Friday, December 23, 2016

Pain Management??


The following response was sent to me when I commented about how many AIDS patients, and others, I know are being required to enroll in pain management courses to determine whether or not they can continue pain medications. Bob's response is a very sad commentary on challenges heaped on top of the daily lives of those suffering debilitating pain... Link to article.
Thank you, Michael.
I'm a long term AIDS patient in Seattle (Dx:1991) and have lived w/increasing anxiety for the last 6 years about my 20 year daily use of prescription oral morphine @30mg TID (90mg/day) which is just under the 100mg/day limit that GPs/Primary Care MDs can prescribe. Above 100mg/day, oral morphine requires a Pain Mgmt. Specialist since 2010. The younger ones have a different (even punitive) training/perspective/experience than older ones. (I'm 63.)
I had severe/overlapping chronic "shingles" (h.zoster) on my face/scalp 1994-98 and still have ongoing nerve pain there and elsewhere. After a year of oral morphine at 90mg TID (270mg/day), I was moved to large doses of Fentanyl patches, 3x100mcg/hour x3days for 1.5 years (1995-97) and then to 11 months of end-of-life IV morphine (1997-98) averaging 30mg/hour. New neurosurgery in '98 reduced the pain significantly and I went back to oral tablets. My pain hasn't been managed well for the past 3 years as my condition has changed but I've avoided going to a PMSp about increasing my dose. I now have an appointment scheduled and feel some dread about it, based on my previous experience with a younger PMSp in 2010. It should be a conflict of interest to have the same physician in charge of a patient's pain management also in charge of unwanted weaning of opiates in long term patients. And while it is a shame this doctor essentially drove his patient to suicide, I reserve the right to choose the same route if this country's laws drive me to that level of unmanageable pain. I've been there before and won't go there again.
If you have questions contact us at Letkidsbekids@mac.com

Thursday, December 22, 2016

Alone, always alone-

Since I first got involved with HIV/AIDS patients I have learned that loneliness, isolation and abandonment contributes to patients outcomes. My book "Ice" shares the stories of many dealing with being ALONE.
This article says it well. 
“My patient and I both knew he was dying.
Not the long kind of dying that stretches on for months or years. He would die today. Maybe tomorrow. And if not tomorrow, the next day. Was there someone I should call? Someone he wanted to see?
Not a one, he told me. No immediate family. No close friends. He had a niece down South, maybe, but they hadn’t spoken in years.
For me, the sadness of his death was surpassed only by the sadness of his solitude. I wondered whether his isolation was a driving force of his premature death, not just an unhappy circumstance.
Every day I see variations at both the beginning and end of life: a young man abandoned by friends as he struggles with opioid addiction; an older woman getting by on tea and toast, living in filth, no longer able to clean her cluttered apartment. In these moments, it seems the only thing worse than suffering a serious illness is suffering it alone.
Social isolation is a growing epidemic — one that’s increasingly recognized as having dire physical, mental and emotional consequences. Since the 1980s, the percentage of American adults who say they’re lonely has doubled from 20 percent to 40 percent.
About one-third of Americans older than 65 now live alone, and half of those over 85 do. People in poorer health — especially those with mood disorders like anxiety and depression — are more likely to feel lonely. Those without a college education are the least likely to have someone they can talk to about important personal matters.
A wave of new research suggests social separation is bad for us. Individuals with less social connection have disrupted sleep patterns, altered immune systems, more inflammation and higher levels of stress hormones. One recent study found that isolation increases the risk of heart disease by 29 percent and stroke by 32 percent.
Another analysis that pooled data from 70 studies and 3.4 million people found that socially isolated individuals had a 30 percent higher risk of dying in the next seven years, and that this effect was largest in middle age.
Loneliness can accelerate cognitive decline in older adults, and isolated individuals are twice as likely to die prematurely as those with more robust social interactions. These effects start early: Socially isolated children have significantly poorer health 20 years later, even after controlling for other factors. All told, loneliness is as important a risk factor for early death as obesity and smoking.
The evidence on social isolation is clear. What to do about it is less so.
Loneliness is an especially tricky problem because accepting and declaring our loneliness carries profound stigma. Admitting we’re lonely can feel as if we’re admitting we’ve failed in life’s most fundamental domains: belonging, love, attachment. It attacks our basic instincts to save face, and makes it hard to ask for help.
I see this most acutely during the holidays when I care for hospitalized patients, some connected to I.V. poles in barren rooms devoid of family or friends — their aloneness amplified by cheerful Christmas movies playing on wall-mounted televisions. And hospitalized or not, many people report feeling lonelier, more depressed and less satisfied with life during the holiday season.
New research suggests that loneliness is not necessarily the result of poor social skills or lack of social support, but can be caused in part by unusual sensitivity to social cues. Lonely people are more likely to perceive ambiguous social cues negatively, and enter a self-preservation mind-set — worsening the problem. In this way, loneliness can be contagious: When one person becomes lonely, he withdraws from his social circle and causes others to do the same.
Dr. John Cacioppo, a psychology professor at the University of Chicago, has tested various approaches to treat loneliness. His work has found that the most effective interventions focus on addressing “maladaptive social cognition” — that is, helping people re-examine how they interact with others and perceive social cues. He is collaborating with the United States military to explore how social cognition training can help soldiers feel less isolated while deployed and after returning home.
The loneliness of older adults has different roots — often resulting from family members moving away and close friends passing away. As one senior put it, “Your world dies before you do.”
Ideally, experts say, neighborhoods and communities would keep an eye out for such older people and take steps to reduce social isolation. Ensuring they have easy access to transportation, through discounted bus passes or special transport services, can help maintain social connections.
Religious older people should be encouraged to continue regular attendance at services and may benefit from a sense of spirituality and community, as well as the watchful eye of fellow churchgoers. Those capable of caring for an animal might enjoy the companionship of a pet. And loved ones living far away from a parent or grandparent could ask a neighbor to check in periodically.
But more structured programs are arising, too. For example, Dr. Paul Tang of the Palo Alto Medical Foundation started a program called linkAges, a cross-generational service exchange inspired by the idea that everyone has something to offer.
The program works by allowing members to post online something they want help with: guitar lessons, a Scrabble partner, a ride to the doctor’s office. Others can then volunteer their time and skills to fill these needs and “bank” hours for when they need something themselves.
“In America, you almost need an excuse for knocking on a neighbor’s door,” Dr. Tang told me. “We want to break down those barriers.”
For example, a college student might see a post from an older man who needs help gardening. She helps him plant a row of flowers and “banks” two hours in the process. A few months later, when she wants to cook a Malaysian meal for her boyfriend, a retired chef comes by to give her cooking lessons.
“You don’t need a playmate every day,” Dr. Tang said. “But knowing you’re valued and a contributing member of society is incredibly reaffirming.”
The program now has hundreds of members in California and plans to expand to other areas of the country with a recent grant from the Robert Wood Johnson Foundation.
“We in the medical community have to ask ourselves: Are we controlling blood pressure or improving health and well-being?” Dr. Tang said. “I think you have to do the latter to do the former.”
A great paradox of our hyper-connected digital age is that we seem to be drifting apart. Increasingly, however, research confirms our deepest intuition: Human connection lies at the heart of human well-being. It’s up to all of us — doctors, patients, neighborhoods and communities — to maintain bonds where they’re fading, and create ones where they haven’t existed.”
Dhruv Khullar, M.D., M.P.P., is a resident physician at Massachusetts General Hospital and Harvard Medical School.
"Ice" is available via http://www.glenbrook.mynetworksolutions.com/
                                                               

Tuesday, December 6, 2016

Helping Hand

Please pass the word on this Helping Hand opportunity. It is applicable in whatever state you live in.
Today I gave a lady a ride to her Oncologist for ongoing radiation. She didn't know about the Road to Recovery program sponsored but the American Cancer Society. She has spent a fair amount of money transporting herself to Swedish hospital. A social worker at Swedish told her of the service. We, Let Kids Be Kids, Inc.,  http://tinyurl.com/2dsn7f3 do not charge for the ride, we are not compensated in any way or reimbursed for expenses related to this Advocacy/Support outreach. If you want to help us there are links on our website. Please tell Cancer patients to call the American Cancer Society and enquire about the Road to Recovery program. Call: 1-800-227-2345 or contact us letkidsbekids@mac.com


Unacceptable

Donald Trump is directly responsible for these increases in unacceptable behaviors. Were he a real leader he would have made a national speech condemning all of this ongoing discrimination. Don't forget he was the source of the birther movement. "On Monday morning, a Metropolitan Transportation Authority worker in a hijab in addition to her uniform was followed off a subway train at Grand Central Station in Manhattan by a man who shoved her down.
“You shouldn’t be working for the city. You’re a terrorist,” he was heard to say.
On Saturday evening, an off-duty police officer who wears a hijab in and out of uniform dropped her 16-year-old son off by their hone and returned from parking the family car to see a man with a pit bull harassing and pushing him..."

Sunday, December 4, 2016

Farewell America

"America died on Nov. 8, 2016, not with a bang or a whimper, but at its own hand via electoral suicide. We the people chose a man who has shredded our values, our morals, our compassion, our tolerance, our decency, our sense of common purpose, our very identity — all the things that, however tenuously, made a nation out of a country.
Whatever place we now live in is not the same place it was on Nov. 7. No matter how the rest of the world looked at us on Nov. 7, they will now look at us differently. We are likely to be a pariah country. And we are lost for it. As I surveyed the ruin of that country this gray Wednesday morning, I found weary consolation in W.H. Auden’s poem, September 1, 1939, which concludes:

“Defenseless under the night
Our world in stupor lies;
Yet, dotted everywhere,
Ironic points of light
Flash out wherever the Just
Exchange their messages:
May I, composed like them
Of Eros and of dust,
Beleaguered by the same
Negation and despair,
Show an affirming flame.”


I hunt for that affirming flame.
This generally has been called the “hate election” because everyone professed to hate both candidates. It turned out to be the hate election because, and let’s not mince words, of the hatefulness of the electorate. In the years to come, we will brace for the violence, the anger, the racism, the misogyny, the xenophobia, the nativism, the white sense of grievance that will undoubtedly be unleashed now that we have destroyed the values that have bound us.
We all knew these hatreds lurked under the thinnest veneer of civility. That civility finally is gone.
We all knew these hatreds lurked under the thinnest veneer of civility. That civility finally is gone. In its absence, we may realize just how imperative that politesse was. It is the way we managed to coexist.
If there is a single sentence that characterizes the election, it is this: “He says the things I’m thinking.” That may be what is so terrifying. Who knew that so many tens of millions of white Americans were thinking unconscionable things about their fellow Americans? Who knew that tens of millions of white men felt so emasculated by women and challenged by minorities? Who knew that after years of seeming progress on race and gender, tens of millions of white Americans lived in seething resentment, waiting for a demagogue to arrive who would legitimize their worst selves and channel them into political power? Perhaps we had been living in a fool’s paradise. Now we aren’t.
This country has survived a civil war, two world wars, and a great depression. There are many who say we will survive this, too. Maybe we will, but we won’t survive unscathed. We know too much about each other to heal. No more can we pretend that we are exceptional or good or progressive or united. We are none of those things. Nor can we pretend that democracy works and that elections have more or less happy endings. Democracy only functions when its participants abide by certain conventions, certain codes of conduct and a respect for the process.
No more can we pretend that we are exceptional or good or progressive or united. We are none of those things.
The virus that kills democracy is extremism because extremism disables those codes. Republicans have disrespected the process for decades. They have regarded any Democratic president as illegitimate. They have proudly boasted of preventing popularly elected Democrats from effecting policy and have asserted that only Republicans have the right to determine the nation’s course. They have worked tirelessly to make sure that the government cannot govern and to redefine the purpose of government as prevention rather than effectuation. In short, they haven’t believed in democracy for a long time, and the media never called them out on it.
Democracy can’t cope with extremism. Only violence and time can defeat it. The first is unacceptable, the second takes too long. Though Trump is an extremist, I have a feeling that he will be a very popular president and one likely to be re-elected by a substantial margin, no matter what he does or fails to do. That’s because ever since the days of Ronald Reagan, rhetoric has obviated action, speechifying has superseded governing.
Trump was absolutely correct when he bragged that he could shoot someone in the middle of Fifth Avenue and his supporters wouldn’t care. It was a dictator’s ugly vaunt, but one that recognized this election never was about policy or economics or the “right path/wrong path,” or even values. It was about venting. So long as Trump vented their grievances, his all-white supporters didn’t care about anything else. He is smart enough to know that won’t change in the presidency. In fact, it is only likely to intensify. White America, Trump’s America, just wants to hear its anger bellowed. This is one time when the Bully Pulpit will be literal.
The media can’t be let off the hook for enabling an authoritarian to get to the White House. Long before he considered a presidential run, he was a media creation — a regular in the gossip pages, a photo on magazine covers, the bankrupt (morally and otherwise) mogul who hired and fired on The Apprentice. When he ran, the media treated him not as a candidate, but as a celebrity, and so treated him differently from ordinary pols. The media gave him free publicity, trumpeted his shenanigans, blasted out his tweets, allowed him to phone in his interviews, fell into his traps and generally kowtowed until they suddenly discovered that this joke could actually become president.
Just as Trump has shredded our values, our nation and our democracy, he has shredded the media. In this, as in his politics, he is only the latest avatar of a process that began long before his candidacy. Just as the sainted Ronald Reagan created an unbridgeable chasm between rich and poor that the Republicans would later exploit against Democrats, conservatives delegitimized mainstream journalism so that they could fill the vacuum.
With Trump’s election, I think that the ideal of an objective, truthful journalism is dead, never to be revived.
Retiring conservative talk show host Charlie Sykes complained that after years of bashing from the right wing, the mainstream media no longer could perform their function as reporters, observers, fact dispensers, and even truth tellers, and he said we needed them. Like Goebbels before them, conservatives understood that they had to create their own facts, their own truths, their own reality. They have done so, and in so doing effectively destroyed the very idea of objectivity. Trump can lie constantly only because white America has accepted an Orwellian sense of truth — the truth pulled inside out.
With Trump’s election, I think that the ideal of an objective, truthful journalism is dead, never to be revived. Like Nixon and Sarah Palin before him, Trump ran against the media, boomeranging off the public’s contempt for the press. He ran against what he regarded as media elitism and bias, and he ran on the idea that the press disdained working-class white America. Among the many now-widening divides in the country, this is a big one, the divide between the media and working-class whites, because it creates a Wild West of information – a media ecology in which nothing can be believed except what you already believe.
With the mainstream media so delegitimized — a delegitimization for which they bear a good deal of blame, not having had the courage to take on lies and expose false equivalencies — they have very little role to play going forward in our politics. I suspect most of them will surrender to Trumpism — if they were able to normalize Trump as a candidate, they will no doubt normalize him as president. Cable news may even welcome him as a continuous entertainment and ratings booster. And in any case, like Reagan, he is bulletproof. The media cannot touch him, even if they wanted to. Presumably, there will be some courageous guerillas in the mainstream press, a kind of Resistance, who will try to fact-check him. But there will be few of them, and they will be whistling in the wind. Trump, like all dictators, is his own truth.
What’s more, Trump already has promised to take his war on the press into courtrooms and the halls of Congress. He wants to loosen libel protections, and he has threatened Washington Post owner Jeff Bezos of Amazon with an antitrust suit. Individual journalists have reason to fear him as well. He has already singled out NBC’s Katy Tur, perhaps the best of the television reporters, so that she needed the Secret Service to escort her from one of his rallies. Jewish journalists who have criticized Trump have been subjected to vicious anti-Semitism and intimidation from the alt-right. For the press, this is likely to be the new normal in an America in which white supremacists, neo-Nazi militias, racists, sexists, homophobes and anti-Semites have been legitimized by a new president who “says what I’m thinking.” It will be open season.

This converts the media from reporters totargets, and they have little recourse. Still, if anyone points the way forward, it may be New York Times columnist David Brooks. Brooks is no paragon. He always had seemed to willfully neglect modern Republicanism’s incipient fascism (now no longer incipient), and he was an apologist for conservative self-enrichment and bigotry. But this campaign season, Brooks pretty much dispensed with politics. He seemed to have arrived at the conclusion that no good could possibly come of any of this and retreated into spirituality. What Brooks promoted were values of mutual respect, a bolder sense of civic engagement, an emphasis on community and neighborhood, and overall a belief in trickle-up decency rather than trickle-down economics. He is not hopeful, but he hasn’t lost all hope.
For those of us now languishing in despair, this may be a prescription for rejuvenation. We have lost the country, but by refocusing, we may have gained our own little patch of the world and, more granularly, our own family. For journalists, Brooks may show how political reporting, which, as I said, is likely to be irrelevant in the Trump age, might yield to a broader moral context in which one considers the effect that policy, strategy and governance have not only on our physical and economic well-being but also on our spiritual well-being. In a society that is likely to be fractious and odious, we need a national conversation on values. The media could help start it.
But the disempowered media may have one more role to fill: They must bear witness. Many years from now, future generations will need to know what happened to us and how it happened. They will need to know how disgruntled white Americans, full of self-righteous indignation, found a way to take back a country they felt they were entitled to and which they believed had been lost. They will need to know about the ugliness and evil that destroyed us as a nation after great men like Lincoln and Roosevelt guided us through previous crises and kept our values intact. They will need to know, and they will need a vigorous, engaged, moral media to tell them. They will also need us.
We are not living for ourselves anymore in this country. Now we are living for history."
Bill Moyers