REALHEALTH YOUR GUIDE TO BLACK WELLNESS
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FERTILITY OPTIONS
Fox News Anchor
Arthel Neville Shares Her Poignant Story
What You Should Know About The Paleo Diet Stopping, Coping With And Recovering From Burnout
Childhood Cancer Survivors
How To Steer Clear Of Pet-Related Infections
CONTENTS this month on REALHEALTHMAG.COM When Olympic gold medalist Jackie JoynerKersee suffered embarrassing side effects from opioid therapy for pain, she went public about the stigma.
Health Basics A—Z
Want to lose weight, exercise smart, eat right, find good health care, sleep better or just get healthy? For tips, click on “Health Basics A–Z” on the realhealthmag.com home page.
Bad Meds For Kids
Recent reports show many doctors treat children who suffer from ADHD, a common behavorial disorder, with scary, heavy-duty antipsychotic drugs.
Eldercare Questions Senior care expert Derrick Y. McDaniel offers tips on what you need to know if at some point you have to care for your aging loved ones.
Digital Real Health
Read Real Health magazine online exactly as it appears in print. Go to realhealthmag.com/ digital to view the current issue and the entire Smart + Strong digital library.
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editor’s letter
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buzz
family planning
News anchor Arthel Neville tried for five years to have a baby, but uterine fibroids made her unable to carry a child. That’s when she decided to hire a surrogate.
Black women and HIV; curing the virus; HIV’s aging effects; hazards on the job; hep C and pregnancy; pet smarts
nutrition
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fitness
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Hospitals become big business
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caveman cuisine
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childhood survivors
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thoughts
Eat food for nutrients; energy bars; drinks that hurt teeth
Best meals to fuel your workout; the guidelines for pregnant women who want to keep working out
sex
How to talk about your sexual health issues with your doc; Ask Doctor Dee: What to do if your boyfriend keeps borrowing money but never pays you back
Today, Paleo diets stress lean proteins, fruits and veggies, and healthy fats—and other foods too. Plus: a recipe for a scrumptious Paleo sweet treat
Kenny Thomas was 8 years old when he was diagnosed with stage III non-Hodgkin lymphoma.
When burnout stops you in your tracks, here’s how to get yourself moving again
Real Health Question of the Month
When you hear what people think about HIV, what stands out in your mind? Sometimes people think of HIV as its own entity, but living with the virus is connected to your overall health. All my doctors know what meds and supplements I take in general, not just for my HIV.
—Maria Davis, HIV/AIDS activist
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A Champ Speaks Up
EDITOR’S LETTER
REAL HEALTH
Hospitals Are a Booming Business
R
ecently, my sister had the misfortune of suddenly becoming ill shortly after midnight. Huge boils broke out on her face, one on her forehead and the other underneath her left eye. She was reluctant to go to the emergency room, but my brother and I were alarmed and convinced her not to delay. After she got dressed, I drove her to the hospital. Fortunately, we live close to a lauded medical institution that’s a Level II emergency trauma center rated very highly by U.S News and World Report in its Best Hospitals rankings. When we arrived at the building, I dropped her off near the entrance to the emergency room. Before my sister reached the sliding doors, we saw at least four ambulances from nearby towns pull into parking spaces directly in front of the ER. As I pulled away from the curb to go find street parking close by, I wondered why ambulances from these neighboring towns were bringing patients to this hospital’s emergency room. Was this now the closest medical facility for these towns? And what happened to all the hospitals that used to serve these other cities? Well, the answer to that question is two words: mergers and acquisitions. Many of the hospitals where I live have been acquired by the top-rated medical center where I took my sister. It seems
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Here’s to your health, JOAN LOBIS BROWN
Issue No. 43. Copyright © 2015 CDM Publishing LLC. All rights reserved. No part of this publication may be reproduced, stored in any retrieval system or transmitted, in any form by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior written permission of the publisher. If you are an individual or organization and would like to subscribe to Real Health, go to real healthmag.com or call 800.973.2376. Send feedback on this issue to info@ realhealthmag.com or Real Health, c/o Smart + Strong, 462 Seventh Ave., 19th Floor, New York, NY 10018. Smart + Strong® is a registered trademark of CDM Publishing, LLC.
hospitals are big business these days, and many have been rapidly consolidating. Indeed, the current trend is for hospitals to expand. In New Jersey, the merger between Hackensack University Health Network and Meridian Health just created one of the largest hospital systems in the state. Is there a reason for concern? As you might guess, experts on both sides of the issue have been vocal. Those who believe this trend is positive say that a larger company—notice I said “company” as opposed to “hospital”— could operate more efficiently because of its size and ability to provide patients with better access to specialists and advanced medical technologies. But other experts ask what these improved services will cost patients. They warn that when individual hospitals merge into larger systems, the leverage the medical system acquires to demand that health insurance companies pay more for medical procedures can drive up health care costs and put more financial pressure on consumers. If the trend continues, medical systems can become huge monopolies. And if I remember correctly from history class, monopolies are rarely a good thing. This is because when businesses lack competition, the quality of the services they provide often deteriorates. Meanwhile, back at the ER, sick patients sat in the receiving area waiting to be called. As the procession of emergency medical technicians from all these different towns filed past, one woman muttered that everyone better order pizza and get ready to pull out their sleeping bags. She made a face, shook her head, rolled her eyes and said, “We’re going to be here all night. Watch!” Fortunately, her prediction didn’t come true. After four hours, a doctor diagnosed my sister with an allergic reaction to a bug bite, handed her a prescription and we left the hospital to go home.
Kate Ferguson, Editor-in-Chief katef@realhealthmag.com realhealthmag.com
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BUZZ
Cautiously Optimistic HIV stigma is still present, but more black women are sharing their stories.
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wenty years ago, when Maria Davis was diagnosed with HIV, some in the black community called the disease “The Monster.” Today, there are still many colorful phrases for HIV, which continues to disproportionately affect African-American women. Higher percentages of black women are living with HIV and they are more likely to be at risk compared with Latina and white women. Davis became an HIV activist and is currently a spokesperson for the I Design (ProjectIDesign.com) campaign. The national HIV education effort was launched by Merck, a pharmaceutical company, to encourage folks living with HIV to communicate candidly with their health care teams. “That’s why I think it’s important to talk about HIV,” Davis says. “That’s why I’m always standing on the corner with my bullhorn educating anyone who will listen about HIV.” Davis remains concerned because too many black women and girls don’t think it’s important to know their HIV
status. What’s more, Davis is surprised by how many people retain dangerous misconceptions about the virus. “I was recently asked if HIV is spread through saliva, or if someone can get HIV by using a bathroom after someone with HIV has used it,” she says. (Note: HIV is not transmitted these ways.) In general, women are still most likely to be infected with HIV through heterosexual sex. What’s more, black women and Latinas are more likely to contract HIV through heterosexual transmission than white women. These statisFor many women, tics are some reasons there’s too why Davis stresses that much left women need to know unsaid about HIV. their HIV status as well as that of their partner. “Everyone has an HIV status—positive or negative—but a lot of women I talk to don’t feel comfortable having that conversation with their partner, whether they just started dating or are in a committed relationship, because they think it will bring up trust issues,” she says.
“Sixteen years ago, I started receiving phone calls from scared women who had just found out they were HIV positive,” says Melissa Grove, MS, the executive director of the Legacy Counseling Center in Dallas. Grove designed a program for these women called the Grace Project that evolved into an annual gathering for women living with HIV. Grove says numbers mean power. “If people don’t know that growing numbers of women are living with HIV, then this issue will not get the attention or funding it deserves,” she says. Meanwhile, Davis, who lives in New York City, continues to spread awareness about the virus. Davis organizes a monthly showcase of artists, “Mad Wednesdays,” in Harlem where she shares her story about living with HIV. “After a speaking event, people will come up to me and share their stories,” she says. “But they whisper when they mention that they have HIV because of the stigma.” Davis longs for the day when no one living with HIV fears to speak up. realhealthmag.com
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BUZZ
HOLDING BACK THE YEARS ARV therapy and HIV-caused aging
No cure for the virus until sneaky HIV hiding in the body is killed Although antiretroviral (ARV) drugs are currently the gold standard for treating HIV, these potent meds only stop the virus from replicating. ARVs can’t get rid of lingering reservoirs of HIV that hide out and mutate in the body. To cure people, you have to get rid of the latent, nonreplicating form of the virus, says Robert Siliciano, PhD, a professor of medicine, molecular biology and genetics at Johns Hopkins University School of Medicine. “The current strategy is called ‘shock and kill.’ The idea is to, with drugs, try and turn on the virus again and then have the immune system kill the infected cells with killer T cells, which are an important part of the defense against
THE NUMBER OF PEOPLE IN THE UNITED STATES LIVING WITH HIV. Source: Centers for Disease Control and Prevention
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viral infection.” But the virus evolves very quickly and can change key parts of its structure to avoid recognition by the immune system. The hidden reservoirs are filled with these mutated versions of the virus that have escaped the notice of the immune system. This means scientists must also figure out a way to activate killer T cells, a type of white blood cell that finds and destroys cells infected by HIV, to spot tiny unaltered segments of the mutated virus. This might allow the killer T cells to “kill the entire HIV-infected cell,” says Kai Deng, PhD, a postdoctoral research fellow at Johns Hopkins who is studying this problem. Siliciano says now that researchers know what the problem is they are developing strategies to solve it. They hope to activate killer T cells that can focus on parts of the virus that didn’t mutate. “There are proof-of-concept types of studies that can be done in the next two or three years to test this strategy,” Siliciano says. But he also cautions that no one yet knows if the strategy would work, because “you also have to be able to efficiently turn the virus back on,” the second part of a two-step process scientists are currently researching. What’s next for scientists are clinical trials to test these strategies. Some are already underway in Europe.
BOTH IMAGES: THINKSTOCK
Target Practice
Today, people with HIV live longer, healthier lives because they take antiretroviral (ARV) meds. But findings show folks living with the virus are more likely to develop age-related illnesses, such as hypertension, heart disease and impaired kidney function, compared with those who don’t have HIV. What’s more, scientists are looking at the long-term effects—both good and bad—of these life-saving antiretrovirals. At the 20th International AIDS Conference held in Melbourne, Australia, in 2014, researcher Peter Reiss, MD, PhD, a professor of internal medicine at the University of Amsterdam, presented findings that showed certain ARVs stopped cells from dividing and replicating, which caused them to grow old before their time. “We need to keep an open mind that some of the drugs that we are using may affect these mechanisms [of aging],” Reiss says. Reiss and many other scientists agree that the connection between the effects of aging and ARVs needs to be studied further. In the meantime, it’s key that people living with HIV embrace a healthy lifestyle and begin ARV treatment as soon as possible.
BUZZ
CHECK THE CHILDREN Are you a mom-to-be with hep C?
Dying for Work Each year millions get injured or die at or on the way to a job. When you arrive at work each day, chances are the last thing you’re thinking is that you’ll get killed, crippled or maimed on the job. But in 2013, almost 5,000 people in the United States died because of work-related incidents. What’s more, an estimated 50,000 workers died from occupational illnesses, according to the U.S. Bureau of Labor Statistics. The leading cause of work-related deaths involves roadway crashes. But the second leading cause of job fatalities in the United States is workplace violence, including assaults, homicides and suicides. For women, the workplace can be particularly lethal. Workplace homicide was the second leading cause of death on the job among women workers in 2013, according to a report by the AFL-CIO about fatalities in the workplace. The leading occupations of those killed at work were supervisors of sales workers, retail sales workers and motor vehicle operators. In addition, a word of caution for those who work in offices: A day spent in your office space can be filled with a multitude of potential health hazards as well. The Centers for Disease Control and Prevention points to physical hazards that can lead to injury or illness, such as cords laid across walkways, low drawers left open and objects falling from overhead, tasks requiring speed, repetition, endurance and control, environmental hazards, and injuries caused by poorly designed, nonadjustable furniture or equipment.
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Pregnant women with hepatitis C virus (HCV) often wonder what the chances are they’ll transmit this disease to their child. If a woman has hep C, which may damage the liver, the chance she’ll pass the disease to her baby is rare. Still, about 6 out of every 100 infants born to mothers with hepatitis C become infected with the virus, says the Centers for Disease Control and Prevention. (What’s more, the risk becomes greater if the mother has both HIV and hepatitis C.) For women with hep C who aren’t yet pregnant, Camilla S. Graham, MD, MPH, the co-director of the Viral Hepatitis Center in the Division of Infectious Diseases at Beth Israel Deaconess Medical Center, encourages them to “go ahead and get treatment and get cured” before they decide to have a child. Also, if a woman with hep C is already pregnant, doctors won’t start treatment because this might be risky for her unborn child. Any ob/gyn should know how to implement safeguards to reduce the risk of a mom-to-be with hep C transmitting the virus to her baby. But, stresses Graham, “I really try to encourage women to go ahead and get tested and treated before becoming pregnant.”
THE AMOUNT OF MONEY AMERICANS ARE PROJECTED TO SPEND ON THEIR PETS IN 2015 Source: American Pet Products Association
ANIMAL HOUSE RULES Easy ways to prevent pet-related infections Most households in the United States own at least one pet. What’s more, a growing body of research supports the belief that owning a pet offers a bunch of health benefits. But the downside to cozying up to Fido or Fluffy is that pets can also spread infection and cause us to become ill. Pets of all kinds (think turtles, snakes, lizards, ferrets and birds, among others, in addition to cute cats and dogs) can pass on illnesses to their human owners when people come into contact with bacteria that live in their animals’ skin or coat, or that pets excrete in their waste. Unvaccinated domestic animals can transmit rabies if
they are bitten by rabid animals. In addition, pets can also cause illnesses such as cat-scratch disease, parrot fever and toxoplasmosis. But the good news is transmissions are preventable if you follow these simple steps: Wash your hands after touching your pet; bag and dispose of your pet’s waste quickly; avoid scratches and bites, and if you are scratched or bitten, get immediate medical care; and get your pets vaccinated and routinely checked at the vet to prevent them from acquiring infectious diseases in the first place. realhealthmag.com
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NUTRITION
Basics to Recharge Your Batteries Are energy bars overhyped when it comes to health?
Yes, you can get all the nutrients you need from food. Many of us have heard that it’s preferable to get vitamins from food alone and not from supplements. But there is no simple answer. It depends on your diet, say nutritionists at East Jefferson General Hospital’s Wellness Center in Metairie, Louisiana. The center’s menus printed below offer a sample breakfast, lunch, dinner and two snacks that provide an average middle-age adult with the recommended daily allowance of protein, carbs, fats, vitamins and minerals required to sustain a healthy diet. Breakfast: ½ cup bran cereal with raisins, 1 cup fresh blueberries and 2 tablespoons slivered almonds mixed in 1 cup fat-free vanilla yogurt. To drink: 1 cup green tea. Snack: 1 medium banana with 4 walnut halves. To drink: 1 cup skim milk. Lunch: A sandwich with 4 slices low-sodium deli turkey and 1 slice Swiss cheese between 2 slices whole-wheat bread spread with 1 teaspoon Dijon mustard, and a salad of 1 cup baby romaine lettuce with ½ cup raw carrots, ½ cup raw red bell pepper, ¼ of a medium avocado, ½ cup chopped tomatoes and 2 tablespoons light balsamic vinaigrette dressing. To drink: a 16-ounce glass of water with lemon. Snack: 1 ounce of cheddar cheese and 8 thin wheat crackers. To drink: an 8-ounce glass of water. Dinner: 4 ounces broiled halibut, 1 large baked sweet potato topped with 1 tablespoon non-hydrogenated margarine and 1 teaspoon cinnamon, and 1 cup cooked frozen spinach. To drink: a 16-ounce glass of water with lemon.
Smile Smarts
Another reason to stop guzzling sweet beverages
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According to recent findings published in the Journal of Public Health Dentistry, when researchers checked the teeth of almost 4,000 study participants, scientists found 79 percent had pearly whites with worn-away enamel (a.k.a. dental erosion). The culprit? Sugary soft drinks and fruit juices that are highly acidic and cause this kind of damage to teeth. But doctors say solving the problem doesn’t require a dental or dietitian’s degree. Simply reduce how many sodas, carbonated drinks, flavored waters, sports drinks and fruit juices you drink each day. What’s more, there’s always one safe way to quench your thirst and protect your teeth: Drink plain ol’ water.
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MILLION THE NUMBER OF U.S. WOMEN WHO EAT NUTRITION BARS Source: Sports Nutritionals Market in the U.S.: Sports Drinks and Nutrition Bars, June 2013
ALL IMAGES: THINKSTOCK
Everything Meals
No contest, energy bars win handsdown as a convenient, grab-and-go food. But many of these portable treats don’t rate so well as healthy sources of nutrients. Many of them are ppacked with hidden sugars, salt andd fats, and way too many calories are unaccounted for or on their labels. One nutritionist calls energy bars nothing moree than “dead food” that lack nutritional value. Inn response, some experts suggest making your own energy bars from as few as two nutritious ingredients, such ass raw or roasted nuts (do it yourself in ann iron skillet) and pitted, dried medjool dates you pulse in a food processor, press into a pan and chill overnight. The next morning, cut into small squares, wrap in wax paper and store the morsels in a tightly sealed container. But if you must grab one of those prepackaged bars, the rule of thumb when selecting energy bars is to find one that has fewer than 5 grams of fat, 3 to 5 grams of fiber and a calorie count that won’t bust your gut. What’s more, don’t depend on these bars to meet your overall nutritional needs, experts caution. Grab healthy, whole foods, such as an apple, and go!
FITNESS
FUELING UP FOR FITNESS Eat this, not that, before you exercise.
Baby Bumps
Moms-to-be can exercise their fitness options.
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In general, working out is great for a pregnant woman if there are no specific conditions or complications that make exercising off-limits to her. This means if she was previously active, she can continue with low-impact aerobics and appropriate strength training exercises—that is, as long as she has her doctor’s approval and makes proper modifications if needed. When women exercise during their pregnancy they can reduce backaches and fatigue, relieve stress, and build up the stamina they’ll need during labor and delivery. According to health experts, exercise may also prevent them from developing gestational diabetes (diabetes that occurs curs during pregnancy). Additionally, even if you’ve never previously ly exercised, docs generally will OK moms-to-be e beginning an exercise program. Just make sure you discuss it with your doctor beforehand. In general, docs will probably rule out very strenuous activity. But walking and swimmming usually get a nod from your doctor. Finally, the American College of Obstetrics and Gynecology suggests moms-to-be who are free e of any medical issues engage in 30 minutes or more of moderate exercise daily.
Ever wonder what foods to snack on before you work out? According to fitness experts, the first thing you should reach for is water to make sure you’re properly hydrated. Many suggest you drink 16 to 20 ounces of H2O one to two hours before you work out. Experts also suggest you enjoy a meal about 45 minutes to an hour before exercising so your stomach has a chance to digest the food. One go-to combo is a serving-size mix of protein and complex carbohydrates ranging from 100 to 300 calories: Think a small dish of brown rice and 4 ounces of chicken. But the combinations are endless. A meal of the correct kind of leftovers is always a good choice, such as half of a tuna fish sandwich made with wi whole grain bread. Want ssomething sweeter? Try nut butter b on whole-grain toas toast topped with luscious slic sliced bananas. What shouldn’t pass your lip lips? Foods high in fat or fib fiber. They can leave you feel feeling sluggish and may take longer to digest and give you the energy boost you need.
THE PERCENT OF WOMEN OF REPRODUCTIVE AGE WHO ARE EXTREMELY OBESE. Source: Prevalence of Obesity and Trends in the Distribution of Body Mass Index Among U.S. Adults, 1999–2010, JAMA, February 2012
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Got Ink? An estimated 3–5 million Americans are living with hepatitis C. Most don’t know it. Get tested today.
THINKSTOCK
Find out how at hepmag.com.
SEX Ask Doctor Dee Dorothy Horton, PsyD, answers your questions.
What do you do if your boyfriend keeps borrowing money and not paying it back?
Let’s Talk Sex
(DOCTOR AND PATIENT) THINKSTOCK; (HORTON) COURTESY OF DOROTHY HORTON, PSYD
Embarrassed to chat with your doc about your sexual health? No doubt about it, talking about sex with your bedroom partner is tough enough as it is, much less doing so with your doctor during an office visit. But if you’re having sexual health issues, or you just have a question, it’s imperative you speak up. Pamela Wible, MD, a family physician in Eugene, Oregon, theorizes that many doctors and patients are afraid of creating a closer bond. “Intimacy means in-to-me-see,” she writes in her blog. “When doctors fear patients, patients fear doctors. Fear begets fear.” But fears can be overcome, especially if you create a plan of action, according to health care experts. Prepare for your doctor visit by researching your issues and writing down your questions or concerns. Once you’re at the office, tell the intake attendant about the issues you
wish to discuss with the doctor. This advanced notice is an effective way to prepare your doc to listen to what you have to say. Also, don’t be concerned about being judged. In general, doctors have seen and heard it all. Still, if your doc responds to your questions or concerns in a judgmental way or makes you feel uncomfortable for any reason, consider finding another health professional with whom you feel a better rapport. Says Wible, “I’m nonjudgmental and accepting, so patients allow me to see who they really are. That’s healthy. And fun.” But if you’re not interested in having fun at your health care visit, that’s OK too. The idea is just to feel comfortable enough with your doctor to confidently ask for the answers you need to your sexual health questions.
THE PERCENT OF ATLANTAAREA PRIMARY CARE DOCTORS SURVEYED WHO SAID THEY FELT COMFORTABLE TAKING A PATIENT’S SEXUAL HISTORY. Source: Journal of the National Medical Association, Vol. 98, No. 12, December 2006
When you lend money to a loved one, your relationship can quickly get complicated. Frankly, before you began lending money to your man, you should have discussed it. Your question seems to indicate that there is already a pattern in place: He asks, you fork over the cash, and then he doesn’t repay you. In your case, you have a perfect reason to say no mas. At this point, you can either stop making loans to him or give him an ultimatum. For example, you may want to tell him something along these lines: “If you don’t repay me this time, please don’t ever ask me for another loan again.” If you have the money to lend without putting the squeeze on your finances, and you feel up to taking another chance on your boyfriend, then go ahead and lend him the cash. But if he takes you for granted and once again doesn’t repay you, be prepared to follow through on your ultimatum. At this point, realize that the relationship may turn sour. If that’s the case, consider this the writing on the wall. This is when you must be ready to walk away and end things with your boyfriend and his mooching ways.
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MOTHERHOOD BY PROXY Like many women who dream of becoming mothers, Arthel Neville was willing to try almost anything—even if it meant another woman would carry her child. By Kate Ferguson
hen Arthel Neville enters
the room, a lingering fragrance fills the air. It’s the scent of steel magnolias, and it’s only intensified by her clear, direct gaze. Her handshake is warm and firm just before we make our way into a secluded anteroom in an alcove off the bustling lobby of a boutique hotel on Manhattan’s west side. Neville seats herself on an upholstered settee that’s reminiscent of vintage furniture. She’s at ease and ready to share her story of trying for five years without success to conceive a child—an effort that led her to hire a surrogate to carry the child for her. The first inkling Neville had a problem
Neville says she and her husband
tried their best to make their time together as lighthearted as possible. In the beginning, it was fun for them to meet each other in different locations. “But then, when you’re on a clock and it’s, ‘OK, me and you, we’ve got 45 minutes; let’s make it happen,’ and then 2 0 REAL HEALTH FA LL 2 0 15
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you’re off to the airport and so is he, that’s not so much fun.” The process was long and arduous, she admits; worse, it didn’t work. After that, Neville’s doctor moved her onto the next phase, injecting the fertility drugs. “I was giving myself injections in my tummy once a day,” she says. “But that also didn’t work.” At this point, Neville turned to in vitro fertilization (IVF), the procedure doctors usually suggest when fertility drugs fail to get their patients results.
TRENDS SHOW MORE WOMEN ARE WILLING TO HAVE KIDS THROUGH SURROGACY.
Left to right: Ellen Levine, editorial director of Hearst Magazines, Arthel Neville and author Nancy Sharp.
During the IVF process, a doctor injects the prospective mother with hormones so she produces multiple eggs, which are later ripened with a med also administered by injection. At the appropriate time, the doctor removes these eggs from follicles in the ovary with a hollow needle. “I cultivated the eggs and we went through the process of extracting them,” Neville says. Basically, Neville’s eggs were placed in a Petri dish and fertilized with her husband’s sperm. The next step would have been to reinsert the eggs into her uterus. But, once again, fibroids foiled
the plan. “I realized the eggs weren’t going to stick because the fibroids were blocking the place where an egg would implant,” Neville says. Now living in Atlanta, Neville spoke with a friend who had been having difficulty getting pregnant. She’d gotten help from a doctor in Los Angeles. “She conceived at 44,” Neville, who is 52, explains. Neville’s friend told her the doctor had conducted extensive blood testing and found that her thyroid levels were off. “This was something not every doctor checks, from what I understand,” says Neville. “So I went to see this doctor to have blood panel work done.” He drew eight vials of her blood. But the test results offered no additional insights to explain her infertility. Soon after, Neville decided to undergo
a third surgery to remove her fibroids. But she still couldn’t conceive. Fresh out of options, she decided to take the advice of another friend. “She recommended a surrogacy agency in Los Angeles, so we flew out to LA,” she says. Basically, surrogacy is when another woman carries and gives birth to your child for you. “There’s a very extensive process there you have to go through— background checks, psychological testing, you name it—which makes sense,” Neville says. Trends show that women have increasingly turned to assisted reproductive technology (ART) as a solution to difficulties they have conceiving. Surrogacy is a method of ART that fertility experts suggest to women who want children but who face health problems, such as chronic miscarriages, a missing uterus, or conditions that make pregnancy and birth dangerous. It’s also recommended for those who had failed fertility treatments and for same-sex couples who desire to start a family. In general, there are two types of surrogacy: traditional and gestational. Traditional surrogacy uses artificial insemination to introduce semen into the genital tract of the woman who will carry and deliver the baby. A traditional surrogate is the child’s biological mother because it’s her egg that’s fertilized by the father’s sperm. For gestational surrogacy, IVF allows
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came in 1998, when the journalist and TV personality paid a visit to her mom in New Orleans. “That’s when I noticed that my [menstrual] cycle became really aggressive,” she recalls. “I remember being at home in my bathroom, doubled over in pain, to the point that I asked my mom for a Valium.” After a beat, Neville smiles and qualifies her recollection. “Not that my mom has Valium. She doesn’t. But this was painful!” During a visit to the doctor the next day, Neville learned that, like many African-American women, she had uterine fibroids. These noncancerous tumors are composed of smooth muscle cells and fibrous connective tissue, and they grow within the walls of the uterus. As Neville discovered firsthand, fibroids can cause heavy bleeding during a woman’s cycle and can create such intense pain that gynecologists may suggest surgery to remove them. Neville opted to have them removed. “We got them out immediately,” she says. But nearly four years later, the fibroids returned. Neville and her husband, Japanese percussionist Taku Hirano, were trying to start a family, and she couldn’t conceive. The fibroids were lodged “right where the egg would implant,” she says. “That was the problem that was preventing me from getting pregnant.” Next, Neville underwent another surgery and got fibroid treatments. Then she began treatments with fertility drugs. Neville took oral meds to stimulate ovulation and increase her chances of becoming pregnant. “My husband travels extensively for work, and there was a time when we would meet in cities when I knew I was ovulating,” she says. “As romantic as the meetings in cities sounds, it’s stressful because sex is a little more clinical at that point.”
doctors to harvest eggs from the mother and fertilize them with the father’s sperm outside her body. The embryo that forms is then implanted into the uterus of the surrogate, who carries the baby to term. Currently, in the United States, there is no uniform federal legislation governing surrogacy, and laws vary from state to state. What’s more, in many instances the laws are extremely unclear. Guidelines concerning surrogacy from the American Society for Reproductive Medicine caution that surrogacy arrangements are ripe for conflicts and disagreements. That’s why the organization advises folks to always use experienced, licensed surrogacy professionals. “Basically, they put you through the wringer to make sure you’re fit to do this,” Neville says. “The only concern we had was to make sure that we were in the right place, so [if our surrogate changed her mind], she couldn’t turn around and say, ‘I carried this baby; this is my baby.’ We made sure to cover ourselves that way.” (Note: California law supports the legal claims of those who will raise the child after birth in gestational surrogacy arrangements.) After the agency rated Neville and her husband as solid prospective parents, it gave them the OK to move forward in the surrogacy process. The couple looked through a book of potential surrogates to find the right person to carry their child. But the young woman they chose was unavailable. Undeterred, Neville and her husband
found another agency and repeated the process. This time the surrogate they chose was available. But there was still one additional hurdle to clear. “The couple on the other side, on the surrogate end of it, she and her husband have to also go through the process, the same psychological exams,” Neville explains. “Well, her husband didn’t show up for the first psychological exam. That’s when a little bit of a red flag waved in the back of my mind.” Neville’s instinct was dead-on. After she booked another appointment, the surrogate said her husband also couldn’t attend that meeting. Neville switched the appointment again after
talking with her husband, who was “on the other side of the world,” she says. But, once again, there was a problem with the surrogate’s husband. “We were waiting for her husband to get off work to come and he never showed,” Neville says. “And we waited and we waited and we waited.” Finally, after about an hour, the surrogate told Neville that her husband wasn’t coming. “I was done!” Neville exclaims. “I left the doctor’s office and jumped in my car.” Neville stopped home and grabbed her cat. “I got back in my car and just drove from Atlanta back home to New Orleans,” she says. “I was done with this.” Later, she spoke to the surrogate. “She was very upset and apologetic, and then she told me she and her husband were having trouble in their marriage,” Neville says. “It was always there underneath the surface, but this process just exacerbated it.” Neville had negotiated surrogacy for five years. Now her hopes were dashed. She’d been prepared to become close to the surrogate. “I would have been there every time she had a doctor’s appointment, every ultrasound,” she says. “I’d have wanted to make sure she was eating right. Whatever it was going to take, that’s what I expected to do.” Today, Neville views what happened as God’s will. “We were just going to do as much as we could,” she says. “But at some point you realize that God gives you what you need and you’re not to tempt fate. We’d done enough. This was obviously not meant to be.” Despite accepting this fate, every so often Neville finds herself yearning. Once she saw a little girl and her mother in a sushi restaurant in Atlanta. The woman was Japanese and her daughter was biracial, the child of a black father, Neville speculates. “I had to excuse myself from the table because I knew that’s what our little girl would have looked like,” she says. Neville adds that people probably look at her and feel she has everything she’s ever wanted. “No I don’t,” she says with a wistful smile. “But I have what I’m supposed to have, so there you go.” ■
BABY WORRIES? HOW TO TELL IF YOU HAVE AN INFERTILITY PROBLEM Infertility arises when couples repeatedly try but cannot conceive a child. It can happen to men and women and can be caused by a variety of factors. In general, you’re defined as infertile if you’ve been trying to conceive a child for at least one year and are under age 35. If you’re older than 35 and haven’t been able to get pregnant after trying for at least six months, you might also have reason to be concerned about infertility. But doctors also suggest that if you want to become pregnant and you’re older than 30 and have a history of pelvic inflammatory disease, painful periods, miscarriages or irregular menstrual cycles, or your partner has a low sperm count, you should check with your doctor. Often, couples don’t want to admit they may have a problem conceiving. Additionally, when the problem goes unresolved, individuals may be tempted to blame their partner for the difficulties. But the reality is that only a visit to the doctor and testing can uncover what might be causing infertility. Experts suggest that partners accept that having a child will be difficult and remember that they’re both on the same team. In addition, rather than hiding their feelings, it’s key for partners to talk candidly about the frustration and anger the infertility may be causing. At this time, support from family and friends can also help soothe the stresses and strains a couple experiences. This is why it can be helpful to share the news with loved ones who are close to you. Experts suggest you may want to consider joining a support group.
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There’s more to getting the proper nutrients than just eating lean meats and fresh, colorful produce. 2 2 REAL HEALTH WINT E R 2014
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PALEO POINTERS What’s so bad about eating good? By Gerrie E. Summers
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Paleo diets don’t include processed or packaged foods. Instead, you dine on whole foods, lean proteins, fruits and veggies, and healthy fats. But the diet also eliminates a couple of key foods, namely, grains and legumes. Some nutritionists think this eating plan is controversial. But others consider it a basic approach to healthy eating that can help boost the amount of nutrients we get each day. in caves and prepared their meals from fish caught in a nearby stream or a woolly mammoth they hunted in the wild, they might have garnished the meal with a few berries from an uncultivated bush. Back then, meat and plant foods were pretty much the only items on the menu. But, today, if you follow the socalled “caveman diet,” a.k.a. the Paleo diet, your hunt for food would more likely require you to stroll through supermarket aisles trying to figure out what modern foods meet these dietary requirements and qualify to be dropped into your shopping cart. While the Paleo diet isn’t as old as the Paleolithic period (which inspired the food plan and is also the period when man first began to shape tools), this way of eating is nothing new. The diet plan espouses eating foods that Paleolithic man would have hunted, fished for or gathered. It includes meat, fish, shellfish, poultry, eggs, vegetables, roots, fruits, seeds, berries, and healthy fats from raw nuts, avocados, and coconut, olive and fish oils. Absent from the list are heavily processed oils such as canola and soybean, salt, sugar, artificial flavors, colors, sweeteners and preservatives, corn syrup, legumes, all grains and dairy. In addition, Paleo diet devotees don’t drink alcohol, or they’ll only imbibe minimal amounts of spirits as well as caffeine. 2 4 REAL HEALTH FA LL 2 0 15
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This current eating trend was popularized by the book The Paleo Diet by Loren Cordain, PhD. He based it on the premise that we are genetically predisposed to eating the way our ancient ancestors did. Cordain theorized that because of our genes, our bodies aren’t able to metabolize foods that developed as a result of the agricultural revolution.
MANY PALEO DIET EXPERTS SUGGEST FOLKS DON’T TAKE THIS MEAL PLAN TO EXTREMES. But detractors of the Paleo diet attack its principles on two fronts: that modern humans are no longer cave-dwellers, and that health concerns crop up with any fad diet. Also, scientifically speaking, it’s impossible to pinpoint exactly what kind of diet our Paleolithic ancestors followed, and many of the plants and animals
consumed are either extinct or have evolved over time. Today, wild game is not readily available, and most animals we eat are domesticated, bred and farmed for food. In addition, plant foods are also processed. As for our metabolism, humans genetically adapt to eating foods that are readily available in their environments. What ancient man ate would vary by region, environment and customs, just as the Paleo diet itself has been modified through the years. In general, many nutritionists agree that
eating whole foods, lean proteins, fruits, vegetables and healthy fats while avoiding processed foods makes sense. But many of these same experts don’t agree that the unavailability of certain foods during the Paleolithic period, such as dairy products, means these foods aren’t beneficial to our health. Indeed, people can experience nutritional deficiencies when they eliminate whole groups of food from their diets. What’s more, besides robbing us of necessary nutrients, this restrictive way of eating can be difficult to maintain. Besides their concern about the Paleo diet excluding entire food groups, nutritionists also find fault with this food plan for its emphasis on eating meat. Critics say this way of eating can result in high cholesterol levels, heart disease and cancer.
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“In general, there are numerous pros and cons to consuming meat,” says Emily Dionne, a registered dietitian and co-author of The Spicy Paleo Cookbook. “In my opinion what really matters most is what sources of meat a person consumes. High-fat red meats, dark poultry meat and cured meats, such as bacon and sausage, are all sources of protein that we could do without. These processed meats are all high in unhealthy, saturated fats—the fats that increase levels of low-density lipoproteins, or LDL, the ‘bad’ cholesterol in our blood—and over time can lead to atherosclerosis, or hardening of the arteries, that ultimately can lead to cardiovascular disease.” More recent versions of the Paleo diet emphasize lean sources of protein, which can actually contribute to weight loss. What’s more, since protein and fiber from fresh produce are filling, this might make followers of these meal plans less likely to binge. “Lean, low-saturated-fat meats are perfectly healthy components of a well balanced diet and provide a number of beneficial nutrients,” Dionne says. “Extra-lean ground beef and white-meat poultry, for example, are high-quality sources of protein, iron, B vitamins, zinc, magnesium and vitamin E.” Still, even too much lean protein can result in excess saturated fat intake. “Portion control and moderation are key,” she adds. Another criticism of the Paleo diet is the renunciation of dairy foods that’s required. “Consuming adequate amounts of calcium and vitamin D is crucial to maintaining healthy bones and preventing conditions such as osteoporosis,” says Dionne. “I agree that low-fat dairy products are an excellent source of these key nutrients. Dairy provides even more health benefits from its content of additional nutrients, such as potassium, magnesium, phosphorous and protein. This is why the Paleolithic diet is by no means right for everyone.” Indeed, no single diet is perfect for everyone. That said, there are some who do benefit from eating a more Paleo-oriented diet. For those who choose to follow this diet plan,
or people who must avoid certain foods because of health or medical reasons, it’s still necessary to consume adequate amounts of key vitamins and minerals, such as calcium and vitamin D, from alternative sources they can tolerate. Most nutritionists agree that the legumes and whole grains, such as beans and steel-cut oats, that the original version of the Paleo diet rules out, are very healthy foods when they’re eaten in moderation. “Whole grains and legumes are rich in
nutrients, are excellent sources of dietary fiber and may help reduce the risk of heart disease, cancer and diabetes,” Dionne says. “That’s why I support the need for incorporating variety and diversity into any ‘diet’ or particular pattern of eating.” Dionne doesn’t believe in any version of the Paleo diet that’s highly restrictive, limiting or unrealistic (not to mention unhealthy). “The premise of the diet itself is quite sound and serves as the perfect framework for ‘clean eating,’” she says. “To follow its ‘rules’ to strict extremes is neither necessary nor beneficial.” In a nutshell, key Paleo diet principles—namely, eating lean proteins, fruits, vegetables and healthy fats— are important components of wellbalanced nutrition. But whole grains, legumes and dairy also play a key role. “In their natural, unprocessed forms, nutrient-rich grains such as oatmeal, barley and rye, and legumes such as black, pinto and navy beans, provide significant health benefits and should be incorporated into all versions of the Paleolithic diet,” Dionne says, “except in the presence of food allergies or medically necessary dietary restrictions. “ Dionne would prefer folks to use the Paleo diet as simply a way to eat more whole foods. She believes in using common sense to modify your diet so that you begin to include more of our ancestral foods such as wild fish, grassfed meats, and organic fruits and vegetables whenever possible. What could be easier and healthier than that? ■
Delectable Desserts Try this scrumptious Paleo sweet treat. Pumpkin Spice Custard Serves 5 1 cup canned pumpkin puree 1 teaspoon cinnamon ½ teaspoon ground ginger ¼ teaspoon nutmeg ¼ teaspoon cardamom Pinch sea salt 2 whole eggs 2 egg whites ¼ cup raw organic honey or pure maple syrup 1 teaspoon vanilla extract 1 cup coconut or almond milk 1. Preheat the oven to 350 degrees Fahrenheit and set a pot of water on the stove to boil. 2. Combine the pumpkin and all the spices in a large bowl. In a separate bowl, beat the eggs and egg whites, and add the honey or syrup, vanilla and milk to the eggs. Pour the egg mixture into the pumpkin mixture and mix well. 3. Pour the formed custard mix into five individual small ramekins, then place all the bowls into a baking pan. Pour the hot water (from step 1) into the pan around the ramekins, which should cover more than half of the height of the ramekins. 4. Bake for 60 minutes or until a toothpick inserted into the center comes out clean. Enjoy warm or chilled. Excerpted from The Spicy Paleo Cookbook: More Than 200 Fiery Snacks, Dips, and Main Dishes for the Paleo Diet by Emily Dionne, RD, and Erin Ray. Copyright © 2014 F+W Media, Inc. Used by permission of the publisher. All rights reserved.
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SAFE&SOUND MEET ONE CHILDHOOD CANCER SURVIVOR AND HIS MOM WHO ARE EAGER TO SHARE THEIR STORIES OF HOPE AND COURAGE. By Jeanette L. Pinnace
In the summer of 2012, Lori Thomas noticed that her 8-year-old son, Kenny, was rapidly losing weight. and had a bad cough. When she took him to the pediatrician, the doctor told her Kenny had a cold. Two weeks later, when Kenny didn’t rally, she returned to the doctor. The diagnosis— that Kenny might be suffering from post-nasal drip—left Thomas skeptical. “You know your kid, and you know when something isn’t right,” she says. It was a Friday, and Thomas was prepared to take her son back to the pediatrician the following Monday. Instead, she and her husband wound up driving Kenny to the emergency room when his back began to hurt and he couldn’t keep his food down. “It was like he couldn’t stop vomiting,” Thomas says. After doctors gave Kenny a chest X-ray, they found a cancerous mass in
In general, several types of cancers commonly occur in children: leukemia (affects bone marrow and blood); brain and other central nervous system tumors; neuroblastoma (affects the adrenal gland); Wilms tumor (kidney); lymphoma, including Hodgkin and non-Hodgkin; rhabdomyosarcoma (skeletal muscles); retinoblastoma (eyes); and bone cancer. What causes childhood cancers remains unclear. But “infants with Down syndrome have a higher risk of cancer,” says Michael Weiner, MD, a pediatric oncologist at the Morgan Stanley Children’s Hospital of New York-Presbyterian and a member of the Hyundai Hope On Wheels Medical Advisory Committee. When she learned about Kenny’s cancer diagnosis, Thomas immediately
his treatment at the University of California, Los Angeles. The doctors there were “just fantastic,” she adds. The next challenge for her was explaining the disease to Kenny. “We told him what he had and what the diagnosis was, but he didn’t understand the gravity of the situation,” Thomas says. “He knew that treatment was going to take quite some time and that he probably wouldn’t be going back to school until the following year. But all he knew was that he was being poked and prodded and he didn’t like it. That seemed to be more of a concern to him than the actual diagnosis.” Thomas says she made sure she told
Kenny the truth; she felt this was fair since he was the one going through the illness. “We never sugarcoated it; we
Left to right: Hyundai Hope On Wheels National Youth Ambassadors Kenny Thomas and Ashley Burnette at the 2015 campaign launch; “Mamarazzi” event with Kenny and his mom, Lori, host Rocsi Diaz and Ashley and her mom, Nicole; Kenny and his parents at last year’s program launch event.
his chest. “He was diagnosed with stage III non-Hodgkin lymphoma,” Thomas says. “Later we found out that, thankfully, it hadn’t spread and was confined to his chest area.” Non-Hodgkin lymphoma is a cancer of the immune system. Kids become sick when unhealthy cells of the immune system don’t work properly, leaving children with no protection against other diseases. 2 8 REAL HEALTH FA LL 2 0 15
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called her sister. “I didn’t know how to tell my mother and father,” she says. She also phoned a girlfriend, who helped Thomas deal with the situation. “Emotionally, it was traumatic,” she says. But Thomas had no time for selfpity. Kenny was in the pediatric ICU at Miller Children’s Hospital for six days, followed by a week on the Miller oncology floor. “His life was saved at Miller,” Thomas says. Then he finished
were always truthful with him about his situation,” she says. For parents with kids who have cancer, developing coping skills is key. Thomas suggests that parents find a compartment into which they can put their personal feelings so they can muster all their strength and encouragement for their child. “We understood what could happen, but we never allowed ourselves to go to the worse place,” she
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He would also sweat profusely at night
says. “One night, he asked me, ‘Mom, can I die from this?’ That was a tough question for an 8-year-old to ask.” When she and her husband talked to their son, they’d speak in positive terms about the future. “We’d say things like ‘when you go back to school,’ or ‘when you grow up and have kids,’ so we always kept positive thoughts in our minds.” Thomas says she was honest with Kenny that cancer could kill him. But she also reassured him that the disease was responding to treatment. Kenny’s treatment entailed several rounds of chemo infusions three to four times each week along with injections of a medication into his spinal column. In addition, he was given a chemo pill to swallow each night through the end of 2014. Last year, Kenny also received his last
spinal injection. Now 11, he’s back in school and everything is going well for him. “He was very fortunate,” Thomas says. “We got news a lot of parents don’t get, and we feel very blessed.” Kenny says that all his classmates knew about his fight with cancer. Occasionally, kids in his class asked him about the bump on his chest. This is where docs placed the port used to give him his cancer meds. Kenny also resumed his usual school activities, including playing basketball again. But now he’s also a National Youth Ambassador for Hyundai Hope On Wheels. The program, founded by Hyundai, is among the largest nonprofit funders of pediatric cancer research in the United States. This year, Hope On Wheels has awarded more than $100 million to fund pediatric cancer research. Other goals of the program are to create public awareness about childhood cancers and generate conversations about the
necessity for more research, as well as improve standards of care for kids diagnosed with these illnesses. Kenny likes traveling to new places and meeting different kids. “I like being the ambassador,” he says. “The only thing that’s not so great is sometimes we have really late flights.” Kenny’s mom thought he would be a good advocate for the program. “We really believe in giving back, and I was happy he was given the opportunity to try to inspire and encourage other young children who are battling cancer,” Thomas says. “It’s important to spread the word.” As an advocate who is helping to educate others about childhood cancers, Thomas has a key piece of advice she wants to give mothers: If you’re told everything is OK, but you believe something is wrong, you need to persist in trying to find out what’s really going on. Although different cancers have different signs and symptoms, Weiner suggests that, in general, if a parent notices their child isn’t well or isn’t acting normally, take him or her to the pediatrician and ask plenty of questions. “This is for anything that doesn’t get better in a reasonable amount of time,” he says. “Just trust your gut and trust your instinct and don’t settle to hear everything is OK,” Thomas advises. “You know your child, and the first time I took Kenny to the doctor I knew something was wrong. If they had done a blood test, they would have known his blood counts were off the chart and he would have been diagnosed a month earlier.” Adds Thomas, “Some moms turn on the lights if their kid just coughs, and I tell them, ‘Good for you.’ Often, it’s nothing, but you just never know.” ■
WHEN THEY THINK THEIR CHILD IS SICK, PARENTS SHOULD NOT SETTLE IF A DOCTOR SAYS ALL IS WELL.
JUST ONE WISH The Hyundai Hope On Wheels program wants to end pediatric cancer. The long-term goals of Hyundai Hope On Wheels are the eradication of childhood cancers by raising awareness, awarding clinical grants and acknowledging the lives of children. But the program’s short-term goal is more immediate: To deliver hope to children and their families who are going through cancer treatment now. Since only 4 percent of funding for cancer research goes to pediatric cancer, programs such as Hyundai Hope On Wheels generate additional research monies. Cancer continues to be the leading cause of death by disease for U.S. children. Each year more than 15,000 kids are diagnosed with cancer in the United States. “For the past 17 years, Hope On Wheels has funded research targeted at some of the most promising pediatric cancer initiatives in the medical community,” says Hyundai’s president and CEO, Dave Zuchowski. “These research awards play a vital role in developing new studies and providing a better understanding of these diseases.” According to Zuchowski, the goal of the program is “survivability,” so doctors can leverage this research and one day “arrive at a time when no family has to ever face the prospect of losing a child to pediatric cancer again.” Marked by a handprint ceremony, the theme of this year’s Hyundai Hope On Wheels program was “Every Handprint Tells a Story.”
For more information, visit the Hope On Wheels website at HyundaiHopeOnWheels.org.
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THOUGHTS
Career Moves
How one woman used burnout to chase her wildest dreams
Totally Burned Out
When you’re so tired you feel like you have nothing left to give
At the age of 35, I was an executive secretary at a major international shipping company based in New York City. I’d been there for almost 15 years. Although the money was good, I was stuck in a dead-end job. There was no place to go in a company where all the executives were men and all the secretaries women. In addition, I felt unappreciated. The executives I worked for were rude and ungrateful. They took the secretaries for granted and hardly any of them even bothered to say thank you as a simple courtesy. Soon, every day began to feel really awful. I was always tired, the workload was daunting, and the tasks each day were tedious and boring. It seemed like nothing I did at work made any difference. Each day played out the same. That’s when I knew it was time to leave. But where would I go and what would I do? After some soul searching, the answer dawned on me as if by magic. I’d always wanted to go to medical school, so I began the process of applying. Today, I’m glad I burned out on my job. Without this catalyst, I would never have pursued my dream to become a doctor. —As told to Kate Ferguson
Psychologist Herbert J. Freudenberger first used the word “burnout” in an article he wrote called “Staff Burn-out,” published in 1974 in the Journal of Social Issues. In 1980, he published his book Burn Out: The High Cost of High Achievement. The psychologist developed his theory based on his work with exhausted mental health workers. But burnout can happen to anyone, “from stressed-out careerists and celebrities to overworked employees and homemakers,” explains PubMed Health, an online service that offers medical information to U.S. consumers and clinicians. When the stress of any job is excessive or prolonged, we can quickly begin to feel hopeless and helpless, overwhelmed by and unable to meet the demands of our job. One immigration lawyer in private According to mental health professionals, there are many ways to deal practice in New Jersey, New York and with burnout on the job. Here, we offer a few tips to prevent, cope with Virginia regards burnout as an unavoidand recover from this daunting state of emotional, mental and physical able risk of his profession that requires exhaustion that’s caused by prolonged stress. he remains constantly on guard. What are some good ways to When he feels threatened by What can you do to cope How can you recover if prevent burnout on the job? burnout’s shadowy presence, he turns when you’re burned out you’re already burned out? Take breaks every few to simple coping strategies he says at work? Support at this time is hours to build downtime work for him: He walks for exercise and One way to cope with key, so talk with friends into your workday. Stretch, won’t accept any new clients, even burnout on the job is or family who care about meditate, take a short though this means losing income. to cash in your vacation you. If you can take time walk during lunch, or listen The busy barrister says if he takes and sick days. Totally off from work, use it to to soothing instrumental on more people than he can handle, fed up? Start looking re-evaluate your life and music while you work. he’ll be too fried to do his best for the for another job. priorities in general. clients he already has. 3 0 REAL HEALTH FA LL 2 0 15
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DREAMSTIME.COM/VLADYSLAV STAROZHYLOV
The Expert Says
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Don’t say
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HEPATITIS C CAN LEAD TO LIVER CANCER Most people with Hepatitis C do not feel sick. Yet liver damage may be silently taking place. Even if you think you’re fine, talk to your doctor about getting tested.
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