Brought to you by Harriet Kohen, LICSW

I often get asked for a list of easy communication “Do’s and Don’ts” with teenagers.  If you only have to remember a few things while communicating with your teen, I like these top ten suggestions from Vanessa Van Petten’s Radical Parenting web site.  Some of these “Do’s and Don’ts” are harder in practice than theory, but they often save the day.  Typically, the hardest ones to implement are the ones we parents need to work on the most!  Want face to face help with your teen?  Give Harriet Kohen a call at Partners in Healing of Minneapolis at 763-546-5797. 

1. Never talk about your teen in front of them as if they are not there.

2. Don’t let your teen place objects between you.  This creates emotional barriers—the remote control is quite popular.

3. If your teen goes into ‘whine’ mode, do not respond until they insist on taking the ‘whine’ out of their tone.

4. Never embarrass your teen to be funny.  This only creates barriers between you and it does not ‘give them thick skin.’

5. If you are in an argument, try changing locations–those three seconds provide space to calm down and reset.

6. Don’t play ‘what if’ with your teen or yourself; this will only end in a battle of logic.

7. Don’t fall into the ‘I’ll do it later’ trap.  We all know they won’t do it later and you will be disappointed.

8. If you want your teen to break a rule, say because ‘I said so.’

9. Always start discussion with what you agree on.  This puts you both on the same page and makes it easier when they have to compromise later.

10. If you feel like you might say something you do not mean, walk away.

Source:  www.radicalparenting.com (August, 2010)

Brought to you by Dr. David Alter's MindMatters

When all you have is a hammer, everything looks like a nail!  For far too long, the treatment of pain has relied on strong pain killing medication and invasive back surgeries.  These two approaches represent the "hammers" that have tried to "nail down" chronic pain.  The results, as nicely pointed out in the accompanying article, entitled "Back Surgery May Backfire on Patients in Pain," have been disappointing for too many pain sufferers.  Too many patients undergoing surgery for back pain experience limited benefits or actually experience increased pain with decreased ability to function. 

 To treat chronic pain effectively demands recognition that CHRONIC pain does not simply reflect damaged tissue that can be fixed with surgery.  Chronic pain is a body and mind condition that requires a body and mind treatment approach!  Chronic pain involves changes in networks of nerves that carry signals between the body and the brain; chnages in the types and amount of messenger molecules that circulate in the blood that cause the body to be more sensitive to pain; changes in mood related to worry, sadness, fear and despair; changes in thought patterns and beliefs that can keep the body in an over-aroused state; and changes in key relationships that influence the level of support or comfort that is so needed WHEN affected by chronic pain. 

 At Partners in Healing of Minneapolis, we have developed a body and mind treatment approach called the Program for Conscious Living that addresses the uniqueness and complexity of your chronic pain condition.  Call our office at 763-546-5797 to learn more about the Program for Conscious Living, and take that next step on your path to better health and improved daily functioning. 

Back surgery may backfire on patients in pain
Patients who had spinal fusion were less likely to return to work and needed more opiates, study says
by Linda Carroll (October 14, 2010) www.msnbc.com 

Just a month after back surgery, Nancy Scatena was once again in excruciating pain. The medications her doctor prescribed barely took the edge off the unrelenting back aches and searing jolts down her left leg. “The pain just kept intensifying,” says the 52-year-old Scottsdale, Ariz., woman who suffers from spinal stenosis, a narrowing of the chanel through which spinal nerves pass. “I was suicidal.”

Finally, Scatena made an appointment with another surgeon, one whom friends had called a “miracle worker.” The new doctor assured her that this second operation would fix everything, and in the pain-free weeks following an operation to fuse two of her vertebrae it seemed that he was right. But then the pain came roaring back.

Experts estimate that nearly 600,000 Americans opt for back operations each year. But for many like Scatena, surgery is just an empty promise, say pain management experts and some surgeons.

A new study in the journal Spine shows that in many cases surgery can even backfire, leaving patients in more pain.

Researchers reviewed records from 1,450 patients in the Ohio Bureau of Workers’ Compensation database who had diagnoses of disc degeneration, disc herniation or radiculopathy, a nerve condition that causes tingling and weakness of the limbs. Half of the patients had surgery to fuse two or more vertebrae in hopes of curing low back pain. The other half had no surgery, even though they had comparable diagnoses.

After two years, just 26 percent of those who had surgery returned to work. That’s compared to 67 percent of patients who didn’t have surgery. In what might be the most troubling study finding, researchers determined that there was a 41 percent increase in the use of painkillers, specifically opiates, in those who had surgery.

The study provides clear evidence that for many patients, fusion surgeries designed to alleviate pain from degenerating discs don’t work, says the study’s lead author Dr. Trang Nguyen, a researcher at the University of Cincinnati College of Medicine.

Unfortunately, for most patients with bad backs, there is no easy solution, no magic bullet. Pain management experts — and some surgeons — say that patients need to scale back their expectations. With the right treatments, pain can be eased, but a complete cure is unlikely.

In the wake of her operations, Scatena has turned to less invasive therapies. She’s learned to baby her back and to find ways to avoid irritating the nerves in her spine. She’s working to strengthen muscles in her lower back and abdomen so her spine will get better support. “I’ve been getting some relief from physical therapy,” she says. “And I hope that’s going to be permanent.”

27 million adults with back problems
A recent report by the Agency for Healthcare Research and Quality, a federal organization, found that in 2007, 27 million adults reported back problems with $30.3 billion spent on treatments to ease the pain. While some of that money is spent on physical therapy, pain management, chiropractor visits, and other non invasive therapies, a big chunk pays for spine surgeries.

Complicated spine surgeries that involve fusing two or more vertebrae are on the rise. In just 15 years, there was an eight-fold jump in this type of operation, according to a study published in Spine in July. That has some surgeons and public health experts concerned.

For some patients, there is a legitimate need for spine surgery and fusion, says Dr. Charles Burton, medical director for The Center for Restorative Spine Surgery in St. Paul, Minn. “But the concern is that it’s gotten way beyond what is reasonable or necessary. There are some areas of the country where the rate of spine surgery is three or four times the national average.”

Burton and others recommend that patients get a second opinion when back surgery is recommended for the treatment of back pain without neurological symptoms, such as sciatica, especially if other treatments haven’t been suggested first.

“We are very successful at improving leg symptoms," says Dr. William Welch, vice chairman of the department of neurosurgery at the University of Pennsylvania Medical Center and chief of neurosurgery at Pennsylvania Hospital. “We are less successful at treating back pain.”

Source of pain is often hard to pinpoint
The reason, Welch says, is that it’s often hard to pinpoint the exact cause of someone’s back pain. Even MRIs can be misleading because abnormalities, such as degenerating discs, can be seen on scans for virtually everyone over the age of 30 regardless of whether they have pain. Even when the surgery is a success, it rarely dispels 100 percent of back pain, Welch says.

And while many surgeons are careful about which patients they recommend for spine operations, some are not so discriminating, says Dr. Doris K. Cope, professor and vice chair for pain medicine at the University of Pittsburgh School of Medicine. “It’s a case of, if you have a hammer, everything looks like a nail,” she explains.

In general, the best results come about through a combination of approaches, Cope says. Each strategy may reduce pain by just 10 or 20 percent, but those percentages can add up so ultimately the patient’s pain is cut back by as much as 70 or 80 percent. Strategies can include exercise and weight loss, Cope says.

That advice resonates with Marilyn Seiger, a friend of Nancy Scatena in Scottsdale. Seiger opted to skip surgery, not wanting to follow her friend's painful path, even though her doctor recommended an operation to fuse two of her vertebrae.

She has gotten some relief from physical therapy, a back brace that reminds her to keep her back straight, and the occasional pain pill.

“I don’t know anyone who’s had surgery for back pain who had success,” says Seiger, 61. “I just figure this is part of growing older. We’re living longer than our bodies were meant to last and we’re just constantly shoring things up.”

Watch this video by Dr. Nate Champion, our naturopathic doctor at PIH, offering advice on natural remedies to prevent flu this winter, instead of or in addition to the flu vaccine.   This video plays best on high quality.   To schedule with Dr. Champion, call 763-546-5797.[video: 560x340]

We are delighted to welcome Naturopathic Doctor Nate Champion to Partners in Healing (PIH).  Dr. Champion brings a wealth of knowledge about naturopathic medicine, homeopathy, botanical medicine, and clinical nutrition to our holistic health center.  Dr. Champion is an expert in treating digestive disorders, particularly inflammatory bowel disease (Ulcerative Colitis & Crohn's Disease). As a result of his own battle with Ulcerative Colitis, he is passionate about helping others who are suffering with these conditions.

Dr. Champion is now scheduling patients of all ages with all kinds of acute and chronic health conditions. He routinely treats children, adolescents, adults, and the elderly. Some commonly treated conditions include (but, are not limited to) anxiety, allergies, arthritis, depression, irritable bowel syndrome, high cholesterol/heart disease, elevated blood pressure, colds/flus, hypothyroidism, diabetes/insulin resistance, obesity/weight loss, pediatric conditions, chronic pain, chronic fatigue, menopause, prostate conditions, autoimmune disorders, along with many others.  Dr. Champion is a member of the American Association of Naturopathic Physicians (AANP) and the Minnesota Association of Naturopathic Physicians (MNANP).

To schedule with Dr. Champion, call Partners in Healing at 763-546-5797.  Use your Health Savings Account (HSA), to ensure your best possible health.  We look forward to partnering with you!

      Authored by Dr. Deborah Simmons

I was very troubled by this article on middle-aged suicide in today's New York Times.  If you or someone you know is suffering, please ask for help.  At Partners in Healing of Minneapolis we provide mind and body support for individuals, couples, and families suffering from depression and bipolar disorder, as well as those who are grieving.  There is hope.  Let us bring sunshine back into your life.  Call us today at 763-546-5797. 

Rise in Suicides of Middle-Aged Is Continuing

By PATRICIA COHEN  (Published in the New York Times, June 4, 2010)

For the second year in a row, middle-aged adults have registered the highest suicide rate in the country, according to the federal Centers for Disease Control and Prevention. Historically, the eldest segment of the population, those 80 and older, have had the highest rates of suicide in the United States. Starting in 2006, however, the suicide rate among men and women between the ages of 45 and 54 was the highest of any age group. 

The most recent figures released, from 2007, reveal that the 45-to-54 age group had a suicide rate of 17.6 per every 100,000 people. The second highest was the 75-to-84 age range, with a rate of 16.4, followed by those between 35 and 44, with a 16.3. 

The rate for 45- to 54-year-olds in 2006 was 17.2 per 100,000 people, and in 2005 it was 16.3. “It’s such a startling rise,” said Dr. Paula Clayton, the medical director of the American Foundation for Suicide Prevention. 

Researchers are puzzled by the increase, but Dr. Clayton said the rise in suicide among Americans born in the 1950s and 1960s was probably a result of a combination of factors, including easier access to guns and prescription drugs and what may be a higher incidence of depression among baby boomers. 

“Ninety percent of people who kill themselves have a mental disorder at the time of their death,” which can be aggravated by drug and alcohol abuse, Dr. Clayton said. Problems related to health, jobs, relationships and finances have also been shown to be important risk factors for suicide, the C.D.C. reported. 

Men are more than three times as likely to commit suicide as women, and they tend to use guns. American Indians, Alaska Natives and non-Hispanic whites are also at greater risk. Veterans are also vulnerable.

About 50,000 people die each year from violence-related injuries; suicides account for more than half that number.

     Authored by Dr. Alana Riss Fine

I was reading this weekend's Parade Magazine and found Emily Listfield's article on smoking cessation and weight management.  Both are about habit control.  Gain control over your own habits and gain peace in your life.  Call me at Partners in Healing at 763-546-5797 and set up an appointment for hypnosis.  I can also teach you the LEARN Program, where you can lose weight mindfully.   

Give Up Smoking Without Gaining Weight (by Emily Listfield)

According to the American Cancer Society, half of all Americas who smoke will die of tobacco-related causes such as lung cancer or emphysema.  For some smokers, however, there's another, more immediate fear.  Nicotine suppresses the appetite and helps boost the metabolism, so many smokers worry they'll gain weight if they quit.  "People feel caught between a rock and a hard place," says Dr. Bonnie Spring of the Northwestern University Feinberg School of Medicine.  "They care about both their appearance and their health."Fortunately, they don't have to choose one or the other.  In fact, controlling your weight may actually help you drop your nicotine habit.  A recent Northwestern study showed that women who joined a weight-loss support were not only less likely to gain weight; they were also up to 29% more successful in quitting smoking.

Dr. Spring hopes her study will change the standard advice:  "Until now, more doctors have warned against trying to control two behaviors at once.  Our results show that trying to manage weight gain does not undermine smoking cessation but rather enhances it." 

         Authored by Dr. David Alter on MindMatters

My daughter recently completed a Rube Goldberg assignment for 9th grade science class. Students had to invent a machine that, once started, would run on its own, and in the process demonstrate four “energy transfers” involving mechanical, chemical, thermal and electrical energy. It occurred to me later that our bodies do the same thing all the time.

•Sound wave energy is converted into electrical and chemical energies so that we can “hear” the sounds of the world.

•Our eyes receive photons of light and convert these packets of light energy into electrical and chemical signals that enable us to perceive the stunning visual world around us.

•Our thoughts are themselves made up electrical and chemical energies. Our thoughts convert these energies into production of protein molecules in our cells that power the activities of our daily lives.

Perceiving pain also requires energy transfers.

Pain is the name for particular types of chemical and electrical energy signals that are translated at different points in the body (e.g., spinal cord nerve roots & structures in the brain itself) into the experience we call pain. We are now rediscovering that imagination has the power to influence these various energy transfers in ways that alter the signal of pain.

How can you learn to do this for yourself?

•Explore imagery training (e.g., guided imagery training, develop hypnosis skills, use cognitive-behavioral techniques for modifying pain maintaining thoughts)

•Imagery training changes the sensitivity of our tissues to pain (i.e., it takes more signals to produce pain)

•Imagery changes the form of the sensation that is perceived (i.e., it changes what was pain into more tolerable sensations)

•Imagery produces physical changes in the way that networks of nerves connect to each other. Our imagination changes the structure of the physical body.

•Using imagery approaches helps your thoughts and mental images to literally restructure the brain, rewire the pain, and enable higher levels of daily functioning to be achieved.

Now, that is a Rube Goldberg project worth repeating!

At Partners in Healing of Minneapolis, we offer a number of imagery training approaches. Find out which is right for you and your body. Contact us at 763-546-5797 or visit us at www.pih-mpls.com for more information.

      (Authored by Deborah Simmons, PhD, LMFT

In my office, I hear a lot about the idea of working less and gaining more time and joy in life.  Victoria Colligan, co-author of Ladies Who Launch: Embracing Entrepreneurship & Creativity as a Lifestyle, and founder of www.LadiesWhoLaunch.com offers these tips on family-life-work balance.  

(May 26, 2010)  Growing up I was taught that hard work and long hours are rewarded. However over the years I have found that some of the most successful people actually work fewer hours, are more productive, take fabulous vacations and still have time to exercise daily without fail. This is because they’re “working smart,” not “hard.”  Here are the top 5 things I have learned from them:

1. Develop a routine that works for you, and not necessarily one that is obvious (in other words, if your most productive work hours are in the evenings, put structure around that and “own it.”). Prioritize and be disciplined. Don’t get distracted.

2. Don’t do everything, just the most important things. This requires a clear sense of what to follow through on and what to let slide. Successful people are absolute geniuses in this area. Find someone to model and carefully examine how they do it.

3. Do not procrastinate. Do the hardest, deadline driven activities first, then shift gears to the fun stuff.

4. Skip long winded conversations. Get to the point and stay there.

5. Do not over-delegate. Stay close to your business so you know exactly what to prioritize at any given moment. Maintain your passion for what you do and most of all, have fun!

Need some help with balance in your own life?  We can help!  Give us a call at Partners in Healing at 763-546-5797 where the art and science of healing begin. 

          Authored by Deborah Simmons, PhD, LMFT

As a member of the American Society for Reproductive Medicine, I provide psychoeducation for people who seek to conceive a baby with a gestational carrier, also known as a surrogate.  My colleague, Sharon LaMoth, owner of Infertility Answers, Inc., wrote this article recently for East Coast Fertility.   There are definitely rules that can make third party reproduction safe and a life-giving experience.  My advice?  Take your time and do your due diligence about all necessary psychological, legal, and medical steps.  They are part of this extraordinary journey.  Do you have questions about the emotions of fertility treatment?  Just give me a call at 763-546-5797.  I am here to help. 

Intended Parents who are considering surrogacy to complete their family, Gestational or Traditional, independently should do their research before making this life changing decision. Often times, when trying to cut financial corners and when desperation and vulnerability are a part of the picture, some Intended Parents may find themselves in a courtroom fighting for their baby just because one (or more) of these top 10 mistakes were made. Although some of these tips seem to be common sense, others may not have been a thought until it's too late. Most Intended Parents think they are saving money by not hiring a consultant or an agency but the harsh reality is that they spend more money and time in the long run then they save.  

Top 10 Don'ts When Planning a Surrogacy Arrangement  
10) Don't work with a woman under the age of 21

9) Don't work with a woman who has never given birth to a child of her own  

8) Don't use a contract downloaded from the Internet with no legal guidance  

7) Don't use the sperm from an ex boyfriend  

6) Don't work with a Surrogate who lives in a state that makes "commercial surrogacy contracts" unenforceable  

5) Don't 'do' in-home inseminations  

4) Don't have the compensation payments to your surrogate come directly from you-use an escrow agent/account  

3) Don't forget to pay all the bills regarding the surrogacy and pregnancy in a timely manner  

2) Don't have your surrogate stay with you for more then a week if at all possible (offer a hotel or condo nearby)  

1) Don't forget or forgo the Psychological Evaluation  

Even if all of these mistakes are avoided any surrogacy arrangement will still offer its own unique challenges. It's always a good idea to have periodic meetings with a psychologist or mental health professional who is an expert in Third Party Family Building and can guide both the Intended Parents and their Surrogate throughout the pregnancy, birth and for at least six weeks after leaving the hospital. The best case scenario is to hire a full service agency.   

Let me begin with some general terms and facts to give you more of an idea of about massage therapists that are certified and licensed.  With this information you will probably surprise your therapist with how much you know and you’ll be able to ask the right questions when making your next appointment. 

Licensing maybe by the city where the therapist works or a State License. California has NO state licensing, but has licensing by each city. Licensing is through the police department and has nothing to do with massage therapy. In other states massage therapists can get a license through the state. Massage therapist may be required to publish their license when advertising, similar to contractors and home remodelers.

Certification and Licensing
Certification or licensing may require 300 hours of training (basic) to 500 hours to 1000 hours of training. Certification of hours is usually with an accredited school. Some licensing may require a Certification plus hours of working with clients.

There is a lot of inconsistency with licensing (or non-licensing) state by state or city by city. For that reason, clients can find great massage therapists through several Massage Therapy Associations. These associations have their own standards and ethics that their members adhere to. 

Science of Massage 
A massage therapist can complete 300 hours of training in about three months. In general, a therapist will learn the science of massage or the basic massage strokes, an introduction to the muscle and skeletal system and probably an introduction to deep tissue massage. A massage therapist with 300 hours of training can do a good massage.

Art of Massage  The next milestone is 500 hours of training. This is the art of massage. The massage therapist will learn more about muscles and how to blend relaxing massage strokes with effective deep tissue work to get the knots out of your back.

Art and Science of Massage 
A massage therapist with 1000 hours of training is very dedicated to their profession and is a specialist. This is the art and science of massage therapy. The therapist will have completed over two years of training and knows the finer points of massage therapy.

Your First Appointment
Massage therapy is like fine dining. You have the choice of dining at a local café if you’re on a budget or you can try fine dining. A massage appointment can be one hour or an hour & half. If you want a massage to feel great and be relaxed, then a therapist with 300 to 500 of training would best fit your needs.

If you have a lot of body tension or your body feels all twisted and out place, then you’ll probably want to work with someone that has over 300 of training. If you are an athlete or workout, you probably want someone with 500 hours or more.

Before booking your appointment, tell the therapist what kind of massage you are looking for. If the massage therapist is too busy to talk to you on the phone or seems a little cold, then call someone else. By the time you finish talking with the massage therapist you should already have rapport or some kind of comfortabilty with the therapist.

Massage Bill of Rights for the Client  As a new client visiting a massage therapist you do have rights. You have the right to say "No". I know this sounds obvious, but I can not tell you how many clients I have talked to that have endured a massage because they felt they were obligated to go through with the appointment. Within fifteen minutes of your appointment you should know if the massage therapist is there for you or just going through the motions. There is a bond, or a sense of energy, that you can feel and know that your therapist is connected with you.

If it doesn’t feel right, then say thank-you and leave. Or, ask the therapist to make whatever adjustments are necessary to make it feel more comfortable. A massage is NOT about pain. Yes you may experience a little of discomfort. As my teacher once said to me, "If the client sits up like a fish, then lighten your pressure."

I remember I had a very well trained massage therapist working on me once and "he knew what was best for the client." Yes he was trained and he knew what he was doing, but that was not what I wanted for a massage on that day. I thanked him and left. A few months later I booked another appointment with him when I needed a more "detailed" massage. If you decide to leave you may be obligated to pay for the session. Personally, I would rather end a session and pay rather than stay and endure something that is not what I need or feels like a suit that doesn’t fit.

If you are not asked to pay for the session, you may tip $10 as a courtesy for the therapist who took the time to book the session. Hopefully this won’t happen.

Massage Bill of Rights For The Massage Therapist 
A massage therapist has the right to be treated like a person and professional. As a client you should always arrive on time and leave when the time ends.

A therapeutic massage by a licensed therapist is not erotic bodywork. If you did not ask for this before booking a session, then do not assume this is included with the massage. Some people think this is always included with a massage – don’t assume anything, ask!

The massage therapist can ask a client to leave for not respecting their boundaries or for any various reasons discussed.

Draping or covering a client during a massage is for both the client and the therapist. It defines the boundaries between therapist and the client. Personally, I prefer a massage without being covered. I always ask about draping before I book an appointment.

Final Words
As a massage therapist, it is a great joy to give a massage and to nurture another human being. It has many health benefits and is more than a luxury for the rich and famous. Our bodies need to be touched and nurtured. It is what makes us feel alive and makes us more loving and kind to others around us.

You can make two people happy today. Call a massage therapist today and relax into health.