The future of medicine

we recognize the true embodied mind
we stop the stigma of the many beaten down
the damage done in childhood caught in time
hearts open and lift the broken off the ground

we learn that diagnoses are a crutch
drugs plaster over deep and seeping wounds
mental labels hurt the patients oh so much
we learn to listen: broken hearts sing grieving tunes

cruel medicines and thoughts are shelved for good
gentle boundaries surround hearts to keep them safe
we rise as friends and families and doctors really should
the angry monster revealed as longing waif

damage done in childhood to the brain
lays survival pathways that we no longer call insane

The photo is me and my sister Chris. I do not know who took it, but I think it was at my maternal grandparents. They are deceased, my parents are deceased, my sister is deceased. I don’t know who to credit.

Exercise the wanting self

Achy this morning

Busy on Monday
Virus on Tuesday
Throwing up and
cancelled clinic
Beloved visitors all week
Worked, nauseated Wednesday
Thursday almost better
Evening festive
But up 1 to 4 am
with someone way too sick
phone to specialists
six times
finally I tell her
if she is not transferred
I think she will die
She chooses to go
Slightly groggy clinic Friday
Hard to type

Achy on Saturday

I make myself
go to the pool
to swim laps
I know
it will help

In the water
the wanting self
is noisy
I want goggles
I am wearing a mask
It leaks
Why haven’t I gotten goggles
I deserve them
Moratorium on spending
currently
and haven’t had time
and I want that
beginner yoga kit
and other things

The wanting self
makes me tired
and it is silly
to want so much
Stymied, the wanting self
goes on about work
I am on lap number twelve
I think
I am uncomfortable
with Mr. J in clinic
who keeps wanting
more pain medicine
and complains about
my boundaries
In the water
I realize
that he is no more comfortable with me
than I with him
I am pleased
to admit that
and can refer him
to a pain clinic
The lady next to me
has a powerful breast stroke
long deep glide
under the water
The wanting self
wants to swim like her
Why don’t I exercise more often?
I am lazy
Maybe I will exercise
before my first cup of tea
every morning
The wanting self
builds castles in the water
plans
that wash away
I wonder if the wanting self
builds up
is stored
in my muscles
and exercise
exorcises
the wanting self
That would explain
fibromyalgia
better than anything
I know of
and why exercise
is the best treatment
and maybe that is why
exercise
and exorcise
are so close
I picture all our
wanting selves
sloshing around the pool
released
they dissipate
Does chlorine
inhibit their return
to our bodies?
We climb sleek
from the pool
and shower

I am less achy
still tired
but my muscles feel
polished
pumped
blood flow
has returned

I must exercise
more often
and exorcise
the wanting self

The Wedding Bells part 17 (Flash fiction chain number 6)

This is my second contribution to flash fiction number 6, hosted by Jithan, Photrabloger, with his beautiful photograph as inspiration. This is part 17, with the theme being a sweet romance, going around a second time because the ending was uncertain.

Major characters:

  • Anna Brighton- 32 year old CEO who owns and runs a publishing company
  • Alex Burns – well established author, Anna’s ex, Toby Blackwell’s cousin
  • Toby Blackwell – co-owns the Blackwell estate, Alex’s cousin

Minor characters:

  • Jenny- Anna’s secretary
  • Melissa Doyle –the bride, Anna’s dear friend
  • Harrison – Melissa’s fiance.

Here are the links to the story so far:

  1. Sona
  2. Click here
  3. Priceless Joy
  4. Frenesthetist
  5. Dr. KO
  6. Sweety
  7. Me
  8. I-Read
  9. First Draft
  10. Soul n Spirit
  11. Phaena Says
  12. The Stardust Elephant
  13. Sona
  14. Click Here
  15. Yinglan
  16. Itchy Quill
  17. me!!!

Part 17

Alex stood starting at the arrow with the heart shaped tip. Anna reached towards him. “Never mind that,” she said, her hands trailing from his shoulders down his arms.

“Wait,” said Alex. “Are you hurt? This doesn’t make sense.”

“It’s just the cupid, Melissa told me,” Anna murmured as she tried to slide into a close embrace.

“No, Anna! You don’t want him! You want me!” Toby was in the doorway. He, too, was holding an arrow with a heart shaped tip. He looked dazed.

Alex stepped away from Anna. “You’re both drugged!” he said.

“When I opened my eyes I knew. I have never been so in love!” said Toby. He was coming towards Anna, arms outstretched. Anna backed towards Alex.

Sara, the flower girl, came in. “Anna?” she said, “You said you’d take me in the garden.” She was holding the paper cone with the ribbons and the bells tinkled. It was empty of flowers now.

“You shot me!” said Toby. He grabbed Sara’s wrist.

“Let go!” said Sara. She was trying to pull away, not quite scared yet.

“Let her go!” said Anna and Alex together. And Anna lost it. Her temper. “Don’t move,” she snarled at Alex, who stared at her in surprise. “Toby,” Her voice was sultry as she walked towards Toby and the little girl. Toby looked up. “Darling,” said Anna, “Don’t think about her.”  She slid her hand up Tobys arm and rested it on his shoulder. Toby dropped Sara’s wrist and reached for her. Sara jumped out of reach and Anna clocked Toby: elbow strike to the temple and foot to the shin. He went down hard. Anna stood over him, ready to strike again.

“Shit!” said Toby, “Ow!” He curled up holding his head.

Sara was clapping, Alex saying, “Anna, Anna, that’s enough.” He touched her shoulders and she let him back her away from Toby.

She looked at Alex. He was grinning. “Trained, I see.”

“Supposed to help with the business killer instincts,” said Anna, a bit sheepishly. Sara was hugging her legs. She picked the little girl up.

“Sarah, do you know where these arrows come from?” asked Anna.

Sara touched the arrow. “No. Mine are suction cup. Mom only lets me shoot at windows.” The tip of the arrow was red. Sara stuck her finger in her mouth. “Mmmm. Jam.” she said.

Toby was sitting with his head in his hands. “I have the mother of all headaches.” he said. “Shit. Anna, I’m sorry.” He looked up. “That didn’t help with my hangover at all. You hit hard.”

Alex held out a hand and helped Toby up. “You both look more normal now. What is with the jam arrows? What is this cupid story?”

Sara waved her cone and the small bells rang. “I don’t know,” said Anna, snuggling the little girl. “Let’s go out in the garden and compare notes. And get you some flowers for that cone,” she said to Sara.

“I am going for an ice pack,” said Toby, “Enjoy yourselves….”

Next is part 18: by Austin

Part 19: by Manvi The Conclusion!

unbearable

each time
I think
I can’t bear it

it hurts too much

you are hitting me when I am down

but then I know
that I have come too close

icarus to the sun

you melt the wax from my wings
impassive
as I fall
from the sky

you forget
I forget
that the sea is my true element

not the air

I fall into the sea

I am safe
no wings
no air
no burning sun
just the depths
my tail is back
and the painful split is healed

I swim
down to the depths

I remember
that you torch me
because it is unbearable
to be loved

you stand on shore
apollo
bright and beautiful

I wonder if you will call me forth
from the froth

I wonder if I will come
forth

Adverse Childhood Experiences 4: Psychophysiological Illness

I went to the 46th Annual OHSU Primary Care Review, held at the Sentinel Hotel in Portland, Oregon last week.

It was excellent. It was surreal since the Sentinel Hotel started as a 1923 Elks’ Club and the satyr cupid friezes kept distracting me with the marble penises and war chariots during the lecture updating us on urinary incontinence.

Three lectures that I went to talked about Adverse Childhood Experiences.

This is the first conference that I’ve been to that anyone has talked about that study since I heard about it, in about 2005. I have not been to a lot of big conferences over the last few years because I opened my own clinic and money was tight.

Anyhow, the study is creeping into consciousness.

In the mornings, we had the big lectures in a large hall. There were three break out sessions in the afternoon, held in the main meeting, billiard room, club room and library. We all joked about Colonel Mustard and candlesticks.

A gastroenterologist, Dr. David Clarke, gave a two hour session titled “Hidden Stresses and Unexplained Symptoms II”.

Objectives:
1. How to uncover the cause of an illness when diagnostic tests are normal.
2. How to find hidden psychosocial stresses that are responsible for physical symptoms.
3. The process used to achieve successful outcomes in stress-related illness.

He talked about childhood stress. That if someone had a really difficult childhood:
“Surviving a dysfunction home is a heroic act and produces individuals who are:
a. reliable and get things done
b. detail-oriented
c. Perfectionist
d. Hard-working
e. Compassionate”

So what is the down side? “Surviving a dysfunctional home also produces emotional consequences that may lead to :
a. Long-term relationships with partners who treat you poorly.
b. Addictions to nicotine, Alcohol, Drugs, Food, Sex, Gambling, Work, Shopping, Exercise.
c. Quick Temper or being violence prone
d. Anorexia and/or bulimia
e. Mental health problems such as nervous breakdown or suicide attempts
f. Sacrificing your own needs to help others
g. Self-mutilation
h. Learning not to express or feel your emotions.”

Got that? Right. Not everyone, not all the time, but the adverse childhood experiences add up. These reliable individuals may eventually get enough positive feedback to decide that they deserve a relationship that is actually good. They may get angry about their childhood or past bad treatment. “They may have a really hard time expressing that anger because they spent years learning how to suppress emotion and the feelings may be directed at people for whom there is still some caring. When there is enough of this anger present it can cause physical symptoms that can be mild or severe or anywhere in between.”

Let me give two examples from my own practice. I can’t remember their names or the details, so I am making those up: no hipaa violation.

The first was an elderly woman who came in with her husband for stomach pain. We started with a careful history. We tested for helicobacter pylori. We tried ranitidine. We tried omeprazole. We studied her diet and did an ultrasound to rule out gallbladder disease.

At the third visit I was starting to talk about an upper endoscopy. This was more than 15 years ago, back when we did not start with a CT scan. Her husband said, “Doctor, is there anything else it could be?”

I was surprised. “Well, yes. Depression is on the diagnosis list. Sometimes depression can present as stomach pain. Could you be depressed?”

My elderly lady covered her face with her hands, started crying and said, “I try not to be!” while her husband nodded.

We cancelled the endoscopy. I said it really was not something to be ashamed of and we talked about therapy. She did not want talk therapy and we tried paxil. She came back in two weeks, and already she and her husband were brighter and relieved.

Second case: again, stomach pain, this time in a four year old. Mom brought her in.

I did a history and did a gentle exam. The exam was normal. Her stomach was not hurting now. She wouldn’t say anything.

We established that the stomach pain occurred on week days only, not on the weekend. In fact, usually at the after school daycare, not in school.

“Is there a time at the school daycare that she has stomach pain?” Mom was shaking her head when big sister piped up.

“It happens before recess.” Mom and I turned to stare at the six year old.

I said, “What happens at recess?”

“The big kids knock her down,” said big sister, pissed. “I try to stop them, but they are bigger than me. She’s scared. The teachers don’t see.”

“Oh. Thank you for telling us!” Little sister was crying and mom hugged her and big sister. Mom did not need instruction at that point. She called me a few days later. She talked to the daycare, they watched and the four year old was protected. Her stomach stopped hurting.

Dr. Clarke also described a case, where driving through a town would trigger four days of nausea and vomiting that required hospitalization. This had been going on for 15 years. He figured out why that particular town was a trigger: when the patient recognized the why, he was able to go for therapy.

People aren’t lying about these illness, they are not making them up. Doctors have called it somatization, but really it is the body holding the emotions until the person is safe enough to deal with them. Doctors need to learn how to recognize this and help with respect instead of stigmatization and dismissal.

I hope that more doctors learn soon…

Dr. Clarke’s list for further reading is below. I don’t have any of these yet, but they are on my wish list.

They can’t find anything wrong!, by David Clarke, MD. See also www.stressillness.com

Psychophysiologic Disorders Association: www.ppdassociation.org

Caring for Patients, Alan Barbour, MD

Unlearn Your Pain, Howard Schubiner, MD

Pathways to Pain Relief, Frances Anderson PhD and Eric Sherman PhD

Ted talk about ACE scores: http://www.acesconnection.com/blog/nadine-burke-harris-how-childhood-trauma-affects-health-across-a-lifetime-16-min

Lentils with wilted spinach

Made this up yesterday:

dried lentils
onion
2 cans organic garbanzo beans
garlic
salt
pepper
olive oil
butter
sesame oil
white balsamic vinegar*

Boil the dried lentils until just tender.
While they are boiling, chop the onion and sauteed it in the olive oil and butter. Leave out the butter for vegetarian/vegan folks. Caramelize the onion a little. Add the garlic for the last minute.
Drain the lentils, place in a heat proof bowl, add the onions and garlic, add the two drained cans of garbanzo beans.
Put washed spinach in the heated frying pan and cooked it until it is just wilted. Add that to the salad.
Add vinegar, sesame oil, salt and pepper to taste.
Enjoy!

* I used white balsamic because it was in front. Use whatever vinegar you like!
Published on everything.com today too.