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The Midlife Second Wife ™

~ The Real and True Adventures of Remarriage at Life's Midpoint

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Category Archives: Monday Morning Q & A

Boomers and Retirement: Preparing for the ‘New Normal’

30 Monday Jan 2012

Posted by themidlifesecondwife in Midpoints, Monday Morning Q & A, Money Matters

≈ 3 Comments

Tags

Baby boomer, Finances, Financial planner, Individual Retirement Account, Money, Pension, Retirement, Roth IRA, Savings account

A Talk with Financial Professional Michelle Mast

Last year, on 1/1/11, the very first baby boomers turned 65; the world welcomes the second wave this year. Happy Birthday, Boomers! If you’re keeping count, between 2011 and 2029, all baby boomers—the cohort born between 1946 and 1964—will have reached the age of 65. In seasons past, that was the age that marked the traditional start of retirement. But it’s a new dawn, a new day, and as Bob Dylan wrote, the times they are a-changin’.

Have you changed with them? If so, and one of your resolutions for the New Year is to save money for your retirement, congratulations! If not, and you are a boomer, then all you have is company to go with your misery, and a future that could be blowin’ in the wind.

Retirement

Image by 401K via Flickr

Michelle Mast is a professional CERTIFIED FINANCIAL PLANNER™ with AXA Advisors, LLC. She says that in 2011, 60 percent of baby boomers saved less than $100,000 toward their retirement1. Mast received a Certificate in Retirement Planning from the Wharton School of the University of Pennsylvania for completing the AXA Equitable at Retirement program. But you don’t need a certificate from Wharton to know that this statistic does not paint a pretty picture. Mast recalls that the rule of thumb used for projecting a person’s retirement plan once called for them to set aside 75 percent of what it cost to live in the manner to which they are accustomed. (We’ll talk in a moment about that.) Today, she says three factors have conspired to drive that projection from 75 percent up to 100 percent: mortality (people are living longer), inflation (‘nuff said), and health care expenses (ditto).

This is enough to send a person diving underneath the sofa cushions—if not to look for loose change, then to hide from the wolf at the door.

I recently spoke with Mast about strategies that might help those who haven’t saved enough for retirement.

TMSW: Michelle, the statistic about the number of boomers who don’t seem ready for retirement is pretty sobering.

MM: I know. And that’s the upside. Research also shows that during the same year, 36 percent of boomers saved less than $25,000 towards retirement, and 29 percent saved less than $10,0002.

What accounts for these low numbers?

There just aren’t as many pension plans today as there were in our parents’ generation. And market volatility may also be playing a role in many cases. But studies show that 14% percent of individuals have no retirement vehicle at all—not even an IRA account3.

This suggests to me that the retirement my generation envisioned may not be the norm.

That’s right. There may be what some people consider to be a “new normal.” A good number of people will be working during their retirement. This is significant: 50 percent of current retirees are finding that their actual retirement spending is equal to or higher than their spending prior to retirement4. Now in some cases, this is because people are doing things they weren’t able to do while they were working—traveling, for example. But people are generally living longer—into their 70s, 80s, and even 90s—especially women. Women have many financial concerns and are an extremely important part of what I’m saying now.

Well, what can be done to turn the tide?

People really just have to focus on savings; there is no such thing as a “retirement loan!” The only way to create the money for retirement is to save the money for retirement. Going backwards, analyze your current cash flow. Are there expenses you don’t have to incur? Can you set aside $10 a month? If so, put this toward an emergency reserve or a retirement account.

Really? Will $10 a month make a difference? I mean, I sometimes think that my nickel-and dime-approach to savings is like rearranging the deck chairs on the Titanic; at the end of each month, I take whatever is left in my wallet, add it to the change I’ve dumped in my little tin can, and put it in a savings account.

There’s no silly way to save. What is important is saving.

Can you talk a bit about that “emergency reserve”? We’ve all been taught how important it is to save for a rainy day. How much should a person plan on setting aside for the deluge?

In the past, the rule of thumb was to have six months of your living expenses in an emergency reserve; that is, in a savings vehicle that’s liquid, where you can access the funds easily if you need to. But in light of all the volatility of the past four years, the conventional wisdom now is that your emergency reserve should be closer to a year’s worth of living expenses. So if you have $3,000 in expenses each month—mortgage, utilities, groceries, etc.—you should have almost $36,000 in your emergency reserve.

I’m going to need more dimes and quarters…You mention a vehicle that’s liquid. You mean like a savings account?

The formula is going to be different for everybody, but yes, a savings account, but also other places where you could house a portion of this money, for example: a money-market deposit account or a certificate of deposit. The idea is to have the money work as hard for you as it can while still maintaining liquidity.

Going back to my measly little $10 a month, if I want to use it to begin saving toward retirement, which investment strategy makes the most sense?

IRAs, or Individual Retirement Accounts, are savings vehicles you can consider for retirement, depending on your particular situation. There are two different kinds of IRAs—a Traditional IRA and a Roth IRA. Here are the key differences:

  • A Traditional IRA will give you a tax deduction at the time you make a contribution. The money will grow, tax-deferred, but when you take it out during retirement, it will be considered taxable income. One thing to bear in mind with a Traditional IRA is that when you reach the age of 70-and-a-half, you have to distribute the Required Minimum Distribution.
  • A Roth IRA is different in that respect; you actually don’t ever have to take money out of it, which makes it a nice legacy to pass on. But if you do take out a withdrawal, the good news is that the money you take out is not taxable income, because Roth IRAs are funded with after-tax dollars. There are, however, no tax deductions for the money you contribute to a Roth IRA; nevertheless, that money will grow tax-deferred, just like the Traditional IRA. This is important to bear in mind: studies have shown that any tax-free benefits during retirement are generally good features. In fact, increasingly 401(k)s are including a Roth feature. Keep in mind that your choice of retirement planning strategies should be based entirely on your individual needs, goals, risk tolerance, and particular situation.

You can also combine distributions when you reach 70; take some funds out of each type of IRA account to minimize your taxable cost.

I’ve heard the term “dollar cost averaging,” but I’m not sure I understand what it means. Can you shed some light on the subject?

Market volatility might cause investors to shift their investment strategy away from equities (stocks). But history suggests that a down market may be a good time to consider investing—and dollar cost averaging (or systematic investing) can be effective because it essentially provides the opportunity to purchase more shares less expensively. With dollar cost averaging, the amount you invest on a regular basis is always the same, meaning that you buy more shares when the price is low and fewer shares when the price is high. This spreads out your cost basis over several years, which helps provide insulation against short-term changes in market price; a lower average cost can ultimately equal a higher return when the market goes back up. First, you’d decide exactly how much money you feel comfortable investing each month, but be sure that you’re financially capable of keeping that amount consistent. You’d next select a long-term investment in which you would like to invest your money. Then, at regular intervals (weekly, monthly, or quarterly), you would invest that money into the investment you’ve chosen. Of course, generally speaking, all investments in equities are subject to fluctuation in value and market risk, including loss of principal—and it’s very important to understand that while dollar cost averaging has the potential to reduce the average cost of a share of stock, it does not guarantee a profit or protect against loss in declining markets. To be effective, there must be a continuous investment regardless of price fluctuations, and you must consider your financial ability to continue making purchases through periods of low price levels.

Some people might be fearful of meeting with a financial professional because they think they cannot afford it. Does a person pay a fee, the way one would pay a doctor or a lawyer, to obtain financial advice?

I experience this question often. Generally speaking, there are three ways that financial professionals get paid: fee-based, commission based, or a combination of both. All are fine; it just depends on the client’s objective and needs. For example, if a person only wants financial advice and doesn’t necessarily want to purchase investments, then he or she would consider a fee-based adviser.

At the end of the day, you want a financial professional who will be unbiased. I’m not going to recommend one account or fund or investment institution over another because of how it might affect my commission. I’ll suggest an account or a provider to you because I believe it’s the best for you.

Michelle, thank you so much for taking time away from your busy schedule to speak with me about these important money matters.

You’re welcome, Marci! It was my pleasure.

1Source: 2011 Retirement Confidence Survey conducted by The Employee Benefit Research Institute (EBRI).

2Source:2011 Retirement Confidence Survey (EBRI)

3Source: Bankers Life and Casualty Company Center for a Secure Retirement, Middle Income Boomers, Financial Security and the New Retirement, 2011.

4Source: 2010 Retirement Confidence Survey, March 2010, Employee Benefit Research Institute, 2010.

Michelle Mast, CFP® , CLU, MBA

Michelle Mast is a CERTIFIED FINANCIAL PLANNER™ professional and holds the Chartered Life Underwriter designation. She has been associated with AXA Advisors for more than 24 years. She works with individuals as well as corporations on both a personal and corporate basis in developing and implementing financial strategies to help them work toward their financial objectives and goals. Mast works in individual financial planning, retirement planning, risk management, college education funding, and strategies for estate planning. She has received the title of Qualified Plan Specialist based on her successful completion of an internal AXA Advisors training program and a written assessment, as well as the title of Retirement Planning Specialist by AXA Advisors, based upon the successful receipt of a Certificate in Retirement Planning from the Wharton School of the University of Pennsylvania for completing the AXA Equitable at Retirement program. Previous work experience includes positions in the accounting and banking field. During her tenure with AXA Advisors she has received numerous awards, including being named to the company’s Hall of Fame and being named a Centurion Leader, and earning the National Growth award and Hallmark honors. Mast was one of 30 select women to participate in the AXA Women’s Council to further women in financial planning and management. She also focuses on assisting women in financial planning and works to incorporate women’s financial concerns with regard to divorce and widowhood. She conducts workshops on financial matters. Mast is a member of the Financial Planning Association and has earned a Bachelor of Science Degree in Accounting from New York University and a Master of Business Administration degree in Finance from Hofstra University.

Michelle Mast CFP®, CLU, offer securities through AXA Advisors, LLC (NY, NY 212-314-4600) member FINRA, SIPC. Investment advisory services are offered through AXA Advisors, LLC, an investment advisor registered with the SEC. Annuity and insurance products offered through AXA Network, LLC.  Individual Financial Professionals may transact business and/or respond to inquiries only in states(s) in which they are properly registered and/or licensed. AXA Advisors, AXA Network, and AXA Equitable Life Insurance Company (NY, NY) are affiliated companies and  do not provide tax or legal advice. Be sure to consult your own tax and legal advisors regarding your particular circumstances.

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The Triumph of Love: A Talk With Author Wendy Swallow

12 Monday Dec 2011

Posted by themidlifesecondwife in Love, Monday Morning Q & A, Relationships and Family Life, Remarriage, Second Weddings

≈ 2 Comments

Tags

Life, Love, Marriage, Premarital Counseling, Relationships, Remarriage, second marriages

Several months after John and I became engaged, I was assisting a journalist at the New York Times with a story—part of my regular duties as director of communications for the music conservatory where I worked. During our e-mail exchange, I mentioned that I was getting remarried, relocating to Virginia, and would soon be leaving my job. She wrote back to wish me luck and tell me about a book that crossed her desk when she was an editor at the Times Book Review. She found it “extremely interesting and well written,” she wrote, and sent me a link that led me to Wendy Swallow’s The Triumph of Love Over Experience: A Memoir of Remarriage. Something told me to read it—most likely the voice inside my head suggesting that after a quarter century of marriage and seven post-divorce years on my own, advice from a person who had been in the trenches might be useful. Deeply in love, John and I share a common sense of how to be in the world and of the world—with the same values, faith, and politics—and we operate from the same zone of trust and honesty. We’ve always been able to communicate easily and openly about our relationship. Still, advice from an expert is always welcome, and I was curious to see how someone else navigated the waters we were about to enter. I should mention that Wendy and her second husband each had two sons when they remarried—all of them teenagers.


THE TRIUMPH OF LOVE OVER EXPERIENCE: A Memoir of Remarriage

By Wendy Swallow
296 pp. Hyperion.

Her book was a comfort to me, a survival guide, user’s manual, and road map all in one. I have recommended it countless times—and not just to second couples—anyone in a relationship will benefit from reading it. Regular followers of this blog already know that I’ve cited Wendy’s wisdom before. One of my favorite quotes appears on the “Secrets to a Happy Relationship” page, which you can find at the top of the blog. When I began formulating the editorial objectives for The Midlife Second Wife, I determined that mine would not be the only voice you would hear; a section devoted to interviews with experts was therefore essential. Wendy Swallow is the first person to whom I reached out. I’m pleased and honored that she agreed to do this interview. Here is an edited transcript of our conversation, which took place on Thursday, December 1, 2011:

Wendy, thanks so much for participating in this interview. I’ve been looking forward to our conversation for some time. So have some of my readers. One of them sent me this e-mail:

I’m not in midlife … and not a second wife, but I’m having thoughts and fears of a second marriage. I’m 43 and said that I would never remarry, but I have recently found someone who I would consider marrying and I’m scared as hell!

Based on the research you did for your memoir of remarriage—and based on your own happy experience—what do you say to people who are genuinely frightened by the prospect of “stepping off the cliff and hoping to be able to fly?”

Those fears need to be taken seriously. That doesn’t mean you give in to them, but you listen to them and examine them. You have to trust your gut on this stuff, but you also have to really believe strongly—and the research bears this out—that the people who do best in a remarriage are those who have really worked to process what happened in their first marriage and their divorce, and who have grown from those experiences. That means perhaps going into counseling, accepting your role in what did not go well in your former relationship and where those problems lay, and in your ongoing relationship with your ex—even if the person that you left seems mostly to blame for the marriage’s failure from your perspective. Everybody has to look at how they contributed to the marriage not working out—even going so far as to ask why you married that person in the first place. This is especially true if you have children. I believe strongly in this. I don’t think it’s an easy process to go through. But if you want to grow and be able to marry again, this is an important piece of the puzzle. You have to keep those lessons in front of you. Researchers find that people who do not do well in remarriage never really learned the lessons of their first failed marriage. The statistics for second marriages succeeding are not great. And for those who remarry a third time, the odds that that marriage won’t work increase, and they go up for each subsequent remarriage.

I know. The numbers are pretty grim. Your reminder that we learn the lessons from our past experiences is critically important. What other conscious decisions must a couple make, and what actions must they take, for their second marriage to have a shot at success?

One of the things Charlie and I told each other early on was this: “I just want to be clear: I’m not rescuing you.” We were mostly talking to ourselves. We married our first spouses because we wanted to help them be more stable in the world. After my marriage ended, it ultimately became more important to me that I be really stable and happy in my single, divorced life. I knew this for myself, but I wasn’t sure that Charlie saw that.

There’s a moment in the book where I write about how we went to counseling with a minister. At the very first session, she managed to surface the whole issue of money, because we had a wealth disparity in our relationship. It wasn’t a bad thing—we didn’t think that money was something we’d have to spend a lot of time worrying about. But we had slightly different attitudes to this disparity in our relationship—we had two alien cultures coming together—and we recognized that it could create challenges in the future. It took—it always takes—compromise and communication to work those things out, so having these counseling sessions helped us; even if you think you know what you’re doing, a little premarital counseling can go a long way.

I want to return to the topic of compromise, but first I have to say something about premarital counseling. In our case, that train had left the station; that’s why I was so glad to read your book. How risky is it to take on a second marriage without going through couples’ therapy first? What advice do you have for those who are leaving it to their own devices?

I do think there’s a lot of good literature out there, and many excellent books that deal with stepfamilies, so there are a lot of resources. You can get counseling in various ways. A wise, good friend can be helpful. Definitely you have to talk to each other.

Before I left my first husband, I remember talking to a friend who remarried. I asked him what worked in his second marriage that didn’t work in his first. He said that when he married his second wife, he told her, “If you have a problem with something I’m doing, tell me right away. Don’t let it snowball.” That was their mantra.

I really thought about that. If you establish that you can talk about the difficult issues together early, then that’s good.

Very early on, our kids got into this habit that we worried about at first: drinking milkshakes at 10 at night and watching South Park in the kitchen. At first Charlie and I hung around, but then we realized they had more fun without us there. So we started taking our dog out for a long walk while they had their time together. It was perfectly natural; we didn’t like South Park. We’d leave the house with the dog for those long walks, and that was when we could talk without people hearing us or wondering why we were huddled together and whispering. We were both working full-time and running all over D.C. with these kids to play practice, SAT prep—we had very little downtime with each other—so those walks were very helpful in giving us a chance to download. His boys would bring their issues to him, mine to me; kids communicate with their own parents, mostly. Sometimes there were things I needed to know, and I wanted to anticipate what level of support was required of me.

That’s a great example of using every opportunity to keep the lines of dialogue open. Let’s get back to the subject of compromise. It’s undoubtedly important, but is there such a thing as too much compromise?

I think you have to trust your gut. You might agree to compromise on something but it doesn’t sit right with you. Trusting your gut has two actions:

1. Listening to your inner feelings, and assessing those feelings. How fair are they?

2. Acknowledging that there may be something you either need to bring back or learn to deal with. Which is it?

It’s not enough to listen to your gut—you must assess your feelings. Let your rational, less emotional brain think about it. Once you’ve done that, ask yourself what you really think will be different after your compromise—what outcome are you looking for?

There’s a famous moment in our family when we all learned a lot about compromise. My youngest stepson, Sam (the second-youngest of the boys) was advocating for a cell phone; he went to a school that was farther from home than the others. We worried about the cost of four cell phones, thinking that if we got one for Sam, we’d have to get phones for all four boys, as they were close in age. It begged the question: Who is ready for something, and who isn’t?

Each boy got his own computer when they started high school; before that, they had to share. And they would be taking their computers to college. We thought we were being fair and equitable. But after much discussion about the cell phone, Sam turned to us and said, “Can no one be special anymore?”

The truth is, each boy was different and had different needs, but we were trying to homogenize everyone. Benjamin called it “the kindergarten effect.” When we all moved in together, I had a cubby for each boy, color-coded toothbrushes and towels. The boys saw it as infantilizing. The house would have run more smoothly if the Wendy-scheme had worked, but the boys weren’t in that place.

Sometimes you set out with a plan that you think is fair and equitable, but life is a lot messier than that. The boys picked up on the fact that we wanted to be fair and equitable—and they appreciated it—but we were also able to articulate that within the family, some had specific needs.

The lesson is, compromise is a double-edged sword. Sometimes an imposition of the will of one person over the other has to be negotiated.

Here’s another compromise-related question, and a timely one, with Christmas only two weeks away: How do you handle the holidays?

In the early days we had a little trouble, because although Charlie and I tried to organize things well in advance, not all parties involved were planners—they would do things at the last minute, or not consult with us, so the matter of who was even going to be with us was often up in the air.

We did okay, though. One of the things we decided early on was that because our kids were teenagers, we were not going to pretend to make a happy family out of the six of us just because we were cohabitating. Both our sets of boys spent time with their other parents. Both of us had joint custody, which was nice. Sometimes we just had his kids, sometimes just mine, sometimes all four, sometimes nobody. We’d have four different alternatives in a two-week period. My older sister, who is a minister, says, when something is stressful:

“I’m trying to hold this lightly.”

This Christmas we’re expecting to have all four boys together for the first time in four years; all four of them without other people. We’re still waiting for word on the fourth and hope we get him. But we’re “trying to hold it lightly.” If it doesn’t work, it’s not the end of the world.

I learned from my first marriage that the good moments in life are not necessarily going to happen on a designated day. Many wonderful moments take place on completely average days.

The other thing is, we really didn’t want the kids to feel the stress of two families on the holidays, so we would accept that the kids were happy with the parent they were with. We’d have a night two weeks into December where we did something special together, like decorate the tree. We learned to get very flexible.

People get into trouble when they have a preset romantic notion of how something should look, whether it’s marriage, or what a holiday is supposed to look like. Life is way more variable. What is precious in life is not a perfectly decorated tree with all people in their seats at the table. Life can be messy.We’ve had holidays where we didn’t even put lights on the tree. It just has to be good enough as it is.

Whatever it is, Charlie will always say, “Let’s make this fun.”

Our first Thanksgiving in a restaurant was kind of sad for me; it wasn’t with my big family. Charlie found this cool restaurant and we were seated way up high. It was a lovely experience, but partly it was because he said “Let’s just make this a really cool event they’ll always remember.

One day we were trying to choose a movie to rent, deciding which one would be the most fun. The boys said, “Let’s do several movies!” It wasn’t what I had in mind, but I took Charlie’s line and asked myself: “Is there some way to have fun here?

Compromise again, which takes negotiating. Pro and Con lists are great tools for that—especially for working through big decisions. For a couple about to get remarried, what in your view are the top three things that should appear on the Pro side of their ledger? And what top three items on the Con side of the list suggest trouble ahead?

On the Pro side, I think that these must be at the top of the list:

1. Both parties need to be tolerant, patient, mature, and capable of self-examination.

In my first marriage, I didn’t understand how mature I had to be in the world. In my second marriage, I learned, partly from working for many years, that there’s something about the business world that enables most people to deal with people even if they don’t like them. A lot of the attributes about how we behave outside of the family can help us be better members of our own family. I don’t think I should give voice to all of my angry moments. I do a lot of waiting, so I don’t feel so strongly about the issue and can then address it with my more mature self.

2. Each person needs to be truly loving. They have to really love each other—love all of each other—the whole ball of wax.

None of us are perfect. We will all disappoint each other at times. But who is really there for me? And who am I really there for? Charlie and I didn’t get married for three years; we didn’t make any rash movements. I had worked so hard to recover from my first marriage that it took my brain time to catch up with my heart in order to accept him with all of his baggage. I knew that it was going to take time. Research bears this out: Rapid remarriage is dicier statistically than thoughtful, careful remarriage.

I knew that there was a whole process that Charlie had to go through—that he and his ex had to go through—without me coming in.

3. Your kids have to be in a place where they will be able to cope with your remarriage.

Charlie and I did not move in together before we married—not for moral or religious reasons, but because I was not going to ask my children to be at the kitchen table with a stranger every morning unless I was sure that this was a permanent thing. And his kids were really not ready; it was a little harder for them when it did happen because their parents’ divorce was more recent.

Not all kids are going to be ready for their parents to remarry. I know marriages that have sort of gone forward without everyone at the table. It’s not that they won’t be successful; it’s just that things will be tougher. It can be painful. I’ve watched a couple of families whose kids went into battle mode. Our own kids did not need to make us unhappy; they were very relieved that their parents were happier once they remarried.

Now, for the Con side …

1. Any impulsive behaviors

One example of an impulsive behavior would be getting together when it is motivated by something other than “this is the smart thing to do.” One thing I found in my research is that women are more likely to remarry partly to solve financial problems. Many women come out of a divorce living a more reduced life, and they struggle significantly. Women are somewhat motivated by financial concerns; who can blame them? But if that is the main motivation, that’s a problem.

Another impulsive behavior is getting married in the first blush of love before you know who somebody is—acting impulsively towards remarriage rather than thinking it out carefully and taking the time to know who you’re marrying. When you remarry, it’s not just the person you’re marrying; it’s their larger family. It’s their baggage. It’s their divorce.

2. Wrangling over property and money from early on in the relationship

We’ve all heard stories of someone who married a person who dictated everything, including where they will live, because the person they are marrying is very established in their lives and their career. If one party is having to give up everything and the other is not giving up anything, that’s destabilizing. It makes you wonder why they’re not compromising. One area where this comes up in a big way, even subconsciously, is property.

When the kids and I moved into Charlie’s house (partly for financial reasons) there were advantages. It was closer to my job. We would be only two blocks from my ex, which was a huge boon for my kids. But it was their house. When we moved my stuff in, I put it all in the living room, then I asked for a shelf or two. We worked it all out, negotiating so that decisions weren’t made automatically and arbitrarily. If one person in a proposed remarriage is unwilling to compromise on some of this stuff, that’s a problem.

The issue of property is interesting. When I was interviewing people for my book, I met one couple that fought because the husband needed a home office and he took away his young step-daughter’s playroom. By the time I’d met them, she was a grown woman who no longer lived at home, but she still hadn’t forgiven him. It’s all about territoriality. People identify certain things, rooms, and buildings with different stages in their lives.

3. The person you remarry doesn’t share your basic values and integrity

Here’s another thing I learned from my divorce. My ex and I had less trouble deciding about how to deal with our kids afterward because he’s trustworthy. He had issues, but trust was never one of them. He never once missed a support payment. He never stood the boys up. We shared the same values on education and on who the boys would become. We shared the same religious life. We shared the basic values.

If either party lacks integrity, then there’s going to be a lot more distrust in a marriage, and trust is the most important thing. You have to really know a person to know if they’ve got a spotty trust history.

Wendy, you’ve written a book about divorce and a book about remarriage. Do you have any plans for a third book about relationships?  

I never really meant to write a memoir to begin with, and then I wrote two even though I thought I shouldn’t write one until I was 80 and my parents were gone. I don’t think I’ll write another book about relationships; I’m not really sure I have anything more to add to the literature at this point. I’ve just spent four years writing my first novel. I’m working with my agent, and hoping it will be published in the next year or so. Part of me wants to do more non-fiction. We now live in Nevada half of the year, and I’ve become very interested in climate change, especially as it relates to the West. When my kids were young, I had all sorts of story ideas in my head about families and kids with issues. Maybe if I ever have grandkids …

You’ve now been remarried for ten years. What would you tell your younger self if you could travel back in time to the eve of your wedding?

It would be to have confidence. I’d say, “Trust yourself and trust Charlie, because it’s all gonna be fine. You’ve made an excellent choice. Trust it and rejoice in it.” 

Wendy Swallow is an author and journalist who recently retired as an emeritus professor of journalism after nearly 20 years of teaching at American University in Washington, D.C.  She started her career as a reporter and editor on the financial desk of the Washington Post, covering the savings and loan crisis, local business, and regional environmental issues.  In academia, she researched and wrote about advertiser pressure on newspaper coverage and the influence of new technology on journalism.  More recently, she has turned to writing about family issues.  She has published two books with Hyperion, Breaking Apart: A Memoir of Divorce (2001) and The Triumph of Love Over Experience:  A Memoir of Remarriage (2005).  In addition to many newspapers, her work has appeared in MORE, Washingtonian, Ladies’ Home Journal, Readers’ Digest, Parenting, The National Journal, Washington Journalism Review, Journalism Quarterly, Journalism Educator, Newspaper Research Journal, and Extra!  She is currently working on an historical novel and divides her time between homes in Reno, Nevada, and Washington, D.C.  She and her husband Charles Shepard have four grown sons.

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A Talk With Physical Therapist Dr. Amanda Miller

03 Monday Oct 2011

Posted by themidlifesecondwife in Monday Morning Q & A, The Healthy Life

≈ 1 Comment

Tags

American Physical Therapy Association, bone density, Connie Schultz, exercise, Health, heel lifts, leg fractures, leg length discrepancy, limb length discrepancy, lower back pain, Marlo Thomas, orthopedics, osteopenia, osteoporosis, Pelvic floor, pelvic obliquity, Physical therapy, Pilates, postural anomaly, Virginia Commonwealth University, Women's Health

Welcome to the “The Midlife Second Wife’s” debut feature—Monday Morning Q & A. In the months to come you can expect to read interviews with experts on a wide range of topics. Among those with whom I’ll be speaking are financial planners, authors, fashionistas, relationship and dating experts, life coaches, artists and artisans, lawyers, therapists, doctors, cooks, butchers, bakers, and even a real honest-to-goodness candlestick maker. Who knows? I might even snag an interview with my hero (and, some have said, doppelgänger), Marlo Thomas. At least, I’ll try! And although these interviews won’t appear every Monday, at least not at the start, I do want you to know that on select Mondays, we’ll be learning from others.

Incidentally, that’s one of the things I’ve come to love about writing this blog. I’m not an expert on anything, really. Well, maybe on life. Because, like you, I am living it. And as Pulitzer Prize-winning columnist Connie Schultz wrote, Life Happens. It happens to me, to my loved ones, to you, to all of us. I want to understand it, learn from it, and move forward—with as much grace and grit as I can muster. Do you know what I think is really cool? As followers of this blog, you get to join me on the journey.

Why does this matter to me? Well, for one thing, I don’t like pain and I don’t like trouble; yet I’ve had plenty of both. And so have you. No one among us gets a free pass. But if even one sentence that I write in this blog helps you avoid either, I’ll be able to consider mine a life well-lived.

So, on to today’s inaugural interview. A suggestion before you start: You might want to take another look at “There Was a Crooked Woman…,” parts one and two, for some context. To recap, Dr. Miller treated me (quite successfully) for severe lower back pain, and I am eager to share with you what I have learned—and continue to learn—from her.

I came to see you for treatment of lower back pain, and you determined that I have limb-length discrepancy—my left leg is slightly longer than my right. Do you see many such cases? Would you say that it’s a common occurrence in the general population?

Leg-length discrepancy is a controversial topic, especially when it comes to treatment. There is a difference between true leg-length discrepancy and apparent leg-length discrepancy that results from other postural anomalies. I think the estimation in the literature is anywhere from a 40-percent to 70-percent prevalence in the population.

That’s around half of the population! To be clear, we’re speaking only about the United States, correct?

Correct.

What makes it controversial? What treatments are considered “controversial?”

The effects of LLD on function and the magnitude of LLD that warrants treatment are controversial. There is disagreement regarding the role that LLD plays in musculoskeletal disorders. There is also not a “gold standard” or most preferred way of accurately measuring discrepancy.

As you know, I broke my left leg several years ago—that’s the leg that’s out of whack. In my case, did the fracture lead to true, rather than apparent, leg-length discrepancy? I guess I want to know the meaning behind the terms “true” and “apparent.” And when you say “postural anomalies,” what do you mean? Can you give me some examples?

True—or structural—LLD can be caused “traumatically” by fractures and repairs, fractures affecting the growth plates in children before they have finished growing, and total hip replacements. They can also be congenital, such as congenital dislocation of the hip, or other skeletal disorders. Postural anomalies include impairments such as scoliosis, and muscle imbalances causing changes in standing/sitting posture. For instance, if you are a swimmer and breathe only to one side during freestyle, you may develop shortening of your oblique muscles—the the trunk muscles that do rotation and side-bending—on one side. That shortening can lead to a slight sidebend/rotation at rest in standing or sitting.

Do fractures always lead to LLD? Would the fact that my orthopedic surgeon had to install a plate in my leg (at the knee joint) have contributed to the problem I’ve been having?

Fractures and other surgeries don’t always cause leg-length discrepancies, but it’s something to be aware of, certainly. And again, leg-length discrepancies don’t always cause pain or dysfunction.

Might either osteopenia or osteoporosis cause LLD?

Changes in bone density can be a factor; muscular asymmetries that change the way the spine, pelvis, and hips move are also factors. For instance, if someone is prone to standing on their left leg with hip cocked, they can cause asymmetric muscle shortening that can appear as a pelvic obliquity or leg-length discrepancy.

Pelvic obliquity. You referenced that when you were treating me; that’s when I discovered you are a pelvic-floor specialist. Could you please talk a moment about what you mean by “pelvic obliquity”?

Pelvic obliquity refers to an apparent change in the bony alignment of your pelvis, often caused by muscle imbalances. The contributing muscles may be of your pelvic floor, or back/hips/trunk.

If LLD can lead to lumbago, or lower back pain, to what other medical issues can it contribute?

Anything from ankle, knee, and hip-dysfunction, all the way up to neck and shoulder pain. Leg-length discrepancy, or any postural dysfunction, can change the way you move and carry out normal activities of daily living, as well as recreational or athletic activities.

How does one even know to check for LLD? If a person is suffering from chronic lower back pain, is LLD something for which a doctor should check?

Your basic primary care doctor—and even most orthopedic doctors—will look for postural dysfunction, and, hopefully, refer you to a musculoskeletal specialist for further work-up. If you are having any dysfunction, and a possible leg-length discrepancy may contribute, make an appointment with a physical therapist

Let’s talk about appearances. You initially thought I would need to wear a heel lift, but determined that my discrepancy was subtle enough that I could do without one. If a person does need to wear a heel lift, does that mean he or she can no longer wear certain styles of shoes? It gets awfully hot in Virginia in the summertime; must a person forgo flip-flops and sandals? And what about high heels?

If a patient needs a heel lift for a true discrepancy, as opposed to an apparent discrepancy, then they will need to wear comfortable shoes that they can put the heel lift in whenever they are doing a significant amount of standing or walking. Flip-flops are inadvisable for anyone who has back pain, unless they provide a lot of support. Some sandals have removable inserts that heel lifts can go under. High heels are dependent on the height of the heel and the width of the back of the shoe. Of course, if all you do in your shoes is walk from your car to your office, and then you sit all day, shoe choice is not as big of a concern.

A friend of mine has a name for the high heels you just described. She calls them “curb shoes”—as in: “I’m wearing high heels, so please pick me up/drop me off at the curb.” But what about a situation where your job has you sitting all day; that’s not good, is it?

The sitting or the shoes??? Neither are great. If you can’t walk comfortably in your shoes, you should probably not be wearing them. If you have to wear them, keep your flats in your purse, and use those for walking.

Other than heel lifts, are there other things a person can do to alleviate not only the leg discrepancy, but also its symptoms? Short of stretching with a medieval torture rack?

Exercise!! If your muscles are stronger, they are better able to control motion and transfer load across your lumbo-pelvis, which means improved stability and decreased pain and irritation across the joint. Appropriate shoe wear and good body mechanics are also essential.

Let’s talk about exercise, then. The first thing you had me doing were exercises to strengthen my core; in fact, I shared your exercise for “setting” one’s TA, or transverse abdominis, in part two of “There Was a Crooked Woman…” Why are these exercises important? And can you talk a moment about what it means, exactly, to strengthen one’s core?

Sure. The core is made up of four muscle groups: the transverse abdominis that you mention, which is the deepest abdominal muscle; the pelvic floor muscles; the multifidus, or the deepest back muscle, and the respiratory diaphragm. These muscles work to optimize intra-abdominal (inner abdominal) pressure in order to help stabilize the spine during load transfer or movement. We often see core dysfunction in people with back, pelvic, or abdominal pain. I believe that the first step in treating this kind of back pain is to improve the function and use of core muscles, along with pain management techniques and lifestyle modifications such as body mechanics—for example, how you transition from a sitting to a standing position.

Yes! Another thing you had me think about was how I’ve been getting up from a chair. I must first “engage my core” in the manner of the exercise I published last week, right?

That’s right. This is something that should happen automatically but often doesn’t in people who have pain.

As I recall, when I was in pain it really wasn’t all that easy to “engage my core,” but I see how important it is. What other exercises are helpful in alleviating lower back pain? And isn’t that something of an oxymoron? If one is in pain, won’t exercise lead to more pain?

Actually, oftentimes movement helps decrease back pain, especially once you are out of the acute phase. A gentle walking program, strengthening and stretching exercises, core work, are all helpful. Avoid a lot of high-impact stuff at first, and make sure motions and activities that you are doing are comfortable and controlled. Never ever hold your breath with exercise, remember to exhale on exertion, and don’t forget to engage your pelvic floor!

I’ve started walking three mornings a week with a friend; I’m up to two miles a morning now.

That’s good! Keep it up.

What about core work? You have Pilates reformers in your exercise studio, and I really enjoyed trying them out. Pilates is all about core work, isn’t it?

That’s right. Pilates does a great job of incorporating all components of your core, including your diaphragm and pelvic floor.

You mentioned pain-management techniques earlier. There’s always some confusion about this when I speak with my friends. Does one apply heat at the immediate onset of pain, or ice? At the end of each session at Progress Physical Therapy, either you or one of your assistants would apply ice to my back, and you told me to ice my back after doing my home exercises. Is there ever a good time for heat-therapy?

Ice is better for inflammation; heat is better for muscle tightness. Always try ice first if you are unsure which category you fall into. Heat can, at times, make inflammation worse.

Hmmmm. “Fall into.” Not the best choice of words when speaking with someone like me! Is there anything I didn’t ask you that you wish I had?

Nothing that I can think of! The moral to the story is keep active. And if you have any specific questions about your core, or specific limitations, please see your physical therapist.

I will, Dr. Miller. Thanks so much for being my first guest on the blog.

You’re welcome!


Dr. Amanda Miller is a member of the clinical staff at Progress Physical Therapy in Glen Allen, Virginia. She earned a Doctor of Physical Therapy degree at Virginia Commonwealth University’s School of Physical Therapy in 2009, and, in 2006, a Bachelor of Science degree at Virginia Tech, where she majored in human nutrition, foods, and exercise and minored in psychology. Dr. Miller is a member of the Women’s Health and Orthopedic sections of the American Physical Therapy Association, and serves as Central District chair of the Virginia Physical Therapy Association. She is also a member of the National Vulvodynia Association and is a clinical instructor at Virginia Commonwealth University.

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