Is There Systemic Racism in Healthcare?

Our Kentucky governor, Andy Beshear, has announced that he wants to make sure that all people of color in the state are covered by health insurance. I’m already hearing the backlash.  “That’s not fair. What about white people? You can’t just cover blacks.” 

Frankly, I think we whine a lot.

First of all, if we didn’t believe it before, the COVID 19 pandemic has clearly shown us that people of color have a disproportionately high death rate. Probably that’s because their health is not as good to start with.  Why is that? The higher rate of poverty is one reason. They are more likely to live in food deserts where healthy food is not as available and if it is available, it’s more expensive. Also, believe it or not, there are still many people who don’t have transportation which makes it difficult to get to the doctor. The bus system is not always an answer. Bus routes have been cut significantly, taxis are expensive, and some places don’t have either. Also, if you go to the doctor, you may have to take off work. Some people can’t afford to lose that pay. 

But this isn’t just about poverty. If it was, we could at least focus on that one issue. It has more to do with lack of trust in the medical system. If you don’t trust that you will be treated well and taken care of, why go to the doctor? If you rarely saw doctors who look like you, if you felt that your parents and grandparents had not been taken seriously by the medical establishment, would you really want to go to the doctor? I wouldn’t. 

It’s hard for whites to really understand the toll that living in our racist society has on people of color, both psychologically and physically. Yes, I did use the word racist. Whites immediately take offense to that. I’m not talking about deliberate racist acts perpetuated by individuals (though you don’t have to look far to see examples of that).  I’m talking about white privilege, which most of us don’t even see because we take it for granted.  I’m white. We don’t generally have to worry each time our sons or daughters walk out the door. Blacks do. That kind of stress takes a toll on health and makes it hard to focus on day to day things like taking care of yourself.  Years of being seen as “less than” influences attitudes people of color have towards themselves and the institutions that seem to be dominated by those who see them as “less than.” 

Do some research of your own. If you go to the National Library of Medicine and search for African Americans and the healthcare system, you will see a number of articles on how the experience of people of color in our health care system is different than that of whites.  There is an interesting discussion from October 2019 titled How Our Health Care SystemTreats Black Mothers Differently. It’s a transcript of an interview with Kennetha Gaines, clinical nurse manager for UCSF Health in San Francisco. You can find it by searching TheCommonwealthFund.How Our Health Care System Treats Black Women Differently. By the way, black women die of pregnancy related complications at a rate 3 times greater than that of white women. 

The book Communities in Action: Pathways to Health Equity (2017) has this quote in chapter 2:

Race and ethnicity are socially constructed categories that have tangible effects on the lives of individuals who are defined by how one perceives one’s self and how one is perceived by others. It is important to acknowledge the social construction (i.e., created from prevailing social perceptions, historical policies, and practices) of the concepts of race and ethnicity because it has implications for how measures of race have been used and changed over time. Furthermore, the concept of race is complex, with a rich history of scientific and philosophical debate as to the nature of race (James, 2016). Racial and ethnic disparities are arguably the most obstinate inequities in health over time, despite the many strides that have been made to improve health in the United States. 

Having been a physician for almost 40 years, I have seen close up how some patients get better treatment than others. It may not be obvious. It shows up in how much time is spent with the patient, how seriously their complaints are taken (or dismissed), whether tests are ordered to investigate the complaint, whether a return appointment is scheduled and just plain bedside manner. As a white physician, I hope I have not participated in that type of discrimination, but I’ve come to understand that most of us who are white have participated in some form of discrimination without realizing it. It’s because we are part of the dominant culture. We are so used to the way things are, that we don’t realize how many privileges we have that are not automatically available to people of color. 

So, to answer my original question, is there systemic racism in medicine, I would say definitely yes. Making sure that people of color have insurance is a first step, but there is still much to overcome. They must be able to trust that they will be treated equally, they must buy in to the need for preventive care because they deserve it, they must have the time, flexibility, and means to get to the doctor.  Most of all, we must convince them that we care about them, and they will be treated with respect and taken seriously. It would help if they saw more physicians and nurse practitioners who look like them.   It’s up to us to make this happen. People of color didn’t create this problem. We did. 

In my opinion, it’s OK to talk about making sure that all people of color have insurance. In my book, we owe them. 

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Ten Reasons Why

    Ten Reasons Why . . .

I’m frequently asked by colleagues, patients, and family members why persons with this disease can’t just stop using.  I’ve compiled a list of reasons that I hear from patients. It’s complicated, and there isn’t one answer for everyone.

Ten reasons why persons with addiction don’t just stop.

1. Once addiction is established, it’s a brain disease. Diseases don’t just go away. It would be great if we could just decide not to have hypertension or heart disease or cancer anymore.  It just doesn’t work that way. Physiological changes have taken place in the brain that perpetuate the addiction. Craving for the drug is often so intense that the addicted person can’t get beyond it.
2. Persons with addiction exhibit thinking that is “bottoms up” rather than “top down.” In other words, addiction “hijacks” the brain’s pleasure/reward pathway which is the limbic system, the more primitive part of the brain. The prefrontal cortex, the part of the brain in charge of logic, reason, and evaluating pros and cons of decisions, is no longer in charge.
3. Persons with addiction often feel that some function is better than no function. They honestly believe that they cannot function day to day without the drug. They mistakenly believe that they are functioning better than they really are.
4. They fear withdrawal. Drug withdrawal is not just a mild case of the flu. It’s more like food poisoning on steroids combined with intense muscle cramps. Most persons with addiction will do anything to avoid it.
5. They have experienced past traumas such as sexual or physical abuse or military combat trauma, and they are using the drug to try to deaden the pain. They are covering the symptoms of post-traumatic stress disorder.
6. They can’t face the damage that their addiction has caused.
7. They have no social support for sobriety. They have no family or friends who are sober. They don’t know what a sober life is like. They haven’t developed the skills to cope with the ups and downs of life.
8. They have chronic pain, and they fear dealing with pain without pain pills. Many of our patients in the clinic had no issues with addiction until they were prescribed opiates for chronic pain. That doesn’t mean, however, that every person who uses pain medications will become addicted.
9. They don’t know how to access treatment, or they feel that they don’t have financial resources to do so. Many women have young children, and they are unaware of options for child care while in treatment.
10. They no longer believe that they can get sober because they have failed before. They have lost family and friends. They have been told that they are losers, and they believe it. They have lost hope.

One of the most important goals of addiction treatment is to restore hope. Once patients begin to believe in themselves again, they are on the road to recovery.

Why Are We Afraid of Universal Health Care?

What does universal health coverage really mean? This is the definition of universal health coverage from the World Health Organization (WHO).

Universal health coverage (UHC) means that all people and communities can use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship.

This definition of UHC embodies three related objectives:

1. Equity in access to health services – everyone who needs services should get them, not only those who can pay for them;
2. The quality of health services should be good enough to improve the health of those receiving services; and
3. People should be protected against financial risk, ensuring that the cost of using services does not put people at risk of financial harm.

In 1948 WHO’s constitution declared health care a universal human right.  The organization works with countries on health care financing to make universal health coverage a reality. The key concept here is the belief that health care is a right, not a privilege. As a physician, this seems like a no-brainer to me. Yet that view is controversial here in the United States.  Many people espouse the view that health care should be available to all, yet believe that it’s too expensive.  The other political issue that hinders universal health care in the US is the philosophy that government involvement in health care is too intrusive into individual privacy and that states should make decisions about healthcare.

Let’s take the first point first. When we say that something is too expensive, what we really mean is that it isn’t a priority. If a member of your family develops a life-threatening illness, health care suddenly becomes first priority, and you rearrange your finances to make sure that your family member gets the necessary care.  We don’t leave funding of the military to states, because it is a priority. We decide, by electing our congress people, what our priorities are.

The Harvard Review published a great article in May of 2015 discussing this issue. The article points out that many poor countries have been able to initiate affordable health care for all citizens at a reasonable cost. Thailand and Rwanda are good examples.  Their infant mortality rate has decreased and life expectancy increased.  The key, according to the article, is that countries have to be committed to the principle that everyone deserves access to health care, and they must have their act together, meaning that everyone is on the same page, to make it happen.  I don’t think we are on the same page about anything at the moment.

Now let’s look at the second issue – the privacy, big Government Issue. How does offering everyone access to health care invade privacy? If you choose not to go to the doctor, that is still your choice.  As far as government involvement in healthcare, we already have it – Medicare. I don’t think most seniors would want to give that up. It’s not completely free, but it is affordable for most seniors.  While the program is not perfect, and not all physicians take Medicare, acceptance by the medical community has improved. Government programs do not have to be fraught with complicated regulations if managed by the right people.

Another prevailing view is that low-income people get health care because doctors won’t turn people away.  Before the ACA, some doctors did see low-income patients on a sliding scale. But many people still couldn’t afford the fees. There were some clinics for low-income people, but they still have to be funded somehow, usually by the state or federal government.  Many low-income people used the emergency room (and still do) for primary care. But who pays for that? We do. It increases the cost of health care because hospitals have to compensate for it.  They key to long-term good health is not acute care – just taking care of the problem at hand. It’s preventive care. That requires visiting a primary care practitioner often enough to head off potential problems.

Universal health coverage can take different forms in different countries. I’ll discuss some of them in the future. No system is perfect. But they all came into being because governments were committed to the idea that health care is a right, not a privilege. If you believe that, you have to conclude that all people deserve access.

Check out the Harvard Public Health Review article “Universal Healthcare: An Affordable Dream,” vol. 4, Global Health, May 2015 (harvardpublichealthreview.org).

 

WHEN DID MEDICINE AND BUSINESS GET MARRIED?

It slipped up on me. I guess I missed the engagement party. I thought I was going about my career taking care of patients as I planned to do when I decided to be a doctor. But today I find myself worrying more about whether I’ve met my billing quota and my RVU (relative value unit) target for the month. The relative value unit measurement tells administrators whether we are seeing enough patients, keeping our schedule full.   I don’t blame administrators. They’re cogs in the wheels of a totally dysfunctional system. They are doing what they can to keep our doors open.

When I interviewed for a position in medical school, I was asked whether I thought that medical care was a right or privilege. It was a common interview question at the time, and I had been forewarned that it might come up. I had no hesitation in answering that question though. I felt then, as I do now, that access to medical care is a right, not a privilege. I wonder if that question is even asked anymore.  Apparently, the correct answer at the time was that medical care is a right. However, I don’t see that organized medicine has ever truly supported that philosophy because if they had, I don’t think we would be in the mess that we are in now.

Somehow, insurance companies got involved in healthcare. I also remember that when I first started working and had to pick an insurance plan, I was advised to look for a plan that had the best catastrophic coverage, because that’s what insurance was really for. The idea then is that you could still pay cash for doctor’s visits and medications. We’ve come a long way from that.

Why have we tied the ability to access health care to a job? Until the Affordable Care Act, if you didn’t work, you didn’t have insurance unless you met fairly restrictive criteria for a state Medicaid plan or you were wealthy enough to buy a private insurance plan or just pay for your healthcare.

At one time, healthcare companies were nonprofit for the most part. But now they don’t claim to be non-profit. Let’s look at the salaries of the CEO’s of the top healthcare insurance companies. This is public knowledge. You can find it at fiercehealthcare.com.

 

Humana CEO Bruce Broussard $10.3 million

United Health CEO Stephen Hemsley $14.5 million

Cigna CEO David Cordani $17.3 million

Anthem CEO Joseph Swedish $13.6 million

Aetna CEO Mark Bertolini $17.3 million

 

So these guys are paid millions of dollars to find ways to deny the medications and procedures that your doctor orders. Of course, that is an oversimplification of what they do – but not much of an over simplification.

I find it interesting that patients are so against a single payer system, yet are willing to have their healthcare essentially dictated by an insurance company with a CEO paid 17 million dollars to rip them off. Go figure. By the way, we already have a single payer system for those over 65 – Medicare.

Doctors and the AMA have some responsibility for the negative view of single payer systems. For many years, the American Medical Association very opposed to any single payer system, also called socialized medicine. That really is not an accurate label for a single payer system. The AMA’s stated mission is “to promote the art and science of medicine and the betterment of public health,” (ama-assn.org). However, in my opinion, the AMA sometimes seems more interested in protecting doctors than in the interests of patients. Don’t get me wrong. We all benefit from organizations that protect our interests, but healthcare is not like any other entity. It’s life and death for patients. Sometimes, what is good for doctors also benefits patients, but not always. I’ve never joined the AMA.

In future blogs I’ll take a look at healthcare systems in other countries. I believe in gathering data before judging something as bad or good. No healthcare system is perfect, not the single payer systems (which are not all the same) and not our insurance-driven system.

I would recommend a book coming out on April 11 by Elisabeth Rosenthal, MD, called An American Sickness: How healthcare became big business and how you can take it back. Dr. Rosenthal has been a practicing physician as well as an author. She has traveled widely, and she is familiar with other healthcare systems. I was able to hear her on a podcast, and I’m looking forward to reading the book as soon as it comes out. One of her messages is that patients can have a role in taking more control of their healthcare and dealing with insurance companies. I have found that insurance companies sometimes listen to patients more than they listen to us. They will often say that they’ve denied something because the doctor didn’t provide enough information, but in reality they are playing the blame game. The doctor probably filled out the confusing, redundant paperwork, but the request still didn’t meet the insurance company’s criteria for approval. I’ve had insurance companies refuse a request 3 times because they sent us the wrong form to fill out 3 times.

Don’t forget Dr. Rosenthal’s book coming out on April 11. It should be a good read if you care about our healthcare system. I found it on amazon.com.

And I still believe that in our country access to food, education, and healthcare are rights. How they are used is up to the individual.

 

 

Defunding Planned Parenthood Is About More Than Abortion

So now we want to defund Planned Parenthood? I’m always interested in how our legislators apply critical thinking to their decisions.     I’ve been taught that when making decisions, you look at all possible implications of the decision. You look at all ramifications, all of the pros and cons. So I’m trying to understand the logic here.

Of course, the issue is that Planned Parenthood performs abortions. Abortions are performed in other places as well, but Planned Parenthood is up front about it. However, abortions only constitute 3% of Planned Parenthood’s care delivery.  The reality is that 80% of services provided by Planned Parenthood prevent unwanted pregnancies.  They provide confidential contraceptive services to women who could not afford it anywhere else. Most of the patients who take advantage of Planned Parenthood’s services have incomes below the poverty level.  Planned Parenthood serves men as well as women.  The organization provides evaluation and treatment for sexually transmitted diseases, provides education to help patients makes responsible sexual decisions, and provides sex education. About 7% of their services involve cancer prevention. They perform breast exams, pelvic exams and PAP smears and vaccinations for human papilloma virus.

Abortion is a controversial issue. But abortions will not stop if Planned Parenthood is defunded. SAFE abortions will stop. If men and women don’t have access to affordable sexual health care and contraception, there will be more unwanted pregnancies.

There is more to this than the focus on abortion because that’s a small part of what Planned Parenthood does.  Defunding Planned Parenthood will primarily affect poor women. Women who have financial resources go to private gynecologists. Though many lower income people now have medicaid, not all do. Many private doctors don’t take medicaid.   This is a not-so-subtle slap in the face to women who have few resources. Many legislators seem to believe that people who are poor (yes that’s probably not a politically correct term) don’t deserve help. They believe that people who live below the poverty level are there because it is their own fault. It’s much more complicated than that.  Most legislators, including our new billionaire President-elect Donald Trump, have no clue how low-income people live day to day.

The logic is interesting. We don’t want women to have access to abortion, and we don’t want them to have affordable access to sexual health care to prevent unwanted pregnancy, and we don’t want them to be on welfare after they have the unplanned babies that they didn’t want in the first place but had because they weren’t on the birth control that could have been provided by Planned Parenthood. That makes a lot of sense.

The lack of concern on the part of our lawmakers and our citizens in my state of Kentucky for those who are struggling appalls me. The defunding of Planned Parenthood is just one example.

Hmmm. . .  I think we have a major deficit of critical thinking here.  It seems to me that our legislators have very little understanding of the complexities of poverty and the lives of many women.

SOMEONE IN YOUR WORLD IS ADDICTED: OPEN YOUR EYES

In the US Revolutionary War, from 1775-1783 there were 50,000 US casualties.  In the Vietnam War (1955-75), there were 211,454 US casualties, while the Iraqi War, from 2003-2011 resulted in 36,710 deaths and the Afghanistan War, from 2001 to the present resulted in 20,904 deaths (US Military Casualties of War, en.wikipedia.org). Over 40,000 women each year die of breast cancer (Jemal et al. Cancer statistics, 2008. CA Cancer J Clin. 2008 Mar-Apr.).   That’s a lot of mothers, fathers, wives, husbands.   Statistics like that grab us. We’re willing to invest in cancer research and treatment.  We honor our military dead. Yet in 2015 alone, more than 52,000 people died of a drug overdose according to the CDC (Center for Disease Control).  Of those 52.000 deaths, 61%  involved an opiate. Between 2001 and 2014, per the National Center for Health Statistics of the CDC, over 250,000 people have died of prescription drug overdoses. Yet, unless one of them happens to be your son, brother, daughter, best friend, wife, those deaths are largely ignored.

We can distance ourselves from those deaths because “it’s their fault.” After all, “they’re drug addicts.” You don’t see fundraisers for drug addiction treatment or parades to celebrate recovery from drug addiction, at least not very often. Yet, we’ve lost more people to drug deaths (not just heroin, but also prescription drugs) over the last 15 years than we did in the Iraqi and Afghanistan Wars combined, or in the Revolutionary War, and we lost more people in 2015 to drug overdoses than we did to breast cancer. What a tremendous waste.

This is a treatable disease.

 Why aren’t people getting treatment? Only a very small percentage of people with addiction are in treatment. There are several reasons. For one, there aren’t enough treatment resources, and there aren’t enough people who specialize in treating addiction, particularly in rural areas. There is still a lot of stigma and misunderstanding People with addiction are told that they are simply weak-willed, that they could stop if they only wanted to, and they buy into that. They are hopeless and defeated, and they believe that treatment won’t work. Nothing could be further from the truth. Addiction is a disease of the brain, a disordered brain. Once a person is in the throes of an addiction, free will is not operating anymore. As with any disease, people who have been ill for a long time, people who grew up in families rife with addiction, need more intense treatment over a longer period. It’s not easy to find that. It may be expensive.

I listened to an interesting webinar today, presented by the American Society of Addiction Medicine on what the Surgeon General’s Report, Facing Addiction in America, means to clinicians treating addiction. Dr. Thomas McLellan of the Treatment Research Institute was one of the speakers.  He points out that 94% of addictions start between the ages of 12 and 25. So that means that we probably aren’t starting treatment early enough.  Addiction related deaths account for 74% of deaths in the 12-25-year-old age group.

Physicians have a role in this abysmal statistic as well. I can say that because I am one. We have been too quick to prescribe opiates and not good enough at monitoring our patient’s use of them. I think, however, that we are getting a little better at understanding when and how to use opiates, when to not use them, and alternative treatments for pain.  However, what I still find infuriating is the negative attitude that many physicians have towards patients with addiction, even patients who are in medication-assisted treatment. I thought we learned better in medical school. You don’t let your personal biases interfere with your treatment of the patient. I’m afraid we’ve lost that concept in the medical profession.

Unfortunately, addiction is like cancer. If treated early and aggressively, the patient can be saved. But if treated too late, some people won’t make it.  I would be willing to bet that someone in your inner circle is struggling with addiction. Open your eyes. Get them into treatment if possible.

And remember, if people don’t have health insurance, they don’t have access to treatment.

You can read the Surgeon General’s report at addiction.surgeongeneral.gov.

 

 

Listening to People with Cancer

 

Over the last couple of years, I’ve had the privilege of working with patients diagnosed with cancer who were referred to our clinic by local cancer treatment centers. I’ve seen people at all stages of the disease, very early to terminal. They are usually referred to me because they’re very depressed or anxious. Sometimes they are willing participants in treatment, eager to tell their story. Sometimes they are angry and resentful, feeling that their oncologist (cancer specialist) must believe that they are crazy if he or she referred them to a psychiatrist. Hopefully, we can get past that.

At first, I wasn’t sure how I could be helpful to them. After all, most people would be depressed, anxious, angry, and fearful when diagnosed with cancer. Those emotions are normal, though patients sometimes feel that they are being referred because of these strong feelings.  Doctors don’t always handle their patient’s intense feelings well, so sometimes that is true. Often though, doctors just feel that their cancer patients could use some help in dealing with the emotional side of cancer.  Usually, patients just need to ventilate for the first few sessions. They need to tell their story, how they were going along in life just fine and then this- a huge boulder hurtling down the mountainside towards them. Usually they feel blindsided, violated, enraged at the unfairness of it.

I realized that they need for me to be the person who can listen to their fears and not back away. Usually family members are cheerleaders, encouraging them to forge ahead with each new treatment, convinced that they are going to beat this.  That’s what family should do. Cheerleaders are important. But often patients feel that they can’t fully let their guard down and talk about how scared they are, or how they maybe don’t want that next treatment, or how they don’t feel like going on that big family vacation that the kids planned, or put into words the thought that families can’t bear – that maybe they won’t make it. They need a place where they can be gut level honest.

Sometimes I put the brakes on those worst-case scenario thoughts or remind them that the prognosis for cancer treatment is better than ever.  Sometimes we work together to find the words to ask for more information from their oncologist. Patients still feel intimidated by their very busy doctors, and they don’t want to “bother” them with questions, or they forget the questions when they see the doctor.  Occasionally they need to find the words to say “I don’t want to do this anymore.”   I help them find their voice. I remind them that this treatment thing is a two-way street, and they are an equal partner. They may not have the knowledge that the oncologist has, but it is their body.

It’s important to have a place where you don’t have to put on your game face.

Many of my patients won’t die of cancer.  They will be survivors. But I have been impressed with the ways that people process a cancer diagnosis.  One lady said to me recently that she stopped worrying so much about the future. She put more emphasis on today.  She had a blood cancer that was likely to go in and out of remission. She said that she accepted that she probably would not live as long as many people, but she would be more present, more appreciative for each day.   This quiet acceptance seems to benefit patients, but it takes some time to get there. It doesn’t mean that they’ve stopped fighting; it means that they are no longer angry with God and the Universe. They can battle cancer but still savor today.

Our medical profession has advanced unbelievably as far as technology. But I am afraid that we have lost some of our emotional connection with patients. We need to remember that quality of life is just as important as quantity of life.

I would highly recommend a book by Dr. Atul Gwande called Being Mortal: Medicine and What Matters in the End.  Dr. Gwande addresses the issue of quality of life and how that concept may run counter to what the doctor recommends. He discusses some creative and humane ways to bring more quality of life to the end of life.

YOUR SMART PHONE AND RECOVERY

Technology has come to the world of mental health and addiction. Cell phones figure prominently in our lives now. They can also figure, positively or negatively, in mental health and addiction recovery.

The cell phone can be a gateway to positive help or an avenue to people who perpetuate illness. Patients starting treatment for recovery need to eliminate phone numbers of dealers and “friends” who use. They know that quick access to these people during a tough time can be disastrous. People experiencing depression and suicidal feelings may not use their phone often enough to call for help and support. They tend to isolate. Communicating with dysfunctional family members can exacerbate addiction and depression, anxiety, and suicidal feelings.

Why not use the phone in a positive way that supports recovery? There are many cell phone apps available now that can be helpful to people experiencing depression, anxiety, mood swings, difficulty with sleep, and/or addiction. Some are better than others. There is little objective research at this point to determine how effective these apps are from a statistical standpoint. However, as with all treatment, you get out of it what you put in. These apps are not replacements for therapy with a professional, but they can aid recovery. You have to find what works for you.

I am going to highlight some apps that have been reviewed online. There are many others, but these are recommended by several mental health sites such as Psych Central and Healthline. Most are free.

One of the most interesting is called Reach Out. It was originally developed for use by military personnel but is available to anyone.  This app is geared toward preventing suicide. It can be used by people who have suicidal thoughts and by family members or friends who are concerned about someone who may be suicidal.   For people contemplating suicide, it has several videos that suggest alternatives, give tips on stopping suicidal thoughts and combating the negative, all or nothing thinking that suicidal people have. It suggests activities that can distract from suicidal thinking. The app lists resources for more information about preventing suicide.  It has a Help Center that lists a suicide hotline number and allows the user to list phone numbers of contacts who can be helpful. Of course, people with suicidal thoughts have to be willing to use it. It’s probably most helpful for people who have recurrent thoughts rather than an immediate impulse, and who are willing to consider alternatives.

For those concerned about someone who may be suicidal, the app lists signs of suicidal thinking, makes suggestions about how to approach the person and what to ask. It also lists resources for more information about suicide.

There are several apps that are useful for persons suffering from severe anxiety and panic attacks. One of them is Breathe2Relax. It illustrates the proper technique for breathing during a panic attack. It gives step by step suggestions on how to deal with a panic attack. Another app for anxiety is SAM, Self-help for Anxiety Management. It also provides suggestions which can be used during a panic attack. These apps work best if you take some time to understand them. There are features that are simple and can be used immediately, but with some work on personalizing the settings, they can be more effective on an individual basis.

Depression CBT (CBT stands for cognitive behavior therapy) is only available for Android at this time. It was recommended by Healthline (healthline.com) as one of the 10 best mental health apps of the year. It offers an assessment tool that allows you to follow the severity of depression and offers audio programs that help with anxiety and depression. It directs the user to resources that help pinpoint negative thought patterns that underlie depression. Pacifica, which is available for IPhone, is similar to Depression CBT.

MoodKit was rated highly on several sites. It has a mood tracking feature and suggestions to improve mood as well as a thought checker to monitor mood.  However, it isn’t free.  It costs $4.99 to download.

None of these apps are appropriate for use alone when you are suffering from severe depression and suicidal thoughts.  You need to be in a formal, face-to face treatment, but the reality is that your therapist can’t be with you 24 hours per day. These apps can be helpful between sessions.

One of the better apps for addiction is Addicaid. It’s free. It has a check-in where you can disclose whether or not you used that day. Either way, you can post and get support from others. It has 12 educational sessions on various recovery topics. You can track your progress, get information on location of meetings and communicate with friends. There is a resource section with hotline numbers.

As I said before, you have to spend some time exploring these apps and getting to know how they work in order to really be able to use them quickly and efficiently.  There are others available. If you google mental health apps or addiction apps, you will come up with more.

So if you have a smart phone, utilize it as an aide in your recovery.

Not Just Any News

Medical news that has an impact on your life. 

Results from a study presented at the European College of Neuropsychopharmacology in Vienna created a buzz in medical news recently. The study was done at the University of Siena College of Medicine, and Dr. Andrea Fagiolini was the lead investigator. The study found that serum testosterone levels, and therefore sexual desire, significantly increased in men after 2 weeks of exposure to a light box for 30 minutes per day.

The study included 39 men who had been referred for treatment for hypoactive sexual desire. Their testosterone levels were measured prior to start of the study. The men were given the Structured Clinical Interview for DSM 5 sexual disorders and a rating scale for sexual satisfaction. They were divided into 2 groups. One group received active treatment which consisted of 30 minutes upon rising in the morning sitting in front of a light box at one meter from the cornea with a UV filter rated at 10,000 lux. The placebo group also spent 30 min. in front of a light box, but the intensity was only 100 lux. After 2 weeks, testosterone levels had risen significantly in the active treatment group, while there was no change in the placebo group. The men in the active treatment group reported an increase in sexual satisfaction.  By scientific standards, the change was considered significant.

According to Dr. Fagiolini, testosterone levels naturally decline during the winter months in the northern hemisphere.  Therefore, it makes sense that testosterone levels are somewhat influenced by light.

Certainly the study does have limitations. There were a small number of study subjects. It needs to be replicated. It would be interesting to know how long the increased libido lasted after the study was completed.  Also, does the effect continue if the light therapy is continued longer term?

Light therapy has been shown to be effective for depression, particularly seasonal depressions that are worse in winter. Is it possible that some of these men were depressed? That was not evaluated. Perhaps now there is more than one benefit from light therapy at least for men. Could that benefit extend to women?  A cheap alternative to Viagra would be welcomed by men and women.

The above study was reported by Liam Davenport at Medscape.com on Sept. 20, 2016.

This week, the American Academy of Pediatrics called for formal restrictions on the use of codeine in children. The FDA issued a safety alert on codeine in 2012, and required a black box warning in 2013. There have been serious, adverse respiratory reactions in children using codeine for pain or in cough syrup.  Codeine is converted to morphine when metabolized. There is a lot of genetic variability in how this drug is metabolized; some patients are ultra-rapid metabolizers, therefore their blood levels will rise quickly. They are very susceptible to respiratory depression (slowed breathing which can lead to low oxygen and death). Children and people with sleep apnea are especially likely to be ultra-rapid metabolizers.

Surprisingly, codeine is available without a prescription in cough medicine in 28 states.  So the message here is to avoid using codeine containing cough medication for your children and ask questions even when your pediatrician wants to prescribe it.

You can read more about this study, reported by Troy Brown, RN, at Medscape.com.

 

 

It’s National Recovery Month

 

September is National Recovery Month.   It’s sponsored annually by the government agency SAMHSA (Substance Abuse Mental Health Services Administration).  National Recovery Month celebrates recovery from mental illness and addiction.

How do we define Recovery? SAMHSA has identified four dimensions of Recovery: 1. Health, 2. Home, 3. Purpose, 4. Community.  The ability to manage one’s disease symptoms by making healthy choices with regard to diet, taking medications as prescribed, and abstaining from substances and activities that do not promote well- being fall within the health dimension.

The home dimension emphasizes the importance of a safe and healthy place to live for recovery to take place. SAMSHA defines purpose as “Meaningful daily activities, such as a job, school, volunteerism, family caretaking, or creative endeavors, and the independence, income and resources to participate in society.”¹  

Last of all, the community dimension speaks to the importance of having a support system consisting of family and friends that provide love and hope.

Notice that the SAMHSA definition of recovery doesn’t say anything about being “normal.” We can’t define normal. People who recover from a serious mental illness or addiction are usually changed in significant ways.  Recovery doesn’t require the person to be exactly as they were. You can’t go through the experience of dealing with a mental illness or addiction without becoming an emotionally deeper, stronger person. It also doesn’t require that the person be totally free of the illness.   People with mental illness and/or addiction (you can have both) are always vulnerable. I particularly like the SAMHSA definition of the health dimension – the ability to manage symptoms by making good choices, not necessarily to be totally without symptoms.

Many people, with and without serious illness, struggle with finding meaning and purpose in life. I like the SAMHSA examples of purpose – having meaningful daily activities such as a job, caretaking, volunteering, being creative.  Living life as best you can meets the definition of purpose in my opinion.

People with mental illness and/or addiction can recover.  If you know someone working to recover, the most important thing you can give them is hope.

 

Check out the resources on recoverymonth.gov

 

http://www.facebook.com/RecoveryMonth

http://www.youtube.com/RecoveryMonth

http://www.twitter.com/RecoveryMont

 

¹ SAMHSA’s Working Definition of Recovery, download PDF at store.samhsa.gov.