My Vitamin D Journey

by Joan Vernikos PhD
December 2015

Early this year I shared on the emerging understanding of the importance of Vitamin D for health, and how you can test and manage your own Vitamin D levels.
Joan Saluting The Sun

My own story around Vitamin D has been fascinating and quite illuminating.

After a summer of sun, swimming and gardening last year my Vitamin D3 serum level was 25ng/ml 25-OHD. That’s average for the US today, so my result was a surprise to me. However Vitamin D3 levels dip as we age plus I have darker skin, which is also a negative factor in Vitamin D synthesis. The recommended normal range is 30-70 so I knew that something needed to change!

To make matters more interesting I was then and we are now entering the Vitamin D winter. This means that anyone living north of a latitude of 35°- almost all in North America and Canada – will get zero benefit from the sun from November to March. You can view this sunshine calendar to see how this works across the globe. 

Most people in North America are deficient in Vitamin D3 even prior to winter. They either don’t expose enough skin for adequate periods of time to make enough and/or do not make up for it from food or supplements.  Some like me may have been taking a daily dose of supplement without really knowing if I need it or if it was enough. Clearly the solution was to measure, and as I noted above my levels as of last Fall were low. I joined the Grassroots Health program ( ) to get my blood levels tested every six months while contributing my data points to their Global Vitamin D Data base.

My blood tests surprised me and I am sharing here what I have learned thus far. As I noted above, in September of 2014 at the end of an active summer and supplementing with a standard dose of 2,000 IU’s of Vit D3 which I had taken as ‘insurance’, my blood level was 26ng/ml or well below the recommended normal range of 30-70ng/ml. Grassroots Health’s data suggest that for every added 1,000 IUs taken the blood level goes up by 5ng/ml. With winter approaching last year I decided to increase my dose by another 2,000 IUs, making my daily dose 4,000 IU. By the end of March 2015 six months later by blood level had increased to 45ng/ml. Out of curiosity I increased my dose by another 2,000 IUs to 6,000/day. My latest Vit D3 blood level in early October and after an active, sunny summer was 73ng/ml. So taking the additional supplements seems to have worked in my case.

Because winter is here I shall maintain this dose of 6,000 IU.  Depending on my blood level at the end of March, I might reduce my intake through the summer by 1,000 or 2,000 IUs and return to 6,000 for the next winter. In my case 1,000 IUs raised my blood level by more than 5ng/ml. Each one of us is slightly different. One dose does not necessarily fit all and depending on your state of health you may need more or less. And it’s important to note that you would need to take extremely high doses for it to be harmful.

My intention is to share my results in the future while we collectively learn more about Vitamin D and its impact on health. Please share your own story with Vitamin D in the comments below.

Here’s to a healthy winter.

Vitamin D and Sunlight - What's The Big Deal?

by Dr. Joan Vernikos

What is It and How Does it Work?
Vitamin D3 is an oil-soluble steroid hormone that forms in your
skin when it is exposed to sunlight. Sunlight converts a cholesterol derivative into D3 also known as cholecalciferol. This is the most active form of Vitamin D. Over 80% is made in this way by the skin. Small amounts are in some foods, including fatty fish such as herring, mackerel, sardines and tuna and in smaller amounts in beef and chicken liver, cheese and egg yolks. In modern times small amounts of Vitamin D3 are added to milk and other dairy products, juices, and cereals. But diet alone won't provide enough Vitamin D to become Vitamin D sufficient.
During the darker months of the year, the modern habit of using sunscreen and our sardine habit not what it used to be, we have unknowingly become deficient in this crucial vitamin for health. The problem is most of us see inadequate sunlight directly above us from 10am to 3pm. Few expose enough skin that is not sprayed with sunscreen to protect ourselves from skin cancer and premature skin aging. Sunscreen reduces Vitamin D3 production by 98%. In the winter the sun is at too low of an angle over most of the US and all of Canada for us to produce adequate Vitamin D from sun exposure.

A bit of back-story: From the 1960’s NASA funded researchers to help us correct the loss of bone of astronauts in space. As part of this research, Michael Holick in Boston University and Bob Heaney at Creighton University, discovered Vitamin D3 was important for bone health by enabling the absorption of calcium from your gut. Without Vitamin D3 any calcium supplements you take simply go right through you unused. With Vitamin D3, calcium is absorbed into the blood from where together with Magnesium and Vitamin K2 it finds its way to bone, to build new bone. Together with calcium, Vitamin D helps protect older adults from osteoporosis. The amount of D3 commonly added to calcium supplements is too low for the job.
The Emerging Story on Vitamin D Preventing & Treating Illness
Since ancient times the sun was used to heal many conditions.  In 1933 medicine recognized 133 different conditions that were treated by sunlight. Without enough D3 circulating in your blood, your body simply does not function as it was intended – ridding the body of intruders, fighting disease, repairing cells. Muscles need it to remain strong and flexible, nerves need it to carry messages between the brain and every body part, and the immune system needs Vitamin D to fight off invading bacteria and viruses. It is used by cells throughout the body. That is its vital role in preventing a broad cross-section of diseases. Vitamin D is important to the body in many ways including, autoimmune disorders such as multiple sclerosis (MS),  Chronic Obstructive Pulmonary Disease(COPD), rheumatoid arthritis, inflammation, oxidative stress, autism, depression, dementia, pain and Alzheimer’s.

UV light exposure in sunshine has other health benefits that are independent of Vitamin D such as increased production of NO (nitric oxide) which lowers blood pressure, and setting the circadian clock. It is now established that Vitamin D3 is needed for each cell in the body to optimally access its own genetic DNA library. This is a big deal. The lower your Vitamin D3, the worse the problems from its deficiency you are likely to see during your lifetime. While sun exposure remains the most effective way to get Vitamin D3, the challenges of doing so coupled with its relative unavailability in foods, mean that we need to take supplements.

Who’s At Risk of Being Deficient?
In winter it is nearly impossible to gain adequate Vitamin D from the sun without spending long periods outside, and few of us do that! Even in the summer, as you might imagine, if you are someone who shuns being in the sun, or only allows a small part of your body to be exposed to the sun’s rays, you are probably deficient in Vitamin D. Even if you are a frequent swimmer or someone who works outside in the garden, if you religiously cover yourself with sunscreen you may still not be getting adequate Vitamin D3. Similarly if you live in more Northern latitudes (or Southern latitudes in the southern Hemisphere), you are also likely not getting enough Vitamin D3.
Black (dark) skin pigment needs 5-10 times more sun exposure than Caucasian (light) skin pigment to produce the same amount of D3. So if you are someone with dark skin or as you get older, you may need significantly more sun exposure to produce the same amount of Vitamin D3 as someone with pale skin. Know that burning is not at all required to get Vitamin D3!  People older than 65 are at highest risk of Vitamin D3 deficiency perhaps because they go outside less as they get older. Aging kidneys and less functioning skin receptors mean that less Vitamin D3 is synthesized. Additionally those who are obese are also at risk because their body fat binds to some Vitamin D3 and prevents it from getting into the blood.

How Much Vitamin D is Enough?
There are varying opinions on this but what I share here is my own options based on the science and what I have learned in a lifetime of work in the area of health.
In order to best know what actions you need to take you will have to have your blood levels measured. There are two vitamin D tests – 1,25(OH)D and 25(OH)D. The correct test is 25(OH)D,  also called 25-hydroxyvitamin D. This is the better marker of overall D status and health.
The recommended normal range is 50-70ng/ml of 25-OHD in the blood. The average person today is vitamin D3-deficient with a serum level around 25ng/ml 25-OHD. That’s what mine was at the end of a summer of swimming and sun. I was sure that my levels would have been much higher.
To achieve and maintain your blood level within this 50-70ng/ml range, you need to take approximately 5,000-6,000 IU’s/day of total Vit D3 from all sources – sun, food and supplements. Add up the amount from the labels of your food and supplements. If your level is low, I suggest you begin with 2,000 IU’s (or up to 4,000 IU’s/day for seniors) in supplements to increase your blood levels to the desirable range. If next time you measure it that was not enough, increase your supplement in steps of 1,000 IU's before you measure again. What matters is not what you take but whether your blood levels are in the right range. Therefore measuring your 25-OHD every 3-6 months is important until you know how to maintain a healthy level. You likely will not need as much supplementation after raising your level, but this will vary on an individual basis, so pay attention! The variations in sun exposure based on your location, the time of  day and of the year that you are outside, how much skin you expose, how old you are, how much sunscreen you use and how much you cover up (or don’t’) will all factor into your Vitamin D3 levels.

The growing body of work shows that to treat cancer or heart disease requires an even higher level of 25-OHD in the blood. Here are some guidelines that might help:

Levels of Vitamin D (25-OH Vitamin D)

  Deficient      Optimal    Treat Cancer and Heart Disease     Excess
 <50ng/ml      50-70ng/ml          70-100 ng/ml                        > 100ng/ml
<125nmol/L  125-175nmol/L      175-250nmol/L                       >250nmol/L
The amount you take in supplements needs to be carefully considered against how much you are getting from the sun itself. For instance if you frequently swim outside in the equatorial tropics  at noon for extended periods you likely will need much less supplementation that someone from Bangor, Maine who rarely goes outside. And know this: it is very difficult to get your Vitamin D3 levels to be too high for your overall health.

If  you want to measure your own blood levels every 6 months which is what I do, then simply purchase the D*Action Measurement Kit, part of the global non-profit Grassroots Project ( This site will also help you stay up on the latest information.

How To Control Sleep Interruptions at Any Age

By Dr. Joan Vernikos
March 2014
It is taken for granted that as we get older we will need to get up several times during the night to pee. Yet I do not believe this has anything to do with aging. Rather, it is something we can almost wholly control through a shift in one key lifestyle habit. My own experiences really turned me on to this reality as I myself passed the age 65 mark.
I was approaching retirement from NASA and was looking forward to getting a proper night’s sleep. During the years leading up to retirement I had been waking up at 5am. My routine was to get off to work early to beat the traffic, then exercise and call colleagues in other time zones before launching deeper into my new day. Yet I was anxious about my sleep. Was it a given that as I aged I would  experience nocturnal diuresis – the technical name for having to get up to pee in the night? I hadn’t yet experienced it but decided to take a proactive approach to preventing this reportedly age-related consequence. If you and your sleep are bothered by these frequent episodes, and even if you are currnently not, you may wish to try it out. Imagine how much better you will feel during the day after a night of uninterrupted sleep.

The Causes

There can be many reasons for nocturnal diuresis:

  • Various kidney, bladder and cardiovascular disorders, prostate issues, diabetes and medications commonly prescribed for them.
  • Diuretics prescribed for high blood pressure and heart conditions, also called ‘water pills’ like Lasix, Bumex, Esidrix or Zaroxolyn.
  • Common non-medicinal diuretics like alcohol, coffee, milk, juice, watermelon or too much water
  • Jet lag, shift-work or other day/night shift habits when the body’s day and night are confused.
  • A sedentary lifestyle.
  • When astronaut and cardiologist Drew Gaffney returned from his 9-day Shuttle mission(STS-40) eager for a good night’s sleep in his own bed, he was frustrated by having to get up multiple times. In space the day-night, light dark cycle is every 90 minutes leaving the body clock very confused.

Sedentary Lifestyle or Aging?

When a baby is born, its diaper is wet around the clock. When it stands up and learns to live in gravity, mechanisms develop involving Antidiuretic Hormone (ADH) that regulates the water in its body. For example drinking lots of water at one time inhibits your ADH making you need to empty your bladder.

During the day, when you are meant to move, ADH starts off low but increases as you stand up, move and are active. This is to help you preserve normal blood volume. But if you spend time lying down during the day or sitting for many hours at the office or at home in front of the TV, or go into a swimming pool, all conditions where gravity’s effect is reduced, your ADH is reduced as it is at night; you urinate more and can become dehydrated.

During the night, ADH is higher overall, reducing the urge to urinate and allowing you to sleep.  Yet research has shown that unlike during the day, if you get into a pool at night the kidneys do not respond to the ADH in the same way as during the day, and you do not need to urinate.  This is because a protective mechanism in your kidneys prevents them from responding to ADH at night in the same way as during the day. However, in the microgravity of space, in volunteers lying in bed continuously and in  those who sit much of the day and therefore use gravity less, this kidney shut-off mechanism eventually  becomes less effective. The result is the need to pee whenever you lie down whether it is day or night.

If you are like so many today and spend most of the day sitting, and especially if you sit uninterrupted for long periods, your body cannot tell the difference between day and night. So it responds to lying down at night with the same urge to pee as it does during the day when the body is expecting more frequent posture changes and movement. This has nothing to do directly with old age except that perhaps one may move less with age.  Much of this is up to us.

My Solution for Nocturnal Diuresis – Move!

I adopted the following habits that have served me well for the 15 years since I retired. Some are based on reducing the challenge you provide your system overnight, and the others on tuning your system so that it functions more optimally:

  • I eat my last light meal and avoid drinking anything the 3-4 hours before I go to bed.
  • I empty my bladder just before I go to bed.
  • My meals are low in fluids; I rarely eat soup or juicy fruit especially later in the day.
  • I avoid naps, rarely read and never watch TV in the bedroom.
  • Most of all I make a point of moving all day, frequently changing posture and never sitting for more than 30 minutes at a time even if I only break it up with 1 minute of standing and easy stretching.
  • Find your preferred activities: For more vigorous activity I personally play tennis doubles once or twice a week and practice yoga twice a week. In the summer months I swim regularly.

Simply, to minimize the need to awaken in the night to pee we can re-tune our systems and the regulatory mechanism of ADH with frequent, all-day movement. Participate in some more vigorous exercise activity from time to time as is possible, and you most suredly will see fewer sleep interruptions and more satisfying sleep. 

For more information on healthy aging habits, visit ThirdAge Health

Developing Relaxation Habits

by Dr Joan Vernikos

In recent weeks I have shared information on the importance of quality sleep and its impact on personal well-being. We all know that a good night’s sleep leaves us refreshed and full of energy to tackle the day. What a wonderful feeling that is!

So what about during our waking hours? During these times the analog to getting quality sleep is our ability to relax.

Let’s talk about relaxation

Relaxation is to release tensions – the tension that comes from feeling that things are not quite right (or really not right!). This tension manifests as different emotions but is characterized by a lack of ease. To relax is to let go and settle into what is, to stop being carried away by the things we see, hear, taste and touch (including ourselves), and instead remain open and curious to what is happening. In essence it is a change in how we relate to the vast amounts of information we manage each day.

Relaxing is a way to lessen the negative effects of stress on your mind and body. Practicing relaxation techniques is basically free and will help you cope with daily stress as well as stress related to particularly difficult situations, from illness to job loss to the death of a loved one. When we are more relaxed, it improves how we feel and how we relate to those around us. Like improving your sleep habits developing ways to relax will help you de-stress your life and improve your health (and surprise! experience more restful sleep.)

The first step begins with developing greater awareness of what is happening around you and especially of what you are feeling. It’s important that we learn to notice when we are getting stressed out in a way that is not helpful or necessary. When we can recognize getting uptight we can then apply instant relaxation techniques. Similarly, we can practice techniques that help us be more relaxed on an ongoing basis. 

Remember that relaxation techniques are skills. As with any skill your ability to relax improves with practice. Be patient with yourself — don't let your effort to practice relaxation techniques become yet another stressor. If one relaxation technique doesn't work for you, try another.

But it does take practice.

Relaxation Tips for Today

  • Breathe. Take a deep breath into your abdomen, hold it and exhale in a big sigh. Do this 3 or 4 times. Breathing is the easiest way to experience immediate relaxation, and your breath is always available to you.
  • Relax your face, jaw and scalp. Allow it to droop - you'll feel better in only a few seconds.
  • Pull your shoulders down. Drop your ear to your shoulder and hold for a couple of breaths. Repeat on the other side.
  • Practice gratitude. In mornings it is easy to feel a bit anxious. Instead, as you wake up consider the gift of another day and what you want to do with it. During the day take a break to recognize a few good things about your life. The more you look, the more you'll find.
  • Participate in your own creative hobbies. Shoot photographs or paint, write or scrapbook, whatever yours may be.
  • Spend time with your pet, showing it love and affection.
  • Exercise. People who are more active experience a greater level of positivity.
  • Unplug. Need any more be said on this?
  • Laugh! Watch or listen to funny shows or spend time with people who make you laugh.
  • Shift it from You to Them. When around stressed out or unhappy people practice developing compassion for the person, thinking how terrible it is for them to be feeling so poorly. Even if they are being unkind, consider that they are only that way because they are unhappy.
  • Go easy on the caffeine.
  • Soak. How stressed can you be in a warm bathtub or jacuzzi?
  • Get a Massage. But don't marry a massage therapist - you'll never get one!
  • Keep a journal. Journaling may be the best way to develop a more accurate view of what is going on in your life, and what you might do differently.
Ongoing Methods for Relaxation 
Practice Meditation, Tai Chi, Yoga or a myriad of other traditionally calming activities. Many have now been scientifically proven to relax you both while you are doing it and well afterwards. Personally, I practice yoga in a class setting once or twice per week and have found it greatly beneficial since I took it up in recent years.

For tips on getting started with a mindfulness meditation practice click here .

A Gravity-based Technique for Deep Relaxation

Here is what I use that might help you too achieve whole body relaxation. 
Lie on your back on the floor with eyes shut, palms up. Try and clear your mind of thoughts. Focus on your breath, gently in and out. Think about gravity pulling you down through the floor. Feel the weight of your heels sinking. Holding onto that feeling, slowly move up to your calves, hips, lower back, abdomen, shoulders, arms; let go giving in to gravity pulling you downward. Feel the knots in your shoulders and neck let go and dissolve.  Mentally move up to your head. Let go of all 15 pounds of it sink through the floor. Feel your scalp and your hair slide down away from your face. Let all thoughts on an imaginary screen be erased by gravity. Nothing is more important than this moment. Now you are in total relaxation. Stay there as long as you like. Relish the moment. Nothing else matters. When you open your eyes you shall feel calm and energized.

We live in a world today that sometimes seems to value busyness over calm – a go-go-go lifestyle that often leaves us feeling stressed out. But the good news is that our natural state is relaxed and open – this is why it is possible to become relaxed at any moment, just like that. If we practice habits of relaxation, over time it becomes easier and easier to let go, even when things are quite challenging. Commit to practicing some or all of these relaxation techniques for two months, and I guarantee the changes you experience in your life will not disappoint you. Good Luck!

Sleep Better, Now!

...And Improve Your Health

by Dr. Joan Vernikos

Here are 10 things you can do starting today to improve the quality of your sleep, and your overall health.
I recommend you print these reminders and put them somewhere you can easily refer to them.
Start with perhaps 2 or 3 and commit to doing them for at least 6 weeks – this is how long it takes to engrain a habit for long-term benefit. Great sleep and the benefits it brings are worth it!
1.    Get up and go to bed at set times. 

2.    When tired, don’t sleep in but rather go to bed earlier.

3.    Be active during the day but avoid exercise or excessive activity for two hours before bedtime.

4.    Reduce your exposure to lights 90 minutes before bed. Avoid laptop, tablet, and smart-phone screens and turn off the TV!

5.    Eat sparingly within 3 hours of bedtime.

6.    Stop drinking fluids within two hours of bedtime.

7.    Well before getting in bed, review the day gone by and then calmly mentally prepare for the next day’s commitments.

8.    Sleep in a dark cool room.

9.    Make the bedroom for sleep and amore. Do not have a TV in the bedroom. And do your reading whenever possible sitting upright in a chair, and not in bed.

10. Spend two or three minutes before getting in bed doing calming breathing  exercises or more formal sitting meditation. For tips on meditation for the average person, click here.

Remember, small investments in your sleep will pay back in a myriad of ways.

Yoga Therapy – Fitness in a Healing Context

The Proof of Yoga's Benefits
by Dr. Joan Vernikos

In 2012 most all of us have heard of yoga and some of us know, or are ourselves, regular practitioners and familiar with the well-being it seems to encourage.

In the West, people practice yoga for a myriad of reasons. Personally, I began a relationship with yoga almost 10 years ago, and though I greatly enjoy my twice weekly yoga class and love the way I feel afterwards, my understanding of how it works has been minimal. I felt like most in the medical community, that the claims of yoga’s health benefits were overrated, and lacking the scientific research to provide the evidence and credibility.

So I organized a workshop in  Palo Alto, California on “Space Health, Aging and Yoga Therapy” in order to hear what the experts had to say and become better educated. This workshop was scheduled to precede a large international gathering of Yoga Bharati followers, some 400 yoga practitioners, teachers and members of the local community.  Tracks included Philosophy, Health, and Research, where perhaps predictably I spent most of my time. It did not take long until my skepticism was addressed.

Research evidence of Yoga Therapy
All medical research begins with observation and case studies, before progressing to controlled evidence-based research. Today, such research from top US and global research institutions is providing much needed evidence about the significant benefits of yoga practice that is understandable to mainstream medicine. For example:
•    Dr. Sat Bir Singh Khalsa , Assistant Professor of Medicine at Harvard Medical School focused on the growing body of clinical research showing its efficacy in a wide variety of mental health conditions, particularly in chronic stress, anxiety, insomnia and depression.
•    Dr. Shirley Telles reported on a study in Bangalore, India that after two weeks of daily yoga children were calmer, improved cognitive skills, better focused and memorized verbal and spatial information.
•    Dr. Helen Lavretsky, Professor of Psychiatry at UCLA used PET imaging and changes in cell gene expression to compare listening to music for relaxation to the daily practice of yogic Kirtan Kriya meditation  in stressed family dementia patient caregivers. The daily yogic practice led to reduced stress, better coping and cognitive function as well as a 43% increased telomerase actvivity indicating improvement in the stress-induced biological changes of aging.
•    Several studies reported reduced blood sugar levels in diabetics and improvement in irritable bowel syndrome and multiple sclerosis in other examples of the healing benefits of yoga interventions.

In the West we have come to rely on the wonders of modern medicine to replace our broken parts, taking a pill to cure a discomfort or an illness, relying on expert advice of medical doctors to guide us. Alternately, we sometimes adapt a technique that is popular in the East to a western method intended for a similar purpose. Power Yoga is one such example. We “modify” yoga believing that making a movement faster, stronger, more contorted than the person next to us, will make it more effective on that muscle, bone, balance, circulation or controlling function. Essentially we bolster the egoic when the benefits of a physical yogic activity are rooted in our doing the opposite. The results, in hindsight, are perhaps to be expected.

In essence we have effectively segregated mind and body in the west. We do not fully appreciate it although intellectually we might recognize that separating mind and body will not lead to total healing. I hear stories repeatedly of healing, of the importance of mind, attitude, and faith to healing even in a physically weak body. How else can we explain countless examples of miraculous recoveries in cancer patients, stroke victims and others with incapacitating conditions?

While we are now beginning to successfully demonstrate through evidence-based research how each yogic practice works physically and physiologically, we frequently ignore the context in which it was practiced in the East, the spiritual component of healing and wellness, thus undermining its full benefits.

In the quest for fitness I have learned that Yoga is much more than exercise. This ancient behavioral practice allows for the development of skills of self-regulation of internal physiological states. For this reason its use and promotion for treatment of a range of conditions has increased, including as an adjunct therapy for psychological wellness and psychiatry.

The Search for Healing
A question we must ask ourselves is “What is the healing we are searching for?” And then, “How can we best find it?” In order to answer these two questions we can begin by observing the practices of other cultures, look back into our own, and learn from centuries of observation and successes. Evidence-based research is now clearly showing that greater health and vitality does not come when we separate the body’s needs from those of the mind.

What is highly attractive about yoga is that it works best when it is practiced in this way –  meditative concentration and self-awareness is blended within a comprehensive physical approach. Research is now supporting these long-held beliefs. Yoga stands to be of great benefit to improve health in the west.

Caregiving is Growing - How You Can Be of Greatest Benefit

by Dr. Joan Vernikos
Giving care is the most noble form of human compassion. Yet it is necessary for the survival of a society, a  need that makes a society work. It fulfills the emotional requirement of giving and receiving, interdependence, generating or strengthening personal bonds. It taps into the instincts of love and nurturing; brings out the best in being human.

However, maintaining the balance between caring for others and sacrifice is a delicate one. It can quickly turn negative; it may take its toll physically and emotionally on the giver as well as those that surround them.  Excessive, unmanaged stress tips the balance. The key word here is balance. In trying to put together a set of guiding principles for effective and satisfying care-giving what struck me was the enormity of the task because every situation is different. Achieving balance begins with learning, understanding, assessing and being prepared.

As the number of those requiring care increases the social, personal and financial impacts of care giving will need to be better addressed, just as the need for child care became accepted and recognized as a social responsibility when working practices changed as women entered the workplace.

Who is a Caregiver?
Anyone who is concerned or cares for another individual or living thing. It begins with children, brothers, sisters or even pets. It includes parents, a husband, partner or wife, friends and neighbors. Professionals like nurses and doctors may be paid for care-giving. Becoming a doctor has been considered a vocation for centuries whether one is paid or not. Florence Nightingale drew attention to this fact when nursing was recognized as a profession.

Stress and Burnout?
Caring for others involves expending tremendous amounts of time and energy. That energy can be physical, emotional, mental, and spiritual. Usually all of those modalities are involved when you care for others. If you expend more time and energy caring for others, eventually you will find yourself feeling completely overwhelmed. Burnout, the next step, can occur when you give more of yourself than you are taking in, It is more likely to happen when you are pulled in different directions outside your care-giving, criticized or not supported by family and friends.

Guilt: Feeling Selfish
It is common to neglect yourself when caring for others. I like the example of flying on a plane that experiences sudden oxygen loss. The instructions to adults are to place the oxygen mask on your-self FIRST, and then place the mask on the child next to you. The idea is, if you give oxygen to the child first, you will lose consciousness and be of no help to the child. The idea is the same. When you are caring for an individual but neglect yourself, you may reach a point where you are really not able to care effectively for the other person. Though we think of care-giving mostly in the sense of caring for a parent, caring for a disabled child can also be all-consuming. Though professional caregivers, you would think, do not have the added emotional load that caring for a family member does, they frequently have a difficult time dissociating their emotions from their care giving job.

Self-care: Manage your time, Take Time Outs
Taking time for yourself will have great energy rewards. You will feel better. You will be able to give better care to those you are caring for. Regular time-outs can take two forms. The same paid help at regular intervals, as for example every Tuesday and Thursday afternoons, allows you to plan your errands, appointments or some social activity. Agreeing with the care-receiver to go to a facility for two to six weeks to allow you to take a holiday. At other times, take a walk or a bike ride. Get a massage, meditate, learn to breathe to relax. What do you do for yourself? Taking a Health Assessment inventory will allow you to monitor where the energy leaks are. Do not sacrifice your sleep habits, nutrition and movement.

It’s a Team Effort
•    The Care-receiver
Care-giving is limited at best without the cooperation and motivation of the care receiver. Before starting make sure you sit down and have a heart to heart talk alone with your care-receiver. Honestly define your and their expectations. Many seniors used to being in charge and independent feel a loss of dignity when they find themselves on the receiving side.  For others, decisions made for them allows them to complain. Explain the options available to each of you, your and their expectations, and how working together and communicating openly can bring about the best results.
•    Family or Others Responsible for the Care
Whether you are a professional caregiver in an Assisted Living Facility, part of a growing At Home Care team or an ICU nurse, you will experience a similar pattern of physical and emotional responses as the amateur family-member.
•    Public Resources
Know your resources – whether they are free or not, identify what helps others most and when you can get help when you need it. Most work environments have employee assistance programs. Use them. Do your market research, ask others. Almost every family has some case of care-giving and most have had to find out the hard way.

Today people are living longer but are not necessarily healthier. The need for giving care to these older persons will continue to grow. More and more of us will be significantly involved in the giving of care in some manner. When greater attention is paid to the well being of everyone involved, and beneficial resources are more wisely used, the caregiving itself can be a more rewarding experience for all.