The Squirrel Who Sneezed in His Sleep

Tonight I heard something I’ve never heard before. It was the most unusual sound, and when I figured out what had made that sound, it surprised me even more, mostly because I had just been thinking how strange it was that it was so quiet.

I remember that feeling of surprise the last time I heard something I never heard before. It was such good news, but I hadn’t expected it. In fact, I had just spent the previous week being completely depressed that I would never hear it at all.

When I was actively thinking that my surroundings shouldn’t be that quiet, even at 3 a.m., it was almost as if I was asking for something to break the silence. The rustling leaves were a familiar sound, but the squeak and the spray weren’t. It was the funniest sound. A squirrel had been sleeping in the tree when suddenly he squeaked, which made him sneeze, which blew the leaves around him like the wind. The silence changed – that quickly – and suddenly everything seemed as if it were back to normal.

I’m going to think about that squirrel next time I start thinking that something else needs to change. If I listen hard enough, I might just hear something else I never thought I’d ever hear. I could learn to like surprises if they start turning out to be good ones.

Listen to Your Gut

I found an article that gives new meaning to the concept of listening to your gut. The opening line reads “Early digestive problems may hardwire the brain for depression.”

http://www.newscientist.com/article/mg21028136.500-do-early-gut-problems-set-the-brain-up-for-depression.html

Researchers at Stanford are trying to figure out which comes first, the gut problems or the depression.  The working theory was that hormones released during sadness trigger negative effects on the stomach area, but now they’re not so sure. The gut problems might trigger the depression.

This isn’t exactly a scientific observation, but I can vouch for their theory. I had bad stomach pains when I was young, before anyone noticed signs of depression in me. Diagnosed with nonspecific gastrothisandthat or whatever, I ended up in the doctor’s office or the ER on a regular basis. I was doubled over in pain, and nobody could figure out why. Here’s the kicker: When I went on antidepressants and mood stabilizers in my mid-20s, the gut problems mysteriously disappeared.

A research group from Kings College in London has narrowed down the genetics of severe recurring depression to chromosome 3, and both the Stanford group and a research group from Washington University in St. Louis, Missouri, have come up with basically the same results. In the research world, all three groups finding the same thing is pretty important.

The curious thing about genetic mapping is that there is so much apparently unrelated information on each chromosome. According to the National Institute of Health, there are currently 51 known disorders known to be associated with chromosome 3, one of which is the thoracic aortic aneurysm my dad had. I’m pretty sure that had nothing to do with depression…although come to think of it, he was going through a pretty low time in his life… But I don’t have any of those syndromes or deficiencies…that I know of…yet…hmm.

But then there’s still this “which came first, the chicken or the egg” thing. Do certain disorders make it easier for depression to surface, or does depression pave the way for certain other weaknesses to present themselves – those gut problems, for example?

See, I think the process of discovering all of this is interesting. Someday, all this research put together will help doctors prescribe more effective treatments for depression instead of “hey, I got a new sample – let’s see what this does.”

If You’re Happy and You Know It, Tweet Your Friends

Social media is a trip and a half. It’s communication on steroids, broken down into semi-connected fragments – a little like my Gemini brain seems to be. It mirrors my life, in a slightly warped way.

I have six sets of people I keep up with, depending on which era of my life happens to be front and center at the moment. In real life, none of these subgroups actually intersect. My family is now scattered all over the country so my high school classmates have never kept up with them, my church friends definitely don’t know my bar friends, and my former coworkers have no idea how awesome my online colleagues are. But I can keep up with every one of them, separately and together, on Facebook. I can introduce them to each other, or I can use the extra features to keep my communication group-appropriate. I even found out that two of my friends, who I would have never guessed had anything in common, are already friends with each other because they take the same classes in college. It’s a miracle. I didn’t even know I knew 175 people, let alone 175 people who wanted to be friends with me. That’s a self-esteem booster right there.

But how many different ways do we really need to keep in touch with each other? It depends on how you like to be touched. Need to know everything right now? Twitter. Need to express yourself? MySpace. Need to get up close and personal with a whole group of people at once? Facebook. Need to stick to business and work a virtual room? LinkedIn. Need to simply give and get information? Scores of other websites are just falling all over themselves wanting you to become part of their community.

I gotta tell you, this is doing a real number on my ADHD. I can’t tell whether all these social media options are feeding the way my brain flips from one thing to the next, or if they’re just aggravating the condition and making it worse.

Then you have the new social politics. If you have a friend on Facebook, and you don’t follow him on Twitter, does that mean you’re being rude? What if you digg something you just stumbled upon, but you can’t tweet it because your BFF just facebooked it all over your wall? And if you don’t learn to use the word “friend” as a verb, are you really ever going to be socially acceptable? 

I have to learn to keep all this straight someday… No, seriously. It’s going to make my head spin until I figure out how to put the puzzle together. The prize is that the spinning stops, the headache goes away, and I end up pointed in the right direction. Wish me luck! I’m going to need it. 

Clueless

I have to say that Squidoo is the coolest website I’ve seen all year. I don’t know why I haven’t seen it before, but I like the idea of each of us being a lens through which everyone can look at some part of the world. The tagline is great: Everyone is an expert on something.

Did you ever talk with an expert one on one, and catch yourself thinking, “I can’t believe that came out of her mouth!” or “Wow … where did that come from?” or “What in the world made him say that?”

You see, everyone – including the expert – is also clueless about something at some point or another. And when you have one of those “huh?” moments, you may have just been a witness to that glorious moment in history, that one moment when this expert will have to say, “Sorry, everyone, I had no clue what to say next, so I just made that one up!”

I’m good for a laugh once in a while, and not because I’m trying to be funny. Let’s just say that the longer I live, the more I learn to shut up when I have no clue what people are talking about. I can play Trivial Pursuit with the best of them, I can explain the theory of relativity, and I can copy almost any tune into sheet music for the piano. Don’t try to talk to me about transposing music for an entire orchestra, though, because I can’t manage the percussion notation. It confuses me, I get dizzy, and I have to tune out before my head explodes. Then there was the time I tried to transpose Wagner’s Bridal Chorus for the bagpipes, never having played the bagpipes myself, let alone seen the sheet music the pipers learn from. (“Oh yeah – no problem!” – how hard could it be, right? I can Google it.) I would be very glad to tell you about that, but the person who actually should be telling that story is the one who asked if I could do it, and I’m not sure he’s speaking to me anymore.

It’s the same with electronics. I’m clueless. We’re remodeling our basement, and my husband decided to change the exhaust fan in the bathroom. Before I went to the home improvement store for painting supplies, I asked if he needed anything. “Whatcha doing, honey?” I said. I was about to regret that question, because he proceeded to actually tell me. That wonderful, patient man saw my eyes glaze over and tried to explain it again in fifth-grade English. As he was pointing at the wires and taking things apart, I caught some of what he was saying, but part of my brain had already shut off by this time. Not wanting to look stupid, I picked up the little orange cone he had put down, noticed it was dirty, and said, “Okay, looks like you need three of these, right?” YES! He thought the lightbulb in my head had finally turned on. I walked into the home improvement store, proud as punch, and asked the guy on the floor, “My husband says to get three of these electrical thingamabobs. Could you please tell me where to find them?”

Now, I can get away with being clueless about electronics. My husband knows about that sort of thing, and what he doesn’t know, we can hire an expert to do. I have no problem admitting I’m clueless in that area. But for some reason, for a while there, I had a problem admitting I was clueless about some types of musical notation. Then there’s the running joke about why men never ask for directions. I know some women who have way too much fun with that one. Unfortunately, they ask for it. The stubbornness is just way too entertaining sometimes.

The truth is, we’re all guilty of that once in a while. Is it a weakness to be clueless about things like when to shut up and when to ask for directions, though? Maybe not. None of us know everything, and even the brightest minds can’t figure everything out. That’s where the strength comes in. Isn’t it harder to admit you’re clueless than announce you know exactly what’s going on?

I might begin to have a hard time admitting I’m clueless about electronics if my husband died and I was left with no money to hire someone if a fixture needed replacing. Would I try to do it myself, or would I call a friend for help? I would probably try to go online, Google it, print out a step-by-step tutorial, and do it myself first so I didn’t bother anyone if I didn’t absolutely have to. (Let’s hope we have a double plot, just in case I screw up.)

Can you see yourself asking someone for help before trying to manage something that confuses you to begin with? Why? I don’t care if we’re talking about exhaust fans, wire hats, or the sheet music for the bagpipes. Why would many of us choose to give up, screw up, procrastinate, or “fake it ’til we make it” before we’ll admit we need directions? Why would we choose to look like a dufus rather than tell someone, “no, I can’t do that – would you help me?” Do people actually choose to be clueless sometimes?

Sometimes it’s easier. Sometimes it just makes your head hurt too much to press forward and learn something new. Other times you want so badly to look good to someone else, you end up doing stupid things to try and impress them…like refusing to turn on the GPS when we’ve been driving in circles through endless farmland, eventually realizing that we passed the same general store three times in the last hour looking for the way back to the highway – the one we can see on the horizon, but can’t seem to find the one road that will take us there. “No, this is the right road. We just didn’t go down far enough.” Three sheep farms, two red barns, and an outhouse later, here’s the general store again. Is it time to put the pride away and ask for help?

For the record, that story was taken from experience, but it wasn’t him. It was me. I’m the one who is most likely to try and “fake it ’til I make it.” Take that appointment for grief counseling I haven’t made yet. It has been two years and nine months, and I’m still driving around in circles, saying, “No, I’m all right, it’s all under control” while I’m playing an emotional game of dodge-the-pothole. Is it time to put the pride away and ask for help?

Everyone has something they’re very good at, and everyone has something they’re clueless about. I don’t care who you are, or where you come from. It’s okay to be clueless once in a while. We all have those moments. If you can finesse your way through those moments, great. If you fall on your face, that’s fine too. (That seems to be how I learn.) Being honest and open to learning has been very good to me when it was time to tell someone I didn’t know how to do something on my own.

And trust me, don’t ever tell anyone you can write for the tympani when you know for a fact you’ll have to do a Google search to find out what a tympani is before you begin.

Should Medicaid Cover Alcohol Intervention? Tell Them!

I’m still amazed that a government agency is asking for our opinions - and better yet, they’re actually listening.

Check out this post for a little background. The verdict is in. The USDA is backing off on a proposal that might have inadvertently encouraged heavy drinking. They had originally proposed to ditch the daily recommendations and set weekly recommended quantities of alcohol, but the public spoke out. Since most people do their drinking only one to three nights a week, those who took the time to comment online were mostly concerned that drinkers would look at weekly guidelines and try to cram one week’s worth of drinking into one night. And that was a real possibility - most of us know how bright alcoholics are when it comes to justifying “let’s have another one!”

The USDA’s new guidelines retained a daily recommendation for alcohol consumption, and they now define heavy drinking and binge drinking as well. They admit there is evidence of health benefits of moderate drinking – apparently they’re trying extra hard not to give anyone the idea that it’s okay to drink like a fish – but they now give the stern “this is bad for your health” statement like you’ll find on a cigarette pack, listing all the health conditions that might get in your way if you drink too much.

According to Join Together, it was the online response from private citizens (both healthcare professionals and concerned consumers) that made a difference in the final policy decision. That is seriously encouraging. All government agencies should have a limited public commenting period like this every time new policies are being considered. 

Get ready to click again – someone else needs our input now. The Centers for Medicare and Medicaid Services (part of the Department for Health and Human Services) is asking what we think about Medicare covering alcohol screening and counseling in primary medical care.

This debate is about whether Medicare and Medicaid should cover alcohol abuse prevention, screening, and counseling. They already cover screening for other medical issues, but this time they’re considering doing that for something that might cross over into services that are normally performed by mental health providers.

Providing the service could mean a significant extension of prevention and early intervention services for individuals struggling with alcohol. It could also be pretty expensive, but then again so is the current drain on state and federal budgets when it comes to incarceration of drunk drivers and other alcohol-fueled criminals, child protective services, healthcare services for abused family members, emergency services for indigent people with alcohol poisoning, and anything else that relates to the public costs of excessive drinking.

A report on reducing underage drinking from the National Academy of Sciences found that government agencies, businesses, and individuals in the United States end up spending – and remember, this is just about underage drinkers – around $53 billion per year (including $29 billion due to violent crime and $19 billion from traffic crashes) because we can’t keep the alcohol away from the kids. Now that’s expensive. And that study was presented back in 2003. What are those numbers like today? And how much greater could the costs be for adults with alcohol problems?

If you want to get in on the debate, their National Coverage Analysis Tracking Sheet is open for comments until March 20, 2011. Let them know – especially if you work in healthcare – what you think about how this might work, who might coordinate the services, how often the services might be offered, or under what conditions Medicare or Medicaid might play a greater role in preventing a lot more unnecessary problems.

Well, That Explains a Couple of Things

This is the best news story I’ve read today! http://www.businessweek.com/lifestyle/content/healthday/649732.html

Can you imagine the guilt on the mind of the staffer who lets the President bum a cigarette, knowing full well that the President is trying to quit? Somehow I just can’t picture anyone saying, “Sorry, sir, you need to tough it out today.”

Tough it out…isn’t that what quitting smoking is like, though? You have this confidence surge every time you resist the temptation, because it’s hard to put the pack down and you know it. If you can resist for a while, you start feeling tough. You start telling yourself, “If I can get through this, I can get through anything.”

But it’s a fight. It’s a constant battle between your lungs and your brain. If you want to quit but it hasn’t happened, your brain says, “I must not be ready to quit.” If you want to quit and it has just happened, you’re fighting the crabbiness and the agitation, and you’re about three steps away from making it all stop by simply having another cigarette. If you don’t want to quit but you’re being hassled about it, your brain says, “It’s my life.” Meanwhile, your lungs are on fire and you’re in denial about it. But on some level, you know that your time is about up if you ever lose your lungs.

I’ve quit smoking three times, and each time I only stopped smoking when the stress in my life eased up on me. I had a hard time being without a cigarette in my mouth when life wasn’t exactly smooth sailing.

Can you imagine trying to go through that as the leader of the free world? I would be lighting up every time I spoke to the Republicans in Congress. I would bring my own carton to a weekend summit of world leaders. I would be frantically signalling staffers to get me an ashtray every time a call came in on that little red emergency phone.

Barack Obama has been going through something similar for at least the past nine months, all while he was functioning in one of the toughest jobs in the world.

If reports of your quitting aren’t greatly exaggerated, Mr. President, congratulations for doing something positive for your health and trying to tough it out. If you can handle this, you can handle anything.

New Rules for Schools

I have a special place in my heart for anyone trying to give guided instruction in current events, especially lately. For one thing, we as a country are in the middle of an incredibly interesting journey on which we’re throwing it all on the table, getting it out in the open, and hashing out some things that have been swept under the rug for a long time. For another thing, the analysis of current events always looks different a month or a year or a presidential term later, so what we first see as truth is bound to change a little eventually. But someone has to get the conversation started.

I have a friend who says he’s teaching a class in civil discourse this coming semester. I think that’s a brave thing to do – I imagine it means he’s going to try to teach young people how to communicate without using anger or irrational behaviour. The more I think about it, the more I think it should be a required class in our schools. All of them. Catch the kids with the attitude problems before they’re old enough to buy guns.

The evidence is piling up in favor of paying extra attention to our country’s educational system. And that’s normal – schools need new rules all the time in response to a changing society. Remember typing class? That changed a bit over the years, didn’t it? In the seventies, it was typing class. In the nineties, it was keyboarding class. I have no clue what they’re calling it nowadays. For all I know, they’re now teaching 5-year-olds their ABCs using the touch typing system, word processing software, and the media controls on the computer, which takes care of all three skills at once.

So I made a little list of the new classes I think ought to be added to each and every school’s curriculum, and be made a requirement for high school middle school graduation. Correct me if I’m wrong, but I think these new classes will really make a difference in the lives of the young adults we throw out into the world with questionable social skills.

- Civil Discourse: how to state opinions and discuss issues in productive ways, especially in response to angry and hateful boneheads (must earn a B or better to pass)

- Criminal Law 101: introduction to the nature of crime and punishment, the penalties for various laws in their local area, and the difference between movies and reality (unit on survival skills to be made available in certain gang-infested school systems)

- Beginning Personal Finance: everything from making change to balancing a checkbook to the joys of compound interest (or the avalanche of compound interest, in the case of credit cards), with a special section on how to avoid getting ripped off

- Fifth-Grade Ethics: why and how to act in everyone’s best interest, how to begin figuring out what that is, and when and how to speak up in the face of injustice (violators of other school rules must repeat this class with the fifth-graders, no matter how old they are)

- Introduction to Gun Safety (mandatory in TX, NM, and AZ; optional everywhere else): how to safely handle, clean, and fire a gun; with emphasis on hunting, the difference between self-defense and self-importance, and the dangers of semiautomatic weapons (prerequisite, Ethics; must be taught concurrently with the class on Civil Discourse)

Feel free to add your own, but I think these five classes could be the start of some cool new rules in school – and save lives, and save the government a heck of a lot of money down the road, and…

Paying for health care

I’ve been reading a lot of pontifications from people who think that they’re personally having to pay for the new health care law. They see that greed exists on both ends of the economic spectrum, and they’re offended at the possibility that they’re paying more than their share. I can understand that.

But when they start talking like everyone who doesn’t work or pay their own way is lazy or not worth a hill of beans, I’m sorry – I can’t let that one roll.

I was recently remarried, and if it weren’t for my husband, I would be one of those without health insurance, so I know what it’s like to have to go without. Most of my friends are still in that situation. They don’t ask for handouts, and if they’re eligible for food stamps, they don’t abuse the system any more than sharing their extra food with hungry out-of-work friends who have even less to eat. Their pride gets in the way of trying to actively work the system.

We’re not redefining greed to borrow from Robin Hood’s “steal from the rich and give to the poor.” Not all rich people are greedy, but not all poor people are greedy. We’re all naturally motivated to get money so we can have edible food and a decent roof over our heads, and some people in every economic situation take it to extremes and find greed to be a wonderful survival tactic.

What has been redefined is how the media works. It is now easier to spread the word about decent people who honestly can’t provide for themselves and earn their keep. Many times it’s not about whether or not they want to work. Employers won’t keep sick people on the payroll if they can help it – and that goes for both physical and mental illnesses. People without insurance tend to stay sick. Others get fired because they either call off work too much or they come to work sick because they’re afraid they’ll get fired – but they’re not operating at 100% so some get fired anyway and they lose their ability to pay the doctor.

It’s a big vicious circle - and it’s a realistic explanation of why people flood the emergency room when they get sick instead of seeing a regular doctor. They know that they can just get the bill later and hope they’re working by the time they get it. A lot of my friends don’t do either one. They can’t pay a regular doctor, and they don’t want the bill collectors blowing up their phone. They’d rather stay sick than incur a bill they don’t have much hope of paying, which in turn screws their chances of staying gainfully employed and screws their kids out of being able to pay attention in school, and it just goes round and round.

Health care reform is really an economic issue as much as a social issue. Full employment means getting the right leg brace and PT for someone with a bad leg instead of letting them limp around everywhere and depend on others. It means early detection of everything from the flu to cancer. It means making sure people with certain types of mental illness get the meds they need to be functional, productive members of society. Just a little bit of the right type of health care can put a lot of people back into the workforce (job availability permitting). More payroll tax income, more sales tax income, and more property tax income could make a real difference in the country’s cash flow.

And if you don’t like Obamacare, I suggest you get execs from the insurance, provider, pharmaceutical, and technology industries together and figure something else out, because what we have in the existing free market doesn’t really work for anyone but the top brass raking in the dough. Lock everyone in a room and don’t let them out – not even to go to the doctor – until they craft a system that everyone can live with.

The Mental Side of Obamacare

The Patient Protection and Affordable Care Act (PPACA) began its journey into the wild blue yonder today.

You know the laundry list of benefits that went into effect today. There’s no way some part of the media has not reached you by now. Across the board, we’re getting ready to see:

• elimination of lifetime coverage limits
• restrictions on or phaseouts of annual coverage limits
• extension of dependent coverage up to age 26
• no more policy cancellations for sick people

And these changes are also being made, but only for employer plans or new individual policies – they may not apply if your insurer chooses not to amend your existing policy:

• no more plans that deny or cancel coverage for children with pre-existing conditions
• free evidence-based preventive care services
• no more out-of-network increases for medical emergencies

Now, I think that making predictions about what these changes will or won’t do is a little like predicting whether getting a new job will make you a happier, more productive person. The grass may look greener, but you don’t know until you get there. There are too many variables involved.

But I have another list for you.

According to the Bazelon Center for Mental Health Law, we have the following facts staring us in the face:

• 26% of Americans have a diagnosable mental disorder.
• Only 29% of those people actually receive treatment.
• 50% of Americans with a mental disorder have problems by age 14.
• Mental disorders are the leading cause of disability for Americans age 15-44.
• Major mental disorders cost America at least $193 billion per year in lost wages alone. This study only focused on comparative wage levels – it didn’t include the costs of presenteeism (showing up but being unproductive) or absenteeism (calling off work) on the job.

Insurance parity is an economic issue. Mental health parity is great, but it isn’t enough. Now we need to get people into treatment and back to productivity, and cost – lack of insurance coverage - is the biggest roadblock to getting that help.

Think of the cost savings if we could get people off of public disability assistance and/or Medicaid. Think of the extra cash flow that America could experience with additional payroll tax income, sales tax income, and property tax income because so many more people would be able to work and buy things like appliances and furniture and homes. Think of what could happen if all those kids got help and became productive citizens instead of being homeless or in jail.

No matter who reacts how to the new law, we’re taking another step in the right direction for the good of our country as a whole. You can talk about bleeding hearts all you want, but the return on investment here is too great to pass up.

Is your subthreshold hypomania getting depressed again?

There’s this big puzzle I’ve been trying to figure out for years, and it’s my brain. I have to catch up with what’s going on in the mental health world, or I feel like that puzzle is never going to get solved. And the more my mood swings grumble at me, the more I go into hypomanic detective mode.

So I ran across this article in NIMH’s Science News section. I love this part of their website. I remember when I was a kid – and this was before we even had a color TV – I learned that doctors did research, and I always wondered what they were discovering. Always did like watching PBS more than the Perils of Penelope Pitstop. After I got older, I forgot all about that show…until I got cable TV and found a whole channel devoted to old TV cartoons. Rooby-Roo!!

Okay…focus…

Results of the Study

The researchers found that nearly 40 percent of those identified as having major depression also had symptoms of subthreshold hypomania (mania that lasts less than four days at a time). Compared to those with major depression alone, those with depression plus subthreshold hypomania tended to be younger at age of onset and to have had more coexisting health problems, more episodes of depression and more suicide attempts.

I could have told them that. No, really.

I think the reason I was so interested in what the doctors were discovering is because I knew I was a little off and I wished I knew why. I spent many of my pre-teen and teenage years trying to compensate in various ways for feeling so blue, and usually overdoing it. Then I would go back to withdrawing from the world because in the process of overcompensating, I had usually done something to embarrass myself. The cycle got a little more amplified over time until my late teens, by which time the ups and downs and my inability to deal with them had become painfully obvious.

The more I think about it, the more I remember being sick, too. Looking back, I think it was partly from flipping between being sedentary and being agitated. There were headaches and allergies and upset stomachs – and I remember feeling a lot better when I discovered that four Tylenol were better than two. The MDs didn’t help much. I got diagnosed with nonspecific this or that all the time in my late teens and early 20s. That was before I saw a psychiatrist and life started to make so much more sense.

Of course you’re going to get sick when your body is being unstable. We’ve always heard that it’s so important for us to take care of ourselves and be firm about giving ourselves and our kids healthy foods and a stable environment. I think we’re just now discovering the full effect of WHY we should do that. I guess the researchers can’t just take people’s word for it, though.

Can we get away from the old “because I said so” script from childhood and start being honest about the fact that mental health and physical health are intertwined in real life?

I’m talking to the people who have trouble with everyday struggles, not to the people in strait jackets. It takes practice to watch the ups and downs and to notice when the coping skills are crumbling. It takes a lot of discipline to put your foot down with yourself or your kids when you notice the subthreshold hypomania is trading jabs with the depression and something’s got to give. Find a good doctor and stay on top of your health before you end up in a corner staring at cartoons and hating life.