Post-Traumatic Stress Disorder(PTSD)

PTSD There are now many precise diagnostic tests available to many medical fields but not to psychiatry.  Many doctors have access to all sorts of new technologies that allow them to make precise diagnoses that can eliminate unnecessary surgery or, if surgery is necessary, these tools enable the doctor to be far more precise and have even allowed some surgeries to be done on an outpatient basis.

Psychiatric diagnoses, however, depend on the observational abilities of the examiner and, therefore, there is the possibility for error.  Even a skilled examiner brings his/her own blind spots and prejudices into the process.

There have been small breakthroughs in psychiatric diagnostic tools, but most laboratory test are too imprecise and cannot be used widely.   A new promising test using data collected with magneto encephalography (MEG), however, is able to pinpoint the existence of Post-Traumatic Stress Disorder(PTSD). 

PTSD is characterized by the re-experiencing of an extremely traumatic event.  One may be haunted in dreams or may experience so-called disassociated states during which the patient behaves as though experiencing the traumatic event at the moment. 

 As a result of PTSD, the patient tries to avoid any stimuli and situation associated with a trauma.  One develops an overall numbing of one's general emotional responsiveness which often results in social withdrawal and markedly diminshed interest in previously enjoyed activities.  This is often accompanied by a feeling of detachment and estrangement from others including the inability to have loving feelings.

In spite of detachment and a seeming lack of interest, there can be a heightened excitability -- exaggerated startle repsonses, being on guard and hyper-vigilant about possible danger, difficulty concentrating, outbursts of anger and frequent difficulties with sleep. 

These symptoms of PTSD may lead to severe incapacitation in every area of one's life including learning, loving, working and socializing. Often the patient feels hopeless about his/her prospects for the future or even his/her longevity.

Although skilled clinicians are able to diagnose and treat PTSD, it involves lengthy evaluations which do not always result in an accurate outcome.  With the new and welcome MEG test, when in doubt we will be able to diagnose PTSD faster and then patients can be quickly triaged and directed into the most effective treatments.

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

The Post-Traumatic Stress Disorder Sourcebook:A Guide to Healing,Recovery,and Growth

Conquering Post-Traumatic Stress Disorder:The Newest Techniques for Overcoming Symptoms,Regaining Hope,and Getting Your Life Back  

Post-Traumatic Stress Disorder for Dummies 

Healing From Post-Traumatic Stress 

I Can Still Hear Their Cries,Even in My Sleep:A Journey Into PTSD  

My Opinion of the Proposed Health Care Reform

Health care I, and many other doctors I know, breathed a sigh of relief when Speaker Pelosi announced that the Health Care bill passed in the Senate would not be approved by the House.  At least for now, the Health Care bill seems dead, in spite of  President Obama's remarks to the contrary after the recent election of a Republican Senator in Massachusetts.

As an immigrant physician who chose America based on the knowledge and perceptions I acquired while visiting the United States, I shivered at the thought that an enormous bureaucracy would make decisions that should be made between a doctor and a patient.  In addition, having some experience with state bureaucracy in a former communist country of my origin, I know how stifling and inefficient such a bureaucracy can be.

It was not uncommon for people to circumvent the bureaucracy by offering bribes in return for quality medical care, while physicians were forced to accept these bribes in order to support their families because the state paid them so poorly.

In my opinion, when bureaucrats run the system, individual talent and initiative suffer.  Everything is reduced to its lowest common denominator and all share equally in poor care.  Yet somehow highly positioned bureaucrats, politicians and the privileged always find ways to exploit the system while the average person is left with no recourse but to accept the state's largess.

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

The Healing of America:A Global Quest for Better, Cheaper, and Fairer Health Care

Health Care Will Not Reform Itself:A User's Guide to Refocusing and Reforming American Health Care 

Cured! The Insider's Handbook for Health Care Reform 

The Truth About Health Care:Why Reform Is Not Working in America 

A Second Opinion:Rescuing America's Health Care  

When Children Have a Chronic Illness

Children with chronic illness Chronic illness may have devastating effects not only on a child's physical development but also on a child's psychological development.

Ill children are often treated differently by their peers who see them as dissimilar and fragile.  Frequent absences from school can prevent a child from forming strong relationships and being an integral part of the school community. 

A chronically ill child is treated differently in the family, too.  Some parents may overindulge their sickly child trying to overcompensate for the unjust hardships and deprivation the child may face.  Parents may be understandably overprotective and unnecessarily shield the child from every challenge.  Puberty is a particularly difficult time.  It is the time when the child strives for independence and detachment from the family, but for a child with chronic illness that leap towards independence is often thwarted by the dependence on others that is necessasary because of the chronic illness.

There are also effects on other family members.  Parents can become overwhelmed by and resentful of the enormous demands their child's illness causes.  Siblings may be resentful because the sick child requires more time and care, invariably taking time and care away from them.  When family members feel angry and resentful while at the same time feeling guilty about their misplaced and inappropriate emotions, there is conflict.  These conflicting feelings are communicated to the ill child and influence the ill child's sense of self.

Children with or without chronic illness learn who they are from their parents and others closest to them.  Loved children feel lovable; abused children often believe they are bad and deserving of abuse; and children of depressed parents often feel inadequate because they fail to make a parent happy. 

Family therapy might be very useful in helping the family of a child with a chronic illness to develop  well, without maladaptive character traits or, worse, a character disorder.  Once that happens, treatment is much more difficult.

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

Helping Children and Adolescents with Chronic and Serious Medical Conditions:A Strengths-Based Approach 

Extreme Parenting:Parenting Your Child with A Chronic Illness 

Parenting Children with Health Issues 

Families Living with Chronic Illness and Disability:Interventions,Challenges, and Opportunities 

In Sickness and in Play:Children Coping with Chronic Illness  

Casey Johnson and Juvenile Diabetes

Casey johnson dies Casey Johnson, heir to the Johnson & Johnson fortune, died recently at the age of 30.  Now, snippets of her life that we are hearing about and seeing reveal that like many other children of the rich and famous, her life was a shipwreck.  Someone should do a study on why people who have so much going for them, so much of what all the rest of us want, either get into trouble and end up having to throw it all away, or die young without ever really enjoying what they had.

Casey Johnson, though, had something else besides wealth and privilege.  As a very young girl she was diagnosed with juvenile diabetes, an incurable disease that takes constant management.  Imagine her having to go through daily finger prickings in order to monitor her blood sugar level.  And imagine having to think about everything you eat in order to keep your blood sugar numbers at an acceptable level.  And think about having to restrict physical activity because overexertion can reduce one's blood sugar numbers to dangerously low levels.  And, of course, there are the daily injections of insulin to control symptoms.

Some of those symptoms, like fainting or becoming incoherent, can result in emergency trips to the hospital, often being witnessed by peers which can be embarrassing.  The growing up process unfolds in a field full of potential land mines.  Puberty is a particularly disruptive and challenging time for kids with diabetes.  The struggle between childhood and emerging adulthood, when the young person wants to assert him/herself, break away from family and shift one's loyalty to one's peers, can be particularly difficult because the chronic illness requires ongoing adult supervision.  In addition, being different and sick can be embarrassing.  Many young diabetics rebel against their illness by challenging it with careless abandon, resulting in more hospitalizations and more embarrassment. 

No doubt, Casey Johnson's diabetes, as well as her wealth and name, shaped her personality.  And there is some sad irony, and maybe subliminal anger in Casey, that the company that gave her such wealth by creating medications to treat so many illnesses never created one that could cure her diabetes. 

But at age 30, when asked what her biggest regret was, Casey Johnson did not say "having diabetes."  She said it was not doing the reality television show with her friend  Paris Hilton. 

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

Type 1 Diabetes for Dummies

The Everything Parent's Guide to Children with Juvenile Diabetes

Type 1 Diabetes:A Guide for Children, Adolescents,Young Adults--and Their Caregivers, Third Edition 

Taking Diabetes to School 

487 Really Cool Tips for Kids with Diabetes  

Avoiding Mistakes with Prescription Medications

Prescription pills We have all heard of mistakes made with prescription medications, even in hospitals.  Some prescriptions sound and are spelled so similarly that it is easy to see how mistakes happen.  But even though drugs may have similar spellings and sound alike, they are often used for very different purposes which makes these mistakes dangerous, sometimes even fatal.

A friend ordered a six-month supply of her antidepressant from a Canadian pharmacy, where she saved money.  About a month later she realized that something was not right.  She felt anxious, "blue," and easily frustrated with a short fuse.  When she looked again at the supply she had received from Canada, she discovered that she was not taking her antidepresssant at all but a medicine used for stomach/digestive problems. At a glance, the medicine started with the same first three letters as her antidepressant and contained the same 20 mgs dosage, but it was a very different medication used for very different illnesses.  While in this case there was no immediate or long term danger, the consequences of prescription mix-ups can be fatal.

There are many sources of medications abroad that are less expensive (but not regulated or under the supervision of a known and trusted pharmacist), and the potential  for  mistakes is enormous.  But even at your own neighborhood pharmacy, you must take responsibility for being informed about what  medications you take, in what dosages, and what they are for. 

Human error is always possible everywhere. For your own protection, always check that no mistake has been made on your order. 

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

Medication Use:A Systems Approach to Reducing Errors

Medication Errors 

Medication Errors Guidebook 

Medication Errors:Lessons for Education and Healthcare  

Where Is the Confident and Courageous America I Love?

The american flag Coming from a totalitarian state with practically everything controlled by the government (your job, your apartment, your retirement age and your mobility), I had an image of America as a place in the sun. 

As a young medical doctor, I first came to the USA while working on a ship that besides carrying cargo also carried 13 American tourists.  During my three week trip I discovered that America was also unexpectedly and exceptionally generous.  I met people  who looked very young for their age, who engaged in their second, even third, careers, and I, too, wanted to live and thrive in a country where you can be young at 50 and where your prospects seem endless.  That was 32 years ago. 

What I see now, though, worries me. The 1993 bombing of the World Trade Center, in spite of subsequent bombings of US targets abroad, was not taken seriously enough.  September 11, 2001, however, changed everything.  It finally focused the public's attention on the dangers of terrorism...for a while. 

 Many of my friends and patients express doubt about our government's ability to protect us from man-made disasters.  They're resigned to whatever fate awaits us, hopeless especially after the attempted downing of an international Detroit-bound Northwest Delta plane on Christmas Day.  The symbolism was not lost on those who wish us harm, and many lament the shortness of our collective memories.

The government appears to be complacent at times, if not unintentionally complicit.  The fear of making value judgements or offending particular groups appears to paralyze the authorities constrained by the straightjacket of political correctness.

If psychodynamic concepts are applied to a nation, then America is behaving like an abused, despised child who concluded that it must be deserving of the hate it encounters.  Once you incorporate the hatred of those who are attacking you, you stop fighting the attackers.  Instead, you exaggerate your imperfections in order to justify their behavior towards you.

Where is the bold and courageous America I once knew with people who are generous, but not in denial, and who are confident in the future?

I'm Dr. Blokar.  I wish all of you a very Happy New Year, and may God bless America.

Abuse of Prescription and Over the Counter Drugs and Alcohol

Brittany murphy In the entertainment industry there have been many performers who have died after accidentally or intentionally overdosing on prescription medications.  Most recently, 32-year-old actress Brittany Murphy died, and while we don't yet have the autopsy report, we did hear that lots of prescription medications were found in her bedroom.

But what about people who are not part of the Hollywood, show business rat race?  It is estimated that more than 50% of young women take prescription drugs, with mood-enhancing stimulants and anti-anxiety drugs being the most used.  Since stimulants often make people feel "wired," stimulants are often followed by sleeping pills and anti-anxiety drugs, creating a dangerous, vicious cycle.

Many people claim that they must take these medications in order to perform well, but steady use of them can lead to serious mood disturbances, causing a person to become irritable, angry and almost manic.  It may even trigger a psychotic manic episode during which all kinds of irrational and violent acts may be committed.

If one adds over the counter medications to some prescription medications, the combination can actually be deadly.  Taking cold medications containing Pseudoephedrine  along with a hefty dose of a stimulant can cause a serious, sometimes fatal, increase in blood pressure and heart rate.  Similarly, liberal use of pain killers which are opioid derivatives, taken with commonly used antihistamines or alcohol, can lead to a dangerous reduction in heart rate and breathing and can be fatal.

People, besides using drugs unwisely, often also drink too heavily.  Alcohol is a potent central nervous system suppressant, and reckless or violent acts are often committed because of alcohol's disinhibiting effect.  Depression, a lasting mood disorder, is a less known but serious consequence of alcohol abuse.

While young people's bodies can usually take lots of abuse and recuperate, every once in awhile the combination or quantity can be deadly.  We will soon know if this is what led to Brittany Murphy's untimely death.

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

Overcoming Prescription Drug Addiction:A Guide to Coping and Understanding

High Society:How Substance Abuse Ravages America and What to Do About It 

Generation RX:Kids on Pills-A Parent's Guide 

Performance Enhancing Medications and Drugs of Abuse 

The Chemical Carousel:What Science Tells Us About Beating Addictions 

Prescription Drugs(Drug Abuse & Society:Cost to a Nation) 

Connecticut Cocktail 

Adolescent Substance Abuse:Research and Clinical Advances 

Drug and Alcohol Abuse:A Clinical Guide to Diagnosis and Treatment 

Prescription Drug Abuse(What's the Deal?) 

Prescription Drug Addiction:The Hidden Epidemic  

Can a House Be Too Insulated?

Radon Recently President Obama encouraged people to insulate their homes under the "Cash for Caulkers" program.  He said making your home more energy efficient by insulating is "sexy."  But is it healthful? There are some who believe that old homes are much healthier because they are not well-insulated and are built with natural materials which are porous, so they allow air to enter and leave freely.  

It is estimated that one out of every 15 homes has too high a level of radon gas (a naturally occurring gas without taste or smell) especially in confined, low lying areas.  Radon, which comes into a home from the surrounding ground and rock, may be responsible every year for 20,000 deaths from lung cancer, and children may be more sensitive and vulnerable to the damaging effects of radon.   Radon easily penetrates many common building materials and most insulation, and while low ventilation does not cause radon gas, it does enable a greater concentration of radon gas once it's in the home.   Increasing the amount of fresh air that gets into a home can dilute radon and other contaminants. 

If it is true that some people get sick from breathing the air in airplanes, it may be because they are in such close contact with others and without fresh air and good ventilation, and some argue that's what a too well-insulated house may be like.  But, do your research, become well-informed and then decide whether going in and out of your home and the opening and closing of doors lets in enough fresh air to make it "sexy" for you to insulate your home and save energy and money.

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

Harmonious Environment:Beautify,Detoxify and Energize Your Life,Your Home and Your Planet

Building Today's Green Home:Practical,Cost-Effective and Ec0-Responsible Home Building 

Green From the Ground Up:Sustainable,Healthy,and Energy-Efficient Home Construction 

Home Enlightenment:Create a Nurturing,Healthy and Toxin-Free Home 

Health and the Modern Home 

The Healthy Home:An Attic-To-Basement Guide to Toxic-Free Living 

The Mom's Guide to Growing Your Family Green:Saving the Earth Begins at Home  

Thin Is In, But Is It Real?

Three_graces By today's standards, Marilyn Monroe, one of the most famous sex goddesses, would be considered fat, maybe even vulgar.  What happened to the ideal of the hourglass figure?  What happened to the ideal of the natural womanly body with wide enough hips and full enough breasts to bear and feed children?

Women feel inadequate if their bodies do not conform to whatever the ideal of female beauty is at a given time.  In Peter Paul Rubens's 17th century paintings, his ideal of a beautiful woman was one who was full-figured, not skinny.  In today's world, represented by the pictures of women on the covers and within the pages of fashion magazines, women who are very thin are the ideal.

Those magazine pictures, however, are airbrushed.  In adddition, clothes are often designed by men, often gay men, and seem to flatter and fit small breasted, thin women who have no discernible curves.

For many women and young girls, the desire to look like those airbrushed photos and be unnaturally thin has led to anorexia, which is resistant to treatment and quite dangerous to one's health, even life-threatening.  Interestingly enough, in countries with limited food supplies, anorexia is nonexistent.  It is a condition that affects mostly women in affluent countries.

Despite the constant bombardment of curvaceous women in sexual images, many girls and women deprive and starve themselves to look like those airbrushed women in fashion magazines -- almost transparent, disembodied and prepubescent as if they never want to look grown up.

Yes, women can be morbidly obese, but they can also be morbidly thin.  A hopeful sign is that there is a growing movement (in France, the government is spearheading these efforts) to require magazines with their airbrushed and misleading female images to carry mandatory disclaimers warning about false images of female beauty. 

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

Media Representations of Female Body Images in Women's Magazines

The Media and Body Image:If Looks Could Kill 

The Body Image Workbook:An Eight-Step Program for Learning to Like Your Looks 

Overcoming Body Image Disturbance for People with Eating Disorders:A Manual for Therapists and Sufferers 

A Look in the Mirror:Freeing Yourself from the Body Image Blues 

Body Image:A Handbook ofTheory,Research, and Clinical Practice 

Body Outlaws:Rewriting the Rules of Beauty and Body Image  


Alexa Ray's Attempted Suicide

Alexa joel Alexa Ray, singer/songwriter Billy Joel's daughter, recently attempted suicide.  Reports about what ticked her off seem to center on a recent breakup with her boyfriend and her relationship with her mother, model Christie Brinkley.

According to reports, Alexa Ray had just returned from a Caribbean vacation with her mother and half siblings.  Apparently her mother, still stunning and trim at age 55, kept criticizing Alexa Ray about her lax attitude toward her weight.  Brinkley, who made a fortune on her good looks and fitness empire, is making the mistake that too many other parents make, that is projecting their personal preferences onto their children and pressuring their children to follow them.  Alexa Ray may need help to learn how to fully appreciate her own value and to find her own calling. 

Of course, Alexa Ray might have a genetic predisposition towards depression and mood swings.  In any case, judging by the number of pills she allegedly ingested, this incident was a cry for help.  Since many people who attempt suicide eventually succeed, though, any attempt or verbal threat of suicide should be taken seriously. 

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

Suicide and Attempted Suicide

Why People Die by Suicide 

Understanding and Preventing Suicide:the Development of Self-Destructive Patterns and Ways to Alter Them 

November of the Soul:The Enigma of Suicide 

Suicide and Attempted Suicide:Understanding the Cry of Pain 

Night Falls Fast:Understanding Suicide 

Depression and Attempted Suicide in Adolescents