How can people with Mental Disorders Become Productive

The best answer I can offer is this: these folks a chance. Whether in designing educational programs or work programs. I realize this has been tried—though mostly abandoned as public funds have been shifted from these programs to either the military or in unjust tax windfalls for the wealthy—in the past and some even survive today.
The best thing we can do for them, ourselves and the rest of society is to protest and work against the kleptocracy capitalism and its attendant wild spending on the military. As our national treasure is consumed by an ever growing military presence around the world—in excess of 700+ military bases across the world—and as this monster metastasizes across the globe the money it sucks up comes directly from maintaining our infra structure, education, medical care, research and social programs that once constituted or security net.
This behemoth is one of the reasons why the sensible social programs like the one I’ve suggested above & once proliferated around our nation are rapidly disappearing. We need to oppose this not only for ourselves but for those among us around whom we as citizens need to rally.

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My part Jindo dog, Dylan (Quora)

We took in a part Jindo who was on the streets in a central valley city in CA. We drove 3 hours to see him and he was a mess. Frightened, wormy, coughy (kennel) and wary. He spent most of the 1st month under our bed. I would lie on the floor next to the bed and talk with him several times a day. He’d come out for his 3 daily relief walks but right back under the bed. Eventually, he appeared. He’s the most loving, intelligent, funny dog we’ve ever had the luck to own.

He soon became my “Therapy” dog. I have a serious chronic auto-immune disorder that took most of my life away. But when we got “Dylan,” (I’m a poet and one of my favorites was Dylan Thomas so my wife liked the name and it stuck).

I also suffer from a spinal cord injury sustained most likely during an 8-hour spinal surgery. When at my desk writing when we 1st got Dylan, he would lie on the bed behind me and to my left. He very quickly somehow knew when the pain was ratcheting up. He would come to the corner of the bed right behind me and gently lay his right front paw on my shoulder. I grew to learn that this was his signal that he could tell, probably by subtle variations in my posture, that the pain was getting to be too much and I should take a break.

He then learned that from the partial blindness in my left eye to growl or nudge me if I was about to “blindly” step into traffic.

When we are having friends over he rather quickly seeks out the most physically or emotionally vulnerable and sit beside them the entire evening.

He’s accepted at Northwestern Hosp. in Chicago where I’ve been a few times for severe pain problems. My son would bring him to visit and he’d jump up on the bed, snuggle into me as I slept.

We walk 3 or 4 miles daily in and around Lincoln Pk. & we are constantly stopped by people wanting to know more about him or take his picture. Whenever we walk by a baby or toddler and here the child squeal “Doggy” we turn around and allow the child to approach and pet him. It makes our walks wonderful as we interact with so much more people than I would walking alone.

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Is there any cure for depersonalization (from Quora)

There is, Sam. Your describing possible symptoms of depression and that your withdrawal is deepening? Contact you family physician and explain what is happening with you and then, please, Sam, follow her/his advice. The longer you let this go the more dangerous to it becomes to all areas of your life. Don’t mess around with this, Sam, it might be very dangerous to you.

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Can I ask out my son’s therapist?
Mark Maginn
Mark Maginn, Psychotherapist, poet, memoirist
Written 2m ago
Certainly can. But should you? Short answer, no. And if you did, I would hope for you son’s sake that he would say no and affirm the boundaries around s/he and you son.

Some would argue that once your son’s treatment has terminated then is would be okay. Simply stated, it would not.

Therapy often goes on in the patient after termination. Dating the therapist would throw that off and leave your son feeling taken advantage of. There may come a point when he would like to go back to his therapist for another round of Tx; not at all unusual.

Don’t disrupt your son’s therapy now or in the future. There are lots of people to date, stay with them.

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Stay Steady

I am still lining up those who would like to be interviewed by me and have their stories posted here. Bear with me, the stories are coming and I will honor those who’ve maintained their will, their purpose, and their heroism in the face of some of the worst misery visited on our species.

Stay with me as I work to bring you the stories of those who face the demonized intruder who not only disrupts a life but also disrupts the lives of those who love the innocent target of pain’s demonic monster.

This ubiquitous demon feasts on those it targets for reasons unknown, or for reasons too unbearable for humans to comprehend.

Those dragged into the pit of mindless pain struggle to find the reasons for nearly unbearable pain, unbearable suffering. We, when the pain backs off just a bit, lash out, lash in, beg and demand answers to the unknowable question: Why? Why for god’s sake me? Why rip asunder me and my family? Why, goddamnit, why?

We might as well be shouting into a black well, a well with no sides, no depth, no beginning, and no end.

We shout our anger, our strength, our love and our hate, but mostly, in time, our despair. A despair so bleak, so cold, so hot, so all encompassing it rents the very fiber of existence.

Existence brought to its knees, existence wounded is an existence out of time. Out of time we rail, we weep, weep, beg and bargain. But existence so damaged, so altered is a veil that hides nothing. A veil torn, nay ripped asunder, ripped from the fabric of breath, of beat, of rhythm, of the veil of breath that breathes independent of the lungs we so honor, we so depend.

Yes, we are ripped, rented, wounded. We touch the very scars that announce our arrival at the godhead we so adamantly refuse.

We are who we are and that we know is the limit of all that we know. Our fabric torn, our fabic burned, tattered and repaired lies before us, a panting sled dog, a bleeding beast that begs for our love, our touch.

Touched. Yes, the best we can do is touch….

Tell us…why! Why……please….

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Suffering from pain: Share Your Story

I am embarking on interviewing and writing more posts about those who struggle with the demon of pain, how they manage, what things they do to help themselves live the best way they can. I intend to do about 20 to 30 more interviews and combine them with my earlier posts, look for themes and publish all in a book form.

I am interested in anyone who would consent to a completely anonymous interview for these upcoming posts. If interested or know of someone who might be, please contact me here.

I am looking forward to doing these kinds of posts as they are usually filled with tremendous humanity and, sadly, awful behavior of those with whom pain folks sometimes have to interact.

I look forward to hearing from you.

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Post by Dr. Jeffrey Fudin, pain specialist.

Is LA Times an OXY-Moron?
Posted by Jeffrey Fudin – September 19, 2016 – Dr. Jeffrey Fudin Posts, Guest Blog, Opioids & Politics
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written-in-stone
Let’s take a look. to see if the LA Times is in fact an oxymoron.

Merriam-Webster’s online dictionary defines moron as “a very stupid or foolish person”, but since this country treats corporate entities as people, I’d say LA Times qualifies. Their legal definition is “a person with a mild or moderate intellectual disability —used formerly — see also idiot.”

Other OXY-morons include anti-opioid zealots in the lay press, some propagandists, and politicians who persistently call OxyContin “synthetic heroin”. One who is skilled in the art and science of pharmaceutics knows this to be untrue. In fact, oxycodone is a precursor to oxymorphone, a CYP2D6 metabolite of the former. Oxymorphone is one substituent on the tertiary amine (nitrogen) different in chemical structure to naloxone as pointed out in a previous post Breaking Bad 2.0: Is it possible to synthesize Oxycodone from Naloxone?. That said, OxyContin, oxycodone, and oxymorphone are synthetic congeners of naloxone, an opioid receptor blocker with virtually no medical dangers and an antidote to what anti-opioid zealots otherwise describe as “synthetic heroin”: morphine, fentanyl, and heroin itself. Naloxone actually saves people from respiratory depression from opioid overdose. In fact, OxyContin is more similar in chemistry to over-the-counter dextromethorphan (the ‘DM’ in Robitussin DM) than it is to heroin. Truth be told, heroin is semi-“synthetic morphine” because heroin is essentially two morphine molecules synthetically sandwiched together by an acetyl group, more commonly known as vinegar. But alas, I suppose not knowing this science doesn’t make someone a moron; professing to know something you know nothing about is certainly short-sided, idiotic, and without a doubt approaches moronism.

On May 5, 2016 LA Times printed an OxyContin dosing article, “You want a description of hell?’ OxyContin’s 12-hour dosing problem” by Rion and Girion (two potential OXY-morons).1 In rebuttal, I wrote an editorial with Drs. Mena Raouf and Erica Wegrzyn in a highly regarded refereed periodical, the Journal of Pain Research, entitled “OxyContin was submitted and justifiably approved by the Agency as a twelve-hour dosage form”, to clarify the idiocy of LA Times authors Rion and Girion and the editorial staff that allows such nonsense to be published.2

I encourage anybody that is interested to look at the JPR article mentioned above by clicking HERE. But, as an educational exercise, I thought it would be nice to engage an up and coming Student Pharmacist Lindsay Worthmann to summarize our JPR editorial and the various issues by posting a guest blog. Overseeing Lindsay’s writing was Dr. Erica Wegrzyn, my current PGY2 Pain and Palliative Care Resident. Here for your information and entertainment is what both of these young professionals had to say…

Ms. Lindsay Worthman and Dr. Erica Wegrzyn:

As we all know, just about every aspect of life is governed in some way, shape, or form by Big Brother and/or the letter of the law. Fortunately, there is some degree of leeway in medicine. Behold, the off-label use function.

When OxyContin came to market, it was intended for every 12-hour dosing (Q12H). This is how the product was approved by the FDA and what the manufacturer (Purdue Pharma) marketed and subsequently endorses. The recent article in the LA Times, mentioned above, called Purdue out for “knowing” that some patients experience an end-of-dose effect as the12-hour mark approaches.1 Now, if this is true (which it sometimes is), patients would be experiencing pain or perhaps mild opioid withdrawal before the next scheduled dose. This can result in additional immediate release medications (like oxycodone) prescribed to cover that time-span, i.e. breakthrough pain. More medications may affect other risks such as overdose, opioid craving, and the like. So what exactly is all the fuss about? It appears that the LA Times is upset that Purdue is not formally addressing this presumed “lack of efficacy”, or what is commonly known as “end-of dose failure” of a 12-hour dosing interval and isn’t promoting its use at 8-hour intervals. This is because Purdue is a pharmaceutical company and is LEGALLY prohibited from promoting off-label uses.

If a patient is experiencing this lack of benefit at Q12H dosing intervals, a Q8H dosing interval sounds like a plausible option. Logically, it makes sense: prevent return of pain, prevent withdrawal, avoid adding additional medications, and maybe even diminish the risk for diversion. The concern expressed by some, with dosing OxyContin Q8H, is that the patient could potentially experience a higher oxycodone plasma level, therefore increasing the risk for side effects such as a loss of consciousness or a decrease in respirations. There is no evidence to support this.

Off-label use is not an uncommon scenario. For example, fentanyl patches are marketed as Q72H, but may be used for Q48H as indicated in the label3. Tricyclic antidepressants (TCAs) such as amitriptyline for neuropathic pain are commonly used off-label4,5.

Can the pharmaceutical companies that make these drugs legally and openly support off-label uses? No.

Is fentanyl often dosed Q48H? Yes.

Is amitriptyline used for neuropathic pain? Yes.

Can oxycodone ER be usedQ8H? Yes.

Obviously, there are always risks associated with off-label use. There are also risks associated with any medication even when taken as prescribed. It is the responsibility of the medical provider to discuss risks vs. benefits of any treatment plan. The further a medical provider deviates from the intended use, the higher the liability. Many antidepressants and anticonvulsants without a pain indication are routinely used to treat neuropathic pain syndromes. Cancer drugs are frequently used for malignancies for which there is poor evidence. In the grand scheme of things, whether or not Purdue Pharma openly supports or endorses OxyContin Q8H is irrelevant, other than their obligation to follow the law and not promote for off-label use.

n closing, it is noteworthy that newspapers should provide accurate information by honest journalists who do their homework and provide each side of a controversial story. Perhaps the term Newspaper here is an oxymoron too, since the definition of oxymoron is “a combination of words that have opposite or very different meanings”.

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Writing Again

Just a heads up. I will be publishing articles here wherein I will be interviewing people with pain and pain care specialists. I expect to publish 2 monthly.

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The Gifts of Behcet’s Disease.

For the last 4 weeks, I’ve had a net another yet another Behcets’s lesion in my mouth. This one stayed the longest, and is still present though less painfully combustible. As it began to recede I had the utterly stupid, as history should note, idea that I would be able to spend a few weeks without some part of my mouth on fire. Right. Yes, to believe in this is to believe in white bunnies bringing me candy every day.

Just as the one began to slip away, another sprouted its painful self of lower left side of my tongue. This is a strategic location because it causes pain no matter what my mouth does.

This should not be such a surprise as I”ve lived with this for nearly 40 fucking years. If it’s not one lesion in my mouth it’s a lesion elsewhere causing the same or worse pain.

This disease is designed, at least for me, to cause the maximal pain. Not simply physical pain, but the pain of one onslaught upon the next. It waits until I’m almost ready to accept a leison free few days when it detonates a new one. This is designed for maximal demoralization.

Lesions and their attendant pain, sometimes agony, are designed to inflict maximal psychological torture. Just when you think you’ve escaped, the fucker tracks you down before you reach freedom at the gate and pulls you back in. All the while laughing manically in my ear. My ear, so no one else hears the agonizing protest gargling up my throat.

Yes, the life of the chronically ill, the chronically painful existence, is quite frankly, the last laugh of Beelzebub. His chared tongue and split lips laughing up brimstone, brimstone he laves over our writing bodies.

It makes me murderous.

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Village of Impermanence

Village of Impermanence

I have been for some time feeling better. So how come I’m having trouble describing it and believing it? I am ambivalent writing about this or even talking about it as 1) superstition tells me to keep it to myself as telling anyone about this turn of events is a jinx, and 2) I have been locked inside a miserable cur of a body for over a half century and I don’t have much to go on when I say that for some time I’ve been feeling what I now call better. Dictionary: better: of superior quality of excellence.

Now, this turn of affairs has me stumped. Am I saying that I am now experiencing a superior quality and that superior quality is, in this case, excellence? I’m really not sure. I know “excellence” does not do justice to this feeling better business. Superior really does the trick, though.

But I can assure the reader that I’m not anxiously wandering about in a linguistic parlor game. No, it is my mind trying to come to terms with this; over the last summer I have begun to feel that elusive…

WE MUST INTERRUPT THIS COLUMN FOR BREAKING NEWS: WE’RE AFRAID IT REALLY IS LITERALLY BROKEN

Our correspondent is sitting by a window in a coffee shop in Lincoln Park in Chicago where he lives. It is a balmy 0 degree with a moderately heavy snow swirling around his perch in the semi-warm shop. Why might you ask, rightfully, is he I doing this?

Last night he started this blog while lying on his bed with his furry pal, Dylan, lying next to him with his head on our correspondents outstretched leg. He’d just returned home with his son who gave him tickets to see his beloved Chicago Bulls play. It was a hoary January night. Traffic was light coming home but the temperature was 8 degrees south of zero. Not such a bad deal, but the front running Bulls got chased off their own court by the lowly Utah Jazz.

Bad omen?

Bad omens need recognizing which, one hopes, leads to planning, the kind of planning that minimizes, again, hopefully, whatever damage is silently, inexorably swinging around the sun on its menacing parabolic arch headed straight for our unsuspecting, “feeling better,” correspondent.

If, like the characters in the movie Melancholia he knew what was coming, would he have stayed home lounging on his bed? While our correspondent is interested in dystopian futures, he never thought that his previously dystopian life could round the sun aiming lustily for him.

Before describing the mayhem headed towards the north side of Chicago, a return to happier days with which this blog began is in order, at least as far as storytelling goes.

As I was saying at the top of this post, I have been getting, slowly and inexorably better. I can feel some of you smirking even now: Never say things are looking up as the other shoe will always drop, most often with a direct hit to the offending–I’m feeling better–skull. You know this to be true as I’ve not hinted too obliquely at what is to come.

After I fell in the garage of a hotel in late winter ‘13, the night before moving into our new home, I was the happy recipient of three surgeries on my spine and back that delivered me from the the hardware from my implanted spinal cord stimulator and all the bolts, plates and screws from extensive spinal surgery 15 years ago to repair the multiplying disabilities from a long ago broken spine.

Some of you are, no doubt, and blamelessly I’d add, saying to yourselves, “Oh, shit! Nothing good ever comes from spinal surgery.” But who listens to such admonitions before the blade slices?

After the surgery, my new doc, a young man in his mid 30s, who seemed to me to be all ears, cradled a lovely medical intellect along with a nice dollop of courage. Why courage you ask, as might you well? Because this young man thought the dose of OxyContin on which I was relying to keep the panther of pain off my chest and breathing heavily into my cringing visage, was woefully deficient in curbing the pain I had been living with for decades.

By the end of fall ‘13 I was very aware of a happy diminution of the panther prowling in tight circles around my body. The arc of his circles frequently carried him and his hunger out of sight. I could hear his slow breathing in the shadows, but he was, much to my giddy surprise, out of sight.

As my panther remained largely on the periphery of my consciousness, I allowed myself thoughts of how I might widen the arch of my circle. To wit: I started the process of getting my clinical social worker license reinstated here in Illinois. By Christmas I had fulfilled most of the requirements to be able to take the exam. This left me in high hope that I may restart a small practice working only with the chronically ill and those with chronic illnesses.

As I felt better I talked to my team of docs about returning to practice and all said they’d be excited to refer to me as they have so many folks struggling with panthers of their own. I’ve even begun looking at offices downtown where I may rent by the hour. It would be perfect as I’m only an 8 minute walk to the Red Line subway that delivers me to the Loop in 15 minutes.

The most obvious indication of reduced panther activity is seen in my daily walks with Dylan. I have gradually lengthened how long and how far we walk. Just a few days ago before the return to the Siberian Express, Dylan and I walked about 8 miles over two hours!

I think you can imagine how I felt about that and you’d be right. Mostly, I was amazed and excited seeing my body as younger than the seven decades I’m working on. Hope rang like the Cathedral Bells in Paris on Easter Sunday. Yes, I felt as if I’d risen from the dead. And I wasn’t wrong about that.

Of course, you must be wondering how Dylan and I can walk under such harsh weather conditions: snow, subzero temperatures turned murderous by the constant presence of the Hawk flaying in from the frozen lakes of Minnesota and Wisconsin: yes, the return of the Polar Express.

Well, we have a nice little sweater for Dylan as well as his red bandana tied rakishly around his scruffy neck. I have a wonderful leather coat the just covers my butt and is lined with some sort of cold resistant cloth. I also have my Cubs hat, ear muffs, thick gloves and a black mask I wear that completely covers my face when the Hawk comes screaming.. We are both warm.

I’ve been able to go out more and more without my cane and can now stand for nearly a quarter of an hour.

This is all lovely, exciting and a rather exquisite punch to the panther’s solar plexus.

I am lighter, happier, humorous and more committed to things I couldn’t commit to before.

I am now on the board of the National Gun Victims Action Council, working on a justice project through my Unitarian-Universalist Church and working with the Socialist Party USA. I feel that I’ve returned to the world.

You know what’s coming in a way that I, in my exalted state of mind, did not. You’d be right to think that someone from a bit of Irish descent would be, at least partially, aware of the possibility of a looming potato famine. Yes, but in feeling better and better I began to rely, in retrospect, on a none too large helping of denial. And denial, unlike revenge, is a dish best served warm and lusty.

However…cliche aside, history, much to our correspondent’s dismay, does, indeed, repeat itself.

Let’s return to our correspondent who is now lying on his back in the mouth of an alley a block from his new digs in Lincoln Park.

Minutes before he headed to the coffee shop a few blocks from his apartment our correspondent realized quickly that being out in zero weather with the Hawk’s Arctic wings beating frostbite, that he’d never be able to last more than a minute or two without his balaclava ski mask.

Without hesitation he turned around to walk home. The hawk instantly pounced: its icy talons threatened to slice the skin from his face. With his computer bag securely over his shoulder, he held both gloved hands over his face to stop the pain.

Walking gingerly since most buildings didn’t shovel the snow from their sidewalks, he headed home. Looking down for the icy menace, his right leg flew upwards followed closely by the left and he watched his feet fly above his head before falling like dead weight down, ever so down to the ice-slicked sidewalk.

Dazed for a few moments he lay on the ice looking up at the snow pregnant clouds closing in above. With the ice beginning to make itself known through his jeans, he slowly got up, readjusted his computer bag and painfully and angrily walked in the middle of the streets the last 2 blocks home.

After surveying the damage at home, at his insistence, his wife drove him to the coffee shop where he now sits writing this.

*********************

It’s little trials like this that so easily puncture a fledgling hope for continuing good health confined to a body that can be so easily upended and damaged.

Though I was feeling better and more hopeful, my doc suggested I invest in a third surgery on my right shoulder. I told him a few weeks ago that I was going back to the gym, for the first time in a decade, where I would slowly try to rehabilitate the bugger and so turned down his advice.

However, this fall two hours ago was partially cushioned by landing on my right arm. You guessed it. I can barely type due to the pain and know well that I’m going to have to go in for my 16th surgery.

Feeling well and nurturing hope is a fragile enterprise, especially as we know our bodies can and will betray us in blink of a panther’s eye.

Right now I’m a bit numb to the anger frenetically dancing around my head. It’s there in all its hope killing glory, waiting, waiting.

My hope is that writing this will help tame the anger and the panther.

And underneath all of this, especially the two falls on ice in the last 1 ½ years, I’m gazing my age right in the dark of its eyes. Am I falling because I’ve been away from this kind of weather for two decades or am I, because of age and disability, not as balanced as once I was?

**********************

I purposely waited a few weeks before finishing this post. Why? Will that fall in the alley be the setback I imagined? The answer, as we all have come to know in questions regarding our bodies, is yes, to a degree, and no to an equal degree to the dystopian future I feared.

Yes, I now have an increase in pain in my back. But my mood of lightness and humor has not taken the hit it could have. You might be surprised to read that I believe my diminished time in the woods with the panther over the last 5 or 6 months is developing a life of its own. As the panther circled wider away from me, my overall mood lightened. That lightness has carried me through this downturn and, I hope, through the trial of yet another surgery.

But know this: what comes next may be the product of the last 6 months, or the awareness that comes with age, and, as in most things, probably a combination of the two and other factors with which I remain oblivious. I now feel the transience of pain, painlessness, health, of trials, and ultimately me. Of course, I knew this intellectually, but now, for reasons I’ve just stated, I know.

Transience: impermanence; the inevitability of dying.

A strange awakening coming with feeling better…The definition of transience used to piss me off. Not anymore. It’s the guarantor of rhythm, dance, song, connection, pain, loss, love and life.

With transience comes the sweetness of moments.

I’m pleased to have joined the village of Impermanence.

May your arrival here come sans a thud on the ice.

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