Mexico Swine Flu Epidemic Worries World
Swine Flu Deaths in Healthy Young People Raise Fears of Pandemic
By Daniel J. DeNoon
WebMD Health NewsReviewed by Louise Chang, MDApril 24, 2009 -- Mexico's deadly swine flu outbreak is caused by the same virus identified in the U.S., says CDC Acting Director Richard Besser, MD.
The CDC is analyzing 14 virus samples sent from Mexico. Seven of them, the CDC learned today, are very similar to the unusual swine flu strain isolated from U.S. patients.
Swine Flu Outbreak:
Get the Facts
Get the latest swine flu information from the WebMD and the CDC, plus other facts you need to know.
Swine Flu FAQ
CDC Swine Flu updates
Swine Flu Case Count Rising
Swine Flu Sickens 2 California Kids
© 2009 WebMD, LLC. All rights reserved.
"People are concerned about this situation," Besser said at a news conference. "We are worried as well. Our concern has grown since yesterday."
Sixty people in Mexico have died of the flu -- and so far, 16 of the deaths are confirmed cases of swine flu, news sources quote Mexican officials as saying.
World Health Organization spokesman Gregory Hartl told the Canadian news agency CBC that there have been some 800 cases in Mexico City, where schools are closed due to the outbreak.
Alarmingly, the flu outbreak in Mexico is striking healthy young people -- a pattern that would be expected if a flu virus new to humans emerged.
"Because these cases are not happening in the very old or the very young, which happens with seasonal influenza, this is an unusual event and a cause for heightened concern," Hartl said in a CBC interview.
That's not the only eyebrow-raising feature of the swine flu outbreaks. Infections have occurred in Mexico, California, and Texas -- where warm weather should mean the end of the normal flu season, says William Schaffner, MD, president-elect of the National Foundation for Infectious Diseases and chair of preventive medicine and infectious diseases at Vanderbilt University.
"Will we see this flu virus transmitted in the warm months? That would give us heartburn," Schaffner tells WebMD. "And is this a harbinger of things to come during our next flu season?"
Another disconcerting feature of the outbreak is that it's probably too late to contain it to limited geographical areas.
"We are seeing cases in Texas and California with no connection between them. This makes us think there has been transmission from person to person through many cycles," Besser said. "For containment we need limitation to a confined geographical area, and we have not seen that here."
The World Health Organization is convening an expert panel to determine whether to raise its pandemic flu alert level. Because of bird flu, we're at level 3. If the panel finds evidence of "increased human-to-human transmission" it goes to level 4. If there's evidence of "significant human-to-human transmission," it goes to level 5.
A pandemic will be declared only if there is "efficient and sustained human-to-human transmission" of a new flu virus. That clearly has not happened yet.
"Whether or not this [swine flu] strain causes a widespread pandemic will depend on its transmissibility among humans. That has not yet been fully elucidated, but should be shortly," Pascal James Imperato, MD, MPH, professor and dean of public health at SUNY Downstate Medical Center, Brooklyn, N.Y., tells WebMD.
Should there be a pandemic -- something that is far from certain -- the CDC has already begun work on a vaccine. Would it be ready by next flu season?
"It would be an Olympic sprint -- a mammoth feat -- to produce a flu vaccine by October," Schaffner says.
What You Should Do Now
Infectious disease experts agree with the CDC that now is a good time to think about what you'd do if there were a widespread flu outbreak.
Here's what you can do right now: Wash your hands often and well.
The CDC has not yet warned travelers to avoid the San Diego or San Antonio areas, and it is not restricting travel to or from Mexico. However, travelers to or from those areas should be sure to use all normal precautions to avoid catching or spreading a cold or flu.
People who live in or visit those areas and who get flu-like symptoms should see a doctor to get tested for the swine flu virus.
Monday, April 27, 2009
Swine Flu FAQ
Swine Flu FAQ
WebMD Provides Answers to Your Questions About Swine Flu
By Daniel J. DeNoon
WebMD Health NewsReviewed by Louise Chang, MD The swine flu virus in the U.S. is the same one causing a deadly epidemic in Mexico. What is swine flu? What can we do about it? WebMD answers your questions.
What Is Swine Flu?
Like humans, pigs get the flu. Four different type A swine flu strains commonly circulate among pigs. Most recent swine flu viruses have belonged to the H1N1 and H3N2 subtypes. Pigs typically get sick but usually don't die from swine flu.
The new swine flu virus infecting humans is very unusual. It's somehow acquired genes from swine, bird, and human flu bugs. And it's also got genes from Eurasian swine flu viruses that aren't supposed to be in North America.
Do Humans Get Swine Flu?
Normally, swine flu bugs don't infect people. Historically, there's a case every year or two in the U.S. among people who have contact with live pigs.
But from December 2005 to January 2009 there was an uptick in swine flu cases. There were 12 human swine flu infections during this time. Eleven of these people had direct or indirect contact with pigs; in the twelfth case it was not known whether there was pig contact.
It's possible this uptick was due to improved reporting systems, but the CDC says "genetic changes in swine flu viruses and other factors might also be a factor."
The new swine flu virus is different. It's not yet clear that it's here to stay. But it is infecting humans, and that has world health officials keeping a close eye on it.
What Are the Symptoms of Swine Flu?
Swine flu symptoms are similar to regular flu symptoms and include cough, sore throat, fever, chills, headache, and fatigue. Some patients have also reported nausea and diarrhea. There is no easy way to distinguish swine flu from other types of flu or other germs. It takes a lab test to tell whether it's swine flu.
Can Swine Flu Spread From Person to Person?
The U.S. residents infected with swine flu virus had no direct contact with pigs. The CDC says it's likely that the infections represent widely separated cycles of human-to-human infections.
Have There Been Previous Swine Flu Outbreaks?
If swine flu sounds familiar to you, it's probably because you remember or have read about the 1976 swine flu outbreak at Fort Dix, N.J., among military recruits. It lasted about a month and then went away as mysteriously as it appeared. As many as 240 people were infected; one died.
The swine flu that spread at Fort Dix was the H1N1 strain. That's the same flu strain that caused the disastrous flu pandemic of 1918-1919, resulting in tens of millions of deaths.
Concern that a new H1N1 pandemic might return with winter led to a crash program to create a vaccine and vaccinate all Americans against swine flu. That vaccine program ran into all kinds of problems -- not the least of which was public perception that the vaccine caused excessive rates of dangerous reactions. After more than 40 million people were vaccinated, the effort was abandoned.
As it turned out, there was no swine flu epidemic
I Got a Flu Shot. Am I Protected Against Swine Flu?
No. There is currently no swine flu vaccine.
It's possible that the seasonal flu vaccine might provide partial protection against H3N2 swine flu bugs. But the strain that appeared in California is the H1N1 swine flu strain. It is very different from the H1N1 human flu strain included in the seasonal flu vaccine.
It's not known whether previous infection with human type A H1N1 flu might provide partial protection against the type A H1N1 swine flu in the current outbreak.
However, the CDC has made a "vaccine seed" from swine flu isolated from an infected person, and has begun the process of developing a vaccine should the need arise. Whether a vaccine could be produced in quantity by next flu season is a huge question.
How Serious Is the Public Health Threat of a Swine Flu Epidemic?
Any flu epidemic is worrisome, especially when a new strain of flu bug is involved.
"Influenza A viruses new to the human population that are able to efficiently transmit from person to person and cause illness may represent a pandemic threat," the CDC warns.
It's worrisome that, unlike seasonal flu, the swine flu outbreak in Mexico is attacking healthy young people. That's a hallmark of pandemic flu bugs.
But it takes more than a new virus spreading among humans to make a pandemic. The virus has to be able to spread efficiently from one person to another, and transmission has to be sustained over time. In addition, the virus has to spread geographically.
Is There a Treatment for Swine Flu?
Yes. While the swine flu bug is resistant to older flu medicines, it remains sensitive to Tamiflu and to Relenza.
Can You Get Swine Flu by Eating Pork?
No. You can only catch swine flu from being around an infected pig -- or, if it's the new swine flu virus, from an infected person.
WebMD Provides Answers to Your Questions About Swine Flu
By Daniel J. DeNoon
WebMD Health NewsReviewed by Louise Chang, MD The swine flu virus in the U.S. is the same one causing a deadly epidemic in Mexico. What is swine flu? What can we do about it? WebMD answers your questions.
What Is Swine Flu?
Like humans, pigs get the flu. Four different type A swine flu strains commonly circulate among pigs. Most recent swine flu viruses have belonged to the H1N1 and H3N2 subtypes. Pigs typically get sick but usually don't die from swine flu.
The new swine flu virus infecting humans is very unusual. It's somehow acquired genes from swine, bird, and human flu bugs. And it's also got genes from Eurasian swine flu viruses that aren't supposed to be in North America.
Do Humans Get Swine Flu?
Normally, swine flu bugs don't infect people. Historically, there's a case every year or two in the U.S. among people who have contact with live pigs.
But from December 2005 to January 2009 there was an uptick in swine flu cases. There were 12 human swine flu infections during this time. Eleven of these people had direct or indirect contact with pigs; in the twelfth case it was not known whether there was pig contact.
It's possible this uptick was due to improved reporting systems, but the CDC says "genetic changes in swine flu viruses and other factors might also be a factor."
The new swine flu virus is different. It's not yet clear that it's here to stay. But it is infecting humans, and that has world health officials keeping a close eye on it.
What Are the Symptoms of Swine Flu?
Swine flu symptoms are similar to regular flu symptoms and include cough, sore throat, fever, chills, headache, and fatigue. Some patients have also reported nausea and diarrhea. There is no easy way to distinguish swine flu from other types of flu or other germs. It takes a lab test to tell whether it's swine flu.
Can Swine Flu Spread From Person to Person?
The U.S. residents infected with swine flu virus had no direct contact with pigs. The CDC says it's likely that the infections represent widely separated cycles of human-to-human infections.
Have There Been Previous Swine Flu Outbreaks?
If swine flu sounds familiar to you, it's probably because you remember or have read about the 1976 swine flu outbreak at Fort Dix, N.J., among military recruits. It lasted about a month and then went away as mysteriously as it appeared. As many as 240 people were infected; one died.
The swine flu that spread at Fort Dix was the H1N1 strain. That's the same flu strain that caused the disastrous flu pandemic of 1918-1919, resulting in tens of millions of deaths.
Concern that a new H1N1 pandemic might return with winter led to a crash program to create a vaccine and vaccinate all Americans against swine flu. That vaccine program ran into all kinds of problems -- not the least of which was public perception that the vaccine caused excessive rates of dangerous reactions. After more than 40 million people were vaccinated, the effort was abandoned.
As it turned out, there was no swine flu epidemic
I Got a Flu Shot. Am I Protected Against Swine Flu?
No. There is currently no swine flu vaccine.
It's possible that the seasonal flu vaccine might provide partial protection against H3N2 swine flu bugs. But the strain that appeared in California is the H1N1 swine flu strain. It is very different from the H1N1 human flu strain included in the seasonal flu vaccine.
It's not known whether previous infection with human type A H1N1 flu might provide partial protection against the type A H1N1 swine flu in the current outbreak.
However, the CDC has made a "vaccine seed" from swine flu isolated from an infected person, and has begun the process of developing a vaccine should the need arise. Whether a vaccine could be produced in quantity by next flu season is a huge question.
How Serious Is the Public Health Threat of a Swine Flu Epidemic?
Any flu epidemic is worrisome, especially when a new strain of flu bug is involved.
"Influenza A viruses new to the human population that are able to efficiently transmit from person to person and cause illness may represent a pandemic threat," the CDC warns.
It's worrisome that, unlike seasonal flu, the swine flu outbreak in Mexico is attacking healthy young people. That's a hallmark of pandemic flu bugs.
But it takes more than a new virus spreading among humans to make a pandemic. The virus has to be able to spread efficiently from one person to another, and transmission has to be sustained over time. In addition, the virus has to spread geographically.
Is There a Treatment for Swine Flu?
Yes. While the swine flu bug is resistant to older flu medicines, it remains sensitive to Tamiflu and to Relenza.
Can You Get Swine Flu by Eating Pork?
No. You can only catch swine flu from being around an infected pig -- or, if it's the new swine flu virus, from an infected person.
Swine Flu: U.S. Declares Public Health Emergency
Swine Flu: U.S. Declares Public Health Emergency
CDC Has Reports of at Least 20 People in the U.S. Sickened by Swine Flu
By Miranda Hitti
By Miranda Hitti
WebMD Health NewsReviewed by Louise Chang, MDApril 26, 2009 -- The U.S. government today declared the swine flu outbreak a public health emergency. Swine flu has sickened at least 20 people in the U.S., by the CDC's latest count.
"We are declaring today a public health emergency," Secretary of Homeland Security Janet Napolitano said today at a White House news briefing. That declaration is "standard operating procedure," Napolitano said. "It is similar to what we do when we see a hurricane approaching a site. The hurricane might not actually hit but allows you to take a number of preparatory steps. We really don't know ultimately what the size or seriousness of this outbreak is going to be."
Swine Flu Outbreak:
Get the Facts
Get the latest swine flu information from the WebMD and the CDC, plus other facts you need to know.
Swine Flu FAQ
CDC Swine Flu updates
Swine Flu Case Count Rising
Swine Flu Sickens 2 California Kids
© 2009 WebMD, LLC. All rights reserved.
As part of the emergency, the Department of Homeland Security is releasing 25% of stockpiled antivirals -- Tamiflu and Relenza -- to the states.
Here's what officials want you to do: Stay home if you're sick, avoid close contact with people who are sick, wash your hands often, avoid touching your eyes, nose, and mouth, cover your mouth or nose with a tissue when coughing or sneezin g, and keep up with health information in your own community.
The CDC has gotten reports of lab-confirmed swine flu cases in eight people in New York City, seven people in California, two in Texas, two in Kansas, and one in Ohio.
All of those swine flu cases have been relatively mild, although one person was briefly hospitalized, according to Keiji Fukuda, MD, assistant director-general for health security and environment at the World Health Organization.
The eight swine flu cases in New York City involved students at Saint Francis Preparatory School in Queens. All have recovered fully, according to a news release from the New York City Department of Health and Mental Hygiene.
So far, U.S. cases of swine flu have been milder than those seen in Mexico, where the World Health Organization has confirmed that at least 20 people have died from swine flu; health officials are investigating dozens more deaths in Mexico.
More swine flu cases are likely in the U.S. as public health officials heighten their hunt for the new strain of swine flu virus, notes Anne Schuchat, MD, the CDC's interim deputy director for science and public health program. Her advice: Be prepared for the possibility that there may be severe cases, and even fatalities, in the U.S.
"I do fear that we will have deaths here," Schuchat said today at a news conference.
Countries around the world are watching for the virus, and scientists are scrambling to learn more about the virus and stop it before it becomes a pandemic.
Fukuda says the global health community is taking the swine flu threat "very seriously" but wants more information before deciding whether to raise the WHO's pandemic alert level from phase 3 to phase 4.
An influenza pandemic occurs when a new influenza type A virus emerges for which there is little or no immunity in the human population, begins to cause serious illness, and then spreads easily from person to person worldwide, according to background information from the U.S. Department of Health and Human Services.
The WHO has a scale ranging from phase 1 (low risk of a flu pandemic) to phase 6 (a full-blown pandemic is under way).
Swine Flu Symptoms
Symptoms of swine flu seen in U.S. patients so far have been "relatively nonspecific -- high fever, cough sore throat, muscle aches, possibly vomiting and diarrhea in some numbers," says Schuchat.
The problem is, those symptoms aren't unique to swine flu.
They "can be caused by so many different things," Schuchat says, which makes it "impossible" for a patient to tell if they have swine flu, as opposed to another flu virus or a different illness.
"This is a dilemma, a challenge, we're wrestling with," says Schuchat. She encourages patients to use their judgment about whether they're sick enough to see a doctor, and to definitely do so if they've recently been to a high-risk area, such as Mexico.
Schuchat also notes that there have been cases of the virus spreading from person to person in the U.S. The two confirmed cases in Kansas are a husband and wife, one of whom traveled to Mexico. Two days after returning home, the spouse became ill, says Schuchat.
WebMD Senior Writer Daniel J. DeNoon contributed to this report.
Saturday, April 18, 2009
Build a Better Date Night
Build a Better Date Night
Feature from "Good Housekeeping" MagazineBy Sarah Mahoney
Whether your trysts are regular or once in a blue moon, you can rev up your romantic routine. For more great dates, check out these 7 fun ideas.
Tell the truth: Did your date nights vanish years ago, along with sleeping in, Sunday brunches, and reading the newspaper over coffee? Or have they become as stale as, well, 15 years of the missionary position?
In either case, you're due for a refresher. Couples should give special time together a high priority, because it not only helps you stay connected, the latest research reports, but it also makes both partners happier. "Date night is one of the best ways couples have to pull back from the fray and remember there's an 'us' hidden in the swirl of their daily lives — and really focus on maintaining and celebrating their connection to each other," says Pepper Schwartz, Ph.D., a sociology professor at the University of Washington in Seattle and relationship expert from perfectmatch.com.
To help keep your marriage strong, date night should be fun — of course — but you should also make it novel in some way, or you'll grow bored with your time together and, possibly, with each other, says Arthur Aron, Ph.D., a psychology professor at the State University of New York at Stony Brook who researches couples' interactions. That doesn't mean that you have to give up your beloved French film nights or ballroom dancing sessions and start bungee jumping just for the sake of novelty. Rather, you should simply make the effort to think creatively about how to spend your time together. "My wife and I love the ballet," says Aron, "and my sister gave us a backstage tour at the local dance company, so we got a different perspective on something we already enjoy."
To discover how to spice up date nights, we found three couples who faced challenges and asked them to road-test expert fix-it advice. Read on to see what worked — and why.
The Kitchen Cure
Names: Nina and Jayme Deibler
Hometown: Pittsburgh
Married: 4 years; she's 37, he's 38
Kids: A daughter, 2
Their challenge: Making date night happen at all
"My husband and I used to have great dates," Nina says. "We both love good food, and we'd often spend five or six hours cooking and experimenting with different wines."
But since their daughter was born, finding couple time has gotten harder. "I travel frequently for my job, and Jayme often works evenings and weekends," she says. "So when we do have a few hours, we usually want to spend them with our daughter."
"Working parents worry that time spent as a couple subtracts from time spent with their kids," explains Schwartz. "But when couples feel guilty leaving a child with a sitter, I tell them, 'This isn't selfish, it's protecting both your marriage and your family.'"
Expert Makeover
"It's great that these two have such a strong common interest," says James M. Graham, Ph.D., assistant professor of psychology at Western Washington University in Bellingham. "I'd like them to indulge their passions in a project they can finish in a few hours — one with a unique twist. Experimenting together makes a date more satisfying, just as team-building exercises draw people closer."
When a couple has to overcome a new challenge, their sense of accomplishment after they succeed is magnified. "Dates that allow that kind of growth let you surprise yourself and your partner," he says, "and see each other in a new light." Just keep changes and challenges moderate. "This should be fun, not traumatic."
The Deiblers decided to try making sushi — a dish they love in restaurants but had never prepared themselves. They bought the basic equipment (including a book of instructions) at a favorite cooking store and arranged for Nina's mom to take care of their toddler for a few hours.
The verdict: A huge hit
Her take: "The expert really nailed it when he suggested a project for us — this was great. And it was a challenge: The rice had to be just the right temperature, and some of the chopping and rolling was tricky. We did need the time without our daughter, but several of my neighbors want to trade babysitting so we can all have date nights. I found this experience very inspiring — it made me feel like we were dating again. Next time, I want to try cooking Indian food."
His take: "The food turned out really well, and we had the kind of fun we haven't for ages. It reminded me how good we are at working together and how we complement each other: Nina did the organizing and the shopping, and got the rice going. Then we took turns chopping and wrapping, tasting as we went along. And because we did it all between 5 and 7:30, we are confident now that we can make something like this happen at least every other week."
5-Minute Fixes
Names: Cate and Dan Adams
Hometown: Salt Lake City
Married: 18 years; both are 49
Kids: Twin girls, 16
Their challenge: Making limited time together feel meaningful
"We've always tried to do date nights, even before we had kids," says Cate. "Then, after the girls were born, we didn't go out often. Now that they're older, we both work full-time and still don't go out much.
"After our last anniversary, we decided that we'd try to spend five minutes each day just talking and connecting. And it's helped. But we'd like to find a way to make that time more special."
Expert Makeover
The experts loved the five-minute ritual, which eases the scheduling pressure that prevents many date nights from happening at all. But Schwartz advised the Adamses to expand beyond their "How was your day?" conversations and get creative. She suggested that they develop ways to mix it up by brainstorming together and surprising each other. She emphasizes that no one, including the Adamses, should feel pressured to come up with something novel for every single date. There's nothing wrong with what the two do now: chat in the kitchen while Dan does the dishes. But sharing a glass of wine, going for a short walk, or just sitting on the deck once a week can make those few moments feel more special.
The overachieving couple decided that they would come up with something different to do every single day for an entire week. One night, they traded foot massages. The next, Cate asked Dan to show her how to fix a flat tire on her bicycle. Another evening, each drew a picture of the best thing that happened to them that day. And one night, after Dan noticed someone selling weird-looking rocks on eBay, they raced down to the creek that runs through their backyard to see who could find the most eBay-worthy stones.
The verdict: Sure, it was nice, but enough already!
Her take: "The night we brainstormed was funny, and we laughed a lot throughout the week. But the best part, honestly, was all the talking we did while we were doing these things. In almost every case, we wound up spending much longer than five minutes, and it was good to realize we could make that much time for each other."
His take: "We had some fun with this, but I missed the quietness — and the spontaneity — of just being able to sit down and talk with Cate and decompress. And having to think of something new to do every night just wouldn't be sustainable in the long run, obviously. But I can see doing something special more often than we do now."
The Active Answer
Names: Camille and Kent Boskovich
Hometown: La Grange, IL
Married: 22 years; both are 47
Kids: A son, 19, and a daughter, 17
Their challenge: Spicing up their tried-and-true routine
These two spend plenty of time together — and enjoy it. They work out at the same gym, they have dinner out once a week, and they often spend weekends driving to their daughter's hockey tournaments in other cities.
Still, "our dates are pretty boring," Camille says. And while they enjoy elaborate events — from opera to White Sox games — they're looking for date ideas that don't take much advance scheduling.
Dating can be complex for couples like this, as they anticipate an empty house — and a kid-less social calendar. Even people with common interests, like these two, need to expand their dating repertoire, says Aron. He advised them to explore more in the fitness realm. They already enjoy it, and his research shows that couples typically find shared physical activity one of the best ways to bond. Aron actually persuaded spouses to Velcro themselves together and crawl across gym mats — and found that it made them feel more in love than they had before this unusual exercise.
"It's really important that they pick something they're both new to," he says — maybe a swing-dance class or snowshoeing. But they shouldn't worry that every activity has to be a perfect fit, says Schwartz. "Think of yourself as an anthropologist doing research, and remember, if you don't like it, you don't have to try it again," she says. Plus, even a bad date can be a good bonding experience and provide a couple with a shared memory to laugh about later.
After looking at their options, Camille and Kent tried a fitness yoga class at their health club: She had taken a few classes in the past but was still a novice, and he had always been interested in giving it a go.
The verdict: Mixed reviews but headed in the right direction
Her take: "I was surprised Kent was game to try this, but it was really great. The instructor asked us to do some tough poses, and Kent kept shooting me a look like, 'Are you kidding me?' On the one hand, I worried that he wasn't enjoying it that much. On the other, it was funny — and it really felt good to do something besides going out to dinner, especially something physical and healthy. So this inspired us: We're going to do a few sessions with a trainer next."
His take: "Honestly, is this a better date than going out for dinner and sharing a bottle of wine? No way. But that said, it was OK, and I would try it again. I'm looking forward to the training sessions. I'm a treadmill guy, so it'll be good to add weights — and fun to do it with my wife."
Originally published on January 15, 2009
Feature from "Good Housekeeping" MagazineBy Sarah Mahoney
Whether your trysts are regular or once in a blue moon, you can rev up your romantic routine. For more great dates, check out these 7 fun ideas.
Tell the truth: Did your date nights vanish years ago, along with sleeping in, Sunday brunches, and reading the newspaper over coffee? Or have they become as stale as, well, 15 years of the missionary position?
In either case, you're due for a refresher. Couples should give special time together a high priority, because it not only helps you stay connected, the latest research reports, but it also makes both partners happier. "Date night is one of the best ways couples have to pull back from the fray and remember there's an 'us' hidden in the swirl of their daily lives — and really focus on maintaining and celebrating their connection to each other," says Pepper Schwartz, Ph.D., a sociology professor at the University of Washington in Seattle and relationship expert from perfectmatch.com.
To help keep your marriage strong, date night should be fun — of course — but you should also make it novel in some way, or you'll grow bored with your time together and, possibly, with each other, says Arthur Aron, Ph.D., a psychology professor at the State University of New York at Stony Brook who researches couples' interactions. That doesn't mean that you have to give up your beloved French film nights or ballroom dancing sessions and start bungee jumping just for the sake of novelty. Rather, you should simply make the effort to think creatively about how to spend your time together. "My wife and I love the ballet," says Aron, "and my sister gave us a backstage tour at the local dance company, so we got a different perspective on something we already enjoy."
To discover how to spice up date nights, we found three couples who faced challenges and asked them to road-test expert fix-it advice. Read on to see what worked — and why.
The Kitchen Cure
Names: Nina and Jayme Deibler
Hometown: Pittsburgh
Married: 4 years; she's 37, he's 38
Kids: A daughter, 2
Their challenge: Making date night happen at all
"My husband and I used to have great dates," Nina says. "We both love good food, and we'd often spend five or six hours cooking and experimenting with different wines."
But since their daughter was born, finding couple time has gotten harder. "I travel frequently for my job, and Jayme often works evenings and weekends," she says. "So when we do have a few hours, we usually want to spend them with our daughter."
"Working parents worry that time spent as a couple subtracts from time spent with their kids," explains Schwartz. "But when couples feel guilty leaving a child with a sitter, I tell them, 'This isn't selfish, it's protecting both your marriage and your family.'"
Expert Makeover
"It's great that these two have such a strong common interest," says James M. Graham, Ph.D., assistant professor of psychology at Western Washington University in Bellingham. "I'd like them to indulge their passions in a project they can finish in a few hours — one with a unique twist. Experimenting together makes a date more satisfying, just as team-building exercises draw people closer."
When a couple has to overcome a new challenge, their sense of accomplishment after they succeed is magnified. "Dates that allow that kind of growth let you surprise yourself and your partner," he says, "and see each other in a new light." Just keep changes and challenges moderate. "This should be fun, not traumatic."
The Deiblers decided to try making sushi — a dish they love in restaurants but had never prepared themselves. They bought the basic equipment (including a book of instructions) at a favorite cooking store and arranged for Nina's mom to take care of their toddler for a few hours.
The verdict: A huge hit
Her take: "The expert really nailed it when he suggested a project for us — this was great. And it was a challenge: The rice had to be just the right temperature, and some of the chopping and rolling was tricky. We did need the time without our daughter, but several of my neighbors want to trade babysitting so we can all have date nights. I found this experience very inspiring — it made me feel like we were dating again. Next time, I want to try cooking Indian food."
His take: "The food turned out really well, and we had the kind of fun we haven't for ages. It reminded me how good we are at working together and how we complement each other: Nina did the organizing and the shopping, and got the rice going. Then we took turns chopping and wrapping, tasting as we went along. And because we did it all between 5 and 7:30, we are confident now that we can make something like this happen at least every other week."
5-Minute Fixes
Names: Cate and Dan Adams
Hometown: Salt Lake City
Married: 18 years; both are 49
Kids: Twin girls, 16
Their challenge: Making limited time together feel meaningful
"We've always tried to do date nights, even before we had kids," says Cate. "Then, after the girls were born, we didn't go out often. Now that they're older, we both work full-time and still don't go out much.
"After our last anniversary, we decided that we'd try to spend five minutes each day just talking and connecting. And it's helped. But we'd like to find a way to make that time more special."
Expert Makeover
The experts loved the five-minute ritual, which eases the scheduling pressure that prevents many date nights from happening at all. But Schwartz advised the Adamses to expand beyond their "How was your day?" conversations and get creative. She suggested that they develop ways to mix it up by brainstorming together and surprising each other. She emphasizes that no one, including the Adamses, should feel pressured to come up with something novel for every single date. There's nothing wrong with what the two do now: chat in the kitchen while Dan does the dishes. But sharing a glass of wine, going for a short walk, or just sitting on the deck once a week can make those few moments feel more special.
The overachieving couple decided that they would come up with something different to do every single day for an entire week. One night, they traded foot massages. The next, Cate asked Dan to show her how to fix a flat tire on her bicycle. Another evening, each drew a picture of the best thing that happened to them that day. And one night, after Dan noticed someone selling weird-looking rocks on eBay, they raced down to the creek that runs through their backyard to see who could find the most eBay-worthy stones.
The verdict: Sure, it was nice, but enough already!
Her take: "The night we brainstormed was funny, and we laughed a lot throughout the week. But the best part, honestly, was all the talking we did while we were doing these things. In almost every case, we wound up spending much longer than five minutes, and it was good to realize we could make that much time for each other."
His take: "We had some fun with this, but I missed the quietness — and the spontaneity — of just being able to sit down and talk with Cate and decompress. And having to think of something new to do every night just wouldn't be sustainable in the long run, obviously. But I can see doing something special more often than we do now."
The Active Answer
Names: Camille and Kent Boskovich
Hometown: La Grange, IL
Married: 22 years; both are 47
Kids: A son, 19, and a daughter, 17
Their challenge: Spicing up their tried-and-true routine
These two spend plenty of time together — and enjoy it. They work out at the same gym, they have dinner out once a week, and they often spend weekends driving to their daughter's hockey tournaments in other cities.
Still, "our dates are pretty boring," Camille says. And while they enjoy elaborate events — from opera to White Sox games — they're looking for date ideas that don't take much advance scheduling.
Dating can be complex for couples like this, as they anticipate an empty house — and a kid-less social calendar. Even people with common interests, like these two, need to expand their dating repertoire, says Aron. He advised them to explore more in the fitness realm. They already enjoy it, and his research shows that couples typically find shared physical activity one of the best ways to bond. Aron actually persuaded spouses to Velcro themselves together and crawl across gym mats — and found that it made them feel more in love than they had before this unusual exercise.
"It's really important that they pick something they're both new to," he says — maybe a swing-dance class or snowshoeing. But they shouldn't worry that every activity has to be a perfect fit, says Schwartz. "Think of yourself as an anthropologist doing research, and remember, if you don't like it, you don't have to try it again," she says. Plus, even a bad date can be a good bonding experience and provide a couple with a shared memory to laugh about later.
After looking at their options, Camille and Kent tried a fitness yoga class at their health club: She had taken a few classes in the past but was still a novice, and he had always been interested in giving it a go.
The verdict: Mixed reviews but headed in the right direction
Her take: "I was surprised Kent was game to try this, but it was really great. The instructor asked us to do some tough poses, and Kent kept shooting me a look like, 'Are you kidding me?' On the one hand, I worried that he wasn't enjoying it that much. On the other, it was funny — and it really felt good to do something besides going out to dinner, especially something physical and healthy. So this inspired us: We're going to do a few sessions with a trainer next."
His take: "Honestly, is this a better date than going out for dinner and sharing a bottle of wine? No way. But that said, it was OK, and I would try it again. I'm looking forward to the training sessions. I'm a treadmill guy, so it'll be good to add weights — and fun to do it with my wife."
Originally published on January 15, 2009
10 Ways to Catch a Liar
10 Ways to Catch a Liar
Experts have 10 tips that can let you know if someone isn't telling you the whole truth.
By Heather Hatfield
J.J. Newberry was a trained federal agent, skilled in the art of deception detection. So when a witness to a shooting sat in front of him and tried to tell him that when she heard gunshots she didn't look, she just ran -- he knew she was lying.
How did Newberry reach this conclusion? The answer is by recognizing telltale signs that a person isn't being honest, like inconsistencies in a story, behavior that's different from a person's norm, or too much detail in an explanation.
While using these signs to catch a liar takes extensive training and practice, it's no longer only for authorities like Newberry. Now, the average person can become adept at identifying dishonesty, and it's not as hard as you might think. Experts tell WebMD the top 10 ways to let the truth be known.
Tip No. 1: Inconsistencies
"When you want to know if someone is lying, look for inconsistencies in what they are saying," says Newberry, who was a federal agent for 30 years and a police officer for five.
When the woman he was questioning said she ran and hid after hearing gunshots -- without looking -- Newberry saw the inconsistency immediately.
"There was something that just didn't fit," says Newberry. "She heard gunshots but she didn't look? I knew that was inconsistent with how a person would respond to a situation like that."
So when she wasn't paying attention, he banged on the table. She looked right at him.
"When a person hears a noise, it's a natural reaction to look toward it," Newberry tells WebMD. "I knew she heard those gunshots, looked in the direction from which they came, saw the shooter, and then ran."
Sure enough, he was right.
"Her story was just illogical," says Newberry. "And that's what you should look for when you're talking to someone who isn't being truthful. Are there inconsistencies that just don't fit?"
Tip No. 2: Ask the Unexpected
"About 4% of people are accomplished liars and they can do it well," says Newberry. "But because there are no Pinocchio responses to a lie, you have to catch them in it."
Sir Walter Scott put it best: "Oh what a tangled web we weave, when first we practice to deceive!" But how can you a catch a person in his own web of lies?
"Watch them carefully," says Newberry. "And then when they don't expect it, ask them one question that they are not prepared to answer to trip them up."
Tip No. 3: Gauge Against a Baseline
"One of the most important indicators of dishonesty is changes in behavior," says Maureen O'Sullivan, PhD, a professor of psychology at the University of San Francisco. "You want to pay attention to someone who is generally anxious, but now looks calm. Or, someone who is generally calm but now looks anxious."
The trick, explains O'Sullivan, is to gauge their behavior against a baseline. Is a person's behavior falling away from how they would normally act? If it is, that could mean that something is up.
Tip No. 4: Look for Insincere Emotions
"Most people can't fake smile," says O'Sullivan. "The timing will be wrong, it will be held too long, or it will be blended with other things. Maybe it will be a combination of an angry face with a smile; you can tell because their lips are smaller and less full than in a sincere smile."
These fake emotions are a good indicator that something has gone afoul.
Tip No. 5: Pay Attention to Gut Reactions
"People say, 'Oh, it was a gut reaction or women's intuition,' but what I think they are picking up on are the deviations of true emotions," O'Sullivan tells WebMD.
While an average person might not know what it is he's seeing when he thinks someone isn't being honest and attribute his suspicion to instinct, a scientist would be able to pinpoint it exactly -- which leads us to tip no. 6.
Tip No. 6: Watch for Microexpressions
When Joe Schmo has a gut feeling, Paul Ekman, a renowned expert in lie detection, sees microexpressions.
"A microexpression is a very brief expression, usually about a 25th of a second, that is always a concealed emotion," says Ekman, PhD, professor emeritus of psychology at the University of California Medical School in San Francisco.
So when a person is acting happy, but in actuality is really upset about something, for instance, his true emotion will be revealed in a subconscious flash of anger on his face. Whether the concealed emotion is fear, anger, happiness, or jealousy, that feeling will appear on the face in the blink of an eye. The trick is to see it.
"Almost everyone -- 99% of those we've tested in about 10,000 people -- won't see them," says Ekman. "But it can be taught."
In fact, in less than an hour, the average person can learn to see microexpressions.
Tip No. 7: Look for Contradictions
"The general rule is anything that a person does with their voice or their gesture that doesn't fit the words they are saying can indicate a lie," says Ekman. "For example, this is going to sound amazing, but it is true. Sometimes when people are lying and saying, 'Yes, she's the one that took the money,' they will without knowing it make a slight head shake 'no.' That's a gesture and it completely contradicts what they're saying in words."
These contradictions, explains Ekman, can be between the voice and the words, the gesture and the voice, the gesture and the words, or the face and the words.
"It's some aspect of demeanor that is contradicting another aspect," Ekman tells WebMD.
Tip No. 8: A Sense of Unease
"When someone isn't making eye contact and that's against how they normally act, it can mean they're not being honest," says Jenn Berman, PhD, a psychologist in private practice. "They look away, they're sweating, they look uneasy ... anything that isn't normal and indicates anxiety."
Tip No. 9: Too Much Detail
"When you say to someone, 'Oh, where were you?' and they say, 'I went to the store and I needed to get eggs and milk and sugar and I almost hit a dog so I had to go slow,' and on and on, they're giving you too much detail," says Berman.
Too much detail could mean they've put a lot of thought into how they're going to get out of a situation and they've crafted a complicated lie as a solution.
Tip No. 10: Don't Ignore the Truth
"It's more important to recognize when someone is telling the truth than telling a lie because people can look like they're lying but be telling truth," says Newberry.
While it sounds confusing, finding the truth buried under a lie can sometimes help find the answer to an important question: Why is a person lying?
These 10 truth tips, experts agree, all help detect deception. What they don't do is tell you why a person is lying and what the lie means.
"Microexpressions don't tell you the reason," says Ekman. "They just tell you what the concealed emotion is and that there is an emotion being concealed."
When you think someone is lying, you have to either know the person well enough to understand why he or she might lie, or be a people expert.
"You can see a microexpression, but you have to have more social-emotional intelligence on people to use it accurately," says O'Sullivan. "You have to be a good judge of people to understand what it means."
Extra Tip: Be Trusting
"In general we have a choice about which stance we take in life," says Ekman. "If we take a suspicious stance life is not going to be too pleasant, but we won't get misled very often. If we take a trusting stance, life is going to be a lot more pleasant but sometimes we are going to be taken in. As a parent or a friend, you're much better off being trusting rather than looking for lies all the time."
Experts have 10 tips that can let you know if someone isn't telling you the whole truth.
By Heather Hatfield
J.J. Newberry was a trained federal agent, skilled in the art of deception detection. So when a witness to a shooting sat in front of him and tried to tell him that when she heard gunshots she didn't look, she just ran -- he knew she was lying.
How did Newberry reach this conclusion? The answer is by recognizing telltale signs that a person isn't being honest, like inconsistencies in a story, behavior that's different from a person's norm, or too much detail in an explanation.
While using these signs to catch a liar takes extensive training and practice, it's no longer only for authorities like Newberry. Now, the average person can become adept at identifying dishonesty, and it's not as hard as you might think. Experts tell WebMD the top 10 ways to let the truth be known.
Tip No. 1: Inconsistencies
"When you want to know if someone is lying, look for inconsistencies in what they are saying," says Newberry, who was a federal agent for 30 years and a police officer for five.
When the woman he was questioning said she ran and hid after hearing gunshots -- without looking -- Newberry saw the inconsistency immediately.
"There was something that just didn't fit," says Newberry. "She heard gunshots but she didn't look? I knew that was inconsistent with how a person would respond to a situation like that."
So when she wasn't paying attention, he banged on the table. She looked right at him.
"When a person hears a noise, it's a natural reaction to look toward it," Newberry tells WebMD. "I knew she heard those gunshots, looked in the direction from which they came, saw the shooter, and then ran."
Sure enough, he was right.
"Her story was just illogical," says Newberry. "And that's what you should look for when you're talking to someone who isn't being truthful. Are there inconsistencies that just don't fit?"
Tip No. 2: Ask the Unexpected
"About 4% of people are accomplished liars and they can do it well," says Newberry. "But because there are no Pinocchio responses to a lie, you have to catch them in it."
Sir Walter Scott put it best: "Oh what a tangled web we weave, when first we practice to deceive!" But how can you a catch a person in his own web of lies?
"Watch them carefully," says Newberry. "And then when they don't expect it, ask them one question that they are not prepared to answer to trip them up."
Tip No. 3: Gauge Against a Baseline
"One of the most important indicators of dishonesty is changes in behavior," says Maureen O'Sullivan, PhD, a professor of psychology at the University of San Francisco. "You want to pay attention to someone who is generally anxious, but now looks calm. Or, someone who is generally calm but now looks anxious."
The trick, explains O'Sullivan, is to gauge their behavior against a baseline. Is a person's behavior falling away from how they would normally act? If it is, that could mean that something is up.
Tip No. 4: Look for Insincere Emotions
"Most people can't fake smile," says O'Sullivan. "The timing will be wrong, it will be held too long, or it will be blended with other things. Maybe it will be a combination of an angry face with a smile; you can tell because their lips are smaller and less full than in a sincere smile."
These fake emotions are a good indicator that something has gone afoul.
Tip No. 5: Pay Attention to Gut Reactions
"People say, 'Oh, it was a gut reaction or women's intuition,' but what I think they are picking up on are the deviations of true emotions," O'Sullivan tells WebMD.
While an average person might not know what it is he's seeing when he thinks someone isn't being honest and attribute his suspicion to instinct, a scientist would be able to pinpoint it exactly -- which leads us to tip no. 6.
Tip No. 6: Watch for Microexpressions
When Joe Schmo has a gut feeling, Paul Ekman, a renowned expert in lie detection, sees microexpressions.
"A microexpression is a very brief expression, usually about a 25th of a second, that is always a concealed emotion," says Ekman, PhD, professor emeritus of psychology at the University of California Medical School in San Francisco.
So when a person is acting happy, but in actuality is really upset about something, for instance, his true emotion will be revealed in a subconscious flash of anger on his face. Whether the concealed emotion is fear, anger, happiness, or jealousy, that feeling will appear on the face in the blink of an eye. The trick is to see it.
"Almost everyone -- 99% of those we've tested in about 10,000 people -- won't see them," says Ekman. "But it can be taught."
In fact, in less than an hour, the average person can learn to see microexpressions.
Tip No. 7: Look for Contradictions
"The general rule is anything that a person does with their voice or their gesture that doesn't fit the words they are saying can indicate a lie," says Ekman. "For example, this is going to sound amazing, but it is true. Sometimes when people are lying and saying, 'Yes, she's the one that took the money,' they will without knowing it make a slight head shake 'no.' That's a gesture and it completely contradicts what they're saying in words."
These contradictions, explains Ekman, can be between the voice and the words, the gesture and the voice, the gesture and the words, or the face and the words.
"It's some aspect of demeanor that is contradicting another aspect," Ekman tells WebMD.
Tip No. 8: A Sense of Unease
"When someone isn't making eye contact and that's against how they normally act, it can mean they're not being honest," says Jenn Berman, PhD, a psychologist in private practice. "They look away, they're sweating, they look uneasy ... anything that isn't normal and indicates anxiety."
Tip No. 9: Too Much Detail
"When you say to someone, 'Oh, where were you?' and they say, 'I went to the store and I needed to get eggs and milk and sugar and I almost hit a dog so I had to go slow,' and on and on, they're giving you too much detail," says Berman.
Too much detail could mean they've put a lot of thought into how they're going to get out of a situation and they've crafted a complicated lie as a solution.
Tip No. 10: Don't Ignore the Truth
"It's more important to recognize when someone is telling the truth than telling a lie because people can look like they're lying but be telling truth," says Newberry.
While it sounds confusing, finding the truth buried under a lie can sometimes help find the answer to an important question: Why is a person lying?
These 10 truth tips, experts agree, all help detect deception. What they don't do is tell you why a person is lying and what the lie means.
"Microexpressions don't tell you the reason," says Ekman. "They just tell you what the concealed emotion is and that there is an emotion being concealed."
When you think someone is lying, you have to either know the person well enough to understand why he or she might lie, or be a people expert.
"You can see a microexpression, but you have to have more social-emotional intelligence on people to use it accurately," says O'Sullivan. "You have to be a good judge of people to understand what it means."
Extra Tip: Be Trusting
"In general we have a choice about which stance we take in life," says Ekman. "If we take a suspicious stance life is not going to be too pleasant, but we won't get misled very often. If we take a trusting stance, life is going to be a lot more pleasant but sometimes we are going to be taken in. As a parent or a friend, you're much better off being trusting rather than looking for lies all the time."
Thursday, April 16, 2009
Can You Trust Your Mammogram?
Can You Trust Your Mammogram?
WebMD Feature from "Good Housekeeping" MagazineBy Fran Smith
Why even smart doctors miss breast cancer - and how to make sure you're getting the best care.
No matter what you know about other diseases, breast cancer is probably the one that scares you most. It is frightening, striking nearly 182,000 women this year and plunging them into a world of complicated, arduous treatment. So it's heartening to know that more women are being diagnosed early, when the odds of beating the cancer are as high as 98 percent. Prevention and treatment are becoming personalized, thanks to genetic tests and new types of drugs. And after decades of no change, the death rate has finally begun to drop — about 2 percent annually since 1990.
Yet behind these impressive statistics lies one dumbfoundingly scary fact: Just because better tools and treatment exist is no guarantee that you'll get any of them. Your mammogram could be interpreted inaccurately, a lump could be incorrectly diagnosed, and you may not receive the best treatment for you simply because of where you live, the type of surgeon you choose — or even the doctor's sex.
That's why it's more important than ever to know the right questions to ask. Breast cancer is a complex disease (some researchers suspect it's at least five genetically distinct conditions), and no single approach works best for everybody. At every step — when you have your annual mammogram or get a suspicious lump checked out or undergo treatment — you should, at the very least, receive care that meets the scientific guidelines issued by leading cancer organizations. Here's how to make sure you do.
Screening Snafus
When you get a mammogram, it's common to have a stab of anxiety about what the radiologist will find. What should also concern you: the doctor who's doing the detecting.
The news: In a new study, researchers reviewed nearly half a million mammograms performed at 44 facilities. At the best centers, doctors identified cancer when it was present just about 100% of the time; at others, that number was closer to 70%, says study leader Stephen Taplin, M.D., M.P.H., a senior scientist at the National Cancer Institute. Facilities with a breast-imaging specialist (defined here as a doctor who spends at least half her time reading mammograms) had the best record.
Why it matters: Getting a regular mammogram is key to finding breast cancer early. Five-year survival rates drop from a high of 98.1% for early, breast-only tumors to 27.1% for advanced cancer that has spread to distant organs.
What you should do: When you call for an appointment, ask if there's a breast-imaging specialist on staff. If not, shop around, advises Diana Miglioretti, Ph.D., a researcher with the Group Health Center for Health Studies in Seattle. "I'd go to someone who has been interpreting screening mammograms for at least 10 years."
Follow-up Foul-ups
If your screening mammogram is abnormal or you have a lump, the next step is often a diagnostic X-ray, which takes magnified close-ups of the suspicious tissue.
The news: In theory, diagnostic mammograms should be easier to interpret than screening ones because the doctor knows where trouble may be lurking. Yet the largest study analyzing how well radiologists do on these critical exams found they missed 21 percent of cancers on average. The real shocker was the range: The top performer found every tumor, while the worst missed an astonishing 73 percent. Doctors affiliated with academic medical centers did best: They correctly diagnosed 88 percent of cancers.
Why it matters: Missing a tumor at this step could mean a delay in diagnosis — possibly a dangerous one, if a tumor isn't detected and treated before the cancer has spread.
What you should do: As with screening X-rays, the doctor who reads your diagnostic X-ray should be someone who specializes in mammograms, says Miglioretti, who led the study. Unless you live in a rural area, you should be able to find such a specialist no more than an hour or two away. "It's worth the drive," she says.
Surgical Biases
The biggest decision many women face when they're diagnosed with breast cancer is whether to have a mastectomy (removal of the entire breast) or a lumpectomy (only the tumor and surrounding tissue are cut out). In many cases, breast-conserving surgery, including lymph node testing and follow-up radiation, has the same lifesaving benefits as mastectomy. Yet your surgeon may not explain the options and consequences clearly or evenhandedly.
The news: Clinical guidelines developed by leading organizations favor breast-conserving surgery because it's less drastic. That's true whether you live in Augusta, ME, or Augusta, GA. Yet a review of 800,000 patient records found that while 70% in the Northeast had breast-sparing surgery, only 58% of those in the South did (the numbers for the West and Midwest were 63 percent and 61 percent, respectively). The review didn't look for a why, but study leader Jack Sariego, M.D., professor of surgery at Temple University, notes that the more rural South likely has fewer radiation facilities and fewer academic medical centers to promote surgical advances.
Beyond your zip code, the type of surgeon and hospital you choose may affect the recommendation you'll receive. Doctors who treat a lot of breast cancer or who work in cancer centers or academic medical centers suggest lumpectomy more often than general surgeons in the community. Surgeons trained after 1981 are also more likely to recommend a lumpectomy than older doctors, past research from the University of North Carolina at Chapel Hill has shown.
Why it matters: In a survey of 1,132 women who had either a lumpectomy or a mastectomy, almost half indicated they did not understand the risks and benefits of their choice.
What you should do: Ask loads of questions, starting with, "Am I a candidate for breast-conserving surgery, and if not, why not?" advises Dr. Sariego. Do your own research. And don't be shy about asking the first surgeon to recommend another for a second opinion. Better yet, look on your own: A recent study shows you're more likely to wind up with someone experienced and affiliated with a cancer program, compared with women who rely on referrals from their doctor or health plan, says Steven Katz, M.D., professor of medicine and health management and policy at the University of Michigan.
While you're asking questions, find out how your lymph nodes will be tested to see if the cancer has spread. A newer procedure, called sentinel-node biopsy, is less invasive and far less likely to cause permanent arm swelling than old-fashioned lymph node removal, but about 35 percent of patients aren't getting it, a recent multicenter study found.
Post-Surgery Neglect
Lumpectomy is just as effective as mastectomy only if it includes lymph node testing and a course of radiation treatments — generally five days a week for about six weeks. That's something your surgeon should make clear before you choose one procedure over the other.
The news: In 2003, only 71 percent of lumpectomy patients followed through with radiation, down from 79 percent in 1992, University of Minnesota epidemiologist Beth Virnig, Ph.D., reported last December. "A lot of women with serious breast cancer are not getting comprehensive treatment," she says.
Why it matters: If you don't undergo a full course of radiation, your chances of local recurrence within 10 years are as high as 30 percent, says Dr. Katz. (If you do, they drop to about 8 to 10 percent.)
What you should do: Talk with a radiation oncologist before surgery. Ask how long your treatment will last and what the side effects might be. For that matter, talk with all the specialists who may be involved in your postsurgical care. Women often feel panicked and pressured to start treatment immediately, but it's usually safe to wait two to three weeks.
Reticence on Reconstruction
If a lumpectomy isn't right for you, a mastectomy followed by reconstruction is an alternative — but you may have to bring up the subject.
The news: Only about one-quarter of surgeons regularly send patients for a plastic surgery consultation before they make their lumpectomy or mastectomy decision, researchers from the University of Michigan found in a 2007 study. Who's most likely to make that referral? Women surgeons — as well as those who treat a lot of breast cancer. Reconstruction can be done during the same surgery as the mastectomy, but it requires the general and plastic surgeons to share turf and mesh schedules, which may be inconvenient for them — even if it's good for you.
Why it matters: Both procedures will alter your appearance, but in different ways. This may seem like a minor worry when you're newly diagnosed and terrified, but it's likely to become important when you're well.
What you should do: "Ask your surgeon how your breast will look, how your clothing will fit," says Amy Alderman, M.D., M.P.H., an assistant professor of surgery at the University of Michigan. Even if you're sure you want breast-conserving surgery, you may want to consult with a plastic surgeon. Lumpectomy sometimes changes the breast more than women expect; a specialist can help you assess what might happen in your case. This is not vanity: Women who end up with extremely uneven breasts are more likely to be depressed and to worry that their cancer will return, a brand-new University of Michigan study found. Or you may want to seek out a breast surgeon who's experienced in oncoplastic techniques, which can improve the look of the breast.
Thankfully, the days of "Doctor knows best" are behind us. But that means breast cancer patients have to work with their physicians to make tough choices. To do that, women must share their fears and desires. "The doctor only knows what's on your X-ray and pathology report," says Karen Sepucha, Ph.D., a senior scientist with the Health Decision Research Unit at Massachusetts General Hospital: "What you care about needs to get on the table."
And you have to be the one who makes sure it does.
More Ways to Get the Answers You Need
Going for a Third Opinion
Kim Friedrich, 37
Mastic, NY
Kim Friedrich was in shock. In February 2007, her left breast had a tumor one-and-a-half times the size of a golf ball; because it was so big and aggressive, the surgeon told her she needed to have that breast removed, as well as the other as a precaution. A second doctor agreed. "I kept seeing myself on my deathbed," Friedrich says. She'd look at her two daughters and seize up with grief — would they grow up without her? While she would have done anything to live, she wasn't convinced she had to lose her breasts. Neither doctor had taken much time with her, she realized. Friedrich began to do research and talked to everyone she could. When an acquaintance raved about her breast specialist, at a cancer center a three-hour drive away, Friedrich pressed for an appointment. The mastectomy recommendations did not surprise the doctor. "That's old thinking," he told her. His advice: a course of chemotherapy (which shrank the tumor down to the size of a pea), followed by a lumpectomy and radiation. It was very tough, but Friedrich has no doubt she chose the right treatment — and doctor: "I got two quick assessments, and felt like they were thinking, 'Let's just do what's fastest and move on to the next patient.'"
When It's Not "Nothing"
Amalia Rigoni, 50
Olympia Fields, IL
Although she'd had a normal mammogram just a few months earlier, in March 2000, Amalia Rigoni was uneasy about a lump she felt in her lower right breast. Both her gynecologist and internist said she was fine. A diagnostic mammogram detected nothing. Still, she insisted on seeing a surgeon. That doctor, a general surgeon, told her to come back in six months. So Rigoni tried another tack: "If your mother had breast cancer, where would you send her?" The surgeon recommended a breast specialist who'd been his professor. The specialist checked her by closing his eyes and palpating the breast. "I don't like the feel of that lump," he said. "It was surreal," Rigoni recalls. "But I said, 'Thank God. At least I know what's going on.'" Almost nine years later — after a mastectomy, reconstruction, radiation, and three years of the drug tamoxifen followed by five on Femara — she's fine. Now Rigoni's a hotline coordinator for Breast Cancer Network of Strength, counseling women who may be facing the same struggle to get answers. "I tell them that doctors may know medicine, but you know your body. If something doesn't feel right, get it checked out." And, she adds, "go to a specialist."
Filling the Info Gap
Evelyn White, 48
San Francisco, CA
Support groups can provide invaluable information that patients may not get from their doctors. Evelyn White, for example, says her medical care was "great." She was diagnosed with breast cancer in February 2006, and underwent a mastectomy. But the chemo that followed left her unable to move — and she was suffering terrible crying jags. A friend thought it might be the medicine that White was taking for nausea — Ativan, a powerful sedative. She asked her doctor about stopping the drug and then, at a meeting of a cancer survivors' organization, heard about an alternative. There was a newer drug, Emend, developed specifically to prevent the nausea of chemotherapy — without causing depression. Once her physician switched the meds, "I felt a thousand percent better, physically and emotionally," says White. Later, the group helped in another key way. White had assumed her cancer was genetic (her sister was a survivor as well), and she was worried that her daughter, 24, might be at increased risk. Armed with information she got from a meeting, she underwent testing and, last year, was thrilled to be able to strike that worry off her list.
WebMD Feature from "Good Housekeeping" MagazineBy Fran Smith
Why even smart doctors miss breast cancer - and how to make sure you're getting the best care.
No matter what you know about other diseases, breast cancer is probably the one that scares you most. It is frightening, striking nearly 182,000 women this year and plunging them into a world of complicated, arduous treatment. So it's heartening to know that more women are being diagnosed early, when the odds of beating the cancer are as high as 98 percent. Prevention and treatment are becoming personalized, thanks to genetic tests and new types of drugs. And after decades of no change, the death rate has finally begun to drop — about 2 percent annually since 1990.
Yet behind these impressive statistics lies one dumbfoundingly scary fact: Just because better tools and treatment exist is no guarantee that you'll get any of them. Your mammogram could be interpreted inaccurately, a lump could be incorrectly diagnosed, and you may not receive the best treatment for you simply because of where you live, the type of surgeon you choose — or even the doctor's sex.
That's why it's more important than ever to know the right questions to ask. Breast cancer is a complex disease (some researchers suspect it's at least five genetically distinct conditions), and no single approach works best for everybody. At every step — when you have your annual mammogram or get a suspicious lump checked out or undergo treatment — you should, at the very least, receive care that meets the scientific guidelines issued by leading cancer organizations. Here's how to make sure you do.
Screening Snafus
When you get a mammogram, it's common to have a stab of anxiety about what the radiologist will find. What should also concern you: the doctor who's doing the detecting.
The news: In a new study, researchers reviewed nearly half a million mammograms performed at 44 facilities. At the best centers, doctors identified cancer when it was present just about 100% of the time; at others, that number was closer to 70%, says study leader Stephen Taplin, M.D., M.P.H., a senior scientist at the National Cancer Institute. Facilities with a breast-imaging specialist (defined here as a doctor who spends at least half her time reading mammograms) had the best record.
Why it matters: Getting a regular mammogram is key to finding breast cancer early. Five-year survival rates drop from a high of 98.1% for early, breast-only tumors to 27.1% for advanced cancer that has spread to distant organs.
What you should do: When you call for an appointment, ask if there's a breast-imaging specialist on staff. If not, shop around, advises Diana Miglioretti, Ph.D., a researcher with the Group Health Center for Health Studies in Seattle. "I'd go to someone who has been interpreting screening mammograms for at least 10 years."
Follow-up Foul-ups
If your screening mammogram is abnormal or you have a lump, the next step is often a diagnostic X-ray, which takes magnified close-ups of the suspicious tissue.
The news: In theory, diagnostic mammograms should be easier to interpret than screening ones because the doctor knows where trouble may be lurking. Yet the largest study analyzing how well radiologists do on these critical exams found they missed 21 percent of cancers on average. The real shocker was the range: The top performer found every tumor, while the worst missed an astonishing 73 percent. Doctors affiliated with academic medical centers did best: They correctly diagnosed 88 percent of cancers.
Why it matters: Missing a tumor at this step could mean a delay in diagnosis — possibly a dangerous one, if a tumor isn't detected and treated before the cancer has spread.
What you should do: As with screening X-rays, the doctor who reads your diagnostic X-ray should be someone who specializes in mammograms, says Miglioretti, who led the study. Unless you live in a rural area, you should be able to find such a specialist no more than an hour or two away. "It's worth the drive," she says.
Surgical Biases
The biggest decision many women face when they're diagnosed with breast cancer is whether to have a mastectomy (removal of the entire breast) or a lumpectomy (only the tumor and surrounding tissue are cut out). In many cases, breast-conserving surgery, including lymph node testing and follow-up radiation, has the same lifesaving benefits as mastectomy. Yet your surgeon may not explain the options and consequences clearly or evenhandedly.
The news: Clinical guidelines developed by leading organizations favor breast-conserving surgery because it's less drastic. That's true whether you live in Augusta, ME, or Augusta, GA. Yet a review of 800,000 patient records found that while 70% in the Northeast had breast-sparing surgery, only 58% of those in the South did (the numbers for the West and Midwest were 63 percent and 61 percent, respectively). The review didn't look for a why, but study leader Jack Sariego, M.D., professor of surgery at Temple University, notes that the more rural South likely has fewer radiation facilities and fewer academic medical centers to promote surgical advances.
Beyond your zip code, the type of surgeon and hospital you choose may affect the recommendation you'll receive. Doctors who treat a lot of breast cancer or who work in cancer centers or academic medical centers suggest lumpectomy more often than general surgeons in the community. Surgeons trained after 1981 are also more likely to recommend a lumpectomy than older doctors, past research from the University of North Carolina at Chapel Hill has shown.
Why it matters: In a survey of 1,132 women who had either a lumpectomy or a mastectomy, almost half indicated they did not understand the risks and benefits of their choice.
What you should do: Ask loads of questions, starting with, "Am I a candidate for breast-conserving surgery, and if not, why not?" advises Dr. Sariego. Do your own research. And don't be shy about asking the first surgeon to recommend another for a second opinion. Better yet, look on your own: A recent study shows you're more likely to wind up with someone experienced and affiliated with a cancer program, compared with women who rely on referrals from their doctor or health plan, says Steven Katz, M.D., professor of medicine and health management and policy at the University of Michigan.
While you're asking questions, find out how your lymph nodes will be tested to see if the cancer has spread. A newer procedure, called sentinel-node biopsy, is less invasive and far less likely to cause permanent arm swelling than old-fashioned lymph node removal, but about 35 percent of patients aren't getting it, a recent multicenter study found.
Post-Surgery Neglect
Lumpectomy is just as effective as mastectomy only if it includes lymph node testing and a course of radiation treatments — generally five days a week for about six weeks. That's something your surgeon should make clear before you choose one procedure over the other.
The news: In 2003, only 71 percent of lumpectomy patients followed through with radiation, down from 79 percent in 1992, University of Minnesota epidemiologist Beth Virnig, Ph.D., reported last December. "A lot of women with serious breast cancer are not getting comprehensive treatment," she says.
Why it matters: If you don't undergo a full course of radiation, your chances of local recurrence within 10 years are as high as 30 percent, says Dr. Katz. (If you do, they drop to about 8 to 10 percent.)
What you should do: Talk with a radiation oncologist before surgery. Ask how long your treatment will last and what the side effects might be. For that matter, talk with all the specialists who may be involved in your postsurgical care. Women often feel panicked and pressured to start treatment immediately, but it's usually safe to wait two to three weeks.
Reticence on Reconstruction
If a lumpectomy isn't right for you, a mastectomy followed by reconstruction is an alternative — but you may have to bring up the subject.
The news: Only about one-quarter of surgeons regularly send patients for a plastic surgery consultation before they make their lumpectomy or mastectomy decision, researchers from the University of Michigan found in a 2007 study. Who's most likely to make that referral? Women surgeons — as well as those who treat a lot of breast cancer. Reconstruction can be done during the same surgery as the mastectomy, but it requires the general and plastic surgeons to share turf and mesh schedules, which may be inconvenient for them — even if it's good for you.
Why it matters: Both procedures will alter your appearance, but in different ways. This may seem like a minor worry when you're newly diagnosed and terrified, but it's likely to become important when you're well.
What you should do: "Ask your surgeon how your breast will look, how your clothing will fit," says Amy Alderman, M.D., M.P.H., an assistant professor of surgery at the University of Michigan. Even if you're sure you want breast-conserving surgery, you may want to consult with a plastic surgeon. Lumpectomy sometimes changes the breast more than women expect; a specialist can help you assess what might happen in your case. This is not vanity: Women who end up with extremely uneven breasts are more likely to be depressed and to worry that their cancer will return, a brand-new University of Michigan study found. Or you may want to seek out a breast surgeon who's experienced in oncoplastic techniques, which can improve the look of the breast.
Thankfully, the days of "Doctor knows best" are behind us. But that means breast cancer patients have to work with their physicians to make tough choices. To do that, women must share their fears and desires. "The doctor only knows what's on your X-ray and pathology report," says Karen Sepucha, Ph.D., a senior scientist with the Health Decision Research Unit at Massachusetts General Hospital: "What you care about needs to get on the table."
And you have to be the one who makes sure it does.
More Ways to Get the Answers You Need
Going for a Third Opinion
Kim Friedrich, 37
Mastic, NY
Kim Friedrich was in shock. In February 2007, her left breast had a tumor one-and-a-half times the size of a golf ball; because it was so big and aggressive, the surgeon told her she needed to have that breast removed, as well as the other as a precaution. A second doctor agreed. "I kept seeing myself on my deathbed," Friedrich says. She'd look at her two daughters and seize up with grief — would they grow up without her? While she would have done anything to live, she wasn't convinced she had to lose her breasts. Neither doctor had taken much time with her, she realized. Friedrich began to do research and talked to everyone she could. When an acquaintance raved about her breast specialist, at a cancer center a three-hour drive away, Friedrich pressed for an appointment. The mastectomy recommendations did not surprise the doctor. "That's old thinking," he told her. His advice: a course of chemotherapy (which shrank the tumor down to the size of a pea), followed by a lumpectomy and radiation. It was very tough, but Friedrich has no doubt she chose the right treatment — and doctor: "I got two quick assessments, and felt like they were thinking, 'Let's just do what's fastest and move on to the next patient.'"
When It's Not "Nothing"
Amalia Rigoni, 50
Olympia Fields, IL
Although she'd had a normal mammogram just a few months earlier, in March 2000, Amalia Rigoni was uneasy about a lump she felt in her lower right breast. Both her gynecologist and internist said she was fine. A diagnostic mammogram detected nothing. Still, she insisted on seeing a surgeon. That doctor, a general surgeon, told her to come back in six months. So Rigoni tried another tack: "If your mother had breast cancer, where would you send her?" The surgeon recommended a breast specialist who'd been his professor. The specialist checked her by closing his eyes and palpating the breast. "I don't like the feel of that lump," he said. "It was surreal," Rigoni recalls. "But I said, 'Thank God. At least I know what's going on.'" Almost nine years later — after a mastectomy, reconstruction, radiation, and three years of the drug tamoxifen followed by five on Femara — she's fine. Now Rigoni's a hotline coordinator for Breast Cancer Network of Strength, counseling women who may be facing the same struggle to get answers. "I tell them that doctors may know medicine, but you know your body. If something doesn't feel right, get it checked out." And, she adds, "go to a specialist."
Filling the Info Gap
Evelyn White, 48
San Francisco, CA
Support groups can provide invaluable information that patients may not get from their doctors. Evelyn White, for example, says her medical care was "great." She was diagnosed with breast cancer in February 2006, and underwent a mastectomy. But the chemo that followed left her unable to move — and she was suffering terrible crying jags. A friend thought it might be the medicine that White was taking for nausea — Ativan, a powerful sedative. She asked her doctor about stopping the drug and then, at a meeting of a cancer survivors' organization, heard about an alternative. There was a newer drug, Emend, developed specifically to prevent the nausea of chemotherapy — without causing depression. Once her physician switched the meds, "I felt a thousand percent better, physically and emotionally," says White. Later, the group helped in another key way. White had assumed her cancer was genetic (her sister was a survivor as well), and she was worried that her daughter, 24, might be at increased risk. Armed with information she got from a meeting, she underwent testing and, last year, was thrilled to be able to strike that worry off her list.
Friday, April 10, 2009
7 Relationship Problems and How to Solve Them
7 Relationship Problems and How to Solve Them
Here's how to resolve the most common relationship problems and get your love life back on track.
By Carol Sorgen
FeatureReviewed by Louise Chang, MDIt's the rare couple that doesn't, sooner or later, run into a few bumps in the road. If you recognize ahead of time what those relationship problems can be, you'll have a much better chance of weathering the storm, experts say.By Carol Sorgen
Ideally, a couple should discuss certain basic issues -- such as money, sex, and kids -- before they decide to start their life together. Of course, even when you do discuss these issues beforehand, marriage (or a long-term, live-in relationship) is nothing like you think it's going to be.
In spite of the fact that every marriage experiences relationship problems, couples who are successful have learned how to manage them and keep their love life going, says marriage and family therapist Mitch Temple, MS, author of The Marriage Turnaround. They gain success in marriage by hanging in there, tackling problems, and learning how to maneuver through the complex issues of everyday married life. Many do this by reading self-help books, attending seminars, browsing articles on the Web, going to counseling, observing other successful couples, or simply by trial and error.
Here are some common issues and ways to resolve them:
Relationship Problem: Communication
All relationship problems stem from poor communication skills, says Elaine Fantle Shimberg, author of Blending Families. "You can't communicate while you're checking your BlackBerry, watching TV, or flipping through the sports section," she says.
Problem-solving strategies:
Make time ... yes, an actual appointment with each other, Shimberg says. If you live together, put the cell phones on vibrate, put the kids to bed, and let the answering machine pick up your calls.
If you can't "communicate" without raising your voices, go to a public spot like the library, park, or restaurant, where you'd be embarrassed if anyone saw you screaming.
Set up some rules ... like not interrupting until the other is through, banning phrases such as "You always ..." or "You never ..."
Remember that a large part of communication is listening, so be sure your body language reflects that. That means, don't doodle, look at your watch, pick at your nails, etc. Nod so the other person knows you're getting the message and rephrase if necessary, such as, "What I hear you saying is that you feel as though you have more chores at home, even though we're both working." If you're right, the other can confirm, and if what the other person really meant was, hey, you're a slob and you create more work for me by having to pick up after you, perhaps they'll say so but in a nicer way.
Relationship Problem: Sex
Even partners who love each other can be incompatible sexually. Compounding these problems, says Mary Jo Fay, is the fact that men and women alike are sorely lacking in sex education and sexual self-awareness. Yet, having sex is one of the last things we should be giving up, says Fay, who addresses the topic in her new book, Please Dear, Not Tonight. "Sex brings us closer together, releases hormones that help our bodies both physically and mentally, and keeps the chemistry of a healthy couple healthy," she says.
Problem-solving strategies:
Plan, plan, plan, Fay says. Make an appointment -- not necessarily at night when everyone is tired. Maybe during the baby's Saturday afternoon nap. Or perhaps a "before-work quickie," Fay suggests. Or ask Grandma and Grandpa to take the kids every other Friday night for a sleepover. "When sex is on the calendar, it increases your anticipation," Fay says, adding that mixing things up a bit can increase your sexual enjoyment as well. Why not sex in the kitchen? Sex by the fire? Sex standing up in the hallway?
California psychotherapist Allison Cohen, MA, MFT, also suggests learning what truly turns your partner on by asking him or her to come up with a personal "Sexy List." And, of course, you do the same. What do each of you truly find sexy? "The answers may surprise you." Swap the lists and use them to create more scenarios that turn you both on.
If your sexual relationship problems can't be resolved on your own, Fay recommends consulting a qualified sex therapist, who can help you both address and resolve your issues.
Relationship Problem: Money
Money problems can start even before the wedding vows are said, from the expenses of courtship to the high cost of weddings. The National Foundation for Credit Counseling (NFCC) recommends that couples who have money woes take a deep breath and have a serious conversation about finances.
Problem-solving strategies: The NFCC offers the following advice for having that much-needed financial conversation:
Be honest about your current financial situation. If things have gone south, continuing the same lifestyle that was possible before the loss of income is simply unrealistic.
Don't approach the subject in the heat of battle. Instead, set aside a time that is convenient and non-threatening for both parties.
Acknowledge that one partner may be a saver and one a spender, understanding that there are benefits to both, and agreeing to learn from each other's tendencies.
Don't hide income or debt. Bring financial documents, including a recent credit report, pay stubs, bank statements, insurance policies, debts, and investments to the table.
Don't blame.
Construct a joint budget that includes savings.
Decide which person will be responsible for paying the monthly bills.
Allow each person to have independence by setting aside money to be spent at his or her discretion.
Decide upon short-term and long-term goals. It's OK to have individual goals, but you should have family goals, too.
Talk about caring for your parents as they age, and how to appropriately plan for their financial needs, if necessary.
Relationship Problem: Struggles Over Home Chores
Nowadays, most partners work outside the home -- and in today's economy -- often at more than one job, so it's important to equitably divide the labor at home, says Paulette Kouffman Sherman, PhD. She is the author of Dating from the Inside Out: How to Use the Law of Attraction in Matters of the Heart.
Problem-solving strategies:
Be organized and clear about your respective jobs in the home, Sherman says. "Write all the jobs down and agree on who does what." Be fair: Make sure each partner's tasks are equitable so no resentment builds.
Be open to other solutions, Sherman adds: If you both hate housework, maybe you can spring for a cleaning service. If one of you likes housework, the other partner can do the laundry and the yard. As long as it feels fair to both people, you can be creative and take preferences into account.
Relationship Problem: Not Prioritizing Your Relationship
If you want to keep your love life going, making your relationship a focal point does not end when you say "I do." "Relationships lose their luster," says Karen Sherman, PhD, author of Marriage Magic! Find It, Keep It, and Make It Last. "So make yours a priority."
Problem-solving strategies:
Do the things you used to do when you were first dating: Make gestures of appreciation, compliment each other, contact each other through the day, and show interest in each other.
Plan date nights. Schedule time together on the calendar just as you would any other important event in your life.
Respect one another. Say "thank you," and "I appreciate ... ." It lets your partner know that he/she matters.
Relationship Problem: Conflict
Occasional conflict is an inevitable part of life, says New York-based psychologist Susan Silverman, PhD, but if you and your partner feel like you are starring in your own nightmare version of the movie Groundhog Day, it's time to break free of this toxic routine. Recognizing these simple truths will lessen anger and enable you to take a calm look at the underlying issue.
Problem-solving strategies:
Conflict resolution skills can help you and your partner learn to argue in a more constructive manner, says Silverman, who offers this advice:
You are not a victim. It is your choice whether to react and how to react.
Be honest with yourself. When you're in the midst of an argument, are your comments directed toward resolution, or are you looking for payback? If your comments are blaming and hurtful, it's best to take a deep breath and change your strategy.
Change it up. If you continue to respond in the same way that has brought you pain and unhappiness in the past, you can't expect a different result this time. Just one little shift can make a big difference. If you usually jump right in to defend yourself before your partner is finished speaking, hold off for a few moments. You'll be surprised at how such a small shift in tempo can change the whole tone of an argument.
Give a little; get a lot. Apologize when you're wrong. Sure it's tough, but just try it and watch something wonderful happen.
"You can't control anyone else's behavior," Silverman says. "The only one in your charge is you."
Relationship Problem: Trust
Trust is an essential part of a relationship. Are there certain behaviors that are causing you to not trust your partner, or do you have unresolved issues that are hindering you from trusting others?
Problem-solving strategies: You and your partner can develop trust in each other by following these tips, suggested by Fay.
>Be consistent.
>Be on time.
>Do what you say you will do.
>Don't lie -- not even little white lies, to your partner or to others.
>Be fair, even in an argument.
>Be sensitive to the other's feelings. You can still disagree but don't discount how your partner is feeling.
>Call when you say you will.
>Call to say you'll be home late.
>Carry your fair share of the workload.
>Don't overreact when things go wrong.
>Never say things you can't take back.
>Don't dig up old wounds.
>Respect your partner's boundaries.
>Don’t be jealous.
>Be a good listener.
Although relationships have their ups and downs, there are things you can both do that may well minimize marriage problems, if not help avoid them altogether, says psychologist Karen Sherman. Be realistic. Thinking your mate will meet all your needs -- and will be able to figure them out without your asking -- is a Hollywood fantasy. "Ask for what you need directly," Karen Sherman says.
Use humor -- learn to let things go and enjoy one another more. And be willing to work on your relationship and to truly look at what needs to be done. Don't think that it will be better with someone else; the same problems you have in this relationship because of lack of skills will still exist
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