Silent John: Dealing with Deafness

I have known John for over twenty-five years. He is a pharmacist at a busy chain store not far from our home. John is a gregarious guy with the same warped sense of humor as I. As a matter of fact, we have told the same jokes to each other over the years, that we now just amuse ourselves by just saying the punch line. Soon, we will just assign numbers to the jokes.

"Hey, John -- number thirty-eight." He will laugh and tell me that is a good one.

John has his health issues. I wrote about one of them here.

Two years ago, he called me on the way to surgery for his heart. He went into his doctor with chest pain; a few hours later, he was heading into surgery for a multiple vessel bypass; another close call.

For the last several years, I have noticed that John has been having difficulty hearing. He did get a hearing aid a few years ago, but did not like wearing it. His job at the pharmacy requires that he answer the phone constantly; and he needs to counsel patients on their medications. It takes quite a while to get used to having a device in your ear, and to get used to the new artificially-enhanced hearing. We had dinner with him shortly after he got his hearing aids and the difference was dramatic. We did not have to shout or look directly at him; and he stayed involved in the conversations. In the past, he would simply doze off sleeping.

About a month or so ago, on a recent road trip to pick up some medical equipment, John could not understand the dialogue on a radio talk show. I had to literally shout to have a conversation with him on this 18-hour round trip. He was not wearing his hearing aids. It was exhausting for me to try and raise my voice to the level where he could understand.

Last night, we had dinner with him and his wife. About a week ago, his hearing took another downward dive. He was nearly completely deaf, now. I literally had to shout in his ears to get a reaction. His wife was very upset that he is not using his hearing aids, which he said did not help. His solution to the issue was to get others to answer the phone in the pharmacy; not really a viable option. Or, he will need to go on disability. He was visibly depressed. He feels that his hearing has digressed to the point where hearing aids will not be effective. He was not the same person that I knew for a quarter of a century.

He was encouraged to see his ENT and audiologist this week. I would like to talk to him on the phone, but he does not have that ability right now. I will call his wife today.

Fear of going completely deaf is a valid fear, but if it happens, it is not the end of the world, or even his professional career. Yes, he may have to make some significant adaptations to his life, but he would not be the alone. All of us, at some time in our lives, will have to make adjustments. Many people think the worst without having all of the facts. They feel a lump and immediately think TUMOR, CANCER, or FUNERAL ARRANGEMENTS. John's hearing plummeted in a very short time. He is thinking that he will have to live the rest of his life in a silent world; but he does not have all of the facts. He may be very embarrassed to find out that his problem is correctable, or he may find out this week that he and his family will have to make some life adjustments.

Life was never intended to be fair. E.coli happens. Lumps can be cancer, and sudden hearing losses can be permanent. As humans, there is not much we can do to change these unexpected bumps in the road, but we do have the ability to change our attitude. As soon as we are finished feeling sorry for ourselves, there is a whole lotta life out there worth living. John may have entered a world that is more silent than the one he prefers, but you do not need ears to listen to the rhythm of life.

"Hey, John...Number 47."

Related Topics:

• WebMD Video: Diagnosing Hearing Loss
• WebMD Video: Sudden Hearing Loss

Technorati Tags: hearing loss, deafness, aging, hearing aids, adaptive technologies

Notitis Media: False Alarm Ear Infections

Working in pediatrics, one of the most frequent reasons for a medical visit is to determine if a child has a middle ear infection or not. Some days, I wish that I had a drive-up window.

Parents are very sensitized by middle ear infections (otitis media) since they can be so painful and so untimely. Ear infections love to appear in the middle of the night, just before you go on vacation, while you are on vacation or out of town, or when you are between insurance policies.

The early symptoms and signs of otitis media vary from child to child, and parents are convinced those are infallible, and predictable. They are not. A verbal child will simply tell you that their ear hurts. Assuming this was an unsolicited comment; then this is usually a reliable sign. A pre-verbal child may exhibit a variety of vague/non-specific symptoms. One, isolated vague symptom of an ear infection in a child is less likely to be a valid indicator. However, if a child exhibits SEVERAL non-specific symptoms and signs, the likelihood of a middle ear infection increases.

PULLING ON THE EARS: Ear infections are typically painful; but there are many other things that can cause a child to pull on their ears. Getting water (or milk, formula) in your ear can result in some odd symptoms that may cause them to pull on their ears. Children who are learning to feed themselves often find a why to get mashed potatoes and peas in there as well. Ears that are stuffy can "pop" or crackle. This is an annoyance that can cause a child to pull on their ears, but this is not an ear infection. Sometimes, children just pull on their ears... or their toes... or their penises (if they have 'em). If every time a boy pulled his penis, a parent would bring them to my clinic, I would never get home. Penis-pulling, a fine art practiced by many, is rarely, if ever, a penis infection.

FUSSINESS: Some parents feel that when a child is fussy, they may have an ear infection. Maybe they do, but there are a few hundred other things that can make a child fussy, from gas pains and teething, to just being tired and uncomfortable. Fussiness is probably the most non-specific of all presenting symptoms.

FEVER: Children with ear infections do get fevers, but fevers can also occur with colds, roseola, gastroenteritis, meningitis, Mad Cow disease, and just about any of the hundreds of different viral infections. Fever is another non-specific symptom. The height of the fever is not necessarily an indication of the severity of the illness. For instance, a child with roseola may have a 104 degree fever for 2-3 days; a child with appendicitis may not have much of a fever at all. Although it is well-known that fevers are not dangerous, are a normal immune response, and do not need to be treated, fevers remains one of the most feared of all symptoms for parents.

STUFFINESS: Most middle ear infections in children are preceded by a cold. The most common scenario for the diagnosis of otitis media is a child who has been sick with a very stuffy cold for about three days prior. Congestion can cause the eustachian tubes to compromise; fluid builds up in the middle ear space; bacteria migrate from the throat into this pool of stagnant middle ear fluid, and a rip-roaring, painful middle ear infection will emerge.

DAY-CARE ATTENDANCE: Middle ear infections are preceded by colds. Colds are readily transmitted in day-care, or by play groups. As soon as children hit that ripe 'ol age of six months, their immature immune system is a virtual magnet for viral illnesses.

FAMILY HISTORY: If parents were plagued by middle ear infections as children, or had tubes (pressure equalization tubes) inserted, then there is a very good chance they will rear a child that carries the "ear infection tendency".

SMOKING: Children who are exposed to cigarette smoke have a higher incidence of ear infections. When I see a child in the clinic who reeks of stale smoke, I want to beat the parents senseless. I spend most of the visit time actively chastising the parents about second-hand smoke. Most of the time, they deny smoking around the child. They claim they smoke outside, never in the car, and never around the child. They lie; just like they lie when they say they only smoke two cigarettes a day, or plan on stopping. If our Child Protective Services were not so impacted by other abuses of children, I would turn in smoking parents for child abuse and endangerment. Both of my parents smoked when I was a child. The air in our windowless television room was literally a blue haze. I used to lie on the floor (below the smog) in order to breathe.

ALLERGIES: A child with environmental allergies may have a higher incidence of middle ear effusion (fluid) and/or infections during their allergy season. If their allergy season is all year, then this is a definite risk factor. Allergies also run in families.

TEETHING: Teething can result in "referred ear pain", but not ear infections. Children who are actively teething have a lot of inflammation in their mouths. This inflammation can cause the lymph nodes in the neck to react/enlarge, and this can cause discomfort to be transmitted to the ears. Children who rub the sides of their jaw and face due to teething discomfort might be misconstrued as having ear-pulling or rubbing.

Ear pain may not be an ear problem at all. There are many, many things that can cause OTALGIA, the medical name for ear pain. Tonsillitis, pharyngitis (sore throat), dental infections, lymph node infections, salivary gland infections (mumps), wax impactions, sinus infections, trauma, foreign bodies, etc. ALL can cause ear pain. Once it is determined that the child does NOT have an ear infection, other sources of ear pain must be investigated.

By understanding all of the various symptoms and signs of childhood ear infections, parents can better judge WHEN to seek medical intervention. About half of the patients that I see for suspected ear infections, do NOT have a middle ear infection; a fact that often disappoints a parent. Not only do I have to carefully justify my medical decision, I am often asked to PREDICT if they might have an ear infection tomorrow... or over the weekend. There is absolutely no way for me to predict outcome, and it does not make biological sense to just treat an ear infection that does not currently exist. I understand that parents know their own children, and to a certain extent, know their child's particular signs and symptoms that existed prior to past infections. I experience a lot of desperation and pressure from parents just to give them an antibiotic, when it is clearly not needed.

Some suggestions to FALSE ALARM ear infection visits:

1. Treat the pain; not just the fever. Ibuprofen and acetaminophen help control the symptoms. When a child is more comfortable; a parent is more comfortable. Pain is always counterproductive and all effort should be made to help a child deal with discomfort.

2. Use some eardrops for pain. Medications such as Auralgan, or the generics, can help middle ear pain. Ask your medical provider for a prescription to keep at home for possible ear pain. Children with tubes, or those that may have a ruptured eardrum should not use them. Make sure that all ear drops are instilled at BODY TEMPERATURE; never cold.

3. Stay out of the ER. A potential ear infection is not life-threatening. In most cases, it can wait until morning when you can see your regular medical provider - one that knows your child - or a less-expensive urgent care facility.

4. Get a home otoscope and learn how to use it. This is a safe, simple tool that can be quite helpful to parents of "frequent-flyers". When your child has an ear infection, ask the medical provider if you can see it. This is how you will learn. Educate yourself. If your child gets a prescription, read about it. Read as much about ear infections that you can.

5. Keep an ear infection diary on your children. Include information on dates of service, symptoms, signs, treatments, false-alarm visits, etc.

6. Don't jump the gun and head for the doctor at the first, vague symptom. Ear infections in a child can have emerging signs. A child pulling on their ear for one hour is less likely to have a diagnosable middle ear infection, than a child with a plethora of symptoms over two to three days. In most cases, it is okay to Count to Three (days that is) before seeking care. Believe it or not, most ear infections will resolve, on their own; IF you give the immune system a fighting chance.

Related Topics:

• Top 10 Questions About the Flu
• Ear Tubes Not Always Needed

Technorati Tags: ear infections, otitis media, middle ear

Hold Your Wee for a Wii - Water Intoxication Death

In September, I posted a Blog called "Dangerous Games", about the risky behaviors of teenagers. In the Blog, I mentioned water intoxication as a potentially dangerous activity. Now, in Sacramento last week, a young mother of three died from drinking excessive amounts of water in a radio contest. She was trying to win a Wii for her family. The goal of the contest was to drink bottles and bottles of water and to see how long you can hold out before urinating. The winner would take home the Wii by not going to wee.

Mrs. Strange did not win the contest (she came in second), but she lost her life. Shortly after the contest, she collapsed in her home and died of hyponatremia, a fatal electrolyte imbalance where the body is critically low in salt. A husband lost his wife; her three children, including a one year old, lost their mother. Today, it was announced that the radio show, the DJs, and eight other staff members lost their jobs over this tragic incident, proving once again that it is not just teenagers that play dangerous games.

Just this month, several members of a Chico State fraternity were sentenced in the tragic death of a young student pledge who also died of water intoxication by drinking excessively from a five gallon jug and then being forced to exercise. What made this incident a bit different was the illegal hazing that was involved. Mrs. Strange signed a waiver for the contest, probably unaware of the risks. During this aired contest, a local nurse called the radio station to warn them, but to no avail. Even the DJs themselves openly (albeit, briefly) discussed the possible risks before the contest began. I don't listen to that station, nor did I hear the show, but I would have driven down there to try and stop it had I known.

When I was an 18-year-old (stupid) college freshman, I played a dangerous game called Water Poker. For each hand that we would lose, we had to drink a small cup of water. As the evening progressed, we all teetered on the edge of hyponatremia. I still remember that night; staggering to the bathroom, disoriented and sick. This could have happened to me or one my friends. We didn't know the dangerous game we were playing. As little as a half-gallon of water (two quarts) in a single setting has the potential of killing you.

When you drink huge amounts of water, you flush out sodium, potassium, and other essential electrolytes. Kidneys overload. Cell membranes rupture from osmotic pressure. The brain swells with edema. Headaches, nausea, disorientation, and dizziness occur, followed by seizures and coma. Death can soon follow.

What next? Will radio stations offer "chicken" contests? Perhaps two drivers head for each other at high speed. The loser is the one the swerves out of the way. Or, how about who can hang the out a twentieth story window without falling? Of course, there are always drinking contests. The winner gets a liver transplant.

Water is the elixir of life. Humans are predominantly bags of salt water, held in by skin and connective tissue. Without water, we die. Without water, our toilets would not work, and our personal hygiene would be in serious jeopardy.

When water is abused or disrespected, it can kill. Water can end your life through drowning. Water can carry us away on a rip tide or float us out to sea on a raft. On a road, water becomes a major hazard to safe driving. When boiled, it can scald our skin. When frozen as an icicle, it can put your eye out. When ingested in excess, water can end a life and create unbelievable sadness.

Without water, we could not cry for the endless victims of Dangerous Games.

Related Topics:

• Teens with Food Allergies Take Risks
• Fewer Teens Report Risky Behavior

Technorati Tags: Jennifer Strange, KNDN-FM, Sacramento, Wii

Why isn't ALL EARS just about EARS?

Good Question. I could have easily called this blog "I'm ALL EARS." In other words, I listen. Listening is probably the best attribute of a good clinician; or person, for that matter. All day long, both in my clinic and on WebMD's ENT Board, I am asked questions. I listen. I try to respond, promptly and to the best of my knowledge.

I didn't fall into the ear-biz by choice. It just happened. As a parent, I had five children, many of which had untimely and painful ear infections. Most of my clinical career involved caring for people of all ages; cradle to grave as they say. In my family practice days, my happiest patient encounters were with children. In the last six years, I have limited my clinical practice to children exclusively. Why? It is time in my career that I listen to my own heart and do something that I love.

Ear infections or problems concerning the ears are among the number one reason why children are brought for medical attention. Over two decades ago, I started teaching parents and child-care providers how to use a home otoscope - the simple device that allows the examiner to peer inside the ear.

By doing so, I caused quite a stir in a doctor-dominated community that feels patients should be bare (not just feet) and stupid. I strongly felt that medicine was much too complex to do it all myself. I wanted patients and families as partners. To become partners, they needed the tools: knowledge, permission to participate in their own care, and of course, an otoscope and other medical tools. I stuck to my guns and now people using home otoscopes are not that strange anymore.


The ear classes led to the need to write a book, so I wrote and published my first book entitled, Ears: An Owner's Manual, now in its second (albeit, small) printing. Amazon has it, but the competition is enormous. I received a $99 check last week for books sold. Now, that will definitely put me in new tax bracket. I am about ready to just give it away; certainly less trouble than packing and mailing books for a few cents profit.

Most medical providers are good at what they do, but are often less successful at these side ventures. Personally, I think the book is good. It was written for the consumer, not AT the consumer. It is in plain, human language; not medicalese.

I have also written four primary care textbooks with a bit better remuneration, but when you add up those hours writing, editing, re-writing, etc. over the two years it takes a person to get a textbook on the market, it comes out to about a buck an hour. My wife threatened to divorce me if I did another book, which would cost me more than a buck an hour. I turned down McGraw-Hill when they asked me to write another. I also published about 200 or so magazine articles in my career; mostly for free or pittance. A person writes because they have something to say, not because they expect to get well-paid for it. A Stephen King I am not.

I work three, 12-hours shifts per week in my clinic and see about 120-130 patients. This 12-hour day is really about 15-16 hours when you add in commute time, phone calls (phone advice, refills, etc.), referrals, consultations, etc. I do take a half-hour per day to eat something. Going to the bathroom used to be optional, but since my untimely kidney stone a few years ago (while seeing a patient!), I try to drink more water, which results in a more frequent need to urinate from time to time. All of God's creatures gotta pee.

On my days off, I write this Blog and answer questions on the ENT board (formerly, the Ear Board). Recently, we added nose and throat to the mix, since I was fielding questions in this area anyway. As a primary care clinician, and not a board-certified otolaryngologist, I am both honored and humbled to run a board. This is what WebMD wanted; someone with down-to-earth, primary care experiences to share. This frees up the otolaryngologists to do what they do best; namely, surgery. Thank God for specialists.

I refer my own patients that need surgery, or a surgical consultation to an ENT specialist when needed. I do not send my patients unless there are no alternatives. ENTs are surgeons, and surgeons like to do surgery. If I do not think that surgery is really needed, or if I am not stumped by what is going on with the patient, I would prefer to handle things on the primary care end. After 33 years of taking care of patients, I know when to call in the ENT cavalry.

When I make referrals, I have a choice. It is mind-boggling for me to get feedback from my patients that the ENT was not people or child-friendly, or informative. Many leave frustrated with lingering questions and much confusion. ENTs see a LOT of children. Not to be child-friendly is inexcusable. Not being child-friendly is a good way NOT to get future referrals; at least, from me. I don't care how technically qualified a surgeon might be; if they come off uncaring, condescending, or downright rude, they are not going to be on my referral list. I guess I should be thankful for rude and uncaring ENTs, for these are the people that make the ENT so busy.

Medical knowledge should be freely shared and I think it is a wonderful service that WebMD is providing. Free. We all have gifts of knowledge that we can share. My neighbor is teaching me how to run a backhoe; I taught him how to take his own blood pressure. My mason is teaching me how to lay cement blocks; I taught him how to deal with his recent testicular infection (See, it is NOT just EARS!). My wife (another primary care clinician) is teaching our granddaughter how to sew. She is teaching us how wonderful it is to be grandparents. Before we leave this world, if we can just impart some of our knowledge and experiences to others, we will leave this world a truly better place.

Thank you for your ongoing support, both on the blog and on the ENT board. You have allowed me to humbly share who I am.

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Technorati Tags: medical practice, ear infections, WebMD

Cold Wars - Chicken Soup and Beyond

The fall and winter months see a dramatic increase in respiratory virus -- colds. No, colds are not caused by cold weather. They are not caused by going outside without a hat or with wet hair; or being in a draft. They are caused by viruses transmitted from person to person. You catch a cold; someone shared it with you. Viruses can be airborne as the result of an uncovered sneeze or cough. Viruses can exist on most surfaces, like door knobs and shopping cart handles. Viruses can thrive on hands for many, many hours, just waiting around for an opportunity to enter the body of an innocent host.

Working in pediatrics, I was proud of my ever-growing collection of medical neckties. After I read an article about contaminated doctor neckties, I gave them up. I have to admit that I had many a tie drag across a little baby's face during an exam, or noticed that a baby was happily sucking on it! Not good.

The two main bodily doors for respiratory viruses are the nose and the eyes; not usually the mouth. Gastrointestinal viruses, the primary cause of diarrhea and vomiting, do enter via the mouth. Intact skin acts like latex gloves; viruses do not enter the body through intact skin, but they happily reside on the surface; namely, the hands.

Humans are tactile creatures. In other words, we touch things. Children are the MOST tactile of our species. Not only do children touch things, they probe things; examine things, stick their fingers deeply and often in their noses, rub their eyes, and pick their butts. Of course, adults do not do those things. The nose-picking exception would be other drivers at red lights. Every time that I look sideways at other drivers at red lights, I see nose-picking. Not just that subtle, quick, innocent rub that we all do; I see some serious probing. I call this Trophy-Hunting.

"He who is without sin may cast the first stone," I hear you cry. Do I pick my nose? Of course, but not in the car where other people can see me and write blog posts about it. Knowing that this practice is a prime cause of respiratory viruses, I consciously try to avoid doing it, unlike children, who have developed nose-picking to some sort of bizarre art form. Let's admit this: Humans are often not the cleanest mammals that share this planet.

When you group children with other children, disease transmission will rapidly occur. It only takes a day or two after a successful viral transfer to develop in a rip-roaring cold. Children and colds are inseparable pairs, especially in day-care, preschool, and even those innocent play groups. In medicine, we have a term for diseases transmitted by animals called zoonosis. I would like to hereby claim the invention of a new word that I term pedianosis -- diseases caused by our kids.

As miserable and as untimely as a cold is for adults, colds are not necessarily a bad thing for kids. Viral infections challenge the immune system, much like vaccines. The more colds you have under your belt, the stronger your immune system becomes. As adults, we have had thousands of colds. Children have only started to pay their dues for living in a world of microorganisms. They may need about fifty or so to jump-start a good, solid immune system. Typically, this will take five or six years. In day-care, they will most likely achieve this benchmark faster.

So, colds are inevitable, unless you live in a bubble. Now for the saddest news -- colds are incurable, at least by modern medicine. Colds, being viruses, do not respond to antibiotics. The symptoms of colds, such as runny noses and coughing can last weeks. Just because you have ONE cold, does not mean you cannot catch another before the first one fades away. These coalescing (back-to-back) colds are very common in children in grouped care. It is not unusual to have a child sniffing and hacking for months during the winter months.

On the Today Show this morning, they talked about the dangers of over-the-counter medications used to treat the symptoms associated with colds -- a several billion dollar business. Each year, thousands of children experience adverse reactions to these drugs; sadly, a few die. Knowing the risks, people stock up on decongestants, antihistamines, expectorants, mucolytics, cough suppressants, herbal remedies, and vitamins anyway.

Do cold remedies work?
That depends on your goal. No remedy, over-the-counter or prescription has been conclusively proven to shorten the course of colds, in spite of what you hear at the health food store or on television, or on the sides of boxes. Vitamin C once purported to be the panacea of cold management failed in studies. Sorry, Dr. Pauling. Echinacea does not work in children according to the studies, although some people swear by it. Zinc lozenges have not been proven to be helpful. Some products have ALL of these things. They, too, may be ineffective.

Chicken soup? The heat and humidity of soup may actually help. Besides, it tastes good. Please keep in mind that this is MY opinion, for all that its worth. I don't want to antagonize all of those natural remedy folks (or non-chicken soup-eating vegetarians) out there that think I am nuts. You have the right to spend your money anyway you want.

There are a few hundred over-the-counter cold remedies that contain drugs. Used as directed, they are safe. Used inappropriately, they are not. Do they help control symptoms? Sometimes. SHOULD we control symptoms? Maybe not.

RUNNY NOSES: The nose is our air filter and humidifier. Mucous (AKA, snot) is the moisture we need for our lungs and throat. Snot is sticky (yuck), but it traps air particles, dust, pollen, and other debris so it can flow OUT, or down our throats into the stomach to be destroyed. If you dry up a runny nose using potent antihistamines, you may be defeating the main purpose of this primitive defense.

STUFFY NOSES: I don't really see any purpose of congestion. We really need to breathe through our noses, but maybe there is a better way than oral or nasal decongestants. The main decongestant is pseudoephedrine; a powerful stimulant that can race your heart and cause insomnia, like strong coffee.

Think about that when you give it to kids. Do you know that methamphetamine (crack, speed, etc.) manufacturers use pseudoephedrine as a main ingredient for this illicit and dangerous drug? I am a big fan of saline nose drops. Human beings ARE saline (water and salt). Our noses get saline from our eyes via the nasolacrimal duct, but often, this is insufficient in a dry, heating home. There is absolutely no harm to using saline in the nose, and it may be very helpful. Stuffy noses can also be improved by blowing your nose (in a tissue, not on your sleeve), increasing the humidity in your environment, or by plenty of drinking fluids (not beer). Do teas help? Sure, teas are fluid. How about orange juice? You bet. Chinese Hot and Sour Soup will make my nose drip like a faucet.

COUGH: The purpose of a cough is to clear the airway; a good thing to do. Expectorants and mucolytics help loosen the cough, but it does not hock it up for you (gross, huh?). Babies and young children may inadvertently vomit accumulated mucous, but they rarely have the advanced skills of hocking a loogie; honed to a fine art by older boys and men. Women and girls abhor this disgusting practice, and rarely develop effective hocking skills. Should a cough be suppressed? Probably not, but those of us who hear our children (or spouses) hacking all night long would disagree. Quieting down an annoying cough at night can help children (and their stressed-out parents) rest, so this common practice may have some peripheral benefits.

FEVER: Fever should be left alone in most cases. Fever another of the body's natural immune responses. Fever is not dangerous and should not be feared, but rather welcomed. Fever, unfortunately, is miserable, so treating the pain and discomfort of an achy, whinny, headachy child may be desirable. There is not need to achieve a perfect 98.6 to make anyone feel better.

FATIGUE: Colds can wipe you out, especially in the first three days when symptoms are at their peak. Listen to your body. If you are tired; rest. If you are sleepy, then sleep. If you have to go to work, call in sick. Not only will rest help the healing body, you will not share your cold with others. Colds are most contagious a day BEFORE you know you have it (nothing you can do to prevent this), and about two days afterwards.

The best way to treat a cold is with contempt. Simple as that.

Related Topics:

• When Your Cold Gets Worse: 6 Signs You Need to See the Doctor
• Surviving Kids' Germs

Technorati Tags: colds, flu, decongestants, chicken soup

Adult Children: When to Stop Parenting

All of our children are adults now, at least chronologically and legally. Of course, not all adults act like adults; so many parents are faced with many on-going parenting issues that extend well beyond that 18th birthday.

We are blessed with five adult "kids". Two are married, but a few days ago, we discovered that THREE are now married. One of our adult children (age 33, law school doctorate, and aspiring administrator) decided on a whim to marry a foreign medical graduate that he has only known for a very short time. They had been dating about a month and carrying on Internet conversations for a few months prior to that.

As the story goes, he wanted to get engaged and wait a year. (Dr. Laura would have approved.) However, her parents had other ideas on this proposed timeline. She is in the U.S. on a temporary, soon-to-expire visa and applying for residencies in internal medicine. Although we are not familiar with current immigration restraints, it is our belief that a different level of visa is required in order to be accepted into a medical residency program and remain in the U.S. Marrying a U.S. citizen would likely help.

To make a disturbing story shorter, her parents flew in from the Philippines and sat down with both of them. We were not aware that this was happening. Her father and mother convinced/coerced/encouraged our son to take this huge step and get married right away; or they would be taking her back with them to the Philippines. (No, as far as we know, there are no babies in the hopper.) So, the four of them headed off for a quickie marriage ceremony about a week ago. We found out about this clandestine marriage a few days ago, when our son decided to inform his family. Needless to say, this came as a shock to everyone.

We met our new daughter-in-law (sort of) that very evening. She is very shy and has no eye contact whatsoever. She consults with our son before answering any personal questions, such as her former last name. (Very, very strange.) She was justifiably frightened to meet us. As much as we would like to believe that this marriage was not just a fast track to a Green Card (denied categorically), we can't help but feel suspicious. He says he loves her and she loves him (great). She is applying to a multiple-year residency, followed by a post-graduate fellowship about three hours away from where he just accepted a new job. He says he will make the six hour commute (naive, or just plain stupid). He starts his new job in a few days, but has not found housing, and has no furniture. He is also desperately trying to study for a very important certification examination required for his new position. (Talk about distractions!)

My wife's reaction? Catatonic at first; upset about the blatant disrespect for our family, next, and now, just deeply, deeply troubled. An adult child has every right to make his own decisions, regardless of how unusual they are. She is his mother. This mother is not just a passive observer of our kid's lives; she is an active, vocal participant.

My reaction? What the hell were you thinking? Of course, I did not say that out loud, but the message was effectively transmitted in one subtle form or another.

The reactions of the rest of the family? Pretty much the same.

I believe we have a few options. We can embrace our new daughter-in-law and accept this marriage as a blessed union made in Heaven. (We are definitely not there yet). We love our son and know that failure to honor this relationship may distance him from his family. We can step back, throw up our hands, and start making our private predictions. (We are trying this on). Or, we can embrace our roles as perpetual parents and continue to share our honest concerns, even though there is nothing we can do about it. (Risky, but more likely to happen.)

My grandmother (not an otolaryngologist) used to say that when your ears are ringing, someone is talking about you. If that is true, there are two new people out with tinnitus.

2007 is going to be an interesting year.

Related Topics:

• Looking for Love: Understanding What You Need
• Love Secret of Happily Married Couples

Technorati Tags: parenting, relationships, marriage

Boys and Their Friends

On my way to the Midwest recently, I took a book with me to read on the plane. I have always been a fan of Bill Bryson; his style and humor, so when I saw the book, The Life and Times of the Thunderbolt Kid, I knew it was a must-read. I was pleased that Bill Bryson was born in the same year - 1951. This wonderful book brought back memories of my childhood that I had forgotten. If you were born in the 50's or thereabout, you need to read this book; or, buy it for someone for Christmas. Mr. Bryson, this is a winner.

It has said that everyone has a novel in their mind. I have been working on mine for nearly two decades; jotting down random thoughts and ideas in preparation for writing it as soon as I retire. Over the years, I have written six books; two for consumers (First and second editions of Ears: An Owner's Manual), two editions of a textbook (Primary Care for Physician Assistants), and two editions of Primary Care for Physician Assistants: Recertification and Review. After editing my last textbook, I vowed never to do it again; a textbook, that is. I definitely am going to write my novel.

Actually, it is already completed, I just haven't written it down. I lived it.

As I read Thunderbolt Kid I had to carefully think about my childhood friends. Maybe Bill Bryson was one of them and writing under a pseudonym. How else could he have possibly known what we were doing?

Before I was an old man, I was a boy. Boys are very unique, and often, strange creatures; especially to their mothers, who incidentally, were never boys. Boys fight, wrestle, take unbelievable risks, are highly-competitive, enjoy gross things, tell lies, think about sex, have questionable hygiene, love to laugh and make others laugh, are loud, belch, fart, pee on the seat, and, of course, play with their penises.

Boys break arms, sprain ankles, get cuts, but otherwise ignore most other bodily discomforts. Although we don't like to talk about it, boys are also deeply sensitive, secretly cry, have very fragile egos, and hate to dance (at least, I hate to dance). Boys do not like to hold hands and are not good huggers; but they often need more hugs and cuddles than girls. For a mother, raising boys is a never-ending challenge. Fathers, although they may deny it, are hardly ever surprised by the bizarre behaviors of boys.

I have one biological brother who is eight years older than me. Growing up, he was my reluctant mentor. Not because he was bigger than me, but because he was the closest thing I had to a father. My older brother is now my best friend. Our father died when I was six. A year later, my mother married again. A year after that, I had a stepbrother; eight years younger. Sadly, my stepbrother and I have never been close.

So, my mother had three boys to rear. Growing up, my mother had 7 brothers and 5 sisters. I don't think she was every particularly fond of boys. My stepfather was definitely not fond of my biological brother or me. Actually, I think he hated both of us; equally, of course.

When I was born, my mother told me that she cried for weeks because she wrongly anticipated that I would be a girl. Of the few surviving baby pictures that I have, I am wearing a frilly dress in some of them; a disturbing fact I try not to think about. Dresses aside, I was a typical boy growing up in our small Appalachian, coal-mining town filled with yes, more boys. Our town seemed to have an overabundance of boys, perhaps Nature's Way of assuring that there would be future coal miners.

Terry was my best friend. We went to kindergarten together; graduated high school together. We were Best Men in each other's weddings. We are still good friends, even though we now live 2500 miles apart. I had many other intermittent friends in my early childhood, but Terry was my BEST friend. Keith moved away. Denny was weird. Tom was REALLY weird.

Since my mother fought with all of the neighbors, it was not permitted for me to play with boys that lived next door. I was expected to hate them, too. Fortunately, Terry lived across town where my mother's reputation was not well-known. Although cautious, Terry was not intimidated by my mother, so we have remained lifelong friends. When I get down to write that novel, Terry will be my main memory-jogger.

I fondly remember when my youngest son, Ryan, got his first BEST FRIEND in Montessori School. His name was Skip. Their eyes would literally light up when they spied each other. Skip was Ryan's Terry, but unfortunately, Skip's family moved away and Ryan was devastated. A few years ago, he reconnected with Skip. It was a good reunion. All of our boys had best friends: Josh had Tommy. Alex had Adam. Benjamin had Timmy. My daughter had hundreds of best friends, but girls are not the subject of this particular Blog.

To boys, friends (good and bad) are perhaps the most important and influential people in their lives; more so in some cases than their parents. Looking back, I can't say that I had any friends that really led me astray. Well, actually, there was Gregory, but he led everyone astray for he seemed to have an endless supply of penny candy. Even in first grade, Greg was a shoplifter savant. I think he could easily be in prison now. Hopefully he does not have Internet access... or friends on the outside.

If you are a parent of boys, allow them to nurture healthy friendships. If this Blog has jogged a childhood memory of a childhood best friend, why not look them up on the Internet and give them a call?

Related Topics:

• Kids and Friendship: A Parents' Guide
• Sound of Laughter Tickles the Brain

Technorati Tags: friends, parenting, health