The mind, once expanded to the dimensions of larger ideas, never returns to its original size. ~ Oliver Wendell Holmes


Showing posts with label Professionals. Show all posts
Showing posts with label Professionals. Show all posts

Tuesday, February 22, 2011

DR. PATCH ADAMS - A Hard Act to Follow

Dr. Patch Adams brought laughter, humor, and compassion into medicine, where it belongs and is sorely missing. There was once a time, not so long ago in history (at least in smaller towns and cities), when your physician was also a friend of the family. You shared both the good times and the bad times and helped each other out. Who better to face bad news and loss with than someone who truly cares?

Medical schools today, teach future doctors to keep arms length at all times; plant firm boundaries between them and the patient; regard clients as helpless dependent children and to be professional and analytical keeping emotions in check. Why, they are so brainwashed they can deliver news such as “you have two weeks to live and there is nothing we can do” without batting an eye. I tend to think this cold, steely approach is nothing more than a coping mechanism designed to help “the doctor” rather than “the patient”. It’s often not until they themselves or a loved becomes a patient, that the negative impact of the physician lacking in compassion is understood.

I was hospitalized recently at a teaching hospital. Although I didn’t mind, I felt like a guinea pig used for interns to practice on. There’s one doctor though I will never forget. She stood out above the rest. A female neurologist came in with her group and introduced herself with a smile. While going over my case, she reached down and held my hand. Such a simple gesture, yet it made a world of difference. Such a caring demeanor is a rare find. Give it a try. You may be surprised at the reactions you receive. It in itself has healing powers.

Now we’ve all heard the phase, “Laughter is the best medicine” and indeed, it is. Doctors who employ humor into their practice can boost patient’s immune systems; raise energy levels while reducing pain. It's a powerful antidepressant without any of the nasty side effects besides the occasional wetting of one's pants.

Patch Adams told of a mother who was tenderly and patiently dealing with the endless screams of her child who was dying from myeloma, among the most excruciating pains one can experience. He walked into the room in his silly clown clothes, a red rubber nose, cheek spreaders, fork earring, and fake snot hanging from his nose and the child looked up and smiled for the first time in ages. He sat with the mother and talked, while clowning with the child. A full hour went by without a single tear. If that’s not a compelling story, what is?

Patch has helped countless people with mild to severe mental illness without the use of Big Pharma’s bounty of magic pills, many of which that they still don’t know how or why they work (among many that don’t). These patients have no where else to turn. They have no money, no insurance, and they do not live in areas that offer free clinics. He indeed takes risks inviting these people into his hospital, which up until recently, was his home. Although there were a couple of tragedies experienced along the way, there were thousands that were helped, able to resume their lives and be functional, even happy. As he points out, much of what we call depression is not a chemical disorder. It’s is the loss of hope, loneliness, troubles that given the proper care can be resolved.

The best doctors I ever encountered had wonderful personalities. One moment they could hit you with an uncomfortable concept, and next leave you chuckling. They were straight shooters, yet never left you feeling angry or abused. It was in this beautifully intertwined approach that you could face painful realities and turn around laughing at the obsurity in them. Like Mary Poppins would say, “Just a spoonful of sugar helps the medicine go down in a most delightful way.”

One doctor wrote on his blog that he attempted to engage in humor and told a joke at the beginning of a session to "break the ice". The patient was indignant. He stopped doing this as a result. WHY?!?  Just because one patient broke his funny bone and like a screcrow has a rod stuck up his pants, doesn't mean he should stop trying. There are many types of humor, just as there are many forms of therapy. You can't please eveyone with the same joke. Also, it takes time to warm people up, especially when they've come to expect distance.

When I was at the hospital I turned the tables on the staff.  I was the witty one. At first they were not quite sure how to respond. But quickly, they sighed a breath of relief and began to laugh, commenting that it's not often they have a patient with such a good outlook on life. If you have a patient who takes life too seriously or is depressed, reccommend for them to take Laughing Yoga or to join a Laughing circle. Even the utterance of a feigned laugh can lead to a good case of the giggles. It's healing. And if you have a problem with laughing inappropriately, just tell people you have to for medicial reasons.

His hospital is a community of people from all walks of life, no different than society functioned just 100 years ago. Everyone contributes something, whether farming, cooking, cleaning, repairing, babysitting or building. It is NOT required, nor is it barter. It is merely a sense of belonging to something bigger than yourself, being productive, accomplishing things, connecting with others, helping your fellow man. Is this model outdated? Maybe, but note there was not the scourge of mental afflictions back then as there is today.

He takes time to know his patients, spending up to four hours with each newcomer on their first day. They talk about everything, not just their chief complaint. They become “friends”. This isn’t to say he doesn’t ask the hard questions, but he does so in an air of compassion and empathy. People relax and feel free to open up and be themselves.

Yoga, chiropractic, acupuncture, meditation, play, theatre, arts, nature, education, and social service are all incorporated into treatment and TREATMENT IS FREE. The whole hierarchy created by the business model of medicine, creating a debt between patient and practitioner is removed. Everyone is equal. The interplay of healing is emphasized. Doctors also benefit from positive interactions and can learn from those they treat. If you really think about it – each patient offers free continuing education to a doctor. Who is he to charge for this service? Yet, in modern medicine, bureaucracy and capitalism rules; and money is the name of the game.

Patients are trained to help themselves. Unlike modern psychiatry whose motive is to use a band-aid effect, numb you up with often toxic drugs, addict you so you have to keep coming back for more and more and then dissuade you from seeking complimentary alternative healing. It’s all a sham pulled over our eyes, to support profits. Note: There are some who suffer from severe or acute conditions, where this approach is necessary because time is of the essence. Once under control though, alternative methods should be employed.

Agreed, being that our world no longer functions in a community setting; it is no longer one for all and all for one. Now it’s a system where everyone has to look out for themselves. Doctors, like any other professional, have to make a living. The economy has forced even the most compassionate doctors to resort to the 7 ½ minute visit, processing patients as if on an assembly line. Laws, malpractice, insurance regulations, 3rd party payers have turned this once honored practice into a system without a heart or soul. Yes, we are grateful it’s there. Some believe the U.S. model is the best in the world. Many disagree.

While it would not be practical or in most cases, possible to adopt Patch Adam’s model for healing, some of his methodology and philosophy can easily be incorporated into any practice. Break down the walls of hierarchy, smile, hold a patient’s hand, give them a hug if they need it, learn to use humor, and clown around once in while. Compassion is beginning to be taught in schools here in the U.S., something that was always taught in Europe. It’s time to put the egos to bed and behave as what you are without the diploma hanging on the wall – an average, everyday American; hopefully one with humanity, humility and the ability to laugh.

DR. PATCH ADAMS - Dealing with Suffering

All you have to do is read the news. There is some sort of major disaster and tragedy taking place at any given moment. You may feel uncomfortable and wish to side step it. The easiest way to cope with bad news is to turn a blind eye. So you don't make eye contact with the homeless or those suffering. Don't turn on the TV when reports of natural disasters hit. Don't read about war, violence, and riots. Don't spend any more time at hospitals or nursing homes than the occasional obligatory visit to a loved one.

Walk into any public place and you are bound to run into a problem of one sort or another playing out before your eyes. Parents fighting with unruly kids; customers complaining about one thing or another; people getting into fights and brawls. Just driving somewhere, it's impossible to avoid road rage. Turning away and tuning out may give you a moment of solace, but it doesn't erase the truth. It may temporarily shelter you from negativity allowing you to languish in your own narrow sense of positivism. However, how can you really feel pride and self confidence when you are contributing to the problem rather than stepping in to lend a hand?

Everyone makes excuses! We've all heard them echoed time and time again. "I've got my own problems to contend with!" "That's their country's problem! Let them tend to their own!" "They deserved it!" "You can't solve the world's problems over night!"  "It's not my business to interfere!" "It all media hype." "Damned bleeding heart liberals!" "I'm just one person. What can I do?" "What is it you want of me?" "I'll be dead by then so what does it matter?!?" Go ahead.  Don't you let other's suffering ruin your good day.

Conflict. Pain. Anger. Hostility. Suffering. Crime. War. Victimization, and yes... Hatred. There is too much of it! Doesn't that make you mad? Of course it does if you have an ounce of humanity in you! But how many of you have actually stepped up to the plate to make a difference? Huh?

Last night I sat in on a lecture by a truly amazing man. Dr. Hunter Doherty Patch Adams. He is the man who brought laughter, humor, and compassion into the field of medicine. He has worked for 40 years as a Family Practitioner and has never charged so much as a dime for his services. He has never bedded up with Big Pharma, the Insurance Industry, Government Propaganda or Capitalism. He doesn't buy into the system and that is what makes him so incredible. He's not wealthy. He lives in a commune. But he's probably the richest man in the world! He has a wealth of goodwill and happiness.

He knows how laughter, a simple smile, clowning can bring light into the darkest places. He has visited hospitals, prisons, orphanages, referee camps, nursing homes, mental institutions, prisons, long term care facilities, and war zones worldwide. He responds to the calls of the neediest. He enters the most horrible nightmarish settings of monumental suffering where all hope is lost and has brought a ray of sunshine. He doesn't accept being put up in nice hotels, being fed anything better than the people he offers his own unique brand of support to and all money earned from speaking engagements goes to his foundation - the Gesundheit Institute, a hospital offering free care and natural therapies.

He explained how although holding a child who has never been loved or held brings tears to his eyes, it also offers him rewards that money could never buy. He is not a religious man so to say, but he prays with families of every background and culture, with love and respect shown towards their traditions. From Atheist to Zoroastrianism, his heart is open to spirituality of any sort, and for that moment he is one and the same with the suffering and those facing immeasurable pain and loss. He'll tell you - "Faith works!" He combines a deep reverence for all mankind with clowning to lighten the hearts of those in pain, and it works. He spreads love, the most important resource in this world, and yet as he says, "We can go from preschool to our post doc and beyond, and not once do we learn anything about its powers." The college students at Northeastern University agreed it's the one area of life they feel least prepared for.

So how do we learn to walk in his shoes when for most of us, they are far too big to fill? First of all we must change our perspective. Don't say I'd like to change; I could change; I should change; I'll try to change. Say I WILL CHANGE!!! It's a decision! Make it and stick to it!

Start small. It's in the slightest actions that we can begin to make changes that affect the lives of others in the most profound ways. Try holding a door for someone; smile at a stranger; laugh at loud for no reason at all (even if it's feigned) and watch genuine smiles come over the faces of those standing near by; clown around with a child who's crying and screaming and watch a smile come over their face. Don't be so serious, uptight and professional - dare to be goofy! Let the child in you come out and shine. Prehaps be a little bit naughty. Laughter is far more infectious than the common cold. It connects people on the spot, forming intimacy. Best of all it's FREE and easy to do!

Don't turn a blind eye to pain. It will always be there and someday, it may be you on the receiving end. Roll up you sleeves (or in Patches case, he rolls up the legs of his oversized clown pants and pulls the waist up under his arms). Be a clown and make them laugh. We WILL make a difference. We CAN make this a better world. WE ALL HAVE THE POWER TO HEAL!!!

Wednesday, November 10, 2010

PSSD or Post SSRI Sexual Dysfunction

PSSD stands for Post SSRI Sexual Dysfunction.

It is estimated that up to 50 - 80% of patients that take SSRIs (Selective Serotinin Reuptake Inhibitors or antidepressants) suffer from sexual dysfunction to one degree or another.  This may occur while taking the drug or upon discontinuation of use.   The actual numbers are difficult to confirm as many people may feel uncomfortable discussing intimate issues with their physician out of shame, embarrassment or fear of stigma.  It should be noted that PSSD can occur on mild-high dosages, short-long term treatment and when  discontinuing SSRIs. Every person is different and no two cases are the same.  Dysfunction may last from weeks to months, or permanently in some cases.

PSSD may include:
  • Low or non-existent libido or sexual drive
  • Anorgasmia or muted, premature, delayed or absent orgasm or ejaculation 
  • Sexual Anhedonia - reduced or lack of pleasure during orgasm or ejaculation 
  • Vaginal dryness or reduced lubrication
  • Decreased vaginal, clitoral or penile sensitivity, ranging from mild to complete genital anesthesia
  • PGAD or Persistent Genital Arousal Syndrome in women unrelated to desire.  Similar to Restless Leg Syndrome, this condition and can be extremely dibilitating, uncomfortable or even painful. ^
  • Spontanious orgasams or ejaculations
  • Priapism - erection lasting 4 or more hours, a potentially harmful condition considered to be a medical emergency that can result in permanent vascular damage
  • ED - inability to develop or maintian an erection of the penis
  • Loss or decreased response to sexual stimuli (visual or physical)
  • Reduced semen volume
  • Impotency
FDA-approved indictaions for treatment with SSRI's include: ^

Depression
OCD or Obsessive - Compulsive Disorder 
Bulimia Nervosa
PMMD or Premenstrual Dysphoric Disorder
Panic Disorder
PTSD or Post Traumatic Stress Disorder
GAD or Generalized Anxiety Disorder
Social Phobia

 "Off Labeling", or the practice of doctors prescribing these drugs for indications for which they have not been approved  is rampant. Such conditions include:

Alcohol Dependency
Chronic Pain
Fibromyalgia
Back Pain
Migraine Headaches
Diabetic Neuropathy
Anorexia
Binge Eating

and of all things - Sexual Dysfunction.  This is simply criminal. The only sexual dysfunction SSRIs have been shown to effectively treat is premature ejaculation, while still potentially causing the other undesirable effects mentioned above.  Additionally, it requires continuous daily use to prevent this problem.   Only two drugs have shown promise in immediate & occasional use: Chlomipramine and Viagra.

If we return to the first and primary indication for antidepressants, namely DEPRESSION,  first it must be recognized that among the most common symptoms are low or non-existent sexual desire and dulled ability to experience pleasure.  If this is already an issue you are concerned with, careful consideration should be taken before beginning treatment with SSRIs. The last thing you want to do is make a bad situation worse.

SSRI's have been shown to be highly effective in improving mood, alleviating self- loathing, revitalizing energy, and returning a sense of normalcy to the depressed individual, which is why they are used as a first-line treatment by medical doctors and psychiatrists.  It should be noted, however, they also have been shown to reduce inhibitions,  give rise to suicidal thoughts and tendencies, cause aggression and mania, induce insomnia and restlessness, and may lead to Bipolar Disease.  However, the most counterintuitive side-effect of all - Antidepressants may cause Depression.

Unfortunately, the medical community heavily uses these drugs in children and teens, exposing them to the risks of reduced sexual pleasure, performance and impaired reproductive abilities as they mature.  Already studies have shown that while the number of teens receiving these drugs is increasing expoentially, sexual activity among the same group has been on a downward trend.  For those looking to promote celibacy, lowering the risk of teen pregnacies, or reducing population growth this may be a bonus, however, the long term effects may not be as positive as one would hope. Additionally, parents should be careful making decisions for their children, that could have life-long impact on their welfare and happiness, unless they are in dire need and there are no other alternatives. It's never too early to consider these possibilities.

Contrary to popular belief, your brain is your largest sex organ. When behaving properly, it produces neurotransmitters (brain chemicals including serotonin) that  increase the communication between cells. Upon stimulation through sensory input, these chemicals signal the body  to increase blood flow to the sexual organs when stimulated and voila - sexual arousal occurs.   Free serotonin is functional (a feel good chemical).   Depression, however, can interfere with the signals. SSRI's block the re-uptake or re-absorption of serotonin into the neurons, thus improving overall mood.  Unfortunately, once again, the drugs can also cause depression both up and downstairs. These factors must be weighed out carefully.

Sexual Dysfunction for an individual can raise havoc with self- esteem, confidence, and anxiety. We live in a world where sexuality is paraded in front of our faces 24/7. Advertising, media, TV, movies, music, fashion - sex is everywhere.  It's only natural to want to live up to these "images" in spite of how inflated they may be.   While one quarter of society suffers from HSD or  Hypoactive Sexual Drive, few talk about it, leaving all too many people feeling inferior or different [while that's far from the case].  It's even more devastating when you used to have the drive, but  find it slowly fading.  Until we learn to measure ourselves as  individuals rather than being compared to artificial standards, we will continue to suffer.

Sexual problems for couples can produce stress, straining their relationship and further complicating dysfunction.  It interferes with connectiveness, intimacy, and the ability to bear children. In spite of the fact that a classic study called "Sex in America" found that 1/3 of couples were having sex only a few times a year, once again the media begs for us to believe a different story. The Social Media Gurus chant that active sexual relations, up to three times a week, should be taking place for everyone from teens to those in their 90's.  Obsession with celebrity portrayals of "Mr. & Mrs. America" on screen and pornography leaves people with unrealistic expectations. PSSD only worsens this issue unless properly addressed. A couple willing to weather the storm and take a new course though, can find new and exciting seas to sail with mutually satisfying results.

Newer antidepressants including Wellbutrin, Remeron, Serzone and Survector (not available in the U.S.) have few or no sexual side effects. ED (Erectile Dysfunction) drugs may be added. Hormones can be used to boost libdo in some cases. Couples or sexual therapy can be helpful in finding alternative methods of coping with this disorder. While PSSD or HSD is the most common complaint addressed by marital/sex counselors, millions of couples suffer in silence.

Open communication for this condition is essential.  Talk to your M.D., ask your psychiatrist if there are alternatives.  Most of all, discuss this issue with your spouce or significant other. And please - report side effects to the FDA. 


Most of all, relax. You are far from alone and this is not your fault.  Don't let anyone tell you it's all in your head.  Seek help and don't feel ashamed or embarrassed. Trust me, they've heard it all before.

^ Formulary

^ Drug Facts and Comparisons. St. Louis: Facts and Comparisons, a Wolters Kluwer Co; 2002.

^ McEvoy GK. AHFS DrugInformation. Bethesda, MD:American Society of Health-System Pharmacists; 2001.
/Source: K.C. Lee, PharmD, M.D. Feldman, MD, and P.R. Finley, PharmD