Tell us, What is the the long and short of being your own friend?

Sarah
That’s a really, really good question. At first, the hardest part was mourning part of my old lifestyle. I knew I was giving up some things—not just certain foods, but certain hobbies and ways of being (i.e. sleeping as late as the children and not exercising, baking, a coffee culture, social eating, and making excuses). My best friend put it to me this way: “You cannot be a SAHM who bakes as a hobby and not expect to gain weight.” Boom.It was also hard to get into the mindset of daily weighings and—gasp—being accountable. I had to learn calories for various foods and proper portioning. Not a lot of food it felt like at first…but after a few months, a surprising amount of food if I chose to eat veggies and to eat clean.The hardest part mid-way through was a distancing of a person close to me who is very, very much into the food culture and who knows that she is overweight. We used to be into food and overweight together. The distance partly comes from this person and partly from me. Food used to be a major shared interest…and now it isn’t. Now I think we wonder what we both still have in common… But I view food as being like a drug, at least for me. It is fine in medicinal doses, but it is like being a recovering addict in many ways. I’ve had to switch cultures, to keep my mind on the right track. This person isn’t ready to make this journey. I don’t judge that: she’s just not ready. I try not to take our mutual distancing personally, and we’re still friendly.

Right now, I am struggling to switch my mindset from “losing weight” to “maintaining weight.” In some ways, it is easier for me to be in a “losing weight” mindset than it is to be in a “maintaining weight” mindset…if that makes sense. Long term, I am scared of losing control over myself again. There is part of me that knows I won’t, because I have educated myself now about food and calories. The documentary Forks Over Knives has been huge for me, as well. But part of me knows the potential is there for a relapse, and I live with that every time I come downstairs to do dishes and feel the tug of my past late-night snacking habit.

The challenge long term is also to keep goals ahead of me. I do best when I have something to work for. I met my weight goal, but now what? I have been thinking about focusing on strength now, and performance. I have to stay hungry for achievement, versus being hungry for food.

Questions:  How about you? What have you found to be the biggest challenges long and short-term?  Please tell us, also, what is your story.  We need to hear.

Sarah McGhaugh is the auther of blog, birdinyourhand, where she describes herself as, “a teacher, entertainer, four star general, and nurse: in other words, a mom.”  Too cute!  She is also my friend :).  Thank you Sarah for engaging with us.  Keep on.

 

Tell Us What You Are Doing

A pair of Hopper balloons.

This morning, running with Kaia Fitness, I did not have a good book downloaded on my iphone and I was in-between groups of girls I could have chatted with. What to do while running?

Apparently I cannot do one thing at a time, such as simply running. Multitasking is one of my geniuses but also one of my many achilles. My friends at Viking Clinical Research say I have not floundered since I was in-utero. Which is not true.

There were orange groves on my left, vineyards on my right and in front coming out of the morning frost floated eight hot air balloons. Seriously gorgeous.

I decided to call my Missouri-brother and say, Happy Sabbath. Of course, when he picked up he said, “I hope you’re running Sana, cuz if you aren’t…?” I told him I was running.
To the fridge and he said, “That’s good, cuz it means you’re out of bed.”

Well connecting with him was fun, despite his snark. And now with you.

Happy Sabbath, friends. Please tell us today what you are doing to be a friend to yourself? Speak out! We need to hear you. Keep on.

Dr. Q

CHANGING DIRECTION: How To Move Into the Future Despite Your Past

Michele Rosenthal 2013Guest Post by Michele Rosenthal, Author, Speaker, Post-Trauma Coach
Founder, www.healmyptsd.com 

Host, CHANGING DIRECTION, a weekly radio program

Author, BEFORE THE WORLD INTRUDED: Conquering the Past and Creating the Future

Have you ever felt like something that happened long ago still defines you today? Sometimes the smallest stress or the largest trauma moves you into situations that imprint so deeply they become a part of who you are. Sometimes, too, those events change who you are: Consequent beliefs, assumptions, interpretations and perceptions alter how you see yourself, others and the outside world.

I know how easily all of this can make you be not such a good friend to yourself! For over twenty-five years I was actually very unkind to myself as the negative events in my life shaped and distorted my inner self connection. Then, I went on a healing rampage. I knew that life was so much more than simply existing or struggling to exist and I wanted to feel better and be happier. It took years to find what process would set me free. Finally, I learned how to shed the past and now have dedicated my life to helping others find healing (much more quickly than I did!) after life’s big and small traumas.

What I’ve learned through education, training, countless conversations, direct interactions and coaching others is that simply finding a path to healing is not enough. As individuals we want to move in a direction that is positive, proactive, and productive. Figuring out how to do that can be challenging, which is why I’ve decided to expand (and retitle) my radio show to talk about how we go about “CHANGING DIRECTION.”

Beginning the week of April 29th, CHANGING DIRECTION will air twice every week: Monday’s and Wednesday’s at 2pm EST/11am PST. The shows will be thirty minutes in length so that you get in-depth, concentrated content in a timeframe that adapts to your on-the-go lifestyle. In addition to the healing support and information we currently provide our dedicated audience, we will also begin providing expert insights on how to reclaim yourself and transform your life in the areas of personal growth, career, health and fitness, finances, relationships, fun and recreation, and family life. Interviewing experts in all of these areas CHANGING DIRECTION offers ideas for how you can change the direction of your life day after day.

In celebration of this shift, we’re offering all of our new listeners a complimentary ebook gift: “52 Ways To Transform Your Life After Trauma” gives you one idea per week to discover new ways to be a friend to yourself by deepening your internal connection and challenging you to explore what it really means to be you. To claim your gift, click here.

You have enormous healing potential; the goal is learning to access it. You can do this. Dig deep. I believe in you!

I thank Michele Rosenthal for her guest post today, her courage to invite us to team with her in this this and her transparent beauty of character.

Michele Rosenthal is a keynote speaker, award-nominated author, post-trauma coach, and radio show host. To learn more about how you can be a friend to yourself by healing your past visit, ChangeYouChoose.com

Follow Michele Rosenthal on Twitter @ChangeYouChoose. Connect with her on Facebook: Michele Rosenthal, plus the Heal My PTSD fan page

 

another answer to ECT questions

Yesterday, we discussed seven bullet points on ECT.  I disclosed that I have a personal agenda in pursuing knowledge and community awareness about ECT.  (Maniacal laugh! j/k)

In my questions at the end, I asked for ways to continue to improve in this effort, and happily, Nance responded with these scintillating questions!  I’m listing the questions in her words, and responding to them one at a time because really, they are what I hear asked about so often from many others that it’s a no-brainer.  We have to talk about it.  🙂

Good looking lady

1.  Please help those of us who fear good memory loss to understand (or feel better, at least) how ECT is still a viable option. Is the good memory loss permanent?

Studies demonstrate, as does the collective opinion of physicians anecdotal experience, that ECT memory loss is temporary.  Some mild memory loss happens during treatment of course because of the seizures, (also known as convulsions.)  Within a few weeks of the index treatment course ending, the memory returns to normal.

When we have seizures, it is typical, whether artificially induced, such as with ECT, or because of pathology, for us to feel sleepy, not remember events surrounding the seizure and even possibly disorientation.

After a seizure, the brain has a period of “quiescence,” or becomes quiet, when its natural electrical activity rests.  During this time, (the index treatment,) it makes sense therefore, that we will not imprint memories well.

ECT starts out with what we call the index treatment – around four weeks of ECT dosed generally three times a week, on Mondays, Wednesdays and Fridays, for a total of twelve treatments.

Index treatment = 3 ECT treatments/week x 4 weeks = 12 treatments total

This is not set in stone and some people have fewer or more.

Furthermore, most people say that within fifteen days of initiating ECT, memory is actually better!  That’s pretty cool.  It ties in with our understanding that our perception of how we concentrate and remember things is worse with brain illness.  However, in many brain illnesses, it stops there.  It is just our perception, when in reality, our memory is just fine.

Soooo, connect that with what we said yesterday about ECT taking about 1-2 weeks to start working, (i.e. round 15 days!)  And, when the brain illness is healing, the symptoms of the brain illness, (in this discussion it is memory loss,) is better.  Yay!  The term to describe this kind of perceived memory loss is “pseudodementia” because there really is no memory loss in the first place.

2.  How often, after the couple of weeks that you mention, would ECT be necessary?

ECT, like most treatments for brain illness, is not a cure.  Healing does happen, but the genetic predisposition remains.  Most of the time when people c/o that their illness got better with ECT but just came back when they stopped, it is because they never transitioned to maintenance ECT.

After the index treatment is done, we need to taper the ECT doses down slowly, monitoring all the while for symptoms of brain illness resurfacing.  When we decide that the symptoms are just starting to come back, we stop the taper and continue the ECT treatments at that frequency.  For example, if you Nance were at this point getting one ECT treatment every three months, we’d continue you with that.  Every three months you would get one ECT treatment and we would monitor to see that your brain illness remained fully treated.

If you relapsed, we would increase the ECT dosing again until you responded fully and then try to taper down again.

3.  Would it completely replace the need for medication or talk therapy?

ECT works alone, as does medication treatments and talk therapies.  However, any of these work best when used together.  We know that our goal is full treatment response and not just – “Ah, she’s better.  That’s great!  We’ll just see how she does for now.  She soooo much better than she was after all.  We should just be glad and not complain.”

Our goal is not to only improve the illness some, but get it fully responding to treatment and allow for maximum brain health.

Leaving a brain illness only partially responding to treatment equals leaving the disease to progress.  When we fight for full treatment response, we are fighting for our brain health fifteen years from now.

One of the beauties about ECT is that is gets us to this great place where we are giving ourselves a healthier brain in our futures.  For example, we know that there is more dementia and earlier onset of dementia if brain illnesses are not fully treated.

Thank you Nancy for these questions and opportunity to further discuss this important, underutilized treatment option for brian illness!

Thank you readers for joining us in this discussion.  Let us connect with our community, increase community awareness and decrease stigma together.

Everything starts and ends with Me.  Keep on.

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The hard work of being friendly to Me – talking about ECT

i take drugs

i take drugs (Photo credit: the|G|™)

I give a lot of talks in my community on understanding electroconvulsive therapy, (ECT,) as a treatment option for brain illness and I am finally able to bullet point most of it.  It has been and continues to be a long love-labor I am honored to be involved in.  (It looks so simple! – Not!) These seven points, believe me or don’t, represent many hours of research, training, practical experience and time looking into my own motives of interest.

Even here! everything starts and ends with me.  Ah.  So sweet.  😉

drum-drum-drum-drum… rollllllll!

Number 1.  20% more effective than medication at any point in treatment.

In other words, if it is a first episode or fifth episode of brain illness, ECT is 20% more likely to get a positive treatment response than psychotropics.

Number 2.  It starts working in 1-2 weeks, versus medication therapy takes 6-8 weeks.

Number 3.  It does not touch the body systems – does not affect metabolism, heart, weight/appetite, sex drive/performance, cause dry mouth, or vomiting and diarrhea, life-threatening rash or anything else common or bizarre side effect to the body.

Name it, imagine it, confabulate about it but ECT does not do that to your body.  It does not touch the body except the brain where we are trying to make therapeutic changes.

Number 4.  It is the gold standard in pregnancy and peripartum for the same reasons – does not touch the body systems.

For the fetus – there really are not yet any psychotropics that are considered “safe.”  Even serotonin agents that once were the go-to pills for Ob-gyn physicians, are now known to risk increasing bowl irritability, lung function problems and possibly even heart disease.

Number 5.  It is the gold standard in the elderly for the same reasons – does not touch the body systems.

As we age, medications metabolize differently, interact more and cause a lot more life threatening side effects.  Even medications we’ve been safely on for years, one day, cause dizziness and falls.  Out of the blue, we start having nausea.  As if betrayed by an old friend, we don’t metabolize them well, our organs are sickened by them, we develop kidney disease.  Etcetera.  It goes on.

ECT does not.  ECT does not do any of this.  It does not touch the body systems.

Number 6.  ECT has been around for eighty years.

That is a big deal.  That is helpful if kept in mind when we consider if it is fad, a gimmick, secondary-gain driven procedure, motives for treatment and other concerns against its use.

So often in practice, we thrill at the medication samples in their shiny colorful boxes so well marketed with commercials on the television to support their use.  Our physicians pull their drawer out and present them as a new chance at treatment response, which they are.  These medications have been around for how long though?  Surely not eighty years.

How long does their patent last even?  Eight to ten years maybe.

What will we discover about study-medication-X over that amount of time?  Maybe nothing dangerous or too intolerable   How bout eighty years of time?  Still, study-medication-X might remain in a relatively safe category.   Maybe.  Or not.

Most medication trials, to get a medication legalized in the USA, are designed to study medications for about 8-12 weeks on any one patient.  Many trials are done over years, and they are compared with each other using complicated mathematical statistical analysis and governments.  It is not bad and I am grateful to be a part of this community of physicians who studies and prescribes medications from this pool of treatment options.  Still, I think how despite the huge number of persons who received this study-medication-X, none of them were individually treated with that compound for very long.

Deciding to launch a medication into the community is based on this.  Once it is on the market, data is collected and made transparent to the community progressively thereafter. But initially, we are making our decisions to use or not to use with this at our spine.

Shiny boxed pills with a few years gathered round them at most of information from individuals who probably used the study-medication-X no longer than several weeks total, verses, ECT that has eighty years of transparent data regarding what we want to know – side effects, efficacy and any other sense.

Can’t poo poo that.  Eighty years has its own kind of luminescence.

Number 7.  ECT works by changing how different parts of the brain communicate with each other.

ECT “turns down” those areas that have overreactive connection.

It turns out, this is similar with how medications work for brain illness, but without the medication side effects.

For a long time, stigma-related opinions about ECT exposed that we knew ECT worked but did not have studies demonstrating how.  That is no longer true.  This is an important milestone for the history of our treatment choices.

None of this is to say that one person’s choice of treatment is superior to another or not.  Rather, the import of this is that ECT is underutilized largely because of ignorance and stigma.  Not that it is qualified as better or worse.  Better or worse is the opinion of you and I with an informed consent.

Who are we to say that a side effect of ECT is more worth enduring than those of one medication or another?  Only the patient can say this and then how that side effect(s) compare for her against the benefits received from treatment.

However, psychiatry is not an area of medicine that yet has a huge array of treatment options.  To obscure one of this caliber, life-saving heroics and life-changing import is a huge loss.  ECT is another paradigm of treatment.  It is not an either/or.

Oh, but to share in what this does, mmmm.  That gives Me a sense of value, connection to you and improves the way I care for my professional and personal self.  Rich.

Gratefully,

Dr. Q

Self-care tip:  Share in what improves your sense of value, connections and the way you take care of yourself.

Questions:  I’d like to continue to improve this.  Any suggestions?

Does any of this ring a bell in your mind of something important to you?  Please tell us about it.

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Treatment Settings in Psychiatry

HEALTHCARE WITH GOVERNMENT OPTIONS PLAN: IS TH...

HEALTHCARE  (Photo credit: roberthuffstutter)

I thought I’d just talk briefly about some treatment settings in psychiatry.  It is confusing for anyone in the community, from nonpsychiatric physicians to architects, to know the differences between these.  Some of us have been through some of these programs but many many of us haven’t.

  • Inpatient, which is 24 hours a day and includes voluntary and involuntary admissions.  Here we have a skeletal number of group therapies and see the physician daily for psychopharmacology adjustments.
  • Partial Hospital Program, (PHP,) which is generally Monday – Friday, from 9am to 3pm, and always voluntary.  Here, we work in intensive psychotherapy most of the day, and psychopharmacological treatments with the physician at minimum once a week.
  • Outpatient, such as in a physician’s private office where psychotropic medication and psychotherapy are used.

It generally takes time to influence the way the genes express themselves in any therapy, whether it is talk therapy, medication or ECT, to name a few options.

This is skeletal.  Any comments or additions?

(Random) Self-Care Tip 🙂 – know your options

Marcos and his brain illness

Man portrait

Man portrait (Photo credit: @Doug88888)

He had always been a small man with wizened lines, a moguled nose that sloped over a deep philtrum and two ears that flew like flags on the sides of his head.  Looking at Marcos has always been a study of human terrain.   For someone with so much activity and exchange with just being seen by others, it was an apparent contrast to how disconnected he remained emotionally.  Brain illness had harmed Marcos.  It was as if he had been scooped out in places.

Marcos and I had worked together for ten years in psychotropic and psychotherapeutic remedies with only partial treatment responses that curved up toward an imagined healthy baseline on currents of hope.  His improvements however, never reached where he would call himself, “well,” and too soon they drifted down despite our cumulative efforts.

About that time, I had returned from Duke University for an update in training on electroconvulsive therapy, (ECT,) and had just opened up a new outpatient ECT surgery treatment center.  When Marcos and I discussed this as a new option, (new for our living location,) he wanted it without contest.

The evidence for efficacy as compared with the side-effect profile in ECT is dramatic.  When I tell patients about it, ECT might sound too good.  However, it has been around for so long that it celebrates itself. Marcos wanted in.

It has been a year already since we started ECT together but I still remember the way he leaned back in his chair that day in my office, animated almost for a change.  His scrubber eye brows were like punctuation marks around his eyes.  “Yes.  I want it.”

Marcos has not been able to taper down ECT at this point in his treatment to less than one treatment every two weeks.  He and his wife argue for it.  We have tried many times to taper down but every time we do, his symptoms come back.  He and his wife ask me separately and together, “Why doctor?  What is the point of decreasing treatments?  I do not understand?  When they work so well and we are not having any problems from them, why are we trying to reduce them?”  So, for now, he maintains one ECT treatment every two weeks.

His wife tells me he is better than he was on their wedding day.  She has never known him to be doing this well and they both think he is closer to whatever that baseline is for brain health he has always thought he was never going to get.  More connected with her, their sex life is having a run.  More connected with their kids, everyone feels like he has become a giver and the kids grades are even getting better.  By taking, Marcos became more of a giver; taking time, courage, emotional energy, even a ride there and from ECT, Marcos took and then was able to give.

Marcos is reading everything he can get his hands on about ECT; personal biographies, scientific articles, he has become his own advocate.  He could not read before ECT.  His concentration was too poor.  Now, with improved focus and attention, he perceives his memory is better.  Marcos believes he is interesting because he is interested in himself.  He is more aware of how others see him and smiles back when he catches the looks he gets just by wearing that face.

ECT is not a cure, but it is a treatment option.  It leads to brain healing, quality of life and improved connections.

Questions:  Have you struggled with quality of life?  How do you describe quality of life?  Please tell us your story.

Self-Care Tip:  Consider changing treatment paradigms to improve brain health.

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