Sunday, June 29, 2008
Hey, so folks have been letting us know about some cool stuff. I'm just now getting a chance to link you in:
Eric from CBS News let us know about a special on Women Vets and their unique issues. Well, I said links to cool stuff, and this was actually really sad stuff. As time goes by, I imagine we'll be hearing more about specific mental health needs in women who've been in combat.
Roberta Isleib wrote to us from Connecticut. She is a psychologist and a mystery writer. I carry a soft spot for shrink/novelists, so here is a link to Roberta's Website.
I went to visit FatDoctor's Blog today. Apparently she's having issues with here curly hair. And apparently there's a blog devoted to naturally curly hair. I can relate, however I found it interesting that there are two types of curly hair: you can be Juliana Margulies or Nicole Kidman. I guess I'm in my own category with wild crazy madwoman hair that frizzles and frizzles some more. Fat doctor has tried a bunch of stuff, I may eventually opt for that Brazilian keratin hair straightening thing. I'm told if you don't leave it on for too long you can keep your curls while bypassing the frizz. If you've tried it, by all means let me know.
Finally, if you're a reader of FooFoo5's blog, he's back after an extended absence.
Saturday, June 28, 2008
Thursday, June 26, 2008
As I was leaving prison today I noticed a man standing on the corner. He was wearing nice pants and a dress shirt. He had a knapsack thrown over one shoulder and was wearing sunglasses while talking on a cell phone. I didn't think anything of it until he looked over and saw me and yelled, "Doc! Hey doc! Remember me? You helped me, you really did. I'd hug you but I know that wouldn't be appropriate."
Frankly, I didn't recognize him at first. I knew who he was after he called my name, but just to see him standing there, well, the context was quite different and he looked very very different from his appearance in prison.
Anyway, he was doing great. He had a place to live, a job, was going to AA regularly, staying clean. He was waiting for his ride to pick him up for AA. His phone rang and he picked it up. "It's my ride," he said. He told his ride: "Hey, guess what? I'm standing here with the doc who saved my life!" His ride pulled up, and the driver immediately started waving and hollering at me too. My patient said, "You remember him? You saved his life too." I had seen the driver maybe twice, just a few days after he had been arrested. I remembered him, remembered that he had never been in trouble before, was facing serious charges and was pretty upset. Then the driver quoted to me, word for word, something I had said to him four years before that had helped him get through incarceration.
As they were driving off they pointed to me and said, "You keep doing what you're doing. You keep helping people."
I don't have any trouble admitting that I choked up a bit and by the time I got back to my car I was in tears.
You see, today was my last day as a fulltime prison doc. After about fifteen years I've decided that for my own sanity I'd need to cut back to part time and go back to doing another job I've always enjoyed doing (more about that later). This was quite the experience to have as I'm going, literally, out the door. It's the experience I'll remember the next time I hear someone knocking docs who do med checks instead of psychotherapy, or saying that prison doesn't help anybody.
It's good to remember that sometimes there are happy endings.
Tuesday, June 24, 2008
Welcome to Grand Rounds, Volume 4, #40 (see future GR schedule). If you missed our first Grand Rounds last year, with our amazing Clicky Brain, then feel free to pause and enjoy.
EDIT: Yikes! It's already into Wednesday and I found out that I missed two Grand Rounds submissions... just left them off completely. Sorry about that. But here they are right at the top, so please check them out...
1. Social worker Still Dreaming writes about "Why I Don't Care About the New iPhone." I know what you're thinking... I really did just overlook her. (She actually like the iPhone.)
2. Midwife With a Knife has an excellent, scholarly post about restrictions on work hours for residents. Wish there were restrictions on hours for producing Grand Rounds!
Here's the rest...
The new Apple iPhone 3G must be stopped! I first recognized the potential dangers of the device whilst perusing Apple's description of the product:
Consider Apples assertions: "(The) iPhone already gives you mobile multitasking. But 3G technology lets you multitask in more places — without connecting via Wi-Fi. Since 3G networks enable simultaneous data and voice, you can talk on the phone while surfing the web, checking email, or using Maps. All from your 3G cellular network."
My appeal is based on the foundation of simple biology. To date, the data from numerous studies supports strong gender difference in the area of multi-tasking, consistently demonstrating that women's brains, though smaller (apparently size doesn't matter here) are inherently better suited for multi-tasking. The Apple iPhone 3G takes multitasking to heretofore unrealized levels! Simply put, the male gender is not cognitively equipped to handle such technology safely. The implications are dire. Overloading of neuronal circuitry could lead, at a minimum to temporary cognitive impairment. Worst case scenario: What if men attempt to drive and use the new iPhone 3G at the same time? Seizure activity might result, leading to increased traffic accidents. The human toll would likely be catastrophic.
Apple should, at the very least conduct research to assess the short-term effects of the iPhone 3G's multi-tasking capacity on the male gender. Until such time as the effects can be determined, in the interim, Apple could market a less dangerous product to men; perhaps, the iPaper-Cups-With-A-String-Between Phone. As mental health professionals, we need to come together on this issue and be heard as one gender-neutral voice. Who know, maybe someday, perhaps with the aid of cognitive enhancing psychotropic medication, men will be able to handle the iPhone 3G. But for now, this may just be a dream.
Christopher Bush, Psy.D.
(A.K.A. Dr. Pink Freud)
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Thank you for listening.
Thursday, June 19, 2008
Like any man....
Okay, so it's the middle of the day. A patient calls to say she's running late. I have a spare moment. I decide to text Roy--haven't talked to him in a bit, just some real brief e-mails-- why not? So I send a text message: Will there be lines?
What would you think if you got a random text message to your phone in the middle of the work day: Will there be lines?
I expected a reply: "?" Or: "lines?" Lines in the sand, lines on a page, lines on my face, lines of what, for what, by what?
Did Roy ask? Did he so much as flinch? Within moments, the reply came: On July 11th? Yes.
He knew. Or I knew what was on his mind, what's always on Roy's mind. Will there be lines? Yes. July 11th? The date the new iPhone comes out. And yes, I did mean: Will there be lines to purchase the new iPhone? Somehow, Roy knew what I was thinking. Hard to be cryptic these days.
Oh, and of course, do submit your posts for Grand Rounds at Shrink Rap! You know the theme.
P.s. This story was not confabulated.
Tuesday, June 17, 2008
Okay, this is official, folks. Dinah, Clinkshrink and I will be hosting Grand Rounds next week. It's been over a year since we first hosted. If you don't know, of course, GR is the weekly compendium of all blogs medical and noteworthy.
Last year we had the Amazing Clicky Brain. This year, the eye candy will be even more spectacular.
Monday, June 16, 2008
Okay, bear with me here while I have a brief fantasy about being a urologist.
New York Times reporter, Gina Kolata writes in "New Take on a Prostate Drug, and A New Debate" about the pros and cons of asymptomatic men taking a medication to decrease their chances of getting prostate cancer. She notes that screening tests reveal cancers (and therefore have surgery and other treatments) that might not prove to be lethal--- some prostate cancers are slow growing and might be better left undiscovered.
With finasteride, as many as 100,000 cases of prostate cancer a year could be prevented, said Dr. Eric Klein, director of the Center for Urologic Oncology at the Cleveland Clinic.
Dr. Howard Parnes, chief of the prostate cancer group at the National Cancer Institute’s division of cancer prevention, also is convinced. “There is a tremendous public health benefit for the use of this agent,” he said.
While it might seem convoluted to offer a drug to prevent the consequences of overtreatment, that is the situation in the country today, others say. Preventing the cancer can prevent treatments that can be debilitating, even if the cancers were never lethal to start with.
“That’s the bind we’re in right now,” said Dr. Christopher Logothetis, professor and chairman of genitourinary medical oncology at M.D. Anderson Cancer Center. “Most of the time, treatment wouldn’t help and may not be necessary. But the reality is that people are being operated on.”
Kolata goes on to talk about whether all men should take the medication as prostate cancer prophylaxis. She says an early study showed that while it shrunk prostates and decreased the rate of cancer diagnosis overall, among study participants there was a slight increase in the percentage of aggressive tumors found, and initially there was concern that the drug was causing aggressive tumors, rather than just unmasking them.
So why does this Shrink Rapper want to blog about prostates? As I read Gina Kolata's article, I thought about ClinkShrink's post, An Ounce of Prevention where we talked about the theoretical option of treating people at risk for a psychiatric disorder who may never develop one. It seems we do this all the time-- how many people take Lipitor or other statins who might never develop coronary artery disease? How many people with osteoporosis are given medications who might never break a bone without it, who might break bones even with them? Oh, and if you're male, and therefore at risk for Prostate Cancer, now there's something else to think about. There is, after all, iodine in our salt and fluoride in our water. Maybe it's not all bad?
Sunday, June 15, 2008
New York Times reporter Benedict Carey likes to write about mental health issues. Today, he talks about the diverse presentation of schizophrenia, as well as variations patients have with regard to treatment response. Carey writes:
The findings confirmed in a rigorous way what psychiatrists who work in the trenches know from experience: Many patients bounce from medication to medication for years. Some find a drug they can live with; others do not and choose not to take drugs at all.
Psychosis can be miserable — and it says something when people prefer its twisted torments to being on a medication.
The shortcomings of the drugs, in turn, cast doubt on one working theory of the biology behind schizophrenia. The drugs act on the brain by numbing cells to a brain chemical called dopamine, which was thought to be overactive for some reason in people with schizophrenia. Most researchers now regard this so-called “dopamine hypothesis” as simplistic at best.He goes on to say that, according to European studies,with the right support, there are patients with schizophrenia who can be maintained for years without medications. Wouldn't it be nice if we knew exactly which patients they were?