Heatwaves got a grip on parts of Europe during the month of June

 

Dear Bloggers,

As the Earth warms, heatwaves are expected to occur more often, with sharper intensity and for longer periods. Rising temperatures adversely affect worker productivity and human health, but for policymakers to take substantive action for heat adaptation, making an economic case is key.

 

The Netherlands was suffering from its first summer heatwave with the national weather service was declaring a red alert on Monday for large parts of the provinces of Zeeland, Noord Brabant and Limburg in the south of the country.

 

The area reached 33 degrees Celsius in the shade in the late afternoon. In some places the temperature was approaching 35 degrees by midday.

Other regions in our country also felt the heat, with my hometown Sneek cooling down to 22 or 23 degrees at night.

Few people were seen on the streets, while many tried to cool off with fans, umbrellas or water bottles in the strong sunshine, with more than 30 degrees in the shade.

The daily maximum temperature of 37 degrees, as announced by the weather forecasts, was to be reached between 3 pm and 6 pm central European time in the city of Amsterdam.

 

"You can really only go out these days after dark, from 10 pm onwards. And even then you're still sweating," the bars and nightclub owner told me.

"I'm only outside because the fridge is empty and I mainly need beer." A random neighbor told me. But in the supermarket, he said, it was "nice and cool."

Temperatures are expected to drop slightly from Thursday after peaking on Monday, but the heatwave will not noticeably subside until next Thursday.

Meanwhile, the maximum temperatures of 32 or 33 degrees will drop after a bit of rain and thunder. People with mental health issues are facing a lot of challenges when it comes to hot weather. I have trouble dealing with the heat and as diabetic it is not easy to keep hydrated and keep the levels regular. For persons with mental health issues it is not easy as well as they sometimes don’t realize the power of the heat and they forget to cool themselves down.

The reasons why mental health patients are more vulnerable during periods of extreme heat are only just beginning to be explored. During heat waves, night-time temperatures are also elevated, leading to poor sleep which might contribute to mental stress.

Those that are taking medication to treat their illnesses are even more vulnerable to extreme heat. Lithium, used to treat bipolar disorder, can become toxic when patients are dehydrated. Tricyclic antidepressants can cause excess perspiration, leading to dangerous levels of dehydration. And clozapine, a powerful antipsychotic used to control schizophrenia, is anticholinergic, meaning that among other effects it reduces or stops sweating, the body’s most important defense against overheating. “This population is the most impaired, but then they’re taking the most high-risk medication that can further worsen their condition and their ability to thermoregulate.

That doesn’t mean patients should stop taking the drugs during heat waves, says our psychiatrist: “These are absolutely necessary, lifesaving medications that improve quality of life among people with disorders.”

That means alerting the entire gamut of social services to risk of heat waves on clients suffering from mental health disorders. “Knowing that there are going to be periodic heat waves, [psychiatrists and psychologists] have to actively engage with our patients by educating them about behavioral ways they can protect themselves,” through adequate hydration, appropriate clothing, and suitable shelter. For the most vulnerable—those with severe mental illness—“we need to engage local organizations and people who are from the community who have established relationships ahead of time to be able to go in and find Mr. Jones (fictive name), who we know is vulnerable because of mental illness.”

Now that heat wave season is upon us, I would suggest that care takers should be setting up a climate-focused group therapy. “It gives patients an opportunity to talk about this issue openly so that they’re more aware and know what to do. And if they feel more irritable or psychotic, they can think for themselves, ‘Oh, maybe the climate is affecting my health.’” 

Climate change is a health threat. But unlike floods, heat waves are predictable, which means deaths from heat waves should not be.

Stay cool and relax during the heat.

The Old Sailor,

 

 

 

 

 

 

The infamous benefits affair of the Dutch tax office

 

Dear Bloggers,

 

Let me tell shortly that many years ago we brought our kids to childcare center and before we had a childcare mother before they had to go to school and sometimes after schooltime they went there as well. At these days our lives were running smoothly I was a sailor on passenger vessels and my wife worked for one of the gas and electricity company and later on for the phone c company. We earned enough to live on and we got support of the tax office for the child care part. Unfortunately they f*#ked up big time and we had to pay back all of the so called support. It turned my stomach upside down when I saw the numbers on the bill. I phoned them If we could agree on a payback schedule and man they were though. We lost all our savings and we had to sell the car to fulfill their needs. I could lucky enough agree on a down payment for the rest so we at least kept a roof over our head and could feed our kids

 

"Just go to your room for a minute, sweetie," I told our youngest daughter as I briefly rub my 10 -year-old daughter's back. "Why?", the girl asks. "Because Daddy is going to tell things that were pretty annoying to us. Or do you want to sit in?" She shakes her head, no, it's old news to her in the years that have gone by she became a young lady who is 19 now. And she has homework to do. Otherwise,  it’s quiet in the house: the oldest daughter is at that point in life that she is living together with her boyfriend and had some therapy. Our oldest, is going on a study to go and work in childcare. "She lives just a block away and she is trying to getting away from it all and build her own life.”

 Our daughter who is now nearly 24 who had to deal with a lot of our problems and learned a lot about the real world and that the tax office is able to send you down on poverty. "I thought I wasn't allowed to talk to anyone about it," she tells. I can only be proud and smile. "Brave kid I have, huh," says a proud dad "Telling all bailiffs and creditors of all these companies that they had to call back or come back when her dad was home. That is something what we kept hidden for years. I'm so proud." I put two glasses of tea on the table and sit down, let's have that conversation about those unpleasant times. "Every time I talk about it, the chaos in my head gets a little more ordered, it feels a little lighter. And it has to, it has to get lighter." We are one of thousands affected by the now infamous benefits affair of the Dutch Tax office. Me and my wife and  two daughters have "stumbled into the financial abyss," as she calls it, and the family still hasn't quite clambered out of it. "People see this house, with furniture, a car out front, and they think: they have it good. We have it better now than we did then, but we're still in debt. You can't always see poverty on the outside. I would love to shout from the rooftops what happened. And at the same time, I don't know if I can find the words. Only now, more than fifteen years later, do I realize all that has happened. Then right after that I think: I just don't believe it. I can't believe this happened to us."

 

We are writing 2014, I am 46, just being a father of two girls one is fifteen and the other is ten. We got married, seventeen years ago and we were moving into our new house in Lippenhuizen, Since we both work, we did need childcare. Part time. So my wife tells me to apply for childcare allowance at the Tax Office. Not much later, she is on sick leave as she has been mentally destroyed by a manager who tries to get rid of people who are standing in his way. After two years she loses her job because the company she works for wants to end her contract as doesn’t recover soon from her CPTSD. She is not able to take care of anything and leaves us with the administration of our family, so we want to stop the allowance. Then follows a message from the Tax Office: 'The amount to the daycare has already been paid out.' 'But I'm no longer at that daycare, my child hasn't been there,' is my defense. They don't care about that at the Tax Office, because we eventually had to pay back three thousand euros over that same year. I just had no idea how. "In retrospect, all the bells should have rung, we should have done everything at the time to resolve it. But I was not the best bookkeeper that you can find and together with my daughter we tried to pay all the bills and debts and we made several phone calls explaining our situation hard, in the mean time I had to fight for my job, getting a lot of understanding from my boss but getting rejection after rejection, from the Tax office to get a solution to pay everything back. And they were pretty stubborn. Luckily we could close payment deals with other companies and we were in the middle of my daughters exams. We got life slowly back on the move. It was total chaos."

 

From the stress, my wife gains more than 10 pounds, due to the medication the medication made her life bearable . "I used to learn from my own father: make sure son that you can keep your own pants up. I thought that was SO important." I was retraining and working for the bus company on a temps office contract. Now things should work out, at least that was what I was thinking. But it doesn't work out, because in order to work, my wife she needs care and our youngest needs childcare. We were also duped by the new care, things have been changed in the tax system and the shelter gets the money straight away, All of a sudden we received the bills and reminders. Desperate and in slightly panic, I also wonder: have I been too naive? "At bad moments I almost break down from feeling stupid," did I make the same mistakes again?

 

I probably could write a book about it, but in a nutshell: the financial misery is increasing, as the debt is now several thousand euros. "And then we did something we should never have done. We took out a loan to pay off the debts. We thought we would be able to hold out for a while." As I say that, our second daughter walks in, along with Mom. She goes upstairs as she doesn’t want to interrupt while I am writing this story and my wife plops down on the couch: "Another long day ahead of us." "But not as long as it used to be," I complement her, and for a moment our gazes cross. We can remember it well: how she worked day shifts, and I worked late and night shifts, how we have struggled in their off hours and weekends. "If I had to do it again, I would probably fall over. We barely saw each other, the guilt and debts grew, we stuck our heads out and my wife’s mom and dad lend us several thousand euros which we paid back with every penny we could miss. At least we did not stick our heads in the sand. What else could we do?" We didn't really talk about it. Not with each other, no time for that, and my wife could not follow this anymore as she was mentally destroyed and had enough to just get through the day. 

And no we did not talk about it  with others, too much shame. And it feels like failure to me. In my family, you don't hang out the dirty laundry. "And we had two kids that needed clothes and they had to get their stomachs full, because we were poor it did mean to ask the kids to help out sometimes but we luckily never ended up in a marriage crisis." At a certain moment we closed our doors more and more. "Only her mother and other relatives we still allowed here. She knew about it and helped without naming it. Then my mother in law she'd say, 'Come on Jacob, put on your coat, take the kids and we'll go to the Aldi and you fill up the shopping cart with whatever you want and what the kids like. I'll pay for it.'"

 

The mail became more imperative, "In the name of the king," it would say. And: 'Restraining order. Bailiffs followed. "We taught the children: when the doorbell rings, act very carefully, they must not enter our home. So our kids went to the door when the bell rang. Even when bailiffs rang the bell." My daughters told them to come back an other time. They couldn’t do anything as our daughter was a minor and my wife was very ill and could not talk to them.  She was bullied, at school, she only told us that in a later stage. Just like that she only told us as well later, "I was hungry pretty often. "That's what kids do. Who see: mom and dad are struggling, they spare them. Children have a thunderous sense of when something is going on." An empty refrigerator, second-hand clothes and, at one point, no longer than five minutes showers. "As a parent, you pretend everything is normal. I made fun of everything."

 

There were agencies demanding money, but no agencies were offering help. "The school didn't come here, they immediately called in community service. Terrible times, just trying to remember?" Says my wife and she nods, "You were checking every day before school to make sure they didn't have holes in their clothes, putting those lunchboxes as full as possible so no one got suspicious." One time our youngest had a hole in her shoe and she told her teacher that we did not have enough money to buy new ones for her. "The next day the teacher got her some shoes to keep her feet warm." Me: "I felt so embarrassed and empty and felt I had totally failed as a father." Debts had now gone up to our top all because of the loan, fines, unpaid bills. The pressure on our relationship was also mounting and no I am not a quitter so it was not going to result in a divorce. We sold our house and moved to a smaller house, we took the money that we earned out to pay off debts the house we bought back was needing a lot of work to be updated and so we wanted to get a higher mortgage only the bank would not give any credits so we had to get a loan again. We are in the middle of the process with the Tax office to get this fixed so we can live a happier life.

 

Our (s)old house 

We are now applying for help at the council as our children missed a lot due to all of this and through a social worker there might be some money for a new bike and school stuff for the children. "It was the first social worker who cared about us and applied for a fund.".

The children's rooms may have been furnished, but we sleep on a  bed that is almost thirty years old. The mattress is in a poor condition. And then comes the day when my  body signals that it's too much. I suffer from arthroses and I did end up in the hospital care. This is followed by rehabilitation getting of the meds that I have been on for years and later at home. Meanwhile, the family no longer has extra debts only for the house. The refrigerator is stocked again and hot water flows in the shower again. I just share our story, thinking we have been lucky they did not take our kids from us and we have survived this crazy part of life. "I asked my daughter if she was sure she is okay with her youth?  Then she said, 'Dad, if we hadn't been so embarrassed, and unknowing maybe help would have come sooner.' She is so wise." She has become very price-conscious, I still go together with her to the supermarket as she doesn’t have a car yet. She has given herself  some pocket money, but hardly ever spends it. "I don't want to use that until I need it," she then says. "When we saw the other day that some euros had been debited from her account at a clothing store, we joked about it at the table: 'So, did you finally spoil yourself?' Then she told us she had bought a shirt for her and her friend." As her friend had to choose either paying the food for the coming days or this great shirt. She has a good heart and when the time is right she will pay me back anyway. 

 

"My tears, they've been so on the surface the last few months." Breathe in. Exhale. "My daughters are too mature for their age. We are doing pretty well now; we are slowly healing, I think. I am teaching the kids that they are allowed to feel what they are feeling. They are allowed to cry and talk about everything. I didn't do that myself for too long. Now we are learning this, together, as a family. But the childhood of those girls, part of it was taken away from them. And I am kind of wizard if it comes to solutions in life itself, although loosing your childhood is irreplaceable. And no I can't buy that back for any amount of money."

The Old Sailor,

Living with inflammatory arthritis

 

Dear Bloggers,

I probably have told you in earlier stories about my stiffness in joints and on a rainy and cold day it is harder to get out of bed and go on the move. No, I am not a complainer somehow there is a feeling that people around don’t know a lot about the condition and that there is a lot of pain involved. (One of the reasons that I only write once a month instead of every week.) I have used quite some pain relievers during the last fifteen years. As I stopped last year with the medication on advice of the rheumatologist. The inflammations took a flight. From sour joints until inflammatory bursitis in my hip and being treated with a nerve Intercostal Block on my rib.

Inflammatory arthritis is a condition many people endure for a lifetime. Thanks to advances in treatment, however, innovative medications can delay and even halt the progression of the disease, and non-drug approaches have can help relieve symptoms so you can live a full and productive life.

What is inflammatory arthritis?

Inflammatory arthritis describes a group of diseases caused by an overactive immune system. The most common symptoms are joint pain and stiffness. Affected joints may feel warm, swollen, and tender. But inflammatory arthritis can also affect other tissues in the body, including the lungs, heart, eyes, skin, and other organs. Left untreated, it can cause irreversible damage. Early treatment is the best way to relieve symptoms and limit the effects of inflammatory arthritis on the body.

While it’s not known what causes inflammatory arthritis in every patient, what is known is that the immune system does not know when to put on the brakes. Normally when we are exposed to bacteria, viruses, or fungi, the immune system produces white blood cells called lymphocytes as well as immune proteins to mount an attack against these invaders. Lymphocytes and immune proteins cause inflammation, which under typical circumstances is limited and resolves once the foreign substance is defeated.

But in someone with inflammatory arthritis, the immune response does not know when to stop. It turns on your body, attacking your own tissues instead of the foreign substance and causes continued inflammation. For this reason, inflammatory arthritis is known as an "autoimmune disease" − auto meaning "self" and “immune” because the immune system loses its ability to distinguish self from foreign.

How are inflammatory arthritis and osteoarthritis different?

Although they share some common symptoms, inflammatory arthritis and osteoarthritis are quite different diseases. Osteoarthritis is a common condition causing wear-and-tear of the cartilage of the joints due to age and/or prior injury. Here are some other differences:

Inflammatory Arthritis - A "systemic" disease which may affect the joints as well as other organs, such as the lungs, heart, eyes, tendons, and skin. Patients may show elevations in proteins such as rheumatoid factor, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) on blood tests. Autoimmune disease related to body-wide inflammation.

Osteoarthritis - Symptoms are limited to the joints. Blood tests for biomarkers are negative. Mechanical wear-and-tear on joints due to age or injury.

 

What are the different types of inflammatory arthritis?

If you are experiencing symptoms that suggest inflammatory arthritis, your doctor will perform a number of tests, including a physical exam, blood tests, and imaging exams (such as X-rays, joint ultrasound, and/or MRI or CT scans). Sometimes the physician takes a sample of fluid from an affected joint for analysis − a procedure called joint aspiration. 

Based on the results of these exams, your physician will determine if you have inflammatory arthritis and if so, which type:

Rheumatoid Arthritis (RA) is the most common form of inflammatory arthritis. It tends to involve more than one of the small joints of the hands and feet. In particular, the lining of the joint or tendons (the synovium) is inflamed, causing warmth, pain, and stiffness. In 30% to 60% of people with RA, blood tests confirm the presence of proteins called rheumatoid factor (RF) or anti-cyclic citrullinated peptide (anti-CCP) antibodies. It is very important to control inflammation in the synovium to stop joint destruction and to treat RA to minimize damage to the heart, lungs, and eyes.

Psoriatic Arthritis is a type of arthritis called a "spondyloarthropathy" that is a combination of psoriasis (red, scaly patches on the skin, especially the knees, elbows, and scalp) as well as pain and swelling in the large and small joints and sometimes the spine. It can cause complete swelling of a finger or toe − a condition called "dactylitis."

 

 

Juvenile Idiopathic Arthritis (JIA) affects young people under age 16, causing inflammation in the joints and sometimes in the spine and ligaments (tissues that connect bone to bone) that lasts for more than six weeks. Swelling or mobility problems, including a limp if the legs are affected, may be the only signs of JIA. Some types of JIA cause eye inflammation that can occur without symptoms, so prompt diagnosis, treatment, and monitoring of JIA are vital to prevent permanent damage. Children and teens with JIA are best treated by a pediatric rheumatologist.

Ankylosing Spondylitis (AS) affects primarily the spin and hip joints, breastbone, and large joints in the body. Over time, AS can result in noticeably reduced motion in the spine. Up to half of people with AS have a gene called HLA-B27, the presence of which can help confirm the diagnosis of this condition when it is found in combination with AS symptoms.

Gout & Pseudogout (calcium pyrophosphate dehydrate deposition disease or CPDD) are forms of arthritis caused by elevated levels of certain crystals in the body. Gout results from excess uric acid, causing it to crystallize in joints such as the big toe and also raising the risk of kidney stones. CPPD occurs when calcium salts form in the joints and are engulfed by white blood cells, provoking inflammation − most commonly in the wrists and knees.

Other autoimmune diseases can cause inflammatory arthritis as a symptom. Examples include Sjogren’s syndrome and lupus.

You and your rheumatologist: A lifetime partnership

If you have inflammatory arthritis, it is imperative that you see a rheumatologist on a regular basis to monitor your health and customize your treatment. Rheumatologists are medical doctors with special training in the care of people with joint diseases and autoimmune diseases. They are different from orthopedists, who are trained in surgery and who may also be involved in the care of people with inflammatory arthritis when medical treatments are not enough.

How do you know whether to start with a rheumatologist or orthopedist? If you have ongoing joint discomfort without chronic swelling or other symptoms, such as fatigue, you may be able to see an orthopedist first. But if your joint pain is accompanied by warmth, swelling, other signs of inflammation, fatigue or discomfort in other parts of your body, a visit to a rheumatologist may be in order. Your primary care physician can guide you.

Because inflammatory arthritis is an autoimmune disease that can affect multiple parts of your body, you may need to see other specialists, too, to keep your symptoms in check and maintain the best quality of life possible.

To prepare for your visit with a rheumatologist:

·     Bring in a full list of your medications, including vitamins and supplements.

·     If you are already taking medications for inflammatory arthritis, make any notes about reactions or side effects you may be experiencing.

·     Provide a list of all health conditions you have had, prior surgeries, and symptoms you may be experiencing.

·     Prepare a list of questions you may have for your doctor.

Your rheumatologist may choose from a variety of treatment options for inflammatory arthritis, depending on the type and severity of your disease, such as:

·     Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen.

·     Steroid medications (corticosteroids) such as prednisone, which are typically used for shorter periods of time because of their side effects.

·     Traditional disease-modifying antirheumatic drugs (DMARDs), such as methotrexate, hydroxychloroquine, sulfasalazine, minocycline, and leflunomide.

·     Biologic DMARDs, which target the proteins driving inflammation, such as infliximab, etanercept, abatacept, adalimumab and rituximab. These medications have revolutionized the care of people with inflammatory arthritis, sparing many from surgery.

·     Surgery may be indicated for specific joints with damage that can no longer be controlled by medications.

 

A diagnosis of inflammatory arthritis can initially feel overwhelming. It can take weeks or even months to come to terms with and understand what having this disease can mean in your life. By developing a close working relationship with your rheumatologist and other caregivers, however, there is much you can do to control inflammatory arthritis and maintain an independent and active lifestyle.

The Old Sailor,

Spring is coming

 Dear Bloggers,

 

It is on its way, Spring. We celebrate that the sun is shining, the birds are singing, the first buds are budding, the sky is blue again. Above all, move with the rhythm of this season, because there is no period more suitable for a fresh start than spring.

 

Sunset at the harbour of Langweer (©Passantenhaven Langweer)

Everything starts up again.

Spring is eminently symbolic of new beginnings. Just look around you. Nature is slowly awakening from its hibernation. The bare branches still seem asleep now, but the spectacle is about to begin. The first buds come out, and then suddenly the party erupts in an explosion of blossom. Along the way, you already see loads of crocuses and snowdrops, and here and there the daffodils are coming out of the ground. The old is cleared away and makes room for the new. With spring, the cycle begins a new round.

 

 

Go Outside

This great reversal does not only apply to nature. After a period of stillness, inner peace, and relaxation, it is also time for us as humans to turn outwards. To leave the past behind and set new ideas in motion. Get clean by cleaning your house, for example. Get outside and meet new people. Enjoy every ray of sunshine there is. Open the windows, clear out stuff you no longer need and feel your home fill with new life energy, using your emotions and thoughts as wonderful tools to live it to the full. Once you have mastered this steering of positive thinking, you can turn your deepest desires and most beautiful dreams into reality.

 

Young, fresh energy

Spring represents cheerfulness, optimism, and bursts of joyfulness. You can feel the energy around you changing. Move with that young and fresh energy and get outside. Be aware of everything around you and look for every sign of spring. Feel the freshly cut grass under your feet, the spring breeze through your hair and enjoy to the full. Feel how it comes in and how it touches you and lock spring in your heart. What a wonderful feeling.

 

Creation and innovative ideas

You will find that because of this renewed energy from the sun and experiencing your surroundings, innovative ideas come to you more easily. You see possibilities and are often brimming with inspiration. Go for creation preferably do something with your ideas and freshen up your home for example with a new and fresh coat of paint, or a fresh piece of wallpaper and if you do not have a lot of money to spare, a good clean-up and purification can also be very satisfying. It gives a feeling linked to spring. It is the place for new beginnings, to make all your dreams and goals come true.

 

Benefits of Modern Seasonal Celebrations

The first day of each season is a wonderful opportunity to pause and connect with nature. Seasonal celebrations are affordable, nature-based, and as easy as you want them to be. It is nice to take a time-out from the clock’s relentless march forward occasionally to appreciate what’s happening in the natural world: What the sky looks like, what local wildlife are up to, which birds are hanging out at the neighborhood pond, and whether the leaves are budding, falling, or mulching the gardens.

Seasonal celebrations are also a suitable time to reflect on the lessons the season imparts. Fall teaches us about the inevitability of loss. Winter shows us the importance of inactivity in plants and animal life, darkness, and stillness. Spring shows the possibility of rebirth. And the bounties of summer are endless. Its light, warmth, and lush crops.

Create some spring traditions this year!

What better time than spring to start some new family traditions? Pick activities that you will want to do year after year and ones that will make the day relaxing and special for you and your family.

Decorate your surroundings.

Collect spring flowers, cherry buds, or whatever symbolizes springtime in your family and display them on a mantle or tabletop. Place bouquets of crocuses, daffodils, tulips, or dandelions around the house. so, they wake up to fresh flowers on the first day of spring.

Observe

The days are getting longer. Go outside on the first day of spring to watch the sun rise and set. Find out what time the sun will rise and set where you live. Go on a walk or hike and identify wildflowers if they are already sprouting in your area. Or visit a local farm and see if you can get a glimpse of calves, lambs, or chicks in the barnyard. Gardening season is here! Spend some time planning your springtime garden. Have each family member pick a favorite flower or plant to sow in honor of the first day of spring. Designate a special garden and make a ceremony of it.

Read

And chilly days aren’t over yet, so on these days grab a warm drink and sit down with a great book or a nice magazine. Just reflect the past time and look forward to warmer weather. That brings you in the mood for the weeks to come.

Craft

Easter is part of spring and yes, it is fun to decorate hard-boiled eggs with harmless paint and even if your kids have grown up it gives a great feeling to do something that you love. Release your inner child and enjoy the time doing something with your hands and it is good for your brain to get creative.

 “Do not be afraid. Change is such a beautiful thing,” said the Butterfly.”

The Old Sailor,