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Vital Conversations

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Illustrations by Jacqui OakleyTalking with Your Children
Honesty is the Best Policy
Each child is different, so there is no one way to address sensitive but important topics with your children. But when it comes to talking with your kids, one thing is certain: Honesty is still the best policy. Dr. Joseph DiSanto of Brandywine Pediatrics in Wilmington offers this advice: “Always be honest. If a child knows that his parent has always been forthcoming and has answered his questions honestly, he will trust that parent later when something comes up.”
 
One of the most potentially awkward but crucially important topics to address with your children is their development, especially their sexual development. “Without strolling too much down memory lane, tell your kids that you remember what they’re going through and what they’re learning about,” says registered nurse Maryanne Bourque, a community education coordinator at Alfred I. duPont Hospital for Children. “It’s OK to tell them that you were scared or curious at their age.”
 
Many adults were raised in families that scheduled The Talk. Now adults themselves, they often try to avoid The Talk. “By the time they bring up these important topics, it’s too late,” says DiSanto. “The child already knows a great deal from the Internet, their friends, and movies and television.”
 
So get started early, and don’t be shy. “Don’t expect to have one talk with your kids,” Bourque says. “It’s not one talk. It’s many talks.” If your young daughter has a question about the girl in her class who is developing breasts faster than she is, for example, you do not need to also address sexuality and intimacy at that time. According to the American Academy of Child and Adolescent Psychiatry, “Parents should respond to the needs and curiosity level of their individual child, offering no more or less information than their child is asking for and is able to understand.”
 
Just as important as the information you provide is the information you confirm or refute. “Part of a parent’s job is to dispel myths,” Bourque says. “Children are bombarded with information from a variety of sources—school, peers, siblings, the Internet, television, and more. Parents must be prepared to answer questions and provide accurate information about their children’s development and changing bodies.”
 
DiSanto urges parents to use real, age-appropriate words to describe body parts. “If you’ve always called it a penis, your 13 year-old won’t giggle when he hears the word ‘penis’ later on.”
 
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It may help to anticipate your child’s questions and concerns. Talk to a healthcare provider, teacher, counselor or clergy member for information, and browse your library for books that use illustrations or diagrams that may aid the conversation and your child’s understanding. Bourque stresses that it’s important to let your children ask questions. “These conversations should not be one-directional. Rather, they should be a give and take.”
 
If you feel uncomfortable, take baby steps. “Broach sensitive subjects a little bit at a time,” says Bourque. “Don’t let your own potential discomfort get in the way of talking with your children.” If a child thinks her parent is trying to duck these issues, she will get information elsewhere, DiSanto warns.
 
A big issue for adolescents and teens is substance abuse. Before you talk about this issue, however, you should be talking to your child about being healthy and taking care of his body from a young age. “Talk about nutrition, exercise, getting enough sleep,” suggests Martha Gregor, director of drug and alcohol services for the Delaware Division of Child Mental Health. “Teach your child how to make healthy choices. Those conversations are the foundation for talking to your child later about drugs and alcohol.” How early do you need to talk to your kids about substance abuse? “Many kids start experimenting in middle school, so you really need to start these conversations before then.”
 
How? Look for teachable moments, for example while watching television together or when your child talks about something that happened in school. A conversation about peer pressure at school—or a similar plot line in a TV show or movie—can be a springboard for a talk about not using drugs or alcohol. If your child is concerned about peer pressure, give her some ideas about what to say and how to keep her cool as she walks away from the situation.
 
Gregor offers the following advice:
 
• Be involved in your child’s life. Know where they are and who they are with, and periodically check on them to verify they are where they’re supposed to be.
 
• Give a clear and firm message that using alcohol or drugs is not acceptable.
 
• Prepare for the possibility that your child might experiment. If you have a spouse or partner, talk together about how to approach the situation as a team, about who will play what role so you can best support one another. (No partner? Enlist the help of a friend, school counselor, family member or clergy.)
 
There are some common signs that your child may be using drugs or alcohol. Have his circle of friends changed? Does she seem uncooperative or moody? Does he have a different attitude or outlook on life? If the answer is yes, Gregor suggests checking with other adults in your child’s life to see if they too have noticed any changes.

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Pick a calm time to address such issues with your child. Try to have the conversation at a time when you will not be interrupted. When you do approach your child, be clear. Talk about what you have observed and mention your suspicions and concerns. Give specific examples about why you suspect there may be a problem, Gregor says.
 
Reassure your child that you are concerned for them and that you care about their health and well-being. Then listen to what they have to say. And listen some more.
 
If you think there is a serious problem, make an appointment for an assessment by calling the Division of Child Mental Health at (800) 722-7710 or the Delaware HELPLINE at (800) 464-HELP. If your child refuses to go to the appointment, go on your own and get information on resources that are available to your family. Gregor recommends visiting Websites such as theantidrug.com, samhsa.gov, and drugfree.org as a starting point.
 
Most importantly, “don’t give up,” says Gregor. “The problem will only get worse if you ignore it.”
 
In addition to your child’s own use of illegal substances, it is important also to talk about buzzed or drunk driving. “You cannot wait until your child is 16 years old and getting their driver’s license to talk about this,” says DiSanto. “Use opportunities as they present themselves, for example, a news story about someone who was arrested for drunk driving. Ask your child if she understands what that person did, why it was wrong, and what it means to drive after even just one or two drinks.”
 
Initiate this conversation when children are young, even as young as 6 or 7. “Children are smart,” DiSanto says. “They will absorb the information.” Equally important is the need for parents to model good behavior. If you are telling your children one thing but behaving in an opposite manner, your children will notice. “Information about substance abuse and drunk driving is believable if it’s consistent and straightforward,” says DiSanto. That consistency includes your own behavior.
 
Both Gregor and DiSanto recommend teaching your children to call you when they’ve made a poor decision about drinking, or when their friend is trying to get behind the wheel after a few drinks.
 
“Offer your child amnesty if they call you for help,” DiSanto says. If he or she calls once or twice, you have done a good job of mentoring and teaching your child. If it happens regularly, however, “You need to address that with your child and your doctor,” DiSanto says.
 
A third critical subject is the children’s activities and commitments. You can teach your children a valuable lesson by helping them prioritize their activities such as soccer, dance class, chorus, karate, and others. “Teach your kids that they can’t do everything,” says Bourque. “Have them pick the one or two activities that are most important to them, and teach them to say no to the others.” In doing so, you not only provide a valuable lesson on time management and boundaries, but you also contribute to the health of the family as a whole.

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DiSanto suggests that overscheduling may be coming from the parents themselves. “In trying to enrich their children’s lives by exposing them to many activities, parents may be contributing to the problem,” he says. “It is my role as a pediatrician to bring this up to the parents because it is related to the health of the child.”
 
No matter the subject, it is critically important for parents to be able to talk to their children about anything. “Be open to your children’s questions,” Bourque says. “Be open to communication with your child. It’s never too soon to talk to your kids—about anything.”
  

Your Aging Parents 

Make a List
As the population ages and life expectancies increase, many adults are faced with caring for their parents. In order to address quality-of-life issues such as living arrangements, health and your parents’ wishes, Patsy McNichol, admissions director at Ingleside Homes in Wilmington, suggests keeping the conversation as lighthearted and casual as possible. Even if you’ve rehearsed what to say, “Try to make it seem less rehearsed and more impromptu. A relaxed mood is more likely to be successful.”
 
Three items every adult should address with their parents are living wills, powers of attorney and living arrangements. “Talking about these issues can be uncomfortable,” McNichol says, “but there are ways to present it without being unpleasant.”
 
McNichol suggests asking benign questions like “How are you?” “Are you comfortable?” and “Do you get lonely?” From there, you can address issues like whether or not your parents have thought about drafting a living will or if they have a power of attorney. At the very least, urge your parents to have a medical power of attorney now, while they are healthy. “It is far better to get these discussions out of the way before a crisis happens. Don’t wait until emotions are high and everyone is stressed or angry.”
 
Another technique is called therapeutic lying: pretending a friend or their family is addressing a similar issue, then using that conversation to segue into more personal topics with your own parents.
 
Enlisting the help of a doctor or other healthcare professional also can be helpful. “A lot of times, seniors will take the advice of a doctor, someone they trust, more than the advice of their child,” McNichol says, “particularly when it comes to living arrangements.”
 
Regardless of when you initiate a conversation with your parents or which specific topics you address, McNichol stresses making a list. “Ask specific questions. Do you have a will? Where is it? Where do you keep the safety deposit box key? Where is your checkbook, and what bills do you owe?” Assuming your parents are Internet savvy, also ask them what their passwords and account numbers are.
 
Once you have this information, McNichol urges you to make a list. Keep all of the information in a safe, handy place for the day you might need it.

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Your Partner, Your Relationship

A Continual Evolution
Many people have the notion that once we reach adulthood, we won’t change. “This is simply not true,” according to psychologist Walter J. Ciecko of Wilmington. “We expand as we take in new experiences and new opportunities. We have different needs at different stages of our lives.”
 
For this reason, communication with your spouse or partner remains vitally important, no matter how old you are or how long you have been together. “You need to communicate with each other what’s happening within you so you can support each other,” Ciecko says. “Continually ask yourself, ‘What am I learning about myself? What are my needs?’ And then communicate that information with your significant other.”
 
Even if you do a good job of communicating with your partner, there are a few universal hot topics that many couples struggle with: sex, money and time.
 
In order to be comfortable talking about sex, you have to be comfortable with your own body, says Debra Laino, a certified sex therapist from Wilmington. “Your sexuality is a part of you. You need to learn how to talk about it, just like any other topic you need to discuss with a loved one. Educate yourself on the physiology and benefits of having sex.”
 
If you are truly unable to talk about it, Laino suggests rephrasing the conversation and talking about pleasure rather than sex or sexuality. Ciecko further reminds patients that intercourse is just one aspect of sexuality, which can help some patients feel more comfortable talking about it.
 
Ciecko suggests staying up-to-date with your partner and knowing what they find pleasing or exciting. Laino agrees. “Periodically ask your partner if there is anything you can do for them or if everything is going well.” By doing so, you will launch a conversation to ensure that both partner’s needs are being met.
 
If needs are not met and there’s little to no conversation about it, resentment can breed. “When communication is not going well between spouses or partners, sex is one of the first things to dissipate,” says Laino. If both partners find the frequency and intimacy of sex in their relationship acceptable, there’s not a problem. If one partner is dissatisfied, however, Laino stresses that communication is essential to resolving the issue before it grows.
 
Money is another issue that many couples argue about. Ciecko suggests having frank and regular discussions about your family’s finances. Who earns the money? How should it be spent? How much should you share with others? Though you may not agree on every point, Ciecko stresses that such conversations are vital in order to ensure that both parties understand the expectations. If there are children in your family, you may wish to talk to them as well, so they also understand the family’s obligations and priorities.
 
A third issue in many relationships is time, especially how to balance individual time and couple time. With children in the picture, this becomes even more complicated, Ciecko says. “Now you have to balance couple time with family time and individual or me time.”

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Ideally, both partners feel as though they have equal power in the relationship, so step one in the communication process is to balance each partner’s needs with the needs of the couple or family as a whole. With so many commitments and stresses on adults and families, Ciecko urges patients to reach an agreement with their partner on how to spend their time. “Keep talking with each other until you get there,” he says.
 
Despite your best efforts to keep the lines of communication open—on all topics—conflict may occur. “Many people were raised in environments where conflict was not handled well and therefore they try to avoid conflict,” Ciecko says.
 
Conflict, however, can be a positive experience, he says, because it provides an opportunity to grow and expand as a person. “Constructive conflict can be a creative process, because it can lead to growth.”
 
In order for conflict to be constructive and not destructive, Ciecko recommends showing up with good energy, remaining neutral and mindful of each other’s positions, and taking the time to determine what you want to say or share before saying it. If a conflict arises and you or your partner do not have positive energy to address it then, Ciecko finds it perfectly appropriate to reschedule the conflict by saying something like, “I am not able to address this at this time, but let’s make a point to talk about it after dinner when we are both relaxed.”
 
That way the conflict is but part of a continual process of growth and evolution, one that helps both partners meet their needs and support each other. 
 

You and Your Doctor

It’s All About Communication
Don’t forget to take care of yourself. That means staying in close contact with your physician. Talking with your healthcare provider can be many things—intimidating, embarrassing, enlightening, scary, sensitive. Uncomfortable shouldn’t be one of them.
 
“Don’t be shy,” says Dr. Bijan Sorouri, a Newark internist. Wilmington chiropractor Karen C. Feeney agrees. “Say everything that’s on your mind, even if it’s a sensitive subject,” she says. “You have to be comfortable talking to your doctor about anything. Your physician cannot help you with anything that you do not tell them.”
 
Remember that your provider is there to help you. “Your healthcare provider is your partner,” says Donna Goldsborough, nurse educator at Bayhealth Medical Center. No question, nor any subject, is off-limits when it comes to your health.

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What’s included in that list? Practically everything, even subjects that may seem irrelevant.
 
• What medications are you taking? “Tell the doctor all your medications, including herbal remedies, over-the-counter drugs, and supplements,” Sorouri says. Says Feeney, “Each doctor you see needs to be aware of what you are taking from another physician, and you should tell them if your medications change.” Telling your healthcare provider about your medications includes the dosages. If you fear you won’t remember, write them down or take the bottles to your appointment so the doctor can read the labels.
 
• Similarly, are you taking any medications every day, even over-the-counter meds? Have you increased your dosages because you weren’t seeing results? “You shouldn’t have to take over-the-counter medications every day,” says Feeney. “This could be a sign of a problem.”
 
• What other treatments are you seeking? What other doctors are treating you? Tell your doctor about any complementary therapies, including physical therapy and acupuncture, you are undergoing so they can coordinate your professional care.
 
• Do you have any family history of illness or disease? “If three out of five women in your family have had breast cancer, all of your healthcare providers need to know this so they can spot a problem early, avoid medications and supplements that could create a problem, and help you follow up with the appropriate doctors and treatments,” says Feeney.
 
• Are you tired all the time? Have you lost or gained weight? Your doctor needs to know so they can rule out any underlying problems that could cause either to occur.
 
• Have you noticed a change in your body? Tell your doctor, even if it doesn’t seem important.
 
• What is your work history? Have you been exposed to potentially hazardous chemicals or substances such as pesticides or dry cleaning solutions? Symptoms may be able to be linked to these exposures,” Feeney says.
 
• Remember that no subject is taboo. “Trust me. Whatever you have to tell me, it’s not the first time I’ve heard about it,” Feeney says. “Don’t be embarrassed to talk about your body.”

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If you tend to be forgetful, write your questions down before your appointment. Better yet, prioritize them so you’re sure to ask your most important questions. And don’t be afraid to bring a loved one with you (a family member or close friend) for support and for an extra set of ears.
 
When in doubt, “share everything with your physician,” Sorouri says. “If you don’t, you’re just compromising your own care.”
 
Goldsborough offers these extra tips: Be prepared to discuss and describe your symptoms and medical history, ask questions, follow the doctor’s instructions carefully, writing them down if necessary, and stay in touch with your provider.
 
Feeney recommends asking the office staff for extra time to discuss your concerns. And if your doctor doesn’t answer your questions to your satisfaction, “Ask again. You should feel like you can talk to your doctor.”
 
Sorouri and Feeney agree: If you cannot talk to your physician, it may be time to find a new one. “Any time you cannot talk to your doctor or you don’t feel comfortable, you have to find someone else,” Sorouri says. Says Feeney, “Remember that your provider cannot help you if you don’t talk to him or her. If you cannot talk to your doctor, or if they dismiss you, find someone who will listen to you.”

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