Is it All in Your Head? A Case to Get Your Cranium (and Spine) Checked

By Claire Fitzpatrick, D.C.

Do you or someone you know suffer from fatigue, confusion, attention disorders, movement disorders or neurological dysfunction? How about hormonal imbalance, mood swings, and global aches and pains? In addition to seeking medical help, it would be a good idea to get your cranial and spinal integrity checked.

You’ve likely heard this at some time in your life: “My doctor told me it’s all in my head…” Whether she knew it or not, she may be right – but not in the way she may think.

Chiropractors are known for their ability to address vertebral integrity.  However, many do not know that cranial, as well as vertebral, integrity is of the utmost importance for the body to regulate nourishment to the brain and spinal cord and excrete waste products into the vestibular and lymphatic system for elimination. It is not an area of study that is widely explored in general medicine; however, doctors of chiropractic are highly educated and well-versed in this area.

In fact, the more you know about cranial integrity and a person’s ability to thrive, the more you may wish to consult with an expert as a standard of care for you and your family.

Here’s a quick primer:

The skull is made up of two sets of bones - the bones of your face and the bones of your cranium, which make up your forehead and the back of your head.  There are 22 bones in total. The mandible (jawbone) is the only movable bone of the skull. The other bones are connected by fixed joints called sutures.

When the sutures along the cranium are out of alignment, as when spinal vertebrae are out of alignment, it is impossible for us to experience optimal health and wellbeing because the dura mater (the tough covering of connective tissue that attaches to the interior of the cranium) gets twisted.

Picture when you twist a water balloon, how the flow of the water is out of balance and presses more on different parts of the sides. It’s the same with the dura.

Cerebrospinal fluid is the nourishing fluid in which the brain and spinal cord float within the dura. When the flow of nourishment in and out, and indeed the pressure of the fluid itself, is uneven and out of balance, waste can get trapped inside and the brain itself is subjected to uneven pressure. As you may imagine, this isn’t good.

For instance, it is impossible to have a fully-functioning hormonal system when stress exists in the brain – which contains and regulates hormones at the highest level – when your cranium has subtle distortions that limit the movement of cerebrospinal fluid in and out of the head and along the spinal cord.

Cranial and spinal distortions can be assessed and adjusted by your chiropractor. Cranial distortions can be similarly addressed by other highly-educated, licensed health practitioners who specialize in craniosacral therapy. The good news is that addressing these distortions usually creates a change that can be felt immediately in most people.

During an assessment of the cranium and spinal alignment, in addition to the position of the cranial sutures, your vertebrae, your sacrum and pelvis, your chiropractor will also assess:

Eye Position – while a certain amount of asymmetry is normal, if there is a very noticeable difference between the action and the position of the eyes, this could be an indication of cranial dysfunction.

Mandible – she will observe whether the jaw is even on both sides, or if one side appears more compressed than the other.

Ears – if the ears are the same height, or whether one is further front or back from the other

Shoulders – if one shoulder is higher than the other.

Leg Length – if one leg appears shorter than another, but corrects when adjusted

Your Gut – whether there is tension in your belly, and if it is from an uneven pull from the fascia surrounding your gut organs

There is promising research coming out suggesting that correcting cranial and spinal distortions can help ear infections, learning impairment, support healthy blood flow in and out of the brain, and improve nitric oxide production. Research also shows that it can improve the autonomic nervous system function and heart rate variability.

In an age of endless blood tests and impersonal doctor office visits, it’s important to remember that there are doctors who actually put their hands on you to see what’s going on; who can help your body adjust naturally without the use of drugs and surgery; and who you can build a relationship with for you and your family. It behooves you to make trips to a physician well-versed in bodywork as part of your primary health care team.

I Feel So Guilty

by Phyllis Larkin, Psy.D
Geriatric and Family Psychologist
XPATSIA.com

Many of those caring for a loved one from abroad feel guilty. Should we?

Let’s take a closer look at this powerful, and misunderstood, emotion in relation to our aging loved ones.

Guilt | Definition by Merriam-Webster
1: responsibility for having done something wrong and especially something against the law. He admitted his guilt.

2:  a feeling of shame or regret as a result of bad conduct. Other Words from guilt. guiltless \ -​ləs \ adjective.

According to Webster, one must have committed an offense. This results in guilt,  the appropriate reaction. Guilt generates feelings of regret for doing wrong. The guilt reaction calls us to change our behavior and make things right with those we have harmed.  

So what have we done wrong?

Most caregivers feel there is “always more” that they can or “should” be doing to make their loved ones lives nicer, easier or more pleasant. “Should” is the problem here. “Should” implies the expectation that you can do all the things others want, regardless of the impact on your life, health, finances or living conditions. Guilt often comes when we can’t meet an “expectation,” yet feel obligated to meet the expectation anyway. Guilt tells you that you “should” be able to meet the expectation even if the demands are unreasonable or unfeasible. But are you guilty? Or are you being harsh with yourself? Let's ask some basic questions about your expectations for yourself:

  • What can you do from abroad?  
  • What is reasonable?  
  • What is appropriate?  

I would encourage you to answer these questions as if you were judging a respected friend or family member.  

  • Would you expect anyone else to meet the obligation given the circumstances?
  • Are you being asked to sacrifice your financial security? Can you afford to contribute to your loved one’s expenses? If you can, how much?  
  • Are you capable of the tasks being requested? Driving to medical appointments is impossible. Reviewing household bills is possible if you are given access via websites or PDF files.  
  • Are resentment or anger preventing you from meeting responsibilities you are capable of? Then you may be feeling appropriate guilt that demands changes to your behavior.
  • Are you breaking laws? Then you are truly guilty and the feeling is congruent with your behavior.
  • Are you feeling irresponsible, even though you are meeting your commitments and doing the best you can? Then the feeling of guilt is unwarranted and needs to be examined. Replace the guilt with an appropriate feeling. You might feel sadness at your loved one's decline, anger that things haven’t gone as you would have liked or grief at the loss of connection due to living abroad.

Healthy guilt is warranted when we have acted immorally, unlawfully, or disrespectfully.

It calls us to change our behavior and results in self-improvement.

Unwarranted guilt is counterproductive. It generates feelings of worthlessness and remorse for responsibilities that are out of our control or our ability to meet them.  Unwarranted guilt does not improve anyone's lives. It just makes us feel bad about ourselves. We feel helpless to change our behavior and this prevents us from doing what we can for those we love.

This prayer can help us decide what we can do and what we can’t:

God, grant me the serenity to accept the things I cannot change,
Courage to change the things I can,
And wisdom to know the difference.

— American theologian Reinhold Niebuhr (1892–1971)

Money Matters

by Phyllis Larkin, Psy.D
Geriatric and Family Psychologist
XPATSIA.com

  • Mom says in a panic, “They turned off the electricity. I don’t know what happened?”
  • Unopened bills are piled on the counter.
  • There are unnecessary new windows and doors on dad’s house, and the replacements were financed through a second mortgage on the house.
  • Since the caregiver moved in, money is being taken out of the bank accounts.
  • Identity theft of mom’s credit.

Unfortunately, the senior population is at high risk for financial fraud and abuse. Isolation, cognitive decline, and physical impairment are exploited by criminals who target seniors. Having financial documents in order helps protect seniors and their families from fiduciary abuse. Below are links to helpful information regarding fraud.

Consumer advisories: Preventing fraud

Beware of scams targeting older adults during the holidays Read the blog
Work with your bank or credit union to protect older adults from financial exploitation Read the blog
How to avoid becoming a victim of an asset recovery scam Read the blog
Planning for diminished capacity and illness Read the blog

Planning is Key

Obtaining access to your loved ones’ bills, financial accounts and assets must be done before the onset of cognitive impairment to avoid costly and painful court proceedings. Procedures for Court Appointed Guardianship differs from state to state so be sure to get specific information about the state that your loved one lives in.

One of our support group members found this excellent guide that addresses the financial documents that you may need to help your loved one. The Consumer Financial Protection Bureau guides are tailored to the needs of people in four different fiduciary roles, and there is a helpful video discussing different situations. These documents should be created before hiring caregivers. All financial documents, bills, and personal identification should be removed from the home if outside caregivers are engaged. Unfortunately, seniors may need to be protected from unsavory family members and these documents help protect their financial security.

Power of attorney

Guides for those who have been named in a power of attorney to make decisions about money and property for someone else.

Court-appointed guardians

Guides for those who have been appointed by a court to be guardians of property or conservators, giving them the duty and the power to make financial decisions on someone’s behalf.

Trustees

Guides for those who have been named as trustees under revocable living trusts.

Government fiduciaries

Guides for those who have been appointed by a government agency to manage another person's income benefits, such as Social Security or Veterans Affairs benefit checks.

 

Red Paper: Amsterdam in January

By Beth Massa

Soggy bits of red paper everywhere. Hardly distinguishable from the remnants of decaying leaves discarded by autumn’s trees and disregarded by Amsterdam’s street sweepers.

“What’s all this red paper all over the place?”

“Fireworks.”

“But why are there so, so, so, many firecrackers?”

“To banish all the bad spirits from Oud en Nieuw.”

Having visited many times, I moved to Amsterdam, intentionally for the rest of my life, on Jan. 6, 2007.

Upon arrival, I threw my suitcases into my temporary housing on the Korte Koningstraat and walked across the Nieuwmarkt over to ‘t Loosje, my regular bruin café, to meet up with my Amsterdam crew. They knew I was moving. They’d known for three years, since the first day we’d all met. So when I walked in for the first time not-from-out-of-town, it was no big thing. There were no cheers or applause or back-slapping hugs. Our gang celebrates in words, not in volume. We’re cool like that.

There was red paper stuck to the sides of my shoes that night. I scraped it off, tossed my shoes in the entryway, and went to bed, staring at the ceiling in disbelief that I had left my country for good. The fantasy was real, and it was for the first time — but only a brief time — terrifying.

_______________________

A year earlier almost to the day, I quit my job and rented an apartment on Da Costakade for three months during the worst time of year — dark, cold — just to make sure I really wanted to live in Amsterdam. I looked forward to taking weekend trips to Paris or to shoot down to Cologne to visit my best friend. But I hardly moved.

Burnout wasn’t a thing where I had worked. You’d stare at your Outlook calendar, which was triple booked with meetings across every hour, all day, every day. You found yourself shutting the door to your office because you could not face having to ask your exhausted and resentful staff to do just a little bit more. You found yourself “underperforming” and then your body would rebel and then you’d have some sort of sudden, dramatic departure. We didn’t know burnout. We only knew failure.

But in that apartment, I would wrap myself in a blanket and stare out the large windows watching the snow fall and melt on the canal outside. Sometimes I didn’t leave the house for several consecutive days. In those months I discovered what I needed from Amsterdam, at that time and in that condition, and it was actually the best time of year.

_____________________________

My 70-year-old mother has been traveling to Europe regularly since 1985. Three years ago, she retired and moved from Seattle to South Bend, Indiana to be closer to her oldest friends and much of our family. She moved to an adorable Tudor in a historic neighborhood across from a park and around the corner from the University of Notre Dame. Her friends and our family were thrilled to have her back, after 20 years being so far away out west. And I was excited, too. It would be so much easier to travel to see each other, and I would get to see our extended family more. But I could tell she was restless. Last June, I asked her, “What do you really want?”

She said, "I want to move to Amsterdam. I don't want to just visit anymore. I've dreamed of living in Europe ever since I was a girl leafing through my collection of Time-Life books. I’ve tried to make a life here. I love visiting with my friends. I’m volunteering. I’ve really tried. I even do Zumba! But I’m bored. I want to move now while I'm young and active enough to enjoy my life in Europe to the fullest.”

After we had a brief mother/daughter squabble (“Why didn’t you just say this in the first place!” “Well I was waiting to be invited.” “Please don’t be passive aggressive, I can’t read your mind.”), I told her to go for it. She sold the adorable Tudor, pared down her belongings, and five months after that conversation over weak coffee at a strip mall Starbucks, I picked up her and her Shih Tzu, Tullymore, from the airport and took them to their new home.

She’d seen the apartment on Funda and through Skype. My mother has this gift for finding treasures where no one else is looking. How she found this perfectly cozy nest of a place, suspiciously affordable, right on the Herengracht, dead center in the middle of the Negen Straatjes, can only be explained by a brief, magical, Harry-Potteresque window, opening for only her to see, and only for a moment. It had been on the website for weeks. This just doesn’t happen. But it did, and we aren’t asking questions.

I staged the moment I would open the door for her to her new home. I’d closed the curtains on the floor-to-ceiling windows, so I could grandly cast them open for that view to receive her. I installed a garish and exotic and ridiculously Alice-in-Wonderland oversized bouquet. She couldn’t speak. We had pulled it off.

What if the house doesn’t sell? It did. What if the movers don’t come in time? They showed up. And worst and most worrying of all, what if at the last minute the airline doesn’t let Tully on the plane? They hardly took notice of him. My mom, the worrier and the planner, could exhale. Deeply. Spiritually. Maybe for the first time in her life.

A few days later, we went to our favorite pizza place in town, which is right around the corner from her apartment, because everything is right around the corner from her apartment. As we hugged goodnight and started to part ways, I reflexively began to well up as I watched the back of her little body, huddled against the cold, walking away from me — just as she had done so many times in the past with a suitcase ka-chunk-ka-chunking behind her.

“This is weird! I want to cry because you are leaving! But I’ll see you tomorrow and the day after that!” She turned around and smiled at me, beaming. Happier than I can recall her ever being. “This isn’t weird, you’re weird,” she yelled back.

And so, she walked that night to her cozy apartment with the Cinerama view over the Herengracht. Her usual life, all her clothes, her dog, her housewares and picture frames, layered like vellum on top of her new life, is taking some getting used to. It seems unreal and it’s disorienting. But that is what I love about Amsterdam. The surrealism of the city never leaves, no matter what circumstances brought you here.

We’ve spent many hours these last weeks looking through her windows at the darkness pierced with a dozen soft spotlights — the theatre of Amsterdam streetlife performed on, in, and around a 400-year-old stage. Never changing, always changing.

The tall, reedy young man in a flat cap and suspenders with a strip of bow tie around his neck, unbowed, parking his car and hustling down the street. What’s he doing? He returns with a golden girl draped in a gold sequined flapper dress. They are going to a 1920s Christmas party. He opens her door for her, awkwardly. Ah! He almost forgot to open her door!

The residents in the apartments across the street. The generously proportioned older gentleman on the top floor flops his foot on the window sill to remove his dress shoes, then shuts the curtains, presumably while he disassembles the rest of his workday finery. The windows of the French cooking school steaming up from a crush of people more than the cooking — presumably there for an office party. The amber glow from the stained-glass windows of the luxury lingerie shop in the corner that gets almost no customers.

But mostly right now the rondvaart tour boats have us nearly hypnotized. A new one cruises by every 20 seconds. The people in the boats looking up, or sadly in too many cases, looking through a phone or iPad. Do we give them a show? We are each other’s scenery. We should pay them no mind. But we are new and giddy. Occasionally, I’ll stand at the window with Tully in my arms. When I hold him like a baby he relaxes so his head falls back over the crook of my elbow. The cameras go up. The people point or wave. The tour boats can roar to a stop. Powerful reverse thrusters hold the boats motionless. They stand so still so they can maneuverer impossibly through the narrow tunnels under the bridges.

Life in Amsterdam can be as mundane and routine as anywhere else. Jobs. Grocery stores. Traffic. Dentist appointments. But first and always first, Amsterdam is a playground you can jump in and out of whenever you like. We see it with a first-timer’s eyes all day as the tourists walk around in a fog of wonder.

Amsterdam is cool like that. It knows what it is, and what it has achieved. It has nothing to prove. And this Northern European city will awaken from its hibernation. Spring is coming. But for the next few months, my reunited family will roar to a stop. To watch. To relax. To recover. To wait. And to marvel.

‘Tis a Very Sexy Berry!

By Claire Fitzpatrick, D.C.

First, a disclaimer: I must inform you that nothing that follows should be construed to imply that this plant, nor its constituents, cures or prevents any disease. Also, this article is not a substitute for going to see your doctor for a proper diagnosis of your health concerns. Before you use any nutritional supplement or herbal remedy, see your physician to make certain it is safe for you to do so, particularly if you are pregnant, nursing, very old or very young.

Okay. With that out of the way…

Sea buckthorn (Dutch: duindoorn) has been on the berry landscape for thousands of years now, but only recently recognized as a veritable superberry in the last decade.

I heard of it five years ago because a hypnotherapist friend of mine spread a rumor about Omega-7 fatty acid (FA). The rumor was: If you are a woman suffering from dry vagina and subsequently painful sexcapades, that Omega-7 is the FA for you. This fatty acid, the rumor purported, is a handy-dandy natural lube manufacturing enhancer. In other words… well… it helps you get wet.

Being a doctor and a woman in the harrowing throes of perimenopause at the time, I was intrigued; so I did a bit of research on Omega-7. It turns out that the easiest, best way to obtain the benefits of Omega-7 is from the sea buckthorn plant. 

Sea buckthorn (Hippophae rhamnoides L.) is native to Europe and Asia’s high temperate zones, and it is very high in everything that makes a food a superfood.

There are documented benefits in more than 130 scientific studies worldwide on sea buckthorn oil. It turns out that the sea buckthorn is a very versatile superberry! In fact, it is one of the most nutrient-rich berries known to mankind. 

Apparently, it helps coordinate the reproductive system with the endocrine (hormonal) and nervous systems (resulting in a happy, lubricated vagina), and helps with menopausal changes. It is also useful in combating urinary tract infections, yeast infections, and related gynecological problems.

 

But wait… there’s more!

Sea buckthorn is said (by almost every other country except the United States) to diminish inflammation, is an antimicrobial, a pain reliever, and promoter of tissue regeneration. It is good for heart and vascular health and preventing cardiovascular disease. It balances cholesterol and lipid content in the blood and thus helps prevent fatty liver. It helps to increase appetite and stomach digestion, is great for skin health and acne, and is a powerful natural antioxidant, antibiotic, anti-fungal, and anti-inflammatory. 

It is a natural stool-softener and is used in Asia for gastrointestinal disease, autoimmune diseases, respiratory disease, and skin disease. It has anti-aging properties and is commonly used overseas to smooth wrinkles and discoloration of the skin. It is wonderful for balancing hormones and the nervous system. If you have cold hands and feet, sea buckthorn seems to be good for preventing chilblains. It also seems to be great for eye health. 

It has been used medicinally in China and Russia since 1977 to treat the adverse symptoms of chemotherapy and radiation; including oral mucositis, vaginal mucositis, cervical erosion, radiation damage, burns, scalds, duodenal ulcers, gastric ulcers, and skin ulcers caused by malnutrition. Additionally, the leaves and bark have been shown to have cancer-fighting properties.

Aside from the alleged encouragement of vaginal mucosa lubrication-producing qualities, clearing these health concerns would make you feel pretty sexy anyway… don’t you think?

This is a great food for all ages, as it contains more than 100 nutrients and extra-nutritional constituents that are normally in limited quantities in food, such as flavonoids, linolenic acid, glucosides, phenols, polyphenols, terpenes, and carotene.

The berry pulp and the seeds are rich in carbohydrates, proteins, amino acids, vitamins (very high in A, C and E), minerals (including trace minerals such as iron, copper, manganese, selenium), which all neutralize free-radicals (are anti-oxidants). 

They have lots of omega 3, 6, 7, and 9 fatty acids which make them a viable alternative to fish oil for vegetarians. However, like the other good vegetarian source of omegas — flax seed, the time between harvest and consumption is short. Unless prepared in a preservative matrix, the berries and seeds need to be flash-frozen, refrigerated, and their oils need to be consumed within two weeks of harvest. 

It does have a nice amount of Vitamin K per 100 gram serving: 110-230 mg in the seed oil and 54-59 mg in the pulp oil. Vitamin K – in particular, Vitamin K2-7 – is very important to help Vitamin D3 absorb properly.

A bit of trivia: A legend says the ancient Greeks found that sick horses that were “let out to pasture” surprisingly regained their health and vitality by eating this berry. They named the shrub Hippophae rhamnoides L., meaning “trees that make horses shine,” and consequently used sea buckthorn leaves as a constituent in the diet of racehorses. According to another legend, Pegasus used sea buckthorn leaves to help him fly. Additionally, it is called “the Holy Fruit of the Himalayas” in Tibet.

You can get these sea buckthorn goodies and many other fine supplements in your friendly neighborhood supplement shop. (Remember: in Dutch, the name is duindoorn.)

Happy lubricating! (Did I just say that?)

Home for the Holidays!

by Phyllis Larkin, Psy.D
Geriatric and Family Psychologist
XPATSIA.com

Scenes from a Rockwell painting rush to mind when we think about the holiday season: the family tableau, cookies baking, ”I’ll Be Home for Christmas” playing in the background…These idealized images, sounds and smells all give us a romanticized version of holidays full of bliss, joy, and harmony. In reality, “Home Alone” is closer to the truth for most families, who struggle to cope with a time of year that creates emotional, financial and travel expectations that are difficult, if not impossible, to meet. Now let’s throw in a parent who is in failing health or experiencing cognitive decline. No wonder some of us are filled with dread instead of hope at this time of year. Is it any wonder this is also the time of year when binge drinking increases, stress takes its toll on our bodies, and family discord spikes?

How to cope:

Prioritize your spending on things that will really create a sense of peace.

  1. Give the gift of time. Offer to take care of your aging loved one and give their primary caregiver a break. Taking mom or dad shopping for new clothes is a great way to show appreciation. Offer to do laundry, fill prescriptions, buy medication boxes and fill them (one month of meds is ideal), drive your loved one on errands, do the grocery shopping, make meals to freeze, install grab bars, put anti-slip mats under throw rugs to deter falls, find a handyman to help as things need to be done, etc….
  2. Don’t spend money you don’t have. The finances of living abroad can be staggering and adding airfare, presents, expensive food, hotels, dining out, and incidentals may be more than you or your family can manage.
  3. If you can afford it, offer to cover the co-pays for your loved one if they are living on a fixed income. This is a gift that will be remembered all year.

Tough talks:

  1. DO NOT have discussions about your loved one’s financial, physical, or cognitive status at family functions! This includes the kitchen or sidebar discussions. Your loved one will feel betrayed and so will the hostess. Keep it light! Save these talks for a private, dedicated time in a safe place.
  2. DO talk about your loved one’s needs and wants (see last month’s blog) in a calm and loving manner. This should take place after a meal, preferably at a time of day when they aren’t tired, and in a place THEY feel comfortable. Plant seeds. Don’t push or insist. “Mom, I live so far away and I need to know what you want. I want to be able to advocate for you if there was ever a time when you couldn’t advocate for yourself.” Then listen. Don’t judge. Don’t cajole. Don’t have an agenda. Ask: “Does Dr. Blank know what you want if you can’t speak for yourself?” More listening…
  3. Be honest about how hard these discussions are to have. “It makes me so sad that mom is having trouble remembering things. I don’t want her to get infirm and dependent, but she is. I can’t imagine how hard it is for you to see this every day.” “Becky, this is so hard on you. You handle all mom’s medical issues! How can I help out while I’m here? Would it help if I handle the insurance paperwork? I can do that from Amsterdam.” “John, can I go to Home Depot and buy the grab bars you want to install?”
  4. If you have siblings, you will want to discuss everyone's strengths, and how these can be used to help your loved one and the primary caregiver. “I can’t be on the ground in an emergency, but I can email, call and pay bills.” “John, you have been so good about helping keep mom’s house functioning. Do you need us to set up an account for these expenses?” “Becky, you have really shouldered the medical appointments and doctors' visits. Do you need help with mom’s insurance co-pays and banking?” “Becky, can I arrange my next visit around your vacation so you and Bill can get away?”
  5. NEVER keep secrets! Don’t band together against one member. Discussions should be open and honest. “John, I know your construction company is doing really well. Do you have the time to do all this stuff? Can we hire one of your workers to help out?” Sally has two kids in college and it’s expensive to hire outside help. Instead of asking for money, say, “Can you ask the kids to spend time with mom so Becky can have an afternoon off?” “Can Billy (Sally’s son) mow mom’s grass this summer? It would really save on yard expenses and she would love to see him when he’s home from school.” “Can Susan (Sally’s daughter) help mom with her marketing? The bags are getting heavy and they both love to shop.”
  6. Engage the next generation in help. This models intergenerational commitments and strengthens family ties. We all share the memory of mom bringing Billy a Coke while he’s mowing her lawn or Susan putting the groceries away while chatting with grandma. These moments last long after the expensive gifts are gone. Gifts of love and time are what we all want. These are the Rockwell moments!

Swooping:

This is a term given to those of us who live far away — we swoop in and then we leave. Often we can see things that those on the ground can’t. We then voice our concerns, tell people what to do or criticize how things are being done. Then we get on a plane and leave a wake of resentment behind. “My sister, who lives in Europe (eye roll) came in and told me how to manage my mother's care! Who does she think she is?” Criticism is never helpful and is never acted upon. Instead, follow this strategy:

  1. Open with a compliment. A real compliment. No sarcasm, no judgment. “Becky, you are doing a wonderful job with all mom’s medical appointments and insurance. Thank you.”
  2. Follow with a compassionate question. “How are you taking care of your arthritis when you’re so busy with mom? I’m concerned about your health. Taking care of mom is exhausting. How are you?” Listen — for a long time. No suggestions, no judgment.
  3. Offer practical help. “Can I order mom’s meds and have them delivered?” “Would it help if I called mom every day so you can have a break from the constant calls?” “Can I transfer money to mom’s account for the grab bars?”
  4. Be open to alternatives. “I need to keep track of the insurance. Could you arrange for her rides to the senior center online?” “Could you send $100/month for her co-pays instead?” “Can you set up a Skype account and show her how to use it?” “Can you set up her online banking and help her pay her bills?”
  5. Execute your commitment. It’s not help if it doesn’t get done. Instead, it leads to resentments and conflict. If you don’t execute the request, you are swooping.

Go bake those cookies, play some Bing Crosby and have a cup of tea with your loved one. Happy Holidays!

Pain can be a blessing


By Claire Fitzpatrick, D.C.

In my office, I see people with shoulder pain, knee pain, headaches, low back pain, and neck pain. What most of us don't realize is that if our bodies find it necessary to shunt resources to areas of pain, it means the body understands that there is an underlying health problem that needs attention. It also means that there are less available resources for our bodies to regenerate properly.

If there is chronic pain (pain that began over three months ago), that means there is flawed neural patterning that began months or years earlier, when something happened in our lives that we couldn’t properly integrate. Maybe it was abuse. Maybe it was a jolt from a bike accident. Maybe the cause is black mold in the walls that we would never think to look for. Maybe it is continuing sorrow, disappointment or the nagging realization that life is not turning out the way we think it should.

If we are lucky…

If we're lucky, our imbalances express themselves with pain and sometimes anxiety. This doesn't feel like a blessing, but pain and anxiety encourage us to find help to relieve our symptoms. With real luck, you find practitioners who want to find the root of the problem.

I happen to think chiropractic is crucial in this process. Chiropractic helps us repattern our bodies and minds so that our bodies AND our minds are more flexible, more adaptable, more able to heal properly. But it often takes a team of dedicated integrative health professionals to help one person with multiple chronic health issues.

It’s easy to find physicians who will provide a quick fix to deaden pain. But a lack of symptoms does not equal good health. If I take painkillers and they deaden the pain, the pain may disappear, but the problem remains. It also means that my body has to deal with a foreign substance that, by definition, interferes with the nervous system’s ability to keep clear the lines of communication between brain and body.

I understand that, sometimes, we need to deaden pain temporarily in order to get through a situation. But many of us rely on painkillers to get through life. And that is not a workable strategy in the long run.

Pain is a cry for help.

Pain is a sign that our neural systems are not firing properly, that there is an improper feed in our bodies due to a buildup of stress. That stress could be chemical, physical, environmental, emotional and spiritual, or a combination of all.

But sometimes healing hurts.

Many times, we think that if our pain goes away, we are healed, and that the goal of our chiropractic care is to go back to our desperate lives, pain-free at least. Sometimes we find something else. Sometimes we hurt more during the process of healing.

Awareness brings consequences. As we heal and as our brains reconnect with our bodies, we can sometimes become aware that there is a bigger problem than the pain.

Awareness also brings us choices.

We now have a chance to face life full on, with awareness of the good, the bad, the ugly and the beautiful. Many of us cannot stomach this awareness right away, and we blame everyone and everything else for the way we respond to others in our environment. We must be patient with ourselves and others during this healing process.

While we must ultimately take responsibility for our choices, when we are subluxated (i.e., in a state of less light, less awareness, inflexibility, inadaptability, holding nerve system interference), we often cannot make the right choices right away. While we are subluxated, our ability to access our full capacity is still limited.

We must be gentle with ourselves while healing.

We mustn’t be hard on ourselves during the healing process, just as we mustn’t be unduly harsh to others during this time.

It’s when we are “painless” — we are disconnected from our bodies, minds and spirits, yet have a sense of dis-ease and dissatisfaction with our lives — that is when we are often the most dangerous to ourselves and those around us.

Pain as a blessing.

We who have pain symptoms at least have the blessings of some level of awareness. There is a chance of reorganizing our patterning. It also gives us the chance to grow in ways that we would never have been aware of without the pain.

We need inner connection desperately. That is what true health is. That is what chiropractic, and other forms of natural health care, offer us.

The Importance of Tune-ups for Good Health

by Claire Fitzpatrick, D.C.

I recently received a wonderful email from a patient of mine. For years, he experienced debilitating back pain. He was often bedridden for two weeks at a time. When he first came to see me, he was suffering from such a flair-up. After three weeks of chiropractic care, his crippling spasms ceased.

Still, he had some pain. During the visit that preceded the email, I had helped him release a very common, recurrent subluxation pattern I see in many patients on the road to recovery. He released it nicely.

Health is a process.

He emailed me afterward to thank me, to say that he noticed a huge change in his yoga practice that day, and that felt particularly healthy and clear. While this was a great report, and I was happy to read it, I knew that it just as easily could have been a report of increased discomfort.

That’s the way of things during the healing process. There is no straight line to perfection. One day is up, one day could be down.

But he will be all right because he is willing to weather his highs and lows. He is “all in” for the long road to personal excellence.

Health is a commitment.

He has a vision of himself free of shocking, debilitating pain, but that’s not all. He has decided that 43 is too young to self-identify as an “old man.” He has seen his father, his mother, his brothers, and his friends get old before their time. He has decided he would not follow them.

At the advice of a friend, he took a chance on chiropractic and me. More importantly, he has taken a chance on himself.

Don’t ignore the engine light.

Once a month, I hold an informational gathering for integrative health professionals. During one of these meetups, a doc made an observation: his patients take better care of their cars than they do themselves.

“What if you only took your car to get serviced when it couldn’t function anymore? Where would you be if you didn’t listen to the little changes — the noises, the lag in pick-up — and didn’t keep it tuned up?”

Many of us do that. We ignore the service light on the dashboard, we hear the knocks and rumblings, but we keep driving until we find ourselves on the side of the road in a cloud of steam and self-flagellation because we knew we should have had the car serviced long before.

But often, we are even more guilty when it comes to our bodies. We count on the fact that our bodies are self-healing mechanisms — and they are. But when the body fails to self-heal, when the nagging pain just doesn’t go away, when we push on and through appointments, commitments, and ideas that the world will collapse if we don’t show up, what keeps us from seeking help?

Why do we treat our bodies worse than the way we treat our cars?

And, who travels the bumpy road of life with you? Who helps you spot the potholes and sharp turns? Who is in the trenches with you, flagging you to the side of the road for a tune up, optimizing your engine so you can speed easily through this crazy race called life at top performance?

These are questions worth considering.

Chiropractic, true health, and you

True health is expressed when our bodies and minds are resilient, flexible, and able to adapt to the ongoing, stresses in our personal inner and outer worlds. That’s what chiropractic is all about.

It is not medicine. You don’t swallow chiropractic.

Chiropractic doesn’t bargain with you. It doesn’t ask you to take a chance with your health, your life, your mental stability, and your family’s stability so that you can deaden your pain. That is why you won’t be “fixed” by one, or two, eight, or ten thousand visits. You won’t be fixed because you aren’t broken.

You are a brilliant, living, breathing being who is changing and adapting to life and living as best as you can. You just need help, like we all need help. Chiropractic offers helping hands.

Chiropractic cannot promise an outcome, but it does promise to do everything it can to help your body reach its optimal potential so that you can have the optimal outcome that is right for you. Chiropractic is here for you.

Chiropractic asks you to have faith in yourself and your ability to heal, to adapt, to grow, to thrive, and to be whoever you want to be. It helps guide your body to help guide you there.

Chiropractic insists on being a good friend, even when you don’t want to hear what it has to say. When you lose faith in yourself and you think chiropractic doesn’t work, chiropractic has faith in you. And, when you’re ready to try again, chiropractic will try with you.

Each adjustment builds healing momentum.

The quickness, power, and longevity of your personal momentum are beyond a chiropractor’s control. Two people may show up with the same symptoms, but they don’t show up with the same past, the same present, nor the same future.

That said, each chiropractic adjustment builds on the last, like exercise, like eating right, like meditating. Each adjustment builds that healing momentum. When you build that momentum in your nervous system, that is when personal miracles happen.

I, as one chiropractor, am honored to be part of your journey. It’s what makes me happy, to see you blossom into the best you that you can be.

In any and all cases, I wish for you a healthy life full of love, peace, and joy.

 

Going Dutch for Thanksgiving

by Beth van Amerongen

What does Thanksgiving have to do with “Going Dutch”? Well, a lot, actually.

If you are an expat living in the Netherlands and will eventually end up in the U.S., you are following in the footsteps of many of the pilgrims. In a nutshell, an English religious group, which was somewhat rebellious, escaped to the Netherlands for its religious tolerance. They first settled in Amsterdam in 1608, where they founded and worshipped at the English Reform Church in the Begijnhof. After a year, the Amsterdam labor guilds proved too restrictive for them, so they moved to Leiden and settled in the vicinity of the Pieterskerk. Assimilating into their new lives didn’t come easily for everyone, including adapting to the more liberal Dutch morals, so in the fall of 1620, roughly three dozen of these expats sailed on the Mayflower to Plymouth Colony.

It is even hypothesized that the first Thanksgiving meal was influenced by the Relief of Leiden, a holiday held on October 3rd that's celebrated with a thanksgiving service followed by a meal. You can read more about the Dutch pilgrims in these articles:

The American Book Center has a multitude of resources available for making your Thanksgiving special, including cookbooks and children’s activity books. Visit the ABC website, type “Thanksgiving” and it will yield over 3,600 results! Don’t forget to show your AWCA membership card when you visit them for a 10% discount.

From fresh cranberries and pumpkin available at local supermarkets to restaurants and butchers creating authentic Thanksgiving meals, options abound in Amsterdam and its surrounds. Whether you want to cook an entire meal from scratch, order a catered meal from a butcher, eat at a restaurant, enjoy a pre-Thanksgiving dinner with a Dutch twist, eat pies in Haarlem or attend an Interfaith Service in Leiden where it all began, there is something for everyone here in the land where the pilgrims once dwelled.

Interfaith Worship Service

Thursday, Nov. 22, 11 a.m.: Non-denominational Thanksgiving Day Service in the church where the pilgrims worshipped: the Pieterskerk in Leiden.

AWCA Events

All AWCA members, partners, and families are welcome to these area events, but space is limited, so be sure to RSVP.

Restaurants with Thanksgiving Meals

Wyer's Restaurant at the Kimpton De Witt Hotel: Nov. 22 (see Thanksgiving dinner in Amsterdam, above)

Seasons Restaurant: Nov. 21-23, 3- and 4-course Thanksgiving dinners

Cafe Belcampo at De Hallen: Nov.22, sponsored by the American Book Center

Butchers and Grocery Stores

Ten Reasons to See “Hamilton” in London

by Danielle Tomich with Suzanne Vine

(Just for fun, I've included song lyrics in italics, followed by a link to listen to the song. Just a few listens, and you’ll likely be enticed to make your travel plans to London.)

 

You might be hoping "Hamilton" is all hype so you can save yourself a lot of time and money. Well, I’ve got bad news for you. It’s the real “duel.”

“I’m about to change your life.” (Helpless)

 

In the musical’s opening, the cast asks about Hamilton, “How does a bastard, orphan, son of a whore and a Scotsman, dropped in the middle of a forgotten spot in the Caribbean by Providence, impoverished, in squalor grow up to be a hero and a scholar?” (Alexander Hamilton) One might ask the same about the show’s creator, Lin Manuel Miranda: how does the son of Puerto Rican immigrant get celebrated by the White House, win a Tony for best musical, win the Pulitzer Prize for Drama and create a box-office phenomenon that’s slated to play on Broadway and London’s West End indefinitely? Immigrants: We get the job done.” (Yorktown (The World Turned Upside Down))

Only in America. Indeed, "Hamilton" is purely American, from the racial diversity of its cast to the music: hip-hop, rap, R&B, and soul. “We need a revolutionary language to describe a revolution,” Miranda said of his choice for musical genres. But there is truly something for every musical taste, including musical theater and classical and opera references.

You may remember from your history lessons that Hamilton — whose mug graces the 10-dollar bill — was killed in a duel. In "Hamilton," the number ten (Ten Duel Commandments) figures prominently.

In that spirit, here are ten reasons for those (especially Americans) who live in Amsterdam — or anywhere in Europe — to see "Hamilton" in London. It’s a splurge for many of us, but oh, what a splurge.

 

 

Number 1: It's"Awesome! Wow!” (What Comes Next?) In the above video, the man in the screen-in-screen is "Hamilton" creator Lin Manuel Miranda commenting about the show on opening night in London. 

 

 

Number 2: What a great excuse to go to London (as if you need one). “Look around! Look around!” (That Would Be Enough)

 

 

Number 3: If it’s good enough for Harry and Meghan, it’s good enough for you and me. The royal couple saw the show on August 29 of this year. Prince Harry is a direct descendant of King George III, his sixth-great-grandfather. To the delight of the audience, and with no shortage of irony, the Prince sang the first two words to a song sung by his on-stage ancestor: “You say the price of my love's not a price that you're willing to pay. You cry in your tea which you hurl in the sea when you see me go by. Why so sad? Remember we made an arrangement when you went away. Now you're making me mad. Remember despite our estrangement, I'm your man.” (You’ll Be Back)

 

 

photo: Fortnum & Mason

Number 4: “Why should a tiny island across the sea regulate the price of tea?” (Farmer Refuted) If seeing King George on stage puts you in the mood for a proper cup of tea, there is no shortage of tea parlors in London. It’s true that the tea in Great Britain is better than in America. I’ve heard it said that the Britons send the tea swept from the floor to the U.S. Perhaps they are still upset over the spilled tea? At any rate, choose any of these tea rooms and treat yourself to a delightfully British tradition.

 

 

Number 5: For an American, there’s something delicious about seeing "Hamilton" in the land of King George. Hamilton was, of course, instrumental in the defeat of the British Army in the American Revolution and establishing a country that would eventually surpass England as a world power.

I heard a lot of American accents in the theater the night we went, and it made me curious how popular the play is with British people. There certainly were a lot of laughs when we heard the King sing, You’ll be back. Time will tell. You’ll remember that I served you well. Oceans rise. Empires fall. We have seen each other through it all. And when push comes to shove, I will send a fully armed battalion to remind you of my love." (You’ll Be Back)

I later came across the above news entertainment segment about how a London audience would react to "Hamilton." It includes part of an interview with the stars of the British cast, above. They weren't too keen on the interviewer referring to the British as the losers.

 

 

Number 6: The recently renovated Victoria Palace Theater is a beautiful place to be “in the room where it happens.” (The Room Where it Happens)

 

 

Number 7: It couldn’t be easier to get there. When you pop up from the tube at Victoria, the theatre is just a few steps away. No parking hassles or fees, no long confusing walks. “Meet me inside.” (Meet Me Inside)

 

 

Number 8: You’ll save a bundle on tickets, compared to what you’d pay in New York. We got great seats in the orchestra section for £100. (In today's exchange rates, that's $128 or €112.) Official ticket prices range from £32.50 to £200. They only take British money, so sing a song of sixpence.” (Stay Alive)

 

 

Number 9: You can actually get tickets. At only three weeks before the show, we were able to get tickets to a matinee. “How can you say no to this?” (Say No To This)

There’s a ticket lottery, too. “I’m ‘a give it a chance.” (Satisfied)

 

Let's face it, we could all use a few extra Hamiltons in our pockets.

Number 10: Tickets are exchangeable and even refundable. “What the hell is the catch?” (Satisfied) The first time I searched, about three weeks before our trip, I could only find matinee tickets. I bought one for myself but would have rather purchased two evening tickets so I could go with my husband, who was working during the day. The website said that exchanges were possible starting 10 days before each performance, so at that time I got on the website and found two evening seats together, which I purchased. To my amazement, I was actually able to get a refund on my matinee ticket! (Hint: when you’re in the Ticketmaster website and want a refund, click on “Hamilton” in the drop-down menu that asks the reason for your request. That takes you to a special section where Ticketmaster treats people like human beings. Thanks, Hamilton. “At least he was honest with our money!” (The Reynolds Pamphlet

 

Hopefully, by now you’re thinking, Then, by all means, lead the way.” (Helpless). Still not convinced? In the words of Hamilton, “I will never understand you.” (Story of Tonight (Reprise))

"Your Obedient Servants," (Your Obedient Servant)

D dot Tom & S dot Vine

Thanksgiving Dinner in Amsterdam

Is Thanksgiving Fake News?

by Rhonda Jimenez

Before we start making our shopping list for the XL Albert Heijn to find canned pumpkin and frozen turkey, let’s take a moment to take a closer look at our beloved holiday and its origins.

Did the first Thanksgiving happen in Plymouth Colony, Massachusetts?

Actually, the first Thanksgiving in America occurred in 1541. Francisco Vasquez de Coronado and his expedition held a celebration of thanks in Palo Duro Canyon in the Texas panhandle. Many cultures during that time celebrated the harvest with a community meal including Europeans and Native Americans.

Weren't the Pilgrims strict religious Puritans who came to the colonies to escape persecution from England?

Technically, they came from Leiden, the Netherlands. When the eventual colonists first wanted to leave the Church of England, the Dutch took them in. Back then, in England, you could be fined for attending unofficial, non-state churches. The leaders found that Amsterdam had a tolerance for their religion and provided a great opportunity for business. They later moved to the city of Leiden to take factory jobs that didn’t require knowledge of Dutch. After about 15 years, the settlers became concerned that their children were becoming too secular and feared the congregation would soon give in to the sinful vices of the Dutch. Plans to move to the New England area of the U.S. were made.

What about the Native Americans?

According to Ramona Peters, the Mashpee Wampanoag tribe’s tribal historic preservation officer, it didn’t happen the way Americans have traditionally been taught (fake news back in the 1800s?). There was a treaty made between the natives and pilgrims and there was a meal to celebrate that treaty. The natives, ravaged by disease, needed to make an alliance as much as the newcomers needed their help to live off the land. It was more business and survival than unity and peace. It was President Abraham Lincoln who declared the first official Thanksgiving during the Civil War. He “made up the story about a feast between opposing sides joined in unity and celebration of the harvest,” said Peters. Lincoln wanted to sew a separated country back together, and created a story to inspire that spirit of unity.

But there was turkey, right?

Another well-believed misconception. Most experts believe fowl, ducks, and deer were consumed, but not turkey. Much of the traditional food found on today’s Thanksgiving table originated from the cuisine of the 1800s when the holiday began to take hold.

What Documents to Include in a “Medical Grab Bag”

by Phyllis Larkin, Psy.D
Geriatric and Family Psychologist
XPATSIA.com

Last month we discussed ways to deal with a medical crisis from abroad. This month I will delve into the legal documents that should be established and/or reviewed to make caring from abroad easier on you and your loved one. This month we will focus on “Medical Grab Bag” documents. (Next month: financial documents.)

With an ill or aging loved one in your life, you will need a “Medical Grab Bag” that contains all the documents your loved one and their doctors will need to respond to medical needs and wishes for emergencies and end-of-life care. Each bag (or envelope) should have the completed documents. The Medical Grab Bags should be in the car, the home, and with loved ones when traveling.

Medical Grab Bag Documents:

  1. HIPAA Release forms for each doctor
  2. Medicare Card
  3. Supplemental Medicare Insurance Card
  4. Medication List with Provider and pharmacy contact information
  5. POLST
  6. DNR
  7. Durable Power of Attorney
  8. Living Will/Advanced Directive

You may feel overwhelmed at the list, however, your loved ones’ doctors are familiar with all these documents. We'll review a few of them here.

I suggest you let your loved one know you want to be their advocate in the case of accident, injury or illness, and that you need to know their wishes in order to advocate for them. By having this tough conversation, you can serve them as they have served you. (We have been discussing how to approach this topic in the Caring from Abroad Support Group. Come and join us!)

HIPAA Release Form (Medical information release)

The Health Insurance Portability and Accountability Act, also known as HIPAA, was created in 1996 by the U.S. Congress to protect the privacy of your health information. The act prohibits your health care providers from releasing your healthcare information unless you have provided them with a HIPAA release form. Unless you have provided a signed release form, health care providers are prohibited from discussing any aspect of your medical information with anyone who is not directly involved in your care. A HIPAA Release does not give you the authority to make medical decisions. You will need POLST, Medical Power of Attorney, or DNR.

A HIPAA Medical release form allows whomever on the release to talk to the physician. It’s wise to have a release form for each physician, insurance carrier, and financial obligations. The identified person will have full access to both medical and financial information so that they can speak and write to health care providers and billing personnel. This form does not give you power for medical decisions.

      • General practitioner or gerontologist
      • Any specialists involved in your loved one's care
      • Insurance companies
      • Hospitals/institutions/medical centers
      • Assisted living
      • Pharmacy (local and mail order)

What is a POLST form?

POLST stands for Physician Orders for Life-Sustaining Treatment. It’s a one-page form, usually on bright pink paper, that specifies the end-of-life treatments that someone does or doesn’t want. Copies are valid.

Why a POLST?
If your loved one stops breathing or their heart stops beating, EMTs and hospitals must follow the instructions on a POLST because it’s a medical order signed by a doctor. It’s legally recognized in many, but not all, U.S. states.

A POLST is usually recommended for terminally ill or very frail seniors who have made their end-of-life wishes clear.

Where to post your POLST?
A POLST is only honored if people know it exists. Make sure doctors, hospitals, and assisted living communities have the form on file and/or post it prominently in your senior’s room. Print copies on neon colored paper for your Medical Grab Bag and for family members.

At home, it is wise to have multiple copies:

  • On the fridge and/or bedside table for EMTs 
  • Glove compartment Medical Grab Bag (Medicare cards, Medicare supplemental Cards, Physicians’ names and contact info, family contact info, Advance Directive, POLST, Living Will)
  • All family members who may interact with medical personnel or EMTs

What is a DNR?

DNR stands for Do Not Resuscitate, and it is also a signed medical order written by a doctor. It tells health care providers and emergency medical personnel not to do CPR on your loved one if they stop breathing or if their heart stops beating.

The DNR is only a decision about CPR (cardiopulmonary resuscitation). It does not affect any other treatments, such as pain medicine, other medicines, or nutrition.

For doctor’s orders about other end-of-life treatments, your loved one may want a POLST instead.

POLST vs. DNR: The most important difference
The primary difference between POLST and DNR is that a POLST covers a variety of end-of-life treatments. A DNR only gives instructions about CPR. (DNR=CPR)

With a POLST, seniors can specify:

  • If they do or don’t want CPR
  • What type of life-prolonging medical interventions they’d want on top of comfort care, if any
  • Under what circumstances they would want to be moved to a hospital
  • If they would want a feeding tube, and if so, for how long

With only a DNR, during an emergency, decisions about other interventions or treatments beyond CPR would be left to EMTs or hospitals.

Why do seniors need a POLST or a DNR?
Without a DNR or POLST, hospitals and EMTs are required to do their best to resuscitate someone who is not breathing or doesn’t have a heartbeat. They cannot stop these efforts without a signed medical order.

How to get a POLST or DNR
After talking with your loved one, discuss their end-of-life preferences with their doctor. The doctor should have access to the appropriate forms for your senior’s state and must sign the official form. They can also make sure the form is filled out accurately and completely so it won’t be rejected during an emergency.

It’s essential to use a form that’s legally recognized in your loved one’s state. No matter which forms are legally recognized, it’s important to discuss end-of-life preferences with their doctor. They can advise you on how to ensure those wishes will be carried out.

How a living will and POLST work together
To make sure your loved one's wishes will be honored in any situation, they should have both a living will and POLST. Keep them in your Medical Grab Bag so you can show them to doctors, hospital staff, and EMTs.

POLST vs. living will

POLST Living Will
Age requirement For any age For age 18 and older
Who can use it? Only those who are seriously ill or frail Anyone regardless of current health
How is it used? To direct immediate medical treatment To direct future decisions about medical treatments
Tells EMTs & hospitals what medical treatments can be used in an emergency YES NO
Guides patient treatment when staying in a facility or hospital YES YES
Appoints someone to make health care decisions on your behalf NO YES

 

Durable Power of Attorney for Healthcare
A medical power of attorney (also known as a health care power of attorney or durable power of attorney for health care) is a legal document that authorizes someone you trust (called an agent, attorney-in-fact, or surrogate) to make medical decisions on your behalf. The agent only has this authority if it is determined by your doctor that you are incapable of making such decisions, or you are unable to communicate your wishes, if you’re in a coma, for example. -Edward A. Haman, Esq., October 2015

Advanced Directive
An advanced directive expresses your wishes regarding medical treatment in very specific situations. It is more limited than a health care power of attorney. A living will does not appoint anyone to make decisions for you, and only applies if you are in a terminal condition, or in a permanent unconscious condition. A few states also permit a living will to be effective when “the burdens of treatment outweigh the expected benefits.” Therefore, if you are temporarily incapacitated but are expected to recover from an illness or injury, a living will does not come into play and does not allow someone to make treatment decisions for you. Only a medical power of attorney would help in this situation.

A living will and a medical power of attorney may be incorporated into a single document or can be separate documents. -Edward A. Haman, Esq., October 2015

How a living will or advanced directive works
A living will / advanced directive is a legal document that contains your loved one's end-of-life preferences. When decisions need to be made about future treatments, a living will guides the health care agent to make choices that honor their wishes.

Because a living will isn’t a medical order, it can’t tell EMTs and hospitals what to do. Even if resuscitation or other end-of-life choices are specified, they can’t be honored. Standard emergency medical protocols must be followed unless a doctor’s orders say otherwise.

Living wills are more useful in non-emergency situations like when someone is in a hospital or skilled nursing facility.

What’s the difference between a Durable Power of Attorney for Healthcare and an Advance Directive?

Here is a quick comparison between the Durable Power of Attorney for Health and the Advance Directive:

 Medical Power of Attorney Advanced Directive
Must be created by an Attorney Yes No
Allows you to clearly state your health care wishes No Yes
Requires Notarized Signatures Yes No
Considered a Legal Document Yes Yes

 

A Farewell to Summer and Son

by Danielle Tomich

“Mama, hold ‘mine’ hand.” (We never did figure out where he got that “mine” instead of “my”— maybe it was a foreshadowing of our feeble attempts to speak Dutch.) But as a child, our son Nick asked this often, and I was always happy to hold his soft, dimpled hand. Now 21 and over six feet tall, he takes my hand in his big one as we sit in the backseat of an Uber, speeding to the airport. I try to remember the last time he wanted to hold my hand, and the tears flow even faster. Now we both need a hand to hold. Neither of us wants to say goodbye.

Nick is returning to the U.S. to start his senior year in college. He just spent his fourth — and final — summer with us in Amsterdam. This goodbye is especially painful because it’s the end of several eras, none of which we want to end: the last of his carefree student summers, our last summer in Europe, and indeed the last months of our time living here. I don’t want to say goodbye to any of this, and especially not to him.

Time insists on marching on, but today I wished for it to freeze — like I have so many times before. Every goodbye, every transition with our children has been heart-wrenching for me. Luckily for us, and in spite of my reluctance to let go, each new era has been as good (or better) than the last. But I cannot bank on that. I know that there are no guarantees in life. It’s scary and sad to let go of this very happy time in our lives.

I am grieving the loss of our son’s everyday presence and the end of his childhood. And yet I look to the future with hope. I miss that little boy, but I love the young man he is now. I even get to hold his hand now, it seems, on very special occasions. I will miss those sweet, slow summers with him (and our daughter, too), but I am excited for him to start his adult life. I look forward to seeing what our new experiences together will be.

Shakespeare said it best: Parting is such sweet sorrow. The memories we made this summer make it hard to say goodbye, but the sweetness we shared is worth the sorrow I feel now. Bittersweet.

My favorite memories don’t involve the museums, churches, or vistas that we’ve seen together. The best memories are of times at home in Amsterdam. Hanging out on our rooftop, listening to music for hours, challenging each other to “name that tune” and talking about the memories the music brings up. Making dinner together, Nick teaching us as much as we taught him. Walking along the endless canals, talking about nothing in particular, trying to absorb it all. Enjoying his pleasure in living in this beautiful, historical place. Mostly, I remember the easy feeling of being with him.

That’s what I need to remember now: that I love being with him no matter where we are and no matter what our circumstances. The eras will change, but we will essentially be the same people. When we meet again for Christmas in Seattle, after we move to Boston, and wherever any of us go after that, we will still be the same family.

And, as my friends ahead of me in the parenting journey have intimated, he may be back under our roof sooner than I expect. That, too, will be bittersweet. For now, I continue to search for — and savor — the sweet and tolerate the sorrow. I know Nick and I will always be close, and that’s the sweetest taste of all.

Even so, I could use a bit of dark chocolate about now. And a hand to hold.

Best Burgers in the ‘Dam

by Rhonda Jimenez

Photo by Haseeb Jamil on Unsplash

Craving the comforts of home? A juicy Black Angus burger? Read on, meat lovers. You don’t have to wait until you’re Stateside to enjoy a tasty burger. American burgers in Amsterdam may sound like a contradiction, but there are some tasty burger joints in the 'Dam. Here is a collection of some of the best burgers.

Best Basic Burger: The Butcher, Nine Streets, Foodhallen, and Albert Cuypstraat
The Butcher offers basic burgers without fancy toppings (no truffle mayo here). There are two locations: a fancy eatery located in the chic W hotel and the original on Albert Cuypstraat (this location has a secret backdoor into the speakeasy late night but you need to be on the list).

Best Burger with a View: Ellis, Prinsengracht, Gravenstraat, and Singel
Dine on the canal’s edge and choose from veggie, chicken, lamb and fish burgers.

Best Build Your Own Burger: Burger Bar, De Pijp, Kolksteeg, Regulierbreestraat, and Warmoesstraat
Choose the meat, fixings, and bun for a custom burger.

Most Fattening Burger: Burgerfabriek, Regulierbreestraat, Warmoesstraat and Nieuwendijk
Try the wagyu and foie gras.

Best Vegan Burger: Vegan Junk Food Bar, De Pijp or Oud West
Try the kapsaloon (loaded fries).

Best Fast Food Burger: Five Guys Burgers, various locations
This one doesn’t technically make the list, but Five Guys Burgers now have locations in Almere and Utrecht (along with several others in the Netherlands). My son and friends often hop the train from Amsterdam Centraal to Utrecht for a fix. It’s conveniently located right in the Utrecht Centraal station.

Eet smakelijk!

The Call

by Phyllis Larkin, Psy.D
Geriatric and Family Psychologist
XPATSIA.com

 

You’re going about your life, and then the call or text comes: Mom or Dad is in the hospital and you have to make decisions quickly.

Here is some practical advice that will help you determine what to do and when to do it.

Don’t rush to the airport yet. Give yourself time to gather information and digest the information you receive. Don’t expect logical thinking from yourself or others until the full scope of the situation is known. If you rush in and start making decisions, other family members may feel “swooped-in-on” and resentful: “Sure, now you come home from your glamorous European life. I have been here dealing with the day-to-day grind…..”

Assess the situation. Get as much medical information as possible to find out what your loved one’s status is: physically, cognitively, and emotionally. Are they in ICU, CCU, post-op? If you are not physically present, medical professionals won’t be able to speak with you without your loved one’s permission, usually in writing. Physicians are very busy and may not be available in your time zone. Contacting the hospital social worker can be very helpful. The social worker can be an advocate for your loved one and help you get the information you need. After the initial crisis, you will need to know your loved one's ability to perform Activities of Daily Living (ADLs) after discharge. (Examples of ADLs are cooking, eating, meds, bathing, dressing, shopping, bill-paying etc.) This will help you determine what type of care your loved one will need after their hospital stay and how long you may need to be available.

Figure out where you fit in. Identify your area of expertise. Finances? Running the household? Hands-on caregiving? Care coordination? Consider the possibility that you may be of more help in sending money, coordinating care, or paying bills online, etc. If you decide to go home, it may be better to wait and help out after Mom is released from skilled nursing and needs someone at home with her. This will give you a chance to get time off, coordinate schedules and be more effective on the ground once you’re stateside.

Ask for help. Hire or call in favors for areas that you can’t fulfill. “I can pay the bills online. Can Sally talk to the doctors?” “I can call/Skype every day at 8 a.m. to make sure Mom is taking her meds and out of bed. Can you check on her weekly?” “Can Dad’s neighbor across the street stop by and pick up the mail? Can she let me know if Dad is lonely, in pain, or needs anything?"

Critical information. Keep all data on a thumb drive or a secure cloud account so that it is easily accessible from anywhere. An old smartphone without internet access can be a great place to store passwords and financial data. Critical information includes doctors' contact information, hospital contact information, Medicare and SSI information, financial and legal documents, POLST (Physicians Orders for Life-Sustaining Treatment), Advanced Directives, medical files, friends and family contact information, banking information, and monthly bills.

Once you have the information, talk with a trusted friend or family member and discuss your options. Be honest about what you can and can’t do.

A ticket for the next plane out may not be the best solution. A flight the next day or even the next week might be better.

 

A Foodie’s Favorite Restaurants in Amsterdam

By Lauren Mescon

How can I possibly share all the great food experiences I’ve had in Amsterdam? My head almost exploded at the task …so many places, so little time!

Here are a few of our favorites, loosely grouped by food type. From Michelin-starred restaurants to holes in the wall, this town offers it all.

High-end, expensive restaurants

— For a once-in-a-lifetime experience, go to De Librije in Zwolle. It is the only 3-star Michelin restaurant in the Netherlands. After a drink at the bar, the fun begins when you’re escorted to your table. Each of the courses is more creative than the previous. The first was a shell containing caviar held by a black rubber glove that had been filled with water and frozen. One of the desserts was coffee that was also served on an ice pack. The monkfish course was the best I have ever tasted, and I am not a monkfish fan. (They had no problem with food restrictions, either.) Our five-hour meal was part food, part art, and part theatre. Our wine pairings even included a Dutch wine (not great though, aroma of asparagus!). You can also sign up for the Saturday overnight package and spend the night in the hotel, which was formerly a women’s prison. You will be greeted at reception with gin and tonics, then you can check into your room and tour the town. It is a typical Dutch town and has a fantastic museum, Museum de Fundatie. The next morning, a multi-course breakfast is again a creative assault of the senses. Do not plan to leave early!

— To celebrate our first “Amsterdammiversary,” we went to Restaurant Vinkeles at The Dylan Hotel. It's a 1-star Michelin, and it’s absolutely lovely. I ordered Dover Sole. It was perfect, and I think the best I have had to this day. Several amuse-bouches added to the experience, and the sommelier suggested an outstanding rosé. Although it was 3½ years ago, the review I wrote on Trip Advisor still gets the most likes of any of my reviews, so I’m guessing it's still fabulous!

— Moon is a revolving restaurant at the A’Dam Toren, just a ferry ride across the Ij. The view is the best 360 in the city, with amazing sunsets. The chef’s tasting menu changes often, so check it out. We took our son and daughter-in-law when they visited — they are the real foodies. (We're faux foodies; we eat too fast and don’t savor.) This is a special occasion restaurant, so if you ever want to "fly someone to the moon," take them there. (If you are adventurous, get on the tallest swing in Europe on the top of the tower. The ride lasts only a minute, albeit a long one, but it’s so much fun. Just make sure you wait to get your drinks until afterward.)

—  John Dory on Prinsengracht is the best upscale fish restaurant, in my opinion. All of the fish is Dutch-sourced and changes daily. What makes it so unique is that you order a certain number of courses, and that’s it. They take care of the rest. I just learned they also have vegetarian and meat options as well. Try to reserve on the early side so you'll have a better chance of sitting by the big window overlooking the canal.

A Taste of Dutch

— Restaurant d’Vijff Vlieghen, (the Five Flies) on Spui is a beautiful old restaurant. It's a dark maze of dining rooms set in canal houses from the 1600s: you could dine beneath a Rembrandt etching. The dishes are tasty classic Dutch. Make sure to check the brass plate on your chair to see what famous person sat there before you! This is a great place to go for a romantic dinner, but also to take guests that want a nice white tablecloth dinner. It's like dining in a museum, plus the food and wine list are both very good.

— Our go-to for everyone that comes into town is Restaurant Haesje Claes, also located on Spui. It is truly Dutch food, with a seasonal menu. The starters include all of the Dutch staples: herring, mackerel and croquettes, and the mains include hutspot (a.k.a. stamppot), beef, cod, and mussels. If you are a vegetarian, try the vegetarian stamppot – it's delicious and you'll be stuffed! The restaurant is always busy, but don’t be put off by the tourists — there are plenty of locals, too. The staff is amazingly friendly and the portions are large. Make a reservation, but if you have to wait, go to their bar next door for a beer; it makes the wait go faster. If you decide just to stay there and order, they’ll bring your food over from the restaurant.

— Moeders (a.k.a. Mother's) on Rozengracht is another Dutch classic. You really do need reservations, but occasionally you can get lucky and just walk in. It is one huge room (huge being a relative term) and the walls are covered with pictures of random mothers. It is a very fun, campy place and the menu is equally campy. The specialty for visitors is their Hollandse Rijstafel, which includes beef, potatoes, and sausage, in many different forms. They have plenty of options for vegetarians and fish eaters, so not to worry. It's a very fun place with friendly staff.

There’s so much good sushi in this town!

Izakaya, located on the Albert Cuypstraat, is particularly non-Dutch, in that you are limited in how long you can stay when you book. When you do book it, make sure to specify you want a table, unless you don’t mind sitting on stools at a long bar. It can also be very loud and is populated by a younger crowd. If you want a fantastic “Japanese grill with South American influences” experience, request the booth by the kitchen, then order the chef’s menu and get a bottle of sake. It’s all absolutely fantastic, and it includes sushi and wagyu beef. (They will honor food restrictions in the tasting menu.) They also have a delicious duck, a la carte. You can also tell the waiter your favorite tastes, and the chef will put something together for you. It is pricey, but worth it for a special night or a celebration — or if you prefer spending money on food over shoes.

— Just as tasty but without the ambiance or buzz is Dragon I, located on Amstelveenseweg. It is also a fraction of the price, with dishes ranging from €4.50 to a Sashimi mix for €16.50. All of the usual dishes are there: edamame, miso, spicy rolls, etc., and they also have a very good duck pancake. Go any time and often, but it doesn’t hurt to have a reservation.

Barbecue: For a southerner, it's a must!

There are two great places here for the BBQ fan: Pendergast Smokehouse and Carnivore. Both places have fabulous slow-cooked meats, including beef ribs, sides of mac and cheese, cornbread, beans, slaw and more. My friends like to debate which one is better so just choose the one closest to home and go for it!

Pendergast Smokehouse, on Groen van Prinstererstraat, is small, so a reservation is a must, but the food is just as promised: real Kansas City BBQ. 

Carnivore on Amstelveenseweg is a bit larger, so you are more likely to get in if you forgot to reserve.

Indonesian Rijstafel: the best “Dutch” food the Netherlands has to offer

Whenever we have visitors, the first thing we offer is Indonesian food. Decide which experience you want and choose from there. The food at all three of these Indonesian restaurants is delicious and something that should not be missed by visitors.

— I am sure there will be lots of disagreement with this, but we regularly go to Sama Sebo, on P.C. Hoofstraat. It is said to be the oldest Indonesian restaurant in the Netherlands, and I think neither the décor nor the waitstaff has changed since it opened. Make a reservation and go hungry. The service is prompt and efficient. They are always happy to snap a photo and will bring you extra things if you run out. Also feel free to tell them if you prefer more chicken than beef or veggies and they will accommodate you. Their command of the English language isn't great (albeit much better than my Dutch or Indonesian), but they know how to serve a great rijstafel and explain the dishes. They also have vegetarian crackers if you don’t like the shrimp ones.

— As a back-up, we often go to Sampurna, located in the Bloemenmarkt. It has all of the same dishes and probably offers a bit more variety than Sama Sebo. (Be sure to reserve in the front of the restaurant if you are the least bit claustrophobic, as the back has no windows and low ceilings.) The staff is very friendly and, again, while their English is not the best, they will offer suggestions for which rijstafel to choose.

— I would be remiss if I didn't mention Restaurant Blauw Amsterdam on Amstelveenseweg. Many of my friends take their guests there, as it is more modern, with clean lines and high ceilings. It can be crowded and noisy, and during my visits, it’s usually been full of Americans.

Best Italian in the city

There are two restaurants that I find amazingly authentic and delicious: Risto Enoteca PepeNero and Lo Stivale d’Oro.

— Make reservations in advance for PepeNero on Eerste Oosterparkstraat. The portions are ample and the service unhurried. If it's warm enough, sit outside. We had the best cod there, and I will not hesitate to go back to order the homemade pasta with tomato sauce and amazing fresh parmesan, prepared in the parmesan wheel. My mouth is watering! I love tiramisu, but this one is served deconstructed, so if you like it that way with very strong coffee as the key ingredient, try it out.

Lo Stivale d’Oro, on Amstelstraat, is located five minutes from the National Opera and Ballet, so it is perfect for a pre-theatre dinner, but of course, go early! It feels like you’re in Italy, crowded and with all of the favorites: antipasto, spaghetti, lasagna, gnocchi, and pizzas, plus delicious desserts of tiramisu, profiteroles, Tartufo and sgroppino!

One last one…

— Krua Thai is the best Thai I have had here. Located on Staalstraat, it is a cozy restaurant with authentic Thai food. No visit is complete without an order of Miang Kham, deliciousness wrapped in wild pepper leaf. Make a reservation as space is limited and it's very popular!

Happy hour not so happy? When 4:20 hits, try these first!

by Claire Fitzpatrick, D.C.

Fitzpatrick Chiropractic
Joy Health and Body

Some of us have trouble with moderation. I know I do.

Like many of us, I tend toward an addictive personality. That means that, if I don’t watch myself, I get attached to people, behaviors, and things that aren’t good for me. If I let them, they ruin my life.

At different points, I have been addicted to approval, bad relationships, cynicism, and despair. All of these are deadly to a healthy, effective, happy life.

For 20 years, I was a 1 ½ pack-a-day smoker. It was hard, but I quit for good 20 years ago. I can never go back to smoking. I cannot smoke in moderation.

Alcohol has an addictive potential for me. So far, it has not had a hold on me as cigarettes did. But I know it could if I let it. Back in the 1990s, when my previous marriage broke down, I drank quite a bit to self-medicate. It only made things worse. In 2000, when I finally decided to do something meaningful with my life, I enrolled in chiropractic school. I quit drinking for five whole years. Afterward, I carefully reintroduced wines and spirits back into my life. Ever since then, I have had great respect for alcohol’s power.

Before I drink, I try to choose when, what, and how much I am going to drink, because making those judgments while drinking doesn’t work. Many of us are unable to drink alcohol, even in moderation. I applaud, honor, respect, and support those reclaiming their lives from alcohol and other addictive drugs. Some of us may not have that level of addiction, but may suspect that, lately, we are “enjoying” our evening beverages too much. It might even be starting to worry us.

If you find yourself in this situation, don’t beat yourself up. Just make sure you are not confusing the act of enjoying with self-medicating, and act accordingly. Here are some healthy, effective tools I have found that keep me in check if I ever find myself looking forward to five o’clock a little too much.

Eat something. If I forget to eat, the urge to reflexively grab a glass of wine in the evening is much stronger than if I have had a nice, low-glycemic afternoon snack, along with some fresh, filtered water.

Dr. Claire’s 4:20 Trail Mix

½ cup organic lightly salted sprouted mixed nuts
½ cup organic semi-sweet dark chocolate chips
¼ cup organic raisins
1/3 cup organic dried cherries
1/8 cup organic sprouted sunflower seeds

Mix together and eat by the fistful. 2-3 should do it. Yum.

Meditate. Meditating calms the nerves, releases stress, increases energy, and rests your brain and body, even while you’re awake. Do this meditation before happy hour or before sampling the cooking wine.

Dr. Claire’s 4:20 Meditation

Lock your door, set your phone to silent. Set the alarm for 20 minutes.

Put on some nature sounds or some trippy Tibetan bowl music. Dim the lights.

Sit in a high-backed chair, get in the lotus position, or in a comfortable lying position. Just make sure your spine is straight.

Turn your palms up in your lap or toward the sky if you’re lying down.

Press your tongue to the roof of your mouth, turn your closed eyes upward toward your forehead like you’re looking up. Imagine a blue moon with a halo against a misty midnight sky (it’s a meditation thing).

Breathe deeply into your belly (not shoulders), and out, to the count of 4.

On the inhale, say silently to yourself, “So.” On the exhale, say, “Hum.” (Also a meditation thing.)

Do this for 20 minutes. You’ll be shocked how fast the time flies, and how great you’ll feel afterward.

Take a brisk walk. Brisk walking is different from rushing. Rushing triggers an adrenal hormone release, which isn’t necessarily bad, but in this case, it triggers the fight-flight response because you rush when you’re on someone else’s time. Brisk walking also releases adrenaline, but because you are walking for yourself, it is a positive rush instead of a negative rush. It also releases endorphins and factors that give a sense of clarity and calm.

Dr. Claire’s 4:20 “Suburban Shuffle”

Find a nice, scenic route with as little cross traffic as possible.

Briskly walk for 20 minutes. Stretch your legs wide enough that you feel your rear end tighten as you walk. Swing your arms deliberately as you walk to increase your cardio and to strengthen your upper arms.

Enjoy the scenery. Then go join your friends.

Do you have your own story? How do you handle the razor’s edge of addictive urges? Let me know.

What is my role now?

by Phyllis Larkin, Psy.D.
Xpatsia

What is my role now?

Moving abroad creates internal and external stressors that can’t be understood by those we love in the States. And those we love in the U.S. have stressors we cannot understand because we aren’t there. This lack of shared experience causes incredible emotional upheaval in most families. Add an aging parent with health or financial problems and things can get explosive. Old family dynamics will likely resurface with a vengeance. Siblings can revert to their 8-year-old selves and parents are likely to become emotionally childish also. If it’s like everyone is reading lines from a play, they are! Every family has its own script, and every member plays a role. In healthy families, everyone plays all the roles depending on life's circumstances. We all are human, we all make mistakes, we all feel lost, we all have humor, we all get hurt, we all need support.

Knowing your roles and strengths can help you be of service without feeling overwhelmed. Here is a list of typical family roles I have adapted from Sharon Wegscheider-Cruse.

Identified Patient: An aging parent living in a constant state of chaos, they feel overwhelmed and unable to cope with problems and difficult feelings. As a result, they become overly dependent, may burn bridges through angry outbursts, lie about their health and/or finances, and manipulate those around them in an attempt to get the help they need. They may isolate themselves and can become secretive to prevent their children or spouse from knowing the truth of the situation. They may blame others (scapegoat/caregiver) for their problems. This creates negative effects for the entire family. Their role is changing from one of power to one of dependency. All other roles in the family are changing as a result of the aging parents’ declining health.

Hero (Savior/Messiah); The family hero is your typical “Type A” personality: a hard-working, overachieving perfectionist. Through achievements, the hero tries to bring the family together and create a sense of predictability. This role is usually taken on because the hero fears failing or being controlled by others. They seek to give hope and stability to the rest of the family by being the “Rock of Gibraltar.” Unfortunately, the driving need to “do everything right” tends to put an extreme amount of pressure on the hero, leaving them highly anxious and susceptible to stress-related illnesses. Other family members will often resent this person for having too much power and control over decisions and finances. Heros and scapegoats often trade roles within the family as the hero becomes exhausted and needs help. Heros need to be taken seriously, but this prevents them from being fun. If they can learn to say no and accept imperfection, they can accept the help they need, relax and have fun.

Caregiver/Victim/Enabler/Secret-Keeper: The goal of this role is to provide care and safety for the identified patient. While most often a spouse, this role can also be taken on by an adult child. In order to “protect” the family, enablers convince themselves that there isn’t a problem, or that they alone can take care of it. In order to diminish the seriousness of the situation, they make excuses for others behavior. Warm, loving, compassionate and fiercely loyal, they have lots of information about the reality of the identified patient’s situation. This person feels overwhelmed by the identified patients secrets, but can’t tell anyone for fear of betraying someone they love. This can result in appearing clueless, apologetic, avoidant, indecisive, or controlling. They are often blamed for the problems of the identified patient, and then react with anger and control to protect themselves and the identified patient. Caregivers, they often sacrifice their own health to care for others. They are loyal, responsible, and fearful for the wellbeing of those they love. They are great problem solvers if they can accept the reality of the situation and accept help from others without controlling the process. They can be counted on to follow through and need to maintain firm boundaries so they don’t get exploited or exploit others.

Lost Child/Loner/AWOL: Shy, withdrawn, and sometimes thought of as “invisible” to the rest of the family, the loner can feel unable to express feelings and is often lonely. They don’t seek attention from other family members, especially when a crisis is present within the family. A typical perception is “At least we don’t have to worry about Harry.” Lost children put off making decisions, have trouble with forming intimate relationships, and choose to spend time on solitary activities as a way to cope with feeling judged and unimportant. Good listeners (because they don’t share their opinion) and often creative, they can come up with unique solutions to family problems. They are often resented for not “showing up;” however, they are also not asked to show up and are often kept “out of the loop.” They can be excellent negotiators and can feel needed at times of crisis if they are asked. If they can learn to speak up and share their opinion they can be a good resource for caregivers.

Mascot/Clown: In trying to deflect the stress of the situation by supplying humor, they aren’t taken seriously. Fragile, vulnerable, and needing the approval of others, mascots are hiding deep pain and fears of inadequacy. Providing comic relief is a defense against feeling pain and fear that is overwhelming. Mascots often grow up to self-medicate with alcohol, drugs, food or work. Mascots can also be helpful in bringing lightness and humor to difficult situations. Hard working and responsible, they can also help the family express difficult emotions, and become leaders in times of stress.

Scapegoat/Black Sheep: Blamed for the family’s problems because they act out the hurt, rejection, and shame of the family, the scapegoat offers the family a sense of purpose by providing someone else to blame. “If only Jack would get his act together!” Their behavior expresses the family’s collective frustration, anger, and failure through impulsivity and risk-taking while shielding the identified patient from blame and resentment. If the family is focused on the black sheep, they aren’t focused on the identified patient or the caregiver. When scapegoats get older, males tend to act out, while females may run away or participate in troubled relationships. Scapegoats can become truth-tellers, identifying the obvious problems and helping the family come to grips with the new reality of the identified patient’s failing health. If the black sheep can help the identified patient in concrete ways and be recognized for their positive contribution, they can relieve some of the burdens on the caregiver. This role has the most power to change if they can learn to speak the truth without anger or manipulation. They can finally feel good by being good and taking appropriate risks. They can become good leaders and be helpful to the hero if allowed.

It very important to realize roles tend to be rigid; however, if one person changes their lines, the other players have to change their responses. Roles in healthy families are flexible and interchangeable. Changes are most likely during times of crisis and stress. Your power resides in your truth when it is expressed with grace and dignity and when listening to the reality of your loved ones. You may be far away, but that doesn’t mean you’re not a resource for those you love.

 

 

I am an Embarrassing American Mom

by Allison Ochs, M.S.W.
Change Edit Management

When my daughter was eight, I went to pick her up from sailing on a Wednesday afternoon. I merrily walked through the harbor in my cute summer dress, very pleased with my life abroad. There I was on the shores of Lake Geneva, and my adorable daughter was sailing and speaking French to other children. As I approached, she smiled and looked up as I introduced myself to her new trainer with my very pronounced accent, "Bonjour, je suis la maman de Carli" (Hi, I'm Carli's mom). He looked me up and down as if I was some weird creature from Mars, not the cute mom of this adorable little French-speaking girl. He then he looked at Carli; everyone was staring at us and I realized how much Carli wanted me to be like all the other moms, without the accent, the bold personality and overly excited approach to life. I explained I was American, mentally shrugged and the two of us started chattering in English as we walked away with everyone's eyes glued to us.

This scenario has replayed itself over and over. My daughter told me she was at a storytelling event and a young Irish man was speaking. She spoke to him creating small talk, "So where are you from?" She meant where in Ireland but when he answered, "I am Dutch," she about fell over. I am sure that young man had this scenario play out as well with his parents when he was a child in Ireland.

Going local or sending your children to a school in a language that isn't your mother tongue means you will embarrass your kids with your accent and strange ways, you won't be able to help them with their homework all the time, you will misunderstand things, and they will feel at a disadvantage.

I thought we would grow out of this, but at 22 my daughter still complains that even though she is fluent and did all of her schooling in French, others tell her she isn't a "true" native speaker. Actually, she isn't a native anywhere and just has to live with comments about how her vocabulary isn't the best in every language.

Is it my fault? Am I to blame? Maybe. I sure tried to fit in everywhere, but regardless of my efforts, this happens. Even if I change passports,  I will forever remain the crazy American mom; I might as well drape a flag over my shoulders. It's the life of an expat child: no matter how much you try to improve your vocabulary and be perfect, someone will make a comment. This is just something you will have to grin and bear.

 

Photo by Stephen Leonardi on Unsplash

Connecting and Reconnecting

by Claire Fitzpatrick, D.C.

Fitzpatrick Chiropractic
Joy Health and Body

We are capable of creating symphonies of connections that carry us as if we were gliding on the surface of a great lake — when we live with full awareness of life’s sorrows and joys; its ironies and horror; its endless hilarity; and its perfect combination of misery and bliss. Meanwhile, the crescendos are breathtaking.

We are all connected in this way, but it doesn’t often feel like that. We often feel disconnected from ourselves, our purpose, and our place in the world. That can happen as an expat, especially. We sometimes let go of an idea to follow another idea, and it’s easy to lose our way and our way to our loved ones.

Do you define yourself by what you do, by your relationship to others, or do you define yourself by who you really believe you are inside?

This article is about taking time to explore these uncomfortable questions, about reconnecting to our inner rhythms, and finding our way to ourselves, our families, our communities, and our lives.

In order to reconnect to the rhythm of our astounding connectedness, we start with a base of wonder, honor, and reverence for the cycles of life and death, including our own. Keep a sense of (sometimes irreverent) humor close to your heart. And follow these steps:

  1. Define what you really want. Write about it, or paint it, or draw it. Use concrete, images that speak to your senses. See the way you want to end. Keep that image in your mind 24/7, and let it guide every choice you make.

  2. Take the steps to get it, even if that includes letting go of temporary pleasures. For instance, if you want to rid yourself of inflammatory disease, do you want that third helping of mac ’n cheese casserole, or do you want to be fully healthy and present for your children’s children?

  3. We have to be ready when people, including our loved ones, get in our way. Change is often scary, and if our loved ones sense our change, they may think that we will change the way we feel about them. Gently, with love, don’t let them get in your way.

  4. We have to respect ourselves enough to follow our goals to their conclusion. Goals are exciting in the beginning, but it’s the day-to-day grind toward the goals that makes them materialize. To finish a marathon, we have to show up at the track every day. Stick to your dreams like your life depends on it — because it does.

  5. We have to throw away false ideas that hurt us and our mission. For instance, if you tolerate the conditions of your relationship because you are worried about what people will think of you, chances are that your loved ones — including children and your partners — already feel your pain, and it pains them. Recognize that this is a false idea and allow others to heal as you heal.

  6. We mustn't wait until we are “ready” to make a change, and we must forgive ourselves for not being perfect. We trip up. That’s part of life. Unless we allow ourselves room to make mistakes, we never really live. Mistakes are always made on the path to success. The greatest achievers on the planet, more often than not, made huge errors, including the error of waiting a very long time to start. They learned how to navigate these waters, and we will visit their lessons as we go.

In her book, “Top Five Regrets of the Dying,” Bronnie Ware interviewed people who were close to death. When asked whether they had any regrets or things they would do differently, she found that common themes surfaced again and again. Here are the most common five:

I wish I’d…

  • Had the courage to live a life true to myself, not the life others expected of me
  • Not worked so hard
  • Had the courage to express my feelings
  • Stayed in touch with my friends.
  • Let myself be happier

How many of these wishes are we violating? How many of us are, right here and now, on a straight-line path of regret and remorse? How many of us are disconnected from our dreams and each other?

Let’s change that. Let’s make a symphony of our lives.

Welcome, Friend, to this wacky vitality ride of mine — and yours.

Until next month: good magic!

Shopping Survival Tips in the ‘Dam

by Rhonda Jimenez

You’ve just arrived in Amsterdam and you have no idea where to shop for what you need. If only they had a Target! Here are some basics to help you survive without that Target or Walmart down the road. Here are a few go-to’s and tips to help you find what you need — fast.

Groceries: You have probably already found Albert Heijn, but did you know that they deliver? It’s so much easier than balancing your bike with a full grocery load and then carrying it up two flights of stairs. Other grocery stores are Jumbo and Lidl. For organic, try Markt (like Whole Foods) or Ekoplaza. TIP: many items you can’t find are usually shelved in strange locations and or have unique packaging. Baking soda is sold in AH, but it’s shelved with the cleaning supplies or even in the refrigerated section. American peanut butter can be found in the small “American section” with root beer and ketchup, not with the Dutch nut butters. Ask for help if you need it. You will slowly find everything you need.

Home goods: Blokker has most items you would find in a Target: supplies for cleaning, kitchen, bathroom, and some home decor. Hema also has some home items as well.

Appliances: Media Markt has all things electronic from irons to video games, much like Best Buy back home.

Back to School Supplies: HEMA and Winter

Fashion: Trendy Nine Streets and busy Kalverstraat are always fun shopping destinations. But when it’s wet or cold, try the Amstelveen Mall. The two large department stores are Bijenkorf and Hudson's Bay. Did you know we now have a Saks Fifth Avenue “Off 5th” outlet? It’s located in Kalverstraat area and also in a huge outlet mall about 1.5 hours away called Batavia Outlets. The outlets will remind you of home, with many of the same outlets you know and love — from Nike to Michael Kors.

American Stuff: If you still can’t find what you need in the grocery chains, try Tijn’s in de Pijp or Eichholtz on Leidsestraat. Both international stores charge a big premium but offer things like canned pumpkin, Betty Crocker cake mix, Pop Tarts, Lucky Charms, and many other American treasures. Make a trip to one; it’s worthwhile!

Furniture: Ikea is a mainstay, but stop by Loods 5 and the outlet behind it — together, they take up a full block — for a huge selection of furniture. There is also a mall called Woonmall at the arena area — long waits, but good quality custom furniture. Online, try Leenbaker, Woonexpress, and Wehkamp.

Good luck on your next shopping adventure: you will survive! Remember, look carefully— they probably have it!

 

Expat Friends Stay in Our Hearts

by Vera Heijligers, Owner, Vera's Expat Resettling Advice

 

“And then she knew: that you could become homesick for people, too.”  —Beau Taplin, "Homesick"

Here we go again. This is the time of year that we say goodbye to friends, places, houses and countries. For some, it’s just for the summer; for others, it’s more long-lasting and therefore more difficult.

Nowadays we can prepare for all kind of transitions — we research new places, we join Facebook groups, we go on look-and-see trips, we listen to everybody, we use social media and the internet extensively — but nothing can prepare us for the feeling of sadness when we have to leave these amazing friends we’ve made in such a short time. But (and this comes with a big “B”), as I always also told my kids when we left again: "If we wouldn’t have moved there in the first place, we wouldn’t have met them!" This kind of became my mantra over the years.

For me, the best thing in my 30-plus years of expat life is definitely the friends I’ve made, even if most of the time we end up living in different places. Expat friends become — much quicker than at home, in my opinion — the family you need in a new place.

It takes some effort, though, to maintain these friendships. We are quick to think, “Why is it always me who has to keep in touch?”

Just get over it. Grab your phone, send a quick Whatsapp and make a Skype date to catch up: it’s like going for lunch or coffee again! Making the effort is completely worth it. You experience different moments of your life with so many different people, and those are moments that only they may know about. That connection is what makes those short and sweet friendships so special.

A best friend may not talk to you every day. She might live in another city or a different time zone, but she’s the first one you call when something happens that’s really great or really hard! The distance becomes minuscule in those moments.

As for the “stayers," try not to get overwhelmed when friends leave. Remember, if it had not been for their moving, you would have never met! And keep your mind open to meet newcomers. You never know what next gem of a friend you might find.

So long, everybody, and may we meet again!

Trapped in My Accent

by Allison Ochs, MSW
Edit Change Management

When I moved to Europe as a 19-year-old, I knew one thing – I was American. I have since spent 29 years living abroad: my entire adult life. I am American, but I have changed. I'm feeling more European, specifically Swiss.

Recently, I was working with a group of teens. One of them made the remark, "I don't mean to be disrespectful but we are in Europe, and this might not be relevant to us." I smiled, "I understand. The thing is, my entire professional career has been in Europe, so I guess I would say it is relevant. This is about you." The kid was being a provocative teen and looked stumped. A while later in the presentation, it came out that I spoke German and French and the same teen slumped further. He was Spanish and must have thought, "Hey lady, I am European. We are more progressive than you Americans when it comes to sex and sexting."

A few weeks ago it happened again. This time an adult was the culprit, saying I was "too American" without even knowing me. I complained to my husband, "Will I ever free myself from this? What can I do?" He laughed, "Aside from faking another accent, no. You are who you are and people who don't know you will just assume based on your accent that you are a typical American." He is right of course, and I guess I will just have to continue living with people misunderstanding me. I think we all do.

Caring from Abroad: Emotions

by Phyllis Larkin, Psy.D

Geriatric and Family Psychologist
XPATSIA.com

 

This is the first in a series of articles about ways to deal with the challenges of caring for an aging parent from abroad.

Often it’s a call in the middle of the night. Sometimes it’s a long-anticipated decline. Mom or Dad can no longer function independently — financially, cognitively or physically — and you live five to nine time zones away. The question is always: What am I going to do now?  

Helplessness and anxiety, with a heaping side of guilt, are just a few of the common feelings around caring for aging parents. Here are some tips on how to deal with those emotions.

Your feelings are normal.

It’s normal to feel overwhelmed. Shock does that to us. It’s normal to feel sad, fearful, panicky and even resentful. Dread is a common reaction: “I can’t just leave my_______ (job, family, spouse, life).” Grief often follows medical events, and it’s normal to find yourself re-experiencing loss and sadness. When the third act arrives, it reminds us all of our mortality and triggers feelings of loss.

What causes your emotions: internal or external?

If you can identify what is causing your emotions, you can better control your reactions. Warning: there is no black and white when it comes to emotions.

Internal emotions are driven by history, experiences, and relationships, whether they were good or bad. “I don’t want to care for Dad; he left us when we were little. Why should I give up my life to care for him now?” “I love mom and feel so bad about not caring for her now. She was always the rock when we were growing up. She cared for all of us, and now I’m letting her down. I feel so guilty.” Examples of internal emotions are: love, respect, longing, regret, resentment, loyalty, or ambivalence (for example, to feel relief with a diagnosis, but overwhelmed with the fallout.)

External emotions are driven by stimulus: living abroad, ICU sounds, medical terminology and procedures, family members, travel complications, work schedules, spousal reactions, legal issues etc. “I just need to get out of the hospital (skilled nursing facility, house.) I can’t stand seeing Mom so helpless and dependent. My brother is AWOL. I just flew eight hours and I haven’t slept in 48 hours. This is costing me a fortune. My husband is asking for a schedule and I can’t give him one. I don’t have any way to access her bank account to pay the bills at the house. I just want to scream!”

Interactive emotions are the combination of both internal and external emotions. It can all get a little overwhelming.

Getting control.

This is a good time to determine what is within your control and what isn’t. You can’t change the situation, but you can change how you react to it.

We can change our internal emotional state by being compassionate with ourselves, not judging our emotions and accepting our human condition. We can avoid catastrophic thinking.

What’s in your control:

  • Your thoughts
  • Your reactions
  • Your time
  • Your attitude

What’s not in your control:

  • Your loved one’s health
  • Other people's reactions, including family members
  • Outcomes of medical decisions
  • Other people's decisions
  • History

What you can do:

  • Eat well: Hunger complicates thinking and feelings.
  • Rest. Sleep as often as you can.  
  • Stay informed about medical issues.
  • Exercise.
  • Meditate.
  • Keep in contact with friends that you can trust who won’t judge your reality.
  • Hire caregivers to help with the burden. (Respite care can be used to get a break from caregiving. It is used by family caregivers to take vacations, recharge patience, catch up with medical needs, etc.)
  • Ask for help and then accept it.
  • Join the AWCA Aging Parents Support Group.

Links:

From a distance: 6 tips for expats with aging parents

When You Quit Your Job to Follow Your Partner’s

by Allison Ochs, MSW
Edit Change Management

The first time I quit my job to move abroad I was 28. I was working and lecturing as a social worker at a University Hospital. Even though I wasn't a hotshot career woman, a VP or earning a lot, I felt like I was on top of the world.

When my husband asked me to quit my job to move to Bordeaux, I answered, "Yes, absolutely. It is now or never." I thought this would be a fun adventure and it would be easy to jump back in. Very naive of me.

In Bordeaux, I excelled at this expat thing. I learned French, had two babies, put my eldest in a French school and thoroughly enjoyed understanding their culture. I took it upon myself to grasp everything from the school system to their relationships. It was marvelous.

The moves continued, my kids grew, and I started working again. As this happened, I became more and more reluctant to move yet again.

I remember saying, "It's not fair. I want recognition too. I can't keep on starting from zero. Don't do this to me again."

I don't think enough credit is given to the partners that quit their jobs to follow. I am still recovering from the position I left last, and sometimes I just want people to thank me — not only my husband but others. I don't want someone to see me as a woman who just drinks coffee and has lunch. "What a great life you have! You've lived all over." I hear that, and I think, "Yes, it's great, but I've left friends behind, been lonely, and gave up on a lot — and no one sees that."

How did I manage? Not always well. I complained for a while, was angry and then decided to create something of my own. I don't think there is a single piece of advice to give anyone who feels this frustration. The only thing I can say is — you are not alone. I haven't met a single veteran expat who hasn't, after years of this, felt some exhaustion and well... a lack of recognition.

Here's to us... the ones who quit our jobs to support our partners and families.

 

Fashion-Forward? Think Green.

by Marloes van Raamsdonk of Lena Library

According to an article in the Daily Mail from 2011, the average woman has 22 garments hanging in her wardrobe she has never worn. Does this stop us from shopping till we drop? Apparently not. Seventy percent of Dutch women buy something they never wear every month. But what about the clothes which are never even sold? 21.5 billion garments were manufactured in 2015 but never sold, resulting in 1.2 billion brand-new items being destroyed. Only 35% of our textile waste can be recycled. What happens to the other 65%? Well, a garbage truckload of clothes is dumped or burned every second. Shocking, right?

Why sustainable?

Nowadays, we can’t ignore the downside of fashion anymore. We’ve probably all read articles on the topic or saw an item on the news regarding the poor working conditions in sweatshops. While we proudly wear our latest outfit, on the other side of the world men, women and even young children work long hours for less than nothing. Is it really worth another person’s life to look good? Imagine your kid sewing buttons onto cute summer dresses. Unfortunately, it doesn’t end there: think about the environment. Research done by National Geographic shows it takes 2,700 liters of water to produce one cotton t-shirt, which is enough water for one person to drink for 2.5 years.

The infinite wardrobe.

At LENA we don’t want to make you feel bad about wearing or buying clothes. On the contrary, we would like to show you ways to enjoy fashion AND be sustainable. Borrowing clothes means endless experimenting with style, shapes, and colors: mix and match to the max. You will always have something new in your closet. Imagine, summer starts and all you have to do is returning your winter items to LENA without the need to store them at home. Let’s be honest, houses in Amsterdam are tiny compared to the U.S.: why waste space on clothes we don’t wear?

Dreaming of a green future.

We want to make a change. Our first priority is to create more awareness and to lengthen the lifecycle of clothes. But we won’t stop there, we believe in thinking big, and we want to change the system. We aim for a world without waste, a world without scarcity: a circular fashion system. LENA library is our first step towards a greener future, but eventually, we want to be the sustainable link between fashion brands and providers of raw material. Worn-out garments CAN be recycled into new quality products without using virgin resources. We want to make that happen.

Fashion-forward, according to LENA:

  • Wearing beautiful clothes in a conscious and sustainable way.
  • A wide range of choice without an enormous walk-in closet full of clothes we never wear.
  • The excitement of new garments without feeling the need to own them.
  • Say NO to fast fashion or bulging closets and still look AWESOME.
  • We believe ethics and aesthetics go hand-in-hand.

Meet the girl bosses.

Four business-savvy women — three sisters, and an "adopted sister" — are ready to change the world of fashion. Open minds and tons of creativity lead to this first fashion library of the Netherlands and three years later it’s still a success. Due to their background in the fashion industry, they know exactly what could be done better. LENA wants to make fashion fun for everyone involved.

LENA & you.

Do you have garments you no longer wear but don’t know what to do with? We would be very pleased if you would donate these items to our library. Your clothes deserve a new life: karma points, guaranteed. Any ideas on sustainable fashion, entrepreneurship or business opportunities for LENA? We are very much interested in your input, so pass by our store for a chat and a cup of coffee. Together we can do more!

Would you like to know more about us? Take a look at our website www.lena-library.com (sorry, Dutch only).

Commemorating the Past: Liberation Day in the Netherlands

by Jennifer van Lent

Bevrijdingsdag (or Liberation Day) in the Netherlands is a unique experience, in part because so many Dutch citizens still remember that day on May 5, 1945, when the Allied Army liberated their country from German occupation. Gatherings are held across the Netherlands beginning May 4 (called Dodenherdenking, or Remembrance of the Dead), with the entire country dedicating two minutes of silence at 8 p.m. to commemorate the brave soldiers and citizens who died in WWII, as well as in other conflicts and U.N. peace-keeping missions. The memorials continue May 5 with parades and concerts across the country.

It is still possible to hear stories from those who suffered the hardships during the "Hunger Winter" of 1944-45 and to listen to Dutch resistance fighters tell harrowing tales about sabotage and escape. My husband's Uncle Frans will never forget the Canadian soldiers who drove through their North Holland village that day, passing out to the children "the best chocolate I ever tasted." King Willem-Alexander and Queen Maxima honor Dutch veterans in Dam Square on May 4th, laying a wreath at the National Monument. Allied veterans from the U.S., Canada, U.K. and Australia still return to the Netherlands to take part as honored guests in parades, concerts and other memorials. 

As the WWII "Greatest Generation" passes on, it is more important than ever to remember our recent past and to honor those who fought and died in the many wars and conflicts of the past 100 years. Here are some suggestions for how and where to celebrate our hard-earned, precious freedom.

Dodenherdenking, May 4: 

Amsterdam, Dam Square: the commemoration typically starts around 7 p.m. (look at the local news for exact times), with a concert and speeches. The 2 minutes of silence begins at 8 p.m.

Opijnen American Cemetery, May 4: Eight American WWII airmen from the 91st Bomb Squad lie forever in the American cemetery in Opijnen, in the east of the Netherlands. For over 70 years, the local village has honored their memory by maintaining their graves and, on May 4, commemorating their sacrifice. The memorial typically begins around 6.30 p.m. (our club typically has members who attend the ceremony, so reach out if you are interested). 

Willem Braam of the Het Gooi Bevrijd Committee and his wife, Marianne

Bevrijdingsdag, May 5:

Het Bevrijd Gooi: This unique event brings WWII veterans to t'Gooi with a three-day remembrance and celebration to honor those who fought in the Netherlands for the Allied Army. The highlight is a parade of WWII-era jeeps, motorcycles and military trucks that wind their way through 11 towns in t' Gooi. One of this year's honorees is a 93-year-old veteran who will be traveling from California to take part in the celebration.

Oorlogsmusuem (War Museum), Overloon and Liberty Park: This is one of my favorite museums and a wonderful place to learn about the Dutch history before and during WWII. One of the oldest dedicated to WWII, this interactive museum has several parts, including the Dutch War Museum and George C. Marshall Museum ("a living museum”) housing a huge collection of military equipment, including planes, tanks and ships).

Concerts:

There are various concerts throughout the area, including:

Amsterdam: the Liberation Day Concert on the Amstel River in front of the Carré Theater is the highlight of the Amsterdam celebrations. If you have a boat, get to the site early and enjoy the fabulous music!

Haarlem: Bevrijdingspop. This is a FREE daylong concert in the Haarlem Hout: very fun, activities for families and adults, and great music! Best to take a train to Haarlem and walk 15 minutes to the event location. You can't miss it — just follow the crowds!

More resources: https://www.iamsterdam.com/en/see-and-do/whats-on/festivals/overview-music-festivals/liberation-day-amsterdam

A Modest American in Europe

woman in American flag wrapped around her sitting on beach

Photo by veeterzy on Unsplash

by Allison Ochs, M.S.W.
Edit Change Management

My first year in Europe was a real shocker. I was so naive and so unprepared for what I was doing. I could write 10 stories just on the topic of nudity (and maybe I will one day), but today let us focus on the basics. The fact is if you are not used to taking public showers, changing in public or having people change in front of you, life in Europe can be a bit challenging at first.

Our first apartment was about two blocks from a lovely park in Kiel, Germany. We had an apartment with no balcony, and when the sun came out, we headed to that park. The first visits to there were not enjoyable for me. Alright, I’ll be honest: the whole first year I felt uncomfortable every time it was hot and we went out.

Germans are very comfortable with their bodies and nudity. This park was close to banks, offices and businesses and I would sit there in shock as women and men would strip down to their underwear, the women would fling their bras off and just stretch out with a sandwich for an hour soaking up the sun. After their hour break, they would just stand up, stretch and slowly put bra, business shirt, skirt and heels back on and stroll off, briefcase in hand. I honestly did not know where to look. My husband (who is German) was a student as well. We meet at the park a lot. He thought watching me be uncomfortable was funny but also surprising. He didn't think stripping to your underwear at lunch was strange and I did. We had many lengthy discussions about nudity.

Just this week, in chatting with another expat mom, we talked about how hard it is to deal with this. I have progressed after 28 years in Europe and can now change on a beach, and I am very free but still not entirely. That little girl from Farmington, Utah still lives in me. I will only go topless at a private pool with my family and I still don’t like being on nude beaches.

Some cultural traits are rooted. This one seems to be a big one for everyone. If you have trouble with it, you are not alone!

North, South, East and West: Stepping Out of My Bubble in Amsterdam

by Suzanne Vine
originally published Nov. 3, 2017 on Suzanne Vine's Amsterdam

Photo by Daria Nepriakhina on Unsplash

In September, I passed my three-year milestone in Amsterdam. Expat years are kind of like dog years, so three years makes me a very elderly expat, indeed. In those three long years, I like to think I have discovered a lot of the city. I like to think I've gotten out of my neighborhood and explored. I like to think some of you are still reading along.

This post gives me the chance to share some of what I have discovered on my journeys and weigh in on the experience of living here for three years. In the end, I may not have much wisdom to share, but I can tell you where to get a good cup of coffee.

Feel free to share this post with your visitors so we all don't have to reinvent the recommendation-wheel every time family and friends come to stay. I purposely left out all tips for the center of town. Most expats already know that part of town and can steer their visitors to the right spots for food, drink, and sightseeing. Frankly, you can just walk up and down the canals and find your own favorite places without much fuss...you and the crowds who visit Amsterdam. I'm going to sound like a cranky Dutch native, but we avoid the center as much as possible during the summer months. Even in the three years since we arrived, I see more and more tourists and hear less and less Dutch spoken. The city seems to be trying to strike a balance between accommodating the tourists — and their money — and keeping the charm of Amsterdam alive and well. Some would say the balance is tipping towards the tourist dollars right now.

A quick geography lesson for those of you who are new or don't live here: Amsterdam is composed of different neighborhoods. Like many of the neighborhoods in New York City — well, actually in Manhattan with its Upper West and Lower East Sides, etc. — the names of the neighborhoods are mostly directions with actual names for some of the neighborhoods tucked inside those big areas. So here we have North (Noord), South (Zuid), East (Oost), West (West). and The Center (Het Centrum), but also de Pijp, and The Museum Quarter (Museumplein). 

It seems like every map you look at divides the city in different ways. Some leave it in big chunks (North, South, East, and West) and some include the names of the neighborhoods. No wonder I get lost so often.

Old South. Like many in the expat community, I live in Oud Zuid, or Old South. Here's the great part about living in our hood: we are a few short blocks to Vondelpark, Amsterdam's Central Park. We're also a few short blocks to the Van Gogh Museum, the Rijksmuseum (home to the Vermeers and the Rembrandts you want to see), and the Stedelijk, the modern art museum. We're also only a short walk from the elegant concert hall, Het Concertgebouw. And we have taken full advantage and seen lots and lots of concerts. We never seemed to do that when we were only a short train ride away from New York City.

You can see a real Picasso sculpture in Vondelpark. I'm always surprised that no hooligans have ever taken a can of spray paint to it. Maybe even they have limits.

My husband Peter and I often have moments when we shake our heads in amazement that we are actually living here. Mine often come when I look up at the majestic Rijksmuseum. How did we get so lucky to live so close by? Or to live here at all?

I took this photo during the Women's March, where for once Museumplein, the square surrounding the museums, was packed with protestors, not tourists taking selfies.

I love the quiet side of the museum, where the bikes outnumber the people.

Now, what's the downside of living in my part of town? For one, it can feel like a bubble. A very tony, one-dimensional bubble. The one "regular" store here - a hardware store - just closed its doors. It will be replaced by yet another "bougie" boutique selling overpriced clothes that appeal to someone, I suppose. That someone is definitely not me. The other downside is that there isn't much culinary diversity. You can find Italian food or Dutch bistro-style restaurants, but where is the Thai? The Vietnamese? The Lebanese? And where are the good coffee spots? That's a problem. So to find what I need, I have to get out and about.

The Dutch pride themselves on being a society of equals. When we came to look for apartments before we moved here, the relocation person told us that there weren't any super-rich here. Then who lives in those houses along the canal near the apartments she was showing us, I asked. The answer? Drug dealers. 

I can assure you that not all the fancy houses in Amsterdam are inhabited by drug lords.

North. So, let's get out of the bubble, shall we? First, we head to Noord, the North. This part of the city is a little out-of-the-way. You have to hop on a ferry behind Central Station to get there unless you have a car. They are talking about building a new bridge that will allow you to bike from behind the station, but I've learned that there can be lots and lots of talk before any shovel breaks ground, so I'll believe it when I see it. For now, take your bike right on the ferry. Once in the North, I recommend heading out to a giant oasis called Het Twiske. You can bring your lunch and have a picnic. You will feel like you are in the middle of nowhere.

When my son Ben was here for a visit, we went straight to the motherland for our picnic provisions: a place called Piqniq, in the Jordaan, a neighborhood in the center of the city. Worth every penny. Gluten-free bread available, making this picnicker a very happy camper.

On the way back from your bike ride through Noord, you can stop for coffee at The Coffee Virus. Very good coffee. Not so good English. Here's a sentence from their website: "We are very ambitious. Actively we look to expand and spread our positive virus at other inspiring locations were [Note: Yup, you read that right], creatively, we adapt to our surrounding." One job idea I have is to help businesses rewrite their "English" into words that make sense. An English Fixer. They really need my help here. 

Although not inside the city limits of the North, once you are up there, you can visit some quaint villages like Marken, and some touristy ones like Volendam.

If you're really feeling like a tourist, you, too, can get in costume and transport yourself back in time, Volendam-style. Let's just say that my daughter Rachel deeply regretted joining me on an outing with the American Women's Club that day.

Ben felt slightly better about our bike ride to Marken, but for some reason, he refused the opportunity to put his face into the your-face-here board set up near the lighthouse.

Another place to visit that's north of my bubble is The Zaanse Schans, a colonial Williamsburg-style village where you can step back in time and see what 18th and 19th-century life was really like. One of my expat friends took every single one of her visitors there, but I actually ventured there for the first time in April. It was a grey, windy day, raw even by the usual standards, so the crowds were somewhat thinner. I can't imagine taking this trip on in the height of the tourist crush in the summer. But we actually enjoyed the tour inside a windmill and the photo ops. Ah, April in the Netherlands. The wind sure kept those windmills busy.

Let's face it: you want to see windmills when you come to the Netherlands. A trip to Zaanse Schans gives you a lot of bang for your buck. You take a short bus ride from Central Station and you're face to face with a whole army of them. I've heard that most Dutch people have never been there.

I don't think the guys inside the windmill - still a working sawmill - had ever seen the likes of our friend Pierre. They did their best to answer all of his questions.

East. Let's head East, shall we? This is a neighborhood where, unlike places like Zaanse Schans, Dutch people do live, and do go for dinner and coffee. The area has changed a lot in the past few years. I think even the Dutch would agree that it has become gentrified. You still see many women wearing hijabs, but now you also see tons of young people in search of good food, and lots of new restaurants to lure them in. And then there's me: an expat who is looking to get out of the bubble and take a bike ride for a bit before settling in with a coffee and a book, or a notebook. Some of my favorite Amsterdam places are in OostCoffee BruRum Babaand Roostwhere there's a book exchange wall. You can take a book if you forget yours, and bring it home. For keeps. They even have some good books in English. Good coffee is a big reason this uptown girl likes to get out of the white bread world of the Old South neighborhood.

The burger craze has hit Amsterdam hard. Smokin' Barrels makes a burger that any American restaurant would be proud to call its own. And, oh, those fries!

In addition to good coffee, you can find some good food. There's Smokin' Barrels, where my friend Vera's daughter Rosanne worked until the wee hours, and De Biertuinwhere you can find yourself older than the other customers' parents. Lest you think all I do is eat and drink, I can also recommend The Tropenmuseuma museum "about people." According to the website, "From Africa to West and Southeast Asia, from New Guinea to Latin America: come to the Tropenmuseum and discover that, despite cultural differences, we are all essentially the same." I'm not sure if that's really true, but it's a lovely little museum with interesting exhibits. This museum is one place which doesn't call Dutch colonizing "exploring" but rather, uses the word "slavery" and the Dutch in the same sentence. Imagine that.

This exhibit about the history of music was fantastic. How could I not be excited about an exhibit that included my favorite musical genre? One can never get enough of this funky stuff.

While you are in this neck of the woods, you can visit Czar Peterstraat, recently voted the nicest shopping street in Amsterdam. And that was before De Pindakaaswinkel, the store selling one thing and one thing only — peanut butter in various flavors — moved in. I discovered the rest of the street when I went in search of the store one afternoon. It's worth wandering around there.

West. Finally, let's head to the West, another area of town that has changed a lot in the past five years or so. You will certainly see more "diversity" out there than in my neighborhood, including many Muslim faces. But as the rents around the city rise and rise, there are more pockets of gentrification. I think of the West as the Brooklyn of Amsterdam. For the coffee fans, try White Label Coffee or Lot Sixty One. White Label is still wedged among kebab joints and inexpensive chain stores, but I'm guessing the neighborhood will soon change. Lot Sixty One now has a line down the block on weekends. Sigh. When we first moved here, I discovered this place — like so many others in this post — while walking with my dog Casey. I knew about four people in Amsterdam, and Peter was one of them. I could always go West (my version of Downtown) and find someplace cozy, or gezellig, as the Dutch say.

Now to really get out of the bubble, you have to go to the Nieuw West, or New West. There you can find some tucked-away gems, like De Cantina. What's not to love about a place where you can read in a hammock, or sit in an old hippie car with your coffee or tea? Note to my expat friends wondering how I find these places: I didn't find this one. Rachel did, on a list of Top 5 Secret Spots in Amsterdam. Shhhh. Don't tell anyone.

This little plant shop, Wildernis, is in Oud West, Amsterdam West. It might as well be in the Wild West to some expats who don't venture there often. You can buy all sorts of plants, and, of course, a cup of coffee or tea after exerting yourself with your plant shopping.

So what has changed about Amsterdam in my three years here? Many would say the expats are responsible for one big change: higher and higher rents. You can't blame those rising rent prices and gentrification solely on the American expats, as one recent local news broadcaster tried to do. He also blamed us for the piles of garbage and the noise. We are definitely not taking credit for those, dear Amsterdam. Of course, many of us do come with big pocketbooks and our American values, like huge kitchens and multiple bathrooms, and the Dutch real estate market is certainly trying to oblige. But we aren't the only ones moving into previously affordable areas and turning them into posh hideouts. For selfish reasons, I want Amsterdam to gentrify, but just enough. I still want to discover places that don't feel like they are part of the bubble.

But let's face it, fancy coffee is a sure sign that a neighborhood is changing over. The city is certainly getting gussied up. Everywhere you look there is construction. Everywhere. Why can't they finish one project before they tear up the streets somewhere else? It's like when kids have to take out every different Lego set all at once and leave them strewn around and mixed up, instead of cleaning up the ones they are finished with before moving on to a new set. The city is as likely to follow my suggestion about finishing one project at a time as kids are likely to follow an organized Lego play routine. But a girl can dream, can't she?

I recently finished a novel called Euphoria, by Lily King. As it so often happens when I read, one passage seemed to be calling out to me, to be exactly what I have been thinking about as I wrote this post. The character Nell - based on the anthropologist Margaret Mead - is describing her favorite part of her fieldwork. She says, "It's that moment about two months in when you think you've finally got a handle on the place. Suddenly it feels within your grasp. It's a delusion — you've only been there eight weeks — and it's followed by the complete despair of ever understanding anything. But at that moment the place feels entirely yours. It's the briefest, purest euphoria." If you substitute her two months for my three years, you will know how I feel.  Sometimes it's euphoria: I can't believe we actually live here! We are so lucky! I think I understand the Dutch and their ways. And then the next moment, it's despair: I'll never really fit in. I'm so far away from home. Where is home, exactly?

I'll end our journey through Amsterdam with a photo of my Dad, taken in 1948 when he visited the Netherlands. He came to Europe on a ship with his father. The overseas trip was a gift for graduating from medical school. The little girls in the photo, I assume, actually dressed that way, unlike the people who dress up to amuse the tourists nowadays. When my dad visited, the world was still a huge place, where people in one part of the world lived very differently from people in another. These days, the world feels like a much smaller place, with H&M and Starbucks uniting us no matter which corner we call home. I often think about how much my dad would have loved to hear about (and read about) my adventures here.  

I didn't crop out the sides of the photo because I love those jagged edges.

In answer to one question we're often asked: No, we don't know how much longer we will stay here. For now, I'm happy to live in my expat land-of-limbo. I'm beyond grateful to have the chance to travel around the city, without the stress and all-consuming schedule of teaching. This move has given me the gift of time, as has Peter, who is, for now, singlehandedly holding down the retirement-fund fort. Thank you, Peter.

I'll close with a quick farewell to a musical part of my past: the late Tom Petty in the Traveling Wilburys: "Maybe somewhere down the road aways, you'll think of me, wonder where I am these days."

I wonder where I'll be, too — somewhere down the road.

Keukenhof: Tiptoe through the tulips, and daffodils, and hyacinths…

by Danielle Tomich

If you’re lucky enough to live in Holland, with the world-famous Keukenhof Gardens in your back yard, you’d have to be some sort of April’s fool not to visit at some point during the season. Here’s some information to help you plan your own tiptoe trip.

What’s up, buttercup? Is it all just hype? No. Consistently listed among the most beautiful gardens in the world, the Keukenhof is a must-see for anyone who enjoys flowers, gardens or convening with nature. Granted, the gardeners leave little to nature: these lush, manicured gardens are artfully designed by people who know what they’re doing. Graced with dozens of varieties of hyacinths, daffodils, and tulips that bloom at different times, the garden changes throughout the season. In fact, it changes each year: At the end of the season all the bulbs are removed and the beds are replanted with different varieties and designs.

More than gardens. The garden naturally has beautiful ponds, bridges, and water features, but it also includes children’s play areas, a windmill, great views of the tulip fields, sculptures, boat rides through its small canals, places to eat and, of course, gift shops. An unexpected delight in 2016 was an area of garden pots and decorations done in Dutch tile mosaics. And don’t miss the flower shows in the pavilions. Not your ordinary state-fair fare, these flower-based art displays are professionally done with great care and creativity.

When to visit. The gardens are open daily March 22 to May 13 from 8 a.m. to 7:30 p.m. Whenever possible, visit on a weekday, preferably mid-week, either first thing in the morning or toward closing time. Check the schedules for the flower shows (in the pavilions), as they may influence your choice of dates.

Early in the season, before most of the tulips have come up, a heavenly fragrance floats like a mist through the gardens: the hyacinths are in their prime. They bloom in violet, pink, blue, white and every hue in-between, and they are often mixed in a bed-bouquet with an equally astonishing array of daffodils and early-bird tulips. If you’re lucky, the cherry trees will be spreading their pink lace canopy. But perhaps the best reason to visit early is to avoid the massive crowds. In its 69th year, the garden is expecting one million visitors this season.

If you go later, you’ll see the most tulips, both in the gardens and in the fields viewable from the vista spots. Timing is tricky (from year-to-year the peak varies), but the last week of April is a good bet. You can check out what’s blooming weekly on the garden’s Facebook page; they update the bloom status every Wednesday.

Rain is a good possibility no matter when you plan to go, but keep in mind that the soft light on those cloudy days will make the colors pop in your photos.

Bike the fields. For a completely different experience, pedal around the fields on a bike from Rent-a-Bike van Dam, located in the parking lot of the gardens near the main entrance. From March 22 to May 13, they are open from 9:30 a.m. to 7 p.m. Not surprisingly, the strategy for beating the bike rental crowd is the same as for the gardens: go mid-week, early or late in the day. Or, take your bike with you on the train. More information on biking near the Keukenhof can be found on european-traveler.com.

Getting there. There is no direct public transportation from Amsterdam to Keukenhof; shuttle buses run from Schiphol, Haarlem, and Leiden. Combination tickets for the bus and the garden are available on keukenhoff.nl. On peak days, such as Easter and weekends, get there very early to avoid long queues. Other public transport options can be found on tulipsinholland.com. Driving is convenient, but parking can also get very competitive during peak times, so get there early. A taxi will set you back about €100 (one-way) for up to four people. It wouldn’t be Holland if the most convenient and affordable option wasn’t to bike. It will take about 2 hours each way from Amsterdam, so consider taking your bike on the train and biking from Leiden or Haarlem. Parking your fiets at Keukenhof is free.

Beating the crowds. Skip-the-line tickets might be a good idea during peak times. They are available from websites such as Get Your Guide.

The final bloom: Bloemencorso (Flower Parade). The annual parade makes its flower-strewn way from Sassenheim to Haarlem twice: in an illuminated evening parade at 9:15 p.m. on Friday, April 20 in Noordwijkerhout and a day-long parade on Saturday, April 21 as the floats travel from Noordwijk and arrive in Haarlem at about 9:30 p.m. On Sunday, April 22, floats will be on view at the Gedempte Oude Gracht in Haarlem. Tickets for grandstand seats and more information is available on the parade website.

Whichever way suits you and your family or visitors, just get to these world-class gardens. And don’t forget your camera!