Tag Archives: love

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Adverse Childhood Experiences 15: Guidelines

I wrote Adverse Childhood Experiences 14: Hope quite a while ago.

The American Academy of Pediatrics has a guideline that physicians should introduce and screen for Adverse Childhood Experiences. The American Academy of Family Practice is skeptical, here: https://www.aafp.org/pubs/afp/issues/2014/1215/p822.html. Here are two more writeups: https://www.aafp.org/pubs/afp/issues/2020/0701/p55.html and https://www.aafp.org/pubs/fpm/blogs/inpractice/entry/screen_for_aces.html.

It is difficult to screen for ACE scores for the same reason that it is difficult to screen for domestic violence and to talk about end of life plans. These are difficult topics and everyone may be uncomfortable. Besides, what can we DO about it? If growing up in trauma wires someone’s brain differently, what do we do?

I don’t frame it as the person being “damaged”. Instead, I bring up the ACE score study and say that first I congratulate people for surviving their childhood. Good job! Congratulations! You have reached adulthood! Now what?

With a high ACE score comes increased risk of addictions (all of them), mental health diagnoses (same) and chronic disease. Is this a death sentence? Should we give up? No, I think there is a lot we can do. I frame this as having “survival” brain wiring instead of “Leave it to Beaver” brain wiring. The need to survive difficulties and untrustworthy adults during childhood can set up behavior patterns that extend into adulthood. Are there patterns that we want to change and that are not serving us as adults?

This week a person said that they blow up too easily. Ah, that is one that I had to work on for years. Medical training helps but also learning that anger often covers other feelings: grief, fear, shame. I had to work to uncover those feelings and learn to feel them instead of anger. Anger can function as a boundary in childhood homes where there are not adult role models, or where the adults behave one way when sober and an entirely different way when impaired and under the influence. There may be lip service to behave a certain way but if the adult doesn’t behave, it is pretty confusing. And then the adult may not remember or be in denial or try to blame someone else, including the child, for “causing” them to be impaired.

What if someone had a “normal” childhood but the trauma all hit as a young adult? I think adults can have trauma that changes the brain too. PTSD in non-military is most often caused by motor vehicle accidents. At least, that is what I was told in the last PTSD talk I went to. Now that overdose deaths have overtaken motor vehicle accidents as the top death by accident yearly in the US, I wonder if having a fentenyl death in the family causes PTSD. Certainly it causes trauma and grief and anger and shame.

I agree with the American Academy of Pediatrics that we should screen for Adverse Childhood Experiences. We need training in how to talk about it and how to respond. I have had people tell me that their childhood was fine and then later tell me that one or both parents were alcoholics. The “fine” childhood might not have been quite as fine as reported initially. One of the hallmarks of addiction families is denial: not happening, we don’t talk about it, everything is fine. Maybe it is not fine after all. If we can learn to talk to adults about the effects on children and help people to change even in small ways, I have hope that we will help children. We can’t prevent all trauma to children, but we can mitigate it. All the ACE scores rose during the Covid pandemic and we are still working on how to help each other and ourselves.

Here is another article: https://www.aafp.org/pubs/fpm/issues/2019/0300/p5.html.

Blessings.

For the Ragtag Daily Prompt: open wound.

The photograph is one of Elwha’s cat art installations. He would pile toys on his bowl. Two bowels because I need to keep out the little ants. Sol Duc would do it too but not as often. I fed them in separate rooms. They would pile things on the bowl whether there was food left or not.

Elwha is still missing, sigh. That is a wound. The photographs are from March 2023.

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Soldier on

Older
bolder
golder
told yer
moulder
soldier on

What is older? Anything and anyone older than me? At one point I have 5 women who are over 100 years old as patients. Two are 104. One is local indigenous tribe and tells me about white women moving to another pew if she sat down near them in church, back when she is in her twenties. I am apologetic at that visit because it is hospital week. Our pacific northwest hospital has chosen cowboys as the theme so being a bit oppositional defiant, I have braids with one feather hanging down. I swear that EVERY ONE of my indigenous patients comes in, including the 104 year old. I apologize, but they mostly seem amused by my rebellion.

They also influence me. Now when a 72 year old complains about being OLD, I say, “You are not old in my practice.” They look confused. I say, “I’ve had five people over 100 all at once, so you don’t get to complain about being old until you are 90.” People laugh, but they also usually look pleased. Over 100 is a LOT older than 72. When someone is over 100, I don’t really doctor them much. I might say, “This is what the book says we should do.” “I’m not doing that,” says my 101 year old. “Ok, cool.” I say. It’s hard to argue with.

And the joke about the centurian? What do you like best about turning 100? “No peer pressure.” Um, yes. I want them to tell ME what they’ve done to reach 100. The one thing that they all have in common is that they are all stubborn. I don’t know if stubbornness is what gets them there or if we just get more stubborn as we get older. Both, perhaps.

By stubborn, I don’t mean that they don’t learn and do new things. I had a woman in her upper 70s who I diagnosed with diabetes. At the next visit she said cheerfully, “I found these five apps for my phone. This one tells me the carbohydrates, this keeps track of the distance I walk, this one tracks my blood sugar.” I don’t remember what the other two did. This was a decade ago. She was retired from Microsoft. I wanted her to teach a class for me and all of my other diabetic patients.

My grandmother took classes in her 80s in lip-reading. She was going quite deaf and her hearing aides were not terribly helpful. She had videotapes and a rather shy teacher who would come to the house. She would glare at him and the videotapes. She attacked learning it like a piranha and was furious that she couldn’t learn it faster. I am like that too and my son learned some patience from the violin. He couldn’t play well immediately and found that practice works.

At what age is someone old? I think that’s moving target and the older we get, the older we think it is. I do think 104 is a lot older than 72. When does your culture think that people are old? My fierce grandmother said that she would look out her window. “I see little old ladies across the street and think, oh, poor things, they are so old. But then I think, OH, I am older then they are!” She died at age 93, fierce until the end and curious about death too. Her last words to my father were, “Look, Mac, I’m dying.” He said, “I’m looking,” and she stopped breathing. She was always curious and funny and could tease quite terribly and she and my mother butted heads and loved each other. She loved my father too, and me.

The photograph is my maternal grandmother, Katherine White Burling and it’s one I took.

For the Ragtag Daily Prompt: older.

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Northern lights

Walt Kelly wrote this poem, which I love.

Northern lights

Oh, roar a roar for Nora,
Nora Alice in the night,
For she has seen Aurora
Borealis burning bright.

A furore for our Nora!
And applaud Aurora seen!
Where, throughout the Summer, has
Our Borealis been?

________________________

A friend named her daughter Nora and I sent her a copy. I especially love the word furore, because it doesn’t rhyme , even though it seems like it should.

For the Ragtag Daily Prompt: aurora.

Elwha is still missing and I did not see the aurora, though tons of friends have posted pictures. This shot of Elwha is from January. I wonder if he saw the lights in the sky?

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leaves

I am working in Grand Junction, Colorado. There are not as many leaves here as at home, but the leaves are still hiding my cat! I am mad at the leaves and sad. Elwha is still missing and it’s been a week. I have had food and the carrier out for him, put up posters on Facebook, contacted the shelters and vets, and searched and searched.

The carrier failed and the door popped off when I put it down. Elwha ran. Sol Duc was still in it, so I put the door back on as fast as I could! Then I left the carrier and went after Elwha, but could not find him. I kept going out and searching, including at 2 am.

Maybe he will show up at home. It’s only 1215 miles by car.

We had another cat who disappeared and we thought was gone. The hardware store called us a month later and said, “We have your cat.” She was thinner and scared to go outside. Elwha only goes out in carrier or with leash and harness. There are prairie dogs and a canal with low trees and bushes behind the building here. I don’t think he’s there, but I am still putting food out. There is another stray tiger who now comes out to study me from a distance.

Anyhow, I wish the leaves would send him back.

For the Ragtag Daily Prompt: leaves.

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Long way

I am a long way from my ocean and from home.

I looked for a job close to home and then the temp company mentions a job in another state. “Where?” I said. They told me and I said, “I’m interested!” We started the process. I always forget what the process is like. It is hella annoying. There is miles of paperwork. We had a delay from the state, because I need a license for each state and they weren’t meeting until after the start date and then they said, “We’ll let you know in two days.” and THEN they said, “We’ll let you know in two days to two weeks.” So I had three weeks of being half packed and trying to just flow with it. I finally got word, yes, ready, two weeks ago Monday. By Friday morning the cats and I are in the car and headed out.

Now I have worked for a week here. The US currently has 500 different electronic medical records and I supposedly learned my 8th (or 9th) on Tuesday. About six hours of training on the computer and my brain shut down after four. However, the support on Wednesday was good and I started seeing patients. I was careful to say, “If I look grumpy, it’s at the computer, not you.”

So far mostly good. Except, one cat got out two days after we got to our destination. He is chipped and I am still walking miles and calling. The local lost pet group is trying to help. I miss him quite terribly. The door popped out of the carrier when I put it down. I feel like a cat mom failure, but things happen. Elwha is big and strong and I may yet get him back. Sol Duc was sensible enough not to run, but I had to secure her before going after him.

For the Ragtag Daily Prompt: flow.

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Tree dreams

Tell me, tall one, what do you dream of in the night? What do you long for in the early rising sun? What messages come to you on the wind, through the rain, through the soil? Your tall branches catching dreams and catching the rays of the sun, some slipping through to me. I send you love and dreams of joy, however that looks to a tree.

For the Ragtag Daily Prompt: dreamcatcher.