Mostly everyone who knows me knows I love performance of “funny” things, had a brief run as a stand-up comic, all of that. But once when I told one of the nurses who I had been working with that I wanted to learn more about “clowning” — meaning classic clowning, costume, makeup, like at the circus — it was plain from her facial reaction that I had struck terror into her. She stammered, “I hope you are not going to do any of that stuff here. I am really scared of clowns. I ran away from one when I was little and clowns still make me really uncomfortable.” Of course I told her I would not do anything that could scare her. I have to admit this affliction was unknown to me in the world of psychiatry. I guess it just isn’t anything anybody would come in and request treatment for, at least not yet. I suppose they would just avoid circuses.
They call it coulrophobia, and it is allegedly ranked among the top ten most common specific phobias by somebody, although I certainly could not find it in any such list. I have never seen a patient who came in with this one as the chief complaint, which means people probably see some kind of non-medication prescribing health professional if they see anyone at all. I mean you can find people on the street or among your friends who are uncomfortable around something — fear of spiders or fear of open spaces. Those are far more likely to be in the top ten.
Read more on Fear of Clowns…
Filed under Diagnosis by on Dec 7th, 2010. Comment. 
Of all the trials and tribulations we can suffer in life, none is so devastating as the loss of a loved one.
Unfortunately, we will all eventually suffer such a great loss and the grief that it brings.
Believe it or not, a properly trained professional can help minimize the grief and help those sufferers to cope. Much of this horrible experience can be truncated, if not removed, by people who know what they are doing.
But it seems that most people don’t believe this, and some people will never learn. Read more on No Need To Suffer Through Grief — Get Help!…
Filed under End Of Life, Family by on Aug 26th, 2010. Comment.
People in an Australian study would rather have a pill than agree to eat chocolate daily for a chronic heart condition.
Some people have an idea why, but I will tell you the truth and the light.
After 30 years of practicing medicine in three different specialties, in three different countries, and in every kind of clinical situation anyone can imagine, I have come to a realization.
No matter how pleasant or non-invasive the alternative methods proposed, people want to just take a pill and get better. Read more on It’s Time For Your Daily Dose Of Chocolate…
Filed under Alternative Medicine by on Aug 17th, 2010. Comment.
I can barely remember when getting on a scale meant a “good” thing. It was about the time of age three or four. I was “growing,” so my height got measured every once in a while, too. Putting on weight was “healthy” growth.
The next time I heard the word “healthy” used in that manner was when my husband’s grandmother of blessed memory, who was quite nearly blind, put her hand on my thigh, and slapped and felt it in the way older women are justified to do, and said “I am glad you are a healthy girl.
Some time not long after that first time that putting on weight was good, it changed suddenly and completely. My mother did not see the contradiction that I told her about. I had to clean my plate. That was told me unequivocally everytime I sat down to eat. But when I was weighed, I was getting fat and it was bad. She acted as if she were totally blind to what to me was, even then, a stupid and obvious contradiction. I have since decided that the customs mothers live and pass on come from some mystical realm of logic, and have less to do with anything akin to reason than they do with some sort of mindless revelation validated by repetition and mimicking, probably of her mother, and so on back through an infinity of Jewish mothers. Not that I think this experience is particularly Jewish, or particularly ethnic in any way. If the patients I have seen (as well as the friends I have had) over the years are any indication,such messages about weight in general and the relationship of weight to food are as ubiquitous as air. Read more on Women+Weight+Scales=PANIC!…
Filed under weight by on Jul 23rd, 2010. Comment.
The first time I found out about neuropathic pain, it was not even mine.
I was living in Amiens, above a cafe, and had adopted the boss, the patronne, as a surrogate mother. I came home late from a laboratory class one night and I tried to figure out what I was looking at with a dim light only on in back. I found this 80 year old woman in the back room with her blouse undone and an older man apparently angry at her pointing his finger. I ran in and asked him to identify himself, as I was concerned for Madame, and there was apparently some difficulty. He was nearly as old as she and they were both laughing heartily indeed. That is how I met this noble “docteur du quartier” (neighborhood doctor) who was performing what he described as an “honest and beneficial auscultation” and prescribing for her chest cold.
His whole practice was cafe backrooms. His patients the cafe patrons, who often had no cars, or no place else to go for medical care. He practiced a simple medicine, and as I advanced in school and he knew what I was learning he told me all that was too technical for him, and he would leave that to the young ones, especially the girls like me, because girls pay a lot of attention to detail and remember everything. And girls are nice and take good care of patients because they care a lot and try very, very hard. He told me not to tell anybody he said that. I never told anybody he said that until just now. Read more on Neuropathic Pain and Benfotiamine…
Filed under Alternative Medicine by on Jun 30th, 2010. 1 Comment.
He was 23 years old with a rich ethnic heritage and identity that he said gave him strength. He looked like any one of hundreds, maybe thousands, of “youths” you could find on the streets. A couple of tattoos. The kind I would see when I was driving with my husband and think sometimes “wow, it was so much easier in the days of Marlon Brando movies.” I would have preferred a handsome renegade in a leather jacket to this obese, angry, unkempt person who clearly did not want to talk to anybody, including me. He was not my patient. A frustrated therapist asked me to see him because no medications had worked on him. She had expected me to come up with a miracle drug we could get samples.
He told me the same thing, over and over again, that he was doomed, that nobody could help him, that I was a nice lady, nicer than most, but I was wasting my time just like the rest of them.
He heard voices, always angry and deprecating voices, telling him he was going to die, that he was no good and deserved to be killed. Many times, in his life, he had attempted to prove the voices correct. Read more on The Devil’s Role In Mental Illness…
Filed under depression by on Jun 25th, 2010. Comment.
A nurse told me, “she called the clinic and she was ranting. She must have been drunk.” I did not think she was. She was a born-again Christian who did a lot of Bible-thumping, not that Bible-thumping by itself actually prevents anyone from drinking. She was in her fifties, trying to go back to school to get a college diploma she had missed earlier in life, with marriage and children. Something spiritual and faith based. I didn’t care what she wanted to learn about, for I truly respect people who are trying to accomplish things. I just didn’t think she would want to be seen buying a bottle of anything, for she was so sensitive about a public image that did not mean very much to anybody else. I think she was sensitive about it because she lived alone and her church was her surrogate family and they lived near her. All her life was in walking distance. Somehow I just did not see her as a drinker.
“I think she did something she usually does not do when she calls us. I think she just took everything her pain doctor prescribed for her.”
I had seen this woman in the office a few days before. She told me she had not yet taken any of her pain medications that day. She was awake and alert and pleasant, really pleasant. She told me she did not sleep and so she needed some sleeping pills. She had been in the hospital for something unrelated, some kind of a minor surgical procedure. Somehow, a nurse I work with had done the research and talked to someone who had taken care of her in the hospital. She slept. Lots. Late. Missing breakfast and eating it when it was cold. She had been on a relatively low dose of pain medications for her chronic pain problem. As far as I could figure, and I had taken care of her for a while, her pain was what you call “benign” pain. I mean, and she had told me the truth on this one, she had osteo-arthritic pain.. So how did she end up on so much pain medicine, and asking me for sleep medicine which she had not received, since in the hospital she had been taking the same thing I had prescribed. Read more on It Was All Prescribed…
Filed under prescription drugs by on Jun 24th, 2010. Comment.
I was up and watching Dr. Oz on June 3, in the morning, because I knew he was popular and wanted to see what he was doing. I only saw the end of the show. He was dancing (in scrubs) with some Brazilians who presented a form of self-defense camouflaged as dance. He was fairly lithe, not overly muscled, and moved well, to the great enjoyment of the audience.
Obviously he was beloved as a personality. But did he really have knowledge? He has the good looks required to get a shot at TV, but there are a lot of caring and skilled doctors who aren’t photogenic or charismatic enough for the ‘tube (and probably don’t dance well, either).
It seemed that people were cheering for him as a personality.
He entertained questions from the audience. A woman had the tail end of a Bell’s Palsy. She asked him how to get rid of it. He told her to wait longer and it would probably go away.
I could tell right away that despite the lovely slide he flashed on the monitor, this woman had been the victim of her Bell’s Palsy long enough that she would probably be stuck with it for life. He got a round a round of applause, presumably for hugging her and telling her that her smile was beautiful. Read more on Dr. Oz: Being On TV Doesn’t Make One A Wizard…
Filed under Celebrities by on Jun 8th, 2010. 1 Comment.
She was exactly my age, with a birthday only two days before mine. Same year. I know that there are more people born under the sign of Aquarius than any other astrological sign, so I am no longer surprised at the number of people who have birthdays in February. (Especially since, if you count back nine months, you end up with June, which is when everyone’s thoughts turn to love and their thyroids and probably other glands are hyper-secreting.) But this was one of those people who makes me think I look awfully good my age. Probably a function of middle class privilege and doing more intellectual than physical work.
This woman had a son who cared about her. The fact that she came to the clinic with him made her fairly special among those I was serving at the time. He had been worried when she seemed too sleepy and too angry and not herself.
Like most patients, she really did not want to tell me much about the other doctors she saw or what medications they gave her. I told her that I could check for interactions, and that her failure to tell me would increase her risk of having problems. I know that a lot of people get “pain killers” and don’t think that they count for “real medicine.” Read more on The Shrink As Sherlock — Detecting Opioid Addiction…
Filed under Addictions by on May 20th, 2010. Comment.
“Just gimme the Prozac and let me outa here.”
In a clinic where most people were indigent and needed more than twenty clinics could give them (food, shelter, friends, job) this woman was well dressed and snappy. She looked a little like some petite actress, maybe Holly Hunter, playing a businesswoman.
In fact, she told me that she was a real estate broker and was not producing enough so that was the proof that she really needed her Prozac. She had been on it for a while, in steadily increasing doses, and now was on 60 mg. Over a couple of years, her dose had slowly been raised from the fairly standard 20mg.
It was a treatment for depression. I had no way — except notes written by previous psychiatrists long-gone — to figure out how depressed she had been when she had actually started on Prozac. And the old notes weren’t much help. Read more on “Just gimme the Prozac!”…
Filed under prescription drugs by on May 12th, 2010. 2 Comments.