again. Think back to other situations in your life where you have had to adjust to change. How did you cope?

Keep in mind that your brain is wired to be resilient and try to work with it and not against it. Things like being present in the moment and not obsessed with what was or could be, let’s the brain do its job.

Every Wednesday is “take a break day” at this blog and if you don’t like that day’s take a break, there are plenty archived ones. If you haven’t read the post “Why Take a Break,” do so as it explains how creative work helps us relax and become more mindful. From this vantage point, you will have more insight in ways to deal with the changes and stressors in life and ultimately make choices that are more likely to increase healing, well being and contentment.

In closing, keep in mind that change can be transforming. It may be the course correction that your life needs to put you where you need to be, which may not necessarily be where you think you should be. Ultimately, as one gent I worked with many years ago in AIDS would frequently tell us, “it’s all a process. Trust in it.”

National Take Back Initiative

The Drug Enforcement Administration (DEA) has scheduled another National Prescription Drug Take-Back Day which will take place on Saturday, September 29, 2012, from 10:00 a.m. to 2:00 p.m. This is a great opportunity for those who missed the previous events, or who have subsequently accumulated unwanted, unused prescription drugs, to safely dispose of those medications. To learn about where to take medications in your community go to http://www.deadiversion.usdoj.gov/drug_disposal/takeback/

Take a Break: Do It Yourself As Seen At the Fair Items

This is the time of year that there are loads and loads of fairs, be they fall or harvest festivals or something else. The state and county fairs will generally have “better living” exhibit halls, where you can see lots of demos for “as seen on TV” items or actually see something new and unique.

This past Sunday, I went to the Big E,  because my husband’s band was performing for the Vermont House-each of the New England states has a “house” or exposition center.  I saw a few things that caught my interest, or outright made laugh, so I decided to go online and see if I could replicate them, or at the very least, find them on line. I had a lot of fun writing this week's "take a break" and I might just have to go back to the fair to see what else can be easily replicated or debunked. 

Infinity Lights: They are actually Universal Lamp Shade Polygons. Dan Goldwater, who is co-founder of Instructables has deconstructed the lampshade and includes the shape you can download and copy. I tried paper and found it too flimsy. Cover stock worked, but the website provides various suggestions for materials. However, for assembling, use the Infinity Lights  website. Once you get the hand of it, don’t be afraid to make bigger or smaller sizes. Really tiny ones could make very interesting Christmas tree ornaments.

Slushy Magic: This is a product very heavily advertised on the Cartoon Network and other kid programming. The kids at the Big E were glued to repeated and repeated again sales pitches. The much advertised product is plastic ice cubes (that’s the magic part) filled with salt water, frozen and then placed in a cup with something liquid that would taste great as a slushy. It’s basic science –salt water freezes at a lower temperature than water. Once it’s frozen, juice, soda etc., that comes in contact with it will rapidly freeze. It’s the same principal for making ice cream in a bag. Since this product was selling for $29 on TV-but only $20 at the Big E- the Coupon Maven figured out a very low cost alternative. 

Scrape-A-Round: When you live in rural Vermont, people take their windshield scrapers pretty seriously. I had to laugh at this product, as it’s basically a plastic funnel (they refer to it as a cone-shaped design). It’s suppose to scrape windows cleaner in half the time. I particularly like this aspect of their marketing, “by removing the cap, the Scrape-A-Round doubles as the ideal shaped funnel for adding antifreeze and windshield washing solution.” Get a grip! It’s a funnel, that you can pick up at your local Dollar Store for a buck versus the $15 for three they are asking for on-line. If it really works the way they advertise, I’ll probably purchase a few plastic funnels from the Dollar Store and paint something on them as Holiday gifts.

ShamWow!: I’ve watched this guy hawk his wears for years at the Big E. Ten years ago, you’d see people gathered around the stall and many bought them. This year, I didn’t see anyone walking around the fair grounds with ShamWow. Microfiber products, which abound at the local Dollar Store, have saturated the market and work quite well. Besides they don’t have a funny smell. You can read more about product comparisons at A Dumbass Investigates the ShamWow.

Dip Mixes: These vendors are very popular, with their array of dip and soup samples and loads of tiny stick pretzels. In truth, you can open a packet of dried Knorr’s vegetable soup, onion soup or ranch dressing and mix with yogurt, mayonnaise and/or sour cream, which tastes just as good or better than most of these dips and costs a lot less. Want something different? Just Google it.

Instant Heat/Cold packs: There were a variety of products that would provide instant heat or cold. The simplest and most environmentally friendly way to handle the need for instant heat is to take two pieces of cloth and sew together and fill with uncooked rice, beans, flax seed, wheat, feed corn, buckwheat hulls, or barley. Don’t sew? Take a sock (preferably clean), knot and fill with any of the items above, and knot again. Place in the freezer for cold and put in the microwave for a minute or so for warmth.

CAM Treatments: Acupuncture

Complementary and alternative medicine (CAM), refers to those practices that are not typically the first approach to treatment offered by Western medicine. Spend any time in a major medical center these days and you’ll see a number of different CAM approaches being offered-from massage therapy, touch therapy to acupuncture. In fact, many doctors, dentists and other medical providers are being cross trained in various aspects of CAM. The National Institutes of Health (NIH) has the National Center for Complementary and Alternative Medicine (NCCAM), and well respected institutions, like the Mayo Clinic, include CAM treatments as part of their information on Diseases and Conditions.

In continuing the series on CAM practices, this post focuses on acupuncture. A meta analysis (a study looking at lots of different research), released this week, has found that acupuncture does relieve pain. The 29 studies reviewed included almost 18,000 patients. The researchers concluded that acupuncture works better than usual pain treatment and slightly better than fake acupuncture. The results "provide the most robust evidence to date that acupuncture is a reasonable referral option," wrote the authors, who include researchers with Memorial Sloan-Kettering Cancer Center in New York and several universities in England and Germany. Archives of Internal Medicine 9/10/12.

According to NCCAM, which funded the study, The term “acupuncture” describes a family of procedures involving the stimulation of points on the body using a variety of techniques. The acupuncture technique that has been most often studied scientifically involves penetrating the skin with thin, solid, metallic needles that are manipulated by the hands or by electrical stimulation.

Practiced in China and other Asian countries for thousands of years, acupuncture is one of the key components of traditional Chinese medicine. In TCM, the body is seen as a delicate balance of two opposing and inseparable forces: yin and yang. Yin represents the cold, slow, or passive principle, while yang represents the hot, excited, or active principle. According to TCM, health is achieved by maintaining the body in a “balanced state”; disease is due to an internal imbalance of yin and yang. This imbalance leads to blockage in the flow of qi (vital energy) along pathways known as meridians. Qi can be unblocked, according to TCM, by using acupuncture at certain points on the body that connect with these meridians. Sources vary on the number of meridians, with numbers ranging from 14 to 20. One commonly cited source describes meridians as 14 main channels “connecting the body in a weblike interconnecting matrix” of at least 2,000 acupuncture points. NIHCAM

How exactly and why acupuncture works is unclear to western science, so that alone will cause some providers to dismiss it out of hand. Others, who have seen the impact on patients not only refer to acupuncturists, but some have been crossed trained in the discipline.

Acupuncture is often used to treat various types of pain, including headache, migraine, joint, dental, post operative and chronic. It’s also being used for a variety of other conditions including: post operative nausea and vomiting; allergies; fatigue; depression; anxiety; menopausal symptoms; digestive disorders, including irritable bowel; infertility; insomnia and to ease the side effects of chemotherapy.

In traditional Chinese medicine, acupuncture involves inserting long, very thin needles just beneath the skin's surface at specific points on the body to control pain or stress. Several weekly sessions are usually involved, typically costing about $60 to $100 per session.

Things to consider about acupuncture

• While some insurance companies cover acupuncture treatment, others, including Medicare, do not.

• There are relatively few complications from the use of acupuncture. However, it can cause potentially serious side effects so find a qualified practitioner. The FDA does regulate acupuncture needles and requires that be sterile, nontoxic and labeled for single use. Practitioners should use a new set of disposable needles taken from a sealed package for each patient and should swab treatment sites with alcohol or another disinfectant before inserting needles. When not delivered properly, acupuncture can cause serious adverse effects, including infections and punctured organs.

• To find a qualified acupuncturist, consider the following:

- Many doctors, dentists and other professionals are trained in acupuncture.

- Ask your provider for a referral. Many medical providers have acupuncturists that they work with.

- Most states require a license to practice and have specific laws pertaining to the practice of acupuncture. Check to make sure your acupuncturist has such a license and operates within your state’s laws. Check the national and state list of Acupuncture Organizations from Acupuncture Today

- Ask family and friends who have recently had acupuncture about providers they liked.

- Many whole food stores, yoga centers and even business directories will provide lists of acupuncturists in your area. Be sure to check qualifications.

- Find out about pricing and payment before you begin treatment.

Take a Break: Gargoyles, Chimeras and Haiku

I’m still under the spell of Paris, where I fell in love with the gargoyles and chimeras. It’s important to set the record straight about these creatures. First of all, a true gargoyle is basically a drainpipe, designed to get water off the roof and away from the building. There is a trench in the gargoyle and the water typically comes spurting out of their mouth. Yes, Notre Dame is loaded with them as are several other buildings in Paris.

Often referred to as gargoyles, the creatures perched on the balcony of Notre Dame are actually “chimeras,” which are mixes of different types of animal parts. I couldn’t help but imagine them having conversations, as some of them looked down right bored.

“Look at that gal getting off the bus. Does she really think that’s an appropriate outfit to wear to church?”

“Geesh, same view for 850 years. You’d think they’d let me move around or something.”

“If that little kid screams one more time, I’m going to give him something to scream about.”

Today’s post is writing a haiku about what the gargoyles and/or chimeras of Notre Dame might be saying. For example:

See the American guy

Staring at me

Very scary dude

Need some inspiration on writing? Check out Creative Writing: A Master Class. This is free from the Academy of Achievement and includes such writers as John Irving, Alexander McCall Smith; Toni Morrison, John Updike, Nora Ephron and many more.

So if you aren’t in the mood for poetry or writing, what about making a nice Dryad Bracelet? Easy to make and can put you in a fall mood.

Reflections on Paris: And that relates to chronic conditions how?

This week we settled our son into an incredibly small room, a seven story walk up no less, as he starts his freshmen year at the American University of Paris. When your last child leaves home, be it for college or some other reason, it certainly gives one pause. However, when they are six times zones away, on a different continent and in the very amazing city of Paris, the thoughts become a bit different.

There is much to love about Paris. Sunday is a day of rest for the city, a welcome change from the US where it’s business as usual for many places. Every few feet there is a café, where the chairs are positioned so you look out on the street, sidewalk or incredible gardens. Parks are in abundance and, if you arrive six hours before your hotel is available, which we did, check your luggage at the hotel and take a refreshing nap on the grass in the shadows of the Eiffel Tower. Lots of interesting things to see and do-they even make it affordable to see various museums, as the first Sunday of the month is free admission. The food is delicious (oh, those macaroons), and maybe what I loved the most, it’s a city designed for walking. Oh, I almost forgot the Seine. You must have flowing water and the Seine is a joy to walk along.

That noted, I found the continual reminders of conflict, war and struggle, via the variety of memorials that seemed to be on every street corner and bridge, to be quite depressing at times. Signs appeared in all sorts of places pointing to the homes or hangouts of the once famous or infamous.

My sense was that the city was memorializing what was and not celebrating and exploring what they could be. At Parent Orientation, the Dean of Students noted, as he hummed a few bars of France’s national anthem, “you wont hear a lot of that at the Olympics. We don’t produce great athletes, but we have great museums.”

On the flight home, I found myself mulling over my impressions of Paris-noting that I was in the old part and not the business district- along with this new stage of life. I decided that I didn’t want to be like this city, focusing so much on what was. Rather, what could I create in this new phase of life?

My first thought was that when my next passport is up for renewal, I want to be traveling and exploring so much that I need extra pages for the stamps from the various countries I’m visiting. Paying for such travel is an issue, but I have some ideas. For starters: anybody out there interested in having me as a guest speaker, run a workshop or program, teach a course? I’m a good public speaker, have lots of experience and am very affordable. What about an article or two?

But I digress from what I learned about life in the chronic disease lane while in Paris. There were the usual reminders, such as

• Be aware of your past, embrace your future, but most importantly, live in the present.

• Take advantage of life’s cafes-stop, take breaks and just observe

• Get out and walk. Find the parks and bright spots where you can enjoy the sunshine.

In watching how people were trying to fit in, and how much I didn’t, it made me think about the isolation that happens so frequently with people dealing with serious illness. There was no way I was going to become French proficient or turn myself into a high fashion Parisian female in a week, Actually, the latter would never be an option. I was the only person in Paris wearing Keen sandals. Now there's a fashion statement!

I couldn’t help but think of the incredible amounts of energy we expand trying to fit in. Whether it’s an illness, or circumstances, we can easily make ourselves feel alone and isolated. The bottom line is that we all have considerable value, no matter how we appear, speak, act, or what our health status might be. Our best is more than good enough. To read more on this topic, check out the following:

• Your Best is More Than Good Enough

• The Lonely Season by Martha Beck

The most eye-opening event of the trip happened minutes before we were home. Having been awake, due to our travel schedule, for 24 hours, I was driving while my husband periodically dozed. Shortly after we entered our town, I suddenly felt a pull on the steering wheel. I had fallen asleep and was drifting off the road. It scared me no end. In fact, when we made it home, I couldn’t sleep as I realized how easily we could have been hurt or worse.

Given that it was almost exactly five years to the day when I was trapped in our house fire, it’s not surprising that this incident put me off kilter. At some point, I had to stop worrying since the combination of jet lag and an inability to sleep is not a good scenario and terribly unhealthy.

Once again, I was reminded that there are far greater powers at play then myself. Again, I had a sense, or a reminder, that there are things I need to do. There is a purpose for me.

I can’t say exactly what I am suppose to be doing or why I was spared from the fire or from a nasty road accident. However, I have come to believe that the universe does seem to have a scheme and it’s best to try and flow with it instead of fighting it.

Saying yes to the universe doesn’t mean I want bad things to happen to me or anyone else. I learned an important lesson, which I won’t soon forget, about trying to push my body when it’s over tired and stressed. Instead I am a bit better at accepting of what happens. By understanding that there is a bigger picture and there is connectedness among us, I can deal much better with life. Consequently, I am a lot more content, which is so good for well-being.

As Ben Franklin, who enjoyed Paris, noted, Happiness consists more in the small conveniences of pleasures that occur every day, than in great pieces of good fortune that happen but seldom to a man in the course of his life.”

Take a Break: Use the Vanilla Bean for Holiday Gifts starting now

I returned home in the early hours of Sept. 5 from taking my son to college. Parent orientation just happened to be in Paris, France, where he is attending the American University of Paris. Needless to say, today's "take a break" is inspired by the wonderful food we were surrounded by, particularly the most amazing macaroons.

Have you ever made your own vanilla? If you haven’t, it’s very simple and better yet, it makes a great gift. However, you have to start two months in advance of when you want to give it.

The recipe is simple:

- 3 vanilla beans (cut lengthwise down the middle)

- 1 cup vodka

- glass jar with tight fitting lid

Make sure the vodka covers the beans. Mason jars are great for this. Store in a cool, dark space for a minimum of two months. Shake periodically and watch the color change.

Vanilla beans purchased on-line are going to be about half the price of ones you purchase at a store.

If you have friends that are gluten intolerant, (Celiac’s Disease), you need to be very careful about what type of vodka you use. While the following are gluten free vodka’s, if you get to the liquor store and forgot the list, just ask: Star Vodka, Tito Vodka, Chopin, Ciroc and Ketel One

Vanilla sugar is also a delicious treat. Take 2 cups of regular granulated sugar and 1 vanilla bean. You can put in a food processor and blend together, or slice down the side of the bean and scrape seeds into the sugar. Bury the bean into the sugar and store in an airtight container for several weeks. If you have left over vanilla bean skins (the seeds have been used in another recipe) just bury them in sugar and let them site. Use the vanilla sugar for cookies, coffee or whatever.

Use the vanilla to make some spectacular gifts for the holidays including, Vanilla Almonds.