I have finally been able to talk about an incident that occurred over 12 years ago. It was, in my opinion, a harassment case. I was verbally and emotionally abused by 2 young Psychiatrists who were serving as board examiners. They were part of a 4 part process that would determine whether or not I had the ability to hang a banner in my office, declaring, essentially, that I knew how to practice Psychiatry.
Let me start from the beginning. I had to travel to Columbus first to take a lengthy written exam covering all of the expected knowledge I possessed in both Psychiatry and Neurology. It was in the fall of 2002.
The best part of the day was stopping in Cinncinnati to meet up with my son Andy, attending the University there, and Peter and Molly who drove down from Oxford, Ohio. What a joy to be with my children and to of course treat them to this great barbecue restaurant that looked over the Ohio River. I could see Kentucky.
I shared my day with them. I felt good about the exam. I studied and of course I was hoping that I was serving as a good role model to them as well. Mom had gone to medical school when they were all in elementary school. Now here we were, all grown up and discussing our accomplishments with rib sauce covering our smiling faces.
I was not surprised to receive my results. I did well in both areas. I was actually surprised on how well I did in Neurology and attributed this to my residency days in radiology. I loved reading MRI's - especially those related to the brain and give a diagnostic assessment.
Close to 10 months later came the oral part of the boards. I was more confident of this part. After all, I actually served as a mentor to residents during mock oral boards, helping them with the essential part examiners would be judging them on. The biopsychosocial formulation was the key. I was such an expert on this that I eventually wrote a book containing these important factors that influence our mental health.
I travelled to Indianapolis this time. I was, of course, nervous. There were horror stories of board examiners. They could be real pricks and have an agenda. I thought I was prepared for anything. After all, I was a mature, older woman, not a typical candidate, and prepared for pretty much anything. I could diffuse what was thrown my way. All I had to do was impress them with my knowledge, organizational skills, and of course my ability to do a biopsychosocial formulation.
I was first escorted into a room with two older examiners and a young man, a patient in a nearby hospital, volunteering to be examined. I asked my questions without taking notes, and after 30 minutes was asked to present the case.
I loved these 2 gentleman. They conducted themselves in a professional manner and even gave me a smile. They are never to comment on your performance but one individual even praised a question that was asked of the patient. It seemed to make him comfortable, at ease, and spew forth a plethora of information that they themselves did not even know. I'm thinking, "I nailed it". And of course when results were mailed to me, I did. I was passed on all four areas.
Now for the last part of that eventful day.
We were all to watch a video. It was a scenario of a man who had an exacerbation of extreme paranoia when he was in a situation involving a Vietnamese woman. He developed homicidal feeling towards that individual and was hospitalized.
I had this one. I could recite the Tarasoff Law (look it up) forwards and backwards and felt that working with Vietnam vets during my residency had really prepared me to discuss PTSD - Post Traumatic Stress Disorder. I had actually worked at the VA right after my Psych residency and was performing Comp and Pens - a process requiring an in-depth interview and investigation. I would then recommend if their symptoms were indeed related to their war experience. They most always were.
I walked into the room after viewing the video. There sat 2 young men. I could have been their mothers. I sat and began to present as I did in the live interview previously. You know, the one I passed with flying colors. They started to interrupt me. I thought I was in the middle of a criminal investigation but instead of good cop, bad cop, it was bad cop, worse cop.
They essentially were, in my opinion, sabotaging my ability to present. How could they possibly know what I know if they are harassing me. I attempted to not show fear and remained composed. These were 2 men trying to fulfill the urban legend of the evil examiners. Where was the roamer? The roamer is a designated man who is assigned to sit in each room for a brief period to assure non-bias. Are you kidding me? This current setup was so subjective that you could cut it with a dull knife.
He finally came in the room, unassuming, and sat quietly. I knew him. He was the roamer during my first interview. He actually gave me a nod and a smile. I breathed deeply and relaxed in my hard, wooden chair that previously was hooked up to electric wires.
Well wouldn't you know it. The 2 pricks began to conduct themselves in an appropriate manner and began to ask me to proceed. From what point guys? You never asked me for the history of present illness, so do I start at the beginning? What would the roamer think? I am half way through the torture and the roamer would assume that I would be further in my presentation that, to this point, was not allowed by these impostors. I calmly asked them what they would like to know now. The roamer got up and again nodded and turned toward the door. Please don't leave me, I wanted to scream. But he did, not witnessing anything that might be construed as bias.
They turned toward me and asked me repeatedly to list the risk factors that one should assess before discharging a patient that was admitted with homicidal intent. Good question. I had this. I began my list of risk - oops - interrupted again. What the hell. How could they possibly pass judgement on me? Oh, they did all right. Right beneath my outstanding pass of the live interview came their 4 failing marks. How could an individual who taught mock boards and passed a live interview not at least pass one criteria of the pricks?
I therefore failed. It took me only 1 week to recover from the humiliation. I was aware of the process that challenged their finding. My husband and a lawyer and significant fee paid to the American Psych and Neuro Board opened an investigation. My claim was that the 2 young pricks were too subjective. I dare not claim harassment. Why? This is a He Said She Said case. I was never asked to come in for an interview. I was told they would investigate and get back with me. I was surprised at the lack of investigation. NONE. They upheld their decision.
Despite the bias aspect of the oral boards I signed up to take it again. After all, Board Certification defines you.
However, 2 months after receiving the news that I failed, my son Andy died. I withdrew from the oral boards as I was not prepared emotionally and again lost a large portion of my fee to take them.
As time passed, I never thought about taking those boards again. Even though the ABPN did eventually agree that oral boards are too subjective and are no longer part of the Certification Process.
I contacted my friend who heads the Psych residency at University Hospitals. She offered me the opportunity to complete "clinical skills" which would then qualify me to take the written exam. She made my day stating that I would pass with flying colors. The cost? You don' want to know.
I have decided to forego this process. I don't need a plaque on my wall to define me. If it comes to a point where insurance companies will no longer reimburse my agency as I am not certified then that will be a sign from God to retire.
As of now, I have a full load of patients who will wait at a bus stop in subzero temps to make an 8AM appointment. I have patients who show up if they are sick. I rarely have cancellations and if I do, they are readily filled.
I love my patients - each and every one. And I am an excellent Psychiatrist. I don't need 2 pricks to define me. My patient show rate and my ability to keep them off the street, out of the hospital, and not self medicate with alcohol and drugs is praise enough for me.
I am a Patient Certified Psychiatrist and proud of it.
Dr. Elaine A. Campbell- As a Psychiatrist, Mental Wellness and Lifestyle Coach, I am dedicated to healthy-eating, exercise, and to the improvement of our physical and mental well-being. Inspired by my new book, "My Life As A Car; A Mental Wellness Guide In Your Glove Compartment", I will be taking weekly journeys with you, addressing possible bumps in the road and exploring ways to navigate them in a healthy way. So, here's to all of our road trips. May we have a lifetime of Happy Motoring!
Thursday, March 5, 2015
Saturday, January 17, 2015
Angels Among Us
The loss of a child is devastating. It changes one's life forever. I know. My family lost Andy 11 years ago yesterday from an accidental drug overdose.
I should highlight accidental as these beautiful young people with lives ahead of them have no idea the type of drug, quantity, or mix that seals their fate. This mindset results in an unintentional outcome of an ignorant assumption that they are invincible.
I am not writing to address drugs. I have blogged that so many times that people can just pull them up and read to their children.
I am not writing to mourn Andy. After 11 years of holidays, vacations, and every day without him, my posts about him are quite numerous.
I am actually writing today to address something that occurred yesterday that I have no explanation for. The video on my FB page from 1/16/15 with my dog Cole can help elaborate on this wonderful phenomenon.
When I arrived at Lake View Cemetery yesterday morning, I stepped out of the car and panicked. Andy's headstone was similar to the majority of headstones in that lot. A simple granite rectangle that stood no more than 6 inches from the ground. What distinguished it was that the granite had a tinge of orange, his favorite color, and etched portrayal of my beautiful son, an etched Bird of Paradise (his favorite flower) and the words, "We'll see you in our dreams".
But where was the headstone? Where were anyone's headstones. I began to walk to certain landmarks and used my boot heel (with utmost respect) to feel for something other than a snow covered landscape. Now I know why people perch wooden crosses and candy canes up - to easily locate their loved ones.
I kept our black lab, Cole, in the car. His arthritis cannot tolerate too much cold and his paws would have been frozen during my, what seemed an endless, search.
Then a man appeared out of nowhere. There was no vehicle parked nearby but my running car and Cole peering out of the window. He had a snow shovel. Should I be scared? I was alone in a desolate place with nothing but a guitar, a Hawaiian blanket, my iPad, and some Birds of Paradise.
Well that fear never entered my mind. He appeared kind and was walking my way. I asked him if he could help me locate my son's grave. He put a smile on his face, mixed with sympathy and caring. It seemed as though that he already knew my dilemma. He explained that he was there to prepare a grave site for a funeral that would take place on the weekend. A shovel, I thought? Where is the backhoe? The office is at least a quarter mile from here.
He drew a map out of his back pocket and asked me what was the number of my son's plot. When I told him he said, "Well I'll be. I'm to clear a spot just a bit above him. I bet it is over here." I was at least 15 feet off of my target and would never have found it. The landmark tree was gone. He placed his shovel on the exact edge of the headstone, proceeded to clean it off, though ice had obscured any of the etchings, and then was kind enough to see that I had a blanket and continued to clear ample snow for Cole and me.
As he finished I ran to the car to get Cole and lift him to the ground. I locked the car. This process took less than 1 minute. As Cole and I lifted our legs to march through the snow, the man had disappeared. Where could he have gone? There were no footsteps indicating he left but he was nowhere to be found.
At the beginning of the video I actually raise myself up, again looking for the man to thank him. My fingers were almost completely numb and had we not have found the grave I could never have played Blackbird for him on the guitar.
Even hoisting myself up I could not find him in any direction. Do you want to know why?
I didn't look up. He was definitely sent from Heaven. Andy must have sent him for Cole and me. And of course Cole had a little extra energy that visit. I told Cole that we were visiting Andy. However, Cole was only 3 when Andy died and I doubted that there was any association. His tail wagged nonetheless. He had loved Andy. Andy practically raised him as his older siblings were in college. Cole's tail kept wagging and he kept encircling the headstone as if he knew Andy was present. And I believe he was.
Angels among us? You bet. I thank God for the miracle that he brought to me yesterday. My soul will be forever grateful.
Cole hated to leave the gravesite yesterday. He usually keeps a slow pace behind but never lingers. I went back and looked at Cole and said, "Come on, boy. Andy is here with us. He is by your side." He came willingly and I lifted him back in the car. He nestled into the Hawaiian blanket.
We headed home with Andy's presence surrounding us.
Please visit You Tube to see our video: http://youtu.be/bGM_0zBV1VQ
I should highlight accidental as these beautiful young people with lives ahead of them have no idea the type of drug, quantity, or mix that seals their fate. This mindset results in an unintentional outcome of an ignorant assumption that they are invincible.
I am not writing to address drugs. I have blogged that so many times that people can just pull them up and read to their children.
I am not writing to mourn Andy. After 11 years of holidays, vacations, and every day without him, my posts about him are quite numerous.
I am actually writing today to address something that occurred yesterday that I have no explanation for. The video on my FB page from 1/16/15 with my dog Cole can help elaborate on this wonderful phenomenon.
When I arrived at Lake View Cemetery yesterday morning, I stepped out of the car and panicked. Andy's headstone was similar to the majority of headstones in that lot. A simple granite rectangle that stood no more than 6 inches from the ground. What distinguished it was that the granite had a tinge of orange, his favorite color, and etched portrayal of my beautiful son, an etched Bird of Paradise (his favorite flower) and the words, "We'll see you in our dreams".
But where was the headstone? Where were anyone's headstones. I began to walk to certain landmarks and used my boot heel (with utmost respect) to feel for something other than a snow covered landscape. Now I know why people perch wooden crosses and candy canes up - to easily locate their loved ones.
I kept our black lab, Cole, in the car. His arthritis cannot tolerate too much cold and his paws would have been frozen during my, what seemed an endless, search.
Then a man appeared out of nowhere. There was no vehicle parked nearby but my running car and Cole peering out of the window. He had a snow shovel. Should I be scared? I was alone in a desolate place with nothing but a guitar, a Hawaiian blanket, my iPad, and some Birds of Paradise.
Well that fear never entered my mind. He appeared kind and was walking my way. I asked him if he could help me locate my son's grave. He put a smile on his face, mixed with sympathy and caring. It seemed as though that he already knew my dilemma. He explained that he was there to prepare a grave site for a funeral that would take place on the weekend. A shovel, I thought? Where is the backhoe? The office is at least a quarter mile from here.
He drew a map out of his back pocket and asked me what was the number of my son's plot. When I told him he said, "Well I'll be. I'm to clear a spot just a bit above him. I bet it is over here." I was at least 15 feet off of my target and would never have found it. The landmark tree was gone. He placed his shovel on the exact edge of the headstone, proceeded to clean it off, though ice had obscured any of the etchings, and then was kind enough to see that I had a blanket and continued to clear ample snow for Cole and me.
As he finished I ran to the car to get Cole and lift him to the ground. I locked the car. This process took less than 1 minute. As Cole and I lifted our legs to march through the snow, the man had disappeared. Where could he have gone? There were no footsteps indicating he left but he was nowhere to be found.
At the beginning of the video I actually raise myself up, again looking for the man to thank him. My fingers were almost completely numb and had we not have found the grave I could never have played Blackbird for him on the guitar.
Even hoisting myself up I could not find him in any direction. Do you want to know why?
I didn't look up. He was definitely sent from Heaven. Andy must have sent him for Cole and me. And of course Cole had a little extra energy that visit. I told Cole that we were visiting Andy. However, Cole was only 3 when Andy died and I doubted that there was any association. His tail wagged nonetheless. He had loved Andy. Andy practically raised him as his older siblings were in college. Cole's tail kept wagging and he kept encircling the headstone as if he knew Andy was present. And I believe he was.
Angels among us? You bet. I thank God for the miracle that he brought to me yesterday. My soul will be forever grateful.
Cole hated to leave the gravesite yesterday. He usually keeps a slow pace behind but never lingers. I went back and looked at Cole and said, "Come on, boy. Andy is here with us. He is by your side." He came willingly and I lifted him back in the car. He nestled into the Hawaiian blanket.
We headed home with Andy's presence surrounding us.
Please visit You Tube to see our video: http://youtu.be/bGM_0zBV1VQ
Thursday, January 15, 2015
"Remember me, Mom" - From Andy
Well, tomorrow is the day. What was it that I intended to do? Oh, yes. Sit at your gravesite and play Blackbird on my new guitar. Why, you ask? Well, Andy, let me tell you.
I can still see you sitting on the edge of the padded chair in the living room so that your Fender black acoustic could perch on that knee of yours. Aww that knee. You were wearing your favorite corduroys with a big safety pin attempting to conceal a hole in the left side. Come on Andy. I had your closet filled with untattered ones. But they were your favorite and this beautiful recital would not have been as perfect without them. It was so you. Did you know that you are buried in them?
You played Blackbird so perfectly. When did your fingers become so adept to play such a challenging song, the third finger constantly strumming the open G string throughout in McCartney fashion. Did you practice it just to surprise me that night? I will never know the answer to that question but I will let you know that you took my breath away. You always could do that so easily.
One example was when you were assigned to be a shepard in the church Christmas pagent. What? Peter was the angel Gabriel and actually was to stand in the sacred pulpit as he gave his speech. I had to take you to the back of the narthex so that your loud consternations might be muffled. The only thing it did provide during that rehearsal was a sound similar to a distant herd of disgruntled sheep.
But even that act of defiance turned into an act of love. Beneath my bedroom door was slipped your apology letter. "I am sorry, Mom. I will wear that sheet and sandals. I love you very much". Yes, you took my breath away. I kept that note for years, not knowing that I would be reading it to the crowded mourners at your funeral. I wanted them to know you like I knew you. A special child that I had the privilege of caring for for 19 beautiful years.
This blog is too limited to list your breathless moments. But I did want to include the last hug. Not the one you gave me the night before you died. "By Mom, see you tomorrow". No not that one.
It was actually the morning of the day you sang Blackbird to me. It was a Saturday, January 10, 2004. You called me from Shaker Animal Clinic and informed me that you were hungry for something from Heinen's. I took your order, added something extra for love, and delivered it. At the time you were finishing up with a puppy check and joined Dr. Rickards and me in a conversation. You didn't have to. The man with the unruly dog was refusing to step up on the scale. I was always so surprised that you, my thin little man, could scoop them up in your arms and weigh them. Some weighed more than you.
Andy, you came into the waiting room and stood by my side and put your arm around my shoulder and kept it there for such a long time. I forgot what Dr. R and I were discussing. All I could feel was warmth, peace, love. Just from your very touch. Yes, Andy. You took my breath away.
You have also made me a firm believer in God. Looking back now, I see that Saturday as God's way of preparing me that he was about to take you home. There would be too many distractions the rest of the week, so Saturday it was. It was if I were anointed. And then to insist you play Blackbird for me before I left that night was truly heaven sent.
Although Blackbird has been my ring tone since we could pick and choose (of course it took your mother days to figure the freakin' techno stuff out), the moment has been incomplete.
I wrote in my last blog that I am attempting to learn and play Blackbird for you at your grave tomorrow. Dad bought me a new guitar and Peter made me a tutorial. But I have a confession to make.
I have fallen into a deep depression. You know about that. We all had our bouts of sadness - seemed to be on the Arnold genetic side of your Mom. I have attempted to go to work and have to come back home. I always worry how my actions might affect others and rumor has it that patients and staff are a bit disgruntled. Although I do have so many loyal patients and staff who offer prayers for my quick recovery. I am grateful to them.
I mentioned the above because I have been a bit vegetative. I get myself to work and feel the energy, the concentration drain. When I come back home I attempt to do something positive, like practice Blackbird, but have not been successful. So I will do my best today to practice. I just am giving you ample warning that it is far from where I wanted it to be.
Maybe I can blame it on the freezing temp interfering with the vibrations of the strings. I am also bringing a guest if he can make it. Cole is now 13 years old. That black lab has such love inside. Just like you. He is burdened with such arthritis. He has difficulty getting into the car. I wish I had you to scoop him in. I will try my best. I am thinking that he will not live out the year.
So, I wanted to bring Cole to not only give me strength to play, but to also see where his own resting place will be. I think you would like that. I honestly believe that he will go straight to heaven and find you.
Eleven years without you. Yes Mom has been brave and then she turns around and wants to join you. Grief, life stressors - they all play a role. But God is not done with me yet, Andy. I don't know why I am here on earth and why he has chosen to test me with the most difficult of lessons, but I will obey.
I know he exists. He gave me that Saturday with you. Hugs and Blackbirds.
So, as I end this blog, I will emphasize one important lesson I was taught. For those reading this, please take nothing for granted. I was given a beautiful Saturday where my breath was taken away twice and I was cognizant of it. I didn't really know the intention of those moments at the time but I do now. "Remember me, Mom". Oh, Andy, I will never forget. Not for a nanosecond.
Love and Peace to all. Don't let a moment go by without realizing the beauty it contains.
With Peace and Love,
Andy's Mom
P.S. Here is a 24 second clip of a 34 minute tutorial on Blackbird. Given to me at Christmas by my son, Pete Psarras, and played on Andy's guitar.
I can still see you sitting on the edge of the padded chair in the living room so that your Fender black acoustic could perch on that knee of yours. Aww that knee. You were wearing your favorite corduroys with a big safety pin attempting to conceal a hole in the left side. Come on Andy. I had your closet filled with untattered ones. But they were your favorite and this beautiful recital would not have been as perfect without them. It was so you. Did you know that you are buried in them?
You played Blackbird so perfectly. When did your fingers become so adept to play such a challenging song, the third finger constantly strumming the open G string throughout in McCartney fashion. Did you practice it just to surprise me that night? I will never know the answer to that question but I will let you know that you took my breath away. You always could do that so easily.
One example was when you were assigned to be a shepard in the church Christmas pagent. What? Peter was the angel Gabriel and actually was to stand in the sacred pulpit as he gave his speech. I had to take you to the back of the narthex so that your loud consternations might be muffled. The only thing it did provide during that rehearsal was a sound similar to a distant herd of disgruntled sheep.
But even that act of defiance turned into an act of love. Beneath my bedroom door was slipped your apology letter. "I am sorry, Mom. I will wear that sheet and sandals. I love you very much". Yes, you took my breath away. I kept that note for years, not knowing that I would be reading it to the crowded mourners at your funeral. I wanted them to know you like I knew you. A special child that I had the privilege of caring for for 19 beautiful years.
This blog is too limited to list your breathless moments. But I did want to include the last hug. Not the one you gave me the night before you died. "By Mom, see you tomorrow". No not that one.
It was actually the morning of the day you sang Blackbird to me. It was a Saturday, January 10, 2004. You called me from Shaker Animal Clinic and informed me that you were hungry for something from Heinen's. I took your order, added something extra for love, and delivered it. At the time you were finishing up with a puppy check and joined Dr. Rickards and me in a conversation. You didn't have to. The man with the unruly dog was refusing to step up on the scale. I was always so surprised that you, my thin little man, could scoop them up in your arms and weigh them. Some weighed more than you.
Andy, you came into the waiting room and stood by my side and put your arm around my shoulder and kept it there for such a long time. I forgot what Dr. R and I were discussing. All I could feel was warmth, peace, love. Just from your very touch. Yes, Andy. You took my breath away.
You have also made me a firm believer in God. Looking back now, I see that Saturday as God's way of preparing me that he was about to take you home. There would be too many distractions the rest of the week, so Saturday it was. It was if I were anointed. And then to insist you play Blackbird for me before I left that night was truly heaven sent.
Although Blackbird has been my ring tone since we could pick and choose (of course it took your mother days to figure the freakin' techno stuff out), the moment has been incomplete.
I wrote in my last blog that I am attempting to learn and play Blackbird for you at your grave tomorrow. Dad bought me a new guitar and Peter made me a tutorial. But I have a confession to make.
I have fallen into a deep depression. You know about that. We all had our bouts of sadness - seemed to be on the Arnold genetic side of your Mom. I have attempted to go to work and have to come back home. I always worry how my actions might affect others and rumor has it that patients and staff are a bit disgruntled. Although I do have so many loyal patients and staff who offer prayers for my quick recovery. I am grateful to them.
I mentioned the above because I have been a bit vegetative. I get myself to work and feel the energy, the concentration drain. When I come back home I attempt to do something positive, like practice Blackbird, but have not been successful. So I will do my best today to practice. I just am giving you ample warning that it is far from where I wanted it to be.
Maybe I can blame it on the freezing temp interfering with the vibrations of the strings. I am also bringing a guest if he can make it. Cole is now 13 years old. That black lab has such love inside. Just like you. He is burdened with such arthritis. He has difficulty getting into the car. I wish I had you to scoop him in. I will try my best. I am thinking that he will not live out the year.
So, I wanted to bring Cole to not only give me strength to play, but to also see where his own resting place will be. I think you would like that. I honestly believe that he will go straight to heaven and find you.
Eleven years without you. Yes Mom has been brave and then she turns around and wants to join you. Grief, life stressors - they all play a role. But God is not done with me yet, Andy. I don't know why I am here on earth and why he has chosen to test me with the most difficult of lessons, but I will obey.
I know he exists. He gave me that Saturday with you. Hugs and Blackbirds.
So, as I end this blog, I will emphasize one important lesson I was taught. For those reading this, please take nothing for granted. I was given a beautiful Saturday where my breath was taken away twice and I was cognizant of it. I didn't really know the intention of those moments at the time but I do now. "Remember me, Mom". Oh, Andy, I will never forget. Not for a nanosecond.
Love and Peace to all. Don't let a moment go by without realizing the beauty it contains.
With Peace and Love,
Andy's Mom
P.S. Here is a 24 second clip of a 34 minute tutorial on Blackbird. Given to me at Christmas by my son, Pete Psarras, and played on Andy's guitar.
Tuesday, January 6, 2015
For you, Andy.
As the anniversary of my Andy's smile having left this physical world approaches, I always feel compelled to write something about my precious boy. But as the 11th year approaches, and actually falls on that Friday that changed my world forever, I feel very different inside. I feel more vulnerable. And I am scared that I am not the strong person I thought I was.
Now having confessed that, I do have to reassure many, especially my children, that I am not wanting to join his spirit. I am not suicidal but I am not embarrassed to admit that the idea has crossed my mind several times. That confession may result in some individuals having less confidence in me as a Psychiatrist. On the contrary, who better to sit across the desk from the mother whose son was shot in the streets of Cleveland. I KNOW their pain. And when I reassure them that I will guide them through this process of catastrophic grief I can say that with confidence.
But the empathy is cracked and the voice is not ringing loud and proclaiming that there will be victory in recovery. It really never happens. No one but Andy's family knows the pain of burying their son, their brother. And though I never would compare the loss of a child to the loss of a sibling, Andy was a piece of me and he took it with him when he died.
Did you know I lost his twin? Ultrasounds were not performed in those days so when I discovered bleeding at 12 weeks and passed some beautiful mass in the shower I thought I had miscarried. When the Obstetrician did the ultrasound, I saw his figure floating freely. Tears of sorrow turned to tears of joy. I don't really tell that story, but as I said above, I am very vulnerable and need to talk about the joy of having Andy in my life. It was highlighted at that very moment.
I think one of the most challenging times of my life following Andy's death was when we lost our home to the consequences of, shall I say, the economy. When you live in a home for 20 years and collected every precious school paper, apology letter slipped under your door at night, favorite stuffed animals, etc., you cannot possibly be told to gather up and be out in a matter of weeks. So here is my big confession. After realizing that I could never find nor gather all of the precious memories of my family - the pictures, the baptismal outfits, the crib - I made the statement that I would rather douse the house in gasoline and burn with it than have a dumpster with a sliding board from every window collect my possessions. I think I meant it at the time. It represented another huge loss. I have since reconciled that miserable historic moment in my life and now describe it as another learning moment from God.
God, what do you have planned for me? I have understood that from pain comes growth. I have been a fairly good student but a reluctant one. Mother Theresa once quoted something about God not giving us more than we can handle. She then followed up with, "I wish he did not have that much Faith in me". Well, I feel that way at times too but I am attempting to turn this current pain around. Here is my first breakthrough.
Christmas is a tough time as it was Andy's favorite time of year. I am Blessed to already have a few things in place to help me. First of all, my brilliant son, Peter, did something special. He now has Andy's acoustic guitar. Andy played Blackbird for me one week before he died. Those are the facts you need to know.
So, to break through the sorrow, I asked Santa for an acoustic guitar. And to add to the joy, Peter downloaded a tutorial from him, playing it on Andy's guitar, for me. I still cry when I sit down to learn but it is a good thing to work through. I plan to play it at Andy's gravesite on Friday, January 16th. I think he would like that.
I am putting this blog out a bit early. I had more strength today to write. As the bitter cold of January continues, my ability to write a tribute on his anniversary may not be as successful.
I loved my tribute last year and encourage all to revisit that blog. It was the best one I had written. Sorry, Andy. Mom is a bit down in the dumps but my fingers are becoming more calloused and the strings are bringing our song to life. That is a good thing. And I know that I need to work through this.
My thanks to Peter for such a precious gift. Thank you, Jim, for the guitar. Thank you, Molly, for asking me how I am doing and giving me hugs and kisses. And thanks to my sisters, Eloise, Elyse, and Ellen, for being there for me,
Just like Blackbird I am taking these broken wings and learning to fly. I am taking these sunken eyes and learning to see.
Grief is a process. I continue to seek God for strength and I thank all of my family and friends for their support. And Andy would like that.
Now having confessed that, I do have to reassure many, especially my children, that I am not wanting to join his spirit. I am not suicidal but I am not embarrassed to admit that the idea has crossed my mind several times. That confession may result in some individuals having less confidence in me as a Psychiatrist. On the contrary, who better to sit across the desk from the mother whose son was shot in the streets of Cleveland. I KNOW their pain. And when I reassure them that I will guide them through this process of catastrophic grief I can say that with confidence.
But the empathy is cracked and the voice is not ringing loud and proclaiming that there will be victory in recovery. It really never happens. No one but Andy's family knows the pain of burying their son, their brother. And though I never would compare the loss of a child to the loss of a sibling, Andy was a piece of me and he took it with him when he died.
Did you know I lost his twin? Ultrasounds were not performed in those days so when I discovered bleeding at 12 weeks and passed some beautiful mass in the shower I thought I had miscarried. When the Obstetrician did the ultrasound, I saw his figure floating freely. Tears of sorrow turned to tears of joy. I don't really tell that story, but as I said above, I am very vulnerable and need to talk about the joy of having Andy in my life. It was highlighted at that very moment.
I think one of the most challenging times of my life following Andy's death was when we lost our home to the consequences of, shall I say, the economy. When you live in a home for 20 years and collected every precious school paper, apology letter slipped under your door at night, favorite stuffed animals, etc., you cannot possibly be told to gather up and be out in a matter of weeks. So here is my big confession. After realizing that I could never find nor gather all of the precious memories of my family - the pictures, the baptismal outfits, the crib - I made the statement that I would rather douse the house in gasoline and burn with it than have a dumpster with a sliding board from every window collect my possessions. I think I meant it at the time. It represented another huge loss. I have since reconciled that miserable historic moment in my life and now describe it as another learning moment from God.
God, what do you have planned for me? I have understood that from pain comes growth. I have been a fairly good student but a reluctant one. Mother Theresa once quoted something about God not giving us more than we can handle. She then followed up with, "I wish he did not have that much Faith in me". Well, I feel that way at times too but I am attempting to turn this current pain around. Here is my first breakthrough.
Christmas is a tough time as it was Andy's favorite time of year. I am Blessed to already have a few things in place to help me. First of all, my brilliant son, Peter, did something special. He now has Andy's acoustic guitar. Andy played Blackbird for me one week before he died. Those are the facts you need to know.
So, to break through the sorrow, I asked Santa for an acoustic guitar. And to add to the joy, Peter downloaded a tutorial from him, playing it on Andy's guitar, for me. I still cry when I sit down to learn but it is a good thing to work through. I plan to play it at Andy's gravesite on Friday, January 16th. I think he would like that.
I am putting this blog out a bit early. I had more strength today to write. As the bitter cold of January continues, my ability to write a tribute on his anniversary may not be as successful.
I loved my tribute last year and encourage all to revisit that blog. It was the best one I had written. Sorry, Andy. Mom is a bit down in the dumps but my fingers are becoming more calloused and the strings are bringing our song to life. That is a good thing. And I know that I need to work through this.
My thanks to Peter for such a precious gift. Thank you, Jim, for the guitar. Thank you, Molly, for asking me how I am doing and giving me hugs and kisses. And thanks to my sisters, Eloise, Elyse, and Ellen, for being there for me,
Just like Blackbird I am taking these broken wings and learning to fly. I am taking these sunken eyes and learning to see.
Grief is a process. I continue to seek God for strength and I thank all of my family and friends for their support. And Andy would like that.
Thursday, September 18, 2014
Marijuana - It's dangerous no matter how you roll it, Mr. President!!!
For those that read my blog in response to Obama's comment on marijuana, I thank you. I even thank those that bothered to leave comments. After all, when you discuss a topic so controversial such as cannabis and you feel that you have the leader of our country in support of your use and you have states legalizing its use, you expect feedback, right?
I am so sick and tired of the marijuana mentality. I had one person suggest that I "be a better parent". I was not at all surprised by the retaliation. I hear it in my office everyday. "My mood is horrible." What do use to help you through the tough times? "I smoke weed twice a day". " I smoke weed anytime I can get it". " I smoke weed. Meds don't help". Do you have a problem with marijuana? "Hell, no, lady. And if you can't get me anything that works better, I'm outta here".
One patient actually said that if I did not give her something stronger, then she would turn to heroin. And of course it would be my fault.
Sometimes I want to throw my hands up in the air and let them go ahead and ruin their lives. But instead I fold my hands in prayer and think of Andy, my son that felt marijuana was safe - that it was not a gateway drug. Oh, by the way, Candie, this is where you get to comment again on my parenting. But, unfortunately, it is the Candies of the world that have closed their minds to anything but THC. So sad.
Since that blog I was contacted by the assistant marketing manager for Healthline - The Power of Intelligent Health. I wanted to include a link to a powerful source of information. Of course the operative term is intelligence. If you are stoned, your limbic system may not be able to navigate through.
Whoa! I am really out of sorts today. I usually don't take this tone with those who disagree with me but this is a topic close to my heart. If I offended anyone, I do not apologize. Take responsibility for your own actions, don't blame others, and start making better decisions for yourself.
Healthline just published an infographic detailing how marijuana affects the body. This is an interactive chart, allowing the reader to pick the side effect they want to learn more about.
You can see the overview of the report here:
I am so sick and tired of the marijuana mentality. I had one person suggest that I "be a better parent". I was not at all surprised by the retaliation. I hear it in my office everyday. "My mood is horrible." What do use to help you through the tough times? "I smoke weed twice a day". " I smoke weed anytime I can get it". " I smoke weed. Meds don't help". Do you have a problem with marijuana? "Hell, no, lady. And if you can't get me anything that works better, I'm outta here".
One patient actually said that if I did not give her something stronger, then she would turn to heroin. And of course it would be my fault.
Sometimes I want to throw my hands up in the air and let them go ahead and ruin their lives. But instead I fold my hands in prayer and think of Andy, my son that felt marijuana was safe - that it was not a gateway drug. Oh, by the way, Candie, this is where you get to comment again on my parenting. But, unfortunately, it is the Candies of the world that have closed their minds to anything but THC. So sad.
Since that blog I was contacted by the assistant marketing manager for Healthline - The Power of Intelligent Health. I wanted to include a link to a powerful source of information. Of course the operative term is intelligence. If you are stoned, your limbic system may not be able to navigate through.
Whoa! I am really out of sorts today. I usually don't take this tone with those who disagree with me but this is a topic close to my heart. If I offended anyone, I do not apologize. Take responsibility for your own actions, don't blame others, and start making better decisions for yourself.
Healthline just published an infographic detailing how marijuana affects the body. This is an interactive chart, allowing the reader to pick the side effect they want to learn more about.
You can see the overview of the report here:
http://www.healthline.com/health/addiction/marijuana/effects-on-body
Friday, August 22, 2014
My Turn - The Ice Bucket Challenge
Note to self. Do not gloat and breathe a sigh of relief after viewing friends and family dumping buckets of icy water on their heads in recognition of ALS and not be named in the challenge. Remember. Your daughter, who is bound to be nominated, has been watching you with eager anticipation.
Yes, Molly nominated me. I took great enjoyment watching others douce themselves in the name of ALS awareness and research. What an ingenious way of spreading the cause. Facebook became another way of reaching millions of viewers via SHARE. The enthusiasm became viral.
Of course, despite the laughter and rekindling of friendships that this challenge has created, it also represents a worthy cause. Not since Lou Gehrig's famous address in Yankee stadium decades ago has ALS received so much focus and attention.
Let's test your knowledge of ALS.
Amyotrophic Lateral Sclerosis is a debilitating illness affecting the motor neurons. It is progressive in its paralysis of muscles including those necessary for breathing and swallowing. The life expectancy after diagnosis is 2 to 5 years. Victims retain their mental capacity and are aware of their disabilities. Understandably, their is a high comorbidity of depression and suicide.
Did you know that 15 people are diagnosed every day? That is 5,600 cases per year. Currently there are 30,000 Americans diagnosed with ALS.
It is not considered to be exclusively due to genetics. Only 10% of those diagnosed have a family history of ALS. That statistic infers that 90% of cases do not.
With regard to other statistics, the majority of individuals affected by ALS are between the ages of 60 and 69 but those younger are not immune. As a matter of fact, the person thought responsible for the Ice Bucket Challenge for ALS is 29 years old and was diagnosed in 2012.
As we have seen in Breast Cancer and Aids awareness, research plays a critical role in improving detection and identifying risk factors. Some studies have revealed that military veterans who served in the Gulf War are two times as likely to develop it compared to the general population. Males have a 20% increased chance of developing ALS while Caucasions have a 93% chance.
The ALS organization, previously receiving $1.6 million in donations, has received, as of August 21st, more than $40 million as a result of ice bucket challenges.
So, as I raise my bucket later today, I will not lose site of the important cause my goose bumps will support. I will also donate the $100 pledge to support further research.
Now. Who can I nominate? Hmmm.....................................................................................................
Yes, Molly nominated me. I took great enjoyment watching others douce themselves in the name of ALS awareness and research. What an ingenious way of spreading the cause. Facebook became another way of reaching millions of viewers via SHARE. The enthusiasm became viral.
Of course, despite the laughter and rekindling of friendships that this challenge has created, it also represents a worthy cause. Not since Lou Gehrig's famous address in Yankee stadium decades ago has ALS received so much focus and attention.
Let's test your knowledge of ALS.
Amyotrophic Lateral Sclerosis is a debilitating illness affecting the motor neurons. It is progressive in its paralysis of muscles including those necessary for breathing and swallowing. The life expectancy after diagnosis is 2 to 5 years. Victims retain their mental capacity and are aware of their disabilities. Understandably, their is a high comorbidity of depression and suicide.
Did you know that 15 people are diagnosed every day? That is 5,600 cases per year. Currently there are 30,000 Americans diagnosed with ALS.
It is not considered to be exclusively due to genetics. Only 10% of those diagnosed have a family history of ALS. That statistic infers that 90% of cases do not.
With regard to other statistics, the majority of individuals affected by ALS are between the ages of 60 and 69 but those younger are not immune. As a matter of fact, the person thought responsible for the Ice Bucket Challenge for ALS is 29 years old and was diagnosed in 2012.
As we have seen in Breast Cancer and Aids awareness, research plays a critical role in improving detection and identifying risk factors. Some studies have revealed that military veterans who served in the Gulf War are two times as likely to develop it compared to the general population. Males have a 20% increased chance of developing ALS while Caucasions have a 93% chance.
The ALS organization, previously receiving $1.6 million in donations, has received, as of August 21st, more than $40 million as a result of ice bucket challenges.
So, as I raise my bucket later today, I will not lose site of the important cause my goose bumps will support. I will also donate the $100 pledge to support further research.
Now. Who can I nominate? Hmmm.....................................................................................................
Wednesday, August 13, 2014
A Tribute to Robin - Suicide Awareness
It was not long ago that the media was focused on Heroin following the death of actor Philip Seymour Hoffman. Although the fatalities resulting from accidental overdoses of this deadly opiate have surpassed deaths from MVA's and homocides in my city alone, the truth often times requires a jolt to our senses. We were in disbelief. Not that this esteemed actor could have suffered from such an addiction but that he was unaware of the potency of the heroin he was using - that he would die that night. It was ruled an accidental overdose. Lesson learned? Heroin is equally capable of causing death as it is euphoria.
Sadly, we are now focused on suicide. We struggle again with our confusion over Robin William's death. Although the circumstances are different, one death accidental, the other, intentional, we struggle with the circumstances surrounding his death - recent attempts to maintain sobriety, knowledge that he was suffering from a severe depression, the awareness that Robin KNEW he would die that night. We just don't want to go there. We don't want to permit our senses to imagine the severe pain he was in.
Now we are focusing on the topic of Suicide. And it seems appropriate for me to follow yesterday's blog devoted to depression with this topic. I had published this suicide article some years ago in a 4 part series dealing with depression. The risks and warning signs are listed. But as we all have concluded, no one can accurately predict the intentions of those that suffer.
The one thing I have learned throughout the years - if one intends to die, they most likely will be successful. The most important risk factors I know are a previous history of attempts, use of alcohol or drugs that can lower inhibitions, the likelihood of rescue is reduced, and, a seldom discussed risk factor - a change in energy and mood.
Allow me to elaborate. If the individual suddenly shows a change in their mood or energy level, e.g., wanting to shop or go outside vs. isolating and beginning to display a smile vs. crying, then consider that suicidal intent may already be present. The smile may indicated an internal resolution that the decision to end his/her life has finally been made. The increased energy allows the sufferer to develop the plan and carry out the intent. Lesson learned? No one is immune.
Below is my original blog.
Over 34,000 people die of suicide a year - translating to one person dying every 15 minutes. Although women are more likely to try, men are more successful because of the more violent means they choose - firearms or hanging. 90% of adults and 60% of adolescents who commit suicide have a diagnosed mental illness, especially depression or substance abuse. And, sadly, 70% of older individuals visited their PCP within the month of their suicide.
The above statistics are important as it underscores this very important consideration - that suicide might be preventable.
Again, I always consider the Biopsychosocial characteristics of an individual when considering signs of suicide as well as risks of suicide. And why? Because there is no poster person that represents the face of suicide. Although statistics are an important consideration, it is the individual we are truly analyzing.
The following are WARNING SIGNS listed by a Suicide Prevention Program called Yellow Ribbon. Please visit them at www.yellowribbon.org:
WARNING SIGNS
Abrupt changes in personality
Giving away possessions
Previous suicide attempt
Use of drugs and/or alcohol
Change in eating pattern - significant weight change
Change in sleeping pattern - insomnia/oversleeping
Unwillingness or inability to communicate
Depression
Extreme or extended boredom
Accident prone (carelessness)
Unusual sadness, discouragement and loneliness.
Talk of wanting to die
Neglect of academic work and/or personal appearance
Family disruptions - divorce, trauma, losing loved one.
Running away from home or truancy from school.
Rebelliousness - reckless behavior.
Withdrawal from people/activities they love.
Confusion - Inability to concentrate
Chronic Pain, Panic or Anxiety
Perfectionism
Restlessness
Many of the above warning signs refer to the biological and psychological factors I discussed in previous posts. Yellow Ribbon also emphasizes the need to consider the RISK FACTORS. Many of those listed here refer to the sociological factors. Coupling the two gives a clearer suicidal risk. I agree entirely.
RISK FACTORS
Problems with school or the law
Breakup of a romance
Unexpected pregnancy
A stressful family life. (having parents
who are depressed or are substance
abusers, or a family history of suicide
Loss of security...fear of authority, peers,
group or gang members
Stress due to new situations; college
or relocating to a new community
Failing in school or failing to pass
an important test
A serious illness or injury to oneself
Seriously injuring another person or
causing another person's death
(example: automobile accident)
Major loss...of a loved one,
a home, divorce in the family,
a trauma, a relationship
Yellow Ribbon stresses the following:
Suicide victims are not trying to end their life - they are trying to end the pain!
How can we help?
First of all, don't be afraid to be direct. Talk openly and matter-of-factly about suicide.
You have to be willing to listen. Allow the person to express their feelings.
Do not be judgmental. Don't debate whether suicide is right or wrong, or feelings are good or bad. Don't lecture on the value of life.
Don't be afraid to get involved, to be available, to show interest and support
Don't act shocked. You want to maintain their trust in you,
Don't be sworn to secrecy.
Offer hope that alternatives are available but do not offer glib reassurance.
Ask if they have a plan. Take action. Remove any means, such as guns or stockpiled pills.
Get help from persons or agencies specializing in crisis intervention and suicide prevention.
If you are experiencing thoughts of suicide, or have even developed a plan or have the intent, please contact someone you know, visit the closest ER or call the number listed below.
If you are worried about someone and see some warning signs and/or identify risks, please consider getting involved.
The National Hopeline Network 1-800-SUICIDE provides access to trained telephone counselors, 24 hours a day, 7 days a week.
When I lost my son, Andy, at age 19, to an accidental drug overdose, I started a foundation modeled after Jason's Foundation which is dedicated to the silent epidemic of teen suicide. Please visit www.jasonfoundation.com if you are concerned about our younger generation.
Peace be with you, Robin.
Sadly, we are now focused on suicide. We struggle again with our confusion over Robin William's death. Although the circumstances are different, one death accidental, the other, intentional, we struggle with the circumstances surrounding his death - recent attempts to maintain sobriety, knowledge that he was suffering from a severe depression, the awareness that Robin KNEW he would die that night. We just don't want to go there. We don't want to permit our senses to imagine the severe pain he was in.
Now we are focusing on the topic of Suicide. And it seems appropriate for me to follow yesterday's blog devoted to depression with this topic. I had published this suicide article some years ago in a 4 part series dealing with depression. The risks and warning signs are listed. But as we all have concluded, no one can accurately predict the intentions of those that suffer.
The one thing I have learned throughout the years - if one intends to die, they most likely will be successful. The most important risk factors I know are a previous history of attempts, use of alcohol or drugs that can lower inhibitions, the likelihood of rescue is reduced, and, a seldom discussed risk factor - a change in energy and mood.
Allow me to elaborate. If the individual suddenly shows a change in their mood or energy level, e.g., wanting to shop or go outside vs. isolating and beginning to display a smile vs. crying, then consider that suicidal intent may already be present. The smile may indicated an internal resolution that the decision to end his/her life has finally been made. The increased energy allows the sufferer to develop the plan and carry out the intent. Lesson learned? No one is immune.
Below is my original blog.
Over 34,000 people die of suicide a year - translating to one person dying every 15 minutes. Although women are more likely to try, men are more successful because of the more violent means they choose - firearms or hanging. 90% of adults and 60% of adolescents who commit suicide have a diagnosed mental illness, especially depression or substance abuse. And, sadly, 70% of older individuals visited their PCP within the month of their suicide.
The above statistics are important as it underscores this very important consideration - that suicide might be preventable.
Again, I always consider the Biopsychosocial characteristics of an individual when considering signs of suicide as well as risks of suicide. And why? Because there is no poster person that represents the face of suicide. Although statistics are an important consideration, it is the individual we are truly analyzing.
The following are WARNING SIGNS listed by a Suicide Prevention Program called Yellow Ribbon. Please visit them at www.yellowribbon.org:
WARNING SIGNS
Abrupt changes in personality
Giving away possessions
Previous suicide attempt
Use of drugs and/or alcohol
Change in eating pattern - significant weight change
Change in sleeping pattern - insomnia/oversleeping
Unwillingness or inability to communicate
Depression
Extreme or extended boredom
Accident prone (carelessness)
Unusual sadness, discouragement and loneliness.
Talk of wanting to die
Neglect of academic work and/or personal appearance
Family disruptions - divorce, trauma, losing loved one.
Running away from home or truancy from school.
Rebelliousness - reckless behavior.
Withdrawal from people/activities they love.
Confusion - Inability to concentrate
Chronic Pain, Panic or Anxiety
Perfectionism
Restlessness
Many of the above warning signs refer to the biological and psychological factors I discussed in previous posts. Yellow Ribbon also emphasizes the need to consider the RISK FACTORS. Many of those listed here refer to the sociological factors. Coupling the two gives a clearer suicidal risk. I agree entirely.
RISK FACTORS
Problems with school or the law
Breakup of a romance
Unexpected pregnancy
A stressful family life. (having parents
who are depressed or are substance
abusers, or a family history of suicide
Loss of security...fear of authority, peers,
group or gang members
Stress due to new situations; college
or relocating to a new community
Failing in school or failing to pass
an important test
A serious illness or injury to oneself
Seriously injuring another person or
causing another person's death
(example: automobile accident)
Major loss...of a loved one,
a home, divorce in the family,
a trauma, a relationship
Yellow Ribbon stresses the following:
Suicide victims are not trying to end their life - they are trying to end the pain!
How can we help?
First of all, don't be afraid to be direct. Talk openly and matter-of-factly about suicide.
You have to be willing to listen. Allow the person to express their feelings.
Do not be judgmental. Don't debate whether suicide is right or wrong, or feelings are good or bad. Don't lecture on the value of life.
Don't be afraid to get involved, to be available, to show interest and support
Don't act shocked. You want to maintain their trust in you,
Don't be sworn to secrecy.
Offer hope that alternatives are available but do not offer glib reassurance.
Ask if they have a plan. Take action. Remove any means, such as guns or stockpiled pills.
Get help from persons or agencies specializing in crisis intervention and suicide prevention.
If you are experiencing thoughts of suicide, or have even developed a plan or have the intent, please contact someone you know, visit the closest ER or call the number listed below.
If you are worried about someone and see some warning signs and/or identify risks, please consider getting involved.
The National Hopeline Network 1-800-SUICIDE provides access to trained telephone counselors, 24 hours a day, 7 days a week.
When I lost my son, Andy, at age 19, to an accidental drug overdose, I started a foundation modeled after Jason's Foundation which is dedicated to the silent epidemic of teen suicide. Please visit www.jasonfoundation.com if you are concerned about our younger generation.
Peace be with you, Robin.
Tuesday, August 12, 2014
In memory of Robin - May your legacy inspire others to seek help for depression.
As we all attempt to understand the tragic death of Robin Williams, a man whose unique talents could make us laugh like no other, we are also contemplating the question, "why?". Why could this man, who was blessed with so many riches, be depressed as the reports are bearing out. Some reports have gone so far as to speculate suicide. We are in disbelief. How could this be?
Did you not think he was human? That he was immune to influences that affect us all - our family history, our ability to cope, our daily stressors? His laughter lifted many of us out of the doldrums, me included. And his sensitivity, his ability to play roles that demanded he tap into his emotional side, enabled him to portray award worthy roles such as Patch Adams and the professor in Dead Poet's Society. But Depression knows no boundaries.
This blog is devoted to Robin Williams. May his legacy inspire others to seek the treatment they need for depression.
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.
Did you not think he was human? That he was immune to influences that affect us all - our family history, our ability to cope, our daily stressors? His laughter lifted many of us out of the doldrums, me included. And his sensitivity, his ability to play roles that demanded he tap into his emotional side, enabled him to portray award worthy roles such as Patch Adams and the professor in Dead Poet's Society. But Depression knows no boundaries.
This blog is devoted to Robin Williams. May his legacy inspire others to seek the treatment they need for depression.
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.
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.
Sunday, May 25, 2014
To my Dad and to our Veterans - You are not forgotten!
My career path was always meant to land me as a Psychiatrist at the VA. I began my career in 2002 at the Brecksville, Ohio VA. To all of the military men and women that were under my care, it was truly a privilege.
My love of the military and my compassion for their heroism and their bravery began when I was a wee lass watching my Dad attempt to hold his hand steady as he worked on his beloved hobbies. When I was older I asked Mom what she understood his problem to be. In those days, long before Post Traumatic Stress Disorder became a recognized disorder in the l980's, it was termed "Shell Shock". My father served in World War II. He was stationed in Germany. The answer satisfied me at the time.
I was priveleged to have Dad leave Pennsylvania and come to Brown Country to stay with us after Mom died. Ellen, my youngest sister, married and left home, in the mid '90's and stubborn Dad was determined to initially gut it out. His health was failing, however, and I can remember one stormy Christmas eve going home to rescue him. The greatest gift that year was having him "home" for Christmas.
It was during his stay with me that I was able to retrieve from his feeble short term impaired but definitely long term intact memory some of the trauma that he endured. Some of the events were survived by his mature defense mechanism of humor. Others were repressed for years and were manifested by agitation, heightened body arousal, avoidance of certain topics, flashbacks, and, most of all, survivor guilt.
His favorite story was the time he sat in the mess hall in Germany with his "men" - Dad was their Sergeant. The air raid alert went off just as they were about to enjoy the first steak meal they had been given to reward them for their many efforts in disabling German land mines. I could just see the wooden tables lined with metal plates and a meager steak that probably looked more like a Porterhouse to them. But there was no ignoring the siren. The troops ran to the lower bunker while bombs landed in close proximity. The impact had shattered the windows only, but the mess hall was intact. Well, all but the steaks. Those metal plates lucky enough to endure the impact now had a few more items added to the meal - shards of glass. Other steaks were blown off the table and were now displaying dirt as well as glass. Well, what does one do in that situation? Dad just laughed and never gave me a straight answer. But I bet the medic was busy treating some multiple mouth lacerations!
The difficult memory that Dad finally felt comfortable and safe in sharing with me over our morning coffee (a cherished time of day with Dad) was the time he was asked to leave his troops and fly to Great Britain. You see, Dad was the expert on dismantling a certain German land mine. Dad did not want to go but a new troop leader was already assigned and you don't ignore orders.
While Dad was absent his troop came under attack. The newly assigned leader panicked and went AWOL and his troop was lost. Dad never recovered. He spent most of his time trying to locate men not only while fulfilling his military commitment, but also until drawing his last breath. He had survivor guilt. He suffered from PTSD. My dear father kept these matters of the heart hidden all of those years. I wanted to hug him and reassure him that it was not his fault. But there are some hurts so deep that only certain actions can begin to heal.
For Dad, his healing was visiting every Vet he knew in our community. He dragged Mom to every Rainbow Division reunion. And every memorial day, when the local cemetery did not place flags on the veterans graves, Dad was out early that day, putting down his garden knee pad and knelt at each grave while placing a flag to honor their memory.
There are so many people that I have lost in my life. My favorite memory was watching Dad pull up a chair at the dining room window with our yellow lab, Scarlett. Dad was waiting for our youngest son, Andy, to be dropped off by the school bus. When Dad would spot the red blinkers arriving in front of the driveway he would shout to Scarlett, "Where's Andy?". Scarlett would come, sit next to Dad as Andy walked up the drive way and wag her tail. "Andy's home, girl".
One day I will write a blog about PTSD. But this Memorial Day Weekend I just want to remember Dad and the beautiful lessons he taught. You might sum his lessons up in these words, Love, Commitment, Devotion, and being the Best at what you were chosen to be.
Dad, you were the best Father, the best Grandfather, and the best Friend imaginable. I hope you have finally found your "men", I hope you and Mom are getting along OK, and finally, when you and Scarlett saw Andy come Home, all too soon, I hope you held out your arms, hugged him tight and made him feel loved and safe, just as you always had.
Happy Memorial Day, Dad. My flag is flying for you and our many deserving Veterans. Thank you for serving our country, and God Bless America!
My love of the military and my compassion for their heroism and their bravery began when I was a wee lass watching my Dad attempt to hold his hand steady as he worked on his beloved hobbies. When I was older I asked Mom what she understood his problem to be. In those days, long before Post Traumatic Stress Disorder became a recognized disorder in the l980's, it was termed "Shell Shock". My father served in World War II. He was stationed in Germany. The answer satisfied me at the time.
I was priveleged to have Dad leave Pennsylvania and come to Brown Country to stay with us after Mom died. Ellen, my youngest sister, married and left home, in the mid '90's and stubborn Dad was determined to initially gut it out. His health was failing, however, and I can remember one stormy Christmas eve going home to rescue him. The greatest gift that year was having him "home" for Christmas.
It was during his stay with me that I was able to retrieve from his feeble short term impaired but definitely long term intact memory some of the trauma that he endured. Some of the events were survived by his mature defense mechanism of humor. Others were repressed for years and were manifested by agitation, heightened body arousal, avoidance of certain topics, flashbacks, and, most of all, survivor guilt.
His favorite story was the time he sat in the mess hall in Germany with his "men" - Dad was their Sergeant. The air raid alert went off just as they were about to enjoy the first steak meal they had been given to reward them for their many efforts in disabling German land mines. I could just see the wooden tables lined with metal plates and a meager steak that probably looked more like a Porterhouse to them. But there was no ignoring the siren. The troops ran to the lower bunker while bombs landed in close proximity. The impact had shattered the windows only, but the mess hall was intact. Well, all but the steaks. Those metal plates lucky enough to endure the impact now had a few more items added to the meal - shards of glass. Other steaks were blown off the table and were now displaying dirt as well as glass. Well, what does one do in that situation? Dad just laughed and never gave me a straight answer. But I bet the medic was busy treating some multiple mouth lacerations!
The difficult memory that Dad finally felt comfortable and safe in sharing with me over our morning coffee (a cherished time of day with Dad) was the time he was asked to leave his troops and fly to Great Britain. You see, Dad was the expert on dismantling a certain German land mine. Dad did not want to go but a new troop leader was already assigned and you don't ignore orders.
While Dad was absent his troop came under attack. The newly assigned leader panicked and went AWOL and his troop was lost. Dad never recovered. He spent most of his time trying to locate men not only while fulfilling his military commitment, but also until drawing his last breath. He had survivor guilt. He suffered from PTSD. My dear father kept these matters of the heart hidden all of those years. I wanted to hug him and reassure him that it was not his fault. But there are some hurts so deep that only certain actions can begin to heal.
For Dad, his healing was visiting every Vet he knew in our community. He dragged Mom to every Rainbow Division reunion. And every memorial day, when the local cemetery did not place flags on the veterans graves, Dad was out early that day, putting down his garden knee pad and knelt at each grave while placing a flag to honor their memory.
There are so many people that I have lost in my life. My favorite memory was watching Dad pull up a chair at the dining room window with our yellow lab, Scarlett. Dad was waiting for our youngest son, Andy, to be dropped off by the school bus. When Dad would spot the red blinkers arriving in front of the driveway he would shout to Scarlett, "Where's Andy?". Scarlett would come, sit next to Dad as Andy walked up the drive way and wag her tail. "Andy's home, girl".
One day I will write a blog about PTSD. But this Memorial Day Weekend I just want to remember Dad and the beautiful lessons he taught. You might sum his lessons up in these words, Love, Commitment, Devotion, and being the Best at what you were chosen to be.
Dad, you were the best Father, the best Grandfather, and the best Friend imaginable. I hope you have finally found your "men", I hope you and Mom are getting along OK, and finally, when you and Scarlett saw Andy come Home, all too soon, I hope you held out your arms, hugged him tight and made him feel loved and safe, just as you always had.
Happy Memorial Day, Dad. My flag is flying for you and our many deserving Veterans. Thank you for serving our country, and God Bless America!
Wednesday, February 19, 2014
Will You Join In My Crusade?
Today, I should be celebrating as Andy's friends are dressing in thier suits and travelling to Columbus to face the Ohio Legislature. They are speaking in support of a bill entitled the Good Samaritan Law which is up for passage today. This law, currently in 17 other states, protects people from prosecution if they call 911 to assist someone who is at risk of an opioid-related overdose. So why am I so sad?
Well, for starters, it won't bring Andy back. But then you say, think of the number of people it will save. Well my answer is this. It will depend upon the person or the company that individual is in. If they are using heroin as well and not acting as the designated "party police", then you are decreasing the odds that someone will have the good sense to act accordingly. My son died alone on a bathroom floor because the drug dealer was called first. Blue-tinged skin was the ultimate warning sign to call 911. I do hope and pray that this law will be enacted and that teenagers' fear of possible repercussions by police will be tempered. I'm skeptical but it may come to pass and the right call will be made. I strongly urge police to get out into the community and into the schools to educate drug users about the law so that life saving decisions can be made without hesitation.
With regard to naloxone, or Narcan - the drug used to reverse the harmful and deadly effects of an opiod like Heroin, I am truly conflicted. Putting Narcan in the hands of parents and police sounds great as a first response agent. It could also save lives. I am not convinced that this is necessarily a good thing in the hands of users. This is not a black or white issue. There is so much gray area. There will always be the following senario, in my opinion. There will be as many saved as there will be those that get a false sense of security. They may tend to party more recklessly and, as a result, die. But, again, naloxone could have saved Andy. The paramedics tried. It was too late.
Now the Good Samaritan Law and availability of Narcan have finally come as a result of Heroin deaths exceeding homicides and MVA's in Cuyahoga county. It could be more in your own county. But here is a sobering statistic. The deaths in Vietnam are equal in number to drug deaths every 18 months. What took them so freakin' long? I was down in Columbus in 2004 speaking with, then, Governor Taft's assistant. Ten years later and shocking death rates should not be the reason you act. Saving one life is worth this Law.
My question is why hasn't Ohio held drug dealers accountable for murder when a death occurs from their transaction?
Unfortunately some of the resistance out there was brought to my attention during a phone call from one of Andy's friends. He was not in favor of such a law for a number of reasons.
1) "Users know they can die from Heroin". Really? So that's why drug dealers can get away with murder? They don't have to be responsible for their illegal action? That is such bull shit! Andy didn't think he was going to die. He wanted to get high with friends. Teens think they are invincible.
2) "There are addicts that deal to support their habit - not to buy expensive cars." Again, bull shit. You are making a choice to sell an illegal substance no matter what the reason. He feels that the punishment should not be the same. Well if you murder someone with your actions there should be a consequence determined by the court. If you are a long time criminal then let the sentence fit the crime. If you are an addict, then the courts should enforce mandatory treatment and probation. As a physician, I would be hauled off in court if I caused a death. And the medication that I prescribed is legal and I have no malintent. Your drugs are illegal and you know that they kill. To me this is a no-brainer.
The other comment he made was in response to my concern over teens' possible cavalier use of Heroin should Narcan be available to them. He actually stated that "no one wants to go through opiod withdrawal - I don't think anyone would use enough heroin to experience Narcan effects". So an addict actually knows when they are below the lethal level? Andy didn't. He died of 1/7th of a lethal dose because he was allergic to codeine - a drug cut into street heroin. And now with fentanyl contaminated heroin, deaths are skyrocketing. And secondly, wouldn't you want to feel withdrawal to know that you are alive? Be glad you can draw breath and feel the pain!!!!
I understand his defense. It's like Jean Valjean being punished for stealing a loaf of bread. There are so many reasons for crimes. They don't see the seriousness of their choice to sell drugs or the potential harm it can cause. And it's not just the possibility of death. Think about introducing youth to drugs which increases their risk of addiction. And wonder if any of those individuals that were hooked on those drugs went on to die? Ever think of that? We all take responsibility for our actions. And hopefully we live to learn from our mistakes. Drug dealers need to be held responsibility for theirs.
With thoughts of Les Miserable and the controversy over the degree of a crime, I ask if anyone out there will join in my crusade? Can you hear the shouts of angry and grieving parents burying their children at the hands of these drug dealers who get away with murder? If so, please write to your Congressmen to make your feelings known.
Finally, thank you, Ohio, for taking the first step. It's been a long time coming. Let's continue the fight.
Well, for starters, it won't bring Andy back. But then you say, think of the number of people it will save. Well my answer is this. It will depend upon the person or the company that individual is in. If they are using heroin as well and not acting as the designated "party police", then you are decreasing the odds that someone will have the good sense to act accordingly. My son died alone on a bathroom floor because the drug dealer was called first. Blue-tinged skin was the ultimate warning sign to call 911. I do hope and pray that this law will be enacted and that teenagers' fear of possible repercussions by police will be tempered. I'm skeptical but it may come to pass and the right call will be made. I strongly urge police to get out into the community and into the schools to educate drug users about the law so that life saving decisions can be made without hesitation.
With regard to naloxone, or Narcan - the drug used to reverse the harmful and deadly effects of an opiod like Heroin, I am truly conflicted. Putting Narcan in the hands of parents and police sounds great as a first response agent. It could also save lives. I am not convinced that this is necessarily a good thing in the hands of users. This is not a black or white issue. There is so much gray area. There will always be the following senario, in my opinion. There will be as many saved as there will be those that get a false sense of security. They may tend to party more recklessly and, as a result, die. But, again, naloxone could have saved Andy. The paramedics tried. It was too late.
Now the Good Samaritan Law and availability of Narcan have finally come as a result of Heroin deaths exceeding homicides and MVA's in Cuyahoga county. It could be more in your own county. But here is a sobering statistic. The deaths in Vietnam are equal in number to drug deaths every 18 months. What took them so freakin' long? I was down in Columbus in 2004 speaking with, then, Governor Taft's assistant. Ten years later and shocking death rates should not be the reason you act. Saving one life is worth this Law.
My question is why hasn't Ohio held drug dealers accountable for murder when a death occurs from their transaction?
Unfortunately some of the resistance out there was brought to my attention during a phone call from one of Andy's friends. He was not in favor of such a law for a number of reasons.
1) "Users know they can die from Heroin". Really? So that's why drug dealers can get away with murder? They don't have to be responsible for their illegal action? That is such bull shit! Andy didn't think he was going to die. He wanted to get high with friends. Teens think they are invincible.
2) "There are addicts that deal to support their habit - not to buy expensive cars." Again, bull shit. You are making a choice to sell an illegal substance no matter what the reason. He feels that the punishment should not be the same. Well if you murder someone with your actions there should be a consequence determined by the court. If you are a long time criminal then let the sentence fit the crime. If you are an addict, then the courts should enforce mandatory treatment and probation. As a physician, I would be hauled off in court if I caused a death. And the medication that I prescribed is legal and I have no malintent. Your drugs are illegal and you know that they kill. To me this is a no-brainer.
The other comment he made was in response to my concern over teens' possible cavalier use of Heroin should Narcan be available to them. He actually stated that "no one wants to go through opiod withdrawal - I don't think anyone would use enough heroin to experience Narcan effects". So an addict actually knows when they are below the lethal level? Andy didn't. He died of 1/7th of a lethal dose because he was allergic to codeine - a drug cut into street heroin. And now with fentanyl contaminated heroin, deaths are skyrocketing. And secondly, wouldn't you want to feel withdrawal to know that you are alive? Be glad you can draw breath and feel the pain!!!!
I understand his defense. It's like Jean Valjean being punished for stealing a loaf of bread. There are so many reasons for crimes. They don't see the seriousness of their choice to sell drugs or the potential harm it can cause. And it's not just the possibility of death. Think about introducing youth to drugs which increases their risk of addiction. And wonder if any of those individuals that were hooked on those drugs went on to die? Ever think of that? We all take responsibility for our actions. And hopefully we live to learn from our mistakes. Drug dealers need to be held responsibility for theirs.
With thoughts of Les Miserable and the controversy over the degree of a crime, I ask if anyone out there will join in my crusade? Can you hear the shouts of angry and grieving parents burying their children at the hands of these drug dealers who get away with murder? If so, please write to your Congressmen to make your feelings known.
Finally, thank you, Ohio, for taking the first step. It's been a long time coming. Let's continue the fight.
Sunday, February 2, 2014
Calgon, Take me Away; Hashtag, #Life Sucks!
As a Baby Boomer I have been very challenged these days in dealing with the whining and griping of thousands of groups with some central theme to complain about. This post is just my way of getting things off my chest. In the good ol' days it was drawing a warm bath and allowing Calgon to "take you away" - kids ask your parents what that means. It was a clean way of escaping and is not a slang term for pot or whatever the hell used today to escape your woes. But if I were to jump in the tub with every thing I hear or read these days my skin would look like a prune.
Although I am in no way politically savvy, some of the comments I do have are directed at minimum wage and healthcare. And God knows I am not a saint, but some of my comments will be directed at pray and Christmas. And though I have never smoked pot, I do consider myself quite educated on the topic of drugs and alcohol and plan to address that as well.
Now to have the guts to address my concerns on paper, you would think I would need a "backbone" to be prepared for the onslaught of dissenters. Not really. I learned from my parents, a Dad who fought in WW II and a Mom who taught me to dream big, that America was built and defended by those who believed that, if I worked hard, and if I kept the Faith, there was no limit as to what I could accomplish. They were right. So, as an American, I am proud to keep company with dissenters. We are entitled to our opinions and we have the right to practice our beliefs. But in doing so, I have always maintained the belief that it was fine to hold to your convictions as long as no one else was harmed.
Well, well, well. Today is the Super Bowl and there will be those opposing prayer before the game. What goes on in the locker room is #none of your business. And what about "God Bless America"? Well it's usually sung during the 7th inning at baseball games, but Gee, I don't know. Despite the phonebook listing Christian churches 200:1 over other places of worship per Andy Rooney, the voice of those offended by our practice of prayer are rising louder and louder. I just don't get it. If you are of another faith do you honestly think that we are saying this to offend you? You know, you have every opportunity, since this is America, a melting pot, the "Home of the Free" to insert whatever you like. And if you are an atheist, then #turn up your headphones. You see, there are alternatives for everyone. It's not forced down your throat and your lawyers should be advising you of that and not taking your money. And it's called a #Christmas tree, people.
Speaking of money, I am miffed about all of this talk regarding minimum wage. I should just sum it up in one sentence by stating that those soldiers putting themselves on the line for my safety and freedom are earning less money than those throwing a burger on a bun for my appetite. But I have to say more.
I started out working for 50 cents an hour as a library page in my hometown of Tarentum, Pa. When I received my first paycheck for the month of $32.00, I tripped several times walking home as I kept glancing at that big check. My parents made me put it in a savings account. I was in 9th grade. By the time I graduated, I was able to buy my own typewriter for Thiel College.
It wasn't about the money. It was about grooming myself to learn the basics in interacting with others. Working enabled me to take small paychecks and plan for my future. It was the principles of which everyone around me abided by and it worked. How can entry jobs with greater minimum wage contribute to the betterment of society? I know that if I were making more money, the cost of returning an overdue book would have been past on to the book borrower to a point where they could buy the book cheaper. What would have happened? No one would have returned the book. #empty shelves. I would imagine something similar happening to fast food prices. #I pay what for French Fries?
As a doctor, I am concerned that I have lost some of my favorite patients. When I returned to the community to work in a Mental Health Center some of my clients chose to follow me. They had private insurance and not Medicaid or Medicare. However, changes occurred in their coverage and they could no longer afford to see me. They could pay out of pocket but that would have been more disastrous. Thus, they were forced to see a new Psychiatrist elsewhere. And this is happening to so many of my colleagues. One had to leave Aetna because of the new demands. I am now termed a provided, not a doctor. Reinbursement by Medicaid and Medicare is dwindling. I love my profession. It was so much better when I did not have government and companies dictating to me what is best for me, the provider, and my now neglected patient. #Where did you go to Med School?
Finally, I am sick and tired of all the talk about drug and alcohol abuse. It's all talk. I see no action and here is why. When my son died of a heroin overdose I was willing to expose my family and our secrets to enable the Plain Dealer to do a series of 7 articles on "Andy's Last Secret". It was to emphasize that heroin is in the suburbs as much or more than the inner city. My husband and children opened ourselves to the community to speak to the known schools were the drug dealer was actively selling, 11 in all, 4 of which were private. We were invited by one of the private schools and included in a forum at one of the public schools. The rest ignored our requests. I even went to Columbus to implore the Governor to consider passing a felony murder law that would hold drug dealers accountable for murder if in the act of selling illegal drug, a death resulted. Other states have this law in place. I got nowhere.
Am I angry? #You bet I am. There was a City Forum this past week that addressed the same topic that Joanna Connors of the Plain Dealer did in 2005. Ohio ranks 11th in the nation of heroin deaths per year. My CEO was kind enough to invite me. I was disappointed not to have been informed of this by the moderator. As a grieving mother for 10 years, as an expert on the topic, as a person who publicly speaks to parents and teens about red flags, as a Psychiatrist, as a person who has attempted to change the law in Ohio so that 10 years later we would not be ranked 11th, I would like to think that my opinion counts. Thank you, Cleveland City Forum for making us all aware of an existing problem that county prosecutors and government have chosen to ignore. #Now What? I suggest #Campbell for Ohio Congress. I want the law passed so that drug dealers will think twice before killing another teen. Hell, if I did that as a doctor I would be behind bars. #What's wrong with this picture?
Calgon does't take it away anymore. And I don't have to look like a prune to voice my opinion. Mom and Dad taught me that its my 1st Amendment right. And I guess if others can do it, so can I.
Although I am in no way politically savvy, some of the comments I do have are directed at minimum wage and healthcare. And God knows I am not a saint, but some of my comments will be directed at pray and Christmas. And though I have never smoked pot, I do consider myself quite educated on the topic of drugs and alcohol and plan to address that as well.
Now to have the guts to address my concerns on paper, you would think I would need a "backbone" to be prepared for the onslaught of dissenters. Not really. I learned from my parents, a Dad who fought in WW II and a Mom who taught me to dream big, that America was built and defended by those who believed that, if I worked hard, and if I kept the Faith, there was no limit as to what I could accomplish. They were right. So, as an American, I am proud to keep company with dissenters. We are entitled to our opinions and we have the right to practice our beliefs. But in doing so, I have always maintained the belief that it was fine to hold to your convictions as long as no one else was harmed.
Well, well, well. Today is the Super Bowl and there will be those opposing prayer before the game. What goes on in the locker room is #none of your business. And what about "God Bless America"? Well it's usually sung during the 7th inning at baseball games, but Gee, I don't know. Despite the phonebook listing Christian churches 200:1 over other places of worship per Andy Rooney, the voice of those offended by our practice of prayer are rising louder and louder. I just don't get it. If you are of another faith do you honestly think that we are saying this to offend you? You know, you have every opportunity, since this is America, a melting pot, the "Home of the Free" to insert whatever you like. And if you are an atheist, then #turn up your headphones. You see, there are alternatives for everyone. It's not forced down your throat and your lawyers should be advising you of that and not taking your money. And it's called a #Christmas tree, people.
Speaking of money, I am miffed about all of this talk regarding minimum wage. I should just sum it up in one sentence by stating that those soldiers putting themselves on the line for my safety and freedom are earning less money than those throwing a burger on a bun for my appetite. But I have to say more.
I started out working for 50 cents an hour as a library page in my hometown of Tarentum, Pa. When I received my first paycheck for the month of $32.00, I tripped several times walking home as I kept glancing at that big check. My parents made me put it in a savings account. I was in 9th grade. By the time I graduated, I was able to buy my own typewriter for Thiel College.
It wasn't about the money. It was about grooming myself to learn the basics in interacting with others. Working enabled me to take small paychecks and plan for my future. It was the principles of which everyone around me abided by and it worked. How can entry jobs with greater minimum wage contribute to the betterment of society? I know that if I were making more money, the cost of returning an overdue book would have been past on to the book borrower to a point where they could buy the book cheaper. What would have happened? No one would have returned the book. #empty shelves. I would imagine something similar happening to fast food prices. #I pay what for French Fries?
As a doctor, I am concerned that I have lost some of my favorite patients. When I returned to the community to work in a Mental Health Center some of my clients chose to follow me. They had private insurance and not Medicaid or Medicare. However, changes occurred in their coverage and they could no longer afford to see me. They could pay out of pocket but that would have been more disastrous. Thus, they were forced to see a new Psychiatrist elsewhere. And this is happening to so many of my colleagues. One had to leave Aetna because of the new demands. I am now termed a provided, not a doctor. Reinbursement by Medicaid and Medicare is dwindling. I love my profession. It was so much better when I did not have government and companies dictating to me what is best for me, the provider, and my now neglected patient. #Where did you go to Med School?
Finally, I am sick and tired of all the talk about drug and alcohol abuse. It's all talk. I see no action and here is why. When my son died of a heroin overdose I was willing to expose my family and our secrets to enable the Plain Dealer to do a series of 7 articles on "Andy's Last Secret". It was to emphasize that heroin is in the suburbs as much or more than the inner city. My husband and children opened ourselves to the community to speak to the known schools were the drug dealer was actively selling, 11 in all, 4 of which were private. We were invited by one of the private schools and included in a forum at one of the public schools. The rest ignored our requests. I even went to Columbus to implore the Governor to consider passing a felony murder law that would hold drug dealers accountable for murder if in the act of selling illegal drug, a death resulted. Other states have this law in place. I got nowhere.
Am I angry? #You bet I am. There was a City Forum this past week that addressed the same topic that Joanna Connors of the Plain Dealer did in 2005. Ohio ranks 11th in the nation of heroin deaths per year. My CEO was kind enough to invite me. I was disappointed not to have been informed of this by the moderator. As a grieving mother for 10 years, as an expert on the topic, as a person who publicly speaks to parents and teens about red flags, as a Psychiatrist, as a person who has attempted to change the law in Ohio so that 10 years later we would not be ranked 11th, I would like to think that my opinion counts. Thank you, Cleveland City Forum for making us all aware of an existing problem that county prosecutors and government have chosen to ignore. #Now What? I suggest #Campbell for Ohio Congress. I want the law passed so that drug dealers will think twice before killing another teen. Hell, if I did that as a doctor I would be behind bars. #What's wrong with this picture?
Calgon does't take it away anymore. And I don't have to look like a prune to voice my opinion. Mom and Dad taught me that its my 1st Amendment right. And I guess if others can do it, so can I.
Sunday, January 26, 2014
Mental Health Awareness Week - Community Resources and Support
In the final part of the depression series, I have included resources in the community and possible supports for those suffering from symptoms and feel the need for assistance.
NAMI, the National Alliance of Mental Illness is an organization at the local, state, and national levels. It's missions statement is the following:
About NAMI: Support, Education, Advocacy, and Research
From its inception in 1979, NAMI has been dedicated to improving the lives of individuals and families affected by mental illness.
NAMI's support and public education efforts are focused on educating America about mental illness, offering resources to those in need, and insisting that mental illness become a high national priority. Mental illness is a serious medical illness that affects one in four families. No one is to blame. Treatment works, but only half of people living with mental illness receive treatment. NAMI has engaged in a variety of activities to create awareness about mental illness and promote the promise of recovery.
Find out more about NAMI advocacy efforts: It can be reached through the following web address: http://www.nami.org/template.cfm?section=your_local_nami.
NAMI also has a blog: http://blog.nami.org/
For individuals wanting a psychiatric assessment of their current problems and our fortunate to have insurance, either private or Medicare/Medicaid, the back of your insurance card or your county mental health department can assist you. For those who do not have insurance, again, the county mental health department can refer you to agencies able to meet your needs.
For emergency situations, call 911, If you are wanting to be connected to a suicide hotline, please call Call 1-800- SUICIDE / 1-800-784-2433; Call 1-800-273-TALK / 1-800-273-8255 .
How about individual support? That it another matter, my friends. It is a shame that baby boomers who have lived to our terrific ages may have limited friends, families or spouses who could prevent situations from snowballing.
Communication is key to any relationship, especially marriage. And trust is one of the most important elements of communication. It is so important to learn to listen. It says, "I value you". "You are important". Being available to one another shows your love, your caring.
Forgiveness is an important action to release yourself from pain. There are no strings attached. It does not give the other person any authority over you. It actually allows you to recognize them as human beings that have similar flaws as yourself.
It has come as a great discovery to me that the greatest support I have is ME thanks to all of the wonderful and caring people I have in my life. I hope that that rediscovery, that rebirth occurs to others in my generation. It is a beautiful think and makes life every day a gift - that's why they call it the Present.
Support of every kind is out there for you. And we never touched on substance abuse that can certainly add to the fire. You do not need to be an alcoholic or drug addict to visit a 12 step program. The import thing is the desire to stop drinking or, as they say, drugging. I have visited these programs and have met wonderful people and received invaluable information and support. Your mind will be clear to make the necessary decisions needed to move forward in a positive direction.
Do you have support in your life? Define it and appreciate it. If not, please contact the above agencies.
NAMI, the National Alliance of Mental Illness is an organization at the local, state, and national levels. It's missions statement is the following:
About NAMI: Support, Education, Advocacy, and Research
From its inception in 1979, NAMI has been dedicated to improving the lives of individuals and families affected by mental illness.
NAMI's support and public education efforts are focused on educating America about mental illness, offering resources to those in need, and insisting that mental illness become a high national priority. Mental illness is a serious medical illness that affects one in four families. No one is to blame. Treatment works, but only half of people living with mental illness receive treatment. NAMI has engaged in a variety of activities to create awareness about mental illness and promote the promise of recovery.
Find out more about NAMI advocacy efforts: It can be reached through the following web address: http://www.nami.org/template.cfm?section=your_local_nami.
NAMI also has a blog: http://blog.nami.org/
For individuals wanting a psychiatric assessment of their current problems and our fortunate to have insurance, either private or Medicare/Medicaid, the back of your insurance card or your county mental health department can assist you. For those who do not have insurance, again, the county mental health department can refer you to agencies able to meet your needs.
For emergency situations, call 911, If you are wanting to be connected to a suicide hotline, please call Call 1-800- SUICIDE / 1-800-784-2433; Call 1-800-273-TALK / 1-800-273-8255 .
How about individual support? That it another matter, my friends. It is a shame that baby boomers who have lived to our terrific ages may have limited friends, families or spouses who could prevent situations from snowballing.
Communication is key to any relationship, especially marriage. And trust is one of the most important elements of communication. It is so important to learn to listen. It says, "I value you". "You are important". Being available to one another shows your love, your caring.
Forgiveness is an important action to release yourself from pain. There are no strings attached. It does not give the other person any authority over you. It actually allows you to recognize them as human beings that have similar flaws as yourself.
It has come as a great discovery to me that the greatest support I have is ME thanks to all of the wonderful and caring people I have in my life. I hope that that rediscovery, that rebirth occurs to others in my generation. It is a beautiful think and makes life every day a gift - that's why they call it the Present.
Support of every kind is out there for you. And we never touched on substance abuse that can certainly add to the fire. You do not need to be an alcoholic or drug addict to visit a 12 step program. The import thing is the desire to stop drinking or, as they say, drugging. I have visited these programs and have met wonderful people and received invaluable information and support. Your mind will be clear to make the necessary decisions needed to move forward in a positive direction.
Do you have support in your life? Define it and appreciate it. If not, please contact the above agencies.
Saturday, January 25, 2014
President Obama - An education on Marijuana
Dear President Obama,
As a mother who regrets not attending Woodstock and lived in a day and age where pot was considered cool and chilled out more people than those living in Valley of the Dolls, I am proud to say that I never tried the stuff. Why? Though I was a nerd and had my nose in a chemistry book all of the time, the true effects of marijuana on the brain were not extensively researched. The real reason is that my mother would have killed me and despite my being away from home, she was sitting on my shoulder, I swear.
Despite pursuing a medical career and using short nose clamps to stop bleeders, I was surprised to see that they actually had another "off hospital grounds" use - to clip to the end of a joint to assure that the user and sharer would not burn their fingers but, more importantly, get, as Maxwell House would say, enjoy the last drop. I know this as I had to pass it around a friend's dinner party in the '70's and made sure in reached the end of the row at a Fleetwood Mac rock concert in the '90's. Mom would have been proud - I passed it along and held my breath.
But now, having a background in radiology, medicine, and psychiatry, I have been exposed to all of the growing literature that is exposing the dangers of marijuana. Ever try to talk to a teen about the dangers in smoking marijuana? Probably the most difficult task facing parents today. Why? They will quickly spout off that no one has died of an overdose of marijuana. And, now, they have you, Mr. Obama, the leader of our country and a role model to many children, teens, and young adults, stating that you do not feel that it is any more harmful than alcohol. Really?
Now, you are to be well informed on all topics and thank God that you have staff to keep you informed of the political issues affecting us all. But guess what? All you have to do is use your fatherly instincts to discuss drugs and alcohol. Protecting our borders? How about protecting our nation's youth. I do not have a committee, a cabinet, an advisor. I have the heart of a mother that fears another unnecessary death will result in the complacency by parents and adults towards alcohol and drugs.
A search of the literature shows other country's publishing the harms of marijuana. Hopefully the United States will soon have legitimate candidates to study now that it is becoming legalized. Let me list a few findings. I will address the medical benefits of marijuana that are often used as the first line of defense when fighting for legalization of this drug.
MEDICAL BENEFITS OF MARIJUANA:
1) Anti-emetic or anti-nausea effects: Early on, THC, the active drug found in marijuana, had been shown to be effective for some patients who suffered nausea from cancer chemotherapy treatment. However, the narrow window between the anti-nausea dose and that which caused unwanted psychic effects made THC difficult to use. In some studies negative side effects occurred in 81% of patients. In another study, 22% reported no effect of nausea symptoms. The advent of serotonin 5-HT3 receptor antagonists (told you I was a nerd) demonstrated a more powerful anti-emetic effect. For this reason, physicians virtually NEVER prescribe THC for use by chemotherapy patients as the new drugs are more powerful and have no psychic side effects.
2) Multiple Sclerosis: Although some studies have shown that cannabis can relieve muscle pain and spasticity in patients and also relieve tremors in animal studies, in can also further impair posture and balance. Please understand that THC receptors are found in those areas of the brain that control posture and balance and memory. In addition, MS patients who use marijuana had a greater number of psychiatric diagnoses and a slower mean performance time on standard neurological tests. And in some trials, an increase in aggressive behavior and paranoid tendencies were demonstrated in standard psychological tests. Overall, without boring the reader any further with studies and trials, a minority of MS patients can receive some symptom relief through the use of marijuana extracts or THC, but a significant percentage of patients suffer unwanted adverse effects.
So Mr. Obama. I wanted to inform you that I am angry with you. You may send your Secret Service to my door, you may decided to audit me, some people will accuse me of taking issue with you because I am a "racist", or, the sad conclusion, I am a person who is uncool and should learn to keep her mouth shut and reach for my surgical clamp.
As a mother who regrets not attending Woodstock and lived in a day and age where pot was considered cool and chilled out more people than those living in Valley of the Dolls, I am proud to say that I never tried the stuff. Why? Though I was a nerd and had my nose in a chemistry book all of the time, the true effects of marijuana on the brain were not extensively researched. The real reason is that my mother would have killed me and despite my being away from home, she was sitting on my shoulder, I swear.
Despite pursuing a medical career and using short nose clamps to stop bleeders, I was surprised to see that they actually had another "off hospital grounds" use - to clip to the end of a joint to assure that the user and sharer would not burn their fingers but, more importantly, get, as Maxwell House would say, enjoy the last drop. I know this as I had to pass it around a friend's dinner party in the '70's and made sure in reached the end of the row at a Fleetwood Mac rock concert in the '90's. Mom would have been proud - I passed it along and held my breath.
But now, having a background in radiology, medicine, and psychiatry, I have been exposed to all of the growing literature that is exposing the dangers of marijuana. Ever try to talk to a teen about the dangers in smoking marijuana? Probably the most difficult task facing parents today. Why? They will quickly spout off that no one has died of an overdose of marijuana. And, now, they have you, Mr. Obama, the leader of our country and a role model to many children, teens, and young adults, stating that you do not feel that it is any more harmful than alcohol. Really?
Now, you are to be well informed on all topics and thank God that you have staff to keep you informed of the political issues affecting us all. But guess what? All you have to do is use your fatherly instincts to discuss drugs and alcohol. Protecting our borders? How about protecting our nation's youth. I do not have a committee, a cabinet, an advisor. I have the heart of a mother that fears another unnecessary death will result in the complacency by parents and adults towards alcohol and drugs.
A search of the literature shows other country's publishing the harms of marijuana. Hopefully the United States will soon have legitimate candidates to study now that it is becoming legalized. Let me list a few findings. I will address the medical benefits of marijuana that are often used as the first line of defense when fighting for legalization of this drug.
MEDICAL BENEFITS OF MARIJUANA:
1) Anti-emetic or anti-nausea effects: Early on, THC, the active drug found in marijuana, had been shown to be effective for some patients who suffered nausea from cancer chemotherapy treatment. However, the narrow window between the anti-nausea dose and that which caused unwanted psychic effects made THC difficult to use. In some studies negative side effects occurred in 81% of patients. In another study, 22% reported no effect of nausea symptoms. The advent of serotonin 5-HT3 receptor antagonists (told you I was a nerd) demonstrated a more powerful anti-emetic effect. For this reason, physicians virtually NEVER prescribe THC for use by chemotherapy patients as the new drugs are more powerful and have no psychic side effects.
2) Multiple Sclerosis: Although some studies have shown that cannabis can relieve muscle pain and spasticity in patients and also relieve tremors in animal studies, in can also further impair posture and balance. Please understand that THC receptors are found in those areas of the brain that control posture and balance and memory. In addition, MS patients who use marijuana had a greater number of psychiatric diagnoses and a slower mean performance time on standard neurological tests. And in some trials, an increase in aggressive behavior and paranoid tendencies were demonstrated in standard psychological tests. Overall, without boring the reader any further with studies and trials, a minority of MS patients can receive some symptom relief through the use of marijuana extracts or THC, but a significant percentage of patients suffer unwanted adverse effects.
3) Glaucoma: THC has been shown to reduce the intraocular pressure in humans who have glaucoma. But the pressure was reduced only when the patient stayed under the effects of THC almost continually. More effective medications such as prostaglandins have been developed to control the intro ocular pressure. Now if one wants to be continuously high and suffer unwanted side effects, it is their choice. but there are better and more effective treatment options.
4) Appetite control: We are all aware of the "munchies" affecting marijuana use. And laboratory studies do support the fact that THC does increase the appetite which may not be a good thing for most of us as poor food choices are made under the influence. With the First Lady munching on an apple with NBA stars, the negative effects that marijuana has on our youth and teens is certainly something the couple should be on the same page with. However, those individuals suffering from debilitating diseases such as AIDS-related wasting syndrome do benefit from the use of marijuana as THC has been able to maintain their weight.
5) Brain Effects:
Because I started my career with a residency in Radiology I will show this MRI coronal view of the brain. The loss of brain matter is highlighted in the cannabis user with increased cerebral spinal fluid and loss of brain matter.. After all, pressure has to be maintained and when the brain loses neurons it is replaced with spinal fluid, thus the decreased gray matter and increased fluid showing as black. The pink is our precious amygdala, responsible for important functions such as memory and emotions. To me a picture speaks a thousand words. Enough said.
6) Psychiatric illness: A recent study found that marijuana use significantly increased the risk of developing mental health problems among those young people who possessed a genetic high risk for schizophrenia. And if there is a family history of substance abuse, a young person is much more likely to develop an addiction to any substance. There is also a strong correlation between development of depression and bipolar disorder. Remember the picture above? You can destroy your amygdala all by your lonesome without a family history. You know the sad thing, so many mask symptoms of depression, bipolar, paranoia, voices, increased stressors, and the will to escape and chill out with marijuana. And my attempts to teach these teens in school auditoriums have been met with laughter and disrespect. Where will this culture that has developed with marijuana use begin to detach itself from the "utopia" they have associated with this drug? One student had approached me after a lecture - one in which I threw out students in the class laughing and rolling their eyes at me. She stated that she was 4 days clean and didn't miss the drug so much as she did the way of life it offered her. This is not a chill out pill, folks, but strong ties develop and makes this particular drug with its "no one has died boasts" a major battle for parents such as myself. Gee, thanks, Mr. Obama.
And now for the most important reason why parents should fight the battle!!
7) Gateway Hypothesis: I saved the most difficult topic for last. My son, Andy, who died at the age of 19 on 1/16/2004, would argue with me that it was not a gateway drug. He also had no respect for me. Although I had taught Drug and Alcohol Abuse and Dependence to med students rotating in Psychiatry at Case Western Reserve Med School, he saw me as a mother who never used and ignored the facts, claiming that it was "safe" and that maybe I needed a joint to "chill out". But there is a tendency for marijuana users to go on to use other addictive drugs. Whether it is a predisposition or just more easily available when traveling in a circle of drug using friends is not completely known. However, studies have shown that 311 pairs of same sex twins with earlier marijuana use (before the age of 17 years) were 2-5 more likely to use illicit drugs. Unfortunately, these young, beautiful individuals have no idea whether it will be their gateway drug. It was my Andy's.
As a mother who has lost a son and knows that marijuana AND alcohol are dangerous, I will fight you tooth and nail on this topic until I am convinced that you have decided to reconsider your position, not as a previous marijuana smoker and using your own experience, but as a father who wants to protect his daughters and set a better example, not only to them but to the youth of our nation.
To the presidential assistant previewing this notice: Please consider passing it along to your boss.
Sincerely, Dr. Elaine Campbell
Mental Health Awareness Week - Suicide
Life has it's ups and downs and I, for one, have had plenty of roller coaster rides. I confessed that I had suffered from depression in the past. I will also be honest about today's topic. I am one of the 24% of individuals who have considered it as a means of ending some extreme emotional pain. And as you are aware from my previous posts, Baby Boomers are more successful than any other generation at attempts and completion. So, let's discuss suicide.
I can throw out all sorts of statistics to you. Over 34,000 people die of suicide a year - translating to one person dying every 15 minutes. Although women are more likely to try, men are more successful because of the more violent means they choose - firearms or hanging. 90% of adults and 60% of adolescents who commit suicide have a diagnosed mental illness, especially depression or substance abuse. And, sadly, 70% of older individuals visited their PCP within the month of their suicide.
The above statistics are important as it underscores this very important consideration - that suicide might be preventable.
Again, I always consider the Biopsychosocial characteristics of an individual when considering signs of suicide as well as risks of suicide. And why? Because there is no poster person that represents the face of suicide. Although statistics are an important consideration, it is the individual we are truly analyzing.
The following are WARNING SIGNS listed by a Suicide Prevention Program called Yellow Ribbon. Please visit them at www.yellowribbon.org:
WARNING SIGNS
Abrupt changes in personality
Giving away possessions
Previous suicide attempt
Use of drugs and/or alcohol
Change in eating pattern - significant weight change
Change in sleeping pattern - insomnia/oversleeping
Unwillingness or inability to communicate
Depression
Extreme or extended boredom
Accident prone (carelessness)
Unusual sadness, discouragement and loneliness.
Talk of wanting to die
Neglect of academic work and/or personal appearance
Family disruptions - divorce, trauma, losing loved one.
Running away from home or truancy from school.
Rebelliousness - reckless behavior.
Withdrawal from people/activities they love.
Confusion - Inability to concentrate
Chronic Pain, Panic or Anxiety
Perfectionism
Restlessness
Many of the above warning signs refer to the biological and psychological factors I discussed in previous posts. Yellow Ribbon also emphasizes the need to consider the RISK FACTORS. Many of those listed here refer to the sociological factors. Coupling the two gives a clearer suicidal risk. I agree completely.
RISK FACTORS
Problems with school or the law
Breakup of a romance
Unexpected pregnancy
A stressful family life. (having parents
who are depressed or are substance
abusers, or a family history of suicide
Loss of security...fear of authority, peers,
group or gang members
Stress due to new situations; college
or relocating to a new community
Failing in school or failing to pass
an important test
A serious illness or injury to oneself
Seriously injuring another person or
causing another person's death
(example: automobile accident)
Major loss...of a loved one,
a home, divorce in the family,
a trauma, a relationship
Yellow Ribbon stresses the following:
Suicide victims are not trying to end their life - they are trying to end the pain!
How can we help?
First of all, don't be afraid to be direct. Talk openly and matter-of-factly about suicide.
You have to be willing to listen. Allow the person to express their feelings.
Do not be judgmental. Don't debate whether suicide is right or wrong, or feelings are good or bad. Don't lecture on the value of life.
Don't be afraid to get involved, to be available, to show interest and support
Don't act shocked. You want to maintain their trust in you,
Don't be sworn to secrecy.
Offer hope that alternatives are available but do not offer glib reassurance.
Ask if they have a plan. Take action. Remove any means, such as guns or stockpiled pills.
Get help from persons or agencies specializing in crisis intervention and suicide prevention.
If you are experiencing thoughts of suicide, or have even developed a plan or have the intent, please contact someone you know, visit the closest ER or call the number listed below.
If you are worried about someone and see some warning signs and/or identify risks, please consider getting involved.
The National Hopeline Network 1-800-SUICIDE provides access to trained telephone counselors, 24 hours a day, 7 days a week.
When I lost my son, Andy, at age 19, to an accidental drug overdose, I started a foundation modeled after Jason's Foundation which is dedicated to the silent epidemic of teen suicide. Please visit www.jasonfoundation.com if you are concerned about our younger generation.
I wish you all brighter days and good mental health. Peace, Dr. Elaine
I can throw out all sorts of statistics to you. Over 34,000 people die of suicide a year - translating to one person dying every 15 minutes. Although women are more likely to try, men are more successful because of the more violent means they choose - firearms or hanging. 90% of adults and 60% of adolescents who commit suicide have a diagnosed mental illness, especially depression or substance abuse. And, sadly, 70% of older individuals visited their PCP within the month of their suicide.
The above statistics are important as it underscores this very important consideration - that suicide might be preventable.
Again, I always consider the Biopsychosocial characteristics of an individual when considering signs of suicide as well as risks of suicide. And why? Because there is no poster person that represents the face of suicide. Although statistics are an important consideration, it is the individual we are truly analyzing.
The following are WARNING SIGNS listed by a Suicide Prevention Program called Yellow Ribbon. Please visit them at www.yellowribbon.org:
WARNING SIGNS
Abrupt changes in personality
Giving away possessions
Previous suicide attempt
Use of drugs and/or alcohol
Change in eating pattern - significant weight change
Change in sleeping pattern - insomnia/oversleeping
Unwillingness or inability to communicate
Depression
Extreme or extended boredom
Accident prone (carelessness)
Unusual sadness, discouragement and loneliness.
Talk of wanting to die
Neglect of academic work and/or personal appearance
Family disruptions - divorce, trauma, losing loved one.
Running away from home or truancy from school.
Rebelliousness - reckless behavior.
Withdrawal from people/activities they love.
Confusion - Inability to concentrate
Chronic Pain, Panic or Anxiety
Perfectionism
Restlessness
Many of the above warning signs refer to the biological and psychological factors I discussed in previous posts. Yellow Ribbon also emphasizes the need to consider the RISK FACTORS. Many of those listed here refer to the sociological factors. Coupling the two gives a clearer suicidal risk. I agree completely.
RISK FACTORS
Problems with school or the law
Breakup of a romance
Unexpected pregnancy
A stressful family life. (having parents
who are depressed or are substance
abusers, or a family history of suicide
Loss of security...fear of authority, peers,
group or gang members
Stress due to new situations; college
or relocating to a new community
Failing in school or failing to pass
an important test
A serious illness or injury to oneself
Seriously injuring another person or
causing another person's death
(example: automobile accident)
Major loss...of a loved one,
a home, divorce in the family,
a trauma, a relationship
Yellow Ribbon stresses the following:
Suicide victims are not trying to end their life - they are trying to end the pain!
How can we help?
First of all, don't be afraid to be direct. Talk openly and matter-of-factly about suicide.
You have to be willing to listen. Allow the person to express their feelings.
Do not be judgmental. Don't debate whether suicide is right or wrong, or feelings are good or bad. Don't lecture on the value of life.
Don't be afraid to get involved, to be available, to show interest and support
Don't act shocked. You want to maintain their trust in you,
Don't be sworn to secrecy.
Offer hope that alternatives are available but do not offer glib reassurance.
Ask if they have a plan. Take action. Remove any means, such as guns or stockpiled pills.
Get help from persons or agencies specializing in crisis intervention and suicide prevention.
If you are experiencing thoughts of suicide, or have even developed a plan or have the intent, please contact someone you know, visit the closest ER or call the number listed below.
If you are worried about someone and see some warning signs and/or identify risks, please consider getting involved.
The National Hopeline Network 1-800-SUICIDE provides access to trained telephone counselors, 24 hours a day, 7 days a week.
When I lost my son, Andy, at age 19, to an accidental drug overdose, I started a foundation modeled after Jason's Foundation which is dedicated to the silent epidemic of teen suicide. Please visit www.jasonfoundation.com if you are concerned about our younger generation.
I wish you all brighter days and good mental health. Peace, Dr. Elaine
Friday, January 24, 2014
Mental Health Awareness Week - Depression Treatment and Options
HEALTH AND WELLNESS -Depression - Part 2 - Treatment options
As I promised, I wanted to devote four of my postings to depression. Today's topic is dedicated to treatment options.
I suspect that the growing percentage of suicide attempts in baby boomers may be influenced by the increasing amount of stressors facing our generation and the reluctance to seek treatment for depressive symptoms. Of course medication cannot magically remove the threat of foreclosure or stop a partner from their emotional or physical abuse. But there is hope for those suffering from the symptoms of depression and we will discuss a number of possible treatments in today's article.
Have you ever heard of the term BIOPSYCHOSOCIAL? It is a combination of the words biological, psychological and sociological. And it is these important aspects of our lives that should be taken into consideration when treating depression.
Biological concerns address not only family history of mental illness, medical illnesses that could contribute to depression, but also to substance abuse problems. This information can contribute to treatment recommendations that might include follow up for current medical symptoms and referrals to substance abuse programs.
Psychological considerations are paramount in considering treatment options. How do you cope with sadness, with stressors, with unexpected changes in your workplace or daily routine? Are you one to "cry over spilled milk" or do you pride yourself in making "lemonade from lemons"? Our defense mechanisms come to play when things go wrong emotionally. I have clients who claim that "this too shall pass" and never need any significant interventions. Others may collapse on my desk with the same mild symptoms, demanding that I find immediate relief. No two individuals experience similar episodes in exactly the same way. Some turn to substances to self-medicate or stop taking medication the minute they experience a side effect that might be transitory or if relief of symptoms does not come within a short period of time. They can perceive their situation quite differently which effects the way they feel and, ultimately, the way they behave.
Social concerns have more recently been at the core of my clients depression. Job losses and financial concerns, foreclosures, broken marriages that occur after years of celebrating anniversaries are just a few of my client's stressors. In addition, a strong support system is an essential element of the care plan. Are family members invested in the welfare of this person? Does the client live alone? Are there caring neighbors? Do they have a spiritual base and is a church family present?
All of the above considerations need to be a part of the initial assessment. Will the client need medication only? If a family member has a history of depression as well, did they respond to a certain medication? Are other medical problems under control or contributing to the situation? Are the client's defense mechanisms inadequate to deal with their current situation? Would a referral to a counselor such as a social worker or psychologist be necessary at this time? Is a case manager needed to address the financial situation, living arrangements or unexplored entitlements that the clients may desperately require?
Without team management, my task is made more difficult because medication alone may not solve the problem. However, I am a psychiatrist and it is my function to treat the symptoms with medication and to refer to the wonderful social workers, psychologists and case managers if needed. God Bless them all. I feel that these important individuals are so overworked and underpaid. They are truly devoted caretakers. And I am proud to claim that my daughter, Molly, is one of those dedicated LISW's.
Now about medication. For client's presenting with mild symptoms, medication may not be necessary. If the symptoms are more moderate or severe, and I am referring to the number of symptoms that they are experiencing, then medication is advised. If the patient has physiological complications, with poor sleep, loss of weight, dramatic change in functioning, or 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.
There it is - my philosophy of medication management in a nutshell (actually "blogshell").
In summary, discuss your full spectrum of symptoms with your doctor so that the right medication can be prescribed. Do not leave the office without a full understanding of the side effects and benefits of the medication. Do not change your dosage or stop treatment unless discussing this with your physician first Should suicidal thoughts develop during the inital part of the treatment (often seen in children, adolescents, and young adults), notify your doctor immediately or present to the Emergency Room for a risk assessment.
Tomorrow I will discuss the topic of suicide.
I suspect that the growing percentage of suicide attempts in baby boomers may be influenced by the increasing amount of stressors facing our generation and the reluctance to seek treatment for depressive symptoms. Of course medication cannot magically remove the threat of foreclosure or stop a partner from their emotional or physical abuse. But there is hope for those suffering from the symptoms of depression and we will discuss a number of possible treatments in today's article.
Have you ever heard of the term BIOPSYCHOSOCIAL? It is a combination of the words biological, psychological and sociological. And it is these important aspects of our lives that should be taken into consideration when treating depression.
Biological concerns address not only family history of mental illness, medical illnesses that could contribute to depression, but also to substance abuse problems. This information can contribute to treatment recommendations that might include follow up for current medical symptoms and referrals to substance abuse programs.
Psychological considerations are paramount in considering treatment options. How do you cope with sadness, with stressors, with unexpected changes in your workplace or daily routine? Are you one to "cry over spilled milk" or do you pride yourself in making "lemonade from lemons"? Our defense mechanisms come to play when things go wrong emotionally. I have clients who claim that "this too shall pass" and never need any significant interventions. Others may collapse on my desk with the same mild symptoms, demanding that I find immediate relief. No two individuals experience similar episodes in exactly the same way. Some turn to substances to self-medicate or stop taking medication the minute they experience a side effect that might be transitory or if relief of symptoms does not come within a short period of time. They can perceive their situation quite differently which effects the way they feel and, ultimately, the way they behave.
Social concerns have more recently been at the core of my clients depression. Job losses and financial concerns, foreclosures, broken marriages that occur after years of celebrating anniversaries are just a few of my client's stressors. In addition, a strong support system is an essential element of the care plan. Are family members invested in the welfare of this person? Does the client live alone? Are there caring neighbors? Do they have a spiritual base and is a church family present?
All of the above considerations need to be a part of the initial assessment. Will the client need medication only? If a family member has a history of depression as well, did they respond to a certain medication? Are other medical problems under control or contributing to the situation? Are the client's defense mechanisms inadequate to deal with their current situation? Would a referral to a counselor such as a social worker or psychologist be necessary at this time? Is a case manager needed to address the financial situation, living arrangements or unexplored entitlements that the clients may desperately require?
Without team management, my task is made more difficult because medication alone may not solve the problem. However, I am a psychiatrist and it is my function to treat the symptoms with medication and to refer to the wonderful social workers, psychologists and case managers if needed. God Bless them all. I feel that these important individuals are so overworked and underpaid. They are truly devoted caretakers. And I am proud to claim that my daughter, Molly, is one of those dedicated LISW's.
Now about medication. For client's presenting with mild symptoms, medication may not be necessary. If the symptoms are more moderate or severe, and I am referring to the number of symptoms that they are experiencing, then medication is advised. If the patient has physiological complications, with poor sleep, loss of weight, dramatic change in functioning, or 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.
There it is - my philosophy of medication management in a nutshell (actually "blogshell").
In summary, discuss your full spectrum of symptoms with your doctor so that the right medication can be prescribed. Do not leave the office without a full understanding of the side effects and benefits of the medication. Do not change your dosage or stop treatment unless discussing this with your physician first Should suicidal thoughts develop during the inital part of the treatment (often seen in children, adolescents, and young adults), notify your doctor immediately or present to the Emergency Room for a risk assessment.
Tomorrow I will discuss the topic of suicide.
Wednesday, January 22, 2014
Mental Health Awareness Week
Did you know that it was Mental Health Awareness Week? I am embarrassed to say that I was more observant of Reverend Martin Luther King and focusing on his dream - Judging one for the content of their character and not the color of their skin.
However, people who suffer from depression, anxiety, mood swings, substance abuse and other mental health issues are indeed judged quite harshly. The stigma remains and those people standing in judgement are unaware that this is not a character flaw.
I received a very touching Facebook feed from a friend. Here is what she wrote:
"Depression, anxiety and panic attacks are not a sign of weakness. They are signs of trying to stay strong for too long. Did you know that 1 in 3 of us go through this in our lifetime? It's Mental Health Awareness Week. Share the support. Let those who struggle know that they are not alone….."
As a tribute to my dear friend I am resurrecting some information on some mental health issues. This long, cold winter and lonely holidays can increase the likelihood of depression. Here is part 1 of a 4 part series I published in 2010 regarding depression. You can pull-up all 4 parts as well as read other important topics related to mental health issues on the blogsite.
Please be kind to those that suffer. Carry an extra blanket in your car for the Homeless.
However, people who suffer from depression, anxiety, mood swings, substance abuse and other mental health issues are indeed judged quite harshly. The stigma remains and those people standing in judgement are unaware that this is not a character flaw.
I received a very touching Facebook feed from a friend. Here is what she wrote:
"Depression, anxiety and panic attacks are not a sign of weakness. They are signs of trying to stay strong for too long. Did you know that 1 in 3 of us go through this in our lifetime? It's Mental Health Awareness Week. Share the support. Let those who struggle know that they are not alone….."
As a tribute to my dear friend I am resurrecting some information on some mental health issues. This long, cold winter and lonely holidays can increase the likelihood of depression. Here is part 1 of a 4 part series I published in 2010 regarding depression. You can pull-up all 4 parts as well as read other important topics related to mental health issues on the blogsite.
Please be kind to those that suffer. Carry an extra blanket in your car for the Homeless.
HEALTH AND WELLNESS -Depression - Part 1
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 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 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.
With Blessing and Peace to all, Dr. Elaine
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 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.
With Blessing and Peace to all, Dr. Elaine
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