For the past four years I've been getting weaker and weaker.
It started out with getting to that serious muscle pain that tells you to quit exercising about ten minutes earlier than usual in my daily workout. I figured I was just pushing myself a little harder than usual. But gradually my workouts got to that pain point sooner and sooner. After 8 or 9 months I just couldn't tolerate it anymore, but I thought it might just be age or something (I was only 38!). It kept getting worse, but I ignored it - I had a more than full time social work job and four year old twins, so the exhaustion seemed understandable. I felt lazy. I was tested for sleep apnea, but didn't have it.
Then one day I couldn't finish grocery shopping, even though I already knew where every resting place in the store was. I sat there crying, feeling like if I took one more step or even stayed standing, I would fall down. I knew there was something seriously wrong that day.
The next time I went shopping, I broke down and used a mobility cart. I felt humiliated, like everyone was staring at me. And I did get glares - I *looked* perfectly healthy but fat. (Now I glare right back - fat people get disabilities too!)
I decided to tell my doctor about the exhaustion again. He suggested we adjust my asthma meds, assuming it was low oxygen levels. A month went by, no change.
For the next 3 years I went to specialists, got tests that all came out normal, and kept getting worse and worse. The thing I kept trying to explain was that I didn't START OUT exhausted, I started with and rapidly regained my usual high energy level. The time between healthy energy and excruciating muscle pain with exhaustion that made me sit down on the floor even in public places got shorter and shorter.
About 2.5 years in, I started having severe muscle pain the day AFTER exertion, just as if I'd been carrying heavy boxes or running 5K's the day before. By 3 years I couldn't stand long enough to sautee mushrooms or take a normal shower. It was (IS) very hard to manage my limited energy because I start out feeling fairly energetic, but quickly tire with minimal exertion.
I switched psych meds in case that was the cause, and lost 40 # in 4 months. I was constantly hot and started sweating a ton, and I have NEVER sweated much. I started eating salt and vinegar chips like they were going out of style and salting my food, which I'd never done - I usually hate salt. I started having excruciating abdominal pain and got my gall bladder out last fall. It took me six weeks to recover from laproscopic surgery, instead of the promised 3 days.
This spring we bought an electric can opener because I would drop the manual one when the burning muscle pain MADE me after a few rotations. My exhaustion level would reach a point I'd only experienced when I'd actually been dying from asthma attacks as a child.
Nobody knew what was happening to me. I was terrified that I was going to die without anyone knowing.
I requested a referral to an endocrinologist, and went to Dr. K who immediately knew that it was SAI when she heard about my 30 years on high dose prednisone and Post Traumatic Stress Disorder from childhood. I also have the classic fat deposit from steroid use called a "buffalo hump." (And seriously, would it KILL them to just say "fat deposit"?) She ordered a bone scan and vit D level, which was 5 out of 60. My bones are fine, thankfully.
Taking steroids isn't an option because they CAUSED the SAI in the first place. Also, because last time I took them I got steroid psychosis. But I can get the vitamin D up where it should be, so I'm concentrating on that. Then I can start the long road toward rebuilding my muscles.
For the past four years I've been getting weaker and weaker.
Back in the 1990's, before Ed and I were married, I had an unplanned possible pregnancy. This would be distressing at any time, but I had a neck level spinal injury and my doctors said I couldn't carry a pregnancy without quadriplegia or death resulting. My fiance Ed and I naturally intended to adopt.
Our condom broke in North Carolina Sunday Night, and the Planned Parenthood there was closed. Uninsured, I had no way to pay for a $500 Emergency Room visit. So I had to fly back to Chicago, drive back to Iowa and wait for Student Health to open. Every hour until I could take emergency contraception - called Plan B now and over the counter - meant it was less likely to work. There's a 72 hour window.
I felt so many conflicting emotions. Of course I wanted a baby from the man I loved, and ending the pregnancy felt tragic, so much so that I considered continuing it and taking the risks. Ed and my best friends talked me out of it, but I remained ambivalent emotionally, though not intellectually.
I've always been passionately pro choice, because minority religious beliefs shouldn't enter into medical care. Lots of Christians think that dancing, music, swearing, celebrating holidays, studying science, going to the doctor and playing cards are sinful and should be illegal. I respect their right to their beliefs and practices, but don't believe they have the right to make those activities federally illegal when they are free to abstain from those activities in this country. If they don't want to have abortions nobody will force them. And nobody could force me either way, I was the only one who could decide - entirely appropriate, it is MY body! Now I understood better why anti-abortion and anti- birth control people feel the way they do.
At hour 51, I took Plan B's first pills, knowing they might not work. I wanted Ed's baby inside me. I wanted to stay alive and healthy.
The hormone pills made me even MORE emotional, and I stayed with my friends until the hormone hurricane was over and I could take a pregnancy test. It was negative, as were later tests. Failing tests was actually a relief.
As a person who occasionally depends on doctors to save my life, I would prefer that they were required to demonstrate prior to med school admission:
1. An aptitude for UNDERSTANDING medical and scientific research. I really couldn't care less if they are brilliant scientists themselves. I sure as shit don't care if they're good at physics. I want them to know that epidemiology can never establish causation. Correlation does not establish causation. Period. Ever.
I want them to know they need to read their journals weekly, and that they can't rely on the authors' conclusions but need to read the WHOLE paper and draw their own conclusions. The ability to understand basic genetics and MZ vs. DZ twin vs. parental concordance is needed. Knowledge of the relative scientific strengths and weaknesses of quantitative and qualitative research should be firmly in place as well. With rare or currently untreatable illnesses, and even healthy conditions like pregnancy where you can't just randomly assign treatment and no-treatment groups, following a population clinically is both ethical and informative.
2. An ability to LISTEN to what patients say and what they don't say, and draw correct conclusions then check with the patient (and witnesses) to clarify. This can be done in seconds in an emergency. A couple of social work courses in assessment would instill this critical ability.
3. A basic understanding of human psychology, including but not limited to: human developmental stages; motivated behaviors (thirst, sleep, hunger, breathing, pain, pleasure) that are not under a person's control; a class on the biological basis of addiction (neurologically similar to epilepsy) as opposed to psychological dependence (which happens equally with marijuana, hugs, and asthma inhalers), and last but not least the common mental illnesses.
4. Female anatomy, physiology and health (including pregnancy) as a medical norm equivalent to male anatomy, physiology and health.
5. While we're at it, how about a grounding in health (including pregnancy) on which to build a separate and parallel knowledge of pathology. I want doctors to recognize the natural variation in human phenotypes, and the effects that harsh or oppressive environments have on individuals and groups over time.
6. Economics, including a thorough review of the cost of treatment and medication compared to the typical income levels of different populations, so that they will not label poor people "non-compliant".
7. Ethics - so that when they see other doctors abusing or butchering patients, they REPORT them to the police. And so when they are having trouble themselves, they seek help instead of harming patients and relying on other doctors to cover for them.
8. A medical history class detailing health and science fads that are still with us today. Positive fads are important, but aversion fads are critical to understanding that one's own biases can cloud clinical and scientific reasoning.
I'd rather be treated by an English Literature BA or Auto Mechanics AD with those skills than a double major Biochem/Physics undergrad without them. It amounts to ten undergraduate classes at the most, only two semesters even for relative slackers.
And while we're at it, I want working interns, residents and attendings to get at least 8 hours of sleep in 24. I've nearly been killed by doctors who were so sleepy they couldn't have counted to ten if asked. Fortunately, either nurses took over and TOLD the comatose docs what to do, or I was an asshole and demanded a doctor who was competent to make legal decisions, let alone diagnoses and treatment decisions. How can people emerge from even a basic biology class without understanding that humans need sleep?
I guess I needed a rant. Hopefully you did too. :)
15 minutes into this movie, my slender son walked out of this movie in disgust and anger. "This movie is too mean to fat people!" See, almost all of the people he loves best, including his twin, are fat. Now, there absolutely are funny fat jokes, and those were the ones shown in the preview. Air vent breaking because of fat guy inside - not funny. Fat guy deliberately breaking air vent using his weight to crush mall "terrorists" - hilarious, comedy gold. Even for people the actor's size. I can go to the pool and hear fat people being made fun of, snarked about and hated on. Why should I pay for it?
The breaking point was when bystanders were all "ewww" when they saw a fat woman's stomach during the first fight scene. Seriously. A two for one sale on "fat people are disgusting and untouchable" and "thoughtless, senseless misogyny sold here!"
What should properly be seen as disgusting is the "forty-plus guy falls for girl a few years older than his middle schooler daughter." Creepy. If she were a clinically underweight but lovely thirty year old he fell for and pursued with borderline stalking methods that worked, whoo hoo, good for them. But when it's a teenager, not so much.
Now, I really did want to see this movie due to the actually funny physical comedy in the previews I saw. And I might have been willing to sit through the hateful jokes for the good ones on my own. But when there's too much hate for my 8 year old twins and ther 7 year old friend in the first fifteen minutes, I won't give the producers my money again. As we walked to the parking lot, my daughter K's (slender) friend M complained about how much she is teased for playing with (let alone being best friends with!) a fat girl. K (European American) isn't teased by other kids for befriending M, an African American girl. I'm just sayin'. (And no, this does not mean that fatphobia is the Last Acceptable Prejudice. It's just one reason we deliberately live in a diverse white-flight neighborhood.)
So this sewer rat might taste like pumpkin pie at the end, but I'll never know.
I saw an awesome Rheumatologist who does NOT think that this is lupus, or fibromyalgia or any other specific autoimmune illness that is destined to worsen, but "adrenal fatigue" from being on steroids for thirty years, worsened by the cortisol output from trauma/PTSD reactions. She described it as "tug of war" on my immune system, and basically agreed with the neurologists that it's a clinical picture they often see in long term steroid takers. I certainly don't regret the steroids - I'm alive to complain about pain, after all! Seems like a pretty fair trade to me. :)
Dr. Keys is the first non-psychiatrist I've ever had who even KNEW about the trauma-cortisol link, let alone took a PTSD diagnosis as meaning anything other than "she's probably just imagining things" or "of course she's casting herself as some sort of medical victim" or just "batshit crazy, must be all in her head or an attempt to score narcotics." Plus I was seriously Vitamin D deficient and was prescribed Vit D, and calcium supplements to protect against osteoporosis in my arms - weight is extremely protective for feet, legs and spine because weight bearing exercise is protective no matter how it is acquired. Also, she said not to worry about weight, just eat a variety of foods and exercise like I always have.
Health At Every Size is gaining popularity with Dr.s who read the research - half of people are fit, no weight differences in that. Even the heaviest fit fat people have better health and live longer than unfit "ideal weight" people. (And "overweight" people live longest and are healthiest of all the weight groups. "Ideal weight" people come next, and underweight and obese people trail mildly.)
Gender is a much more important lifespan factor - women are sicker but live over a decade longer on average. Men have fewer illnesses, but those illnesses tend to come late in life and be acute and short rather than chronic and long. There's some thought that chronic illness might even be protective, but it's not established and we really have no idea why women live longer. And yet there's no "War on Maleness" and we don't advise men to have sex reassignment surgery to improve their health, the way some people are convinced to have their stomach and intestines mostly cut out so they can't absorb nutrients and will lose weight. I'm not convinced by the science that it's any more rational. :)
"Carrie" Assessment and Plans Assessment Carrie has a seven year old son, Joseph Jr. (JJ), whose imminent birth caused her to marry Joe despite misgivings. He has been diagnosed with ADHD, and his four year old sister Rachel appears to have it as well. Carrie's addiction and possibly the macho tendencies in Joe – she could hide her drugs in the diapers because he never performed the chore of changing either child. In any case, she is overwhelmed by her rambunctious children and has difficulty setting structure for them to help with the ADHD symptoms and provide a family routine. Carrie is also apparently sexually preoccupied, having multiple affairs as well as sexually charged arguments with Joe in which they "make up" by having passionate sex. Joe suspects the infidelity but Carrie will not confirm it for fear of breaking up the marriage. She will not consent to couples or family therapy because she fears the issue will come up, even though those therapies might help unify the family more. LEISURE/RECREATION Carrie's recreation involves drinking, smoking marijuana, snorting cocaine and having sexual affairs with multiple men including her drug dealer in a sex-for-drugs prostitution arrangement. The drugs and drinking were expected and frequent events in her family of origin, which may influence her lack of a role concept without substance abuse involved. Her sister in law uses drugs with Carrie as well, despite Joe's family image of being straight and narrow abstainers. It is normative for mothers of young children to derive some of their leisure/recreation with them, but this does not appear to be the case for either Carrie, Joe or both together. There do not appear to be any family activities going on, or attendance of JJ's or Rachel's school events. It appears that alcohol and drugs provide Carrie's only respite from her stressful, chaotic and powerless life as an isolated stay at home mom without non-using friendships. This area is deferred unless legal issues arise. AXIS II: 799.9 Diagnosis Deferred V61.20 Parent-Child Relational Problems Carrie was clearly suffering from physiological withdrawal symptoms including moodiness and shakes from cocaine dependence (DSM 4R AXIS I 304.2). I believe that Carrie has the strong motivation of potentially losing her children and the unpleasant withdrawal symptoms from cocaine. Carrie is admitted to residential treatment, but her insurance refuses to pay more than seven days. Since her family is wealthy they chose to self pay for the rest of the 30 day course of inpatient treatment. She plans to return to weekly individual therapy with me following her residential treatment. A summary of our mutually agreed on formal treatment goals at intake follow. The first priority is that Carrie has been referred to her primary care physician for an examination today, including her potentially lethal asthma with prescriptions written in the customary way. Carrie seems to be in the action stage in this area of treatment. The physician will also consider a prescription to treat depressive symptoms. The agency, with Carrie's written consent, will keep a copy of all prescriptions and pass any medication scheduled during program hours. There is no risk for HIV infections as Ms.O has been celibate by choice for many years and has tested negative every year for work. Our nurse will track respiratory signs daily and as needed, and therapists will assess Carrie for worsening depression daily. The possible role of depression in her recent relapse will be explored in itself, as well as along with other psychosocial factors. Carrie identified her religious faith creating a positive outlook, limiting her social circle to "safe" and trusted individuals including a few close friends, 12 step sponsors and her church family as supports in her recovery. She identified a tendency to be "attracted to bad people" and lack of power over addiction with any use at all as addiction triggers that may or may not be se t off at work. Carrie was open to identifying triggers and using behavioral methods to dampen or eliminate them. Mary Heil, BS LBSW
Prof. Rodney Mulder
Carrie's medical history is minimal by her report, despite a ten plus year substance abuse history and domestic violence until her "after her first child was born." which would seem to imply that her husband physically abused her during pregnancy. She is not forthcoming with medical history details such as whether she practices safe sex when high or uses nicotine. She does not report taking any medication or practicing birth control methods of any kind. Carrie will be referred to a medical doctor for a gynecological exam to rule out AIDS and other STDs as well as cervical cancer potentiated by them. Weight is also an immediate concern - Carrie is severely underweight, only 3 pounds over the anorexia diagnostic level. Weight instability through rapid losses and cycling due to crack use may put her at risk for medical problems, although she reports no weight-associated illnesses in her family history or personal health indicators. Carrie reports that when she uses crack she simply has no appetite and does not eat. She reports no history of otherwise disordered eating. Carrie says that she experiences withdrawal symptoms from crack cocaine use, and her moodiness and jitters are evident. She has a history of blackouts from alcohol beginning at age 16, nine years ago. Crack withdrawal causes her labile mood and shakes, but cardiac effects of withdrawal are not always as evident in women as men. I have referred her to a local gynecologist for a medical examination. Carrie appears willing to seek medical care and take any prescribed medications while in our program.
General Observations: Carrie presents today with excellent self care but quiet and withdrawn demeanor. She avoids eye contact and is only getting the treatment she needs because her husband threatened to call CPS on her for neglect of their two children. Her memory, insight and orientation are intact and she poses no immediate danger to herself or others. Carrie gives the overall impression of numb, overwhelmed mood and poor insight into or denial of the serious nature of her substance abuse. She appears shocked, and agrees to my recommendation for inpatient treatment, when we explore how her children could be harmed if she is too intoxicated or crashed to respond to an emergency in the night. Carrie gives a "mild" trauma history of a forced abortion at age sixteen and domestic violence in her marriage, which she minimizes. Carrie reports that she has never had counseling or attended NA or AA, so we have arranged a beginning in her first residential substance abuse program: individual, group, and family available might raise her self esteem, helping the domestic issues.
We plan to provide individual outpatient treatment following her inpatient program, and Carrie feels that this will be adequate. Mood symptoms will be monitored by staff due to the link between depression and substance abuse or dependence, especially crack cocaine. There seems to be no need for a psychiatric referral, but inpatient will monitor symptoms. Carrie appears to have subclinical problems in several areas: mood disturbance, dangerously low (nearly anorexic level) .weight with risky weight cycling due to substance abuse. Formal psychiatric treatment is deferred at this time, but will be reconsidered should the depressive mood prove disruptive to Carrie's substance abuse treatment. If she is diagnosed with depression or another psychiatric illness, Carrie indicates a willingness to take medication if recommended by the physician.
Carrie reports that she started drinking as a young adolescent, and snorted cocaine only after she married into wealth. Her report today was enough data to diagnose her with Cocaine Dependence. She had been using cocaine daily for six months, and is visibly experiencing cocaine withdrawal after two days clean with obvious jitters, moodiness and general malaise. She reports use triggers being the kids' behavior, high stress and being at family parties with alcohol. Carrie has tried several times to quit on her own without success. Carrie experienced her first alcohol blackout at age 16 following a forced abortion. Carrie noted heavy alcohol and drug abuse in several generations of her family of origin. Carrie's social roles and functioning have been seriously impaired by her substance abuse: she is neglecting her children, prostituting herself for cocaine and having affairs, there is hostility and tension in her marriage, and her use as a teen cut off her schooling and she has no GED and virtually no job experience as a result. Carrie realized for the first time the potential of hurting her children by using heavily after they are asleep. She consents to attend our residential treatment program for the 30 days her insurance covers. We agree that she will try the very intensive residential treatment first, re-entering this individual program afterward for further intervention. She has private insurance that will cover part of the residential treatment, and the family agrees to self pay for 16 days of inpatient treatment.
FAMLY & SOCIAL
Carrie tells me that she is the middle sister of three, with no brothers. She felt sibling rivalry keenly and acted out with substance abuse and sex from early adolescence to get attention from her parents. Carrie's family is distant at this time, but not intensely hostile. However, she must attend "raucous parties" with drug and alcohol use rampant to get any time with her family at all when they come to New Jersey twice annually. They will not forsake the parties to visit with Carrie. Her present family seems dysfunctional to a moderate degree. Joe was twenty years old when he started to date Carrie at only fifteen, and coupled with the physical abuse early in marriage, resistance to parenting equally, and his family's enmeshed approach with Carrie, there seems to be a dominance issue in their relationship. Emotional abuse is evident, including the threat to call child protective services on Carrie unless she met with me. Carrie feels that she has no privacy in Joe's enmeshed family, which includes the secretary at the family business as well as Joe's intimidating father. Her sister in law Maureen was told by Joe's father to move in to help with the children, but Carrie and Maureen ended up doing drugs together and had the same dealer. The family always sides with Joe, who shares even the most private details of their marriage with his family.
Carrie, who comes from a working class background, feels out of place in her upper class neighborhood and avoids forming relationships with neighbors. She does not have friends or family (except Joe and his dad) who don't use substances at this point in her life. Carrie feels confined as a stay at home mother but her lack of a high school diploma or GED severely limits her ability to get jobs. This may be part of the dominance issue in her marriage, since Joe instigated her high school dropping out. She has thoughts of leaving Joe, and they once separated, but the only work she could find was a cocktail waitress job, which paid next to nothing and certainly would not let her raise the children. It also gave her frequent opportunities to drink, if it was a typical tavern job. She does not want to lose custody of her children, which is likely if she divorces Joe given his superior ability to support them and lack of formal substance abuse history.
LEGAL & MILITARY
Carrie has no family or personal military background, and no she legal issues relating to substance abuse at least yet. Joe has threatened to turn her in to child protective services for neglect, and even if he doesn't, a divorce and custody battle seem likely.
AXIS I: 304.2 Cocaine Dependence with Physiological Dependence
AXIS III: Deferred
AXIS IV: V61.10 Partner Relational Problems
AXIS V: Current GAF: 45
GAF over the past year: 60
Carrie is a 25 year old European American woman who presents today requesting substance abuse treatment following six months of daily powder cocaine use. She agreed to seek treatment because her husband Joe threatened to report her to child protective services for neglect of their children.
AXIS II was coded 799.9 Diagnosis Deferred, because Carrie functions very successfully socially when uninfluenced by substances and no signs of personality disorder were present. Axis III was also deferred because Carrie is apparently in good health, but she was referred to a medical doctor because her probable unsafe sex practices during prostitution and affairs, long term alcohol and drug use and physiological withdrawal from cocaine pose numerous health risks. The AXIS IV Diagnosis of Partner Relational Problems and Parent-Child Relational Problems reflects Carrie's addiction related hostility and anger in her relationship with Joe and impaired ability to care for and provide structure to her children JJ and Rachel. Therefore on AXIS V, Carrie seems to fall in the severely impaired Global Assessment of Functioning range of 45, compared with a GAF of 60 in the past year, before she added daily cocaine use to her pre-existing alcohol and marijuana use, which do not appear to rise to the level of dependence at this time.
The second treatment priority addresses the psychosocial path from recovery to relapse and will focus on the substance abuse itself: to help Carrie identify possible triggers for this binge relapse. It appears that she is in the preparation stage and has recently had enough difficulty to produce relapse. She appears to be regrouping and making progress, recognizing the need for treatment and actually seeking it immediately is a positive sign. Initially it appears that depressed mood with less attention to self care and prevention, loosened standards for forming social ties and possibly an unusual vulnerability to known psychological and physiological addiction relapse triggers at work may be the major contributors. Carrie plans to explore these matters during individual and groups therapy.
The third main treatment goal is psychological: to restore Carrie's self esteem and self-confidence through individual and group treatment. She appears quite devastated emotionally by this relapse, although intellectually she recognizes it as part of an episodic illness. Carrie reported feeling discouraged, hypocritical and even incompetent in her professional addictions treatment provider role, which she highly values. These statements point to the contemplation stage, with a need to rebuild Carrie's confidence, self esteem and re-acceptance of existing strengths the goals that can move her toward emotional and physical addiction recovery. Obliquely assigning Carrie leadership roles in the educational portions of treatment may boost her confidence, and reinforcing her naturally emerging leadership role in groups will counter these false beliefs. Individually exploring relapse as a teacher and something that happens to virtually everyone with an addiction may help her accept the event emotionally and neutralize it.
The fourth goal employs Carrie's leisure time and activities, increasing time spent in her supportive, drug-free church activities and daily or more often 12 step group attendance with her few very close friends. Carrie stated that expanding her social circle too much contributed to her relapse because, "I'm attracted to bad people." She will identify strategies and implement a plan of strengthening positive leisure activities.
Carrie is supported by her employer socially and administratively by the 70% of her coworkers who are in addiction recovery themselves. She has an uncharacteristically accepting workplace where she can be open about the need for leave and the purpose. The only treatment issues here are to assist her in filing for FMLA and identify potential work triggers creating plans to manage them during vulnerable times of life.
With respect to Carrie's goal to earn and online Social Work Administration master's degree, exploration of her readiness to start and the effect of stress versus the stress relieving enjoyment of studying will be examined. It does not appear that education has triggered relapse in the past, but this issue still warrants exploration and setting up coping strategies.
Since Carrie has never served in the military and has not experienced legal issues for many years, these areas of treatment are deferred.
I believe that Carrie's treatment prognosis is excellent. She is a professional substance abuse counselor, very educated and aware of the components of treatment. She was sober for 16 years before this relapse and comes to the program immediately following a four day relapse binge. Carrie is strongly motivated for change, has a deeply held personal faith and a drug-free church family for help, and attends 12 step programs daily. Given her quick action, insight, and willingness to participate in treatment, it seems likely that intensive outpatient therapy will resolve the issues surrounding this brief relapse. If the need emerges for more intensive treatment, Carrie is eligible for our residential treatment program.
"Carrie" Assessment and Plans
Carrie has a seven year old son, Joseph Jr. (JJ), whose imminent birth caused her to marry Joe despite misgivings. He has been diagnosed with ADHD, and his four year old sister Rachel appears to have it as well. Carrie's addiction and possibly the macho tendencies in Joe – she could hide her drugs in the diapers because he never performed the chore of changing either child. In any case, she is overwhelmed by her rambunctious children and has difficulty setting structure for them to help with the ADHD symptoms and provide a family routine.
Carrie is also apparently sexually preoccupied, having multiple affairs as well as sexually charged arguments with Joe in which they "make up" by having passionate sex. Joe suspects the infidelity but Carrie will not confirm it for fear of breaking up the marriage. She will not consent to couples or family therapy because she fears the issue will come up, even though those therapies might help unify the family more.
Carrie's recreation involves drinking, smoking marijuana, snorting cocaine and having sexual affairs with multiple men including her drug dealer in a sex-for-drugs prostitution arrangement. The drugs and drinking were expected and frequent events in her family of origin, which may influence her lack of a role concept without substance abuse involved. Her sister in law uses drugs with Carrie as well, despite Joe's family image of being straight and narrow abstainers. It is normative for mothers of young children to derive some of their leisure/recreation with them, but this does not appear to be the case for either Carrie, Joe or both together. There do not appear to be any family activities going on, or attendance of JJ's or Rachel's school events. It appears that alcohol and drugs provide Carrie's only respite from her stressful, chaotic and powerless life as an isolated stay at home mom without non-using friendships.
This area is deferred unless legal issues arise.
AXIS II: 799.9 Diagnosis Deferred
V61.20 Parent-Child Relational Problems
Carrie was clearly suffering from physiological withdrawal symptoms including moodiness and shakes from cocaine dependence (DSM 4R AXIS I 304.2).
I believe that Carrie has the strong motivation of potentially losing her children and the unpleasant withdrawal symptoms from cocaine. Carrie is admitted to residential treatment, but her insurance refuses to pay more than seven days. Since her family is wealthy they chose to self pay for the rest of the 30 day course of inpatient treatment. She plans to return to weekly individual therapy with me following her residential treatment. A summary of our mutually agreed on formal treatment goals at intake follow.
The first priority is that Carrie has been referred to her primary care physician for an examination today, including her potentially lethal asthma with prescriptions written in the customary way. Carrie seems to be in the action stage in this area of treatment. The physician will also consider a prescription to treat depressive symptoms. The agency, with Carrie's written consent, will keep a copy of all prescriptions and pass any medication scheduled during program hours. There is no risk for HIV infections as Ms.O has been celibate by choice for many years and has tested negative every year for work. Our nurse will track respiratory signs daily and as needed, and therapists will assess Carrie for worsening depression daily. The possible role of depression in her recent relapse will be explored in itself, as well as along with other psychosocial factors.
Carrie identified her religious faith creating a positive outlook, limiting her social circle to "safe" and trusted individuals including a few close friends, 12 step sponsors and her church family as supports in her recovery. She identified a tendency to be "attracted to bad people" and lack of power over addiction with any use at all as addiction triggers that may or may not be se t off at work. Carrie was open to identifying triggers and using behavioral methods to dampen or eliminate them.
Mary Heil, BS LBSW
This is just such a horrible accidental death. She probably just hit her head on her ski. Natasha Richardson was a brilliant actress and fine human being, and her death at such a young age leaving two sons to grow up without her is tragic.
I'm going to riff on some themes from not-good articles, so if anyone doesn't want to read that or might be triggered regarding brain death or emergency medicine please be warned. I'm distressed over coverage because of personal experience with my brother Mike's brain death in the 1980's, and I understand how these public articles and discussions can feel to read. :(
I had an absolutely identical accident in junior high, and the back of the ski gave me a concussion and dislocated 2 of my neck's vertabrae. I had an identical lack of symptoms, and my girl scout leaders were identically advised to take me to the ER and identically refused. For good reason - millions of falls like this happen every year, and only one person dies. It's tragic, but it was an ACCIDENT and nobody did anything wrong. This seems lost on many journalists and commenters - I feel like we've culturally completely lost the acceptance that some things are not in anybody's control, and sometimes there's just no cause to blame anybody. Nobody, least of all Natasha Richardson herself, could have prevented her death.
I hate the health moralism in many of the articles I've seen, "This goes to show she should have been wearing a helmet." or "This shows she should have gone to the hospital with no symptoms." or "it must be malpractice - see what socialized healthcare does." Also, the laughable American neurosurgeon saying "this is why we keep people with possible head injuries 24 hours for observation."
First, I can GUARANTEE that if she had shown up immediately in any US ER, she would've been told to take ibuprofen and discharged immediately with advice to come back if she started to stumble around or slur speech, NOT "kept 24 hours for observation." Her only prayer would have been a typical long wait, but once symptoms appear there's just so little time before brain surgery is futile that she still might not have lived. Most of the surgeons quoted even said so.
Starting when I was 21, my family had to watch my brain dead brother Mike linger for years with no hope of recovery because, "you can't sue us for 'saving his life' but you can for stopping treatment so we won't." (Direct quote from a hospital administrator to my grieving parents, may he burn in hell. But only for a bit, I'm a universalist agnostic, after all.)
Mike and I both had severe asthma, and after watching a movie on a "vegetable" swore a pact to kill each other if it ever happened to us, which frankly was not unlikely given our medical histories. We were maybe 13 and 12. And I didn't follow through on my promise to him, from a blend of cowardice and the knowledge that if I killed him as requested, my parents would just be agonized all over again.
And I can never forgive myself for breaking that promise.
I know intellectually today that I promised when I was too young to understand fully the promise made, and that we didn't regard anyone else's feelings when we made the pact, and even that because Mike was brain dead (presumably unaware) and my parents were not I probably made the "best" choice for everyone else involved.
And none of it changes the magnitude of my betrayal of the person I loved most in the whole world.
Because watching what happens to your brother when bean counters keep the dead artificially alive is disgusting and enraging to a degree that I'm not sure I can express. My funny, loving, cynical, brilliant and occasionally cruel little brother Mike's corpse was mutilated for years by people who swear to preserve health and life (albeit reluctantly by most of them). He was overdosed on antifebrile medications to force his brain stem to regulate body temperature, and steroids to keep him breathing so he couldn't die of an asthma attack. They bloated his body unrecognizably. Because he was brain dead he wasn't "eligible" for physical therapy and his muscles withered and contracted, contorting his limbs. He was often racked with coughing because of opportunistic viruses. I was really outraged when they gave my already dead brother TB treatment that some inner city kid it would actually save desperately needed and would never get because his parents were poor. A recurrence of TB and pneumonia at once finally allowed Mike the peace denied him for six years after his original death. He'd died again and been resuscitated at least 10 times in the interval, all against my parents' wishes.
At least we have laws now that allow families like Natasha Richardson's to stop medical interventions that keep a brain dead beloved family member from dying peacefully. The immediate grief and pain are no less, but I wouldn't wish the prolonged version on any mother's 12 and 13 year old sons. Truly there are things worse than death, but kids shouldn't have to know it.
If you don't have an advanced directive, I urge you to write one and give it to everyone in your family.
I'm fat. I've always been fat, Venus of Willendorf Fat. It's seldom stopped me or upset me, but if I could take an otherwise safe pill to be thin, I'd do it. It'd pay for itself in clothing savings. Still, when my (then) kindergarten son wrote a list of his 5 favorite things about me for Mother's Day, and number three was "SOFT" in scraggly capitals, I melted.
Off the cuff, from the prof who inspired me to pursue neuroscience after I was shakily returning to school after 8 years feeling dulled by years of menial jobs: "Oh, I assumed you were heavily influenced by Stephen Jay Gould, you think exactly like him." That was nice to hear, until I took his advice and READ SJG's brilliant science essays from the journal _Nature_, when it became clear how unbelievably awesome that casual comment really was.
From an ex - "Please don't take this wrong, but you could make a LOT of money giving blow jobs like that." I didn't take it wrong. :)
"You sing like an angel, will you sing me to sleep?" A friend I'd just met on a car trip. Sadly, I had been punished and shamed for singing, and pretended I didn't hear her by acting asleep. :( Update: "Wow, you can really sing!" My very first ever BAND mate a few weeks ago when we rehearsed together for the first time. And she's a brilliant and experienced fiddler!!!
And of course, "Will you marry me?" :)
New Orleans, Louisiana Rep. John LaBruzzo (R-Metairie) proposed paying women on welfare $1000 to undergo tubal ligation, a not especially effective, unsafe, surgical (with attendant risks)irreversible method of sterilization. He later added that he would offer the same to men (on welfare?! we don't GIVE adult men welfare in the US, hence massive male homelessness) for vasectomies, which ARE effective, safe and reversible but also carry surgical risks. Just to make this amount clear, $1000 is less than the cost of:
a running used car without mechanical problems within 50 miles of NOLA
ONE month's rent for a 2 BR section 8 apartment in NOLA (remember, women must have at least one child already to qualify for any welfare payment, and zoning typically outlaws sharing a 1 bedroom or studio with a male child) Sorry, no deposit!
one BEDROOM's deposit and first month's rent in a 4 bedroom house in LaBruzzo'a own district of Metairie (with a girl child and wealthy owners willing to rent to the poor)
10 monthly bus passes for a mom and child in NOLA
one part time semester of community college in New Orleans
and very likely one MONTH of groceries for LaBuzzo's three person upper class family
OR - if you doubt that LaBruzzo's ALL ABOUT EUGENICS:
10 years of instantly reversible, non-sterilizing, non-hormonal and non-surgical copper IUD use - with followup gyn exams every other year (should be yearly) - oh, but wait, that wouldn't PUNISH women for being poor!
Paternal abandonment is the top cause of child poverty in the United States.
Rearing children is the top risk factor for poverty in elderly women in the United States, REGARDLESS of marital status or household income before age 65.
The United States is the only G20 nation that does not count the unpaid labor of women caring for the old, the sick or disabled and the young in its GDP. This nation was economically founded on slavery. It is perpetuated by the unpaid labor of women of all ethnicities and races.
Anyone want to petition the American Psychological Association with me to remove the weight requirement from the anorexia nervosa diagnosis in the DSM 5 (psychiatric Diagnostic and Statistical Manual)?
That's right. No matter how malnourished and close to death you are from self-starvation, no matter if you meet every single symptom (what you report) and sign (what the diagnoser observes) of anorexia nervosa, if your BMI is 81% or more of the lowest "healthy" BMI, you can't be diagnosed with Anorexia Nervosa. My local inpatient hospitals take patients off behavioral plans and starvation precautions the second they hit 81% of "Ideal weight" - 82 lbs for someone my height (5'2') and 116 for a person a foot taller than me. Needless to say, this is less than helpful to my patients.
Did you notice that even at starvation level, we're only allowed a THIRTY FOUR POUND difference over a foot of height? That's less than four pounds per inch of (usually) torso.
GROSS OUT WARNING! SKIP the next paragraph if you are squeamish!
Anyone who has ever seen the "human steak" cross sections at the Chicago Museum of Science and Industry (or anywhere else) can appreciate that this is kind of ridiculous. If I had 32" circumference steak that weighed four pounds for my St. Patrick's Day party, people would think I'm a skinflint because I can guarantee it wouldn't be an inch thick.
Not to mention, putting a *weight* requirement in a psychiatric diagnosis would seem bizarre to anyone not bred in our fucked up culture. I mean, there's no requirement that we withhold the bipolar diagnoses from everyone not in the TOP 20% of BMI measures because everybody knows only REALLY fat people are "jolly." (Yes, I'm aware that mania isn't a bit jolly to live through - but it makes as much sense as labeling only REALLY thin people "starving.")
People can be dangerously malnourished at ANY weight - indeed, about half of the "10 fattest people" in a Dimensions article had died of malnutrition/starvation trying to lose weight. Even when the DSM was originally assembled, there were actual medical tests to diagnose malnutrition that were far more accurate than body weight, for crying out loud. Electrolyte levels. Anemia. Micro and macro nutrient deficiencies. Chronic dehydration. You know, all the problems bariatric surgery survivors (I say survivors both because this surgery is often fatal, and because it is deliberate amputation and mutilation of healthy organs.) encounter down the line.
Malnutrition, not weight, needs to be the basis of determining whether dieting has turned into self-starvation.
Of course, that would force psychiatrists and psychologists to acknowledge that the medical framing of self-starvation as pathological behavior for the thin and a "healthy lifestyle" for the fat is unscientific, superstitious and based on hatred rather than reason.
The only problem with the govt. purchasing health care from private medical providers is that the privatization of medical care is the main problem. Until the 1980s, medical providers were almost exclusively nonprofit. Insurance had been around for years, but when push came to shove the nuns did not ignore patients bleeding at the threshold as profit hospitals literally do. Much of what is blamed on managed care was in place well before the idea was even developed, let alone impossible to avoid. I saw the for profit take over close up - my mom was a nurse.
The first thing that happened was that doctors had to pay for attendance privileges.
The second thing was that the management required the hospital to RUN OUT of medical supplies before re-ordering. Oh, you needed a stent in your heart NOW? Too bad, we used the last one yesterday and we only order stents on Mondays. As long as your insurance or sister is willing to pay for you to stay another week, you *probably* won't die before next Thursday. Either way, we make more money.
The third thing was drastically cutting nursing care. Patient:nurse ratios skyrocketed. In the newborn nursery, the ratio went from 3 newborns to one nurse (can I get a shout out from triplets' parents on this one?) to 10 to one. Better pray your baby doesn't get sick suddenly - there's nobody with time to notice before that breathing problem causes brain damage.
Laws HAD to be passed mandating for profit hospitals to provide lifesaving (only) treatment to anyone who came in. My mom's hospital literally caused the deaths of refused patients. As long as elderly black people were dying, that was okay with the Quad Cities leadership and press. However, when a white woman pregnant with twins experiencing life threatening complications was told to go to the (nonprofit) university hospital 50 miles away if she wanted treatment, and she died on the way (meaning so did the twins) the press took notice. Again, before managed care. Greed ruined health care all by itself.
Not that managed care has been a good idea - I'm a psychiatric social worker who has watched patient care deteriorate horribly. People transferred from the medical hospital after nearly successful suicide attempts get 3 or 4 days inpatient at most. Antidepressant drugs don't kick in for 4-6 weeks (despite the claims of pharma that it's 2 weeks with newer meds). I'll defend big pharma for a minute though - I don't think Prozac causes suicide. I think releasing suicidally depressed patients after 3 days with a prescription that can't possibly help for another month, and no follow up care, causes suicide completion. Our local community mental health - which privatized under the Bush administration and renamed itself something so vague that nobody could possibly know what they do - doesn't even have a listing under that heading in the phone book.
The vaguely christened a big utilization review committee that challenges every day in the hospital even for INVOLUNTARILY COMMITTED VIOLENT/HOMICIDAL PATIENTS. Homicidal people can't be involuntarily committed unless they have a coherent and workable plan to kill (a) specific person(s) and the realistic ability and tool(s) to do so. Community mental health won't buy meds even for potentially lethal patients. These people are typically way too ill to work, so they seldom have insurance. Antipsychotic medication costs $800-1200 in typical doses to prevent suicide or homicide. Mentally ill people taking medication are less violent than the general population, but untreated psychosis can and does lead to violence and even homicide.
I guess if you're a Republican in a gated community with a gun under your pillow, this doesn't affect you. At least until your son goes to college at Virginia Tech. Or your niece has cancer surgery that removes most of the skin on her back and torso and sent on a trip across the state three hours after general anesthesia because she doesn't have $5000 up front in cash. From a university hospital taken over by for profit investors. Or your 28 year old receptionist dies alone in her apartment of pneumonia after being sent home by the ER, and is found by her 10 year old kid coming home from his weekend with dad.
For profit medicine is a bad idea. For profit insurance/managed care is too. These companies ration care as surely as the Soviet government did. They kill people every day. For money.
It's immoral. It needs to end.
Health care isn't just a human right, it's good for our society. That "illegal" little girl might be the next Jonas Salk and invent the HIV vaccine - if she lives through the leukemia that will only be caught in time if she has access to medical care today, regardless of her parents' immigration status and poverty.
Ah, the fresh odor of racism floats across the web in news article comments.
Nadya Suleman has a bachelor's degree in child and adolescent development and is currently earning a Master's degree. That's more education than the famous Duggers, who have 20 kids at this point, have earned.
Oh wait! They're WHITE, that totally makes it okay to have as many kids as they can get busy and make.
People are assuming that this highly educated woman is just going to give up her professional status and go on welfare, because her name is not "white" sounding. I have no idea if she is a woman of color or not, but I'm seeing a lot of racism here based on her ethnic sounding name. There are overwhelmingly more white people on welfare than "ethnic" people.
My great grandma had sixteen children who survived to adulthood (at a time with 50% child mortality before age 5), and nobody blinked an eye. Her sister had nineteen surviving children. They were both pregnant and nursing constantly from the time they married in their teens until they reached menopause. As with most contemporary women, unless they died in pregnancy or childbirth before menopause, which happened in about one in 200 pregnancies. Neither one was rich, they were farmers.
Like Ms. Suleman, my ancestors had extended families and supportive neighbors to help them rear their many children. This system works all over the world for many people facing extreme poverty, no birth control and living in conditions that they couldn't begin to imagine in their comfortable racist lives.
From Holly Sklar's 2006 "Imagine A Country" essay:
"Imagine a country where some of the worst CEOS make millions more in a year than the best CEOs of earlier generations made in their lifetimes. In 1980, CEOs of major companies made an average 45 times the pay of average full time workers. In 1991, when CEOs made 140 times as much as workers, a prominent pay expert said the CEO "is paid so much more than ordinary workers that he hasn't got the slightest clue as to how the rest of the country lives."...In 2005, CEOs made even more - 352 times the pay of average workers." [Emphasis mine]
Bailouts and other forms of corporate welfare, such as tax loopholes and tax shelters that result in both corporations and their CEOs paying a lower tax rate than their regular employees, need to come with an expectation of corporate responsibility. In other words, with the sames "strings attached" as individuals experience. Non profit companies with over fifty employees manage to survive and thrive with restrictions similar to those below.
If we are going to bail companies out or afford special reduced taxation, we need to limit the CEO pay to 10 times the pay of the company's lowest paid full time worker. At the present annual minimum wage earnings of $14,872, CEOs would be paid a minimum of $148,720 annually. It would serve as an incentive to compensate employees better: the individual CEO's salary will rise proportionately as the company's lowest pay rate is increased. That is more than adequate income for people who have driven our economy into the ground, and it would encourage corporations to support raising the minimum wage to a living wage for single parent families with 3 kids, instead of keeping it brutally low. Minimum wage goes up, CEO's wage goes up. Compensation through company shares is a great idea for all employees, so CEOs can enjoy the same number of shares issued to all employees. It will motivate all employees to higher productivity and loyalty to the company.
Companies getting bailouts and tax reductions need to be held to worker-friendly personnel policies as well. They must staff their workforce by hiring their own employees and provide full benefits packages with a minimum of one sick day per month, one week of paid vacation a year, medical insurance with full maternity care included (with contraceptive coverage required) and parity in psychiatric rimbursement and benefits (no restriction on number of treatments, any more than Parkinson's patients would have such limits). Temporary and contract employees can only be used for twelve weeks - the duration of the Family Medical Leave Act. If the company offers paid matenity AND paternity leave, they can extend this period by the number of days of paid leave to ensure they can hold an employee's job. Likewise with paid sick leave. After that bailout companies will need to hire these people as company employees with benefits, or fill the position with another person if and only if the temporary worker was measurably failing to meet job requirements.
In the interest of public health, bailout companies employing food and health workers must provide unlimited paid sick days to employees for airborne or bodily fluid communicable infectious diseases, with a doctor's note required. A reasonable provision for excessive infections would of course be included, it could be managed through the Americans with Disabilities Act guidelines.
WHOO HOO!!! Obama just capped bailout company executive salaries at $500,000 - so close to what I wanted that I'm overjoyed. Non-profits are some of the most dynamic, creative and best run companies in our economy, and executive salaries seldom crack 100K. Despite dire warnings that nobody good would POSSIBLY agree to work at five times that salary, there's a huge reserve of expert executives out there who would be happy to take over. And they are USED to fiscal frugality, which is exactly what we need.
Check out THIS new law going into effect February 10 - a friend questioned if it could possibly be true because it's so mind-numbingly stupid, based on a complete misunderstanding of actually toxic levels of lead. I'm sure this is due to the outcry over Chinese toys with lead based paint, but STILL. Here's the LA Times report:
Regulators rethink rules on testing children's clothing and toys for
lead The Consumer Product Safety Commission gives a preliminary OK to exempt
some items from testing after complaints of hardship to thrift stores
and sellers of handmade toys.
By Alana Semuels
January 7, 2009
The Consumer Product Safety Commission has given preliminary approval to
changes in new lead-testing rules after complaints that the measures
could have forced thrift stores and sellers of handmade toys to dispose
of merchandise or even go out of business.
If formally adopted, the changes approved on a first vote Tuesday would
grant exemptions to last year's Consumer Product Safety Improvement Act,
which seeks to ensure that products for children do not contain
dangerous amounts of lead.
As currently written, the act would require all products aimed at
children 12 and under to be tested for lead and phthalates starting Feb.
10. Phthalates are chemicals used to make plastics more pliable.
Large manufacturers and retailers say the cost of testing will not be a
burden. But small businesses such as handmade-toy shops and thrift
stores say the requirement would force them to spend tens of thousands
of dollars to test products such as clothing, in which the threat of
lead is almost nonexistent. Many thrift stores said they would be forced
to stop selling children's clothing or close altogether.
The commission's two members (a third seat is vacant) voted tentatively
* Items with lead parts that a child cannot access;
* Clothing, toys and other goods made of natural materials such as
cotton and wood; and
* Electronics that are impossible to make without lead.
The commission also tentatively approved a rule that clarifies how it
determines exclusions from the law.
The vote opens up a 30-day public comment period that will begin when
notice of the rules are printed in the Federal Register. Interested
parties can find out how to submit comments by signing up to receive
e-mail from the CPSC at www.cpsc.gov .
No final rules will be approved until after Feb. 10, when the testing
rules go into effect.
That means retailers and manufacturers who sell untested children's
merchandise would technically be in violation of the new law starting
Feb. 10. Whether federal regulators will enforce the rules -- which
might entail inspections at thousands of secondhand stores and toy shops
across the country -- is another question.
"The CPSC is an agency with limited resources and tremendous
responsibility to protect the safety of families," said Scott Wolfson, a
CPSC spokesman. "Our focus will be on those areas we can have the
biggest impact and address the most dangerous products."
So I went to Snopes, and this outrageous and ridiculous legislation is for
real - and it is unfounded in reality - especially when you know how little
clothing and footwear the exceptions allo. And citizens are not allowed to
formally object until AFTER the law goes into effect. The only reason anyone
knows about this is because Consumer Protection is "considering" relaxing
the restrictions, which have no scientific merit in any case.
I signed up to comment when the agency grants the opportunity.
The "exception" under consideration would still ban (re)selling or
buying the huge majority of children's clothing items. This would effect
everything from thrift stores to grannies who knit baby sweaters and sell
them on eBay to garage sales.
It only allows pure wool, cotton, leather, felt, REAL velvet made with
wool or cotton instead of microfibers, suede, fur, silk, cashmere and
angora - plus lesser known "natural" fiber clothing to be exempted from lead
inspection. Any of which could have the miniscule, completely harmless
lead levels enforced here. These are exponentially lower than the
lowest estimate of any hazardous level of lead. Have you checked the
price of even The cheapest natural fiber (100% cotton) clothing recently?
All mixed fiber or non-"natural" fiber kid's clothes would be illegal
to buy or sell without costly lead inspection. This means all pajamas
for infants and children will be illegal to sell by any individual or
thrift store, since flame retardants are non "natural". All permanent
press, fleece,rayon, microfiber, nylon, acrylic, lycra and polyester
clothing would be illegal for thrift shops or family and small businesses
to sell. Most shoes and boots (including any with velcro closures), socks with
elastic so they will stay up, waterproof coats and snowpants, any gloves or mittens with
thinsulate, most hats and belts and all UNDERWEAR with elastic
waistbands instead of cotton drawstrings, metal zippers and snaps or
buttons made of ivory, wood, metal, stone, or bone. Even glass probably
isn't technically a natural material, since it is artificially created,
and plastic is right out. Indeed, any fitted wrist sleeves, wool and
cotton pants or sweats with elastic waist bands or polyester drawstrings
would be subject to inspection. Can you even begin to imagine the cost
of inspecting all of that clothing, or of legally clothing the under 12
crowd in your family with none of these fabrics available to you second
hand or for sale by a clothing maker you hire? And are diapers
considered clothing? Back to metal pins, metal snaps and non-plastic
buttons on those pure cotton diapers with wool as the only allowable
"waterproof" cover, and I can attest from wearing woolen sweaters in
rain storms that wool soaks all through relatively easily. I'm not concerned about
disposables or plastic/latex covers and toddler accident proof undies,
since I don't see them being handcrafted or resold. How about baby
swaddling blankets? are they clothes or bedding? And wouldn't you think
that metal fasteners are a damn sight more likely to contain trace lead
It's like some cultish cross between fanatic pushers of organic fibers
and Levitican Law observance being enforced by the federal government.
What's next, outlawing shrimp, crab, lobster and tuna? Or forbidding
women from living in their homes every menstrual period until they
undergo ancient Jewish purification rituals - and do we even know what
those rituals involved? Or outlawing visual arts and electronic media
because they are graven images?
This incredibly short sighted, expensive and stupid policy comes at a
time of economic collapse, with unemployment higher than any decade since
the Great Depression, when thrift shops will be more necessary than ever
for struggling families. Even WE routinely buy our kids' clothes at
Goodwill because they grow so fast and clothes are so expensive. And that was
before my job ended last month. We now qualify for subsidized housing because we are
officially low income (which would be nice to move to, if there were subsidized
apartments available in our county). I have no idea how we'll dress our
twins if this law goes into effect even WITH the exceptions. Despite
the fact that the agency could never actually enforce inspections due to
its small size, the legal obligation could still drive thrift shops out
of the children's clothes businesses, and possibly out of business
altogether as usually children's clothing and footwear represent at
least 50% of sales.
I urge everyone reading this who was ever a child to go to the
Commission's website and tell them to revise the restrictions in even
the present amended version under consideration. I'm going to strongly
suggest an exception for all second hand and small businesses or individuals
from ALL of the clothing restrictions. The level of lead here wouldn't harm
a Chihuahua,let alone a human child. What happened to science as the basis of such
regulation, instead of irrational panic?
Pallid Regina (grin) at has a fascinating questionnaire related to her thesis. I strongly encourage everyone who reads this to help her out with your thoughts. Here are mine.
1. Describe a fairy tale princess: what does she look like, what are her primary personality traits?
A fairy tale princess is always stunningly beautiful, with skin as pale as milk, petite and slender build, and evident extreme youth (barely pubertal, usually). Her primary personality traits are focused on a tabula rasa ideal - she is a blank slate without experience or opinions of her own. She is completely "innocent and ignorant." (Jane Austen phrase that I love - if you haven't already read it, check out _Northanger Abbey_'s first chapter for a brilliant mockery of the gothic "princess" ideal, which continues throughout this funny and charming novel.)
The fairy tale princess is perpetually sweet and obedient, even to those who abuse her, she is completely passive. She does not think for herself, but must be guided by others even in completely plain circumstances (think Snow White needing to be told by the pitying servant that she is an assassination target, although she is too beautiful for him to kill her directly as ordered). She is usually a single child and typically wealthy with a few exceptions, so she has minimal exposure to other people (siblings, and especially *male* siblings who might familiarize her with men destroying her innocence) and "real life" (the need to work for a living and ability to gain knowledge). She is a blissfully ignorant sexual commodity.
However, sometimes fairy tale princesses DO develop character. Cinderella is honorable. Snow White is actively kind and helpful. Beauty becomes non-judgmental and accepting of difference.
2. Describe any connection you feel, positively or negatively, to a fairy tale princess or fairy tale princesses in general.
As a very little girl I remember being impressed with the bling surrounding a princess. As a skeptical 10 year old I liked the Little Mermaid because she decided walking on knives for the sake of someone who didn't love her was bullshit, and sensibly returned to the sea where people DID love her. (In fact, when the Disney version that changed the ending came out I was FURIOUS, because it destroyed the entire point of the story.) Mostly I was a tomboy though and didn't have much interest. As a teen I fell in love with Robin McKinley's retelling of Beauty and the Beast, and as an adult with her Deerskin.
3. Which fairy tale princess do you relate to the most?
Cinderella - I was from a working class family and abused by my grandmother. I'm a slob and hate housework. I thought her fairy Godmother was awesome and wished I could have one.
4. Please describe why/how you relate to this princess the most.
I couldn't imagine wealth. Cinderella was actively turning the other cheek and not stooping to her stepmother's level. So she wasn't passive. She was trapped in abusive circumstances she had no power to escape, like I was.
5. What book versions of fairy tale princess stories did you/do you own?
I own Robin McKinley's _Beauty_ and _Deerskin_.
6. What movie versions of fairy tale princess stories did you see in the theatre?
Snow White, when I was very little. I enjoy both Cinderella and Beauty and the Beast as an adult. I hated the Little Mermaid movie.
7. What movie versions of fairy tale princesses did you/do you own?
Beauty and the Beast.
8. In what ways do fairy tale princesses represent positive female role models?
Cinderella, the Little Mermaid and Beauty, even in the original stories, represented honor, kindness, determination, recognizing and learning from mistakes, loving herself, overcoming adversity, accepting others as they are and prizing character over looks to the extent that she could choose a partner that others unjustly rejected.
9. In what ways do fairy tale princesses represent negative female stereotypes?
Where do I even begin?! Beauty = good, not beautiful = evil, dark skinned = ugly AND evil, mature woman = evil. Ignorance and passivity. Greed. Reinforcement of women as a sexual commodity rather than an independent beings. Real or pretended stupidity so as not to outshine the Prince, who is seldom an intellectual giant himself. Women as tricksters. Young = good, old = evil.
10. Would you/do you read fairy tale princess stories to your child?
I read my 7 year old twin daughter and son Cinderella sometimes when they were younger. I plan to introduce them to Mckinley when they are young adults.
11. Would you/do you take your child to see fairy tale princess movies in the theatre?
There aren't any, but we have a dvd of Beauty and the Beast that Katie likes to watch with me once a year or so. She's been too young for the jokes in "Cinderelly" but might be growing into them. I'll consider Ever After when she's a young adult. Teddy isn't really interested in any kind of fiction and never really has been. Even as a preschooler when he would make believe play he would stop in the middle to clarify that he was not REALLY a dragon or puppy or whatever, he was really still himself.
He stopped believing in Santa Claus when he was 4, and showed doubts even at age 3. We feared this would ruin his twin's Christmas, but Katie blithely disregarded his opinion about Santa ("You're just wrong, Teddy.") and continued to believe with all her heart until this year, when she made a smooth transition from Santa as a real person to Santa as a metaphor of generosity and love, which she believes in with all her heart.
12. Would you/do you allow your child to own fairy tale princess movies for repeated viewing?
I let my kids watch the ones I approve of with discussions of the ideas in the movies and how they compare to real life. They don't happen to want to see them more than once every six months to a year. They're at the slapstick age.
13. Describe your first memory of Cinderella.
I think Cinderella was my first introduction to social injustice, I remember being enraged by the treatment she got and loved the idea of a fairy godmother who could make everything right.
14. Describe your current opinion of Cinderella.
Overall I believe that Cinderella is a good portrayal of an honorable and hard working woman who overcomes adversity, both internally and externally. Traditional portrayals of Cinderella as good and deserving due to her sexual attractiveness and the Ugly Steps as evil and undeserving due to their lack of it piss me off, naturally. I emphasize the behavior and not the physique as "ugly" to my kids.
15. Describe your first memory of Snow White.
Loved her red cheeks and brown hair and primary colors dress - I was probably 3 or 4, so that's pretty much it. Oh, she liked to sing like I did. And the dwarves were amusing.
16. Describe your current opinion of Snow White.
She's an idiot who can't recognize danger when it's right in her face. Her calling is to be a servant to dwarves and reform them in a creepy way. Wouldn't actively introduce it to my twins and if they saw it I'd want to talk about the assumptions and implications in the movie.
17. Describe your first memory of Sleeping Beauty.
It's vague I think I only read it once in first or second grade. There was nothing in it to appeal to me at that age.
18. Describe your current opinion of Sleeping Beauty.
This is a straight up sexual allegory involving "malevolent old woman curses baby" and a conquering/hunting/possessing man "saving" the ultimate passive child-bride. Repulsive. I don't think I know anyone who would show this to my kids, but it would piss me off and prompt a discussion that I could probably not resist turning it into a lecture. With the friend first. :)
19. In what ways do you think fairy tale princesses are still relevant in today’s society?
They accurately reflect the patriarchy that still exists, with women as a sexual commodity and men as owners/buyers/determiners of which women go for the highest price. See also racism, ageism, looksism, classism... They're an excellent introduction to what is wrong with that kind of thinking.
20. What else would you like to say about fairy tale princesses?
They are typically nasty, petite and brutish representations of racism, sexism, classism, ageism, pedophilia and a host of other social ills.
On the other hand, several of the traditional princesses appeal to me precisely because they break the mold (albeit not completely), providing important and positive lessons, and/or modern retellings turn them to good account.
Little Mermaid - don't sacrifice or change yourself trying to make someone love you because it's a self betrayal and won't work anyway, choose the people who DO love you over romance.
Cinderella - mean people can imprison your body, treat you harshly, and force you to work for them, but they can never own your spirit and dignity if you don't let them, and good people exist who will love you as you are.
Beauty - form your own opinions of others based on character and not appearance or reputation, choose partners to your own liking and ignore prejudice against those partners.
21. Would it be OK if I asked you follow up questions on your responses?
1. Do you identify as male or female?
2. What is your age range (under 18; 19-25; 26-30; 31-39; 40-50; 51 & older)?
3. What is your ethnicity?
White mutt - obviously our families immigrated here at some point, but nobody keeps track of who, where, or when. At a guess based on the degree of generational knowledge loss and the Irish, Dutch, English and German surnames involved I'd say some time after the Civil War but before the 1880's. My dad's dad was born in 1898 and his parents weren't first generation immigrants. My mom's grandpa was an American WWI fighter pilot and barn stormer after the war, which was kind of the James Dean of the Twenties. Great grandma Ruth's parents did NOT approve and they essentially had a shotgun marriage after she came home after ten o'clock one night. Their wedding photo is one of the most beautiful, happy pictures I've ever seen and they were lovebirds right up to my great grandpa Charlie's last breath.
4. What social class do you identify with (poor, middle class, upper class, etc.)?
Both working class and middle class.
5. What country do you live in?
When training doctors are taught science involving research rather than memorization at all, it is usually epidemiology, which can NEVER establish anything more than a *chance* that there might be a statistically significant correlation between one thing and another. Correlation can never establish causation at all (Did you know that over 80% of child rapists drink water?! See what I mean? Correlation never implies causation.) This is the kind of study all over the news that makes people think that eggs are a wonder food one decade and a Silent Killer the next. BTW, when the correlation is lower that 200%, it means there is no relationship between the studied factors better than chance.
So, "Men who ate kiwi fruit more than twice a month were 198% more likely to have their penises shrivel up and fall off." means exactly the same thing as "Men who ate kiwi fruit more than twice a month were no more likely than other men to have their penises shrivel up and fall off." So feel free to ignore any such media "proof" that there is a magic food or diet. There isn't. We're omnivores who have lived on every possible type and range of foods. Actual malnutrition syndromes like beri beri or scurvy, and toxic exposures as with lead poisoning from food storage jars painted inside with lead based pigments are the exception, not the rule.
Epidemiology is a perfectly sound scientific method: it identifies out of the endless range of possibilities which correlations *might* actually have a causal relationship, and warrant a true scientific test with controlled diverse populations, double blinded so neither researchers nor participants know who gets what. And even when a cause and effect relationship is established in that test, the direction of cause and effect is not established. To do so we must do another true test with proper methods.
There are many things we truly do not know, and it's not malpractice to do your best to treat people with illnesses based on existing observations, even if they are technically guesses and hunches. Qualitative research is just as important as the above quantitative methods, because they can yield important "your mileage may vary" case evidence about individual differences and group differences that can't be quantitatively captured. Quant research can only reflect populations and are biased toward the average - evidence for outliers or any other individuals can't be adequately captured.
Studies linking BMI to cancer in populations can't yield any information at all about an individual's risk of getting cancer based on her BMI. Medical practice is not currently scientfically based for the most part, even when there's good evidence.
For example, in reproductive medicine there would be essentially no episiotomies or circumcisions performed in hospitals if medical practice were truly scientifically based. Episiotomies (cutting the vagina with a scalpel to make more room) CAUSE vaginal/labial/anal tears 90% of the time and worsen them when cut after a tear starts, while outcomes for the babies are just as good for the the mothers without episiotomies, meaning that episiotomies aren't "saving babies' lives". Circumcision has no scientifically significant health benefit at all, it's basically just a cultural genital mutilation ritual. (Which is admittedly up to the parents, many of whom don't regard it in this light.) Some obstetricians simply won't believe the science on either common practice because their approach to medicine uses faith based thinking rather than scientific thinking.
Faith based thinking is wonderful in the proper context, of course. But it has deadly results when used in medicine, where the faith based belief that fat people are less healthy because of their own moral turpitude, the "fact" that they are chronically non-compliant pathological liars because they report that they followed treatment but did not lose weight and that they are less deserving of care because they are perceived as (these are quotes from medical professionals) "repulsive" and "lazy" and "sloppy" and "lacking in self control." If fat people lived morally upright lives eating less food than the WHO and UN call starvation levels, they wouldn't be fat, and moreover they would enjoy all the health benefits that malnutrition brings. Like the scurvy, beri beri, and brain damage caused by malabsorption of necessary nutrients.
Chemo dosing key to ovarian cancer survival in obese women
Monday, January 05, 2009
News staff writer
Adjusting chemotherapy doses so they are consistent with body weight appears to eliminate higher death rates that have been found among obese women with ovarian cancer, according to a new UAB study.
The study compared survival rates between obese and non-obese women with ovarian cancer.
Earlier studies had found that obese women with ovarian cancer were likely to have shorter survival times than non-obese patients with a similar type and stage of ovarian cancer.
The new study, which is being published in journal Gynocology Oncology, found no statistical difference between obese and non-obese patients who underwent similar surgeries and were given chemotherapy based on their body weight.
"Often chemotherapy dosing is calculated using ideal body weight as a guide," said Dr. Kellie Matthews, an OB/GYN at the University of Alabama at Birmingham and lead author of the study. "We found using actual body weight works best, and it wipes away much of the difference in survival rates between obese and non-obese patients."
Researchers looked at records from 304 patients diagnosed with an aggressive form of epithelial ovarian cancer, and showed that when actual body weight was used in chemotherapy dosing the overall survival was 40 months for non-obese patients and 47 months for obese patients - statistically identical rates when considering the relatively small size of the study.
This life-and-death medical need to dose by the actual woman's actual weight has been known for YEARS with respect to breast cancer. A cancer, I might add, that exists mostly in fat tissue, making dosing based on "ideal weight = lean mass content" less tenable in the first place. Even if muscle absorption vs. fat absorption differ, an ignorant guess/assumption that fat does not absorb chemo meds at all is uncalled for. Doctors persist in dosing fat women inaccurately, despite controlled, double blinded research showing that mis-dosing of chemo is both killing fat people and leading to the assumption that being fat, and not widespread malpractice, is why high weight is linked to cancer deaths.
And practicing medicine without basing it on sound existing science IS malpractice. Yet most med schools teach next to nothing about research and interpretation of it. The "science" classes involve identification of structure and function, a rote memorization of information, which has little to do with the complete scientific method.