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False advertising

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Peel Health Campus is a private hospital providing some public and private medical services to people of the Peel region. In recent months it has spent a huge amount of money on PR campaigns such as the one above, plastered all over the Transperth train network starting in October 2012. Local newspapers are full of stories singing praises to this wonderful institution.

But they’re not pulling the wool over my eyes. My wife and I have been right in the middle of two cases of clinical iatrogenesis at Peel Health Campus (PHC), both of which were traumatic, and we know they were the results of fundamental issues in management and funding.

Others have been even closer to the action, and we have heard many horror stories. Recently, the Chief Operating Officer at PHC, Ashton Foley, took the courage to blow the whistle against this hospital, resigning from her position. She has been harassed as an attempt to shut her up, but the resulting enquiry has revealed some shocking information:

Peel Health Campus scandal

We have nothing against the staff of this hospital, although many need to stay more up-to-date with current medical knowledge. It is the management and economic model that are at fault here, and give us reason to mistrust the services provided by PHC.

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Posted by on November 9, 2012 in Life

 

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Voices

I studied schizophrenia this year at University, and wrote a fairly lengthy literature review on the subject. I learned about auditory and visual hallucinations that fall under the umbrella of psychotic experiences, and it made me wonder how some of my experiences sometimes resembles those of people with schizophrenia. The idea is that mental illness is not something you either have or don’t have, like a switch on an electrical appliance turns it on or off, but that your mental health is a dimension or continuum, and your symptoms vary from one end to the other. How far you are along that dimension determines to some extent how well you can cope in daily life. If you can’t cope, you tend to get diagnosed with a disorder and receive treatment.

The rest of us have some symptoms that can sometimes be a bit unsettling, but with which we tend to live quite happy lives. Having just experienced one of these psychotic experiences, and realising that it happens quite often, I thought I would write about it.

Jonathan Keegan -- audio hallucinations

Oh no... Must have forgotten my tablets again!

Sometimes when I’m really tired and trying to concentrate on reading something, I tend to doze off to sleep. This usually happens gradually, and sometimes I become aware of “noise’ starting to crowd my thoughts. Sometimes the noise is made up of conversations I’ve had during the day, which I’m either replaying in my mind or continuing. Sometimes there’s some music as well. I never experience them as coming from “outside” my mind, so in this sense it’s quite different from what people with schizophrenia go through.

The unsettling part is that the noise sounds quite confusing and sometimes gets a bit overwhelming. The nice part is that I can snap out of it very easily. About 5 minutes ago I did just that. I was dozing off again, I became aware of this internal noise which included some annoying conversation or negative thought, and I woke myself up with the thought: “that’s enough, quiet now”. Instantly the noise disappeared, and I could once again hear the soft sound of my computer’s fan, the peaceful snore of my 18-month-old boy in his bedroom, and could feel the tranquility of the night.

Another interesting thing happening while I doze off is that I tend to think about what I just read, then my mind goes into a sort of autopilot, approaching what I just read in novel ways, problem-solving, exploring alternatives etc. Sometimes, the things I did or heard during the day become new problem-solving strategies, and this can result in funny combinations when I become aware of it.

For example, every Tuesday I play badminton for 2 hours straight. During the rest of the day, if I’m reading a book or something else and I doze off a bit, I’ll have vivid images of badminton situations flash into my mind. Sometimes they are so vivid that I get a nervous reflex causing me to flex my arm. At other times, as it happened tonight, I’ll be thinking about what I’m studying in “badminton” ways. I might be having an internal argument with someone from Church or University, and each retort will show itself as a raquet hit on the shuttle. I usually win the argument by smashing the shuttle really hard and feeling quite good about it 🙂 It’s very difficult to put into words, because it doesn’t make much sense to the conscious mind.

The same thing used to happen when I used to play chess. In my semi-conscious state I would often approach newly learned material with chess strategies, even if the two were completely unrelated.

This has even happened quite a few times with music, but in a reverse way. I would be listening to a piece of music in a comfortable chair or in bed, closing my eyes, when I entered into this semi-conscious state between wakefulness and sleep. Then, the music would start taking a meaning related to the events of the day, and my thoughts would start organising themselves around the music. At times I would have a feeling of sudden insight, or a strong emotion, but as soon as I woke up from that state, I could no longer make sense of it, even though the pleasant feelings linger for quite a while.

These kinds of experiences are difficult to share or even to think about, because our mind tends to shut them down or push them away as “silly” or embarrassing. That is a healthy mechanism to help us stay psychologically balanced, but every once in a while it’s good to be able to reflect on the kinds of experiences “healthy” people have that are in common with those of people with severe mental health illness. However, one thing I do not share with them is the suffering, distress and sometimes horror through which they go. I had a brief taste of this recently in one of the very few nightmares I have.

I was dreaming about my son Joshua, and suddenly his teeth grew long and he started snapping his jaws at me with a sort of evil look on his face, while I was holding him at arms’ length. It woke me up, and although I wasn’t particularly horrified by it, I did find it quite scary. Then I remembered having watched a video of what people with schizophrenia potentially experience (through sight and hearing), and I shuddered at the thought that I might experience this kind of “living nightmare”, not being able to discern between reality and the hallucinations. Truly frightening and sobering!

 

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Self-care for psychologists

OK so today we had a very interesting lecture for our unit “Preparation for professional practice”. The lecture was called “Self-care for therapists“, and was presented by Dr. John Manners, a clinical psychologist who has been practicing for an amazing 38 years, and doesn’t intend on retiring. He apparently loves what he’s doing, although he almost seemed to try very hard, during his 3-hour seminar, to dissuade us from pursuing this career path…

Empathy can be harmful

Empathy can be harmful

Basically, he started his presentation by telling us that any good clinical psychologist will be negatively impacted by their work, because the therapeutic nature of our services depends on our ability to empathise with our clients. This means that we must feel what they are feeling. The problem is that many of our clients are feeling truly horrible things, and some of these things are even deeply traumatic. If we want to help them, we must literally experience what they are experiencing. How do we do that without getting permanently injured in the process? John had a number of great tips for us.

The first category of advice was about managing the work.

  • Titrate the processing of trauma: since most therapeutic approaches involve some sort of exposure to a feared object or situation, we must be careful not to cause our client to be re-traumatised. Instead, we must help them to re-live the trauma in small, manageable steps. This also means that we, as therapists, can deal with it in small steps.
  • Remain emotionally connected: successful therapy will never be administered by computers or by therapists who behave like robots. It is essential to be emotionally present.
  • Maintain a separation between self and other: even though we must feel what the clients feel, we must not identify or merge with them. We must not take their load on our shoulders. This is their therapeutic space, their story, not ours.
  • Have clear boundaries: we’re a team, but we’re not friends. I’m the therapist and you’re the client, I facilitate your healing using compassion and empathy, but this is still a professional relationship.
  • Timing and spacing of difficult clients: some clinical psychologists see up to 8 clients a day, for nearly an hour each. It’s essential to spread out those that are particularly challenging and emotionally draining. If you’re a morning person, have your tough clients in the morning.
  • Have a symbolic way to “finish” each session: takes notes, put the files away etc. Don’t take any work home, and find something “normal” to do when you get home, so you can get back in touch with the good old mundane.
  • Debrief before going home: after some particularly challenging sessions, it’s essential to debrief with a colleague. You discuss the case, exchange ideas, share your feelings, and engage in a bit of therapeutic exchange. Don’t leave anything undigested to ruminate overnight!
  • Keep responsibilities where they belong: as a therapist, I’m not responsible for my clients’ healing or safety, they are. I’m just a facilitator, helping and inviting my clients to change. If they don’t change, I’m not responsible.

The second category was about managing ourselves:

  • Challenge your idealism: Your view of the world should be somewhere half-way between utter cynicism and naive idealism. Either extreme is unhealthy and not conducive to therapy
  • Have realistic expectations of yourself and others
  • Monitor your internal pace: if you tend to be a sprinter, convert to a marathon runner, be aware of compassion fatigue.
  • Enliven your personal life: do intrinsically fun things in your own time (play with children, exercise, listen or play music, express yourself artistically etc.)
  • Maintain intimate relationships and close friendships: don’t let the austerity of your work contaminate your relationships.
  • Obtain frequent supervision, no matter your current expertise and experience. It’s a requirement of the profession, but do it because it’s the right thing to do, not because it’s required
  • Obtain personal psychotherapy: to increase insight, resolve childhood issues, identify barriers to self-care etc.
  • Have a healthy sense of self: “I’m OK”, not “I’m better|worse than such and such”. Ask yourself the questions: “What am I? What defines me? What am I not?”. Find three things that represent who you are as a person. Know yourself, otherwise you can’t help others discover who they are and be satisfied with it.
Although I didn’t agree with all of John’s opinions (I think I could have a great discussion with him about positive psychology), he really impressed me as a person. I think I have a lot in common with him, and probably just as much not in common 🙂 I learned a lot from that lecture, that’s for sure!
 

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Hypoglycaemia

What goes on in someone’s mind when they go through hypoglycaemia? Would you like to find out from someone who is actually going through it while he types this post?

I have type 1 diabetes. I usually manage it really well, with the occasional bump in the road. Picture in your mind a tightrope walker. Survival is all about keeping the wobbles as small as possible. Once a wobble begins, if it doesn’t get under control, it amplifies exponentially and becomes increasingly difficult to bring under control. Any corrective step necessarily brings you into another “spike” as you gradually reduce the amplitude of your rope’s wobble.

It’s a bit like that for type 1 diabetes, and that’s what happened to me just now. I have had a bit of a cold for the last few days, and this typically increases blood glucose levels, requiring more insulin to be injected. I didn’t take enough insulin, which caused my blood glucose to spike last night. I then took extra insulin, but took too much, so now my blood glucose is too low, and that is called hypoglycaemia.

So how does it feel? Apparently it’s different for each person, and it even varies for each individual from one “episode” to another. Generally, these are the effects:

  • If I’m asleep when it happens, I wake up. As far as I know, that is always the case, and I’m very thankful for it!
  • My heart starts pounding very hard and slightly faster than resting pace
  • I start sweating profusely. This always happens if I get very low, and can be very uncomfortable
  • A feeling of urgency begins to grow in my mind, and becomes increasingly powerful as the minutes elapse, but sometimes it goes away even though my blood sugar is still going down.
  • I tend to become irritable
  • My thinking becomes muddled. Rational thinking becomes difficult, and I have at times rejected advice to eat something to get back up and going
  • I sometimes get a patch of “light” in my field of vision, bad enough to prevent me from driving
  • After a few minutes of getting up, my appetite just goes through the roof, and doesn’t go down until a good 10 minutes after I’ve started eating/drinking something with sugar. This, in combination with my inability to think straight, often leads me to overcompensate my eating, leading to another blood sugar spike later in the night. This happens slowly enough though, that by that time I have had enough common sense to take slow-acting insulin instead of fast-acting.
  • I feel a great weakness in my legs and arms, a bit like after I’ve cycled really hard for 20-30 minutes straight
  • If I don’t do anything, I lose consciousness and can even go into epileptic seizures. This has only happened twice, and only once with seizures. Don’t try this at home…

After the time it took me to write this article, I am no longer in hypoglycaemia, most of the symptoms have disappeared, and I am ready to go back to bed. The food was nice, I have to admit, but it’s a poor excuse for a midnight snack!

 
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Posted by on March 27, 2011 in Life

 

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Peripheral Neuropathy

Onset of type 1 diabetes

Back in the winter of 2003, one very cold night in a tin shed in Donnybrook, Western Australia, I suddenly awoke with a dry mouth and a terrible urge to drink water. This happened about three times that very night, with a very pressing trip to the toilet before another large drink of water. I didn’t know what was happening to me.

This pattern continued, night after night and throughout the day. My initial conclusion was that I felt thirsty because I had a dry mouth, and that all this water was making me go to the toilet all the time. I thought I had a dry mouth because my nose was always blocked, and I breathed through my mouth.

I lost weight rapidly, from about 90 Kgs to 75 in a few months. I was ecstatic! I had always struggled to lose weight, and all of a sudden it all came off without any effort on my part. In fact, I continued to have a very unbalanced diet, very unconcerned about nutrition or diets: no matter what I ate, my weight remained constant at 75 Kgs.

A few times I worried that this constant thirst and need to urinate were abnormal (I drunk and eliminated up to 5 litres a day!), but it never occurred to me that I had diabetes, and that I had it bad. I felt great!

Diagnosis

In July 2006, while working at home as a computer programmer, I started to get Repetitive Strain Injury in my fourth finger of the right hand (the finger that pushes left against the mouse). The second knuckle was extremely swollen and painful, and I decided to go see a doctor, something I hadn’t done for about 4 years. While I was at it, I chose to check my cholesterol, my blood glucose and a few other things that should be checked periodically.

As soon as the lab results were in, I received a call from the doctor, who expressed concerns that I may have diabetes, since my fasting blood glucose was abnormally high. I did the usual analysis to confirm such a diagnostic: HbA1c, the average concentration of glucose in the blood over the last 3 months. I can’t remember how high mine was, but it was way too high.

So the diagnosis was confirmed: I had diabetes, and it was of the type that requires insulin injections, constant monitoring and a drastic change of lifestyle.

I received the news with mixed feelings, but shock, horror, anger or bitterness were certainly not among them. I have an outlook on life, mainly due to my religious convictions, that helps me to look any new challenge as an opportunity for growth. I knew I had an unhealthy attitude and relationship towards food and health in general. I thought that this was a chance to educate myself and take control.

The new symptoms

Soon after the start of the insulin therapy, a series of very disturbing and painful symptoms appeared:

  • Excruciating, sharp lancing pain in the parotid glands whenever I salivated
  • Cold sweats and interminable shivers
  • Continuous bruise-type pain in the arms, shoulders, thighs, back, belly and hips
  • Sparodic sharp pains in the same areas
  • Hyper-sensitivity to the slightest changes in temperature
  • Difficulty in concentration
  • Affective symptoms: irritability, mild depression
  • Asthma-like symptoms, with very little relief given by Ventolin

This was very disturbing, especially since the nurses and doctors who were available to me, and who “trained” me to my newly found condition, expected me to feel a lot better after my blood glucose was brought back to normal. Their eyes sort of glazed over when I said I felt much worse, and they would generally ignore what I said and tell me to keep at it and I would feel a lot better.

None of them knew what I had. Even a diabetologist in Bunbury had no idea, and apparently didn’t even consider the possibility of diabetic neuropathy. Of course, I had no idea either, and nothing the doctors prescribed had ANY effect!

It was becoming difficult to eat, difficult to work, difficult to do anything. I felt helpless, completely unable to determine what was wrong with me, and unable to find help. I think that the affective symptoms were mostly a result of this helplessness.

First diagnosis of neuropathy

After about 5 months of agonizing uncertainty and helplessness, I finally found a medication which, strangely, completely erased ALL of the symptoms I described above: tramadol. This solution came after doctors tried a number of different pain-killers, and this was almost their last resort.

The relief was only partial though, because I was now completely dependent on a new medication, and I still didn’t know why I had these symptoms. I ventured into the obscure world of Internet self-diagnosis, and mislabelled my condition as “Sarcoidosis”, but I was completely off the mark.

About a month later I managed to see a neurologist in Perth, West Australia. He performed a clinical examination and announced that I had diabetic neuropathy. He was shocked that my diabetologist hadn’t even considered it, since it was rather common. To her defense, I have to say that neuropathy usually develops after many years of untreated diabetes (20-30 years). The damage to the nerves is very slow and gradual. However there can be additional factors which combine with the elevated blood glucose to damage the nervous system much more extensively in a much shorter period of time.

I was so ecstatic to finally know what was wrong with me (or so I thought) that I didn’t realise that this neurologist had only performed a very superficial examination (pricking my toes and fingers, testing reflexes with a hammer etc…) and hadn’t offered any suggestions for a cure other than: “The body doesn’t like sharp rises and drops in blood glucose. If you keep your glucose level stable, your nerves may heal over time and these symptoms may disappear.”

Second diagnosis

About a year later, this time in France, one of the doctors I saw was surprised that I was taking tramadol, and first suggested that I lower the amount I was taking, to reduce the risks of long-term dependence. I lowered it from 300mg a day to 200mg, without any noticeable problems. Just in case you’re wondering what happens if I stop taking it altogether, it’s quite simple: the symptoms all come back, one after the other!

A few weeks later I finally saw a neurologist who seems to know his field. After the initial clinical examination, he went on to perform some nerve conduction speed tests using electrodes, and an electromyography (EMG). It was far from comfortable (especially the large jolts!), but he obtained some results which he interpreted easily: he declared that I had a specific form of neuropathy. I don’t remember the exact diagnosis, but I will ask him next time I see him.

He told me to stop taking tramadol, which was not specific enough for my condition and could lead to dependence. Instead, he prescribed Lyrica. He also prescribed a number of blood tests, which I am yet to organise. They mostly explore different anti-bodies which may be attacking my nervous sytem. If nothing is found in these results, he said he would likely prescribe a lumbar puncture. Here’s a link to a video if you’re feeling brave.

After looking at these horrible websites, I wasn’t overly excited about the thought of having a huge needle inserted into my spine, but I knew it could be the answer to so many questions. Accordingly, I went to the hospital, and Dr Hinault himself performed the procedure. It was done in 5 minutes. The sensation was like a constant electric discharge in my lower back. Quite unpleasant, but not painful. I later learned that this was very similar in sensation to an epidural, so now I have at least some empathy for mothers giving birth 🙂

Unfortunately or not, the tests revealed nothing in my spinal fluid, so to this day I still don’t know what caused my neuropathy. The good news, however, is that after slowly taking less and less Lyrica, I have now stopped taking it entirely. I have nearly none of the symptoms I described above, except some light tremors in stressful situations. I often wonder if I have the condition at all anymore, I guess my nervous system must have slowly fixed itself. Isn’t the human body incredible?

 
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Posted by on December 3, 2009 in Life

 

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