Faith and Gratitude - "Andy Sitings"

I sleep with a tattered blanket and a small ball with Homer Simpson imprinted on one side. They are tucked away under my pillow and, if I choose, I can touch them with my fingertips at any time during the night.  Now, you can stop reading this article now and conclude that an admission such as this warrants no time to read further.  Or, as I hope, your curiosity has gotten the best of you and you have asked yourself, "Why?"

I believe that we all struggle with Faith.  At least I certainly have.  And we are all familiar with the phrase that God does not present us with any situation that we cannot handle.  It was actually Mother Theresa that wisely added, "I wish that He did not have so much faith in me."  She said it first.  I said it second.  It was during the eulogy of my son, Andy, on January 21, 2004.

We can never anticipate how we might react to our worst fears.  Mine was, as most parents are, losing a  child.  I could not imagine life without them.  And because that fear was so great, I prayed to God that He would protect them when I was unable to.

This blog addresses the miraculous ways I have managed to navigate life minus one precious passenger.

My first clue that there was something guarding my emotional destruction occurred in my living room the day following Andy's death.  I was, by no accident, sitting in the wing chair Andy often used to practice his guitar and play "Blackbird" by the Beatles just for me.  I gazed out of my contacts, now foggy from smudged makeup and tears, and beheld a room full of my family, friends, and neighbors.  We were grief-stricken and paralyzed.  Though my contacts did not clear, my thoughts amazingly did.  I felt an unexpected and unexplainable strength wash over me.  I reached for a pen and paper and began to prepare my son's eulogy.  I also became determined to see my loved ones through their sadness, their hopelessness.  Life would continue for all of us.

When I think back to that moment I am still amazed at that powerful feeling.  I call in my "Footsteps in the Sand".  That was my first real introduction to God.

Now, I would be lying if I told you that I have not collapsed at times when I hear "Blackbird", when I see a skateboarder, when I see one of his friends, so mature and grown up, when I see a commercial about saving animals, when I see a smile that can light up a room, when I see a whale breach the ocean, when I see my son Peter play his guitar, when I hold our daughter's son, Andrew, when I see a Peace sign, when I get a hug or am told, "Guess what, I love you!"

But the moments of loss have been so outnumbered by what I refer to as "Andy Sitings".  Well, I should really give credit to my sisters for coining the phrase.  They have them all of the time.  When they occur to me, they are nothing less than miraculous.  I will mention just a few.

It was at least a year before I could really enter his bedroom.  The essence of Andy lived there for so long.  But that did not mean that I was immune to reminders of his presence on earth.  I could open my dresser and find Birthday cards, notes, and pictures.  So I was a bit desensitized, but not much.  I found some precious things.  One was a book written to his friend, Carey, in grade school.  He described how much he cared for him.  I sent it to Carey that August.  In October, Carey lost his twin brother, Andrew.  I am glad I found that book.  I don't think that it was an accident that I  chose to go through Andy's belongings that month.

I was so sad that I was unable to locate "Ba-ba".  It was a tattered blanket that Andy named and clung to for several years.  He would cuddle up with me and suck his thumb.  He was my only thumb-sucker - just like me.  We had identical calluses on our right thumb from the wear and tear.

Years had since gone by and I found myself once again in his closet.  I don't know why.  Maybe I was wanting to change a light bulb. Really? There was nothing visible on his shelves but somehow I went on tiptoes and reached to the farthest corner of that top shelf.  There it was!  I have no explanation of why I would find myself in an empty closet, wanting to replace a light bulb that was not needed, and deciding to reach for one particular corner.  I hugged it.  I smelled it.  And I have not slept a night without it.

We have moved several times since leaving Andy's childhood home.  Sometimes it is a blessing to be away from those memories and sometimes it is gut wrenching for those very reasons.  I emphasized several times because the following story is absolutely unexplainable.

We had been settled into our new home for several months.  One day, our 1 year old grandson, Andrew, was walking around the gravel driveway on his newly found legs.  He bent down with precise balance and picked up a small ball with Homer Simpson on it.  Where did this ball come from? Could the dogs have found it in there romp in the woods, thinking their aging joints could out run the deer?  Couldn't be.  They hated the gravel and remained in the backyard.  Against my concern about germs and the origins of this ball, it was the perfect size for Andrew's fist and he tightened his grip, determined to not give it up. So we brought it inside and it was placed in Andrew's collection of balls.

One day during a visit, my son Peter spotted the ball.  "Oh," he remarked, "you brought Andy's fuze ball over".  My memory of Andy bouncing that silly ball from ankle to ankle came rushing back.  I stared at that ball with all of its wonder. How did that ball find itself in our driveway? You may find explanations.  I certainly have mine.  And that is why it is nestled with Ba-ba.

Why am I writing about this now?  Well, I have no answer for that.  I just felt compelled to sit down and share some of my precious miracles that sustain me.

During this time of year, I am privileged to be connected to some faiths and traditions that are celebrating life - my daughter-in-law, Shirin, and her parents including us in the Persian New Year celebration, my son-in-law, Jeremy taking Molly and Andrew to a Seder to celebrate his Passover tonight, and my preparing to listen to Peter play the organ in church Sunday for the Contemporary Easter Service.   I have come to appreciate that Love and Faith and Miracles are not confined to one religion.  They are part of our everyday life.  We just have to open our hearts to listen and to be led.

I hope that you all find the Love and the Beauty of this life with all of it's hidden mysteries and treasures.  Andy would like that, as I often said in his Eulogy.  And I am certain that you will find Peace.  Andy has taught me this lesson.  And I am forever grateful.

"I'm Depressed. Is there hope?" ABSOLTUTELY!

One of the most difficult questions a Psychiatrist has to answer happens to be the title of this post.  It comes in several forms:

     "Will I ever get better?" 

     "These stupid meds aren't working!"

     "I've lost all hope."

Have you ever felt this way?  I am writing this blog today to address these very important concerns. With education, understanding, patience, and support, depression is very treatable.

Before I delve right in and discuss treatment options, there are three important concerns that need to investigated.   Without knowledge of these influencing factors, adequate treatment for depression is less likely to be achieved.   

Have you ever heard of the term BIOPSYCHOSOCIAL? It is a combination of the words biological, psychological and sociological.  Let me explain.

Biological concerns address not only family history of mental illness and medical illnesses that could contribute to depression, but also substance abuse problems. One question I will always ask the patient is if their use of alcohol or drugs has increased to help them cope.  I don't ask them if they drink or use drugs because the answer is often "No".  I don't ask them how much, either, because I would probably need to double the amount.  Self-medicating is less threatening and they are more likely to answer with an affirmative or just deny ever using.  I will use this information as a teaching point - they cannot expect to respond to medication as effectively if under the influence of alcohol or drugs.

Psychological considerations are paramount in considering treatment options. Answer me this question: How do you cope with sadness, with stressors, with unexpected changes?  For example, some may "cry over spilled milk" while others may make "lemonade from lemons"? Our defense mechanisms come to play when things "go wrong".  No two individuals experience similar episodes in exactly the same way. Some may gather family for support and identify the stressor and take action to minimized their symptoms.  Some may turn to substances to self-medicate or stop taking medication the minute they experience a side effect that might be transitory.  Or they may feel the medication is ineffective if relief of symptoms does not come within a short period of time. These, again, are important teaching points.  Some individuals want immediate relief.  If they are not informed that, unlike tylenol that relieves a headache in 20 minutes, anti-depressants require more time and work differently, they may be less compliant with treatment.  Education is key. 

Social concerns have always influenced our emotional state.  Job losses and financial concerns, foreclosures, broken marriages that occur after years of celebrating anniversaries are just a few of the stressors challenging my patients. In addition, a strong support system is an essential element of the care plan. Do you have access to family members or friends when life throws you punches or do you isolate?

All of the above components are necessary when considering treatment options. Are the symptoms beginning to affect function? If so, an anti-depressant might be prescribed at this time. Are other medical problems or substance abuse issues under control or contributing to the situation? If not, then involving the primary care provider and/or referral to a substance abuse program is also necessary.  How strong are the coping or defense mechanisms?  What was your answer to the above question? Are you making lemonade or crying over the spilled milk?  A referral to a counselor such as a social worker or psychologist may be necessary at this time? Is a case manager needed to address the financial situation, living arrangements or unexplored entitlements?  Support comes in all forms and may be a very critical element in the overall treatment plan.

Now about medication. For client's presenting with mild symptoms, medication may not be necessary. Did you know that research has determined that exercise including yoga can be effective for these individuals?  If the symptoms are more moderate or severe, and I am referring to the number of symptoms present, then medication is advised. Remember the pneumonic SIGECAPSS in my last blog?  The more symptoms present will influence treatment.  And certainly if the patient has a dramatic change in functioning, or is expressing suicidal thoughts, plan or intent, then hospitalization is usually recommended at that time.

The selection of medication depends on the symptoms that are described by the client. And certain neurotransmitters in our brain are utilized to help target and relieve symptoms. I am referring to serotonin, norepinephrine, and dopamine.

If anxiety, obsessive compulsive traits, or ruminations are present (those thoughts that show up at bedtime or tend to act like a broken record), then my first choice is a serotonin agent. They are classified as SSRI's or Selected Serotonin Reuptake Inhibitors (lexapro, zoloft, celexa, paxil, prozac, luvox) and can be very efficacious in targeting symptoms that include anxiety, ruminations, guilty conscious, and obsessive compulsive traits that predominate one's depression. Concerns that often leads to non-compliance are side effects - transient stomach or abdominal discomfort, headache, or more importantly, sexual dysfunction, specifically the inability to experience an orgasm. This needs to be discussed with patients prior to treatment.

Medications that include both serotonin and norepinephine also supply benefit for concentration and anxiety. If focus is a problem, often times a combined drug can offer benefits. SNRI's (Serotonin Norepinephrine Reuptake Inhibitors) include effexor, pristiq, cymbalta, and remeron. Remeron is benefical if the client is unable to sleep as it has sedative properties and causes no sexual side effects. Cymbalta is used in clients that have some of the physiological symptoms of depression. Effexor and pristiq provide not only serotonin and norepinephrine, but some affinity for dopamine which is addressed below.

Dopamine, to me, is the "feel better" neurotransmitter, providing energy, motivation and concentration. If the symptoms are more consistent with a "couch potato", or a withdrawn nature, than a dopamine agent like wellbutrin may be indicated. Although it also has no sexual side effects, it is limited in client's who have no history of seizure disorder or eating disorders.

Education is an important aspect of the initial assessment. Medication needs to be taken consistently and the client needs to be aware that responses to medication may require at least 2 to 3 weeks. Any concerns regarding side effects or thoughts of discontinuation of the medication need to be discussed with the doctor. Follow-up appointments are critical in determining the response to the medication, whether dosage needs to be adjusted or whether other agents need to be considered for adjunctive benefits.

And I cannot sign off without commenting on the media's influence on the public's attitude towards medication.  (Don't even get me started on the movie industry's depiction of the medicated patient - a "walking zombie"!)  Perhaps the increased suicidal thoughts of adolescents when first placed on anti-depressants was an important discovery.  What do you do with that information?  You work more closely with the patient and educate the patient and family.  You don't scare the public into thinking that anti-depressants are responsible for suicide.  On the contrary, because the scare prevented teens and parents, and even adult patients, from seeking treatment, teen suicides increased.  What a shame!  Depression is treatable.  Don't be afraid to seek treatment.

There it is - my philosophy of treating Depression in a nutshell (actually "blogshell").

In summary, discuss your full spectrum of symptoms with your doctor so that the right treatment plan can be recommended.   If medication was prescribed, do not leave the office without a full understanding of the side effects and benefits of that medication. Do not change your dosage or stop treatment unless discussing this with your physician first.  Should suicidal thoughts develop either during the initial part of the treatment (often seen in children, adolescents, and young adults), or at any time during the course of therapy, notify your doctor immediately or present to the Emergency Room for a risk assessment.

Do I have the Blahs or am I Depressed?

Recuperating from my concussion (see last blog) has certainly had an effect on my mood.  And for lack of a better description, I feel really blah!

Now, as a Psychiatrist whose primary role is to conduct mental assessments on my patients, you better be darn sure that I am paying close attention to my perceptions, my feelings and my behavior.  I have come up with a diagnosis of the BLAHS secondary to my injury.  It has left me with feeling B-lue - a sadness that has me lying on the couch a bit more than usual; L-ittle changes are noted in my energy, concentration, appetite, and sleep pattern; A-ware of the change, linking it to a recent event and in my case, dealing with symptoms of my concussion, not working and feeling unproductive; H-ourly changes, i.e., it does not persist for days or worsen, but rather fluctuates with visits from family, emails, and listening to my favorite music; S-hort lived -as in, this, too, shall pass.

Even though I have the knowledge to explain the recent change in my feelings and behavior, I am also wise enough to talk about this with my primary care physician. Most individuals do not.  Some episodes of feeling BLAH actually evolve into a depression.  I may be sitting at home today, but I am motivated to get the word out!

So - my goal today is to provide some information on depression.  I have decided to resurrect a previous blog on the topic.  Here goes!

What is depression? If you were to ask your friends or family, or be brave enough to conduct a survey of passing strangers on a street corner, I guarantee you would get a variety of different responses. That is because depression has become an umbrella term used by many individuals to describe a number of different moods ranging from "the blues" or feeling "blah" to a severe, debilitating state where nothing but suicide could end their pain. There is quite a gap between these two ends of the spectrum. So, let's begin by defining depression more clearly.

First of all, I am very grateful to have a person who is feeling "depressed" actually sitting in my office. Most of my patients who are depressed may be referred by their primary care provider (and may not follow through). Some are brought by a family member or friend, not necessarily willing to provide details to a complete stranger. Very few individuals come on their on volition. So, when I am given this opportunity, I better be able to diagnose my client correctly. 

As a psychiatrist, I rely on specific criteria to diagnosis an individual with a major depressive episode. The interview is critical in gathering the objective data. I rely on an acronym to obtain the necessary information - SIGECAPSS. This represents the following symptoms: (S) Sadness or depression; (I) lack of interest or anhedonia; (G) guilt, poor self-esteem, worthlessness; (E) loss of energy; (C) poor concentration; (A) changes in appetite, either increased or decreased; (P) psychomotor retardation or agitation - most likely observed by others ("All you do is sit around" or "You seem more edgy than usual"); (S) changes in sleep pattern, either increased or decreased; and, most importantly, (S) suicidal thoughts, plans, or intent. The DSM-IV manual (the psychiatrist's bible for establishing diagnoses) requires that at least five (or more) of the above symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) (S) depressed mood or (2) (I) loss of interest or pleasure. If the symptoms cause significant distress or impairment in social, occupational, or other important areas of functioning such as family relationships then it becomes a major depressive disorder. I have also been required to rule out any medical condition that could contribute to depression (e.g. hypothyroidism), any concurrent use of alcohol or drugs that can influence or mimic some of the above symptoms, or bereavement symptoms that have not become more debilitating after a two month interval. I am not at all dismissing the depression that can be attributed to other general medical conditions, substance abuse, or pathological bereavement. These individuals are just diagnosed under a different terminologies. In addition, individuals with other mental illness, including bipolar disorder, schizoaffective disorder, or adjustment disorder with depressed mood can also experience the same symptoms. It is beyond the intention of this posting to address these other conditions but will be discussed at another time.

When I wrote above that I am "grateful" to be able to assess a person face to face, I truly meant this. Depression is treatable. Statistics claim that women are twice as likely to develop depression than are men. Based on the gender of my clients, I suspect that this statistic is true. However, men are also less likely to admit that they might be suffering from depression. Considering the other statistic that woman are more likely to attempt suicide but that men are more successful, I am concerned that this younger segment of my generation (the 46 to 54 year olds) are experiencing more stressors.

PLEASE!!!!! Even if you are feeling "a little blah", or if a friend, a colleague, a family member gives you some feedback about a change in your behavior, promise me that you will at least talk to your primary care physician. If you do not have one, turn your insurance card over and call the number for behavior health services for a referral. If you do not have insurance, there are community mental health services in your county that can offer you services. MOST IMPORTANT - if you have thoughts of suicide, please go to the nearest Emergency Room for an evaluation. Please promise me that. I may not know you or the extent of your grief or your stressors. But I do know that everyone on this earth is precious. Life is precious. Please have faith and know that you are loved.

It's a Concussion - again!

For those who have noticed that I have been acting a bit "didsy" this week, the verdict is in.  No I am not turning into that perceived blonde persona.  Nor am I showing my advancing age - well the CT scan would suggest otherwise with that dreaded "generalized atrophy" nonsense.  No people.  Elaine has a concussion - again!  

How well timed.  The NFL is undergoing its Concussion Crisis.   And I have always believed that things happen in threes.  Two famous woman with precious brains had recently succumbed to a fall, hit their heads and suffered the consequences.  I refer to Hilary Clinton and Barbara Walters, of course.  I do not claim to be famous, but the mere fact that I, too, like Hilary, suffered dehydration, fainted and hit my head has created an opportunity to blog about it.

Who knew?  It was a regular weekend with the usual takeout.  Then the twist.  Well, more like a gut wrenching pain.  I never had food poisoning before but I saw more of the bathroom than my grandson that weekend.  I dragged myself to work that Monday morning.  Note: I never have to drag myself to work.  I met with my dear nurse, Dawn, who noted I was listless and tired.  "Go home and go to bed".  My boss agreed and I left within the hour.

I can't recall many details after that.  I know that I arrived home safely and flipped on my favorite reruns of NCIS.  I was trying to beat Ducky to the forensic findings when wooziness set in.  I knew to drink more water but never made it.  The details can only be reconstructed from the findings - an overturned dining room chair, my hands covered in blood.  I lifted my head - ouch!  I looked at the floor.  Blood.  I must have reached back in my grogginess to assess the situation.  There was a 3 inch gash in the back of my head - you know that area where the hair is shorter and to go the ER would require shaving the area to investigate further.  Vanity thy name is Elaine!  Not proud.  Not proud at all.

The only sensible people in this scenario were my family and coworkers.  I staved off any efforts to be driven to the hospital.  The bleeding was controlled, sensorium "intact".  I promised to follow-up with my doctor in the morning, took 2 tylenol and went to bed.  Didn't sleep much, though.  (See signs of concussion below).

Now I reported to work the next morning and begin to fax some documents.  At least I thought I was faxing - phone numbers were a bit jumbled.  But the big AHA moment came when my daughter texted me, wondering why I dare join some dating site on Facebook.  WHAT?  I called my doctor immediately, got a head CT, and the diagnosis was confirmed.  No bleed or subdural or fracture.  Thank God.  It was a concussion.

I hope you are all dumbfounded by the actions of a medically trained individual who not only knew the signs and symptoms of a concussion, but also survived a previous one in 1989.

My current symptoms are no where as serious - unable to remember how to use my coffee maker, vertigo, headache, putting orange juice on my children's cereal, getting lost in my hometown, word searching, and memory loss.  It developed into a post concussive syndrome.  To this day I have to walk out of stadiums if the noise reaches a certain decibel. 

But I have some classic symptoms which are resolving.  My headache is better.  I  am not in a fog but do record when I last took Tylenol for fear I might double dose.  My sleep is, at best, 4 hours per night.  I hope that improves soon.  I feel fatigued and I want to cry at the drop of a hat.

Here are a list of symptoms that are common:

• Headache or a feeling of pressure in the head
• Temporary loss of consciousness
• Confusion or feeling as if in a fog
• Amnesia surrounding the traumatic event
• Dizziness or "seeing stars"
• Ringing in the ears
• Nausea or vomiting
• Slurred speech
• Fatigue

Some symptoms of concussions may be immediate or delayed in onset by hours or days after injury:

• Concentration and memory complaints
• Irritability and other personality changes
• Sensitivity to light and noise
• Sleep disturbances
• Psychological adjustment problems and depression
• Disorders of taste and smell

Gosh.  I didn't realized how many symptoms I had.  But you know the most disturbing thing?  This could have been prevented.  I wish I could have done things differently.  Famous last words, right?  Not really.   Let's revisit the crime scene.

When your going through twice as much Charmin as normal, for God's sake replace fluids - not just with water but with electrolytes.  Have Gatorade in your pantry.  And don't be so cavalier about your bathroom habits.  Any changes from your normal pattern that continue and lead to symptoms like increased thirst, dizziness upon standing, poor skin turgor (you know, that "when I pinch my skin it stays puckered" look) may indicate dehydration.  

If you do fall and hit your noggin, please be aware of signs and symptoms of a concussion.  And you know what?  If you are confused, you may not even know what is happening.  Have a friend or family member on speed dial and don't pull an Elaine move - LISTEN TO THEM!

Now I will enlist the help of spell and grammar check.  I may feel fine but need to recognize when a little help is needed. 

Stay healthy.  Avoid dehydration.  Avoid falls.  Live everyday to it's fullest.  Life is fragile.  And so is your noggin! Protect it as best you can.   Peace.

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Missing Andy - You left the best part!

I saw you today, Andy.  As I took the dogs out at 6 AM I heard a plane overhead.  It was flying above the clouds before dawn and the light that flashed created this beautiful halo effect on the sky as it passed by.  So beautiful - like an angel not knowing whether to help me with stubborn Pumpkin and Cole or just to continue on the journey..  You then put the thought in my head.  Remember when you told the teacher how funny your Mom was when she scolded Pumpkin for doing "poo-poo" in the kitchen?  I guess I said, "You don't have permission to do that!".  Well, I told the dogs that it was a bit too cold, Mommy forgot her robe, and that they do not have permission to scour the freaking yard all morning to find the perfect spot.  It worked, Andy.  Thank you for that sweet memory.

I saw you yesterday.  A stranger passed by and took the time to gaze into my eyes and give me a nod and a smile.  How heart-warming.  You always could light up a room with your smile.  Thank you for that moment.

I saw you last weekend.  I picked up the Sunday newspaper and the flyers tumbled to the floor.  You loved the Sunday after Thanksgiving when all of the toy stores would advertise their products.  You studied them for weeks as you made your list.  Of course you would check with me to make sure you were not being too greedy for Santa.  You were never greedy, Andy.  You taught me the true meaning of humility.  I hope to always strive to be more like you.  Thank you so much for that lesson.

I hugged you last Friday.  We were celebrating Jeremy's birthday and their rescue cat cuddled up on my lap then stood on it's hind legs and stretched its paws over my shoulder.  How many dogs and cats did you save?  I treasured that hug, just like the one you gave me the night before you died.  I will never take for granted that tomorrow is a guarantee.  I will embrace today.  That's why they call it the Present. Thank you for teaching me that a hug is priceless and should never be taken for granted.

I found the remnants of Ba-Ba.  That tattered cloth that you treasured was in a bin with your hockey equipment, your favorite books, your hacky sack, your Tasmanian devil figure, your notes to me, your ski trail maps, your guitar picks - just the most precious assortment of objects that I could ever imagine.  Well, I took Ba-Ba and placed it under my pillow.  Don't think your Mom cukoo monkey.  My thoughts of seeing you in my dreams have been bolstered by that very act.  Thank you for being so precious.  Thank you for the possiblility of  sweet dreams.

I heard you last week.  As impossible as that sounds, your brother, Peter, made a recording for me.  He used his new Microphone that Santa brought him and, playing your black acoustic guitar, recorded Blackbird by the Beatles.  You played that for me the Saturday before you died.  It is now my ring tone.and your nephew, Andrew's favorite lulaby.  Thank you for teaching me that broken wings do not hinder the ability to fly.

Tonight I will mourn the last time that I physcially hugged you.  We were passing each other in the driveway and you actually stopped the car, ran to me and said goodbye.  I guess you might say that that simple act of hugging and saying goodbye was more than coincidence.  You see, your  Mom has become a firm believer in divine intervention..  I will never take anything for granted.  With my heightened awareness and my admitting that there exists something greater than ourselves, I now know that you are with me.  I only need to look, to feel, to open my heart. 

Andy, even though I no longer feel the warmth of your hug, see your angelic smile, hear your voice saying, "Guess what Mom, I love you",  you left the best parts behind.  God has put you in so many aspects of my life now.  I thank God for that gift and I thank him for allowing me to be your Mom for 19 wonderful years.  Peace, my son.  I love you dearly and miss you so very much.   Mom

Rich and Famous

I have come to the conclusion that, despite recent opportunities of notoriety, I will never be rich and famous - that is by society standards.

Let me elaborate.  To the very few followers that I am indeed grateful to, you must be aware of the humiliation of my first book signing.  My experience had taught me that, to sell books, you have to spill a little of morning OJ on your manuscript to make it more "juicy."  (Oh, Elaine, that was too weak!)
Who cares?  My next book was to be entitled, My Life as a House.  I intend to add a subtitle - Without Curtains.


Now back to my lament.  My book signing at Barnes and Noble promised to be more successful.  There had been plenty of advertisement through the company.  Earlier that week I was asked to be an expert commentator on the nightly news regarding the Dark Knight Rises tragedy.  And the very day I was to sign my book, my picture appeared in Cleveland Magazine.  (Oh, Elaine, you're smokin'!)

Despite a hurricane-like storm that began minutes before my timed appearance, several people staggered, rather ran in.  Wow!  Could this be for me?  Why are they waiting in the vestibule?  Are there that many bargain books lined up out there?  Oh no.  They are soaked.  They are waiting for the storm to pass.  Hey people.  My motto is, "Don't wait for the storm to pass, learn to dance in the rain".  Can anybody hear me?  I wave to them.  Some acknowledge me with a nod.  Others just stare at the rain as it crescendos and beats against the beautiful flowers now bent to the ground.

In the midst of this water fest, I see a beautiful woman struggling with a large golf umbrella in one hand and a beautiful child in her arm already challenged by a diaper bag.  The child sees me, smiles, and extends his arms toward my table.  It is my grandson, Andrew, and my beautiful daughter, Molly.  Shortly following them is a man, dressed in my favorite color orange and drenched, holding a potted sunflower. It was my son-in-law, Jeremy.  Only my family knew that my Mom called my 3 sisters and I her flowers.  I was the sunflower, Eloise, the rose, Elyse, the daisy, and Ellen, the violet.  The flower was dripping but happy and was set to my side on the table.

Then my son, Peter, and his beautiful wife, Shirin, entered the store.  He had been so proud of this scheduled event that he put an announcement on his Facebook page.   And sure enough, in between his bringing me drinks from the Starbucks counter in the store, his friends made their appearance as promised.

And let us not forget "plumber Jim".  My husband wanted to rent a sign to wear so that he could walk up and down the boulevard announcing my presence inside.

I sold 7 books that evening.  Rich and Famous?  You bet!  God has given me more blessings than I could ever imagine.  If I never sell another, I will be forever grateful for my fame and fortune - as a woman, as a mother, and as a Ya-Ya.

50 Shades of Red

As I reflect back on my life, I recall times when I felt a warm sensation that  highlighted my cheek area, for which I could claim too much blush, or a flaming red invasion that shamelessly knew no boundaries, encompassing my entire face and neck.  Embarrassment vs. Humiliation.  We have all experienced the body's autonomic reaction to a perceived moment of shyness or shame.

May I share my latest experience of embarrassment?  I am turning a red hue as I type.

I was delighted when asked to do a book signing at a quaint, locally owned book shop. It has managed to withstand the economy and the convenience of on-line shopping and savings of powerful chains.  Every passerby is drawn to the store, if just to smell the aroma of parchment or to have the wooden floor creak melodiously under foot.  It's a reminder of the old shops back in my hometown and, without reading a book, I am transported to a time of penny candy.  My pink Shwinn bike can sit on the sidewalk without a chain or body guard.  Sorry - I digressed.

The day of the event came with no fanfare.  A bright yellow paper was taped to the window announcing my presence and a discussion about the book between the hours of one and three.  On entering the shop, 2 copies of my book were displayed on a table with, again, the same bright yellow paper, only this time encased in a plastic cover.  I was directed to the back room.  Now for those unfamiliar with the layout of the store, the back room has a small alcove leading into it with lots of jig-saw puzzles on the wall.  The room is about the size of an average sized dining room.  As I stepped into the very organized room I was greeted by a small plate of cookies, an assortment of folding chairs, and a table, again displaying my book.  A worn, but very distinguished wooden chair, fit for a professor emeritus, waited for me.  Behind me, literally 18 inches behind me, was the NY Times best-selling books.  A pathway between the chairs and my table led to the locked staff bathroom.

I sat done with waited abandon.  I dug out the special pens that I just bought across the street at a darling card and gift shop.  The lady at the gift shop wanted to match the color of the pen to my book cover.  How sweet.  But the darn pen would not write.  Another pen stopped writing after 2 words.  A helper came over and they both determined that the whole batch of pens were unsuitable.  But they worked diligently to find two pens that at least were salvageable. They gave them to me without charge.

The day was hot - I mean 90 degrees hot.  That morning had brought a gentle rain which would have been perfect had it continued.  What a perfect invitation to browse.  But it cleared and left the pavement a bit steamy.  OK.  The shop was air-conditioned.  Would they know about the free cookies?

People began to trickle in the room.  Two patrons were mothers of small children that were permitted to use the staff bathroom.  One mother made eye contact with me and I smiled.  When her son finally came out of the bathroom, given several warnings by the shop owner not to stuff too much paper in the toilet, he had the good manners to approach me and ask about my book.  He was more impressed by the cover and asked if I "colored it" myself.  The child was so enamored that the mother actually bought a book.  Yeah!  My first sale.

The first hour went by slowly. I mean, it dragged.  My beautiful daughter, Molly, stopped by to give me support.  Now mind you, she possesses several copies of the book.  I was so devious.  I slipped her a twenty and said, "Go buy my book".  Pathetic.  Just pathetic.

Then the pace picked up.  Several people entered the room and walked straight toward me.  I would rise and extend my hand.  They would awkwardly accept my welcome to the NY Times best-selling section and then reach directly behind me for this popular book in trilogy form.  I endured this humiliation for the remainder of the second hour.  I was dressed in hot pink but, as you guessed, my face was wearing red.

At the end of my time - well, actually I had 8 minutes remaining but the stop owner was kind enough to rescue me - I picked up this "book of the hour" along with its 2 other sequels and proceeded to checkout.

I commented on the title and felt that it implied some spiritual theme.  He laughed at me and announced that he calls it Smut One, Two, and Three.  "Go ahead", he said.  Turn to any page and read.  Stupid me.  I did.  And as the shop owner stared at me to confirm that he was right, I magically turned more red.  "See"? he said.  So all afternoon, my book on feeling good about yourself was competing with REALLY feeling good.  I packed up my belongings and headed home.

As I thought about my experience I had to smile.  I am working on a series of books, too.  My Life as a...  The next book is about a house, with each room devoted to topics of health and wellness.  My master bedroom section was to deal with insomnia, erectile dysfunction, and peri-menopausal issues to name of few.  Now should I edit my work in progress?  Hmm...

Missing Andy - The Grief Process

Today is Andy's Birthday. He would have been 28 years old.  I am missing him so much.  He died at the age of 19, eight years ago. I used to grabbed my locket with Andy's picture in it. It had a lock of his hair tied with an orange ribbon - his favorite color. That was stolen from our home among many other items.  I mourned the loss of that locket.  It was a tangible connection to my son.  I have since realized that as I go to grab that part of my chest where the picture of Andy rested, my hand is now closer to my heart.  And that is where my son truly resides.  

I feel guilty having a life span that has tripled his. This earth would be such a better place with him being here, sharing his smile and saving animals. Sometimes I can get through the day, smiling when I think of him, and at other times, I can't catch my breath, like today. But I recover. That is part of the grieving process.

Grief is experienced differently by every one of us.  I never thought that I would survive the loss of a child.  It has changed my life forever.  The worst part of this journey was immediately after.  My husband and two older children huddled together in the family room and attempted to sleep that night.  I would doze off into a dreamland that still recognized my son as a beautiful, living, vibrant young man, saving animals and smiling to brighten my day.  When I awoke, the reality of his death came crushing down on me and I couldn't bear the pain.  I looked around at my family.  I knew that they, too, were suffering just as much.


Something unexplainable happened.  I felt a sense of strength that pulled me from that tear-stained couch.  I grabbed a piece of paper and pen and wrote his eulogy.  As I sat in the living room the next day, I sent up a prayer and thanked God for the "Footsteps in the Sand" experience that he was providing for me.  I promised Andy that we would go on.  I wanted to make my family whole again - just not my husband, Peter, and Molly, but my beautiful sisters and their families.  I would help his friends adjust to this tragedy and I would pledge my God-given talents to fighting drug and alcohol abuse among teens and young adults.


This journey has not been an easy one.  But I am writing this article to address grief during this month of Mental Health Awareness.


Allow your self to feel the shock, the pain, the grief, the anger, and the guilt.   Avoid the desire to withdrawal.  Know that these feeling and behaviors are more intense initially.  Accept support from others.  You might feel that no one understands what you are going through.  My sister-in-law lost her son to SIDS.  She organized the relatives that weekend into scrubbing down my kitchen.  It was a source of embarrassment for me as I was not the most immaculate housekeeper but it was also a source of catharsis. I had to laugh as I entered the kitchen and saw her recruits glance at me with a look of "save me".  


I found that my spirituality was heightened that day and it, along with family support, has given me the strength to carry on.  However, I know that others are not as fortunate.  


If grief evolves into a depression (see previous post devoted to this) please seek out a professional who can best provide you with the treatment you deserve.


I no longer look up at the sky and see dark clouds.  They always part for me to reveal the rainbow.  I know that its my Andy smiling down from heaven.  I miss you so much.  I will love you always.  Peace, my dear son.  Love, Mom

Am I Depressed?

May is Mental Health Awareness Month.  Therefore, the topics I will be posting this month are related to different mental health issues.  I will begin this month's topic with Depression -  an illness several of you may have experienced during your lifetime.  

What is depression? If you were to ask your friends or family, or be brave enough to conduct a survey of passing strangers on a street corner, I guarantee you would get a variety of different responses. That is because depression has become an umbrella term used by many individuals to describe a number of different moods ranging from "the blues" to a severe, debilitating state where nothing but suicide could end their pain. There is quite a gap between these two ends of the spectrum. So, let's begin by defining depression more clearly.

First of all, I am very grateful to have a person who is feeling "depressed" actually sitting in my office. Most of my patients who are depressed may be referred by their primary care provider (and may not follow through). Some are brought by a family member or friend, not necessarily willing to provide details to a complete stranger. Very few individuals come on their on volition. So, when I am given this opportunity, I better be able to diagnose my client correctly. 

As a psychiatrist, I rely on specific criteria to diagnosis an individual with a major depressive episode. The interview is critical in gathering the objective data. I rely on an acronym to obtain the necessary information - SIGECAPSS. This represents the following symptoms: (S) Sadness or depression; (I) lack of interest or anhedonia; (G) guilt, poor self-esteem, worthlessness; (E) loss of energy; (C) poor concentration; (A) changes in appetite, either increased or decreased; (P) psychomotor retardation or agitation - most likely observed by others ("All you do is sit around" or "You seem more edgy than usual"); (S) changes in sleep pattern, either increased or decreased; and, most importantly, (S) suicidal thoughts, plans, or intent. The DSM-IV manual (the psychiatrist's bible for establishing diagnoses) requires that at least five (or more) of the above symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) (S) depressed mood or (2) (I) loss of interest or pleasure. If the symptoms cause significant distress or impairment in social, occupational, or other important areas of functioning such as family relationships then it becomes a major depressive disorder. I have also been required to rule out any medical condition that could contribute to depression (e.g. hypothyroidism), any concurrent use of alcohol or drugs that can influence or mimic some of the above symptoms, or bereavement symptoms that have not become more debilitating after a two month interval. I am not at all dismissing the depression that can be attributed to other general medical conditions, substance abuse, or pathological bereavement. These individuals are just diagnosed under  different terminologies. In addition, individuals with other mental illness, including bipolar disorder, schizoaffective disorder, or adjustment disorder with depressed mood can also experience the same symptoms. It is beyond the intention of this posting to address these other conditions but will be discussed at another time.

When I wrote above that I am "grateful" to be able to assess a person face to face, I truly meant this. Depression is treatable. Statistics claim that women are twice as likely to develop depression than are men. Based on the gender of my clients, I suspect that this statistic is true. However, men are also less likely to admit that they might be suffering from depression. Woman are more likely to attempt suicide but men are more successful.

PLEASE!!!!! Even if you are feeling "a little blue", or if a friend, a colleague, a family member gives you some feedback about a change in your behavior, promise me that you will at least talk to your primary care physician. If you do not have one, turn your insurance card over and call the number for behavior health services for a referral. If you do not have insurance, there are community mental health services in your county that can offer you services. MOST IMPORTANT - if you have thoughts of suicide, please go to the nearest Emergency Room for an evaluation. Please promise me that. I may not know you or the extent of your grief or your stressors. But I do know that everyone on this earth is precious. Life is precious. Please have faith and know that you are loved.

May is Mental Health Month

May is a very special month to me.  I am able to celebrate the birthdays of my Grandson, Andrew, my niece, Gretchen, and my nephew, Billy.  I am able to reflect on the beautiful memories of my youngest son, Andy.  I am honored by family on Mother's Day.  And, very importantly, I am able to discuss mental health issues.  Tomorrow designates the beginning of Mental Health Awareness Month.  I believe that knowledge is power.  Join me during the month of May for topics and discussions on mental health issues.    

My Final Journey

I was recently asked to be an Inspirational Luminary on www.Inspiremetoday.com.  The request was to write a 500 word essay in response to the following question. "If today were your last day and you only had 500 words to share, what wisdom would you want to pass on to humanity? What have you learned that matters, and what doesn't?"

Since my use of car metaphors has been successful in helping others prepare their own “chasses” for life’s journeys, it is not at all surprising that I turned once again to my own car interior to find needed inspiration.  So, here are my words of wisdom.

If my journey were to end tomorrow, I would take comfort in knowing that, despite the impending storm outside, I had full control of my steering wheel and my control panel.  Why would this be reassuring?  Well despite the hazardous driving conditions, a fate certainly out of my hands, peace of mind would come with the knowledge that I am the pilot or driver of my soul.  A winding road and skidding tires would not dictate my final hours.   My navigation skills would serve as my guide.

My safety belt is on.  I am not going to throw caution to the wind and become disinhibited.  I will remain true to my beliefs.

My rearview mirror is playing a movie of my life.  Yes, there were some unhappy memories, but far fewer than my joys so I take pride in having used each road block as a detour to follow a better path.

I’m certainly not going to pull over to the next gas station and get tanked.  I want my final memories of my life to be vivid.  I want to cherish every friend, family, and acquaintance that crossed my path.

My gear is in drive, not reverse and my foot is going a bit below the speed limit.   After all, I will never pass this way again and I want to remember each cloud, each flower, each red barn.  A calf sucking on its mother is a thing of beauty.  Why did I never see that before?  A tear of joy forms in the corner of my eye.

The air conditioner and heater are off.  The windows are open.  I feel gentle rain and smell a clover-scented wind as it tosses my hair.

My glove compartment is basically holding the contents that were included since the assembly of this old, or should I say classic, model.  All that were necessary was a birth certificate or registration to validate my existence and my owner’s manual that assisted me in reaching out to my fellow man.  Whether it was a smile or a wave to a stranger, or a kind gesture to give up my right of way, the manual defined my essence.

And then there is the roadside assistance button.  Oh, come on.  We all have one.  When the going gets too rough and none of our car features are providing comfort in our final hours, then just push the button and say a prayer.  This particular device can bring immediate relief.

As I reach my final destination, I apply the break and reach for the ignition.  However, my navigator’s voice instructs me to look up to the sky and peer through the clouds.  As I turn off the ignition, I see a rainbow.

Adult Autism

Were you aware that today is Adult Autism Awareness Day? I have often paid attention to certain days of the year, designated to honor certain individuals or celebrating food. Before I became vegan I could recall National Ice Cream Day. Did I honestly feel that it was imperative to eat my way through a quart of Ben and Jerry"s? Well of course I did. The next day should have been devoted to National Guilt Awareness because I was certainly embracing that one. However, when it comes to our mental and physical well-being, there are certain days I feel compelled to pay homage to. And today is no exception. When I was in elementary school, none of my peers were ever evaluated for ADHD. They were referred to as underachievers or classroom disrupters and they suffered the consequences of this ignorance among educators and parents. And then there were children who stood apart from the crowd. They may have been spotted in the playground, standing alone with an inability to relate, an inability to look you in the eye. They may have been labelled as "odd" because of ritualistic or repetitive behaviors. What if these special individuals were suffering from undiagnosed autism? Today there is a plethora of information on autism. Pediatricians and parenting books have improved the diagnosis of autism in children. But diagnosing adult autism is more challenging. These individuals have been living with this disorder and have developed their own coping mechanisms to try to "fit in" and, unfortunately, mask symptoms. Adults may not be able to provide a complete physical or developmental history of childhood years, complicating matters further. The purpose of today's post is to provide information to those individual's wondering if they, or a loved, has autism. Common symptoms are listed below. Please note that having one or two symptoms does not indicate a disorder. But an adult having several symptoms may be a cause for concern. - Difficulty forming friendships or relationships: When one is afflicted with language limitations and idiosyncratic behaviors, it is difficult to develop meaningful relationships. And when an autistic adult has inability to understand nonverbal cues, how can they ever hope to be successful in pursuing a romance - a relationship very dependent on reading the nonverbal behaviors in another. - Verbal communication difficulties: 40% of individuals diagnosed with autism may nay never be able to speak and are completely nonverbal. Those adults that can converse often have difficulty in processing thoughts into spoken language. It is difficult for them to make their needs known or to maintain a conversation. - Non-verbal communication difficulties: As noted above, relationships are hampered by the impairment in interpreting facial expressions and gestures. - Lack of empathy: Many autistic adults have the inability to understand what other people might be thinking or feeling. This lack of appreciating another's perspective again interferes with developing relationships. - Preoccupations: Adults with autism are likely to have very limited interests and may be extremely knowledgeable about certain subjects such as history, word-origins, etc. This hyper-focus presents many challenges. - Sensory processing difficulties: This over-sensitivity or under-sensitivity to sensations such as smells, sounds, sights, and other input can cause an autistic adult to avoid social situations. - Repetitive behaviors: Some autistic individuals repeat words, phrases or behaviors which provides a sense of comfort. It is predictable and under the control of the individual but does not serve a purpose. - Need for routine: Examples of this behavior include a refusal to try new foods, following the same schedule day after day and having increased anxiety and discomfort when this cannot be accomplished, inability to change plans, and obsessive/compulsive type tendencies. - Savant tendencies: I always remember the movie "Rainman" when Dustin Hoffman demonstrated the skill seen in approximately 10% of autistic individuals. - Insomnia: As many as 70% of autistic people have problems with sleep secondary to sensory issues. Though this symptom is not diagnostic of autism, the disorder is more likely if other symptoms are present. - Anxiety: A common problem in adults with autism, it can present as temper tantrums, depression, obsessive/compulsive tendencies and poor concentration. The above individual symptoms can be common in the general population, but if you are able to identify several characteristics in yourself or a family member, then please consider consulting a professional such as your family doctor or a psychiatrist for further assessment. Please be reassured that you do not have to suffer needlessly. Treatment is available and can improve the quality of your life.