Ask a Registered Nurse

Question: I have a grandmother with insulin-dependent diabetes.

My father has diabetes, but it is controlled by oral medication. Can you please tell me my risk factors of my getting the disease? I am 28 years old, eat healthy, exercise, and have no symptoms at this time. Thank you.

Answer: (Compiled by Sangita devi dasi, RN, CHPN)

Let us begin by briefly explaining the different types of diabetes.

*Type 1: Generally occurs during childhood and adolescence and results from the body’s failure to produce insulin.

*Type 2: This is the most common form of diabetes, which can occur at any age and results from insulin –resistance combined with relative insulin deficiency.

*Gestational diabetes: Usually occurs halfway through pregnancy as a result of excessive hormone production in the body.

*Pre-diabetes: The stage before diabetes, where blood glucose levels are higher than normal, but not high enough to be diagnosed as diabetes.

What is diabetes? Diabetes is a disease in which the body either does not produce insulin or does not use insulin the way it should be used. What is insulin? Insulin is a hormone made in the organ called the pancreas that assists the body convert glucose (sugar) into energy. When insulin is not produced or is used improperly, glucose builds up in the blood and can very well lead to complications in the way the body intricately functions.  Diabetes can lead to heart disease, stroke, blood vessel disease, high blood pressure, high cholesterol, eye problems/blindness, kidney disease, and nerve damage.

Since you asked me about risk factors that may put you at risk for developing diabetes, I will post this short test for you to take. Remember that certain factors, such as obesity, poor eating habits, and lack of exercise are the leading risk factors of diabetes. Certain races have a greater chance of developing the disease including, African Americans, Native Americans, Asian Americans, Latino Americans, Pacific Islanders, and senior citizens of all races.

Take this simple test and know your risk:

Click here For more information and a Risk Test  from the American Diabetes Association

Symptoms to Recognize Diabetes:

1.     Frequent urination

2.     Fatigue

3.     Excessive thirst

4.     Frequent infections

5.     Extreme hunger

6.     Dry, itchy skin

7.     Unexplained weight loss

8.     Slow wound healing

At Vaisnavas C.A.R.E. we always recommend you see your healthcare practitioner for more information and guidelines to follow in order to prevent you from developing any disease or to keep such a serious disease as diabetes under control.

Thank you.

Suicide
July, 2008

Question: “I was very sad when I read about another ISKCON youth in our movement who committed suicide. How unfortunate for his family, especially his mother. Being the mother of teenagers, can you please explain what brings one so young to the point of suicide and what are the signs we, as parents, should be looking for”?

Answer: (Compiled by Sangita devi dasi, RN, CHPN, Certified Hospice Educator) It is difficult to comprehend that suicide is the third leading cause of death for young people ages 10-24, according to the U.S. Centers for Disease Control and Prevention (CDC). Risk factors for suicide in this young population group include substance abuse, depression, and mental illness, such as bipolar disease and schizophrenia. Another risk factor for many includes social isolation. This is caused when children isolate themselves from their peers or other youth ridicule them and subject them to isolation. Young people may be dealing with:

• Questioning their sexual identities

• Dealing with shame

• Lack of acceptance from their families

• Bullying from peers and other forms of ridicule from peers

• Interpersonal conflicts at school or in their neighborhoods

It is not that solutions to some of the problems above do not exist. It is just that young people do not often have the ability to see the answers.

The CDC also reports that cultural variations make it more difficult for youth at this age. In fact, Native American/Alaskan Native youth have the highest rates of suicide related fatalities.

What is surprising to know is that children as young as 9 years old commit suicide. Children under the age of 12 have not developed problem-solving skills nor have they fully developed verbal skills nor do they have the ability to express their deep innermost feelings. They are dependents and may be fearful of honestly speaking with their parents or other family members about what they are thinking.

The most common time for a suicide attempt by a young person is during the after-school hours before parents come home from work. The most common weapon used is a gun which accounts for 47% of completed suicides among people of this age group. Hanging/suffocation accounts for 37% and is increasing in girls ages 10-14 years of age. In addition, poisoning accounts for 8% of completed suicides among the young.

Signs to look for in your children and teens:

• Feelings of hopelessness

• Frequent sadness, tearfulness, and crying

• Decreased interest in activities that were previously enjoyable

• Chronic medical conditions or constant complaints of being physically ill

• Boredom, low energy level

• Social isolation

• Poor communication

• Difficulty with relationships

• Low self esteem

• Guilt feelings

• Extreme sensitivity to rejection or failure

• Increased irritability

• Anger or rage or hostility

• Complaints of headaches and/or stomachaches (frequently)

• Frequent absences from school

• Poor performance in school

• Lack of concentration

• Major change in eating and/or sleeping patterns

• Talk or expressions of self-destructive behavior

• Efforts or talk about running away from home

• Sudden cheerfulness after a period of depression signaling relief from suffering that has been achieved by a final decision to commit suicide.

Remember that most people in general, not just young people, do not usually commit suicide while in a deep depression because they simply do not have the energy to do so. They wait until they are just pulling out of the depression to plan the suicide when energy is back and they are able to complete the plan.

Talking with your child at-risk for suicide about suicidal ideation does not cause them to commit suicide, so ask them if they are contemplating suicide, if they have a plan, or if they have access to the means to complete a suicide (for example, if they are planning to shoot themselves, do they have access to a gun). Once a person is identified as a high risk for suicide they should not be left alone. Immediately identify resources in your community. Visit the counselor at your child’s school and find a psychologist in your area who cares for children. He or she will most likely refer you to an inpatient facility for youth at risk for such dangerous self-destruction.  Notify your child’s teacher of the problem. According to the ages of your other children at home, gently explain the situation to your other children or other members in the family so all are aware of the danger that is right in front of them. Build a closer family bond.

Call a suicide hotline in your community for other resources and information. The number is in your local phone book. Call your local hospital and ask for the psychiatric department. Please do not wait until your child attempts suicide to find the resources right in your neighborhood. Get help now. Keep making calls until you receive the right type of assistance for your child or teen.

If you have any stories or advice you would like to share with our readers, please send them to jusaniya@vaisnavascare.com They will remain anonymous if you desire.

Thank you very much. You could help to save a precious life today.

Your servant,
Sangita devi dasi

On behalf of the V-CARE Volunteer Team

June, 2008

Question: My doctor told me I might have Chronic Fatigue Syndrome because I am always tired and cannot seem to get enough sleep. Can you please give me a simple explanation of what is Chronic Fatigue Syndrome?

Answer by Sangita devi dasi, RN, CHPH, Certified Hospice Educator:

Most people feel tired at night, get sleep, and feel refreshed in the morning. With those who are diagnosed with Chronic Fatigue Syndrome (CFS), which affects over one million people in the United States alone, bed rest and sleep does not ease their weariness. It is usually found in people ages 25 to 45. However, teens are often diagnosed with this illness as well. Women are diagnosed with CFS more often than men. This may just mean that women report their symptoms to their physicians more often than men.

Those with severe Chronic Fatigue Syndrome have problems simply performing their normal daily activities. For those without this disease, it is difficult to imagine staying that exhausted and tired during the entire day, so much so that you can fall asleep at any time with no relief.  CFS is hard to diagnosis at times due to the fact that it is often mistaken for other diseases such as mononucleosis, Lyme disease, thyroid conditions, diabetes, multiple sclerosis, some types of cancer, depression and bipolar disorder.

An international panel of CFS research experts formed a definition in 1994 to assist physicians to better diagnose the disease. Patients diagnosed with Chronic Fatigue Syndrome usually have:

1.     Severe chronic fatigue for at least six months after ruling out other known medical conditions

2.     Four or more of the following symptoms at the same time:

*Substantial impairment in short-term memory or concentration

*Sore throat

*Tender lymph nodes

*Muscle pain

*Multi-joint pain without swelling or redness

*Headaches of a new type, pattern, or severity

*Un-refreshing sleep

*Feeling very tired for at least 24 hours after performing normal physical activities
 

Unfortunately, there are no specific diagnostic tests to confirm a person has CFS. In addition, there is no cure.  Many doctors recommend a change in life-style, for example, reduced stress, stretching exercises, and nutritional supplements. For many with Chronic Fatigue Syndrome, many of the symptoms decrease in time. Some even improve in a year or two of being diagnosed with no further relapses.

Please speak with your healthcare practitioner if you have any of the symptoms above or if you have any questions about what you think may be CFS. Thank you very much.

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April, 2008
 
Question: Can you please tell me something about Reflexology and how it works? Thank you very much.
 
Answer by: Susan Pattinson, RN, CHPN, Certified Hospice Educator
 
Reflexology is a method of using the thumb and fingers to stimulate the reflex areas that relate to different parts of the body. This can trigger physiological changes that empower the body and mind to heal itself.
 
Basically, this method of treatment works on many levels by being a deeply relaxing therapy that stimulates the circulatory and lymphatic systems. It helps to release any blockages in the flow of energy around the body. It also allows energy to move freely, enabling us to stay in a healthy state of being.
 
Simply stated, the body is divided from head to toe into 10 energy zones. There are five zones on each side of the midline, which runs down the center of the body. As we now know, energy is constantly flowing through these zones. The flow of energy ends in the feet and hands. There, reflex points are formed. The right foot represents the right side of the body and the left foot represents the left side of the body. It is interesting to note that when there are organs on both sides of the body, such as the lungs, the right lung will be found on the right foot and the left lung is found in the left foot.
 
Benefits of Reflexology include:
 
It clears away blockages in the flow of energy around the body which helps to:
 
1. Reduce stress and tension
2. Improve circulation
3. Decrease or remove pain
4. Balance the nervous system
5. Enhance the lymphatic system
6. Improve sleeping problems
7. Increase energy
8. Detoxify and cleanse the body
9. Improve skin tone
10. Help to promote self-healing
 
A brief history of Reflexology begins in ancient texts from China, Japan, Russia, and Egypt. Early doctors in China made equal use of acupressure and Reflexology. Eventually, acupuncture was introduced and Reflexology was all but forgotten.
 
A doctor by the name of Dr. William H. Fitzgerald is known to have laid the foundation of modern Reflexology in 1917. He wrote about his "zone therapy" and found he could control patient's pain in other parts of the body by working the "zones" in the feet or hands. His work was further developed by an American physiotherapist, Eunice Ingam, with the discovery that the feet were more responsive to pressure than the hands. She drew a map of the body and expanded on Dr. Fitzgerald's "zone theory" by corresponding the body parts to the points in the feet. Each organ, gland, and body part corresponded to reflexes found in the feet.
 
The first Reflexology Association was started in America in 1973. This practice has now spread worldwide. Many hospice and palliative care facilities, as well as nursing homes, use Reflexology on a regular basis to treat their patients.
 
I hope this gives you the information to get you started and that you will continue your research and knowledge of this complementary therapy. If anyone has further information to offer, please send it to: jusaniya@vaisnavascare.com. Thank you.
 

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February 4, 2008

Question: A childhood friend of mine has been diagnosed with Lou Gehrig’s disease. Can you explain something about this illness?

Amyotrophic lateral sclerosis, or ALS, is a disease of the nerve cells in the central nervous system or the brain and spinal cord. These nerve cells are responsible for voluntary muscle movement. Many people know ALS as Lour Gehrig’s disease, named for the famous baseball player, Lou Gehrig, who suffered from the illness for years. In approximately 10 percent of all cases, ALS is caused by a genetic defect. In other cases the cause is unknown. At present, there is no known cure for ALS. In this illness, the nerve cells, or neurons, waste away or die over time, and can no longer send messages from the nerves to the muscles. Eventually, this leads to muscle weakening, twitching, and an inability to move the arms, legs and body. ALS slowly worsens. Eventually, when the muscles in the chest area stop working, it becomes difficult or impossible to breathe on one’s own. Patients with ALS often choose to be placed on a hospice program when they choose to have no aggressive treatment at this point, meaning they wish to die naturally with dignity and no placement on a ventilator or breathing machine. Others choose to be placed on a ventilator in order to live a longer life. It is an individual decision and we should not pass any judgment on anyone’s decision either way. Additional symptoms that may be associated with this disease:

*Muscle contractions
*Muscle atrophy
*Muscle spasms
*Ankle, leg, and feet edema (swelling)
*Weight loss
*Drooling
 
Symptoms usually do not develop until after the age of 50 although I have had patients who were much younger.  Those with ALS have a loss of muscle strength and coordination that eventually progresses. Every day, common activities such as getting out of a chair or walking become impossible. Sometimes, the muscles that effect breathing and swallowing may be affected first.  As ALS worsens, more muscle groups develop problems. It does not affect sight, smell, taste, hearing, and touch. The patient also remains continent of bladder and bowel. Generally, ALS patients keep their intellect, but occasionally he or she may laugh or cry uncontrollable without reason.  This is often known as “emotional incontinence.”
 
Other symptoms include:
 
Muscle weakness (decrease in muscle strength and coordination slowly develops)
Muscle weakness slowly worsens and commonly involves one limb first, such as one hand.
Paralysis
Muscle cramps
Voice changes such as hoarseness
Speech problems, such as slow or abnormal speech patterns
Difficulty swallowing, gagging, or choking
Difficulty breathing, requiring increased effort to breathe
 
Some tests that may be done include:
 
*EMG to see which nerves are not functioning normally
*MRI of the head to rule out other diseases such as a brain tumor, for instance.
*Genetic tests, to see if there is a history in the family of ALS
*Breathing tests to see if the respiratory muscles are affected
*Blood tests to rule out other conditions that may cause similar symptoms
 

In conclusion, ALS is a most awful disease to live with. Many patients live for years with the illness, even up to 20 years (rare). Most of the ALS patients I have cared for in hospice lived approximately 8 years or so. It is hard on the family caregivers because at a certain stage, the ALS patient requires 24-care, around the clock. It can be exhausting for the family members and patients may become depressed feeling as though he or she is a burden to loved ones.

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January, 2008

Preschooler Development

Question: I have a 3 and ½ year old daughter and would like to know the normal development of this age group. Can you give me some pointers?

Answer: By Susan Pattinson, RN, CHPN

Basically, the definition of the normal social and physical development of children ages 3-6 years old includes many important milestones in a child’s early years. I will list them in various categories.

Physical Development:

*Gross motor development in the 3-6 year old should include: 

•       Becoming more skilled at running, jumping, early throwing and kicking

•       The ability to catch a bounced ball

•       The ability (at 3 years) to pedal a tricycle but perhaps not steer well until around age 4

•       The ability (at around 4) to hop on 1 foot, followed with balancing on 1 foot for up to 5 seconds

•       The ability to perform heel-to-toe walk

*Fine motor development milestones should include:

• The ability to draw a circle upon request at about 3 years

• Drawing a person with 3 parts

• Beginning use of children's blunt-nose scissors

• Self-dressing (with supervision)

• The ability to draw a square by age 4

• The use of scissors progressing to cutting a straight line

• The ability to put clothes on properly

• Managing spoon and fork neatly while eating

• Spreading with a knife by about age 5

• The ability to draw a triangle

LANGUAGE DEVELOPMENT:

• The 3-year-old uses pronouns and prepositions appropriately

• The 4-year-old begins to understand size relationships

• The child enjoys rhymes and word play

• The 5-year-old shows early understanding of time concepts

• The child is able to follow 3 simple commands

Stuttering:

Stuttering may commonly occur in the normal language development of children 3 - 4 years of age. It occurs because ideas come to mind faster than the child is able to express them. It more commonly occurs if the child is stressed or excited. When the child is speaking, give your full, prompt attention, and do not comment on the stuttering. If the stuttering is accompanied with other signs, such as tics, grimacing, extreme self-consciousness, or if the stuttering persists longer than 6 months, consider having the child evaluated by speech pathologist.
 

BEHAVIOR:
The preschooler learns the social skills necessary to play and work with other children. As time passes, the child's ability to cooperate with a larger number of peers increases. Although 4- to 5-year-olds may be able to start participating in games that have rules, the rules are apt to change frequently at the whim of the more dominant child.
It is common, within a small group of preschoolers, to see a dominant child emerge who tends to boss the others around without much resistance from the other children.
It is normal for preschoolers to test their limits in terms of physical abilities, behaviors, expressions of emotion, and thinking abilities. Having a safe, structured environment within which to explore and face new challenges is important, but well-defined limits must be included.
The child should display initiative, curiosity, the desire to explore, and enjoyment without feeling guilty or inhibited.
Early morality develops as egocentrism gives way to the desire to please parents and others of importance. This is commonly known as the "good boy" or "good girl" stage.
Elaborate story-telling may progress into lying, a behavior that -- if not addressed during the preschool years -- may continue into the adult years. Mouthing-off or backtalk in the preschooler is usually a means of getting attention and attempting to elicit a reaction from the adult it is directed toward.

SAFETY TIPS:
Safety is extremely important for preschoolers.

The preschooler is highly mobile and able to quickly get into dangerous situations. Parental supervision at this age is essential, just as during earlier years.

Car safety is critical. The preschooler should ALWAYS be in a child seat/booster with seatbelt when riding in the car. At this age children may be riding with other children's parents. It is important to review with others, who may be supervising your child, your rules for car safety. (a great site with child ages/stages and types of car restraints to use can be found here --this is an outside link, hit your browser back button to return)

Falls are a major cause of injury for the preschooler. Climbing to new and adventurous heights, the preschooler may fall off playground equipment, bikes, down stairs, from trees, out windows, and off roofs. Lock doors that access dangerous areas (such as roofs, attic windows, and steep staircases) and provide strict rules for the preschooler to understand areas that are off limits.

Kitchens are a prime area for a preschooler to incur burns, either trying to help cook or coming in contact with appliances left to cool off. Encourage the child to help cook or learn cooking skills with safe, cool recipes. Maintain alternate activities for the child to enjoy in an adjoining room while cooking, keeping the child away from the stove, hot foods, and other appliances.

Keep all household products and medicines safely locked out of the reach of preschoolers. Know the number for your local poison control center. The National Poison Control Center (1-800-222-1222) can be called from anywhere in the United States. You should call if you have any questions about poisoning or poison prevention. It does NOT need to be an emergency. You can call for any reason, 24 hours a day, 7 days a week.

Because language skills develop at a rapid rate in the preschooler, it is important for parents to read to the child regularly and talk with the child frequently throughout the day.

Discipline measures for the preschooler should provide opportunities for making choices and facing new challenges while maintaining clear limits. Structure is important for the preschooler, and having a daily routine (including age-appropriate chores) can help a child feel an important part of the family unit and enhance self-esteem. Reminders and supervision may be necessary for such chores to be accomplished. Recognizing and acknowledging good behavior or a chore performed correctly or without extra reminders are extremely important. Take the time to note and reward the good behaviors.

From age 4 to 5, backtalk frequently occurs. Parents are encouraged to address such behaviors without reacting to the words or attitudes presented by the preschooler. If the child feels such words provide power over the parent, the behavior will continue. This is one of the hardest areas for parents to remain calm while they try to address the behavior.

When anticipating a child's entry into school, it is important for parents to keep in mind the wide diversity among children at 5 - 6 years in terms of attention span, reading readiness, and even fine motor skills. Both the overly anxious parent (concerned about the slower child's abilities) and the overly ambitious parent (pushing skills to make the child advanced) can be detrimental to the child's normal progression into the academic setting

If you have any comments or questions, kindly send them to:
jusaniya@vaisnavascare.com

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December, 2007

September 27, 2007
 
Question: I have been married for over ten years. I am ashamed to admit it, but I feel trapped in an emotionally and often, physically, abusive relationship. Can you give me some information to help me? I am sure I am not the only one experiencing this.
 
Answer: By Susan Pattinson, RN, CHPN (Sangita devi dasi, ACBSP)
 
You are correct when you say that you are certainly not the only woman experiencing this type of inappropriate relationship. There are many “red flags” that need to be recognized in order to see warning signs and symptoms of spousal abuse. Seeing these signs and symptoms is the first step in getting free or in seeking assistance to help change the relationship. It is important to mention that in some cultures, it is the general belief and teaching that women should “tolerate” abuse of this type. It may not be openly spoken of, but it is talked about in whispers and behind closed doors. It is even believed in some cultures that to tolerate abuse from your husband shows a high degree of “chastity” on the part of the woman. However, women should never have to tolerate living within a cycle of abuse inside her home, a home which should be her safe haven from the dangers of the outside world. This article is not meant to be a forum for an internet debate. Our only hope is to help those women who need and want assistance in a violent situation and see no way out. (Note: It is important to point out that men are sometimes the victims of abuse and are battered by their wives, but statistics find that women are five to eight times more likely than men to be victimized by a partner.)
 
A basic definition of “domestic abuse,” sometimes called “spousal abuse,” occurs when one person in an intimate relationship or marriage tries to dominate and control the other person. The abuser often uses fear, guilt, shame, and intimidation to hurt and wear down his partner in order to gain complete power over her. An abusive husband may threaten his wife, hurt her, or hurt their children or other relatives (or even a pet) living in the home. Abuse that includes physical violence is called “domestic violence.” Domestic abuse knows no boundaries and can occur within all age groups, ethnic backgrounds, and financial income levels. Violence by one partner towards another is an independent choice made by the abuser to take control over his spouse. It is not necessarily about anger or rage. This is known for the following reasons:
 

The abusive husband does not usually physically hurt other people, other than his wife.

The abusive husband waits until there are no witnesses and abuses the person he claims to love.

When abused women are asked if her abusive husband can stop hitting her when the police come to their home, she will say “yes.” The husband then looks calm while the wife, who has just been beaten, looks hysterical and out of control. If he were really 'out of control' he would not be able to stop himself when it is to his advantage to do so, such as when the police or neighbors arrive at the door.

An abusive husband often increases his abusive behavior from pushing his wife to hitting her in places where the bruises and marks will not show. If it were true that he were 'out of control' he would not be able to think clearly enough to limit where his kicks or punches were directed.

Spousal abuse is used for one purpose and one purpose only--to gain and maintain total control over his victim. In addition, you may recognize some of the following strategies used by your husband to exert power over you:

1. Dominance: Abusive men need to feel in charge of the relationship. Your husband will make all decisions for you and the entire family. He will tell you what to do, and expect you to obey without question. He may even go as far as to treat you like a servant, child, or even as his possession.

2. Humiliation: Your husband will do everything he can to make you feel bad about yourself. He will try hard to make you have very low self-esteem until you feel as though you are worth nothing. This is done because if you believe you are worthless and that no one else will want you, you are less likely to leave him. Insults, name-calling, and shaming you in public places are all his “weapons” of abuse made to grind down your self-esteem and make you feel powerless.

3. Isolation: This is a common tactic used by an abusive husband. In order to increase your dependence on him, an abusive husband will literally cut you off from the outside world. He may keep you from seeing family, friends and neighbors. He may even forbid you from going to work or school. Many abused wives must ask permission to do anything, go anywhere, or see anyone. Most often, her husband will deny her permission in order to keep her more isolated and without anyone to turn to for help. I know of one situation where the abusive husband, a police officer, locked his wife and two sons in a closet every morning before he went to work. Years later, his older son, committed suicide.

4.Threats: Abusive husbands or partners often use threats to keep their wives from leaving them. They scare them from dropping legal charges against them by threatening to kill them or to kill their children or other loved ones. Some abusive husbands threaten to report their wives to child services saying she is an “unfit” mother. He may even threaten to commit suicide if his wife leaves him. Then when she agrees to stay, the cycle of abuse begins all over again.

5. Intimidation: An abusive husband might use many types of intimidation styles in order to scare you into submission. Some of these may include threatening looks or gestures, smashing things in front of you, destroying property, hurting your pets, or putting weapons on display. These messages may be non-verbal, but are heard loud and clear.

6. Denial and blame: Abusive husbands become very expert at making excuses for his inexcusable behavior. They may blame their behavior on an abusive childhood, or may even blame his wife for making him become abusive. In fact, he may often minimize the abuse or deny that it occurred making his abused wife feel like she is literally “going insane.” He may somehow make her feel that the abuse is always her fault for having done something wrong or that she somehow deserve the abuse to occur.

7. Guilt: After the abusive episode takes place, the abuser may feel some guilt, but please understand that this guilt is not due to what he has done to you. It is often over the possibility of being caught and facing legal and social consequences, such as losing his job or social position in the community. After an abusive episode, your husband may apologize for what he has done. His apologies and loving gestures in between the episodes of abuse can make it difficult for you to leave. Your husband may have you believing that you are the only person who can help him. “Things will be different this time,” he may say. Ask yourself how many times he has said these things and how many times the violence has then continued. 

Remember that domestic abuse often begins with threats and verbal abuse and then spirals to physical violence-- and even murder. There are different types of domestic abuse, including emotional, physical, sexual, and economic abuse. Many abusers behave in ways that include more than one type of domestic abuse, and the boundaries between some of these behaviors may overlap. Physical injury may be the most obvious danger, but the emotional and psychological consequences of domestic abuse are also severe. In any society or culture, no one deserves this type of pain! Your first step is to recognize that your home situation is abusive. Please read the signs and symptoms below and ask yourself how many of them pertain to your situation:

1. You are afraid of your husband.
2. Your husband belittles you or tries to control you.
3. Your husband pushes, shoves, hits, kicks, or slaps you.
4. You feel helpless.
5. You feel worthless.
6. You feel trapped and alone.
7. You are afraid your husband will hurt your children or even take them away from you.
8. You avoid speaking about certain topics out of fear of angering your husband.
9. Your husband forces you to have sexual relations when you do not want to. He may even "rape" you.  (This is "sexual abuse.")
10. Your husband tells you it is your fault that he has hit you. Then he promises he will never do it again...but he does.
11. Your husband destroys personal property, especially things that mean a lot to you.
12. Your husband follows you from place to place and does not trust you.
13. Your husband will not allow you to go to school or to work.
14. Your husband denies you money for food, prescriptions, transportation, or your children's needs.
15. A part of you believes you deserve to be hurt or mistreated.
16. You believe that if you had done or said something differently, your husband would not have gotten angry and violent.
17. You sometimes wonder if you are the one who is “crazy.”
18. Your husband embarrasses you in front of others.
19. Your husband tries to isolate you from friends, neighbors, and family members.
20. Your husband ignores you or puts down your opinions. He makes you feel useless and ignorant.
21. Your husband controls the money, the car keys, where you go, and who you see.

There are many more signs, but the more you answered “yes” to the above signs, the more you need assistance. Please call a Women’s Abuse Hotline in your community by looking in your community phonebook or by calling the assistance operator for a hotline in your area. Or consult with someone you can trust who can assist you in finding help and a way out of the situation. The answer is not always having to break up the marriage unless the lives of you and/or your children are in danger. If you feel you or your children's lives are in danger, then you need to leave immediately and find an emergency shelter or other safe haven until the situation calms down and more help can be found. We do not want you to remain part of a growing statistic of domestic violence.

Again, it is important to remember that domestic abuse occurs in every neighborhood and in every socioeconomic background. For more on this subject, we suggest you read the book, "Not to People Like Us: Hidden Abuse in Upscale Marriages" by Susan Weitzman. You can find it on amazon.com.

There are many counseing programs designed to help families trapped in the cycle of domestic violence. Many families who lived for years in a violent situation were changed by receiving family counseling. In addition, seek legal assistance and find out your rights as a citizen. Find help soon. Protect yourself and your children—before it is too late.

In the United States, there is an abuse hotline called SEWAA for women from Pakistan, Sri Lanka, Napa, and India. The phone number is: 1-215-627-3922.

In the United States, there is an abuse hotline called Korean Women's Support Committee--1-215-886-8725.

In the United States, there is an abuse hotline for those who speak Spanish, called Expanol Hotline--1-215-235-9992.

Another one in the U.S. is called: Congreso de Latinos Unidos--1-215-291-8742.

There are help for the abusers. For a man trapped in a cycle of abusing your wife and wanting to stop it, please call the Men's Resource Center at 1-610-971-9310.

It is advised to contact a domestic violence agency BEFORE an emergency occurs. There are domestic violence programs available 24 hours a day, 7 days per week. They are available in many countries around the world. In the West, most countries have several emergency shelters to bring you and your children to in order to avoid another violent situation or to escape one. Appeal to the courts, the legal system, a trusted friend or relative. Keep seeking help until someone will assist you. Go online and search for safe shelters or abuse hotlines in your area of the world. Most are free of charge and volunteers are trained to help you. Talk to someone and if that does not help, talk to someone else. Keep talking until you and your children are safe!

You have the courage to face your fears!

Please contact Vaisnavas C.A.R.E. at jusaniya@vaisnavascare.com if you have more questions. 

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September, 2007

Question: Can you give me some pointers on how I can lower my cholesterol?

Answer: By Sangita devi dasi
(Susan Pattinson, RN, CHPN, Certified Hospice Educator)

Many research studies show that women are more likely to have high LDL (“bad”) cholesterol, than men. However, simple lifestyle changes can help a great deal to lower the “bad” cholesterol as well as raise the “good” cholesterol called HDL..

Consider the following tips: 

1. Obviously, avoid foods high in saturated fats, stop smoking cigarettes if this is a problem because smoking decreases HDL (“good”) cholesterol levels. In addition, work on maintaining an active lifestyle. Estrogen keeps HDL levels high. However, as a woman approaches menopause, estrogen levels drop, and so do HDL levels. Exercise can help keep your HDL levels of “good” cholesterol at appropriate levels.
    

2. Weight loss of 10 pounds if your body mass index is 25 or more can lower cholesterol by 5 to 8 percent. This decreases the amount of fat that goes to the liver where your body produces cholesterol. Therefore, your LDL levels will decrease.
    

3. Eat 5-10 grams of soluble fiber a day. This can lower cholesterol by 3-5 percent. This kind of fiber binds to cholesterol so when it leaves your body, so does the cholesterol. Great sources of soluble fiber are: beans, oatmeal, apples, citrus fruit, broccoli, carrots, and Brussels sprouts.
    

4. Eat about 1 to 1 and ½ ounces of nuts per day. This can lower cholesterol up to 12 percent. Nuts that can lower LDL are: walnuts, pistachios, almonds and macadamia nuts. They can also lower triglycerides and raise HDL due to the fact that they contain healthy monounsaturated fats. These nuts should be raw and unsalted. Include them into your daily calorie count.

Finally, remember that eating actual “good” food will work better than taking a pill (supplement) that is sometimes thought to lower cholesterol levels. Therefore, some people feel that taking the supplements allows them to eat whatever high-calorie, high fat foods they desire. Obviously, we are not discouraging you from taking supplements/vitamins, etc., We are simply saying that to eat a healthy, low-calorie, low-fat diet will do more to lower your LDL cholesterol level and to raise your HDL levels than supplements alone. Side by side, these tips along with good supplements and vitamins can help you to feel better very soon.

Stay healthy!  Please continue to send us your health questions to” jusaniya@vaisnavascare.com.

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August, 2007

Question: Can you explain the eye disease called Macular Degeneration?

Answer by: Susan Pattinson, RN, CHPN (Sangita devi dasi)

Macular degeneration is also known as Age-related macular degeneration or Senile macular degeneration. It is a disorder that affects the macula, otherwise known as the central part of the retina of the eye. It causes decreased visual acuity and possibly loss of central vision, leaving the afflicted person with peripheral vision only. 

The macula is the part of the retina that allows us to see fine details at the center of our field of vision. Degeneration results from a partial breakdown of the retinal pigment epithelium (RPE--the layer between the retina and the choroid which is the layer of blood vessels behind the retina). This RPE acts as a filter to determine what nutrients reach the retina from the choroid. Some components of blood can be harmful to the retina and are kept away from it by normal RPE. When breakdown occurs it interferes with the metabolism of the retina. This causes thinning of the retina, sometimes called the “dry” phase of macular degeneration. These harmful elements may also promote new blood vessels to form and fluid leakage may occur (known also as the “wet” phase of the disease). Symptoms include: blurred vision, distorted vision, or absent of central vision.

Macular Degeneration results in the loss of one’s central vision only. Peripheral or side vision remains intact. It does not lead to complete blindness but it can cause one from reading or driving. Chances of getting macular degeneration increases in people over 50 years of age. By age 75, approximately 15% of adults in the United States alone have this disease. Additional risk factors include: family history and cigarette smoking. Elderly Caucasians are at greater risk for getting this illness.

Some tests to evaluate the retina of the eye may include, but are not limited to:

1.      Visual acuity test

2.      Refraction test

3.      Pupillary reflex response

4.      Retinal examination by various techniques

5.      Retinal photography

6.      Fluorescein angiography

There is no specific treatment for “dry” macular degeneration. However, it is thought that zinc supplements may help to slow the progression of the disease. In addition, laser photocoagulation (laser surgery to coagulate leaking blood vessels) may be helpful to some patients during the early stages of the “wet” form of the disease.

A newer form of treatment for patients with “wet” macular degeneration is photodynamic therapy which can be performed in a doctor’s office rather than in the hospital. This treatment uses a medication called Visudyne that is injected into a vein in the arm and then circulates through the body to the eyes. It then destroys abnormal blood vessels in the eyes.

Most patients with mild “dry” macular degeneration will never have disabling central vision loss. However, there is no way to predict who will progress to a more severe type of this disease..

If you or someone you know shows signs of this disease, please consult your healthcare practitioner for diagnosis and treatment. In addition, there may be support groups in your community with this illness. This may help you to learn about products that may help increase one’s quality of life while living with macular degeneration.

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July, 2007

Question: At what age do children start to realistically understand the death of a relative?

Answer: By Sangita devi dasi

(Susan Pattinson, RN, CHPN, Certified Hospice Educator)

This is a very important question and I thank you for writing to us to answer this. Basically, when a child hears that a loved one has died, he will perceive the loss according to his age, cognitive development, and level of emotional maturity. It is important to remember that young children exhibit grief more through their behavior than in words. For example, a child may feel tremendous loss when a relative dies, but may simply lack the words to verbalize what he is feeling. If he is feeling anger because of the loss, he may misbehave more frequently or argue with others over seemingly unimportant issues. Watch for conduct that is out of character for that child as clues to deeper emotions. Many children will exhibit their grief through play. Those around the child should be aware of “games” with themes surrounding death and immortality. Conversations children have while pretending to role-play may reveal hidden emotions. Artwork, such as drawing pictures, may also disclose thoughts and feelings that the child is unable to verbalize.

Allow your children to grieve in his or her own way. They should not have to conform to adult ideas concerning grief and bereavement. . Provide opportunities for your child to ask questions about the deceased relative. Depending on your child’s age, he may harbor feelings of guilt for having caused the death. For example, if at any time your child had bad thoughts toward that relative, he may now feel that he caused that person to die. It is important to discuss these feelings of guilt so these feelings do not linger.

Young children often find it easier to discuss disturbing events while they are physically engaged in other activities, such as playing with toys or dolls, and not looking directly at the adult who is speaking with them. You may find an opportune moment to discuss these concerns while your child is coloring or drawing. If the child has a bedtime ritual such as storytelling or discussing the day’s activities, he or she may feel secure at this time and more willing to share his thoughts and feelings.

Since the developmental stage of a child affects his or her concept of death, I have included the following brief summaries of various age groups, their cognitive understanding of death, and possible signs of distress.

1. Ages 2-4 years: Children at this age are self-centered and literally think that the world revolves around them. This is the pre-conceptual stage when they are unable to grasp concepts. Death is seen as abandonment, reversible, and non-permanent. Therefore, a child may wait for the deceased person to return. Anxieties may exhibit themselves through regression of certain behaviors, such as wanting to be fed, asking to drink from a bottle instead of a cup, and bedwetting.
2. Ages 5-7 years: Children at this age are gaining more independence while exploring the world outside of the self. They are also expanding their use of language. They tend to ask many “Why?” questions. As mentioned above, children at this age may feel guilty because they link thoughts with events. For example, if the child was once angry and wished harm on the loved one who has died, he may feel responsible for causing the death of that relative. This age is a time when fantasy is believed to be true. Imagination is powerful at this age. Death is still seen as reversible. Anxieties may be revealed through role-play as explained above. Children at this age may experience nightmares and be more violent in their play.
3. Ages 8-11 years: Children at this age are entering the beginning of logical thinking. Death is seen as a punishment. They are beginning to understand that death is irreversible and final. Their loved one is not coming back. Anxieties may cause problems with concentration in school. They may isolate themselves from others. They may have sleep disturbances. They may worry about how life will change now that the relative has passed away. For example, they may worry excessively about having to move away from their house and the neighborhood they have lived in, leaving behind friends and other family members. These adjustments become secondary losses to the already traumatic event of losing someone dear to them.
4. Ages 12-18 years:  This age group can now problem-solve and are capable of abstract thinking. They are capable of conceptualizing death and to make sense of it on their own terms in combination with what they have been taught throughout childhood. Anxieties can manifest through depression and anger. Adolescents may isolate themselves while at home, spending more time in their bedroom. At this age, it is sometimes easier for children to talk about their loss to those outside the family.

There are many books written on this important subject that may also assist you with your situation. The key to any grief situation involving children is to allow for open communication in order to clarify any misconceptions they may have. 

Patience on your part is essential.

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July, 2007

Question: Recently, my grandmother passed away at the age of 78. I noticed at the funeral that the women in my family (my sisters, mother, and aunts) showed their grief much more than the men in our family (my grandfather, father, brothers, and uncles). We cried while the men seemed to barely show any emotion.

It made me wonder if there is a difference in the way men and women grieve after losing a family member. Is there a difference or did I just imagine this?

Answer: By Sangita devi dasi

(Susan Pattinson, RN, CHPN, Certified Hospice Educator)

Actually, there have been many studies done on the differences between the genders during times of grief. The outcome of some of these studies will help you to understand that you did not imagine the differences you observed in your relatives when your grandmother passed away.

Research shows that the hormone known as prolactin may help one to produce tears while feeling emotionally upset. In one study, William H. Frey II, director of the Alzheimer’s Research Center at Regions Hospital in St. Paul, Minnesota (U.S.), concluded that an increased level of prolactin found in women’s tear glands might make them more susceptible to crying than men. It is also interesting to note that as men age and testosterone in the body decreases, prolactin seems to increase. Therefore, older men may show their emotional grief more than younger men.

Another interesting difference between the genders is that women’s estrogen increases the effect of oxytocin, a hormone that helps heighten social “bonding,” while a man’s testosterone is thought to counteract it. A woman’s increased level of oxytocin is thought to lead them into more nurturing types of activities during the grief process. This may explain why women who are grieving after the loss of a loved one may tend to reach out to others in order to create an expanded social network. This need to reveal one’s thoughts to friends and family at a time of loss often helps women to reduce their stress.

When we are speaking about the loss of a spouse, we must consideration that different generations face various challenges when a spouse passes away.  These challenges might explain some of the variations in their grief response. For example, when a younger man loses his wife, he may be left with young children to raise and a busy household to run while maintaining a full-time job. With so many life demands it might be difficult for him to process and work through his grief. There simply isn’t enough time to truly think about his loss, what to speak of revealing his mind to others in a confidential manner. On the other side, when an older man loses his wife after many years of marriage, it might be difficult for him to form a new identity and face the future without his life partner. In addition, women are often the ones who maintain a couple’s social connections with friends and relatives, so a new widower may suddenly feel socially isolated. This complicates his grief process even more and may even lead to depression.

One final point is that upbringing and culture play a major role in how someone exhibits his grief. From an early age, some men are raised to believe that “men don’t cry,” while other cultures are more acceptable of a man showing his emotions. Some men may feel as though they want or need to cry, but may be embarrassed to display so much emotion. It may help a man to hear that it is perfectly acceptable to cry. Then, as a family member or friend, allow him the privacy he needs to release his feelings of grief however he wishes to do so.

With all this being said, it is still a fact that individuals grieve in their own unique way when losing someone close to him or her. However, grief often becomes complicated when a person continually masks his or her feelings of loss. In this case, as a friend or relative who cares, it might help to suggest to someone that there is no shame in speaking with a professional bereavement counselor who is trained to assist with a troublesome grief process. Below are some resources for those who need assistance with grief:

1.     The Compassionate Friends at: www.compassionatefriends.org

2.     AARP Grief and Loss Program at: aarp.org/families/grief_loss

3.     Hospice Foundation of America at: hospicefoundation.org

4.     GROWW: Grief Recovery Online at: www.groww.org

Please let us know at Vaisnavas C.A.R.E. if we can be of further help.

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June, 2007

Question: “Can you give me some information on jaundice. I’m not sure what causes it. Thank you very much.”

Answer: By Sangita devi dasi (Susan Pattinson, RN, CHPN, Certified Hospice Educator)

Derived from the French word for the color yellow, jaune, jaundice causes the skin, sclera (white part of the eyes), and mucous membranes of a person to turn a yellowish color. This is due to the bilirubin in the body not being metabolized correctly. Four mg/kg of bilirubin is produced every day. Out of this amount, 80% comes from the breakdown of the heme (iron) component of aged red blood cells (RBCs) and the remaining 20% comes from muscle myoglobin and cytochrome metabolism.

Bilirubin comes in two forms. The first, lipid soluble  (unconjugated or indirect) passes through cells and the blood-brain barrier. The second type, water-soluble (conjugated or direct) dissolves in aqueous solutions, such as plasma, bile or urine. The liver, specific enzymes, and bacteria in the intestines work together as a team to convert lipid-soluble bilirubin into its water-soluble form. Eventually, some of the bilirubin is excreted in the stool, but most is reabsorbed back into the blood, filtered by the kidneys, and excreted into the urine which is the cause of urine being yellowish in color.

Jaundice itself is not a disease, but is a clinical sign of excessive levels of bilirubin in the blood caused by a variety of disorders. For example, jaundice caused by elevated levels of unconjugated bilirubin can be caused by red blood cell hemolysis. This means the bilirubin that spills into the blood when your red blood cells die is too much for the liver to conjugate. Another example is when people lack the specific amount of a substance needed to convert bilirubin to its conjugated state. This is a hereditary disorder called Gilbert’s syndrome. Patients with this syndrome may become jaundiced during times of stress or illness. In addition, gallstones, inflammation of the gallbladder, infections, pacreatitis (inflammation of the pancreas) and tumors on the biliary ducts can also cause one to become jaundiced. Hepatitis A, B, and C are viral infections in which jaundice is a common symptom.

Signs and Symptoms of jaundice in adults include:

• Increased itching
• Bruising easily
• Pale stool (Caused by the lack of bilirubin in the intestines)
• Urine that is orange and “foamy” in appearance (Caused by excess secretion of bilirubin by the kidneys)

Treatment for adults is aimed at eliminating the cause of excess bilirubin secretion. This can include gallstone removal, withdrawal of a toxic drug or alcohol, or the treatment of an infection if that is proven to be the source of the jaundice. The patient with liver disease is placed on a special diet that is high in calories (3,000 calories/day) and high in carbohydrates. Patients are encouraged to consume fatty foods in moderate amounts. The diet calls for foods low in protein. If the patient is exhibiting swelling (edema), he or she may be restricted from using salt. In conclusion, the diet includes: high calories, high carbohydrates, moderate fat, low protein, and low sodium intake.

For the intense itching that comes with jaundice, it is recommended to keep the skin well moisturized with a fragrance-free lotion. The patient should also bathe in lukewarm water. Hot water will only increase the itching. Tepid water-soaked towels can be placed on the areas where itching is the most annoying. The skin should then be patted dry and again moisturized with a fragrance-free lotion. Many patients state that a 100% pure cornstarch powder helps to relieve the itching as well.

Another population where jaundice is sometimes seen is in newborns. This is mainly due to their undeveloped livers being unable to break down bilirubin fast enough. Very high levels of bilirubin in a neonate can be extremely serious. Levels higher than 20 mg/dL can cause deafness and brain damage. However, with proper care, newborn jaundice can resolve within 1-2 weeks. It is imperative for your physician or healthcare practitioner to closely watch for signs of jaundice in your baby within the first few days of life.

I hope this answers your question about jaundice. If you need further information, kindly let me know.

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May 18, 2007

Question: What is Crohn’s Disease?

Answer:  Crohn's disease is a chronic inflammatory bowel disease that causes swelling of the digestive tract (GI tract). It can affect any part of the GI tract, but it usually occurs at the end of the small intestine, known as the ileum, and at the beginning of the large intestine, known as the colon This disease is sometimes mistaken for other GI diseases that cause similar symptoms, such as ulcerative colitis, diverticulitis, or irritable bowel syndrome (IBS).

Symptoms range from mild to severe. They vary in each patient, but most people with Crohn’s disease will experience times of “flare ups” followed by times of remission when the symptoms decrease or simply disappear for some time. Common symptoms include:

• Severe diarrhea