Saturday, December 31, 2011

Kaplan University Health and Fitness of an Elder Unit 8 Revised EF-310/HW499 Tonia Weakland-Wilhelm 10/19/2010 12/28/2011


This is a case study of Marsha, a 51 year old woman who is interested in weight loss and is in search of a program. She has inquired about purchasing a membership to my fitness facility.  It is my duty to evaluate her present health and fitness level to determine the appropriate steps to take, to help her reach her goal. 
The results of the initial par-q screening (physical activity readiness questionnaire)  revealed valuable information about her that can guide us to creating a program that is appropriate for her needs.(Howley, p.23-24) She is 5 feet 5 inches (1.65 m) tall. She weighs 240 pounds (109 kg).  Her blood pressure is 152/88 mmHg. Her lifestyle is sedentary, having never had a regular exercise routine. She sits at a desk job. She does not have any leisure activities. She has not had a physical exam from the doctor in three years. There is a family history of heart disease and diabetes.
Marsha’s BMI is calculated to be 40.4. This is considered to be extremely obese. (CDC, Assessing Your Weight, np) Her blood pressure is high. She is inactive, has a strong family history of diabetes and heart disease. She has not been to the doctor for an exam in three years. She needs to go to the doctor to get a complete physical and medical clearance before she can start a program. The exam will determine the safety of moderate to vigorous exercise as part of her weight loss program. Assessment of her cardiovascular health can be done using a treadmill or cycle ergometer. (Howley, p.78) Standardized tests for strength and flexibility need to be done as well. 
The nutritionists at our fitness center can evaluate Marsha’s diet and preferences. Her daily energy requirements are 2,480 calories per day. She should target to take in approximately  750 fewer calories than that in order to sustain healthy weight loss. The nutritionist can work with her regularly to create menu plans and strategies to help her make healthy food choices, get her essential nutrients and sustain a caloric intake of 1730 K-calories per day. (mytcm.com, np)
Marsha came to the fitness center of her own free will. This shows that she is mentally prepared to make a change. We need to talk with her to determine her interests and to help her set realistic goals. Her trainers will need to pay attention to her level of enthusiasm in order to ensure she is able to adhere to the activities recommended. We need to encourage her to increase lifestyle activity and create a structured workout program. If she is willing to come into the gym for one hour of structured exercise, three days per week and find ways to be more active in her daily activities, she can loose a couple of pounds per week. Walking with a partner would be a great thing for her to do every day. As she progresses, she could increase her frequency and duration of her structured workouts. (CDC, Physical Activity for Everyone, np)
It is important to keep Marsha motivated so that she will be successful. We will work with her to develop a program that she will enjoy. We will help her understand the risks of being overweight and to reap the benefits of a healthier lifestyle. We will implement a reward system for reaching short term goals. We can give her coupons to boutiques to go shopping for new clothes as she moves down in dress sizes. We could also offer her membership incentives for recruiting friends. 
Regular physical activity is key to achieving good health and a healthy weight. With a thorough initial consultation and medical examination, ongoing  support, and motivation, we will be able to help Marsha reach her goals. 
References
Howley, Edward & Franks, Don. (2007), Fitness Professional’s Handbook, Fifth Edition, Human Kinetics, Champaign IL
My TCM website, retrieved July 25, 2010, Copyright © 2010 - myTCM.com.au, myTCM.com.au, University of Sydney, Australia
Physical activity for a healthy weight, retrieved from CDC website

Tuesday, December 27, 2011

This Christmas Day


On this Christmas Day, I gave my time at St. Anthony's of San Francisco. We served about 4,000 meals and gave hand knitted scarves and hats. Though I did not wake up in the morning with my children or open one gift that day, I really believe it was one of the best Christmases I have had, because I was more in tune with the true spirit of Christmas. From now on, I intend to make it a tradition to serve on holidays. Furthermore, I intend for my children to join in as well. In our consumer society, we place too much emphasis on materialism, especially with our children. Rather than asking kids what they got for Christmas, I will ask what they gave. 

Monday, December 12, 2011

Yoga Experience Fall 2011


Yogas citta vritti nirodaha
This semester I have made a commitment to myself, to deepen my practice, to take my spirituality and my career to the next level. The principles of Raja yoga have integrated into my awareness of my every day life. As I deepen my practice, my conscious awareness continues to expand. I have expanded my horizons in yoga by studying the Yoga Sutras in class, trying different styles of yoga and by being consistent with my practice.  
Lately, more than ever, I have been living my Raja Yoga. I keep in mind the eight principles of Ashtanga Yoga throughout my day, beginning with Yama, moral restraint in action, speech and thought. I practice Ahimsa by cultivating compassion for all beings and practice non-violence by refraining from use of force. Sometimes this is difficult. I do catch myself becoming forceful in some situations, such as with parenting, I find myself raising my voice or getting a little pushy when my kids are not behaving how I want them to. At times I loose my patients, but I am more aware of it today. When I catch myself loosing my patients, I take a deep breath and a step back. 
Satya is honesty with behavior, thought and intention. This too is an ongoing practice. I have taken big steps toward being honest with myself. Today, more than ever before in my life, I am willing to speak my truth and do what is right for me, rather than what I think I should do to please others. I think Asteya, non-stealing comes easily to me. I am not one to steal people’s time, energy, or belongings. Brahmacharya, the practice of celibacy is more of a challenge for me. I find that I tend to go for all or nothing. If someone is attracted to me and I am not attracted to them, then I simply turn them down. If I am attracted to someone, I may move quickly even if I know it would probably be in my best interest to slow down. There needs to be more than an initial attraction. I want there to be a real heart connection. Early this year, I hurt someone’s heart as they felt more strongly for me than I did for them. When it didn’t work out, it ruined the chance for a good friendship. To correct this behavior, I have recently made a vow to renounce loveless sex. If my heart is not in it, I won’t do it. This allows me to have more respect for myself and to not hurt or confuse anyone else. 
Aparigraha is the separation between wants and needs. More and more, I have been able to distinguish between my wants from my needs. There is not much I want for on the material plane. My budget is tight. I often only buy things for myself if I feel I need them. My material requirements are becoming more modest all the time. 
The Niyamas are discipline in actions, conduct and attitudes. I have been developing these. Saucha is purity or cleanliness of physical body, diet, thought and environment. My diet has improved a lot this year. I eat a lot more vegetables and fruits, while eating a lot less processed foods, enriched grains, sweets and fatty foods. I feel better and have more energy. My home and car have been more consistently clean in recent months than they have been in the past. I have noticed that keeping a cleaner environment helps me to keep a clear head. Santosha means to be satisfied and appreciate what we have and to keep a positive attitude toward what we do not have. I have come a long way with this concept as I have matured. I am content knowing that my worldly needs are met. If there is something I do not have, I distinguish whether it is a want or need. If it is a want, I do not pay much attention to it. If it is a need, I devise a plan to get the need met, while practicing patience and diligence toward reaching that goal. This is Tapas, a burning enthusiasm for practice and life’s work. Through discipline, self control and persistence I can eventually attain anything I am passionate about. This year I finally received my Reiki Master attunement which had been a goal of mine for several years. I have also been working towards my Bachelor’s degree and am now working on my final quarter. The attainment of that goal is just a couple of months away. Swadhaya is self study, self discovery, mindful self reflection. In conjunction with my Reiki training and my yoga practice, I took a course entitled Multi-dimensional bodywork, in which we journeyed through the chakras, identifying our old wounds, clearing the false ego and getting more in tune with our true selves. It was truly an amazing experience that transformed me in depth. Ishvarapranidhana is a knowing of a higher power. I have always believed in a God of some form. My Yoga practice definitely brings me closer to my higher consciousness and with the chakra work I have done, I feel a strong connection in my seventh chakra to spirit. 
My Asana practice has improved this semester. I have been much more consistent about showing up to my regular class as well as trying classes at new places. This semester I took a couple of asana classes at Integral Yoga Institute, the YMCA and at a Bikram studio in Santa Rosa. I enjoyed the variety of styles and theories for practice. Pranayama has become a habit. Not only do I intentionally sit and practice nadhi shodan (alternate nostril breathing) or kapalah bahti (breath of fire) at some point almost every day, I also invoke ujai breath or four part breathing throughout my day whenever I wish to become more grounded, centered and present. Practicing asana and pranayam have helped me to improve my focus, known as Dharana. Regular practice helps me to meet the many demands of my life. When I find myself stressed, tired or scattered, I practice asana, pranayam or meditation, then return to my tasks with a renewed ability to focus and stay present. Dhyana or meditation has become a daily ritual for me as well. As often as I can, I do sit quietly for anywhere between five and twenty minutes in meditation. I also call upon a meditative state throughout my day, focusing on staying present, grounded and connected to source. My yoga practice is the foundation of my spiritual life, complimenting my Reiki and bodywork practices which have ritualistically opened me up to source. I am now more aware of my seventh chakra than I ever was before. I have tasted Samadhi. I do not know if I will attain full enlightenment in this lifetime, but I am more confident and more in touch with my higher power than I ever have been. 
The entire practice of yoga boils down to this one point, sutra 1:2, to settle the mind into silence. All of the Yogic practices and the sutras lead back to this quieting of the mind, which enables us to become more in tune with our true nature, which is peace. Sutra 1:5 deals with the different types of activity of the mind. These are right knowledge, wrong knowledge, imagination, sleep, dream and memory. Each of these result from our experiences. If we are attached to our experiences, they continue to live inside of us and will haunt us like a ghost. Yogic practices can help us to detach from our experiences, so that they loose their power over us. In recent months I have done a lot of work with that. I have identified past experiences which had taken hold of my subconscious mind, taken action to release them and to reclaim my own power. The Yoga Sutras speak of detachment. This can be difficult to do. There is much I am attached to, but just acknowledging the attachment allows me to loosen my grip. Attachment is but one obstacle to enlightenment. Others are illness, fatigue, doubt, carelessness, laziness and delusion. The three thieves of the heart that tend to keep most of us from reaching our potential are self doubt, self hate and fear. Today I work diligently to face these and to overcome. There was a time when I did not even try many things I was interested in because I doubted myself. There still are many things I would like to try. One by one, I am facing my fears, overcoming my doubt and going for it. 
Yoga has helped my mind to become more clear and serene. The qualities of my heart are continuously being cultivated. Much of my life is now full of joy. I have compassion for those who suffer, but do not necessarily take their problems on as my own. I let my light shine, practicing loving kindness with passion. This makes me attractive as a friend, a teacher and a practitioner of healing arts. 

Thursday, September 8, 2011

ALCOHOLISM A PUBLIC HEALTH ISSUE

Signs and Symptoms of Alcoholism
Alcoholism is a mental health disorder that is characterized by an uncontrollable compulsion to drink. A combination of social and biological factors may lead to alcoholism. One primary risk factor is a family history of the disease. This is due to both the influence of being exposed to and effected by alcoholic behavior and the possibility of genetic factors. People who suffer from alcoholism become physically dependent on the drug. Alcoholics build up a tolerance, needing more and more alcohol to get the desired effects. Without alcohol symptoms of withdrawal can present within a couple of hours. These symptoms can include irritability, nausea, tremors and anxiety.
 Excessive alcohol consumption interrupts key receptors in the brain that effect the ability to create memories. This can lead to alcohol induced amnesia commonly known as a blackout. Additionally this interruption effects cognitive abilities for days after the drinking has stopped, so if alcohol consumption persists, it takes a toll on the hypocampus, an important emotional center of the brain. Alcoholic depression may worsen with time as do poor choices that negatively effect the life of the alcoholic. Life becomes unmanageable, home and career being effected and physical health declining.
Help For Alcoholics
Alcoholics Anonymous is the original Twelve Step Program that provides a structured path toward recovery from alcoholism. It is the primary model upon which many alcohol and drug rehabilitation programs are based. It’s premise is spiritual growth and personal accountability. The program is fully self supporting and self sustaining, which are powerful reasons why it works for those who work it. AA meetings can be found in virtually every community in the United States and around the world. 
Residential Alcohol Rehabilitation centers are live in programs for individuals undergoing the earliest stages of alcohol detox and returning to sobriety. Licensed counselors and other professionals care for and guide addicts toward a healthier life, treating the addiction, the mental health afflictions and the possible physical ailments caused by alcohol dependency. 
Sober Living Environments are also known as half way houses. When people leave the strictly regimented alcohol rehab facility, they may not be ready to return to independent living. Sober houses provide an environment for addicts to live in providing structure, recovery planning and tools while allowing them to have more freedom to readjust to life in society. 
Support and Prevention for Families
43% of Americans have been exposed to alcoholism in their families. Although people can not stop their loved ones from drinking, help is available that can provide support and guidance for those effected by alcoholics. Al-Anon and Al-Ateen family groups are twelve step programs related to Alcoholics Anonymous. Al-Anon members are able to recognize codependent, enabling behavior patterns that may do more harm than good for themselves and the addict. Through peer support and literature provided by the program, families can learn healthier ways to deal with the problems that arise due to alcoholism. Members do not dispense advise or directions, rather they share their experience, strength and hope. Members come to understand problem drinking as a family illness that affects everyone. By listening to members speak at  meetings, one can hear how they came to understand their own role in this illness. The insights gained put them in a better position to play a positive role in the future. Research shows that when problem drinkers enter a recovery program, their chances for success are improved when they are supported by family members who are in a family recovery program. Al-Anon meetings can be found in communities nationwide and around the world.
Statistics
Alcohol is the number 1 drug problem in America. Americans spend more than $90 billion dollars on alcohol each year. An average American may drink 25 gallons of beer, 2 gallons of wine, and 1.5 gallons of distilled spirits each year. 15 million Americans are dependent on alcohol. 500,000 are between the age of 9 and 12. Alcohol related problems are costing the American economy at least $100 million in health care and lost of productivity every year. About 1 out of 4 Americans admitted to general hospitals have alcohol problems or are undiagnosed alcoholics being diagnosed for alcohol related consequences. Alcohol abuse is the third leading cause of death, causing 35 to 40 percent of motor vehicle fatalities, as well as chronic liver disease and cirrhosis, home injuries, drownings, fire fatalities, job injuries, and 3 to 5% of cancer deaths. to 40% of all industrial fatalities and 47% of work related injuries can be linked to alcohol consumption and alcoholism. A 2001 survey shows 25 million Americans reported driving under the influence of alcohol a number that grows each year. Among young adults age 18 to 25 years, almost 23% drove under the influence of alcohol. The latest death statistics released by the National Highway Traffic Safety Administration (NHTSA), show that 17,488 people where killed in alcohol related traffic accidents last year. This report represents nearly 800 more people where killed than the previous year.In 1996, local law enforcement agencies made an estimated 1,467,300 arrests nationwide for DUI offenses. Four of ten criminal offenders report alcohol as a factor in violence. Among domestic violence victims, three quarters of incidents were reported to have involved alcohol use by the offender. 
Resources and References
Al-Anon Family Groups, http://www.al-anon.alateen.org/
Alcoholics Anonymous, http://www.aa.org/?Media=PlayFlash, retrieved July 2011
The Biology Behind Alcohol Induced Blackouts, Medline News Today,http://www.medicalnewstoday.com/printerfriendlynews.php?newsid=230582, 07 Jul 2011, retrieved August 2011
California Department of Motor Vehicles, http://dmv.ca.gov/about/profile/rd/duistats89_99.htm 
CDC Alcohol and Public Health,http://www.cdc.gov/alcohol/faqs.htm, retrieved July 2011 
Katcher et all, Estimating alcohol-related premature mortality in san francisco: use of population-attributable fractions from the global burden of disease study,http://www.biomedcentral.com/1471-2458/10/682, retrieved July 2011
Medline News Today, Researchers Find Key Genetic Trigger of Depression,http://www.medicalnewstoday.com/printerfriendlynews.php?newsid=204903 , retrieved August 2011
National Institutes of Health, NIH News, Wednesday, January 19, 2011 http://www.niaaa.nih.gov/NewsEvents/NewsReleases/Pages/Genevariantspredicttreatmentsuccessforalcoholismmedication.aspx, retrieved August 2011
Schneider, Mary-Jane, Introduction to Public Health, Jones and Bartlett





Wednesday, August 24, 2011

Alcoholism: Chemistry and Public Health


An alcoholic is someone who’s life has become unmanageable due to their physical and psychological dependence upon alcohol. Almost everyone in society knows someone who is effected by this all to common illness. The causes of chemical dependency are many and not fully understood. It seems that there is no singular cause; rather a combination of genetic, biological and environmental factors contribute to one’s susceptibility to the disease. Statistics demonstrate the effects alcoholism has on economic burden and health disparities. Interventions can be taken at all levels ranging from individuals and communities to state and federal government in order to prevent or treat alcohol addiction. Research and education are key to understanding, preventing and treating this common and complex disease. The disease of alcoholism is an issue that seriously undermines the health and wellness of individuals, families, and communities thus vigorous action must be taken toward prevention and treatment of this disease.
The disease of alcoholism actually has little to do with alcohol. Drinking is but a symptom of a psychological problem. Mental disorders such as alcoholism occur in all racial, ethnic, and socioeconomic groups. About one in four adults in the United States suffer from a diagnosable mental disorder. Depression is the most common cause of disability for the age 15-44 demographic.(CDC, Genomics and Health) Other common mental illnesses include anxiety, bipolar disorder and schizophrenia. Many alcoholics suffer from one or more mental disorders in addition to addiction. This is called dual diagnosis. The specific causes of most mental disorders, including addiction are not completely known or understood. It seems that a combination of biological, genetic, psychological, social and cultural factors are involved. Having a family history of addiction and mental disorders increases the risk. 
Millions of people are dependent upon alcohol. Alcoholics may drink to socialize, relieve stress, relax or sleep. They become dependent upon alcohol and it’s effects, developing an uncontrollable compulsion to drink. In time, an alcoholic develops a tolerance to alcohol’s effects; they need to drink more to feel the high. Psychologically, the alcoholic becomes unstable, exhibiting unexplained mood swings, anxiety, severe depression, angry outbursts, acts of violence, or suicidal tendencies.  “If they do not have alcohol, they may begin to experience withdrawal symptoms in as little as two hours of not having a drink. These symptoms can include irritability, nausea, tremors and anxiety.” (rehab-international.org) 
“A person who drinks too much alcohol may be able to perform complicated tasks, such as dancing, carrying on a conversation or even driving a car, but later have no memory of those escapades. These periods of amnesia commonly known as "blackouts," can last from a few minutes to several hours.” A study conducted at Washington University School of Medicine in St. Louis identified the brain cells involved in blackouts and the molecular mechanism that appears to underlie them. The report which appeared in the July 6, 2011, Journal of Neuroscience found that large amounts of alcohol does not kill brain cells, but interferes with key receptors that effect memory.
The receptors product steroid hormones that inhibit long-term potentiation “LTP”. This process strengthens the connections between neurons and is crucial to learning and memory. Some receptors become inhibited but later others activate, initiating a cascade of interference with synaptic plasticity in the brain's hippocampus, which is important in cognitive functioning.(Medline news, The Biology Behind Alcohol-Induced Blackouts)
Alcoholism is a danger to public health because people who are addicted to alcohol never know when to stop and they have no regard for any of the consequences of their excessive drinking. Irresponsible behavior by the alcoholic effects not only the health of the individual, but families, businesses and the community as well. Alcohol is the third leading cause of death in the nation, causing 35 to 40 percent of motor vehicle fatalities, as well as chronic liver disease and cirrhosis, home injuries, drownings, fire fatalities, job injuries, and 3 to 5 percent of cancer deaths. (Schneider, 220). Alcoholism can also result in cardiovascular problems, liver disease, pancreatitis, esophageal and oropharyngeal cancers. “People who consume excessive amounts of alcohol will also have an increased risk of developing arthritis, cancer, heart disease, hyper- and hypoglycemia, kidney disease, obesity, nervous disorders, psychological disturbances and malnutrition.” (Rehab-international.) A study conducted in San Francisco California between 2004 and 2007 found that 10% of premature deaths in the city were somehow related to alcohol. (Katcher et all)
Risky behaviors such as drunk driving endangers the lives of others, not just the alcoholic. Alcoholics who engage in risky behavior often wind up with legal problems. Statistically, there was an alcohol related auto accident resulting in fatality every 38 minutes in the U.S. (SAMHSA) In the state of California there were 203,866 DUI arrests in 2007. (DMV.gov) The number of drunk driving arrests grows yearly, unfortunately so does the number of drunk driving fatalities. 
Alcoholism is the number one drug problem in America. It is estimated that 43% of Americans are exposed to alcoholism in their families. (drugrehabs.org) Families of alcoholics suffer emotional distress, financial consequences, and sometimes violence in the home. Unborn children of alcoholic mothers suffer serious medical consequences. Fetal alcohol syndrome is characterized by physical deformation, emotional and mental disturbances and sometimes mental retardation. Alcoholism tares families apart when left untreated. There is help available for alcoholics and for their families.  
Alcoholics only go for help when they are ready. If they get into trouble, they may be forced into a treatment program, but in order to truly recover they have to want it for themselves. Twelve step programs are the primary model for alcohol rehabilitation, treatment, and help for their families. Alcoholism is a problem even when the alcoholic remains sober. They cannot function well without it. Their life can become a bigger mess when they are sober without some sort of program or active lifestyle management for the recovering alcoholic. They must take specific action to work on their problem. (rehab-international.org) 
Alcoholism requires rehabilitative treatment. The withdrawal symptoms of alcohol detox are very intense and can be fatal without medical intervention. In 2006 thirteen percent of drug-related emergency department visits by minors were a result of alcohol, either on its own or after being combined with other substances. In the same year, two million five hundred thousand people were treated for alcoholism at rehabilitation centers. These programs are usually live in programs that offer a strict structured environment that combines twelve step philosophy, professional counseling, behavioral modification and medical care as needed. Rehabs are intended to pull the alcoholic out of crisis. Sober living environments also known as half way houses are a good option for the recovering alcoholic who is fresh out of rehab and still needs the structure of the drug free environment. 
Prescription medications or holistic therapies are sometimes prescribed to individuals who are detoxing or recovering from alcohol addiction. The drug Ondanestron is currently used to help control nausia and vomiting for chemotherapy patients. An experimental study at the University of Virginia found that this drug has helped people with drinking problems to reduce the amount of alcohol they drink. It works by effecting serotonin receptors. Genetic variants of serotonin receptors have been found in people with severe drinking problems. (NIH News) Holistic therapies such as acupuncture and Yoga have also been found to be effective in helping alcoholics to find some relief in the form of energetic healing and spiritual guidance. After all,  disease starts on an energetic level.
For lifestyle management the twelve step program Alcoholics Anonymous is by far the most popular organization. Twelve step groups put a strong emphasis on spirituality and personal accountability. Established in the 1950’s by Bill W. AA has grown to become a world wide network.  AA meetings can be found in every community in the U.S. and in many other countries. Many other twelve step programs have grown out of the AA model. Al-Anon is also a twelve step program designed to support the families of alcoholics. It is believed that the families of alcoholics also suffer from the same disease, even if they do not drink, because they suffer from the consequences of alcoholic behavior, emotional distress, abuse, and develop unhealthy behaviors for survival. All twelve step programs use the same twelve steps and the Al-Anon member is encouraged to work the steps just the same as the alcoholic. (aa.org)
Twelve Steps of Alcoholics Anonymous and Al-Anon
  1. We admitted that we were powerless over alcohol- that our lives had become unmanageable.
  2. Came to believe that a Power greater than ourselves could restore us to sanity.
  3. Made a decision to turn our lives over to the care of God as we understood Him. 
  4. Made a searching and fearless moral inventory of ourselves. 
  5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.
  6. Were entirely ready to have God remove all these defects of character.
  7. Humbly asked Him to remove our shortcomings.
  8. Made a list of all persons we had harmed and became willing to make amends to them all. 
  9. Made direct amends to such people whenever possible, except to injure them or others. 
  10. Continued to take personal inventory and when we were wrong promptly admitted it.
  11. Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out. 
  12. Having had a spiritual awakening as a result of these steps, we tried to carry this message to others, and to practice these principles in all our affairs. 
(aa.org)
The old adage goes “an ounce of prevention is worth a pound of cure.”  Public service announcements encouraging responsible behavior with alcohol are mostly aimed at preventing drunk driving and underage drinking. Laws against providing minors with alcohol or driving while intoxicated are strict, but their effectiveness is limited. The alcohol industry spends $2 billion on advertising each year and Americans spend $90 billion on alcoholic beverages. (DrugRehabs.org) Teenagers are susceptible to peer pressure and media influence. Parental involvement and modeling are probably the best defense against teen alcohol abuse. It is well known that alcoholism runs in families. If parents are alcoholics, the children are more likely to develop drinking problems themselves. The opposite may also be true. If children are brought up by emotional healthy adults who model responsible behavior and communicate openly with  them, then the kids are less likely to give into media influence and peer pressure. 
The disease of alcoholism is complex in cause and cure. The factors that contribute to alcohol addiction are a combination of genetic, biological, psychological, familial and social influences. This is not a disease anyone consciously chooses. Therefore it is important to have compassion for those effected by alcoholism and to understand that it is an illness that can be treated. Public Health must address prevention of alcohol abuse, protecting the community from the dangers of alcoholic behavior and treating those afflicted with the disease. 
References
Alcoholics Anonymous, http://www.aa.org/?Media=PlayFlash, retrieved July 2011
The Biology Behind Alcohol Induced Blackouts, Medline News Today,http://www.medicalnewstoday.com/printerfriendlynews.php?newsid=230582, 07 Jul 2011, retrieved August 2011
California Department of Motor Vehicles, http://dmv.ca.gov/about/profile/rd/duistats89_99.htm 
CDC, Public Health Genomics, Mental Health Awareness,http://www.cdc.gov/genomics/resources/diseases/mental.htm, retrieved August 2011
Katcher et all, Estimating alcohol-related premature mortality in san francisco: use of population-attributable fractions from the global burden of disease study,http://www.biomedcentral.com/1471-2458/10/682, retrieved July 2011 
Medline News Today, Researchers Find Key Genetic Trigger of Depression,http://www.medicalnewstoday.com/printerfriendlynews.php?newsid=204903 , retrieved August 2011
National Institute on Alcohol Abuse and Alcoholism,http://www.niaaa.nih.gov/Pages/default.aspx, retrieved July 2011 
National Institutes of Health, NIH News, Wednesday, January 19, 2011 http://www.niaaa.nih.gov/NewsEvents/NewsReleases/Pages/Genevariantspredicttreatmentsuccessforalcoholismmedication.aspx, retrieved August 2011
Schneider, Mary-Jane, Introduction to Public Health, Jones and Bartlett

Tuesday, June 21, 2011

Wellness and Integral Medicine Tonia Weakland-Wilhelm Kaplan University CM-220-Unit 9

“Integral health can only be achieved through the development of our inner life and our inner healing capacities.” (Dacher, p9, 2006) Integral Health defined is the expansion of consciousness, knowledge and explores the fundamental meaning of medicine. Conventional allopathic medicine is limited, because it is based on a disease model. It is most effective at addressing symptoms of acute health crisis while not being very effective for chronic disease, our major problem today. (Ageless Zone) The technology behind allopathic medicine is remarkably advanced but this comes at a high price. Science has a limited view, focusing on biology and does not take into consideration, the effects of mind and spirit on the health of the whole person. Healthcare costs are very high, causing financial difficulties for many and making health care unobtainable for some. It is less costly to maintain good health than to cure disease. A new model of care must be focused on wellness. For thousands of years practice of medicine was based on spiritual premises. Today we can combine traditional healing practices with modern allopathic medicine. Clinical studies are proving that complimentary and alternative therapies have measurable and subjective benefits that address healing of the body, mind, and spirit. Creating an integral model of healthcare requires carefully combining complimentary and alternative therapies with allopathic medicine, creating a personalized system that is patient friendly, economically sustainable, more obtainable to the masses and can be utilized widely as a means of preventative care and for treatments of pathologies of various kinds. 
Undoubtably, remarkable achievements in the modern sciences and medicine have resulted in dramatic improvement in quality of life. (Dacher, 2006, p. 25) The discovery of disease causing bacteria, viruses, and the subsequent development of proper sanitation techniques have contributed in major decrease in deaths due to acute infections, increasing life expectancies. The last century saw the invention of antibiotics, immunizations, and pharmaceutical drugs to treat a plethora of illnesses or disorders. Eighty years ago penicillin was discovered by Alexander Flemming. (CDC) In 1954 Polio vaccines began distribution. By 1994 Polio was eradicated in the Western Hemisphere. (College of Physicians of Philadelphia) Most Americans today die from chronic illnesses such as heart disease or cancer, which can often be prevented with a healthy lifestyle. Medical technology is helping many people afflicted with these common illnesses to live longer. Surgeries can accomplish many amazing transformations. Organ transplants and reconstructive surgeries are extending and improving the quality of life for many people.  But for all of the wonderful things allopathic medicine has to offer, it also has its flaws. The healthcare system in the U.S. is failing many American people.
High costs of healthcare premiums and procedures are indications of a broken system. 50,000,000 Americans today do not have healthcare coverage. (Moore, 2007) Because allopathic medicine is based on a disease model, preventive care generally consists of screening for pathogens and does not go further. Many people only go to the doctor if they’re sick. Some do not go even when they are ill, because they do not have the money to pay for their care, because it can be difficult to get an appointment, or they are just not comfortable with going to the doctor.
“Don’t get emotionally involved with your patients.” (Schlitz et all, 2005, p xvi) This is the counsel of elder medical doctors to their medical students. Doctors are thought to be more objective when emotionally detached. Doctors are allotted very little time with patients in most conventional medical settings which contributes to their being robotic and impersonal when interacting with patients. Furthermore, doctors get paid for prescribing procedures and medications. Insurance and pharmaceutical companies do not generally pay for seemingly healthy people to get nutritional counseling, fitness training, or stress reducing therapies. 
Many Americans turn to complimentary and alternative practices or CAM to address their needs of caring for themselves. According to a 1991 study at Harvard University,  34% of people in the U.S. pay out of pocket for CAM services,  Examples of such practices include but are not limited to Yoga, massage therapy, traditional Chinese medicine, various forms of energy work, spiritual healing and indigenous healing traditions. The feature and benefits of such practices vary widely. People may be drawn to one type of CAM practice over another for a number of personal reasons. Let’s focus in on a few common forms of CAM. 
“Yoga is an ancient science developed over 5,000 years ago in India. Its purpose is to calm the mind so we can abide in our peaceful nature.” (Integral Yoga, 2011) The Integral Yoga Institute is one of many global organizations that has shared this ancient practice with the modern world. The intention of Yoga is to have a healthy body, a mind at peace, and a life with purpose. The physical practice of Yoga asana is only one component of the total practice. There is Karma Yoga, the Yoga of action, which includes mindfulness in all action; selfless service is encouraged. Bhakti Yoga is practice of love and devotion, including ritual, chanting, and loving the divine nature in everyone. Jnana Yoga is the Yoga of wisdom, which includes seeking truth through self inquiry, discernment, intellect,  intuition, contemplation, and study of philosophy. Raja Yoga is the practice of control of the mind. This includes the physical practice of postures, which is what most people associate with Yoga. It also includes practicing restraint and meditation. (Vedanta Society, San Francisco, 2011) Yoga can benefit anyone who embarks on the practice.  Therapeutic Yoga is a carefully designed collection of restorative yoga, gentle yoga, breath work, guided meditation, and hands-on healing techniques. (Integral Yoga) Therapeutic Yoga helps many people who are living with chronic illness or injury, as well as pregnant women and aging populations.
Massage therapy is another ancient healing modality; it can be found in a variety of forms in practically every culture the world over. Therapeutic touch is used by most people, in some form as a way of healing. Swedish, Shiatsu, Deep Tissue, Breema, Ralfing, Thai Massage, and Reiki are some common styles of therapeutic touch. Specific types of massage are beneficial for treating a range of injuries and conditions. Athletes and cancer patients can both benefit from massage therapy, however the techniques employed would be completely different. Healing touch works on more than a physical level. It also serves to support mental, emotional wellbeing. Massage therapists can be found in hospitals, chiropractor’s offices, physical therapy clinics, day spas and resorts. Many people consider massage therapy to be an important aspect of their personal wellness regimen. Still for many people a professional massage is considered to be a luxury item. 
An integral model of healthcare brings together the most beneficial aspects of allopathic and CAM therapies. Health is influenced by a combination of physical, spiritual and environmental factors. “Integral health is holistic, evolutionary, intentional, person-centered and dynamic.” (Dacher, p 30-31) Conventional medicine focuses only on the biological body. Health care must be designed to fit the patients’ needs, not the other way around. Integral medicine goes beyond looking at people from only a physical perspective. The goal of the integral model simultaneously seeks to understand, heal, and strengthen the psycho-spiritual, interpersonal, and worldly aspects of human experience. 
“Getting and staying healthy requires screening for common ailments, getting recommend annual exams, and customizing care according to one’s personal health record.” (One Medical Group, 2011) Redirecting the primary focus of the U.S. health care system, wellness and prevention services would benefit the overall health of Americans and create more continuity within the various branches of health and wellness disciplines. Nutritional counseling, stress management programs, and fitness regimens would be all inclusive as a personalized program for all people, whether or not they are acutely suffering from disease. All practitioners in these various fields of expertise working together with the oversight of a primary care physician would improve quality of care and quality of life. According to the Harvard study previously mentioned, 72% of people who use CAM never talk to their doctors about it. (Shlitz et all, np) Potentially, this could be hazardous if a negative interaction was to occur with conflicting treatments, due to lack of communication.  Furthermore, a physician such as an Osteopath, who is knowledgable of CAM could help patients determine which treatments are best serving as complimentary and which are alternative. 
More personalized care would return the human element to health care. The medical industry as a whole needs to reconnect with patients emotionally, physically, and spiritally. Allocating more quality time between doctors and patients provides an opportunity to build trust and understanding. Registered nurses, yoga teachers, doctors and other health care professionals can learn how to integrate therapeutic CAM into their professions. Early intervention and education of the youngest Americans regarding nutritional counseling, life skills training, emotional health, and physical health will help to ensure the next generation of adults is healthier than the current population. 
An integral model of health care would make health care affordable and accessible for more people. CAM practitioners, working under the direction of a physician could bill the medical insurance for the treatments. If doctors were able to take more time with their patients while they are healthy and recommend personalized health maintenance programs, this would prevent much of the chronic illness that now is so prominent in American society. The costs of treating the symptoms of common chronic illnesses such as diabetes or heart disease drive up costs for everybody. Many Americans simply go without health coverage. This can be an expensive gamble. People may go without care when they need it, due to lack of funds. Meanwhile problems get worse, until they become critical. Medical bills are a common cause for bankruptcy. These problems can be fixed. Use of modern technology to streamline medical records, prescription refills, and appointments are some ways to improve the quality of healthcare while reducing costs. Any practitioner with access to the client’s records could see the client’s history and use that knowledge in their interactions with said client. 
An integral model would benefit our nation’s economy on a large scale. Our nations economy is facing many challenges today. Out of control health care costs are a major factor in these troubled times. Treatment of preventable, chronic illnesses such as diabetes and cardiovascular disease drive up everyone’s costs. Solving this problem will take a total cultural shift. We as Americans need to become more physically active, learn to manage our stress more effectively, and eat healthfully. Instituting wellness programs within health insurance programs, integrating these programs into workplace benefits packages, and offering incentive programs will encourage people to make the necessary changes. In many parts of the country, entire overhauls of the structure and planning of cities and neighborhoods may be required. Neighborhood designs should encourage walking and biking, having stores and parks within a reasonable distance, and having ample bike lanes so that bikes do not compete with cars. Because of our fast paced lives, we have become a fast food nation. We need to make a major shift with regards to the food available to people on the go. Jamie Oliver made a TV series called Food Revolution where he proved that healthy food can be made quickly and inexpensively. Individuals can take a stand for this by voting with their food dollar, but sometimes choices are limited. This is why our citizens, government,  and health professionals need to put pressure on the food industry to provide more healthful choices to us. When this happens, we will see less diabetes, heart disease, cancer, mental health problems, and fewer sick days at work.
Obstacles to creating an integral health care model revolve around the debate between modern science and spiritual tradition. Many scientists, especially of older schools are opposed to or skeptical of CAM practices. Careful research of CAM is needed to gain a deeper understanding of how CAM therapies work. Though many CAM therapies have been traditionally used for thousands of years, it is still important to run them through modern scientific trials to prove their efficacy today. Complimentary and Alternative medicine is being researched and scrutinized. The problem that we face is not trial methodology per se but how to measure outcomes. Clinical trial methods usually adopt randomization, double-blinding or placebo controls. The results of CAM treatments are often subjective in nature. Treatments appearing to benefit patients in non-specific ways require adaptation of testing methods in order to measure the benefits.  These subjective benefits are typically labeled a placebo effect. Studies to understand the non-specific effects continue to be further explored. Much of CAM is faith based or spiritual in nature. This causes clashes between ‘believers’ and scientists who have not proven efficacy through scientific research.  Solid research on the effectiveness of CAM and subsequent implementation would ultimately improve patient care.(JRSM) 
It is time to return the soul to health care. “Integral Health recognizes that the crisis in health care today is also an opportunity to bring about profound personal and social transformation.” (Ageless Zone) Compassion, and wisdom are the mark of a great health care professional. Good medicine revolves around patient care. Allopathic institutions must change their view of disconnecting from the patient to identifying with them in order to understand their needs. Individuals must be empowered to take complete charge of their own mental and physical wellbeing, before problems arise.  Every individual in the nation should be given the education and resources to make healthy lifestyle choices. This change must reach into schools, community planning, as well as health care facilities. It is not enough to screen for biological pathology. The mind and spirit are where the seeds of wellness or disease lye. When we broaden our definition of what it means to be healthy, we implement societal changes which emphasize healthy lifestyle, our entire society will be healthier and happier and more prosperous. 
References
Centers for Disease Control and Prevention, Antibiotics: One of the Greatest Discoveries of the 20th Century, Retrieved May 2011
College of Physicians of Philadelphia, The History of Vaccines, Retrieved June, 2011, 
Dacher, Integral Health, 2006, Basic Health Publications, Laguna Beach, CA
Integral Yoga Institute website, San Francisco CA, Retrieved May 2011,
Journal of the Royal Society for Medicine, UK, Retrieved May 2011
Moore, Michael, Sicko, 2007, Dog Eat Dog Films
One Medical Group, Retrieved May 2011
Schlitz et all, Consciousness and Healing, Integral Approaches to Mind Body Medicine, 2005, Elsevier Inc., St. Louis MO

Friday, May 20, 2011

Advanced Yoga Final Paper; My Yoga Journey; Spring 2011 05-18-2011


Tonia Weakland-Wilhelm
City College San Francisco
Advanced Yoga
Final Paper
My Yoga Journey 
Spring 2011
05-18-2011
Hi Suvani,
Thank you for another wonderfully enlightening semester of Yoga.  This semester I have taken my Yoga practice to higher levels.  I feel stronger in mind, body, and spirit. Although I did not spend as much time in your class as I would have liked, I did deepen both my physical and spiritual practices.  I can now hold poses that were less accessible not long ago.  I have a broader understanding of therapeutic aspects of poses and apply those concepts when I work with my clients, teaching Yoga.  Also I have been attending events at local ashrams.  I want to become more involved with the local Yoga community.  I continuously strive to overcome the obstacles which hinder my Yoga practice and that hold me back from creating what it is I want in life. Yoga, for me is becoming my way of life. 
I really enjoy my Yoga classes at City College, especially your class. I took my first ever Yoga class at City in 1998. After several years of practice, I took my first Yoga Teacher training at Mount Madonna Center in Watsonville California during the summer of 2005. There I discovered the spiritual practice which began fill the void I had for many years been looking for.  I came back to City College in 2010 because I thought it would be a convenient and affordable way to keep up a Hatha Yoga practice of my own.  I did not expect to get all of the spiritual aspects from a community college class.  I was pleasantly surprised to find you. I really got a lot out of the class last semester, so I felt like the class was worth repeating. 
This semester, as always, I had a lot going on.  I think I could have managed my time better.  Time management has been an ongoing struggle for me.  I juggle so much. I am a single mother, running my own business, while working on my Bachelors Degree in Health and Wellness.  I find myself up late, just trying to take care of as many of the day’s responsibilities as I can, and then, exhausted, I go to bed around midnight. Then I find it difficult to get up early and start all over.  Yoga helps me to do something good for me, set an example for my clients, and grow many aspects of myself.  Yoga is what makes the chaos of my life manageable.  It is everything else that gets in the way of my practice and which dedicates me to my practice at the same time.  I am always looking for ways to become more involved, but often find time and money as primary obstacles.  Perhaps if I made a conscious effort to get up really early, meditate, and take care of the things that require quiet and concentration early, maybe I could break the cycle.  I’ll give it a try. 
Thanks in part to you and your lectures about Navaratri last fall, I have increased my interest in participating in Yogic holidays and rituals.  Earlier this semester, I attended a Shivaratri event at Brahma Kumaris center in San Francisco.  It was a beautiful place with lovely people and delicious food.  They gave a great presentation that discussed what Navaratri represented. They discussed who Lord Shiva is and how He is represented by a single point of light.  They also tied it into an acknowledgement and validation of all spiritual faiths.  There was also a beautiful performance by some Kathack dancers from the Chhandam dance school.  They seem like a good organization, giving back to people by working with children from poor families in India. Actually, they reach out in particular to daughters of prostitutes, to show them there is a better way.  After the dance performance we meditated a while, then there was a darshan ceremony  which I found out was an offering and an asking for longevity.  The evening was completed with a very good meal.  Brahma  Kumaris has workshops going on all the time.  I hope to make it to some of them soon.  I am especially interested in attending the Monday night workshops and the monthly Circle of Wise Women.  The Women’s circle should be accessible, for it is held on Saturdays, once a month.  I may try going to the Monday evening workshops during the summer while my kids are not in school.  Maybe I could bring my kids or my boyfriend, but I’m afraid my daughter or my boyfriend may be resistant. My thirteen year old daughter is a typical teenager.  A psychic once told me to get her into Kathak dance to get her more grounded.  My boyfriend is actively trying to turn his life around, but needs to find his own path toward enlightenment.  My son, although he is only four years old, loves Yoga and is generally very well behaved.  I can take him with me because he still has an open mind. 
Just last week I was researching for a class I am taking. I looked up the Integral Yoga Institute because I am researching to write a thesis on Integral Health.  To my delight, I found out that they are located only one block from the elementary school my son is going to be attending in the fall.  They had a specially Full Moon Bhakti event going on Tuesday night, so I went.  I brought my son with me too.  It is a beautiful victorian house on Dolores Street in San Francisco.  Everyone there was really nice.  My son did quite well, listening to us grown ups chanting and counting our Rudraksha beads.  While the rest of us were chanting the Gayatri Mantra, my son practiced plank pose and downward dog.  He was very quiet and respectful.  He really liked it there at the Yoga house as he called it. My intention is to begin spending time there in the fall, while my son is at school. I have wanted to become more involved with a Yoga community, so I will need to get to know the people of course, but I think it could be a good fit. They offer a work trade for classes, so I could offer my time in service and take hatha classes.  I could help prepare the post meditation lunches and learn more about healthy ayurvedic cooking.  They have a lot of teacher training available there too, including therapeutics.  I want to gain as much knowledge as I can on Yoga Therapeutics because my primary career practice is working privately with clients, many of whom have limitations of mobility or injuries they are rehabilitating.  My long term goal is to be an Occupational Therapist who practices in an integral way, using the philosophy and techniques I adapt from complimentary and alternative medicine, which I already practice and the allopathic approach which I am a student of as well. 
My physical body and physical practice has grown stronger this semester.  I especially see the growth in my inversions practice.  I used to not like to do certain inversions at all, because they hurt my neck or low back.  That changed a couple of years ago when I took a class with Judith Lasater on Yoga and Kinesiology.  I learned how to do headstands and shoulder-stands properly in that class.  I found new benefit in the poses, but they still did not become a regular part of my practice.  Last semester, in your class, I found new joy in my inversion practice.  I became determined to make them an integral part of my practice.  I began practicing more dolphin poses and forearm planks.  I started practicing more headstands, handstands, and shoulder-stands on my own.  This semester I have noticed I have more strength and balances than ever before.  I can hold a headstand for at least  ten deep breaths, can come down with complete control, and have no neck discomfort when I’m done.  I have even begun to teach these inversions to some of my clients, which I never did before.  Many of my clients are not ready to do such challenging poses, but I have learned a lot about modifications in this class as well, which I share with my students.  Inversions have become a regular part of my own practice and today I push myself a little harder when I’m on the mat in general. I try to take each pose to a more challenging level. When I practice half moon pose, I strive to balance while taking my hand to my foot and I can now take bound angel pose, which I have not been able to do since before I had my son five years ago. Actually, I woke up with a bad kink in my shoulder one morning recently. It bothered me for a couple of days. In practice I felt like if I took bound angel it just might help. I took the bind and I felt my shoulder POP back into place. It feels so much better now!
Because of Yoga, I live my life with more awareness.  I am increasingly able to control my mind and focus, by using my breath and meditation.  It used to be a bit of a struggle, to make time to meditate.  Today I meditate whenever I want or need to.  I call upon my breath anywhere, anytime.  I am also teaching more pranayam, meditation, and more chakra work.   Meditation, pranayam, and working with the chakras in class has been an inspiration for me and my spiritual practice.  I have made the commitment to take my spiritual practice and career to the next level, by initiating my Reiki Master training.  I have learned about the chakras from the perspective of Reiki and from a Yogic perspective.  It is my intention to pull them together, to perform healing treatments using compassionate touch, bija mantras, color, breath, and meditation.  When I teach Reiki, I intend to teach all of these aspects in my Reiki and Yoga classes. 
Thank you Suvani for all of the wisdom you have shared. Thank you for the joy and laughter you spread. I hope to continue to learn from you and I would recommend your class to anyone. 

namaste,
Tonia


References

City College San Francisco, http://www.ccsf.edu/NEW/ 


Wednesday, May 4, 2011

My Big Idea to Change the World


So fo my new class 'Composition II' my ongoing class assignment is to create a 'big idea' that will create change. This is only the beginning. Read it over. Tell me what you think. I appreciate your constructive feedback. 
Pitch / Mission Statement
An integral approach to health care will defragment models of health and wellness, drawing together the very best of allopathic, complimentary and alternative care, while focusing on all aspects of the person, being body, mind, and spirit. 
I think this as a good start for my effective thesis statement. As we progress through class, I will probably be able to refine it to make it stronger, but I do think it represents my primary intention of changing the way we approach health care in this country. 
Research will be required to answer the questions this mission poses. I have already taken a number of classes that focus on various aspects of health. In order to do credible research I could refer back to those classes. Text books, web sights that were utilized in class, and peer reviewed articles will all be trusted sources. I will avoid using sources that are biased such as advertisements or that use fallacies. I will carefully scrutinize any information I come across to ensure that it does not contain blatant fallacies. 
Evidence from thousands of years of practice and modern scientific clinical studies are proving that complimentary and alternative therapies do have measurable benefits. Such therapies could be utilized widely as a means of preventative care and integrated into standard medical treatments, thus integral medicine. Conventional allopathic medicine is limited.  Primarily allopathic medicine only acknowledges biological factors. Modern medicine focuses on screening for pathology. As long as there is an apparent absence of disease or disfunction the patient is considered to be healthy and no further investigation or treatment is found to be necessary. It is most effective with acute “crisis” medicine while not being very effective for chronic disease, our major problem today. Many people do not even go to the doctor for medical treatment or advise unless they are acutely ill. Many of the chronic illnesses that plague our society today could be prevented with some more attention to the body, mind and spirit. Integral Health realizes that disease prevention may not just depend on the elimination of biomedical risk factors but more on the mind-body interaction of individuals. It is not enough to get a flu shot and think you will always be healthy. Diet and exercise are of course important factors to health, but so are meditation, spiritual practice and selfless service. When all of these factors are encompassed and embraced by patients, practitioners, and insurance executives a major shift will take place that will lead to a healthier, happier America. 
References
Dacher, Integral Health the Path to Human Flourishing, 2006, Basic Health Publications, Laguna Beach CA

Thursday, April 28, 2011

An Affirmation

Dispassionate

Not influenced by strong emotion, and so able to be rational and impartial

I face life's challenges in a calm, dispassionate way.

Monday, April 25, 2011

I Am Change


It is our responsibility to create change in the world so that the world can be healthy, happy, safe, clean and at peace. The problems in the world are many. Greed and corruption are at the root of most of these problems. Good, honest people as a whole need to stand up for what they believe is right and take actions that are beneficial to individuals as well as the greater good. “Be the change you wish to see in the world” is a famous quote by Gandhi, one that I try to live by. My major contribution to make positive change comes through the work I do. 
I am blessed with a gift that is my career in healing arts. I have a business I call Your Happy Place. It is a day spa where I offer personalized services in skin care, body therapies, yoga and energy work. Every time I see a client, I have an opportunity to help them relax, rejuvenate, de-stress, and teach them how to be more positive. My work is a spiritual practice for me that helps me attain higher levels of consciousness. My training helps me to mature on an emotional level, psychologically, physically, and professionally.  I have the opportunity to help make the world a little happier with each person I touch. 
My intention is to continually expand my consciousness for the benefit of all those I encounter. I plan on going around the world to study with Great Masters in India, Japan, and China. I believe that gaining more worldly experience will be deeply fulfilling, for traveling and serving are things I have always aspired to do. I could go to Thailand to learn Thai Massage.  When my kids are grown I could go live in an ashram in India. I could join the Peace Corps. There is always so much I would like to see and do, but I must take it all one step at a time. Right now, I just need to finish my degree.