Chasing it


Baby needs a new pair of shoes.

That ought to be the campaign slogan for the current push to legalize casino gambling in New York State. There will be a hard-fought, big-money campaign designed to win your vote if the state legislature can get out of its own way long enough to twice pass the required constitutional amendment for legalization.

There’s no gambling in New York State. So says the state constitution — except for nine full-service Native-American casinos (Aksesasne Mohawk in Franklin; Lakeside in Cayuga; Mohawk Bingo Palace in Franklin; two Seneca Alleganys in Cattaraugus; Seneca Niagara; and the ever-popular Turning Stone, near Syracuse). Oh, there are also nine Racino facilities at race tracks like Monticello and Saratoga (where no one gambles, right?) equipped with video slot machines. Then, of course, there is the state lottery, where it’s only a dollar, so it’s not really gambling, as the state siphons off proceeds from where they’re supposed to go — to schools (ironic, huh?). And church bingo, on-line poker, millions of Super Bowl pools, and on and on.

So, with all that, what’s the prize? Well, supposedly, full casinos will service the New York City market, for which many fancy suitors have lined up waving cash in the faces of the deciders. And with full legalization, the state’s share of the “earnings” goes up exponentially.

The deliciously ironic aspect of the whole farce is that state lawmakers could actually put an end to the hypocrisy of the state constitutionally-mandated ban on gambling in the face of what is already billions of dollars of gambling.

What the good solons of the state, both houses of the legislature, Senate and Assembly, have already done is step one — approving a 17-word addition to the state constitution that would allow “casino gambling at no more than seven facilities.” Those seven sites have yet to be decided upon (and there’s the rub, but back to that in a minute).

What needs to happen next is for a newly elected state legislature — and elections for such are this coming November — to approve it again. That could happen as early as January.

The governor, of course, then has to approve it. And when that happens, the entire thing is subject to a statewide referendum, and that’s where the campaign slogan kicks in.

The difficult part is deciding those seven sites. That will be the largest part of the battle.


Too much cash at stake

Once before, in 1996, a state legislature passed the required bill. The second legislature was set to pass it early in 1997, with New York City mayor Rudy Guiliani’s approval, because there were to be no casinos in the city. But as the legislators were getting ready to vote, a guy started running gambling cruises out of New York Harbor: no gambling until the boat got into international waters, twelve miles out. That enraged Guiliani who, with maximal clout, began to reassess his position. And Donald Trump, owner of an Atlantic City casino, began pouring lobbying money into the fight, seeking to defeat the proposition for competition. Scared leaders in the fight began abdicating, creating chaos on the Albany floor, leaving gaping vacuums of power until the measure was ultimately defeated.

Now, in what are hopefully the dying throes of recession, governmental entities are starving for new fresh cash. The casino effort has been revived.

Good food is self-love

[wide][/wide]We all know that Americans’ poor eating habits are responsible for the obesity pandemic. Many people still don’t know what good food is or believe that eating well just isn’t possible. Fighting those assumptions has transformed Health Quest nutritionist Roufia Payman’s job into a mission.

Payman works out of Northern Dutchess Hospital in Rhinebeck. She said she’s much busier than when she started her career 30 years ago. She’s seeing many more young people now. More people are coming to her with gastro-digestive problems that are a direct result of eating junk food. Others suffer from hypertension, elevated cholesterol and elevated triglycerides. Unhealthy food is the cause of at least 40 percent of the cases of diabetes, cancer, stroke, and other diseases, Payman said she had calculated. Poor diet impacts even a disease such as arthritis, since too much animal fat and sugar causes inflammation and excess weight puts stress on the joints.

Forget the fad diets. Payman, one of the speakers at Health Quest’s women-only Better than Chocolate event this past Thursday night, June 28, said she coaches her patients to change their eating habits permanently. They are told to eat fresh vegetables and fruits, lean proteins, low-fat dairy, nuts, and whole grains and to avoid processed, refined foods, which she calls “poison.” One of her patients, a schoolteacher who was a couch potato when she first consulted Payman five years ago, has lost over 110 pounds and now is a fitness enthusiast, teaching Zumba classes. Another is an 85-year-old who lost 15 pounds in two months and now enjoys rounds of golf.

“It’s a vicious cycle,” Payman said. “You eat bad food, which makes you tired and depressed, [and] which causes you to eat more to comfort yourself. My mission in life is to teach people that food is your medicine. Don’t make medicine your food.”

Payman grew up in Iran, where everyone shopped at local markets, bought their meat from butchers, and only ate fresh foods. Spinach, cilantro, eggplant, tomatoes, garlic, onions, parsley, radishes, and scallions were key components of the Iranian diet, with a few tablespoons of plain yogurt served at each meal.

Educating people to deal with marketing hype is a big part of Payman’s job. “The most important think I teach them is how to read labels,” she said. “Sugar is poison. Soda, fruit punches and other juice, even sports drinks — are garbage.”

She reads the ingredients from a box of raisin bran to her patients, showing them that the cereal, contrary to marketers’ claims of its cancer-fighting antioxidants, is full of sugar and refined carbohydrates. The additives in food are particularly designed by food companies “to get you hooked,” she said.

Her program includes consultations and recipes tailored to each person. “You have to really get to know your client, their background and relationship with food,” she said. “You teach them step by step.”

The basic message, however, is the same: “Learn to love the food that loves you back.”

“We’re too focused on a number on the scale or vanity,” Payman explained. “It’s about wellness, the quality of your life. I always say life and death are in the hand of God, but the quality of life is in your hands. What determines that quality is how you fuel your body.”

Payman advises her clients to avoid “anything white” — choosing brown rice, whole-wheat pasta, and whole-grain bread over white. Refined carbohydrates affect blood sugar, leading to dangerous swings, she said. For breakfast, a meal that she says should never be skipped, she recommends eating a lean protein like an egg. Natural almond butter or peanut butter on a slice of whole-grain bread is an excellent option.

Payman advises eating six meals a day — three smaller sit-down meals and three snacks and eating smaller amounts of good food more frequently. Protein is particularly important. It keeps blood sugar stable and prevents the kind of ravenous hunger that causes people to eat a bag of chips in one sitting.

Nuts, such as almonds or pistachios, fruits (washed, of course), raw carrots, grape tomatoes, and low-fat cheese are excellent snack foods. Busy commuters can keep some nuts in the car and bring pieces of cut-up apple or other fresh fruit or vegetable along. For drinks, water is best, along with herbal and black teas and coffee in moderation.

Given people’s busy lives, planning is key, she said. “Make dishes such as vegetarian chili or turkey burgers in advance and freeze them, so when you come home you simply take the food out of the freezer and it’s ready. If you don’t plan your meals, you won’t succeed.”

There’s never an excuse for not eating well, she added. “Today I was screaming at some poor man: Don’t tell me you don’t have time. Boil a dozen eggs in the morning and take one with you. For lunch eat a peanut-butter sandwich.’”

It’s a myth that good food costs too much. Payman said she was in complete agreement with a point made by keynote speaker Jessica Applestone, co-owner of Fleisher’s Grass-Fed and Organic Meats, Such foods as hormone-free, grass-fed beef don’t have to break the bank. Applestone said $50 worth of beef, sausages, chicken, pork, and bacon was enough to supply 10 meals, an affordable $5 per meal.

A small, three-ounce serving of meat is sufficient and in fact healthier, said Payman. Your dinner plate should be filled half with dark green leafy vegetables, a quarter with a whole grain such as brown rice, bulgur wheat, quinoa, or barley and the remaining quarter with a lean protein. Payman also recommended an eight-ounce serving of seafood a week.

In her talk, Applestone lambasted the labeling that prevails at the supermarket. Except for “organic,” all other health-suggestive labels, such as “free range,” “all-natural” and “artisanal” should be suspect, she said, given that they aren’t backed up by a certifying organization. Similarly, a consumer shouldn’t assume that a meat branded with the name of a farm means the animal was hormone-free and raised in a free-range pasture. Usually, it’s just another marketing ploy.

Better than Chocolate, held at Poughkeepsie’s Grandview, also featured Kelli Mayfarth, a board-certified genetic counselor at Health Quest. In her talk about genetic testing for breast cancer, Mayfarth said that genetic testing continues to evolve, with a new test for 20 genes introduced just this year. However, she noted that only 10 percent of overall cases of breast cancer are attributable to heredity.

Payman said that the best way to avoid falling prey to one of modern society’s common diseases was to eat well, exercise at least half an hour five days a week — and enjoy both. “Food isn’t just one thing. It’s the body, mind, and soul,” said Payman. “Always take 60 seconds to meditate before you eat. It’s about learning to love yourself. Good food is love.”

Pet med ethics

Just because you can do something medically, should you? Particularly when the patient is an animal?

We’re a household of aging cats. Except for the feisty shelter kitten we brought home last year, everyone’s a geezer. One has arthritis. Another is on daily meds for hypothyroidism. And yet another just had surgery for a hernia.

A visit to the vet’s office is never less than $300, and usually more like $500. There’s flea and tick repellant, blood tests, dental work, vaccinations and the range of illnesses that come with age.

Our latest visit revealed a new tool in the modern veterinarian’s arsenal. A very elderly, nearly motionless dog was being treated with a laser while we waited for our appointment. The laser, we were told, reduces inflammation and pain.

“It’s a great tool for chronic conditions as well as post-op healing,” we were told.

After the procedure (painless, we’re told) the dog lay sprawled across his owner’s lap. If ever an animal looked like there was no joy in his life whatsoever, it was him.

I’ve had animals all my life, dogs, cats, horses, even a donkey. I’ve been faced with enormous vet bills and I’ve scraped together the money when it was necessary. But how much is necessary?

There was an extensive discussion on the ethics of spending $25,000 for pet health care in The New York Times on April 9. Advances in medical technology have made procedures possible that simply weren’t in a veterinarian’s arsenal before, unless you took your pet to a high-tech facility like Cornell. Heart stents for Fido and chemo for Kitty are becoming routine offers. But there’s a price, and not just in dollars.

If we agree to a major medical intervention for our companions, is it really for them?

I know a couple who recently took their aging Yorkie to Cornell for surgery on his cataracts. The outcome is great — he can see and he’s a happy (though still neurotic) little dog. But I question the days in a hospital, pain, bandages, strange smells, major upheaval for a nervous animal and long days at home in a spaceman collar, confined as he was to a small area, frustrated, confused and uncomfortable. Would it have been kinder to simply let him be a blind dog? Who was that surgery for?

My crankiest old cat is arthritic. He’s also slowly failing. The signs are there: he sleeps more, he’s grumpier with the other cats, sometimes his breathing seems funny. How much should I intervene? I delayed taking him to the vet for fear they’d be pushing batteries of tests that would only tell me what was already obvious, while stressing out an old cat who just wants to sit quietly and be petted.

Thankfully, a new veterinarian in the area who seems to be on my wave length: Don’t overdo the interventions for geriatric animals, depending on the overall health picture. Dr. Eileen Jefferson has started a practice called “Ethical Veterinary.” Her partner and right-hand man is Brian Shapiro, former head of the Ulster County SPCA and a former county legislator.

They make house calls. She examined my cranky cat, pronounced him pretty fit for his age. She came prepared to do the gamut of labwork if needed, but she saw no red alerts. She offered some joint supplements to ease his stiffness and recommended he be allowed to simply be so long as he seems comfortable with no major changes. He stumped off with a definite I-told-you-so swing of his tail.

It’s a fine line. When our animals are miserable, when their futures seem to hold nothing but needles, drugs, scalpels and discomfort (even pain), is it cruel to keep them with us? The one thing we can offer them is a painless death, something we still cannot offer humans, even when we can’t control their pain or avert the inevitable. It’s an incredibly hard decision to euthanize our animal friends, and yet it’s a final gift, too. It’s not something to be done lightly, but I have been in situations where it’s the right choice.

My suffering cat, whose lust for biting kneecaps and diamond rings has descended into glassy-eyed lethargy, showed me when he’d had enough. My beloved dog, who could no longer stand up, made it clear it was time. Quality of life is what counts, in my opinion. Even if I had all the money in the world to try some expensive intervention, it wouldn’t have been right. The bottom line isn’t about me — it’s about them.

Authority is leadership

The TV spot for a bank showed a 30-something mother with her pre-teen daughter and friends. Instead of talking to each other, they were — what else? — both texting. The daughter was hot on the heels of some boy named Chas, while Mom was in pursuit of financial freedom. At one point, the mother became terribly excited and exclaimed (I am paraphrasing) to her daughter: “The bank is texting me about my checking and letting me know how much we have in our account.”

My husband groaned out loud. Was he in pain?

“Only existential pain,” he said as waved his hand at the screen. “I mean how much information do kids need these days?”

“What do you mean?”

“A healthy, happy family is not a democracy,” he said and changed the channel.

At first I thought it was just his formal Montana upbringing that found the new intimacy between parents and children a bit unwieldy, even awkward. In his family it would have been inconceivable for his parents to place themselves on such an equal footing with the four children. There was an abundance of love and involvement (they were all musicians and played together nearly every night after dinner), but not at the expense of a very clear hierarchy of authority. One’s mother or father was not one’s buddy.

Being from the Northeast, where people stood on stoops and yelled down to the other end of the block at dinnertime and where our emotions were as visible as our shirts, I dismissed his disapproval as an archaic remnant.

But over the course of the day, as I watched parents interacting with their children at supermarkets, hardware stores, in therapy sessions and at school yards, I began to see his perspective differently.

Parents as friends

What I saw was that most parents wanted desperately to be friends with their children. They dressed the same, talked the same, giggled the same with them, jockeyed for position to be cool or hip. No topic was out of bounds. They discussed their sex lives, their finances, their politics, and the issues they had in their social and work relationships.

I thought I would be appalled, but I wasn’t. I was embarrassed. It was a feeling not unlike watching someone leave a bathroom with her dress tucked into her pantyhose or seeing a colleague do something horribly revealing or inappropriate at a party. In those situations, I would have felt like covering my face to avoid being a witness the next day.

I took to wondering why. Why are parents so reluctant to be parents? What has happened in our culture and in our families that we are more worried about whether our kids like us than whether we properly prepare them for a life that is almost always challenging and sometimes damned unfair?

Many adults today have a difficult time with true authority. They vacillate between a laxity that is boundary-less and a sporadic struggle for power. I don’t believe there is just one reason for this. Authority for some of these parents may have been excessive, unyielding, irrational or capricious. Those people would certainly confuse authority with dominance and cruelty. Precisely because they love their children, they naturally want neither to be that way nor for their children to suffer as they did. That’s understandable. But I think it is still erroneous.

Authority for others may be antithetical to their more modern understanding of love, which is easygoing, permissive, unconditional (often in the wrong way), and blooming with constant emotional reassurance and validation. In their minds, authority says no when love says yes.

Anyone who has trained dogs knows that love and “no” are not mutually exclusive. In fact, I believe the only way to truly give unconditional love is to be able to say no, to love the person and loathe the behavior.

Still others seem to have misinterpreted biblical injunctions about authority with children. They have rejected them out of hand because they have mistakenly come to associate them with corporal punishment and shame. The most obvious interpretive error is the popular one which reads the Hebrew for “rod” (as in “spare the rod and spoil the child”) for a reed or a stick. That’s a misinterpretation. A biblical authority is not punitive. Parents are given the injunction to educate their children and to hold them accountable to the performance of all the commandments — after the children have been helped to understand them.

Authority is compassionate

It is a shame that authority has earned itself such a miserable reputation because it is perhaps the most essential element of truly effective and loving parenting. Authority can be quite kind and loving even when it is correcting negative behavior.

Nature abhors a vacuum. So do children. When parents do not provide authority, children assume the dominant position. It is not necessarily a bad thing. It is survival. Someone has to be in control.

So what is a parent to do? Start by revisiting ideas on authority. Authority is calm, sure-footed, firm, confident and compassionate. If you are tentative, hesitant, punitive or vacillating, you are giving mixed messages and can no longer be trusted to lead. Authority is leadership. Children naturally gravitate to leaders, to adults who seem to know what they’re doing. Children want someone to guide them while at the same time allow them to make mistakes and learn. Authority says: Follow me. I know what I’m doing. Authority says: I understand what you need. Authority says: I will keep you safe.

Most parents do not give themselves permission to be the boss and loving at the same time and are terribly relieved to hear that they may. So are most children.

When as a therapist I did behavioral contracts with children I always warned parents of the imminent dangers of setting new limits. “One, you may be a bit awkward at first. Be patient with yourself and your adjustment to a new role,” I urge. “Two, the better you get at it the more your child is going to test you. He is going to rebel. He may fly in the face of your authority. Stay still. Let him spin. Research has shown that there is a predictable learning curve to that reaction and that the tumult will pass — if you are consistent and maintain the authority over time.”

I have done a lot of hand-holding with parents as they experience the back draft of their newfound authority. But when it’s all done and the heat has passed, there is a new relationship to be enjoyed, one in which the parent is the parent and the child is able to relax in their loving, sure hands.

Focus on what you have

[wide][/wide]As a student in high school at Onteora several years ago, Nicole Chartrand participated in several sports and took classes in anatomy and physiology, English, history, and health.

She also spent part of each day at Kingston and Benedictine hospitals touring the facilities and becoming well versed in American standards of health care. She witnessed both a live birth and an autopsy.

Shadowing Dr. Richard McNally, medical director of pathology, convinced her she wanted to work with patients rather than in the lab, and it prepared her for her participation in the rigorous New Visions program the following year. In that program, she helped out at local health-care agencies.

This background turned out to be excellent preparation for the four months she spent in Rwanda last year as a junior at Houghton College. The basic standards Chartrand had become used to were lacking in Rwanda, particularly in the impoverished countryside, where she spent a month and a half at a health-care clinic in a small village.

“Wow, these people do not have the resources we have in the States,” she said. “It was hard knowing that while you could possibly save a life in the States, in Rwanda these people were going to die.”

Chartrand, one of 20 students in Rwanda in the highly competitive Go Ed semester-study-abroad program and one of three focused on health care, spent two and a half months taking classes in the capital of Kigali. While the hospitals in Kigali lacked equipment such as machines for CAT scans or MRIs, they were relatively sophisticated compared to the facilities in the clinic in the village of Rwamagana, about an hour’s drive north, where Chartrand was based for the remainder of her time.

The standard of health care in the countryside was abysmally low, with people relying on traditional medicine in many cases based on superstition. For example, practitioners won’t touch somebody having a seizure because they believe the person is possessed by devils, she said. “They wouldn’t let me go near them, either, so I couldn’t treat them. You have to respect the cultural differences.”

Lack of medicine for malaria resulted in many deaths, she said.

People were vulnerable to illness because they didn’t practice basic sanitation, Chartrand’s group discovered when they conducted a survey of conditions in a small village in the north of the country. The survey revealed that people had to walk a great distance to get water — sometimes as long as ten hours — which they then transported in large cans. Though the water might be contaminated with pathogens, nobody boiled it before drinking. (The community health-care workers Chartrand accompanied tried to educate the villagers about such basic practices, distributing picture books showing people boiling water, washing hands, and performing other health-protecting tasks.)

In the Rwamagana clinic, Chartrand assisted in the “little surgery” (as the French term translates). Some of her patients were soldiers getting circumcisions to reduce the risk of AIDS. Others were people receiving treatment for old wounds suffered during the genocide, such as festering machete wounds.

A group of children was once brought in who had been injured from an unexploded grenade they had discovered that had gone off. “They came in gaping in shock,” Chartrand recalled. “It was really sad. I treated four of them, and they were all saved. When the child who was only four years old started to cry, we said, we’re good. When they don’t cry, it’s a bad sign.”

The great distance people have to walk to the hospital to get care was another challenge. “Africans are very reserved,” she said, “They don’t complain about things, and you know if they’re coming to the hospital something is very wrong.”


A heart for people

Chartrand was able to communicate with some Rwandans in French, a language spoken only by those who attended school — which many people can’t afford. She picked up some words in Kinyarwanda, despite its status as the world’s fifth most difficult language. Residing in a nursing school near the clinic, she became friends with the students in the school. One was a young woman who after suffering from debilitating symptoms was moved to the capital and a few weeks after died.

Chartrand said the disease from which she was suffering was never identified, but was probably cancer. “She was only 21, and when her disease began, they didn’t have the tests to diagnose it or the chemotherapy to treat it,” she said. “It was a very hard experience.”

Chartrand returned to the U.S. in May, and later in the year transferred to SUNY-New Paltz, where she is now a senior majoring in molecular and cellular biology. After graduating this December, she plans to apply to medical school. In the meantime she expects to work as an emergency medical technician, having obtained her EMT certification through BOCES last summer.

Chartrand described her experience in Rwanda as invaluable. “It’s given me a heart for people,” she said. “I definitely want to go back, whether it’s Rwanda or some other place hurting for health-care practitioners.” She’s committed to community-based health care, whether abroad or in this country.

“I learned that people will trust you more if you have a relationship with them,” she said. “That’s just as important as what you are doing for them medically.”

Living in Africa also was valuable in testing her values, she added. “Going outside your comfort zone really teaches you what you believe in and why — doing something that’s right, rather than because it’s something everyone else does in your culture.”

She took away many lessons from the Rwandans. “Amidst all the poverty and pain, there’s still so much joy,” she said. “It’s an inexplicable joy, which we don’t see here in the States. We have access to anything we want, yet still we’re so unhappy.”

Learning to appreciate the little things was a big thing she learned. “I’m so appreciative of going to college and being able to afford it,” she said. “It’s such a luxury. Or walking or living in a place where I don’t have to be scared my house is going to get bombed. Even though they [The Rwandans] have so little, they focus on what they have, not on what they don’t have.”