Healthy Weight: A Continuing Crisis

Looked at from one perspective, eating disorders can seem the domain of the rich and famous, the models and the actresses, of Victoria Beckham and Princess Diana, in reality they are widespread–across financial groups, ethnicities, and genders (would you believe that nearly 1/4 of  preadolescent cases of anorexia occur in boys, with binge eating disorder hitting males and females equally?)–and are, in addition, deadly serious.

In fact, the numbers are hard to get your head around.  Approximately 24 million people in the U.S. have an eating disorder in one form or another. And–more challenging yet–a paltry 10% of those will receive treatment.

Whereas we like to think of ‘those with mental illness’ as other than us–think of schizophrenia or bipolar disorder; we prefer to see them as diseases that could never touch us–eating disorders are like European sparrows–common in every state and hard to eradicate.

We’re all familiar with the terrifying anorexia nervosa, which can turn into bulimia nervosa (a disorder on its own, characterized by binge eating and purging [usually by vomiting, although some use laxatives, or even extreme exercise. binge-purge cycle, using vomiting or laxatives] when the starving person can’t take it any more.

At first blush, it looks like bulimia is the get-out-of-jail-free card: eat all you want and stay skinny. This is not a slam-dunk, however.

Although bulimics are often ‘normal’ weights, they are usually extremely unhappy with their body shape and size and live in fear of gaining weight. Additionally, the purging causes a number of physical symptoms, ranging from a chronic sore throat to gastrointestinal problems to electrolyte imbalance to worn tooth enamel. (In fact, I have an aunt and a cousin–her daughter–who both suffered so badly from bulimia they had to have their teeth completely re-surfaced. Don’t fancy that insurance covers that either.)

Sometimes the patient binges without purging–binge eating disorder.  If you subtract the bingeing and eat mostly at night, you might have night eating syndrome.  Here the sufferer grazes all evening, sometimes waking up to eat. She feels she can’t eat in the morning but may have to eat in order to get to sleep.  Add to this people who restrict according to any number of current fads: gluten-free (for those without celiac disease),  sugar-free,  carbohydrate-free, etc.

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75% of “normal” weight women [which, I acknowledge, is a rather loosey-goosey kind of term] believe themselves to be overweight, while 90% overestimate their body size.  Reading fashion magazines wreaks havoc with women, both young and old. In an article titled “Still killing us softly: Advertising and the obsession with thinness,” researchers ran a number of studies on women after exposure to fashion magazines such as Seventeen.

In one of their surveys researchers told girls between the ages of 11 and 17 that they could have three magic wishes–anything they wanted. What came out as the number one wish, far, far ahead of number two? The winning wish for these young women was  to lose weight and keep it off” (Kilbourne, 1994).

When the same team surveyed middle-aged women (no age was provided, so I’m assuming these women were clearly years older than myself), asking them what they would most like to change about their lives, more than half of them said their weight.

Back to the those adolescent girls. Eating disorders is actually the third most common illness to be found in that population (it follows only asthma, and–ironically–obesity).

But there is more shocking news yet to come. I did a little unofficial survey amongst family members, asking which mental illness they thought had the highest mortality rate, and I got a plurality of “bipolar”s with a “schizophrenia” thrown in for good luck.  I actually give them partial credit, since bipolar disorder has the highest suicide rate of all the disorders (although eating disorders, are, tragically, giving it a run for its money)–but. . .

20% of people who suffer from anorexia, one of the more common of the eating disorders, will die prematurely due to complications related to the disorder, complications from heart problems to osteoporosis to gastrointestinal complications to dental problems. . .to suicide.

Suicide has become such a real problem that, if we include all eating disorders in the numbers, a the American Psychological Association highlights the findings of a 2003 Archives of General Psychiatry study which found that those with these conditions are 56 times more likely to suicide than their peers.

In point of fact, eating disorders have a higher mortality rate than any mental illness.  For anorexia alone approximately one in 10 cases ends in death.  If you narrow the scope to women between the ages of 15 to 24, the mortality rate from anorexia is 12 times higher than any other cause of death.

So. . .to turn to treatment.  Sadly, if you simply look at the statistics, it’s just bad news heaped on top of bad. A mere 10% of those with eating disorders ever receive treatment at all, and only 35% of those get treatment at places that specialize in treating eating disorders.

The costs to treat these illnesses are staggering in themselves. In the US, just outpatient treatment alone, which includes therapy and medical monitoring, can cost $100,000 or more. That’s cheap compared to costs of inpatient treatment, which can be $30,000 a month–or more. And–hold on to your hats here–it is generally estimated that those with eating disorders need between 3-6 months of care.  I saved the “best” for last: health insurance companies more often than not deny coverage–surely of inpatient stays, and sometimes of outpatient care, as well.

Those shockingly high costs stand in the face of distressingly lowgovernment expenditures on research into causes of and treatments for eating disorders. Check out the chart below, published by the National Institute of Health in 2011.

Research dollars spent on Alzheimer’s Disease averaged $88 per affected individual in 2011. For schizophrenia the amount was $81. For autism $44. For eating disorders the average amount of research dollars per affected individual was just $0.93.

Perhaps the lack of spending and the ineffective treatment are linked in a vicious cycle. Indeed, eating disorders are one of the most difficult of the mental illnesses to treat.  McAleavey (2008) writes that, “because eating disorders are often difficult to treat and the individuals who have them often exhibit significant comorbidities, the long-term success rate (3-5 years or more)–defined as recovery and abstinence from the disorder behaviors–is in the 40% to 50% range, at best.”

Of course it’s a matter of your perspective:  true, half of those treated don’t get better, but that means that half of those treated DO.  This absolutely obligates us to do our best to get our children, friends, spouses–anyone we love and care about who is suffering from an eating disorder–into treatment, and the quicker the better, as early diagnosis and treatment greatly improve chances of recovery.

And treatment takes Ms. Clinton’s proverbial village. Best practice usually requires a psychologist to identify the most important issues, help develop a treatment plan, and work with the patient to replace destructive behaviors with more constructive ones; a psychiatrist who might be needed to deal with what are often underlying depressive issues; and a family therapist.  Important theories of the “causes” of eating disorders include family triangles, history of depression and self-injury, and previous sexual abuse, although the experts are far from a definitive answer.

Because there is so much collateral damage from these disorders, the team isn’t limited to mental health workers. There is need for a primary care physician, to monitor the patient’s health–and a nutritionist may be on hand to  assess the patient’s nutritional intake and work to create a better nutritional plan.

And, fortunately, researchers have begun barking up new trees, looking into whether any DNA variations are linked to the risk of developing eating disorders, and utilizing neuroimaging studies to try to better understand eating disorders and possible treatments. In fact, already one study found different patterns of brain activity between women with bulimia and healthy women.  Clearly, looking for new avenues instead of relying on the same old treatments that have failed us in the past is cause for hope.

Should you yourself want to do something, there are many things to do, some maybe very close to home (which is a strong preference of mine), and a number of organizations that do good work. I just list one here, the National Eating Disorders Association.

Unlike so many organizations, NEDA is not just looking for money. You can volunteer, attend on of their walks, register to receive advocacy alerts–or, of course, donate financially (no one ever turns that away).

If it’s you, dear reader, with a “hidden” eating disorder, take a risk on treatment.  The tremendous physical and psychic toll the disorder inflicts costs all those whom you love and love you, not “just” yourself.  It’s a good week to take the first step.

Mental Illness Awareness Week

I know, I know. Another Awareness week.  These things can get old fast.

But behind each Awareness Day, Week or Month that we cover is an intricate tale of unmanaged suffering too painful to overlook.

You might think mental illness (MI) affects only a small few–but you’d be thinking wrong.

According to Kessler et al in the “Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication,” published in 2005, 26.2% of Americans 18 and older–that’s about one in four adults [they did the math for me, so I’m pretty sure it’s right]–suffer from a mental disorder in any 12-month period. However, the Center for Disease Control estimates that “about half” of U.S. adults will develop a mental disorder. I say we hold by Kessler, shall we? Both agree that suicide is the 10th leading cause of death in the U.S.

Meanwhile, one in 17 (that’s about 13.6 million) Americans live with what’s known as “serious mental illness” (they even have their own acronym: SMI), which includes major depression, schizophrenia, or bipolar disorder.  SMI is defined by federal legislation as a mental disorder that substantially interferes with life activities and ability to function.

While everyone seems to know about the debilitating effects of cancer, multiple sclerosis, or AIDS, few are aware that, according to the National Institute of Mental Health, mental disorders are the leading cause of disability in the U.S. and Canada.

Looking outside ourselves for a moment, the statistics are virtually the same, with the World Health  Organization (WHO) estimating 1 in every 4 people worldwide will develop one or more mental disorders at some point in life.  As of 2010 that’s a staggering number– 450 million people.

It’s hard to get your head around a number like that;  it means that mental illnesses are more common than cancer, diabetes or heart disease.

Yet treatment is much vastly more inadequate. In fact, there is a general inequity in treatment resources between wealthy and impoverished countries when it comes to mental health. WHO points out that in low-income countries there are 0.05 psychiatrists and 0.42 nurses per 100,000 people.  I know, it’s very hard to get your around that. I’m trying to picture 5-hundredths of my own psychiatrist arguing with me about my weekly blood-tests.  Surely I would win in that case?  In high-income countries, the rate is 170 times greater for psychiatrists and 70 times greater for nurses.

However, these higher percentages in wealthy countries isn’t worth much. Wang et al (2002) estimates that every year in the U.S. 8.5 million people with SMI fail to receive what the researchers term “minimally adequate treatment” (and they really do mean minimally*) with standards usually established by the American Psychiatric Association.

Availability for treatment of children is staggeringly less adequate. Both in the US and around the world, half of all mental illnesses begin before the age of 14. Yet, notes WHO, the majority of low- and middle–income countries have–get ready for this–one child psychiatrist for every 1 to 4 million people. Just think what they could charge Medicare!

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Okay–so what to do?

The National Alliance of Mental Health (NAMI) is a start. (NAMI is the country’s biggest mental health organization. It advocates at all levels of government, supports research–and is just there for the mentally ill.  Check out their site for Mental Illness Awareness Week 2013.)

When they say “write a Letter to the Editor,” NAMI provides you with the entire structure for that endeavor–and practically every line as well.  Your biggest job is remembering how to sign your name. [See Model letter to the editor.]  Same with the Op-Ed, except they ask even less of you [Model op-ed]. (Truthfully, I exaggerate a little.  For each of the previous, NAMI requests that you put in a personal anecdote.  It doesn’t seem too much to ask, given all they’ve provided.)

Then–no fools they–they provide a link to their store, where you can buy anything from a Mental Health Care Gets My Vote! Bumper Sticker to A Family Guide: What Families Need to Know About Adolescent Depression to a Famous People Poster (which, to be honest, struck me as fairly random. It includes Abraham Lincoln, Beethoven and Charles Dickens–right alongside Carrie Fisher and Patty Duke).

Look-you may very well not want one of these, but some people’s greatest contribution to causes is spending money, and if that’s you, you’ve got to go with what they’ve got–maybe even buying your own copy of A Mental Health Recovery and Community Integration Guide for GLBTQI Individuals: What You Need to Know.

AND–did you think I would ignore this?–this is also the week where you need to take the crucial step of either getting yourself screened for depression, or firmly encouraging someone near you to do so.

In 2007, just under 3 out of every 100 people in the US were treated for depression. That would be just fine–but the CDC reported that 1 in 10 adults are actually depressed.

Simply determined you won’t be seen in any mental health practitioner’s office?  Okay–you win (I really don’t know what)–but there are online screenings.

Pick a reliable site, like, Psych Central, which has an 18-question quiz it asks you to take weekly, or Mayo Clinic, which has its own Depression self-assessment.  Better yet– since it’ll actually mean something to your doctor, should you ever get in to see one–choose the Depression and Bipolar Support Alliance. This professional level inventory uses a standardized diagnostic test, known, as they all are, in letter gibberish as the QIDS-SR, which means (guesses here-anyone?): the Quick Inventory of Depressive Symptomatology Self-Report (any winners?).

Back to those NAMI Op-eds and Letters to the Editor–and their requests for personal anecdotes.

If MI statistics don’t move you, perhaps just a word or two from your local sponsors, or someone who’s been through it, might mean more. We owe it to the mentally ill to make sure they have access to good health care and strong advocacy groups, not just because it’s ‘the right thing to do,’ but because MI could strike one of us, at any point in time. My motif: You think it can’t–but it can.

I know the following to be true, from first-hand experience, and I assure you, although you may feel confident it could never happen to you, the statistics and I think you might be wrong:

  • MI can sneak up on you, insidiously making its way into your life to the point that it feels unmanageable, You sense it’s coming, you don’t feel well, something’s wrong, your parent, friend, spouse has urged you to see a therapist for months.  If you don’t take care of it–I mean, really treat it–you may soon be sicker than you could have ever imagined.
  • You think you are fully independent.  You work, you live alone, you run your own life. MI can take that all away from you inexorably.
  • You have a job, a career, really. You earn a living, and are well thought-of.  You think that because that is true today it will be true tomorrow and next month, year, decade…. MI isn’t interested in your career plans. Just as food for thought: I was a well-respected English teacher, for 10 years, and I pulled my students through those classics, sometimes kicking and screaming. (If I only knew then that I’d actually be heading down that “Road Not Taken”–and wouldn’t recommend it to my worst enemy.) Now, after months of the whole sickness thing–hospitalizations, ECTs,  multiples of med trials–I’m able to go back into the school where I once did that teaching–as an aide to my sister, who’s the assistant principal. It is a tremendous step, and I’m grateful. But I’ll give you 3 spins of the wheel to guess what I do there.  Give up? Yesterday I passed out Clorox wipes; the week before I did Kleenex boxes.
  • Think you’ll never move back home? Couldn’t possibly stand living with your sister-in-law, let alone your mother, Heaven forfend? Wait until your depression is so bad you can’t get out of bed to bathe, couldn’t possibly make it to the store to get food, and you wake up in the morning so afraid of the day that you scream out for someone–anyone–to come.  Mom and sis start to look pretty good in the face of outright terror and self-neglect.
  • Time betrays you.  You’ve spent your whole life feeling they’re just aren’t enough hours in the day. And then, suddenly, you feel like you’re swimming through a molasses of minutes. You find yourself gripped by an unnameable fear, counting the seconds, clutching your covers, convinced you won’t make it through to the moment when you can just sleep again.  But you’re afraid even of sleep, with its blessed release, because sleeping means waking up to do it another day.
  • Have you always been, deep down, a little vain about your looks?  Between the gym, your hairdresser, and some quality makeup, have people always taken you for younger?  Well one class of meds puts 25 pounds on you in a month for starters, while another makes your hair fall out in chunks. You’ll need a new cover for your shower drain–and your doctor will teach you how to monitor your new-found diabetes. There are plenty of places to donate your size twos–and fours, and sixes, and eights. . .
  • Always been pretty swift? Did well in school, had a hot-shot career? Real MI is going to surely rock that boat. Aside from the leave-of-absence (end-date unknown) you’ll be taking anyway, SMI comes all wrapped up–just like a Christmas gift–with cognitive impairment.  That’s without ECT (see below). So you can spend some of your endless hours re-learning skills you had mastered by adolescence: practicing reading advanced texts, depending on your GPS for the routs to your brother’s house, or re-teaching yourself how to use your iPhone, even though you used to be an Apple whiz.
  • Remember that scene from “One Flew Over the Cuckoo’s Nest,” the one that makes you want to sign right up for electroconvulsive shock therapy (ECT)?  I know, I know: You say to yourself now that you would never undergo such a treatment (even though it’s nothing like the movie).  But the truth is: you cannot imagine what you will do to try to relieve a depression so crippling that life has become a morass of minutes. You just might find yourself begging for it.
  • And then you may not realize quite how unique suffering from MI is–until you to want to reach out to others, and they, simply put, don’t want to hear about it. When they ask, “Hey, where you been these past two months,” I assure you they do not want to hear, “Oh, I was locked up in a hospital where I stayed in bed all day except when it was time to wait in the med line–oh, and except for the days when they took me to the OR on a gurney to force a grand mal seizure. That’s pretty much it–how ’bout you?” In fact, you may never be able to tell some of your friends about your experience with MI. [Interestingly, the CDC ran a study in 35 states + DC and found that 22.3% of those interviewed believed “people are caring and sympathetic to persons with mental illness.”]

So that’s it. I was no different from you. But things can change, and mental illness is non-discriminatory. It also gets worse without treatment, increasing damage to the brain with multiple episodes.  But here in this country, approximately 60% of adults and almost 50% of children ages 8-15 suffering from MI received no services in 2012.

So sign a petition to Congress or a Pledge for Wellness–take for yourself or get a friend or family member in for a Depression Screening. Maybe let a friend who’s been through the ringer with MI finally talk about it. Just do something. Because it’s awful–and because it could happen to you.

[*According to the NIMH “minimally adequate treatment for major depressive disorder (MDD)” is either 4+ outpatient visits with any kind of medical doctor plus a prescription for an antidepressant or mood stabilizer for at least 30 days; OR 8+ psychotherapy sessions lasting at least 30 minutes each.  This does, indeed, strike me as minimal, although not, perhaps, as adequate.]

National Prematurity Awareness Month and Day

My oldest niece is the closest I ever came to having a child of my own.

I do fully understand that you can never truly grasp what it’s like to have a child until you do, indeed, have one, but if all it took was a love so deep and wide that the famous Spanish explorers could drown their armadas in it–well, I’d qualify as a psuedo-parent.

I even had that crazy and most unpleasant paternal trait, that one where, when your child does something, anything, that you think is special, it makes you want to go outside and accost total strangers: That’s my kid! Did you see what she can do?

When my niece was real young and wanted someone, someone important like mom, she would call out “Auntie Rhona – Mommy,” as if we were one, one person whose attention she needed, one person who had to see her latest creation, one person to the rescue.

My love for her has always held its own, and, even now, now that she is a teenager, with all that that entails, it is still there, holding her–and she is not too big to fit.

But there is something particularly special about my precious niece – something that would’ve changed the structure of my world inalterably if her apparent destiny had become reality.

Sophie should have never made it out of the neonatal intensive care unit (NICU).

Sophie is not just my special niece (and I’ve got others, who, believe you me, I’ve got no lack of love for) because she is the first, because she is so acutely sensitive to others’ needs, or because she is “a good kid.”  Sophie holds a special spot in all of our hearts because she she came into life the size of a Bic pen.

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12 years ago we knew good news wasn’t coming.

My sister had pre-eclampsia, a no-joking condition that’s a combination of raised blood pressure and something called proeteinuria, which–pretty much like it sounds–is the presence of protein in the urine. Unhindered, it can damage organs like the liver or the kidneys, leading to issues with blood clotting.

I don’t have one positive thing to say about pre-eclampsia–except that you can only get it when you’re pregnant.

Now, you should know, in my family we don’t mess around.  You see the word ‘pre,’ and, having done 7th grade grammar, you realize it means ‘before’ (that’s what I’m assuming you know; no need to set me straight). But the illness has the potential to progress to a much more dangerous condition–eclampsia.  That occurs in only 1 in 2,000 pregnancies.

My sister, apparently, didn’t want to miss that part of the action.  Eclampsia can cause fits and convulsions, and–and I bless my stars we all were too stupid to know this at the time–can also cause the deaths of both mother and baby.

Worldwide, preeclampsia is responsible for up to 20% of the 13 million preterm births each year.

A baby is considered premature if it is born before 37 weeks, and considered severely premature if born before 32 weeks.

My niece was born at 27.5 weeks. She weighed 1 pounds and 13 ounces.

This, in short, is far less than ideal.  But, sadly, it is not unusual.

In 2009 the March of Dimes (I’ll come back to them) and the World Health Organization published the first white paper on the “global and regional toll of preterm birth worldwide.”

Of the 13 million infants born premature each year, more than one million of them die within a month of their births.

Additionally, premature births make up 9.6% of all births and 28% of newborn deaths. The highest rates of premature birth are in Africa–which is what you probably figured.

Now guess where the second-highest rates are.  Clear yourself of all prejudices.

What’d you guess? South America? Asia?

You lose.  North America has the second highest rates (that IS Canada and the US combined, but still).

Premature babies (assuming they live at all) can–and often do–suffer from any or all of the following short-term problems:

  • Babies born before 28 weeks are at heightened risk of intraventricular hemorrhage, or bleeding in the brain.
  • Difficulty breathing is common, due to an immature respiratory system. In serious cases, this can prevent other organs–themselves not fully developed–from receiving the oxygen they need.
  • Hospital acquired infections affect up to 40% of infants in the neonatal intensive care units (NICUs).
  • Babies born before 30 weeks frequently  experience a heart problem known as patent ductus arterioles (PDA), an opening between two major blood vessels leading from the heart.  They also suffer from low blood pressure.
  • Any baby born before 38 weeks has a higher risk of developing blood problems, like anemia (insufficient red blood cells) or infant jaundice (yellowish skin discoloration of the baby’s skin and eyes).

Assuming the NICU sends the premie home with the above problems resolved, there are long-term problems to face, as well.

  • Currently, one in 10 babies is born prematurely in the U.S.  Half of those who are extremely premature will go on to have mental or physical disabilities, a quarter of them severe.
  • Researchers in Rhode Island determined that at least one-third of babies born pre-term need school services at some point during their education.
  • One in 10 premature babies will develop a permanent disability such as lung disease, cerebral palsy, blindness or deafness.
  • Chronic lung disease that requires ventilation occurs in at least 20% of preterm infants.
  • While the prevalence of mental retardation is 0.4% among full-term infants, it is 4.4% among premies.

Clearly, the babies need intervention, and the parents need support. So in 2009, to raise awareness of the seriousness of the issues facing children born too soon, the March of Dimes began their campaign for awareness with Prematurity Awareness Month in November.  Within that, World Prematurity Day was launched on November 17 in 2011 and has grown far beyond the founders’ initial projections, currently being observed in over 50 countries.

So. . .another awareness month.  What now, right? Wondering what you can do to make a difference?

The March of Dimes is glad you asked. First–what is this March of Dimes?

The March of Dimes is an interesting organization begun by President Roosevelt himself in 1938 to fight polio, which it did–quite effectively–until the mid 50s.  With the invention of the Salk vaccine in 1955, they were out of a mission, so to speak, so they pretty much had the choice of either disbanding or finding themselves a new purpose.

It always takes some time to truly find yourself, so it wasn’t until the mid-1960s that the organization decided to focus its efforts on infant mortality and birth defects. In 1976 they changed their name to the March of Dimes Birth Defects Foundation, and in 2005 they added to their mission reducing the number of preterm babies–and the damage these babies suffer post-birth. They, of course, have lots of ideas about what you can do.

  • You can donate to the March of Dimes’ program to support families in the NICU. Giving birth to a premature child is overwhelming and difficult, and the March of Dimes NICU Family Support says it is there for the parents during their “baby’s stay in the hospital, during the transition home, . . .and [even if their] baby never makes it home.”
  • Thought it was all going to be about giving money?  March of Dimes asks you to donate your cell phone. They say they can raise money through that venue to go ahead and improve the health of premie babies.
  • You’re more of the ‘get-up-and-go’ type? There’s Mothers March, which is actually the organization’s first–and largest– fundraising event, begun in 1950 (again, then to fight polio), but which has morphed into a campaign to give babies the best start they can have in life.

But really, you don’t need the March of Dimes to make the Awareness Month or Day special.  You can always blog about prematurity–its causes and its effects.

You can make it your business to spend some time visiting babies in the NICU. Studies show that tactile stimulation (including massage or cuddling, but also including just plain human touch) can improve weight gain in premature babies. Spend 20 minutes a week cuddling a premie.

Or–if you’re as lucky as I am, to have a premie in your life who has not just survived but thrived–well, you can hold that success story tight and tell her how much you love her. Because her fight to make it has altered and enriched your world forever.

Wear purple today and all month–the color for prematurity awareness.

The Little People: Prematurity Awareness Month

You may recall that I wrote about my love affair with my severely premature the born niece.

No don’t get scared off – you don’t haveto hear about how wonderful she is again, how acutely sensitive she is to others’ needs, how she’ll drop me a text from time to time just to say she loves me.

I’ll skip to something far more relevant, especially right now, as people try to sign up for insurance, and face the equivalent of the blue screen of death. For as much as we in America pride ourselves on having the best care in the world, it happens to be that precisely no one else– even after extensive research – agrees with us. The most expensive health care? We win hands down. The best? Not on your life – literally.

My sister – the one who brought us my special premie niece Sophie, before we had regular niece and nephew programming – married an Englishman (couldn’t resist that accent, I bet) and, before I knew it, was over the pond, living in a small hamlet in the UK.

In due time we had the exciting news that she was expecting – although all too soon we had the much – less – than exciting news that she had preeclampsia, and the scary news kept coming, until my sister was in the hospital, dreadfully sick, and to save both baby and mother–in short– it was time for my niece to come – even though of course, at 27.5 weeks, it was no time to come at all.

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In England they were quick to put the patient ‘in hospital’ (as they say), even for days they thought might be just watching. She didn’t have a limit of hospital days on her insurance plan. There was no issue of preapproval. Here was a very sick expectant mother. So they pulled out all the stops.

And there is no doubt that saved my little niece’s life. As my sister sickened and as her preeclampsia  became a full blown case of eclampsia, the doctors pumped in steroids to hasten lung development.

I’d like you to hear my sister’s thoughts on her English prenatal experience in her own words:

FROM MIRIAM:

Both Barry and I just wanted to make the point that our health care cost in the UK was 0, which  would have been over $70,000 here in the US– and that was almost 12 years ago

Actually, I think it was 1000 pound a day for 70 days in the hospital.  So well over $100,000  for mediocre treatment.
The UK was doing kangaroo care and a lot of other cutting edge treatments before the US ever got them.
I think one of the most important things was that we had a midwife come to the house as opposed to having to go to a clinic every week or month. That was just for prenatal care.  They gave postnatal care at the home as well

I  spent a lot of time in the hospital before both children were born, which probably prevented them from being born even earlier than they were;  again the cost was–drum roll please– 0.

In fact, I had my preeclamsia seizure in the hospital.  I could have died as well as little Sophie if I hadn’t been in the hospital in the first place.

Finally, Barry and I stayed overnight in the hospital with Sophie the night before we went home. We had our own little hotel-like suite.

As Ricky Ricardo would say to Lucy, we in the US have “some s’plaining to do.”