Dr. MB Speaks Out

An Old Sibling Issue That Still Hurts

Dr. E, guest blogger

I have one sibling, a brother three years older than I am.  As kids, we really had very little to do with each other.  Just being different genders was one reason, but there were others.

We had to change schools every three years because each school housed only three grades, so every time I entered a school, my brother exited, on his way to the next school.  And we had very different interests: my brother loved ham radio stuff, and I was into tropical fish and children's theatre.

So it's hard to say whether or not we got along, since we really didn't have much of a relationship at all until we got older.  My parents, however, created a problem that angered me to no end, while my brother seemed hardly aware of it.

At one point, our Dad, who loved new cars, got one just about the same time my brother got his driver's license, so instead of trading in the older car, our Dad kept it.  Before I got my license, my brother had exclusive use of the older car, of course, but when I got my license, I thought we would share the older car.  I was so wrong.

My brother considered the car his property and did not want me driving it, and my otherwise good parents, agreed.  Their thinking, they said, was that as a teenage girl, my dates would pick me up in their cars, but as a boy, my brother would need the car to pick up his dates.  But why I was not allowed to drive the car when my brother didn't need it for a date was a question my parents never answered.

I feel hurt and angry as I write this even though it was decades ago.  Call it boy over girl favoritism; call it older child favoritism; call it our parents deciding it was easier to argue with me than with him;  call it the erroneous sociological and parenting ideas of the decade (the 1950's); or just call it what it was...totally unfair. 

What could my otherwise good parents have been thinking!

I'm Dr. E, guest blogger.   For more information, click on the following resources:

 Studies in Sibling Rivalry

The Everything Parent's Guide to Raising Siblings:Tips to Eliminate Rivalry,Avoid Favoritism,and Keep the Peace  

Siblings Without Rivalry:How to Help Your Children Live Together So You Can Live Too 

Keep the Siblings,Lose the Rivalry 

Brothers:26 Stories of Love and Rivalry 

The Importance of Sibling Relationships in Psychoanalysis 

Making Brothers and Sisters Best Friends 

Brothers and Sisters:Developmental,Dynamic,and Technical Aspects of the Sibling Relationship  

Do Enhanced Medicare Programs Make Sense?

Dr. E, guest blogger

I have an elderly relative in a nursing home.  She has Medicare, of course, and secondary health insurance provided by the state she lives in, a state with excellent health care coverage.

I recently got a phonecall from a social worker at the nursing home.  She told me that they had a few openings for residents to join, at no cost, an Enhanced Medicare Program available to nursing home residents and wondered if I'd like to sign my relative up.  "What are the pros and cons?" I asked.

The social worker seemed stunned.  Since she presents the option as a gift your relative has been chosen to receive, she is used to most people saying "thank you" and signing right up.    She was hard pressed to answer my question as well as others I asked.  She finally gave me the local and national information phone numbers for the Enhanced Medicare Program she was promoting.

What I learned from making those calls is that Enhanced Medicare Programs for nursing home residents are run by several different private insurance companies, who have persuaded the Federal government, with questionable and self-serving studies, that these programs reduce patient hospitalizations and thus reduce Medicare costs.  From what I've learned and seen, however, nothing could be further from the truth.  That insurance lobby in Washington must be way more powerful than we've been told!

 I was told that the way these enhanced plans work for nursing home residents is that Medicare pays a significant monthly fee to these companies.  In return, the only added benefit for my relative is that an outside nurse practitioner would visit my relative just once a month.  We do not know how long the nurse's visit is or what the qualifications of the nurse practitioner are.  And, I wondered, do the nursing homes get a fee for every resident they sign up?  The social worker seemed more like a saleswoman for the program than an informed patient advocate. 

But here is the main question:  since licensed nursing homes have nurses round the clock and aides who see residents 24/7, and since these nursing homes also have doctors who make periodic visits and are available for phone consultations 24/7, and since Medicare and secondary insurance pay for everything else, how can this brief, just once a month visit, which costs Medicare a great deal of money, end up saving Medicare anything?  

I did my part to reduce questionable Medicare costs incurred by insurance companies in this country: I declined enrollment in the plan for my relative. 

The bottom line is that there's no substitute for your being totally involved with your relative's health and care in a nursing home.  Call the relative daily, if possible; stay in  constant communication with the nursing home staff/doctors; and and make unannounced visits as often as possible.

I'm Dr. E., Ph.D.   For more information, click on the following resources: 

Medicare Meets Mephistopheles

Healthcare Fraud:Auditing and Detection Guide 

Medicare and Medicaid Fraud and Abuse,2009 ed. 

The Political Life of Medicare  

Reforming Medicare:Options,Tradeoffs and Opportunities

Amy Bishop:Should She Get Away With Murder?

In 1986, when Amy Bishop was 20-years-old, she shot her brother after she had a fight  with her father as he was leaving their Massachhusetts home.  Her mother, the only witness, said her son's death was an accident.  Amy went on to marry, earn a Ph.D. at Harvard, have children and work.

People remember her as being quite a menace in their quiet Massachusetts neighborhood.  It is said that she tried to get her child's teacher fired and also successfully barred an ice cream truck from coming to her street because, she said, her children were lactose intolerant.  In 1993, she and her husband were suspects in an attempted pipe bombing of a doctor she had worked for at Boston Children's Hospital.  And in 2002, she punched a woman in a House of Pancakes and then fled with her family.  The manager wrote  down her license plate, though, so she was brought to court and convicted of assault.

Astonishingly and unfortunately, the administration at  the University of Alabama did not have any of this information when they hired Amy Bishop, but they denied her tenure recently.  Her research and publications did not meet high enough standards for tenure, and students criticized her for  being disorganized, not making eye contact, simply reading from a textbook and too often expressing her extreme political views with unsettling passion. Several weeks ago, during a department meeting at the university, Amy Bishop pulled out a loaded gun and killed three colleagues and wounded others.

It appears she was psychotic, most likely suffering from paranoid schizophrenia.  Having this mental illness, however, should not necessarily exonerate her from being convicted of murder and serving her sentence.  She planned the attack; she got a gun; she trained with it at a local shooting range; she brought the loaded gun with her to the department meeting; and she calmly got up and started systematically shooting her colleagues in their heads.

Having gotten away with so much all her life, she might have started to believe that she was invincible and that when all the facts were presented, she would be exonerated.  She may think that her powers of persuasion are so great and her genius so valuable, that she will go free.  She most likely convinced herself that she had been wronged and that the people she killed deserved it.  She probably believes that somehow, once again, she won't have to pay for the consequences of her actions.

What is certain, however, is that Amy Bishop should not get away with assault and murder this time. She knew what she was doing and knew right from wrong when she fired her loaded gun and killed and injured her innocent colleagues.

I'm  Dr. Blokar.  For more information, click on the following resources: 

Schizophrenia for Dummies

Surviving Schizophrenia:A Manual for Families,Patients,and Providers 

The Complete Family Guide to Schizophrenia:Helping Your Loved Ones Getting the Most Out of Life 

When Someone You Love Has a Mental Illness 

Schizophrenia,Causes,Symptoms,Signs,Diagnosis and Treatments  

Tiger Woods and So-Called Sexual Addiction

People of power and privilege, both men and women,  historically have engaged in extramarital affairs.  Having money and time on their hands, they indulge in all of life's pleasures, including extramarital sex.  A big difference today, however, is that journalists and the internet make it certain that eventually they will be caught.

"I thought I could get away with whatever I wanted to.  I felt that I had worked hard my entire life and deserved to enjoy all the temptations around me.  I felt I was entitled.  Thanks to money and fame, I didn't have to go far to find them," Woods said in his recent press conference.

Talented Tiger Woods, through hard work and discipline, rose to the pinnacle of success in the world of golf, and fame and riches followed.  In his private life, married to a beautiful woman and the father of two adorable children, he seemed centered, modest, and generous, funding important programs to benefit underprivileged children.  

But once the sordid truth about Tiger's multiple extramarital affairs were exposed, he needed cover, so he signed himself into a kind of "sanitarium" where people rich enough to engage in excessive sexual activity also can afford the treatment.   When he made his first public statements a few days ago, I was glad he never used the phrase "sexual addiction," because personally I do not see excessive sex, excessive eating, excessive gambling, excessive exercising or excessive working as "addictions."  One can use sex, like all of these activities, to deal with anxiety, loneliness and feelings of emptiness, and all of these activities help people avoid addressing their deeper and more painful issues.   In my opinion these are neurotic compulsive behaviors that can be successfully addressed in insight oriented therapies. 

It is possible that Tiger Woods's issues are more banal.  Prior to being caught, he was disciplined in keeping his game topnotch and keeping in top physical shape.  He was very focused and able to maintain his image.  Perhaps he is just another rich and famous man with strong narcissistic traits and an extraordinary sexual appetite and simply wanted to satisfy it while it lasted.

Based on some of his public statements a few days ago, however, and his plan to go back into therapy at the treatment center where he had been, he may indeed suffer from neurotic compulsive behaviors that can be treated with insight oriented analysis. 

"My real apology to [Elin] will not come in the form of words; it will come from my behavior over time," Woods said.  Only time will tell his wife and the rest of us whether Tiger Woods can keep his resolve to never engage in extramarital behavior again.

I'm Dr. Blokar.  For more information, click on the following resources:  

Healing the Hurt Behind Addictions and Compulsive Behaviors 

No Stones:Women Redeemed From Sexual Addiction  

Deceived:Facing Sexual Betrayal, Lies, and Secrets 

The Psychophysiology of Sex 

Addicted?:Recognizing Destructive Behaviors Before It's Too Late 

Facing the Shadow:Starting Sexual and Relationship Recovery  

   

Problems With Mixing Medications

Some foods and liquids, like grapefruits and alcohol, for example, should not be taken with certain medications, even non-prescription medications, because they may interfere with the drug's effectiveness, and some seemingly harmless over-the-counter medications and even herbal supplements can cause problems when taken together with certain prescription drugs.

Recently, for example, it was reported in a newspaper in England that women taking Tamoxifen (a drug given in order to stop the recurrence and spread of some breast cancers) together with certain antidepressants were more likely to die from breast cancer than those women not taking Tamoxifen with certain antidepressants.  These antidepressants, according to the research, seem to interfere with the metabolism of the Tamoxifen.

Another example is a thyroid medication used to treat low thyroid function that should not be taken with calcium tablets because the calcium interferes with the body's ability to absorb the thyroid medication which makes the thyroid drug less effective.  Since, in this case, the consequences do not create severe health problems, there are no red flags that would make the doctor or pharmacist warn you about mixing calcium and this thyroid medication.  Mixing may result in your having to take a higher dose of the thyroid medication, though, to get the desired result.

Calcium, as a matter of fact, is one of those seemingly harmless, over-the-counter supplements that can interfere with the absorption of many medications, so I recommend taking calcium supplements many hours apart from other medications.

Not all research is good research, so not every study requires us to panic or change our routines.  Always tell your doctor, therefore, about all the prescription, over-the-counter drugs and herbal supplements you are taking and ask about which can be taken together.  And ask your pharmacist the same question.   In the end, you must take responsibility for being informed  so you can make the right decisions for yourself. 

I'm Dr. Blokar.  For more information, click on the following resources:

Medication Errors

You:The Smart Patient:An Insider's Handbook for Getting the Best Treatment 

Taking Your Medicine:A Guide to Medication Regimens and Compliance for Patients and Caregivers 

Preventing Medication Errors and Improving Drug Therapy Outcomes:A Management Systems Approach  

The Search for Meaning in Our Lives

When women in their twenties and thirties seek help from a therapist, the primary goal is to get help in finding and keeping the right mate.  For men in their twenties and thirties, the primary goal in seeing a therapist is to get guidance on career issues.

But when people seek the help of a therapist in their forties and older, no matter what the presenting symptoms may be, the underlying issue commonly involves the existential meaning of one's life.  Humans question why they are here and why our lives can be so easily replaced and forgotten after we're gone.  And no matter what our beliefs are, we are all frightened by the thought of what happens to us after death.  There are some literary works that explore the existential question of the human condition that are helpful.

A wondeful short and simple book is Viktor Frankl's Man's Search for Meaning.  Six decades after being published it is still in demand.

Leo Tolstoy's Anna Karenina is a great literary work in which the character Levin (basically Tolstoy himself) goes through a major crisis of meaning at the height of his career and the fulfillment of his personal dreams.  We can learn a lot from Levin's struggle.

Fyodor Dostoevsky"s Brothers Karamazov and Thomas Mann's Magic Mountain are also helpful. 

If you read these books in high school, it doesn't count.  You were too inexperienced, and these books require a mature and fertile mind in order to bear fruit.  These books are not easy literature, but life is not easy either.  Great literature, like life, is not clean-cut and linear.   It is messy and chaotic in spite of our best efforts to control it,  but life is intoxicating at times and even miraculous regardless of what we are feeling.

Do not be lazy.  After all, you have only one life to live, and in order to make it worthwhile, you need all the help you can get.

I'm Dr. Blokar.  For more information, click on the following resources: 

Finding Meaning in LIfe,At Midlife and Beyond:Wisdom and Spirit From Logotherapy

Passages:The Mystery of Death,Finding Meaning in Life 

Real Answers to the Meaning of Life and Finding Happiness 

Prisoners of Our Thoughts:Viktor Frankl's Principles for Discovering Meaning in Life 

Worldly Wisdom:Great Books and the Meaning of Life

Man's Search for Meaning 

Finding Meaning in the Second Half of Life:How to Finally,Really Grow Up 

Anna Karenina

The Brothers Karamazov

 Magic Mountain