By Diana Price

A cancer diagnosis is a life-changing event. No doubt about it. But for mothers of small children, it becomes clear very quickly that it is not a life-stopping event. Life must go on in spite of the elephant in the room: meals must be offered up, tears and noses must be wiped, baths must be drawn and dirt must be scrubbed, bedtime stories must be told, and small and big catastrophes must continue to be averted on a regular basis. In the midst of this, of course, is the reality of the diagnosis, which must also be dealt with. But the way in which parents choose to deal with it—and how surrounding issues are discussed with the children who are affected—can do much to alleviate the potential emotional burden families face.

Now families have a brilliant tool to help begin conversations about cancer treatment and, specifically, the disconcerting hair loss that can be upsetting for children. In Nowhere Hair (Thousand Words Press, 2010; $15.99), author and 12-year cancer survivor Sue Glader offers a whimsical and refreshingly honest look at the natural questions a young girl has about her mother’s suddenly absent hair and provides clear, reassuring explanations. Glader’s words are accompanied by stylish and endearing illustrations by Edith Buenen, which convey the hopeful and heartfelt spirit of the story.

For the book’s young star—and for the reader—the sometimes-silly yet poignant take on the topic serves to normalize the experience: it’s okay to be confused, worried, scared, and sad, the book says. And perhaps most important, Nowhere Hair shows us that though cancer treatment is scary and worrisome, it doesn’t change who we are on the inside, nor how much we love each other. Life does go on: mamas still hug their children, silliness is allowed, and all feelings—happy, sad, and otherwise—are valid.

For more information about Nowhere Hair, visitwww.NowhereHair.com

Our sense of smell has a powerful influence on our emotions and mood. Unlike our other senses, which are processed through the brain stem, our sense of smell is processed through the limbic system, which governs emotion and memory. The smell of freshly baked chocolate chip cookies can take us straight back to our great-grandmother’s kitchen; the smell of wet grass in the fall might remind us of hours spent practicing on the soccer field.

Aromas are powerful memory triggers and mood enhancers—so much so that they can be used to relieve stress, uplift our mood, and provide an energy boost.

Understanding Aromatherapy

Aromatherapy refers to the practice of using essential oils or other aromatic compounds to enhance physical and emotional health and wellbeing. These essential oils are extracted from flowers, bark, stems, leaves, roots or other parts of a plant. Many practitioners believe that inhaling the aroma of essential oils can stimulate brain function. Furthermore, some essential oils can be absorbed through the skin, where they reach the bloodstream and promote healing.

Aromatherapy is gaining momentum as a form of alternative healing. It is used to address many issues, including pain, fatigue, stress, nausea, cognitive function, and more. There is a wide variety of essential oils and each is associated with its own healing properties.

Using Aromas to Ease Stress

If your life is overrun by stress, consider incorporating aromatherapy into your daily routine to boost your mood and ease your tension. A certified aromatherapist can help concoct the right aroma for you, but you can also experiment on your own. It’s important to note that essential oils are highly concentrated and need to be diluted with another oil or lotion before applying directly to the skin.

Try these essential oils to quell your stress:

• Jasmine: Enhances mood and reduces anxiety
• Lavender: Promotes relaxation and a general sense of wellbeing
• Vetiver: Often referred to as the “oil of tranquility” for its calming properties
• Tangerine: Calms the nervous system and relieves stress, fear, and sadness
• Chamomile: Encourages calm, peace, and patience
• Grapefruit: Reduces fatigue

Combining two or three oils together often seems to make them more effective.

There are several ways to use essential oils:

• Vapor Inhalation: Place a few drops of the essential oil into steaming water. Place a towel over your head and lean over the water and inhale the fragrance.
• Infuser: Place a few drops of the essential oil into a burner or infuser and allow the aroma to waft through the room.
• Mist: Place a few drops of the essential oil into four ounces of distilled water for a room spray.
• Tissue: Place a few drops of the essential oil onto a tissue and wave it under your nose.
• Bath: Add a few drops of an essential oil to your bathwater for a soothing, relaxing treat.
• Massage: Blend essential oils with a “carrier oil” or lotion and use it for an aroma-filled massage.
• Compress: Add a few drops of an essential oil to a bowl of warm water; dip a washcloth in the water and wring it out to be used as a soothing compress.
• Ointment/Salve: Mix a few drops of your favorite essential oil with an ointment, carrier oil, or lotion and use it directly on your skin.

Safety First

Aromatherapy is a wonderful, effective, and enjoyable way to reduce stress, but it’s important that you use caution with essential oils. Consult a professional to ensure that you are using the oils properly. Follow these tips:

• Keep essential oils away from your eyes.
• Always dilute oils before applying to skin.
• Keep essential oils away from children.
• Never ingest the oils.
• Less is more. Overuse can lead to headaches and nausea. If you’re overwhelmed by an aroma, drink some water and get some air.
• Read and follow all warnings.
• Pregnant women should consult a professional before using aromatherapy.

Stop and Smell the Aroma

Aromatherapy is extremely effective for stress relief. It’s a simple, fun way to breathe new life into your tired body. So, if you’re feeling stressed and run down, consider stopping to smell the aromas.

Behold the luscious, red pomegranate—it is a fruit rich in flavor and nutrients and is a delectable wintertime treat. A symbol of abundance and fertility throughout history, the pomegranate has achieved superfood status in recent years. It offers a wide array of nutritional benefits and adds a delicious, colorful element to any meal.

Pomegranate Facts

The pomegranate is a rich, red fruit about the size of an orange. The outer husk of a pomegranate is inedible; however, inside the fruit are hundreds of tiny seeds called arils. These tiny red seeds are loaded with antioxidants. Some people consume the seeds whole, while others prefer pomegranate juice.

The pomegranate was originally native to Iran and Northern India; however, it has been cultivated in the northern hemisphere for centuries. Its peak season is between September and February.

Health Benefits of Pomegranates

Rich color in fruits and vegetables indicates a concentration of nutrients. Pomegranates are a vibrant, red color, so it’s no surprise that they are loaded with nutrients.

Pomegranates are rich in:

• Potassium
• Fiber
• Vitamin C
• Vitamin B5
• Antioxidants called polyphenols

Pomegranates have been found to have many health benefits, including:

• Reducing cholesterol
• Reducing blood pressure
• Improving erectile dysfunction
• Preventing dental plaque
• Reducing inflammation
• Alleviating symptoms of menopause
• Preventing cancer
• Improving response to cancer treatment
• Protecting against environmental damage and aging

That’s a tall order for such a tiny seed. Researchers are scrambling to evaluate the benefits of pomegranates in scientific studies. Although numerous studies have identified strong health benefits associated with the consumption of pomegranates, it’s important to remember that pomegranate is no substitute for medical treatment. However, daily consumption of pomegranate seeds or juice can’t hurt and just might help promote health.

Consuming Pomegranate

Pomegranate seeds and juice are a wonderful addition to the menu.

• Sprinkle the seeds on a salad for a dash of color, flavor, and nutrition.
• Add pomegranate juice to a smoothie for a delicious antioxidant boost.
• Blend pomegranate seeds or juice into a homemade salad dressing.
• Sprinkle pomegranate seeds into oatmeal for a hearty, nutritious breakfast.
• Stir pomegranate seeds into yogurt for an added boost.
• Use pomegranate seeds to decorate desserts in place of sugary sprinkles.

Q: What is urinary incontinence?

Do you avoid running, lifting, or jumping on a trampoline for fear of getting wet? Or do you find you make sure you know where the bathroom is wherever you go so that you don’t have accidental leakage? If either or both of these situations sound familiar, you have urinary incontinence.

Simply put, urinary incontinence is the involuntary loss of urine, a common but seldom-discussed problem. It is more common as we age, but it is important to know that it is not a normal part of aging. In fact, it is never normal. While some women may have this infrequently and consider it a minor nuisance, for other women it can be very socially, psychologically, and physically distressing.

Q: What causes urinary incontinence?

There are several causes of urinary leakage. Knowing which type of leakage is occurring is an important step toward preventing it.

One of the most common types of leakage is called stress urinary incontinence. This type of leakage occurs with activity—such as running, lifting, and even sneezing—and is caused by a sudden increase in pressure in the abdomen. The urethra—the tube from the bladder through which urine passes—is usually held closed during activity to prevent leakage of urine during times of increased abdominal pressure. In some women, however, the seal becomes weak and opens with these increases in pressure, allowing urine to leak.

Another common type of leakage is called urge urinary incontinence. This is part of a condition referred to as “overactive bladder.” Overactive bladder can cause urinary frequency and the sudden, strong urge to urinate. When leakage actually occurs, we refer to it as urge urinary incontinence; it often happens in response to triggers, such as running water, driving into the driveway, or just spontaneously. Sometimes the leakage occurs on the way to the bathroom or just prior to sitting down on the toilet. Women often wonder Is it in my mind? because it will start just after they have thought about the bathroom. The problem is actually in the bladder; it is as if the bladder is eavesdropping on the brain and then running ahead without permission.

Overactive bladder can be caused by irritations to the lining of the bladder, such as diet, tobacco, or a kidney stone. Rarely, overactive bladder can be a sign of a neurologic disorder or growth in the bladder. Another source of bladder overactivity is postmenopausal vaginal dryness from lack of estrogen. The pelvic floor muscles can also contribute to bladder overactivity if they are inflamed or in spasm. For about half of women with overactive bladder and urinary urge incontinence, no identifiable cause is found.

It is also common for women to have both causes of leakage at the same time, and each has to be addressed appropriately.

There are other, less common causes of urinary leakage. If you have leakage that does not seem to fit into any of the above categories, you should discuss the symptoms with your physician.

Q: Is treatment available?

Yes. The vast majority of women are significantly improved or cured of leakage after seeking appropriate treatment. The treatment will vary depending on the cause of leakage and a woman’s individual preferences.

Stress urinary incontinence. This condition occurs due to a weakening of the support structures under the urethra. It can often be improved or cured with muscle exercises known as Kegels. The American Urogynecologic Society website has written instructions for doing Kegels that women can access (www.voicesforpfd.org/p/cm/ld/fid=12). It often takes three to six weeks of regular exercises before improvement is noted. Some women require additional evaluation and specialized instruction from a pelvic floor physical therapist to get optimal results.

For some women with stress urinary incontinence for whom therapy is not the answer, there are nonsurgical options that rely on mechanical support of the urethra. This can be as simple as wearing a tampon during exercise: the presence of the tampon applies pressure to the urethra through the vaginal wall. Another method of mechanical support is called a pessary—a sturdy, silicone device shaped like a diaphragm that sits comfortably in the vagina to support the urethra. This can be used throughout the day or be placed just prior to exercise.

Surgery may be the best option for some women with stress urinary incontinence. Luckily, current surgical repairs are highly effective, long lasting, and often minimally invasive.

Urge urinary incontinence and overactive bladder. Many women are able to identify items in their diet that irritate the bladder, and simply avoiding those items can greatly improve their continence. Common bladder irritants are citrus, tomatoes, caffeine, carbonation, and alcohol. Tobacco smoking can also cause bladder irritation. If other sources of irritation are identified, such as a urinary tract infection, a lack of estrogen, or overactive pelvic floor muscles, treatment of these conditions will improve symptoms. Some women respond to bladder “retraining” and physical therapy as well.

Women who are unable to determine the cause of urge urinary incontinence and overactive bladder should see their healthcare provider; a bladder control medication will usually improve their symptoms.

Q: Can lifestyle modification (such as exercise and food and beverage choices) help alleviate urinary incontinence?

For stress urinary incontinence, just being generally physically fit (even without doing Kegels) can decrease symptoms of urinary incontinence. Doing Kegels on their own also benefits many women. Although women can avoid the activities that cause leakage, my hope is that they seek help before making these types of lifestyle modifications so that they do not become less active. Being of normal weight for your height can also improve continence; even a proportionately small loss of weight when one is overweight can decrease leakage for some women. Urge urinary incontinence and symptoms of overactive bladder can also be improved through lifestyle modifications for many women. This might include the dietary modifications noted above; it may also include not drinking fluids in excess in general and not drinking large amounts right before bedtime.

We also work with women to retrain the bladder by putting off going to the bathroom for longer periods of time. If lifestyle modification does not improve symptoms or if you have any of the warning signs listed below, you should see a physician.

Q: What else should I know about urinary incontinence?

Infrequently, urinary incontinence can be an indication of a more serious underlying problem. Warning signs of a more serious issue include:

• Sudden severe leakage
• Blood in the urine
• New leakage associated with any other new complaint, such as back pain, numbness, or pelvic pain

If any of these warning signs are present, you should see your healthcare provider for an evaluation to ensure that the leakage is not due to a more serious underlying health problem. Urinary incontinence is very treatable and should not stop a woman from living her life to the fullest. Eighty-five to 90 percent of women with incontinence can be made much better or cured. So if you have urinary leakage, know that you can get help, get dry, and get back to living your life!

A goal is something we want to achieve. Setting goals is a powerful way to implement change in our lives. Without goals, we have no vision for where we are going. With them, we have a road map and a visible destination.

But setting goals isn’t as simple as stating our desire. There is an art to goal setting—master the art and you’re more likely to achieve your goals.

To experience success, set goals that are S.M.A.R.T.: Specific, Measurable, Attainable, Realistic, Timely.

Specific: A goal needs to be specific, otherwise how will you know what you are working toward or when you have attained it? Resist the temptation to set vague goals such as: “I want to lose weight” or “I want to get in shape” or “I want to expand my business.” Instead, get specific: “I will lose five pounds by March 1^st”; or, “I will be able to run three miles without stopping by April 1^st”; or, “I will have three new clients by the end of the year.”

Measurable: A goal needs to be measurable so that you can track your progress and document your success. You can measure weight loss by tracking your weight, your clothing size, or inches lost. Similarly, you can measure financial goals by setting a target number for savings. In contrast, a goal such as “I want to grow my business” is neither specific nor measurable. How will you measure growth? Set a benchmark that you can track.

Attainable: Set yourself up for success by setting attainable goals. “I want to lose 20 pounds in a week” is not an attainable goal. A goal like that is a guarantee of failure, which leads to misery. Instead, set a goal to lose one pound a week for 20 weeks. That is an attainable goal that will leave you feeling successful.

Realistic: It’s fun to dream, but it’s also important to be realistic. If your goal is to circumnavigate the world by sailboat, but you have a full-time job and small children at home, you’re probably not on track to work toward this goal right now. File it away for a later date and instead, focus on goals that are realistic for your current life. You may dream of being an Olympic skier, but very few make the cut. Do you have the time and money to devote to the pursuit? If not, set a more realistic goal such as winning your age group in a local ski race.

Timely: In order to be useful, goals need to have a time frame. Without a time frame, we have no motivation to take action. Having a specific time frame will spur you into action and help you monitor your progress. If you’ve been saying, “I want to write a book” for years, it’s time to set a finish date and start working toward it.

So, get busy. Set smart goals and have fun working toward them. The sense of accomplishment you’ll feel will be worth it!

In preparing to write about managing change, a favorite John Lennon quote comes to mind: “Life is what happens to you while you’re busy making other plans.”

I used to think that I had some degree of control over what happened in my life. Work hard, follow the Golden Rule, and good things will happen. But as I moved through life, I learned that things don’t always work out that way—things often turn out differently than we anticipate. While challenging, these situations can offer us opportunities to grow, if we remain open to that possibility.

Being flexible and adaptable is very helpful when dealing with life’s unanticipated roadblocks and detours. The control you have over your situation lies in how you react. You cannot control what has happened, but you can control your reactions. Below are some strategies that can help you navigate the challenges that can accompany unanticipated change—and help you begin to carve out the life you want.

Allow yourself time to grieve your loss (whatever that loss may be). We all work through change at our own pace, and only you know how much time you need to adjust to your new normal.

Express your emotions in the way that is most comfortable for you. This expression can take many forms. Write in a journal, draw a picture, paint or dance or sing. Remember, this is for you—nobody else needs to judge. This creative expression of your emotional life can be an important part of the healing process. Set aside some time for it each day.

If your situation requires that you process a lot of new information—perhaps in doctors’ appointments or other meetings—ask a friend to accompany you and help you review the information. It’s always helpful to have another set of ears and the support that a close friend can offer.

Deal with the situation in bite-sized pieces. You would not try to eat a steak without cutting it in pieces and then chewing and swallowing each piece, would you? It is the same with information. It is usually not necessary to digest it all and act immediately.

Breathe. Breathing from your diaphragm can help relieve anxiety. Concentrating on breathing takes your mind off what you are dealing with, if only for a brief moment. Try it: take the deepest breath you can and feel the breath go from your toes to your nose. I challenge you to think about something else while doing this exercise!

Be in the present. If you are in the moment, you cannot worry about what will happen in the future or what has happened in the past. (Eckhart Tolle’s book The Power of Now is an excellent resource for learning more about living in the present.)

Recognize the humor. Every situation offers humor. Spending time trying to find the humor or seeing funny moments can take your mind off the situation. Smiling uses fewer facial muscles than frowning. Try to smile, if only briefly, and you will feel better.

Claim your power. Often when facing challenges, we feel like we do not have any control over our lives. What can you do to regain control? Focus on what is important to you. Set a daily schedule that includes these things. Is it taking a walk? Meditating? Making time to speak on the phone?

Allow others to help you. We often find it difficult to accept help from others, but people want to help. Don’t worry about reciprocating now. When you accept help, you are allowing others to give and experience the joy that comes from giving.

Remember that the only thing that is permanent is change. Try to be flexible. It is easier than digging in your heels and resisting.

Take an inventory of all the good things in your life. Make a list of them and add one thing, no matter how small, each day!

It’s not always easy to understand why things happen, but in many cases we can make peace with our situation when we look at challenges as opportunities for growth. What have you added to your “good things inventory” today?

Denise King Gillingham, MSW, CPCC, is a certified co-active coach who specializes in helping people achieve enduring life change through accessing their inner wisdom. Her international practice includes clients from all walks of life. Denise received her master’s degree in social work from Columbia University and has been a mental health professional for more than 15 years. She shifted her focus from therapy to coaching in 2006. Her professional experience includes private therapy practice in Prague, Czech Republic; crisis intervention with New York University; in-patient therapy at Payne Whitney Clinic in New York City; and substance abuse counseling at Bronx VA Medical Center in New York City. She develops and conducts workshops on emotional intelligence for organizations in the United States and Europe. Contact Denise at dkgcoach@gmail.com.

By Diana Price

I’m a runner. I’m not very fast, I do not own a fancy watch that tells me where I am or what my pace is, and I have yet to lose a toenail, but I’m committed. I like to wake up running—to leave home in the still-hazy early-morning light and feel my body come to life as my feet find their rhythm, my wheels start to turn, and my senses awaken.

Though I have pounded my share of pavement at various points in my life, my feet have always felt most at home on dirt. The soft, forgiving surface of packed earth, the crunch of a long gravel road, and the winding, rocky steep of a mountain trail ascent mark my favorite runs. And though oatmeal and electrolytes no doubt have some impact, I like to think that my best runs are fueled by my senses—the high-alpine smell of sage and pine; the bright, wide, blue-bird sky; and the dense quiet of morning in the open.

Trail running—the official term for what those of us who do our best to avoid pavement do—is growing in popularity. In fact, according to the American Trail Running Association (ATRA), the number of participants in official trail events and races more than doubled between 2000 and 2010. Nancy Hobbs, executive director of ATRA, a Colorado-based nonprofit corporation created to serve the trail- and mountain-running community, says that the increasing popularity of the sport is due to the physical challenge it presents, the beauty of the landscapes frequented by trail runners, the opportunity it provides to participate in new events and try new terrain, and the overall change of pace that it offers to those accustomed to road running.

Women and Trail Running

Among those turning to the trails are growing numbers of female runners who are discovering the joy and the fitness opportunities to be found in trail running. “The growth among women is certainly a factor in the increased participation,” Nancy says. “Whereas 20 years ago the number of women was a very small percentage of the overall participation, this has grown. There are more women out there mentoring other women, and the can-do attitude is prevalent.” The combined physical and mental challenge that the sport offers is a major draw, Nancy says, as women learn to navigate trails and test their endurance: “When you can get to the top of a trail or run a trail race from start to finish that you didn’t think you could do, it’s really empowering—especially for women.”

In addition to providing a sense of accomplishment and the physical reward of increased fitness, trail running can function as an invaluable stress management tool for women increasingly striving to balance career and family. Elinor Fish, former managing editor at Trail Runner magazine and owner of Run Wild Retreats, says, “Running is proven in studies to make you more resistant to emotional stress by reinforcing brain structures. It’s no wonder that respondents to a survey by the Outdoor Foundation [a national nonprofit organization promoting outdoor enjoyment and environmental stewardship] rated relaxation as their number one reason for trail running—above fitness!”

For many women, trail running also offers a valuable opportunity to build community. “The fun thing about trail running is that it’s social,” says Elinor. “Market surveys—as well as my 10 years of organizing running clinics—show that women prefer to train in groups for mutual support and motivation. Women enjoy running more when they are not pressured to keep up with faster or competitive running partners.”

Ultimately, trail running provides a uniquely accessible option for women interested in a truly transformative physical activity. “Running is simple to learn, easy to access, and a low-cost way to get fit and lose weight,” Elinor says. “For women looking to change their lives in the form of improving their health, losing weight, or feeling better about themselves, running accomplishes all three things simultaneously and with relatively little time and cash investment—even running for as little as a half hour three times a week can produce results for a beginner.”

Trailblazer

Elinor herself has long known the joys and the benefits of trail running. A competitive runner for more than 20 years, she ran track and cross-country in college in British Columbia. It was after graduation, she says, that trail running stole her heart as she began to log many solo miles in mountain terrain. In 2010 she founded Run Wild Retreats (see “Run Wild” sidebar) to introduce other women to the joys inherent in trail running and, in the same year, was a finisher in the famed Lifetime Fitness Leadville Trail 100—a 100-mile trail race in the Colorado Rockies.

Throughout her life, running has both grounded and empowered her. “Running has kept me healthy,” Elinor says. “It has kept me feeling good about myself, given me confidence, helped me lose weight after the birth of my son, taught me how to build a plan and execute a goal, been the center of my social life, and been my moving meditation and a source of solace, my stress management system, and my mechanism for feeling alive.”

One Foot in Front of the Other

If you’re ready to step off the pavement and give trail running a try, it’s as simple as finding yourself some dirt. According to the ATRA, “any unpaved surface” qualifies as a trail, so even if you’re a city dweller, you’ll likely be able to find some form of soft ground within reach. Check out parks and nature preserves and contact local running clubs for more information about the best options in your neck of the woods. Keep in mind that a smooth trail or dirt road provides a great place to start as you gain fitness and experience, which you can follow up with more-challenging terrain and even some technical elevation gain and loss as your training progresses. But beware: once you’ve made the switch to softer ground, you may never go back.

Run Wild

Trail running and wellness retreats offer women the opportunity to run, relax, and connect.

Elinor Fish knows well the gifts that trail running can provide. In her more than 20 years as a runner, she has benefited from the fitness, increased confidence, stress relief, and community that running offers. “For me trail running gives an opportunity to meditate, take a break from the day, spend time in nature, and feel incredibly empowered,” Elinor says. Inspired by her own experience, she dreamed of passing her passion along. “I wanted to introduce other women to the joy of running so that they could feel those same things.”

In 2010 Elinor made her dream a reality when she founded Run Wild Retreats, trail-running and wellness retreats created to educate women about running and yoga in a nurturing, relaxing environment and inspire them to make these activities part of their lives. The three-day retreat, held for the second year in a row at Vagabond Ranch in Colorado, featured daily trail runs in surrounding wilderness, yoga classes, and seminars on a range of topics, including sports nutrition, increasing endurance, staying motivated, preventing injury, training for a race, and selecting the right shoes and gear.

Though all participants have some running experience, individual goals vary, Elinor says, and she designs the retreat to accommodate different fitness levels and personal objectives. “It’s important for me that runners of all levels be able to run as far and as fast as they want,” she says. “I want to provide everyone the opportunity push themselves if they want or to take it easy if they want.”

For Megan Evans, who traveled to the 2010 retreat from Houston, Texas, the goal was simple: to “have fun and run in a different environment.” Daily runs on the beautiful trails around the ranch provided Megan with the new challenge she was seeking—she actually ran farther than she had ever run at that point—and the community of women gathered for the retreat offered a welcome chance to connect. “I loved meeting the other participants,” she says, adding, “Elinor provided a really supportive environment and helped us all enjoy ourselves.”

For more information about Run Wild Retreats, visit www.runwildretreats.com.

Resources

• American Trail Running Association
  www.trailrunner.com
• Trail Runner: One Dirty Magazine
  www.trailrunnermag.com

By Kari Bohlke, ScD

The winter and darkness have slowly but steadily settled over us. By such easy stages has the light departed that we have not, until now, appreciated the awful effect.

—Frederick A. Cook, MD, Through the First Antarctic Night, 1898–1899

In his narrative of a voyage to Antarctica, first published in 1900, Dr. Frederick A. Cook chronicles the ordeals of a high-latitude winter: “The curtain of blackness which has fallen over the outer world of icy desolation has descended upon the inner world of our souls.”¹

Though the conditions experienced by Dr. Cook and his colleagues were undoubtedly more extreme than most of us will ever experience, the depiction of winter gloom is familiar to many. “If you ask people if they generally feel better or worse at one time of year than another,” says Janis Louise Anderson, PhD, assistant professor of psychology at Brigham and Women’s Hospital in Boston, “up to 25 percent of people in the northern latitudes say that they feel worse in the winter.”

For some of these people, seasonal mood changes may be mild, reflecting a simple preference for one season over another rather than a disorder. Others, however, may find that their daily lives are profoundly affected during certain times of year. Seasonal affective disorder (SAD) “is a depression that comes back on a predictable basis every year and goes away on a predictable basis every year,” explains Dr. Anderson. “It can reach a level of major depression.”

Symptoms of depression include persistent sadness, loss of pleasure in usual activities, difficulty concentrating, feelings of guilt or hopelessness, sleep problems, and appetite changes. For someone with SAD, symptoms typically appear in the fall and persist through the winter months. If untreated, symptoms generally go away sometime in the spring.

SAD tends to be more common in women, at higher latitudes (regions farther from the equator), and among people with a family history of mood disorders or alcoholism. The condition can occur at any age, but people most often begin to notice symptoms in their early twenties.

Though the biological basis for the condition is still not well understood, changes in length of day and exposure to light appear to be factors. As a result, light therapy plays an important role in treatment for many patients. “There are a couple different kinds of light treatment,” explains Dr. Anderson. “The standard one is to acquire a device that has fluorescent tubes that put out a white light that’s pretty bright.” Use of about 10,000 lux (lux is a measure of light intensity) for half an hour each morning provides relief to many patients. Devices called “dawn simulators” are another approach. These devices are used to gradually increase the amount of light in a bedroom before someone wakes up. “The dawn simulator has less research,” notes Dr. Anderson, “but it’s looked successful in the trials that have been done.”

The need for special (and safe) light equipment is important for patients to understand. “Sometimes people just want to put brighter bulbs in their rooms,” says Dr. Anderson. “That’s really just a waste of money because you cannot get the level of brightness that you need from ordinary light bulbs.” In addition, because light treatment devices are not regulated by the US Food and Drug Administration, it’s important for patients to do their homework and talk with their healthcare provider before buying a light box. The light box needs to provide a type and an intensity of light that’s likely to be effective against SAD while filtering out potentially harmful ultraviolet light. It’s also important to talk with your healthcare provider about your other health conditions and medications (including herbal remedies such as Saint-John’s-wort and dietary supplements); some conditions and medications can increase photosensitivity and make light treatment risky.

Other treatments that may be used for SAD (either alone or in combination with light therapy) include antidepressant medications and cognitive behavioral therapy. Simply getting outside during daylight hours may also provide a boost to your mood. “In the winter the sun is still very potent and still many times brighter than indoor light,” says Dr. Anderson. “The trick is to get out in it.”

In short, the message for SAD is much the same as for nonseasonal depression: Seek care. Help is available. 

References

1. Cook FA. Through the First Antarctic Night, 1898-1899: A Narrative of the Voyage of the Belgica among Newly Discovered Lands and Over an Unknown Sea about the South Pole.New York: Doubleday and McClure; 1900.
2. Magnússon A, Stefánsson JG. Prevalence of seasonal affective disorder in Iceland. Archives of General Psychiatry. 1993;50(12):941-46.
3. Axelsson J, Stefánsson JG, Magnússon A, Sigvaldason H, Karlsson MM. Seasonal affective disorders: relevance of Icelandic and Icelandic-Canadian evidence to etiologic hypotheses Canadian Journal of Psychiatry. 2002;47(2):153-58.</li.

Hibernation Is Not the Answer

Asked about how to manage mild seasonal mood changes (those that don’t meet the criteria for a SAD diagnosis), Dr. Anderson responds, “It’s certainly true that light can be helpful there too, so it’s not necessary to have a clinical depression to feel some benefits from having more light exposure. Also, when you’re physically active it helps your mood, so getting outdoors and taking a walk in the morning light would be a great thing for people. Sometimes people say, ‘Oh, it’s winter; it’s the time of hibernation. I’m just going to lie on the couch.’ That’s bad because we are not bears, and it’s not good for us to just lie around in the winter.”

Iceland in January: Cold, Dark, and…Happy?

To illustrate the role that genetic factors may play in SAD, Dr. Anderson points to Iceland, a high-latitude country with an unusually low incidence of SAD. Iceland is located just below the Arctic Circle, and the shortest winter days have only four hours of sunlight. Nevertheless, SAD appears to be less common in Iceland than in the United States.² This lower risk of SAD even seems to apply to people of Icelandic descent who live in other countries.³ Researchers have speculated that Icelanders may be genetically adapted to winter darkness.

Guidelines and suggestions for patients and loved ones spending time in the hospital.

Recently, several people I know were all in the hospital at the same time. It was so stressful trying to schedule all of those visits. Does it send an uncaring message when you don’t visit someone in the hospital?

The need we often feel to visit loved ones in the hospital stems from a belief fostered through family values over decades. Many of us were raised under this caring ideology that obliges us to make such visits. And yet given the way hospital care has changed over the years, it’s worth rethinking the practicality and the effectiveness of this tradition.

To begin with, the primary reason patients are admitted to a hospital is so that they can receive medical attention and get relief from pain and symptoms. Given these goals, if someone is in the hospital for only two to three days, there generally isn’t a lot of time for entertaining visitors. The hospital staff has schedules that must be adhered to and protocols that must be carried out, resulting in hectic days for many patients. One of the most common complaints I hear from patients is that they never get any rest while in the hospital and they go home more exhausted than when they were admitted.

So before you rush to make a hospital visit, here are some things to consider:

• Find out if there is a contact person or primary caregiver and communicate with that person rather than with the patient.
• Ask the contact person these questions:
  • Why was the patient admitted?
  • Any idea how long he or she will be hospitalized?
  • Is it a private or a shared room?
  • When are the visiting hours and mealtimes?
  • Does the patient want visitors?
• If the answers to these questions indicate that it might not be realistically beneficial to make a visit, or if the caregiver suggests that a visit is not necessary, heed that advice. Don’t assume that you know better or that it will be “different” if you go.

Next, be honest with yourself about these questions:

• Do you really want to make this visit, or does it feel like an obligation?
• Are you visiting in order to make yourself feel better?
• How do you really feel about being in a hospital?
• What is your current stress level?

If you’re visiting merely out of obligation or guilt, that’s not a good reason to visit. If you’re uncomfortable with medical environments or are stressed out yourself, you can actually do more harm than good to the person you’re visiting. When people are sick, they are more vulnerable and more sensitive to their surroundings and often pick up on negative feelings regardless of how well we may try to mask them. You want to ensure that you are not a source of stress or worry to the hospitalized person, so self-assess honestly.

Once you’re sure that a visit would be beneficial, here are some guidelines that can help you make a positive and effective impact with your presence:

• Don’t arrive unannounced; patients get unannounced visits around the clock.
• Don’t plan to stay a long time. Offer to leave shortly so that the patient doesn’t have to ask you.
• Do turn off your phone and refrain from texting. If you’re going to visit someone, be fully present.
• Don’t assume that it’s okay to bring flowers, balloons, or food. Each hospital and patient is different, so ask about the hospital’s rules andwhat the patient needs.
• Do ask, “Do you need anything?” If the answer is no, offer practical suggestions such as slippers or socks, a comfy blanket or pillow, or a light sweater; or offer to lend an electronic book device or portable DVD player.
• Do refrain from comments like, “You look great,” “Much better than I thought,” and “Everything is going to be fine.” Patients are very sensitive to placating comments.
• Do encourage the person to vent and purge: ask about his or her concerns and feelings; expressing one’s feelings facilitates the healing process.
• Don’t tell stories about other people who have had the same illness. Patients deserve to feel that their experiences are unique, regardless of their diagnosis.
• Do bring some news from the outside world. Being in the hospital can foster feelings of isolation.
• Don’t complain about what’s going on in your life; remember whom the visit is about.
• Do offer to take the patient for a walk to the common room or around the halls if he or she is able to ambulate safely.
• Do offer to read aloud. Being read to can be very comforting to someone who’s feeling too tired to read for him- or herself.

Last, it’s good practice to take a moment before the visit to refocus, let go of whatever else is on your mind, and enter the room acutely aware of why you are there. Patients relate that the most comforting visits are from those who are mindful, genuine, and concerned.

Are there other things—beyond making a hospital visit—that I can do as a concerned friend or family member to show that I care? How else can I be of help?

If the patient does not want visitors, or if a visit is just not practical, there are several other ways to demonstrate that you care, which can often be more helpful to a patient than an in-person visit.

Here are a few suggestions offered by my former clients:

• Offer to be a contact person and pass on updates to friends, family, and co-workers via phone calls or e-mails.
• Organize a group card or group e-mail that shows the patient that many people are concerned.
• Find out what else you can do in the “outside world” that might be helpful—run some errands, check the mail, water plants, or attend to a pet, for example.
• Offer to visit or assist the primary caregiver, other family members, or children.
• Order a movie, book, gift basket, or other treat and send it to the patient’s home so that it will be there when he or she returns from the hospital.
• Find out when the patient expects to be discharged and do something for the homecoming—cut the lawn, wash the car, prepare a meal, or attend to other household tasks.
• Create a “save the date” for when the patient is discharged and plan something fun.
• Don’t forget the patient after he or she returns home; this is often when people recuperating really need and appreciate company the most.
• If distance or time prevents you from visiting the patient at home, buy or make several “get well” or “thinking of you” cards and send one every so often; actual greeting cards arriving in the mail convey a personal touch very different from electronic forms of communication.

During my recent hospital stay, I experienced a surprising amount of stress surrounding family, friends, and visitors. Are there things that patients can do themselves to prevent the unintentional emotional strain that is sometimes caused by those who care?

When you are already compromised by an illness or a hospitalization, minimizing stress is crucial to the healing process. As a general rule, one of the most important yet simple things an individual can do to reduce emotional stress is to practice open and honest communication.

Being hospitalized renders us vulnerable, an uncomfortable state for almost everyone. The bottom line is, no matter how strong or independent you may be, you will need help—and those who care about you want to help—and yet miscommunication surrounding helping can cause many interpersonal conflicts. So, as the patient it’s important that you assess your feelings about asking for and accepting help.

If you are accustomed to reaching out and asking for what you need, you are quite fortunate. If you are not accustomed to asking for and accepting help, there are still ways your needs can be met.

Here are a few guidelines to help facilitate communication, reduce stress, and avoid emotional conflicts:

• If you are uncomfortable calling others and asking for help directly, maybe an email or text message would be easier for you.
• If you have an especially close friend or family member, solicit his or her help in asking for you.
• Regardless of how you relate what you need and what you don’t need, be honest with yourself and others. You do a disservice to yourself and those around you when you are not completely truthful.
• Instead of worrying about what others might be thinking, conserve your energy for your primary goal: healing and recuperating.
• Remember, it really is about you when you’re hospitalized; you are the patient!
• Don’t be afraid to say no to anything that might increase your stress, including visitors, phone calls, flowers, gifts, or anything else that you truly do not want.
• If you do want visitors, make sure they know to ask you before visiting. This allows you to manage who visits and when.
• Decide what will be the best way for you to receive communications (cell phone, hospital phone, e-mail, or text messages) and let everyone know that this is your preference.
• Put an “out-of-the-office” notification on your e-mail account with a return date that extends beyond your hospital stay; this way people know not to expect a prompt reply.
• Choose a point person to run interference for you. If you’re comfortable giving that person access to your e-mail, he or she can also send out group updates to your designated contacts.
• Also assign a point person from your job to update your co-workers.
• Find out when meals are served, when the doctors do rounds, and when any procedures might be scheduled so that you can manage your visiting hours with minimal interruptions.
• Keep a list of things you would like people to bring. It’s much easier to refer to a list when people ask if you need anything, and it can prevent people from bringing things you don’t want or need.
• Make a comprehensive list of things you will need when you return home. That list will serve as a great resource for alternative suggestions of ways people can help if you would prefer not to receive visitors or if your loved ones are unable to visit.

Online Resources for Patients and Caregivers

If you will be in the hospital for a long time or expect a long recuperation, here are some websites that offer free tools to facilitate a help schedule and to keep family and friends updated about your progress and your needs.

Lotsa Helping Hands
www.lotsahelpinghands.com

CaringBridge
www.caringbridge.org

CareCalendar
www.carecalendar.org

CarePages
www.carepages.com

Kathryn (Seng) Gurland, LCSW, is a Licensed Clinical Social Worker and Cancer Navigation Consultant in New York City. Having lost sisters Judi and Peggy to cancer, Kathy is acutely aware of the need for personalized services for those affected by cancer. Her many years as a medical social worker and private psychotherapist, specializing in psycho-oncology, pain and palliative care, and end-of-life-care, exposed her to the intricacies of cancer and its effect on everyone involved. Assuming the roles of advocate, healthcare surrogate, and caregiver for her sisters motivated her even further to develop PEG’s Group, a private consulting group of Cancer Navigators. The company name, PEG’S Group, originated out of her sister Peg’s name and stands for Personal, Educa­tion, Guidance, and Support. PEG’S Group has been both a personal and professional endeavor conceived and developed by Kathy to meet the vital needs within the cancer community that our healthcare system is unable to provide at this time. For more informa­tion, visit www.pegsgroup.com. Kathy holds af­filiations with NASW, AOSW is on the Advisory Board of the NASW’s Communication Network Committee and is a regular contributor to SocialWorkers­Speak.org.
If you have questions that you would like to see addressed from a social work perspective, please send them to editor@omnihealthmedia.com.