This may be one of the most important articles I have ever published on any of my blogs. Please, read it carefully and use the information to help someone you know and love. Enjoy.
The New York Times
April 2, 2006
A Depression Switch?
By DAVID DOBBS
Deanna Cole-Benjamin never figured to be a test case for a radical new brain surgery for depression. Her youth contained no traumas; her adult life, as she describes it, was blessed. At 22 she joined Gary Benjamin, a career financial officer in the Canadian Army, in a marriage that brought her happiness and, in the 1990's, three children. They lived in a comfortable house in Kingston, a pleasant university town on Lake Ontario's north shore, and Deanna, a public-health nurse, loved her work. But in the last months of 2000, apropos of nothing — no life changes, no losses — she slid into a depression of extraordinary depth and duration.
"It began with a feeling of not really feeling as connected to things as usual," she told me one evening at the family's dining-room table. "Then it was like this wall fell around me. I felt sadder and sadder and then just numb."
Her doctor prescribed progressively stronger antidepressants, but they scarcely touched her. A couple of weeks before Christmas, she stopped going to work. The simplest acts — deciding what to wear, making breakfast — required immense will. Then one day, alone in the house after Gary had taken the kids to school and gone to work, she felt so desperate to escape her pain that she drove to her doctor's office and told him she didn't think she could go on anymore.
"He took one look," she told me later, "and said that he wanted me to stay right there in the office. Then he called Gary, and Gary came to the office, and he told us he wanted Gary to take me straight to the hospital."
They drove to the Providence Continuing Care Center's mental-health hospital, still known locally as the Kingston Psychiatric Hospital, or K.P.H., its name when it was built in the 1950's. "It's a dingy, archaic place," Deanna said, "typical of older mental hospitals." There, in the locked ward that also contained psychotic patients, she would spend the next 10 months straight and about 85 percent of the three years after that. Her depression would prove resistant to every class of antidepressant, numerous combinations of antidepressants and anti-anxiety drugs, intensive psychotherapy and about a hundred sessions of electroconvulsive therapy. Patients who have failed that many treatments usually don't emerge from their depressions.
Finally, in the spring of 2004, Deanna's psychiatrist at the hospital, Dr. Gebrehiwot Abraham, received a fax from a University of Toronto research team asking if he had an appropriate candidate for a clinical trial of a new, experimental surgery for treatment-resistant depression. The operation borrowed a procedure called deep brain stimulation, or D.B.S., which is used to treat Parkinson's. It involves planting electrodes in a region near the center of the brain called Area 25 and sending in a steady stream of low voltage from a pacemaker in the chest. One of the study's leaders, Dr. Helen Mayberg, a neurologist, had detected in depressed patients what she suspected was a crucial dysfunction in Area 25's activity. She hypothesized that the electrodes might modulate the area and ease the depression.
The procedure, Dr. Abraham told Deanna and Gary, had worked safely in thousands of Parkinson's patients. But it would carry some risk of neural complications (it was, after all, brain surgery), it would be uncomfortable and it might not work.
"We were in tears," said Deanna, who is now 41. "We felt we'd tried everything and nothing worked. But we talked about it and decided, 'Well, what have we got to lose?"'
What she hoped to lose, of course, was her depression. But depression, which 5 to 10 percent of Americans suffer in any given year and about 15 percent will suffer in their lifetimes, can be hard to lose. Drugs, as shown in a comprehensive study released last month by the National Institute of Mental Health, are effective in only half of patients with major depression. Psychotherapy does no better. For those people who are not helped by therapy or drugs, electroconvulsive therapy, or ECT, can bring relief. But few of those cures are complete. These therapies usually ease rather than cure depression while sometimes bringing side effects like insomnia or memory loss, and their potency often proves fleeting; as many as half to two-thirds of those successfully treated relapse within two years. Neither neuroscientists nor psychiatrists can say exactly what depression is. Neurologically and psychologically, what Hippocrates called the "black bile" and Susan Sontag "melancholy minus its charms" presents an almost impossibly complicated puzzle.
The expectations for the Toronto team's D.B.S. study were accordingly modest. When I later asked Mayberg's collaborator Dr. Andres Lozano, the neurosurgeon who performed the operations, what he had expected, he replied, "Nothing."
As it turned out, 8 of the 12 patients he operated on, including Deanna, felt their depressions lift while suffering minimal side effects — an incredible rate of effectiveness in patients so immovably depressed. Nor did they just vaguely recover. Their scores on the Hamilton depression scale, a standard used to measure the severity of depression, fell from the soul-deadening high 20's to the single digits — essentially normal. They've re-engaged their families, resumed jobs and friendships, started businesses, taken up hobbies old and new, replanted dying gardens. They've regained the resilience that distinguishes the healthy from the depressed.
These results brought a marvelous surprise to both the patients and the doctors involved — and nervous anticipation about whether their luck will hold. Though a few of the patients are more than two years out from the surgery, none completely trust their cure. No one can tell them for sure that it will last, and they worry. The study doctors and the wider medical community, meanwhile, are guarded about whether D.B.S. will prove so effective in larger trials. "I can't emphasize enough that we need a large, randomized study to confirm this as a treatment," says Valerie Voon, a University of Toronto psychiatrist who was with the team for the first six patients and who is now a research fellow at the National Institutes of Health.
Those caveats notwithstanding, many scientists following the trial say they believe it will change how psychiatrists define and treat mood disorders. Mayberg, who speaks of a "paradigm shift," notes that she developed the trial to evaluate not a treatment but a hypothesis. In that sense the trial succeeded. Mayberg's focus on Area 25 tests the emerging "network" model of mood disorders, a new way of looking at psychiatric conditions that isn't restricted by the neurochemical model of mood that has dominated over the past quarter century or so. Rather, it incorporates neurochemistry into the concept of the brain as a circuit board or wiring diagram. The network model carries profound implications for research and, ultimately, treatment. The Prozac revolution showed everyone that tweaking neurochemistry can dampen and sometimes extinguish depression — but only through a generalized approach, hitting the entire brain. ("Carpet-bombing," one neuroscientist calls it.) And the 50 percent success rate of antidepressant drugs suggests that they aren't hitting depression's central mechanism. The network approach, on the other hand, focuses on specific nodes, pathways and gateways that might be approached with various treatments — electrical, surgical or pharmacological. This small trial appears to confirm this model so emphatically that it's already changing the neuropsychiatric view of the brain and the direction of research.
"People often ask me about the significance of small first studies like this," says Dr. Thomas Insel, who as director of the National Institute of Mental Health enjoys an unparalleled view of the discipline. "I usually tell them: 'Don't bother. We don't know enough.' But this is different. Here we know enough to say this is something significant. I really do believe this is the beginning of a new way of understanding depression."
When she started her research in the late 1980's, Helen Mayberg, too, looked at neurochemistry. "That's where biological psychiatry was then," she told me. "It was about the brain as a bowl of soup. You whip up a chemical, add it and stir. An alchemist point of view. But I soon realized I wanted to find out where things were changing."
Lively, smart and quick-witted, Mayberg talks of brain science with contagious excitement. She possesses just the kind of presence someone having a hole drilled in his head would welcome — authoritative but warm. Mayberg originally considered becoming a psychiatrist, but she didn't like the discipline's resistance at the time (it was the 1970's) to neurological explanations of mood. So she became a behavioral neurologist, doing a residency at Columbia University and then moving to Johns Hopkins.
Setting aside the bowl-of-soup model did not mean deciding that neurochemicals weren't important. Rather it meant deciding that neurochemistry, and particularly the chemistry dictating how individual neurons communicate with one another, was probably driven by traffic between different brain areas, and that identifying the patterns in that traffic might yield new understanding. (Or, using another metaphor, if the brain is an orchestra, then the neurochemical approach focuses on how well individual players listen and respond to the players adjacent to them; the network approach, like a conductor, focuses on how the orchestra's sections — strings, winds, brass, etc. — coordinate and balance volume and tone. When both are working well, you've got music.)
Imaging tools for tracking these relationships, like PET scans and later functional magnetic resonance imagery, were just maturing as Mayberg pursued her work. Neuroscientists were soon using these tools to help identify networks involved in mental processes ranging from distinguishing facial expressions to experiencing alarm or pleasure. Each of these networks engages different brain areas in different combinations. The areas active in recognizing a fearful expression, for instance, won't match those for recalling old memories, though some areas might overlap. Defining the network involved in any given process requires figuring out not just which parts are involved but also which parts are most vital and how one affects another.
By the 1990's, Mayberg was trying to define the network that goes awry in depression. She and other researchers soon established that depression involved abnormal patterns of activity in a network that includes limbic areas (a cluster of evolutionarily older brain areas around the top of the brain stem), which control basic emotions and drives like fear, lust and hunger, and the newer cortex and subcortex responsible for thought, memory, motivation and reward.
Several researchers were working on this. But Mayberg, and, separately, Dr. Wayne Drevets, then at Washington University and now at the N.I.M.H., increasingly homed in on Area 25, which seemed crucial in both its behavior and its position in this network. They found that Area 25 was smaller in most depressed patients; that it lighted up in every form of depression and also in nondepressed people who intentionally pondered sad things; that it dimmed when depression was successfully treated; and that it was heavily wired to brain areas modulating fear, learning, memory, sleep, libido, motivation, reward and other functions that went fritzy in the depressed. It seemed to be a sort of junction box, in short, whose malfunction might be "necessary and sufficient," as Mayberg put it, to turn the world dim. Maybe it could provide a switch that would brighten the dark.
To work the switch, Mayberg needed a knife. In 1999 she moved from the University of Texas at San Antonio to the University of Toronto, where she met Lozano, who had become expert at using deep brain stimulation for treating Parkinson's, the neurological affliction that causes tremors and rigidity as well as cognitive and emotional declines. By the time he and Mayberg met, he'd slipped electrodes into the brains of almost 300 patients.
Depression is more elusive than Parkinson's. But approaching Area 25 with D.B.S. allowed the researchers to use a known tool. Neurosurgeons found as early as the 1950's that they could treat Parkinson's by destroying a small portion of the hyperactive globus pallidus, a brain area that is crucial to movement. The treatment illustrated one of the brain's many oddities: some areas can cause more trouble when they are excessively active than when they have no activity at all. In the early 1990's, surgeons increasingly began to use D.B.S. to quiet the globus pallidus by sending it steady, rapid pulses of low voltage. Patients' tremors would instantly ease or cease; their rigidity and uncontrollable body movements would fade over a week or two. Killing the current revived the symptoms. Surgeons have now implanted D.B.S. electrodes in some 30,000 Parkinson's patients worldwide. The procedure is not a cure-all. It helps some patients less than others, does little to alleviate Parkinson's cognitive and emotional decay and occasionally creates complications including infection, bleeding and memory loss. Its biggest problem may be its success. So many medical centers now do it that some do it badly or on poorly qualified patients. But done well, it usually works.
Mayberg knew all this from the literature and learned more in conversations with Lozano. She grew increasingly convinced that applying D.B.S. to Area 25 might control depression.
"So one day," she told me, "I went to Lozano and said: 'I want to turn off Area 25. Can we put a stimulator there and see if that does it?' And he goes, 'Why not?' "
Occasionally, Deanna felt good enough to go home. This feeling seldom lasted more than a few days. "You could tell she was getting bad again when she couldn't sleep," Gary said. "That was the red flag. She'd be around the house all night, watching TV, up worried, cleaning. Then she'd get worse each day. Her eyes got that sunken look. Those were the scariest times, when she was getting like that and I would drop the kids at school and go to work and know she was home alone."
During the bad periods, which was much of the time, Deanna thought about suicide almost constantly. Through the windows of the locked ward she could see Lake Ontario, cold and immense. While she was there, one patient managed to reach the lake, beyond the parking lot and a grove of trees, and drown himself. Deanna thought obsessively of doing the same.
"I imagined that all the time," she said. "That I would walk out there and walk into the lake and that would be it."
As the months and years passed and all treatments failed, it began to feel as if there were only one way out.
"It started to seem like, this is not going to stop," Gary said. "This is our life now. There were times I thought that it was going to end" — he
looked across the table at Deanna — "only when you committed suicide."
"The worst part for me," Deanna said, "was not being able to feel anything for my children. To hug them, to have them hug me, and feel nothing. That was devastating. An awful, awful place to be."
The D.B.S. operation involves an intrusion that is delicate but brutal. The patients are kept awake so they can describe any changes, and the only drug administered is a local anesthetic. The surgical team shaves much of the patient's head and attaches to the skull, with four screws drilled through skin into bone, the stereotactic frame that will hold the head steady against the operating table and serve as a navigational aid. Mounting the frame takes only about 10 minutes. But because it involves driving screws into the skull ("You can't truly feel it," as one patient said, "but you can hear it and see it and smell it"), and because it leaves you with a steel frame around the head, many patients find this the most distressing part of the whole business.
Gary found the frame more than he could take. He kissed his wife and went elsewhere, hoping she wouldn't be a vegetable when he next saw her. Then Deanna was rolled to an M.R.I. machine, where scans would be taken; the scans would help guide Lozano in placing the electrodes.
During the hour or so while the computer processed the scans, Deanna chatted with Mayberg. The day before, she told Mayberg, on video, that what she most wanted was to hold her children and feel it.
When the scans were ready, she went to the operating room. She was placed on a table, which was tilted back like a La-Z-Boy. Lozano and his team bolted the stereotactic frame to the table, as it was described to me later. There was some scrubbing on her head, some chitchat among the surgical team, much fiddling with sterile drapes and instruments. Then Lozano fit a half-inch burred bit into a drill, turned it on and started drilling. He drilled right into the top of Deanna's skull, which brought a rattling sensation and a sound like that made by an air wrench removing the lugs off a car's wheel. Then he did it again.
Now Lozano threaded a guide tube — "It's a straight shot," he said later, "really quite easy" — down between crevices and seams to one side of Area 25, which is in two small lobes at the midline of the brain. He slid the first electrode and its lead down the tube, then repeated this for the other side. All this took nearly two hours. After he double-checked his locations, he wired the leads to a pacemaker and gave Mayberg a nod. They could turn it on anytime now.
Mayberg had squeezed into a spot at Deanna's side some time before. She had told Deanna that if anything felt different, she should say so. Mayberg wasn't going to tell her when the device was activated. "Don't try to decide what's important," Mayberg told her. "If your nose itches, I want to know." Now and then the two would chat. But so far Deanna hadn't said much.
"So we turn it on," Mayberg told me later, "and all of a sudden she says to me, 'It's very strange,' she says, 'I know you've been with me in the operating room this whole time. I know you care about me. But it's not that. I don't know what you just did. But I'm looking at you, and it's like I just feel suddenly more connected to you.' "
Mayberg, stunned, signaled with her hand to the others, out of Deanna's view, to turn the stimulator off.
"And they turn it off," Mayberg said, "and she goes: 'God, it's just so odd. You just went away again. I guess it wasn't really anything.'
"It was subtle like a brick," Mayberg told me. "There's no reason for her to say that. Zero. And all through those tapes I have of her, every time she's in the clinic beforehand, she always talks about this disconnect, this closeness and sense of affiliation she misses, that was so agonizingly painful for her to lose. And there it was. It was back in an instant."
Deanna later described it in similar terms. "It was literally like a switch being turned on that had been held down for years," she said. "All of a sudden they hit the spot, and I feel so calm and so peaceful. It was overwhelming to be able to process emotion on somebody's face. I'd been numb to that for so long."
It worked that way for other patients too. For those for whom it worked, the first surges of mood and sensation were peculiar to their natures. Patient 4, for instance, was fond of taking walks, and she had previously told Mayberg that she knew she was getting ill when whole landscapes turned dim, as if "half the pixels went dark." Her first comment when the stimulator went on was to ask what they'd done to the lights, for everything seemed much brighter. Patient 5, an elite bicycle racer before his depression, told me that a pulling that he had long felt in his legs and gut, "as if death were pulling me downward," had instantly ceased. Patient 1, who in predepression days was an avid gardener, amazed the operating room by announcing that she suddenly felt as if she were walking through a field of wildflowers. Two days after going home, she put a scarf over her shaved, stitched head, found her tools and went out to reclaim her long-neglected gardens.
Not all was light and flowers. On a purely biological level, the improvement made by D.B.S. sometimes amplified the side effects of the high doses of medication the patients had been taking. Doctors don't quite understand this phenomenon, but they see it happen in other instances too; it is as if the patient, deadened, is again made sensate. Deanna broke out in hives and felt nauseated; her hands shook. These symptoms eased when she (as several of the patients have done) reduced her meds — slowly, so as not to introduce new variables. She now takes standard doses of Effexor, an antidepressant, and Seroquel, an anti-psychotic drug.
The cure also brought challenges at home. As with other disabilities, any partner turned caretaker gets used to calling the shots, and rearranging power, dependencies and expectations after a sudden recovery can prove hard. One patient, the cyclist, faced this challenge starkly, for he had started a relationship and married while he was depressed. "Frankly," he told me, "I'm not sure we've quite finished working this out." All the patients have benefited from coordinated assistance from psychiatrists, social workers and occupational therapists who try to smooth the transition.
"That help is crucial," says Mayberg, who is now a professor of psychiatry and neurology at Emory University in Atlanta. "We're just fixing the circuit. The patient's life still needs work. It's like fixing a knee. They need that high-quality physical and supportive therapy afterward if they're really going to move around again."
This transition is not back to a former self and family but to a new one. Gary Benjamin says he sees similar things in military families. "These soldiers get sent away for six months, they come back and all they want to do is return to their old home. But their old home isn't there, because everybody's changed. It takes some tough rearranging sometimes."
For a change so profound, these seem acceptable adjustments. And the treatment so far seems remarkably free of side effects. No one has suffered significant neural complications, probably because, unlike ECT, which sends 70 to 150 volts through the entire brain, these electrodes deliver only about 4 volts to an area about the size of a pea.
But what will happen when larger groups are treated? The team is continuing to operate on depressed patients, with a goal of 20. And would the successes stay high and the side effects low in a large, placebo-controlled trial? Neither Mayberg nor any of the other collaborators cares to guess. Other treatments have started this well and fizzled. For instance, vagus nerve stimulation, which sends a low current to the brain via a major nerve with connections to various brain areas, appeared to help about half of the patients in a small, initial, uncontrolled trial, but failed its only placebo-controlled trial. (In a controversial move, the Food and Drug Administration overruled its own reviewers and approved the device as a depression treatment anyway.)
"What if you do a hundred patients," I asked Mayberg one day, "and they do no better than placebo?"
"I suppose that's possible," she said. But she doesn't think that will be the case. The several authorities I talked to agree that the high success rate so far, along with the soundness of the theoretical base and D.B.S.'s track record with Parkinson's, suggests that this isn't just a lucky run.
"This just makes so much sense," says Dr. Antonio Damasio, director of the University of Southern California's Brain and Creativity Institute and a renowned neurologist, "and the weight of the results is so sizable. I would be surprised if they had no results with a larger body of patients."
On the other hand, even if it works, no one sees this becoming the new Prozac. The procedure costs too much (around $40,000) to use on anyone who hasn't tried everything else. The appropriate candidates for D.B.S. probably number in the thousands, not the millions. Perhaps the most sensible worry is that if the thing works, doctors might use it too freely, as they tend to do with successful new treatments; witness the problematic boom in D.B.S. for Parkinson's.
In the end, the procedure's greatest clinical value may lie in inspiring less intrusive ways of tweaking key nodes — localized delivery of drug or gene therapies, or other means still to come. Such possibilities probably lie at least a decade away.
Regardless of how it pans out in the clinic, Mayberg and Lozano's D.B.S. study is already changing how neuroscientists and psychiatrists think about depression. One possibility, for instance, is that refining the networks that go awry in depression may reveal neurological subtypes of depression that can be diagnosed and treated differently. For example, Mayberg has already found that patients who respond well to Prozac usually show a change in their brain scans only a week after they start medication — even though they don't feel a difference for 3 to 10 weeks (a long and sometimes dangerous wait). She's done preliminary work suggesting she might be able to identify such Prozac-friendly patients before they even start the drug. If she or others can replicate and elaborate on this diagnostic ability, doctors might be able to characterize a patient's depression and choose a best-odds therapy — Prozac for one patient, talk therapy for a second, both for a third — at the very beginning of treatment, savings weeks or months of trial and error.
The network model — which some scientists also call a "systems" model — also offers an organizing principle for research. Andreas Meyer-Lindenberg, a researcher with the N.I.M.H., points out that research on depression has so far followed clues left by drugs that were found to be effective only by chance. "We'd find a drug that helped depression, figure out how it works and make hypotheses from that about how the brain works," he says. The effectiveness of selective serotonin reuptake inhibitors (S.S.R.I.'s) like Prozac, for instance, inspired piles of research showing that mood regulation depends heavily on the availability of the neurotransmitter serotonin. (Neurotransmitters are chemicals that help carry messages across the spaces between neurons; S.S.R.I.'s treat depression by making more serotonin available in those spaces.)
This focus on neurotransmitters is the "bowl of soup" approach that Mayberg speaks of, and it has formed the bulk of depression research for more than two decades. Defining the networks the neurotransmitters move within, however — and in particular identifying Area 25 as a key gateway within the depression network — will let researchers bring their neurochemical knowledge to bear on specific targets.
"With this D.B.S. work," Meyer-Lindenberg says, "they have characterized in detail a system" — or network — "underlying a major disorder. It's not a simplistic thing where you're saying it's all about this one area and you inject a current and everything's fine. It's a very complicated system. But this D.B.S. work shows us that amid this complicated system there is a place of overlap, a common denominator" — Area 25 — "that's a very attractive treatment target." Here, Meyer-Lindenberg says, researchers can try to apply the knowledge they've gained about neurochemistry and genetics. The network theory presents a framework around which to apply these perspectives.
Meyer-Lindenberg's own work shows the power of this approach. Last June he published a study on the serotonin transporter gene, or sert gene, which helps determine serotonin availability. Other research had shown that people with the "short" version of the sert gene run more depression risk. Meyer-Lindenberg found a way to identify how various brain areas were affected by having that short version. Then he took 112 patients, half with the long version and half with the short, scanned their brains and asked the computer to find areas that scanned differently in the two groups. The area showing the most difference was Area 25.
Along with redirecting research, the quieting of Area 25 may also change our conception of depression from a condition in which something is lacking — self-esteem, resilience, optimism, energy, serotonin, you name it — to one in which an active agent makes a person sick.
"Most people think of depression as a deficit state," Mayberg says. "You're low, you're negative. But in fact, talk to a depressed person, and you have this bizarre combination of numbness and what William James called 'an active anguish.' 'A sort of psychical neuralgia,' he said, 'wholly unknown to healthy life.' You're numb but you hurt. You can't think, but you are in pain. Now, how does your psyche hurt? What a weird choice of words. But it's not an arbitrary choice. It's there. These people are feeling a particular, indescribable kind of pain."
This anguish, Mayberg suggests, is the manifestation of a neural circuit run amok. For doctors, establishing this should focus research and care. For those of us who've never known depression, recognizing it may help us see depression not as a dead absence but as a live affliction. We might even stop indulging the romantic notion of depression as intrinsic to one's identity. For this notion, too, was tested by Mayberg's experiment. When a steady, 4-volt thrum calmed these patients' anguish, they did not lose their identities. They regained them, feeling again the engagements with the world that most define them: flowers for the gardener, lightness for the cyclist and, for Deanna, a long-missed connection to others.
When Deanna, Gary and I finally finished talking, they insisted on driving me to my hotel. Halfway through town, Gary pulled off the main road, drove up a long, sinuous driveway and parked in a lot facing a dark, rambling building.
"This is the hospital," Gary said. "You see where Deanna stayed."
In the winter dark, the secure ward, off to the left, was easily discerned. It was a low wing, the only one with a few lights still on inside. Outside, bright flood lamps illuminated an exercise yard ringed by 20-foot-tall cyclone fencing topped with razor wire.
"And there's the lake," Gary said, motioning behind us. Through trees I could make out its blackness.
We sat several minutes, but no one said much.
"Well," Gary said, putting the minivan in gear. "We'd better get home."
David Dobbs writes on science, medicine and culture. His last article for the magazine was about autopsy.
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Monday, April 03, 2006
Friday, March 31, 2006
Sleep Tight
More folks I know have sleep disorders than any other type of maladjustment problem. They simply don't get enough rest. This article raises awareness on that matter. Enjoy !
The New York Times
April 2, 2006
Can't Sleep? Read This
By WILLIAM L. HAMILTON
TRY this sometime.
Plaster about two dozen electrodes to your face and head and tape some more to your chest and legs. Give yourself two to three feet of wire on each, and attach the other ends to the wall next to a bed, so they tug tightly when you move. Make sure the bed is in a room that you've never seen before, something that looks like a hospital room disguised as a hotel room. A kind of Soviet-era bugged spy box for information gathering, with a video camera, pointed at the bed, blinking silently from the ceiling.
Then turn out the lights and go to sleep.
I'm not a very cooperative lab rat, but this would describe a typical night at a sleep clinic, where data is gathered on how you sleep. This describes my night at the Center for Sleep Medicine at the Mount Sinai Medical Center in Manhattan. I woke up the next morning at 7 with someone misting my head. That softens the glue on the electrodes. On the subway ride home I looked like an escapee, discs of plaster crusted on my skull. Just another alien abduction.
I have joined the national discussion on sleep, a statistic in what is being called an epidemic of sleeplessness, or the growing perception that in bed, extracurriculars aside, we're not being our personal best.
It is a discussion being conducted in doctors' offices, at dinner tables, on Web sites like talkaboutsleep.com and sandiegodreamcatchers.org, and in chat rooms, where people call themselves "midnightclyde" and "sleepymoon."
"Nutrition, physical fitness, now sleep," said Dr. William C. Dement, director of the Sleep Disorders Clinic and Research Center at Stanford University, of the modern history of the American obsession with wellness.
Dr. Dement, who basically founded the idea of sleep medicine, is, at 77, the Sandman. He said the only periods during which he ever recalling losing sleep were when applying for grant money. "Twenty-five years ago everyone started jogging, worried about fitness," he said. "Now sleep is having its moment. Ninety percent of your waking health is dependent on your sleep."
Since 1970, when Dr. Dement founded his clinic, the nation's first, sleep has spawned university departments, associations, journals, conventions, academies and foundations like the National Sleep Foundation, which declared last week National Sleep Awareness week, ending today with daylight saving time, when we lose an hour of sleep by the clock whether we normally snooze with the gods or not.
Like many others, I complained to my doctor of poor sleep, and of tiredness during the day. He prescribed a sleep evaluation, to be conducted at a sleep clinic.
With baby boomers again leading the charge (I'm 54; you lose your natural gift for sleep as you age), sleep has become a commercial industry. In addition to pills (more popular than ever), breathing masks, nose pillows, hypnotic podcasts, aromatherapies and specialty bedding, there are sleep clinics like Mount Sinai's, which are proliferating.
With a tantalizing promise of self-improvement, like a day spa crossed with a night class, accredited facilities in the United States have tripled in number, to 963, in the last 10 years. (There are roughly 900 more unaccredited centers.) Sleep doctors warn that a shortage of trained, certified personnel like the technicians who administer the overnight testing could be sleep's next crisis.
"Think you have a sleep disorder?" asks the American Academy of Sleep Medicine, which accredits sleep centers, at its Web site, www.aasmnet.org. "Find a sleep center near you!"
Dr. Stasia J. Wieber, director of the Comprehensive Center for Sleep Medicine at Mount Sinai, said of evaluations: "A lot of people do it because their friends did it. But we only do an overnight sleep study when it's indicated. Everyone leaves with a diagnosis, but not everyone gets thrown into the lab. A physician has to order the study."
The overnight evaluation at Mount Sinai costs $1,500; most insurance companies cover it.
I arrived at 8 in the evening with an overnight bag, filled out a form on my sleep habits to determine my overall sleep "hygiene," then changed into my nightwear (tattered workout clothes) and sat in a chair watching "Armageddon" without sound on a corner television while a technician worked behind me, wiring my head.
Mount Sinai also evaluates pediatric sleep disorders. Down the hall, someone sang a lullaby, with the soft disembodiment that foreshadows horrible events in movies. On the television Bruce Willis said goodbye to Earth, his finger on the bomb.
Lights out. During the night, as I traveled between wakefulness and sleep, sending back streams of data like a space probe, the technician appeared and disappeared, adjusting my wires, and exiting my consciousness in a ring of light — the door to the corridor — like a spectral visitor, a goblin that only the sixth-sensed see. He monitored my voyage from a desk somewhere in the clinic, taking notes as I sped through the blackness.
The next morning, miles from a cup of coffee, my head damp with mist and dotted with what looked like old toothpaste, I filled out another form, asking, among other things, what I had dreamed about.
"I dreamed I was wired to a bunch of wires, in a threatening tangle, that pulled me back to a wall every time I tried to escape," I wrote, truthfully.
"Perhaps it was not a dream," the technician said, reviewing my responses, with a graveyard humor that was also chilly and serious. Working nights will do it to you.
During an office visit with Dr. Wieber two weeks later, I was told I have sleep apnea. I stop breathing 16 times an hour as I sleep, which she explained is considered moderate.
When you stop breathing, because of an inadequate passage for air between your tongue and the back of your throat, your body sends a message to your brain that something is going wrong, and your brain, in an emergency response, wakes you up. You lose sleep. And you are at increased risk for heart attack and stroke, studies have shown.
Medically, the first line of defense is a machine with a mask called a CPAP (continuous positive airway pressure) device. Then there is a Clockwork Orange-like dental device, which is not effective in every case, explained Dr. Wieber. And there was a surgical procedure, for select cases.
Rock, hard place.
The CPAP (pronounced SEE-pap) mask was simpler and showed great success, she said. But it meant snorkeling your way down into the deep of sleep, more scuba diving than sheep counting. Every single night. And you look like Dennis Hopper in "Blue Velvet," to yourself and anyone else. I freaked out.
In a subsequent telephone conversation, Dr. Wieber assured me I was not alone.
"It's hard to wear a mask every night," she said, adding that for patients who are hearing of apnea and its treatments for the first time, the mask "might come as a shock." But she added that 70 to 75 percent adopt it, and compliance is good.
"For people walking around tired all day, it's a no-brainer," said David Schneiderman, 44, chief operating officer for a commodities clearing corporation in New York, with assurance. Mr. Schneiderman, who was diagnosed with apnea in 2002 and who wears a CPAP mask every night, recalled his wife and daughter telling him that before he was evaluated, he slept like a man in a cartoon.
"The dresser drawers would pull out and push in, from my snoring," he said. Now, with his snorkel-like CPAP in place as he prepares for bed, "my daughter comes in to kiss me goodnight: 'Goodnight Darth,' she says." Mr. Schneiderman added that he slept so well that he could no longer nap during the day.
Apnea, a recognized threat, is the tip of the iceberg, say sleep doctors. There are more than 80 identifiable sleep disorders, including restless leg syndrome and classics like insomnia.
"People think if you have apnea you die," said Dr. Thomas Roth, director of the Sleep Disorder and Research Center at Henry Ford Hospital in Detroit, who is cynical about the nation's discussion on sleep and the fashionable interest in the subject, and recited the rest of the wives' tales that have garnered the greatest media attention. "If you have insomnia, you're neurotic. If you don't sleep a lot, you're macho."
Dr. Roth, like many sleep specialists spoken to, believes the awareness of inadequate sleep, or the importance of good sleep hygiene, is still developing.
"Go to every school in the state and see how many have taught one word about sleep," he said. "My daughter's high school hygiene and health textbook? One page. That will be hard to justify to kids, because they don't sleep well either."
In a study released on Tuesday the National Sleep Foundation reported that more than half of the teenagers polled, ages 11 to 17, said they got less sleep than they thought they should, and a third suspected they had a sleep disorder. Only 7 percent of the parents polled thought their children had problems sleeping, though 28 percent of the teenagers said they fell asleep in class and were too tired to exercise.
More than half said they had driven while drowsy during the last year. Caffeine and electronic games, computers, personal telephones and televisions in the bedroom were culprits called out in the study: familiar to teenagers, but absent in their parents' suppositions about how much, or how well, their children sleep.
"Changing human behavior is a very difficult challenge," said Dr. Roth, who expressed pessimism about people's ability to embrace better sleep habits when, like eating or exercise, changing them went to the core of how people liked to live. He compared the epidemic of sleeplessness to the national epidemic of obesity, which is worsening.
And then there is blissful denial. If only that could help you sleep. "Ninety percent of the time, people with sleep problems think they're champion sleepers, and that they're just somehow too sleepy," said Dr. Meir Kryger, director of the sleep disorder clinic at St. Boniface General Hospital in Winnipeg, Manitoba, of his adult patients.
"It's a strange business," he said of sleep.
Tell me about it. Just not before I turn out the light.
###
The New York Times
April 2, 2006
Can't Sleep? Read This
By WILLIAM L. HAMILTON
TRY this sometime.
Plaster about two dozen electrodes to your face and head and tape some more to your chest and legs. Give yourself two to three feet of wire on each, and attach the other ends to the wall next to a bed, so they tug tightly when you move. Make sure the bed is in a room that you've never seen before, something that looks like a hospital room disguised as a hotel room. A kind of Soviet-era bugged spy box for information gathering, with a video camera, pointed at the bed, blinking silently from the ceiling.
Then turn out the lights and go to sleep.
I'm not a very cooperative lab rat, but this would describe a typical night at a sleep clinic, where data is gathered on how you sleep. This describes my night at the Center for Sleep Medicine at the Mount Sinai Medical Center in Manhattan. I woke up the next morning at 7 with someone misting my head. That softens the glue on the electrodes. On the subway ride home I looked like an escapee, discs of plaster crusted on my skull. Just another alien abduction.
I have joined the national discussion on sleep, a statistic in what is being called an epidemic of sleeplessness, or the growing perception that in bed, extracurriculars aside, we're not being our personal best.
It is a discussion being conducted in doctors' offices, at dinner tables, on Web sites like talkaboutsleep.com and sandiegodreamcatchers.org, and in chat rooms, where people call themselves "midnightclyde" and "sleepymoon."
"Nutrition, physical fitness, now sleep," said Dr. William C. Dement, director of the Sleep Disorders Clinic and Research Center at Stanford University, of the modern history of the American obsession with wellness.
Dr. Dement, who basically founded the idea of sleep medicine, is, at 77, the Sandman. He said the only periods during which he ever recalling losing sleep were when applying for grant money. "Twenty-five years ago everyone started jogging, worried about fitness," he said. "Now sleep is having its moment. Ninety percent of your waking health is dependent on your sleep."
Since 1970, when Dr. Dement founded his clinic, the nation's first, sleep has spawned university departments, associations, journals, conventions, academies and foundations like the National Sleep Foundation, which declared last week National Sleep Awareness week, ending today with daylight saving time, when we lose an hour of sleep by the clock whether we normally snooze with the gods or not.
Like many others, I complained to my doctor of poor sleep, and of tiredness during the day. He prescribed a sleep evaluation, to be conducted at a sleep clinic.
With baby boomers again leading the charge (I'm 54; you lose your natural gift for sleep as you age), sleep has become a commercial industry. In addition to pills (more popular than ever), breathing masks, nose pillows, hypnotic podcasts, aromatherapies and specialty bedding, there are sleep clinics like Mount Sinai's, which are proliferating.
With a tantalizing promise of self-improvement, like a day spa crossed with a night class, accredited facilities in the United States have tripled in number, to 963, in the last 10 years. (There are roughly 900 more unaccredited centers.) Sleep doctors warn that a shortage of trained, certified personnel like the technicians who administer the overnight testing could be sleep's next crisis.
"Think you have a sleep disorder?" asks the American Academy of Sleep Medicine, which accredits sleep centers, at its Web site, www.aasmnet.org. "Find a sleep center near you!"
Dr. Stasia J. Wieber, director of the Comprehensive Center for Sleep Medicine at Mount Sinai, said of evaluations: "A lot of people do it because their friends did it. But we only do an overnight sleep study when it's indicated. Everyone leaves with a diagnosis, but not everyone gets thrown into the lab. A physician has to order the study."
The overnight evaluation at Mount Sinai costs $1,500; most insurance companies cover it.
I arrived at 8 in the evening with an overnight bag, filled out a form on my sleep habits to determine my overall sleep "hygiene," then changed into my nightwear (tattered workout clothes) and sat in a chair watching "Armageddon" without sound on a corner television while a technician worked behind me, wiring my head.
Mount Sinai also evaluates pediatric sleep disorders. Down the hall, someone sang a lullaby, with the soft disembodiment that foreshadows horrible events in movies. On the television Bruce Willis said goodbye to Earth, his finger on the bomb.
Lights out. During the night, as I traveled between wakefulness and sleep, sending back streams of data like a space probe, the technician appeared and disappeared, adjusting my wires, and exiting my consciousness in a ring of light — the door to the corridor — like a spectral visitor, a goblin that only the sixth-sensed see. He monitored my voyage from a desk somewhere in the clinic, taking notes as I sped through the blackness.
The next morning, miles from a cup of coffee, my head damp with mist and dotted with what looked like old toothpaste, I filled out another form, asking, among other things, what I had dreamed about.
"I dreamed I was wired to a bunch of wires, in a threatening tangle, that pulled me back to a wall every time I tried to escape," I wrote, truthfully.
"Perhaps it was not a dream," the technician said, reviewing my responses, with a graveyard humor that was also chilly and serious. Working nights will do it to you.
During an office visit with Dr. Wieber two weeks later, I was told I have sleep apnea. I stop breathing 16 times an hour as I sleep, which she explained is considered moderate.
When you stop breathing, because of an inadequate passage for air between your tongue and the back of your throat, your body sends a message to your brain that something is going wrong, and your brain, in an emergency response, wakes you up. You lose sleep. And you are at increased risk for heart attack and stroke, studies have shown.
Medically, the first line of defense is a machine with a mask called a CPAP (continuous positive airway pressure) device. Then there is a Clockwork Orange-like dental device, which is not effective in every case, explained Dr. Wieber. And there was a surgical procedure, for select cases.
Rock, hard place.
The CPAP (pronounced SEE-pap) mask was simpler and showed great success, she said. But it meant snorkeling your way down into the deep of sleep, more scuba diving than sheep counting. Every single night. And you look like Dennis Hopper in "Blue Velvet," to yourself and anyone else. I freaked out.
In a subsequent telephone conversation, Dr. Wieber assured me I was not alone.
"It's hard to wear a mask every night," she said, adding that for patients who are hearing of apnea and its treatments for the first time, the mask "might come as a shock." But she added that 70 to 75 percent adopt it, and compliance is good.
"For people walking around tired all day, it's a no-brainer," said David Schneiderman, 44, chief operating officer for a commodities clearing corporation in New York, with assurance. Mr. Schneiderman, who was diagnosed with apnea in 2002 and who wears a CPAP mask every night, recalled his wife and daughter telling him that before he was evaluated, he slept like a man in a cartoon.
"The dresser drawers would pull out and push in, from my snoring," he said. Now, with his snorkel-like CPAP in place as he prepares for bed, "my daughter comes in to kiss me goodnight: 'Goodnight Darth,' she says." Mr. Schneiderman added that he slept so well that he could no longer nap during the day.
Apnea, a recognized threat, is the tip of the iceberg, say sleep doctors. There are more than 80 identifiable sleep disorders, including restless leg syndrome and classics like insomnia.
"People think if you have apnea you die," said Dr. Thomas Roth, director of the Sleep Disorder and Research Center at Henry Ford Hospital in Detroit, who is cynical about the nation's discussion on sleep and the fashionable interest in the subject, and recited the rest of the wives' tales that have garnered the greatest media attention. "If you have insomnia, you're neurotic. If you don't sleep a lot, you're macho."
Dr. Roth, like many sleep specialists spoken to, believes the awareness of inadequate sleep, or the importance of good sleep hygiene, is still developing.
"Go to every school in the state and see how many have taught one word about sleep," he said. "My daughter's high school hygiene and health textbook? One page. That will be hard to justify to kids, because they don't sleep well either."
In a study released on Tuesday the National Sleep Foundation reported that more than half of the teenagers polled, ages 11 to 17, said they got less sleep than they thought they should, and a third suspected they had a sleep disorder. Only 7 percent of the parents polled thought their children had problems sleeping, though 28 percent of the teenagers said they fell asleep in class and were too tired to exercise.
More than half said they had driven while drowsy during the last year. Caffeine and electronic games, computers, personal telephones and televisions in the bedroom were culprits called out in the study: familiar to teenagers, but absent in their parents' suppositions about how much, or how well, their children sleep.
"Changing human behavior is a very difficult challenge," said Dr. Roth, who expressed pessimism about people's ability to embrace better sleep habits when, like eating or exercise, changing them went to the core of how people liked to live. He compared the epidemic of sleeplessness to the national epidemic of obesity, which is worsening.
And then there is blissful denial. If only that could help you sleep. "Ninety percent of the time, people with sleep problems think they're champion sleepers, and that they're just somehow too sleepy," said Dr. Meir Kryger, director of the sleep disorder clinic at St. Boniface General Hospital in Winnipeg, Manitoba, of his adult patients.
"It's a strange business," he said of sleep.
Tell me about it. Just not before I turn out the light.
###
Thursday, March 30, 2006
Brainiacs are different (yawn)
Yet another confirmation of the obvious - intelligent's children's (and i suspect adults will show similar indications) brains look different than other children's brains. Still fascinating - just not surprising. Enjoy.
The New York Times
March 30, 2006
Scans Show Different Growth for Intelligent Brains
By NICHOLAS WADE
The brains of highly intelligent children develop in a different pattern from those with more average abilities, researchers have found after analyzing a series of imaging scans collected over 17 years.
The discovery, some experts expect, will help scientists understand intelligence in terms of the genes that foster it and the childhood experiences that can promote it.
"This is the first time that anyone has shown that the brain grows differently in extremely intelligent children," said Paul M. Thompson, a brain-imaging expert at the University of California, Los Angeles.
The finding is based on 307 children in Bethesda, Md., an affluent suburb of Washington. Starting in 1989, they were given regular brain scans using magnetic resonance imaging, a project initiated by Dr. Judith Rapoport of the National Institute of Mental Health.
This set of scans has been analyzed by Philip Shaw, Dr. Jay Giedd and others at the institute and at McGill University in Montreal. They looked at changes in the thickness of the cerebral cortex, the thin sheet of neurons that clads the outer surface of the brain and is the seat of many higher mental processes.
The general pattern of maturation, they report in Nature today, is that the cortex grows thicker as the child ages and then thins out. The cause of the changes is unknown, because the imaging process cannot see down to the level of individual neurons.
But basically the brain seems to be rewiring itself as it matures, with the thinning of the cortex reflecting a pruning of redundant connections.
The analysis was started to check out a finding by Dr. Thompson: that parts of the frontal lobe of the cortex are larger in people with high I.Q.'s. Looking at highly intelligent 7-year-olds, the researchers said they were surprised to find that the cortex was thinner than in a comparison group of children of average intelligence.
It was only in following the scans as the children grew older that the dynamism of the developing brain became evident. The researchers found that average children (I.Q. scores 83 to 108) reached a peak of cortical thickness at age 7 or 8. Highly intelligent children (121 to 149 in I.Q.) reached a peak thickness much later, at 13, followed by a more dynamic pruning process.
One interpretation, Dr. Rapoport said, is that the brains of highly intelligent children are more plastic or changeable, swinging through a higher trajectory of cortical thickening and thinning than occurs in average children. The scans show the "sculpturing or fine tuning of parts of the cortex which support higher level thought, and maybe this is happening more efficiently in the most intelligent children," Dr. Shaw said.
The I.Q. was tested when the children entered the program. Further tests were not needed because I.Q.'s are so stable, Dr. Rapoport said.
Dr. Thompson said the new study opened huge possibilities because researchers should be able to identify the factors that influence the brain by looking at the scan patterns identified by the researchers.
The Bethesda children have had genetic samples taken from their cells, so genes that have even the mildest influence on the brain should be detectable, Dr. Thompson said. The pattern of development may also be affected by factors like diet, hours spent in school or the number of siblings, and these may come to light by asking parents how they raised their children.
"There are many enigmas of intelligence that they can now solve," he said.
I.Q. scores and measuring intelligence have long been controversial. Brain-imaging studies by Dr. Thompson and the study group have advanced the field by identifying physical features of the brain that correlate with I.Q.
In 2001, Dr. Thompson reported that based on imaging twins' brains the volume of gray matter in the frontal lobes and other areas correlated with I.Q. and was heavily influenced by genetics. Despite the great importance of genes in brain function, Dr. Thompson said experience could also change the brain.
"Unless you have strong natural potential, you won't become a world-class marathon runner," he said. "But that disillusionment is rapidly replaced by the notion that you can improve your own performance."
The institute's team has many genetic studies in progress. The analysis reported today was not intended to look at the relationship between genes and intelligence.
"A lot of research in intelligence has not been that great," Dr. Shaw said. "I would hope by this modest descriptive study to put things on an empirical footing."
One goal of the study was to establish normal development patterns, to diagnose what goes awry in children with schizophrenia or attention deficits. Dr. Shaw said his team did not have the full answers as to how the brain differed in those cases.
###
The New York Times
March 30, 2006
Scans Show Different Growth for Intelligent Brains
By NICHOLAS WADE
The brains of highly intelligent children develop in a different pattern from those with more average abilities, researchers have found after analyzing a series of imaging scans collected over 17 years.
The discovery, some experts expect, will help scientists understand intelligence in terms of the genes that foster it and the childhood experiences that can promote it.
"This is the first time that anyone has shown that the brain grows differently in extremely intelligent children," said Paul M. Thompson, a brain-imaging expert at the University of California, Los Angeles.
The finding is based on 307 children in Bethesda, Md., an affluent suburb of Washington. Starting in 1989, they were given regular brain scans using magnetic resonance imaging, a project initiated by Dr. Judith Rapoport of the National Institute of Mental Health.
This set of scans has been analyzed by Philip Shaw, Dr. Jay Giedd and others at the institute and at McGill University in Montreal. They looked at changes in the thickness of the cerebral cortex, the thin sheet of neurons that clads the outer surface of the brain and is the seat of many higher mental processes.
The general pattern of maturation, they report in Nature today, is that the cortex grows thicker as the child ages and then thins out. The cause of the changes is unknown, because the imaging process cannot see down to the level of individual neurons.
But basically the brain seems to be rewiring itself as it matures, with the thinning of the cortex reflecting a pruning of redundant connections.
The analysis was started to check out a finding by Dr. Thompson: that parts of the frontal lobe of the cortex are larger in people with high I.Q.'s. Looking at highly intelligent 7-year-olds, the researchers said they were surprised to find that the cortex was thinner than in a comparison group of children of average intelligence.
It was only in following the scans as the children grew older that the dynamism of the developing brain became evident. The researchers found that average children (I.Q. scores 83 to 108) reached a peak of cortical thickness at age 7 or 8. Highly intelligent children (121 to 149 in I.Q.) reached a peak thickness much later, at 13, followed by a more dynamic pruning process.
One interpretation, Dr. Rapoport said, is that the brains of highly intelligent children are more plastic or changeable, swinging through a higher trajectory of cortical thickening and thinning than occurs in average children. The scans show the "sculpturing or fine tuning of parts of the cortex which support higher level thought, and maybe this is happening more efficiently in the most intelligent children," Dr. Shaw said.
The I.Q. was tested when the children entered the program. Further tests were not needed because I.Q.'s are so stable, Dr. Rapoport said.
Dr. Thompson said the new study opened huge possibilities because researchers should be able to identify the factors that influence the brain by looking at the scan patterns identified by the researchers.
The Bethesda children have had genetic samples taken from their cells, so genes that have even the mildest influence on the brain should be detectable, Dr. Thompson said. The pattern of development may also be affected by factors like diet, hours spent in school or the number of siblings, and these may come to light by asking parents how they raised their children.
"There are many enigmas of intelligence that they can now solve," he said.
I.Q. scores and measuring intelligence have long been controversial. Brain-imaging studies by Dr. Thompson and the study group have advanced the field by identifying physical features of the brain that correlate with I.Q.
In 2001, Dr. Thompson reported that based on imaging twins' brains the volume of gray matter in the frontal lobes and other areas correlated with I.Q. and was heavily influenced by genetics. Despite the great importance of genes in brain function, Dr. Thompson said experience could also change the brain.
"Unless you have strong natural potential, you won't become a world-class marathon runner," he said. "But that disillusionment is rapidly replaced by the notion that you can improve your own performance."
The institute's team has many genetic studies in progress. The analysis reported today was not intended to look at the relationship between genes and intelligence.
"A lot of research in intelligence has not been that great," Dr. Shaw said. "I would hope by this modest descriptive study to put things on an empirical footing."
One goal of the study was to establish normal development patterns, to diagnose what goes awry in children with schizophrenia or attention deficits. Dr. Shaw said his team did not have the full answers as to how the brain differed in those cases.
###
Wednesday, March 29, 2006
Dance around these blogs
Lots going on around my blogosphere right now.
Ever notice that there are now 10 (ten) blogs here (see list to the right - PLUS - three of the blogs aren't even listed yet - you have to peek at my profile page at the bottom to see 'em)?
Check some of these others out - they contain entries not found here at the main 3deye blog (although at times i post a particularly good entry in several blogs at once).
And since i believe in the Buddhist saying that "your most beloved teachers are your critics," please feel free to suggest improvements for your reading / viewing pleasure here.
Or you may just complain if you wish. Feels good sometime to simply vent. I have an alligator's hide, so pull no punches.
MEANWHILE
Check out OUR Constant Gardeners blog at
http://constantgarden.blogspot.com/ for the latest stuff there.
Enjoy !
p.s. Want to contribute to any of these blogs on a regular basis? That's doable. Just write to me and tell me. Welcome.
Ever notice that there are now 10 (ten) blogs here (see list to the right - PLUS - three of the blogs aren't even listed yet - you have to peek at my profile page at the bottom to see 'em)?
Check some of these others out - they contain entries not found here at the main 3deye blog (although at times i post a particularly good entry in several blogs at once).
And since i believe in the Buddhist saying that "your most beloved teachers are your critics," please feel free to suggest improvements for your reading / viewing pleasure here.
Or you may just complain if you wish. Feels good sometime to simply vent. I have an alligator's hide, so pull no punches.
MEANWHILE
Check out OUR Constant Gardeners blog at
http://constantgarden.blogspot.com/ for the latest stuff there.
Enjoy !
p.s. Want to contribute to any of these blogs on a regular basis? That's doable. Just write to me and tell me. Welcome.
Tuesday, March 28, 2006
To the Ladies I love
This "hot flash" bugaboo has got to stop. Here's how to achieve that.
Enjoy, ladies.
Oh - I like dark beer (Guiness, Abita Springs, Shiner Bock, Fat Tire, etc). Call me to come over for a beer and to discuss how this treatment helped you. We'll both have a good laugh and I'll get to drink some favorite beer as well.
The New York Times
March 28, 2006
Personal Health
A Chance Find, and Voilà ! Goodbye, Hot Flashes. Hello, Sleep.
By JANE E. BRODY
A widely used drug that has been mired in controversy for most of its decade-long life may now bring relief to postmenopausal women whose lives have been disrupted by unrelenting hot flashes. The relief may be especially welcome to women who have had breast cancer and cannot take estrogen.
The drug, best known by its trade name, Neurontin, but now prescribed generically as gabapentin, was approved by the Food and Drug Administration in 1994 to treat epileptic seizures. In 2002, it was approved to treat postherpetic neuralgia, horrific pain that sometimes follows shingles.
Aided by the Internet and, the government has said, an illegal marketing campaign by its parent company, Neurontin sales eventually exceeded $2 billion a year before its patent expired and the generic gabapentin entered the market in 2004.
The parent company, Warner-Lambert (since bought by Pfizer), was investigated after a whistle-blower said it had paid doctors to promote Neurontin to their colleagues for a host of additional symptoms not approved by the F.D.A. The whistle-blower also said the company had paid to have research articles prepared claiming benefits of a dubious nature.
Varied Applications
As a result, Neurontin has been used for problems like migraines, social phobia, attention-deficit disorder in children, gastric ulcers, restless leg syndrome, essential tremor, osteoarthritis, backache, insomnia, anxiety, bipolar disorder, panic attacks and withdrawal from cocaine and alcohol — all known as off-label uses.
Its most frequent off-label use is as an adjunct to drugs used to treat pain, especially pain thought to have nerve involvement.
Thus, gabapentin was part of the medication prescribed for my unrelenting pain after a double knee-replacement operation last year. It was prescribed again last fall when I developed debilitating back and leg pain caused by a pinched nerve in my back.
Between the two prescriptions, I made a discovery that changed my life for the better. While taking Neurontin three times a day for the knee pain, I had none of the hot flashes that had plagued me day and night after breast cancer in 1999 made me stop postmenopausal hormones. But when I weaned myself from gabapentin last May, the hot flashes returned, resulting in three sleepless nights in a row. I wondered whether it could be a factor and decided, with my doctor's approval, to try just one 300-milligram capsule before bedtime. Voilà ! No hot flashes. No waking up damp and clammy and unable to go back to sleep.
I've stayed on the drug, and this winter I've been able to wear turtlenecks. I'm sleeping much better. On the dose that helps me — 300 milligrams after breakfast and 300 or 600 milligrams at bedtime — I've noticed no unusual effects beyond an ability to sleep comfortably for seven hours a night.
Last September, I found a report in The Lancet, the medical journal, by researchers from four medical centers who conducted a clinic trial using gabapentin to treat hot flashes in women with breast cancer. In the study, 420 women having two or more hot flashes a day were randomly assigned to take 300 or 900 milligrams of gabapentin or a look-alike placebo each day in three divided doses for eight weeks.
About one patient in five on the placebo reported a decline in hot flashes, while a third of those taking 300 milligrams of gabapentin did and nearly half of those on 900 milligrams reported a benefit.
The researchers, led by Dr. Kishan J. Pandya of the James P. Wilmot Cancer Center at the University of Rochester Medical Center, found that "only the higher dose of gabapentin was associated with significant decreases in hot flash frequency and severity." They recommended that the drug "be considered for treatment of hot flashes in women with breast cancer."
Dr. Pandya undertook this study after Dr. Thomas J. Guttuso Jr., a neurologist then at the university's medical center, published findings in February 2003 in Obstetrics & Gynecology. Dr. Guttuso and his colleagues had randomly assigned 59 postmenopausal women who suffered from seven or more hot flashes a day to receive gabapentin or a placebo for 12 weeks.
Reducing the Heat
Those who took 300 milligrams of gabapentin three times a day reported a 54 percent reduction in overall hot flash activity (frequency and severity) compared with a 31 percent drop in the placebo group.
In an interview, Dr. Guttuso, now at the Jacobs Neurological Institute at the University at Buffalo, discussed a soon-to-be-published study by Dr. Sireesha Y. Reddy and colleagues that pitted 2,400 milligrams of gabapentin daily against 0.625 milligram of estrogen, the gold standard for controlling hot flashes.
Participants suffered from moderate to severe hot flashes, defined as seven or more per day, accompanied by sweating. Gabapentin relieved hot flashes as effectively as estrogen, Dr. Guttuso said. Although about 40 percent of the women taking 2,400 milligrams of gabapentin daily reported side effects (sleepiness, dizziness and swelling of the feet), they felt that the benefit of the drug outweighed them, Dr. Guttuso said.
Gabapentin has other benefits. "It does not interact with any other medications, which is very unique," Dr. Guttoso said, "so doctors don't have to worry about other drugs a patient might be taking. Also, gabapentin is not metabolized, so it has no effect on the liver. It's fully excreted in the urine." He said that it works through a receptor on the membranes of brain and peripheral nerve cells.
Estrogen normally acts as a brake on cells in the brain's temperature-regulating center through pathways called calcium channels. Gabapentin binds to a channel.
Gabapentin was developed to help avoid the addictive quality of drugs called GABA analogues (Valium, Ativan and Xanax) used for anxiety and seizure disorders. The modified drug proved nonaddictive.
Properly designed clinical trials are needed to show just how helpful gabapentin is against various conditions and whether prolonged use may have unexpected adverse effects. At high doses, side effects like drowsiness, dizziness and weight gain from retained water can limit its usefulness.
Now that the drug is without patent protection, future F.D.A. approvals will depend on studies by two companies. One, PharmaNova, has patented a sustained-release formulation of gabapentin and is studying its role in treating hot flashes. Meanwhile, Pfizer has introduced a chemical cousin of gabapentin, sold as Lyrica and approved for treating nerve pain caused by shingles and diabetes. It should control hot flashes, too.
Lyrica is being studied in patients with hot flashes under a licensing agreement with the University of Rochester, which has patented new uses of gabapentin and other drugs that use the same mechanism.
###
Sunday, March 26, 2006
Emotions Key
Dana Reeve tells viewers: “Your emotional state has a tremendous amount to do with sickness, health and well-being."
It's one of those insights which seems obvious at first, but then we don't live as if we believe it.We must.
Enjoy.
MSNBC.com
Dana Reeve poignantly begins PBS program
Months before death, is ‘hopeful' in introduction to ‘The New Medicine’
The Associated Press
Updated: 6:08 p.m. ET March 25, 2006
CHARLOTTE, N.C. - Dana Reeve would live only about three more months after she taped an introduction to the two-hour PBS documentary “The New Medicine.”
The widow of paralyzed “Superman” actor Christopher Reeve was battling lung cancer diagnosed last summer, but was upbeat on that late November day of the taping.
“She was very hopeful at that point that she would survive,” director Muffie Meyer recalled. “She was buying Christmas presents for her son that day, and really had a tremendous amount of energy.”
In her introduction to the first segment of “The New Medicine,” Reeve tells viewers: “Your emotional state has a tremendous amount to do with sickness, health and well-being. For years, my husband and I lived on — and because of — hope. Hope continues to give me the mental strength to carry on.”
The project was the last she is known to have completed before her death March 6. “The New Medicine,” which debuts Wednesday (check local listings), looks at how mainstream doctors are embracing the idea that true healing involves treating the whole patient — not just the symptoms of a disease.
By airing after her death, Reeve’s appearance unintentionally underscores one of the central points of the documentary: Holistic medicine is a tool for fighting illness — not a cure-all.
“Part of the challenge is we get patients all the time that are really looking for a magic cure,” said Dr. Tracy Gaudet, an obstetrician-gynecologist who heads the Duke Center for Integrative Medicine in Durham and is featured in the PBS program. “We’re not in the business of magic cures; we’re in the business of good medicine.”
The idea behind her center, Gaudet said, is to use any available techniques — from alternative to mainstream — that might improve a patient’s experience. Accepted practices include herbal supplements, acupuncture, massage and meditation.
“The Science of Emotion,” the first hour of the documentary, follows Gaudet as she treats Tammy Patton following her hospitalization in the 25th week of pregnancy. Patton’s water has broken prematurely, exposing her fetus to the risk of infection and increasing the chance of premature birth.
Stress is known to raise the risk of infection and to spur early labor, so Gaudet led Patton through a series of relaxation exercises intended to hold off labor.
“We can help your mind take a little vacation,” Gaudet told her patient. Patton ended up carrying her baby boy four more weeks. So the birth was still premature, but the boy has a good chance of a healthy life.
Also featured in the program is Dr. Ralph Snyderman, the chancellor emeritus of health affairs at Duke who helped start the center. Snyderman said recently that before he was an administrator, he specialized in technology-driven, federally financed research.
“I was about as hard-nosed a physician-scientist as you could find,” he said. But he learned that patients had problems “beyond what was going to be solved through pure science and technology alone.”
Reeve, in an off-camera interview with the film’s producers on the day she taped her introductions, said she had consulted with integrative medicine guru Dr. Andrew Weil and was doing “creative image work” — a technique in which patients learn to relax by evoking images and sensations.
With her doctors’ blessing, she said, she also was taking botanical supplements along with the medicines she was prescribed at Memorial Sloan-Kettering Medical Center.
The PBS film almost consciously avoids a New Age tone. There are a few shots of yoga classes and one segment in which scientists study the brain waves of a Buddhist monk as he meditates.
But there are no magic crystals, no “cancer diets” or trips to Mexico for treatments outlawed in the United States. Just a sincere effort to find something — anything — that will lead to a better quality of life for patients.
© 2006 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.
© 2006 MSNBC.com
URL: http://www.msnbc.msn.com/id/12012024/from/RS.4/
Saturday, March 25, 2006
End of life Issues
Who among us does not identify with this article ? This is why I felt it was so important to my life and the lives of those I might help in some way, that I volunteer my time to the Hospice organization. It is among the best personal decisions i have ever made. Enjoy.
pic at left:Edith Tusubira, right, a nurse, helped Bernice Goodman at the home of Ms. Goodman's daughter Nancy in West Roxbury, Mass. Nancy Goodman's company offers care benefits, but she says they are nearly useless.
pic at right: Kent Burtis, right, a technician for Verizon in Bayville, N.J., gets lunch for his father, Ivan Burtis, each workday, but an aide does the morning shift. "It's kept me from slitting my throat," Kent Burtis said of that benefit.
The New York Times
March 25, 2006
As Parents Age, Baby Boomers and Business Struggle to Cope
By JANE GROSS
Nancy Goodman's employer, a telecommunications company in Boston, offers benefits to help employees care for elderly parents. But she found them nearly useless during four years of caring for her mother, who has Parkinson's disease, and her father, who died of kidney failure last year.
"They say they want to do the right thing," Ms. Goodman, 58, said of her employer, which she would not identify for fear of losing her job. "But when it comes down to it, they're not seeing the true picture."
Ms. Goodman's lament is common, as corporate America scrambles to help the soaring number of baby boomers, mostly working women, whose obligation to frail, elderly parents results in absenteeism, workday distractions or stress-related health problems.
Companies are responding, but experts say they often use child care benefits as a model when they do not suit the different and unpredictable needs of the elderly. In addition, at a time of cutbacks in expensive health insurance and pensions, the most commonly offered benefits are those that cost a company little or nothing, like referral services and unpaid leaves.
Ms. Goodman, for instance, tried her company's referral service to supplement inadequate staffing when her parents lived at an assisted living center in Connecticut. It was "like going to the yellow pages," she said, since it did not relieve her of the time-consuming tasks of arranging for and supervising the services from afar. Ms. Goodman was also entitled to a year's leave of absence, a benefit a new mother might appreciate. But if she took a leave now, what happened if her mother lingered?
Employees with ailing parents, more than 20 million nationwide, cite other benefits that would allow them to focus more on their jobs, like geriatric case managers to guide them through the mysteries of Medicaid and Medicare, or backup care for emergencies like a last-minute business trip. Companies that offer this kind of hands-on assistance generally pay for at least part of the service.
But they are rare. According to the Society for Human Resource Management, which represents more than 200,000 human resource and other corporate officials, 39 percent of its members said in 2003 that elder care benefits were "too costly to be feasible." Only 1 percent of their companies subsidized any elder care benefits last year. And only 3 percent offered the emergency backup care — subsidized or otherwise — that experts say saves money by keeping workers at work.
"The perception among companies is that they can't afford elder care benefits," said Frank Scanlan, a spokesman for the society.
It is the largest companies that are the most generous, but even those often subscribe to the mistaken notion that the Mommy Track and the Daughter Track are the same, said Chris Gatti, president of the Work Options Group in Superior, Colo. Work Options, whose clients employ 400,000 people nationwide, provides in-home care for children and the elderly.
"These benefits fall under the same umbrella but are fundamentally different," Mr. Gatti said. "Child care programs are relatively straight-forward and easy to administer compared to elder care, which is a maze with lots of sharp corners and dark secluded places."
An individual supervisor can ease an employee's burden but still leave them vulnerable to management changes. Just 6 percent of employers have written policies about elder care, according to surveys by the Society for Human Resource Management, while 76 percent say they help employees on a case-by-case basis.
For Ms. Goodman, the one godsend since her father died and her mother moved into her Boston apartment has been permission to work at home. But that is likely to change with a new boss. "I'm walking on eggs right now," Ms. Goodman said.
The distinctions between child care and elder care have become apparent as the first of the 77 million baby boomers turn 60 and their parents live past 85, joining the fastest-growing segment of the population.
The most obvious is that children's schedules are predictable — a school holiday next Monday — while elderly parents' needs — a trip to the emergency room — are crisis-driven. Also, children are raised at home; an elderly parent often lives far away.
Guiding the decisions of an elderly parent also requires mastery of arcane legal, financial and medical matters.
"It's a new and very confusing skill set," said Maureen Corcoran, a vice president at Prudential Financial. "You don't just give people a list; you lead them there. Otherwise they spend hours upon hours figuring it out themselves."
For both employees and employers, the costs of elder care are enormous, according to studies by the MetLife Mature Market Institute, which is in the midst of updated analysis to reflect rapidly changing demographics.
The price tag for employers in 1997 ranged from $11.5 billion to $29 billion a year. Most expensive were the replacement of lost workers (at least $4.9 billion a year), workday interruptions ($3.7 billion) and absenteeism ($885 million). The employees lose salary, Social Security and pension benefits as a result of refusing promotions, switching to part-time work or retiring early.
Certain benefits mitigate these costs, and certain companies have learned there is a clear return on investment. At Prudential, for instance, subsidized emergency backup care prevents absenteeism and workday interruptions. Prudential's 21,000 employees, with one phone call to Work Options Group, can get help for parents by the next morning, for a co-payment of $4 an hour.
A $20-an-hour aide, on an eight-hour shift, would otherwise cost a Prudential employee $160, rather than $32. Yet the company says it will save $650,000 during a three-year contract with Work Options, Ms. Corcoran said, because "if our employees needs are taken care of, they can focus on work."
Diane Yankencheck, a Prudential employee in Newark, said the service kept her working during a crisis. Her father has a degenerative neurological disease and round-the-clock care. Her mother manages the household, or did until she broke her wrist. Now an aide from Work Options cooks, cleans and helps her bathe and dress.
Kent Burtis, a Verizon technician in Bayville, N.J., uses similar backup care for his father, who is paralyzed and incontinent. For a while, Mr. Burtis spent hours before work feeding, diapering and dressing him. Now an aide does the morning shift. "It's kept me from slitting my throat," Mr. Burtis said.
Elder care benefits most often seem a luxury at small companies and nonprofits. So even at AARP, dedicated to the needs of older Americans, Deborah Russell, the director of work force issues, was daunted by coordinating long-distance care for her mother and then missing weeks of work to be at her bedside when death neared.
Ms. Russell and her two sisters, grateful for AARP's excellent referral service, still spent "an inordinate amount of time on the telephone" during working hours, distracted and unproductive. As their mother's condition deteriorated, and the siblings rotated weeks in Florida, Ms. Russell used paid vacation time rather than the 12 weeks of unpaid leave guaranteed by the federal Family Medical Leave Act or AARP's more generous 16-week program, also unpaid.
Another benefit assumed to be useful is the flexible spending account, governed by the Internal Revenue Service and widely offered by companies. It permits the use of pretax dollars for dependent care, as long as the dependent meets the I.R.S. definition. Virtually all children do, but most aged parents do not. That means tax breaks for baby sitters but not companions for the elderly.
Experts disagree about whether women will push employers for help with their parents, as they did 30 years ago when child care was their pressing issue.
Ellen Galinsky, 63, president of the Family and Work Institute, led the charge for a day care center at Bank Street College when she was a researcher there in 1969. After "huge resistance," the center opened in 1974. Ms. Galinsky predicts a similar awakening to elder care issues because "demographics are destiny."
"Everyone I know is dealing with this," said Ms. Galinsky, who recently stayed at the bedside of her 98-year-old mother for the last two months of her life. The institute allows unlimited sick leave for such family emergencies. But even with that leeway, Ms. Galinsky said: "I was on another planet. It's like no other experience. I barely have words for how hard it is."
Todd Groves, founder of LTC Financial Partners in Seattle, who advises human resource managers on long term care, is not convinced that women like Ms. Galinsky will have the same galvanizing effect this time around, regardless of their numbers or their passion.
"Back then you still had a paternal business culture," Mr. Groves said. "Now people feel out on their own. They are fearful about their careers and don't feel they can ask for help."
###
Not at home-cooked Meals
I am constantly amazed at the niche industries that inventive folks , well, invent ! This is a remarkable concept that is already earning hundreds of millions of dollars a year. I still do it the old-fashioned way: cooking from scratch at home ! But what this article describes is far better than eating at chains or bringing home takeout. Enjoy.
PHOTO: Jeannette Balantic, center, and Madeline Craig, of Floral Park, on Long Island, put together enchiladas at Super Suppers in Bethpage, N.Y.
The New York Times
March 26, 2006
Meals That Moms Can Almost Call Their Own
By KIM SEVERSON and JULIA MOSKIN
SEATTLE — Jodi Robbins and her family were on a grim dinnertime merry-go-round.
Takeout pizza was a mainstay, except on the nights when Chinese food seemed more appealing. When Ms. Robbins cooked, it was spaghetti or tuna casserole over and over, with rarely enough time to make a salad.
Their routine was expensive, fattening and boring. In the rush to get through the day, the family had lost control of the dinner table.
So Ms. Robbins now goes to Dream Dinners in West Seattle, where she spends just under two hours assembling dishes like cheesy chicken casserole and Salisbury steak from ingredients that have been peeled and chopped for her. She does not have to pick up a knife, turn on a stove or wash a dish.
All she has to do is pop the meals in her oven and, for about $3.50 a serving, experience the satisfaction of putting a home-cooked meal — of a sort — on the table.
Americans, pinched for time and increasingly uncomfortable in their kitchens, have been on a 50-year slide away from home cooking. Now, at almost 700 meal assembly centers around the country, families like the Robbinses prepare two weeks' worth of dinners they can call their own with little more effort than it takes to buy a rotisserie chicken and a bag of salad.
The centers are opening at a rate of about 40 a month, mostly in strip malls and office parks in the nation's suburbs and smaller cities, and are projected to earn $270 million this year, according to the Easy Meal Prep Association, the industry's trade group.
"It's been keeping us from ordering pizza all the time," Ms. Robbins said. "And you still feel like you're cooking."
The prototype, a kind of elevated cooking session among friends in a commercial kitchen, popped up in the Northwest in 1999. The concept did not take off until 2002, when two Seattle-area women streamlined the process so customers could make 12 dinners for six in two hours for under $200. That company became Dream Dinners, which opened a year later and now has 112 franchise stores, with 64 under construction.
Super Suppers, which opened a year later in Fort Worth, is the largest chain, with 121 franchise stores and 77 more under construction. For people with few cooking skills, the centers keep things simple with a rotating menu of mostly stews and casseroles designed to be assembled in freezer bags or aluminum trays, then taken home to be baked or simmered in a single pot.
Customers select their dishes online ahead of time. When they show up, they follow recipes that hang over restaurant-style work stations filled with ingredients like frozen chicken breasts, chopped onions and jars of seasonings.
Cheerful workers hover around, carting off measuring spoons as soon as they are dirty and pouring fresh coffee. They encourage the calorie conscious or sodium sensitive to customize meals. And if someone hates broccoli, it can be left out. For people who feel guilty about not cooking for their families, the centers offer absolution in just a couple of hours.
Lisa Johnson, who lives in a suburb of Raleigh, N.C., especially hates shopping and cleanup. But she is determined to keep the family together at the table, at least occasionally. She became a meal assembly convert after just one visit.
"We're always hearing that eating dinner together is the cure for obesity, learning disorders, drugs, divorce and every kind of problem we have in society," she said. "But what no one tells you is how to do all that cooking."
Although women still do 80 percent of the food-related work at home, the amount of time Americans spend cooking dinner has declined to about 30 minutes from about two and a half hours since the 1960's, according to market research by Mintel International and the NPD Group. At the same time, the country is showing signs of restaurant fatigue. Spending in restaurants, which had been growing steadily since World War II, has been flat since 2001.
Meal assembly centers are not necessarily a return to the home-cooked food generations grew up eating. For one, no one actually cooks at them. The chopped vegetables and frozen meats at most of the centers come from industrial food suppliers like Sysco, and recipes include ingredients like canned wax beans and that old hot dish standby, cream of chicken soup. Nothing is cooked on site, although workers in the back room may chop scallions or slice raw beef into serving sizes.
But it may be a start.
"With every generation, fewer and fewer girls — and boys — are growing up hanging around the kitchen," said Laura Shapiro, who writes about modern cooking in America. "But the incredible popularity of cooking shows on TV shows that people are hungry to cook, hungry to be in the kitchen."
Even an "assembled" family meal will always be more meaningful than takeout because of the physical connection between the cook, the food and the family, said Bradd Shore, director of the Emory Center on Myth and Ritual in American Life.
"When a mother says, 'Do you like my lasagna?' that is much more loaded than, 'Do you like the lasagna?' " Dr. Shore said. "The fact that she made it with her hands is powerful."
Mayra Didomenico, a mother of two and a pharmacist, just wants to save time and money.
"Every week I go to the supermarket and spend $200 and I still have to cook it," she said as she filled bags with frozen marmalade-glazed pork chops at a new Super Suppers store in Bethpage, N.Y.
So why not just buy frozen food? "At least here I am seeing the ingredients," she said.
In addition to dinner, the centers offer a kind of canned camaraderie.
"People are looking for a communal feeling, whether it's around a table eating together or in a storefront measuring food into little bags with their friends," said Marc Halperin, director of the Center for Culinary Development in San Francisco, which develops products for clients including Kellogg's and Starbucks.
Meal assembly centers often encourage customers to attend with friends, drink wine while they "cook" and even dance, as a set of couples did on a recent night at Super Suppers in Bethpage.
"They turned off the music, pulled out a big-screen TV and we all watched 'American Idol,' " said Evan Glass, a construction company executive.
Stephanie Allen, who helped found Dream Dinners in the Seattle area in 2002, says her customers first come in with friends, but after two or three visits return alone. "They want to get in and get out and get their dinners done," Ms. Allen said. "They can say, this is something I made, I can have my in-laws over to dinner, and I won't get a hard time from them."
As long as the in-laws are not food critics. Some of the nation's most experienced cooking professionals who attended a food panel recently at New York University had never heard of meal preparation centers. Once it was explained, they expressed disdain.
"People basically don't want to cook but they don't want to be told they are not cooking," said Madhur Jaffrey, the Indian cookbook author and actor. "It's an illusion."
###
Thursday, March 23, 2006
Hair today - gone tomorrow
Every now and then, a post is so good, I will lift it from its original home (in this case, Humor Me blog) and reprint it here in 3deye. The following article about the fine art of waxing is one such post. Enjoy (and put that drink down, you will be laughing out loud).
play with the kids. I then had the thought that would ring painfully
in my mind for the next few hours: "Maybe I should pull the waxing
kit out of the medicine cabinet." So I headed to the site of my
demise: the bathroom.
It was one of those "cold wax" kits. No melting a clump of hot wax,
you just rub the strips together in your hand, they get warm and you
peel them apart and press them to your leg (or wherever else) and you
pull the hair right
off. No muss, no fuss. How hard can it be? I mean, I'm not a genius,
but I am mechanically inclined enough to figure this out. (YA
THINK!?!)
So I pull one of the thin strips out. Its two strips facing each
other stuck together. Instead of rubbing them together, my genius
kicks in so I get out the hair dryer and heat it to 1000 degrees.
("Cold wax," yeah...right!) I lay the strip across my thigh. Hold the
skin around it tight and pull. It works! OK, so it wasn't the best
feeling, but it wasn't too bad. I can do this! Hair removal no longer
eludes me! I am She-rah, fighter of all wayward body hair and maker
of smooth skin extraordinaire.
With my next wax strip I move north. After checking on the kids, I
sneak back into the bathroom, for the ultimate hair fighting
championship. I drop my panties and place one foot on the toilet.
Using the same procedure, I apply the one strip across the right side
of my bikini line, covering the right half of my *hoo-hoo* and
stretching down to the inside of my butt cheek (Yes, it was a long
strip) I inhale deeply and brace myself....RRRRIIIPPP!!!!
I'm blind!!! Blinded from pain!!!!....OH MY GOD!!!!!!!!! Vision
returning, I notice that I've only managed to pull off half the
strip. CRAP!!! Another deep breath and RRIIP! P!! Everything is
swirly and spotted. I think I may pass out...must stay conscious...Do
I hear crashing drums??? Breathe, breathe...OK, back to normal.
I want to see my trophy - a wax covered strip, the one that has
caused me so much pain, with my hairy pelt sticking to it. I want to
revel in the glory that is my triumph over body hair. I hold up the
strip! There's no hair on it. Where is the hair??? WHERE IS THE WAX???
Slowly I ease my head down, foot still perched on the toilet. I see
the hair. The hair that should be on the strip. I touch. I am
touching wax.
CRAP! I run my fingers over the most sensitive part of my body, which
is now covered in cold wax and matted hair.
Then I make the next BIG mistake...remember my foot is still propped
up on the toilet? I know I need to do something. So I put my foot
down.
DAMN!!!!!!!! I hear the slamming of a cell door. *hoo-hoo*? Sealed
shut! Butt?? Sealed shut!
I penguin walk around the bathroom trying to figure out what to do
and think to myself "Please don't let me get the urge to poop. My
head may pop off!"
What can I do to melt the wax? Hot water!! Hot water melts wax!!!
I'll run the hottest water I can stand into the bathtub, get in,
immerse the wax-covered bits and the wax should melt and I can gently
wipe it off, right??? WRONG!!!!!!!
I get in the tub - the water is slightly hotter than that used to
torture prisoners of war or sterilize surgical equipment - I sit.
Now, the only thing worse than having your nether regions glued
together is having them glued together and then glued to the bottom
of the tub...in scalding hot water. Which, by the way, doesn't melt
cold wax.
So, now I'm stuck to the bottom of the tub as though I had cement-
epoxied myself to the porcelain!!
God bless the man who had convinced me a few months ago to have a
phone put in the bathroom!!!!!
I call my friend, thinking surely she has waxed before and has some
secret of how to get me undone. It's a very good conversation
starter - "So, my butt and who-ha are glued together to the bottom of
the tub!"
There is a slight pause. She doesn't know any secret tricks for
removal but she does try to hide her laughter from me. She wants to
know exactly where the wax is located, "Are we talking cheeks or who-
ha?"
She's laughing out loud by now...I can hear her. I give her the
rundown and she suggests I call the number on the side of the box.
YEAH!!!!! Right!! I should be the joke of someone else's night.
While we go through various solutions. I resort to scraping the wax
off with a razor. Nothing feels better then to have your girlie
goodies covered in hot wax, glued shut, stuck to the tub in super hot
water and then dry-shaving the sticky wax off!!
By now the brain is not working, dignity has taken a major hike and
I'm pretty sure I'm going to need Post-Traumatic Stress counseling
for this event.
My friend is still talking with me when I finally see my saving
grace....the lotion they give you to remove the excess wax. What do I
really have to lose at this point? I rub some on and OH MY GOD!!!!!!!
The scream probably woke the kids and scared the dickens out of my
friend.
It's sooo painful, I but I really don't care. "IT WORKS!! It works!!"
I get a hearty congratulation from my friend and she hangs up.
I successfully remove the remainder of the wax and then notice to my
grief and despair....THE HAIR IS STILL THERE.......ALL OF IT!!!!!!!!!!
So I recklessly shave it off. Heck, I'm numb by now. Nothing hurts. I
could have amputated my own leg at this point.
Next week I'm going to try hair color......
Now that's funny ........ Notttttttttt Send this on to other folks
who need a good laugh! ###
Hair today - gone tomorrow
My night began as any other normal weeknight. Come home, fix dinner,play with the kids. I then had the thought that would ring painfully
in my mind for the next few hours: "Maybe I should pull the waxing
kit out of the medicine cabinet." So I headed to the site of my
demise: the bathroom.
It was one of those "cold wax" kits. No melting a clump of hot wax,
you just rub the strips together in your hand, they get warm and you
peel them apart and press them to your leg (or wherever else) and you
pull the hair right
off. No muss, no fuss. How hard can it be? I mean, I'm not a genius,
but I am mechanically inclined enough to figure this out. (YA
THINK!?!)
So I pull one of the thin strips out. Its two strips facing each
other stuck together. Instead of rubbing them together, my genius
kicks in so I get out the hair dryer and heat it to 1000 degrees.
("Cold wax," yeah...right!) I lay the strip across my thigh. Hold the
skin around it tight and pull. It works! OK, so it wasn't the best
feeling, but it wasn't too bad. I can do this! Hair removal no longer
eludes me! I am She-rah, fighter of all wayward body hair and maker
of smooth skin extraordinaire.
With my next wax strip I move north. After checking on the kids, I
sneak back into the bathroom, for the ultimate hair fighting
championship. I drop my panties and place one foot on the toilet.
Using the same procedure, I apply the one strip across the right side
of my bikini line, covering the right half of my *hoo-hoo* and
stretching down to the inside of my butt cheek (Yes, it was a long
strip) I inhale deeply and brace myself....RRRRIIIPPP!!!!
I'm blind!!! Blinded from pain!!!!....OH MY GOD!!!!!!!!! Vision
returning, I notice that I've only managed to pull off half the
strip. CRAP!!! Another deep breath and RRIIP! P!! Everything is
swirly and spotted. I think I may pass out...must stay conscious...Do
I hear crashing drums??? Breathe, breathe...OK, back to normal.
I want to see my trophy - a wax covered strip, the one that has
caused me so much pain, with my hairy pelt sticking to it. I want to
revel in the glory that is my triumph over body hair. I hold up the
strip! There's no hair on it. Where is the hair??? WHERE IS THE WAX???
Slowly I ease my head down, foot still perched on the toilet. I see
the hair. The hair that should be on the strip. I touch. I am
touching wax.
CRAP! I run my fingers over the most sensitive part of my body, which
is now covered in cold wax and matted hair.
Then I make the next BIG mistake...remember my foot is still propped
up on the toilet? I know I need to do something. So I put my foot
down.
DAMN!!!!!!!! I hear the slamming of a cell door. *hoo-hoo*? Sealed
shut! Butt?? Sealed shut!
I penguin walk around the bathroom trying to figure out what to do
and think to myself "Please don't let me get the urge to poop. My
head may pop off!"
What can I do to melt the wax? Hot water!! Hot water melts wax!!!
I'll run the hottest water I can stand into the bathtub, get in,
immerse the wax-covered bits and the wax should melt and I can gently
wipe it off, right??? WRONG!!!!!!!
I get in the tub - the water is slightly hotter than that used to
torture prisoners of war or sterilize surgical equipment - I sit.
Now, the only thing worse than having your nether regions glued
together is having them glued together and then glued to the bottom
of the tub...in scalding hot water. Which, by the way, doesn't melt
cold wax.
So, now I'm stuck to the bottom of the tub as though I had cement-
epoxied myself to the porcelain!!
God bless the man who had convinced me a few months ago to have a
phone put in the bathroom!!!!!
I call my friend, thinking surely she has waxed before and has some
secret of how to get me undone. It's a very good conversation
starter - "So, my butt and who-ha are glued together to the bottom of
the tub!"
There is a slight pause. She doesn't know any secret tricks for
removal but she does try to hide her laughter from me. She wants to
know exactly where the wax is located, "Are we talking cheeks or who-
ha?"
She's laughing out loud by now...I can hear her. I give her the
rundown and she suggests I call the number on the side of the box.
YEAH!!!!! Right!! I should be the joke of someone else's night.
While we go through various solutions. I resort to scraping the wax
off with a razor. Nothing feels better then to have your girlie
goodies covered in hot wax, glued shut, stuck to the tub in super hot
water and then dry-shaving the sticky wax off!!
By now the brain is not working, dignity has taken a major hike and
I'm pretty sure I'm going to need Post-Traumatic Stress counseling
for this event.
My friend is still talking with me when I finally see my saving
grace....the lotion they give you to remove the excess wax. What do I
really have to lose at this point? I rub some on and OH MY GOD!!!!!!!
The scream probably woke the kids and scared the dickens out of my
friend.
It's sooo painful, I but I really don't care. "IT WORKS!! It works!!"
I get a hearty congratulation from my friend and she hangs up.
I successfully remove the remainder of the wax and then notice to my
grief and despair....THE HAIR IS STILL THERE.......ALL OF IT!!!!!!!!!!
So I recklessly shave it off. Heck, I'm numb by now. Nothing hurts. I
could have amputated my own leg at this point.
Next week I'm going to try hair color......
Now that's funny ........ Notttttttttt Send this on to other folks
who need a good laugh! ###
Tuesday, March 21, 2006
Let's Talk !
Conversation is my second favorite way of creating loving, interesting, exciting, heuristic moments in my life and the lives of those i love. Enjoy.
The New York Times
March 20, 2006
Connections
Are We Having a Conversation Yet? An Art Form Evolves
By EDWARD ROTHSTEIN
What is there to talk about?
The question should be taken literally. We can talk about the weather — which means just making casual contact, assuring each other that we are temperate in nature and not about to erupt in torrential outbursts. We can talk about politics — if we can assume certain shared convictions that will prevent other kinds of storms and disruptions. We can talk about family — if we can assume that we take that kind of a personal interest in each other.
But whatever we choose, there's a certain amount of risk involved, a tentative guess made about what should be shared and what should not, what would please the other and what would not. La Rochefoucauld said, "We often forgive those who bore us, but we cannot forgive those who find us boring." That is only the beginning.
Conversation is one of those acts that require subtle forms of social imagination: an ability to listen and interpret and imagine, an attentiveness to someone whose perspective is always essentially different, a responsiveness that both makes oneself known and allows the other to feel known — or else does none of this, but just keeps up appearances. It may be, then, one of the most fundamental political and social acts, indispensable to negotiating allegiances, establishing common ground, clearing tangled paths. Conversation may reflect not just the state of our selves, but the state of society.
O.K. But listen to "talk" radio, with its combative recruitment of allies; or "talk" shows in which guests are promoting themselves or their products and hosts are prepared with leading questions; or "talk" news shows in which conversation becomes a form of shouting. Look at our isolating iPods, at text messaging with its prepackaged formulas, or instant messaging with its iconic smilies, so necessary to make sure the telegraphic prose is not misunderstood. CUL8R.
This state of affairs helped inspire Stephen Miller's new book, "Conversation: A History of a Declining Art" (Yale, $27.50). Mr. Miller, who is a contributing editor to The Wilson Quarterly, finds countertrends, as well — Internet communities that lead to new forms of conversation, diverse gatherings in which disagreements become an expected aspect of conversation. But, he writes, the "forces sapping conversation seem stronger than the forces nourishing it." So Mr. Miller, in response, is recounting another kind of conversation that has taken place over the centuries, one whose subject is conversation itself.
Cicero gave advice about conversation (It ought "to be gentle and without a trace of intransigence; it should also be witty"). Montaigne hailed its pleasures ("I find the practice of it the most delightful activity in our lives"). Henry Fielding praised it ("This grand Business of our Lives, the Foundation of every Thing, either useful or pleasant"). Adam Smith prescribed it (calling it one of "the most powerful remedies for restoring the mind to its tranquillity").
There were also those who opposed it, or at least strongly declared other preferences. Rousseau sneered at the chatter in French salons. Wordsworth preferred nature and solitude. The writers of Romanticism shifted the emphasis, preferring to share feelings and perceptions rather than honor conversation for its own sake. Conversation became confessional — which in many ways, it still is. "Modern writers," Mr. Miller suggests, "tend to dwell on the emotional rewards that come from conversation."
In fact, in Mr. Miller's account, the United States may have played an important role in the evolution of the mode of non-conversation now developing. During the 19th century many European writers scorned American conversation, perhaps too much, Mr. Miller suggests, accusing it of excessive focus on money and commerce. There may have also been an American suspicion of conversation altogether: Thoreau couldn't be bothered with it, and Melville was wary.
Mr. Miller points out that in the 20th century, literary figures were also admired for being laconic. Was this an extension of early Romantic early suspicions? A democratic rebellion against the artifice and artfulness of 18th-century conversation? Did it even lead, perhaps, to the self-absorbed focus on self-fulfillment and self-expression that have, in Mr. Miller's view, extended from the years of the counterculture into the present?
Like a well-mannered host, Mr. Miller presents some hypotheses, but also leads the conversation along. For him, the powers and possibilities of conversation were most clearly revealed in the 18th century. Samuel Johnson praised the two key journals of the age, The Spectator and The Tattler; they were being published at a time, he said, "when two parties, loud, restless, and violent, each with plausible declarations, and each perhaps without any distinct termination of its views, were agitating the nation."
The journals, Johnson said, "adjusted" conversation with their "propriety and politeness." That character also helped define London coffeehouses, in which political debate and conversation between varied classes took place. Andrew Marvell wrote: "It is wine and strong drinks make tumults increase/ Choc'late, tea, and coffee are liquors of peace."
But Hume may be the patron saint of conversation here, for though he noted that politeness "runs often into affectation and foppery, disguise and insincerity," he also saw a necessary connection between politeness and freedom. Hume suggested that politeness was not, in fact, "natural to the human mind," but "presumption and arrogance" were. Society depends on artifice. Conversation is an art.
As Mr. Miller suggests, American conversation now prides itself on angry authenticity or on being kind and "nonjudgmental"; it is meant to be "natural" and full of "self-expression." This does not make for great conversation or a vital political life.
Hume, in contrast, welcomed the necessary artifice of manners, through which, he argued, "a mutual deference is affected; contempt of others disguised; authority concealed; attention given to each in his turn; and an easy stream of conversation maintained, without vehemence, without interruption, without eagerness for victory, and without any airs of superiority."
It is an ideal worth talking about.
Connections, a critic's perspective on arts and ideas, appears every other Monday.
###
The New York Times
March 20, 2006
Connections
Are We Having a Conversation Yet? An Art Form Evolves
By EDWARD ROTHSTEIN
What is there to talk about?
The question should be taken literally. We can talk about the weather — which means just making casual contact, assuring each other that we are temperate in nature and not about to erupt in torrential outbursts. We can talk about politics — if we can assume certain shared convictions that will prevent other kinds of storms and disruptions. We can talk about family — if we can assume that we take that kind of a personal interest in each other.
But whatever we choose, there's a certain amount of risk involved, a tentative guess made about what should be shared and what should not, what would please the other and what would not. La Rochefoucauld said, "We often forgive those who bore us, but we cannot forgive those who find us boring." That is only the beginning.
Conversation is one of those acts that require subtle forms of social imagination: an ability to listen and interpret and imagine, an attentiveness to someone whose perspective is always essentially different, a responsiveness that both makes oneself known and allows the other to feel known — or else does none of this, but just keeps up appearances. It may be, then, one of the most fundamental political and social acts, indispensable to negotiating allegiances, establishing common ground, clearing tangled paths. Conversation may reflect not just the state of our selves, but the state of society.
O.K. But listen to "talk" radio, with its combative recruitment of allies; or "talk" shows in which guests are promoting themselves or their products and hosts are prepared with leading questions; or "talk" news shows in which conversation becomes a form of shouting. Look at our isolating iPods, at text messaging with its prepackaged formulas, or instant messaging with its iconic smilies, so necessary to make sure the telegraphic prose is not misunderstood. CUL8R.
This state of affairs helped inspire Stephen Miller's new book, "Conversation: A History of a Declining Art" (Yale, $27.50). Mr. Miller, who is a contributing editor to The Wilson Quarterly, finds countertrends, as well — Internet communities that lead to new forms of conversation, diverse gatherings in which disagreements become an expected aspect of conversation. But, he writes, the "forces sapping conversation seem stronger than the forces nourishing it." So Mr. Miller, in response, is recounting another kind of conversation that has taken place over the centuries, one whose subject is conversation itself.
Cicero gave advice about conversation (It ought "to be gentle and without a trace of intransigence; it should also be witty"). Montaigne hailed its pleasures ("I find the practice of it the most delightful activity in our lives"). Henry Fielding praised it ("This grand Business of our Lives, the Foundation of every Thing, either useful or pleasant"). Adam Smith prescribed it (calling it one of "the most powerful remedies for restoring the mind to its tranquillity").
There were also those who opposed it, or at least strongly declared other preferences. Rousseau sneered at the chatter in French salons. Wordsworth preferred nature and solitude. The writers of Romanticism shifted the emphasis, preferring to share feelings and perceptions rather than honor conversation for its own sake. Conversation became confessional — which in many ways, it still is. "Modern writers," Mr. Miller suggests, "tend to dwell on the emotional rewards that come from conversation."
In fact, in Mr. Miller's account, the United States may have played an important role in the evolution of the mode of non-conversation now developing. During the 19th century many European writers scorned American conversation, perhaps too much, Mr. Miller suggests, accusing it of excessive focus on money and commerce. There may have also been an American suspicion of conversation altogether: Thoreau couldn't be bothered with it, and Melville was wary.
Mr. Miller points out that in the 20th century, literary figures were also admired for being laconic. Was this an extension of early Romantic early suspicions? A democratic rebellion against the artifice and artfulness of 18th-century conversation? Did it even lead, perhaps, to the self-absorbed focus on self-fulfillment and self-expression that have, in Mr. Miller's view, extended from the years of the counterculture into the present?
Like a well-mannered host, Mr. Miller presents some hypotheses, but also leads the conversation along. For him, the powers and possibilities of conversation were most clearly revealed in the 18th century. Samuel Johnson praised the two key journals of the age, The Spectator and The Tattler; they were being published at a time, he said, "when two parties, loud, restless, and violent, each with plausible declarations, and each perhaps without any distinct termination of its views, were agitating the nation."
The journals, Johnson said, "adjusted" conversation with their "propriety and politeness." That character also helped define London coffeehouses, in which political debate and conversation between varied classes took place. Andrew Marvell wrote: "It is wine and strong drinks make tumults increase/ Choc'late, tea, and coffee are liquors of peace."
But Hume may be the patron saint of conversation here, for though he noted that politeness "runs often into affectation and foppery, disguise and insincerity," he also saw a necessary connection between politeness and freedom. Hume suggested that politeness was not, in fact, "natural to the human mind," but "presumption and arrogance" were. Society depends on artifice. Conversation is an art.
As Mr. Miller suggests, American conversation now prides itself on angry authenticity or on being kind and "nonjudgmental"; it is meant to be "natural" and full of "self-expression." This does not make for great conversation or a vital political life.
Hume, in contrast, welcomed the necessary artifice of manners, through which, he argued, "a mutual deference is affected; contempt of others disguised; authority concealed; attention given to each in his turn; and an easy stream of conversation maintained, without vehemence, without interruption, without eagerness for victory, and without any airs of superiority."
It is an ideal worth talking about.
Connections, a critic's perspective on arts and ideas, appears every other Monday.
###
Sunday, March 19, 2006
POP access
Readers who know me - understand instantly how important this article is to me - it strikes at the very center of my soul and heart and mind and body right now. CP is 11. The "Classic Childhood" portion (literacy to puberty) of his life is just about over. I am hoping - after his mother reads this - that she will permit more contact. Pray for us. Enjoy.
The New York Times
March 19, 2006
Weekends With Dad, Courtesy of D.S.L.
By LYNETTE CLEMETSON
WITH work and the school week behind them, Charles A. Mason III and his daughter, Arielle, who live more than 1,500 miles apart, prepared for their scheduled weekend visit. There was no packing involved, no plane tickets, no car rides or drop-offs. All it took was some instant messaging on their home computers and a little fidgeting in front of their respective Webcams, and father and daughter were chatting, playing checkers and practicing multiplication tables.
"It's funner than talking on the phone, because I can see him," said Arielle, 10, who lives with her mother in Longmont, Colo., but has regular "virtual visits" with her father as part of the custody arrangement her parents worked out after her mother moved eight years ago. "It's just like being in front of him, but with games and computer stuff added."
As for Mr. Mason, who lives in Warrenton, Va., the video chats are a vast improvement over telephone calls, during which his daughter — like many children her age — is often monosyllabic and easily distracted.
"I can barely hold her attention on the phone for five minutes," he said. "When we can play checkers and look at one another, I can keep her talking about school and life for an hour or more."
As divorce has remained a constant, custody arrangements have evolved over the last half-century. Increased awareness of the toll divorce can take on children and fathers' increased involvement as parents, combined with the demands of working parents who often have to move in order to get and keep jobs, have made for increasingly creative and sometimes complex custody agreements.
As the legal system begins to acknowledge the potential benefits of technology in bridging the physical and emotional distance caused by divorce and separation, more families are experimenting with computer-assisted custody sharing.
Although any separating couple can opt for virtual visits in their custody agreement, debate surrounding the issue is unfolding on the state level as advocates push to have the option spelled out in state laws in order to broaden awareness of the practice and enable judges to grant such visits where they see fit.
In January the Wisconsin Legislature passed a measure allowing judges to grant virtual visits in custody agreements. If Gov. James E. Doyle signs the bill, Wisconsin will become the second state officially to allow such visits, following Utah, which entered virtual visits into its state code in 2004.
Efforts to push similar legislation are in various stages in several states, including Virginia, Illinois, Missouri, Florida, California and New York.
But not everyone gives virtual visits a ringing endorsement. In addition to concerns that it may be used to limit in-person visits, some lawyers and noncustodial parents also worry that it may be used to bolster the case for a custodial parent's contested relocation.
In 2001 an appeals court in New Jersey overruled a lower court decision denying a custodial parent's request to move out of state, reasoning that the court did not consider computer-assisted visits as an option for the noncustodial parent who objected to the move.
A Massachusetts court ordered video visits in 2002 in another contested relocation dispute. The father in the case, who argued that video visits were being imposed to replace in-person visits with his children, lost his appeal to stop the move.
"The danger is that it will become a substitute for real time," said David L. Levy, chief executive of the Children's Rights Council, based in Hyattsville, Md., which advocates for children affected by divorce and separation. "Virtual time is not real time. You can't virtually hug your child or walk your child to school. We don't want this to be seen as an excuse to encourage move-aways."
The Utah and Wisconsin regulations specify that virtual visits should be used as a supplement to, not a substitute for, traditional visits. The Wisconsin bill also specifies that virtual visits should not be used to justify a custodial parent's relocation. The laws define "electronic communication" as contact by video conference, e-mail, instant message, telephone or other wired or wireless technology.
"I think that most judges understand that children require physical one-on-one contact with the absent parent," said Cheryl Lynn Hepfer, president of the American Academy of Matrimonial Lawyers.
Mr. Mason, who sees Arielle in person over spring and summer breaks and alternating holidays, said virtual chats allow him to maintain a comfortable rapport with his daughter between visits. At one point during a recent call, Arielle repositioned the camera toward her piano keyboard and played him a few songs she had learned.
"I have always wanted to attend my daughter's recitals," said Mr. Mason, 42, a director of information systems for the Wolf Trap Foundation for the Performing Arts. "And here it was, Sunday afternoon, and I was getting a private recital just for me. It makes me feel closer, like I have some input."
Some parents fear that incorporating a Webcam into their children's computer activities will make them vulnerable to online predators. Those who allow virtual visits say the equipment involved requires the same parental supervision as any other technology in the home.
Vada Dreisbach, Arielle's mother, said she maintains control of the Webcam and the passwords for logging on to the necessary computer programs. She also has the computer set up so that Arielle can receive instant messages from only her father. She logs her daughter on and off before and after each visit.
"It's a very isolated connection," said Ms. Dreisbach, 43, a meteorological systems engineer. "There is a lot of coordination involved, but the more comfortable a person is with the technology, the less scary it is."
Despite the demand for long-distance custody arrangements, those who support virtual visitations say it is an option that is still relatively unknown. Some lawmakers and lawyers said legislation is needed, if only to raise awareness among lawyers.
"Lawyers and judges tend to be behind the technology curve," said Brian M. Hirsch, a family lawyer in Reston, Va., who represented Mr. Mason in his custody case. "We tend to look at something new and immediately think, 'How can this be abused?' And the judges I have asked to do this have had a very negative reaction to it."
Judge James C. Hallock, an associate judge in Kane County, Ill., who supports virtual visit legislation, said many judges need the parameters of such measures spelled out for them. "Some judges my generation and older never even turn on a computer," he said. "That makes it difficult to understand how this could be a good supplement to a relationship."
State Senator Jay O'Brien of Virginia said he introduced virtual visiting legislation this year after witnessing a divorced relative's difficulty with trying to see his children. His bill failed to pass Virginia's Senate Courts of Justice Committee, which decided that since there was nothing expressly barring virtual visits, there was no need to permit it officially.
Senator O'Brien said he plans to work on the language of his bill and reintroduce it. "In my own life I have seen a family member struggle with this, and if his requests weren't specifically permitted by the code, it was not going to be granted in his case," he said. "I think it is necessary to inform courts and attorneys to ask for this where it is appropriate."
John M. Speer, a financial consultant in Palm Valley, Tex., says he could benefit from state involvement. Though technically permitted by the terms of his custody agreement to visit with his three children every other weekend, such visits have become financially prohibitive since he moved from the Chicago area, where his children live, to Texas in 2001.
"Flying all three children here so often, or flying myself there and paying for a hotel, as much as I want to, I just can't do that all that often," Mr. Speer said. "Having another way to see one another and communicate would prevent the distance from growing between us during the months we're apart."
Because his ex-wife, he said, has yet to approve his requests for Web visits, having the option of such visits written into Illinois statute would allow a judge to approve the visits over her objections.
Michael Gough, who successfully lobbied for the Utah provision after his ex-wife and daughter, who was 4 at the time, moved to Wisconsin in 2003 and led the advocacy effort for the Wisconsin legislation, is working with lawyers and noncustodial parents around the country to push for similar legislation in other states.
Mr. Gough, a computer security consultant, runs a Web site called www.internetvisitation.org, which tracks legislation, offers divorce resources and gives user testimonials. He also runs a how-to site called www.videocalltips.com that walks users through the mechanics of video conferencing and rates software and Webcams.
Still, some families have found virtual visits more hassle than they're worth. When Alex Tomaszczuk moved to California in 2004, he bought a Webcam for himself and one for his ex-wife and children, who remained in Virginia. The image on the screen broke up if the kids moved around too much, and coordinating visits around the three children's busy schedules proved difficult.
"In some respects it's just easier to pick up the cellphone when I'm on the freeway and talk to them for 45 minutes," said Mr. Tomaszczuk, 50, a government contracts litigator who still works from Virginia part time and sees his children in person at least twice a month.
Jim Buie and his son Matthew struggled with myriad technical problems when they began experimenting with video visits in 1999. Matthew, then in high school, was living with his mother in North Carolina, and Mr. Buie was living in Maryland. But as the technology improved, Web visits became a cherished link between father and son, and they continue them, even though Matthew is now 22.
Matthew, who directs audio systems for a cruise line, took a break in a cafe in Aruba during a recent Caribbean cruise to check in with his dad via Webcam.
The two chatted about Matthew's forthcoming cruise schedule and joked about the bold Caribbean shirt he was wearing. Mr. Buie remarked that he still had not met his son's new girlfriend and asked him to bring her along for an introduction on their next virtual visit.
"This way of communicating has become something special that we share," said Mr. Buie, 51. "Of course it's not as good as seeing him in person. But at least I can see him. It has kept us close."
###
The New York Times
March 19, 2006
Weekends With Dad, Courtesy of D.S.L.
By LYNETTE CLEMETSON
WITH work and the school week behind them, Charles A. Mason III and his daughter, Arielle, who live more than 1,500 miles apart, prepared for their scheduled weekend visit. There was no packing involved, no plane tickets, no car rides or drop-offs. All it took was some instant messaging on their home computers and a little fidgeting in front of their respective Webcams, and father and daughter were chatting, playing checkers and practicing multiplication tables.
"It's funner than talking on the phone, because I can see him," said Arielle, 10, who lives with her mother in Longmont, Colo., but has regular "virtual visits" with her father as part of the custody arrangement her parents worked out after her mother moved eight years ago. "It's just like being in front of him, but with games and computer stuff added."
As for Mr. Mason, who lives in Warrenton, Va., the video chats are a vast improvement over telephone calls, during which his daughter — like many children her age — is often monosyllabic and easily distracted.
"I can barely hold her attention on the phone for five minutes," he said. "When we can play checkers and look at one another, I can keep her talking about school and life for an hour or more."
As divorce has remained a constant, custody arrangements have evolved over the last half-century. Increased awareness of the toll divorce can take on children and fathers' increased involvement as parents, combined with the demands of working parents who often have to move in order to get and keep jobs, have made for increasingly creative and sometimes complex custody agreements.
As the legal system begins to acknowledge the potential benefits of technology in bridging the physical and emotional distance caused by divorce and separation, more families are experimenting with computer-assisted custody sharing.
Although any separating couple can opt for virtual visits in their custody agreement, debate surrounding the issue is unfolding on the state level as advocates push to have the option spelled out in state laws in order to broaden awareness of the practice and enable judges to grant such visits where they see fit.
In January the Wisconsin Legislature passed a measure allowing judges to grant virtual visits in custody agreements. If Gov. James E. Doyle signs the bill, Wisconsin will become the second state officially to allow such visits, following Utah, which entered virtual visits into its state code in 2004.
Efforts to push similar legislation are in various stages in several states, including Virginia, Illinois, Missouri, Florida, California and New York.
But not everyone gives virtual visits a ringing endorsement. In addition to concerns that it may be used to limit in-person visits, some lawyers and noncustodial parents also worry that it may be used to bolster the case for a custodial parent's contested relocation.
In 2001 an appeals court in New Jersey overruled a lower court decision denying a custodial parent's request to move out of state, reasoning that the court did not consider computer-assisted visits as an option for the noncustodial parent who objected to the move.
A Massachusetts court ordered video visits in 2002 in another contested relocation dispute. The father in the case, who argued that video visits were being imposed to replace in-person visits with his children, lost his appeal to stop the move.
"The danger is that it will become a substitute for real time," said David L. Levy, chief executive of the Children's Rights Council, based in Hyattsville, Md., which advocates for children affected by divorce and separation. "Virtual time is not real time. You can't virtually hug your child or walk your child to school. We don't want this to be seen as an excuse to encourage move-aways."
The Utah and Wisconsin regulations specify that virtual visits should be used as a supplement to, not a substitute for, traditional visits. The Wisconsin bill also specifies that virtual visits should not be used to justify a custodial parent's relocation. The laws define "electronic communication" as contact by video conference, e-mail, instant message, telephone or other wired or wireless technology.
"I think that most judges understand that children require physical one-on-one contact with the absent parent," said Cheryl Lynn Hepfer, president of the American Academy of Matrimonial Lawyers.
Mr. Mason, who sees Arielle in person over spring and summer breaks and alternating holidays, said virtual chats allow him to maintain a comfortable rapport with his daughter between visits. At one point during a recent call, Arielle repositioned the camera toward her piano keyboard and played him a few songs she had learned.
"I have always wanted to attend my daughter's recitals," said Mr. Mason, 42, a director of information systems for the Wolf Trap Foundation for the Performing Arts. "And here it was, Sunday afternoon, and I was getting a private recital just for me. It makes me feel closer, like I have some input."
Some parents fear that incorporating a Webcam into their children's computer activities will make them vulnerable to online predators. Those who allow virtual visits say the equipment involved requires the same parental supervision as any other technology in the home.
Vada Dreisbach, Arielle's mother, said she maintains control of the Webcam and the passwords for logging on to the necessary computer programs. She also has the computer set up so that Arielle can receive instant messages from only her father. She logs her daughter on and off before and after each visit.
"It's a very isolated connection," said Ms. Dreisbach, 43, a meteorological systems engineer. "There is a lot of coordination involved, but the more comfortable a person is with the technology, the less scary it is."
Despite the demand for long-distance custody arrangements, those who support virtual visitations say it is an option that is still relatively unknown. Some lawmakers and lawyers said legislation is needed, if only to raise awareness among lawyers.
"Lawyers and judges tend to be behind the technology curve," said Brian M. Hirsch, a family lawyer in Reston, Va., who represented Mr. Mason in his custody case. "We tend to look at something new and immediately think, 'How can this be abused?' And the judges I have asked to do this have had a very negative reaction to it."
Judge James C. Hallock, an associate judge in Kane County, Ill., who supports virtual visit legislation, said many judges need the parameters of such measures spelled out for them. "Some judges my generation and older never even turn on a computer," he said. "That makes it difficult to understand how this could be a good supplement to a relationship."
State Senator Jay O'Brien of Virginia said he introduced virtual visiting legislation this year after witnessing a divorced relative's difficulty with trying to see his children. His bill failed to pass Virginia's Senate Courts of Justice Committee, which decided that since there was nothing expressly barring virtual visits, there was no need to permit it officially.
Senator O'Brien said he plans to work on the language of his bill and reintroduce it. "In my own life I have seen a family member struggle with this, and if his requests weren't specifically permitted by the code, it was not going to be granted in his case," he said. "I think it is necessary to inform courts and attorneys to ask for this where it is appropriate."
John M. Speer, a financial consultant in Palm Valley, Tex., says he could benefit from state involvement. Though technically permitted by the terms of his custody agreement to visit with his three children every other weekend, such visits have become financially prohibitive since he moved from the Chicago area, where his children live, to Texas in 2001.
"Flying all three children here so often, or flying myself there and paying for a hotel, as much as I want to, I just can't do that all that often," Mr. Speer said. "Having another way to see one another and communicate would prevent the distance from growing between us during the months we're apart."
Because his ex-wife, he said, has yet to approve his requests for Web visits, having the option of such visits written into Illinois statute would allow a judge to approve the visits over her objections.
Michael Gough, who successfully lobbied for the Utah provision after his ex-wife and daughter, who was 4 at the time, moved to Wisconsin in 2003 and led the advocacy effort for the Wisconsin legislation, is working with lawyers and noncustodial parents around the country to push for similar legislation in other states.
Mr. Gough, a computer security consultant, runs a Web site called www.internetvisitation.org, which tracks legislation, offers divorce resources and gives user testimonials. He also runs a how-to site called www.videocalltips.com that walks users through the mechanics of video conferencing and rates software and Webcams.
Still, some families have found virtual visits more hassle than they're worth. When Alex Tomaszczuk moved to California in 2004, he bought a Webcam for himself and one for his ex-wife and children, who remained in Virginia. The image on the screen broke up if the kids moved around too much, and coordinating visits around the three children's busy schedules proved difficult.
"In some respects it's just easier to pick up the cellphone when I'm on the freeway and talk to them for 45 minutes," said Mr. Tomaszczuk, 50, a government contracts litigator who still works from Virginia part time and sees his children in person at least twice a month.
Jim Buie and his son Matthew struggled with myriad technical problems when they began experimenting with video visits in 1999. Matthew, then in high school, was living with his mother in North Carolina, and Mr. Buie was living in Maryland. But as the technology improved, Web visits became a cherished link between father and son, and they continue them, even though Matthew is now 22.
Matthew, who directs audio systems for a cruise line, took a break in a cafe in Aruba during a recent Caribbean cruise to check in with his dad via Webcam.
The two chatted about Matthew's forthcoming cruise schedule and joked about the bold Caribbean shirt he was wearing. Mr. Buie remarked that he still had not met his son's new girlfriend and asked him to bring her along for an introduction on their next virtual visit.
"This way of communicating has become something special that we share," said Mr. Buie, 51. "Of course it's not as good as seeing him in person. But at least I can see him. It has kept us close."
###
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