Is Your Kid at Risk of Becoming a Problem Gambler?

Many parents may not mind their kids playing poker, but even those moms and dads know that there are risks. The biggest of those, namely, is the risk of addiction. Ed Looney, executive director of the Council of Compulsive Gambling of New Jersey, says that as a rule of thumb, 80% of kids who start gambling will just dabble in it with no further harm, 15% will have some signs of problem gambling (playing past their budget, lying about losses), and 5% will become truly addicted.

While those numbers are estimates, it is a fact that addiction to gambling can be just as ruinous, if not more so, than being hooked on drugs or alcohol. The rate of suicide for gambling addicts, for example, is higher than for any other type of addict.

So is your kid at risk? Here are some good web resources to help you find out.

The most kid-friendly site is, set up by the state of Louisiana to teach adolescents about the risks of gambling. The site features interactive cartoons, games (of skill, of course, not chance), and a self-quiz for adolescents to find out whether they are at risk of developng a problem. The quiz can be accessed directly here.

You can find another solid self-assessment, for kids as well as adults offered by the National Council on Problem Gambling here.

If you think your child (or you) does have a problem, Gamblers Anonymous can direct you to support.

Because the Canadian government sets aside a percentage of their lottery and casino returns toward helping problem gamblers, the best research and counseling services tend to be located there. The latest studies and lots of research can be found at the Web home of McGill University's International Centre for Youth Gambling Problems and High-Risk Behaviours in Montreal.

Sleep, Snoring and the Blues

I started snoring in the middle of the night last week. The next morning, my wife was as nice as could be about it, but I could tell it bothered her. She hadn't been able to wake me or push me onto my side to get me to stop, and she ended up spending much of the night with her pillow on her head, trying to block out the noise.

I know that everybody snores from time to time--even my 90-lb. dog and my 15-month-old baby--but I was still embarrassed. I suspected my snoring had something to do with the onset of the fall allergy season--a theory supported by a study of French allergy sufferers published in the Archives of Internal Medicine last week that found that most of them were troubled by some kind of sleeping problem and that 35% had full-blown insomnia.

People joke a lot about snoring and insomnia, but they're no laughing matter. In fact, they are just the opposite, according to a new study exploring the relationship between sleep-related breathing disorders and clinical depression.

The research, which was also published in last week's Archives of Internal Medicine, was part of the large Wisconsin Sleep Cohort Study, which has tracked the sleep patterns of more than 1,400 men and women since 1988. The subjects are brought into a lab every four years for a full evaluation of their sleep habits. Having undergone one of those overnight polysomnographies, I can tell you that they are no fun. Researchers attach little electrical leads all over your body--including your eyelids--to measure brain activity, eye and muscle movement, leg movement, airflow, chest and abdominal movement, heart rhythm and oxygen saturation. In the Wisconsin study, the subjects were also asked to complete the Zung depression survey, a 20-question test carefully designed to determine whether you are clinically depressed.

Judging from the results, the experiment was worth the trouble. Although it has long been known that there was an association between poor sleep and depression, the researchers were able to take the link an important step further. They were able to measure what scientists call a dose response. This one suggests a causal relationship between the severity of a sleep disorder and the odds of becoming depressed. After adjusting for age and gender, the scientists found that patients with minimal breathing disorders were 1.6 times as likely to become depressed as those without. Those with mild cases were twice as likely, and those with moderate to severe cases were 2.6 times as likely.

Sleep disturbances are a well-known symptom of depression. But Dr. Phyllis Zee, a professor of neurology at Northwestern University who wrote the accompanying editorial in the journal, told me that the new evidence suggests that it may be the other way around: the sleep disruptions are what's causing the depression. Another theory is that during episodes of the severe disorder known as sleep apnea--when breathing briefly stops altogether--there are moments when the brain isn't getting enough oxygen, another possible risk factor for depression.

Regardless of the cause, there is a message here for patients and doctors: snoring and other sleep-related breathing issues should be treated seriously, both for the trouble they cause in their own right and for the deeper problems they could trigger.

As for me, my snoring seems to have ceased for the time being without further ill effects. My wife, my child, my dog and I are all sleeping through the night.

Sanjay Gupta is a neurosurgeon and CNN medical correspondent

With reporting by With reporting by Shahreen Abedin/ New York

College? Retirement? How to handle two big financial challenges

Walter Updegrave
Money Magazine Senior Editor

It's difficult to save for two major expenses like retirement and a child's education - how can you do it without being completely strained?

My wife and I recently bought a home and are now looking into getting a jump on saving for retirement and for our son's future college tuition. But we're unsure what to do first.

We have a little over $100,000 in our 401(k)s, but little savings beyond that. I think we should build an emergency cash fund first to tide us over in case we're hit with unexpected expenses. But my wife thinks we need to open a 529 account for college tuition?

What do you think? Is it possible to do both and not be too strained?

-- Wayne Peterson, Randallstown, Maryland

ANSWER: Is it possible to save for retirement and for a child's education at the same time? Sure, but it requires a pretty decent income and lots of disciplined saving. And even then it's no picnic.

Indeed, as a practical matter, I think most people have enough trouble just saving adequately for their retirement. Throw in college education and it just becomes too overwhelming. Too often the result is that people don't address either goal adequately, or they get so discouraged that they sometimes give up altogether, figuring it's hopeless.

That's why I recommend that people avoid trying to do too much and, instead, adopt a realistic saving plan that focuses on the most important goals first and then moving on to secondary ones.

So which goals are most important and which are secondary? Well, ultimately that's a personal decision. But if you look at this issue in terms of what strategy has the best overall chances of securing your family's current and future financial security, I think the following three-step approach makes sense for most people.

Have an emergency fund First, build a cash reserve, or emergency, fund. Here, I'm talking about having about three month's worth of living expenses in a very safe and readily accessible account - a money-market fund, savings account or perhaps an ultra-short-term bond fund, something with an average maturity of no more than two years.

The idea is to have a buffer that acts as a first line of defense against financial setbacks, a stash you can fall back on to cover unexpected expenses you can't fund out of your paycheck or to carry you until you find a new job in the event you're laid off.

Some people say this fund should hold as much as six months' expenses. The only problem I have with that is that putting together that sort of cushion can be so challenging for some people that they never make it, and then might not get around to saving for other goals.

You can give yourself a bit more wiggle room by opening up a home equity line of credit that you could tap when your emergency fund is on the verge of being tapped out.

Put as much as possible in retirement accounts After you've got your emergency reserve funded, start plowing as much as you can into your 401(k) or other retirement savings plan.

You, apparently, have embarked on this part of the plan before accumulating the emergency stash. I think it's better to do it the other way around, or, if you can manage it, build your cash reserve fund as you save at least something for retirement. But the most important thing is that once you've got that cash reserve together, you want to fatten up those retirement accounts.

Ideally, you want to contribute at least enough to your 401(k) to take full advantage of whatever match your company offers. But if you really want a shot at a comfortable retirement, probably shoot for socking away 10 percent to 15 percent of your salary in your 401(k).

If that's more than your plan allows, then do the max and try to make up the rest by opening up an IRA or even a taxable mutual fund account.

If you get started early enough - say, in your 20s or early 30's - contributing this amount should give you a good shot at an income that, combined with Social Security, should fund a comfortable lifestyle in retirement. If you don't get started until your 40s or later, however, you should try to ramp up your savings even more.

You've already accumulated $100,000 in your 401(k). That's great. But without knowing how old you are and how much income you'll need to live comfortably in retirement, I can't really say whether that hundred grand, combined with however much you save for retirement on a regular basis, puts you on track.

Any financial adviser should be able to crunch the numbers so you can assess your progress, or you can get a sense of whether you're on the right path by going to an online calculator such as our Retirement Planner tool.

Only then comes the rest Once you know you're on track for retirement, you can start to think about other goals, such as saving for a child's education. I put this goal behind retirement not because I don't think it's important. Rather, it's a question of options.

Unless you think you can get by on Social Security - which I think one look at the Social Security administration's benefit calculator will reveal as wishful thinking - your only hope for a comfortable retirement these days is to save rigorously throughout your career.

There's really no other way to do it.

With college expenses, on the other hand, there are several alternatives. Your kid may qualify for financial aid. You may be able to hit up the grandparents for help. Students can earn part of their tuition, or take out college loans. You could borrow against your home equity. You could even dip into your retirement accounts or other savings if you really, really need to.

So given the many options for paying for college and the fact that you're largely on your own when it comes to funding retirement, I wouldn't start a 529 savings plan or any other type for that matter until I was reasonably certain that I had my retirement savings under control.

Call me a Scrooge. But I think it makes more sense to send your kids to a less expensive school if necessary or saddle them with some loans rather than pay for their education if doing so means they might have to support you in retirement because you never saved enough. In any case, that's the way I see it.

Enhance your family's current financial situation by building a reserve fund and then set the stage for your future financial security by saving for retirement. If you can still manage to after that, then do whatever you can for your kids' education.

Using the Weapon That Depresses Depression

Mark A. Sutton and Bruce Hennigan, M.D.

Perseverance. After faith, it’s the strongest weapon we have with which to fight depression. It helps us break a deadly cycle of which we may not even be aware. And breaking that cycle produces some positive side effects: new, powerful habits that actually act as our allies.

How does the weapon of perseverance accomplish all this? First, let’s take a look at this deadly cycle.

When we notice depression’s arrival, what is our reaction? In my counseling and discussions with depressed people, I’ve discovered we initially react in one of two ways. Some of us are always caught by surprise. We never expect the depression to return again and can’t see it coming until it has completely surrounded us. Others of us know our depression is pretty regular; we understand its signs and can watch as it approaches and settles in.

That is the first stage of the cycle of depression. But whether we are surprised by its appearance or we see it coming, we often react in the same way to the cycle’s second stage, and this is the part that is most important — and deadly. Let me talk directly to you for a moment. After realizing you are experiencing a depressive episode, how do you react? If you are like many I’ve counseled, you give up. You throw up your hands and say, “Depression is here again. There’s nothing I can do about it.” And then you let the disease dictate how you will react emotionally. Black moods and periods of doubt control you until the depression leaves and the cycle, for the moment, is complete. Then you wait, without realizing it, for the next cycle to begin.

But what if you changed the cycle? Believe it or not, it is within your power to do so. Again, you may not be able to stop depression from descending on you, but you can choose how you will respond to it. I want to pound this into your thinking.

Here's where the weapon of perseverance delivers a mortal blow to your enemy. You simply tell depression: "I'm never giving up or giving in to you. You may continue to plague me, but I'll fight you with everything I've got. My emotions don't belong to you, and I refuse to let them be held hostage without a fight. You may knock me down, but I've decided to keep on getting up. And I'll fight you every time.

What does this type of attitude accomplish?

  • It breaks your usual cycle. You no longer simply give up when depression hits you.
  • The process of deciding to fight depression, even when you don’t feel like doing so, begins to give you more control over your emotions and helps you no longer feel like a victim.
  • As you decide to fight depression every time it appears, you build confidence in yourself. In many cases this shortens the amount of time depression stays with you.
  • Using the weapon of perseverance on a regular basis builds powerful habits in your behavior. Use it long enough and eventually you begin fighting depression when it appears without even realizing it!

Let me give you a word of encouragement. Even a little effort on your part each time is helpful. Even if you can’t successfully fight off depression this time, but begin trying to do so, you have made progress. Making the decision to do what you can each time will make you stronger. Perseverance pays off. Flash back to 1968. The Mexico City Olympics are taking place amid great fanfare. As the marathon contestants line up, spectators buzz about possible winners of the race that gave birth to the entire Olympic movement. Most of the attention focuses on Mamo Wolde of Ethiopia, and rightly so; he will win the marathon. But he will not be the only winner that day.

With the crack of the starter’s gun, the contestants begin their quest for a gold medal. One of the runners, John Stephen Akhwari of Tanzania, finds himself trapped in the middle of some other runners several miles into the race. Unable to see well, he falls and hurts his leg horribly. He watches in anguish as the other racers continue. John Stephen Akhwari will not win the marathon on this day. He has come to Mexico City and failed…or has he?

Now flash forward to the end of the race. Wolde, the Ethiopian, has already won. An hour has passed, darkness is falling, and the last spectators are leaving the stadium. Suddenly their attention is drawn to the sounds of police sirens. The marathon gate to the stadium is thrown open, and, unbelievably, a lone runner stumbles into the stadium for his last lap. It is John Stephen Akhwari. Hobbling painfully on his bandaged leg, grimacing with every step, knowing he cannot win the race, he continues all the same. Finally he crosses the finish line and collapses.

Why, someone asked him, didn’t he stop after injuring himself? After all, there was no way he could win the race. Listen to John Stephen Akhwari’s response: “My country did not send me to Mexico City to start the race,” he said with dignity. “They sent me to finish the race.” Perseverance is a powerful weapon.

Let’s flash back two thousand years to another man who knew how to persevere. The apostle Paul was a man who devoted himself wholly, unselfishly, to God. But it certainly did not ensure him a life of pleasure and ease. You could say his life was maxed out with beatings, persecutions, and, to add insult to injury, multiple imprisonments. These prisons, I might add, had no weight rooms, color television or time off for good behavior. In addition, some of Paul’s peers criticized the apostle for getting himself into what they believed were embarrassing circumstances.

Paul, put in prison once more, could have given up. Instead, he had this to say: “I am not ashamed, because I know whom I have believed, and am convinced that he is able to guard what I have entrusted to him for that day” (2 Timothy 1:12). Paul knew God would not fail him. He believed that the Christian who stayed faithful, even in the tough times, would be ultimately blessed for his perseverance.

God has a special place in his heart for those who endure. Human power doesn’t interest him. Dynamic personalities and great people skills don’t impress him. He sees through smiles and designer clothes, looking for something more. “The eyes of the LORD are on those who fear him, on those whose hope is in his unfailing love” (Psalm 33:18). If you’re giving the best of yourself to God and trusting in Christ to save you, then the heavenly Father’s eyes are on you. He blesses you every time you get knocked down by depression and then get up, still trusting God and still willing to live for him. Looked at in this way, depression does not make you a failure. Instead, it makes you a strong Christian and a winner in God’s eyes.

Even if depression keeps knocking you down, make the decision today to keep getting up. Let Paul’s creed also be yours: “Therefore put on the full armor of God, so that when the day of evil comes, you may be able to stand your ground, and after you have done everything, to stand” (Ephesians 6:13). Keep on standing.

A Mother's Choice

Jennine Lee-St. John

Do laws that let women abandon their infants protect babies or encourage parents to desert them?

The baby now named Tessa Leavitt was born in a motel bathtub on the night of June 18, 2005. Her mother cleaned her, breast-fed her and cut the umbilical cord herself. The next day, the young Hispanic woman swaddled the infant in a white towel and took her to Fire Station 15 in Whittier, Calif., where she rang the doorbell and told the firefighters, "I want to give up my baby." When the paramedics arrived 30 minutes later, she put the child on their gurney and left. "It was eerie," recalls firefighter Kevin Cull. "The ambulance went off in one direction, and she just crossed the street and walked off in the other direction."

Tessa's birth mom gave up her child under California's Safely Surrendered Baby Law, which lets parents avoid prosecution for abandoning their newborns if they leave the infants with staff members of emergency rooms or other approved places, including fire stations. Since 1999, 47 states have adopted similar laws permitting children to be relinquished, with age limits ranging from 3 days old in 16 states to 1 year in Missouri and North Dakota. In California the baby must be under 72 hours old, but a bill recently passed by the legislature would extend the deadline to 30 days. Governor Arnold Schwarzenegger, who has not stated a position on the measure, has until Sept. 30 to sign or veto it. The longer grace period has renewed debate over whether such leniency actually protects children or encourages parents to desert them.

The record doesn't help answer that question. Since 2001, when California enacted its safe-haven law, more than 150 newborns there have been surrendered safely, but at least 160 have been illegally abandoned. The experience has been similar in other states. In the five years before 2001, when North Carolina began allowing the surrender of infants up to a week old, there were 10 known cases of babies who were illegally abandoned and died. From 2001 to '04, nine infants were illegally abandoned and died, while five or six were given up under the safe-haven law. Illinois, which this summer extended its safe-surrender deadline from three days to seven, has had 27 official relinquishments since 2001, but 44 babies were simply abandoned, 20 of whom died.

Opponents of safe-haven laws say these statistics prove the statutes don't work and may even increase the numbers of children who are given away. "These laws are persuading women who wouldn't have abandoned their babies in any form to do so," says Adam Pertman of the Evan B. Donaldson Adoption Institute. Even some people who favor legal surrender of newborns are uncomfortable with expanding the law's reach to month-old babies. Los Angeles County board supervisor Don Knabe has lobbied Schwarzenegger to leave California's three-day law intact. He says pushing parents to make an early decision ensures that unwanted infants get the care and medical attention they need, and dissuades parents from abusing a baby and then waiting for the bruises to fade before giving up the infant. "If someone waits 30 days to surrender a baby, there is no way to determine if that baby suffered any harm during that time," he says.

But advocates for longer amnesty periods say it's important to provide an alternative for parents who try to keep their newborns but become dangerously overwhelmed. "If the baby's being abused, don't we want to save that baby too?" says Dawn Geras of Save Abandoned Babies in Chicago. Alberto Torrico, the state assemblyman who sponsored California's 30-day extension, and Donne Trotter, a state senator who pushed the later deadline in Illinois, agree. They argue that parents should have time to decide if they are fit. "The reality of raising a baby really dawns on you once you get it home," Torrico says.

Still, the main impetus for drafting surrender statutes was dealing with brand-new moms who would not hesitate to leave their babies in Dumpsters. "They don't look at the baby as a human being," says Debbe Magnusen, founder of Project Cuddle, a national hotline to rescue unwanted babies, who has helped mothers ranging in age from their teens to their 30s. "It's a tumor or an object or a problem." Spreading the word about the existence of surrender laws has been hard. The details of California's are supposed to be taught in sex-ed classes and publicly advertised. But with no state funding available, it's up to local governments and private foundations like Magnusen's to promote the law.

Somehow Tessa's birth mother found out about it. And giving up her baby gave the child a chance at a good life, at least in the eyes of Donna Leavitt, who with her husband Rob ended up adopting the girl: "I can't help but think that the safe-surrender sign at the fire station helped lead Tessa to us." The Leavitts would love for their daughter to meet her birth mom. But in most cases that is unlikely, since the law allows surrendering parents to be anonymous. "Many of these mothers do not like their babies," says Magnusen. "We're not asking them to love the baby, just not to kill it." In California, they may soon have more time to make that decision.

With reporting by reporting by Stacie Stukin/Los Angeles

3 kids found dead in fetus theft case

Associated Press Writer

Autopsies were planned Sunday for three young children who were found dead hours after a woman was charged with killing their pregnant mother and her fetus in a grisly attack.

The two boys, ages 7 and 2, and their 1-year-old sister were found together Saturday in an East St. Louis apartment where their mother lived, State Police Capt. Craig Koehler said.

The children were last seen Monday with family friend Tiffany Hall, 24, now charged with first-degree murder in the death of their mother, who is believed to have been slain days before her children disappeared. Hall is also charged with intentional homicide of an unborn child, prosecutor Robert Haida said.

Koehler declined to say whether Hall was suspected in the children's deaths. The cause of their deaths had not been determined, he said.

The bodies of DeMond Tunstall, 7, Ivan Tunstall-Collins, 2, and Jinela Tunstall, 1, were found in an apartment at the John DeShields public housing complex, capping a furious two-day search that included scouring an 1,100-acre state park.

Authorities said a lead directed them to check the apartment, which had not been searched previously. They declined to elaborate.

"Anytime you have three deceased children, it's a very emotional time," Koehler said late Saturday as he fought back tears. "All these investigators have worked tirelessly with one outcome in mind — to find these children alive."

The body of their mother, Jimella Tunstall, 23, was found Thursday in a weedy East St. Louis lot. Authorities believe her womb was cut open after she was knocked unconscious.

An autopsy showed Tunstall, who was seven months pregnant, bled to death after sustaining an abdominal wound caused by a sharp object, believed to be scissors, said Ace Hart, a deputy St. Clair County coroner.

Relatives say Tunstall grew up with Hall and had let her baby-sit her children.

"She said (Hall) was looking out for her," Tunstall's brother, Ernest Myers, told the St. Louis Post-Dispatch.

Family members told the newspaper Tunstall had lost custody of her children at one point but was trying to get her life back on track. "She had a heart of gold," Myers said.

Officials suspect Tunstall was slain on or about Sept. 15, Haida said. The same day, Hall summoned police to a park, saying she had given birth to a stillborn child, Hart said.

Hall and the fetus were taken to a hospital, where she would not let doctors examine her and offered conflicting reasons for why she went into labor, alternately saying she had consensual sex and was raped, Hart said. The dead baby showed no signs of trauma, and an autopsy the next day failed to pinpoint a cause of death, Hart said.

Hall has two children of her own. Koehler said they are "safe and sound."

Authorities say Hall acknowledged to her boyfriend during the baby's funeral Thursday that the child wasn't his, and that she had killed the mother to get it. The boyfriend, reportedly a sailor home on leave, told police, who arrested his girlfriend hours later, investigators said.

Hall, jailed on $5 million bond, will likely be arraigned Monday on the two charges, each carrying a 20 to 60 years or life in prison, Haida said. The murder count could be punishable by the death penalty.

DNA tests should determine definitively whether the baby was the one Tunstall was carrying, Hart said.

Before You Buy A Bra

Tina Kells

Buying a bra may seem simple, but it is actually quite complex. First and foremost it is essential that you know your correct size. A proper fitting bra is important for both comfort and posture and is especially important during the teen years when your body is growing. A poorly fitting bra can cause back problems, muscle tension, and even headaches. Since teens are still growing, the strains caused by an improperly fit bra can lead to life long problems with posture and back pain. For this reason, teens should be fit by a lingerie consultant at least twice a year or, preferably, after every noticeable growth spurt. Another important consideration is the reason the bra is needed; is it for support, coverage, comfort or athletics? There are different styles of bras designed for specific body types, fashions and activities and they come in a variety of fabrics. Despite popular misconceptions, no one bra can "do it all".

First/Training Bras
Training bras are are for young girls who have started to develop breasts but who do not yet fit the standard bra sizes. A young girl who has started to develop should wear a training bra, but there is no harm in letting a girl get one before there is a real need. Remember, training bras are intended for girls of any age who have started to get breasts and who are not yet able to be fitted with a regular bra. If your breast size warrants a full fitting bra you should wear one, even if you are very young.

Light Support Bras
Light support bras usually have no underwire and are good for girls with smaller breasts. They are less constricting than full support bras and many girls feel that they are more comfortable. Because they are wireless they offer less shaping than other bras and are most flattering on trimmer figures. These bras come in padded and unpadded versions; which you choose is really a matter of personal preference.
Bullet List (optional)

Full Support Bras
Full support bras usually have an underwire or plastic boning holding them up. They can be worn by women of any breast size and are a must for those with larger cup sizes. These bras offer a shapely cut and are built more like bikini tops than underwear. These also come in padded or unpadded version and are flattering on any figure type.

Push Up Bras
Once called "padded bras" this is the category that the world famous Wonderbra falls under. These bras lift the breasts and add shape them with extra padding. Some more innovative push up bras use silicone inserts or water sacks to imitate the fullness of a natural breasts. They are said to "lift and separate" creating a full cleavage look on breasts of all sizes. These bras always offer lots of support.

Sports Bras
This is the most uncelebrated of the bras, and ironically, it is probably the most important one for growing teens to have. Sports bras do more than offer full support, they also stop the breasts from moving during athletic activity. Breast tissue is very delicate and the growing tissue of the teen breast needs to be protected during high impact exercise. Even girls with smaller breasts should invest in a good sports bra if they take physical education or participate in sports.

A Top 10 Fact Sheet on Breasts

Mike Hardcastle,
  1. Breasts can start growing as early as age 10 and don't stop until your early 20's.
  2. Breasts have been overly sexualized in Western culture making them too big a part of a girls physical identity.
  3. Breasts have a biological purpose - for feeding babies.
  4. Having a baby changes ones breasts forever, and many women get larger (but much less perky) breasts after pregnancy.
  5. During puberty breasts can develop rapidly causing discomfort, sensitivity and even stretch marks .
  6. Larger breasts do not make a girl more feminine, sexier or better.
  7. Very large breasts can cause back pain and poor posture.
  8. Bras are more than just underwear, they are necessary to keep your breasts supported and to stop injury to the breast tissue while playing sports..
  9. Breast cancer is rare in teen aged girls but it is important to get used to checking your breasts for lumps and irregularities as soon as you start having your period - this is especially important if you have a family history of breast cancer.
  10. All breasts, no matter what size and no matter what guys may say, are beautiful and amazing to the opposite sex!

Overcoming the Fear of Making Mistakes

Margaret Chuong-Kim, M.A.

When I was a little girl growing up, my parents frequently warned me against making mistakes. They believed that as long as I did things slowly and carefully, and learned from other people’s blunders, there was no need for mistakes to be made. Whenever I did screw up I was often chastised for not being careful enough, for not thinking things through, or for not listening closely enough when I was told about other people’s mistakes. I grew into an anxiety-ridden teenager, afraid of making even the tiniest mistake, and strove for perfection.

As a young adult, I came to realize that I couldn’t hold onto the ideal of perfection any longer. For one thing, I can never be perfect! No one can. That is an impossible task, and to strive for perfection is to guarantee failure. For another thing, trying to avoid mistakes was limiting, because in order to do so I was avoiding trying new and different things.

How can you break free from the fear of making mistakes?

First, determine where your desire for perfection comes from. For me, it was the fear of being criticized, first by my parents, then by people in general. Maybe you learned to associate making mistakes with being judged, rejected, and ridiculed, and you have carried that association with you to this very day. Think about where and how your perfectionism originated.

Second, examine your beliefs about making mistakes. I had learned to believe that a mistake would lead to catastrophe. For example, if I chose poorly in terms of whom I befriended, surely that was indicative of my downward spiral into becoming a gangster. If I failed a math test, surely that meant I would never get into university and end up a homeless bag lady. You may be thinking, “illogical beliefs”, and indeed they are, but that is the nature of the fear that drives perfectionism. What are your “illogical beliefs”? Choose an instance where you are afraid of failing or making a mistake. What would happen if you failed or goofed-up? Then what would happen after that? How do you think you would handle it?

Third, find instances that prove your beliefs wrong. For instance, I have had my share of questionable characters as friends, and I have failed more than one math test in my lifetime. The world did not come to an end, I did not end up a gangster, and I did get a decent education. These facts prove my old beliefs wrong. What are some facts that dispute your beliefs about making mistakes?

Fourth, develop new beliefs. The fear of making mistakes develops as we grow and perceive other people’s reactions to our screw-ups. When we experience other people responding negatively to our mistakes, we learn to think of mistakes as something bad. However, contrary to popular belief, making mistakes can be good. How else would you learn without screwing up? Think about when you learned to walk for the first time. You were really terrible at it, as was I, as was everyone in the world. Even after we tried walking for the twentieth time, we were still not very good at it. But babies haven’t learned negative associations with making mistakes yet. Can you imagine if babies were afraid of making mistakes? No one would ever learn to walk. No one would ever learn to tie shoelaces. No one would ever learn to read or write. So think of making mistakes as a learning experience. It’s how we grow and expand our horizons. It’s how we develop as people. Making mistakes is also part of the human condition. To be imperfect is to be human, and we can’t expect any more than that.

Fifth, be kind to yourself when you make mistakes. You may experience the tendency to beat yourself up after you’ve made a mistake. You tell yourself you’re an idiot, you convince yourself that you’ve let all of your friends and family down, you torture yourself with guilt, and you think over and over again about how you screwed up. When you find yourself doing this, interrupt the process by reminding yourself that you have just had an opportunity to learn something. Ask yourself what you have learned. Ask yourself how you might apply it in the future. Remind yourself that you’re human. Then pat yourself on the back for adding a new skill to your set. Congratulations!

There are always at least two ways to interpret a situation, and you can choose to look at making mistakes in a positive way, or you can choose to look at mistakes in a negative way. It’s certainly more productive to perceive slip-ups as positive experiences. I find it helpful to think back to when I was a tiny little kid and how I must have made hundreds of mistakes in a week! But boy, so much learning went on and life sure was a lot more fun then.

Sixth, make some mistakes! In other words, try something new. Is there something in your life that you’d like to try, but fear is getting in the way? It may be a new sport, it may be taking a course at a local college, or it may be trying to learn how to cook. Whatever it is, so long as you’re not hurting anybody, why not give it a try?

Dancing on the Edge

Flirting With Danger
I thought it was innocent at the time.

She was a church staff member, so we spent a lot of time together. She'd sit in my office, and we'd talk. At times she told me about the difficulties in her marriage, and I counseled her. But I should have stopped her right there; I was filling a need I had no right to fill.

We never touched, we never kissed, we never even verbalized our underlying feelings. But there was a definite attraction, and I liked that vibe. It was fun.

For me it was all in my mind, but it progressed from there. I started thinking about her on weekends. I kept telling myself, I can handle this. It hasn't gone too far; it's okay. But it could have; the opportunity was waiting.

Occasionally, I got scared. I'd think, I don't want to do this. I have a great wife; I have a family. I don't want to go down this road. And while it was somewhat fun knowing I was getting away with something, it also gnawed at me. I knew it wasn't right.

Then one day I was on the phone in my office, when she came up behind me and pinched my rear end. That's when fear finally kicked my senses back into my head. "I'm going to talk to my wife about this," I told her.

Blowing the Whistle
I actually first spoke with the senior pastor of the church. Then I went home. I hadn't physically cheated on my wife, but my mind had already gone that direction. I was unfaithful in my thoughts and in not telling my wife what I knew was happening but didn't want to admit. I had to tell her now.

I had compromised my relationship both with the Lord and with my wife. I loved her (still do). In fact, there was nothing terrible in our relationship—I thought we had a solid marriage. This other woman had nothing to lose by entering into an extramarital affair. I had everything to lose.

What's really scary? I had a good marriage and I was still vulnerable. Imagine what might happen if someone's in a bad marriage!

It all came down to me being stupid and making a stupid choice, of enjoying sin and flirting with it.

Planning for "Never Again"
Life is experience. And I've learned a lot from the edge I tap-danced along.

First, you must admit to yourself your attraction to someone else. If you find that you're convincing yourself everything is okay, it's not. And that's the point. If you're not mature enough to blow the whistle on yourself, then you're heading straight for danger. You'll start hiding things—things you thought you would never do—and your prayer life will go down the tubes. You'll be tormented, standing before your congregation without a clear conscience. Justification is one of the strongest indications there's a problem.

Next, you must confess it. And you must change—that's non-negotiable. I often hear people confess, "I know what I'm doing is wrong, but . . ." and they continue dancing on the edge. In order to change, you have to cut off that relationship.

If you feel you cannot talk with your spouse about your thoughts or a situation, you set yourself up for trouble. You need to be honest—for both yourself and for her. Also, listen to your wife. Spouses are perceptive—often they're the first to tune in to danger lurking in the shadows.

On the other hand, be accountable to selected, trusted people, because there are times you can't just lay this kind of stuff on your wife. Yes, you need to be forthright, but you need to protect her, too. You don't want to continually discourage her and make her feel like chopped liver.

What's more, work on satisfying each other's physical and emotional needs, because it doesn't just happen. Any one of us is vulnerable when unmet needs might possibly be fulfilled somewhere else.

Above all, be careful. Guard your marriage and your mind. It will help keep you from waltzing toward the edge and stumbling over it.

Planning for Health Care in Your Retirement

Start saving now because it's more costly than you might think

With the oldest baby boomers turning 60 this year, millions of Americans may soon reach the sobering conclusion that they haven't set aside enough money to cover their health-care costs in retirement.

Increasingly, companies are eliminating retiree health benefits or cutting back coverage. Even if you are one of the fortunate few to have an employer-sponsored health plan, you may encounter significant cost-sharing. And if you plan to retire before you become eligible for Medicare, you may have to pay the entire premium on your own.

"Just like you're not going to get the gold watch, you're not going to get the benefits that your father and grandfather got" when they retired, said Tracey A. Baker, vice president of Cooper, Jones & McLeland Ltd., a financial planning firm in Fairfax, Va.

Baker, a member of the Financial Planning Association (FPA), said health-care costs are often retirees' second largest expense after the mortgage. Yet most Americans aren't as knowledgeable as they need to be about what their insurance covers and what Medicare does and does not cover.

In fact, a 2005 survey co-sponsored by FPA and Aetna Inc. found that people vastly underestimate what their health-care expenses will be in retirement. Fifty-two percent of those surveyed said they expected to spend less than $300 a month, yet retirees in the survey actually spent more than double that amount.

So how does one begin the planning process?

"Well, I think the first step is simply to acknowledge the fact that health needs need to be included as part of retirement planning," said Barbara Stucki, a project manager with the National Council on the Aging in Washington, D.C. "It is not just an income issue."

Many Americans are living longer, healthier lives than their grandparents did, and diseases that once meant certain death, including heart attack and stroke, are more likely to leave people with some sort of impairment. So having the resources, say, to make home modifications can greatly improve one's quality of life.

"For example," Stucki said, "if a person lives in a two-story house, they may need to put a bathroom on the first floor."

People also should plan for the routine health costs they'll encounter every month, including premiums for supplemental insurance, often called "medigap." The most popular plans cost an average of $155 a month, according to Anne Werner Richardson, a consultant on health and aging issues in Washington, D.C.

If you enroll in Medicare Part B, as most Medicare beneficiaries do, your monthly premium ($88.50 in 2006) will be deducted from your Social Security check. Plus, there's a $124 annual deductible. "So that totals $1,186 a year just for Part B," Richardson noted.

Prescription drugs are another routine expense. If you enroll in Medicare Part D, you may have to pay a monthly premium, an annual deductible and some portion of the cost of your drugs. Your actual cost will depend on the drugs you take and the coverage you have.

To offset catastrophic expenses, such as an extended nursing home stay, Baker strongly advises clients to buy long-term care insurance. A 2005 survey by the MetLife Mature Market Institute showed that a private room in a nursing home costs $203 a day, on average. That's $74,095 for just one year.

"Long-term care's much like your homeowners' insurance," she said. "It's just an insurance you hope you will never need, but it would be devastating if you didn't have" it.

If you think Medicaid will pick up the tab for nursing home care if you get in a financial bind, think again. The rules for qualifying for that federal-state program just got a lot tougher. As of February 2006, anyone who has more than $500,000 in home equity, for example, no longer can qualify for Medicaid. That means people who are house-rich but cash-poor who might have qualified for assistance in the past are no longer eligible, Stucki cautioned.

"People do need to think very carefully about how to manage their money and what kind of quality of life and choices that they want," she said.

More information

The U.S. Social Security Administration has online tools to help you plan your retirement.

SOURCES: Tracey A. Baker, CFP, vice president, Cooper, Jones & McLeland Ltd., Fairfax, Va.; Barbara Stucki, Ph.D., project manager, Use Your Home to Stay at Home initiative, National Council on the Aging, Washington, D.C.; Anne Werner Richardson, consultant, health and aging issues, Washington, D.C.; Oct. 20, 2005, press release, Financial Planning Association; MetLife Mature Market Institute, Westport, Conn., The MetLife Market Survey of Nursing Home and Home Care Costs, September 2005

Last Updated: Sept. 21, 2006

Copyright © 2006 ScoutNews LLC. All rights reserved.

Reasons You Don't Have an Orgasm


Let's be honest -- climaxing can be tricky at times. But learning to correct simple bedroom boo-boos can ensure you reach your peak potential a lot more often. Read on.
Going...going...gone. Sometimes it seems like just as your man's sliding into home, your orgasm's fouling out. But rather than chalk it up to bad luck, it may simply be time to switch up your gratification-getting MO. "Without meaning to, women often wind up getting in the way of their own sexual satisfaction," says sexologist Carole Altman, Ph.D., author of You Can Be Your Own Sex Therapist. "You have to own your orgasm -- you can't just rely on a man to get the job done." The first step: fixing the following carnal errors.

Racing Through Foreplay

Here's the scenario: Your guy is eager to get to the main event. Problem is, you're not exactly ready and you're afraid that if you ask for a little more pregame action, he might think you're too high-maintenance in bed or just get frustrated. Plus, like a lot of women, you may feel self-conscious about just lying there and receiving pleasure. But don't rush through the warm-up.

"Most women need about 20 minutes of arousal time to reach the 'orgasmic platform,' when the clitoris is most sensitive and the body is primed for stimulation," says sexologist Yvonne K. Fulbright, author of the Hot Guide to Safer Sex. "Skipping the whole sexual-response cycle makes it harder to get off." We know that 20 minutes may sound like a long time, but trust us, the good guys don't mind.

In fact, it's a turn-on. "It was really hard for me to orgasm, so I'd tell my boyfriend, 'It's okay, don't worry about it' when it didn't happen," says Melissa, 29. One night, he told me to lie back and just let him do his thing to me. I eventually orgasmed, and he clearly loved every minute he spent getting me off." A bonus of peaking preintercourse: "Having an orgasm during foreplay increases a woman's chances of climaxing during intercourse," says Altman.

Tuning Out

We all know it's easy to get distracted during sex. Everything from "Is my stomach jiggling?" to "Wow, he should have that mole on his chest checked out" can make you lose frisky focus. And once that happens, your orgasm is down for the count. "Your brain is a vital part of the sexual experience, registering sensations and releasing feel-good chemicals to the body," says Georgia sexologist Gloria G. Brame, Ph.D. "Any mental distraction can spark conflicting, nonsexual impulses in the brain and lessen your pleasure."

What if you find yourself making a mental grocery list mid-act? First, reengage your body. "Focus on how he feels inside you and how your body is responding," says Brame. "Also touch yourself or even switch positions to physically bring yourself back to the sex."

Another tune-in trick: breathing slowly and deeply from the pit of your belly. "Yogic breath will not only keep you centered, it will also make the sex better," Fulbright points out. "Circular breathing, where you try to sync up your inhalations with your partner's, can put the focus back on the body and help you reconnect with each other."
Ignoring Your C-spot
Although the G-spot gets a lot of press for being your erotic epicenter, it's the clitoris that packs the most pleasurable punch for you during sex. "There are more nerve endings in the C-spot than there are inside the vagina," says Fulbright. "So it's rare for women to have an orgasm without some sort of clitoral stimulation."

To stimulate your C-spot during intercourse, climb into girl-on-top position, arch your body toward him and grind your pleasure point against his pelvis. If you're in missionary, make sure to keep your legs pressed tightly together while moving your hips in a circular motion, suggests Altman. "As he is moving in and out at this angle, it will stimulate the clitoris," she says. "It can also create friction between your vaginal lips and your clitoris, which can enhance sensation." Fulbright also suggests stimulation when you're in doggie-style or girl-on-top position.
Forgetting to Pee
In the heat of the moment, it's easy to overlook the little things like, say, your bladder. But when your man stimulates your G-spot during sex, it can suddenly make you feel like you have to pee. "The G-spot is surrounded by the Skene's glands, which are connected to the bladder," Altman explains. "So anytime there is contact with your G-spot, you are going to feel like you have to urinate, even if you don't." The result? You clench up and don't let go and climax. Plus, according to certain experts, some women may release ejaculatory fluid and mistake it for pee, so when it starts to come on, they cut off the flow and basically flatline their orgasm.

Fortunately, there's a simple solution: Use the bathroom just prior to sex. "Since you know you don't have to pee, when you're on the verge of orgasm, you'll be able to go with the sensations and let loose," says Brame. Not to mention the fact that peeing first can greatly decrease your risk of a UTI.

Changing Positions Too Often
Erotic acrobatics are always a fun way to keep your sex life exciting, but testing out all those pretzellike positions in one sitting actually makes it harder to orgasm. "The key to satisfaction is steady stimulation in a position that hits your pleasure points," Brame points out. "You need to develop a rhythm, and once you feel yourself building toward climax, the sensation must be consistent or you'll lose momentum."

If for some reason you get sidetracked and have to start from square one, don't panic. Just get yourselves back into that orgasm-inducing position and go for a randy round two.

Psychological Effects of Terrorism on Our Children: An Expert Perspective

Caroly Pataki, M.D.

The recent terrorist attacks shocked all of us in the United States beyond our wildest nightmares. It is not difficult to imagine the helplessness, fear, sense of loss, and distress experienced by a child after a direct trauma such as the death of a parent. Even indirect exposure to a trauma, however, such as hearing about the terrorist attack in a far away city, can evoke intense emotional responses in children.

For those of you who are parents, teachers, and clinicians, the big questions in your minds probably include:

  • What do we tell our children?
  • What will a child of 5, 8, 13 or 17 really understand?
  • What is a "normal" reaction in a child to such an abnormal event?
  • How can we help?
  • What are the signs that a child may need professional help?
  • How can we find out more about this topic?
The following article will address these questions.

Universal Effects of Traumatic Events on Youth

While very young children are less verbally articulate about their feelings than older children, most children of all ages will experience some of the following features after exposure to a trauma:

  • Increased anxiety when separated from family members
  • Re-experiencing the exposure through intrusive thoughts, nightmares or repeatedly talking about the traumatic exposure
  • Increased sensitivity to sounds such as sirens, planes flying above, thunder, loud noises
  • Sleep disturbance, or fear of the dark
  • Increase in minor aches and pains such as stomachaches, headaches
  • Poor concentration with decreased school performance in some cases
  • Increased thoughts about death and dying
  • Irritability and increase in worrying
If you have a preschooler, or have spent some time with a child between the ages of three and six, you have probably noticed that he or she is able to identify emotions including anger, sadness, happiness, and even envy. A child of preschool age can also tell you why he or she thinks another person feels badly about something. A 5-year-old may even express concern that a peer’s feelings have been hurt.

Looking for emotional cues
When under stress, however, preschool children rely heavily on cues from important adults to help them choose emotional responses to given situations. When a crisis occurs, such as the recent terrorist attack, preschoolers will most likely check parent or teacher responses in order to regulate their own emotions.

Fear separation more than death
Preschool children are not really interested in the details of the world’s politics, nor will they demand to know the details of the death toll or devastation. They are most concerned about whether their families will be well and stay together. In general, preschool children do not understand the finality of death. They believe that death is a temporary condition, and is reversible, as in sleep. They worry much more about being separated from their parents than about dying.

When preschool children fear separation, they may have nightmares, become more aggressive, and express concern about the deaths of others in that it represents "separation". Understanding the developmental thought process of a preschool child is helpful in deciding how to talk to your child, and how much to say. The following are suggested considerations when talking to your preschooler about the recent terrorist attack:

  • Reassure your child that he or she is safe
  • Limit the number of details given to your child to the simplest explanations
  • Be honest without sharing all of your own worries or fears
  • Limit your child’s exposure to news reports and discussions of the devastating consequences of this crisis
  • Continue routines that the child is familiar with, and avoid unexpected separations
  • Ask your child if he or she has any worries
  • Spend extra time with your child in an activity that is comforting
School-Age Children

School-age children tend to polarize even complex situations into "right" and "wrong", and most feel secure with clear-cut rules. It is evident, however, if you have ever listened to school-age siblings argue, that there is some room for negotiation, that is, some flexibility to adjust the "punishment" to the "crime".

Wanting to help
At the same time, children from ages six to eleven are developing empathy, and a sense of altruism. Thus, faced with a crisis, such as a terrorist attack, school-age children are likely to be emotionally responsive to the feelings of people directly affected by the attack, and they may also express a desire to "do something to help". This altruistic desire may take the form of an action such as collecting money, or donating clothes or toys to families who are in need.

Comprehension challenges
School-age children will ask many questions about an event such as the terrorist attack, but they may misunderstand the information they are given, so, it is extremely important for parents and teachers to check with children regarding their understanding of things. In the face of a major crisis, school-age children may incorrectly believe that they or their families are at fault, or they may fear that their school is likely to be attacked. Thus, children in this age range require a great deal of explanation, and a limited amount of information. If exposed to too much, too often, a school-age child is more likely to become confused rather than better informed.

Death through their eyes
School-age children do recognize death as final and real, and they conceptualize it as a remote event, and one that only happens to "old people". In present times, a significant proportion of video games, computer games, and fantasy play of school-age children is based on aggressive themes, and involves killing. In many games, the death and dying is personified into a "bad guy", and the "good guy" is glorified after killing the bad guy.

The following are given as suggestions for considerations when talking with school-age children about the terrorist attack:

  • Answer your child’s questions without providing all the details
  • Check your child’s understanding of the situation after discussions, since school-age children may misinterpret information resulting in guilt or fear
  • Encourage your child to talk about his or her worries, and angry feelings as well as altruistic thoughts
  • Invite participation of your child in altruistic actions such as collecting money, sending clothes, toys or other items to families in need
  • Expect some repetition in the discussions about the traumatic event
Adolescents Early adolescence is a time of exploration and searching for social acceptance by peers. A sense of identity is initiated in adolescents during these years, promoted by success in their ability to function independently, while accepting nurturance and guidance from parents.
In early adolescence, the ability to apply concepts learned in one situation to another begins to develop. Logical thinking prevails, while many unrealistic notions and magical ideas still coexist.

The immortal early adolescent
By the age of thirteen, an adolescent understands the finality and inevitability of death, but that same adolescent may feel immune to the possibility of his or her own mortality. In other words, young teenagers often have a sense of omnipotence, that danger can harm others, but not them. These feelings have an impact on a young adolescent’s concept of danger, and vulnerability.

Late adolescent development
Older adolescents are able to comprehend more sophisticated world situations and are also more able than younger adolescents to separate personal fears of danger to themselves from world events.

The following are suggestions to consider when talking to adolescents regarding the terrorist attack:

  • Encourage your teen to voice his or her beliefs and fears about the traumatic events
  • Keep in mind that even older adolescents may revert to more concrete and immature solutions to complex problems when under stress
  • Be tolerant of adolescents who may be overly idealistic under stress
  • Encourage your adolescent to seek out the facts and be exposed to the news, while continuing their usual activities
  • Discourage your adolescent from becoming fixated on the event to the exclusion of regular academic, social or sports activities
  • Encourage your adolescent to actively participate in altruistic endeavors along with peers or family members
How Parents and Teachers Can Help

Most experts agree that in a national disaster situation such as the terrorist attacks, there are a number of steps that parents, teachers, and other adults who are in daily contact with children can take to allay fears and provide comfort to children and adolescents. The following are general guidelines:

  • Reinforce to children and adolescents that they are safe
  • Allow less exposure of news and other broadcasts about the trauma to younger children, and more to older children and adolescents
  • Explore the worries and fears of children of all age groups especially about death
  • Allow children and adolescents to express feelings of anger and let them know that they will feel better over time
  • Redirect misplaced feelings of "hate"
  • Maintain predictable routines
  • Correct misperceptions of children who feel "at fault" or believe that they are in acute danger
  • Expect some degree of distraction, decreased focus, and possible irritability
  • Discourage deviation from usual activities, social life and sports games
  • Provide some activities that will be comforting to children such as reading a story to young children, listening to music for older children and adolescents
  • Limit the number of reminders of the event in the classroom and at home
Trauma Reactions to be Concerned About

There is no question that we have all been affected psychologically by the tragic terrorist attack on the World Trade Center and the Pentagon on September 11, 2001. Fear, anger, sadness, grief, retribution, and misery have been experienced by one and all.

Normal reactions
In my experience, young children respond acutely by worrying about their immediate safety and proximity of their parents. School-age children and young adolescents probably express more initial curiosity about the events. For many children and adolescents, after several days, a barrier seems to go up and they no longer want to discuss the sad realities in detail. Nevertheless, all children and adolescents may remain fearful, clingy, more concerned about the location of their family members, and slightly distracted. All of the above is normal and expected.

Reactions to be concerned about
How can you tell when a child is having serious psychological distress that warrants mental health intervention?

Some children will develop more enduring and significant psychiatric symptoms after exposure to a traumatic event. Children at highest risk are those who have already had psychological distress related to trauma, loss, depression and anxiety. However, some children without prior difficulties will develop significant symptoms after one exposure.

Psychiatric disorders that may occur following an exposure to trauma include depression, generalized anxiety disorder, as well as posttraumatic stress disorder. Signs that should prompt a psychiatric evaluation include the following:

  • A child’s refusal to return to school for several weeks following the trauma
  • A major change in the child’s overall energy level, appetite, sleep pattern or mood
  • Significant withdrawal from usual family, social or sports activities
  • Significant and persistent deterioration in school function
  • Re-experiencing the trauma frequently through intrusive thoughts, flashbacks, or nightmares
  • Exhibiting a sense of "foreshortened future", that is, a child’s belief that he or she will never live to grow up
  • Any self-injurious behaviors or wish to die
The following are some resources that will provide you with more information on this topic:

American Psychological Association
Brochures available such as:

"Talk to Someone Who Can Help"

"Managing Traumatic Stress: Tips for Recovering from Disaster and Other Traumatic Events"

"Reactions and Guidelines for Children Following Traumatic Disaster." by Robin Gurwitch et al. from the Dept. of Pediatrics, University of Oklahoma.

To order these brochures, call 1-800 964-2000 Or visit the APA Web site at:

Red Cross
The Red Cross offers disaster counseling literature on its Web site, at:

United States Department of Health and Human Services
The United States Department of Health and Human Services also offers literature on its Web site, at:

Penis transplant removed after two weeks

AP Medical Writer

Chinese doctors say they successfully transplanted a penis on a man who lost his own in an accident, but had to remove it two weeks later because of psychological problems experienced by the man and his wife.

The case appears to be the first such transplant reported in a medical journal — European Urology, published by the European Association of Urology.

The Chinese doctors could not be reached for comment, and their report does not explain how the 44-year-old man lost his penis. It says only that "an unfortunate traumatic accident" left him with a small stump, unable to urinate or have sex normally.

Surgeons led by Dr. Hu Weilie at Guangzhou General Hospital performed the transplant in September 2005, a hospital spokesperson said Tuesday. The penis came from a 22-year-old brain-dead man whose parents agreed to donate his organ.

"There was a strong demand from both the patient and his wife" for a transplant, and the operation "was discussed again and again" and approved by the hospital's ethics committee, Hu writes in the journal.

Despite how shocking and radical the operation sounds, it involves standard microsurgery techniques to reconnect blood vessels and nerves.

From a medical point of view, "the main hurdle is the functional recovery," said Dr. W.P. Andrew Lee, chief of plastic surgery at the University of Pittsburgh Medical Center.

From arm and leg reattachments, it's known that nerve regrowth occurs at a rate of about an inch a month and often is insufficient to allow normal use, he said.

However, the ethical and psychological challenges in such cases can be even more paramount, as this and other recent transplants involving hands and faces illustrate.

"Some of the considerations for a penile transplant are the same as for a hand or face transplant," such as the need to take lifelong immune-suppressing drugs to prevent rejection of the new organ, Lee said.

The drugs can cause kidney and other damage, acceptable risks when the transplant involves a vital organ such as a liver or heart, but more ethically perilous when the operation is aimed at improving quality of life rather than extending it, Dr. Yoram Vardi, a neurology and urology specialist at the Rambam Medical Center in Haifa, Israel, writes in an accompanying commentary in the urology journal.

Psychological issues are keenly important. The world's first hand transplant recipient stopped taking immune suppression drugs and later requested that the hand be amputated.

Lee recalled speaking with the recipient of the world's first double-hand transplant in France, who told him it took months for him to accept his new hands and stop referring to one as "it."

Fourteen days after the penis transplant, the recipient and his wife requested that the organ be removed "because of the wife's psychological rejection as well as the swollen shape of the transplanted penis," the surgeons report in the journal.

Lab examination showed no sign of rejection, the doctors report.

If adequate attention had been paid to the need for counseling and other psychological concerns surrounding the transplant, "the need for penile amputation could probably have been avoided," Vardi wrote in his commentary.

Who Pays for Special Ed


Parents want the best for their disabled kids. Public schools say they can't handle the cost.

Luke Perkins has been living "two disparate lives," court documents say: one at school in Berthoud, Colo., where the autistic boy was making some progress, and the other outside school, where the 9-year-old was so unruly he could not take part in such basic activities as going to church or eating in a restaurant. He became so destructive at night that his family resorted to locking him in his bedroom, which had been stripped of furniture because he kept smearing feces all over everything.

As with many autistic children, the skills Luke was acquiring in the classroom were not very portable. (Learning how to use the toilet at school, for example, didn't translate into his knowing how to use one anywhere else.) Alarmed by his regression at home, the Perkinses in late 2003 enrolled Luke in a Boston boarding school renowned for its success with autistic children. And because federal law requires school districts to provide an extended school day and even residential services if a special-education student needs them, his parents informed Colorado's Thompson school district it had to pick up the bill for Boston Higashi's $135,000 annual tuition.

Not surprisingly, the district balked. It argued that Luke, now 11, had been doing just fine at his local elementary school and that it shouldn't be held responsible for his backsliding at home. But both an independent hearing officer and an administrative-law judge disagreed and found that Luke's disability was severe enough to warrant a publicly financed 24-hour educational program. The district is now suing in federal court to try to overturn those rulings.

The battle over who should pay how much to educate Luke Perkins is only the latest front in the war over funding for special education. It has been three decades since the Education for All Handicapped Children Act first guaranteed a free education tailored to meet the individual needs of students with disabilities. The goal of that law is honorable: to protect children whose disabilities for too long condemned them to low expectations. But the number of kids receiving special-ed services--for physical, cognitive, learning and other problems--has doubled since fiscal 1977, to an estimated 6.9 million (or roughly 11% of all students nationwide), and cash-strapped school districts are struggling to find funding for those children, who on average cost more than twice as much to educate as nondisabled students.

The result, in many instances, has been wrenching--and often expensive--clashes between parents seeking the best for their child and school administrators trying to balance the needs of all students. Special-ed costs threaten to eat into budgets for school endeavors that are not federally mandated, like athletics or the gifted-and-talented program. The money has to come from somewhere, says Becky Jay, who was president of the local school board when the Perkinses first asked for tuition reimbursement, "and regular kids lose out."

School districts stress that federal law does not require providing the best possible education for students like Luke. Rather, the law, which in 1990 was renamed the Individuals with Disabilities Education Act, guarantees only a free "appropriate" education. "It doesn't say 'free minimal public education,' and it doesn't say 'free optimal public education,'" says Francisco Negrón, general counsel for the National School Boards Association. "It's somewhere in the middle."

When Congress called for the creation of individualized education programs for special-ed students, the process was designed to be a collaboration between schools and parents, a compromise between scarce dollars and infinite hope. But often there is no such thing as a happy medium. School districts spent approximately $146 million resolving special-ed disputes in 2000, when some 11,000 parents of disabled students asked for due-process hearings to try to get more services for their children. This year the Department of Education expects about 14,000 parents to request such a proceeding, which Peter Wright, a special-ed attorney in Deltaville, Va., likens to a cross between a nasty divorce and a medical-malpractice suit. Each side feels betrayed by the other, and each brings in a slew of expert witnesses. "The cases that are on the table tend to be really difficult, thorny questions," says Andrew Rotherham, co-director of the Washington think tank Education Sector. "How much is enough?"

In the Perkins family's dispute--which has cost the district $191,000 in legal fees--school administrators say the parents are penalizing the district for Luke's behavior off campus. "The issues that they had were really surrounding home," says Karen Pielin, the district's special-ed director. Teachers from Berthoud went to the Perkinses' house to help get Luke on a schedule that would reinforce what he was learning at school. But Luke's father Jeff, a rheumatologist, said that even though they tried hard, the competing needs of their three other children made it impossible to keep Luke on exactly the same regimen 24 hours a day. "Luke's routine," Jeff testified, "is not our only--and cannot even be our main--goal."

The Perkinses repeatedly asked to send Luke back to a district nearby where they felt the teachers were better equipped to handle autistic students. Julie Perkins says she begged Thompson's special-ed director to transfer her son. "I was in tears, and she was a stone wall," Julie says. The family's transfer requests were denied because Thompson wouldn't reimburse the other district for the cost of teaching Luke. Meanwhile, at Berthoud Elementary, with one-on-one training and a trio of teacher's aides constantly at his side, the third-grader was advancing in such areas as writing the alphabet and using a computer mouse. But those skills had to keep being retaught, and Luke's parents regarded him as falling further behind. After hiring a therapist to observe Luke at school, the Perkinses learned that he was spending a lot of time throwing fits on the floor or hiding under a table. "His behavior was so out of control that education was simply a pipe dream," Jeff says.

So Luke's parents searched online for better intervention methods and came upon Boston Higashi. The school uses rigorous exercise to get autistic children to start eating and sleeping regularly. And once those biorhythms are on track, students can begin to acquire basic living and academic skills. Within four months of being at Higashi, Luke went home for vacation mostly toilet trained. He has since conquered such complex tasks as riding a unicycle and walking on stilts--activities that have given him confidence to try other new things. "I do think he can have a life that's happy and maybe even productive," Jeff says. "If we had left him in the situation he was in, he would have ended up being institutionalized."

That belief makes it particularly hard for the Perkinses to hear people criticize them for fighting to keep Luke at Higashi or suggest that they just wanted to get a troublesome child out of their house. At their due-process hearing, the school district's attorney "was telling us that we were bad parents and that we just wanted to have an easy life," Jeff says, blinking back tears. He also insists that "we're not insensitive to the money issues." But he argues that the family's tax dollars contribute to the $2 million tuition-assistance fund Colorado created this year to help local districts with children whose special-ed services cost $50,000 or more a year. In other words, Luke is entitled to his share.

As other states create similar funds for high-needs children, the cost crunch has been complicated by mixed messages from the Federal Government. Parts of the No Child Left Behind Act require schools to raise the academic performance of children with disabilities, but the Federal Government picks up less than 18% of the additional cost of educating those students. And amid the increasing demand for special-ed services, Congress and the Supreme Court have made it harder for parents to challenge school districts' decisions on how much support their kids should receive. Although the latest version of the statute added a requirement for a last-ditch resolution meeting before the start of court hearings, which often cost each side $10,000 a pop, there's also a new provision that makes parents pay a district's legal fees if a court finds that they have filed a "frivolous" or "unreasonable" lawsuit. And the Supreme Court upped the ante in June when it ruled that a district didn't have to reimburse parents who prevailed in court for the fees many pay consultants to help wring additional services from school systems. The resources required--in terms of money and time--make it all but impossible for low-income parents to mount a successful campaign.

"It is very much a David and Goliath situation," the Perkinses' attorney, Jack Robinson, says of going up against a school district. Even parents who have the means to get a good slingshot don't always win. Over the past 15 years, a few dozen kids have been pulled out of Boston Higashi because their families failed to get public funding and couldn't afford the tuition. As the Perkinses await reimbursement from the Thompson district, money is getting tight. The family has had to take out a $90,000 loan to battle the school district. "We've spent every penny," Julie says. "We are right on the line."

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Help for parents choosing schools

Families who struggle to find the best secondary school for their children are to receive extra support and advice in a new pilot scheme in London.

Families of children with poor attendance records or special needs and refugee families will be targeted by the new "choice and transition" scheme.

The two-year £130,000 scheme, being piloted in Wandsworth, may be rolled out across England if it is a success.

It will explain to parents how to get the best out of the admissions system.

The scheme - sponsored by the Sutton Trust and the government - will give independent advice to less privileged parents about the quality, suitability and likelihood of securing a place at local secondary schools.

Visiting schools

Officers will encourage parents to visit schools and help them understand the information supplied by the schools.

They will explain admissions processes and help parents provide the information required in application forms.

And they will advise on the financial help available for meeting the cost of school uniforms and school trips.

Parents will also be offered assistance once their child has started at secondary school.

Pupils themselves will receive extra academic help to prepare them for the Year 6 test which is sat by all pupils in the Wandsworth borough.


Sir Peter Lampl, chairman of the Sutton Trust, said: "The transition between primary and secondary schools is a critical and complex stage in a child's education.

"Many families from less privileged backgrounds do not know how to navigate it successfully and to make most of the opportunities available.

"We have trialled similar projects at Pate's School in Cheltenham and the Belvedere School in Liverpool.

"Both of these have been enormously successful, and I am sure their work can be adapted so that parents in Wandsworth and other parts of the country have access to high quality independent advice and assistance."

Scheme to be expanded

Schools Minister Andrew Adonis said the Department for Education and Skills would be evaluating the success of the pilot scheme with a view to signing up other schools and local authorities for similar initiatives.

"It is important that disadvantaged children are given the same options as other children when making that crucial move from primary to secondary school," he said.

"The chance to go to a good school should not be the exclusive preserve of only those who come from the right backgrounds."

School admissions could be confusing to some parents, especially those in "challenging" circumstances, he said.

Maternity rights to hit small firms

Bob Howard
BBC Radio 4's Money Box

New rights begin in October for women expecting a baby or waiting to adopt a child from next April but some small businesses say it will hit them hard.

The changes are encapsulated in the Work and Families Act and have far reaching consequences for employers and employees.

Women's paid maternity leave will be extended from six to nine months and even small employers will now have to keep their job open for a year.

Mark Linton is a director of a small, Birmingham-based events management company.

He set up almost exactly a year ago and his firm consists of another male director and two women whom they employ.

He hopes to take on two more staff within the next year but like many small business owners he is concerned about the new responsibilities he will face if his employees go on maternity leave.

"I think it could be quite drastic," he told BBC Radio 4's Money Box.

"It's difficult because you have to balance the fairness of it all. It will be detrimental to the organisation if we have to leave the post open for a year."

Leave rights

There are other aspects of the Work and Families Act which worry small business organisations.

At the moment female staff must have worked for nine months to qualify for more than six months maternity leave.

From April, every woman will be eligible for a year's maternity leave from the moment they begin employment.

Women will still have to work for around nine months to get Statutory Maternity Pay.

Matt Hardman of the Forum of Private Business said larger firms can quite easily absorb the costs, but warned: "The danger with this legislation is it's the smaller firms who are going to be hit hardest."

There is already some help available.

Rachel Roe, a legal adviser with Working Families, told the programme companies already receive 4.5% extra in their government compensation for the disruption caused when staff have to be temporarily replaced.

"Maternity pay is fully funded by the government," she said. "It's not out of the small employer's pocket unless they choose to top it up. There's an additional 4.5% in there to reflect the additional administration costs."

Employers' benefits

The act does contain provisions which should benefit employers as well. Staff will in future have to give eight weeks notice of when they intend to return to work, more than double the current requirement.

Jim Fitzpatrick, employment minister at the Department of Trade and Industry, told the programme: "We have introduced new ways of paying, time allowances when it ought to be paid and keeping-in-touch days to encourage staff to be able to keep in touch with their company.

"We're always very sensitive about the impact on business generally and small businesses in particular."

But there are concerns the new legislation may backfire.

Three quarters of company directors said they thought the new law would discourage employers from taking on women of child bearing age, in a recent survey.

It has been estimated that around 10m women workers fall into this category, a third of the workforce.

Any reluctance to hire them would be a clear breach of sex discrimination laws.

Rachel Diney, head of discrimination at law firm Beachcroft, said: "I can see that there's an argument that inadvertently this will have exactly that result.

"I suspect that those employers who won't comply with the law and have been evading it will persist in that practice."

The government however says there are already adequate safeguards to stop this sort of discrimination.