Christianity and medicine – how do we fit?

There is an awkwardness, like seeing two boyfriends at the dance, when talking about medical treatment along with one’s Christian “treatment” toward health. I’ve heard in public about a Christian depression recovery program, “Daniel and Revelation will help heal your depression because for every negative statement, there is an admonition!” As a strong believer in God who is a better Psychiatrist than I am, I still feel an awkwardness with this approach. Maybe the people in these circles are guarded against the medical community disregarding the power of God. Maybe vice versa. A dear Jewish colleague of mine disclosed his regrets about developing many years ago in a culture of medicine in which he perceived he would be discriminated against if he practiced with faith. It was much stronger in the 60’s. Now it’s almost posh to say otherwise and he feels a bit robbed of experience. 

In church today the man over there said, “Evil causes stress.”  It’s hard for me to take that. My mind envisions a beaker over a flame burning off everything else that intersects in the differential, and nothing but evil is left, like a black stain. 

Question: Christianity and Medicine, how do we go together? Please answer? It helps to be a friend to Me. 

Controversy – ECT machines and the FDA

Hello Friends,

Once again, ECT is being bullied and manhandled by stigma, using fear instead of science, to steer people away from a lifesaving treatment. In this instance, they are targeting the ECT machines as an angle to keep others from having access to treatment. Science and life example clearly states the efficacy and success rates with ECT. The machines, …really?

The best way to diminish stigma is to tell others your own story.

Tell others here:

RE: FDA ECT DEVICE RECLASSIFICATION

Please post your comments to the FDA website: http://www.regulations.gov , as soon as possible.

To post comments for the proposed rule:

http://www.regulations.gov/#!submitComment;D=FDA-2014-N-1210-0001

To post comments for the draft guidance document:

http://www.regulations.gov/#!submitComment;D=FDA-2014-D-1318-0002

_____________________

A colleague, whom I tremendously respect, responded to this elequently. I wanted to share it with the world. He has so many years of practice, a deep skill set in the art of medicine, and in these short paragraphs, captured much of the beast in ECT stigma. Thank you Dr. Guerra!

Electroconvulsive therapy is a treatment for potentially fatal illnesses including major depression, bipolar disorder (manic, depressed, mixed, rapid cycling), catatonia, and schizoaffective disorder. It has a remarkable rate of success. Many patients only remain well with continuation or maintenance ECT. In more than forty years of practice, I have seen hundreds of lives saved and hundreds of my patients restored to productive lives.
ECT remains the most rapidly effective form of treatment for those who have not responded to psychotherapy and/or medication. For the acutely suicidal or catatonic patient the risk of mortality may be equal to that of a ruptured aortic aneurysm.  
As we in psychiatry and medicine are trying to fight the stigmatization of the mentally ill, a few points demand attention:
Among the treatments for potentially fatal illnesses (chemotherapy, radiation, surgery), ECT has the highest rate of success with the least physical damage. In fact, while cognitive difficulties occur with ECT, they are generally short-lived and are not the result of physical damage to the brain. By contrast, treatments for other life-threatening conditions, like cancer, often leave patients permanently damaged in the service of saving lives. Treatments such as those for cancer are embarked upon (with consequent debilitating effects) even when the likelihood of remediation or cure is low. In all cases, clinical judgment and the consent of family and other stakeholders are involved before a decision to treat occurs. Such informed consent is the standard for the practice of ECT as well.

An agreement regarding the safety of ECT machines is reflected in the decision to change their classification. Restricting the clinician’s ability to apply his or her clinical skills and knowledge does not improve the safety of ECT machines. It only communicates that the safety of the ECT apparatus is of concern for some diagnostic categories by not of concern for others. Furthermore, restricting the ability of clinicians to apply treatments according to a set of guidelines does nothing the make the apparatus safer.
Having determined that the machines are safe for some, they must be safe for all. Their use must be left to the discretion of the treating physician.

The restrictions being imposed do not seem logical to me. They tie the hands of clinicians, promote stigma, and will foster diminished access to treatment for those most desperately in need.

Frank Guerra, MD, DLFAPA, FACA
Psychiatrist/Anesthesiologist
Medical Director
The Guerra Fisher Institute
Boulder, Colorado
Clinical Professor of Psychiatry and Anesthesiology
University of Colorado School of Medicine
Past President
Colorado Psychiatric Society

Bilbo and Me, trying to get to the Smoky Mountain

jake

Imagine, a young father playing basketball with his buddies on a Sunday in the gym, joking around, slapping each others butts, (because, help us, that’s what they do!) Sweat is rolling down his face. Call him Jake. He’s heavier after three kids, but he’s trying to lose the baby weight. His wife has to wear earplugs to sleep, he sounds so loud in their bed. Jake has been playing hard for about thirty minutes. He’s feeling good. He never lost his touch. He’s with his same buddies from high school. They stay in contact. They’ve got each other’s backs. They’re running down the court. He’s guarding Tom and everyone’s diverted, running, heaving and breathing hard. Tom makes the shot and they’re all slapping each other’s butts. They are throwing the ball back into play and someone laughs at Jake. “Hey Jake! Get up!”

Obstructive Sleep Apnea (OSA) is a leading cause of early heart attack.

I wrote this out in what may seem almost tasteless detail only because this is how it happens. I wish it didn’t and I want it to stop. It is as horrible as you imagine. Jake dies. His wife and gorgeous kids are left to live life without his laughter and counsel and noisy snoring that his wife would do anything to have again. Jake’s community is man-down. Obstructive sleep apnea is a deadly sleep disorder.

CPAP is 99% effective when used to treat OSA. It works. It is just not always the easiest treatment to tolerate for many reasons. But it is worth fighting for. The fight for CPAP might look something like multiple visits to your primary care practitioner to get that referral to go through to your sleep lab. A referral is made, and silence, then made again, silence, then finally by the third or fifth try, it goes through. Or multiple visits to your sleep specialist, exchanging one sleep mask after another and then another until you finally find one that keeps a good seal on your face through the night. There are truly a mountain of barriers to compliance that you will trek across, more barriers than Bilbo encountered heading toward Smaug, and you’ll need as much courage.

Keep on!

Questions: To start with, how is your breathing, or your loved one’s? Did you know that you might have to walk such a circuitous trail toward being your own friend? Who else will do this for you?

Self-Care Tip: When you are deflected, when you get stuck in the moment of loss, pull back into the big picture. You are your own friend and it starts with Me.