Thursday, April 17, 2014

Is Nurse Jackie Your Co-Worker?

Nurse Jackie
Nurse Jackie (Photo credit: Wikipedia)

Do you work with a Nurse Jackie?

If you don't happen to subscribe to Showtime, The Movie Network or Movie Central, you may have no point of reference to Nurse Jackie. The series premiered on June 8, 2009, so soon it will be five years old and the sixth season premiered on April 13, 2014. It is what is called in the business a "dark satirical comedy-drama series" which takes place in an emergency department of a New York City hospital. Each episode is 30 minutes in length.

Just the other day an associate explained that she had never seen the show, but happened upon it during "Watchathon Week" and was drawn into Season 5 of Nurse Jackie. Our associate was able to piece together the ongoing storyline and realize that Jackie Peyton is in fact a registered nurse, mother, soon to be divorced wife, friend, co-worker, part time girlfriend and a reluctant member of Alcoholics Anonymous. Jackie is addicted to prescriptions medications and perhaps more.

So why ask if you with a Nurse Jackie? Check out the following headline...

USA Today "Doctors, medical staff on drugs put patients at risk..."

A USA TODAY review shows more than 100,000 doctors, nurses, medical technicians and health care aides are abusing or dependent on prescription drugs in a given year, putting patients at risk.
 Here are some startling facts that are highlighted in this news article:
  • Nearly 8,000 people in eight states needed hepatitis tests after David Kwiatkowski, an itinerant hospital technician, was caught injecting himself with patients' pain medicine and refilling the syringes with saline. He infected at least 46, mostly in New Hampshire.
  • "Drug diversion" is the official term used to describe the act of a health care worker stealing drugs.
  • The latest drug use data from the U.S. Substance Abuse and Mental Health Services Administration, released in 2007, indicated that an average of 103,000 doctors, nurses, medical technicians and health care aides a year were abusing or dependent on illicit drugs. Various studies suggest the number could be far higher; an estimated one in 10 practitioners will fall into drug or alcohol abuse at some point in their lives, mirroring the general population.
  • Safeguards to detect and prevent drug abuse in other high-risk industries rarely are employed in health care. No state has universal drug testing requirements, and hospitals, nursing homes and other facilities almost never do so on their own. Many institutions also lack video surveillance and high-tech systems to track dangerous drugs.
  • Many states lack rules to ensure that medical facilities alert law enforcement or regulatory agencies if they catch employees abusing or diverting drugs, so those staffers often are turned loose to find new jobs without treatment or supervision. Disciplinary action for drug abuse by health care providers, such as suspension of a license to practice, is rare and often doesn't occur until a practitioner has committed multiple transgressions.

Here is a USA Today video discussing "drug diversion"

If you are having trouble viewing the video, you can see it here.

Some final thoughts...

USA Today's investigative reporting is important and needed. Remember to take the time to read the whole article. Perhaps it will start the conversation. The questions raised are not new, but like everything else in life, we have a new generation of medical professionals and patients that are impacted by the disease of addiction and in their own ways looking for help.

Sometimes television (and movie) characters serve as teachers. As viewers we might see something that opens our eyes to what we have noticed in our spouse, child, sibling, parent, friend and yes, co-workers. Nurse Jackie comes in all walks of life, the only difference is she can "divert" the drugs as opposed to doctor shopping, stealing them or buying them on the streets.

Writing today we thought back to another fictional television emergency department located in Chicago. ER (1994-2009) had Dr. John Carter. Wikipedia reminds us...
As a result of Carter's chronic battle with pain, survivor guilt, and resistance to getting help, he eventually develops a narcotic addiction and begins to make a series of errors on the job. After Abby Lockhart catches him injecting left-over fentanyl from a trauma into his wrist, Carter's colleagues hold an intervention and Dr. Greene demands he go to an inpatient rehab center for medical doctors in Atlanta or be fired. Although initially opposed to going, Dr. Benton confronts him outside the hospital and boards the plane with him.
Remember recovery is possible...
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Friday, April 11, 2014

New Study: Eating Disorders Are Gender Neutral

New study examines men and eating disorders

This week the BMJ Open Medical Journal published online the results of a new study, The role of gendered constructions of eating disorders in delayed help-seeking in men: a qualitative interview study. This research was conducted by Ulla Raisanen of the HERG Health Experiences Research Group at the University of Oxford, Oxford, UK and Kate Hunt also of HERG and the MRC/CSO Social and Public Health Sciences Unit at the University of Glasgow, Glasgow, UK.

The objective of this study was: "To understand how young men recognise eating disorder (ED) symptoms and decide to seek help, and to examine their experiences of initial contacts with primary care."

Study's Parameters

  • The design of the study was a qualitative interview study
  • 39 young men and women were interviewed 
  • 10 participants were men
  • Ages of men ranged from 16 and 25
  • All participants had experience with eating disorders

Study's observations and conclusions

Interestingly, but not necessarily surprising, some of the young men had assumed that an eating disorder was something only young girls and women got, so seeking help from their parents or medical professionals was delayed.  According to the press release issued by the BMJ Open:
None of the men was aware of the symptoms of an eating disorder, and friends, family, and teachers were also very slow to recognise the symptoms, frequently putting the changed behaviours down to personal choices.
It was only reaching a crisis point or being admitted as an emergency that triggered the realisation of what was happening to them, the men said.
They also delayed seeking help because they feared they wouldn’t be taken seriously by healthcare professionals, or didn’t know where to go for support.
And their experiences of the healthcare system were mixed. They said they often had to wait a long time for specialist referral and had sometimes been misdiagnosed, or, as in one case, told by the doctor “to man up.” They complained of insufficient information about eating disorders targeted specifically at men.  
While it is a small study, it offers valuable insights and it can start the conversation.

ABC's Healthy Living interview with Ron Saxen regarding his struggle with binge eating disorder (BED)

This interview with Ron Saxen took place in November 2011; however, he is very articulate and explains the earliest recollections of his eating disorder. He also wrote a book The Good Eater.


If you are having trouble viewing the video, you can see it here.

Some final thoughts...

We are hopeful you will read a number of the related articles provided below. Many offer similar information about this study. At Cottonwood Tucson we do treat eating disorders; our aim is to uncover and resolve possible psychological issues related to disordered eating. Trauma and grief therapy can also help eating disorder patients to address longstanding emotional issues that support or trigger distorted perceptions about body shape and size.

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Thursday, April 10, 2014

Cottonwood Tucson's Sweetwater Program Celebrates Five Year Milestone

2009 inaugural year for Sweetwater Adolescent Girls Program

Yes, you read correctly, it has been five years since Cottonwood Tucson introduced our restructured Sweetwater Adolescent Girls Program. It was March 2009 when we presented the new "look and feel" of Sweetwater and welcomed our first clients to our 90 day residential program for girls ages 13 -17.

Sweetwater staff celebrates five years of patient care!
Cottonwood Sweetwater staff gather to celebrate the five year milestone

On March 26, 2014, some of our Sweetwater Cottonwood Tucson staff joined together to celebrate the 5-year anniversary of the reopening of the Sweetwater Adolescent Girls Program.

It was announced at this gathering that one of Sweetwater’s first patients had recently called to report celebrating 5 years of sobriety. These success stories are a reminder of the great work we do at Cottonwood and are a tribute to our staff!

A brief overview of our Sweetwater Adolescent Girls Program

While the entire Sweetwater Program is about helping teen girls find recovery with addiction treatment and co-occurring disorder treatment if necessary, continuing each girl's scholastic curriculum is strongly emphasized. In this regard, Cottonwood is a member of the National Association of Therapeutic Schools and Programs (NATSAP), additionally in 2010/2011 we were awarded the Excellence in Education Award from the Woodbury Reports.

The educational needs of each adolescent patient are thoroughly evaluated and thoughtfully considered as part of her participation in treatment. Sweetwater adolescent treatment program offers ongoing education provided by Desert Willow Educational Services, a certified school. The teacher from Desert Willow coordinates educational assignments with each patient's current school to determine educational direction while the patient is in treatment. Tutoring is offered twice weekly and educational credits are transferable.

The Sweetwater Program includes the following:
  • Accredited school program, consisting of daily structured classroom hours and therapeutic curriculum consistent with educational standards. 
  • Psychiatric and Medical services 
  • Psychoeducational groups, including focus on addictions, mood disorders, trauma recovery, and eating issues. 
  • Wellness program, including a nutritional assessment and a fitness consult with ongoing evaluation of health/wellness needs 
  • Individual and Group therapy 
  • Intensive family program with parenting skills classes 
  • Equine assisted counseling
  • Art therapy, recreational therapy, community outings, Challenge Course events 
  • Comprehensive aftercare plans 
  • Nursing coverage 24 hours a day

To learn more about our Sweetwater Program we invite you to preview our brochure and a typical weekly schedule. 

A safe place for adolescent girls - and their families- to begin the journey of healing

Thursday, April 3, 2014

Fort Hood: "Circumstances Remain Very Fluid"

Fort Hood shooting incident leads the news

Last evening breaking news carried the horrific story of another mass shooting at Fort Hood, Texas. From about 4:30PM Central Daylight Time (CDT) and on through today the news media has been covering the story of Army Spec. Ivan Lopez and his, as yet not fully understood, assault on fellow US Army personnel, starting with the deaths of three soldiers, the wounding of 16 others and concluding with his suicide.

Senate Armed Services Committee hearing on the Army, Fort Hood

English: John McHugh as United States Secretar...
English: John McHugh as United States Secretary of the Army (Photo credit: Wikipedia)
It so happens that the Senate Armed Services Committee had planned a hearing for today (April 3, 2014) with Army Secretary John McHugh and Chief of Staff Ray Odierno. The topic for this hearing was to be on the Defense Authorization Request for fiscal 2015; however, Senator Carl Levin (D-MI) invited both witnesses to update the committee about the Fort Hood events.

The Washington Post provided a video and complete transcript of the testimony. Army Secretary John McHugh offered the following information, reminding the committee and the world that "the circumstances remain very fluid."
Based on our discussions last evening with Lieutenant General Mark Nilley and a subsequent conversation I had about 10:45 with the secretary of defense, these are the facts as we understand them. But again, things are changing at this moment. The specialist, the alleged shooter involved joined the United States Army in June of 2008. When he first enlisted in the Army, he was an 11 Bravo; that’s an infantry soldier, as most of you know. He later, upon reupping, transferred his MOS to an 88 mike, a truck driver. We are tracking at the moment that he did have two deployments, including one four-month -- approximately four-month deployment to Iraq. As a truck driver, his records show no wounds, no involvement -- direct involvement in combat; as General Milley, said no record of Purple Heart or any injury that might lead us to further investigate a battle-related TBI or such. He was undergoing a variety of treatment and diagnoses for mental health conditions ranging from depression to anxiety to some sleep disturbance.
He was prescribed a number of drugs to address those, including Ambien. He was seen just last month by a psychiatrist. He was fully examined. And as of this morning, we had no indication on the record of that examination that there was any sign of likely violence, either to himself or to other, no suicidal ideation. So the plan forward was to just continue to monitor and to treat him as deemed appropriate.
Lieutenant General Nilley did indicate in Wednesday's late night news conference that Ivan Lopez was being evaluated for post traumatic stress disorder (PTSD). There will be many questions asked and answered, records will be reviewed, a timeline will be established and somewhere down the road a final report will be issued. Whether or not we will ever really know what triggered Mr. Lopez's final actions remains to be seen.

A look back at the evolution of military's approach to PTSD and its treatment

By chance a few days ago, we came across a United States Navy Training Film (previously restricted). The title of the four part series is "Combat Fatigue Irritability." It was filmed in 1945 and it stars Gene Kelly. According to the Official YouTube Channel of Naval History and Heritage Command, the history program of the Department of the Navy US Navy History:
Hollywood legend Gene Kelly stars in this 1945 Navy training film dramatizing the condition known at the time as "combat fatigue." The film delves into the symptoms and treatment of what we now call Post Traumatic Stress Disorder. Kelly had been commissioned a year earlier as a Lieutenant Junior Grade in the United States Navy. Source: Naval History and Heritage Command, Photographic Section, UMO-1. 

If you are having trouble viewing the video series, you can view it here. Each of the four videos is 7-9 minutes in length.

Some final thoughts...

It is important to remember that PTSD is the most current name for what the medical community has documented for more than a century. During our Civil War it was called "hysteria or melancholia," during WWI it was called "shell shock," by WWII doctors called it "combat fatigue," and after the Vietnam War, in 1980, PTSD officially became recognized as a mental health condition when it was included in the Diagnostic and Statistical Manual of Mental Disorders, which was developed by the American Psychiatric Association (APA).

The days ahead will be difficult and painful for all Fort Hood victims. This includes the injured and their families, the deceased and their families, the community of Fort Hood, the US Army and our fellow countrymen.

Tonight we will recite the Serenity Prayer, a special prayer said daily by those in recovery. 
God grant me the serenity to accept the things I cannot change; courage to change the things I can; and wisdom to know the difference.   
Peace and comfort to all. 

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Tuesday, April 1, 2014

Excellence In Mental Health Act ~ A Big Step Forward

Official portrait of United States Senator (D-MI).
Official portrait of United States Senator (D-MI). (Photo credit: Wikipedia)

Excellence In Mental Health Act: S264 and HR1263 pass in both houses

This headline might surprise you. Both the US Senate and the House of Representatives have found common ground to pass the Excellence In Mental Health Act. Last week the House of Representatives voted in the affirmative and on Monday, March 31, 2014, the senators voted 64 to 35 to pass the bill and forward it to President Obama for his signature.

The senate version S264 was introduced by Senator Debbie Stabenow (D-MI) on February 7, 2013. The original sponsor in the House of Representative was Representative Doris Matsui (D-CA) introducing the house version HR1263 on March 19, 2013.  Both bills were designed to expand access to community mental health centers and improve the quality of mental health care for all Americans.

Some history and news about this act...

It was just about 60 days after the tragedy at Sandy Hook when Senator Stabenow determined that perhaps the best approach to prevent events like Sandy Hook, Tucson, Aurora, Boston, or Washington, D.C. was to provide more and better mental health care. Stabenow worked closely with Senator Roy Blunt (R-MO) as Representative Matsui worked with Representative Leonard Lance (R-NJ). According to Linda Rosenberg, the President and CEO of the National Council for Behavioral Health:

"This represents the largest single federal investment in community-based mental and substance use treatment in well over a generation. After decades of devastating funding cuts, this represents a turning point in terms of federal support of community mental health services. As many as 240,000 people will be able to receive critical behavioral health services as a result of Excellence Act funding. Much work remains to ensure quality mental health and substance use treatment services are available to all who need them, but today is a day for celebrating this historic moment. And for applauding the bill's tireless bipartisan champions, Senators Stabenow (D-MI) and Blunt (R-MO) along with Representatives Matsui (D-CA) and Lance (R-NJ).

When people receive the quality mental health and substance use treatment they need, the benefits extend far beyond the individual – to their families, their professional colleagues and their community at large. We are all better off when quality mental health and substance use services are available."
The Excellence in Mental Health Act will create a two year pilot program in eight states. The states are not pre-selected; every state can apply for their community mental health centers to receive more federal funding IF they provide certain mental health services to patients. The clinics must be open 24 hours a day, 365 days of the year offering psychiatric care and integrate the mental health care with physical checkups. 

Senator Blunt addresses the senate...

If you are having trouble viewing the video, you can see it here.

Some final thoughts...

Passing an act and having the President sign it into law is just the first step. Last October we celebrated  the 50th anniversary of The Community Mental Health Act of 1963, an act that was written with hopeful and constructive ideas, but eventually lacked the funding that was needed for its complete implementation. Here's hoping that the Excellence In Mental Health Act will be funded according to plan and serve as a new foundation for community mental health.

The Excellence In Mental Health Act is a big step forward and a great contribution to the conversation. 

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