100 Steps Towards Resilience

The most important aspect of building resilience is learning to take excellent care of yourself – mind, body, and spirit. Think of caring for yourself as if you were your own child – giving to yourself at least as much as you give to others. You are worth it!

Here is a list of 100 ways to consider building your resilience. This is not a checklist – only a list of suggestions. Please take the ones that appeal to you and let go of the rest.

1. Put a post-it on your mirror that says, “I love and accept you, just the way that you are!” – And then say it out loud every day while you're staring into your own eyes.
   
2. Create something. – Many of us have gotten away from actually making things. Create some artwork. Write something. Build something. Make something that didn’t exist before. Most importantly, enjoy the process.
3. Buy a bouquet of your favorite flowers every now and then. – Brighten up your life.
   
4. Use colored pens for no particular reason. – Blue and black are fine, but how about purple?
   
5. Take a walk without a destination. – It’s a great way to get some exercise and clear your mind. Be mindful of what you see, hear and feel.
   
6. Take a hot bath.
   
7. Try something new. – Go out on a limb. Learn something new. Do that thing you’ve always wanted to try. The more experiences you have, the richer your life will be.
   
8. Get enough sleep. – Everything is harder when you’re tired.
9. Meditate. – It takes a little practice at first, but if you find a meditation that works for you, you will be calmer and more peaceful.
10. Write in a journal. – Write anything that calls you. Ideas, experiences, dreams, frustrations – get them out of your head and down on paper.
    
11. List the things that you’re grateful for. – You can’t help but feel better when you literally count your blessings.
    
12. Treat yourself. – We struggle to be disciplined, especially with money and food. Once in a while, treating yourself to your favorite coffee or seeing a movie (if that’s what you like to do) makes all the difference.
    
13. Smile. – Even if you need to fake it. Eventually, you won’t be faking it anymore.
    
14. Replace negative thoughts. – Listen to what’s going on in your head and actively quiet the voices of pessimists and critics. Instead, when you are thinking something negative about someone or a situation replace it with this statement directed towards yourself, “ (Your name), I love and accept you just the way that you are.” When you love and accept yourself, you are much more likely to love and accept others.
    
15. Drink plenty of water. – It’s basic, but it’s so good for you.
    
16. Stretch. – Before you start your day, take a few minutes for a good muscle stretch. It just plain feels good. And, it’s fast, easy and free.
    
17. Put some “me time” on your calendar. – When life gets busy, doing things for yourself is the first thing to be sacrificed. So, actually block out time on your calendar.
    
18. Call a friend. – Think of someone who you enjoy and ring them up!
    
19. Ask for help. – This can be hard. But it’s so important to recognize when you need a sounding board, or some advice, or an extra pair of hands.
    
20. Say no, if you absolutely must. – Your time is valuable. Set boundaries to avoid becoming overwhelmed. However, remember your best opportunities in life come from remaining open. So, first say “yes” to those things that strike your fancy and carefully consider saying no to those things that you dread.
    
21. Give someone a hug. – We all need human contact.
    
22. List the things that you like about yourself. – We can all list the things that we don’t like about ourselves. Turn that around and think about your many positive qualities.
    
23. Delegate. – Hire someone to mow the lawn or scrub the floors or shovel the driveway. Teach the kids to do laundry. Give that project to a co-worker. You do not have to do it all.
    
24. Take a deep breath. – And another. Now another. It’s like a mini-break to reset yourself during the day.
    
25. Light a candle or use a reed diffuser. – Your sense of smell creates the strongest memories. Find scents that relax you and enjoy them.
    
26. Claim some space for yourself. – A place where you can go to have a quiet moment to read a book, or meditate, or write, or sleep – somewhere that you can get some peace and privacy.
    
27. Get out into nature. – Reconnecting with the earth is just good for your soul. Feel the breeze. Breathe the fresh air. Listen to the waves. Watch the birds. Nature nurtures the soul!
    
28. Buy the good ice cream. – Even on the tightest of budgets.
    
29. Use lotions & soaps with scents that you love. – It’s a nice way to pamper yourself, plus you’ll smell good all day.
    
30. Give a compliment at least once per day. – Telling someone that they had a fantastic idea or that they look beautiful in that color creates a pleasant environment and makes two people feel good for the price of one.
    
31. Listen to your music. – Listen to whatever makes you happy and leave air space for other’s happiness, too.
    
32. Play. – Something we forget as adults. A board game, a sport, finger painting – find something frivolous and have fun!
    
33. Eat foods that you love. – Food is to be enjoyed! Put food into your body that nourishes you in every way.
    
34. Be silly every now and again. – We take ourselves entirely too seriously. Let go. Be spontaneous and outrageous!
    
35. Laugh. – Sometimes you just need a good laugh to lift your spirits.
    
36. Limit screen time. – Too much time in front of computers, TV’s, video games, and blackberries (or all of the above) disconnects you from the world immediately around you and makes your brain mushy. Make sure that you’re getting plenty of input from the non-virtual world.
    
37. Be present. – Be deliberate about experiencing what’s happening right now. It’s all about the journey – don’t miss yours!
    
38. Stop worrying. – Just stop! Live in the moment.
    
39. Trust yourself. – You are smart, capable and talented. You’re choices are just as valid as anyone else’s. Don’t second guess yourself.
    
40. Do something that’s only for you. – Remember that hobby that you used to have time for? Or that food that no one else in your house likes? Reclaim it.
    
41. Make sure your health is in order. – What’s more important than your health? See your doctor regularly. Make sure you are getting the vitamins or supplements that you need. Advocate for yourself as you would for your child.
    
42. Give to someone in need. – Donating your time or your stuff or your money to someone less fortunate makes you feel good and puts your problems into perspective.
    
43. Sparkle! – Feeling down on yourself? Get all dolled up. Wear something that makes you feel beautiful. It’s a good way to find your strut.
    
44. Dance. – It’s great exercise and inherently joyful!
    
45. Stand up for yourself. – Your needs are important. Don’t let anyone disregard them. Pushing back can be scary but it’s empowering too!
    
46. Celebrate! (for any reason at all) – Your kid lost a tooth! Your taxes are done and filed! The week is more than half over! Let’s party!
    
47. Enjoy your kids. – It’s easy to rush through the day without really connecting with them. Make a conscious effort to talk with them about their day.
    
48. Avoid self-deprivation. – When it comes to food, it’s OK to cut back on things that aren’t good for you (sweet, sweet carbohydrates), but if you feel deprived, it’s probably not maintainable. If there is one thing you can’t live without – eat. Simply limit the quantity to a true serving size.
    
49. Forget the word “should”. – Instead of doing what you think you’re supposed to, follow your own path.
    
50. Pay attention to your energy. – Are you most productive first thing in the morning? Are you sluggish after lunch? Honor your natural cycles and plan accordingly.
51. Find a mantra or an affirmation that lifts your spirits. – “Today is a new day.” “I know that life always supports me.” “I have wonderful people in my life.” Find one that works for you.
    
52. Stand tall. – Your spirit can’t soar when you slouch. You feel much more powerful when you stand up straight and look the world in the eye.
    
53. Be romantic. – See the best in others and the best in life. It feels good.
    
54. Get a hot stone massage. – It feels soooo good.
    
55. Choose optimism. – Thinking positive thoughts has a tangible impact on your day and on your life. Where your attention goes, energy flows!
    
56. Dream big. – You can do anything you set your mind to!
    
57. Tune out the naysayers. – People criticize for many reasons, especially if they have negative feelings about themselves. That’s their “thing”, not yours. Follow your heart – not everyone has to get it.
    
58. Add color to your surroundings. – Find the colors that strike your fancy and use them in your space. Looking for calm, fill your world with sage green and navy blue. Looking for energy and passion, fill your world with Sicilian red and sunflower yellow.
    
59. Surround yourself with the things you love. – Especially, photos of loved ones.
    
60. Declutter. – You should have ONLY the stuff that you love. Purge everything in your life, both physical and emotional that you don’t honestly need, use or love. Everything else distracts you from your true intentions and bogs you down.
    
61. Stop procrastinating. – Procrastination is a form of perfectionism. Accept that it’s not going to be perfect and just get it over with. Image how great it will feel to not have it hanging over your head any more!
    
62. Listen to your inner voice. – Your instincts are good. It’s important to listen to your own head and heart.
    
63. Cut yourself (and everyone else) some slack. – Arguably the most important tip on this list. We hold ourselves to impossible standards and then beat ourselves up when we don’t meet them. We are our own worst critics. And, when we consistently criticize ourselves, we can’t help but criticize others, too.
    
64. Slow down. – When you’re living your life at top speed, you’re missing most of it. Stop and take a breath. Look for ways to adopt a more humane pace.
    
65. Identify your passion. – What do you love? What makes time disappear? Do you have a volunteer opportunity you feel passionate about? Are you passionate about traveling to foreign lands? How about learning to play the guitar? Find something in your life that really floats your boat and then schedule that activity for two hours twice per week.
    
66. Speak kindly about yourself. – You’re awesome. If you believe it, so will everybody else.
    
67. Move your body. – Climb rocks on the shoreline. Run a marathon. Take a tap dancing class. Power walk. Anything that feels good that gets your blood moving. The only limitation: it has to be fun. Don’t take a spinning class if you hate spinning.
    
68. Invest in matching under garments. – This one is for the ladies, of course. It’s your own little secret.
    
69. Pay attention to your body’s messages and purge things that aren’t good for you. – Unhealthy foods, cigarettes, a miserable work environment, toxic people – do what you have to do to set boundaries and demand the highest quality of life. You deserve it. Things that don’t nourish and support you don’t belong in your life.
    
70. Limit your news consumption. – It’s important to be well-informed, but the non-stop feed of histrionic tragedy is not helpful. Read the news, instead.
    
71. Say yes to life. – Opportunities are everywhere. Learn a new language, join a curling team, go camping. When new things present themselves to you – jump at the chance.
    
72. Stop hating your body. – Have compassion for your body. Nurture it.
    
73. Sing loudly. – And feel the music.
    
74. Be kind. – Being nice to someone else. You will have made the world a better place. What feels better than that?
    
75. Tell someone you love them. – We often forget to say it out loud. It matters.
    
76. Take all of your vacation days. – You earned them. Don’t give them back to your company for nothing.
    
77. Take pride in the hard times that you have overcome. – What didn’t kill you made you stronger. It wasn’t easy, but you did it!
    
78. Let someone else be in charge for a while. – Other people can be responsible while you do something for yourself.
    
79. Don’t answer the phone unless it’s someone you want to talk to right now. – Some people find it difficult not to answer a ringing phone, but it’s liberating once you learn to ignore it or even better, just turn it off.
    
80. Have faith. – It’s going to work out. The future is bright!
    
81. Take a personal inventory. – Does your behavior match your true intentions? If there’s a disconnect, you’re carrying a heavy weight.
    
82. Go on a retreat. – For a couple of minutes or a couple of days, get away for a bit to re-energize.
    
83. Put your finances in order. – Money problems are enormously stressful. Paying off debt where possible, putting bills on automatic payment, and working with a financial planner if necessary can all help to ease the strain.
    
84. Eliminate all expectations of perfection. – In fact, eliminate the word ‘perfect’ from your vocabulary.
    
85. Find a good way to blow off steam. – Talk, run, dance…find a healthy alternative to wallowing in anger.
    
86. Be who you are. – Dedicate time for soul searching to uncover your true self, and live that way.
    
87. Spend some time alone for quiet reflection. – We spend all of our time go, go, going. Try stopping to think about your life, your goals, and your dreams.
    
88. Keep your words positive. – Happiness and complaints cannot coexist.
    
89. Let light and fresh air into your house. – Sunlight is a must. Open up those windows!
    
90. Turn off your e-mail, cell phone, blackberry, fax, etc. for a while. – It’s not healthy to be accessible 24/7.
    
91. Pare down your to-do list. – Feeling overwhelmed? What’s on your list that can be delegated, avoided, or eliminated?
    
92. Avoid boredom. – Keep your brain active to keep the blues at bay.
    
93. Make your home a haven that reflects your personality. – Your home should be a place where you can take a breath and really relax. If it isn’t, you may have some work to do.
    
94. Let go. – 80% of everything is irrelevant. Focus on the other 20.
    
95. Minimize multi-tasking. – It’s not good for you and well ultimately undermine what you are trying to get accomplished.
    
96. Break your routine once in awhile. – Get out of a rut and into a groove.
    
97. Take action! – If something isn’t right in your life, fix it!
    
98. Plan ahead. – With a few minutes of organizing your time and to-do’s, you will be better prepared to take on the day.
    
99. Intentionally enjoy your journey. – As you go through your days, look around. Be present with what you see, hear and feel. You might be amazed at what you’ve been missing.
    
100. Spend time with people who make you happy. – Who nourishes and supports you? Surround yourself with those people.

How to Identify an Indigo Child

By Ezmeralda Lee, contributor to eHow

Indigo children may have possibly been around for several decades however, it was not until the 1982 book, "Understanding Your Life Through Color" by self-styled, psychic Nancy Ann Tappe, when the term was coined. New Age followers firmly believe that such children are born with a high spiritual consciousness and may even possess psychic abilities. However, psychologists and others believe that Indigo children have more conventional traits such as a higher level of empathy and creativity.

Instructions:

1. Study the child's aura, as the Indigo hue of a child's aura is the distinguishing characteristic of Indigo children. You may have a reading done of the child, if you do not possess the ability to read auras. If you sense a child is attracted to deep purples and blues, likes his room painted in these colors or prefers Indigo clothing, these are indications of an Indigo child.
2. Observe the attitude of the child starting from birth. An Indigo child has a strong, inherent sense of superiority and self-worth, often believing that she has been born to lead others or have the right and ability to do so.
3. Pay attention to how the child interacts with authority. An Indigo child will feel that he is the natural "leader of the pack." This is precisely why such a child often challenges or rebels against authoritative persons. An Indigo child will respond with a highly intelligent justification for his action or indiscipline and will also rarely feel guilty in response to disciplinary measures. As such children grow they will frequently assume positions of power and authority.
4. Notice how the child reacts to traditional systems and practice. An Indigo child has an extremely creative and active mind but will display intolerance and impatience when confronted with old traditions. At times such a child will get bored in a classroom or quickly lose patience when waiting in a queue. An Indigo child will often complain about what she perceives as an old system and will take the initiative to create better ways of organizing her room, classroom and even the world around her.
5. Watch if the child shows signs as a "loner" or displays anti-social behavior. An Indigo child often prefers to be alone and will also express her feeling of being different than everyone else. An Indigo child will find it difficult to adjust to school and extracurricular activities, unless she is able to bond with other Indigo children.
6. Listen carefully while the child communicates with you. An Indigo child knows exactly who he is and will not hesitate to talk about his psychic ability, sense to identify auras and the desire to advise or heal others. An Indigo child will also not hesitate to tell you what he needs and wishes to have, often amazing you with his blatant perception of self-identity, position in society and the world.

Tips & Warnings

• Try and empathize with the child's view of life by being a patient listener while also offering advice in a calm, soft-spoken manner.
  
• Do not reprimand or question the child's behavior in a harsh or overly, aggressive manner as an Indigo child is prone to acute frustration and depression.
  

Read more: How to Identify an Indigo Child

Medicinal Plants for Female Sexual Dysfunction

A recent article in The Journal of Sexual Medicine identifies and describes the popular and clinical uses of medicinal plants for Female Sexual Dysfunction (FSD) in climacteric (menopausal) women. Although there is very little evidence from the literature to recommend the use of medicinal plants for treating FSD, Mazaro-Costa, et al, list those plants that are currently used for female reproductive disturbances, most notably the climacteric state to correct aspects of female sexual dysfunction. More research is needed before strong recommendations can be made.

Black cohosh – Cimicifuga racemosa

Current use: Menopausal therapy for hot flashes, profuse sweating and vaginal complaints

Active Ingredients: triterpene glycosides, phenolic acids, flavonoids, volatile oils, tannins

Standardization: 2.5% triterpene glycosides

Research: was not statistically significant in treating hot flashes after 16 weeks; does improve the vaginal maturity index in postmenopausal women; approaches significance in treating vaginal dryness; statistically significant in treating anxiety

Mechanism: SERM (does not affect ERα or ERβ but does have an effect on ERϒ), high affinity for various serotonin receptors

Safety: Relatively safe; however, case reports about liver toxicity. Because of unknown MOA and potential estrogenic effect it should be avoided during pregnancy and lactation and in children under 12.

Ginkgo - Ginkgo biloba

Current use: asthma, fatigue, tinnitus, memory improvement

Active Ingredients: flavonol, glycosides, terpene lactones, bilobalide

Standardization: 6% terpene lactone sna 24% flavones glycosides

Research: 300 mg improved physiological sexual arousal but no subjective sexual arousal; when combined with sex therapy increased sexual desire and contentment; effective in alleviating antidepressant-induced sexual symptoms in 84% of cases

Mechanism: Relaxes smooth muscle, facilitates peripheral blood flow, has NO-scavenging abilities

Safety: Side effects are rare and limited to mild, transient and reversible; drug interactions with warfarin, aspirin, lithium; safety in pregnancy and breastfeeding has not been established

Maca – Lepidium meyenii

Current use: Andean aphrodisiac an/or fertility-enhancing, menopausal therapy

Active Ingredients: sterols which possess phytoestrogen activity

Standardization: Unknown

Research: RDBPCT decreased psychological symptoms including anxiety, depression and sexual dysfunction and did not affect estradiol, FSH, LH or SHBG levels.

Mechanism: Unknown

Safety: Unknown

Puncture vine – Tribulus terristris

Current and traditional use: ancient aphrodisiac, UTI treatment, inflammation, edema and TCM sexual dysfunction

Active Ingredients: Steroidal saponins (tribestane, vitanone and protodioscin)

Standardization: 16.4% protodioscin

Research: 49/50 women experienced improvement in all or some menopausal symptoms (hot flashes, depression, genital discomfort, libido) however, may lack validity due to conflict of interest

Mechanism: increase endogenous androgen production by increasing LH release from the pituitary gland; increases NO release

Safety: Phototoxic reactions; safety during pregnancy and lactation has not been established

Red clover – Trifolium pretense

Current use: Menopausal therapy for hot flashes, profuse sweating and vaginal complaints

Active Ingredients: phytoestrogens such as genistein, formononetin, daidzein and biochanin A

Standardization: 9-15% isoflavones

Research: meta-analysis showed a marginal effect for treating hot flashes with 40-82 mg/day; significant beneficial effect on vaginal and sexual health in postmenopausal women

Mechanism: SERM (does not affect ERα or ERβ but does have an effect on ERϒ), high affinity for various serotonin receptors

Safety: Safe and well-tolerated in women with one first degree relative with breast cancer; supplements containing these isoflavones did not adversely affect breast density, skeletal strength or cardiovascular status; none of the CCT have reported adverse effects at doses upt to 160 mg of isoflavones per day.

Chasteberry fruit – Vitex agnus-castus

Current use: Premenstrual syndrome

Active Ingredients: triterpene glycosides, phenolic acids, flavonoids, volatile oils, tannins

Standardization: 0.05% agnuside and 0.08% casticin

Research: topical application - improvement in vaginal tone, thinning and lubrication with less dyspareunia; increased uterine weight, serum progesterone and estrogen levels in ovariectomized female rats; decreased LH and Prolactin

Mechanism: SERM (affects ERα or ERβ), decreases LH and prolactin; dopaminergic D2 receptor agonist; increases melatonin secretion

Safety: Relatively safe

Dong quai – Angelica sinensis

Current use: replenishing the blood, treating menstrual disorders and menopausal symptoms; when used in Traditional Chinese Medicine is used in conjunction with other herbs

Active Ingredients: ferulic acid and Z-ligustilide; has no phytoestrogens.

Standardization: ferulic acid 0.4-0.7%, 0.5-5.0% ligustilide

Research: When used alone has not effect in treating menopausal symptoms; has no estrogenic effect in humans but did in rat studies; when combined with Matricaria chamomilla demonstrated a reduction in hot flashes, improved sleep; when combined with Astragalus membranaceus helped decrease mild hot flashes; the improvement of sexual symptoms was not explored

Mechanism: not mentioned

Safety: few side effects including headache and potentiates anticoagulant therapy; do not use in children or adults with diarrhea, hemorrhagic diseases, hypermenorrhea, pregnancy or lactation; some concerns about liver toxicity

Zalloh – Ferula hermonis

Current use: native to Syria and Lebanon, used as a strong aphrodisiac for both sexes, treatment of frigidity and circulation enhancement

Active Ingredients: ferutinin has binding capacity for estrogen receptor α and β equivalent to about 1/10 of the binding affinity of estradiol

Standardization: not mentioned

Research: may be suggested for female sexual dysfunction associated with desire disorder

Mechanism: estrogenic effect, increased production of progesterone and therefore stimulate female sexual behavior

Safety: Unknown

Hops - Humulus lupulus

Current use: in Germany hops baths are used for treatment of gynecological disorders and hops extracts have been reported to reduce hot flashes in menopausal women

Active Ingredients: 8-prenylanaringenin; isoxanthohumol which can readily be converted to 8-prenylnaringenin by intestinal microbes; three flavonoids with estrogenic activity including: 6-prenylnaringenin, 8-geranylnaringenin and 6,8-diprenylnaringenin

Standardization: 0.11 + 0.01 mg of 8-prenylnaringenin/capsule

Research: RPCCO studies with 50 postmenopausal women over 16 weeks showed superiority over placebo for treating hot flashes; other studies have shown improvement in climacteric symptoms; topical application combined with hyaluronic acid, liposomes and Vitamin E showed significant improvement in vaginal dryness. Animal studies demonstrate an estrogenic effect on the uterus, vagina and mammary gland secretion however in vitro study did not confirm androgenic or progestogenic activity of the active ingredient.

Mechanism: may act as a SERM

Safety: safe alternative treatment for genital atrophy in postmenopausal women when HRT is not recommended; causes drowsiness; inhibits cytochrome P450; unknown safety during pregnancy and nursing.

Reference: J Sex Med 2010;7:3695-3714

Natural Hot Flash Remedies

Are you suffering from hot flashes or night sweats? If so, you are in good company. Approximately 75% of American women experience vasomotor symptoms as they transition through menopause. Prescription hormonal therapy is available - if you find your symptoms intolerable. However, safety concerns are mounting.

Here are 6 natural ways to cool down when the heat is rising:

1. Use the 3-4-5 method of breathing to calm down when the heat starts to rise. Breathe in through your nose to the silent count of three, hold for four and breathe out through your mouth for five. Really focus on distending your lower abdomen with each inhalation, and count slowly. You should continue this pattern until your hot flash subsides.
2. Eat a healthy diet filled with vegetables, fruits, whole grains and omega-three fatty acids (found in cold water fish, green leafy vegetables, walnuts and ground flax seed). And, sip plenty of cool water throughout the day; this decreases your core body temperature thereby reducing the frequency of hot flashes.
3. Avoid dietary triggers like spicy food, alcohol and most caffeine. Although it does contain caffeine, it is okay to drink green tea. Here's the trick. Steep fresh green tea in hot water for 45 seconds, poor off that water, and then steep the same tea as you normally would. This way you will remove 80% of the caffeine and retain all the good anti-oxidants. The occasional morsel of dark chocolate is fine, too.
4. Try an herbal therapy shown to decrease the frequency and severity of hot flashes: St. John's Wort 300 mg three times daily. Black cohosh, although used for centuries, has not been found to be effective when subjected to scientific analysis. Teas containing lemon balm, hops and valerian decrease anxiety and promote sleep, countering night sweats.
5. Use bedtime rituals to decrease disruptive night sweats. Take a cool shower before bed, turn on a small bedside fan, and listen to calming music. Sleep under sheets made of 100% cotton. Just in case, keep a change of clothes and sheets in your nightstand to ease the pain of awakening to drenched pajamas and soaked sheets that need changing.
6. Stop smoking.

Take heart - hot flashes and night sweats are usually temporary. Most women experience resolution within 2 years. Use this period of transition to nurture yourself. Embrace your passage from one stage of life to the next. Hang in there. The best is yet to come!!

Prevent Complications Associated With Cesarean Delivery

A wonderful, concise, evidence-based article by Dr. Patrick Duff was published in the December edition of Obstetrics and Gynecology entitled, "A Simple Checklist for Preventing Major Complications Associated with Cesarean Delivery".

Dr. Duff proposed the following evidence-based eight steps to significantly reduce maternal morbidity and mortality associated with cesarean delivery:

1. Clip the hair at the surgical site just before making the incision

2. Cleanse the skin with chlorhexidine solution rather than povidone-iodine solution

3. Administer broad-spectrum systemic antibiotic prophylaxis before the surgical incision rather than after the neonate's umbilical cord is clamped

4. Remove the placenta by traction on the umbilical cord rather than by manual extraction

5. Close the uterine incision in two layers rather than one

6. In women whose subcutaneous tissue is greater than 2 cm in thickness, close the layer with a running suture

7. Patients at intermediate risk for deep vein thrombosis [BMI > 30, those with gross varicose veins, those immobilized for > 4 days before surgery, those who have concurrent medical illness that predisposes to thromboembolism (e.g. sickle cell disease, sickle cell C disease, cancer, antiphospholipid syndrome, hereditary thrombophilia with no history of DVT or PE)] should receive prophylaxis postoperatively with either sequential compression devices or subcutaneous heparin

8. Patients at high risk for postoperative deep vein thrombosis (those with more than two risk factors in the moderate-risk category, those with prior DVT or PE, those who have a cesarean hysterectomy) should receive prophylaxis with both sequential compression devices and subcutaneous heparin until the patient is fully ambulatory

Referenced article: Obstet Gynecol 2010;116:1393-6

Mindfulness and Parenting

A very helpful excerpt on the benefits of practicing mindfulness while undertaking the challenges of parenting - from Jon Kabat-Zinn's chapter "Parenting and Practice" in Wherever You Go There You Are: Mindfulness Meditation in Everday Life.

And it gets more challenging as the children grow older and develop their own ideas and strong wills. It's one thing to look after the needs of babies, which are very simple, after all, especially before they can talk and when they are at their absolute cutest and most adorable. It's quite another to see clearly and to respond effectively and with some modicum of wisdom and balance (after all, you are the adult) when there is a continual clash of wills with older children, who are not always so cute and cuddly, who can argue circles around you, tease each other mercilessly, fight, rebel, refuse to listen, get into social situations in which they need your guidance and clarity but may not be open to it; in short, whose needs require a constant energy output that leaves you little time for yourself...

These trials are not impediments to either parenting or mindfulness practice. They are the practice if you can remember to see it this way. Otherwise, your life as a parent can become one very long and unsatisfying burden, in which your lack of strength and clarity of purpose may lead to forgetting to honor or even see the inner goodness of your children and yourself.

Children can easily become wounded and diminished from a childhood which consistently fails to adequately honor their needs and their inner beauty. Wounding will just create more problems for them and for the family, problems with self-confidence, with communication and competencies, problems that don't disappear on their own as the children grow older but usually amplify...

It is obvious that, with all that energy going outward, there has to be some source of energy coming in which nurtures and revitalizes the parents...I can think of only two possible sources (of this energy): outside support from your partner, other family memebers, friends, baby-sitters and so on and from doing things you love, at least occasionally; and inner support, which you could get from a formal meditation practice...if you can make even a little time in your life for stillness, for just being, for just sitting, or for doing a little yoga, for nourishing yourself in ways that you need to be nourished...

Parenting and family life can be a perfect field for nindfulness practice, but it's not for the weak-hearted, the selfish or lazy, or the hopelessly romantic. Parenting is a mirror that forces you to look at yourself. If you can learn from what you observe, you just may have a chance to keep growing yourself.

Picture: My husband, Stuart and our three sons in 2003 (Mitch 19, Shayne 14, Alex 13)

I wish I knew then what I know now!

Chronic Pelvic Pain

I attended a very fascinating conference over the weekend. The event was hosted by the International Pelvic Pain Society in Chicago, Illinois. Throughout the 4-day event, a common thread linked many common pain syndromes of the anatomic structures below the umbilicus and above the upper thighs. Such ailments include chronic pelvic pain, Irritable Bowel Syndrome (IBS), Interstitial Cystitis (IC) and other bladder pain syndromes, dyspareunia (pain with intercourse), vulvar pain, vaginal itching/pain, hip pain, fibromyalgia, postoperative pain, back pain, endometriosis.

Twenty percent of women suffer from chronic pelvic pain (CPP). The typical patient with CPP doesn't look "sick", is frequently embarrassed by her symptoms, fears she will not be taken seriously by her doctor and has difficulty speaking to loved ones about her symptoms. Sufferers of CPP frequently experience alienation, hopelessness, anxiety, depression, suicidal ideation, sleeplessness, narcotic addiction concerns, sexual dysfunction, loss of relationships and loss of employment.

Women who seek medical advice for CPP are often discouraged as so many are told, "There is nothing else in there that could hurt - everything we have looked at is normal." The pelvic muscles, ligaments and nerves of the pelvis are the common denominators in CPP - regardless of the etiology.

The basics of the chronic pain cycle: (1) recurrent activation of the afferent nerves from the source of pain to the dorsal horn of the spinal cord; (2) prolonged release of neurotransmitters in the dorsal horn including substance P; (3) upregulated inflammatory response and release of other neurotransmitters in the dorsal horn; (4)resultant loss of sensitivy or hypersensitivity of the tissue pain source with expansion of the receptive field; (5) prolonged exposure to painful stimuli eventually causes centralization of the pain (i.e. communication with the brain) and local upregulation of pain fiber generation and inflammation resulting in hypersensitivity to pain and organ dysfunction (6) resulting in muscular contraction, other tissue changes and ultimate end-organ dysfunction.

The goals of chronic pain management consist of removal of the noxious stimulant if still present, and modulating the neurological and immune response (i.e. neuromodulation) to an insult. Examples of neuromodulation include biofeedback, drugs with neurotropic and psychotropic effects (oral and topical), soft tissue manipulation and utilization of neurostimulatory devices that stimulate including TENS units, acupuncture and sacral nerve stimulation. The suggested treatments vary according to the type and source of pain. Research indicates that peripheral pain is best treated with topical applications whereas visceral (organ e.g. bladder) pain is best treated with dorsal horn nerve activation.

Little was mentioned regarding complementary and alternative therapies for CPP other than hypnosis for IBS and acupuncture for IC. Lifestyle modification has proven beneficial for those with chronic inflammatory conditions, including CPP. Such alterations in every-day behaviors serve most people well, such as following an anti-inflammatory diet, consuming anti-inflammatory supplements, smoking cessation and limiting exposure to other environmental toxins. Because the efficacy of hypnosis in treating IBS has proven to be helpful, presumably other mind-body approaches should be consider (e.g. mindfulness meditation, Tai-chi, Yoga, guided imagery, art therapy, music therapy, aromatherapy, etc.) Energy therapies should also be considered as acupuncture has already proven helpful. It is important that these treatment modalities be subject to scientific inquiry in reference to treatment of CPP.

Congratulations and thanks to those scientists who continue to pursue additional knowledge. My learning has just begun.

Resources:

International Pelvic Pain Society Intake Form

National Vulvodynia Association Tutorial

Anti-inflammatory Diet

Fibromyalgia Information Foundation

Pelvic Pain and Urgency/Frequency Scale