Posted by: Bob Stott

Last week, an article of mine went live on the Therapy Times site, entitled "Dying with Dignity", focusing on palliative care professionals and respiratory therapists coming together to aid the terminal patient. While I didn't face the usual struggles I come across when writing an article – wading through PR fluff or "reliable" sources who pack up and leave for Indonesia (oh, it happens) – I still ran into a bit of a writing wall.

With a lot of articles in which I spotlight therapists combating some tragic or debilitating trauma, I do my best to show both sides of the story: the tragedy but at the same time, the silver lining where therapists' efforts are making real differences. End-of-life therapy took me somewhere else entirely. On a topic like this, it was hard to locate that time-honored silver lining.

Also, covering a subject so intertwined with personal spiritual beliefs, I was having some minor troubles trying to walk a politically correct tight rope. Myself an agnostic and out-of-practice Catholic, I didn't want to validate or discount anyone's spiritual perspective on the proper management of end-of-life therapy. While illness and dying are a normal part of life, everyone, even therapists and palliative care workers, seem to have different ideas of where one's own spirituality fits into the process.

The Joint Commission has an accreditation standard that includes the patient's right to spiritual care and support, and although clinicians may recognize the need to provide spiritual care, many are understandably uncomfortable asking questions about spirituality or religion, for fear of superimposing their own ideas on the patient. From my research, it's clear, even today, that the relationship between spirituality and the patient's coping abilities is relatively new in the therapeutic literature. The number of studies addressing spirituality has tripled in the past five years alone.

Unwilling to make a spiritual stand myself, I decided to focus on the medicine of end-of-life field. Going into a topic like this, you have a misconception that the elephant in the room will be the removal of ventilator from the patient, the allowance of the patient to die – that very Grey's Anatomy-esque drama. But the entire road to this point can be a gauntlet, from dealing with hostile family situation to juggling demands for more aggressive preventative treatments.

Choosing to embrace palliative care over aggressive treatments is not giving up, and it's not giving in. A patient's decision to change the focus of their treatment from "cure" to "comfort" is about weighing quality of living versus quantity of life. It is about clarifying choices and the goals of the individual and family. As the patient juggles the aspects of palliative care – holistic care, pain management, home versus hospice care, spiritual issues, and familial support – experts say its crucial that healthcare professionals remain supportive of these decisions.

Its been an interesting article, seeing this hot topic from a lot of different angles, and coming to terms with my own ideas of mortality and end-of-life has been a real eye-opener. By all means, if you'd like, read my article and let me know your own unique perspective about patient management in end-of-life care.

I believe anyone who's even mildly connected to the media – I'll naturally excuse those living under a rock on Mars with their fingers in their ears – is well aware of the dismal economic conditions that have been the talk of the country for several months now. Many fear of another "Great Depression," although I think this belief is motivated predominantly by a demographic whose Y2K bomb shelters and survivalist communes are not currently making profits.

I probably shouldn't mock, considering I've seen firsthand the economic sludge that many of those seeking work are wading through, even in a populous city like Philadelphia. The job market is a muddled mess, and I'm seeing skilled workers and Ivy League college graduates turning to manual labor and receptionist jobs to make ends meet, which in turn forces former candidates for these jobs into even lower rungs of the job circuit.

We've reached economic gridlock: people are trapped in houses they can't sell because no one is moving and the housing market itself is just barely limping along, while senior citizens are staying at jobs they can't retire from due to escalating healthcare expenses and dwindling social security coverage. Travel agencies are consolidating and those that aren't are flat out drying up, because people don't have money to travel. National conferences over the summer and into the fall have reached record all-time lows. It seems the popular idea is to bundle up, settle in, and wait out this economic winter.

While a gridlocked economy may limit what people choose to spend their money on, it probably won't keep them from seeking medical attention. Healthcare is one of the largest and still fastest-growing job sectors in the United States. In particular demand are physicians, nurses, physical therapists, pharmacists and health aides. And while less money is being thrown at frivolous expenses and fringe benefits, people are still going through the rigors of surviving the day to day stresses – and with the weight of the limping economy on everyone's mind, stress has become one of the most popular companions.

As one would expect, the beleaguered economy is also straining many Americans' mental health: anxiety, depression, sleep problems and money-rooted marital conflicts are on the rise. Requests for mental health therapists increased 15 percent to 20 percent between June and August of 2008, no doubt driven by individual concerns about the family's financial situation. A poll conducted this past spring by the American Psychological Association found that 75 percent of Americans report stress due to financial problems. A similar poll one year ago put the number at half of the respondents, who said financial stress is hurting their professional and personal lives.

As one who is currently also struggling with the strain of a besieged economy, I make cuts and savings where and when I can. Its autumn now in the Keystone State now and I'm still biking to work in the morning, despite the damp chill that often comes with it. Since June, I think the bicycle has more than paid for itself – a paltry $250 that would have been long gone in a gasoline investment. Grocery shopping is kept to the basics and the essentials, and I try to keep an observant eye on the electrical appliances so as to keep that monthly electric bill to a minimum. However, it's just like putting duct tape over the holes in a dam: I'm slowing it down but that's about all.

Let's clear the air: I'm no Angelina Jolie. At best, I strive for daily Good Samaritan status but that's as easily attained these days as holding the door for an old woman or helping an owner chase their dog that has slipped the leash.

That charitable imperative that some people seem to have hardwired into them every time they see a commercial for abandoned and abused pets or starving children in Indonesia – well that, more or less, skipped me over. Its not apathy, however, just a feeling that the problem is too big for my meager contributions to matter in the grand scheme of the universe. And, as a stalwart pessimist, you can believe that – right up until someone presents you with an opportunity to be hands-on, to be there to see the difference you make. And all those elaborate excuses just shatter at your feet.

This past August, I returned for my second year as a volunteer counselor at the Ronald McDonald Camp, a one-week sleep-away camp in Greeley, Pennsylvania, for children with cancer and their siblings. A non-profit organization, the camp, sponsored by Philadelphia's Ronald McDonald House, is funded entirely by charitable donations raised throughout the year to provide patients from age 8 to 17 with outdoor activities and festivals, allowing them to be – if only for one week – just like any other kid.

When first approached by my girlfriend about volunteering at the camp, I remember putting up the usual excuses: * I don't know if I can take off a week from work. * I'm not the best authority figure – sometimes just a big kid myself. * I won't know anyone there. * I've never had cancer – how can I relate to these kids?

The list went on, but the excuses just became more and more transparent, and I began to sound like a 6-year old on the first day of school. I was just scared – of the time commitment, of being a bad role model, of being stuck in awkward social situations, of simply embarrassing myself. It was just a matter of getting over myself and the little boy scared of not belonging. I don't think I've ever made a better decision.

You go in with these preconceived notions that there will be some kind of divide between yourself and the campers – that the subject of cancer will be the elephant in the room – but that simply wasn't the case. These kids already know everything there is to know about IVs, hospitals, and physical rehabilitation, have already been through more than I could imagine. Yet at camp, these topics, if not taboo, are taken in stride. Kids mention their childhood cancers as if it was a past broken bone, talk about ongoing chemo treatments like follow-up doctor visits, and it never ceases to amaze me how much they just want to be kids for a week. Not an icon, not a survivor – just kids.

The counselors too, a completely volunteer base, also take the weeklong packed schedule in stride. No one complains when kids who have spent months housebound or undergoing treatment inside a cancer ward want to spend every waking moment outdoors (with counselors in tow), paddleboating, canoeing, climbing the ropes course, fishing, horseback riding, swimming, or even spending an hour straight of just tossing a baseball back and forth. I saw more muscle bruises, cramps, and shoulder strain than I've seen in years, and not once would I have traded any of them back.

Possibly the most rewarding part of returning to camp is seeing the campers from the previous year, who were undergoing bouts of chemo treatments, and have now come back strong and healthy. One of my shining moments was seeing a camper I had in my cabin last year – Ethan, a bald, spindly-limbed eleven year old, who never seemed to stop smiling at his own wry humor. Upon seeing me this year, Ethan immediately pulled off his familiar Mario Bros. baseball hat (the only way I could have recognized him) to reveal a thick mop of dark wavy hair, and with that familiar grin, said, "Hey Bob, look! I've got hair!"

Its an endurance gauntlet, suddenly playing Mama Bear to seven rambunctious 12 year olds, but at the end of the week, its more than worth it to watch them exchange e-mail addresses with one another, hug me goodbye, and confirm for the seventeenth time that I have their parents' e-mail addresses so I can send them the photos I've taken of them catching a monster fish, flying through the trees on a zip line, or sitting proudly on a horse for the first time.

With any luck, I'll be back to share it all with them again next year.

I heard an urban legend once from a friend of mine that several major corporations secretly spike the communal water cooler with amphetamines in the mornings to improve sales and vitality in the office. Looking at it from a strictly production-minded perspective, I can totally understand where they're coming from.

Coming into the office after a prolonged vacation (or a unsanctioned office happy hour that went "longer" than expected), you really notice how vital our country's last legal drug – caffeine – has become to perform even the basic functions and pleasantries around the office. To a lot of people I know, an extra dose (or two or three) of caffeine has become the main way of getting around any number of Life's unpleasantries, combatting boredom, melancholy, cabin fever, work overload, and even sickness.

A friend of mine, unwilling to call out before her winter vacation, made it through an entire week of work while struggling with the flu – how you ask? She dosed herself every hour and a half with a half cup of black coffee, no cream, no sugar, a system she continues to swear by. And who says, its not addictive.

But the bottom line question still arises: can caffeine – the savior of Monday mornings and delayer of hangovers – kill you?

Absolutely! But, ladies and gentleman, let's not lock up the coffee pot just yet.

The experts say you'd have to drink 80 to 100 cups of coffee in rapid succession, which equals about 6 gallons of coffee – approximately 10 to 13 grams of pure caffeine. Even if you could drink that much coffee, the excessive amount of water trapped in your body would kill you first by diluting essential nutrients in your bloodstream. So, while the point is moot, your death is not. Let's not attempt to set new records, shall we?

However, while it takes a lot to kill, it can take significantly less to cause ill effects, and long-term effects of caffeine remain somewhat unclear. Our latest contestant to try their hand at breaching the Caffeine barrier is a young woman in the United Kingdom, who drank seven double-shots of espresso in a mere four hours. The caffeine binge went as most would expect – gasping for breath with a racing heart on the way to the emergency room. She fully recovered within a day from the overdose, and doctors explained she had ingested three times the safe daily amount of caffeine.

With these stats in mind, how big of a role does caffeine play in your daily upkeep? Also, does its documented ill effects keep you from using it to make it through the wee hours of the morning?

Posted by: Bob Stott

As I finish up another intense air drum solo (to a standing ovation, I might add from the spider plant and the collection of multi-colored highlighters) to the wicked drumbeat from "Thanks for the Memories" courtesy of Fallout Boy, I could not help but notice the accelerated heartbeat and the tiniest bit of perspiration, the standard package deal that comes from flailing your arms in front of you for even a few seconds at a time. While my wild moves might not solidify my standing at the office as a balanced and reserved individual, new research says that I might be doing the best possible thing for someone who spends a majority of their day in a stationary position.

A study published in the journal Science has revealed that fidgeters – my people, the ones who cannot seem to stop their incessant foot-tapping, thumb twiddling, head bobbing, or incoherent humming to no audible song – are thinner, on average, than non-fidgeters.

The study found that sedentary (the statues of the workplace) burn at least 350 fewer calories compared to even a low-level fidgeter (the fairly infrequent foot tapper). The study suggests that sedentary people prefer to sit still due to a genetic predisposition, while many fidgeters are afflicted with opposing genetic tendencies that require freedom of movement and activities that match the amount of food intake.

While full-blown fidgeters are known to be an annoyance in the workplace, as much they were in school with the pencil tapping on the desk, many of the fidget behaviors either go unnoticed or are of no bother to anyone. The study suggests that an easy way for obese people to lose weight is to simply speed up their metabolism a little each day – essentially, just fidget more.

For those not predisposed to move while working (some find it a distraction to their workflow as opposed to the focusing element that fidgeters feel it induces), there are a few simple ways to incorporate more motion into routine activities, even without the full-blown air instrumental solo. The trick is to maintain a 'motion-minded' perspective. Putting a post-it on the side of your computer that reads simply 'Move' can usually provide sufficient motivation for a few seconds of activity. Recommended methods of the new 'fidget diet' are:

• Tap your feet

• Swing your legs

• Drum your fingers

• Stand up and stretch at intervals

• Move your head from side to side

• Change your position every ten minutes

• Wriggle and fidget

• Pace up and down

• Don't use the internal phone – go in person

• Use the bathroom on a different floor

• Park in the far corner of the parking lot

• Stand up while you're on the phone

• Clench and release your muscles