On Mental Illness

I have once again risen from the the ashes to create another post. Only read on if you wish to know about the crazies.

So I have started my psychiatry rotation. Once again, I am at the veteran's hospital, only now I am in North Little Rock, a nice half hour drive twice a day. Granted, I know some make much long commutes daily to and from their jobs, but I think they too fall in the crazy category. Starting on January 7th, I did three weeks of outpatient clinic where I saw patients who mainly suffered from depression and/or PTSD. I saw a patient who was at least manic, if not bipolar, who denied his condition despite a recent episode of wandering neighborhoods all night and hiding in peoples' bushes. I saw a schizophrenic in clinic who, while currently well controlled on antipsychotic medication, continued to report the voices of demons telling him he was the son of Perdition and the Antichrist. Those two together are a might heavy charge, if you ask me. Now, and for the next two and a half weeks, I will be working with the patients who are committed because they are super crazy, are super depressed, or have super PTSD symptoms. So I currently have a schizophrenic patient who is NOT well controlled on his medications. His retard Christian Evangelist born-again psychologist, likely from the hills of Deliverance, told him to stop taking the meds as they were causing his diabetes. While this may be true, it's better to have easily controlled diabetes than psychotic symptoms requiring hospitalization. He came in, self admitted, with grandiose delusions about how God worked through him in such a way that he was to communicate with high religious figures to spread information about the Antichrist. Again, a crazy claiming connection to the bringer of everything evil. Is there really a connection? He also thinks the police and millions of others are constantly surveilling him, just waiting for him to slip up and say the name and whereabouts of the Antichrist. It's him and "his people" versus the rest. I haven't yet asked what side I am on for fear of my life. He also sweats blood, much like Jesus and the apostle John, and doesn't want meat even though he knows animals are God's gift of meat to us. More medications, I say.

I would also like to bring up something educational. I saw to patients receive ECT, or electroconvulsive therapy, this morning. Let's dispel some Hollywood misconceptions, shall we? ECT does deserve its criticism, IF YOU LIVE IN THE PAST! It used to be a very barbaric procedure, and overused, such as we have seen as follows:

Jack Nicholson in One Flew Over the Cuckoo's Nest

Or, more recently, this one:

Ellen Burstyn in Requiem for a Dream



Notice, these people are awake and either strapped down or several people are holding them down. This is so far removed from the case of today, it's hard to imagine a time like this. Now, people are under full anesthesia, intubated so that they may breathe, and have been given a paralytic agent so that the induced seizure doesn't cause physical harm or kidney damage. The seizure lasts between thirty seconds and two minutes, ideally, and the only indication of its presence is an EEG (a machine which monitors electrical activity of the brain) and a seizing foot. The physician puts a blood pressure cuff around ankle to keep the paralytic agent out of the muscles of the foot to give the team a physical indicator of seizure activity. There may be some facial grimacing as preventing this would require far more paralytic agent. When the procedure is done, the paralytic agent is reversed with another drug, the patient is woken up and extubated. Simple (and boring) as that.

To be fair, here is a link to a pamphlet opposing ECT: http://www.antipsychiatry.org/ect.htm

There are MANY things wrong with this pamphlet. First, the website itself. I at first thought this was by a Cruise-lovin' scientologist based on that alone. Nope - it's a blood sucking lawyer, perhaps even worse. Second, he quotes books and articles dating as far back as the 30's up to the nineties, with a few updates at the bottom. Outdated information is a sign of poor research. Thirdly, amongst all his listed sources and recommended readings, ALL are opposing pieces. A well-written stance provides information from both sides. Now, there are some M.D.'s out there who also oppose ECT - psychiatrists in fact. Fair enough. But since when does any psychiatrist know an inkling about how their treatments really work? Fourthly, the "author" uses more quotation marks than Lisa Ramsey on a crack "binge" - simply "annoying." Sure there is some short term memory loss - as in they might forget the morning of the treatment, maybe the day before hand. Any more than that is exceedingly rare. Sure they may be in a trance for a bit after the procedure, but so are most seizure patients. It's called being in a post-ictal state, and it always passes without harm. There is no good evidence for permanent brain damage, especially since chronically depressed patients, the only patients in whom it is used, likely have brain damage anyway. It is NOT used as a scare tactic for patients - that's just crap. All the patients I have seen involved in it chose to do it on their own accord, and it's a rare enough procedure that the possibility of them being scared into it by others is highly unlikely, if not impossible. Here's what ECT IS:

1. More effective than taking a pill every day.

2. A VERY good option for those who have recurrent, severe depression unresponsive to other medications.

3. A last resort.

4. It can, and does very well, turn this:

In to this:

So there you have it, my standing on ECT. Just thought I would dispel some common myths about it. Soon, I will give my standing on the presidential candidates based on their standings on health care issues. Our good friend connection in Chicago, Carrie, hasn't yet reported on individual health care opinions, and I need to be informed. I fear for the future of medicine.

Belated

Fireworks from God only knows where, or to celebrate what year; but New Year's fireworks just the same.



So I'm about two months behind on blogging. I have little to blame except for myself, the surgery rotation, board exams, Christmas, New Years, family, the Wii, Rachel's need for attention, Cali's need for attention, etc., but nothing else. It really has been a busy time aside from the past week and a half. So, what's been going on?

Let's begin with surgery. It's over, long over in fact. I had fun, liked it a lot, didn't really mind the long hours, and met people in whom I instill trust to one day write for me a letter of recommendation used to land an awesome ophthalmology residency. Don't want to get ahead of myself, though. Plastic surgery taught me more about wound care than I cared to know - I saw some deep, nasty looking wounds. Vascular surgery was less than exciting, but this lies merely in the fact that the attending was gone for most of the first week, and the second week was in alignment with Thanksgiving. These all added up to not much to do for two weeks but sit around and wait for evening rounds. My four weeks of "general" surgery at Children's was fun, although I didn't want to do any clinic. I guess I just hoped to go for eight weeks without any clinic, it being surgery and all. I did see some impressive childhood tumors, ones that required two adult hands to hold and looked like big balls of pulsating goo. They had dedicated blood vessels larger than the ones that supplied their little arms. It's amazing to think that many of these childhood cancers have a better prognosis than many of the smaller adult cancers. I asked one of my surgery attendings there if he could write me a letter when the time came; he was glad to oblige.

The holidays came and went, much as they do every other year. Families were seen, gifts were exchanged, as were household common colds, and Cali was left home alone yet again for what seemed to her like years. We came back to critter who wanted us to believe she was a gray old hag. Hag maybe, lazy for sure, but not gray or old. I got a Wii for Christmas. I have played it ALOT, as has the Mrs. But she spends more time toying with the Sims and finding a new job than she does with the Wii. I, on the other hand, just wish to sit on the couch and try my hand at another (totally scientifically inaccurate) surgery. Good one, Mon. I've also been reading Life of Pi, another gift I got from Monica, even if it was given last year. Oh, and she also got us all tickets to the Trans-Siberian Orchestra. It was a show as much about lights, lasers, and fire as it was about music. What's in store for next year? Does she perhaps have something in store for the next holiday, MLKJ day? Only time will tell.

I am on call starting today for my job. That's right, the job I acquired back in AUGUST, I am finally going to make some money with. Oh, and help save some peoples' sight. Maybe I will get some sleep, maybe I won't. The great thing is, if I don't get much sleep, I am still off from school until Monday, and I'm not on call from 8AM to 4PM, so plenty of nap time.

Well, I really don't have much else to say. You've heard all about Rachel from her blog, I'm sure. Anything else I might have to say is not rated for this public blog.