• COUPLES
H bands vv opay 1
too uch Does he spend more time with the computer, his golf clubs or the guys than he does with you? A survival plan for lonesome wives. BY LIANE KUPFERBERG CARTER
Stephanie Grant* worries that her husband will burn down the house someday. He incinerates food in the oven, scorches pots, forgets tea kettles set to boil. Once she reached the toaster just as the wallpaper above it * Name changed for privacy.
Does he putter away his leisure hours while you work overtime?
was igniting. What could make a usually attentive husband so oblivious? "The computer," says Grant, a salesperson in Laurel, Md. "My husband is addicted. He flips it on to read his e-mail even before he takes his
morning shower. Last year he brought his computer on our family vacation-and it wasn't a laptop model. At Thanksgiving he and my brother-in-law squabble over the computer like two kids, each one shouting 'My
You're playing golf again?
turn! My turn!' He uses it every free moment. When he's not working, he's playing games like Myst. His computer is his mistress. " Grant is not alone. There are legions of "widows" who have perfectly healthy husbands-women who 11>
• COUPLES FLONASE®
BRIEF SUMMARY
(fluticasone propionate) Nasal Spray, 0.05% w/w For Intranasal Use Only.
SHAKE GENTLY BEFORE USE.
The lollowing is a brief summary only; see full prescribing information for complete product information. CONTRAINDICATIONS: FLONASE Nasal Spray is contraindicated in patients with a hypersensitivity to any of its ingredients. WARNINGS: The replacement of a systemic glucocorticoid with a topical glucocorticoid can be accompanied by signs of adrenal ~nsuff1c1ency, and '"addition some patients may expenence symptoms of withdrawal, e.g., joint and/or muscular pain, lassitude, and depression. Pat1ents prev1ously treated for prolonged periods with systemic glur.ocorticolds and transferred to topical glucocorticolds should be carefully monitored for acute adrenal insufficiency in response to stress. In those pat1ents who have asthma or other clinical conditions requiring long-term systemic glucocorticoid treatment, too rapid a decrease in systemic glucocorticoids
rna~;~~ ~fs~~6~~~~~~~r~f ~~~ iK~~~~-~ay systemic prednisone could increase the likelih:l' of hypothalamic-pituitary-adrenal IHPA) suppression compared with a therapeutic dose of either one alone. lherefore, FLONASE Nasal ~ray should be used with caution in patients ~~~~~nr~;i~".\'c~~~~~e~S:~fF[~~~e ~~~~~~~::;o~~~Yo~ri~;ase In inhaled glucocorticoids could increase the risk of signs or symptoms of hypercorticism and/or suppression of the HPA axis. . Patients who are on immunosuppressant drugs are more susceptible to infections than healthy indi~duals. Chickenpox and measles, for example, can have a more serious or even fatal course In patients on immunosuppressant doses of cort1costero1ds. In such pat1ents who have not had these diseases, particular care should be take~ to avoid exposure. How the dose, route, and duration of corticosteroid adminiStration affects the risk of developing a disseminated infection is not known. The contribution of the underlying disease and/or pnor cort1costero1d treat- . ment to the risk is also not known. If ex~sed to chickenpox, prophylaxiS with varicella zoster immune globulin (VZIG) may be 1nd1cated. If exposed to measles, prophylaxis with pooled intramusc~lar immunoglobulin (IG) may be indicated. (See the respect1ve package inserts for complete VZIG and IG rrescrlblng information.) If chickenpox develops, treatment with antivira agents may be considered.
PRECAUTIONS: General: Rarely, immediate hypersenslt~ity reactions or contact dermatitis may occur after the intranasal admlmstrat1on of ffuticasone propionate. Rare instances of wheezing, nasal septum pertoratlon, cataracts glaucoma and increased intraocular pressure have been reported iollowing the intranasal application of glucocorticoids. Use of excess1ve doses of glucocorticoids may_lead to signs or symptoms of hypercorticism, suppression of HPA function, and/or suppre_ss1on of growth in children or teenagers. Knemometry studies 1n asthmatic children on orally inhaled glucocortlcoids showed Inhibitory effects on . short-term growth rate. The relationship between short-term changes 1n tower leg growth and long-term effects on growth is unclear at this time. Physicians should closely follow the growth of adolescents tak1ng glucocorticoids by anY. route, and weigh the benefits of glucocorticoid therapy against th'e possibility of growth suppression If an adolescent's growth appears slowed. .. . Although systemic effects have been m1mmal w1th recommended doses of FLONASE Nasal Spray, potential risk Increases with larger doses. Therefore, larger than recommended doses of FLONASE Nasal Spray should be avmded. When used at larger doses, systemic glucocorticoid effects such as hypercorticism and adrenal suppressi!Jn may appear. ~ .such changes occur, the dosage of FLONASE Nasal Spray should be d1scont1nued slowly consistent with accepted procedures for discontinuing oral glucocorticoid therapy. . .. In clinical studies with ftuticasone propionate adminiStered intranasaiiY.. the development of localized infections of the nose and pharynx w1th Candida a/bicans has occurred only rarely.When such an Infection develops, it may require treatment with appropnate local therapy and discontinuation of treatment with FLONASE Nasal Spray. Patients using FLONASE Nasal Spray over several months or longer should be examined periodically for evidence of Candida Infection or other signs of adverse effects on the nasal mucosa. FLONASE Nasal Spray should be used with caution, if at all, in patients with active or quiescent tuberculous Infections; untreated fungal, bacterial, or systemic viral infections; o~ ocular herpes Simplex. Because of the inhibitory effect of glucocort1colds on wound healing, patients who have experienced recent nasal septal ulcers, nasal surgery, or nasal trauma should not use a nasal glucocorticoid until healing
r~~~H~ior
Patients: Patients being treated with FLONASE Nasal Spray should receive the following information and instructions. This . information is intended to aid them in the safe and effective use of thiS medication. It is not a disclosure of all possible adverse or intended effects. Patients should be warned to avoid exposure to chickenpox or measles and, if exposed, to consult their physician without delay. Patients should use FLONASE Nasal Spray at regular Intervals as directed since its effectiveness depends on Its regular use. Adecrease in nasal symptoms may occur as soon as 12 hours after starting therapy with FLONASE Nasal Spray. Results in several clinical trials indicate statistically signfficant improvement within the first day or two of treatment· however, the full benefit of FLONASE Nasal Spray may not be achieved until treatment has been administered for several days. The patient should not increase the prescribed dosage but should contact the physician if symptoms do not improve or if the condition worsens. For the proper use of the nasal spray and to atta1n maxtm.um ,Improvement, the patient should read and follow carefully the patients Instructions accompanying the product. . Carcinogenesis, Mutagenesis, lmpalnment of. Fertility: Fluticasone propionate demonstrated no tumongemc potent1al1n stud1es of oral . doses up to 1.0 mg/kg (3 mg/m' as calculated on a surtace area bas1s) for 78 weeks in the mouse or inhalation of up to 57 meg/kg (336 mcg/m~ for 104 weeks in the rat. . . Fluticasone propionate did not induce gene mutation 1n prokaryotiC or eukaryotic cells in vitro. No significant clastogenic effect was seen 1n cultured human peripheral lymphocytes In v1tro or In the mouse micronucleus test when administered at high doses by the oral or subcutaneous routes. Furthenmore, the compound did not delay erythroblast division in bone marrow.
FLONASE® (fluticasone propionate) Nasal Spray, 0.05% No evidence of impairment of fertility was observed in reproductive studies conducted In rats dosed subcutaneously with doses up to 50 meg/kg (295 mcg/mry in males and females. However, prostate weight was significantly reduced in rats. Pregnancy: Teratogenic Effects: PregiiJincy Category C: Subcutaneous studies in the mouse and rat at 45 and 100 meg/kg, respectively (135 and 590 mcg/m', respectively, as calculated on a surface area basis) revealed fetal toXICity charactenslic of potent glucocorticoid compounds, including embryonic growth retardation, omphalocele, cleft palate, and retarded cramal OSSification. In the rabbit, fetal weight reduction and cleft palate were observed following subcutaneous doses of 4 meg/kg (48 mcg/m~. However following oral administration of up to 300 meg/kg (3.6 mg/m~· of fluticasone propionate to the rabb_it, there were no maternal effects nor increased incidence of external, v1sceral, or skeletal fetal defects. No fluticasone propionate was detected in the plasma in this study, consistent wtth the established low bioavailability following oral administration (see CLINICAL PHARMACOLOGY sect1on of full prescnb1ng information). Less than 0.008% of the dose crosses the placenta following oral administration to rats (1 00 meg/kg, 590 mcg/m~ or rabbits (300 meg/kg, 3.6 mg/mry. There are no adequate and well-controlled studies in pregnant . women. Fluticasone propionate should be used dunng pregnanq only 1f the potential benefit justifies the potential risk to the fetus. Ex nence to because there is a natural increase In glucocorticoid production during pregnancy, most women will require a lower exogenous glucocorticoid dose and many will not need glucocorticoid treatment dunn9 pregnancy. Nursing Mothers: It is not known whether flullcasone pro.p1onate_1S excreted in human breast milk. Subcutaneous adm1mstration of tnt1ated drug to lactating rats (1 0 meg/kg, 59 mcg/m~ resulted in measu~ble radioactivity in both plasma and m1lk. Because other glucocortlcmds are excreted in human milk, caution should be exercised when FLONASE Nasal Spray Is administered to a nursing woman. Pediatric Use: The safety and effectiveness of FLONASE Nasal Spray in 1
~:~1~~rd~~~ ~ee~~;r~~~:e growth suppression, the_possibility that
a~d
ey are particufarty sensitive to this effect of glucocortlcoldS should be cons1dered (see PRECAUTIONS). Geriatric Use: Alimtted number of8atients above 60 years of age (n; 132) have been treated with FL NASE Nasal Spray in US and nonUS clinical trials. While the number of patients is too small to perm1t separate analysis of efficacy and safety, the adverse reactions reported in this population were sim1lar to those reported by younger patients. ADVERSE REACTIONS: In controlled US studies, 2,427 patients received treatment with intranasal fluticasone propionate.ln general, adverse . reactions in clinical studies have been pnmanly associated W1th1mtallon of the nasal mucous membranes, and the adverse reactions were reported with approximately the same frequency by patients treated with the vehicle itself. The complaints did not usually intertere With treatment. Less than 2% ol patients In clinical trials discontinued because of adverse events; this rate was similar for vehicle and active comparators. Systemic glucocorticoid side effects were not reported during controlled dinlcat studies up to 6 months' duration w1th FLONASE Nasal Spray. If recommended doses.are e~ceeded, h~wever, or if individuals are particularly sensitive or If 1n conjunction w1th systemically ad~lms tered glucocorticoids, symptoms of hypercortiCism, e.g., Cushing s syndrome, could occur. . . The following Incidence of common adverse reactions IS based upon seven controlled clinical trials in which 536 patients (57 girls and 108 boys aged 4 to 11 years, 137 female and 234 male adolescents and adults) were treated with FLONASE Nasal Spray 200 meg once daily over 2 to 4 weeks and two controlled dinical trials in which 246 patients (119 female and 127 male adolescents and adults) were treated with FLONASE Nasal Spray 200 meg once daily over 6 months. Incidence Greater than 1% (Causal Relationship Possible): Respiratory: Epistaxis, nasal burning (incidence 3% to 6%); blood In nasal mucus, pharyngitis, nasal irritation (incidence 1% to 3%). Neurological: Headache (incidence t% to 3%1. Incidence Less than 1% (Causal Relallon~hlp Possible): Respiratory: Sneezing, runny nose, nasal dryness, SinusitiS, nasal congestion, bronchitis, nasal ulcer, nasal septum excoriation. Neurological: Dizziness. Special SenSJ~s: Eye disorder, unpleasant taste. Digesffve: Nausea and vomitlnQ, xerostomia. Skin and Apfllllldages: Urtlcana. .. . Postrnarketing Experience: In addition to the events from chmcal tnals, the following have been reported dunng postmarket~ng expenence. Hypersensitivity reactions, including angioedema, skm rash, edema ol the face and tongue, pruritus, urticaria, bronchospasm, wheezing, dyspnea, and anaphylaxis/anaphylactOid reactions, which 1n rare
instances were severe.
Alteration or toss of sense of taste and/or smell and, rarely, nasal septal pertoration.
OVERDOSAGE: There are no data available on the effects of acute or chronic overdosage with FLONASE Nasal Spray. Intranasal administration of 2 mg (1 0 times the recommended dose) of fluticasone propionate twice daily for 7 days to healthy human volunteers was well tolerated. Single oral doses up to 16 mg have been studied in human volunteers . with no acute toxic effects reported. Repeat oral doses up to 80 mg da1ly for 10 days in volunteers and repeat oral doses up to 10 mg darlyfor 14 days in patients were well tolerated. Adverse reactions were of m1ld or moderate severity, and incidences were similar in active and placebo treatment groups. Acute overdosage with this dosage form Is unlikely since one bottle of FLONASE Nasal Spray contains approximately 8 mg of fluticasone propionate. Chronic overdosage may result In Signs/symptoms of hypercorticism (see PRECAUTIONS).
6/axoWe/lcome Glaxo Wellcome ln.c. Research Triangle Park, NC 27709 Made in England
©1997 Glaxo Wellcome Inc. All rights reserved. Printed in USA. FLN611AO
October 1996 RL-367 GLA-01-047M July 1997
(continuedfromp. 52) are married to men who love to play. That doesn't mean playing around with other women; these husbands probably wouldn't have time for that. They're too busy cruising the Internet, or maybe they're swinging golf clubs, armchair-quarterbacking the Super Bowl or shooting the breeze in a bar with buddies. And unlike the workaholic, who may say, "But honey, I'm doing it for you," the "playaholic" drives his wife crazy because his activity doesn't help the family. "It's a breach of contract," explains Tom Anastasi, author of The Fight-Free Marriage (Nelson). "He's a different person from the one she signed on with. It's hard to love, honor and cherish someone you rarely see."
How his leisure passions can affect your love life "My husband, Dave, is a golf nut," says Wanda Neller,* a designer in Pleasantville, N.Y. "When we were engaged he'd joke that we had a Prenuptial Golf Agreement. He made it clear that his zeal for golf wouldn't go away after we got married. Dave always has clubs in our car's trunk; all our vacations are planned around golf. He goes away without me for golf weekends. Once, one of these outings fell on Valentine's Day, and he went anyway. He has a whole network of golf buddies whom he's met teeing off around the country. When one of them, a young guy I didn't even know, came to town, we put him up-for a month! I told Dave that guy was our own Kato Kaelin." Betsey Grimm, another golf widow, also feels that her schedule is dictated by her husband's golf cravings. Not only does he play every weekend, but when he's at home he's glued to cable TV's Golf ChanneL "He tapes it," Iaugbs Grimm, an apparel designer and manufacturer in *Name changed for privacy. 54 McCALL'S I AUGUST 1997
Wellesley, Mass. "To me, it's about as interesting as watching paint dry." In fact, 26 percent of respondents in a recent McCALL's survey considered sports on television their number-one enemy in the battle for their husband's attention. "My husband, Seth, replays taped games blowby-blow, over and over," says Tracey Murray, a paralegal who lives in Manhasset, N.Y. "The worst part is that if his favorite team loses, he 's in a bad mood. Then we all have to suffer."
When he's more mad about play than mad about you (and you're mad) What bothers many women is that their husband seems more passionate about something other than them. "I just can't understand
hours. Sometimes it's very inconvenient. If I ask him to alter his plans in advance for something important, he grumbles and does it. If I ask at the last minute, he won't budge."
why he invests so much emotion in each game," says Murray. She does understand his other obsession, which is dining in nice restaurants. However, she adds quickly, "One anniversary I made the mistake of choosing a restaurant with a huge TV tuned to sports in the bar area. I spent the
entire evening looking at the back of his head ." Other wives get steamed when their husband's playtime takes precedence over the family. "Peter's Wednesday nights out with the guys are sacred," says Mary Sutherland,* an educator in New York City. "He's gone for four or five
What to do if he's crossed the line into Norm Territory Is your husband acting like one of the guys (for instance, Ralph Kramden and Ed Norton, out with their Raccoon Lodge pals)? Or does his behavior resemble that of Norm Peterson, the barfly from Cheers who avoided his wife, Vera, by affixing himself to the same stool night after night? Experts say there's no absolute amount of play that indicates a problem; warning signs are different for every couple. If your husband acts defensive, angry or secretive the way Ill-
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Norm did, call a time-out and figure out a way for you both to get some of what you want, advises Kimberly S. Young, an assistant professor of psychology at the University of Pittsburgh at Bradford. Keep in mind that couples in healthy relationships have a normal need for private time, points out Peter Rosenzweig, Ph.D., author of Married and Alone: The Way Back (Plenum). But be concerned if you think your husband is avoiding intimacy with you or if you're saddled with most of the family chores. A husband who feels entitled to watch television endlessly is sabotaging family life. "Some husbands feel that after a hard day of work, they've earned TV time," says Anastasi. "And let's face it, assisting a child with
homework is taxing. It's much easier to veg out." If your husband is using this sort of excuse, consider professional counseling.
Don't be a martyr: Remember, girls should get to have fun too Instead of kvetching about what he's doing for himself, start assessing what you can do for yourself. When you replenish your physical and emotion reserves, you'll be less resentful. No great revelation, yet women find that making this happen can be difficult. They've been socialized to put others first. Even while working outside the home, many mothers still feel more responsibility for the house and the children than their husband does. The moms are making dinner, giving
kids baths, doing laundry or paying bills; the dads are channel surfing. "Women have been taught to stick Band-Aids on everyone else before tending to their own needs," says Michele WeinerDavis, author of DivorceBusting and Change Your Life and Everyone in It (both from Fireside). "Meanwhile, men seem so guilt-free. Then women get furious when men act entitled to take off for, say, basketball-without even asking!" She says this resentment is fueled by equal parts anger (at always being left holding the bag) and envy. "Women need to play too," says Anastasi. "Try to find that balance." Sometimes the solution is as workable as just keeping an eye on the clock. He
can still pal around with friends every Friday night for a couple hours, but you can meet him afterward to catch a late movie. Or if "Gotta golf' is his mantra, ask him to tee off early enough on Saturdays that he's done before lunch. "No one can be everything for someone else," Neller says. "While Dave was out playing, I took some courses and started a decorating business. I was happier after I stopped trying to control him and started working on developing myself. The answer was within me." Humor helps. Every spring, Neller's husband drafts his teams for fantasy baseball. "This year, when he was talking in his sleep about who to trade," she says, "I whispered, 'Give me Brett Saberhagen. '" •
~arpet odors.stop·here~ . -~ . lt eliminates tough odors.Jt ~eshens with potpourri. \ ' · Its 'G!ade"Carpet & Room Potpourri.
• COUPLES (continuedfromp . 55) Don't expect him to give it up completely. "I really struggled with this until I learned that when my husband has had his time away, he's more present and pleasant at home," says Mary Sutherland. Make specific requests. State what needs to be done and whywithout hysterics. For example, "Please skip golf next Saturday morning so you can attend our daughters' soccer match." (Now you're thinking, "Why should I have to do that when they're his kids too?" So true. But just being right won't change the outcome.) Schedule solo escapes. If your husband's not going to buy you a ticket to a concert, do it yourself. "Rather than be bitter on the weekends when my husband is away playing," says Betsey Grimm, "I now hire a sitter for
3
ave more nwith or without him Feeling as if everyone's having a great time but you? Here's how to lighten up-and get the nurturing you need.
1
Join him. Instead of moaning about the things you don't do together, discover new things that the
two of you might like to do. Every week for two months, take turns picking a neverbefore-tried activity. Then, both give it your best shot. Get real-compromise. Does that weekly Guys' Night Out make you crazy?
2
4
a couple of hours on Saturdays and get a manicure."
5
Date-all over again. Remember, dating is the best relationship glue. When you have an evening out together, you're less likely to focus on the game he says he can't live without.
Establish family rituals. Whether it's Monday Night Chinese Takeout or Monthly Monopoly Marathons, brainstorm as a family for fun ways to share more positive time.
6
?
Go with the guilt. Not the preferred method, but often effective. Point out that he's a role model for the kind of father his son will be. What type of example does he want to set? If he digs in his heels, mention that no one on his deathbed has ever been heard to say, "I wish I'd spent more time on golf."