What One Therapist Found When She Entered Private Practice
This essay from the NYTimes is a bit of an eye-opener for anyone who is thinking of going into private practice. Due to people seeking less therapy and using more psychiatric drugs alone (massive pharma marketing campaigns encourage this), we are now at a point where many therapists can’t get enough referrals to survive. Meanwhile, many people in need of help can’t get it because they don’t have insurance, have high deductibles and copays, or have very little coverage for mental health with their insurance policy.
Hope and Progress- World AIDS Day
Art from South Africa
Since the emergence of HIV as a pandemic in the late 1970′s, good news has been rare. With remorseless efficiency the retrovirus has eluded decades of medical interventions. But there is cause for hope, and one huge lucky break. Although the medications that are effectively allowing people with HIV to stay healthy do not eliminate the virus, and in spite of the fact that it rapidly mutates– treating HIV reduces the risk of infecting others. From BBC News…
The [antiretroviral] drugs reduce the amount of virus in the blood, and cut the risk of an infected person passing HIV on.
Last year, at the UN General Assembly, governments agreed to set the goal of getting 15 million HIV-infected people worldwide on the life-saving antiretroviral medicines by 2015.
The WHO says this target could be within reach – provided countries can sustain current rates.
And it says about eight million people in low and middle-income countries are getting the treatment they need, up from just 0.4 million in 2003.
Dr Gottfried Hirnschall, director of the WHO’s HIV department, said: “The challenge now is to ensure that global progress is mirrored at all levels and in all places so that people, whoever they are and wherever they live, can obtain antiretroviral therapy when they need it.”
It was not until the 1980′s that it was possible to test for HIV, and in the 90′s a test was developed that could measure the viral load.
It was not a sure thing that treating people with HIV would reduce the risk of spreading the virus. Early drugs, like AZT, caused the virus to mutate into resistant forms and did not do much more than buy time for AIDS patients. Still, lives were saved and in time better drugs were developed. With the PCR test that measures the amount of viral copies in the blood it is possible to know how effective a particular drug is for a patient. There are more drugs, and cheaper, and easier to take.
Too long, and too much grief, but it is possible to see the end of this epidemic.
Research for a vaccine continues.
And a pandemic, like other natural disasters, shows how interconnected we are. It is not possible to eliminate the threat of HIV without caring for people across social and national lines. We are one human race and we succeed or fail together.
MORE: Nicholas Kristof at the New York Times says South African coffin makers are seeing a decline in business.
Birth Control vs Woman Control | Emancipation Conversation
Ninjanurse sounds off on the difference between birth control and woman control.
When Nurses Get Depressed
There’s always lots of stuff to keep you up at night. This weeks New Yorker has an article by Jerome Groopman, a doctor with a writing habit, who explains the rise of drug-resistant bugs worldwide.
Obituary for Lia Lee
The Modesto Bee has published a lovely tribute to Lia Lee, her devoted family and her contribution to knowledge and practice of medicine.
By Stephen Magagnini
Foua Yang crumpled in tears on the staircase in her south Sacramento home, just feet from the empty hospital bed where her daughter Lia Lee lived most of her life.
“I’m deeply saddened that Lia’s no longer of this world, I love her very much,” said Yang, clutching a picture of Lia as a lively 4-year-old in traditional Hmong finery, running from her mom.
Lia – who in July celebrated her 30th birthday in that bed surrounded by her mother, brother, seven sisters and numerous nieces, nephews and cousins – died Aug. 31 after a lifelong battle against epilepsy, cerebral palsy, pneumonia and sepsis, a toxic reaction to constant infection.
Her family’s struggles with hospitals, doctors and social workers were chronicled in Anne Fadiman’s best-selling 1997 book, “The Spirit Catches You and You Fall Down,” which altered America’s views on cross-cultural treatment. She became a symbol for all disabled children and immigrants intimidated and confused by Western medicine.
Lia Lee’s family allowed journalist Anne Fadiman into their home and private life, even allowing her to witness a shamanic ceremony performed as an attempt to call Lia’s spirit back to her body, back to her loved ones. They allowed Ms. Fadiman to read Lia’s medical records, interview her social workers. After the book was published, readers wanted to know what happened to Lia. The family continued to care for her every day of the rest of her life, but they did so in privacy. The American way of going public for self expression or for a cause, was not their way.
The Spirit Catches You and You Fall Down is a fair-minded and insightful account of the failures that led to a tragic outcome in the treatment of Lia Lee.
Kmareka has a nurse’s review of the book with links to Hmong-American sites. A generation of Americans are connected to Hmong culture through their parents who came here as refugees of the Vietnam War.
There will always be tragic miscommunications as we are all fallible. We can only and always strive to do our best. Lia Lee did not die in vain, the example of herself and her family teaches us all to do better.
Lia Lee has Passed
Another Square in the Quilt
UPDATE: As of 12:30pm Sept 2, there is no new news on Google regarding the condition of Lia Lee, but we received a comment from Jeff, “I am writing with sad news. Lia Lee, the daughter of Hmong immigrants whose life story inspired the The Spirit Catches You and You Fall Down, died Friday, August 31st, 2012.”
We send our deepest condolences to the family of Lia Lee. Caring for a child with such need creates a powerful love, and I know she will be sadly missed.
This is a review originally published on Kmareka December 9, 2009, of ‘The Spirit Catches You and You Fall Down’.
Anne Fadiman’s book is a powerful work of journalism, years in the making, that analyzes step by step the failures in communication and a clash of cultures that left a little girl in a chronic vegetative state– caught between life and death.
There were many mistakes, and even more missed opportunities to prevent this catastrophic outcome, but no villains. That is, unless the villain is war itself. Specifically, the war in Southeast Asia where the Hmong were recruited as soldiers and then left stranded in refugee camps or dropped into a life in the US they weren’t prepared for. The following passages are from Marcy Sheiner, taken from her website Dirty Laundry. Check out the whole article for insight into the history that brought the Hmong to the United States, and Lia Lee to Merced, California. Thank you to Marcy for letting me quote her here.
For assisting the CIA in Laos, the Hmong were promised they’d be welcome in the U.S.—but when the troops left the country, they jetted only generals and hotshots out, leaving the rest of the populace to fend for themselves. With the Laotian army hunting them down as enemies of the state, Hmong families set off on foot, carrying whatever they could manage. Many, particularly the old and the young, died along the way. Most possessions were eventually shed.
When they arrived in Thailand they were put into refugee camps, where they waited to be rescued by the Americans. Those who were finally brought to the States were ‘resettled’ all over the map, without regard for family cohesion or transferability of survival skills: Detroit, Minneapolis, Utah, Vermont—the Hmong were distributed all over the country so as not to unduly ‘burden’ any one locality.
A recent article on the fate of the Hmong left behind is here. For supporting the United States they are fugitives and nationless.
The Lee family settled in California, and Lia was born American. She should have had the best medical care in the world. Her doctors and nurses were well-intentioned, her care expensive. But mis-communication thwarted the best efforts of all the people involved in her care.
From an interview with Anne Fadiman—
Q: Can you talk a little about Lia’s doctors (Neil Ernst and Peggy Philp) as doctors?
They are as excellent in the medical sphere as Lia’s parents are in the parental sphere. Neil and Peggy are warm, competent, highly skilled clinicians, both Phi Beta Kappa graduates of Berkeley who chose Merced because they wanted to serve the underserved. If I lived there they would be my children’s pediatricians. Communication between them and the Lees was defeated when the culture of medicine ran up against the culture of the Hmong: two very strong, stubborn, uncompromising cultures. The impasse had nothing to do with any professional or personal shortcomings on the part of these excellent doctors.
Unlike many American patients, Lia Lee had continuity. Her pediatricians, Drs. Ernst and Philp, were husband and wife. They alternated taking call at night. They lived just a few minutes from the hospital and responded many times to Lia’s medical emergencies. Lia was not shuffled from doctor to doctor, but had the care of experienced doctors who knew her from infancy. This shouldn’t have turned out so badly. From Mai Na M. Lee, Professor of History at University of Minnesota, via Hmongnet…
When Fadiman arrived in Foua and Nao Kao Lee’s apartment in 1988, she found Lia, their seven-year-old daughter who was pronounced brain dead two years earlier by her American doctors, alive and lovingly cared for. Lia had her first epileptic seizure when she was just three months old. According to the Lees, recent immigrants from the Secret War of Laos who did not speak English and could not even communicate their infant daughter’s sickness to the doctors, the seizure stemmed from spiritual causes. After several seizure episodes, and only when Lia was brought in still convulsing did the doctors properly diagnosed her as suffering from epilepsy. From the American doctors’ perspective, Lia’s condition was biological in origin and could be alleviated with drugs. Over the next four years Lia’s anticonvulsant prescriptions changed 23 times. Gradually, the Lees doubted the effects of these complicated multiple prescriptions. When they refused to administer the drugs to Lia, the doctor had Lia placed in foster care. A few months after returning home to her parents, Lia had a massive seizure which left her brain dead. With death imminent, the doctors allowed the parents to take Lia home. Two years later, when Fadiman arrived to investigate the story, the Lees still harbored hopes of reuniting Lia’s soul with her body and arranged for an elaborate pig sacrifice.
I cared for a child in a vegetative state, and heard her grandparents calling to her, “Wake up, wake up.” It’s unbearable to witness. It seems so impossible that a child could be living and breathing but unreachable forever.
Lia Lee was 5 years old when she suffered her brain injury. She must be 27 years old now.
Lia’s family allowed Anne Fadiman into their home and their confidence. It’s all the more striking that they have not followed the American way of seeking attention, for vanity or for a cause. They don’t have an internet presence. It seems like everyone close to Lia or her family protects their privacy.
Anne Fadiman’s book is now used as a text for health professionals. Lia’s doctors teach other doctors how to care for patients across cultures.
UPDATE: Many are wondering how Lia and her family are doing now. They are very private people. Follow the Dirty Laundry link and scroll down to a comment by Janice K. for the most recent news I could find on the net.
I’m pasting a book review on Amazon.com here– the writer has not identified herself except as Lia Lee’s sister, it was posted in 1997…
I don’t think I should be writing in here since I am a part of the book. This book was amazing! It took me two days to read it and of course I shed a few tears on the way. My sister, Lia Lee, is doing well although she will never be able to see the bright sunlight or the incredible stars that we see everyday and everynite. She is an incredible child with so much love and affection from her family and the many friends she have encountered during her hardships. I was only 7 when all this happened, but I do recall everything from the door slamming incident to the day the doctors told my family that it was okay for her to come but she will not live pass 7 days. I will never forget that week or those many years of pain my family or the doctors had to go through. This book has given me a better view of what can really happen when two different cultures have their own ways of interpreting medicine or life in general. We must understand that different cultures have different ways of curing a person and doctors have their policy they must follow. To avoid another incident like this, we must work together as a whole and not blame each other for not cooperating with one another. Lets hope this book tells us what can happen in the future if we don’t work with this now. Anne did a great job on this book! My family couldn’t have ask for more. She has become a great friend of my family and we are greatful for it. Anne-thank you !
Amazon is worth visiting for an intense discussion including people who were close to the case.
Professor Mai Na M. Lee’s article on HmongNet is excellent, and not to be missed if you want the perspective of a Hmong-American writer familiar with both cultures.
Yeng M. Yang, MD has an insightful review of the book in Hmong Studies Journal, Spring 1998.
RELATED NEWS: One of the soldiers murdered in the Fort Hood shootings was Kham Xiong a Hmong-American serviceman waiting to be deployed to Afghanistan.
CONNECTIONS: I gave my copy of ‘The Spirit” to a Hmong-American student who is training to become a medical assistant. She says she likes the book. She showed it to her family and she said she would email me their comments on it.
PROVIDENCE, RHODE ISLAND: On the way to a community garden party I saw some Hmong ladies walking together. They were dressed in their traditional clothes. South Providence was home to my Irish grandparents, now to Asian, Central American and African immigrants. We’re the smallest state with the richest culture.
A PRAYER: To always strive to listen to my patients, across whatever differences divide us.
Diet, Pharmaceuticals and Diabetes
Kmareka is proud to cross-post with Elizabeth Carrollton, from Drugwatch.com. Ninjanurse spends her working days nagging people to take their meds, and needs to add the caveat that general advice and debate on the internet is no substitute for medical care for your own individual situation. So talk to your doctor and don’t even think about ignoring diabetes if you like doing stuff like seeing and walking and staying alive.
A Balanced Diet and Healthy Lifestyle for Type 2 Diabetes
The course of action a physician takes to manage diabetes is directly related to the severity of the patient’s diabetes. In some instances, diabetes health can be controlled through diet, exercise and other similar healthy lifestyle modifications. Although prescription drugs may be needed in addition to eating a balanced diet, only a physician can make this call.
Diabetes is a condition where blood glucose levels are much higher than the normal range, which on a glucometer is around 90. Once a diagnosis of prediabetes or diabetes has been established, it is imperative for a physician or registered dietician to create a course of action based on the patient’s weight and lifestyle.
Diabetes medications are also taken into consideration at this time. Patients need to be aware of the severe side effects of certain medications like Actos, which increases the risk of bladder cancer. Additionally, other diseases and health issues are part of the diagnosis and treatment process.
According to the National Institutes of Health’s MedlinePlus, the main factor in eating for diabetes health is to limit sugar intake. The National Institutes of Health also declares that eating smaller portions more frequently is essential in regulating glucose levels. In other words, rather than eating three larger meals per day, a person with diabetes should aim to eat smaller meals about five times a day.
Besides sugar being an issue, carbohydrates are also a variety of food that should be limited, due to their effect on glucose levels. This is because carbohydrates like white bread and crackers generally cause sugar levels in the body to increase.
Besides restricting sugar and carbs, a person with diabetes should incorporate foods into his or her diet that are part of a well-balanced diet. Fruits and vegetables, for example, are a vital component of a healthy diet, since they contain the necessary nutrients for cells and organs to function properly. Not to mention, the vitamins and minerals in veggies and fruits help support a healthy immune system.
Plus, the fiber within fruits and vegetables plays a positive role on cholesterol levels and on heart health. The American Heart Association (AHA) and the American Diabetes Association (ADA) note that fiber is important to heart health, which is oftentimes comprised by diabetes and certain diabetes medications, such as Actos.
Living a healthy lifestyle that includes exercise affects heart health, diabetes health and overall health. Being overweight, especially being in the category of obese, contributes to cardiovascular problems, such as congestive heart failure, which are made worse by taking certain diabetes drugs like Actos. Moreover, being overweight can lead to type II diabetes. It may worsen the severity of the diabetes if a person gains weight after he or she received a diagnosis of diabetes. When a person is considered to be in the stage of prediabetes, gaining weight can force that person into having full-blown diabetes.
Therefore, living an active lifestyle can help one maintain a healthy weight that can help manage diabetes, prevent complications of diabetes and prevent cardiovascular disease. It reduces stress and according to the National Institutes of Health, exercise contributes to a lower blood sugar and prevents future weight gain.
Elizabeth Carrollton writes about defective medical devices and dangerous drugs for Drugwatch.com.
Dangerous Speech from Doctors
So, what is it with these laws that try to stifle doctors from speaking honestly with their patients about matters that concern their health? Going back to the Reagan years, ‘gag laws’ are popular with the same politicians that preach against ‘gummint interference in our health care’.
Mining corporations in Pennsylvania have legislated to put doctor’s careers at risk if they disclose the names of chemicals that have made their patients sick.
In Florida, pediatricians had to fight for the right to follow their best judgment in protecting children. Today, Medscape.com, reports that the First Amendment still protects us…
Florida chapters of national medical societies such as the American Academy of Pediatrics (AAP), along with several individual physicians, sued the state in federal court to block what they called a “gag law.” They argued that physicians should be free to ask patients, especially parents of young children, whether they own guns, and if so, to advise them about safe storage. The ultimate goal is to prevent shootings that occur, for example, when a child finds a loaded pistol in a desk drawer.
The National Rifle Association (NRA), which had lobbied for the law’s passage, unsuccessfully tried to intervene as a party in the federal case. It saw the Second Amendment and the right to bear arms at stake, as opposed to the First Amendment and free speech.
Louis St Petery, MD, a pediatric cardiologist in Tallahassee, Florida, and executive vice president of the state’s AAP chapter, hailed Judge Cooke’s latest ruling as a victory for preventive care.
“We were not out after gun owners’ rights,” Dr. St Petery told Medscape Medical News. “We were out to protect children. Pediatricians need to discuss [gun safety] issues openly to prevent children from getting killed.”
Government is flawed and corruptible, but when special interests use local power to pass bad laws, citizens can and must call on our Constitutional rights. Industry loves deregulation, except when it’s bad for business.
Cash-Only Psychiatry
Fox News psych pundit Keith Ablow warns that having affordable insurance makes America soft and infantile.
But Fox News’ resident psychiatrist Dr. Keith Ablow may win the prize for the most outrageous reaction. In a column posted on FoxNews.com and during an interview Monday afternoon on the network, Ablow claimed that the court’s decision will “iInfantilize” Americans:
ABLOW: [T]oday it could be healthcare, tomorrow it could be a hybrid vehicle that you are penalized financially for not buying. It takes control of your behavior in the way that a parent would of a child, and it diminishes us in terms of our autonomy and ability to achieve things even for liberty on the world stage, quite literally.
I’m only a nurse, but in my observation, mental illness takes control of people’s behavior in ways that devastate their own lives and the lives of people close to them. Mental illness often strikes in early adulthood, turning promising students into people who struggle all their lives with disability. People with mental illness are likely to suffer loss of earning power, to the point of living in chronic poverty. It’s not that people can’t recover, but mental illness is common, difficult to treat, and often undiagnosed. Good psychiatrists and counselors are often not available to the people who need them the most. This care is expensive, and when states are cutting costs mental health treatment programs disappear while the need grows.
If Dr. Ablow has refused gummint insurance, such as Medicare, Medicaid, VA— then he gets credit for being consistent. He would only spend his non-TV time ministering to the wealthy, but the wealthy suffer from mental illness too.
If he takes the gummint money and goes on Fox to try to shame people for wanting affordable health care– I think there’s a name for that kind of thing. Projection? Reaction Formation? Denial? Snake Oil Peddling?
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