Archive for July, 2008


A small study in Japan (n=13) looked at the autonomic, neuro-immunological and psychological responses to wrapped warm footbaths.   “Warm wrapped footbaths” were associated with an increase in parasympathetic activity and decrease in sympathetic activity as measured by serum cortisol levels and salivary igA levels.  Hmmmm…. so footbaths are relaxing…..  

I actually do recommend bodywork, whether massages or pedicures, to patients to help manage and mitigate the effects of stress.  How much better to get a pedicure than to pop an extra benzo.

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Why do I do what I do?

At the simplest level, it is because I love what I do.  A colleague/ mentor encouraged me a few years ago, to imagine what my practice would be like if I were free to practice medicine the way I wanted to.  So I did…then I made it happen…and it has made all the difference.

 

I was originally drawn to medicine through my love of science… and the observation that nothing “grossed me out”.  In junior high, I contemplated psychiatry…as I enjoyed helping my friends work out their problems.  In med school I was drawn to OB and ER, but quickly realized that I do not function well in the middle of the night.  After a few weeks on my psychiatry rotation, the decision was clear.  I signed a residency contract before the start of my fourth year of medical school. 

 

Psychiatry embodies several aspects that I loved from ER and OB/Gyn rotations:  an ongoing relationship with patients, the opportunity to really listen and hear people, and the fact that it is never boring.  I have always loved stories… I may not be the greatest with names, but I generally remember all of the stories.

 

I often discuss with my patients the concept of basic human needs:  obviously food and shelter… but also intimacy, joy, and a sense of “purpose”.   My medical practice fills many of those needs in myself.  I sometimes question why being a wife and mother isn’t “good enough”, although I do believe that they are most noble and important roles… it seems to come back to the thought, “…because I know I’m supposed to be doing something more.”

 

A therapist who offices with me, has a verse from Galatians 6:2 on his business cards… “Bear each other’s burdens, and in this way you will fulfill the law of Christ”.  I do consider my practice as my ministry.  I am blessed and honored by these people who trust me with their wounded souls and chaotic lives.  I do not take my responsibility lightly; I continually look for ways that I can facilitate relief from their suffering.

 

My patients sometimes remark, “How can you do this?  How can you listen to these stories all day?” I guess it comes to down to my steadfast and stubborn belief that things can get better.  I was once afraid to share this optimism with patients. Now I realize that giving someone hope and the assurance that they don’t have to go down the path alone, can be very powerful medicine.

Bipolar Voices

One of the frustrations that I hear voiced from my patients with bipolar disorder is the feeling of isolation and of being an outcast.  “How can I talk with someone who will think I’m crazy if I tell them I’m bipolar.”  Add this loneliness to an existing depressed mood and you have a downward spiral of negativity and hopelessness.  One of the few positive outcomes of direct to consumer advertising by drug companies has been the subtle move towards mainstream acceptance of mental health disorders.  Unfortunately, there are miles to go before one can admit with the same nonchalance that one has bipolar (or any other mental disorder) as one would with high cholesterol.  While a few support groups exist, they do not meet the needs of all patients and tend to be utilized by those who are not functioning well.  “Where are the bipolar patients who aren’t on disability and on five different meds?”  Most likely, they are working, spending time with their family….but probably not attending a support group; at least, not while they are doing well.  It’s a shame too:  it would be nice for those who have had success in managing their condition to share some of their strategies and tips with others.  Until then, there is a wonderful multimedia collection of stories on the New York Times website from patients living with bipolar disorder:

http://tinyurl.com/bipolarvoices

Fad Diet De Jour

As I was reading the Sunday paper, I notice an article entitled “Clinic Takes Advantage of New Weight loss Discovery”.  Turns out, this was not an article, rather a paid advertisement, and in no way a “new discovery”.  I am personally and professionally interested in weight management so I decided to do some investigation. 

 

This local, family practice physician is promoting hCG Therapy for weight loss.  The ad includes the statement, “If you can’t lose weight, it may be because your body’s signals that used to come from brain areas like the amygdala, hypothalamus, and pituitary gland have stopped sending hormones to your stored fat, telling it to move.  HCG Therapy replaces this process.”  I have had two different patients try this program, in their words, “out of desperation”.  They were charged $2500 (paid up-front) for 6 weeks worth of injections of hCG.  Neither patient lost weight, but more shocking, neither patient was told that this was NOT FDA approved.  Stephen Barrett, M.D. talks about this “therapy” on his website: www.dietscam.org/reports/hcg.shtml . I found more information about this “discovery” on the Dr. Weil’s website as well:

 

The acronym hCG stands for human chorionic gonadotropin, a hormone produced during pregnancy. It is made by cells in the placenta and is believed to mobilize abdominal fat to help nourish the fetus. The notion that daily injections of hCG combined with a severely limited caloric intake of only 500 calories per day would prove an effective weight loss method goes back to 1954 when a British physician, A.T.W. Simeons, proposed it. The idea is that if the hormone can convert fat to calories during pregnancy for use by the baby and, in the process, speed the mother’s metabolism, it can do the same thing when injected into people who want to lose weight.

 

The trouble is, it doesn’t work. Over the years, a number of clinical trials have tested the diet both in Europe and the United States, and none has found that hCG has any positive effect. Sure, you can lose weight on this diet – but that’s because you consume only 500 calories per day, not because you inject yourself with hCG. A study published in the American Journal of Clinical Nutrition in 1976 found no statistically significant difference in weight loss, percent of weight loss, hip and waist circumference, weight loss per injections, or hunger ratings among patients who were on a 500-calorie-per-day diet combined with hCG injections and those who were on the diet and received placebo injections. Taking hCG doesn’t appear to be particularly unsafe, but there is no scientific proof that it does any good. (www.drweil.com/drw/u/QAA400413/Pregnancy-Hormone-for-Weight-Loss.html )

 

Such programs “takes advantage”…of individuals’ desire for an “easy fix” and belief that “if it is from a doctor, it must be real treatment.”  I am saddened that there are members of the medical profession engaging in such seemingly profiteering practices.  While I understand the desperation and frustration of failed weight loss efforts, why not promote increasing exercise and a healthier diet (nutritious, balanced)?  Even if individuals did lose some weight from the ultra-low calorie diet, what is the likelihood that they would be able to maintain that weight loss?  Extremely low, especially if the thoughts and behaviors that led to the weight gain were not addressed.  Sometimes there are no shortcuts.  As they say, “If it sounds too good to be true…”  

I consider myself to be a Christian Psychiatrist.  To me, this is a distinction that implies something more than the mere fact that I am both a practicing Christian and psychiatrist.  As such, I incorporate spirituality into my treatment when appropriate:  this can manifest through discussion of appropriate verses from scripture to suggestions of daily personal quiet time and meditation.  I will pray before (and sometime while) seeing patients for God to give me the words to relieve suffering, to shed light on a situation, or to give me discernment in the proper path.  I believe fully that I am an instrument of healing and that God is the true healer.  I also believe that our bodies have an innate capacity for self-healing that we are to facilitate.  This does not mean that I consider myself a “spiritual healer” or that I don’t use psychopharmalogic tools; in fact, I would estimate that 95% of my patients are on at least one medication or another.  Nevertheless, I am convinced that God is at work: I have experienced times when I felt the Spirit was present and times when I have had responses that I couldn’t attribute to anything from my formal training. 

 

I do not consider my position to be one of proselytizing:  while I fully acknowledge the “great commission”, I think it an abuse of my position to do so in my practice, especially directly.  Beyond “bearing the burdens of another” (Gal. 6:2), I endeavor to reflect Christ in all that I do.  One risk inherent in promoting oneself as a Christian Psychiatrist is that of alienating patients of differing faiths and viewpoints.  I have noted patients’ comments “I know you’re a Christian but…”;  I welcome such opportunities to reassure patients that I am not here to judge and that my only ambition for them is whatever ambition they have for themselves.  Another responsibility inherent in Christian Psychiatry is the same for all who practice medicine:  continuing education.  I frequently say, “Whatever you feed grows”.  My own spiritual lifei is fed through a non-denominational bible study:  BSF (Bible Study Fellowship).  BSF is a seven-year, intensive study that I find both spiritually and intellectually fulfilling. (www.bsfinternational.org) 

 

Is it necessary for a psychiatrist to share the same religion in order to effectively treat?  As was referenced by the Shrink Rap blog-post “A Shrink Like Me”, (http://psychiatrist-blog.blogspot.com/2007/05/shrink-like-me.html) I agree that shared religious belief is a preference… not necessity, much like the preference for male or female therapist; but also something more…it speaks to a desire for more complete understanding.  In “my neck of the woods”, it is certainly more common than not.  Overall, I like to think that spirituality represents another tool to be utilized judiciously and I am pleased to have it as a part of my stratagem.  

Managing cravings

While listening to the Scientific American’s “60 Second Psych” podcast this morning, I couldn’t help but notice the implications for CBT (Cognitive Behavioral Therapy) treatment of over-eating.  The topic, “When Craving is Better than Getting” discussed a study published in Nature Neuroscience demonstrating that “our own calming thoughts can significantly dampen the arousal we feel when we are anticipating positive rewards.

 

In a recent article about brain cells, Joshua Freedman a U.C.L.A. neuroscientist, noted that a monkey feels maximal reward not when he eats a grape but rather when he gets it in his possession, anticipating he can eat it.

 

Reward anticipation is very strong and can have a negative impact, (think: addiction), according to researchers from Rutgers and New York universities. They studied the effect of cognitive therapy on the physiological reactions to anticipating positive reward, and the results are published in Nature Neuroscience this week.”

 

Many of the struggles associated with “disordered” eating stem from the emotional relationship we have with food.  This leads to situations where we may know that eating a certain item is not in our best interest; nevertheless, we eat it anyway due to the perception that “it will taste so good” or “it will make me feel good”.  Through CBT, it is possible to recognize such thoughts as “distortions” and replace them with ones that are corrected, or at least consider the further implications of actions: ie, “If I eat this, it may taste good for a moment, but then I will regret it.  Ultimately, it will feel better to eat more heath-fully.” 

 

I love finding evidence supporting Mind-Body medicine:  affirming that our thoughts affect our emotions, which in turn, affect our beliefs and our behaviors.  Our thoughts really do hold great power.

 

 

Saint Dymphna

Saint Dymphna

At the urging of friends, family…, I have decided to start blogging.  When I first started, I was not exactly sure who my audience would be, what my objectives were, or if this endeavor would prove to be worthwhile.  But I decided to give it a try and see what emerged.  I suspected it would end up part-musing,  part-rant.  After a few weeks, I found myself drawn to posts that would further clarify ideas discussed in treatment, give additional background information, or discuss news headlines that are applicable to my practice.  Therefore, I have decided to link this blog with my professional website and abandon anonymity.   I will continue to maintain the utmost level of confidentiality, and all (if any) patient references will be confabulated.

 

A little about myself:  I am a private-practice, outpatient psychiatrist who does psychotherapy as well as medication management.  I am very interested in integrative psychiatry and “mind-body-spirit” medicine, with particular interest in Christian psychiatry.  I live and practice in the heart of “the Bible-belt” and “Tornado Alley”.  I currently work  part-time… it seems to be the best balance for now as I am also the mother of two boys, both under age 5. My current professional interests include Mindfulness Based Stress Reduction (as per Dr. Jon Kabat-Zinn);  Cognitive-Behavioral Therapy for weight loss ( Judith Beck, PhD), and trying to convince my  friends and patients that doing Yoga and/or meditation doesn’t mean they love Jesus any less.

 

Why Dymphna?  Given the initial goal of anonymity, I tried to find a name with some tie to mental health.  St. Dymphna is the patron saint of mental health professionals, those who suffer from mental illnesses and nervous system disorders, and happy families.  Not too bad… plus she’s Irish.  It’s my nod to my “Bubba” who was both Irish and Catholic and who always believed in me (even when I converted to a Protestant faith).  She is now in her heavenly home and I miss her.  All things considered, I have decided to leave the name of the blog unchanged.  I hope you enjoy!