Balanced Living in the New Year

So its a new year! As is traditional with many people at this time of year, I have made a few resolutions. One of them is to do my very best to improve my health and try to get my immune system to be less explosive and destructive towards my physique – I don't mind it attacking and slaughtering cold germs. :) I will admit that this goal will be a little challenging because there is much I can't really change. Celiac disease has really demolished a great deal of my body organizations. So much of my digestive processes are unable to work well anymore and as my immune system has caused so much periphery injury to other organs as well. Those are things that I can't change, but I can hope to try and make it possible for my body to attempt to heal faster... to try and help my immune system to be less reactive and over responsive... to take more time and give more focus towards the physical frame that keeps me able to live in this complicated world and my confusing and necessary probation toward eternity. Add to all of that the stumbling of my heart and the struggles it faces to hold its rhythm steady and constant... to not race and fall into the trap of super ventricular tachycardia and the palpitations it causes.

However, there are a few things that I can try and my doctor is agreeable. One thing that I can do is to focus more on pure food and to really spend more time paying attention to what I do eat. I tend to look at all food with a skeptical eye... I watch for gluten in not only food, but everything else in my life- laundry detergent, hair care products, cat litter, hand lotion... I could go on forever, because it seems like gluten is in everything. I have spent so much time with a fierce focus on whether something has gluten in it and whether I can eat it that I have tended in the last few years to not really ask the next important question; “Should I eat it?” And as my finances have become a little shakier, cheaper food that might not be as healthy has been much more attractive. But over the last few months, I have found some ways to get fresh vegetables that are cheaper than most and as I have been sick and busy, I haven't felt like eating which has also helped keep less healthy food out. But I am going back to a process I was required to do by my physician earlier last year and I have been documenting everything I eat from the portion of fish to the tiniest measurement of vinegar. I can then break it down into calories, daily requirements and vitamins and make sure that I am getting most of the necessary elements that I need and can hopefully over time need fewer supplements and maybe my body can start to heal a little faster. It would be nice to only take two of three medications daily by the end of the year instead of almost ten tablets daily. :) (If you would like to have a basic checklist for your daily physical intakes in both elements and major needs such as fat and protein, you can go here and see the one that I am using. Its been quite useful to me!)

Along with more awareness and a renewed concentration on my diet and food, I also want to try to create more balance in my life... maybe become more mindful on my thoughts, activities and take more time to visualize he future and what I would like to accomplish. I think I have allowed myself to fall into a little bit of a rut in both attitude and behavior... letting life buffet me along in its wake and not struggling constantly to stay focused on the most important things: service, friends, family, the gospel. Meeting basic needs and trying to come to terms with my ex's choices as well as school, work and all else has kept me more centered on temporal things and not necessarily things that are the most important over time. I would like to work over the next few months to bring my mind back to a more settled state and to bring my energy back to my priorities... what is really important and what really matters to me. Funnily enough, I think this part of the goal will be the most challenging. Balance and mindfulness has never been a strong suit in my case. But I want to try!

What kind of resolutions have you decided to attempt this year... and what safeguards have you set up to keep you focused on continuing your goal? Please share!

Ethical Concerns for Providers when Dealing with Refugee Populations

There is no doubt that mental health professionals and other service providers can help alleviate the effects of trauma, torture and other crimes that are perpetrated against people and communities due to circumstances, religion, war, etc... Throughout this class, I have learned quite a bit about the consequences to both individuals and groups based on trauma/ torture and have even broadened my views of how those terms should be defined. Between therapies that are individualized or set up for groups (such as a family, community or people with the same traumas and problems in common) and interactions that attempt to alleviate suffering through the use of medical training, pharmaceuticals, neurobiological or cognitive therapies, etc... Many groups and professional have been focused on – and continue to try- to help victims and the society as a whole heal, develop techniques for survival and daily care, as well as trying to improve the quality of health and life of those affected. However, there can be challenges as well as ethical problems that the mental health / medical provider can face in these situations.

One challenge can come in the form of using pharmaceuticals to help the patient deal with some of the symptoms that cause difficulty in their lives. While studies do suggest that medication makes a bigger impact on an individual's symptoms, the issue is not that black and white. How the patient and/or their family feels about medical care in general (or mental health medication specifically) has an effect on how the medication is used and therefore, how successful it can be. An individual's culture may also weigh into the decision to use medical treatments/ medicine of any kind. And how the services are provided might also affect the utilization of those services. Language, economics, and other barriers can cause misunderstandings and challenges as well. A perfect example of this problem can be found in the book, “The Spirit Catches You and You Fall Down” written by Anne Fadiman. An amazing and very sad biography.

Another thing that is very important for the provider to acknowledge and understand is that the trauma itself may be what the provider wishes to treat and focus on... but the provider is still treating a person. An individual with different perceptions, biases, experiences and other ways of seeing and moving through the world. And so while trying to treat the troublesome symptoms of the past trauma, it is imperative that the person being treated isn't seen in the narrow sense as a label or a diagnosis. The patient needs to be viewed and looked at in the 'prism' of their views and life... so recommendations and therapies need to be available to the patient in a way that fits their current set of circumstance and needs. I thought of an experience in my life when I had a few sick animals who lived with me and my family in a one room yurt. The vet said that one cat needed to be fed a special food, another cat needed a different special food and the other cats couldn't eat either food. When I mentioned that I lived in one room, I was told to deal with it. I did figure out a solution that worked, but it took a while and I didn't use the resources that had been offered nor have I been back to that clinic. I probably would have felt differently and used the resources offered if the provider had made them seem possible. Just a thought on that topic.... So making sure that the resources used are more helpful than stressful and really address the 'whole person' are needed. That takes more time and energy as well as an understanding of an an attempt to put your own biases, etc... aside. That is a bit difficult to do for most of us. :) Also making sure that the resources are available to use in a way that works for the client makes them more likely to be utilized and more likely to help the patient with lasting change in their lives... which is the goal!

Another important element – which I touched on in the last paragraph is to make sure that a thorough understand of the person and their culture are attained. By understanding what is important to the individual and what they use to not only make decisions but base most of what is important in their life on.... the suggestions and recommendations that are given by the mental health providers are more likely to not only be followed but misunderstandings are more likely to be caught quickly and early in the process. That helps develop the trust relationship between the provider and the patient as well as help the patient to work harder to help themselves because not only does it matter to them as individuals, the provider has shown that it matter to them too. (Aren't we all more likely to accomplish our goals when we have a friendly goal 'buddy'?) So by having decent understanding of the background and viewpoint of the patient, the service providers can make fewer but more meaningful referrals and help keep the patient on task. An example is not suggesting a patient with PTSD have an occasional drink to relax but maybe a cookie or a walk with a friend instead. If the culture sees nightmares and terrors as a curse from God that must be overcome.... then they are much less likely to take the Ambien to sleep nor will their family encourage them to do so. Telling an individual to eat pork or stop smoking for their health when smoking is part of their religious practices or the eating of pork is against their beliefs will either cause total noncompliance or partial uncompliance as the patient will only do it when they feel pressed to do so or have another compelling reason to do so. It is important that the clinician recognizes what his values are and recognize when he is potentially pushing values and cultural norms on the patient and not actual treatment. I know those examples are not mental health related, but I thought they did help me make the point I was attempting to make. :)

Another thing that it is imperative that mental health providers think about when dealing with challenged and refugee populations is to follow the information and tools that have work in the past as evidenced by studies and their own observations and life experience, but to also recognize that the current work that is being done can give good insights into potential therapies simply because if it appears to be currently working, with so few good studies out there.... if every is in agreement to try something new... that has the potential to help victims now as well as future populations. This kind of flexibility to look outside the box but also to be cautious and thoughtful about trying therapies that haven't had a lot of use and study is a challenging but needed trait in these providers. It is also this flexibility that allows the clinician to look at the individual in a well rounded way, and not just the way that they have been taught to see certain symptoms or mental distress.

Lastly, it is important that the clinician recognize and maintain clear boundaries between themselves and their patients so that both parties can work together for improvement and satisfaction. When the boundaries are loosened, both parties may find it very challenging to continue to work together and to work towards progress in the manner that was possible when the division between the two was clearly laid out. Providing services that also allow the individual to have privacy not only from strangers who do not have a legitimate need to know their information, but also family can also help the patient by making things clearer and less likely to be misunderstood through another person's biases and thoughts mixing into the mix. An example could be when the parties involved have a language barrier – a translator from outside the patients inner circle may make a different translation that a family member or a friend who may interpret what the patient is saying or needs based on what they think the patient needs... not quite the same thing. This kind of translation can also compromise a patient's need and right for confidentiality making services more challenging for them to get and undermining the trust needed between the patient and the provider. The provider must also to make sure to care for and recognize problems that may crop up with themselves from working with this population and take care to not allow themselves to become burned out or harmed in the process of helping others... which can cause them to be unable to continue to help or even to cause more trauma to the patient.

To be a provider to such a challenged population comes with both risks and rewards for the clinician and the patients. Understanding the important ethical concerns that should be addressed can help everyone involved do a better job, be safer, and to help people gain more resiliency and a better quality of life through the therapies. What more can we ask for? :)

Our Debt to the Enlightenment...

So, I was sitting in class this week and we were asked what we were thankful for in our lives that is directly a result of the Enlightenment. I was very surprised when I really thought about it and realized that I am so blessed as so much of my life and the things I take for granted can be traced back to the philosophes and the time historians have titled the Enlightenment. I know that I am able to do many things and even go places safely because of the humanist ideas, etc… that came about during this time. I figured I would take a moment to mention a few examples that came to my mind.

One example is medicine. I was premature at birth and only weighed around five pounds. I had breathing problems and was ‘slow to thrive’. I am now a happy healthy adult that is too hyper for many and for the most part I don’t have reminders of my feeble beginning. If I had been born in the 1600’s there was some understanding of the human body, but the understanding of how the body itself was really formed and interacted with itself was only discovered and really started to develop during this time. My lung challenges alone would probably have been my death warrant because so little was really known. As a celiac, I would have had a very limited life because this disorder is really a disorder where the body attacks itself in the presence of unacceptable proteins and these sorts of complicated chemical reactions and transactions in the body are still being discovered today- during the Enlightenment they were just beginning to understand the existence of these reactions. Also, chances are that food itself would have been an issue for me. If all I could eat was bread, then I could eat it and feel sick… or starve. Not too many options there. If I was sickly I would be less likely to survive to adulthood, much less likely to survive childbirth and, as evidenced by my beautiful son, my children would be prone to medical challenges as well if they were able to survive. I take for granted that I can have a quite variable diet and can find food that I can eat almost anywhere that I can afford and enjoy. I also am able to have medical treatments that were only a dream forty years ago, but wouldn’t have been possible without the desire and work of some many people –mostly men, but women shouldn’t be ignored- during this time.

As a woman I can attend school, I can own property, I can become divorced or married as I please… all ideas that came about or started during this time frame. During this time, voting rights for more than just the elite began to be discussed and I can –and do- exercise my right to vote whenever I am able (much to the consternation of my extremely conservative parents… They still can’t figure out where they went wrong) As the writers and elite of this time became more humanist and allowed boys of all families to be able to look at education, it allowed for the doors to be opened wider for me. I can walk down the street wearing anything I want (almost) and I do not worry about being jailed, beaten, or even killed for my ‘audacity’ or ‘promiscuousness’. I can chose a religion (or not) based on my conscious or the voice of my own mind and heart, and not on the particular law/government/church in power at the time. Heck, I can study science in a room of my peers of both genders. I can have a nontraditional job for my gender- and while we definitely still have challenges with that it our society, it certainly is much more possible!

I think the thing I am most thankful for impact wise is the ability to question anything. To be able to ask questions about my environment, people, topics of all sorts… and not only be physically safe but have conversations and be able to form my opinions through study, observation and my own moral guidelines. Before the Enlightenment, as a woman, I didn’t have a lot of options for what I could do with my life. I might get more options if I was wealthy and had an understanding husband (because I would probably have had to have one to have continued to have more options), but those options would have necessarily been limited by the facts of percentages. After all, very few men were wealthy and as women could not own money or property with very few exceptions, only women married to wealthy and ‘tolerant men’ could have had more options for their lives. (And even then, their options were still limited in comparison to the options I now have for choices in my life.) At least once a week, I can have a conversation with a friend of family marriage on something difficult; gay marriage, human rights, universal health insurance, discrimination of women in the workplace, what is modesty, etc.... I enjoy them and I can have them and agree or disagree appropriately as I see fit and learn, think, and study out what was said. I would really feel like my life was incomplete with out that aspect of conversation in my life.

When you look at your life and look back at all the changes that came with that time frame, what are you most grateful for? What things changed that you don't see as benefits in your lives? What do you remember about the Enlightenment from your past classes? :)

Migraines and Women

This week in class we studied three neurological disorders extremely common to women; migraine, Alzheimer's disorder and multiple sclerosis. I wanted to take the time to discuss the basics of migraines but also share a small autobiography from an old school friend who still suffers from migraines. I feel like unless you have truly suffered from migraines (or as my friend mentions sensory disorders and/or autism) you can have no idea what it truly is like and a definition will never been able to truly communicate that information to you. I have only had two migraines in my life and I wouldn't wish them on another living soul. I hope this information is not only informative to others, but also a forum for others to share their experiences as well for the education of my readers.

Migraines can be describes simply as a bad headache- however, that simple explanation really doesn't describe the scope, pain or symptoms of this disorder. A migraine can usually be divided into five separate phases called 'prodrome', 'aura', 'headache proper', 'headache termination', and 'postdrome'. While not every migraine sufferer will go through all five of these phases for every migraine, all migraines will usually have a few of these components. Migraines can also be divided into two types- migraines with 'aura' and migraines without. Symptoms of a migraine attack coming can happen a few hours or even days before the onset of the 'headache' and symptoms are not limited to, but can include irritation, euphoria, depression of affect/mood, intolerance of smell or sound that would usually be acceptable, aura, throbbing, pulse-like or pressure-like pain, as well as nausea and vomiting. It can be brought on by such things as inappropriate sleep, hormonal changes or menstruation, fasting, specific foods, environmental factors, possibly stress and even smoking or alcohol.

Some treatments include light medication such as over the counter pain relievers for mild symptoms as well as caffeine. For migraines that are not as mild, there are some pharmaceutical options that can be given orally, subcutaneously, or intra-nasally that have been shown to help. The most commonly used medications depending on symptoms and patient tolerance include Sumatriptan, DHE, anti-nausea medications, opiates, beta blockers, anti-epileptics, hormones such as estrogen and more. Other individuals use chiropractors, massage and acupuncture to control migraine symptoms.

I also got a pretty good biography from a friend -Renee Wrede- about her history and life dealing with migraines. I asked her specifically because I knew that at least for a while she was having them very frequently. What she wrote is a little long and is only lightly edited for spelling.

My hx of migraines
I started to noticed my headaches when I was little - about age 11. I remember pressing the side of my face against the cold window on the school-bus on the way home to relieve some of the hot throbbing pain around my eye/temple area. My family would tell me to lay down with a cool washcloth - but that didn't seem to help. Sleep and pain meds at the time offered limited relief. My PCP at the time told me that I would "grow out of it" - and seem to doubt my headaches - the sensitivity to light, sounds, touch, smell.

At age 13 I had a new doctor who first used the term "migraine" - he was able to describe my pain in detail - it was very validating. By this time I was experiencing weekly migraines and my family did not seem to believe me. By then we had noticed that cocoa triggered my migraines.

My new doctor prescribed a new upcoming pain med at the time (can't spell it) Toridol? It provided little to no relief.

I continued to experienced horrible migraines throughout school - if caught soon enough I was able to tame it down to where I could still function.

In April 2006 when my neck was broke while working with a teenage client my migraines went into overdrive. I struggled with the pain of the undiagnosed break and the migraines that seem to be a result of the break. Days went by without any relief - I was apply ice to the base of my neck as well as my head and face. I received burns for the cold on various parts of my head because covered ice packs were never "cold enough" so I opted to placing ice packs/bags of ice/frozen veggies/frozen juice cans directly on the point of pain.

I went to ER 2 -3 times a week - which eventually labeled me as "drug seeking" - although my tests always came out negative. I was diagnosed with a "mood disorder" because my pain affected my mood and my ability to work/focus/eat/socialize, etc.

8 months after the break the pain of the break had decreased but the migraines were ongoing. By now my migraines always included limited to no vision in my left eye. Black dots or white shimmering "diamond" images danced around my left vision moments before the pain began. I begged to be referred by a Neurologist - Dr. Good enough.
It was Dr. Goodenough who discovered the fracture in my neck. He also encouraged me to record my headaches and pains.

This was very informative - and helped me identify the migraines from the sinus headaches. It also helped me to identify that my hormones play a HUGE part in my migraines - they appear to cycle around my cycle. And Dr. Goodenough prescribed a daily med Topamax to prevent the migraines as well as a Relapax for when the Monster Migraines attacked. It seem to work - my migraines decreased from daily to 14 a month. Pretty good at that time.

I think my stress level, my physical and mental health continues to play a role in my migraines. I am still triggered by smells and cocoa. Now I experience 2-3 migraines a month. Did I mention that I often throw up when I have a migraine - this was particularly painful in 2006 while my neck was healing.

Despite the pain - it often amazes me how all my senses are brought to a new level - I remember laying on the floor in the dark ER bathroom - the only place that sheltered me of the light, limited smells, and muffled the sounds of the ER - and while I groaned with the frozen peas to my head I thought "I can smell bacon - they must be cooking bacon - God I want to throw up and die!" (They were in fact cooking bacon one floor below!) This is what I call the "superman affect" of my migraines - my hearing, smell, sight, touch are so enhanced that it's painful - I can only imagine that this might be similar to the term "sensory overload" that we often use with children an autism diagnoses. It's intense and it's hell.

I think one friend described migraines best when she said "At first you're in so much pain that you fear dying. Finally near the end you're in so much pain that you fear that you'll never die!"

After the break in 2006 - after the mood disorder and drug seeking labels - I wanted my life to end. The constant pain was too much - I couldn't take it any more. One night at the ER I whispered (I can't speak at a normal level during a migraine) - to the doctor on duty to kill me. "If you care about me - you'll kill me now." The room was dark - my boyfriend stood by my bedside - my connection with friends and family had also been affected by my migraines. The ER doctor laughed (loudly) and seem to take my request as a joke. Little did he know that I had already spoken to family members about custody of my son and possible funeral arrangements.

I can totally understand ending your life when you're in so much pain with no end in sight. I am grateful that a friend suggested Dr. Goodenough - it is frustrating that the ONLY assistance and support I received was from a provider whom I had to seek out. However, now I'm in a better place. Life is good - and I have a hard time believing what life was like 4 short years ago.

If you are reading this and suffer from migraines, please feel free to comment anonymously if you wish. If nothing use, I want to have a better understanding of the problems, but I also want to know how I can help people who are having these problems. Understanding the disorder I think will help. :)

Radiation and the Human Body

When I was in Washington state recently, I visited a museum that had a small section set up to talk about radiation.  I found it really interesting as I just haven't thought about it very much.  If I had, I think that I might have figured that I had a lower dose than the average individual.  After all, I live in a yurt, don't have running water and went at least five years without electricity- I only have one plug now so some have joked that I still don't have electricity.  I consider myself to, with few exceptions, be extremely healthy and until the last few years I ate really well- mostly organic, etc...  I used a radiation calendar at the museum and it estimated that my average was 362 millirems per year.  That didn't sound too bad except that the American average radiation exposure dose is 360 millirems....

It turns out that I have some risky behaviors that keep my radiation exposure at the average level.  It also seems that the world is more radioactive than I had ever imagined.  We live in a world filled with radiation- in the food we eat, in the water we drink... even in the air we breathe.  Half of an average person's exposure every year comes from natural sources.  The rest is all man made so to speak and can usually be separated into three separate categories; medical, commercial, and industrial.

Natural sources seem to be pretty much unavoidable.  The average person is exposed to 40 millirems of radiation from food and drink alone.  Drinking water (especially bottled water), bananas, carrots, red meat and beer are just a few examples of foods that emit radiation.  Any individual that breathes will get about 200 millirems of exposure from radon in the air.  Our bodies - these beautiful and unique temples that house our soul- carry approximately 240 millirems with us throughout our day.  So each of us is an organism that,  while needing to avoid exposure, actually gives off radiation and exposes those around us.  So one form of risky behavior that I engage in is sharing a bed with my husband. The radiation that we give off will give each of us a slightly higher radiation level than those who sleep alone. (Gives a new, positive perspective on being single, doesn't it?  : )

Out of the man made sources of radiation, medical testing really tops the list.  In the guise of caring for our bodies, we sometimes take a greater risk with them then we need to.  With the excuse of 'keeping up appearances' we get porcelain crowns on our teeth if they are needed. (For full disclosure, I have a crown and so I too, am "keeping up appearances".) So many medical tests these days use radioactive chemicals or machines to work. How many X-rays have you gotten in your lifetime? Do you have a pacemaker? When I was sick last year I spent so much time in radiology I am surprised that I don't glow (and on that subject.... maybe it's my husband who is at more risk by sleeping next to me! :D ) Ultrasounds, thyroid imaging and more are all big exposures.

Other ways that we expose would be through television, video game stations,  and computer usage.  If you are in any building with a smoke detector, use an airplane for travel, use luggage inspection at airports, or live within 50 miles of a coal burning electrical plant and/or.......... you are getting higher radiation exposure than those who do not.  Where you live in relation to altitude and sea level makes a difference as well.

Now, most doctors agree that radiation exposure causes cancer and that radiation exposure causes a weakened immune system. A research group studied the amounts of radiation in common medical procedures in 1980 and today – we get seven times more radiative exposure for diagnostic tests now than we did twenty years ago. A study that was just released in the last few days illustrates a disturbing trend in light of the former thought. The study looked at radiology trends for three years over five major healthcare markets. They found that one in ten adults under 64 years of age had in that period of time had a heart procedure/test involving radiation exposure. The biggest used test is called myocardial perfusion imaging (heart stress test) and it accounted for 74% of the procedures in this study. The next was heart cauterization and stents. I am sure that many of these tests were necessary. But I do question whether we are giving medicine and its disciples more leeway with our bodies than we should. Surely, many of these tests did not have benefits that outweighed the risks of the exposure. I wonder how to work on keeping my exposure low (and maybe even lower it) without serious compromise to my lifestyle. But I also wonder if I am being negligent to this great gift that Heavenly Father has given me by simply ignoring the problem through ignorance or even priorities. After all, if I don't care for myself.... who will? And reducing our levels will benefit our families and all those who surround us.

I encourage all who read this to click on the links I have added and see what your approximate radiation exposure is and think of ways you can maybe reduce it. See what you find out... you might be pleasantly surprised... and I might be jealous of your low score!

1. http://www.epa.gov/radiation/understand/calculate.html

2. http://www.nrc.gov/about-nrc/radiation/around-us/calculator.html

(The pie chart above is outdated, but I fell in love with it and I couldn't find a more modern, accurate one. I guess I have always loved pie charts....)