How to cope with panic attacks panic disorder

1. Take your anxiety with you..........feel those sensations, knowing they are NOT a disease that will harm you/kill you. Learn to rebreathe into a paper bag, because most of the dizzy/light headed sensations are because of oxygen/carbon dioxide imbalance....rebreathing into a paper bag helps this or breathing slowly in through your nose and out through your mouth.

2. Eat small regular meals, every 2/3 hrs. When we dont eat for a while, sugar levels are effected, and eventually adrenaline is released...causing more panic.

3. Get into a bedtime routine of...no caffine after 6pm, a warm bath, good book, bedroom nice temperature, and use music on low to help you drift off.

4. Try aromatherapy oils such as Lavender, or Neroli. A few drops in your palms, rub together, inhale. Use also as a massage in olive oil.

5. Read read read......by fully understanding panic and anxiety, you will be able to come to terms with it. Knowledge is the key.

6. DONT STOP going out to work or out socially. Your panic WANTS to control you, dont let it. Feel it, but go about your day.

7. See your GP, because medication can be of great help. Try counselling through the NHS or privately. Bach rescue remedy helps some people.

8. Talk to family and friends or post on panic forums to other sufferers.

9. Never give up.

10. Dont drink too much alcohol, it never helps anxiety.

11. Get some fresh air everyday, half an hour is fine.


This was taken from a forum I read on http://www.nomorepanic.co.uk/ posted by a 'Paula Lynne' I found this most useful& hope it will also help you too.

How to remember names

Forty eight years old clerk working in a government department was visibly upset when he entered my office. He wanted treatment for Alzheimer’s disease. Alzheimer’s disease is the most common form of dementia. Dementia is a serious loss of cognitive ability beyond what might be expected from normal aging process. It is characterized by loss of short-term memory, inability to learn new things, defects in reasoning and problem solving. The clerk who came for treatment didn’t show any sign of such cognitive functions. So, I asked the 48 year old clerk: Mr. S., why do you think you are suffering from Alzheimer’s disease?

Mr. S. settled down in the chair and started describing his problem: Doctor, I have some memory problems. I can’t remember names of persons whom I know very well. I can recognize their faces, but I can’t remember their names. Often this causes me trouble. Some of my friends accuse me that I lack sincerity in friendship. That is why I could not remember their names. It creates some problems in work place also. My colleagues accuse that I am careless.

I tested his recent memory in the following simple way: I showed him four objects, viz. a pen, a cellular phone, a wrist watch and a paper weight. I asked him to keep them in memory. After five minutes I asked to tell the names of four objects. He recalled all the four objects in the same order. I reassured his memory power was intact.

Tim Hallbom

Tim Hallbom, a Neuro-Linguistic Programming (NLP) trainer, NLP Institute of California, author and therapist writes:  "One of the things that brain researchers have discovered in the last few years is that your internal dialogue occupies the same auditory nerve in your ear as external sound."

Researchers have established that the people forget names because they're usually involved in some other internal conversation. So, it's real hard to hear the other person saying their name when you're having an internal conversation with yourself about how you're coming across or what you're going to say next.

In remembering names, the first thing that Tim recommends is to concentrate on staying external with the person by listening to them. Then repeat their name to yourself three times while you're looking at them.

To get the visual part in, imagine that you can see their name written on their forehead. To make it more permanent, see their name in your favorite color of magic marker. This will make it stick out the entire better. Do this while you're saying their name to yourself. If you repeat this technique for some time it becomes automatic and you can do it effortlessly.

Franklin D. Roosevelt 

Franklin D. Roosevelt, the 32^nd President of the United Sates was a master at recalling names. He continually amazed his staff by remembering someone's name that he had only met once, months before. Asked how he did it, he said he saw the person's name written out on their forehead. 

Words That Work in Deceptive Drug Company Advertising to Physicians

"It depends upon what the meaning of the word 'is' is." ~ Bill Clinton

I recently came across a rather humorous document from a legal action that was taken way back in 2008 against the drug company giant AstraZenica (AZ) in litigation over marketing issues with its antipsychotic drug, Seroquel (Quetiapine). I thought it would be fun to share with my readers.

It came from the United States District Court, Middle District of Florida, Orlando division in the matter of Seroquel products liability litigation, Case # 6:06-md-01769-ACC-DAB, on April 24, 2008.

It was a Q&A between a lawyer and the AZ executive who was involved in organizing the slides used in promotional talks given to physicians. It concerned the use of the term "unsurpassed" in slides used to market the drug.

Seroquel was one of the newer "atypical" antipsychotic medications. They were called that to distinguish them from the old, "typical" antipsychotics like Haldol. The old drugs were notorious for causing acute neurological side effects such as a Parkinson's disease-like tremors and muscle spasms (which can be easily countered with another class of drugs), as well as a long term one called tardive dyskinesia (TD) that could become permanent. 

To see what TD looks like, watch the Batman Movie The Dark Knight with Heath Ledger playing the Joker, who I guess was supposed to have been an ex mental patient, and was portrayed as having the mouth movements typical of TD.

The new '"atypical" drugs are much less likely to cause these neurological problems, but instead are far more likely to cause metabolic syndrome - weight gain, increased cholesterol, and even diabetes. (Recently released ones in the last few years are better on this score as well, but Seroquel is one of the worst offenders in this regard). Pick your poison. Atypicals have never been shown to be more effective than the typicals for the hallucinations and delusions characteristic of psychotic disorders.

In fact, AZ's own documents showed that the company analyzed 10 studies, and found that none of them showed that Seroquel was superior to any other antipsychotic drug.

So how did AZ spin this in its sales presentation to doctors? Their slides said the drug was "unsurpassed" in efficacy the treatment of schizophrenia. They found that this word was one that worked.

This is funny because there are two different definitions of "unsurpassed." The definition most people think of is "superior in achievement or excellence to any other." In other words, most people would think that the slide indicated that Seroquel was the most effective antipsychotic drug available.

The more literal definition, however, is "as good as or better than any other." This means that other drugs can be equally as good. Obviously, that wasn't the message that the slides were meant to convey to the doctors, but because the lesser known definition exists, this gave the company plausible deniability against the charge that it was making claims unsubstantiated by any research - even though that was the take home message most people would take home. Pretty sneaky!

The company man responded to questions about this with mental sommersaults, some of which - as my friend Peter Parry points out - are cringe-worthy. So here it is (minus some objections by the involved lawyers):

Q. Let me just read the conclusion to the jury and then ask you a question about it. "Conclusions. The intended claim of 'superiority versus Haloperidol' is highly unlikely using these data, however 'a claim of equivalence is not ruled out.' Did I read that correctly?

A. Yes, you did.

Q. Were you ever informed of that Technical Document No. 5 or its conclusions?

A. I have told you twice already no.

Q. Okay. Do you think you maybe should have been informed of this information before you Went around making claims of unsurpassed efficacy?

A. No, because I took my guidance from the head of clinical, the disclosure committee, and the SERM group. By the way, how is

equivalence different from unsurpassed?

Q. Do you really think you get to ask me questions? Is that what you think this process involves, that you get to ask me questions and I give you answers?

A: I'm trying to answer your question.

Q. Well, let me ask, since you asked me a question, let me ask you a

question: "Unsurpassed," "unsurpassed,"- what does that mean?

A. It means --

Q. Nobody is better; right?

A. It means equivalent.

Q. So if I really -- I'm trying to think of something. If I tell

somebody that I went to a track meet and I saw an athlete that has been

unsurpassed, I mean he was -- her, let's say her. Her ability to do the broad jump and the high jump and the relays were unsurpassed, and I was just so impressed and I go and tell you it was unsurpassed, you believe that means I'm saying she was equivalent to everybody else at the meet?

A. Possibly, yes. That's the correct grammar. Possibly, yes. She

was possibly better; she was possibly equivalent.

Q. And if I come home and --your child, you said, is 5 years old?

A. I have got two.

Q. How old are they? Mine are 22, 20, and 17. How old are yours?

A. 3 and 5.

Q. When your child comes home from school let's say from first grade

and says, "Daddy, I" -- well, I don't think first grade. And your child may be smart because you are smart. So let's just go to fifth grade. Go to

fifth grade. "Daddy, my grade in my English class was unsurpassed." What

are you going to say, "Congratulations.You made the same grade as everybody else"? Is that what you are telling this jury, is "unsurpassed" means the same?

A. Yes, it does, it means the same as or better. That's exactly what it means.

Q. So -- that's exactly what it means. So when AstraZeneca -- I'm glad to know this. This is interesting and I'm glad we're getting this out here. So when AstraZeneca made the claims of unsurpassed efficacy in regard to Seroquel, what they were meaning to say was, "We are just the same as everybody else"; is that right?

A. No, but I think we were incredibly careful with the use of grammar to depict what the clinical studies showed and concluded.

Q. You were trying to be tricky?

A. No. We were being incredibly precise and using the correct language. Of course, the language varied from country to country and label to label. The global impression from the safety and efficacy review group was our efficacy was unsurpassed.

Q. And you said in order to use that language, using your words, you were being incredibly careful; is that right?

A. No, I didn't. I said "incredibly precise."

Q. "Incredibly precise"; is that right?

A. Yes.

Q. All right. So if somebody understood the term "unsurpassed efficacy" to mean that you were better than others, they were just being incredibly what, dumb?

A. No. We would never make a claim without showing supporting documentation. So, for example, in the U.S., the doctor could read the label,he could read the FDA approval, and he could see the total span of facts.

Q. I'm not asking about the label and I'm not talking about the FDA

approval. I'm talking about what you've called at various points during this deposition a slogan or a phrase used in regard to Seroquel, and that was unsurpassed efficacy. Are you telling this jury honestly under oath that you were being so incredibly precise in the marketing of Seroquel that "unsurpassed efficacy" really meant that "We were the

same as everybody else"? Is that what you're telling this jury?

A. No. I'm saying that we chose that word to explain the fact that in the studies that we had done, our efficacy was unsurpassed when used in the right patients in the right dose in the right population. You can read a document like this without the context and it would be easy to be misunderstood about the total conclusion for what we say about Seroquel. 

Initial Reactions to the Return of Major Depressive Disorder

Please note - this article is about major depressive disorder, which is different from the most common form of depression, which has a variety of different causes, and is a normally an isolated, one-off episode.

Do Not Blame Ourselves

A reaction we may have to major depressive disorder’s return is to blame ourselves for its return, asking ourselves questions like, “What have I done to cause this relapse?”

When depression was forcing its way back into my life in 2010, I kept going through this issue, wondering if I was doing too much, not exercising enough, and so on. Here’s such an entry from my diary:

3.11.10 – Here I am, making lists again.
I believe the primary cause of what I’m going through now is a combination of the following:
1. Was not eating properly for a few months due to throat problems, and lost 6kgs
2. Add to that getting sick repeatedly throughout winter, perhaps seven illnesses in a row...
3. As a result of getting sick so many times, I did not exercise regularly.
4. Pushed myself way too hard practising the the piano.
5. Though of course, it could be my damaged, epilepsy ridden brain simply misfiring, with no rhyme or reason at all.

However, major depressive disorder, which is also known as recurrent depression, is called that because it re-occurs, and does not need anything to trigger it. Instead, it is a malfunction of the brain and nervous system, and new episodes may trigger from time to time, as sufferers can have several episodes during their life. We can have months, years, or decades free of it before it triggers again.

Succumbing to another episode of major depressive disorder in 2010 was none of my doing, it was simply another episode caused by the disorder. And it followed the same pattern it took back in 1989 - 1994. Therefore must not blame ourselves or feel guilty when it returns. We are not a failure. We cannot prevent such episodes, but by responding to them correctly, for example by trusting entirely in God, keeping our eyes fixed upon Jesus, using Dr Claires Weekes techniques of facing, acceptance, learning to live with it, and letting time pass; medication, counseling, exercising, etc, we can reduce the severity and duration of the episode.

Do Not Feel Guilt if Previously Dealt with Fears Return

When I suffered an emotional/mental collapse during my first major depressive episode in Dec 1989, a fearful thought/doubt entered my mind that became an obsessive fearful thought, which terrorized me night and day, week after week, for months. I received significant relief when the fear was addressed by my counselor, but it continued to plague me until the end of that depressive episode. After I recovered, it popped up a few times but was easily dispatched. So to all intents and purposes, it had been dealt with.

Several months after the onset of this new depressive episode which began in 2010, I suffered another emotional/mental collapse, and that same fear, which had previously been dealt with, resurrected, and with almost as much power as it had back in 1989-94.

One reaction to the return of previously dealt with fears is to feel guilty, to think we have regressed to falling prey to those fears again, perhaps even thinking our walk with the Lord is going backwards. However, we have to remind ourselves that the only reason these fears have returned is because of depression. For when we are depressed, our mind typically loses its flexibility and resilience. If we were not depressed we would have got rid of the fears with ease.

So we must must not feel guilt if any previously dealt with fears return, but remember that those fearful thoughts will reduce in severity and duration as we recover from this depressive episode.

However, we may need to receive prayerful/Biblical counseling or therapy to help us deal with and overcome those fears. At the very least, we need to speak to someone wise to help us see the true perspective about what we fear, and learn to see things as they see them.

“There is now no condemnation for those who are in Christ Jesus,” Romans 8:1

Maintain Hope

Regardless of how bad a new major depressive episode becomes, we must NOT lose hope. We need to keep reminding ourselves that we recovered from it last time, and we will recover from it this time.

We need to remember that our hope in Jesus gives us the strength we need to persevere and endure whatever trials come our way. ‘We continually remember before our God and Father your work produced by faith, your labor prompted by love, and your endurance inspired by hope in our Lord Jesus Christ.’ 1 Thessalonians 1:3

Set Realistic Recovery Goals

We also need to set ourselves realistic goals for recovery if we enter a new episode of recurrent depression. Unrealistic goals create time pressure, which only makes things worse. It took me five years to recover from a major depressive episode last time, so when I was diagnosed with it again in 2010, I mentally set aside five years to recover from it again. That means five years of doing less, of reduced responsibilities, of never feeling guilty for not doing as much as I was before the onset of this depressive episode. And Jesus understands exactly what we are going through, and is there to comfort and strengthen us.

‘For we do not have a high priest who is unable to empathize with our weaknesses, but we have one who has been tempted in every way, just as we are—yet he did not sin.’ Hebrews 4:15

How to avoid having panic attacks on the subway

This is one dude's funny, self-deprecating look at his experiences with panic attacks on New York subway trains. The first one went like this:

out of nowhere, i started feeling really intense feelings that i couldn’t control, like more and more and more nervous and scared and i wanted to get off the subway so much but i couldn’t obviously because it was moving. then my legs started shaking and i was sweating and i could only see straight in front of me it felt like the universe was collapsing in my mind, and i was hyperventilating and i slid my headphones down to my neck and gently touched the arm of this middle-aged woman next to me who was also holding onto the pole. it felt like i couldn’t control my thoughts and they were spiraling towards a point where my mind would snap and/or i would actually die

so the woman whose arm i touched took one of her ipod earbuds out and suspiciously said “is everything okay?” like i think she thought i was like trying to get money from her or gonna bomb the train or something because i was nervous and sweaty and i look a little middle-eastern, and my hand was trembling, and i said to her “i don’t know what’s happening to me, i’m really sorry, i’m terrified, i don’t know why, can you talk to me please? just for like thirty seconds?”

But the panic attacks apparently didn't end there, and over time, to combat panic, the writer came up with the five techniques for managing his anxiety on the subway. (Actually, there are eight, but who's counting?) For instance, technique number one:

wear a bunch of rubber bands around your wrist and then when you start feeling terrified, pull them as far from your wrist as possible and then release them so they snap back against your wrist and it stings. this is a cheap solution that will distract you from the terror, but you will also confirm peoples’ suspicions that you have a mental illness

And technique number three-point-five:

try to envision where you are, but above ground, when you’re on the subway. like if you are on the C line for example, between Spring Street and Canal Street, think about that car wash on 6th Avenue that charges different prices for a carwash depending on the time of day, then think about that restaurant Lupe’s, then think about the Soho Grand hotel, then you’re at Canal! then do that all the way home. you will find that you know the city better than you thought you did

Clever stuff. Worth a read, for sure.
Also worth a read, or so I hoped when I wrote it five years ago: an account of my first subway panic attack.

Want to break the cycle of anxiety Hop on your bike

Just came across an recent article from a small-town paper about a local resident who's using cycling as a tool to fight anxiety disorders. And I quote:

STRATHMORE resident Justin Sacr can't drive a car for fear he has knocked down someone every time he hits a bump.

The 33-year-old has lived with anxiety and obsessive compulsive disorder since age 14 and, because of the phobia, his bicycle has become a 'lifeline'.

"I cycle to work every day. It has been a blessing in disguise because exercise helps me a lot," he said.

"It releases chemicals in your brain, like antidepressants, but in a natural way. It helps with your thoughts. You might look normal on the outside, but on the inside you're going through hell."

From experience: This guy's spot on. Cycling can have a hugely positive impact on your quality of life if you deal with anxiety. It's an especially good way to battle the shrinking-of-your-world of agoraphobia. The lightheaded feeling and elevated heart rate? That's what's supposed to happen when you exercise. Just push yourself to go a bit farther out of your comfort zone each time out. You'll feel better about yourself, more able. Guaranteed.

Book Review How Not to Be Wrong by Jordan Ellenberg

A while back (11/2/11) I reviewed the book Stats.con by James Penston. That book discussed how the statistics used in randomized clinical trials can be highly deceptive. How Not to be Wrong also covers some aspects of statistical misuse, in more detail, and certainly in a much more entertaining way. Some of his comments are funny as hell. 

Jordan Ellenberg

Consider the widespread use of a statistic call the p value, which estimates the probability that the result of a study could have just been a chance coincidence rather than an actual meaningful finding. A study is generally considered positive if the p value is 5% or less.

5% is of course not 0%. There is a one in twenty probability that the study results that are deemed positive were in fact negative. But what happens if journals only publish the positive studies and not the negative ones, when there might be a large number of negative studies, and when the positive study results are not reproduced (replicated) in a second study? Well, people start believing things that are not true, that's what.

The reason for this is because, as the author points out, improbable things actually happen quite frequently. Especially if you do lots and lots of things – like experiments. 

Another issue he mentions is that, if your sample size is too small, the chances increase dramatically that one of your subjects will be an outlier that dramatically but artificially changes the average for whatever characteristic you are measuring. With a small sample, you are more likely to get a few extra prodigies or slackers in a study of people's ability to perform certain tasks. A famous example: if Bill Gates walks into a bar with a few other people, the average guy in the room is a billionaire.  

Here’s how the author starts out a discussion of the p value problem (pages 145-46) :

"Imagine yourself a haruspex; that is, your profession is to make predictions about future events by sacrificing sheep and then examining the features of their entrails...You do not, of course, consider your predictions to be reliable merely because you follow the practices commanded by the Etruscan deities. That would be ridiculous. You require evidence. And so you and your colleagues submit all your work to the peer-reviewed International Journal of Haruspicy, which demands without exception that all published results clear the bar of statistical significance.    

      

Haruspicy, especially rigorous evidence-based haruspicy, is not an easy gig. For one thing, you spend a lot of your time spattered with blood and bile. For another, a lot of your experiments don't work. You try to use sheep guts to predict the price of Apple stock, and you fail; you try to model Democratic vote share among Hispanics, and you fail…The gods are very picky and it's not always clear precisely which arrangement of the internal organs and which precise incantations will reliably unlock the future. Sometimes different haruspices run the same experiment and it works for one but not the other — who knows why? It's frustrating…

      

But it's all worth it for those moments of discovery, where everything works, and you find that the texture and protrusions of the liver really do predict the severity of the following year's flu season, and, with a silent thank-you to the gods, you publish

      

You might find this happens about one time in twenty.

      

That's what I'd expect, anyway. Because I, unlike you, don't believe in haruspicy. I think the sheep's guts don't know anything about the flu data, and when they match up it's just luck. In other words, in every matter concerning divination from entrails, I'm a proponent of the null hypothesis [that there is no connection between the sheep entrails and the future]. So in my world, it's pretty unlikely that any given haruspectic experiment will succeed.

      

How unlikely? The standard threshold for statistical significance, and thus for publication in IJoH, is fixed by convention to be a p-value of .05, or 1 in 20... If the null hypothesis is always true — that is, if haruspicy is undiluted hocus-pocus —then only one in twenty experiments will be publishable.

      

And yet there are hundreds of haruspices, and thousands of ripped-open sheep, and even one in twenty divinations provides plenty of material to fill each issue of the journal with novel results, demonstrating the efficacy of the methods and the wisdom of the gods. A protocol that worked in one case and gets published usually fails when another harupex tries it, but experiments without statistically significant results do not get published, so no one ever finds out about the failure to replicate. And even if word starts getting around, there are always small differences the experts can point to that explain why the follow-up study didn't succeed."

The book covers many subjects about which the non-mathematically-inclined can learn to think in a mathematical way in order to avoid coming to certain wrong conclusions and to zero in on correct ones. Many of these, however, are irrelevant to this blog – the chapters on lotteries come to mind. I of course found those parts a bit less interesting. But the chapters relevant to medical studies are so right on.

Another important topic the author covers is known mathematically as regression to the mean. This phenomenon can lead, as examples, to overestimates about the genetic component of human traits and explains why fad diets always seem to work at first but then later on everyone seems to forget about them. As mentioned, when you average any measurement applied to human beings, the averages can be deceptive.  

In addition to the sample size considerations described above, you can get into trouble if you start with a sample that contains people who are higher or larger on average on the relevant variable that the average person in the general population.

If two tall people marry, their progeny will usually be, on average, tall compared to others in the general population. However, they are not all that likely to be taller than their parents. As Ellenberg states, “…the children of a great composer, or scientist, or political leader, often excel in the same field, but seldom so much as their illustrious parents” (p. 301). Their heredity mingles with chance environmental considerations, and pushes them back toward the population average. That is the meaning of regression to the mean.

To understand this, think about those who embark on weight loss diets. One needs to consider the fact that most people’s weight tends to fluctuate a few pounds either way depending on a lot of chance factors, such as their happening by an ice cream truck. And when are people most likely to start a diet? When their weight is at the top of their range! So by the law of averages, they are probably in many instances going to lose weight whether they diet or not. But when they do diet, guess what happens? They attribute the loss to the fantastic new diet!

I can not say for certain, but I wonder if studies on borderline personality disorders (BPD) yield misleading results because of regression to the mean. Long term follow-up studies on patients with the disorder seem to indicate that it seems to go away after a few years in a significant percentage of subjects. This finding is misleading, however, when you look closer. 

To make the BPD diagnosis, the subject needs to exhibit 5 of the 9 possible criteria. Many of the "improved" subjects merely went from 5 criteria down to 4 of them, and were therefore not diagnosed with BPD any longer. Actually, they became just what we call "subthreshold" for the disorder. Their problematic relationships, however, were still pretty much the same.

These results could mean that subjects with BPD may naturally vacillate between meeting criteria for the disorder and being subthreshold, or between exhibiting a high number of the criteria and a lower one. Which would mean that if they qualified for the diagnosis at the beginning of the long term follow-up study, a significant proportion of the long-term study subjects were at their worst. If so, the study results may indicate regression to the mean, and therefore say nothing else significant about the long term prognosis for the disorder.

Other important statistical issues the author discusses clearly and brilliantly include assumptions that two variables are related in a linear fashion when the are not (non-linearity - cause and effect relationships that are not based purely on an increase in one variable always leading to either an increase or decrease in another); torturing the data until it confesses (running multiple tests on your study data, controlling for different things, until something significant seems to pop up); and the following problem inherent in studies designed to see if two things like being married and smoking are correlated: 

"Surely the chance is very small that the proportion of married people is exactly the same as the proportion of smokers in the whole population. So, absent a crazy coincidence, marriage and smoking will be correlated, either positively or negatively."

Any one who is serious about critically evaluating the medical literature owes it to themselves to read this book.

The Thief comes only to Steal and Kill and Destroy

I took a day off work today so that I could take my family to Werribee open range Zoo today. My little son was especially excited to see all the animals.

For me, however, this was a trip I did not want to make. I find travelling through the city difficult at the best of times, as the city centre is a rabbit-warren like maze of freeways, tunnels and confusing off-ramps.

Yet the primary reason for my reservations for this trip was that the city is in the midst of carrying out extensive road works, and I heard a couple of months ago that they had closed the road I normally used to get through the city to reach the West Gate Bridge.

As this day approached, I found myself bombarded with fearful thoughts. Those insidious “what if” thoughts came in thick and fast. What if I couldn’t find the correct off-ramp? What if upon finding the correct off-ramp, I was in the wrong lane and couldn’t reach it in time? What if I ended up travelling down an unknown section of the freeway, not knowing how to get back to the West Gate Bridge?

So I woke this morning looking for any excuse not to go. Perhaps the threatened thunder storm was moving in? That would make the perfect excuse. But with sunshine streaming through my bedroom window, I knew that excuse would not wash.

Then I made a decision. I would face this fear. I would not let fear of what could go wrong immobilise me and ruin this family occasion.

I recalled what I had read in the Bible last night. In 1 Corinthians 15:10 Paul writes, “But by the grace of God I am what I am, and his grace to me was not without effect. No, I worked harder than all of them—yet not I, but the grace of God that was with me.”

So it was God’s grace working through Paul that helped him to serve God, to live the life God gave him.

So I loaded my family into the car, faced my fears, and braved the changed traffic conditions, availing myself of the power of God’s unlimited grace.

And after all those fearful thoughts, after all those “what ifs” - do you know what went wrong? Absolutely nothing – I followed all the road signs and found the route to the bridge, and all the way to the zoo. (And if something had gone wrong, we would have found our way back to the correct route eventually.)

And we had a wonderful time. We watched an irresistibly cute family of meerkats frolicking in their habitat, we learned that zebras roll in rhino poo to smell like rhinos, so that the short sighted rhinos think the zebras are rhinos and leave them alone (ewww), we saw giraffes, hippos, even camels. And my kids had a ball, racing around the walkways and giggling their heads off.

On the way back from the zoo, I reflected on how Satan wants to rob us of the fullness of life that Jesus has given us. Satan will never hesitate to throw fears at us in an attempt to scare us into immobility, to stop us stepping forth in faith to receive the blessings that God is reaching out to give us.

The thief comes only to steal and kill and destroy; I have come that they may have life, and have it to the full. John 10:10

Satan wants to rob us of God’s blessings to make our hearts sick, but by trusting in God and stepping forward in faith, by availing ourselves of His grace, we stand ready to receive fulfilled heart’s desires, and life.

Hope deferred makes the heart sick, but a longing fulfilled is a tree of life. Proverbs 13:12.

Nairobi Parenting Clinic How Best to Handle Criticism

Nairobi Parenting Clinic: How Best to Handle Criticism:Have you ever had a grain of sand get into your eye and felt it's sting? Have you ever seen gold at the stage where it's being mined and after it has been refined? Have you ever  been criticized for something you may or may not have done? If yes, how did it feel to be criticized and how did you react to the criticism? Read through the following article to discover how criticism can sting like a grain of sand in the eye and how you can 'mine gold' from it...

It Aint Bad to Get Mad!

My kids have a doll called "The Elf on the Shelf," which was a gift from last year's holiday season. It sits on a shelf or perches on top of the fridge or dangles from a light fixture during the day, staring with baleful eye at the children's antics. During the night, it flies on swift wings and narks to Santa about their misdeeds. Then it returns and sits in a different spot.

My children named their elf "Harry Spotts," and registered it with the Elf on the Shelf web site.

What it says or does makes no difference, for is Santa really going to deliver coal to my children? All the threats are in vain, for if they get one less plastic rinkamadink for Christmas they will not even notice, and will continue to carry on with their "mouth farts" and other atrocities at the dinner table.

"The elf is watching!" we may exhort, and they pause. But then they continue with the "mouth farts" and other bad things, and we know, in our hearts, that they have won.

I said to my husband the other day that I need my own Elf on the Shelf. My elf will have one clear purpose: To prevent me from sending angry emails. I am an Angry Email Sender. Ever since the advent of email, I have been sending angry ones. To wit:

• The three-pager I sent my wine-sodden, fat roommate back in Stuyvesant Town to tell her she was a fat, wine-sodden bitch

• The four-pager I sent my other roommate back in Brooklyn, to explain to her that she was a nutbag whose cats urinated excessively and she needed a swift kick in the brain

• The email(s) I sent to the beloved husband some years ago, to tell him that he had offended me in various regards and I wished to explain my rightness in all things, and his wrongness

• The email I sent to certain management personnel at a particular establishment not terribly long ago, in which I used the phrase "soul crushing" to rather devastating effect, such that it is now (soon to be) a trending hashtag on Twitter

If I could have written an email to my three boys expressing my foaming furor over the continuing #mouthfart trend, I would have done so! I find email to be a very handy tool for expressing rage.

Apparently, I need an elf to stop me from hitting "send," and to kindly direct me to put my missives in the freezer for a while to cool off. My elf will be called "Mr. Jinks" or maybe "Dave."

But do I? Isn't it okay, sometimes, to say exactly what we think? Is it okay to remain silent while a coworker sits next to one at a business dinner, chewing his or her salad with a dreadful "monghgh monghgh mongrrg" sound? It is acceptable to stand by while good people get reamed, and naughty ones get rewarded? Shall we be meek and quiet while someone tells an offensive joke, or lets her cats poo on one's comforter for sport, or drinks the last dregs of the wine box? Shall we make merry with the evil poo-head who piddled on our petunias?

That's when I realized. It ain't bad to get mad. It's GOOD to get mad. It's not like Santa's going to bring me coal because I hit "send" on that email that included the words "reptilian" and "fuck-headed douche muppet" in the same sentence. And do you know how I know that? Why, Sesame Street taught me: