Category Archives: Mental Health

May: Mental Health Awareness and Suicide Prevention Month

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May is mental health awareness and suicide prevention month; many people start to feel desperate with their depression symptoms around the first couple weeks of spring. Mostly because people think once the “winter blues” are over, and spring has sprung, they will start to feel better miraculously. When that doesn’t happen, the true feelings of depression can sink in: helplessness and thoughts of harming themselves (i.e. suicide) can become overwhelming. It can be hard to see the signs in people who are really close to you, but it is important to know the signs and see them in others, as over 1 million people attempt suicide annually.

depressionWhat are some signs of Depression/Suicide?

-Clinical Depression is usually emphasized by a loss of interest in life, sadness, disinterest in previously enjoyed hobbies, difficulty concentrating, trouble with eating and sleeping.

-Thinking about death a lot (verbalizing, drawing, or referring to death a lot)

-Feelings of hopelessness or worthlessness

-Making changes to wills, plans, or making statements about not being around much longer

-A sudden switch from someone being really deeply depressed and sad to very happy

-Calling people to say goodbye

-Previous suicide attempts (50% of those with prior attempts will try again and be successful)

Risk Factors:

-Previous suicide attempts

-Family violence

-Physical or sexual abuse history

-Firearms in the home

-Chronic illness or pain

-Mental illness history

-Substance abuse problem

What do you do if you think someone is at risk?

-Listen to them, and reassure them that you care about them, you are listening, and you care. If they say that they want to kill themselves, it is an emergency, call 911 (or emergency services where you live), do not leave them alone, and remove any firearms, knives, other weapons, or drugs and alcohol.

-If they are not actively threatening but you feel they are at risk, have them call a Suicide Hotline 1-800-SUICIDE (1-800-784-2433) or 1-800-273-TALK (1-800-273-8255). And, assist them with finding a mental health professional and you can always start with your Healthcare Practitioner (HCP) to help with a referral.

Many times we missed the subtle signs and symptoms, especially when we are close to the victim. It has happened to me in my very own family, and right after it happened all you think about is “how did I miss the signs?? I spent so much time with them?” It’s important to remember that we all have comfort levels with people, and sometimes you are too close, it almost takes an outsider to see the situation for what it is; you are so used to the persons behaviors or traits, that it is not abnormal to you. And you might just think they are finally out of their funk when they become happy again; but really they have made a plan. It is important to not blame yourself, if someone you love takes his or her own life. It is not your fault, and the symptoms are very hard to see. What’s important is learning and seeing the symptoms in others and helping them.

Knowing when you see the symptoms, and what to do is important. So pay attention to the signs, and how you can help.

Yours in Good Health

B

Thoughts on the Marathon Monday Attack….I refuse to say Massacre

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It’s so hard to put into words the range of feelings that you have after such an event, which are the same feelings that the healthcare and emergency service workers from 9/11, Katrina, and Sandy must have all dealt with.  I honestly felt that nothing like this would ever happen in Boston, I know I was living in a dreamland, and even when I was running to the Emergency Department, hearing about victims, I didn’t really believe it. I kept telling myself that it was just drama….because until I left the hospital, and my family members were telling me what they heard on the news: I had no idea what was going on.  Just as all of you at home, watching the news, had no idea what was really happening in the hospitals.

I guess I needed to believe that there weren’t bombs, that it was just a transformer that blew, because it was easier to focus on what needed to be done. I have never been prouder of the emergency response crew in this city, and especially the staff at my hospital. In the face of a complete disaster and chaos, we had organization, and saved as many lives as we could. I cannot describe what I saw, because I just don’t want to relive the horror, but the images of not only victims but their family members and what they must be going through right now: the pain, the suffering, and the loss kept me awake all night last night. I also feel like I didn’t do enough, I don’t know if anyone feels like they did enough, especially in the face of being called a hero: we did our jobs, and we did our jobs well, but we couldn’t save everyone.

We all need to remember that this is also just the beginning, there will be Post Traumatic Stress (PTSD) from this event, and if you have lost a loved one, there are resources available at the local hospitals, police stations, and there will be outreach by the city. If you need to talk to someone immediately, the help hotline is available 800-427-3606.

If you would like to help, please donate blood and/or blood products, contact the American Red Cross.  And the Salvation Army is helping victims and their families, so any extra clothes, food, etc, please contact them and see how best you can help.

You can attack us, you can say the Red Sox suck, but all you do is make the city that I love, the city that is my home, grow stronger, bond together, and help each other to overcome this tragedy. It is so unfortunate that this had to happen on one of the best days that Bostonians love to celebrate, young and old alike, and I know there is so much sadness as fall out, but I truly am proud of EVERYONE that helped victims yesterday, we faced something that we never thought we would, and we were kept safe by the men and women in law enforcement.

I saw a war zone in Boston yesterday, but I have never felt safer because of the amazing people in this city. It was an attempted massacre; we said no.

Boston, you are my home.

Yours in Good Health

B

bosotn marathon

Not enough sleep? Weight gain will become a problem.

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You hear it all the time: If you don’t get enough sleep, you will gain weight. When I think about it, it doesn’t totally make sense because you aren’t sleeping, so you are being more active, right? Then I think about those days after I work a night shift, when I am getting things done in a haze, my brain is not fully functioning, and thinks happen a little bit slower, I feel miserable, and when I have a chance to stop and rest, I take it…so I begin to understand a bit more the whole weight gain portion.

sleep and weight gainWhy exactly does sleep make me gain weight?

When you do not get enough sleep, you are feeling tired and energy levels are low, leading to the use of caffeine and/or sugar to boost your energy levels to help you get through the day, which leads to energy crashes later in the day.  For those of you who exercise in the afternoon, it usually means that it doesn’t happen, because your energy is zapped. And if you are a morning exerciser, you tend to feel to exhausted to get to your workout; a lack of energy leads to a lack of drive.  And when you become dependent upon stimulants to get through the day, it can become a cycle, as sometimes you can overdo it with the caffeine and then have trouble shutting it down, even if you do have time to sleep. When you are tired and sluggish, you also tend to be more lazy; you don’t shop for healthy foods and/or cook for yourself, so you tend to eat what is available and easy.  None of these things are particularly good for your waistline.

There are two main hormones that regulate your eating cycle: ghrelin and leptin. Ghrelin is the hormone that tells you when you are hungry and you should eat, and it is at much higher levels when you are sleep deprived. Leptin is the hormone that tells you to stop eating because you are full, and unfortunately it is in lower levels when you are without sleep. A lack of exercise, high ghrelin, and low leptin levels is basically the trifecta for weight gain.

Add on top of that, your body is not functioning optimally with a lack of sleep, so it’s not just your brain that feels fuzzy, so do the cells in your metabolism, so they aren’t working at their best either. It’s not as if one night with a lack of sleep is going to make you gain 15lbs immediately, but when it becomes a cycle of sleeping less than 7-8 hours per night, and we are frequently reaching for comfort foods, eating more than we normally do, skipping on our exercise, and relying on stimulants to get through the day, it’s not healthy, and you will gain weight.

What can I do?

Cut back on the stimulants and don’t have any after 12pm, and start making a bedtime routine (essentially set a bedtime for yourself) to try to break the cycle.  Also, forcing yourself to get some exercise, even though you already feel exhausted, even if it is just a long walk, really will exhaust your body….in a good way!  It will help to relax your muscles when you are done, and get your brain ready to shut down and get a better sleep/rest. Also try to avoid heavy meals and alcohol right before bed, it can make you have troubled sleep and increase the risk of heartburn. Also, maybe a soothing lavender bath/shower before bed, to help calm your system and ready yourself for sleep.

Once you start sleeping regularly, you will feel a boost in energy, be more efficient, and be healthier.  You can get into a health and wellness cycle by getting regular exercise, and eating healthier, which will lead to a really easy drop in weight…all by making one lifestyle change!

If you DO get 7-8 hours of sleep at night but it is troubled sleep or you always still feel exhausted in the morning you should see your Healthcare Practitioner (HCP) because you may have Obstructive Sleep Apnea (OSA) or another process going on that requires a sleep study or more in-depth review.

Try to set a routine, and breaking the habit of caffeine can be miserable (I used to be a complete caffeine addict and have sleeping issues, so I KNOW how hard this is) but it is so worth it to be able to cut the cord and feel yourself without relying on caffeine and starting to be healthy again.  It seems impossible sometimes, but, I promise, it isn’t!

Yours in Good Health

B

Refocus and Trim the Fat From Your Life

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I had a bit of an epiphany, as a good friend was helping me pack up and start the process to move into my new home soon: you need to trim the fat from your life. Now, in the past few years, due to various life circumstances, I have moved approximately every two years, so while I should totally be used to the process, I’m not.  I am never prepared for moves. I get anxious about having to pack, so I stare at my boxes a few days before finally kicking it  into high gear. But this time was a little different, I made a date with a friend who offered to help, we made a plan, and we attacked.

getting it done!After she left, with boxes piled high, and me getting ready to dig deep and live off of reusable plastic plates for a little while, it left only the things visible that we put in piles. We left a trash heap that was stuff I held onto that could be trashed (or recycled…just out of my house), and then there were the piles of stuff I needed to go through. Ugh. The things I need to go through is stuff I totally know I need to go through but just haven’t because I am dreading it. Why? I have no idea.  Now, I am not a hoarder by any means, but I have my box of important paperwork, and next to it, my pile of things that may be important but I just haven’t felt like going through them. So tonight, I did! And I feel amazing. I accomplished my goal of packing, and only kept the most important things, and now I have rid my life of the excess. And dealt with a bunch of things head on that I haven’t wanted to.

Physically I have trimmed the fat out of the boxes, but I also feel like this was emotionally a huge hurdle; I cut ties from my past, and now I can look forward, to my new life, in my new home.  Totally fresh and a real new start.

It got me thinking though, that I have done this at various times in my life, that I have felt that I have held onto “friends” or kept people in my life that cause anxiety/drama/stress so I try to keep them at arm’s length, maybe because of our past I feel I need to hold onto some semblance of a relationship, but it has become toxic. There have been a couple of those people in my life recently, that I have moved on from. While it is always sad to lose a relationship of any sort, it was also so cathartic. Much like throwing out some of the stuff I have been holding onto that I don’t need, getting the negative and toxic relationships out of my life has made me feel infinitely better, instantly happier, and so much more positive in every aspect of my life.

Every two years, you should re-evaluate and re-focus your life. I am not encouraging everyone to cut out everyone they are having a tiff with in their lives, but I am just thinking about ways that we can all make our lives simpler, happier, and easier. Whether it is ditching the project that you started and never finished that causes you to stress every now and again (or just getting the gumption to finish it up), or go out on a limb and do something that you’ve been wanting to try, starting that eating healthy kick, or surround yourself with positivity: trim the fat. Get the extra stuff out of your way that is preventing you from doing what is good for you, or what you want to do.  You are the only person who can make the right choices in your life to get you where you want to be; you are the master of your destiny.

Think positive.  Live positive. Be positive.

Yours in Good Health

B

Post Traumatic Stress Disorder: Diagnosis & Current treatments

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In light of the Marathon Monday bombings, fires in Texas, the Sandy Hook School shooting, the devastation of hurricane Sandy, along with other horrific and traumatic events have occurred recently, there have been many people experiencing Post Traumatic Stress Disorder symptoms, including me, the first few days after the bombing. Post Traumatic Stress Disorder (PTSD) is frequently associated with combat veterans coming back from war, but it is also associated with other traumatic events, and is commonly misunderstood.  There are many side effects, some subtle and some not so, but the average person tends not to really understand this disorder, what sufferers go through, and the current available treatment options.

What is PTSD?

PTSD is the bodies stress response after some sort of traumatic event, usually where people feel their lives (or others around them) are in danger.  Some events that can result in PTSD are: exposure to live combat (i.e. war veterans), serious accidents (car accidents, plane crashes), physical and/or sexual abuse (especially during childhood), large-scale or national disasters (terrorist attacks, school shootings), after a loved one’s suicide or traumatic loss of life, and natural disasters (tornadoes, forest fires, hurricanes).  Basically any major traumatic event will lead to some form of PTSD, which can be transient, in that the symptoms come and go, or are experiences for a short period of time then go away and never come back, while some people experience the symptoms for the rest of their lives.

one of the many reasons for PTSD

one of the many reasons for PTSD

Who will get PTSD?

It is truly unknown why some people experience symptoms and others don’t.  You can put two people in the exact same situation and they will respond differently, and it is very difficult to predict who will have more severe symptoms.  Usually the experience itself determines if people have symptoms and the length of time. Some other factors that may lead to a more intense PTSD reaction:

-If the event was fatal (people died)

- How close the survivor was to the event (i.e. someone who actually had a gun aimed at them during en event and were not shot would have more risk of long-term symptoms vs. their significant other would be effected by the event but have a lesser risk for long-term symptoms)

- If a person was injured during and event or lost someone close to them

- The control you felt during the event(s) or lack thereof

- If treatment, therapy, assistance was sought out after the event

What are the symptoms of PTSD?

As I stated earlier, some of these symptoms are more subtle than others, and most people who survive traumatic events will have some of these symptoms immediately, then they can go away, or continue on. I was in a state of hyper-arousal for a few days following the bombing and definitely having nightmares, but I also felt like I was in a fog and very forgetful, so I appreciated people being understanding with me. Once the symptoms last more than 4 weeks continuously and start to effect your personal life and work life, or cause you great distress consistently, you fit the criteria for PTSD as a diagnosis. The four main symptoms of PTSD are: 1. Reliving the event (having nightmares, constantly thinking about the events during the day causing you to be unable to concentrate). 2. Avoiding similar situations (If you were in a traumatic car or plane accident, no longer riding in cars or planes). 3. Inability to feel (many PTSD victims have a lack of experiencing true feelings after the event, they describe themselves as being “numb”  or having “dulled” feelings). 4. Constant hyper-arousal (always anxious and expecting something bad to happen, constantly looking over their shoulders, worried). These symptoms can lead to behaviors by the victims to try to combat them.  Some people drink or take drugs to slow their minds so they aren’t constantly thinking about the event, while some become severely depressed leading to suicidal thoughts/actions or extreme anger, or acting out and being very promiscuous to try to get their mind off of the event. These are all coping skills that are not healthy and can lead to problems at work, in relationships, suicide, and addiction.  There are ways to help and alleviate the symptoms of PTSD.

 

What are the Treatments?

Some people are treated with Selective Serotonin Reuptake Inhibtors (SSRIs) to help with depression.  Psychotherapy (counseling) in conjunction with SSRIs can help to alleviate the symptoms of PTSD and help people to get back to their mental state (basically) from before the event.  Cognitive Behavioral Therapy (CBT) is the most effective type of therapy to help victims to work through their feelings about the event and their responses to it; you learn the skills to actively change your thoughts and feelings in response to the traumatic event.  Essentially you work through your feelings and change your response, and no longer keep your feelings bottled up about the event, prior, and after. There is also Prolonged Exposure therapy, where you talk about the event and your feelings so extensively, that it no longer causes you such pain and anxiety, you then expose yourself to   things you have been staying away from to decrease your anxieties.

There are treatments out there, and they are not quick or easy, but they work.  All victims need to know that they should not keep their feelings inside, and they need to talk to a therapist that will help them work through their feelings. I was encouraged to talk about the event with people at the hospital that experienced the same event, and talk to everyone who asked; it was very, very hard, but also made me feel better.  I also used the outlet of writing about the event as a form of therapy, and I felt SO much better having people hear my story. It can be horrible to relive experiences, but it will be worth it to work through the feelings and anxiety, and be able to live your life without the fear or stress of that traumatic experience, and truly begin to live your life again.  If you know anyone with symptoms, or you think you might have symptoms, talk to a family member, your HCP, a therapist, anyone to get help.  If you are in crisis, call 911, go to the nearest emergency room, or call a suicide prevention line (800-273-8255) * if you are a veteran, you can press 1 after dialing the same suicide prevention number and speak with someone trained to specifically work with veterans.

**The FBI set up a victim assistance line specifically for the victims of Monday’s bombing.  Please ask for help, and talk to someone….anyone. It WILL make you feel better.

Take control of your life back.

Yours in Good Health

B

This is a little hard to talk about: Erectile Dysfunction

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Many people are unclear as to what Erectile Dysfunction (ED) actually is, despite those really ridiculous Cialis and Viagra commercials on TV (which can be horribly awkward to watch in mixed company at times!!) ED affects between 15 and 30 million men in the US and approximately 22.3% of all office visits to HCP’s are for ED.  It is something that many men are embarrassed about and feel unable to speak to their partner about, and it can cause huge rifts in relationships. It is important to know that signs and talk to your partner about it, it is a physical issue that is normal, and totally fixable, so go to the doctor together and make it a couple problem, and don’t let your partner suffer and feel badly alone!

What exactly is the definition of ED?

It’s the inability to maintain an erection that is firm enough to have sex, on an ongoing basis, along with trouble getting an erection, difficulty maintaining an erection, and/or a reduced sexual desire.  If you have any of these symptoms, especially if you have diabetes or heart disease, you should go see your HCP and talk to them about it, your options, and to find out what might be going on with your body. Don’t let it get too far that your partner might get upset or think that they are the one causing the problem…be open about it and go to see your HCP.

erectile-dysfunctionWhat are the causes?

There are SO MANY possible causes of ED, in which some are physical, mental, and a combination of the two.  Some physical causes are: heart disease, atherosclerosis, high blood pressure, diabetes, obesity, metabolic syndrome, Parkinson’s disease, Multiple sclerosis, low testosterone, Peyronies disease (a build up of scar tissue in the penis), tobacco use, alcohol (alcoholism), substance abuse, pelvic/spinal cord surgery, enlarged prostate, and prostate cancer.  So, obviously it goes from being something that is easily fixed, to things that are more serious. As far as psychological issues: stress, depression, anxiety, fatigue, and relationship issues can all cause ED. Another psychological reason that many men have a form of ED, in this current society, is due to the inability to get their partner pregnant; we have a society wrought with infertility and it can case serious relationship problems on many levels. As well, many medications that your HCP might put you on for various health issues, can also cause ED.

Before you go to your HCP appt:

Write down symptoms that you have had even including things that you might think unrelated to ED.  Also, write down any life changes going on, including anything that might be causing relationship stress.  An update list of current prescribed and over the counter medications are always important to bring to every appointment, but especially to an appointment regarding ED.  Try to bring your partner to your appt and both of you talk before you go and both write down list of questions both separately and together.

What might happen at/after your appt?

A physical exam, which is standard at all appointments, but your HCP will inspect your penis, testicles, and check for nerve feelings.  Most likely you will have blood drawn to assess your risk of heart disease, diabetes, cholesterol, and testosterone levels.  A urinalysis may be performed to also look at your risk of diabetes, etc.  An ultrasound may be done to look at blood flow to your penis, it uses a plastic probe on the outside of your penis to project a video of the current blood flow (a non invasive exam). They also might have you go home and perform an overnight erection tests; many men have erections at night during sleep, and have no idea that they had an erection, if the test is positive, then the reason you have ED is psychological.  What they will ask you to do is to put a piece of tape that they will give you (it is easily split) around your penis, and if you wake up in the morning and the tape it split open, you’ve had an erection.

How do we treat it?

You can take oral pills like Viagra, Cialis, and levitra which are medications that enhance your bodies natural nitric oxide levels which helps muscles relax and allows more blood flow to your penis, allowing for a stronger erection.  You may need to change doses and change times that you take before getting an erection.   You need to talk to your HCP to take these drugs if you also take any nitrate drugs like nitroglycerin, Imdur, or Isosorbide because you can have too much of a build up of nitrates in your blood.  Also be careful with blood thinners and alpha blockers (for enlarged prostate).  Your HCP will have to discuss using medications if you have had a stroke, have either low blood pressure or uncontrolled high blood pressure, heart disease or heart failure, and/or uncontrolled diabetes.
Other medication options:
Alprostadil injections: a small needle is inserted in the base or side of the penis and you inject the medication, due to the small size of the needle there is usually little to no pain, and you can get an erection within 5-20 minutes and the erection usually lasts around an hour.
Alprostadil penis suppository: Using a special applicator, you insert a small suppository 2 inches up the inside of the urethra. The side effects can be pain, bleeding from the urethra, dizziness, and can cause a fibrous build up inside your penis.
Testosterone replacement: if you have low testosterone levels, oral supplements can help to increase your levels and ability to maintain/obtain an erection.
Other options:
Penis pumps: a hallow tube with a hand or battery-powered pump, you put your penis inside, pump out the extra air, which causes blood to flow to the penis and cause an erection, you need to put a tension ring on the base of your penis, then remove the pump.  The erection usually lasts long enough to have sex, then remove the tension ring.
Penile implants: implants are surgically places on both sides of the penis, either inflatable or semi rigid rods.  The inflatable implants, are inflated before sexual intercourse to help obtain an erection and the semi rigid rods allow for a firm but flexible penis at all times. Due to it being surgical in nature, there is a risk of infection, and usually a later option for ED.
Blood vessel surgery: at times a leaking vessel can cause a decrease in blood flow to the penis, a simple surgical procedure may be able to fix that problem.
Psychological counseling: if the problems are psychological in nature, counseling can help to talk about the problems and may help to decrease ED issues.

How can you fix it with lifestyle changes?

If you use tobacco, quit. Lose weight to get to a healthy level, exercise regularly, get treatment for alcohol and drug abuse, and work through relationship issues with your partner and with the help of a professional.

Alternative medicine:
Acupuncture is said to help with ED and relieve stress and anxiety, so it can help with some psychological problems.

Due to all of the possible causes, it is not only the first sign that something serious might be going on, but it also is something that might be fixed simply and easily, so I really encourage seeing an HCP early to talk about it.  Be open and honest with yourself, your partner, and your HCP.  ED is not something to be embarrassed about or something that you should allow to ruin a relationship.  If you notice any of these problems with yourself or your partner, please talk about it and go see you HCP ASAP!!

Yours in Good Health
B