Chronic Illness and Relationships: Communicating and Managing Stress

Don't let chronic illness weaken the bond between you and your partner.Reviewed by Kimball Johnson, MD

Having a chronic illness such as diabetes, arthritis, or multiple sclerosis can take a toll on even the best relationship. The partner who's sick may not feel the way he or she did before the illness. And the person who's not sick may not know how to handle the changes. The strain may push both people's understanding of "in sickness and in health" to its breaking point.

Studies show that marriages in which one spouse has a chronic illness are more likely to fail if the spouses are young. And spouses who are caregivers are six times more likely to be depressed than spouses who do not need to be caregivers.

Making Lust Last

By Keith Ablow, M.D. Rekindling Passion For The Husband You Still Love   People sometimes tell me they know a couple married 20 years whose sex life is still as good as it ever was. Here's what I tell them in return: "There are only three possibilities. One: This couple is lying. Two: They are telling the truth, because they didn't have good sex to begin with. Or three: Sex is all they really have together. They never connected emotionally." I've drawn that conclusion by listening...

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Clinical psychologist Rosalind Kalb, vice president of the professional resource center at the National Multiple Sclerosis Society, says, "Even in the best marriages, it's hard.  You feel trapped, out of control, and helpless."

But with patience and commitment, there are ways you and your partner can deal with the strain a chronic illness can place on your relationship.

Relationships can suffer when people don't discuss problems that have no easy or obvious solution, Kalb says. And that lack of discussion can lead to feelings of distance and a lack of intimacy.

"Finding ways to talk openly about challenges," she says, "is the first step toward effective problem-solving and the feelings of closeness that come from good teamwork."

Marybeth Calderone has limited use of her legs and hands because of a neurological disorder called Charcot-Marie-Tooth. Her husband Chris says that figuring out when to communicate is his biggest challenge.

"My wife gets frustrated with herself when she can't do things, like organize our 8-year-old daughter's desk," he says. "A lot of times, I'm not sure if Marybeth is angry at me or with her condition. Often, I try to figure it out on my own and don't say anything.”

The right level of communication is key. Boston College social work professor Karen Kayser says, "If the couple is consumed with talking about the illness, that's a problem. If they never talk about it, it's also a problem. You have to find a middle ground."

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What Causes Sinus Problems?

If you are plagued by sinus problems, take a moment to consider these valuable parts of your head. What can turn good sinuses into problem sinuses?

Your sinuses are hollow air spaces within the bones between your eyes, behind your cheekbone, and in the forehead. They produce mucus, which helps keep the inside of your nose moist. That, in turn, helps protect against dust, allergens, and pollutants.

No one is completely sure why we have sinuses, but some researchers think they keep the head from being too heavy.

Sinuses are also are responsible for the depth and tone of your voice. This explains why you sound like Clint Eastwood when your sinuses are all stuffed up.

If the tissue in your nose is swollen from allergies, a cold, or environmental triggers, it can block the sinus passages. Your sinuses can’t drain, and you may feel pain.

There are eight sinus cavities in total. They are paired, with one of each in the left and right side of the face.

Two sinus cavities are located in the forehead.Two are behind each cheekbone.Two sinus cavities are within the bones between your eyes.Two are behind each eye.

Sinus Blockages

Each sinus has a narrow spot, called the transition space (ostium), which is an opening that’s responsible for drainage. If a bottleneck or blockage occurs in the transition of any of the sinuses, mucus backs up.

An Extra Sinus

About 10% of people have an extra sinus. The extra sinus “effectively narrows that transition space,” says Ford Albritton, MD, chairman of otolaryngology at Presbyterian Hospital of Dallas.

Deviated Nasal Septum

Another common issue is a deviated nasal septum, the thin wall of bone and cartilage inside your nasal cavity that separates your two nasal passages. Ideally, your septum is situated in the center of your nose, equally separating the two sides. But whether from genetics or injury, in about 80% of people, the nasal septum is displaced to one side, making one nasal passage smaller than the other. A deviated septum is one reason some people have sinus issues. A deviated septum can also lead to obstructed breathing and snoring.

Narrow Sinuses

More often, certain people just have variations in their anatomy that creates a longer, narrower path for the transition spaces to drain. “It’s pure genetics, since it’s the way we’ve inherited how our sinuses are put together and how easy or difficult it is for them to stay open or become blocked,” Albritton says.

Sinus Sensitivity and Allergies

Finally, there are certain people who have sensitivity to things in the environment and to the foods they eat. This sensitivity triggers a dilation of blood vessels in the nose, and sometimes releases chemicals from cells in the nose that cause swelling.

Your doctor can prescribe medications to control your symptoms. People with sinus problems and allergies should avoid environmental irritants such as tobacco smoke and strong chemical odors, which may increase sinus problems.

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Fungal Meningitis Patients: A Long Road to Recovery

Dec. 26, 2012 -- Johnnie McKee thought she was out of the woods.

McKee, a 72-year-old grandmother of four from Bethpage, Tenn., was one of nearly 14,000 people who found out this fall that they'd been exposed to tainted medications made by the now shuttered New England Compounding Center.

In her case, the threat came from a steroid shot that she'd had on Sept. 7 to relieve some nagging back pain.

"We got a letter. We were told that if we could make it 28 days, that we'd be clear," says Fred McKee, her husband of 51 years. "We watched it and worried about it," says Fred, his voice filling with emotion.

But Johnnie felt fine. She didn't have any of the symptoms they were told to look for -- headaches, nausea, fever.

The waiting period passed, and she felt good enough to get back to her yard, which she had always tended with great care. "She mowed the lawn," says Fred.

Then, on Oct. 8, the pain hit like a bolt of lightning at the base of her spine. "It was just excruciating pain," says Fred. Their surgeon told them to drive to the emergency room at St. Thomas Hospital in Nashville, where doctors had started to treat a wave of patients who were battling a rare type of fungal meningitis, an infection of the brain and spinal cord.

"There were three criteria they looked for to determine if you have fungal meningitis, and she met all three," Fred says.

Still, he says, they didn't worry. But that may have been because they didn't understand what was coming.

"I don't think we really realized that we were really getting into a two- to three-month hospitalization period and a six-month-to-a-year complete recovery," he says.

Since the outbreak began, 620 people have been infected and 39 have died in 19 states. No one has been cured.

"As far as we know, no one has been taken off medicines, and we wouldn't recommend that now; it's still too early," says Tom M. Chiller, MD, MPH, deputy chief of the Mycotic Diseases Branch at the CDC in Atlanta.

Many hope they are on the road to recovery, but no one can tell them when it will end.

Experts say they've never seen these kind of fungal infections, much less this many cases.

"It's very difficult for the doctors and the patients because we can't say, 'Well, just two more weeks of this and it will be over.' What we're saying is that we're going to keep treating you. We're going to keep caring for you, and when the experts tell us we can stop, we're going to do that," says William Schaffner, MD, an infectious disease specialist at Vanderbilt University in Nashville.

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How a Child's ADHD Affects Their Siblings

Having a child with ADHD means dedicating time to meeting their special needs, and to making sure that doesn't come at the expense of your other children.

"Being a parent of a child with ADHD can be hard," says Terry Dickson, MD, director of the Behavioral Medicine Clinic of NW Michigan, and an ADHD coach.

ADHD Multimodal Treatment

ADHD (attention deficit hyperactivity disorder) is characterized by inattention, hyperactivity, and the inability to control impulses. It affects an estimated 1.5 to 3.5 million school-age children in the U.S. Everyone, especially younger children, may have symptoms of ADHD from time to time. But with ADHD, the ability to function with daily activities is affected. A diagnosis of ADHD can be hard to make, and evaluation must be made by a specialist. There are several different approaches to...

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"It's so important for parents to show all of their children -- both the child with ADHD and the kids without -- that they are equally loved. But given the needs of a child with ADHD, it takes work to keep it balanced."

When there's a child with ADHD in the family, it's common for their siblings to feel jealous and to act out if they sense their parents' attention shifting away from them.

"It works like a squeaky wheel," says Los Angeles psychotherapist Jenn Berman, PhD. "The child who is being the loudest gets the most attention from the parents."

Usually, that's the child with ADHD, so it's normal for parents to spend most of their energy focusing on meeting that child's special needs, whether it's in therapy, extra time at home doing homework, or a special effort on managing disobedience or impulsivity.

The behavior of children with ADHD can also make them hard to get along with as a peer, which means their brothers or sisters simply might not like being around them.

"The child who doesn't have ADHD might prefer to be at a friend's house than at home, might not invite other kids over to hang out, or might be embarrassed socially," says Dickson, who has a child with ADHD.

School is another outlet for kids who have a brother or sister with ADHD.

"It can be a reprieve where kids can get away from the stress they might be experiencing at home, or kids can use it as an opportunity to act out for attention," says Mark Wolraich, MD, a pediatrics professor at the University of Oklahoma Health Sciences Center.

The bottom line is that parents need to share the love and the attention with all their children,whether or not they have ADHD.

Balance is the key. Here are tips from the experts on how to help your kids with an ADHD sibling learn, adjust, and grow:

1. Manage expectations. Parents expect immediate obedience from their kids who don't have ADHD, Dickson says. It's common for them to think that their child should know better because they don't have the condition. But remember, they're still kids, and helping them understand boundaries and rules is just as important for them as it is for the child with ADHD.

2. Be fair. Just like you shouldn't be extra hard on your kids who don't have ADHD, you shouldn't be too lenient with the one that does, Dickson says. Be clear about the house rules and enforce them equally with all the kids.

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Teen Marijuana Use Remains at All-Time High

By Rita Rubin
WebMD Health News

Dec. 19, 2012 -- A new survey shows marijuana use by teens remains high, and officials say it will probably increase as a result of Washington and Colorado decriminalizing the drug last month.

“Based on what we know ... we are predicting that it’s going to go up,” says Nora Volkow, MD, director of the National Institute on Drug Abuse. “Just the fact that there are some states that have made it legal ... will send a message” to teens throughout the country.

Already, the proportion of teens who consider marijuana to be harmful is the lowest it’s been in decades, according to the 2012 “Monitoring the Future” survey of eighth, 10th, and 12th graders. The annual survey of teen drug use is conducted by researchers at the University of Michigan.

The survey's silver lining is that it shows the use of illicit drugs, alcohol, and cigarettes is declining.

Still, about 70% of eighth graders said they thought regular use of marijuana was harmful, while about 42% said they considered occasional use harmful. Those rates are the lowest since the survey began asking eighth graders that question in 1991.

Among 12th graders, the proportion who said regular use was harmful was about 44%, occasional use, about 21%. Those are the lowest rates since 1979 and 1983, respectively.

The survey shows that 6.5% of high school seniors said they smoke marijuana daily, which is about the same as last year but up from 5.1% five years ago.

Use of synthetic marijuana, known as K-2 or Spice, was stable in 2012, with slightly more than 11% of high school seniors reporting they had used it in the past year, the survey shows.

Teens who think marijuana is safe to use are mistaken, Volkow says. “I think that the data are quite clear that smoking marijuana during adolescence is harmful to your brain.”

A National Institutes of Health-funded study, published in August in the Proceedings of the National Academy of Sciences, found a significant drop in IQ -- an average of eight points -- between the ages of 13 and 38 in people who had been heavy marijuana users since their teens. Even those who quit using the drug showed impaired mental abilities if they had started smoking marijuana in their teens.

“Findings are suggestive of a neurotoxic effect of cannabis on the adolescent brain and highlight the importance of prevention and policy efforts targeting adolescents,” the researchers concluded.

Washington and Colorado voters approved measures legalizing possession of up to an ounce of marijuana by people 21 and older. Washington’s law went into effect Dec. 6, while Colorado’s is set to become effective Jan. 5. Medical use of marijuana is legal in 18 states and the District of Columbia.

Although marijuana is illegal under federal law, President Obama told ABC’s Barbara Walters in a Dec. 11 interview that going after recreational users in states where marijuana is legal should not be a “top priority” of federal law enforcement officials.

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What Cancer Patients Need to Know About the Flu

By Rita Rubin
WebMD Health News

What do cancer patients and survivors need to know about the flu? WebMD asked Lisa Richardson, MD, associate director for science in the CDC’s Division of Cancer Prevention and Control.

Should cancer patients get immunized against the flu?

Absolutely. The CDC recommends that everyone 6 months of age and older get a flu vaccine. That message is especially important for cancer patients, because if they get the flu, their risk of getting severe complications is higher, due to their weakened immune system.

What type of flu vaccine is best for cancer patients?

Flu shots are safer than FluMist, the nasal vaccine approved for healthy people ages 2 to 49. FluMist contains live, albeit weakened, flu virus, while flu shots contain killed virus, which can’t make you sick. (Some people run a low-grade fever after getting a flu shot, but that’s a sign your body is making antibodies against the disease, not a symptom of the flu itself.) If you’re over 65, the CDC recommends that you get the Fluzone High-Dose shot, which spurs the aging immune system to produce more antibodies against the flu. The CDC has not yet recommended that younger people with weakened immune systems, such as cancer patients, also get the high-dose vaccine.

What about survivors who have been cancer-free for a long time?

People who’ve had leukemia or lymphoma, which are cancers of the immune system, are most at risk for complications from the flu. Another group of survivors who have an elevated risk of complications from the flu are those who were treated with certain chemotherapy drugs that could alter their immune system long-term.

But if your immune system is compromised, does the flu vaccine work as well?

Getting a flu shot is better than not getting a flu shot, although it might not work as well as in a healthy person. If you do contract the flu after getting immunized, chances are you won’t get as sick as someone who hadn’t received a flu shot.

Does having cancer increase your risk of contracting the flu?

Some scientists believe cancer patients are more susceptible to coming down with the flu, but that hasn’t been confirmed. However, it is clear that once they become sick, they have a higher risk of complications.

Will a flu shot interfere with any cancer treatments?

Flu shots haven’t been shown to reduce the effectiveness of cancer therapy, but that misconception probably helps explain why many patients mistakenly refuse to get immunized.

What should cancer patients or survivors do if they think they might have come in contact with someone who has the flu?

Call your doctor. If you’ve had chemotherapy or radiation therapy within the past month, or if you have leukemia or lymphoma, your doctor might prescribe an antiviral medication to prevent you from getting sick.

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How to Talk to Children About School Shooting

Dec. 14, 2012 -- As the nation grieves over the horror of the school shooting in Connecticut, parents across the U.S. -- both in Newtown, Conn., and elsewhere -- are struggling with how to help their children through this tragedy.

WebMD talked to Leslie Garrard, PsyD, a child psychologist at Miami Children's Hospital, and Melissa Brymer, PhD, director of terrorism and disaster programs at the UCLA-Duke National Center for Child Traumatic Stress. We asked for their best suggestions on what parents and others can do now to help children cope.

Q: What reactions should parents and other caregivers in Newtown expect from the children who have gone through this tragedy?

A: Kids can have a wide range of reactions, Garrard says. "Any exposure to trauma can have immediate reactions and lasting effects. Parents need to be very [mindful] and watch their children."

"Some kids withdraw, some are dismissive, although internally they are scared. Some cry and some are outwardly terrified. Some become depressed. Some just kind of shut down. Some might have nightmares and re-experience the traumatic events. ... They may be fearful of leaving their parents."

Q: What reactions are typical from children who didn't go through it, but watched news coverage or heard details about the tragedy?

They can also have [the same range of] reactions -- maybe not as strong, but they can also be impacted, Garrard says. "When watching it and seeing it on TV, it's very scary."

The American Academy of Pediatrics President Thomas McInerny, MD, says in a statement that if possible, "young children should not be exposed to the extensive media coverage of the event -- in other words, turn off the TV, computer, and other media devices."

Q: Is this age -- elementary school -- a particularly difficult one to experience trauma?

A: Yes, according to Garrard, because it affects emotional development and the way we view the world -- whether it's safe or not.  But "I think kids are very resilient. They can learn to maneuver the world and get through and past things. However, they do need a lot of care to get through things.''

Q: What is the best thing parents can do now?

A:  The most important thing parents can do is talk to their children, Garrard says. "Sit down with your child. Tell them a really bad thing has happened. Maybe they have already heard it on the news. Tell them, 'We need to talk about this.'"

See how they feel about it, Garrard says. You want them to share their feelings.

"Technology makes things a lot more complex," Brymer says. "They are getting information through Twitter feeds and Facebook. It's harder to keep up with what your kids are hearing. When we tweet, we hear something from someone and then you re-tweet. You can't fact-check when you tweet or post something on Facebook."

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When Are Children Ready to Date?

By Virginia Sole-Smith
WebMD Feature

Dating. Parents may joke that it’s an experience they want their child to have -- just not until somewhere around the age of 30.

Seriously, though, when is your child ready to date? Consider this: It's not just about their age.

You and your child may see that very differently.

A 6th grade girl may say, "Jacob is my boyfriend," but what does that mean?

"At this age, kids use dating labels but aren’t ready to have much direct one-on-one interaction beyond maybe sitting together at lunch or recess," says Dale Atkins, PhD, a family therapist in New York. "Most of the activity happens in a pack, and communication takes place between friend groups."

By 8th grade, dating probably means talking on the phone and hanging out, usually in groups. By high school, kids are more likely to develop serious romantic attachments.

Notice what "dating" seems to mean to your child and then talk about it. Michelle Anthony, PhD, a developmental psychologist and learning therapist in Denver, suggests an opening line like: “It sounds like a lot of kids are talking about dating now. Is that something you’re interested in?”

If you can't tell what dating means to your kid, try discussing dating as shown on TV shows or in movies that are age-appropriate. For instance, Atkins suggests asking your child why they think someone acted the way they did, and whether they made a good or healthy choice.

It's not just about your child's age. It's your job, as their parent, to figure out if your child is ready to handle the level of dating they have in mind.

Pay attention to how they respond when you start a conversation about dating. “Of course it will probably be uncomfortable for both of you,” Anthony says. “But if he’s so uncomfortable that he gets angry or shuts down or otherwise just can’t continue the conversation, that’s a big sign that he’s not ready for this.” If so, assure your child that there’s no hurry to start dating.

Instead, if they answer your questions or seem eager to date, you can steer the conversation toward reassuring them that these feelings are normal. 

Is your child ready to connect with someone? Are they just trying to keep up with their friends? Are they confident and able to take care of themselves? Would they tell you if something went wrong? Do they look physically more mature than they are, emotionally? "A 12-year-old who looks 16 isn’t ready to date someone who is 16," Anthony says.

You may not love the idea of your child beginning to date, but don't try to pretend it’s not happening.

"Parents can be so uncomfortable with the idea of their kid becoming more grown up -- we wish our kids could stay kids," Atkins says. "The problem with that attitude is that your kid still is a kid. And he or she needs your guidance and support right now."

You don’t want them learning the rules of dating from peers or the media, without your input. The more you talk to your kids about what it means to be in a healthy relationship, the more likely they are to experience that, whenever they start dating.

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