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Archive for the ‘
Tip Sheets ’ Category
Introduction
Peace, Joy and many guests (sometimes unwelcome guests) like Depression and Stress, which can affect your health and ruin your holidays. Planning ahead, being realistic and seeking Help (support) in time of need can help rid depression and stress. Some people will find themselves in a whirlwind of demands – work, family, shopping, cleaning, care giving for elderly or kids on school break, cooking, parties, funerals, visiting the sick, studying and many other activities. So much for peace, joy and the pursuit of happiness, right?
However, some simple guidelines can minimize and help alleviate the depression and stress that often are part of the holiday season. You may even end up enjoying the holiday more than you ever thought you could!
Trigger points
Holiday depression and stress are often the result of three predominate trigger points. Understanding these trigger points can help us plan ahead on how to accommodate them.
Finances
Our financial situation can cause stress at any time of the year (just like our relationships). However, in a sluggish economy, overspending during the holidays on gifts, clothing, travel, food, and entertainment can increase stress as we try to make ends meet while ensuring that everyone on our gift list is Happy.
Relationships
Our relationships can cause conflict, stress and dysfunction at any time. But tensions are heightened during the holidays. Family and marital conflict and misunderstanding can intensify. With so many needs to accommodate, specifically with family from out of town that we have not seen in a while, we may feel overwhelmed. On the other hand, if we are facing the holidays without loved ones or family, we may find ourselves especially lonely, sad or depressed
Physical Demands
Partying, cooking and shopping can exhaust us. Feeling exhausted increases stress levels. Sleep and exercise are very healing, curing and can relieve stress; however, we are usually sleep deprived during holidays, as our physical demands are heighten due to the extra demands, as well as overeating and drinking, which are all ingredients for holidays illness.
11 steps to alleviate
Holiday stress – We must make a conscious effort to help prevent normal holiday depression from escalating into chronic depression. When stress is at it peak we need to Stop and re-group. Here are some tips:
Budget – Before going shopping, decide how much money you can afford to spend on gifts. Stick to your budget. If you do not, then you could feel anxious and tense and upset for months afterwards as you struggle to
pay off the debt. Homemade gifts are awesome. Or donate your time, visit someone in the hospital or a nursing home, happiness nor friendship cannot be bought via a material item.
Plan – Plan ahead, and set a schedule for shopping, cooking, visiting friends and family, partying, exercising, etc. Allow extra time for travel so that when you’re sitting in traffic you do not increase your anxiety level and stress out.
Say NO – Learn to say no. NO to the things you truly do not want to engage in. NO to the activities you have no desire in participating in. NO to those family members or so-called friends you truly do not want to visit with. Say Yes to the things and activities that truly fill your spirit and soul.
Stick to your healthy eating habits – Have a healthy snack before holiday parties so that you do not go overboard on sweets, alcohol, sodas and carbs. Remember portion control. Read labels to find out just how many calories are in the specific product you decide to buy and consume. Walk and schedule time for physical activity. Go dancing!
Take a break – Make some time for yourself, 10-15 minutes alone, for private meditation, without any distractions. It will refresh you for the rest of the day. Go to a quite place for a few moments of solitude, with God, the Universe, your creator, the stars, Heaven, whatever you believe in. Find something that calms you, inhale all the good the universe has in store for you and exhale all the toxins in your life.
Be aware of your feeling – It is alright to cry or to express your feelings. You do not have to be Happy simply because it is the holiday season. Acknowledge your feelings. It is normal to grieve the loss of a parent during the holidays, the loss of a partner, the loss of employment, a friend’s recent cancer diagnosis. Remember – this too shall pass.
Change is good – Be realistic, as families move and grow, traditions often move and grow with them. Stick to the things you can and want to do. Be creative with the traditions you cannot engage in as a family unit any longer because of long distance or other issues. Use the high-tech ability of Facebook, twitter or simply the traditional post office method of mailing a card, for example in connecting with an elderly relative or friend without a computer.
Seek help – Get support if you’re feeling sad or isolated – from family members, friends, community, social services agencies or your religious group. Getting involved and helping others always brightens our spirits and creates good Chi. On the journey toward helping others you’ll also make new friends.
Resolutions – Change begins with our every waking moment; we do not need to wait until a particular day during the holiday session to make all the life-altering changes or to deal with past issues. Stop and be realistic about your resolutions, as they can set us up for failure if they are unrealistic. Set attainable short-term goals with a reasonable time frame.
For example, you do not need to loss 40 pounds in one week – you can start by taking small do-able steps, such as starting a walking club with your neighbor and changing your eating habits. Remember the Journey of a thousand miles starts with one step.
Things might go wrong – Forget about perfection. Expect and accept imperfections. Things might go wrong but you do not have to go with them
Seek professional help – Sometimes we need the assistance of a professional to help us navigate a difficult situation. If you find that you are feeling extremely sad, angry, anxious, unable to sleep, irritable, hopeless, helpless, unable to face the day to day activities, unable to cope, constantly arguing, isolated, and any of these are exhibited over several weeks, please talk to someone. Seek the assistance of your doctor – if you do not have a doctor, go to the family health care center in your neighborhood as you could be experiencing depression.
Acceptance – Accept that things are not always going to go as planned. One way to minimize holiday depression and stress is acknowledging that the holidays can and will trigger depression and stress. Accept that things, events and people are not always going to go as you planned. Take steps to proactively manage your depression and stress during the holidays. You might truly enjoy and be grateful for this holiday session this year – more than you imagine.
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Tags: holiday stress and depression, Maribel Quiala
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Introducción
Paz, Alegría y muchos invitados (algunas veces invitados no bienvenidos) como la Depresin y Estrés, los cuales pueden afectar su salud y arruinar sus fiestas. Planear con tiempo, ser realistas y buscar ayuda (apoyo) en un momento de necesidad, puede ayudarlo a eliminar la depresin y el estrés.
Muchas personas se encontrarán en un mundo lleno de demandas- trabajo, familia, compras, limpieza, cuidar a personas mayores o los niños durante las vacaciones de la escuela, cocinar, fiestas, funerales, visitar enfermos, estudiar y muchas otras actividades. Demasiado para la paz, el disfrute y la búsqueda de la felicidad, ¿verdad?
Sin embargo, algunos simples consejos/ ideas pueden minimizar y ayudar a aliviar la depresin y el estrés que forman parte de temporada de celebraciones. Usted incluso puede terminar disfrutando más de estas fiestas de lo que imagin.
¿Cuáles son los puntos desencadenantes?
La depresin y el estrés de época festiva son con frecuencia el resultado de 3 puntos predominantes que los provocan. Entender estos puntos nos puede ayudar a cmo acomodarlos.
Finanzas — Nuestra situacin financiera puede causar estrés en cualquier época del año (igual que nuestras relaciones). Sin embargo, en una economía lenta, gastar en exceso durante las fiestas en regalos, ropa, viajes, comida, entretenimiento, puede aumentar nuestro estrés a medida que tratamos de hacer que el dinero nos alcance, y a la vez, asegurarnos que todo el mundo de nuestra lista de regalos esté Feliz.
Relaciones — Nuestras relaciones pueden causar conflicto, estrés y disfuncin en cualquier momento. Pero las tensiones se intensifican muchas veces durante la época festiva. Conflicto familiares, maritales y malos entendidos pueden intensificarse. Específicamente, si debe atender las necesidades de familiares que viven fuera de la Ciudad, y que no ha visto por algún tiempo. Pero por otra parte, si estamos en las fiestas sin nuestros seres queridos, o familia, podemos sentirnos especialmente solos, tristes y deprimidos.
Demandas Físicas — Salir de fiestas, cocinar, ir de compras pueden agotarnos. El sentirnos exhaustos aumenta nuestros niveles de estrés. El sueño y ejercicio son muy buenos para curar y aliviar estrés, sin embargo durante las fiestas tendemos a dormir poco, a medida que las demandas físicas se intensifican por compromisos adicionales. Comer en exceso y beber son también ingredientes de las enfermedades festivas.
11 Pasos para Aliviar el Estrés durante la Fiestas
Debemos hacer un esfuerzo consciente para ayudar a prevenir que la depresin normal de las fiestas escale hacia una depresin crnica. Cuando el estrés está en su punto más álgido, necesitamos Detenernos y re-agruparnos.
Algunos consejos:
Presupuesto — Antes de ir de compras, decida cuánto dinero puede permitirse gastar en regalos. Manténgase firme en su presupuesto. Si no lo hace, entonces puede sentirse ansioso, tenso y molesto varios meses después, mientras hace esfuerzos para saldar la deuda. Los regalos hechos en casa son increíbles, done su tiempo, visite a alguien en el hospital o en una casa de cuidados, la felicidad y la amistad no pueden comprarse con cosas materiales.
Plan — Planee con tiempo, establezca una lista con horario para hacer las compras, cocinar, visitar amigos y familiares, ir de fiestas, hacer ejercicios, etc. Deje tiempo para cuando maneje, así que cuando usted esté sentado en el tráfico no aumente sus niveles de estrés y ansiedad.
Diga NO — Aprenda a decir No. No a las cosas con las que usted verdaderamente no quiere comprometerse. No, a las actividades en las que usted no tiene deseo de participar. No a miembros de la familia o a los llamados amigos, que usted no quiere visitar. Diga SI, a las cosas y actividades que realmente le llenan su alma y espíritu.
Manténgase firme en sus hábitos saludables de comida — Tenga una saludable merienda antes de ir a una fiesta, para que no se sature con dulces, alcohol, sodas y carbohidratos. Recuerde su porcin de control. Lea las etiquetas para saber cuantas calorías tiene un producto específico que usted decide comprar y consumir. Camine y establezca un horario para cualquier actividad física. ¡Vaya a bailar!.
Tome un descanso — Dedique algún tiempo para usted, 10-15 minutos solo, en meditacin, sin ninguna distraccin. Esto le refrescará por el resto del día. Vaya a un lugar tranquilo para pequeños momentos de soledad con Dios, el Universo, su Creador, las estrellas, el Cielo, con lo que usted crea. Encuentre algo que lo calme, inhale todo lo bueno que el Universo ha reservado para usted, y exhale todas las toxinas de su vida.
Esté consciente de sus sentimientos — Está bien llorar y expresar sus sentimientos. Usted no tiene que estar Feliz, simplemente porque llegaron las fiestas. Reconocer sus sentimientos es normal para aliviar el dolor de la pérdida de un padre, la pérdida de su compañero, la pérdida del empleo, o por un amigo al que le han diagnosticado cáncer recientemente. Recuerde que esto deberá pasar.
El Cambio es bueno — Sea realista. A medida que las familias se mudan y crecen, las tradiciones con frecuencia se mudan y cambian con el tiempo. Preserve las cosas que usted puede y quiere hacer. Sea creativo con las tradiciones que usted ya no puede realizar en la unidad familiar, por la larga distancia u otras situaciones. Use la facilidad de la alta tecnología de Facebook, Twitter, o simplemente el tradicional método de enviar cartas a través del correo postal, para comunicarse con un anciano que no tiene computadora.
Busque Ayuda — Busque ayuda si esta sintiéndose muy triste, aislado de los miembros de la familia, amigos, comunidad, agencias de servicios sociales o los servicios religiosos. Involucrarse y ayudar a otros siempre hace brillar nuestros espíritus y crea buen Chi. En la travesía de ayudar a otros, usted también hará nuevos amigos.
Resoluciones o Propsitos — El Cambio comienza cada momento que despierte. No necesitamos esperar a un día particular en la temporada de fiestas, para hacer todos los cambios de nuestra vida relacionados con el pasado. Deténgase y sea realista sobre las resoluciones que nos pueden hacer sentir fracasados, si son fantasiosas. Establezca metas realizables de corto alcance, dentro de un marco razonable de tiempo. Ejemplo, usted no necesita perder 40 libras en una semana. Usted puede comenzar realizando pequeñas metas, como establecer con un vecino un club de caminatas, y cambiando sus hábitos alimenticios. Recuerde que el camino de mil millas comienza con un solo paso.
Las cosas pueden ir mal —Olvídese de la perfeccin. Espere y acepte imperfecciones. Las cosas pueden ir mal, pero usted no tiene que ir con ellas.
Busque Ayuda Profesional — Algunas veces necesitamos la asistencia de un profesional para que nos ayude a navegar por una situacin difícil. Si usted se está sintiendo extremadamente triste, furioso, ansioso, con problemas para dormir, irritable, descorazonado, sin esperanza, incapacitado para enfrentar las actividades del día a día, incapacitado para hacer las cosas, pelea constantemente, aislado, y esto le ha estado sucediendo por varias semanas, por favor hable con alguien. Busque ayuda de su doctor, si no tiene doctor vaya a un centro de cuidado familiar en su vecindario, porque usted puede estar padeciendo de depresin.
Aceptacin — Acepte que las cosas no siempre van a salir como las plane. Una forma de minimizar la depresin de las fiestas y el estrés es reconociendo que esta temporada navideña va a desencadenar depresin y estrés. Acepte que las cosas, eventos y las personas no van a ir como usted lo calcul. Tome los pasos activos para su depresin y estrés durante esta época. Usted puede verdaderamente disfrutar y estar agradecido de la temporada festiva este año, más de lo que puede imaginar.
¡Abundantes bendiciones para todos!
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Tags: Maribel Quiala
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Introduction
Disasters and tragedies of any kind such as floods, hurricanes, illnesses, accidents and financial dilemmas all have the potential of making people feel a loss of control. When we no longer feel a sense of mastery over our lives, we tend to get depressed and helpless. The recent mortgage crisis and its cascade affect on other industries such as real estate, construction, bank loans and retail businesses has made many of us feel that we've been dealt a very bad hand—and are stuck with it. Here are some quick tips for dealing emotionally and financially with today's economic crisis. In no way is this advice a substitute for financial and mental health counseling, two actions that I highly recommend.
Dealing with Financial Disasters
- First and foremost—FORGIVE yourself. Conduct an actual Forgiveness Ceremony with your closest friends and family members. Write down your and your family's positive attributes and read them out loud to everyone. Then add that you forgive yourself, your partner, life, fate and, if you believe in any kind of Supreme Being or Power, forgive him too. Remind yourself that very few of the wisest pundits foresaw this economic problem so how would you expect yourself to have seen into the future? If you don't forgive yourself, you will remain immobilized, which is the real foe.
- Get your brain and emotions into what I call "Disaster Management World-View." Make a list of your positive characteristics and skills. Make another list of the things for which you are still grateful. When you watch disaster survivors on television, you see someone standing in front of the remains of their homes. There is usually nothing left but rubble and an upturned bath tub. You also hear most of the survivors saying things like "Well, at least we have each other." Or, "We're alive and that's what counts." Get a perspective. People do recover. They might have to move, live with less and readjust their dreams, but they can do more than survive—they can also thrive. Crises have a way of challenging us to break out of our routine behaviors and to be our best selves.
- Review your finances and see where you can cut back, if possible. Some families cut back on vacations, dining out or buying fun but unneeded things.
- Think outside the box regarding your interests and skills. It's easy to get into a rut and think that because you worked in job area X, you have to look in that field for work. Make a list of your skills, talents, accomplishments, education/training, and interests. Read the list to friends and family and see what other industry sectors they think might be a good place to look for a new line of work. Often times, we can't view ourselves accurately. Seek free or very inexpensive career counseling by contacting your local Chamber of Commerce and see what they suggest about your background. They might suggest, for example, a new line of work or more training. Many communities have an organization of professional retirees who want to help by reviewing your work history and offering advice. Family Service agencies also offer sliding fee assistance.
- Remember what I call the "Three P's" of gaining control of bad situations.
- Pro-action: DO something. Talk to someone. Devise a new plan instead of relying on your old behavior. Re-using the ” same old, same old” techniques that haven't worked will make you feel helpless, anxious, angry and depressed. The best cure for those ills is taking the reins and devising an action plan.
- Persistence: Contact your lenders, bank, credit unions, and credit card companies. Don't take the first set of "no's."
- Pinnacle: Don't waste your time talking to the low person on the totem pole. Go to the top of the food chain as far up as possible. Identify who can make a decision. If you took the first step—Pro-action—then you will have come up with a new payment plan, an explanation of what you are doing now to cut back on expenses or any other actions that might convince a lender or creditor as to why YOU are someone they should help.
Dealing with the Emotional Fallout of Financial Disasters
- Get positive and grateful. Make a list of your positive characteristics and things that matter and for which you feel grateful. Get your priorities straight.
- Don't use the same, ineffective methods of handling this stress. It won't work if you do them louder or more often. Using a failed strategy will only lead to more failure. For example, if yelling, sleeping all day or withdrawing hasn't produced any effective changes, they probably won't in the future either.
- Develop an action strategy. Seek emotional counseling—if for no other reason than to use as a "sounding board."
- Know the signs and symptoms of serious emotional problems in yourself and others. Disasters turn everyone into what I call The Feeling Cops. If something is bothering you, it is your job to TELL others. If you observe problematic behavior in others, it is your job to ASK the person about it. The next step is to DO something about it. Be on the lookout for increased anxiety, depression, sleeping or eating too much or too little, increased substance abuse, arguing, fighting, hitting and thoughts of suicide. During hard times, domestic violence, couple problems and substance abuse occur more frequently. Seek counseling or medical help immediately—even if your partner doesn't want to.
- Work as a team with your spouse/partner. Blame and self-blame are not useful. Treat everyone in your family the way you would want to be treated. Tell your children that things will change, but that you will all be okay. Children can be very resilient if they know their parents love them and will care for them.
I wish you the very best.
To read more articles about relationships by Dr. Wish, please visit her Web site www.lovevictory.com.
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Tags: emotional and financial stress, LeslieBeth Wish
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Introducción
Cuando los padres -casados, solteros o del mismo sexo- se divorcian aparecen muchos trastornos emocionales. Establecer entonces una guía de paternidad responsable puede ayudar a minimizar bajo cualquier circunstancia, los profundos efectos, muchas veces de por vida, que sufren los hijos únicos o múltiples, quienes de pronto se ven a sí mismos atrapados en un interminable recorrido de altibajos emocionales.
Los niños que sin darse cuenta son trasladados al sistema de cuidado de crianza temporal, pueden incluso experimentar una mayor sensacin de pérdida y confusin. También bajo una gran presin, están aquellos niños que deben transitar el laberinto legal para una posible reunificacin con sus padres biolgicos, otros familiares, o seguir el proceso de adopcin.
Aunque la sentencia de separacin o divorcio puede romper la relacin entre los adultos, la misma no absuelve a ninguna de las partes -en la mayoría de los casos- de ser padres responsables. Ningún niño debe sufrir los daños colaterales del fracaso de una relacin de pareja. Por eso, las normas para una paternidad responsable pueden ofrecerle un terreno positivo y neutral, a través del cual, todas las partes pueden operar, incluso si no quieren hacerlo.
En un mundo perfecto, la habilidad de comunicarse, comprometerse, ser flexibles, tolerantes, moderados, objetivos, justos e imparciales, formaría parte de la segunda naturaleza de las personas, y las ayudaría a enfrentar cualquier adversidad. Sin embargo, no vivimos en un mundo perfecto y por eso, es de suma importancia que los padres, parejas y otras personas encargadas del cuidado de los menores re-evalúen, revisen y mejoren la manera de comunicarse, por el bien de los niños.
No siempre es fácil llevar a cabo una paternidad responsable, incluso en las mejores circunstancias. Por eso, los siguientes puntos ofrecen normas, exploran actitudes y comportamientos para lograr una exitosa y responsable paternidad en cualquier situacin, especialmente cuando el bienestar de los niños es el principal y único objetivo.
Obstáculos que impiden una Paternidad Responsable
Resentimiento, egoísmo y negativa a comprometerse son tres de los grandes obstáculos que evitan una paternidad responsable. Los ejemplos de cmo se manifiestan son muchos e incluyen:
1. La necesidad de estar en lo correcto- Nadie se mantiene en lo correcto "todo el tiempo", la cooperacin es la clave. La rigidez y mentalidad cerrada solo sirven para mantener a los padres/esposos separados comportarse de manera extraña entre ellos, sin ningún beneficio para los niños.
2. Poner a los niños en el medio- Cuando un niño es usado como amortiguador entre los adultos, se puede desarrollar el Síndrome del Niño en el Medio, donde los adultos se transforman en otros niños dentro de esta dinámica. En estos casos, la autoestima del niño puede ser duramente golpeada.
3. Asumir al niño como "propiedad" – Intentar controlar a la otra persona asumiendo el control del niño, nunca tendrá un resultado positivo para ninguna de las personas involucradas. ¡Sea flexible!
4. Competencia – La tendencia de competir para ser el "padre favorito" puede crear expectativas insanas en los niños, y esto puede llevarlos a volverse manipuladores.
Donde no hay deseo o intencin de cooperar, no se pueden cumplir las normas para lograr una paternidad responsable. Es importante recordar, que muchas veces el padre más generoso con el comportamiento de los niños, por lo general, es el que obtiene los mayores beneficios a largo plazo.
La mayoría de las parejas entran en etapa de crisis, cuando el acuerdo que hicieron en buenos tiempos y que debe mantenerse después de la separacin, no se respeta. Cuando los padres deciden contratar a un abogado para que los represente, esto puede mermar los ahorros de sus vidas. Ellos pueden llegar al punto, donde han perdido toda objetividad mas allá de una actitud antagonista del uno con el otro, volviéndose de esta manera, incapaces de proteger la salud mental espiritual y física de sus hijos.
Conserjería
La disposicin de buscar la intervencin neutral de un profesional, puede ayudar a las personas involucradas a desarrollar en gran parte, una relacin positiva y estratégica, y manejar los asuntos o problemas a medida que éstos aparezcan.
La conserjería puede ayudar a forjar respecto entre las partes, y por lo tanto, a reducir discusiones, conflictos pequeños y peleas internas.
Por lo general, la corte ordena a los padres a asistir a sesiones con consejeros o terapeutas que los pueden ayudar a llegar a algún acuerdo. Estos padres pueden sentirse muy abrumados con los asuntos legales de la separacin, sus propios problemas emocionales y por la pelea de bienes materiales, olvidando de esta forma los principios básicos de la paternidad.
En este caso, la tarea del consejero es trabajar con los padres y desarrollar o estructurar las cualidades que ellos necesitan, para llevar a cabo el rol de la paternidad de manera más efectiva.
Algunos puntos claves son:
• Aceptacin de la responsabilidad compartida y el acuerdo entre padres biolgicos, padrastros, parejas y padres adoptivos de comportarse bien, para el beneficio de los niños.
• Entender que los niños, si ellos lo desean, tienen el derecho de mantener una relacin positiva y de afecto con uno de los padres, ya sea el padre adoptivo, padrastro, o abuelos. Cada uno tiene la responsabilidad de apoyar esta relacin, a pesar de las dificultades que puedan existir.
• Reconocer la obligacin de promover una relacin positiva con el otro padre, por el bien de los niños
• Llegar al acuerdo de nunca hablar negativamente o hacer comentarios negativos del otro padre, en presencia de los niños.
• Ser responsables con el tiempo que se ha comprometido con los niños. El otro padre no debe interferir
• Demostrar un comportamiento apropiado en el teléfono, sin tener que acosar al otro padre o a los niños.
• No preguntar a los niños sobre la vida personal del otro padre o guardián.
• Comunicarse directamente con el otro padre, sin usar a los niños para que lleven y traigan mensajes sobre asuntos legales, educativos o de dinero.
• Evitar expresiones, actitudes negativas o de preocupacin con relacin al otro padre, en el momento de entregar o recoger a los niños.
• Evitar planear actividades con los niños que coincidan con el tiempo que le pertenece al otro padre.
• Elaborar un plan para tomar decisiones médicas y educativas de manera compartida.
• Construir las relaciones desde la fortaleza de los individuos, y no desde los problemas que están enfrentando.
• Realizar una reunin conjunta, a manera de intervencin, para discutir todos los asuntos de manera abierta
Muchas personas pueden olvidar estas recomendaciones o estar totalmente en desacuerdo con ellas, esto incluso pasa entre parejas que viven juntas. Las mismas son más difíciles de recordar y poner en práctica cuando hay una separacin, divorcio o ruptura. Una orientacin psicolgica es una herramienta invalorable para conseguir un balance cuando se presenta esta situacin.
Conclusin
Establecer límites y normas de paternidad responsable, puede llevarnos a nuevas oportunidades de hacer decisiones compartidas que son saludables y beneficiosas para los niños, especialmente cuando las relaciones de parejas están viviendo una etapa de transicin debido a la separacin.
Una orientacin psicolgica puede tener un efecto positivo de largo alcance y ayudar a reconstruir la comunicacin, confianza y el entorno familiar, facilitando a los padres reconectarse y satisfacer las necesidades de sus hijos con mejores resultados.
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Tags: Guia de Paternidad Responsable para Familias en Transicion, Maribel Quiala
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By Stacy Collins, MSW, Senior Practice Associate
National Association of Social Workers
The Changing Landscape of Cancer Treatment
Most cancer treatment involves regular visits to an oncology office or hospital for intravenous, or IV, chemotherapy. But cancer treatment is changing and more and more, cancer treatment involves taking pills. Oral chemotherapy – taking pills to treat cancer – offers many benefits: fewer office visits; less time away from work and family and less interference with personal schedules. Patients welcome the absence of painful needle sticks that IV chemotherapy requires. But the advantages of oral chemotherapy are balanced – if not outweighed by – the responsibility for self-treatment of a serious disease.
Treating Cancer with Pills
When a person receives IV chemotherapy, the oncologist knows exactly how much medicine a person receives because the treatment is closely supervised by medical and nursing staff. But when treatment is done at home, the responsibility for adherence – ensuring that cancer medication is taken as prescribed – falls on individuals with cancer and their caregivers.
What Is Adherence?
Adherence means taking medications safely, timely, faithfully and accurately. It also means that:
- No doses are skipped
- No extra doses are taken
- No doses are taken in the wrong quantity, at the wrong time, or under the wrong conditions (e.g., with or without food)
Adherence is very important in cancer treatment. However, many adults have a poor track record with adherence. Recent research shows that more than 50 percent of Americans do not take prescription medicine as instructed. The numbers are even worse with cancer drugs – it's estimated that only 30 percent of people with cancer take their medication as prescribed. Non-adherence (not using medication as prescribed) is associated with more doctor visits, more hospital admissions, and longer hospital stays – all of which contribute to rising health care costs. The estimated cost to the U.S health care system of non-adherence to prescription medications is $100 billion – and rising.
Why Is Adherence to Cancer Medication So Important?
With any medication, non-adherence can have a serious impact on a person's health. But the stakes are often higher in cancer treatment. Not taking cancer medication as prescribed may mean that that drug won't work, since a certain amount of medication (referred to as a "therapeutic level") needs to be in the body in order for the drug to be effective. In many cases, cancer may return if a person takes the cancer medication occasionally, or stops taking it altogether. Non-adherence can also affect how the doctor views the patient's illness, and may result in unexpected changes to a patient's treatment.
The Challenge of Adherence
As simple as it sounds, adherence can be challenging. Many people have difficulty fitting medication-taking into a busy lifestyle, which may include work, family, and other obligations. Some people fear that cancer treatment will take away enjoyment and pleasure in life; others may feel burnout or "treatment fatigue" from long-term use of cancer medication.
Ways to Incorporate Medication-Taking Into a Busy Life
- Use weekly pill containers – These inexpensive tools allow you to organize your medications into daily doses, and are especially helpful if you are taking multiple medications or planning to travel.
- Explore electronic adherence tools – such as cell phone text reminders.
- Identify pill-taking cues – Consider taking your medication when you do other regular activities, such watching certain TV shows or brushing your teeth.
- Develop an action plan for unexpected and special events - such as weekends, vacations and celebrations.
- Ask your loved ones for help– Adherence is always easier when you have support from others.
Keep in mind – medication adherence is
difficult and everyone makes mistakes
at times. |
- Understand how your cancer drug interacts with food and other medications you are taking – A pharmacist is an excellent resource if you have questions about food and medication interactions.
- Maintain regular phone or face-to-face contact with your health care provider. Cancer medication instructions are often complex. Talk to your health care provider if you have any questions about your treatment. And remember to report side effects, as these can also affect adherence to your medication.
Special Considerations for Older Adults with Cancer
Older adults face special challenges in maintaining good adherence. Having more than one illness at the same time (often referred to as "co-morbidity") is one such challenge. For older adults, having multiple conditions (such as cancer and heart disease or diabetes) increases the number of prescription medications, which makes adherence more difficult. Older adults are also at increased risk for dementia or other cognitive problems, and may forget to take their medications or become confused about medication instructions. They may also have arthritis or other functional difficulties, which may make it challenging to open pill bottles.
Adherence decreases as the number of
daily medications increase. |
Ways to Improve Cancer Medication Adherence With Older Adults
Make sure to have clear instructions for all cancer drugs. A doctor or nurse should review the instructions in the office and also provide written instructions to take home. Be sure to ask questions if anything is unclear or confusing.
- Caregivers and loved ones should fully understand the medication instructions. Cancer medication instructions are often complicated, so it's helpful for caregivers and family members to understand the instructions as well, even if the person with cancer can take the medication without assistance.
- Have an updated, written list of medications in hand, when talking with health care professionals and caregivers.
- Ask the pharmacy to provide easy-to-open medication caps, pre-loaded medication dispensers and large print medication labels.
- Use a pharmacy that provides home delivery of medications, such as specialty pharmacies that ship overnight.
Resources
The National Transitions of Care Coalition (NTOCC) has some helpful tools to help you organize your medications. NTOCC has created My Medicine List for persons who take multiple medications or visit the doctor often, to help manage their medications and medical appointments. Visit www.ntocc.org/Portals/0/My_Medicine_List.pdf for more information.
###
Bio:
Stacy Collins, MSW, is a Senior Practice Associate at NASW, specializing in adult and pediatric health care issues. Ms. Collins has over 20 years of experience in health care advocacy, education, and direct service with national and community-based organizations. As one of the NASW staff covering oncology, Ms. Collins developed a web education course for social workers on promoting adherence in oral chemotherapy, in conjunction with the National Coalition for Cancer Survivorship. Prior to joining the NASW staff, she was the project director for a federally –funded initiative to develop community engagement strategies for large-scale cancer clinical trials. Ms. Collins holds an MSW from the Catholic University of America and a BA from the University of Virginia.
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By Stacy Collins, MSW, Senior Practice Associate
National Association of Social Workers
The Changing Landscape of Cancer Treatment
Most cancer treatment involves regular visits to an oncology office or hospital for intravenous, or IV, chemotherapy. But cancer treatment is changing and more and more, cancer treatment involves taking pills. Oral chemotherapy – taking pills to treat cancer – offers many benefits: fewer office visits; less time away from work and family and less interference with personal schedules. Patients welcome the absence of painful needle sticks that IV chemotherapy requires. But the advantages of oral chemotherapy are balanced – if not outweighed by – the responsibility for self-treatment of a serious disease.
Treating Cancer with Pills
When a person receives IV chemotherapy, the oncologist knows exactly how much medicine a person receives because the treatment is closely supervised by medical and nursing staff. But when treatment is done at home, the responsibility for adherence – ensuring that cancer medication is taken as prescribed – falls on individuals with cancer and their caregivers.
What Is Adherence?
Adherence means taking medications safely, timely, faithfully and accurately. It also means that:
- No doses are skipped
- No extra doses are taken
- No doses are taken in the wrong quantity, at the wrong time, or under the wrong conditions (e.g., with or without food)
Adherence is very important in cancer treatment. However, many adults have a poor track record with adherence. Recent research shows that more than 50 percent of Americans do not take prescription medicine as instructed. The numbers are even worse with cancer drugs – it's estimated that only 30 percent of people with cancer take their medication as prescribed. Non-adherence (not using medication as prescribed) is associated with more doctor visits, more hospital admissions, and longer hospital stays – all of which contribute to rising health care costs. The estimated cost to the U.S health care system of non-adherence to prescription medications is $100 billion – and rising.
Why Is Adherence to Cancer Medication So Important?
With any medication, non-adherence can have a serious impact on a person's health. But the stakes are often higher in cancer treatment. Not taking cancer medication as prescribed may mean that that drug won't work, since a certain amount of medication (referred to as a "therapeutic level") needs to be in the body in order for the drug to be effective. In many cases, cancer may return if a person takes the cancer medication occasionally, or stops taking it altogether. Non-adherence can also affect how the doctor views the patient's illness, and may result in unexpected changes to a patient's treatment.
The Challenge of Adherence
As simple as it sounds, adherence can be challenging. Many people have difficulty fitting medication-taking into a busy lifestyle, which may include work, family, and other obligations. Some people fear that cancer treatment will take away enjoyment and pleasure in life; others may feel burnout or "treatment fatigue" from long-term use of cancer medication.
Ways to Incorporate Medication-Taking Into a Busy Life
- Use weekly pill containers – These inexpensive tools allow you to organize your medications into daily doses, and are especially helpful if you are taking multiple medications or planning to travel.
- Explore electronic adherence tools – such as cell phone text reminders.
- Identify pill-taking cues – Consider taking your medication when you do other regular activities, such watching certain TV shows or brushing your teeth.
- Develop an action plan for unexpected and special events - such as weekends, vacations and celebrations.
- Ask your loved ones for help– Adherence is always easier when you have support from others.
Keep in mind – medication adherence is
difficult and everyone makes mistakes
at times. |
- Understand how your cancer drug interacts with food and other medications you are taking – A pharmacist is an excellent resource if you have questions about food and medication interactions.
- Maintain regular phone or face-to-face contact with your health care provider. Cancer medication instructions are often complex. Talk to your health care provider if you have any questions about your treatment. And remember to report side effects, as these can also affect adherence to your medication.
Special Considerations for Older Adults with Cancer
Older adults face special challenges in maintaining good adherence. Having more than one illness at the same time (often referred to as "co-morbidity") is one such challenge. For older adults, having multiple conditions (such as cancer and heart disease or diabetes) increases the number of prescription medications, which makes adherence more difficult. Older adults are also at increased risk for dementia or other cognitive problems, and may forget to take their medications or become confused about medication instructions. They may also have arthritis or other functional difficulties, which may make it challenging to open pill bottles.
Adherence decreases as the number of
daily medications increase. |
Ways to Improve Cancer Medication Adherence With Older Adults
Make sure to have clear instructions for all cancer drugs. A doctor or nurse should review the instructions in the office and also provide written instructions to take home. Be sure to ask questions if anything is unclear or confusing.
- Caregivers and loved ones should fully understand the medication instructions. Cancer medication instructions are often complicated, so it's helpful for caregivers and family members to understand the instructions as well, even if the person with cancer can take the medication without assistance.
- Have an updated, written list of medications in hand, when talking with health care professionals and caregivers.
- Ask the pharmacy to provide easy-to-open medication caps, pre-loaded medication dispensers and large print medication labels.
- Use a pharmacy that provides home delivery of medications, such as specialty pharmacies that ship overnight.
Resources
The National Transitions of Care Coalition (NTOCC) has some helpful tools to help you organize your medications. NTOCC has created My Medicine List for persons who take multiple medications or visit the doctor often, to help manage their medications and medical appointments. Visit www.ntocc.org/Portals/0/My_Medicine_List.pdf for more information.
###
Bio:
Stacy Collins, MSW, is a Senior Practice Associate at NASW, specializing in adult and pediatric health care issues. Ms. Collins has over 20 years of experience in health care advocacy, education, and direct service with national and community-based organizations. As one of the NASW staff covering oncology, Ms. Collins developed a web education course for social workers on promoting adherence in oral chemotherapy, in conjunction with the National Coalition for Cancer Survivorship. Prior to joining the NASW staff, she was the project director for a federally –funded initiative to develop community engagement strategies for large-scale cancer clinical trials. Ms. Collins holds an MSW from the Catholic University of America and a BA from the University of Virginia.
Tags: MSW, Social Work and Cancer, Stacy Collins, Taking Pills to Treat Cancer
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By Bette J. Freedson, LICSW, LCSW, CGP
I have many years experience teaching people how to manage stress and cope effectively.
My tips are easily applied and get results.
Tips for Nips
- Breathe deeply and normally from your abdomen, taking deep breaths for further relaxing. The breath can take you physically out of the worry.
- Think in a balanced way. Keep thinking positively without beating yourself up for the worry thoughts. Keep returning to the positive thought and wave the worry on its way.
- Use mental imagery to rehearse difficult situations and to prepare for stressful events that cause you to worry in advance.
- Refrain from worry traps such as catastrophic thinking, black and white thinking, crystal ball thinking, and personalization. All you have to do is recognize them and turn the channel.
- A simple process called S-O-L-V-E can be used for solving problems and making decisions with less worry.
- You can use awareness of the way emotions and thoughts interact to create choices that can be worry-free.
- Intuition is your ally in nipping worry in the bud. You can learn how to manage worry by dipping below the fears into the territory of trust.
###
Bio:
Bette J. Freedson, LICSW, LCSW, CGP is the author of the "Relax and Learn Seminars: Skills For All Seasons," a repertoire of workshops based on the principles of effective stress management. In her work Ms. Freedson emphasizes the power of the mind/body connection to improve decision-making, increase effective coping, reduce time wasted in conflict, boost morale and productivity at work, and create greater harmony in relationships.
Ms. Freedson practices clinical social work at The Listening Place in Lynn, Massachusetts. Besides maintaining an additional private practice in South Berwick, Maine, Bette is Social Work consultant to Maine School Administrative District #35.
Tags: Bette Freedson, Stress Management Tips
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By Bette Freedson, LICSW, LCSW, CGP
Introduction
"If Only I knew then…….." How often do working mothers, or any mothers, say that to themselves as they think back on the toddler ages of their kids?
Toddlerhood comes on with a fury of needs and activities that keep mom's reflexes responding and her head spinning. There is barely time to meet every need and deal expertly with every situation whether the mother is working inside or outside the home—or, as is often the case– both. Realizations of what could have been done differently, and lessons learned, are often revealed in reflections of the past.
What some of the older moms have learned through experience might be helpful to some of the younger moms now in that wild, wooly and wonderfully sweet period called Toddler.
Twelve Tips
Here is what I learned then– that I know now–and wish I had known then…
- Believe in the unconditional love of your toddler for you.
- Set realistic and reasonable limits.
- Stay consistent in your reactions and responses as much as possible.
- Keep disciplinary measures short and to the point.
- Depersonalize your child's reactions to discipline, limits, and you.
- Keep in mind that children of toddler ages are concrete thinkers, and are not born with innate understanding of concepts grownups may take for granted.
- Know that curiosity is normal. Give answers that are short and make sense. Toddlers do better without tons of detail.
- Inform yourself about normal emotional development.
- Trust you have no need to fear their fears. Know that it is okay for them to need reassurance and a sense of security.
- "Me" time is important. No need for guilt.
- Adopt the motto: This too shall pass. —Second motto: Chaos will not make me crazy.
- Know you deserve to have support.
###
Related Articles:
Bio:
Bette J. Freedson, LICSW, LCSW, CGP is the author of the "Relax and Learn Seminars: Skills For All Seasons," a repertoire of workshops based on the principles of effective stress management. In her work Ms. Freedson emphasizes the power of the mind/body connection to improve decision-making, increase effective coping, reduce time wasted in conflict, boost morale and productivity at work, and create greater harmony in relationships.
Ms. Freedson practices clinical social work at The Listening Place in Lynn, Massachusetts. Besides maintaining an additional private practice in South Berwick, Maine, Bette is Social Work consultant to Maine School Administrative District #35.
Tags: Bette Freedson, Early Childhood Development Tips
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By Bette Freedson, MSW
Introduction
The best way a parent can encourage their four year old to love learning is to model it! If you love learning (and it doesn't have to be academic), your child will see it, and the encouragement will be a natural.
You did not have to be the star in your school to encourage your kid to love to learn. Just do this. Think about what you love to learn, how you learn best, and about what juices up your own learning excitement.
Some Tips:
- Read, read and read some more to your child, and let your four year old "read" to you. You might choose some stories you liked as a child. You might pick up on what naturally interests your child for choices of what to read– and choices of what to do.
- Take them to museums.
- Take them to gardens, and to lakes and woods.
- Take them on field trips to see things being made. And yes, even to amusement parks. All kinds of fun can turn children on to curiosity about how things work.
Teach your child to do the things you enjoy doing, and be generous with showing your pleasure. The secret is to let your child experience your own joy when you go where you love to go, and do what you love to do.
Four-year-olds are precious sponges, who will soak up your enthusiasm and very possibly be turned on for the rest of their lives. And then, lucky parent, they will teach you!
###
Related Articles:
Bette J. Freedson, LICSW, LCSW, CGP is the author of the "Relax and Learn Seminars: Skills For All Seasons," a repertoire of workshops based on the principles of effective stress management. In her work Ms. Freedson emphasizes the power of the mind/body connection to improve decision-making, increase effective coping, reduce time wasted in conflict, boost morale and productivity at work, and create greater harmony in relationships.
Ms. Freedson practices clinical social work at The Listening Place in Lynn, Massachusetts. Besides maintaining an additional private practice in South Berwick, Maine, Bette is Social Work consultant to Maine School Administrative District #35.
Tags: Bette Freedson
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By Maria Elisa Cuadra-Fernandez, LCSW-R, ACSW, CASAC, CPP, CPS, CEO, COPAY, Inc.
Introduction
What is Heroin?
Other Related Health Concerns
Addiction to Heroin
Symptoms of Withdrawal
What Parents Can Do
Treatment Is Available
Getting Help
On Long Island, COPY Is a Bilingual Professional Resource
Introduction
The recent and unexpected deaths of several Long Island teenagers as a result of heroin overdose have been met with deep grief as well as shock and disbelief by many. Heroin, always thought of as an "inner city" problem affecting low income communities is now being seen in affluent suburban communities, on Long Island. This frightening reality poses new challenges and needs for parents who now are just beginning to learn how to protect their adolescent children from this danger.
This new influx is believed to be connected to the availability of higher "purity" heroin (which is more suitable to inhale) and to decreases in prices, making it more obtainable by youth. The thing that many teenagers don't understand is that all routes of administration (inhaling, smoking, and sniffing/snorting) are all highly addictive. Also, purchasing substances on the streets is highly dangerous as there is no assurance of its' purity nor its' potency. Overdoses and/or poisoning can occur because young people have no idea of what and how much they are administering to themselves.
What is Heroin?
Heroin is extracted from the seed pod of certain poppy plants. It is a processed form of morphine and is sold as a white powder, a brown powder, or a black sticky substance often called "black tar". One of the many dangers of "street heroin" (heroin sold on the street) is that it is often "cut" (mixed) with other substances. Heroin confiscated by authorities has been found to contain starch, sugar, powdered milk, and quinine. Sometimes, confiscated heroin has also contained strychnine and other poisons. Educating teenagers to the seriousness of these dangers is enormously important and necessary.
Other Related Health Concerns
Heroin abuse, like other substance abuse, is a progressive disease process. In teenagers it often begins as "recreational" use, increases slowly, and eventually leads to daily use and loss of control. Loss of control signals that both a psychological as well as a physical disease process is active. Loss of control also signals that the disease has moved from one of substance abuse to addiction.
Addiction to heroin puts teenagers at much higher risk for infection to HIV, Hepatitis C (HCV), and Hepatitis B. It also interferes with judgment, particularly when they are under the influence of the drug. This can lead to unprotected sex and the greater likelihood that the substance abusing partner is HIV positive or HCV positive. It can also result in unplanned pregnancy and/or an increased risk of sexual assault.
Other possible consequences from pro-longed use include bacterial infections of the blood vessels and heart valves, abscesses, infections of soft tissue, liver or kidney disease, scarred/collapsed veins, and pneumonia and/or tuberculosis. Once again, educating teenagers to these consequences and dangers is most important.
Addiction to Heroin
Adolescence is a time of exploration and experimentation. This makes many adolescents particularly susceptible to experimentation with heroin if available in their social circles. Unlike adults who begin their addictions by ingesting substances to avoid and/or cope with problems, adolescents frequently begin theirs with innocent experimentation thereby making education all the more important. Because heroin is so highly addictive its' use can easily "derail" teenagers from a healthy life course and interrupt their emotional and psychological growth and progress and their academic success. One of the most detrimental consequences is the addiction itself.
Addiction to heroin leads to drug seeking which is compulsive, molecular as well as neurochemical changes in the brain, physical dependence as evidenced by increased tolerance to the drug. Behavior changes become obvious to parents but also confusing. Often, parents never suspect that the changes might be a result of a growing dependence on this lethal drug. As the teenagers' body steadily adjusts to the presence of the drug, withdrawal symptoms begin to occur if use is reduced.
Symptoms of withdrawal that parents can notice are restlessness, complaints of muscle and joint pain, insomnia, bouts of stomach upset that include vomiting and diarrhea, goose bumps on the skin and complaining of feeling cold, and involuntary leg movements.
What Parents Can Do
- Read and share this article with your teenager.
- Be alert to the above mentioned symptoms of withdrawal.
- If your child appears impaired do not assume s/he has consumed alcohol alone.
- Notice changes in your child's patterns of behavior.
- Notice if s/he is associating with a different crowd.
- Secretiveness is often present.
- Refusing to bring new friends home to meet you is common.
- Notice unexplained periods away from home without legitimate explanation regarding their where-abouts.
- Drop is school performance.
- Cutting school.
- School or other officials reporting to you that your child has publicly misbehaved.
- Arrest or official reprimand for unruly behavior and/or public intoxication.
Treatment Is Available
If your child is experimenting with heroin or other substances, it is vital that you know as soon and as early as possible and that you actively seek professional help for your child and for your entire family. Family education and family involvement are pivotal for successful treatment.
Remember, all addictions exist in a context. A professional can quickly guide parents in re-evaluating and changing family dynamics thus making the presence of substance abuse harder for the teenager to maintain. Treatment can be provided both out-patient and/or inpatient depending on the needs of your teenager and family and on the level of care that is necessary. Therapy, detoxification, and psycho-tropic medications are available to effectively assist in a full recovery from heroin or other substance abuse.
Getting Help
The New York State, Office of Alcohol and Substance Abuse Services (OASAS) is a wonderful resource to obtain licensed professional treatment facilities in your community and surrounding areas.
On Long Island, COPAY is a Bilingual Professional Resource
COPAY has successfully provided substance abuse treatment and education to adolescents, adults, and families for more than 30 years. If you suspect drug abuse in your teenager, call COPAY today at 516-466-2509. Schedule an appointment with one of our experienced professionals and discuss your concerns. COPAY also offers a Parent/Child Screening Service whereby you can contract for two sessions with a professional to explore your concerns with your child. In addition to the two sessions a urine toxicology evaluation will be completed that will provide clear answers and reassurance regarding substance use. It will clearly inform you if treatment/intervention is needed.
COPAY also provides a 12 week Educational Series for Families and Teenagers. Here, you and your child will learn about substance abuse and why it's best to avoid it. You will also learn about addiction in the context of the family and who families can change their structures thus making it difficult for the addiction to contine.
In addition to these services, COPAY offers intensive, medically managed, out-patient treatment for addiction to drugs and alcohol as well as treatment for co-existing mental health problems. All calls to COPAY are strictly confidential.
Call COPAY today at 516-466-2509. We are here to assist you.
COPAY is proud to be supported by the Great Neck UCF, Greentree Foundation, United Way of LI, Hispanic Federation, LI Fund for Women and Girls, March of Dimes, GNMCCCP, Levitt Foundation, The Horace and Amy Hagedorn Fund at LICF, Act for Youth, Manhasset Community Fund, and the National Tennis Association.
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Tags: Heroin and Teenagers, Heroin and Youth, Maria Elisa Cuadra-Fernandex
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