Why Not Skip Medication and Go Naturallllllll?!

The little Train

The train was tarnished from soot.  The engineer, Jack, grimaced over the craft, while he hauled wood into the fiery oven hidden in her belly.  She was a steam engine and her whistle sounded through the air like a shiver breaking ice.

Indians watched from a bouldered distant peak.  They saw the smoke and marked its passage with each puff.

Just then, a mischievous current sucked up that chimney-spew like a genie to her lamp and the loud wind masked the sound of her turning wheels.  To the unfamiliar natives looking on, the tiny far off train appeared to have stopped, silent to them now and no smoke to ribbon the air.

Not so, though.  Jack did not know they were watched, he and his steely lady.  He did not know he was described in the mind’s of others.

Moving.  Not moving.  Progressing.  Stopped.

But the sensory descriptors were misleading.

Music please.  (Perhaps tom-tom pow wow drums.)

As in this tidy little parable, we think that when we get relief from symptoms, it means that the disease process is better.

Anxious?  Have a beer and vuala!  Better.  Can’t sleep?  Smoke some weed and, “Aaaah.”

No?  “Of course not!” we say.  “We don’t do those plebeian substances.  We use our medications as prescribed.  We don’t abuuuuse them.  If we need more, we ask for more.”

This dialogue is usually regarding benzodiazepines.  “Doctor, I can’t take antidepressants or those other meds!  Why is everyone always pushing drugs on me?  I’m just taking klonopin.”  Or, “Doctors over-prescribe!  I just need xanax!”

Brain disease runs something like the steam engine train.

The steam coming out of the chimney is what we see in symptoms, such as, anxiety, inner tension, fear, insomnia, irritability and so forth.  Get rid of the smoke and we think the disease is dealt with.  However, the train is still going.  The disease is still progressing, although not as notably disruptive as before.  To stop the train, we must stop the engine, or the disease process.  I’m not saying we must cure the disease, rather, just slow or stop the disease progress to treat it effectively.

Our goal is more than symptom management.  Our goal is to treat the underlying illness to preserve brain health and prevent against further injury.

Self-Care Tip:  When medically indicated, consider medical therapy.

Question:  When your symptoms improve, how do you continue toward treatment goals?  How do you go past getting “better” to full treatment?  Please tell us your story.

Sleep Hygiene – my version

1.  The bedroom is only for sleep and for sex.

  • If you aren’t having sex than all you get to do is sleep.  No food, no phone, no TV.  Only sleep.
  • The bedroom is a sanctuary for sleep. Your subconscious is way to powerful to toy with.  When you go to bed you want it to be telling you to sleep, not read that last chapter or check the latest on @Twitter.
  • This can be a change in family culture and affects everyone in the home.

2.  No naps longer than 20 minutes during the day time – Known as a “Power Nap.”

  • If you are tired and have the luxury of lying down, do it!  But set your alarm to wake you up in 20 minutes.  You can do this 20 times a day if you want to.  But no longer than 20 minutes.  Anything longer will break into your deeper stages of sleep and throw off your sleep cycle (also known as sleep architecture) at night.

3.  No caffeine second half of the day.

4.  Exercise but not before bed.

  • Exercise will help regulate your sleep cycle at night if you just give your sleep initiation some space.
  • Try to get forty to sixty minutes 5-7 days a week of aerobic exercise to get best results.
  • Look at exercise like a pill.  A prescription.  Something for your medical and emotional health (inspiring to me), not necessarily for your waistline (inspiration notoriously short-lived.)
  • Every day think, “I’m exercising so I feel good, so I sleep good, so I can do what I want in life” – what ever that may be for you.  Some people will say, “…so I’m not a crazy Mom!”

5.  Keep the lights dim before bed.

  • Light turns off melatonin release from the pineal gland in our brains.  Darkness releases it.  Having your face 6 inches from the computer screen or TV before you lay down doesn’t give your body much time to turn itself off.  Melatonin is a cornerstone in sleep architecture.
  • Some people who feel they must be on the computer or TV before bed have found that wearing sunglasses for at least the last 30 minutes helps.

6.  Go to bed and get out of bed at the same time every day.

7.  If you can’t fall asleep in 30 minutes, get out of bed and do something else until you feel sleepy.  Then go to bed and try again.

  • Refer back to #5 when choosing what and how to do your activities during that time.

8.  If you can’t fall asleep in 30 minutes, consider taking a sleep aid.

9.  Do not take any sleep aids over-the-counter except melatonin, valerian root, or chamomile.

  • All others including anything containing diphenhydramine, block your deep sleep. You may end up sleeping a longer amount of time, but you won’t be getting restorative sleep.  It is during the deep sleep that your body heals, replenishes it’s hormones and neurotransmitters, and consolidates memories.

10.  If you choose to take a prescription sleep aid, do not take benzodiazepines such as diazepam, temazepam, clonazepam, alprazolam, or lorazepam to name a few.  These also block deep sleep.

  • Sleep aids safe for deep sleep and sleep architecture, include atypical benzodiazepine receptor ligands – such as zolpidem (Ambien), eszopiclone (Lunesta), or zaleplon (Sonata).  The main differences between these are how long it takes for them to be metabolized/washed out of the body.  Some are quick and some last the full 8 hours.
  • Trazodone (Desyrel) is also safe for sleep structure and maintenance.
  • Sometimes people will find that combining something like zolpidem with trazodone is most effective for them rather than using only one agent.

11.  Do not use alcohol to sleep.  Alcohol is a depressant (will make you depressed) and also blocks deep sleep.

12.  Do not smoke before bed or if you awaken from sleep.  Nicotine is stimulating.

13.  Don’t sleep with your pets or children.  They are disruptive.

  • It’s not personal.  It’s sleep hygiene.

Self Care Tip #34 – Use these tips to decode how to sleep well.  Be a friend to yourself.

Questions:  Why do you skip the bits of sleep hygiene that you do?  What helps you in your tough work of being your own friend in regards to sleep?  Please tell us your story.  

When To See A Psychiatrist

Singer Brandy Norwood in September 16, 2010.

Even car accidents happen for “good reasons!”

Wanda didn’t want to hear the reasons.

Anything could sound like a good reason for bad performance.  It is what it is.  Just own it!

And Wanda was out.  And just as quickly as she concluded, I flashed back to the quivering resident who messed up on internal medicine rounds.  I stood there with my spine like a steel rod.  My white coat felt heavier with my fair-weather reference books bulging in my pockets.

Keep your chin up and look at her!  I told myself.

This wasn’t the first time for me, so I had the “luxury” of practicing a previous well-described lesson from my attending on how to respond to feedback.  Those days seemed like a series of stings, burns and frost-bite, but I am grateful for that at least – the knowledge of how I’m supposed to “take it.”

Wanda came back into my mind’s focus as memories of internship faded.  Wanda wasn’t even mad at me.  She was telling me this story as an example of her difficulty coping with anger.  Here she was asking for help while justifying her position.  Don’t we all, though?

I saw the irony in her criticism of those who gave reasons for their foibles as compared to her own explanation for anger and medical care.  Yet again, aren’t we all inconsistent like this?  Wanda is not alone.  She even had good insight too.  Explaining away our mistakes is shabby, lacks class and is insincere.

Some time ago in a post, Please Don’t Say “But”, we talked about this, which later we termed “presence.”  But why see a psychiatrist about these things?  Because insight is only worth so much.  If the mechanics to respond to the insight aren’t well, then you’ll be able to withdraw from your self just that.  In Wanda’s case, it was spitting anger, hot to the touch and not much safe.  It had quite an effect on her interpersonal relationships and quality of life.

But Wanda was suffering in more than her apparent psychological and sociological selves.  She was also suffering in her biological self.  (See biopsychosocial model.)  Wanda, was ill.

When we find that we can’t do what we want, don’t respond the way we intend, have negative emotions and behaviors we didn’t invite, see the associated deterioration in our connections and quality of life – when we are suffering, we need to look for help.  It’s hard to be productive and survive without support.  Any bit of nature will tell you that.  Ask a peach tree if you don’t believe me.

Question:  Does it make sense to you that emotions and behaviors might be all we have to show us that we are medically ill?  If not, please tell us why.

Self-Care Tip:  When insight isn’t enough, consider a medical consult.  Be a friend to yourself.

Medical Therapies Are Like Old or New Rugs

English: Physician of Rome During the Empire -...

The older I get, the more reputation I accumulate.  I am an old rug.

Have you ever seen a child – their smooth, unblemished skin like marsh-mellows;

their eyes, cupcakes, (my children’s are chocolate);

the way they look at the world open-mouthed swallowing flies;

the way the world looks at them?  Both sides hungry.

We say about these kids in contrast to us old property, “They have it all.”  They have it all because they just have not been around for very long.  They do no have a bunch of mistakes accumulated, crafted and woven into their lives; mistakes that could not be outed.  

Children do not have a limited supply of first beginnings.  When you have been around a while like us, first beginnings seem like they have changed their constitution.  On this side of the freeway, even though we have the freedom to start over at any point in our lives, starting over means something different when you have been around.  

It is not a matter of value.  Being around does not devalue Me.  It does not take away our worth.  It does not improve our worth – the Me we speak of.  Perhaps it will improve our worth in other ways or lessen it – but it won’t touch Me.  

There is nothing like a veteran office staff who knows how to do everything that your office needs.  That person is different from somebody out of high school.   Better for the position – yes, but not a better Me.  There is nothing like having a physician who has practiced for ten or twenty years and seen patients walk out angry, has seen patients die, has seen in action which treatments do what.  There is nothing like a physician who has worked with a medication long enough to know the inside of it; that there is good and there are things that happen that are not so good and that when you cannot unravel those things from that therapy, you try to see it together.  A more valuable physician for the job, but not a more valuable Me.  

The office staff, the physician and the child have reputations.  Those who have been around would take up more ink.  

Treatments are like that too.  The longer they have been around, the more reputation they have.  It is like being at a party and you see somebody who has been to all of the parties.  Somebody who has been the first to come and the last to leave, who has hurt people and been hurt and who has gossips surround them.  When you see that person, you walk in the door and think, “Oh boy!”  Or, “Yes! the party girl is here.”  But no matter what you think of them, there is something to say about them lasting as long as they have in these circles.  There’s a reason they keep getting invited and a reason they weren’t taken off lists.  

A treatment that’s been around a really long time, that has gotten a bunch of heat and perhaps even been referred to as “barbaric,”  has remained in circulation for reasons worth knowing.  If it didn’t offer lasting and unique benefits, if it’s benefits weren’t considered greater than the risks and potential negative outcomes, if people’s lives weren’t improved more than they were damaged – that treatment, like so many others, would have extinguished on their own much earlier in history.  

Questions:  What do you think when you see the treatment that you have been offered.  Has it been around long enough to get a reputation.  Or is it the new kid, the new child with velvet for skin?  Their eyes have not woven in shards of particled light that tangled the loom perhaps?  You with reputations, who are older than this and still around, tell us your story.

Self-Care Tip:  When considering treatments, consider their age as you consider their reputation.  Be a friend to yourself.

Medications and Being Chosen by Fear

English: In 1870 he lost an arm, in 1917 he lo...

Many have been hurt by medications.  There are those life ending treatments.  There are accidents.  It doesn’t matter what remote or near number in the chance-line the side effect has to the victim or the survivors.  They happened and they happen.

If you are a survivor of something like this, if your child died or your mother almost did, if you lost your favorite thing in life – lost what you identified yourself by or if you were changed without being asked, you know what I am talking about.

How do you come back after that?  How do you endure opening your pill dispenser on Wednesday, on Thursday, every week, every day, how do you take medications when they are prescribed?

On my end as a physician, each prescription is a choice.  Each prescription carries the bit I am allowed to participate in.  Signing my name, I am saying with the informed patient, that the benefits outweigh the risks.

When you take your medications, know that you are not alone.  Know that you are doing this with numbers of other courageous people taking their medications.  Know that your physician, with the research behind this, with the high numbers of other persons generous enough to enroll themselves in those medication trials before the Federal Drug Administration (FDA) approved it.  Know that the FDA is with you and know that the benefits out weigh the risks for you.  That you decided the benefits are greater than the risks means you know what they are and you are choosing to take care of yourself.

Medication isn’t for everyone.  Medication hurts a lot of us.  Taking medication with this knowledge is still something many of us choose.

If we are not taking our medication because the fear precludes it, we can do better than that for ourselves.  We can choose not to take it without being chosen by fear.  On the flip side, we can choose to take medication without being chose by fear.  Being chosen by fear hurts us too.

Self-Care Tip:  Go into the space of where your fears are and let it lose power over you.

Questions:  How do you claim your freedom to choose when it comes to something as complicated and scary as medication?  Please tell us your story.

Consider the Barrier Stigma Plays in Your Ability to Take Care of Yourself

Esther... The Girl Who Became Queen DVD Cover

I am just going to come right out and say it.  I have been trying to be clever, a Queen Esther toward her King and Hamon, on behalf of the people she loved.  (Yes.  I am Queen Esther in this story.  You can play her in another one.  Maybe tomorrow.)  I have been talking about treatment options for brain health and it is just not going where I was trying to take us – ECT.

ECT, my friends.  Electroconvulsive Therapy.  Many people see this as an extreme option for the dire, filtered out treatment failures.  That is an ugly description but I believe pretty close to what we have culturally got.  Many of you have told us how you escaped receiving electrically induced convulsions.  You hid from the boogie man and lived to tell us.  (There are chemically induced convulsions but we have more control of the convulsions through electricity, so that is the standard of care.)  Others have testified that it destroyed them with a catalog of specific and nonspecific complaints.

Interestingly we have not heard from you who have received ECT.

Come out, come out wherever you are.

Stigma perhaps hides you, and we can understand why.  Stigma toward ECT is like stigma toward anything – pretty off topic and hurtful.  Although it is improved by education and empathy, it is not fun challenging it “alone.”

Tonight I am not going to talk about the pros and cons of ECT, but to say that you are not alone.  You who are in treatment or have been in treatment or are considering ECT – would you tell us what you know, personal or impersonal?  There are many of us who would benefit from your education and empathy.

(What would that do to stigma?  What would that do for us?)

It would be wonderful to hear questions any of you have, as well, and anything related to ECT that you would like to share.  Please tell us your story.

Self-Care Tip – Consider the barrier stigma plays in your willingness to receive treatment and to connect with others.

What We Will Do For Brain Health – Looking For Heroes

Death and the Maiden #2

Image by CapCat Ragu via Flickr

My dad is turning seventy-seven tomorrow folks.  He could have died a gazillion times before now, but it is the tumbling of those near-deaths into big life that teaches and recruits me.  He makes life feel like open space, warm skin, color and lyrics.  Now his spine is crumbling, his legs are weak, his lips are always moving in and out like a rabbit and he’s almost too hard of hearing to comfortably socialize with.  Still, it is the life, the interest he has, the way he doesn’t stop growing that somehow dims the many times he might have died.  Why does the one time he will die seem impossible to juxtapose against any future then?  Where will life go, if he is not there to infuse us with his humble will?  I think it may fall asleep with him but I know it will not and I cannot imagine it otherwise.

These past few posts we have talked about “special efforts” for brain illness.  We asked, “Is there any treatment you think is too extreme to consider to get brain health?”  We have not said the reason we cannot fairly answer.

I don’t know how life will be without Dad; we never know how life will be when our brain is bad and then more bad.  It’s hard to tell.  We can only imagine and usually our imagination will be wrong anyhow.

Any answer to this question, “Is there treatment you think is too extreme to consider to get brain health?” is shaped by our understanding of what “extreme” means.  It changes shape and margins with the degree of brain illness.  With each turn, as our disease process exacerbates, so progresses our willingness to believe what is reasonable versus what is “extreme.”

Many of you have told us of your own specifics in your fight for brain health.  People do heroic things and I’m thinking you and I might have a bit of a living hero in us.  In part, it is the inherent unknown in growth that testifies to life itself.

“Is there treatment that you think is too extreme to consider to get brain health?”  I imagine my answer would be, no.  Please tell us more about yours.  Your view from your degree of extreme helps.  Keep talking.

Self-Care Tip – Let the hero in you speak, grow you and testify to life.