Standing at the Edge of the Universe

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It’s been almost three months since I’ve written, an unintended break that’s been weighing on me.

In August, a pretty serious health crisis happened to my father (and only a few months out from a kidney transplant, it was particularly complicated), one we hadn’t seen coming at all.

“It’s like standing at the edge of the universe,” one of his surgeons said to the two of us, referring to what would happen if we didn’t proceed with the major (and risky) surgery. And that one phrase seems to encapsulate the experience of acute, serious illness so well.

Overnight, my siblings and our spouses were whisked out of our daily lives and into waiting rooms and consultation rooms. The waiting, that is the all too familiar part—we have a routine now. We bring iPads and laptops, share phone chargers and delegate “to call” lists for updates. One makes coffee runs, another is responsible for cracking the jokes, another serves as the contact person for the surgeon and the floor. I usually take the pre-op shift so I can lay eyes on him before he is wheeled back; once he’s in recovery, someone else stays on later.

Since my father provides a lot of care for my mother, we split our time between his ICU and step-down floors and doing overnights at her house, and then after she too had surgery, we traded visits between different hospitals, rehab centers and respite care facilities.

More than two months after it all started, both parents are now home together and settling in. Both are recovering well, and have a renewed sense of hope and possibility.

There is much to say about this experience: the amazing opportunities medical science and premium health care offer, the stress of illness on families, how fortunate I felt I had siblings to help dig through the trenches. But for now, all I will say is we’ve pulled back from our perch at the edge of the universe, from the tense, draining unknown.

Things are calmer now, more predictable. I’ve found a groove with my courses, our new schedule, and lots of other changes. I hope to back here more regularly, and back at my usual writing spots like WBUR’s Cognoscenti and Psychology Today.

Thanks for hanging in there through the silence.

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Order Ciprofloxacin (Ciloxan): Composition, Uses, Safety, and Online Purchase Guide

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Ciprofloxacin is a broad-spectrum fluoroquinolone antibiotic widely used in ophthalmology and otology to treat bacterial infections of the eyes and ears. On this page you will find a detailed medical overview of the drug’s composition, mechanism of action, clinical uses, safety profile, and practical guidance on how to order ciprofloxacin (Ciloxan) online safely and responsibly.

Table of Contents

Composition of ciprofloxacin drops

Cipro eye and ear drops contain ciprofloxacin in the form of ciprofloxacin hydrochloride. Each milliliter of solution contains 3.5 mg ciprofloxacin hydrochloride, which corresponds to 3 mg of pure ciprofloxacin.

In addition to the active substance, the formulation contains several excipients with specific technological and safety roles. These include benzalkonium chloride as a preservative, acidity regulators such as sodium acetate, acetic acid, sodium hydroxide, or concentrated hydrochloric acid to maintain the desired pH, stabilizers such as mannitol and disodium edetate, and purified water as the solvent.

Ciprofloxacin eye and ear drops bottle with labeled composition

The combination of active ingredient and excipients is designed to ensure chemical stability of ciprofloxacin, comfort during instillation into the eye or ear canal, and reliable antimicrobial preservation of the multidose bottle. Patients with known hypersensitivity to benzalkonium chloride or other components should consult a healthcare professional before use.

Dosage forms and brands

This medication is primarily available as eye and ear drops marketed under brand names such as Ciloxan. These topical preparations are formulated specifically for ophthalmologic (eye) and otologic (ear) use.

Oral tablets containing ciprofloxacin, including products sold under the names Baycip and Cipro, represent different dosage forms with distinct indications, systemic exposure, and dosing regimens. They should not be confused with or substituted directly for ophthalmic or otic drops without medical supervision.

Mechanism of action

Ciprofloxacin belongs to the class of antibiotics known as quinolones, more specifically the fluoroquinolones. Its primary antibacterial effect is bactericidal, meaning it kills susceptible bacteria rather than merely inhibiting their growth.

The core mechanism of action involves interference with bacterial DNA synthesis. Ciprofloxacin selectively inhibits the bacterial enzyme DNA gyrase (also referred to as topoisomerase II), which is essential for supercoiling and replication of bacterial DNA. By blocking this enzyme, ciprofloxacin prevents cell division and leads to rapid bacterial cell death.

Medical illustration of ciprofloxacin mechanism of action on bacterial DNA gyrase

This targeted mechanism explains the high activity of ciprofloxacin against a wide range of Gram-negative and Gram-positive organisms and its usefulness in treating infections of the cornea, conjunctiva, outer ear canal, and middle ear with tympanostomy tubes.

Antibacterial spectrum

Ciloxan (ciprofloxacin drops) is highly active against most Gram-negative bacteria, including Pseudomonas aeruginosa, and many aerobic Gram-positive bacteria such as staphylococci and streptococci. Its in vitro activity has been extensively documented for both ocular and otologic pathogens.

For ocular infections, confirmed susceptible Gram-positive aerobes include Staphylococcus aureus (including methicillin-resistant strains), other staphylococci such as S. epidermidis, various corynebacteria, Streptococcus pneumoniae (pneumococcus), and viridans group streptococci. Confirmed Gram-negative aerobes include Acinetobacter, Haemophilus influenzae, Pseudomonas aeruginosa, and Moraxella species.

Additional ocular pathogens considered susceptible based on systemic inhibition zone diameter (IDD) criteria and minimum inhibitory concentrations (MICs) of ≤ 1 μg/mL in vitro include:

  • Aerobic Gram-negative microorganisms: Acinetobacter calcoaceticus, Enterobacter aerogenes, Escherichia coli, Haemophilus parainfluenzae, Klebsiella pneumoniae, Neisseria gonorrhoeae, Proteus mirabilis, Proteus vulgaris, and Serratia marcescens.
  • Other susceptible organisms: Peptococcus spp., Peptostreptococcus spp., Propionibacterium acnes, and Clostridium perfringens.

Non-susceptible organisms include some strains of Burkholderia cepacia, Stenotrophomonas maltophilia, and certain anaerobic bacteria, particularly Bacteroides fragilis, which may show resistance to ciprofloxacin.

Ophthalmic indications and efficacy

Ciprofloxacin eye drops are indicated for corneal ulcers and superficial infections of the eye and its adnexa caused by ciprofloxacin-susceptible bacteria. Clinical trials in patients with acute bacterial eye infections have confirmed high efficacy against a broad range of pathogenic microorganisms.

Ciprofloxacin has demonstrated in vitro activity against many additional ocular pathogens; however, the clinical relevance of these findings is not always fully established. Specifically, for some microorganisms, the safety and efficacy of ciprofloxacin in treating corneal ulcers or conjunctivitis have not been confirmed in adequately controlled clinical studies.

The relationship between systemic in vitro susceptibility parameters such as IDD or MIC and clinical outcomes after topical ophthalmic administration has not been fully defined. Nonetheless, ciprofloxacin concentrations measured in tear film, corneal tissue, and the anterior chamber after topical use are often ten to several hundred times higher than the MIC90 values for sensitive ocular pathogens, supporting its clinical effectiveness.

Otologic indications and efficacy

In otology, ciprofloxacin ear drops are used for the treatment of acute otitis externa (inflammation and infection of the external ear canal) and acute otitis media with tympanostomy tube drainage when caused by susceptible organisms. Clinical trials in patients with acute otitis externa have confirmed high activity against a wide spectrum of bacteria responsible for ear infections.

Topical ciprofloxacin has been shown to be active in vitro against most strains of the following microorganisms implicated in ear infections, although for some species the full clinical significance remains to be clarified:

  • Aerobic Gram-positive microorganisms: Bacillus spp., Corynebacterium spp., Enterococcus faecalis, Staphylococcus aureus, Staphylococcus haemolyticus, Streptococcus pneumoniae, and viridans group streptococci.
  • Aerobic Gram-negative microorganisms: Achromobacter xylosoxidans subsp. xylosoxidans, Acinetobacter baumannii, Acinetobacter junii, Acinetobacter lwoffi, Acinetobacter radioresistans, Acinetobacter genospecies 3, Citrobacter freundii, Citrobacter koseri, Enterobacter aerogenes, Enterobacter cloacae, Escherichia coli, Haemophilus influenzae, Klebsiella oxytoca, Klebsiella pneumoniae, Moraxella catarrhalis, Proteus mirabilis, Pseudomonas stutzeri, and Serratia marcescens.

For otitis media, ciprofloxacin has also shown in vitro activity against Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus pneumoniae, Escherichia coli, Haemophilus influenzae, Moraxella catarrhalis, and Pseudomonas aeruginosa. As with ocular use, the correlation between systemic susceptibility criteria and clinical outcomes after topical otic administration is not fully established.

Diagram showing ear and eye infections treated with ciprofloxacin drops

Overall, ciprofloxacin ear drops provide a convenient option for localized therapy in ear infections, achieving high concentrations at the site of infection with minimal systemic exposure. Frequent medical follow-up is recommended to ensure optimal response and to allow timely modification of treatment if necessary.

Resistance and cross-resistance

Resistance to ciprofloxacin generally develops slowly; however, parallel resistance within the class of gyrase inhibitors has been observed. Susceptibility studies show that many ciprofloxacin-resistant bacteria are also resistant to other fluoroquinolones.

In clinical trials of ciprofloxacin eye and ear drops, the incidence of isolates that acquired resistance during therapy was low. Due to the unique mode of action, there is typically no cross-resistance between ciprofloxacin and antibacterial agents with different chemical structures, including beta-lactam antibiotics, aminoglycosides, tetracyclines, macrolides, peptides, sulfonamides, trimethoprim derivatives, and nitrofurans. Consequently, bacteria resistant to these drug classes may still be susceptible to ciprofloxacin.

Preclinical safety data

Like other quinolones, ciprofloxacin has been shown to cause arthropathy in young animals of most species studied after oral administration. At a dose of 30 mg/kg, joint changes were minimal. This exposure is approximately 270 times higher than the recommended clinical ear dose for treating a 10 kg child with 0.27 mg ciprofloxacin in each ear twice daily.

In a one-month study in young beagle dogs, no joint damage was observed after topical application of Ciloxan eye drops, and there was no evidence that local ocular therapy adversely affected joints. Clinical and radiographic evaluation of 634 children who received oral ciprofloxacin likewise showed no skeletal toxicity.

Reproduction studies in rats and mice using doses 50 times the maximum daily ophthalmic dose for humans and 900 times the recommended ear dose (equivalent to treating a 10 kg child or a 50 kg adult with 0.27 mg or 0.36 mg of ciprofloxacin in each ear twice daily, respectively) did not reveal impairment of fertility or teratogenic effects.

In rabbits, oral ciprofloxacin at 30 and 100 mg/kg did not cause malformations, although significant maternal toxicity was noted. Intravenous administration of doses up to 20 mg/kg did not produce toxic effects on embryos, embryotoxicity, or teratogenicity.

Pharmacokinetics

Following topical ocular application in humans, ciprofloxacin is well absorbed into the eye. Concentrations measured in the tear film, cornea, and anterior chamber reach levels ten to several hundred times higher than the MIC90 for sensitive ocular pathogens.

Systemic absorption after topical ocular use is low. After seven days of treatment, plasma concentrations ranged from below the detection limit (< 1.25 ng/mL) up to 4.7 ng/mL. The mean maximum plasma concentration achieved with topical ocular therapy is approximately 450 times lower than that observed after a single 250 mg oral dose.

In children with ear drainage via tympanostomy tube or perforated eardrum, topical otic application resulted in undetectable plasma ciprofloxacin levels (detection limit 5 ng/mL). In animal models (chinchillas), ciprofloxacin appeared in plasma and middle ear fluid after intramuscular injection and penetrated the inner ear following topical administration to the middle ear.

The systemic pharmacokinetics of ciprofloxacin are well characterized: the drug distributes extensively into body tissues, with tissue concentrations generally exceeding plasma levels. The steady-state volume of distribution is approximately 1.7–2.71 L/kg, with serum protein binding of 16–43%. The serum half-life is about 3–5 hours.

After single oral doses of 250–750 mg in adults with normal renal function, 15–50% of the dose is excreted unchanged in urine and 10–15% as metabolites within 24 hours. Both ciprofloxacin and its four major metabolites are eliminated via urine and feces. Renal clearance typically ranges from 300–479 mL/min, and approximately 20–40% of a dose is excreted in the feces as unchanged drug and metabolites within five days.

Pharmacokinetic profile chart of ciprofloxacin distribution and elimination

Clinical indications

Ciprofloxacin eye and ear drops are indicated for the treatment of the following conditions caused by ciprofloxacin-susceptible bacteria:

  • Ophthalmic indications: corneal ulcers and superficial infections of the eye and adnexa, including conjunctivitis and blepharoconjunctivitis.
  • Otic indications: acute otitis externa and acute otitis media with tympanostomy tube drainage.

Contraindications and precautions

Ciprofloxacin is contraindicated in patients with known hypersensitivity to ciprofloxacin, other quinolone antibiotics, or any component of the formulation.

Because systemic exposure after topical application is low, drug–drug interactions are unlikely. However, as with all antibacterial agents, prolonged use may promote overgrowth of non-susceptible bacteria or fungi. If superinfection occurs, appropriate alternative therapy should be initiated.

Serious and sometimes fatal anaphylactic hypersensitivity reactions have been reported with systemic quinolones, sometimes after the first dose. Reactions may include cardiovascular collapse, loss of consciousness, tinnitus, facial or throat swelling, dyspnea, urticaria, and pruritus. If an acute hypersensitivity reaction occurs with ciprofloxacin drops, treatment should be discontinued immediately and emergency care initiated if clinically indicated (e.g., oxygen therapy and airway management).

Tendinitis and tendon rupture have been associated with systemic fluoroquinolones, particularly in elderly patients and those receiving corticosteroids. Although systemic levels from topical eye/ear therapy are very low, treatment with CILOXAN eye/ear drops should be stopped at the first sign of tendon inflammation.

Eye drops specific precautions: Clinical experience in children under 1 year of age, especially neonates, is limited. Use in newborns with gonococcal or chlamydial ophthalmia neonatorum is not recommended, as it has not been adequately studied. In addition, the risk of drug entering the nasopharynx during instillation should be considered, as this may contribute to bacterial resistance.

CILOXAN eye drops contain benzalkonium chloride, which can irritate and discolor soft contact lenses. Wearing contact lenses during active eye infection and treatment is not recommended; patients should be advised to remove contact lenses before instillation and to avoid using them until therapy is completed and symptoms resolve.

Ear drops specific precautions: The efficacy and safety of ciprofloxacin ear drops in children under 1 year of age have not been fully evaluated. Frequent medical monitoring is recommended to assess treatment response and determine the need for additional therapeutic measures.

Pregnancy, breastfeeding, and driving

There are insufficient data regarding the use of CILOXAN in pregnant women. Animal studies do not indicate direct harmful effects with respect to reproductive toxicity at clinically relevant exposure levels, but, as a precaution, it is generally advisable to avoid using ciprofloxacin eye or ear drops during pregnancy unless the expected benefit clearly outweighs potential risks.

Ciprofloxacin is excreted in breast milk after oral administration. It is unknown whether measurable amounts appear in breast milk after topical ocular or otic use. Therefore, CILOXAN should be used with caution in breastfeeding women, ideally under medical guidance.

This medication has little or no effect on the ability to drive or operate machinery. However, transient blurred vision or other visual disturbances may occur immediately after instillation of eye drops. Patients should wait until vision has cleared before driving or using machines. There are no specific data on the effect of ear drops alone on driving or operating machinery.

Dosage and administration

Ophthalmic use in adults and adolescents (including the elderly): For superficial bacterial infections of the eye and adnexa, the usual dose is 1–2 drops instilled into the conjunctival sac of the affected eye(s) four times daily.

For severe infections, the dosage may be increased to 1–2 drops every two hours during waking hours for the first two days, then reduced according to clinical response. Typical treatment duration ranges from 7 to 14 days.

If other topical ophthalmic medications are used at the same time, an interval of at least 5–15 minutes between applications is recommended to avoid washout and to ensure optimal absorption.

Directions for use: To avoid contamination of the dropper tip and solution, patients should take care not to touch the eyelids, surrounding structures, or any other surfaces with the tip of the bottle. The bottle should be tightly closed after each use.

Overdose

Because ciprofloxacin eye and ear drops are intended for topical external use, toxic effects due to overdose in ophthalmology or otology are not expected when used according to recommendations. Accidental ingestion of the contents of a single vial is unlikely to lead to clinically significant systemic toxicity in individuals with normal renal function.

Adverse reactions

Reported undesirable effects after use of CILOXAN include:

  • Local eye or periocular reactions such as stye, eye discomfort, ocular hyperemia, corneal deposits, photophobia, eye itching, increased lacrimation, and eye discharge.
  • Systemic or upper respiratory symptoms such as rhinitis and dysgeusia (altered taste).
  • Neurological symptoms such as headache and dizziness.

If severe or persistent adverse reactions occur, use of ciprofloxacin should be reassessed and medical advice sought promptly.

How to order ciprofloxacin (Ciloxan) online

You are currently reading an information page about Ciloxan and other ciprofloxacin eye and ear preparations. If you are interested in this medicine and considering an online purchase, it is essential to combine convenience with safe medical practice.

Before you order ciprofloxacin online, review the indications, contraindications, and potential adverse reactions described above and, whenever possible, consult a healthcare professional to confirm that ciprofloxacin is appropriate for your condition. Many reputable online pharmacies provide access to licensed pharmacists or physicians who can answer questions about dosing, interactions, and safe use.

Our partner online store offers CILOXAN and related ciprofloxacin products with mail delivery and discreet packaging. In many jurisdictions, topical ciprofloxacin may be available without a traditional paper prescription, but you should always follow local legal requirements and medical guidance. To explore current prices, available forms, and shipping options, use the Online Store button at the top of this page.

By combining accurate medical information with responsible purchasing behavior, you can use ciprofloxacin eye and ear drops effectively and safely for the treatment of bacterial infections.

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Lessons from the Whole30 Challenge (Or, the importance of mindfulness)

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Somehow, it’s already August. I always think summer will mean extra time, but with freelancing, summer classes, and adventures with my two-year-old, the weeks have flown by, and the hours are full.

If you read my interview with Dr. T. Colin Campbell, author of Whole, over at WBUR’s Commonhealth, you know nutrition has been on my mind lately. For the past few months, I’ve incorporated a lot more vegetarian meals, eliminated dairy, and really examined what we buy and what our habits are.

And then my husband started doing the Whole30 Challenge—you know, the one that’s all over the Internet these days and often invites comparison to the Paleo diet. In case you’re not familiar, here’s a quick summary: for thirty days, eliminate dairy, gluten, all grains, legumes, sugar (including honey, agave, and alcohol), seed oils, etc. to calm down the inflammation in your body. Basically, you should eat plenty of clean, whole foods–plenty of vegetables, along with protein, fruit, and healthy fats like olive oil, coconut oil, avocado, etc. After the thirty days, can you assess what you’d like to try and introduce back into your diet, and what you’re better off avoiding.

The changes in him were immediate, and not just in terms of weight loss. His congestion and joint pain decreased, and his energy levels increased. We’ve never been huge consumers of processed food (being gluten-free and then also dairy-free makes that hard, anyway) but watching him, I began to see how our choices could be even cleaner and healthier.

With celiac disease and other autoimmune conditions, I am all too familiar with how inflammation can wreak havoc in your life so I jumped on board and did my own Whole30 Challenge, and it’s been a great experience. I’ve lost weight, yes, but more than that, I’ve gained so much energy (I used to drink 6-7 cups of coffee daily, and now, even with the same lack of sleep, I drink one) and I am much more conscious of what foods make me feel good, and which ones simply aren’t worth it.

For example, I know I won’t be re-introducing dairy since I don’t miss it and am less congested without it. I don’t plan on re-introducing rice or corn, but I do think quinoa has an occasional place in the rotation. I’ve discovered nightshade vegetables like tomatoes and eggplant really bother me and aren’t worth it, and gluten makes my husband feel truly horrible.

Kale is our favorite new food, and we some days we have it with all three meals. Since we never bought sweets or desserts I thought I was doing pretty well avoiding sugar, but I now see the many small ways it crept into my diet, like the cane sugar in in my almond milk and in vegetarian soups I often had for lunch. We are both amazed at how much more we enjoy fresh fruit, and crave it in a way we never did. (Interestingly, I just came across this NYT article that makes the case for eating fruit.) Olive oil and a squeeze of fresh lemon taste better than any salad dressing, which usually have some sort of sweetener.

Honestly, the hardest part for me was getting used to drinking black coffee, and while I will try it out with completely unsweetened almond milk, I now know I can drink black coffee and be okay—it took me a long time to acquire that particular taste, admittedly, but I did it, and I feel so much better without adding chemicals or sugar to it. I am not a huge red meat eater (remember, I’ve been vegan for breakfast and lunch and eating mainly vegetarian for dinner), but I’ve been getting a lot of my protein from eggs and fish, and since it’s summer, we’re throwing so much on the grill.

It’s been a great exercise in thinking thoughtfully about choices and paying close attention to what makes our individual bodies run best, and we plan to keep with it.

Have you tried the Whole30 Challenge? What benefits did you notice? Are you doing some sort of modified Paleo diet? What recipes or resources are most helpful?

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On Leafy Yards, Summer Play, and Lyme Disease

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I am surrounded by ticks.

No, seriously. And I’m not just talking about all the recent media coverage of ticks and Lyme disease, like this New Yorker article on Lyme disease, or the fact that I devoted a chunk of my recent book to Lyme disease, the controversy surrounding the chronic Lyme diagnosis, and the role of social media in this polarization.

There are deer ticks everywhere in my lovely neighborhood sanctuary. I have pulled ticks off my husband’s legs, my daughter’s arms, and have had them crawling across the lens of my glasses. Most of the neighbors on my street have had Lyme disease at least once, and a town social media message board frequently has posts about people getting diagnosed with it, or advice on how to prevent it.

I am so hyper-aware of them that my two-year-old climbed up on my husband’s lap and tilted his head back.

“Daddy, let me check your neck. Ticks really like necks!” she told him. On the bright side, at least I know she is listening and absorbing, right?

We do thorough tick checks as soon as come in and every night. I try to wear long pants or light colors as often as we can, and when she’s wearing dark pants in the grass I tuck them into her socks. I scour her thick blond curls and scalp. We use organic methods of tick control in our yard.

Not everyone who gets bitten by a tick knows it, or gets the telltale bull’s-eye rash. Symptoms of Lyme disease can mimic many other conditions, and there is a lot of debate surrounding the accuracy of the basic Lyme blood test. It feels like it’s everywhere here in New England, yet feels so inscrutable, too.

I am fortunate that we have doctors who have extremely low thresholds for testing for Lyme, and live in a community where it is very much part of the public consciousness. But still, even with information, awareness, and prevention strategies, I feel a little besieged when I step out into our leafy, seemingly peaceful yard. Misdiagnosed and/or untreated Lyme, chronic Lyme, and Lyme’s co-infections are nasty business. I don’t want to run to the doctor every time we have unexplained symptoms like achiness, fatigue, or swelling, but I also don’t want to take chances.

I thought it was a great time to link to the Q&A on chronic Lyme and Lyme’s co-infections I did with my friend, fellow writer, and chronic Lyme patient Jennifer Crystal. It’s definitely worth a read, as is her more recent recap of news coverage over at her blog, Touched By Lyme.

Tell me, readers, do you live in an area with a lot of deer ticks? Is Lyme disease on your mind all the time in these summer months? Have any tips or tricks to share?

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Friday Links Round-Up

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I have a few new links to share with you.

Jennette Fulda, author of Chocolate & Vicodin, posted a lovely review of In the Kingdom of the Sick. It’s always nice to hear feedback from someone who lives in the kingdom, too.

I took a break from writing about health and science and my newest post over at WBUR’s Cognoscenti is all about education in the digital age.

Lastly, I had the chance to read Whole, Dr. T Colin Campbell’s new book, and interviewed him about the whole food, plant-based diet and disease prevention for WBUR’s Commonhealth. Prevention is incredibly important, but does placing so much emphasis on nutrition as the cause and cure for much of what ails us place unrealistic expectations on those with genetic and/or autoimmune conditions? See what Dr. Campbell has to say, and share your comments or experiences with the WFPB diet over there.

Have a great weekend!

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One and Only; One and Everything? (Or, Parenting after Infertility)

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First there was Frank Bruni’s NYT essay on the gift of siblings, which was quoted, linked to and shared all over social media. It’s a lovely piece, and one that made me pause and really consider how much of my life experiences were and are shaped by having siblings, in my case, older brothers.

Bruno quotes writer Jeffrey Kluger, who observed that ““Siblings are the only relatives, and perhaps the only people you’ll ever know, who are with you through the entire arc of your life.” That shared history and familiarity can be a tremendous gift, and source of comfort.

Next came Lauren Sandler’s Op-Ed on being an only child and being the parent of an only child, a precursor to the release of her new book, One and Only: The Freedom of Having an Only Child, and the Joy of Being One. (It’s next up on my reading list.) In her article, Sandler takes on the misconceptions attributed to only children—that they are spoiled, selfish loners—as well as their parents, who must also be selfish, or care more about money or material goods than parents who have several children. She uses research to beat back these assumptions, and urges readers to consider the numbers:

“In hundreds of studies during the past decades exploring 16 character traits — including leadership, maturity, extroversion, social participation, popularity, generosity, cooperativeness, flexibility, emotional stability, contentment — only children scored just as well as children with siblings….only children are, in fact, no more self-involved than anyone else. It turns out brutal sibling rivalry isn’t necessary to beat the ego out of us; peers and classmates do the job.”

Lately, it seems like conversations about family dynamics and the decisions we make regarding family size are everywhere, and I find them cropping up all over the place in my own life, too. At two and half, my daughter is at the age where many of her classmates and friends now have younger siblings. All her cousins have siblings. Sweetly and innocently, she’s already asked me why she doesn’t have brothers or sisters. “Some families and bigger, and some are smaller,” I tell her. “What matters is that families love each other.”

When we’re in line at grocery stores, when I’m pushing her on the swings at the playground, or chatting with other moms, people ask me if she’s my first, if we’re going to have more. It’s a totally natural question, but if you’re parenting after infertility (and high-risk pregnancies) and/or parenting with chronic illness, it isn’t an easy or automatic question. It’s one I’ve been fielding since I was still pregnant with her. My response then was that I was focused on bringing this baby into the world safely, not future babies.

My response now echoes a similar sentiment. “We’re enjoying where we are right now.” After the long journey to get here, the fact that we have this happy, healthy little girl still blows our minds. Everyone responds to parenting after infertility in different ways. We never thought we’d be here, and some days it feels almost greedy or presumptuous or lacking in gratitude to assume lightning would strike twice like this. That might sound strange, but I wonder if some of you out there can relate.

What is a normal conversation for many other families, what is a natural progression in size for many families, is anything but for families with infertility or chronic illness (not that these are the only variables that make this complicated, of course—these are merely the ones that shape my perspective.) I wish this conversation was different for us, but that isn’t our reality. A few years ago, I wrote that the responsibility involved in making a decision like this—to embark on this high-risk road—was staggering. But really, the responsibility of being a parent in general is staggering, the competing considerations don’t get easier: We owe her the best of us, emotionally and physically. Siblings can be so enriching and wonderful. So are healthy (relatively speaking) parents.

It’s not an either-or situation, clearly, but what our responsibilities are to her as a toddler and young child and what she might want or need later are sometimes hard to navigate.

If she is an only child, I admit I sometimes worry about the misguided assumptions about only children as being spoiled or expecting the world to go their way, but I also know that her friends, relatives, and her experiences being in school, existing in groups, and generally learning to be social and empathetic. We’ve worked consciously to find a community, and communities within that larger community, where she will be supported and where she will feel connected to people beyond just the two of us. She calls her extended family and her gaggle of cousins “my people” and those bonds are incredibly important, and will be her shared history, too.

As I read Sandler’s essay and some related interviews with her, one thing that really struck me were all the negative labels attached to parents with only children—that their choices reflect selfishness or materialism, that they chose a small family so they wouldn’t have to deal with the chaos and inconveniences of more children, etc.

Maybe their choices reflect what is best for their individual family unit, and what allows everyone to thrive. Maybe it has always been their plan, their ideal social, economic, and philosophical situation. Maybe it isn’t their ideal choice, and the inability to have more children is a source of immense sadness. Whatever the reason, I don’t understand or appreciate the instinct to judge this choice, to assume negative motivations behind it, or to question the decisions parents make in terms of limiting their family size.

I know firsthand the many benefits of siblings. As a parent in a potential only-child family, I’m hopeful the benefits and opportunities of this path are enriching, too. I appreciate Sandler’s work and that she’s using research to speak back to these stereotypes—I wish she didn’t have to, though.

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Psychology Today and recent headlines

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I am thrilled to have the opportunity to blog at Psychology Today. My first post at my new blog, In the Kingdom of the Sick, is up today. I would love it if you’d click on over, leave a comment, and subscribe to it. I will be posting lots of new content and articles over there, and will not replicate the material that appears here on my personal blog.

I also have a new piece up over at Cognoscenti, WBUR’s Ideas and Opinions page, where I am a regular contributor. It’s all about collaboration between patient and provider, and why participatory medicine is so important. I wrote a lot about this in my new book, and am happy to see it getting mainstream media attention.

Up next here: a book review of My Foreign Cities, a memoir about a woman’s experiences living with her husband’s cystic fibrosis.

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Making Order Out of Chaos

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When I read Duncan Cross’s prompt for the latest edition of the Patients For A Moments blog carnival, which asks how we recharge, I was sitting in my home office. Stacks of bills and paperwork that needed to be filed took up most of the desk space. An assortment of mail, cards, and other mementos took up residence on top of the filing cabinet, patiently waiting to be stored more permanently. Folders filled with journal articles and research piled up in leaning towers on the floor, competing with books I need to read and review, files to read through for my teaching and research projects, and various stickers and drawings from my trusty little assistant.

In short, my home office reflected the state of my life the past several months—exciting and productive but incredibly intense and long, too. (Teaching an overload (4 courses), managing the pre-launch book tour and subsequent book tour, doing in-person book events and interviews, freelancing, helping out with care before and after my father’s transplant, etc.)

Having all these very big things happen all at once equals a lot of emotion, a lot of responsibilities, and very little sleep. My husband works weekends, too, and with some juggling the two of us we kept up with the basics: laundry, weekly cleaning (dusting/vacuuming/scrubbing), cooking, etc.

But the long-term stuff? The filing, the organizing of pantry and shelves, the sorting through drawers, the de-cluttering and boxing up of old toys and games? All that stuff slipped to the wayside. We were just trying to keep up with the everyday stuff; filing paperwork was just not a priority.

This all goes back to the central question Duncan Cross asks—what do we do to recharge when we are run down? After reading it, I ignored the looming deadlines, closed down my laptop, and spent some time organizing my office. The desktop was pristine. Each scrap of paper had its rightful folder. Each stack of folders had its rightful drawer. I felt a little less burnt out and frazzled.

For a moment, I debated sitting back down and tackling the deadlines, but something in me just couldn’t. I’d done that at the expense of so much for so long.

So then came clearing out all our drawers and closets, then the intense dusting behind and underneath the furniture, and I felt even less burnt out and frazzled. Then came the whole downstairs, too. A couple hours later, I flopped down on the couch, wheezy and exhausted, but it was the first time in so long I felt settled. Even though I was incredibly sleep deprived and getting over a sinus infection, I felt so energized.

While the examples are not always so extreme and time-consuming, I realized after the fact that putting my life into order in the midst of chaos is something that always makes me feel a little better. Even something as small as writing out a To Do list has the power to both calm and recharge me when I am a hospital patient and I am physically unable to make order out of the chaos.

After a 14-hour stint at the hospital the day of my father’s transplant, my husband made sure the house was clean and organized before I got home, because he knew it would make me feel better to have things orderly when I was in such an emotional state.

My office is now a sunny, neat place to get work done, instead of a omnipresent reminder of how frenzied the past few months have been, and putting more order back into the household makes me feel like I have more control over my life in general.

How do you recharge? What do you do when life and stress and illness start to spiral?

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Navigating Work-Life Balance by Asking for What You Need (Part 2)

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In this final installment of a week-long series on chronic illness and employment, we pick up where we left off: frustrated by her circumstances and her chronic conditions, Leah Roman had a huge choice to make. Just how much was she willing to sacrifice her health? If she asked for what she truly needed, what would that look like? Follow the rest of her story, in her own words. We’d love to hear your thoughts on her big decision.
 

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From August to October 2012, I dealt with a particularly bad flare-up.  As it had in the past, my flare incited my chronic hip bursitis.  The bursitis made it almost impossible to get up and down the stairs- a feat required of the two-train commute into my Philadelphia office.  There are 48 stairs just to reach the train platform in my suburban town.  After trying various strategies to accommodate the commute (e.g., traveling with my husband so he could carry all my stuff; using the SEPTA elevators-which are often hard to find and/or out of service), I always seemed to get the same result:

I always collapsed on the couch exhausted at 6:30pm.  I was too tired to make dinner.  I was too tired to exercise.  I was too tired to make social plans.  I avoided plans on weeknights because I was too exhausted from that day’s work.  I avoided plans on weekends because I needed that time to recover from one exhausting week before another exhausting week started on Monday.

After much soul searching, I decided to take the advice of a mentor who helped me adjust to a life with chronic illness.  She said, “Ask for what you need”.  So I did.

I needed a flexible schedule.  I needed a commute that was physically do-able, even on the worst day.  I needed to reduce my stress level.  I needed to feel more independent and get through my day without so much help.  I needed to get over my fear of working from home.

My biggest fear was that working from home would be isolating. Having a chronic illness is isolating enough and I often thought that going into the office (even with its challenges) got me moving and socializing when my instinct may have been to hide at home under the covers. I was also lucky enough to have my best friend in Philly work just across the aisle in our workspace. I got through many difficult days because we made time to have lunch together and she has consistently been one of my biggest cheerleaders. I was worried about the isolation of working at home without our lunch dates.

Even with these fears and uncertainty, I left my full-time position and started my own public health consulting business in January 2013.  I immediately felt relaxed.  With chronic illness, so much is out of our control. Now I could decide when to work and how much to work. I particularly enjoy the opportunity to control the message about my health and my recent work change.  No- I am not “too sick” to work.  Instead, I made a conscious decision to design an employment situation for myself that was balanced, enjoyable, profitable, and sustainable- flare or no flare.

Prior to January, I would drag myself out of bed at 6:30am- often with a poor night’s sleep due to one nagging pain or another.  My husband and I joked that he duct taped me together (i.e., collected my work bag, packed my lunch, found my keys) and shoved me out the door in time to catch the train.  By the time I arrived at my desk, I was exhausted!

In contrast, I am now well rested.  I sleep until I naturally wake up.  My morning starts very calmly with breakfast and conversation with my husband.  I’ve noticed that this calm morning carries into the workday.  I no longer feel pressured to work early “regular hours” like everyone else.  I work when my body is naturally energized (usually 10:00am-6:30pm).

I also use my flexible schedule to integrate exercise or errands into the day when I have more energy.  I initially worried that work from home would be too sedentary.  After all, I was used to a city commute.  So I wear a pedometer every day.  If I have not walked enough, I explore the neighborhood or utilize the wonderful indoor track in our town.  I also took this opportunity to sign up for joint-friendly aquatic classes offered at our YMCA.  The majority of these classes are offered during the “regular” 9-5 workday, so they were previously inaccessible.  As I slid into the pool on my first day and immediately felt comforted by the cool water, the instructor recognized the peaceful look on my face.  “The water,” she said.  “It is like medicine.”

These aqua classes have been a game changer for me.  First, they have been a wonderful way to exercise.  I feel no pain when I am in the water.  Second, they are a great way to socialize- which helps address my fear of isolation now that I’m working from home.  With my aqua classmates, I’ve certainly found my place among fellow exercise misfits.  We have a mix of older and younger swimmers.  Almost everyone has limited ability to exercise “on land” due to obesity or injury or chronic disease or age or arthritis.  I love this group of people.

Back home in my office, I relish in my privacy…especially if I have a bad day.  I can sit in my office chair or on the couch and pack my hips or hands in ice without drawing any attention to myself. I do not need to explain myself anymore.

Putting together this post, I realize that I am incredibly lucky.  I am lucky to be on my husband’s (very good) health insurance so that I can be more flexible with my employment options.  I am lucky to work in public health, which is an industry that lends itself very well to contract and consulting work.  My business has been busy since the moment I started in January.  I am lucky to have incredible friends, family, and colleagues that have helped me get my company off the ground.

And finally (in some ways), I’m lucky for this illness. I know so many people that work their whole lives before realizing that they had no work-life balance, were burned out, and missed out on an opportunity for a better life.  Having a chronic illness forces you to consider these questions early.  It forces you to put yourself first and it teaches you to be creative in finding solutions for change.

 

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Visit Roman Public Health Consulting, LLC, and make sure you check out Leah’s blog, Pop Health. Thanks so much for sharing your story with us, Leah!

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Navigating Work-Life Balance by Asking for What You Need (Part 1)

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Picture this: You are young, you are ambitious, and you have big plans for career. Suddenly, chronic illness manifests itself, and everything changes. Now, you’re not simply a novice employee trying to make your mark, but you’re trying to figure out what’s going on with your body, how to hide your symptoms so you don’t look unreliable, and you aren’t sure how you can make all this work.

Sound familiar? The please read Leah Roman’s story below, in her own words, and share your experiences. It’s an insightful and thoughtful look at one woman’s journey in the professional world, and I think many of you can relate to the building tension and frustration in her story.

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In January 2006 I was 25 years old and very busy! That month I graduated with my Master of Public Health degree, started my first “professional” level job in the field, and landed in the emergency room with what I would later realize was the initial flare up of my chronic illness. I had swelling in my face and neck. I had hives. I had started having strange reactions to foods. I had a low-grade fever. In short- I felt terrible. Convinced it was simply an allergic reaction; the doctors pumped me full of Prednisone and Benadryl and sent me on my way.

I remember feeling paralyzed with anxiety during that time. How would I tell my new boss of two weeks that I needed to take a sick day? How would I ask her for the hours of sick time necessary to accommodate the follow-up appointments and tests to address my symptoms that simply would not go away? What if I eventually got too sick to work? I was single and needed to work full-time to keep my health insurance.

Since 2006 I have been operating with a “working diagnosis” of Undifferentiated Connective Tissue Disease (UCTD) to account for my joint pain, fatigue, sun sensitivity, and rashes. The chronic fevers, flushing, and food sensitivities remained a bit of an outlier until two years ago. I was referred to a talented autoimmune dermatologist who finally attributed that group of symptoms to a mast cell activation problem. The way she explained it was that my mast cells (the cells in your immune system that make histamine) “behave badly” and react to things they shouldn’t (e.g., food, heat, and sun). While there remains some debate about which symptoms are attributed to which condition (and whether I meet all the criteria for each), I have responded well to the updated cocktail of rheumatologic and antihistamine medications.

The first few years of work with this chronic illness were the hardest. Being young and naïve in the workplace, I did not always know my rights in terms of privacy. I did not always know how much to share and how much to keep private (especially when asked a direct question about my health by a supervisor). When I first got sick, I only ate food that I brought from home (due to my new food reactions). Several co-workers, to my face and behind my back, speculated that I must have an eating disorder- what else could explain my weight loss and refusal of catered or communal food?

In Laurie’s new book In the Kingdom of the Sick, I felt especially connected to the section about the workplace. Chronic illness symptoms do not always meet the criteria for a disability. Therefore, you may not be eligible for a formal accommodation. As she also points out, one of the major challenges is that your symptoms are often inconsistent- you may need an accommodation one day and not the next! And what about asking for accommodations for diagnoses that are unknown or tentative? Many of us wait years and years to get the correct diagnosis.

I found that I needed accommodation around issues that did not seem “normal” to my co-workers. For example, early in my career I declined an invitation to a staff sporting event being held on a near-by athletic field. Since it was being held outdoors in July (without shade), I had to decline. I declined because my extreme sun sensitivity can trigger fevers, rashes, and full-on flare-ups. Although I tried to explain the severity of my situation, I was told by my supervisor “You better start going to these events or people will think you are not a team player.” I received similar “warnings” over the years when I declined work dinners or parties where I was unable to eat the food and/or too fatigued to stand all night at an event after working all day.

I think it can be difficult for those without chronic illness to understand the intricate level of planning it can take to navigate a “normal” day at the office. For example, I have lived with low-grade fevers for seven years. When I shop for work clothes, my focus is primarily on finding layering options that can allow me to get down to short sleeves at a moment’s notice if my temperature begins to rise. I often “pre-treat” myself with Tylenol prior to an important meeting to ward off a fever and its resulting flushing. The experience of severe chronic flushing at work silenced me during meetings for many years.

I also spend a lot of time protecting myself from the various “hazards” in my physical environment. Having spent much of my working life in Boston and Philadelphia, I have worried about the health of several old buildings which have housed my offices. Some spaces have had a history of mold or water damage. How does that environment affect my poor easily activated mast cells? I have had reactions set off by colleagues sitting in close proximity while wearing strongly scented perfumes or lotions. And then there is the art of dodging co-workers who insist on coming to work sick and putting colleagues who take immune suppressant medications at an unfair risk for illness.

And finally, while it is exciting to be invited to present and attend conferences…work travel can be treacherous with a chronic illness! From the physical strength needed to maneuver your suitcase, to trying to stay on the eating-exercise-medication schedule that keeps you in balance…it can be exhausting. I once traveled to Missouri to co-facilitate a training. At the last minute, I discovered that I could not eat the meal options being provided by my host organization. As a result, I was up at 5am to visit the grocery store to purchase all the “Leah-friendly” food I would need to survive for the next two days.

To be fair, for each challenge and difficult situation that I faced in the workplace, there was a sensitive friend/co-worker/mentor/colleague that I met in my offices and travels as well. These people grabbed my suitcase and hoisted it into the overhead without asking; they sat apart from the group just to have lunch with me in the shade; they strategically steered colleagues to choose a restaurant where they knew I had safe food options; they did not ask why my schedule was a bit more flexible that everyone else’s. I am incredibly grateful for the kindness and friendship of every single one of these people.

I have spent the last seven years balancing these challenges and victories in an ongoing debate about my ideal work situation. Finally, I approached a turning point in August 2012.

Want to see how all of this resolved? To be continued….

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