Friday, December 19, 2014


Holiday parties, celebrations, driving under the influence...

If you've checked in with friends and family over the past few days, then you may have realized how many people are prepping for a holiday "get together." It could be you've noticed Facebook friends chatting about attending holiday celebrations, including everything from their children's school holiday program to their annual "office party." 

Complimenting all of the chatter about holiday parties are the news items listing the locations of the sobriety checkpoints along your local highways and byways. And this year there are even new creative apps that may be able to convince you not to drive while under the influence.

First let's talk about the "Breeze"

It could be that this year people will add a "breathalyzer" to their holiday wish list. This contraption caught our eye as you actually breathe into it and with an app that you can have on your smartphone (Android or iPhone) it will help you determine if you are sober enough to drive. It is important to remember that this app is not certified by the Department of Justice and Mothers Against Drunk Driving (MADD) has not endorsed it.  Here is a brief news report from ABC30. See what you think.

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

ENDUI a new app to see just how drunk you are...

On December 11, 2014, the State of Maryland's government and police officials announced the availability of a new app called ENDUI. This particular app is free and will work on both Android and iOS.  This creation of this app was funded by the National Highway Traffic Safety Administration.

According to the Seattlepi.Com:
Users enter their sex, height, weight, and number of drinks consumed to help figure out their blood-alcohol level. They also can play two interactive games to test reaction time and cognitive agility. And the app uses GPS technology to call cabs and pre-load phone numbers for potential designated drivers...One of the games on the app involves pressing a red "brake" button when an image of a pedestrian passes by or a car ahead stops. The app says just how fast — or slow — users react and how much time their car would have needed to avoid a collision. The other game shows nine road signs that blink in different order; users try to recall the order, which gets increasingly challenging with each round — with or without drinks.  

Investigate what is available in your own state...

ENDUI is sponsored by the State of Maryland; however, other states have also designed similar apps. Those states include New York, New Mexico, Colorado and California. It is important to remember that all of these apps are clever, but they can really only assist you in determining your impaired condition. It is always a good idea to:
  •  plan ahead, don't assume that you will be able to drive home
  •  talk with your family members and friends and choose a designated driver who is committed to making sure that everyone will get home safe
  • make sure you have the phone number for a local taxi service and/or a service like UBER
  • if your local AAA is offering rides home, take advantage of their generosity
Most importantly our Cottonwood staff wishes you a safe and healthy holiday celebration. 

Thursday, December 18, 2014

Cottonwood Tucson Honors Employees ~ The 2014 Hildreth Award And Stone Award Presented

"Leadership is not about a title or a designation. It's about impact, influence and inspiration. Impact involves getting results, influence is about spreading the passion you have for your work, and you have to inspire team-mates and customers." Robin S. Sharma

Cottonwood Tucson's Annual Hildreth and Stone Awards presented

On Friday, December 12, 2014, Cottonwood Tucson's staff gathered to honor two employees by presenting The Hildreth Award and The Stone Award.

2014 Hildreth Award recipient ~ Amanda Scofield

Amanda Scofield
Amanda is a Lead Patient Care Facilitator (PCF) and has been at Cottonwood since 2008. As her job title indicates, the PCF's are those who make each and every day run smoothly, interacting with our patients and every staff member. Recently, we asked Amanda to talk about a day in the life of a PCF.   Here's is how Amanda described a typical start to any day...

"Along with the typical duties of taking vital signs and tracking patients down for appointments and meds, I’m attending staffing and taking notes in TIER at rapid fire pace. The family members at the Hampton decide that they need a ride after all, so I send a tech off the floor. We’re waking up the young adult males yet again; resorting to song and dance to get them to acknowledge our presence. Then Peter calls and says that there’s a snake outside his office so off we trek with the snake box and grabber. Then Rebecca calls and gives us the revisions to the clinic schedule. (Bill has an appointment at 10, but Tab wants to see him at 9. So, we’ll put Joe in at 10. Betsy will take Joe’s old appointment at 11 – it’s like a math word problem.)"

And so the day goes. It is Amanda and the PCF team who respond to every need with grace, compassion, and determination to complete each task and, by doing so, assure that each patient receives the care and attention required to compliment their hard work as they begin their journey of recovery. 

Congratulations to Amanda!

2014 Stone Award recipient ~ Charles Gillispie
Charles Gillispie

Charles is a Specialty Counselor and has been at Cottonwood Tucson since 1993. He is a licensed independent substance abuse counselor with a Master’s Degree in Fine Arts. He is an active member of the National Association of Poetry Therapy and has published articles describing his work at Cottonwood in Addiction Professional, Arizona Together, Journal of Poetry Therapy, and Therapeutic Recreation Journal. (You can see a sample of Charles' articles here.) Additionally, Charles has received two professional development grants from the Arizona Commission on the Arts in support of his work with therapy and writing. Charles is a founding member of the San Pedro River Pilgrims, a backpacking club dedicated to the pursuit of spirituality through wilderness adventure.

Congratulations to Charles!

Turning our lens on Cottonwood Tucson's staff

At Cottonwood Tucson we are grateful to have been able to gather, from across the country and around the world, a group of uniquely talented individuals who have hundreds of years of combined experience in the treatment of behavioral health disorders. Each staff member plays a vital role and, as Robin Sharma said in our opening quote today, they each in their own way spread their passion for their work, they inspire each other and they inspire our patients.

Here's to health...and the magic of recovery!

Friday, December 12, 2014

Holidays ~ Grief Stirs Every Sense

Dealing with grief during the holidays...
Children looking at holiday cards ~ 1910

Did you ever stop to wonder why we have so many major holidays crammed into the last 90 days of the year? For many of us these holidays hold special memories of our childhood. These memories may be positive or negative, depending on our life experiences. And so then, each year as the days grow darker we find ourselves either looking forward to the holiday season or dreading it. And grieving the loss of a loved one may complicate one's holidays in ways they least expect.

Over the past couple of weeks we've noticed telling remarks on social media, we've read op-eds in various print media, and of course this week many news outlets have started to air what has now become a yearly traditional segment on "grief during the holidays."

As we watched some of these news segments, clicked through social media statuses, and thumbed through the newspapers...certain phrases or even just a single word would catch our eye.
  •  There was the smell of cookies baking in the kitchen
  •  Or the sight of the mailman stuffing our mailbox with holiday cards
  • The touch of each year's first snowfall and building a snowman
  • Or the taste of Mom's turkey gravy drizzled over mashed potatoes
  • Finally, to hear a favorite holiday song, one that you sang with your family 
Memories do light the corners of our minds, awaken every sense and it is those memories that are played over and over again as we deal with grief during the holiday season.

Dr. Margaret Rutherford talks about coping with grief during the holidays

Dr. Rutherford often writes for The Huffington Post and we found her recent "3 Tips For Coping With Grief During The Holidays" to be not only helpful, but to the point.

  1. Especially if it has been recent, allow others to help you. You could still be in shock. It is the time for receiving from those who love you. 
  2. Know that your grief will be unique to you. Don't feel that you must grieve the same way others do. Everyone will be different. Do the things that take care of you. That might be distraction. It might be the doing of tasks. It might be journaling about your pain. Whatever helps. 
  3. Understand that there are many facets of grief. Anger, denial, despondency. All of these feelings are normal. The most important thing is not to become stuck in any one feeling. It takes time. Frequently a lot of it.

How to reach out and touch those who are grieving...

Factually there are many people who have never experienced the loss of a loved one. It is sometimes hard to imagine that to be true...but it is. However, it is so vital that we consider the thoughts and feelings of someone who is grieving.  It is really about being aware and in tune enough to think ahead of what the grieving person is likely to be experiencing.

We came across an article published by My Fox News Detroit. They interviewed Peggy Nielsen, MA, LPC who offered the following advice.
  • Don't pressure a child or an adult to stop grieving – Avoid phrases like, “It's time to move on, It's the holiday's get over it”. Each person grieves in their own time and their own way. 
  • Don't avoid them – You may not know the right thing to say or do. Simply being around can be helpful. Comforting things to say even long after the death, “I'm sorry for your loss” or I'm so sorry that that happened to your son or daughter.” 
  • Don't say, “It was for the best” - This doesn't diminish the pain and sense of loss. 
  • Don't say “I know how you feel;” unless you have been in a similar situation and can offer suggestions about what helped you to heal. 
During the holiday season, we would offer one more tip: If you are sending holiday cards, stop and think how your holiday card (maybe it is a glossy family photo memory collage) might impact someone who is grieving. Take a few minutes, buy a special card or write a special personalized letter to them instead. 

Some closing thoughts...

Grief is a normal and unavoidable part of human existence. We all will likely suffer the pain of grief at some point in our lives, usually with the death of a friend or loved one. When we suffer this kind of life event, we mourn and over time we accept our loss and – without forgetting - move on. But for some, it seems impossible to let go, and even years later, the pain of loss remains acute. This can be exacerbated when a loved one is lost to suicide, when a death is sudden and unexpected, or when one has an extremely close relationship with the deceased, such as parent/child, for example. If the process of grieving becomes stalled, this is when grief becomes complicated grief.

Start the conversation...

Thursday, December 11, 2014

Depression: One Scientist Raises An Infectious Disease Theory

Depression is in the news, again...

It's true; depression is in the news, again. If you take a few minutes and google the word depression in today's news you'll see the following headlines.
These are all interesting articles and worth reading, but we also came across another item in the news that focuses on one psychologist's theory that perhaps depression is caused by an infection(s).

Meet Dr. Turhan Canli

Dr. Canli is a researcher at Stony Brook University in New York. He asks a simple question: "Is depression an infectious disease?" The press release concerning Dr. Canli's theory was published on November 14, 2014. He recently had his paper Reconceptualizing Major Depressive Disorder As An Infectious Disease published in the journal Biology of Mood & Anxiety Disorder.

According to the above referenced press release, Dr. Canli presents three arguments:
First, he points out that patients with MDD exhibit illness behavior such as loss of energy, and that inflammatory biomarkers in MDD also suggest an illness-related origin. Second, he describes evidence that parasites, bacteria and viruses that infect humans in a way that alters their emotional behavior. Thirdly, Dr. Canli brings the notion of the human body as an ecosystem for microorganisms and the role of genetics.

 Learn more of Canli's theory in this TEDx Talk


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

Looking back...and Looking forward

Looking back

History has a way of encouraging researchers specifically and the public in general. This is a good time to recall that is was only in 1982 that two Australian scientists suggested that the bacteria H.pylori was the main cause of stomach ulcers!

According to the CDC, in the early 20th century this is how ulcers were viewed: "Ulcers are believed to be caused by stress and dietary factors. Treatment focuses on hospitalization, bed rest, and prescription of special bland foods. Later, gastric acid is blamed for ulcer disease. Antacids and medications that block acid production become the standard of therapy. Despite this treatment, there is a high recurrence of ulcers." The dietary factors often blamed were caffeine, alcohol, coffee, colas, and spicy foods.

It turns out the Australian scientists, Barry J. Marshall and J. Robin Warren, went on to prove their hypothesis and in 2005 they were awarded The Nobel Prize in Physiology "for their discovery of the bacterium Helicobacter pylori and its role in gastritis and peptic ulcer disease."

Regarding depression and its treatment, we have made progress since the early 20th century. If you're a fan of Cinemax's THE KNICK, then perhaps you saw the episode that dealt bluntly and apparently historically correctly with one practitioner's theory on how to treat depression. The character Eleanor Gallinger suffers from severe depression after her infant daughter dies from meningitis. Eventually Eleanor is committed to an insane asylum. The treatment Eleanor receives is based on the real treatment provided by Dr. Henry Cotton who was the medical director at the New Jersey State Lunatic Asylum from 1907-1930. His theories and practices may surprise you.

A look forward

Earlier this month The Huffington Post interviewed Dr. Canli. If you read the interview you will see that Canli really wants to start the conversation, he would like scientists to think outside the box and consider that depression is a disease which impacts about 10% of the population in the United States alone and it could be that we have overlooked biological reasons as a causative factor. He is hopeful research and studies can be constructed on a large scale basis to look for an infectious cause of major depressive disorder and perhaps a simple blood test can be developed to diagnose depression and from there make treatment more uniform.

Let's start the conversation...

Friday, December 5, 2014

Anesthetic Awareness Can Cause PTSD and/or Depression

English: A thoracic surgeon performs a mitral ...
English: A thoracic surgeon performs a mitral valve replacement at the Fitzsimons Army Medical Center. Slovenščina: Kirurgi med operacijo. (Photo credit: Wikipedia)

Anticipating a surgical procedure...

It is probably safe to say that no one looks forward to having a surgical procedure. Of course, depending on one's medical condition, a successful surgery is what a patient anticipates and desires. Non-emergency surgeries (elective) are preceded with considerable pre-op examinations, like EKGs, lung x-rays, blood work, maybe an MRI or even a stress test.

If you're a family member or close friend who accompanies a loved one to a hospital or day surgical center, then you are aware of all the preparations, the surgery time, the recovery time, maybe some ICU time and then either your loved one goes home or is moved to a hospital room for a day or more stay. Everyone waits for the surgeon to pronounce "the operation was a success!"

When queried about their actual surgery, thankfully patients routinely will report "I don't remember a thing!"

But some patients experience anesthetic awareness

Last week we came across a news article on CNN: "'I couldn't move': Patients who wake up during surgery."

Yes, this can happen, albeit rare. For example, we casually inquired of an associate if she had ever heard of anesthetic awareness and she immediately offered that in the 1970's her mother had her gallbladder removed. When she saw her mom the morning after the surgery her mother immediately exclaimed that she had awoken before the surgery was complete, could feel the surgeon working, felt the sutures being completed, but she could not move or signal the surgical team that she was awake.

According to the American Association of Nurse Anesthetists (AANA):
"Patient awareness under general anesthesia (or anesthetic awareness) is a rare condition that occurs when surgical patients can recall their surroundings or an event—sometimes even pressure or pain—related to their surgery while they are under general anesthesia. Severe cases of anesthetic awareness happen infrequently, but research is ongoing to determine the causes of awareness and prevent it from happening."

New study examines anesthetic awareness and long term psychological consequences

In the October 2014 issue of Anaesthesia - Journal of the Association of Anaesthetists of Great Britain and Ireland an original article was published: The 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: summary of main finding and risk factors. 
A printable pdf version of the full article can be seen here.

Study's parameters...

  • Researchers surveyed 3 million patients
  • All patients were from the United Kingdom and Ireland
  • Each patient had received general anesthesia
  • Each patient reported voluntarily 

Study's findings...

The researchers found in their study that one in 19,600 patients unintentionally wakes up during surgery. This is a much lower rate than previously discovered in a study conducted in the United States (one in 1000). According to CNN's article:

  • Researchers did find that certain surgeries requiring "lighter" anesthesia, like emergency C-sections, carried a higher risk -- a rate of one in 670. 
  • Most incidents of anesthetic awareness occurred among patients who had received paralytics as part of their anesthetic cocktail -- presumably since they couldn't move to alert doctors to the fact they were regaining consciousness. 
  • Contrary to folklore, awareness was most likely to occur when patients were being put to sleep before surgery started or after the surgery had ended -- not when the surgeon was actually operating. 
  • Patients described a range of sensations, including choking, paralysis, pain, hallucinations, and near-death experiences. 
  • Most episodes were short-lived, with 75% of them lasting under five minutes. 
  • Despite this, nearly half of all patients who were conscious during surgery had long-term psychological consequences such as PTSD and depression.

The importance of education

Dr. Daniel Cole, Vice President of the American Society of Anesthesiologists points out that anesthetic awareness happens when not enough anesthesia to suppress consciousness is provided to the patient.  Most particularly it can occur with emergency c-sections, heart surgeries and surgeries following an emergency trauma. 

Both Dr. Cole and Professor Jaideep Pandit, the lead author of the study and consultant anesthetist at Oxford University Hospitals, agree that educating physicians about anesthetic awareness is critical; however, Pandit also feels educating patients is crucial while Dr. Cole feels that it is most important to only talk to high risk patients and those who raise the topic.

If you or your loved one have surgery, particularly if you have children who are surgical patients, it is important to know of anesthetic awareness and to be observant of post surgical symptoms of PTSD and depression.