Archive for the ‘Mental Health’ category

Memories of a new puppy and Pet Therapy

December 14th, 2016

It was a brisk, early, spring, weekend morning and Joanna, then a 16-year-old, now mother of four, said that we needed a transition dog. Tessie, our part-golden, part-black lab, part-border collie was getting long in the tooth, and it was our custom to always bring a replacement puppy into the house when the older dog was beginning to head toward the rainbow bridge.

So, at Jo’s insistence, we drove to a dog pound about 23 miles away. When we got there, it was closed, but she kept pushing hard for a new puppy.

We then headed for another sanctuary for abandoned dogs, a no kill shelter. That shelter was about 31 miles in the other direction. We arrived right before closing time and were directed to a room that was filled with a half dozen beautiful, little, white puppies.

The puppy that jumped the highest and yipped the most was not our choice. It was instead it’s little brother, the most loving and cuddly of the brood. The volunteer said that he was probably part sheep dog and part poodle, but we really didn’t care what he was because he was adorable.

We paid our fee, packed him up, jumped into the car and headed home to our older dog Tessie for what would become months of mothering, teaching and unconditional love and patience. Jo named him Brody, and it fit him perfectly.

Tessie taught him how and when to go to he bathroom and, she taught him to be terrified of thunder, to bark at the meter readers, to play with the cats as if they were his very best friends, and to beg from me at the table. While Brody reminded Tessie how to play, he became her adopted puppy.

One evening, a newly roasted turkey was placed on the stove to cool. While working on my computer, I heard some noise in the kitchen. The next thing I heard was puppy feet on the steps and then a thump, puppy feet and a thump, puppy feet and a thump. Then Brody, the puppy appeared at my chair, his belly was completely distended, and he smelled of turkey breath. He and Tessie had eaten the entire thing. Kind of like the Butkus dogs on “A Christmas Story.”

Well, Brody grew to be the best dog and best friend ever. In fact, when my mother visited, she would hold complete conversations with him as if he was a human being.

In her obituary I wrote that “She often scolded her sons for not talking enough to their animals.” Somehow the Pittsburgh newspaper accidentally changed that line to “She often scalded her sons for not talking enough to their animals.” Only those who knew my mom could have ever appreciated the absurdity of that printed mistake. So, when people said they were sorry and scanned my body for burn scars, I knew why.

It was about six years after he joined us that I went on a heart healthy diet that excluded all meat, and, since I was the only sucker in the family who would sneak him table scraps, he had to follow my diet. He became a vegetarian dog. In fact, with some of the new fat free products and make believe meats, I always made it a rulethat if Brody wouldn’t eat it, I wouldn’t eat it either. That diet extended both of our lives.

After Brody died my life became doggy less, and I’ve never gotten over that disconnect, but with my schedule and all of the traveling that I do, it would not be fair to either the dog or to me.

So, I always spend considerable petting time with my daughter’s dog, Chipper, and believe me when I tell you that when I’m around, he is completely spoiled in every way because I’m just a dog kinda guy.

And in Tessie’s memory I added pet therapy at the hospital while I was a CEO, and I’m still convinced that those dogs provided as much healing as many of the drugs.

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The Patient-Physician Connection

November 28th, 2011

With age, one sometimes begins to accumulate wisdom, and, although I am not one to focus on the woulda, shoulda, coulda opportunities that have passed me by, one regret that I surely have is that I had not met Dr. David Rakel  until about three years ago. Dr. Rakel is the Director of the University of Wisconsin Integrative Medicine program.  He attended medical school at Baylor in Houston, Texas, and completed a family practice residency in Greeley, Colorado.  He is a doctor, a father, an academician, but most importantly, he is a healer.  Of all of the physicians that I have ever known – and there have literally been hundreds of them, Dr. Rakel embraces all that is good in the medical profession.

David P. Rakel, MD - Healing Hospitals - Nick Jacobs, FACHE

David P. Rakel, MD

In his presentation, “Placebo or NoCebo,” David outlined the ingredients present in a healing environment:  1. A relationship with a helping person, 2. A healing setting, 3. An explanation that gives a sense of control of a symptom.  4. A ritual procedure or plan that involves active participation of both parties – patient and clinician – that results in belief towards action.  He spoke passionately about the importance of touch, the intrinsic value of healing, and the fact that something was done with the ritual.  One of my favorite, tongue- in- cheek quotes that David had was from Voltaire: “ It is the physician’s duty to amuse the patient while nature cures the disease.”

Dr. Rakel talked about the intelligence of being positive while giving the prognosis, showing empathy, empowering the patient, and demonstrating the importance of having a connection between the physician and patient.  I’m sure that I’m not capturing all of the salient points that David carefully made, but I am sure that I understood his commitment to connection with the patient and the significance of using as many positive words as possible to convey that connection.

Once again, a great quote from Dr. Rakel revolved around the fact that you get better faster if you have unconditional love from your pet than a bad connection with your doc.  He and his research on the common cold both suggested that, “It is better to stay home and be licked by your dog, than to spend time  at a clinic with a grumpy doc!”

His recommendations to his residents and to all of the physicians to whom he lectures is that the physician needs to display empathy, compassion, patience and the ability to listen.  His counsel to meditate revolved around the need for us to get out of our chaos and influence self-healing mechanisms.  He described this journey from awareness to awakening to authenticity and finally to awe where the closer that we get to authenticity, the more beautiful our lives become.

Dr. Rakel then launched into numerous studies that evolved around the placebo effect such as the study where arthroscopic knee surgeries were “faked,” but resulted in positive outcomes.  By referring to obesity as working toward optimal weight; chronic pain as myofascial health, depression (and this is my favorite) as potentially happy, the patients are not labeled with negative implications, and we accomplish a shift in our intentions.  Not unlike what Newton, Einstein and Stephen Hawkins have done in physics, perceptions have been shifted by changing the manner in which we observe things.  He said, “How about if we tell the patient that they are potentially happy rather than clinically depressed?” Our intention is reflective of our future.

Finally, Dr. Rakel suggested that physicians protect time in their schedules, create space, create positive patient expectations, be fully present and listen to the patient, that they offer support and collaboration and create a plan by using words that heal rather than words that harm.

Right on. Thanks, Dr. Rakel.

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Who Let Us Down?

June 12th, 2009

Recent news:

WASHINGTON, DC James von Brunn, the white supremacist who allegedly opened fire Wednesday at the U.S. Holocaust Memorial Museum in Washington, D.C., suggest that a lifetime of hatred had reached a critical mass. The 88-year-old is charged with murdering a security guard at the building.

LITTLE ROCK, Ark.  —  A Muslim convert charged with fatally shooting an American soldier at a military recruiting center said Tuesday that he doesn’t consider the killing a murder because U.S. military action in the Middle East made the killing justified.

NBC News is reporting that at Camp Liberty, the main U.S. military base in Iraq, which is located near the Baghdad International Airport, a yet unnamed serviceman walked into a “stress clinic” in the camp, opened first, killing at least five. Contrary to earlier reports, the soldier did not kill himself but is now in custody.

When things like this happen, we all stop and ask what went wrong?  In two of the three situations, we had relatives or friends nearby.  My daughter-in-law’s friend was working at the museum, and my son-in-law is stationed beside the stress clinic at Camp Liberty.

I’ll never forget when the Reagan administration began the movement to close down  mental hospitals.  A friend worked at the mental hospital nearby.  We had had a rash of threatening letters, some very upsetting encounters, and a several other incidents in the community when this friend said to me, “You know, we had 2,000 inpatients and 500 outpatients at the mental hospital.  Now we have 2,500 outpatients. Nobody’s left town, and when they don’t take their meds, there can be problems.”

Pfc. Joe Dwyer carried a young Iraqi boy who was injured during a heavy battle between the U.S. Army's 7th Cavalry Regiment and Iraqi forces near the village of Al Faysaliyah, Iraq, on March 25, 2003. Dwyer died of an apparent overdose at his home in North Carolina on June 29, 2008. Photo credit: Warren Zinn / Military Times file
Pfc. Joe Dwyer carried a young Iraqi boy injured during a heavy battle between the U.S. Army’s 7th Cavalry Regiment and Iraqi forces near the village of Al Faysaliyah, Iraq, on March 25, 2003. Dwyer died of an apparent overdose at his home in North Carolina on June 29, 2008. Photo credit: Warren Zinn / Military Times file

When you consider that there are about 6.5 billion people in the world, if only 5% of the total people living on this planet are suffering from some type of mental illness, we’re potentially talking about the equivalent of the entire population of the United States with some mental health issues. ( Sorry if  my math is slightly off.)  Point is, that’s a lot of people.  So, what are we doing for them?

The Rand Corp. released a study of returning service members and is estimating nearly 20 percent of the 1.6 million who have served since this war began will develop Post-Traumatic Stress Disorder (PTSD). That is nearly 320,000 PTSD sufferers – more than the population of Pittsburgh.

White supremacists are such old news.  We have had to hear about their beliefs over and over during the past sixty years or so.  Maybe when they are arrested,  as James von Brunn had been more than once, it would help them to serve their time doing community service as tour guides at Auschwitz?

Our soldiers, however, are an entirely different story.  We have spent the past several years meeting with experts in mental health who do know what to do for them.  That’s the good news.  The bad news is that this care is not being rendered.    The military has strict guidelines on the treatment of PTSD, but, if you ask our returning soldiers how faithfully these guidelines are implemented, the general answer is that “There’s not enough money to provide this care for our Guardsmen and women.”

We don’t pay our school bus drivers a living wage, and they are in charge of our most precious loved ones.  We couldn’t afford to send armour with our early troops deployed to Iraq and have had more amputees than in any war since the Civil War, and now we don’t have enough money to treat PTSD.

That type of rationalization makes me tired.  We have enough money, we just don’t have our priorities and incentives in line.

depression female young woman african american black mental health Nick Jacobs

Did anyone notice that James was boiling over with insanity?  How about Mohammed?  Our PTSD patient in Iraq knew that he was in troble, but we busted him, and then put him beside a driver with a gun on his hip.  That weapon became his killing tool.

This blog was not intended to be depressing.  It is intended to reemphasize that we in healthcare should be about caring. It is about teaching caring, love and respect.  It is about helping those who need help, and detaining those who won’t accept that help.   We have drugs, but, as the Virginia Tech shootings demonstrated, in certain phenotypes the receptors are not there to allow those drugs to be absorbed into the body.

Mental health help has a long way to go, and we all need to be part of that journey.  Telepsychiatry, PTSD clinics, screenings for radicals?  Surely someone cares.

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