5 New Ways Childbirth is Changing

When I finally became pregnant after years of infertility treatments, my mind excitedly jumped between thoughts: How would we announce the big news to our friends and family? How would I have the quintessential birth experience?

Instead of wondering how many pickles I might crave or if I'd be hit hard with morning sickness—uh, yes, was I ever!—my mind raced feverishly to those last hours of my ninth month where I would be in tip-top pregnancy health and would be in complete control of every contraction and decision that would affect my voluptuous body until my precious bundle of joy entered the world. All in a calm, serene setting, of course.

I chuckle now, eight kids later, when I recall how I lived in awe of the anticipation of all that could or would happen to my growing body, as well as the total emotional journey I experienced throughout my first and subsequent pregnancies. Each and every pregnancy was different for me, both physically and emotionally, but one thing that remained constant each time I learned I was pregnant was that I would always visualize the end result: delivering the healthiest, most adorable baby under the best possible circumstances.

It’s been 12 years since I’ve been to the delivery room, and although I was a frequent flier for nearly a decade I still love connecting with expectant and new moms to share in their miraculous birth stories. It just never gets old for me!

Whether you’re expecting, thinking of becoming, or trying to become pregnant, or just love all things pregnancy like I do, you might be interested to learn about these five interesting trends that women and their partners can experience during labor and delivery.

5 Ways Childbirth is Changing

1. Gentle Cesarean Section
2. Dancing To Stimulate Labor
3. Being Camera Ready
4. Crowd Birthing
5. Birthing Apps and Podcasts

Here is each trend in more detail.

1. Gentle Cesarean Section

I never had a Cesarean section with any of my deliveries, yet statistics show that 1 in 3 babies are born via C-section. According to a study done by the Centers for Disease Control (CDC) in 2016, 31.9% deliveries were C-sections. There are several reasons—chronic health conditions, multiple births, problems with the placenta—for delivering through this surgical procedure, in which the baby is born through a cut that your doctor makes in your belly and uterus. Your doctor or midwife will present the case for a C-section birth during your pregnancy care if it becomes the best option for delivery.

The traditional stories one hears of a C-Section delivery aren’t always warm and fuzzy. The baby is born in the OR (operating room) in a very sterile and clinical environment. Mom has monitors attached to her arms and chest throughout the procedure and can’t see anything because a large, blue drape hangs between her chest and stomach. Her partner is seated next to her head but is also in the dark to the actual birth until the baby is surgically delivered and whisked off to another section of the OR, where pediatricians will do evaluations. Then, many minutes later, mom will meet her baby for the first time when either a nurse or her partner give her a peek.

Thanks to Dr. William Camann, director of obstetric anesthesia service at Brigham and Women's Hospital in Boston, the process of Cesarean delivery was tweaked so that the new mother could be more visually involved during the birth. He envisioned using a clear drape rather than a blue one so that mom could watch the birth and be a part of the experience.

That was ten years ago and was the catalyst for others in the medical profession to follow suit. Soon after the term gentle C-section was coined. Now women who need to deliver via C-section can try and incorporate this calmer, tender approach to their delivery. Some of the gentle aspects that C-section parents can expect are soothing music being played during the birth, aromatherapy, and skin-to-skin contact immediately after delivery because mom’s chest will be freed of the usual monitors during surgery as they will be placed beside her.

If you’re expecting and are curious to know if your hospital is on trend with the “Gentle C” be sure and ask your health care provider for more details.

2. Dancing to Stimulate Labor

A few months ago, I stumbled upon a fantastic youtube video of a pregnant woman dancing in the delivery room alongside her OB GYN to a very catchy pop tune, "Paradinha" by Brazillian singer Anitta. This video soon went viral because the OB had not only choreographed the dance, he was right there by his patient’s side dancing with her. I highly recommend you check it out—it will definitely make you smile.

The force behind this dance, which included squatting and fun arm and leg movements, is part of a care practice known as freedom of movement throughout labor. The Journal of Perinatal Education states “Freedom of movement is important in making the birth of your baby easier. It is the best way for you to use gravity to help your baby come down and to increase the size and shape of your pelvis. It allows you to respond to pain in an active way, and it may speed up the labor process.”

Even if you haven’t been to a club in ages, you might want to put your dancing shoes on when those first few contractions begin—lots of women are on board with getting their groove on to have a little fun when  it's showtime.

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3. Being Camera Ready

Today’s babies are not only being born with cutting-edge medical technology, they are also coming into this world being streamed on social media venues. My eight babies were born between 1993 to 2005—we actually had a Polaroid Instant camera for the first birth and had a video camera the size of a small TV. After our first few kids were born, my husband had to rush out to the local pharmacy to get prints made that we’d taken with our Kodak camera.

Today—wow, has that all changed! Now we have live photos, videos, announcements, and play-by-play details of every event happening in our lives thanks to our smartphones and the ability to connect to our favorite social media channels.

And because we have instant access to capture all these milestone moments, including the ability to take dozens of selfies, more and more moms-to-be are wanting to primp for the camera, despite what kind of pain she is in, so that when she and that beautiful new baby meet the rest of the world, she looks great.

I’ll sheepishly admit that I totally relate to this scenario. Since our first baby was born to us through adoption, I was able to arrive (though overwhelmed with emotion) at the hospital to meet our daughter wearing a super cute outfit and not a hair out of place. I rocked those first few new mommy photos, and to this day when I look at them, I get teary eyed but still pat myself on the back for having a great hair day. Now, one year later, the story all changed when I delivered our first son, after 28 hours of labor and nearly three hours of pushing. I walked into the hospital wearing yet another super cute outfit (that I specifically bought to wear when I went into labor—sigh!), and had actually spent 45 minutes, during contractions, blow-drying my hair and applying my make-up so I could look fresh and perky at the hospital. (I know—ridiculous!)

I won’t lie—even when I was in hard labor, I managed to reapply my lipstick. Yet, when pushing began—everything changed. My blonde bob of a cut was now soaking wet and plastered to my head and my sergeant of a delivery room nurse looked me in the eyes and said “Honey—lose that hair bow—this isn’t a beauty pageant!” 

Those new mommy photos with my son look nothing like me, but I accepted there was no way to look anything other than exhausted and elated that I had finally given birth.

Trending now, however, is a way to help new moms look their best right after delivery. The New York Times is now reporting that women pre-book a team of stylists—specifically hair and makeup pros—to come to their hospital rooms for the purpose of getting the new moms camera-ready for their first photos with their babies.

The more the merrier is the new concept in “crowd birthing,” where the parents-to-be invite a small army, perhaps eight to ten of their closest family and friends to witness their baby’s arrival.

In a New York Times Fashion & Style article, John Barrett, founder of Bergdorf Goodman, was quoted as saying, “For some new mothers, the treatments offer an emotional boost as well as an aesthetic one. “It’s really important that you feel good, that you don’t look in the mirror and say, ‘Oh, my God,’ because having a baby is like running a marathon. Just feeling ‘I look normal’ afterward is such a nice thing. It’s good for the psyche.”

So if you feel the need to look glamorous and put together after delivery, keep this fab trend in mind!

4. Crowd Birthing

To some people, the adage “two’s company, three’s a crowd” rings true for many occasions. Not so in some delivery rooms.

For many couples, gone are the days when an intimate birth experience was shared between themselves and their new baby. The more the merrier is the new concept in “crowd birthing,” where the parents-to-be invite a small army, perhaps eight to ten of their closest family and friends to witness their baby’s arrival.

This is such a personal choice for couples to weigh in on. Personally, I couldn’t imagine having one of my brothers or my father-in-law watching me give birth, but for many woman they feel there is strength in numbers. Having a support system of several people to lean on can help to relieve stress and keep the laboring mom more focused and relaxed. If you think a few more warm and familiar faces surrounding you when the big day comes is for you, be sure and check with your health care team and hospital to see if delivery room parties are good to go.

5. Birthing Apps and Podcasts

Today, we have a fantastic selection of apps and podcasts for everything from saving money, educational topics, to handling life's challenges, so why not have birthing apps and podcasts at our disposal to help us with all things pregnancy and delivery?

Technology in the 21st century has made it very easy to be pro-active in your pregnancy and birth. One of the greatest features of using these tools is that you can access the information almost immediately on your smartphone, laptop, or iPad.

I have several friends and colleagues that are expecting babies this summer. Here are a few of the apps and podcasts they can’t live without.

The Bump: This pregnancy and baby editorial app includes articles that cover all your symptoms and developments.

What to Expect: This app is from the popular “What to Expect” series and covers everything from taking your pregnancy test to taking your baby home from the hospital or birthing center.

Pregnancy +:  This app shows interactive images of every stage of your pregnancy.

The Birthful Podcast: The host of this podcast, Adriana Lozada, talks with other birth professionals to share everything from breastfeeding to bed-sharing to vaginal birth after C-sections.

The Cord Podcast: This podcast is hosted by Amy Neuhedel who is very enthusiastic about pregnancy and delivery. The Cord is a collection of helpful tips and interviews with birth professionals, and moms who are pregnant or have delivered.

What type of delivery experience have you had or hope to have? Share your thoughts in the comments section at quickanddirtytips.com/mighty-mommy, post your ideas on the Mighty Mommy Facebook page. or email me at mommy@quickanddirtytips.com. Visit my family-friendly boards at Pinterest.com/MightyMommyQDT

How to Hold Back Tears (Plus Two Big Myths About Crying)

All crying is not created equal. There are times when it’s appropriate: your best friend’s wedding, after a heart-shattering breakup, or the first time you hold your grandchild.

But there are also times and places our culture has decided it’s inappropriate to cry, like at work or school. But many of us struggle with seemingly random crying, including listener Jessica, who wrote in and asked how to avoid bursting into tears, whether in the conference room at work or attempting to get past page two of The Giving Tree with her kids.  

Originally, I had intended this week’s episode to cover only how to hold back tears. But in diving into the research, I found that many of the truisms about crying are wrong, or at least partially wrong. 

Therefore, this week we’ll cover two big myths of crying and round it out with how to access the shut-off valve for your own waterworks.

Why Do We Cry?

Interestingly, humans are really bad at pinpointing why we cry. When asked, most of us report we cry when we’re physically hurt, or someone we care about gets married, dumps us, or dies. 

Those all make sense, but those are the prototypical reasons to cry, not the actual reasons we cry. When researchers ask about the most recent time we cried, we tell a very different story. It turns out we cry for really mundane reasons: we have a small personal failing, a minor conflict, or we’re on the receiving end of criticism. In short, we do cry over life’s milestones, but mostly we cry over everyday interactions.

Does Crying Really Make You Feel Better?

Let’s look at the idea that crying makes you feel better. Again, this is an area where popular perception isn’t the whole story. 

Most psychologically-minded people, mental health professionals included, are guilty of encouraging crying. Let it out, we say. It’s cathartic! We even warn that bad stuff might happen to your health if you bottle up your feelings. But is that true? Not so fast. 

Turns out we only feel better after a good cry 50% of the time. What’s happening the other half of the time? Well, anyone who’s ever been depressed can tell you crying doesn’t make you feel better in the midst of a depression. Neither, it turns out, does crying over an event that’s uncontrollable.

Likewise, if people react to your crying with disapproval, you definitely won’t feel better. And crying often gets a bad rap, especially for men. Anthropologists would say that inopportune crying breaks what’s called “display rules.” For western culture, crying in public or at work registers for men as weak and for women as hysterical, emotional, or at worst, manipulative. 

That’s sexist, to be sure, but still, no one wants to cry in front of the boss. So how to play within the display rules of crying? There’s no foolproof way, but the best of the science offers three things to try.

Tip #1: Act more powerful.

Let’s look more closely at those mundane reasons we cry. Most “irrational” crying is actually triggered by feelings of powerlessness or helplessness.

This is why a minor brush-off, getting stood up, a confrontation at work, or not being taken seriously at the conference table can lead to unexpected tears. It seems random, but when we look deeper, it makes sense.

It also makes sense according to evolution. Tears do two things. One, they signal that we need support from others, and second, they diffuse aggressive situations. A study in the uber-prestigious journal Science found that women’s tears contain an odorless chemical that reduces testosterone levels in men. 

At the time the study was published, the popular press spun it into “crying turns men off,” but in evolutionary terms, it’s super-practical, signaling to potential partners that what she needs when she’s upset is some support rather than a roll in the hay.

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Evolution aside, the way to hold back tears when you’re undercut or disregarded is to act more powerful in the moment. 

Try this: if you feel tears coming on, channel your inner boss. Be assertive. Take up space—stand up straight, put your hands on your hips. Act like you own the place (politely, of course). If you’re a customer or patient, remember the outlet in question works for you. All in all, remember you’re not helpless. You have rights, dignity, and a voice. 

Okay, you say, that’s great for when I feel invalidated or disrespected, but what about getting through The Fault In Our Stars or even a pregame "Star Spangled Banner"? How to hold back tears when we feel empathy, compassion, or are simply deeply moved?

First, cut yourself some slack and reframe your self-judgment. Think of yourself as someone who feels deeply, who sucks the marrow out of life. Thoreau would be proud. 

But if you’re welling up at a commercial not involving injured puppies and a Sarah McLachlan song, compassionate crying can feel awkward, especially if you’re in public. So try this...

Emotion determines your expression, to be sure, but it turns out your expression also determines emotion.

Tip #2: Arrange your face.

Participants in a research study at Columbia University were told they were taking part in a brain-wave monitoring study. Monitoring electrodes were placed on their face and they were instructed to keep as still as possible because movement would compromise the data. Then, they watched a series of both neutral and emotional videos. 

What happened? The study, which wasn’t about brain waves at all, instead found that inhibiting facial expression decreases the strength of emotional experience. Emotion determines your expression, to be sure, but it turns out your expression also determines emotion.

So next time Adele’s "Hello" comes on in a crowded elevator, or the TV over the bar shows a toddler being reunited with a parent in army fatigues returning from their tour of duty, keep a poker face and you might not have to fake having something in your eye.

Tip #3: Breathe slowly. 

No matter the trigger, if you do find yourself crying, you can rein it in faster by breathing slowly. Since crying is a form of stress relief, substitute another form of stress relief—slow breathing—to lower the pressure. 

Notice I say breathe slowly rather than breathe deeply. Deep breathing, especially if done at a rapid pace, can upset the balance of oxygen and carbon dioxide in your bloodstream and make you feel anxious or lightheaded, which is the last thing you need when you’re trying to keep it together.

Finally, what about welling up in tears of joy, gratitude, or the awe of standing on the edge of the Grand Canyon? Psychologist Ad Vingerhoets of Tilburg University in The Netherlands, arguably the world expert on crying, calls tears from positive emotions “exclamation marks.” They express feelings that cannot be expressed any other way. So when you well up with positive emotions, just let the tears flow. And also during "Steel Magnolias." Nothing but a box of tissues can save us there.

Order Ellen's book HOW TO BE YOURSELF: Quiet Your Inner Critic and Rise Above Social Anxiety. Get even more savvy tips to be happier and healthier by subscribing to the podcast on iTunes or Stitcher, or get each episode delivered straight to your inbox by signing up for the newsletter. Follow on Facebook and Twitter.

For free, helpful downloads to fight social anxiety and be your authentic self, visit EllenHendriksen.com.

Image of woman holding back tears © Shutterstock

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Say Your Piece (or Hold Your Peace)

Today we’re going to talk about the right word to use in a common expression: “to say your piece.”

This came up recently in the workplace of our guest writer Samantha Enslen.

Sam assures us that she never fights with her coworkers. But one day she was having a teeny disagreement with her colleague Magi via chat. Sam stated her point; Magi stated hers. Then, Magi wrote “I’ve said my peace.” P-E-A-C-E.

Sam chatted back, “I think you mean ‘I’ve said my PIECE.’” P-I-E-C-E.

Now the fight was really on.

What’s interesting, Sam discovered, is that both women were thinking of real sayings. There are two expressions—one uses “peace” with an “ea,” and the other uses “piece” with an “ie.” But their meanings are very different. 

Speak Your Piece

The first expression is to “speak one’s piece" or “to say one’s piece”—spelled P-I-E-C-E. This means to say what you think and then announce that you’ve done so. 

For example, if you were arguing with a friend over the merits of Star Trek versus Star Wars, you might explain your point and then say, “I’ve said my piece.” In other words, you’ve said everything you have to say on the subject. Now it’s up to your friend to make her own decision.

This word “piece” in this expression alludes to a memorized poem or speech, the kind you might have made in elementary school. It first appeared in print in the early 1800s. 

This phrase calls to mind the expression to “give someone a piece of your mind,” but the two are unrelated. The latter one dates back to the 1500s, and the “piece” here simply means a “portion.” Note that the portion of the mind in this phrase is always negative. You only give someone “a piece of your mind” when you’re angry and ready to share some fierce criticism.   

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Hold Your Peace

The second expression is to “hold one’s peace” or to “keep one’s peace”—spelled P-E-A-C-E. This is the near-opposite of the previous phrase; it means to keep quiet.

For example, if your friend insisted that Star Wars was superior—and you were tired of arguing about it—you might “hold your peace” and simply say “you’re right.”

You’ve probably heard this expression in traditional Christian wedding ceremonies. The person officiating usually says something like this:

Into this union these two people now come to be joined. If anyone can show just cause why they may not be lawfully wed, speak now or forever hold your peace.

In other words, if you got a problem with these two getting married, now’s the time to say it.

Hold Your Tongue … and a Bit About King Alfred

“Hold your peace” was first seen in writing in 1250. But a variation of this phrase, to “hold one’s tongue,” goes back much farther. The first recorded use was in a book called “Gregory’s Pastoral Care.” This was written by Pope Gregory I around the year 590 and translated into Old English by King Alfred The Great in 897. 

Let’s take a moment to say that Alfred was a pretty cool guy. He was king of the Wessex region at the time the Vikings were raiding England. As part of their onslaught, the Vikings regularly destroyed monasteries—and all of the books within them. At the time, monasteries were not only religious centers, but also centers of learning—somewhat like the maesters’ Citadel in Game of Thrones.

Alfred saw that this destruction was eating away at literacy and learning. In his introduction to “Pastoral Care,” he wrote that “so general was its [Latin’s] decay in England that there were very few on this side of the Humber who could understand their rituals in English or translate a letter from Latin into English ... so few that I cannot remember a single one south of the Thames when I came to the throne.”

In response, he began to translate books from Latin into Anglo-Saxon (aka Old English), and he recruited a group of scholars to help him. He chose books he thought it “most needful for men to know, and to bring it to pass ... if we have the peace, that all the youth now in England ... may be devoted to learning.”

In short, Alfred was an early proponent of translating important texts from Latin into English, so they could be understood by a broader range of people. So that more people could read—and learn how to read.

(A side note: this seems like a simple idea, but in the United States, the Catholic Mass was spoken in Latin all the way up to 1964.)

OK! After a couple small detours, we’ll wrap this segment up. We talked about two phrases: speak your piece, with an “ie,” and hold your peace, with an “ea.” The first means to say what you think. The second means to keep your opinion to yourself.

Samantha Enslen runs Dragonfly Editorial. You can find her at dragonflyeditorial.com or @DragonflyEdit.

Sources

Ammer, Christine. Hold one’s tongue, piece of one’s mind, speak one’s piece. American Heritage Dictionary of Idioms, 2nd ed. Houghton Mifflin Harcourt, 2013. 

Oxford English Dictionary, online edition. Oxford University Press. Hold one’s peace, hold one’s tongue, speak one’s piece,  (subscription required, accessed March 6, 2018).

Image courtesy of Shutterstock.

Why Is My Doctor Always Late?

One of my biggest pet peeves in life is tardiness. I hate it when other people are late. It’s as if they are not respecting my time.  But you know what? I hate being late myself even more.  In fact, I cringe at the thought. Conscientious, successful people are on time.

Always. 

So you can imagine that nothing irks me more than being late myself. But I am late - 10 minutes, 30 minutes, sometimes even an hour. And what’s worse? It happens on a daily basis.  Yes, I’m late almost every single day as a primary care doctor. 

This makes me feel overwhelmed and frustrated. It's the one aspect of my profession I truly wish I could fix.

But I’ve had to accept this unacceptable situation as the reality of working in primary care in the United States. It’s a complex problem that is out of my control and it’s a hard pill to swallow. However, that doesn’t mean I can't try to offer a solution. And this podcast episode is my attempt to do just that. 

This week I’m going to give you a snapshot of what a common morning in the life of a typical primary care doctor looks like - warts and all. Next week I will propose a new process to help minimize this issue as much as possible.

Sponsor: Visit GoDaddy.com to get your $2.95 .COM domain. Some limitations apply, see website for details.

A Day in the Life of Dr. Tardy

Dr. Tardy is a great doctor. She cares about her patients, she tries to do the right thing for them, tries to take the time to listen without making them feel rushed. She doesn't like to take any shortcuts when it comes to patient care. That means that she tends to run late. 

Here’s a typical schedule in the life of Dr. Tardy, a primary care physician who works in a large group outpatient setting. It consists of 11 patients, scheduled in 20-minute time slots: 

• 8:30  Mr. Never-Goes-to-the-Doctor
• 8:50  Ms. UTI
• 9:10  Ms. New-Stroke
• 9:30  Ms. High-Copay
• 9:50  Little-Junior-1
• 10:10  Little-Junior-2
• 10:30  Ms. Diabetes
• 10:50  Mr. Needs-a-Navigation-System
• 11:10  Ms. Sadness
• 11:30  Mr. Follow-Up-Blood Pressures
• 11:50  Mr. Acid Reflux

First Patient: Mr. Never-Goes-to-the-Doctor 

The first patient on the schedule is brand new to the practice. Forgetting that he needs to arrive at least 15 minutes prior to his appointment to complete paperwork and processing, he arrives at 8:30am. He doesn’t come to the doctor’s office very often and he scheduled this appointment over 6 weeks ago – do we blame him for forgetting this small detail?

Thankfully, the swift-working front desk staff do their magic to rush his processing…but it’s now 8:40. 

The medical assistant calls his name and takes him to measure his vital signs, and places him in the exam room.  By now it’s 8:45. 

Most doctors are now using electronic medical records and a progress note for the patient visit cannot be opened until the patient is actually processed and roomed. Once that happens, Dr. Tardy comes in to see the patient. It’s now 8:50.

She's already running 20 minutes behind schedule and it’s only the first patient of the day. Not good.

Back to the Doctor’s Desk

Thankfully, the patient is pretty healthy, so the visit takes only 15 minutes to complete.

Dr. Tardy heads back to her desk to start the same process for the next patient. Her flow is interrupted, however, as one of the nurses seeks her out to show her an abnormal electrocardiogram (EKG) she performed in the nurse clinic. The doctor has never met this patient, who belongs to the patient panel of another doctor who is out on vacation. Dr. Tardy needs to search the patient in the electronic medical records, study the medical history, and compare the current EKG with her previous one in order to determine the next step of action. 

This is an urgent issue; she cannot simply ignore this EKG. The process takes her at least 5 minutes. She is now running 25 minutes behind.

Next Patient:  Ms. UTI

Thankfully, the next patient is also healthy. She has some urinary symptoms and it’s pretty straightforward. Dr. Tardy orders the appropriate tests and provides her the proper treatment. This one took only 10 minutes to treat and 5 minutes to document. Woo hoo!  We now can subtract 5 minutes and are only 20 minutes behind.

Next Patient:  Ms. Stroke

The next patient is a hospital follow-up. An 87-year-old woman who suffered a stroke since Dr. Tardy last saw her. She is now unable to speak clearly and requires a family member’s presence to help facilitate the visit.  The doctor also needs to request the records to be transferred over from the hospitalization in order to get the medical details.

Thankfully, the wonderful medical assistant did that prior to her visit…phew! 

How long will it take to peruse the packet of hospital notes from her 10-day stay? After reading the novel-length paperwork, here’s what Dr. Tardy determines will need to be accomplished during this visit:

1. The patient requires referrals for multiple specialists: physical therapy, speech therapy, neurology. Each one of these referrals takes time to submit.

2. The family is frustrated because they cannot care for her at home and multiple psychosocial aspects of a stroke need to be addressed. The patient is depressed and the family is understandably shaken up. They look to Dr. Tardy to ease the pain and provide support and guidance, not to mention help in coordinating her living placement. Dr. Tardy listens to her patients.

3. The patient is also diabetic and her blood sugar levels are out of control. Dr. Tardy needs to address that urgently.  After all, diabetes is a contributing factor to the stroke in the first place.

All of this needs to happen in a 20-minute patient slot. Not possible. Dr. tardy tries really hard and this visit miraculously takes only 30 minutes to complete and another 5 minutes to document. Now the doctor is 35 minutes behind. 

Back at the Doctor’s Desk

Dr. Tardy gets interrupted again in between patients because of a critical lab value on one of her patients. The patient must go to the ER and Dr. Tardy needs to call her to explain to her exactly why it’s imperative that she be seen ASAP. The patient doesn’t want to go because of a high hospital copay. Dr. Tardy must convince her to go anyway. This takes another 5 minutes to achieve and Dr. Tardy is now 40 minutes behind.

Next Patient:  Ms. High-Copay

The next patient is a 45-year-old who complains that she needs all 4 of her medical issues addressed today because she has a $60 copay and it's a financial hardship for her to come for more frequent visits. She wants to discuss:

1. her high blood pressure
2. her low back pain
3. her depression symptoms
4. and she wants her pap smear done

Dr. Tardy explains that unfortunately time does not allow her to handle all these things in one visit. She suggests that they can complete the pap smear at a future visit since there are no copays for preventative screenings due to Obamacare. 

Ms. High-Copay is not thrilled to have to return, but reluctantly agrees. Dr. Tardy cannot help but feel slightly uncomfortable with the reaction she receives. After all, Dr.Tardy is human and she cares about her patients. This visit still takes Dr. Tardy 30 minutes to complete and by now she’s 50 minutes behind.

Next Two Patients: Little-Juniors-1 and 2

Mom brings in her two kids – they have been struck with the same bug and are coughing and sniffling every which way. Dr. Tardy does save some time, however, because she can address both kids’ conditions to one parent. 

Great! She saves 15 minutes here, placing her at 35 minutes late. How lucky.

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Next Patient:  Ms. Diabetes

Dr. Tardy’s next patient is a 58-year-old woman with diabetes. She comes to Dr. Tardy for her 3-month follow up and to discuss how she can quit smoking because she knows that it, along with diabetes, is a risk factor for heart disease. 

Dr. Tardy wants to make certain that the patient has all the resources and tips she needs to succeed, so she takes her time addressing this issue, along with discussing the management of diabetes – both conditions are time-consuming and vital. After all, she doesn’t want Ms. Diabetes to end up with a stroke like her previous patient. 

At the end of the 20-minutes, just as Dr. Tardy is about to close the visit, Ms. Diabetes discloses something that cannot be ignored. 

“Wait, Doctor, there is one more thing…”  She admits that she’s been experiencing chest pain for the last 3 weeks, and this is the reason she finally decided to quit smoking.  

Dr. Tardy needs to evaluate this chest pain very thoroughly and cannot tell Ms. Diabetes that she needs to return to discuss this at a future visit. It must be done now. She takes a more detailed history, performs an EKG, and discusses the next steps and management with the patient. This takes her another 20 minutes to complete, and places her 55 minutes behind.

Mr. Needs-a-Navigation-System

The next patient is 15 minutes late – he is brand new and got lost attempting to locate the clinic. The practice, like many others, has a policy to accept patients up to 15 minutes after their scheduled appointment time.

Ans since Dr. Tardy is late herself, it’s not an issue this time. But what if next time she is actually on time? Then she’d be running late due to a GPS snafu.

Ms. Sadness

Dr. Tardy's next patient was scheduled to discuss tingling in the hands and feet. But during the visit she reveals multiple other complaints that don't seem to be connected: abdominal pain, shortness of breath, feelings of anxiety.  

Dr. Tardy, having a great sense of intuition, suspects that there may be something deeper going on and works hard to get the patient to open up.  

After some extensive detective work, Ms. Sadness starts to cry uncontrollably. She reveals that not only has she been battling depression for a few years, but that she now "Wishes she were dead." Dr. Tardy finds this comment disturbing and spends a great deal of time trying to understand the level of depresssion and to determine if the patient is seriously suicidal.  

Ms. Sadness reveals that she has thought about killing herself by swallowing a bottle of pills belonging to her husband. She has never quite gone through with it, but thinks about it each and every day. Dr. Tardy realizes that Ms. Sadness needs help right away. After all, Dr. Tardy has taken an oath to "Do no harm" and she cannot allow Ms. Sadness to simply walk out of this exam room after revealing these disturbing plans.   

Is this a 20-minute visit? No. But how is the person scheduling the appointments supposed to know that this visit would requore much more time? The patient simply made this appointment for "tingling in the hands and feet." This visit took 40 minutes to complete and Dr. Tardy is now running over an hour late. 

Last Patients of the Morning

Thankfully, the last patients scheduled for the morning are understanding and wait for Dr. Tardy. She sincerely apologizes to each one, as she does to every single appointment she is late for. 

By the time Dr. Tardy ends her morning, she is scheduled to see her first patient of the afternoon. It’s a relief to reset the schedule once again, but this means that not only does she not have a break in the day (which doesn’t really bother Dr. Tardy), but she also has no time for returning patient messages, reviewing lab results, or refilling prescriptions. This means tacking on about 2 hours at the end of her day to complete these tasks after her jam-packed afternoon schedule.

And this is a typical morning for a primary care physician in the United States. Are you tired yet?

Who Is to Blame?

Who is at fault here? Is it Dr. Tardy? Is she too accommodating? Could she have ignored that “By the way, I have chest pain” comment at the end of the visit with Ms. Diabetes? Could she have ignored that financial hardship plea? Should she have ignored the urgent patient lab values or that abnormal EKG reading that could have potentially placed those patient lives in jeopardy?

Should she have allowed the suicidal patient to simply walk out of the clinic?

If not, then do we fault the current health care system model in the United States which underpays primary care doctors for each visit so that they are required to see more and more patients in a shorter amount of time?  Do we blame the medical practice that requires 20-minute appointment slots for each patient in order to survive? Should they stop allowing patients to be 15 minutes late in order to maintain good business practices?

I’d like to hear your thoughts on this complex issue. Please post your ideas in Comments below or on the House Call Doctor's Facebook page.

Be sure to tune in next week when I will do my best to provide a solution to this great dilemma. If doctors and patients can work together, we can resolve this challenge and create a better health care system for everyone.

Related: 

• How to Spend Less Time Waiting for the Doctor
• Why Can't My Doctor Spend More Time With Me?
• 7 Tips to Make the Most of Your Visits to the Doctor

Please note that all content here is strictly for informational purposes only. This content does not substitute any medical advice, and does not replace any medical judgment or reasoning by your own personal health provider. Please always seek a licensed physician in your area regarding all health related questions and issues.

5 Ways to Not Get Divorced During the Homebuying Process

Even the most level-headed couples can go a little crazy when hunting for a home. If not careful, stress levels can suddenly shoot through the roof.

This shouldn’t come as a surprise. Most homebuying decisions swirl around major life changes: marriage, a new baby, job relocation, retirement, and downsizing. Those are tectonic shifts in one’s life, and adding a hefty down payment and a 30-year mortgage to the mix doesn't ease the burden.

Tensions don’t end there. A home isn’t just an investment; it’s a place you’re tethered to for years. You’re literally shaping your future by the neighborhood you choose.

In such an emotional situation, people easily become overwhelmed. In fact, a U.K. report found that 70 percent of respondents thought buying a home was a critically stressful time in their lives. Only one other life event was ranked worse: getting a divorce.

Yet it’s not practical to live in the same place forever. In other words, it’s up to every couple to rethink the way they handle the house-seeking experience, starting with preparing themselves for the reality of the situation.

Decisions, Decisions, and More Decisions!

Any homebuying newbie can relate to how complicated the process can be. When two people are involved, however, the strain amplifies. Luckily, knowing a few upfront expectations and being prepared to make tough decisions can ease the pressure.

First, understand the substantial financial burden. You must openly talk about your expenditure expectations with your partner. Partners can have significantly different ideas of what they are willing to spend to have a comfortable, safe home.

You must also accept that both of your priorities won’t necessarily align. For example, you drive east for work, and your spouse drives west. Whose work is more important if you can’t find a house centralized between the offices? In addition, what if the new home allows your partner to be 10 minutes from relatives, while you have a two-hour trek to visit yours? Until these considerations are aired out, a couple will be far from acing the homebuying process.

5 Ways to Keep Your Marriage Intact During Homebuying

Overall, communication is essential. In fact, with a few steps, you can turn looking for the perfect house into a way to strengthen — not wreck — your relationship:

1. Stick to a budget

Ironically, people often discuss stretching their budgets before they’ve even set them. Take a pragmatic approach, and know your budget first. A fast way to figure out your top monthly payment is by multiplying your combined monthly income by 0.25. For example, if you two make $10,000 a month, your mortgage payment with taxes and insurance shouldn’t be more than $2,500.

At that point, you can work backward. Use a mortgage calculator, like the one provided by Zillow, to figure out that a $2,500 monthly payment equates to a $500,000 house. Don’t even consider asking your mom to co-sign a loan to get more money. Instead, acknowledge the fact that you two can only afford what you can. Accepting this will help you both make decisions logically.

2. Start with the “good,” and work up to “best”

You know you can afford a $500,000 house, but don't initially schedule showings in that price range. The first three homes should be listed at about 20 percent below your budget. As you walk through the homes, notice what you like and what you don’t. For your next house, go up to the $450,000 level. Jot down what you love and hate. Finally, step into a $500,000 home. Is it tremendously better than the $450,000 one? Are its advantages worth an additional $50,000?

By starting at “good” options and moving toward “best” choices, you gain control over the process, and both partners have a chance to air out their objections. But be warned: If you flip the order and start with a $500,000 listing, anything less would seem subpar.

3. Quantify what’s important

Try to quantify preferences to put a more rational tenor on the process. An example is weighing the objective value of school districts and home prices. Typically, a home in a stellar school district will cost up to 25 percent more than comparable homes. Thus, for your money, you would have to get a smaller home to live in a preferred community.

Talk about this not as a way to “steal” opportunity from your kids but as a way to look at the pros and cons of each decision. For example, if you have 15 percent less of a house, your kids could attend a better school. This is a more rational approach than blaming your partner for not caring about your children's education. Quantifying priorities allows both of you to look at the big picture.

4. Speak magic words

Couples involved in buying homes often forget to incorporate productive, positive phrases into their conversations. Even if it doesn’t come naturally, emphasize how grateful you are for your partner throughout the process. Talk about how you appreciate that he or she has helped make it possible to look at better homes. Or admit that you’re blown away by the flexibility you’re seeing in your partner’s willingness to incur a longer commute to work.

While it isn’t an easy feat to be affirmative, you'll end up with better long-term results. You’re starting a new chapter together, after all. Don't you want your partner to know you are here for him or her in this journey? All it takes is a sprinkling of gratitude.

5. Invest in a little reflection

Whether or not you’re religious or spiritual, make time for reflection before signing on the dotted line. This will ground you and your partner and create a sense of much-needed calm. Ask yourself: “Is this really the direction for us? Is this where we’re supposed to be?”

In addition, vow not to bicker about dollar amounts after making your choice. Rather, use your home as a launching pad for the next page of your relationship.

Who has time to heap additional stress into their lives? Avoid the price of a divorce lawyer, and focus on the exciting possibilities ahead that come with buying a new home. The homebuying process might not be a cake walk, but your marriage doesn't have to pay for it.

An entrepreneur at heart, CEO Mike Kalis leads the team at MarketplaceHomes.com, a Detroit-based brokerage that specializes in new construction sales and property management. If you purchase a new home through Marketplacehomes.com, we'll agree to buy yours. Marketplace Homes has sold more than $3 billion in new construction homes through its unique home trade-in system and manages more than 3,500 single-family properties for investors who have 1 to 10 properties. It also offers new-construction homebuyers a guaranteed lease on their previous properties for up to six years.

Image © Pexels

Back to the Basics: 8 Simple Food Tricks with Justin Chapple

I have way too many friends who rely on Google for the most basic cooking questions you can imagine. Hopefully this section will get them off their computers by offering best practices for preparing everyday foods. Plus, I’ve shared cooking temperatures for the usual suspects—chicken, beef, and pork—as well as some handy measurements.

1. EASIEST CRISP BACON

The secret is (wait for it . . .) the oven. Preheat it to 400°F and line a large rimmed baking sheet with heavy-duty foil. Arrange bacon slices in a single layer and bake for 15 to 20 minutes, until browned and crisp. Using tongs, transfer the bacon to paper towels to drain and crisp more.

2. HARD-BOILED EGGS

Use a saucepan just big enough to hold your eggs, which will help control how quickly the water comes to a boil. Cover the eggs with water and bring to a boil, then simmer over medium-high heat for 8 minutes. Drain and cool the eggs under cold running water or in a bowl of ice water.

3. SOFT-BOILED EGGS

These are eggs with firm whites but runny yolks, delicious warm or cold (see page 45). Fill a medium bowl with ice and water to make an ice bath. Fill a medium saucepan halfway with water and bring to a boil over high heat. Using a slotted spoon, carefully lower the eggs into the water and simmer over medium heat for exactly 7 minutes. Using the slotted spoon, transfer the eggs to the ice bath to cool. Very gently crack the eggs on a work surface and then carefully peel off the shells.

4. SUNNY-SIDE UP

Fry an egg over high heat and you’ll end up with unpleasantly chewy whites and dry, crumbly yolks. Instead, warm 1 to 2 tablespoons of fat (oil or butter) in a large nonstick skillet over medium heat. One at a time, crack the eggshell on a flat surface and drop the egg into the skillet, then immediately reduce the heat to low and cook sunny-side (yolk) up until the whites are firm and the yolks runny, about 5 minutes. Transfer to a plate and season with salt and pepper.

5. DIY SHRIMP: SHELLING AND DEVEINING

You can usually buy pre-cleaned shrimp, but you should definitely learn how to clean them yourself because you never know when you might have to. Plus, it’s easy! Start by peeling off the shell. Whether you choose to leave the tail intact or not is up to you. Using a paring knife, score the shrimp lengthwise along the back to reveal the vein. Lay the shrimp flat on a paper towel, then scrape out the vein.

6. DIY SHRIMP: REMOVING THE VEIN BUT NOT THE SHELL

This is ideal if you’re making peel-and-eat shrimp (see page 191), or if you want to grill the shrimp shell-on (this keeps ’em juicier). Using the tip of a scissors blade, cut along the back of the shrimp through the shell, leaving it otherwise intact. Using a paring knife, remove and discard the vein. Fold the shell back around the shrimp. Done!

7. FLUFFIEST WHITE RICE

I can’t even tell you how many people ask me how to steam white rice. Start by rinsing your rice well, until the water runs clear. This will help ensure the grains don’t clump (if you want your rice sticky, don’t rinse it). For every 1 cup dry rice, use 11/2 cups water. In a medium saucepan, bring the water to a boil over high heat. Add the rice and a generous pinch of salt, but don’t stir it yet. Return the water to a boil and then stir it once, cover, and simmer over low heat until all the water has been absorbed and the rice is tender, about 20 minutes for 1 to 2 cups rice. Turn off the heat and let it steam, covered, for 20 minutes, then fluff it up with a fork.

8. BEST-EVER QUINOA

My friend Kay Chun taught me this spectacular way to cook quinoa, and I’ve used it ever since. First, rinse your quinoa as it’s coated in naturally occurring compounds called saponins, which can make it taste bitter. Plus, quinoa can get a bit dusty. Next, fill a medium saucepan with water, bring it to a boil, and add a generous pinch of salt. Add the quinoa and simmer over medium-high heat until tender, about 10 minutes. Drain it well in a fine sieve, shaking out any excess water. Return the quinoa to the hot saucepan, cover, and let it steam for 10 minutes. Fluff it with a fork and serve, or spread on a large baking sheet to cool and use later.

Excerpted from Just Cook It!, (c) 2018 by Justin Chapple. Reproduced by permission of Houghton Mifflin Harcourt. All rights reserved. Photography © 2018 by David Malosh

Can Being Fit Prevent or Delay Dementia?

If you need another reason to get or stay fit as you age, a study on 191 women in Sweden just gave us even more motivation to get out there and move—and keep moving. The study was published in a recent online issue of Neurology®, the medical journal of the American Academy of Neurology. 

This study showed that women with what was called "high physical fitness" in their middle age, were nearly 90 percent less likely to develop dementia in the decades to come when compared to women who were only "moderately fit." The researchers are quick to point out that more research is required to determine what stage in life it is most important to achieve this high level of cardiovascular fitness—but the results are pretty clear that once again, fitness plays an important role in healthy aging. 

High Physical Fitness and Dementia

In the study, the 191 women (average age of 50) were asked to ride a stationary bicycle until they were exhausted to measure their peak cardiovascular capacity. The workload was measured (as it often is on a bike) in watts. The average peak workload for all the women was 103 watts.

After the test, it was determined that 40 of the women met the criteria for a "high fitness level" which equaled 120 watts or higher. 92 women were in the "medium fitness" category, and 59 women were in the "low fitness" category which was measured as 80 watts or less or having to stop the test due to a high blood pressure reading, chest pain, or other cardiovascular issues.

Only five percent of the highly fit women developed dementia.

The study followed the women for the next 44 years, during which time the women were tested for dementia a total of six times. During those years, a total of 44 of the women developed dementia. But interestingly, only five percent of the highly fit women developed dementia, compared to 25 percent of moderately fit women and 32 percent of the women with low fitness.

In the end, the highly fit women were 88 percent less likely to develop dementia than even the moderately fit women. And if the highly fit women did develop dementia, they started showing signs of the disease about 11 years later than women who were moderately fit. The researchers said that correlated to the women developing it at age 90 instead of age 79.

How Does Exercise Prevent Dementia?

Study author Helena Hörder, Ph.D., of the University of Gothenburg in Gothenburg, Sweden said "These findings are exciting because it's possible that improving people's cardiovascular fitness in middle age could delay or even prevent them from developing dementia. However, this study does not show cause and effect between cardiovascular fitness and dementia, it only shows an association. More research is needed."

This study is not the only one that has shown a positive correlation between fitness and dementia. Even the official Alzheimer's website states "Leading a physically active lifestyle can have a significant impact on the well-being of people with dementia." Also, a study from the Mayo Clinic concludes that "moderate-intensity physical exercise should be considered as a prescription for lowering cognitive risks and slowing cognitive decline across the age spectrum." 

My take on all this is that even though this new study was done on a relatively small number of women (and all from Sweden) I still think that it provides enough evidence for me to renew my dedication to staying fit and active as the candles on my birthday cake begin to overtake the frosting.

For more aging info, senior health tips, and to join the fit conversation, head over to Facebook.com/GetFitGuy or twitter.com/getfitguy.

Also don't forget to subscribe to the Get-Fit Guy podcast on Apple Podcasts, Stitcher, SoundCloud, Spotify, Google Play or via RSS.

Choose the Right Retirement Accounts in 3 Simple Steps

If you’re confused by all the tax-advantaged retirement account options you can choose from, you’re not alone. While it’s great to have more choices than fewer, it can certainly cause analysis paralysis.

Instead of getting caught in a fog of retirement confusion, it’s time to get clarity. Using one or more retirement accounts to sock away savings on a regular basis is the best way to build wealth for the future.

In this post, you’ll learn three simple steps to choose the right accounts for your situation. Plus, I’ll answer a couple of questions on this topic that I recently received from podcast listeners.

3 Simple Steps to Choose the Right Retirement Accounts

1. Know the retirement account restrictions.
2. Choose your retirement plans.
3. Choose your retirement tax types.

Let's explore these steps in more detail. 

Step #1: Know the retirement account restrictions.

If you understand a couple of restrictions that the IRS imposes on retirement accounts, you can easily use the process of elimination to select accounts. The only restrictions you need to keep in mind are 1) an income limit for the Roth IRA (Individual Retirement Arrangement) and 2) a deduction limit for the traditional IRA.

What’s the Roth IRA Income Limit?

The Roth IRA is the only retirement account that factors in annual income for eligibility. You’re prohibited from making contributions when your income exceeds certain amounts for your tax filing status.

The Roth IRA is the only retirement account that factors in annual income for eligibility. You’re prohibited from making contributions when your income exceeds certain amounts for your tax filing status.

For 2018, if you file taxes as a single and your modified adjusted gross income (MAGI) is higher than $135,000, you cannot contribute to a Roth IRA. And when you earn from $120,000 to $135,000, you’re in a phase out range, which reduces the amount you can contribute.

If you’re married and file taxes jointly, you cannot contribute to a Roth IRA when your household’s joint MAGI exceeds $199,000. And when you earn anywhere between $189,000 to $199,999, your contribution is reduced.

In other words, when you earn below the phase out ranges for your tax filing status ($120,000 for singles and $189,000 for when you’re married filing jointly), you can max out a Roth IRA. For 2018, you can contribute up to $5,500, or $6,500 if you’re over age 50, if you have at least that amount of earned income for the year.

If your income is in a phase out range, you might be allowed to contribute $4,000 instead of $5,500, for example. To calculate your allowable contribution, there’s a worksheet in IRS Publication 590-A.

But what happens if you open a Roth IRA but have income that rises above the allowable threshold? There’s no downside. You can keep the account, enjoy its tax-free growth, and manage your investments any way you like. You just can’t make any new contributions to a Roth IRA when your income exceeds the annual allowable limit.

Please note that this income limit doesn’t apply to Roth accounts you may be offered at work, such as a Roth 401k or a Roth 403b. You can always contribute to a workplace Roth, no matter how much you earn.

What’s the Traditional IRA Deduction Limit?

Now, let’s cover the second restriction that I mentioned, which is a deduction limit on the traditional IRA.

A major advantage of traditional retirement accounts is getting a tax deduction for contributions. For example, if you earn $50,000 doing freelance work and max out a traditional IRA by contributing $5,500, your taxable income for the year would be reduced to $45,500. The lower your taxable income, the less tax you pay.

But when you or a spouse are covered by a retirement plan at work, your allowable deduction for contributions to a traditional IRA may be reduced or eliminated, depending on how much you or your spouse earn.

When you or a spouse are covered by a retirement plan at work, your allowable deduction for contributions to a traditional IRA may be reduced or eliminated, depending on how much you or your spouse earn.

For 2018, if you file taxes as a single and your MAGI is higher than $73,000, you can contribute to a traditional IRA, but you can’t deduct contributions on your taxes when you also have a workplace retirement plan. And when you earn anywhere between $63,000 to $73,000, you’re in a phase out range, which reduces the amount you can deduct.

If you’re married and file taxes jointly with MAGI more than $121,000, you can’t deduct traditional IRA contributions when you have a workplace plan. And when you earn anywhere between $101,000 to $121,000, the deduction is reduced.

To make this restriction a bit more complicated, if you’re married and don’t have a retirement account at work, but your spouse does, there are also deduction limits. In this situation, if you live with your spouse or file a joint tax return, you can’t deduct traditional IRA contributions if your household MAGI exceeds $199,000. And the phase out range is from $189,000 to $199,000.

Again, this deduction limit doesn’t prevent you from being eligible for a traditional IRA. You can always max one out, but the tax deduction you receive may be reduced or eliminated.

You may be wondering if it’s worth it to make non-deductible contributions to a traditional IRA. They’re not as good as deductible contributions, but you may not have another option if you’re a higher earner.

The good news is that non-deductible contributions to a traditional IRA still grow tax-deferred until you take withdrawals in retirement, giving you substantial tax savings over time.

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Step #2: Choose your retirement plans.

Now that you understand that high earners have income and deduction limits, you can use this information to choose retirement plans. Here’s a summary of the three main types of retirement plans:

1. Employer-sponsored. Can be used when offered by your employer. Examples include a 401k, 403b, or a 457 plan.  
2. Self-employed. Can be used by any individual with some amount of self-employment income. Examples include a SEP-IRA, solo 401k, or a SIMPLE IRA.  
3. Individual. Can be used by any individual (including minors) with some amount of earned income, or by a spouse with no income who files taxes jointly. The only two options are a traditional IRA and a Roth IRA.

You can even have multiple retirement plans as long as you don’t exceed their annual contribution limits. For instance, if you have a job with a 401k and income from a side business, you can contribute to an IRA, a 401k, and a SEP-IRA in the same year.

Rules for Employer-Sponsored Retirement Plans

If you’re fortunate enough to have a retirement account at work, that’s the first plan you should choose. Not only do they come with high contribution limits and broad federal legal protections, but many employers offer free matching funds just to reward you for participating.

If you’re fortunate enough to have a retirement account at work, that’s the first plan you should choose. Not only do they come with high contribution limits and broad federal legal protections, but many employers offer free matching funds just to reward you for participating.

For 2018, you can contribute up to $18,500, or $24,500 if you’re over age 50, to most types of employer-sponsored retirement plans. If your employer pays matching funds, you can exceed the annual limits.

Rules for Self-Employed Retirement Plans

If you don’t have a workplace retirement plan, but are self-employed, a SEP-IRA is a good choice if you have employees or plan to someday. And if you’re a solopreneur with no employees, a solo 401k is a great option.

For 2018, you can make SEP-IRA contributions for each of your employees (including yourself) up to 25% of each employee’s compensation for a maximum of $55,000. If you have a 401k or 403b with another employer, the total you can contribute to both plans is limited to 100% of your compensation, up to $55,000.

With a solo 401k, you can contribute up to 25% of your net earnings up to $55,000, or $61,000 if you’re over age 50. If you also participate in a 401k at another company, the total employee contribution you can make to both plans is $18,500 or $24,500 if you’re over 50.

See also: 5 Steps to Create Your Own Self-Employed Benefits Package

Rules for Individual Retirement Plans

If you’re a worker who doesn’t have a retirement plan at work, your go-to option is an IRA. As I mentioned, just about everyone is qualified to have one and you can combine them with other types of retirement plans.

However, IRA contribution limits are relatively low. As I previously mentioned, for 2018, you can contribute up to $5,500, or $6,500 if you’re over age 50. So, maxing out an employer-sponsored plan or a self-employed plan first makes sense, when possible.

I received a related question from Bill L. who says, “Love the podcast. What options do temporary or part-time employees have to cut taxes and save for retirement when they don’t qualify for a workplace plan that’s only offered to full-time employees?”

Thanks for your note, Bill. Many people work for small businesses that don’t offer a retirement plan or that require you to be a full-timer to qualify. Unfortunately, administering a retirement plan is costly for companies, so consider yourself lucky if you do have one at work.

The solution for anyone who doesn’t have a retirement plan at work is to open an IRA.  And if you work for yourself, you can also choose retirement plans just for the self-employed.

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Step #3: Choose your retirement tax types.

After choosing one or more types of retirement plans to fund, a key decision will be which tax type to choose: traditional, Roth, or both. Most retirement accounts come with a Roth option and you can split contributions to both types, as long as you don’t exceed the annual contribution limit.

Most retirement accounts come with a Roth option and you can split contributions to both types, as long as you don’t exceed the annual contribution limit.

For example, if you’re qualified for a Roth IRA and are under age 50, you could contribute $2,000 to a traditional IRA and $3,500 to a Roth IRA in the same year—but not $5,500 to both.

The same concept applies when you have a workplace plan with a Roth option. You could contribute $10,000 to a traditional 401k and $8,500 to a Roth 401k in the same year—but not $18,500 to both.

So, how do you know if a traditional, Roth, or a combination of tax types is right for you? Well, start by answering these three questions:

1. Is my income tax rate going to be higher or lower in retirement?

With any traditional retirement plan, you get a break by delaying taxes until you take withdrawals in retirement. You end up paying tax on your original contributions and their investment growth.

Roth accounts work the exact opposite way. With a Roth, you pay tax upfront on contributions, and then pay zero tax on withdrawals in retirement. You skip paying tax on all the investment earnings, which can be a massive savings.

To pay as little tax as possible, consider if your income tax rate could be lower now relative to when you retire. If you believe that you’ll be in the same or a higher tax bracket in retirement, choosing a Roth is best.

The idea is that paying tax on Roth contributions upfront at a lower rate saves you money. Here are some situations where your tax rate could be higher in retirement than it is today:

• You’re currently in an entry-level job and expect to be earning more in the future. 
• You expect to receive an inheritance in the future. 
• You have a hunch that income tax rates for all Americans will rise in the future.

But if you’re further along in your career and earn more now than you believe you will in retirement, you’re generally better off with a traditional IRA or traditional plan at work. When you take withdrawals in retirement, you’ll end up paying less tax if you have a lower tax rate than you do today.  

Problem is, none of us really know what will happen in the future, especially if you’ve got a long way to go until retirement. So, if you’re not sure about your tax rates, another tip is to diversify by having both traditional and Roth accounts. That way you’ll have taxable and non-taxable money to spend in retirement.

For instance, you could put half your contributions in a traditional 401k and half in a Roth 401k. Or you might have a Roth retirement plan at work and a traditional IRA on your own.

See also: Which Is Best: A Roth or Traditional Retirement Account?

2. When do I prefer to pay income tax?

While most people would prefer to never pay taxes, when it comes to your retirement nest egg, at least you have control over when you pay them.

If you have a heavy tax burden from high earned or investment income, making contributions to a traditional retirement account is a smart way to reduce what you owe. You’ll get a tax deduction in the year you make traditional retirement contributions, which cuts your current tax bill.

If you have a heavy tax burden from high earned or investment income, making contributions to a traditional retirement account is a smart way to reduce what you owe.

Roth contributions are never tax deductible, so they don’t help your current tax situation. But, as I mentioned, the beauty of a Roth is that withdrawals in retirement are completely tax free. If your account mushrooms in value over many years, you get to keep every penny in retirement.

So, your current and future tax situation plays a big role in whether you should use a traditional or Roth retirement account. But don’t get too bogged down in the decision. You can always start or stop contributions at any time if your financial situation changes.

3. Do I want penalty-free access to the account before retirement?

Tapping a retirement account before you reach the official retirement age of 59½ typically comes with having to pay income tax, plus a 10% early withdrawal penalty. While you might think it’s unfair to have your wrist slapped, financially speaking, to access your own money, the purpose is to make sure you have funds to spend in retirement, not before!

However, there are some exceptions. Roth accounts offer more flexibility than traditional ones when it comes to taking early withdrawals. That’s because you must pay tax upfront and you control the account as an individual. A Roth IRA allows you to withdraw your original contributions (but not their earnings) at any time and for any reason.

While I recommend leaving retirement accounts untouched until you retire, having a Roth IRA does give you the most flexibility to tap your funds ahead of retirement. So, if you’ve got a long way to go and are worried that you might need to spend some of your retirement savings, choose a Roth IRA, if you’re eligible.

I received a question from Kathryn M. who’s got a retirement account dilemma. She says, “I contribute $18,000 per year to a traditional retirement plan at work, but we also have a Roth option. I don’t have an IRA, but I’m leaning toward choosing a Roth IRA since I already have a traditional account at work. But my boyfriend and I expect to get married in a couple of years and our joint income will likely be too high to qualify for a Roth IRA. So, should I open a traditional IRA instead and change my contributions at work to the Roth option?”

Thanks for your note Kathryn and congratulations on doing such a great job earning and saving! I’m a big fan of using a Roth at work because they don’t come with income limits and allow you to make relatively high annual contributions. So, unless you really need the tax deduction of a traditional plan, switching over to the Roth at work makes sense.

Again, unless you need the tax deduction of a traditional IRA, I’d open a Roth IRA while you’re eligible. And if your joint income makes you ineligible down the road, you can simply let it ride and contribute to a traditional IRA instead.

We’ve covered some of the biggest considerations for choosing retirement accounts, but there’s no right or wrong answer. If you’re still not sure, having a combination of tax-deferred and tax-free accounts covers all the bases.

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Why You Should Do Obstacle Course Racing to Get Fit

I took part in my first Tough Mudder event knowing exactly what I was getting myself into. I had trained and prepared myself as much as possible and I was ready to have a fun day of teamwork and getting dirty. What I didn’t know or prepare for was what that the weather was going to turn on us—drastically! The sun went away, the rain came, the wind began to blow, and then finally it started snowing on us. At one point I was so cold that when I jumped into the icy water, in the obstacle known as the Arctic Enema, I didn’t really notice any temperature difference at all. 

Our teeth were chattering but we were still smiling, laughing, and high-fiving like crazy - so it couldn't have been all bad.

Many times during that event I wished that I was on the set of American Ninja Warrior obstacle TV show, where everyone seems warm and (mostly) dry. Despite the fact that our teeth were chattering down at the finish line while we were getting cleaned up by hosing ourselves down, we were still smiling, laughing, and high-fiving like crazy—so it couldn't have been all bad.

What is an Obstacle Course Race?

Obstacle course races (or OCR for short)—like the Spartan, Tough Mudder, and Warrior Dash—have been sweeping the nation for a few years now. From 20,000 participants in its 2010 debut year, the Tough Mudder alone has had 2 million participants to date. There are more than 60 Spartan races every year in the USA alone, and if you have heard the ads on this podcast, you will know that they boast five million people in their obstacle loving community.

Obstacle racing, in a nutshell, is an event where you must overcome various physical challenges between which you make forward progress on foot. The physical challenges (or obstacles) include climbing over walls, carrying heavy objects, traversing bodies of water, crawling under barbed wire, jumping through fire, and more. Since the creation of these races is rooted in the military, it’s no surprise that many obstacles are similar to those you see in Army movies where the hero is going through basic training (and either failing hilariously or succeeding heartwarmingly). But over the years the obstacles have become more and more unique, and they now pretty much all test endurance, strength, speed, mobility, grit, and mental toughness.

The OCR races vary in distance and difficulty level, combining trail running, road running, and cross country running in distances ranging from 1-mile arena sprint events to 26.2+ mile “death races”! Some of them are staged in the middle of a nice flat field, while others (like the one I did) take place on an out-of-season ski hill.

Where ever or whoever was first to come up with the idea, I am pretty sure every kid in history has set up some sort of obstacle course in their backyard.

OCR is still a relatively new sport and word has it that the U.K.’s Tough Guy race was first created in the 1980s, as was the Camp Pendleton Mud Run in San Diego. But these events didn’t really take off in North America until around 2010. Some say that the roots of these races go as far back as the Ancient Olympic Pentathlon, which included five events consisting of a short running race, Javelin throw, Discus throw, Long jump, and finishing with a wrestling match.

Whereever it originated and whoever was first to come up with the idea, I am pretty sure every kid in history has set up some sort of obstacle course in their backyard and ran themselves and their friends through it. And if the popularity of these races is any indication, we are all still just big kids playing in the mud and climbing the neighbor’s fence.

The Obstacle Events

Let’s start with the race that I did back on that snowy day in September. (Yes, I live in Canada). Tough Mudders are not really races per se because there is no timer. It is instead a non-competitive challenge where teamwork is encouraged and often required. For me, there was no way I was going to be able to pull myself up the wall of mud in front of me, without a boost from the bottom and a hand from the top. And of course, I took my turn boosting and pulling, when the time came.

On the other end of the spectrum, Spartan races are more about competition than teamwork. There is a timer and unless you brought along some helpful and non-competitive friends, you are on your own. They also pride themselves on the spartan-esque “no frills” obstacles that look as though you could have purchased them at the local hardware store.

Warrior Dash, on the other hand, is apparently simply an active excuse to party. Finishers get fuzzy warrior hats and are greeted with greasy turkey legs and beer in the finisher's area. Along with the awards for speed, there is also an award for the craziest costume.

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The Obstacle TV Shows

American Ninja Warrior is actually based on a show called "Sasuke," from the Tokyo Broadcasting System which is currently in its 35th season.

If you are watching TV at odd hours of the day, you may have seen American Ninja Warrior on TV. That show is actually based on the wacky show called "Sasuke," from the Tokyo Broadcasting System. Sasuke is currently in its 35th season in Japan which makes it nearly as old as the Tough Guy race in the UK. While the Japanese version is whimsical and almost brutal in its humor, the American Ninja Warrior takes itself a little more seriously and adds elements of drama rather than humiliation.

The Ultimate Beastmaster (on Netflix) is similar to Ninja Warrior (and Sasuke) in many ways. The biggest difference is that the course is an impressive structure that is designed like the insides of an enormous beast. The dinosaur-like design takes it so far that the obstacles are actually called the Digestive Tract and Spinal Descent. Contestants enter through the mouth of the beast, and well, you can guess the rest. One of the hosts, former NFL football player turned actor Terry Crews, loves to remind the audience of this beastly resemblance with his bloody catchphrase.

The biggest difference between these shows and the events that you and I can participate in is the lack of running between obstacles. I would guess that it has to do with camera angles and duration of the show. If a camera had been following me for the 2+ hours I was out running around the ski hill looking miserable in my first Tough Mudder event, the audience would have turned off the TV and the show would have been canceled before I crossed the finish line. So it makes sense that the TV versions are set up the way that they are. That being said, CBS did cover the Spartan World Championships in Lake Tahoe in 2017, so who knows what the future holds for televising these events.

Obstacle Fitness

In my article and podcast called What Does the Word "Fitness" Really Mean?, I outlined what I think are the most important parts of fitness. And no, six pack abs and a thigh gap are not listed. Interestingly though, many of the components that make a well-rounded and fit human are involved in obstacle course success.

Components such as being able to:

• Carry a heavy load of groceries, a child, or supplies home,
• Get around our office building or apartment without the need for elevators,
• Stay on our feet for an entire workday without the need to sit down,
• Move large pieces of furniture to clean behind,
• Walk, run, or cycle to our workplace or perform errands,
• And (as strange as it sounds) squat or sit on the ground without the need for a pillow or lumbar support.

I don’t want to go all ‘survivalist weirdo who lives in a bunker’ on you, but to recap some of my points from that earlier article, let me ask you this: if a particularly un-cute dog was chasing you, would you be able to lift your own bodyweight over a fence to avoid getting your shoes nibbled? If your home was on fire, would you be able to lower yourself off of your balcony or roof to safety? If your car broke down in the middle of nowhere (with no cell service), how far could you powerwalk to get help? Not to mention the all-important question: in a zombie apocalypse, could you outrun one of those fast moving Zombies from the movie "28 Days Later"? These are all skills that you would develop if you trained for an obstacle course race.

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Training for Obstacle Course Races

Here are five examples of workouts that will get you ready for an obstacle race and also whip you into the kind of fitness I was just outlining.

#1: Glute Burner

A simple workout that requires only you and your buns of steel.

• 200M walking lunges
• Run max distance for 5 minutes
• 200M walking lunges
• Run max distance for 4 minutes
• 200M walking lunges
• Run max distance for 3 minutes
• 200M walking lunges
• Run max distance 2 minutes
• 200M walking lunges
• Max distance run for 1 minute

#2: Battle Lungs and Legs

All you need is one set of dumbbells or Kettlebells for this lung buster.

Do 3-5 rounds for time (as fast as you can with good form) of:

• 50 leg levers
• 40 mountain climbers
• 30 burpees
• 20 kettlebell or dumbbell swings
• 10 dumbbell manmakers (40lb men/25lb women)

#3: The Running Bear

To do a Bear Complex, you will need a barbell. Do these exercises in this order, back to back. Power clean, front squat, push press, back squat, and second push press. Completion of the five lifts equals one rep. 

• Do 10 Bear Complex using a challenging weight. Then run 1 Mile.
• Do 8 Bear Complex, followed by running 800M.
• 6 Bear Complex, followed by running 400M.
• 4 Bear Complex followed by 200M
• A final 2 Bear Complex.

#4: Heavy Stuff Stairs

All you need is something heavy and a flight of stairs.

• Find a staircase, 3-5 flights.
• At bottom of stairs, do 5-10 clean and jerks with your heavy item (sandbag, heavy backpack, or dumbbells)
• Carry the heavy item to the top of stairs. Carry it back downstairs.
• Set the heavy thing down and hold the plank position for 60 seconds.
• Repeat for as many rounds as you can.

#5: Living Room Beast

You only need a chair and something to jump onto for this one. Do as many rounds as possible of:

• 10 lunge jumps per side
• 15 burpees
• 20 box jumps onto the couch  
• 25 chair dips
• 30 jumping jacks
• Finish with a 2-5 minute cold shower (remember that arctic enema I mentioned earlier?)

If you are a marathon runner, triathlete, or a yoga enthusiast, these workouts may seem like the machinations of a madman. But if you give them a try, just a few times per week, you will enjoy the increase in stress resilience, increase in lung capacity, increase in lactic acid threshold, and many other important increases in physiological parameters. Keep these up for a while and next thing you know you will be the one causing Terry Crews to say those dreaded of all words: “into the blood!” as you make your way through the Ultimate Beastmaster. 

For more obstacle info, beastly tips, and to join the Spartan conversation, head over to Facebook.com/GetFitGuy or twitter.com/getfitguy. Also don't forget to subscribe to the Get-Fit Guy podcast on Apple Podcasts, Stitcher, SoundCloud, Spotify, Google Play or via RSS.