"So... how do you earn a living?"

by MH

I recently subjected myself to the necessary discomfort associated with visiting a dentist and was happy to hear that I had no significant new dental issues.  However, finding no new problems for which to propose costly solutions, the dentist instead suggested I replace two existing fillings using more modern materials.  As part of the faux casual conversation that preceded the preparation of the "treatment plan" the smiling dentist asked, "so, how do you earn a living?"

I was taken aback.  I also had very little time to construct an appropriate answer given that a suspicious-looking implement was being guided towards my mouth even as the question was being articulated.  

However, as I drove home afterwards I reflected on some answers I could have given...

1. None of your business.  All you  need to know is that I can afford whatever option you propose, but will only go ahead with if I'm convinced it's necessary. 
2. I don't earn any  money.  Rather, I am a parasite on my family and society.
3. I have entered into a collaborative and mutually-beneficial partnership with my husband whereby he works in a wage-earning role and I mind our children (including one with PWS), look after the running of our home, engage in voluntary work of benefit to society, ensure our long-term financial stability by investing and prudently spending the money that my husband earns, and assist older relatives whom I know rely on my support.
4. Despite my unkempt appearance I am in fact already so filthy rich that I no longer feel the need to earn and instead luxuriate in a life of idleness and excess (I doubt he'd have believed this one).
5. I earn my place in this world by working as a carer, volunteer, housekeeper and friend.  These activities take so much of my time and energy that there are, sadly, not enough hours left for me to also earn money.

Of course, I didn't say any of these things, but instead mumbled something slightly incoherent about having young children and let it pass.  And OK, OK, in hindsight I can see that maybe I over-reacted slightly and took just a teeny-weeny bit too much offence at the question.  After all I was in a dentist's chair at the time and in a tense mood as a result.

However, even though my mood has now considerably improved, I still find the question objectionable.   I have a problem with it because it implies a norm (earning money) and hence divides people into those who conform with this norm and those who don't.  It also disregards the reality that societies generally rely on large numbers of people engaging in unpaid work, and it is these unpaid workers (people like me who don't earn) who make it possible for others to earn ... if there was nobody to look after my dentist's children then he couldn't work as a dentist.  To me, although not explicitly-stated, this question also sounds value-laden, as if earning is better than not earning. In addition, I have a problem with this because it totally unnecessarily ignores the socially-acceptable alternative means of finding out the same information.  Where I live, etiquette suggests that one should ask "what do you do?", when seeking to find out a person's work status.  This formulation gives people the option to identify whether they are part of the paid or unpaid workforce or not and gives them the freedom to describe how they spend their time.

Debate around what work societies choose to pay for is, of course, hardly new.  I think I may be particularly sensitive to questions like this because so many adults with PWS fall into the non-earning category and so, of course, may my son.  If this happens, it won't be because he has no talents or no means of making a valuable contribution to society.  In fact, I believe he can and will make a very valuable contribution to society.  However, if my society remains as it is now, the contribution he makes may well be in areas that do not attract wages. 

I guess I should just advise him to visit a different dentist then ... or come up with a grand plan to change society before he reaches working age!

I could eat a hundred of those!

I had been thinking about dieting for quite a while – well, since January 1^st as it happens.  But dieting requires exercising as well and I’m not that keen on exercising.  But over the last year and a half, I put on weight after two operations to restore my hip and then my knee to a state of perfection.  Now, fully equipped with state-of-the-art joints, there can be no more prevaricating or excuses not to repay the hours of intricate repair by my friendly surgeon, and use them to their fullest capacity and, of course, this means putting my money where my mouth is.

One of my daughters introduced me to something called MyFitnessPal which is an app for my phone.  This clever little app will let me write up everything I’ve eaten, it will even scan in barcodes for my convenience, it will calculate the amount of calories I’ve consumed and, should I exercise the new joints, it will subtract the calories expended so I can “buy” my next meal with added extras if I so choose.

I’m intrigued by this patient and understanding little helper that doesn’t nag me or say ‘no, you can’t have…’ but relies on my conscience to sort things out.  At the end of the day when theoretically I should have stopped eating, it will give me a pat on the back for completing my day’s work and tells me in 5 weeks time, if I continue in such style, I will weigh a sight less than when I started.  So far, I’ve managed nearly 6 weeks and, yes, I have lost a few kilos.  The first week was difficult, and this is where my best learning happened.  I learned what it felt like to be constantly hungry; I learned that being grumpy was pretty much ongoing; I learned that I actually felt better after I’d had a walk for 30 minutes and while walking, I wasn’t feeling hungry.  I learned to love cottage cheese and look forward to wafer-thin biscuits that taste like cardboard.  I learned that when I couldn’t sleep at night, it was often because I was hungry, so I learned how to sneak into the kitchen and raid the cupboards.  I learned very quickly not to have peanut-butter in the house.

In effect, I learned what it felt like to be my daughter – the one with PWS.  When she says, “I could eat 100 of those,” I can say, “me too, I wish we could, but do you know how long we’d be walking into next week?!”  I crave a piece of chocolate last thing at night; and, if MyFitnessPal says I can have one, it tastes like heaven.  The other night we went down to friends for a “fish and chip” evening.  I told my husband he’d just have to take one for the team while I took, in a plastic container, a meal of lettuce, smoked fish and couscous.  I explained to our hosts that I was trying to lose weight and they were very understanding.  But, just like my daughter (the one with.. etc) I just wanted a little taste – it smelled so inviting, so yummy, surely I could just have one chip?  And yes, I could have sneaked one off someone’s plate and they would have been polite enough to ignore me, but I didn’t.  I ate my lettuce, smoked fish and couscous and, actually, it tasted really nice and didn’t give me that heavy feeling that a huge plate of fish'n'chips can do.

This brings me round to the argument of fat vs sugar.  Have you noticed recently there is a lot in the newspapers and magazines about the ‘deadliness’ of sugar?  No longer is fat the No.1 Evil that it was purported to be; sugar has taken over.  We’re told that when we were still living in caves, the amount of fat we ate then didn't kill us, it, in fact, protected us and enabled us to get through the hardship of famines.  We've realised that diseases like diabetes, various cancers, and weight-related illnesses didn't exist back then; they've come along since the invention of sugar.

When fat was the No.1 Evil, food manufacturers quickly learned to sweeten foodstuffs with sugar while labelling foods “fat free, lite, low-fat” etc.  I noticed even peanut-butter and the all-time staple of Aussies and Kiwis, Vegemite and Marmite, are higher in sugar content than ever before.  Sugar is hidden in so many manufactured foods and we barely notice how addicted to this we have become.

A huge amount of research is being done into obesity – something we all already know – and it is interesting to learn that hunger, the most basic survival instinct of all, is controlled not by the gut, but by the brain.  Research is being undertaken to find ways to trick the gut hormones into convincing the brain we’re full on less food.  Similarities between the brain-signalling of obese people and alcoholics, and the difference between them and their thinner counterparts, is being investigated.  We are learning that our genetics are linked to both our food preferences and our ‘varying natural ability to activate our satiety switch – the signal that tells us we’re full’ (North & South March 2014: The Food + Science Issue). Of course, my daughter (the one with ...etc) has a dysfunctional brain, so her satiety switch mostly doesn't work.

There are several conditions that affect both brain and gut which could be caused by a poorly functioning immune system, “People who have autism have increased rates of leaky gut and IBS (Irritable Bowel Syndrome), and it turns out that these individuals who are obese, particularly kids who are the offspring of obese parents, also have a higher incidence of gut problems, such as leaky gut, colitis, and inflammatory bowel disease” (Christine Jasoni, Neuroscientist, ibid).  This piece of information made me very aware of the number of times my daughter (the one with.. etc) has admitted herself to hospital because of bowel and gut problems; it also reminded me of our own PW researchers who have observed this in Prader-Willi syndrome.

There is so much that is against our having a healthy dietary regime with its full complement of exercise that it is no wonder the world is experiencing a huge rise in obesity.  There are the food manufacturers who want us to buy more of their processed foods – so lace them with sugar, or, when saying they are sugar-free, with fat, so that we become addicted to the taste.  There are our own genetics which play a part in whether we are “sweet” or “savoury” eaters; there is our brain fighting our gut; there is our own hard-wired selves who desire food practically more than anything else and the good old dopamine feel-good hormone that says to our brain, “have more!!” 

All of this just brings me back to MyFitnessPal and my own feelings of hunger and how much I have associated with my daughter (the one with…etc) as I fight to become fitter in order to battle the aging.  The old saying (albeit slightly altered), “walk a mile in her shoes” comes to mind, frequently.

PWS and "Other People"

By MH

 

Last year I saw an accusation that was widely shared on the sites of organisations that support people with disabilities.  It was structured as a question and answer and went something like this: 

• Question: "What is the biggest problem faced by parents of children with special needs?"   
• Answer: "Other people".  

It is a sentiment that many of us, accustomed to intolerance, insensitivity and rejection, can instinctively relate to.  But is it fair? 

At my son's 8th birthday party (he has PWS) 2 minor incidents revealed to me a vision of a happier and more inclusive world.  The custom, where I live, is for children to have birthday parties in venues outside their home - typically sports or play centres where 2 hours of fun is accompanied by a meal.  Finding a venue that provides a meal comprised of anything other than junk food is always a challenge and so was the case that year.  The matter, as usual, was resolved by me supplying my own food.   

The first incident that brought a smile to my face happened during the meal, when one of the 15 or so happy children noticed me carrying a large platter of fruit skewers into the room with 8 candles on top - our alternative to a birthday cake.  Announcing my arrival to the others she declared, "Oh look, we're having a fruit cake".  While the offering comprised no cake and all fruit, it was still accepted without complaint or comment as "the birthday cake".    Some fruit pieces were swapped, all was soon eaten, a few good-natured skewer battles occurred and play continued.  The fact that my son was not having a traditional cake did not appear to cause any problems for him or any of the other children present.

The second incident, which brought a tear to my eye as well as a smile to face, occurred when, as the party drew to a close, all the children congregated on a large bouncing castle.  A complicated game was hastily agreed that involved all children having to cross the centre of the castle from one side to the other.  Within seconds of the game commencing one child realised that my son was unable to cross the castle.  She immediately (and loudly!) commanded everyone to stop bouncing to make it easier for him.  When he still couldn't manage, another child positioned herself in the centre to hold his hand to help him across.  As I was standing out of sight and there were no other adults present I felt certain that this modification of the game had been done not for the approval of adults, but because the children instinctively understood that everyone needed to be included.  I also felt certain that my son felt neither patronised nor different as a result of the game's rules being changed to meet his needs.

I don't think this group of children was unique or particularly remarkable.  Yes, all of the children attended the same school which proudly promotes an ethos of equality and inclusion, but they also came from different backgrounds and experienced different parenting.  My son, to my knowledge, was the only child at the party who had a disability. Yet all the children were able and willing to engage collaboratively and inclusively with each other.  They were also sufficiently open-minded to accept that things may not always be the same - e.g. some "birthday cakes" may be very different to others.

The question this raises, of course, is what happens?  How do open-minded, tolerant children turn into adults who  are perceived to be the biggest problem faced by parents of children with special needs?  I don't have the answer.  But I think it's an important question.  And do I personally believe that the biggest problem faced by parents of children with special needs is other people?  No, just other adults!

Guilt

How can I talk to you about guilt?   It's not an easy subject and I feel awkward talking about it, but sometimes when I stop and analyse my feelings, they seem to be conditioned by guilt.

When my daughter was born, I grieved - we all did - for the daughter we were expecting and didn't get.  Time goes by and the grief calms down.  It never disappears entirely because there are hundreds upon hundreds of little things that other children do that remind you your own child can't; but it abates.  It becomes replaced with pride in what your child can do, rather than what they can't.  Suddenly, you have this amazing opportunity to see life from another perspective and you stop searching for those rose-tinted spectacles that made life the way you wanted to see it, and you clean the lenses of your old glasses, and suddenly get a whole new view.

Most of the time it's rewarding, it gives you courage to go on, it fills your heart with love for your child who tries so darn hard to do everything in life that they can.  Then there are times when your 'life spectacles' cloud over and it takes time to get back the right perspective.  The knock-backs are still there, but can be seen differently and learned from. Yet, even the smallest of knock-backs can still hurt.

"I visited my niece yesterday, Mum.  It was lovely, and she is so sweet.  I played with her on the floor, but she didn't smile at me, just at her own mother.  And the clothes I bought for her, well, they don't want them.  They've got enough clothes."

And immediately I feel hurt on her behalf.  I know how she has shopped in all the second-hand places for these little clothes.  I know how she has bargained for them and I know how carefully she has washed them all, hung them out to dry, folded them and taken them as gifts for her niece.  

"Mum, I hope you don't mind, but I have been thinking about not visiting Grandma much any more.  (Grandma is in a retirement home.  She is frail and forgetful.)  I just don't think she knows me, really.  She tells me she does things like play bowls, and I know she doesn't.  And she never says goodbye to me."

And immediately I feel hurt again.  I know how she plans her visits to Grandma, how she takes her little things that she thinks she might like.  I, too, wish Grandma was not like this.  I feel guilty that my daughter is not loved enough.  I feel guilty that I am not loving her enough to prevent even the slightest knock-back.

So, I asked, "Did you mind when your sister said not to bring any more clothes because they have plenty?  And do you mind not going to see Grandma, now that she is old and forgetful?"

And here's when I know my feelings of guilt are totally unfounded -

"No, not at all.  I know they've got heaps of clothes!  They're already spilling out of the cupboard!  And no, I don't mind about Grandma - I don't want to upset her."

Why can't I have babies?

This was a question my daughter used to ask me when she was around 10 -13 years old.  It's heartbreaking to break the truth, but parents will often hear this sad refrain and wonder how to answer.

Here are my thoughts:
It's true that females with PWS are unlikely to regularly menstruate unless they have sex hormone therapy and this is now a recommended treatment because it helps strengthen the bones, help prevent kyphosis (forward curvature of the spine) and helps make the person feel more like their peers;  more 'normal'.  Many girls will still menstruate, even lightly and irregularly, and if sexually active, do run a risk of pregnancy, but a large percentage of our PWS population will not have sex hormone treatment, will not menstruate, may never be sexually active and still desperately want their own babies.

Girls with PWS love babies - so do the boys, but the girls have a strong nurturing streak as often seen with their attraction to anyone's baby!  Many also have large collections of dolls and act out their fantasies.  This may extend to fantasies about boyfriends, and I mean really strong fantasies that they insist on being true!  This calls for patience and understanding.  If it gets more unrealistic and even confrontational, then the collaboration of parents with professionals, school teachers, counsellors, and the wider family (particularly people whom the child admires and sees as an 'expert') to help unravel the fantasy even to the point of explaining, for example, that "although, because of Prader-Willi Syndrome, your body works a little differently from others, so that you may never have children - and many, many women in the world don't, or can't - but your sister (cousin, friend, etc) may still let you help care for her baby.  You may well become an aunty to lots of children!"  If the child hears the same story from all, then they generally accept that what they are hearing is correct.  When the child is ready to understand more about their condition, you can either do this slowly, bit by bit, yourself, or seek professional help.


The collaboration of parents with professionals helps legitimise the situation of PWS;  the same story from counsellor (or school) and parents, is often more easily accepted as being ‘ok'. This acceptance will play a major role in if, how, when and where this human sexuality is expressed.  I personally think there is a need for honest, uncomplicated sex education that is two-way.  In other words, listening to the child/teen/adult's concerns and questions, as well as giving the educational side of things.  Softening the blow is always good, but remember that people with PWS are not dumb, they are quite astute and frequently need to hear the full, detailed story!

Deep water.  Yes, often it is, and I know I've written about this in a previous blog and I've been through the whole "I want to have sex" drama with my own daughter, but before I proceed, I just want to reiterate that this is a personal issue for each and every person, and for each and every family.

My daughter decided a couple of years ago when she was in her mid-twenties, that she and her long-standing boyfriend (and that's another story... I mean, she insists he's her boyfriend, yet she hardly ever bothers to see him unless there's a present in the offing) were going to have sex.  This was nothing to do with babies that I could see, it was all about sex.  Great, I thought.  Just what I need, and in spite of the numerous blocks I tried to put in the way (visit to the doctor for sex health education, visit to the sex clinic, sex talk from me, sex talk from her residential manager), she was determined.  To cut a long story short, we (her parents, and her residential staff) agreed it would be ok.  So armed with a box of condoms ("will this be enough, Mum?") she and her boyfriend had sex.

When I next spoke to her, I asked her how it all went (well... you know our kids, they're always willing to share!).  "Did you sleep together?" I asked, and in all innocence she replied, "No, he went home!"  I tried again, "Did you and .. make love?"  Her reply, "What's that?"  It was at that point, I remembered her concrete thinking.  "Did you have sex?"  I asked.  "Oh!  Yes," she said, "twice, but the second time it wouldn't work."

It was all I could do to contain myself.

"We're not going to do it any more, we'll wait til we get married," was her final comment on the subject.

It led me to think about all of this.  Somehow, all she was wanting to do was to be like the next person.  She was acting out a fantasy.  A curious situation, I admit, but she was behaving like a teenager wanting to explore her own sexuality.  She was well out of her teens, but her knowledge about sex was still exploratory and, as far as she was concerned, needed to be tested.

As I said before, everyone's different and I've heard a lot of stories from parents about this subject, but I think the hardest part is the very first time you hear, "Why can't I have babies?"