Ever heard of capitation? In healthcare, it can mean that a clinic makes more money by following more patients. Payments are per person, rather than per service. I guess I shouldn’t be surprised, then, that they refused to dismiss this guy from their care.
He was a 32 year old young man who was diagnosed with an anxiety disorder. He had been working independently as a pool cleaner but he couldn’t stand it anymore. He was always nervous. As a matter of fact, this man was nervous about everything he did. Perhaps it was a generalized anxiety disorder, but surely something a great deal more. He wasn’t having panic attacks, and he exhibited far more than the usual one or two things found in generalized anxiety disorder.
I tried to start him on some medications — as much as I didn’t like the medications he had been started upon. He had been given regular Xanax in slowly increasing doses. As nervous as he was, he wasn’t stupid. He said, “It’s really funny. The medication makes me sleep, but it sure doesn’t stop me from being nervous.” Read more on The Nervous Pool Cleaner…
California is known as “The Golden State” and some have called it “The Land of Milk and Honey.”
The Beverly Hillbillies noted that it was the home of “Swimming pools – Movie stars.”
That should be encouraging for people like my 27 year old, freckled, red-headed patient. After all, he had a pool cleaning business. But he was nervous — really nervous.
He did not have full-blown panic attacks, though he certainly fit the criteria for generalized anxiety attacks. Sometimes he did get a “heart in the throat” kind of feeling; something which some people would have called a “truncated anxiety attack.” But he had a lot of them and they really didn’t cramp his style very much.
He did not sleep very well, confessed that concentration was poor, and had great difficulty trying to find any interest in collegiate academics. As a result, his grades suffered considerably. And while I could potentially chalk this up to him falling into a category of males who may be better equipped for trade school than an actual 4-year college (based on patience; not necessarily intelligence), I didn’t believe this to be his case at all.
This guy was anxious. Read more on Stuck On The Treatment Treadmill…
I think everybody loves to eat. Eating can be pure, sensual delight. And those that don’t like eating – well, they come see somebody like me because that can be a real problem. It can be a problem for those that REALLY love to eat also – like the 700 lb. woman that not only makes her living in eating contests, but wants to be a record holding “Most Obese Woman” in the world.
I’ve seen some patients who could be in the running for this. Sometimes they have medical treatment to blame. Many medicines can add weight even if you eat nothing but air and water – seriously. I have seen people gain weight regularly, usually 15 to 20 pounds a month or so. Steroids, psychotropics and some other drugs can make you gain weight and keep you losing weight. Even treatments for diabetes – like insulin. Read more on Will Your Doctor Help You Lose Weight? Fat Chance!…
I had a patient once, long ago and far away, who was the worst “Caffeine Fiend” – properly known as “caffeinism” in medical lingo — I had ever heard of.
He was only 27 but depression and obesity added ten or fifteen years to his appearance. He was single and did not have much of a social life, but he did not much care. He was one of the earlier generation of people to build himself a career doing something with computers, with some sort of techie abilities which I could not understand at all. That enabled him to work from home at least part of the time, and only occasionally would he have to make a mad run to and from his employers’ office. This was in rural northern California, somewhat removed from the Silicon Valley mainstream of this type of activity.
The “from” part was important, as he did not much like to hang around with other humans, much preferring the company of his computer. Read more on Tale Of A Caffeine Fiend…
My dear, remarkable father of blessed memory was no mere a musician. He was a Harvard-trained composer and arranger, played that complicated organ at his temple for fifty years, and was very, very serious about music.
In fact, he was so serious that only “serious” music could be played in our household. After all, he was a classmate of Leonard Bernstein, and studied under Aaron Copland and was one of the few fellowship students allowed to attend lectures by the great Stravinsky.
Now THAT’S serious!
As such, I missed out on popular music while growing up. I was not allowed “American Bandstand” after school. I was not give Beatles records. We didn’t even watch Elvis on Ed Sullivan.
She was 29 and I thought she was beautiful, although nobody else did, I am sure. No normal scales in my clinic could weigh her, but I would put her between four and five hundred pounds. Except for someone who brought her to see me ( I think, in the back of a pickup truck, but I did not press the issue) she did not leave the house. Others did her shopping, she had some kind of public assistance.
She was on the standard medication for her depression as well as her panic attacks; paroxetine (Paxil) 40 mg, to lower their intensity and frequency, and a little bit of Xanax, which is supposed to stop such attacks in their tracks. She used it sparingly, hardly at all — no really — she did not use it. It did not work. The most addictive medication doctors give for this sort of thing and she didn’t even want it because it didn’t work. I love this woman, I loved her candor. She told me the last psychiatrists had renewed these medications for the last six months, even though they didn’t work.
What was wrong??? Read more on Panic and Diabetes…
People who have panic disorder go to doctors to take care of it. I have had maybe hundreds of patients, more than I can count over my years of practice, who have come to me with this. Most of them do well. Usually the panic disorder runs its course.
That is not to say that panic disorder is not terrifying. Often people believe that their first panic attack is a heart attack. Often they have come to me already addicted to benzodiazepines by emergency room physicians who (understandably) worry a lot more about the immediate comfort of the patient than about the long term situation. Here is the official government take on panic disorder. Yes, find a psychiatrist you can trust. Yes, they recommend family and support groups. Good stuff, but free and easy to recommend. Yes, there is some exciting new research but as long as insurance companies and HMOs determine how people get treated, it is unlikely that research will be quickly translated into treatment.
Last summer, there was a movie, called “Snakes on a Plane“ which I think my husband wanted to see. The “plot” (which obviously fell a little short of classic Shakespearean construction) has something to do with a witness transported on a plane and somebody tries to “whack” him with a bunch of snakes. I absolutely did not want to see it. (To my husband’s credit, we still have not. Yes, there are men who love their wives THAT much.) I don’t much like snakes. I tend to avoid them. I do not run screaming if I see a garter snake.
Incidentally, they say the film initially did quite well, probably because of a lot of internet hype. It went on to do less well than expected. I cannot help but wonder if that had something to do with the way a lot of people feel about snakes.
In college when I took comparative vertebrate zoology, they called it “herpetophobia,” which literally means fear of reptiles. The more correct term is “ophidiophobia,” more specifically meaning fear of snakes. Read more on Getting Rid of Phobias Without Drugs…
I first heard the term “helicopter parent” on some news broadcast. I started my search, as I do with all new concepts, with Wikipedia. Despite or perhaps because of its imperfections, I have come to rely on Wikipedia as my first line on what people think and do.
These are the folks who originated the name tag, and sell the products that are supposed to help fix the problem.