Promising New Treatments for Melanoma

Desiree Ratner, MD
Director, Comprehensive Skin Cancer Program
Mount Sinai Beth Israel
Director, Dermatologic Surgery
Mount Sinai Beth Israel, Mount Sinai St. Luke's, and Mount Sinai Roosevelt


Promising New Treatments for Melanoma

It can be frightening to learn you have melanoma, the least common but most dangerous form of skin cancer. When caught in its early stages, melanoma is almost always curable with surgery, but when it metastasizes -- that is, spreads to other areas of your body -- it is notoriously difficult to treat.

In the past, patients diagnosed with the most advanced stages of melanoma usually had only a few months to live. However, metastatic melanoma is no longer the automatic death sentence that it once was. Chemotherapy, once the standard (but largely ineffective) treatment for advanced melanoma, is giving way to new, more successful therapies that are prolonging survival and improving patients' quality of life.

The promising new drugs approved by the U.S. Food and Drug Administration (FDA) in just the last few years fall into two classes: targeted molecular therapy and immunotherapy. The side effects of both tend to be much more tolerable than those of chemotherapy.

Targeted Molecular Therapy

About half of patients with metastatic melanoma have tumors whose cells contain a genetic mutation, most commonly in a gene called BRAF. As its name suggests, targeted therapy attacks and kills those particular mutated cells.

A recent study of one of the newest targeted drugs, nivolumab, found that 32 percent of patients responded to it and, in a third of those patients, the effects lasted six months or longer. This is good news, considering chemotherapy's traditional response rate of only 5 to 20 percent. In fact, the results represented such a significant improvement over previously available drugs that the FDA approved nivolumab three months ahead of schedule, in December 2014.

When targeted drugs work, the tumors shrink for a time, allowing patients to live normally for a while, rather than feeling continuously ill. Unfortunately, this type of drug eventually stops working for many patients as their genes undergo further mutations. To address this issue, researchers are investigating combinations of targeted therapies.

The New England Journal of Medicine, for example, recently published promising results of a study in which patients were treated with a combination of two targeted drugs. Those who received the double therapy survived for a median of 11.4 months without progression of the disease, versus 7.3 months for patients taking one drug alone.

The bottom line is that even though patients who respond to targeted drugs may still die of melanoma, they are surviving longer and with a better quality of life than ever before.

Immunotherapy

Immunotherapy strengthens the immune system by supporting activation of the body's cancer-fighting T-cells. For example, the FDA-approved drug Yervoy (ipilimumab) blocks a molecule called CTLA-4, which normally keeps immune cells in check. Blocking CTLA-4 "takes the brakes off" of your immune system, allowing T-cells to proliferate and launch a stronger attack on the harmful melanoma cells.

A 2013 analysis of data from 1,861 patients treated with Yervoy revealed exciting news: the patients' median overall survival was 11.4 months; 22 percent of them survived at least three years; and 17 percent were still alive after seven years, with no deaths due to melanoma after that. Such long-lasting responses to anti-cancer drugs in people with metastatic melanoma were previously unheard of.

Individual Factors

Despite these recent breakthroughs, there is no "one size fits all" treatment for patients with metastatic melanoma. Your medical oncologist (a doctor who specializes in treating cancer with medications) should consider the individual factors of your case to determine which drugs make the most sense for you. And that's the exciting part: these new therapies are giving real options to a set of patients who previously had none.

Even so, nobody wants to get metastatic melanoma. Checking your skin regularly for new or changing growths is crucial because, when caught early enough, melanoma can be stopped in its tracks. To learn what to look for, see the American Academy of Dermatology's online reference for identifying the "ABCDE" warning signs of melanoma, and this guide to melanoma from the American Cancer Society.

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The Emotional Weight of Social Media

We've heard it time and again; our culture is obsessed with social media. It's true; screens are our lifeblood. We are relentlessly tweeting, messaging, poking, liking and engaging with each other online. We have access to information that we've never had before, and let's face it, who doesn't love a good selfie of Ellen DeGeneres at the Oscars or an ice bucket challenge or two? But the truth is that beyond becoming a habitual part of our daily lives; social media has begun to define how we feel. We create personal profiles online but we often forget that our social media presence and behavior doesn't always show who we really are, or who others are for that matter. Social media has become an important factor in our own emotional weight.

According to Todd Leopold at CNN, studies have show that "social media can have effects on mental health... getting 'likes' for Facebook posts actually results in a release of dopamine, a brain chemical associated with pleasure. Moreover, sad or moving posts can promote release of oxytocin, the 'love hormone,' which makes us feel protected."

It makes sense, Facebook and Twitter have become platforms for us to curate and share our successes, accomplishments and changes in life. This can contribute to our own lives in wonderful ways but it also has its challenges.

The problem is two-fold: Being dependent on the satisfaction received online can be a slippery slope. And not getting that satisfaction, and the natural problems with social media (online bullying, exclusivity and fast access to potentially emotional harmful content) can put our real life, tangible feelings at stake. There are ways to use social media effectively and enjoy it without making us feel emotionally heavy or weighed down. Here are a few of my favorite ways to help you lighten the emotional weight of social media:

Express Gratitude Online: When you log in to your Facebook I'm sure your feed is speckled with those self-promotional or celebratory posts. The: "I'm so excited to announce that..." or "I can't believe I..." posts. You know what I'm talking about. It's awesome to share successes online, it allows the word to spread quickly and as Leopold told us, it can even make you happier. But it can also be frustrating. Have you ever been having an absolutely awful day, logged into Facebook and seen a post about someone else's' "fabulous" life and felt like you were going to snap? Those posts are great but are often not very helpful if you're feeling unhinged or having a hard time in your own real life.

So why don't we begin to turn it around and start to create posts that express gratitude. Why not thank someone you love for being there for you online? Send a message of appreciation or a quick hello to a family member? Write a post about the way an old teacher or mentor encouraged you. Expressing gratitude, simply saying thank you will lift your spirits while also supporting and celebrating someone else.

Take a Social Media Breather: When we depend on our phones to evade awkward situations, to curate our own life through selfies, to gain likes and pokes and comments, we lose sight of what truly is important; engaging with each other in person and enjoying our time in front of each other. Social media is important, it is relevant but I promise if you try unplugging you'll connect with your world in a deeper, long lasting way. Taking a breather also allows you to return to social media with a different perspective. You'll find more enjoyment in engaging with others digitally because you've taken the time to work on in-person relationships. You may even find that social media matters less and less to you the more time you spend focused on others in real life.

Recognize that Social Media is a Game: It isn't who we really are. People curate and choose photos and information to share that highlights exactly how they want to be seen. Adrienne Erin of Socialnomics says that, "We are all at war with one another for likes and favorites and we compete by posting pictures of our expensive dinners, vacations and social interactions." Remember those self-promoting posts I mentioned before? They are great but they aren't actually what the world looks like. Life isn't always a steady uphill climb of happy, exciting events. But people don't want to share the mundane online because it's not as exciting. That's why it's good to remind yourself that we are all in this together. Life is beautiful because it isn't always the same. Imagine how boring your successes would be if they happened every minute of every day like they do on social media? We are all human, we all go through hardships, we all wait in line at the grocery store, and we all don't always feel awesome. But every color of life is important and unique and we all go through them. Life is so much more than a like. Enjoy social media but remember to not take it too seriously!

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A Health Care System That Works

My husband and I got married last year in Bled, Slovenia. While it's not the most popular wedding destination (which it should be), it's one of the most enchanting places I have ever seen. It was also convenient that he grew up in a town nearby and his family still lived there.

Two days before the event when we went to pick up some friends at the airport, I realized that I had severe pain in my lower abdomen. It had slowly crept up on me. That night after dinner, we decided to head to the emergency room in a nearby town called Jesenice.

We explained the situation to a physician and soon she ushered me into a small room for examination. After a few minutes, she stepped outside and had a long conversation with my husband in Slovene. His facial cues did not help my anxiety.

When they were finally done, he looked at me, took a deep breath and said "Looks like you have a cyst and it may require surgical intervention".

The good news was that the cyst was very benign and removing it was a minor procedure. The bad news was that we had a wedding happening in less than 48 hours.

They gave me a prescription for antibiotics and painkillers. I was asked to return to the hospital immediately if the condition worsens. I was also informed that if I were to get the surgery, I had to refrain from eating or drinking for at least six hours prior to the procedure.

As we headed outside, we stopped at the reception to pay for the services rendered. It is quite unusual for them to have a foreigner get treatment at their hospitals, so it took a while for them to process the fees.

A lady behind the counter finally emerged and with a rather regretful voice said "I am not going to lie, this visit is going to cost you. It's going to be €7.92 (approximately $10), but you don't have to pay it now. Pay it next time."

Despite everything this made me chuckle. We insisted on paying the bill and headed to the pharmacy. The cost for all my medication was €17.94 (approximately $24).

Back at the hotel, we contemplated on canceling the wedding but decided to play it by ear. Next day, after breakfast, I diligently took my medication. However as time passed, the pain soon became excruciating and the pills were no match to the pure agony.

It also didn't help that I had not eaten anything since breakfast. Around 4 p.m., I made the grave mistake of unwittingly taking a bite out of an apple. The problem is when you're under anesthesia, all the normal reactions, like swallowing becomes impossible and since you can't control your gag reflex, your stomach contents could regurgitate into your airways and can potentially be fatal.

What that meant was that I had to wait for another six hours before I could get the surgery. It also meant I had to use ER services again because of the late night hours. We finally got to the hospital close to midnight. While they did some tests to confirm my condition, I tried to convince the surgeon to postpone the procedure until after the wedding. My efforts however failed miserably when mid-sentence I realized that I was about to pass out.

Next thing I knew, I was getting wheeled into a surgery room. They asked me to count as the anesthesia was flowing through my veins. After counting to six I lost consciousness and when I opened my eyes I was in a different room. The surgeon came by to explain that the procedure was successful and I should stay in the hospital overnight. My husband stayed there with me.

Next morning after the checkups, I was discharged around 6 a.m. Given that we were getting married at 4 p.m. that afternoon, they didn't want to hold us up with any paperwork or payment processing. They also needed additional time to figure out the cost since Slovenia has universal healthcare and their citizens don't pay for these services. Despite all the drama, the wedding ceremony went better than even originally planned (topic for another article).

We went back to hospital after a couple of days. The bill for the surgery, medication and stay overnight for both of us was €657.26 (approximately $887). In stark contrast, years ago, my husband went to an emergency room in the U.S. for a cat bite. There was no surgery, no stitches and the wound was relatively superficial. Yet his co-pay was around $1500 and the total was over $8000. Obviously his insurance was not great but still that service does not warrant a bill that high.

The beautiful thing about Slovenia, like so many other developed countries, is when you are a citizen and need medical care, you don't think about whether your insurance is good enough and what you can and cannot afford; you just get treated. It's extremely affordable even for non-citizens like me.

Not to mention I did more paperwork in the U.S. to get reimbursed from my insurance provider compared to one or two forms that I signed to get a surgery in Slovenia. Yes, U.S. is "the best country on Earth"! Hooray! But a tiny and young country like Slovenia has a much better health care system than U.S., and that's just sad!

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5 Phrases That Send Me Spinning

The room is dark and hazy. Pedals whir. Bright eyeballs and shiny teeth glow in the eerie blue light. I smile and say hello to everyone even though I recognize no one. I wonder if I've gone through the looking glass along the wall and stepped into an alternate world where the beat is heavy, the energy frenetic... and the language completely mysterious.



Before I know it, I join the one two rhythm and begin the grueling energizing ascent up an imaginary hill. The words I hear seem to have no meaning, and I wonder if all this activity is causing some kind of aphasic episode. Luckily my brain is smarter than I am. It refuses to acknowledge it doesn't understand the enigmatic instructions, and by the time we reach down for the next quarter turn (um... what?) it is already decoding the cryptic phrases that only make sense right here right now:

Gimme a quarter turn. This does not mean with your body, your head, or any part of your anatomy. Whatever you do, please do not actually turn one quarter clockwise, counter-clockwise or any wise. It's impossible to do that anyway since you are, hopefully, perched on your bike pedaling like crazy. One two one two one two.

"Gimme a quarter turn" is the foundation of a spin class. It means reach down, grab the red resistance knob, and turn it one quarter to the right to add resistance. And hope the instructor does not ask you to do it again. It's a futile hope. Every quarter turn adds more resistance until pretty soon you're pushing your bike up Mount Everest. Which is the point. It's worth it.

Tap backs. Yep, that's what he said. These sound elusive, confusing, and exciting: I'll tap your back if you tap mine?! Or something. I'm going to leave it there. Some moves are better left unexplained.

Go to the hover. Right, now I'm really in an alternate world. Complete with Marty McFly, hover boards and that must be the easiest way up this hill. Almost. Not quite. What it means is squeeze those abs (more on that later), summon every ounce of strength you may or probably do not have, and hover hummingbird-style above your bike. Don't stop pedaling! I promise, your thighs (and abs) will thank you one day. If they ever talk to you again!

Singles. I believe this is a shout-out to all the single people in the room. An invitation for them to do those awesome-looking push-ups and tap backs. Since I'm not one of them, I ignore this part. And pretend I don't hear him say, "Gimme a quarter turn."

Squeeze those abs. This is my favorite! The one I will never understand, no matter how loud the music. Because... how? How do you squeeze your abs? I've deduced that it does not mean grab the kangaroo-like pouch you will forever have after four pregnancies and give it a juicy squeeze with your hand. It has something to do with squeezing from the inside. The problem with this instruction is it assumes you have abs inside to squeeze. I don't. See aforementioned kangaroo pouch. So I can't. This is too much resistance.

I love this class. I love the loud music, the beat, and the tap backs. And also disco lights! I love the darkness (because the instructor can't see that I'm not giving him a quarter turn. Sneaky!), and I love the vibrant, motivating trainer telling me I can do it, especially when I feel like I can't. Which is almost every day. I believe him when he tells me. And then I do it.

Mostly, I love these quirky phrases that really only make sense in this world. Because where else would you hear anything as fabulous as, "Squeeze those abs!"

This post originally appeared on Red Boots. Follow Nicki Gilbert on Twitter and on her blog.

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4 Ways to Live an Amazing Life

An "amazing life" will have a different meaning for each of our lives. The one theme that everyone strives for in life is freedom. We long for freedom from financial stress and freedom to live and love. The freedom to wake up each day and spend our precious time on the things that are important to the kind of life we want to live.

For years, I was in survival mode. I was happy just to wake up and limp through each day. I had no hope or dreams and never gave a second thought to what I wanted from life. I was overweight, overworked and stressed beyond my limits in my marriage. My finances were a joke -- we were in serious debt. We spent money faster than we made it.

You may be going through some stressful situations in your life right now. Happiness feels like a fairy tale that only happens to characters in a movie. Here are four ways you can life a amazing life and experience real freedom.

1. Eat Healthy and Move More

I'm not a health expert, but there are enough books, websites, and courses that can teach you what it means to eat healthily. In the last year, I've lost 170 pounds through portion control meals and avoiding junk food. What you eat affects how you feel and it essential to living a long life.

Along with healthy eating is exercise. Again, what exercise you should be doing and how often will be different for each of us. Exercise provides you more energy, helps you keep the pounds off and gives you an excellent opportunity to relieve stress. It can be a time for you to plan, refresh and challenge yourself. That discipline will boil over into other areas of your life.

2. Grow Your Relationships

Stress in relationships -- romantic or not -- can affect your mood or worse. There will always be ups and downs in relationships, but the toxic ones can kill your happiness. Our relationships should lift us up and compliment our life. Communication is crucial and understanding that we won't always see things the same way as others will help. Deciding to love that person each day and keeping situations in the right perspective will help your relationship grow.

3. Do Work You Love

Most of us will spend 40 hours plus in some form of work. That time could be spent doing something you love or hate. To many of us spend a bulk of our week doing work we don't enjoy, and that doesn't fulfill us. With so much of our week spent miserable, that stress festers into other areas of our life.

Yes, the economy is still recovering. Yes, finding a job you love seems like it's right up there with finding a unicorn, but these are just self-limiting beliefs. Every day people all over the world wake up and do work that they love. It's not easy to find a good job or start a business, but it is possible, and it can happen if you start today. With over 2.5 billion people on the Internet every day, a wealth of new opportunities have presented themselves. Don't let your work keep you from an amazing life.

4. Live Fully Present

Life is short and time is the one resource we can never recover. When you live life distracted, you waste that precious time. Learn to live each moment. Be there and tune out the distractions that will make you miss what's right in front of you. Listen, breath, and understand what that moment means. There will be plenty of time to check Facebook later.

Today my life is a different story--today I wake up each day amazed that anyone can live life this way. I lost the weight; I got financial freedom by paying off the debt entirely. We now invest and make our money work for us. I quit a job I hated with every fiber of my being to live my dream of being a writer. We moved our family to our dream destination of Maui, Hawaii. I have to pinch myself each morning.

Life may not be what you want it to be right now. You may be where I was and are struggling to believe life can be better--I'm here to tell you it can. You can wake up every day and experience true freedom in every area of your life. It's going to take time, sacrifice, and more determination than you think is possible, but it's possible for you, too.

It all starts with what you believe about yourself and your dream. If you don't think it's possible, you won't do anything about the kind of life you want to live--you won't take action. Don't listen to doubt, fear, or self-limiting people or beliefs. Dig deep and take control of your life. You can and will find your happy place. You will find what an amazing life means to you.

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4 Ways to Make Your Period More Enjoyable and Restorative

This article was originally posted on HerAfter.com, a site for women learning to live fully after cancer and other physical and emotional battles.

It's time to end our war with our "time of the month."

For too long, women have been pretending our periods are some kind of hideous beast that arrives to ruin our lives every month. But it's time to stop treating it as an inconvenience. It's time to stop using it as an excuse for our inability to practice willpower, or as logic motivating our bad behavior, As with the debates in our culture on weight, on women in politics, on sexual prowess v. slut shaming, and so much more:

It's time to stop shaming our bodies. That includes its functions, its needs and all it's miraculous cycles -- including the "period."

Having a period isn't a burden, it's a blessing. It doesn't make us irrational or unbearable, it makes us human, beautifully human. It's an essential function that gives us the ability and choice to have children, a choice that is individual and personal and should be taken seriously.

Though this is not at all an article about women's reproductive rights (though if you're looking for one, Bri Seeley's article on the choice not to have kids is a great read), it is still important to realize how powerful it is to have reproductive rights, to have the political and biological the choice to be a mother. Because today, rather than be shoved in tents while we menstruate, or having our worth decided by our ability to bear heirs, we have the freedom to reproduce or not, to function in society while menstruating, and so much more that women before us fought hard and bravely for.

If you're looking for more about how your mother and grandmother fought for your ability to be self expressed, check out this recent article.

It's also a monthly reminder. With all the roles women take on today -- mother, boss, entrepreneur, role model, sister, friend, confidante, girlfriend, the list continues -- we could use a reminder to slow down, honor our bodies and offer a little rest, relaxation and reward.

Yes, the side effects are serious, and can often need medical support. The pain can be unbearable, the emotional roller coaster of it can be overwhelming. But the act, and the time, should be sacred.

This will sound crazy, but it shouldn't: I enjoy having my period. During my chemo, the doctors essentially "froze" my reproductive cycle, so as to protect it as much as possible from the therapy. It took full years after treatment in which I didn't have any cycle at all -- a dream to some girls, a nightmare to me, who was in a hurry to get my body back to normal. When it finally did return, it was happily welcomed with gratitude. To this day, 10 years later, I'm still happy to get it every month as a sign of my body's incredible ability to heal and renew.

Here are a few ways to turn your "week of hell" into a week of healing, of physical and emotional cleansing, and most importantly of self respect:

Be kind.

If your body is feeling overly-tired because of the cycle, pay attention. Allow extra time to rest and recuperate from the important work your body is doing internally. Getting enough sleep and time for the muscles to rebuild and restore is very important.

Honor your body.

Fit into your schedule restorative activities like gentle yoga (no inversions!) or long, hot baths or a massage. Don't punish your body for what it's doing, offer yourself chances to see how miraculous and beautiful your body is by honoring it like a temple.

Keep a journal.

If you're the type who's hormones go haywire during this week, sending you into tears at the site of just about anything (read: me), keep a journal. It will help you express the emotions that come up, identify your triggers, and give you a deeply personal and intense look at the power of your feminine capabilities. After all, isn't it incredible that our hearts can feel so much from our cycles? Isn't it incredible the way our body can affect our mind? Isn't the body magnificent?

Be conscious.

We like to pretend that it's our week to "be bad," and overeat. But products like dairy and sugar, as rewarding as they might seem, can make things worse. Be sure to drink plenty of water, eat well, and keep your relaxation time geared toward positive activities rather than passive ones (IE reading rather than hours in front of the TV). This will ensure you finish the week with a feeling of peace rather than bloat. That said, eat a little chocolate. And make sure its the good, expensive kind.

Rachael Yahne (@RachaelYahne) is a writer, blogger, and 10 year cancer survivor. You can read more of her articles about healing from life's big struggles on her website, HerAfter.com. Articles cover topics like beauty, well-being, purpose, and pretending to be 'normal' after treatment and recovery.

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Life -- Living With the Growing Pains

Henry Ford is quoted as saying: "Life is a series of experiences, each one of which makes us bigger, even though sometimes it is hard to realize this. For the world was built to develop character, and we must learn that setbacks and griefs which we endure help us in our marching onward."

Growing Pains

Growing, and especially rapid personal growth, is rarely a comfortable or easy experience (I'm speaking from lots of personal experience here!). However, if we persevere with our struggle (often largely with ourselves) and find a way to come out at the other end of the dark tunnel, we have learned what we were meant to and may find ourselves in a wonderful new place -- the tunnel led to a gorgeous, green valley, more beautiful than we could ever have imagined.

When there are struggles, challenges or issues in our lives; when things are not working out the way we would like; when obstacles arise; relationships falter or breakdown; disasters occur and all the other minor and major challenges that face us daily, in order to overcome them, to change our circumstances, we are forced to grow, to become "bigger," as Mr. Ford said.

Being Grateful

A mentor of mine gave me an interesting perspective once as I was dealing with yet another challenge (I must be a very big person by now). He suggested that I be very grateful to the person who was the source of my dilemma. "Why grateful," I ask, thinking about the lost sleep, soul searching, fear and hard work that was occurring.

He suggested that it was as if God had decided that I was capable of more, more joy, more satisfaction, more giving, more growth; it was time to offer me an opportunity to "be bigger," and that he had given me a gift to help me. And of course that gift was the person triggering the above lost sleep etc. In fact, my mentor said, "Think about the words 'the present.' A present is a gift. The present, what's happening to you right now, is a gift from this person (and/or God)."

Well, of course, this concept took some time to filter through my beliefs; I wondered if this was new age "woo woo" stuff; if it was just a cop out (NO -- there's too much hard work involved for it to be a cop out); and the idea of being grateful for pain took some work!

Live in the Present

However, it now makes sense to me. I like the idea that the present is a gift. Living in the present, no matter how challenging, is always more rewarding than wallowing in the past or being terrified of something in the future. And if we manage to conquer the challenge, inevitably we are presented with a "gift" of some sort -- a new relationship; new job; new opportunity; new life.

And then I thought that if I wasn't growing during my life (not just physically), I would probably be very bored in nanoseconds! Recall that old saying -- I forget who originally said it -- "if you're green, you grow, if you're ripe, you rot!" The day we think we know it all, we've done it all is the day we start to rot. We lose our zest for living.

Here is another quote that I think you will agree is relevant:

"The world is round, and the place which may seem like the end, may also be only the beginning." -- Ivy Baker Priest, a former U.S. treasurer who must have been a very wise woman.

Zooties!

Amanda Gore

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Self-Care: What Gets in the Way and 5 Things Not to Miss

Taking care of ourselves is so crucial but often ignored.

These kinds of practices are needed when we are healing major imbalances. But they are also essential to pepper throughout our busy lives. We can easily miss this when we feel at the peak of health.



I recently read an impressive list of "successful moms" in a popular parenting magazine. They were all juggling businesses, families, philanthropy and even school. They were accomplishing a lot at once. I noticed not one of the moms talked about success as quality time spent with herself or her kids. Success was measured in dollars and reach.

It made me wonder about how we define success these days. Can we see success in time spent in precious relationships? In being ambitious about being a mom, dad, or caregiver to our art or healing, students, friends or family? In taking time to pause and listen to ourselves?

We are often so busy we forget to stop, pause, rest and heal.

I've noticed my self-nurturing practices have been full of a lot of slow activities. Writing slowly. Reading slowly. Doing yoga slowly on the ground, super-snail slow, yin-restorative-like.



The other way we miss self-care is through so much pressure often to rush back in to do everything we are used to doing. What I'm finding is true self-care often involves really pausing deeply. Taking some time out and reflecting before recommitting to what nourishes us.

Here Are 5 Questions for Radical Self-Care

1. When and where today can I stop, pause, rest and heal?

Sometimes my pause looks like a meditative morning walk into work. Other times it is a few calm breaths taken on lunch break. Throwing legs up the wall or a kickback on the couch before dinner. Even a yoga nidra guided meditation in the evening before bed. The way we pause matters less than just that we are doing it.

Planning or thinking about it helps make sure the pause happens. And I notice I'm always more present in the rest of my day when I take this time!

2. What do I need right now? Am I hungry, tired, thirsty?

Asking ourselves basic questions is so key. According to Maslow's hierarchy of needs when we take good care of these basic needs the higher ones, like creativity, fulfillment, joy, purpose and self-actualization can follow.

3. Is there anything I'm avoiding or need to deal with?

At times, we can't rest because we are unsettled by our issues. Acknowledging and then addressing them is necessary. Once identified, take care of it with integrity so we can be fully present with whatever we are doing.

4. With whom can I take some time to really connect today?



This is such a wonderful question!

I've started to apply this one whenever I can. I notice I rush through the day, feeding, entertaining and occupying my toddler. Everything gets done but we don't actually stop to notice one another, though we are together all day. The moments I take to slow down, breathe slowly and observe as he plays are so precious. I also notice he will look up from his activities in the moments and smile at me before going back into his imaginary world of play.

5. Can I slow down and let go even more?

How, when and where.

Sometimes not everyone understands the need for slowing down, rest or recuperation. And that is ok. Everyone is on their own journey. Sometimes we need to just let things go so we can be present and our full selves where we are.

So if some folks don't understand or are pressuring you to do more than you want, check in with your own self-care, listen and respond with love. After all, only by truly and deeply taking care of ourselves can we sustain our ability to be there to take care of others.

Happy stopping, resting and healing.
Susanna Barkataki

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Don't Know What You Want? 10 Simple Steps for Creating a Personal Vision Retreat

Last month I told friends I was taking a few days off to go on a vision retreat, and I realized people had no clue what I was talking about.

"Is that a course you're taking?" someone asked. Good question.

Vision retreats are about charting our own course, for our life, our own way.

Most of us weren't taught to step back from the drone of our lives and reflect on whether or not we're happy. We're too busy living.

For many people, once the work day is done, bills paid, birthday party planned, legs shaved, and dinner made, we're too exhausted to even think about the next day, let alone envisioning a different future. We're just happy we made it through alive.

When we're super busy it can seem pointless -- even frivolous -- to go off dreaming about some future reality.

Ironically that's the time a vision retreat is most crucial.

When we're suffering from busy-sickness, time-poverty, career confusion, or lack of fulfillment, it's time to stop and look at the bigger picture. We don't need to wait until we get sick, make a careless error, or something falls apart to examine where we are and where we're going.

Whether you're retired, a single parent, student, school teacher, business owner, or managing a bustling family, a vision retreat can help you get clear about what's most important. It can help you find clarity to make the shifts you've been dreaming about.

Here are 10 thoughts on creating a personal vision retreat of your own.

1. Schedule It Now. Book it, or it won't happen. Schedule one day, a few days, or even a week, whatever feels right for you.

2. Don't try this at home. This is key. You might think you can vision in your house, but getting out of the familiarity of your surroundings allows your mind to think in expansive ways -- and you won't be tempted to do the laundry.

3. It doesn't have to be expensive. If a big trip isn't practical, pack a picnic and go to a quiet park with your journal for the day. Turn off your phone.

4. Go alone. Giving yourself space and quiet allows your heart to speak more clearly. You'll also be less distracted by conversations and other people's agendas. This doesn't apply if you're going on a vision retreat for your marriage, joint business, or co-created project. If the idea of going alone feels scary or selfish, more reason to do it and overcome fear. You are worth it.

5. Relax. The longer the retreat, the more breaks you'll need. I like to practice yoga, go for walks, use inspirational card decks for creative ideas and support, eat healthy delicious food, nap, dream, or journal.

6. Plan Your Agenda. Give yourself tasks to work through. Here are some ideas:

- List 10 things that feed your soul, personally and at work. Circle the ones that are most important to you.

- Write down the broad categories of how you spend most of your time, for example family, friends, work, nature, health, household, volunteering, hobbies, social media, etc. If you want to get fancy, make a pie graph of what your main tasks are on an average day.

- Go from the broad to the specific. If you wrote "family," what are you doing exactly? Are you hanging out, making meals, shopping, or driving kids to sports? If your vision retreat is focused on your career, write down your specific work activities.

- Circle the specific activities you would like to eliminate or do less of (see #7).

- Let your imagination go wild. Brainstorm how you can do more of the things you love, and less of what you dislike. Write down ways you could make small changes in your life now.

- Write out actionable steps you can take toward your goals, and put them into your day planner.

7. Honor Your Feelings. Don't talk yourself out of how you feel. If you hate cleaning, but you don't have a clue how you could eliminate it, just acknowledge your desire. Notice if you don't want to admit that you hate writing reports at work. If you can't even admit this to yourself, how can the Universe give you something different? Getting honest with ourselves is healing, and it's okay to ask for what you want.

8. Get Coaching. For longer retreats, bring along an inspirational audio-program, online mini-lecture, or meditation created by someone you admire. Or schedule a morning coaching call with your mentor each day to be guided through your vision process. Usually the first person that comes to mind is the right choice.

9. Stomp on the Box. Don't just think outside the box -- there is no box. Here are some questions to help you think big: A) If the world were to end next year, would you be happy about how you spent your time? B) Are you sharing your gifts and talents in the best way possible? C) Think ahead one year. If your life is exactly the same as it is now, will you be happy? D) What do you want people to say about you after you die? What's your legacy?

10. Let go. Remember this quote "The fastest way to make God laugh is declare your five-year plan." Planning gives us direction, clarity, and purpose, but ultimately we are co-creating with Spirit. Don't use this quote as an excuse to just go along with whatever comes, but do recognize that sometimes there is a better plan than the one we vision for ourselves. The point is to get clarity about our goals, and take action to achieve them.

Getting clear about what we want -- and don't want -- is an important first step in creating change.

I'd love to hear your thoughts in the comments below. When you're 103 in your rocking chair looking back on your life, what will make you smile out loud?

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Breaking the Silence: Mental Health Awareness Month in Beirut

Feeling empowered by the success of our recent mental health event at the American University of Beirut, volunteers from our mental health awareness group (WA3I/وعي) spoke with hundreds of high school students this week in Beirut to help open minds and erase stigma related to mental illness. As far as we know, our event Tuesday at the International College (a high school in Beirut) was the first time in Lebanon -- and possibly the Middle East -- that a group of speakers shared their personal mental health struggles before a high school audience. It was the perfect way to mark Mental Health Awareness Month in Beirut.

From the stage, our volunteers spoke in detail about issues never discussed in Lebanon in public: suicide attempts, self-injury, hospitalization, eating disorders, alcoholism, and drug addiction. Breaking the silence around these taboos is no minor task -- some revelations were met with gasps. With bold honesty and compelling humility, these brave speakers opened a door to dialogue and understanding.

In the question-and-answer period that followed (moderated by school counselor Dana Taher Mirza), one student asked how to be a good support for a struggling friend. Another asked if medication alone can bring relief. From the audience's positive feedback after the event, we realized we're on the right track. Around the world, awareness raising sessions like ours have been shown to increase mental health literacy and favorably influence the attitudes of young people.

My inspiration for this venture came from my experience volunteering for "Ending the Silence" -- an educational program of the National Alliance on Mental Illness (NAMI). When I helped run this program in New England, we arranged for volunteers of all ages to speak about their personal struggles with mental illness at high schools throughout Rhode Island and Massachusetts. Similarly, our WA3I awareness volunteers in Beirut are reaching out to young people in Lebanon to put a human face on mental illness and eradicate the stigma associated with it. Because our first high school event was so well-received, we've already received a number of invitations to do future events just like it.

In addition to the usual pressures of growing up, young people in Lebanon are forced to contend with a host of literal and figurative triggers: ISIS gun battles on the Syrian border, deadly explosions on the Israeli border, and suicide bombers blowing up in Beirut. In addition to the current chaos of the Syrian war, young people in Lebanon also live with the legacies of the Lebanese civil war. By advocating for more acceptance of mental health care, we're trying to help those who are struggling with mental illness -- or just the difficulties of daily life -- to get the support that they need.

While on the surface our mental health awareness work in Lebanon looks like an innovation, it's more like a reclamation -- since the first mental hospitals in the world appeared in the Middle East. In the medieval cities of Baghdad, Cairo, and Fez, the earliest psychiatric hospitals treated whomever was in need of care, and set no limit on the length of a hospital stay. Treatments included medication, recreation, rest, aromatherapy, music therapy, comedy performances, and even massage with sweet musk and myrrh (and chains when needed). One 10th century medication I came across in my academic research on this all-too-often forgotten topic was named: "the key to joy from every sorrow and the gladdening of the soul" (مفتاح السرور من كلّ الهموم ومفرّح النفس).

Since our young group in Beirut is the first public advocacy collective in Lebanon composed of people living with mental illness and their allies, we've been forced to contemplate a range of related issues: the Americanization of mental illness, the shortage of mental health professionals in Lebanon, the lack of insurance coverage for mental illness, local media coverage of suspected student suicides, the high frequency of migrant worker suicides in Lebanon, gender disparities in global mental health, and the general dearth of disability discourse in the Middle East. It's been thrilling and inspiring to watch these young trailblazers connect the dots.

Raising awareness about mental health is not just a regional imperative, but a global one. Mental illness affects people of all ages, and cuts through all race, class, gender, ethnic, and religious divisions. Our group alone consists of college students, graduate students, professors, and mental health professionals from a range of different backgrounds in Lebanon, Tunisia, Western Armenia, and America. In the sectarian minefield that is Lebanon, I've seen through our mental health events and my volunteer work at St. Jude's Children's Cancer Center in Beirut that coming together to confront physical and mental illness is one of the most effective and inspiring ways to transcend difference and find commonality in the vulnerability and mortality we all share.

Over the past few years, I've been saddened to see some of my students in Lebanon attempt suicide to escape their pain. I never could have imagined that I would eventually team up with them, as we've done this year in Beirut, to reach out and persuade others to get help. A constant refrain I'm now hearing from young adults in Beirut is: "We can change this -- our generation is different and more open-minded." Let's hope so -- because like so many other things in Lebanon, this too is a matter of life and death.

To learn more about WA3I, follow us on Twitter (@WA3ILebanon) and Facebook, or contact us at wa3ilebanon@gmail.com.



___________________

If you -- or someone you know -- need help, please call 1-800-273-8255 for the National Suicide Prevention Lifeline. If you are outside of the U.S., please visit the International Association for Suicide Prevention for a database of international resources.

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The Secret Diet Health Industry Professionals Don't Want You to Know About!

I would like to introduce to you the holy grail of diets: One that guarantees permanent weight loss and improved health one hundred percent of the time. One backed by decades of medical studies and clinical research, including exhaustive triple-double-blind studies yielding equal results each time. For years, nutritionists, dietitians, and other health professionals have been aware of this diet and its incredible efficiency, but never before has it been revealed to the public... until now.

The diet I am referring to is the CD diet, a secret among health industry professionals. Although the CD diet has been written about extensively in almost every major health and fitness publication, you are most likely still unaware of its existence. Due to the strength of its effectiveness, it is intentionally hidden under multiple names in order to mislead those that seek it out most desperately - the yo-yo dieters.

For the first time ever I will expose the hidden face of the CD diet and make it clearly recognizable to you so that guaranteed success may be found within your dieting efforts. The true form of the CD diet can be acknowledged under the aliases of the Paleo diet, the Vegan diet, the Gluten-free diet, the Mediterranean diet, the Intermittent Fasting diet, the Small-Frequent-Meals diet, and many others. Because they all work! All of the time!

At this point you are probably extremely confused and wondering to yourself, what exactly is the CD diet, and how can all of those contradictory diets use the same thing and guarantee equal results one hundred percent of the time? That's because the CD diet is composed of two magical words: consistency and discipline. Applied to any diet, consistency and discipline will guarantee you your desired outcome every time (within reason of course).

The Consistency and Discipline diet is the key to unlocking permanent, life-changing results. It is the only thing that explains how one person can lose weight eating a high carbohydrate and low fat diet, while another person can lose the same amount of weight eating a low carbohydrate and high fat diet.

It is not a matter of whether the Vegan diet versus the Paleo diet works better for weight loss; rather, it is a matter of which of those two diets work best for YOU -- and that's the diet that best suits your lifestyle, allowing you to stick to it in the long run.

Now that the secret has been revealed, the difficult part is choosing which one. This is particularly challenging because "best for you" has multiple meanings. The diet that works best for you is going to be the one that suits your lifestyle, budget, schedule, and the limitations of your self-discipline.

For example, one diet popular amongst millionaires is the PC diet (private chef diet). This diet consists of private chefs who pre-prepare gourmet meals designed to meet specific health goals. It has proven extremely effective and the results are lasting. But if you are not a part of the wealthy elite group that can afford this service, then this might not be the best option. Your budget cannot sustain it.

Likewise, many people have heard that eating small frequent meals is the best means for weight management. But if you are someone with an insanely busy schedule and limited opportunities to eat throughout the day, the stress of trying to squeeze in six smalls meals will most likely not be a sustainable diet plan.

Selecting the diet that works best for you also means choosing the one that best suits your body type. If you are someone with a slower metabolism, then the vegan diet might not be the best choice because it is generally higher in simple sugars and carbohydrates. Those two nutrients are the most easily overeaten and commonly result in weight gain. This is due to the fact that most simple sugars and simple carbohydrates are higher in calories and less filling.

The solution to this problem is simpler than it may seem. It initially requires an investment of time and energy to get to know your body type and to figure out which dietary habits are sustainable for you. Don't be discouraged by this step. Of all the things one can choose to invest time and energy into, health deserves to be towards the top.

What works best for most people is a middle of the road approach. The extreme dieting types like the ones that omit hours of the day you can eat (intermittent fasting) or eliminate whole food groups (Vegan, Atkins, Ketogenic) are the least likely to be sustainable. It is difficult to continuously apply consistency and discipline to these intensely restrictive diets.

And it is the consistency and discipline that are critical for longevity.

When the consistency is lost, so are the results. Maybe you shed 10 pounds on your 7-day juice cleanse. But after a few happy hours and endless h'ordeuvres, you'll gain an additional 15 pounds back by the end of the month.

Equally, if the discipline is lost, then the goal is likely never to be obtained at all. Many people attempt the Ketogenic diet -- which excludes all simple sugars and carbohydrates, including those from fruit and 'high sugar' vegetables like carrots, beets, and tomatoes--hoping for expedient weight loss. This hardly seems sustainable for a life long dieting practice. For most, this can be religiously followed for about a week, maybe two for the super-dedicated, and then a sugar craving emerges and all of the progress made goes out of the window following a pizza and ice cream binge.

Choose a diet with guidelines by which you can apply consistency and discipline. The decision could be as simple as minimizing processed and packaged goods in order to eat more whole foods like fruits, vegetables, nuts, and meats. Save the alcohol and sweets for the weekend. This easy common adjustment is often referred to as a 'detox'. However I recommend against holding this perspective. Detoxes are not the language of permanent behavior change, because a detox generally has an end date.

In order to develop lifelong, healthy dieting practices, permanent behavior change backed by consistency and discipline should be your new goal. By making small positive adjustments to your diet, you can eventually transform the way you eat in order to create a healthier happier person.

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10 Things Dr. Seuss Can Teach Us About Life

I've always been a huge fan of Dr. Seuss. His stories provide a great message on many different levels. As a parent, the morals I found within his writings enabled me to teach my kids many valuable lessons. As I got into the business world, it was me who learned invaluable lessons as I read quote after quote from Dr. Seuss.

Life can be funny, from here and to there
And success is a sliver as thin as fine hair
So how can you find it, searching high, seeking low?
Precisely how to grip it, it's so hard to know
It's the ultimate quest we search for each day
In clue corners and hint houses the answers they lay
I'm quite sure the solution can be found here by you
Through the quotes of the creator of Thing 1 and Thing 2
So read on blog readers, keep your brains nice and loose
As you study the musings of that man Dr. Seuss.

"Think and wonder, wonder and think." -- Dr. Seuss
Take time to get deep in your thoughts. Expand your "what-if" possibilities. You can accomplish great things if you give yourself freedom to spend time thinking about the limitless possibilities.

"Only you can control your future. -- Dr. Seuss"
Although you will have lots of supporters, cheerleaders and guides along the way, it is you that is in control of your future and no one else. Don't rely upon others to believe in your dreams more than you do. Your future belongs to you and it is up to you to control it.

"Unless someone like you cares a whole awful lot, nothing is going to get better. It's not." -- Dr. Seuss
Don't just do. Care as well. Be conscientious, mindful and caring when you take your journey. There will be many delicate things in your wake. Be aware of your surroundings and while it is great to have focus, don't lose sight of the role you play in making this world a better place to be.

"Adults are just outdated children." -- Dr. Seuss
Don't forget to have fun. Be playful and enjoy life. All work and no play leaves little room for fun in your life. Have fun and enjoy the ride.

"Whenever things go a bit sour in a job I'm doing, I always tell myself, 'You can do better than this."' -- Dr. Seuss
There will be times when things go perfectly well. And then there will be times when things aren't perfect. Understand, you have plenty of room for improvement. Be open to make changes along the way. Be flexible enough to make changes quickly. Be wise enough to know when change is needed.

"Why fit in when you were born to stand out?" -- Dr. Seuss
Being unique, special and totally YOU is awesome. There is no one better at being you than you. When you play your role well, with confidence and without hesitation, you will succeed not just in business, but in life as well.

"To the world you may be one person, but to one person you may be the world." -- Dr. Seuss
There are people in this world that need you, including your kids, your family, your friends and your supporters. Never lose sight that you may only be one person, but you are very important person. You have an impact in this world and it is impressive.

"Sometimes the questions are complicated and the answers are simple." -- Dr. Seuss
Don't get so caught up in asking so many questions that you don't move forward for lack of knowing all the answers. You will never know everything. Keep moving, keep smiling and keep loving life as you take your journey.

"A person's a person, no matter how small." -- Dr. Seuss
There is no such thing as an insignificant life. Everyone from the stockroom employee to the CEO plays a vital role in business. Stay humble, keep humility in your heart and keep your ego in check. Never look down upon someone and feel you are better than they are. The bigger your position within an organization, the more aware you need to remain of everyone on your team.

"And will you succeed? Yes you will indeed. 98 and ¾ percent guaranteed." -- Dr. Seuss
Think it into existence. Goal setting, visualizing and charting your path from here to there are essential steps towards success. You have greatness within you and you have control over your future. The only reason you will not succeed is if you quit. Stay in the game, have a positive attitude, stay consistent and be persistent. You will succeed.

You've got this, quite surely, success is your friend
It's not hiding from you, it is just 'round the bend
It's your job, you see, to keep up the pace
We know you're a winner, so go win this race
Life is a journey, for all of us here
We've got feelings and emotions, we've got worries and fear
If we do it together and walk hand in hand there
From the bottom of our toes, to the top of our hair
Be a lover of life, work hard and play harder
Ambition and good luck come to those who are smarter
As we finish this story of Seuss and his words
May your dreams soar to heights with the highest of birds.

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How Do You Want to See the World?

When you leave old thinking behind, anything is possible.

-- by Linda Bloom

I am a recovering pessimist. I grew up in a family that had a basement freezer crammed with food and cases of canned goods stacked against the walls. All this hoarding was preparation for the economic or political disaster that my parents were certain would occur.

I grew up hearing stories about my grandfather's assault on a Russian army officer who had taunted him with anti-Semitic remarks. As the story goes, he then fled and deserted the military, leaving Russia to emigrate to the United States. There were stories about the pogroms and violence that occurred in the old country, particularly on Easter Sunday, when angry neighbors took it upon themselves to punish the "Christ killers." There was also a steady stream of stories about all of the relatives who perished in the Holocaust because they didn't leave Europe in time.

My parents' caution was well-meaning, but it left me with a sense of anxiety and a pervasive belief that doom and catastrophe are always right around the corner.



When I left for college, I thought that I had been admitted by mistake, and didn't think I would graduate. I expected failure. I expected to fall in love but also that I would probably be left by my beloved. But I had no idea that my general attitude was deeply pessimistic -- I just thought it was realistic.

By studying psychology and human development, I came to understand that we all form protective beliefs, and that these beliefs can be modified. What a concept! I put the theory to the test and was delighted to discover that it was actually possible for me to change my thinking. With concerted effort, my rich imagination -- which had been catastrophizing -- started to envision successful outcomes for the scenarios I anticipated.

So much of my happiness now is a result of my efforts to put my inner pessimist in his place. When he sneaks onto the scene and starts spinning his fearful scenarios, I know that he is just doing his job to protect me by preparing me for trouble. But these days I talk back. I say things like, That may or may not happen. Thank you for sharing, but I choose to believe that things will turn out well.

I've had losses and tragedy in my life; every life has to contain its share of joys and sorrows. I have come to trust that it is possible to make a full recovery from some ordeals, and at least a partial recovery from the even most devastating blows. To waste precious life energy worrying about what might happen is unproductive and can even become self-fulfilling. I now know that I have choices. I still have to exert effort when pessimistic thoughts arise. But with experience and practice, it has become easier to trust that things generally do work out--and not necessarily in the way in which I expect.

Some people see optimists as "Pollyannas," believing they are in denial about reality. Of course optimism can be taken too far. But those who criticize optimists are often pessimistic themselves, and believe that they are stuck with their attitudes for life. Maintaining optimism as a life view is a much more harmonious way of living. Despite some negative experiences, I see people as being basically good, the universe as a friendly place, and nature as trustworthy. So much of my energy that used to be used defensively has now been freed up for more creative pursuits.

If you think that your own beliefs and attitudes are fixed, I challenge you to reassess, and dare to believe in the possibility of transforming the darkness of pessimism into a more hopeful outlook. Working with our attitudes and beliefs is an essential part of cultivating the art of joyful living. Don't take my word for it; give it a try and see for yourself. You may be in for a pleasant surprise.

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Liquid Diets Are Not My Cup of Tea

Who remembers Carnation Instant Breakfast? You just needed to add milk or water to these nutritious, artificially-flavored, sugar-laden meals-in-a-packet. My mother drank them before she took off for work. I drank them before I took off for school. We both tolerated the taste in the spirit of fast, nutritious and calorie conscious consumption. It's still in the marketplace along with an assorted other liquid meal options.

Flash forward. Today, I dread the idea of liquid meals. They remind me of being ill or watching my sick father consume Ensure (also a nutrient-dense but sugar-laden drink) during his hospice days. Sure, I enjoy drinking smoothies, sipping soups and hydrating with fresh juices. But I also find pleasure through mastication, so I can't tolerate the idea of a living on a liquid-intense diet for my nutrients.

What amazes me is all the smart, healthy people who are turning to liquid meals as replacements for the real deal meal. My inbox is flooded with offers and books on juicing-detox diets. The health food stores stock shelves filled with powdered concoctions to boost your metabolism, add protein and help detox your system.

The last straw to hit me is an article in the May 25, 2015, edition of The New York Times on how time-pressed Silicon Alley entrepreneurs and wonks are drinking liquid meals by the gallons. Who has time to eat when you're working on the next big tech thing? This quote really struck a nerve with me:

"The time wasted by eating is, in Silicon Valley parlance, a 'pain point' even for the highest echelon of techie. Elon Musk, Tesla's founder, once said, "If there was a way that I couldn't eat so I could work more, I would not eat. I wish there was a way to get nutrients without sitting down for a meal."

This is comment from someone who is considered a thought leader. I'd like to see him put the brakes on the idea that eating is a waste of time. In auto talk: Eating provides fuel for your body. Why would you put second rate fuel in a first rate body?

Too busy to eat? What kind of message does that send? More important, think about the cracks it puts in the family table, the art of dinner conversation and the pure pleasure of consuming a great meal?

Juicing loyalists says a fresh liquid diet boosts your energy, cleanses your system and makes your skin glow. I've tried juicing, meal replacements, energy boosting drinks and protein packs all in the spirit of health and wellness. I'm not knocking what I haven't tried, and I really have tried to go the juicing route. I just don't find the appeal of a liquid meal as pleasurable as eating -- and chewing -- real food. I'd rather boost my energy taking a walk outside, doing yoga, getting a good night's sleep and eating a delicious meal prepared with farm fresh vegetables and fruits and lean proteins.

I'll take a gnaw over a straw any day, I enjoying masticating my food and plan to do so until the day comes when I have no teeth. Chew on that!

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The Coffee Complex

For many of us, coffee is what gets us out of bed in the morning. It is the magical substance that gets us going -- that gets us doing. According to the National Coffee Association's 2015 Survey, 59 percent of American adults drink coffee on a daily basis. Admittedly, I am one of these people.



My first exposure to coffee occurred at a very young age, when I was maybe 6 or 7. My mother has been an avid coffee drinker for as long as I can remember, and she used to let me sip the watery remains of her iced coffee once she was finished. As I got older and entered teenage-hood, my father would brew me hot coffee to go, which I would take to school in a silvery thermos. Then my obsession with Twin Peaks inspired me to try black coffee, which I began ordering at cheap diners, drinking the piping hot liquid out of thick mugs.

A little over two years ago, my relationship with coffee changed drastically, as I began to experience chronic fatigue as a result of a viral illness. Caffeine became a form of self-medication more than anything else. Today, the promise of a jolt of energy remains all too tempting. When my energy level is artificially improved, I begin to feel more like my happy, authentic self. I can "do" things: make a phone call, go for a short walk or hang out with a friend. I can feel somewhat productive.

As someone with chronic fatigue, I often wonder where I fit in to our culture of productivity. Our society, generally speaking, is result-biased; we are rewarded for the things we create or achieve externally (i.e. earning a diploma, getting a new job, writing a novel, buying a house, etc.) While all of these milestones are wonderful achievements to be celebrated, I can't help but think how our result-oriented society is rather exclusionary. What about those who are not able-bodied, for whom brewing a pot of coffee in the morning is a struggle? How can we measure their self-worth?

One alternative would be to place introspection on equal ground with external achievement. Imagine a world where people were praised for attending to their mental (and physical) health before they were celebrated for landing that promotion. A world where simply "being" was as important -- if not more important than -- "doing." A world where "feeling" was on par with "thinking."

This may sound like an absurd, utopian vision, one that is quite un-American. After all, we are a nation of doers, achievers and coffee drinkers. But I would like to see us find a balance between the internal (our thoughts and feelings) and external (our actions).

Perhaps a more realistic goal would be to redefine "being productive" on an individual basis. For some, being productive might mean getting out of bed in the morning. For others, the same could mean writing a ten-page paper. Embracing this fluid scale of productivity would empower those who do not fit the able-bodied stereotype. Eventually, we could begin to break down the shame perpetuated by ableism.

So how does this all relate to coffee?

Unconsciously, I have been using caffeine as a means of conforming to the ableist ideal of productivity. This can be dangerous, as drinking coffee can actually lead me to overexertion. In other words, I am fooled into thinking I can do more than my body is able.

I don't know when or if I will stop drinking coffee, but I will begin to use the substance with more awareness. I will allow myself the time and space to heal both my body and mind. I will give myself permission to do only what I can, and to feel a sense of accomplishment even on days when I do absolutely nothing. I will step back and simply "be."

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4 Ways My Life Changed in 4 Years of Sobriety

I painted this mug four years ago on May 25, 2011. I was hungover, shaking, and scared as I painted these lyrics from the song Fee by one of my most favorite bands, Phish. The three days prior, despite the promises I made to myself, I spent drinking and feeling completely powerless over alcohol. I did not know it then, but that was the first day of my sobriety. Soon after, through a series of synchronicities and miracles, I was guided into the open arms of a fellowship and to a sponsor who worked the 12 steps with me. She encouraged me, while also calling me on my crap so I could grow and transform into the woman I am today, or as our linage says: "A woman of dignity and grace."

These past four years have been quite the ride, and in this blog I am going to share four ways that my life has transformed in my recovery. Before I dive in, I wholeheartedly acknowledge and honor that there are different recovery paths. I believe if there is a path that resonates and keeps you clean, then power to you -- keep on truckin'. This is simply my experience.

Miracle One: Goals and dreams seamlessly came into fruition. 

I used to create goal lists all the time, and yoga teacher training would always be in the top three. I didn't even really have a regular yoga practice and I certainly was not in union with my body and my heart. I believe now that something deep in my soul knew that one day teaching yoga would be a purpose, passion, and dharma of mine. However, at that time, I could never get my act together to really save for the training or do the research to find a program and teacher that I loved. When I was three months sober, an opportunity to embark on a 200-hour teacher training path basically fell into my lap at a rate I could afford with an organization that I was passionate about. I have been teaching ever since and feel aligned and connected through this work. I have immense gratitude that I have never stepped into one of the yoga classes that I guide foggy or hungover. This is one of the many miracles that causes me to me to gratefully, humbly, and wholeheartedly bow at our final Namaste.

Miracle Two: I acquired Integrity.

There were periods in my drinking days when my Thursday-Sunday self could not keep up with the more efficient and productive Monday-Wednesday self. I would change appointments, flake on people, and procrastinate because I was either partying or feeling ill. One of the biggest initial shifts, besides feeling energized and having extra cash, was knowing that I would show up for something and follow through. In early sobriety I used to make plans or tell someone I would have something done by a certain time and part of me would think: "Will this really happen?" After time, I began to trust in my capacity to follow through.

Miracle Three: I learned how to set boundaries.

I learned how to communicate my truth clearly and compassionately and let go of the outcome and response of others. I learned that I can't take responsibility for other people's feelings, and reactions. All I can do is be truthful and keep "my side of the street" clean. This one is not easy, and I am still practicing it. The first couple of conversations I had that fell under this umbrella were terrifying. I was, and still am, blessed with angels in the form of my sponsor, therapist, soul sisters, and spiritual running buddies who guide me and illuminate the trail that they so bravely and gracefully blazed before me.  It gets a little easier each time I have to be direct to someone about what does or doesn't work for me. As I walk through the uncomfortable feelings and the fear, I dive more deeply into my power and my truth. And now, I get to be one of those Angels in the lives of the lovely souls just embarking on their path.

Miracle Four: I cultivated a true relationship with Spirit.

Call it The Divine, Higher Power, Universe, or as author Tosha Silver writes in Outrageous Openness, "The Force that keeps the birds aloft in the sky." My relationship to this Higher Power is the single most important piece of my recovery. I learned how to make conscious contact with this Force in my life through daily prayer and meditation. I feel Divine connection within and experience sychronicities, coincidences, and "God shots" often.  I learned how to turn it over, offer it up, surrender and trust.  Even when the storms of life do arise I feel supported, connected, held and never alone.

My favorite of the many slogans I have heard is: "Stick around for the Miracle." For me, there has not been once single moment where the sky parted and I was healed and transformed. There are, however, small but consistent shifts into a new way of being. My willingness to do the work, follow suggestions, and prioritize my spiritual practice are like little miraculous specks of kindling that fuel a Devine fire that keeps steadily burning within. The obsession to drink has been lifted and I can thrive in sobriety in many situations from the most tame of cocktail parities to (yes), even a Phish concert.

I wish you all a fun, connected, and miraculous start to your summer.

Namaste,

Carolyn Jean

I am a certified Life Coach and I also teach yoga in the San Francisco Bay Area. http://ift.tt/1DIEuBj

Need help with substance abuse or mental health issues? In the U.S., call 800-662-HELP (4357) for the SAMHSA National Helpline.

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The Criminalization of People With Mental Illness in America: A Matter of Human Rights

It proved to be a bittersweet Mental Health Awareness Month this May 2015. As mental health advocates posted articles and assembled educational community forums, Human Rights Watch shocked America with the truth. A 127-page investigative report describes a criminal justice system in America and its use of excessive force, even systemically brutal and malicious. The report, "Callous and Cruel: Use of Force Against Inmates With Mental Disabilities in US Jails and Prisons," charges in no uncertain terms that, "Jails and prisons staff throughout the United States have used unnecessary, excessive and even malicious force against prisoners with mental disabilities."

According to Jamie Fellner, U.S. program senior advisor at Human Rights Watch and author of the report, "Force is used against prisoners even when, because of their illness, they cannot understand or comply with staff orders." The report is essentially a compilation of the multitude of individual cases and class actions, Justice Department investigations and interviews with over 100 correction officials and use of force experts. The report includes the death of Damen Rainey, a 50-year-old inmate who was locked in a shower, which according to the Miami Herald, "had been converted to a torture chamber at Dade County Correctional Institution." Additional alleged atrocities uncovered by The Herald describe a pervasive culture of mental and physical abuse, which includes a starvation squad, racial beatings, sexual assaults and threats of retaliation if complaints were filed. The Department of Justice and FBI are investigating.

One can understand why Broward's pioneering Mental Health Court was established as a human rights model. With the release of this latest Human Rights Watch report, it is more than fair to say that all mental health courts should embrace a human rights framework. So what does that mean? It means that although, for example the U.S. has not ratified the U.N. Convention on the Rights of Persons with Disabilities those fidelities can become aspirational values and embedded within the court process. That dignity is promoted and due process and equal rights under the law protected. It means that individual substantive constitutional rights are preserved and all statutory entitlements and legal protections against abuse, neglect and harm are advanced. Further, a human rights orientation respects individual choice and ensures these principles of dignity and self-determination are braided through all operational and procedural constructs of the court process. More importantly, there is authenticity and urgency to the court's therapeutic mission of diversion from the criminal justice system to community based system of care. Of course, public safety and victim's rights are paramount judicial considerations which must be balanced.

America stands at a crossroads. As the Human Rights Watch report informs us, jails and prisons are unsuitable substitutes for psychiatric hospitals or residential programs. They can be dangerous and potentially deadly. In America, hundreds of thousands of people with serious mental illness are being housed in our nation's jails and prisons. Many due to untreated mental illness, stigma and severely underfunded and fragmented state-wide systems of behavioral health care.

It is true, prison guards and jail correction officers are not trained social workers or mental health practitioners. The use of excessive force and other abusive practices must be investigated and perpetrators held accountable. The criminalization of people with serious mental illness has been a source of epic human suffering, victimization and economic loss. It is worthy to note that Florida, the 3rd largest state, has defiantly rejected Medicaid expansion funds and stands at 49th funded in the United States. The correlation between failed governmental policies of deinstitutionalization and the resulting criminalization of people with mental illness is well settled.

It is beyond time to reject criminalization as an acceptable substitute for the funding and development of qualitative and recovery focused community based systems of care. It is time to recognize that America's human stain -- is one of basic human rights.

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The Pain I Didn't Think I'd Survive

April 25th is the birthday of my third son. His name was Roger, because that was the name one of my other little boys, who loved Roger Rabbit, gave to him. He died before he was born, and I gave birth to him knowing that he was already gone. My partner and I held him in our arms and said goodbye for a while, and then they took him away and we didn't see him again.

We hadn't planned that pregnancy; we were hopped up on hormones and new love and an overly-optimistic belief in the diaphragm-plus-rhythm method. My partner was pretty young, just at the start of his career, and we hadn't been together long, so it was very scary for him. Still, we welcomed and loved our baby and got very, very excited about adding our own child to the little family we had with my boys.

Everything seemed fine. Then I got a terrible "flu" that I couldn't shake. My temperature was raging and I knew it was worse than a flu should be. I went to my general practitioner, but she dismissed me angrily, saying I ought to know what the flu was. She told me to take paracetamol and said my baby and I would be fine.

The flu-like symptoms cleared up and I went and had a routine blood test. The hospital called me up on a particularly happy and hopeful trip in the country with my partner and the kids and asked me to come in for a scan. I had no fears at that stage, but when I got to the hospital, the doctor looked at the monitor and told me, very kindly and gently, that our baby had died in the womb, that they would try to find out why, but often, it "just happens," that they would give me a pill to induce me and then, because I was already at five months and he was big, I would give birth to him in a couple of days.

I've always tried to be in control, especially in public places, but I howled and cried uncontrollably for a while. Then, my partner and I tried to get on with things. We told the boys, who had been so thrilled about the baby, and comforted them. We did the house painting we'd planned just for something to do. We watched endless episodes of "Spaced" to try to laugh and snap out of it. We did what we could.

I passed the ensuing days in a tuned-out state and went to the hospital feeling numb. My boys had been born by caesarean, so it was my first natural delivery. Because there was no need to protect the baby, they gave me morphine when the pain became great. It meant that when I was holding him, I was half-drugged and dreamy. But I still remember. The hospital staff at UCH, who could not have been kinder to us, encouraged us to take pictures with our baby, as apparently, it would help. I have to say that later -- strange as it may seem and as tragic as those pictures were -- it did.

Then began a strange time of waiting for results. It mattered in case it was something that would affect another pregnancy. They found nothing. I had to wait for my results in the baby wing, looking at pictures of happy babies, until the nurses found me crying and hustled me somewhere else. They thought I might like to see him again, and I had a desperate desire to do so, but then they came back and said that he had changed and it wouldn't be a good idea. They gave me tiny doll's clothes for his funeral and they arranged it for me. I went home feeling completely lost.

I then threw myself into planning his funeral. It seemed so silly in some ways, but it meant a huge amount to me. I invited my best, most beloved friends. I planned the music carefully. I still can't hear the Barber Adagio without feeling weepy. Somehow I wanted the funeral to take the pace of the christening that should have been, to commemorate Roger. He was cremated and after some time I collected his ashes, alone in my car, and brought him home.

We planted a cherry tree in the house we had in the country. I poured out his ashes in the roots. I wanted the tree to grow and to blossom every year. The tree would be a living manifestation of Roger. Over the next weeks, that tree became such a comfort to me. I tried to get on with normal life, but I'd find myself at a party in London and just be seized with the need to get away, to get to Roger's tree, to water it and make sure it was thriving.




UCH had a church service for all those parents who had lost babies in the womb, like Roger, or who suffered a miscarriage. People read poems. I cried a lot. It helped.

Then, after a few weeks, I got worse. I stopped coping. I'd been trying to get back to being fun, jolly, to make myself attractive to my partner, to drive us all past it. It stopped working. First, I was assailed by fears: that my partner would leave me; that the baby had been the glue that stuck us together; that Roger's death was, in a thousand ways, all my fault; that I was a failure and unlovable. I could see that though we had been close before, my partner was drawing away into his own ways of coping with his friends, which didn't involve me. And, then, even worse, I was continually and unexpectedly hit by waves of pain, thinking, feeling, shouting inside my head, "where's my baby?" I had thought my divorce a few years prior had been painful, but I would cheerfully relive that pain a thousand times again to have my baby back. I had horrors. I had dark dreams. I had never experienced anything like it. I swung between managing to fool myself that I was all better and the plunging into the blackest, weeping despair.

My relationship did indeed break up, in the way of all self-fulfilling prophecies. The doctor gave me Prozac and it made me swell up like the Elephant Man and end up in A&E on a drip. I drank a bottle of tequila, despaired and called a help line. I called the Samaritans. They were amazing. But the darkness didn't go. I became very worried about myself. I was very, very alone with my little boys, trying to pretend for them that it was all OK in the day, then falling apart after every bedtime.

I was lucky. My sons were due for a summer holiday with their father and my mother took a couple of weeks with them too. I got myself a backpack and went off on a low-budget, grassroots group tour of Indochina. The first night I broke down crying in a Bangkok bar listening to Eric Clapton's "Tears from Heaven," about the loss of his son. A nice chap in the group said, OK, spend this evening telling me all about it, then try to put it all away for the rest of this trip. I did that. It got better.

I was then consumed with moving, traveling, seeing things and being with people. I fell into a highly unsuitable passing relationship with a funny surfer guy; swam for my life against a riptide and then nearly drowned in diving accident; got pneumonia and spent days on a drip in a hospital in Phuket. It was all kind of crazy, in so many ways, but it was living again, and focused me on how much I wanted to survive.

When I got home, my partner was waiting for me. My boys were well and happy to see me. We were among the most fortunate. We had another baby, a beautiful daughter so incandescent in her wild and creative way that I can't believe I produced such a magical creature. Life went on and became, after a few more minor bumps, very happy indeed.

When we sold the house in the country, we dug up the tree and its roots and the earth around it and brought it to where we lived in London. We planted the tree in the garden and for a few years, I prayed for Roger there every year on his birthday. The children know it's his tree. But the sad, or perhaps the happy, healthy thing, is that now we forget. We forget his birthday. We forget that we lost him. Day to day, he's left us, and our focus is with the living. While sometimes I feel guilty about that, I think it's perhaps a sign that we are designed to heal, to forget, and get over even the worst pain. I know there are people who suffer much more than I have done, who lose children they have known and loved. I cannot imagine that pain. But I have felt a pain that I thought I couldn't survive and in my own -- perhaps rather odd -- way, found a way to do it.

Only after I felt able to talk to other women about my experience did I learn that sudden antenatal death syndrome is common. Since experiencing it, I've seen it discussed on "ER" and "Grey's Anatomy" and that helped me, too. I think we need to talk more openly about these things. To share our losses so we don't feel so alone and to share the ways we've dealt with it. It would have helped me, and my partner, if we hadn't felt so alone in our loss, and if we had been able to find, in others, a compass to guide us back to normal life. This common loss, this secret pain, is better when brought out of the darkness and into the air.


Need help? In the U.S., call 1-800-273-8255 for the National Suicide Prevention Lifeline.

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