What matters now - get the free e-book

Here's a free e-book that you should not miss. It's a compilation of quotes from the best contemporary minds. It's inspiring. It will make you stand up from your chair and make a difference. I plan to print it and read at least one page a day... hey, it might even get me to start writing again.

Below is one page extract that is significant to this blog... Just like the author below, I found that once I became free of my anxiety I became much more skilled socially than most of the people around. While being trapped in social anxiety and trying to find a rational way out of it, without even realizing it, you learn a lot about human nature and being social.

S O C I A L S K I L L S

I have really bad social skills, so I am constantly noticing
how the whole world revolves around social skills.
Research that really blows me away is that people would
rather work with someone who is incompetent and
likable than someone who is a competent jerk. And
then I saw that in some cases elite British crew teams
will put a weaker, but very likable, rower on a boat
because people row faster if they row with people they
like.
In my life, I have had to learn social skills one by one,
because I have Asperger Syndrome. I learned to smile at
jokes even though I’m too literal to understand most of
them; I listen to the rhythm of a sentence to know
when it’s time to laugh. And I learned how to say, “How
are you,” with the right tone of voice – to express
interest – although to be honest, saying that phrase
gives me so much anxiety that I never actually say it.
A few years ago I found myself smack in the middle of
the recruiting industry. I ended up, somehow, being an
expert on how to attract candidates, and an expert on
how to present yourself well to employers. At first I
thought it was absurd. I’ve never worked in human
resources, and I’ve never been a recruiter. But then I
realized that I’m an expert on the hiring process because
it’s all about social skills, and I’ve been studying them
my whole life so that I don’t look like a freak.
In fact, it’s not just getting a job. Or giving a job.
Getting or giving anything is about social skills. The
world is about being comfortable where you are and
making people feel comfortable, and that’s what social
skills are. What’s important is to be kind, and be
gracious and do it in ways that make people want to do
that for someone else.

Penelope Trunk is the founder of BrazenCarerist.com. Her blog is
blog.penelopetrunk.com.

Engage with Grace - a Blog Rally

Last Thanksgiving weekend, many of us bloggers participated in the first documented “blog rally” to promote Engage With Grace – a movement aimed at having all of us understand and communicate our end-of-life wishes.

It was a great success, with over 100 bloggers in the healthcare space and beyond participating and spreading the word. Plus, it was timed to coincide with a weekend when most of us are with the very people with whom we should be having these tough conversations – our closest friends and family.

Our original mission – to get more and more people talking about their end of life wishes – hasn’t changed. But it’s been quite a year – so we thought this holiday, we’d try something different.

A bit of levity.

At the heart of Engage With Grace are five questions designed to get the conversation started. We’ve included them at the end of this post. They’re not easy questions, but they are important.

To help ease us into these tough questions, and in the spirit of the season, we thought we’d start with five parallel questions that ARE pretty easy to answer: 

Silly? Maybe. But it underscores how having a template like this – just five questions in plain, simple language – can deflate some of the complexity, formality and even misnomers that have sometimes surrounded the end-of-life discussion.

So with that, we’ve included the five questions from Engage With Grace below. Think about them, document them, share them.




Over the past year there’s been a lot of discussion around end of life. And we’ve been fortunate to hear a lot of the more uplifting stories, as folks have used these five questions to initiate the conversation.

One man shared how surprised he was to learn that his wife’s preferences were not what he expected. Befitting this holiday, The One Slide now stands sentry on their fridge.

Wishing you and yours a holiday that’s fulfilling in all the right ways.

To learn more please go to www.engagewithgrace.org. This post was written by Alexandra Drane and the Engage With Grace team. If you want to reproduce this post on your blog (or anywhere) you can download a ready-made html version here

Dr. Rob's post on anxiety

Dr. Rob has a great post on anxiety. Make sure you read it. It's worth knowing what happens in a doctor's head when you have anxiety.

http://distractible.org/2009/10/09/anxiety/

Doing well!

Long time, no see!

I'm in a contemplative mode right now, so I figured I could write an update. My social anxiety is better than ever. I'm feeling funny at times, but I just acknowledge it and brush it off: it's just like having a runny nose: just take a tissue, wipe your nose and move on. No big fuss. Just yesterday I casually invited my brothers in law out for lunch... me? alone with guys other than my husband?making the invitation without any hint of hezitation? - who's this girl?

I dropped yoga for a long time, and I just got back to it this last week. I am a different person, I found back my anxiety-free world. I see now that I have conditioned myself to be anxiety-free when doing yoga. So I need to keep on doing it. It's great!

I will be moving out of the country for 6 months and I am quite emotional and observant about everything around: admiring my neighbourhood, the trees, the birds, my car. I am packing my whole house and it's great to touch each object. Bring back memories.

For those of you that were around at the time when I had an impossible dream, the dream became quite possible. I am taking an online course of Health Care for IT Professionals and doing really well and I think by the end of this course I will be able to find some work. My doctor was already interested in me coming to review her workflow and help with their new EMR system.

The conclusion is: social anxiety can be beaten without medication. You can achieve your dreams no matter how crazy they seem to be. Just don't give up. Keep pushing yourself. But you need to know what you're pushing for: clarify your priorities and your goals.

Exposure Therapy Helps Relieve Social Anxiety

No man is an island, and as human beings, we have to interact with society in some form or the other if we are to survive on a day to day basis. So you can understand how social anxiety becomes a problem for those who live with it day after day and restrict their lives because of this mental disorder. When you’re afraid of communication and other aspects of public life like driving, flying, walking on the streets, shopping and the like, you can see how it becomes a problem to do perform even the most basic activities.

While some people turn to medication as a way to resolve these feelings of anxiety and fear, drugs are not recommended unless your symptoms are severe and unmanageable. Besides, medicines that are used to treat such disorders include anti-depressants, beta blockers and benzodiazepines that are full of chemicals that could turn out to be addictive and that also come with their own side effects. Instead of relying on medicines, one of the best ways to tackle social anxiety is to try exposure therapy.

For those of you who know how to ride a bike, this form of treatment is just like learning to ride your bike for the first time. You’re scared, you have no sense of balance, and you’re terrified of hurting yourself. But you go ahead and try it because you so badly want to ride that new bike. Exposure therapy is all about overcoming your fears too, step by step, bit by bit. Just as someone holds on to your bike for the first few minutes and then lets go so that you try to gain a sense of balance, exposure therapy too involves breaking down your fear into smaller pieces and tackling the smallest one first.

So if you’re scared to talk to the opposite sex, start out by talking to someone you already know, like the girl/boy next door who always smiles at you, the smile that you were too nervous to return until now. Then move on to talking to people who are normally courteous, like salespeople and customer service representatives. It’s not going to be easy, and just like in the biking lesson, you’re going to end up falling quite a few times. But the key to success is to pick yourself up, brush the dust off your clothes, forget the minor bruises that you may have, and get right back on that bike again.

xposure therapy works best when you have someone to support you, just as your dad or mom would hold on to the bike till you’re able to find your bearings. You also need to know when to push yourself and when to stop – go as far as your fear will let you go but stop once you reach that point. You need to keep at one level till you feel no fear at all, and only then can you move on to the next level. It’s a slow process, but the infusion of confidence you feel when you master each level and move on to the next one will help you cross the next one faster than you did the first. So stick with it, and you’ll find yourself managing your anxiety in no time at all.

This post was contributed by Alisa Johnson, who writes about the types of nurses. She welcomes your feedback at Alisa.Johnson1982 at gmail.com 

Livin' in the moment - the book

A commenter asked me to recommend other books like Michael Pollan's. I did not read other books like Michael Pollan's, but here's another recommendation: brand new, released on March 17, David Romanelli's book: Yeah Dave's Guide to Living in the Moment - Getting to Ecstasy through wine, chocolate and your iPod list.  

The book is excellent! I went to his yoga classes whenever he was around over the last year and I am reading his email newsletter and I pretty much know all the jokes, but I still find it refreshing to read the book. Dave is great. He's just another guy and is admitting it. Only he's not just another guy. The way he's observing the world and the way he's showing how he deals with it it's very original. He's fun and honest, silly and serious. 

I have a hard time realizing why I like him, but I am hooked. His is the kind of yoga that I want to practice. You can also check out his blog for funny and interesting weekly posts. 

6 years - We Will Not Forget You

6 years ago, on Valentine's day, I was admitted into the hospital. I was 24 weeks pregnant and I was feeling great. But my doctor's appointment showed a blood pressure of 180/100, and my kidneys were spilling a lot of protein - sign that they are not functioning well... I had preeclampsia. It is a disease that could be very dangerous for the mother and the baby. The only known cure is delivery of the baby, and at 24 weeks of pregnancy, this is problematic as the babies cannot live without a lot of interventions and they risk blindness, deafness, cerebral palsy, and all sorts of other issues.

My baby was stillborn on February 17, and my own hospital ride after delivery was quite bumpy: fluid in the lungs, unexplained high fever, high blood pressure... the problems never seemed to end. 

After this, we became involved with the Preeclampsia Foundation and I made a ton of friends there and acquired knowledge about my disease and support for our subsequent pregnancy. I am so grateful that the organization and the forum exists because they were my family for a number of years. If you know anyone having any similar issues, make sure you tell them about the website.

6 years later, I finally feel a bit more detached from the experience. I'm still thinking about it, but the trauma is mostly gone. Of course having a 3 years old that is extremely happy and healthy and normal in any way helps a lot.

This year, for the first time, my 3 yo son could somewhat understand what I'm talking about. He asked if we're lightning a candle for Angel's birthday, and he wanted to sing Happy Birthday and to bake Angel a cake. We will go see the ocean where Angel's ashes were spread. It is comforting to know that anywhere there's a sea or ocean there could be a microscopic cell of our dear son.

The other thing I did for Angel was to plant a little garden of Forget-Me-Nots and Lilly-of-the-Valleys (called little tears - Lacramioare - in Romanian). It is great during the spring and summer, but in the winter, there's nothing there. 

I have a friend, Kitty, that takes great nature pictures and she happened to have the Forget-Me-Not picture above. She got me a beautiful print that I framed and I am now keeping with my family pictures. I love the personal nature of buying stuff made by friends, and to personally know the artist or person that made something. 

Photo courtesy of Kitty Wilkin

 

My class graduated

For the last couple of years while I was blogging about social anxiety, I also followed a number of other social-anxiety related blogs. And, happily for all of us, it seems that we all graduated: 

• S A Dave got a job and he's doing pretty well there and has no spare time to write,
• "The guy at Successfully Shy" moved on with life (and Congratulations for the recent event!)
• Matt released his e-book
• Drew gave away his blog to Vladimir
• and I keep dreaming about starting to blog about something else.

I keep promising and I always come back. Well, I had a very promising proof of my emotional maturity this week-end and I also will start having a bit more time at work... so I think now it's the time to get this project going. 

It's time for a new generation of socially anxious to take over. The world is so much different these days: you have UTube and communities all over the place. Good luck to you all! 

Books - Michael Pollan

I heard a few people positively mentioning Michael Pollan's - The Omnivore Dilemma, so I read it and I loved it so much that I had to also read In Defense of Food. 

Finally food and nutrition books that make sense instead of scaring you to death and making you wonder how come other people aren't dead by now with the food they eat. The Omnivore Dilemma starts by  describing the industry of growing corn in America and all its uses, and the drama of both the producer and the consumer in an industrialized agriculture. It continues with a trip to a "post-organic" farm in Virginia, and end with his adventures in hunting and gathering the food for a meal the way our ancestors must have done it. 

In Defense of Food suggests a heathier way of eating that might help avoid the Western diseases. It explains where nutritionism and reductionist studies fail. He suggests that we restart eating the way our ancestors did and keep the food culture alive. We need to know where our food comes from and need to be mindful while eating it.

I especially loved The Omnivore Dilemma... as I read through it, I wanted to go and start a farm myself... 

In the end I have an idea where I want to go and I have a probable explanation for my ulcerative colitis. While this was not mentioned as one of the Western Diseases, I think it fits right in. The books are very well researched, they are shockful of references.

My conclusions: over the next couple of years I will work on restarting to eat the way my parents did, I will start my own garden and will subscribe to a CSA. I will work toward going less often to grocery stores and on eating more plants and more diverse foods. I will also work towards becoming more mindful of our eating and cook more. I will prefer food quality to food quantity.

And I now decided: I do not want to become a vegetarian. I will try to shift the ratio from meat towards plants, but I see no need to give up meat completely. (check meat.org if you want to become a vegetarian)

 

  

Wellsphere and bloggers

I had a post earlier this year ranting about health websites that try to buy small blogs like mine. The website that contacted me was Wellsphere - basically a collection of medical blogs. I answered to the mass email by saying that i am not interested and that if they really want to help people they can link to my blog. I did get the link and as opposed to people that gave away their posts, I actually got a few hits from them. 

Wellsphere was sold earlier this week for a lot of money. The bloggers are very offended as they did not get any money out of the deal but gave away all the rights to their content republished by Wellsphere. 

For more details about this check Dr. Rob's comment. Always be very careful  what you sign up for and make sure it's really what you want. 

I'm grateful for my eyes

A yoga teacher friend of mine, Kitty had a heartbreaking post today about her hearing getting worse. She a great yoga teacher and she's taking beautiful nature pictures. If you want to see and buy some of her stuff, you can visit her on Etsy. She's a wonderful person, one of those that I probably would have never known if blogging and social networking wasn't around. I am so moved by Kitty's inner beauty and by the fact that people like her exist and they are around us. One more time, social networking is heaven for us the socially anxious. 

Anyway, her post made me remember the scare I used to have about my eyes for years. Especially by the end of January I was having huge issues with my eyes: I was unable to read at night and had big problems during the day. My eyes get very tired and it seems to be related to natural light: it seems to be better in the summertime than during the winter. The new more efficient halogen lights might also be helping. 

In addition, this year I have eyeglasses with progressive lenses which allow my eye to pick whatever position works best at a certain time. My dioptries keep growing every year, so I imagine that one day I might need some sort of operation or even become blind. Fortunately this doesn't seem so close this year, so I am just enjoying it. 

I read about a book a week for the last month or so. I love them all. And I want to write about them all, but never get the time... Hey, I got to go start a new book!

For now, I am grateful for my eyesight and wish Kitty all the best! 

People in my life

I visited a friend yesterday and met her nice husband. This gave me a moment of reflection on how my life changed over the last couple of years. Two years ago, I thought I only have my husband close. I looked at anyone with suspicion: I was scared of being cheated, abandoned, ignored. I was scared to leave my kid with anyone. I only trusted one or two doctors.

Now I have people and friends in my life. I have friends to share my fears and worries, and brag about my achievements and joys. I have people that I am comfortable leaving my kid with at anytime (granted a three years old can take care of himself better than a one-year old, but anyway). I'm not scared of trusting my house with some people: what's the worst that can happen, and I know they are nice anyway, especially if I treat them nicely. My work world has been populated with people with their lives, desires, achievements and failures, were before I just saw work and "resources" that could get sick, wanted vacations and free days and all sorts of other stuff that was in the way of work. 

My guard was way up and I let it down. And I started seeing a lot of beautiful interesting stuff behind it. Love and you will get love, trust and your trust will be answered, but most importantly, from Lance Armstrong: "I don't take anything for granted, this way anything that happens is a miracle"

There are great people out there, just give them the chance to show you. They are in many ways just like you, and in many other ways quite different. Accept the differences and accept them for what they are. 

I'm twittering

I am yogileana on Twitter.

I like Twitter for little thoughts. I don't want to throw in everybody's face that I deal with social anxiety and I want to talk about things that might be irrelevant to the SA people.

I will load all my posts into Twitter, so if you want to follow me there go ahead.

I like the fact that all messages should be at most 140 characters. This will help me become a better writer, I think!

If you wish to vote for me

Here's the link for voting for the best patient blog. Please consider voting for me.

http://medgadget.com/2008bestpatient.html

I must admit that I could not vote. The system never got my vote in. I tried to vote for Duncan Cross that I nominated, but it never registered. I tried in both Chrome and Internet Explorer browser, from different locations. Considering the large numbers, I suspect it's a me issue and this humbles me deeply as I am building web applications, and still have no idea what could be wrong.

Geek Doctor

Oh, wow! I was nominated in the finalist list of best patient blogs! That's pretty neat! Here's the list of finalists. The voting starts tomorrow. If you like this blog, feel free to vote for me. 

I have mentioned John Halamka's blog before, but I never discussed it in detail. I read it since the first post and I did not miss one entry in more than an year. I started reading it because I want to work in IT in a hospital and John is the CIO in Paul Levy's BIDMC hospital. As expected, I learned a lot about IT in healthcare, but the blog goes so much further.

I started by being critical and resistant. What, open source used extensively in a large organization? You mean Oracle is not your main database? You don't think that relational databases are the best databases? You buy and build?

Then I just listened and learned. And John's blog was a huge support for me in my yoga journey. I hang out with people that were so different than the world I'm living in: stay at home moms, and teachers and athletes and artists... was this meditation thing something that rational people do? Like programmers, engineers, doctors? And then he started the series of personal, lifestyle entries on the blog on Thursdays. After a series of posts that demonstrated that this is one of the most rational people I ever met. While not practicing yoga himself, a lot of the subjects John is covering have to do with stuff that I studied: treasuring each moment, keep the emotion in the present, respect your personal and family time as separate from your work time, and most important: accept everybody, even if you don't agree, or especially when you don't agree... there might be something to learn in your resistance. 

John' blog was nominated a a finalist in the Medgadget awards for Best Medical Technologies/Informatics Weblog. I for one will vote for him. And will keep reading his blog. Thanks for writing! 

I'll soon have a blog pot about a few books that I recently read that I found very enlightening. Two of them were recommended on John's blog. 

2008 and 2009

I disappeared for a while in a "holiday anxiety". I suspect this is not unusual to those of you that struggle with the same issues as I do. I decided to go with the "presence is the best present" this holiday and to share time and love instead of buying presents and sending cards, but I did not tell anyone and when the time to give love came, I just got ashamed of going outside the box and avoided it all.. This is too funny and a good lesson that if I will try this again, I need to better plan who do I send love to, when and how, because picking up the phone and calling is not my thing apparently! It's all behind now and next year there will be a new holiday season.

2008 was a great year. It was an year of change. I came to terms with my anxiety, I learned to love my job, I learned to be a better mother, wife and person, and to be nicer to myself especially. I got someone to help with the household and this was major: because I learned what it takes to work with someone successfully, mostly trust and the knowledge that everything will be well. She is a wonderful person too, but I saw that it is possible to find wonderful people. This freed my time for myself, and my family. My health was so and so, but I learned that I am not my diseases and I learned to put my health in the background. I also learned that I am the best person to take care of myself and it is my responsibility to figure out what my body needs or doesn't need.

What about 2009? More and more I realize that I want to write, I need to write, and it is also my best way to communicate with others. So I hope I'll find a way to incorporate more of that into my life. I want to continue to add more exercise and fun into my schedule. And continue to work on my health and my relationship with my family and others. I think it will be another even better year.

Happy New Year!

Who, me? Self-centered?

This post might come as an unexpected and unpleasant surprise to some of you. It might even push some away if you haven't yet seen this idea. The first time I read about it, I was uncomfortable and resistant, but thinking about it some more, I realized it is so true.

This condition might look like we are caring a lot about others, but we mostly are caring about others in relationship to US: do they like ME, do they think I'm looking good, writing well, doing the right thing? We are quite self-centered. We bask in the happiness that someone likes us, we are anxious about saying the right thing or saying anything or not blushing, or not sweating. We fear that the wrong look or attitude might push some away. It's important for us to be called someones best friend, the best employee, the nicest person, etc., and we're desperate if someone else becomes the employee of the month, the best friend, etc.

I want to be nominated in the 5 best patient blogs, but I do not want to win, this would be disastrous next year when I might not even be nominated anymore. I will probably quit before that happens - running away is better than being demoted. I think this is actually a common trait, probably most people think more or less about things this way, we just take it to extreme.

So, what to do about it? It's ironic, but the first thing to do is to accept that we are normal, OK, looking good enough, acting OK, saying the right things, and when we don't, just accept that it happens to everyone: we all say stupid things every now and then, we blush at the wrong time, friendships die, relationships end, with or without our help. It's just stuff. And while being relaxed about us, we can now look at others with more compassion and love: see what they really are about, hear them, help them without caring what they think about us. Most people would feel more honesty in this approach and will be more attracted to us.

We need to relax, and we'll start seeing a bigger picture and doing things to help everybody and we will be appreciated even more. And if not, it just happens, just move on. We all are just fine and normal.

Trying to help

My world has changed a few days ago. One of our acquaintances, a young guy just out of college, died from an overdose of medication. He was battling depression for a long time and addiction more recently. Over the last couple of months his family and friends (my husband included) tried an intervention on him. Everybody tried their best, but in the end none of this worked. Maybe I, probably just like everybody else around him, feel a little bit of guilt. As it happens he was one of the nicest kindest guys I ever met.

I knew about his depression, I heard that he feels worthless maybe an year ago. And I just listened and didn't do anything at the time. So I am doing something now. I am doing it for any of the guys out there that might be depressed and feeling worthless. I am doing it in the hope that someone will understand that their perception that they are worthless is just that: a perception. That depression and any other mental health issues can be treated and resolved, that the stigma is not as huge as it seems, that opening up is possible and helpful. I am working to get this blog more popular. It's not about me anymore.

It feels like for me increasing my self esteem was the solution. But there was so much work into this, and I was a successful professional: my husband, my therapist, a successful profession, a healthy child, all my blogging friends and all my friends that supported me even after finding out that I have social anxiety. And the cherry on the top: yoga with their concept that the divine is in each of us. And finally I got it: I am worth something.

If you hear someone repeatedly mentioning how they are no good, then it's time to act and talk to them. If you think you are no good, go get help. We are all worth for living a decent life.

Medgadget 2008 awards

I nominated myself for a 2008 patient blog award. I mostly did it to increase the readership of my blog. There are two kind of people that might be interested:

• The ones that have no idea that they have social anxiety; they land here by accident, figure out that what's been bothering them for a lifetime has a name and then get help and relief. One visit alone can help these people.
  
• The ones that like my writing, and find an inspiration in my success story; they read the whole thing and subscribe and come back for more.
  

For newcomers, I hope you find answers and inspiration in this blog, for subscribers, please go to MedGadget, read these blogs and cast your votes.

FYI, I also nominated another blog that I have been reading over the last month or so. Duncan Cross has Chrohn's disease and writes about health care. His point of view is original and well-thought. It brought me a great balance to read a chronic patient's point of view instead of only reading the doctors/hospital administrator's point of view. Extremely refreshing and well-written.

I'm not asking you to vote for me, just to consider these blogs among others!

New and old visitors

I want to salute two visitors.

One of them came in two days ago and submitted a comment on my emotional immaturity post. Apparently he found me by searching emotional my entire life. He bumped into my blog and figured it might be social anxiety. He might never come back, but I am happy that this blog is here to be helping people like him. I remember searching for what's wrong with me and reading my first book about social anxiety...

The other visitor... I only see him through statistics counter. As far as I know the visitor never submitted a comment. (S)He comes in every three-four weeks from Paul Levy's blog. (S)He's from Massachusetts General Hospital. I counted 17 visits now, but with changing IPs it could be more than that and it could also be someone else. Thank you for your quiet presence and for coming back. When I see the familiar entry I feel like greeting an old friend.

Challenges benefits

Paul Levy invited me and 30 other bloggers to participate in the blog rally "Engage with Grace". I think the subject is worth the discussion and I might write about end-of-life discussions and options at a later time.

Here I'd like to share my sense of great achievement with a challenge. Paul asked me if I am OK to be interviewed by a reporter for a newspaper article. I accepted saying that I would be more comfortable on email, but that I could do it by phone.

I talked to the reporter and it was fine. I was not as witty as I would have liked and I did not say all that I wanted to say, but I took the challenge and got through this. The article ended up not mentioning me or any blogger other than Paul, so I did not become famous overnight.

But I was so happy afterward, happy to have done this, happy that next time I will feel better about it, happy that I am just normal. I felt powerful. And I realized that without my social anxiety this would have been just another phone call instead of a very pleasant experience.

Instead of dreading what you can't do, take challenges and celebrate all the stuff that you can do!

Engage with Grace

We make choices throughout our lives - where we want to live, what types of activities will fill our days, with whom we spend our time. These choices are often a balance between our desires and our means, but at the end of the day, they are decisions made with intent. But when it comes to how we want to be treated at the end our lives, often we don't express our intent or tell our loved ones about it.

This has real consequences. 73% of Americans would prefer to die at home, but up to 50% die in hospital. More than 80% of Californians say their loved ones “know exactly” or have a “good idea” of what their wishes would be if they were in a persistent coma, but only 50% say they've talked to them about their preferences.

But our end of life experiences are about a lot more than statistics. They’re about all of us. So the first thing we need to do is start talking.

Engage With Grace: The One Slide Project was designed with one simple goal: to help get the conversation about end of life experience started. The idea is simple: Create a tool to help get people talking. One Slide, with just five questions on it. Five questions designed to help get us talking with each other, with our loved ones, about our preferences. And we’re asking people to share this One Slide – wherever and whenever they can…at a presentation, at dinner, at their book club. Just One Slide, just five questions.

Lets start a global discussion that, until now, most of us haven’t had.

Here is what we are asking you: Download The One Slide and share it at any opportunity – with colleagues, family, friends. Think of the slide as currency and donate just two minutes whenever you can. Commit to being able to answer these five questions about end of life experience for yourself, and for your loved ones. Then commit to helping others do the same. Get this conversation started.

Let's start a viral movement driven by the change we as individuals can effect...and the incredibly positive impact we could have collectively. Help ensure that all of us - and the people we care for - can end our lives in the same purposeful way we live them.

Just One Slide, just one goal. Think of the enormous difference we can make together.

(To learn more please go to www.engagewithgrace.org. This post was written by Alexandra Drane and the Engage With Grace team)

Opportunities

It's almost two years since I started this blog, and the online world is so different now than it was back then. What great opportunities for anyone to get to terms with their social anxiety.

Part of it is this huge reference related to social anxiety: blogs, personal health oriented websites, forums, e-books.

And this is not all. You can find blogs about anything. This is great for people that feel isolated and don't feel like they can match anywhere. I found blogs that are a pleasure to read about anything of interest to me: social anxiety, any area of healthcare (doctors, CEOs, IT people, patients, etc.), people that wear glasses, people that do yoga, meditation, zen living, passionate about tribes, and so on. It's amazing!

I think that part of my success with social anxiety is finding people that have common interests and realizing that I'm not alone out there.

Go look for people that share your passions! I bet you'll find enough! Don't miss your opportunities!

Overcoming social anxiety?

I got a few emails lately from people thanking me about the blog and hoping to follow my steps in overcoming social anxiety. I know I heard this before and I didn't believe it and I know that probably the people dealing with this will feel that overcoming SA is the right way out of their misery, but I did not overcome it. It's still there, every day, every encounter. I just don't beat myself up over it. I'm OK with it and with myself.

I thought that the way out of it was to have at least one close friend, and I tried and I'm still trying to get there. I made a few tries and never quite got to it. Part of it (maybe the biggest part) is that I don't really have time to dedicate to a friendship. Maybe I created this lifestyle to avoid getting to close. It seems to be a pattern either in my choice of friends or in the way I am interacting with them. But that's fine. I just go on and try other people and other ways.

I also hate telephones. They are perfect for getting things done, clarify stuff, setting a meeting, managing an activity and keeping everyone in the loop, but just talking? It seems that anytime I try it, there is a bad signal, there is no return of calls after leaving a message, it's the wrong time, etc. Plus, I like to drive when I'm driving, work while at work, eat dinner with family and spend time with my kid when I'm around. This leaves open the between 9:00 PM and 7:00 AM... who would talk to you then... oh and did I mention that I also like to sleep at night? What a solid argument for avoiding yet another means of interaction!! See? I did not overcome social anxiety. I just accept it as part of who I am. It is my charm!

In conclusion, my advice is to not look for overcoming anxiety, but accepting it. Once you accept yourself for what you are, you become less tense and you do your best in most situations.

Another overview post

I've been slow to write lately and I would so much love to restart writing. I want to write about life and work, not necessary on this blog, but I'll keep you guys updated once I get started somewhere else. This post is another overview of my journey in beating anxiety.

• Educate yourself. The first thing I did was to figure out what's wrong and read a book about it. At the time I realized that I need to figure out what's with me because nobody else can figure it for me.
• Find a buddy. Next, I educated and engaged my immediate family in my fight with social anxiety. I think it is impossible to do it by yourself. Either a family member or a friend or even an Internet forum would work for that. You need a buddy.
• Find professionals to help. The next step was to talk to my doctor and find a therapist. This part took a long time for me because I was also dealing with a difficult pregnancy.
  
• Identify and stop the emotional dips. When I started therapy, for months and months, we just discussed the latest drama du jour. We wouldn't talk about anything else because there was always some crisis that I was in: work, family, friends, etc. there was drama everywhere. One of the most important things that I did was to drop friends and causes that made me have highs and lows: I stopped talking to friends that were depressed and were pulling me down, I dropped relations that I was too involved in: the kind where you check your email every five minutes to see if there's an answer, I dared to say no to social engagements that were making me uncomfortable. I just gave myself a break! That was a great way to work on SA. Once the main issues out of the way you can tackle issues one by one and take on only how much you can carry.
• Add challenges. I am a fighter, I'm always finding something to challenge myself, so this is not a struggle for me. The struggle is to not drop the ideas after the first disappointment. We had parties and I worked on my relationships at work, but the biggest challenge and the most successful was to start writing this blog.
• Open up. The person that inspired me to start writing the blog, Paul Levy, was the one person that paid attention to me and had a kind word for me throughout my journey. His fight for transparency in his hospital operation taught me that openness and transparency is the right way to work on my own issues. This was confirmed by Irvin Yalom's book. I told friends about the blog. I never got a negative reaction. Some were just quiet about it, but mostly I got some very friendly feedback.
• Ease the guilty feeling. I realized that my worst moments happen when I feel guilty: that I don't talk enough, that I'm too shy, that I'm not doing enough stuff around the house, that I'm not spending enough time with the baby, that I'm not working enough hours. The guilt just paralyzes you and it's useless. Once I gave myself permission to be shy and quiet and nice, and realized that I did spend as much time as I could both working and with the family and that there's not more time than that, things just became easier. I'm shy, so what? I'm quiet, so what? I said a stupid thing! Oh, well, it happens to everyone.
  
• Define your dream. Spend time to think about your priorities in life, what you want to do. Dream big! Write it down, find things that you can do next week to help you get there, collect pictures and articles about it. Simply allowing yourself to think about your dreams will make you feel better, but making progress toward it it's possible too. It's important to know what's meaningful to you and go for it!
• Drop the fear. What are you fearful of: What other people say? That you'll lose your money, house, car, retirement money? That you will lose your job? That you will be killed? That you will get sick? That your partner cheats on you? At the end of the day, it really doesn't matter. We all will live less than 100 years unless you're really lucky. Money is an illusion. Other people mind about their own business more than about you, and if they mind about you for a minute, they will forget it right away. I've been in that anxiety free land for about a week or two and it was great. I aim to get back there.
  

I think that's it! This helped me. It's a journey that never ends. I am still working through most of these items. There is no end!

Good luck to all of you!

Tips for new bloggers

These days I have more subscriptions to my blog than ever before... Don't take this to be in the millions of readers LOL, just around 30.

Anyway I just figured I'll post a few tips that helped me. Paul Levy got me started and I continued to learn by example from him and others. But this was long ago and I can repeat for the new readers that might want to take up blogging.

In blogging, just like anywhere else, the most important thing is to have relationships.

• Be nice and notice others if you want to be treated nicely and noticed.
• Link to other blogs you like and that are relevant to your blog. Best way to be noticed and the others might reciprocate and link back.
  
• Write at least 5 posts before starting advertising or linking to your blog. This way new comers can see what's it about and decide if they are interested. There is a lot to read these days.
  
• It is not that easy to keep up with writing regularly, so find your pattern of writing before promising anything.
• Build a relationship before asking for any favors: write (nice thoughtful) comments on other blogs, answer to comments on your blog. I'm more likely to listen to someone that added my blog in a post or article than someone that sends a mass-mailing looking email that tells me they like my blog - without any details.
  
• If you get obvious spam, just delete it and don't think twice about it. It's part of online life these days. If you deleted something by mistake, just apologize if possible and move on...it doesn't really matter.

Good luck and have fun!

The run for writers

Do you know WebMD? There are now lots of WebMDs emerging. They each come with the promise to help you manage your health and give you a community to support you. It seems that any person that can put together a web site and has the money to support it teams with one or more MDs and they put up these web sites that will resolve the health issues of the world. They need to build communities and they are in need of experts... they can probably easily find their MD experts... hey you can't refuse some money when you're a doctor in US. And they are all over the mom-and-pop blogs like mine. I've been offered $50 per article by one and visibility for republishing my posts by another. I guess negociation could get me more, but I don't care about being an anxiety expert.

I used my blog to help me with the anxiety. And it did. I am pretty much done babbling about anxiety. I still have a post or two of advice planned, but that's it. I love blogging and I'll probably do this with other aspects of my life, but I don't care about talking about anxiety any more. I have no issue with people in need finding my blog and getting the support and encouragement they need, but I'm not sure these websites are the solution to that. Right now google serches gets to my blog easily.

Back to the web sites, for the first one I was recruited by a young out-of-school person. This time it is an Internist with 25 years in practice. Wow! Where did we get? Where did we push these guys. I guess this is where our primary care heads to: the Internet! That's what we want, that's what we'll get!

I actually know what it takes to build a helpful online community. We had it for the Preeclampsia Foundation. You start with a small team and then extend it to the fans in the community that are the closest to the original team. You train people and watch them. These guys seem to recruit anyone that can write anything.

I wish them luck, maybe some of them will succeed, but it doesn't look to me like they are on the right path. I recommend that they read Seth Godin's blog!

Thoughts on managing health with a chronic condition

This post is probably going to come as a surprise after my earlier comments about alternative medicine. My conclusions over the last couple o weeks came as a surprise to me too, and I took a long time to think about how to write this post in a way that does not offense anyone.

Some of you probably read my vents against doctors. I have since read a lot and understood a lot and it is amazing that there actually are good doctors out there considering what we're putting them through.

This post is about my thoughts on Evidence Based Medicine and managing your health especially with a chronic disease. Last year I complained about having ulcerative colitis. I kept on with flares every couple of weeks ever since. We added more conservative medicine and then tried Prednisone (which worked dramatically well, but would not cause remission unless I stayed on it... long term use of steroids is not my ideal healthcare plan, so I weaned off as soon as possible), tried 6MP, a chemo drug that is sometimes useful for ulcerative colitis as well. My doctor recently suggested Humira - an auto-injectable drug for rheumatoid arthritis and Chrohn's.

Trying more and more powerful drugs gave me pause. Instead I decided to stop and think. My thoughts were that a colon-sparing diet, while not advised by my doctors or any doctors on the Internet should be a better solution. If you cut yourself, you don't just go out and play in the dirt, you add a band aid or a glove, you do something to protect the cut while it's healing. I understand that the flares are not caused by food, but it makes sense to spare the colon while it's flaring and eating milder foods.

I read that Aloe is good and I went with it. I found a place that sells this supplement. The research for it is done by an MD, and I found good revisions about it. And I went against my own advice and got this quite expensive supplement. It came with a chart for my symptoms that I am supposed to fill out and fax each 30 days. It also came with a suggestion of a diet. It still has starches and vegetables and protein, it's just avoiding high-fiber, dairy and gas-causing foods.

For three weeks I finally feel better than ever before. The symptoms are still there, healing little by little, but I can live and feel comfortable at work and not hate my life. And I could have done this an year ago if my doctors didn't discourage me from trying anything... because it doesn't work. I was going to try stronger and stronger medicine without first trying to slightly change my lifestyle.

I don't know if it's the Aloe. I actually think the diet is the main benefit. I think charting is important. And maybe the Aloe is doing its part as well, maybe it's just placebo. I don't really care. I feel great and I wouldn't stop either one.

My doctors went with Evidence Based Medicine. Now, I am not the one to argue with Evidence Based Medicine. I think we absolutely need to go with it. But I think it's misunderstood and misapplied. I think that a lot of doctors don't understand when and how it applies and have no idea how to read the studies. It is so difficult to study all aspects of a human life or even of one disease. You can just make guesses and pick up a few aspects to study. In addition, with the drug companies having the most money, most research will of course go with the drug research - less controversial too because you can make double blind studies. So you have these specific studies that you extend. In my case I think that the studies are about food not causing the flares, but what I needed was something to help me get into remission, and food restrictions might help with that.

On the other hand each person is different and the studies are built to be as general as possible. So maybe diet didn't help 75% of the people, but what if I am within the 25% that it actually helps. (a disclaimer here: I did not actually read any studies, I do not think I am able to interpret them correctly, I am just trying to see where I went the wrong direction and learn something)

So, my conclusion is that with a chronic disease you need to know your own body and know and understand what is good for you. Doctors are essential of course and know a lot about everybody, but only you know yourself. The first step when diagnosed is to log each symptom and start tracking down what's going on. Whether it's anxiety or hypertension in pregnancy or colitis, knowing what's going on and having data is invaluable. Log it down, chart it, learn trends and patterns. And here is where alternative medicine is different and better I think than traditional medicine: it encourages lifestyle changes, noticing what's going on and mild solutions before jumping to the big guns. Of course I don't talk about cancer here or any other acute disease and also not about the potent herbs with side-effects.

In my life, in the name of evidence based medicine, I was told that there's no need to stop going to work when I was pregnant and seriously ill with preeclampsia (yes, there is a study that proved that bedrest is not better than no bedrest for preeclampsia), but my baby died a week later and I had no clue about it. I would think that telling us: you and your baby are very sick; if you need to work, there is no evidence that this will hurt your baby, but taking some time off and resting as much as possible would probably be better (of course someone could argue that worrying to death is not that good either).

I was told there is no need to chart my blood pressure on a chronic hypertension pregnancy, but when things started going down I saw the trend and told my doctors about it. The climbing blood pressure could have been easily dismissed in weekly office readings.

I was told there is no need to diet or log what I'm eating because it doesn't matter... and here we are again... it actually matters. So go to your doctors, listen to them, but know yourself and manage your own health. And if you are sick with a rare or terrible prognosis disease either learn to read those studies or find someone that can read them...correctly!!! probably not your PCP, unless you are lucky.

Psychiatry and medication vs. talk therapy

A good article that summarizes the status of psychiatry and the push towards more medication for insurance-accepting providers.

http://www.kevinmd.com/blog/2008/08/matthew-mintz-as-psychiatry-goes-so.html

While the author mentions that this is not necessarily a bad thing, I think that having divided care especially with the health care providers not having time and not being reimbursed to talk to each other is just another link that can fail you. You know my advice: if you can afford it, go with the providers that do not accept health insurance and try no medication longer than you think!

Brain programming and self-esteem

More and more I am convinced that my recent success in beating social anxiety has more to do with the amount of positive programming about myself that I got. It finally got to that critical level when I began believing it. And it could have been anything: tapes, more therapy, or anything else.

This is not a new idea, I encountered it in more than one self help books: You need to be sure that you are great and wonderful and beautiful and lovable. If people around you reinforce this idea, you will start believing it and acting on it.

Sometimes people make mistakes, even the smartest people act stupid at times. Allow yourself to do or say stupid things. It's not a big deal. Just apologize and move on not giving it a second thought. You will make better decisions if you strongly believe in yourself than if you worry about being wrong about anything you do or anything anyone else thinks.

Having this in mind, it makes a lot of sense to do as many as possible of the following

• Use tapes like those from Dr. Richards at the Social Anxiety Institute,
• Keep in touch with friends and family members that make you feel good, and excuse yourself from seeing people that make you feel bad about yourself
• Find a good therapist
• Participate in groups for SA or whatever groups where your presence is welcome and you are well-liked
  
• Do yoga. Yoga teachers are supposed to be supportive, so it is likely that in a yoga studio you would find a good environment for growing self-esteem

My yoga program was subtitled: Love living in your body. Every week we would hear a variant of encouragement to love our selves and our bodies. "Love your body for what it is now, not next year, not when you'll love 10 pounds or when you'll have a boyfriend. It's perfect, right now, just as it is. You can walk and run and jump and it doesn't hurt to do this. It helped grow these amazing children that you have and helps keep you alive. Touch your thighs and belly and arms and say Thank you, body, thank you!" It worked great and after more than an year of therapy in which I heard a lot of: you're wonderful just as you are, you just need to start believing it, it finally sinked in.

I'm playing with Facebook and Linked In these days and I am so happy to see people trying to connect to me... and I say that they are doing it because I am nice. It's great to love yourself, quite a novelty for me.

About.com

About.com has a page on social anxiety disorder and the moderator, Arlin Cuncic, released an article about the best SAD blogs. My blog is mentioned in that article positively... pretty neat if you think about it. I'm growing. The website is informative and has a forum and a newsletter. I think it's worth keeping an eye on it.

Thank you Arlin.

I am a Certified Yoga Teacher

Woohoo! I passed the exam. It wasn't that difficult, but while studying I realized how much we learned that other people do not know. I would have loved to go deeper into anatomy and physiology, and to have more power, better balance and less fear, but it only has to start here. I have a lifetime to learn and build my life and my body as I'd like them to be.

I learned an incredible gem yesterday that will probably help me better explain what yoga and meditation does to your mind. Imagine a jar with dirty water. The dirt in the water are our daily thoughts. There are lots of them and they are hanging around popping in and out and moving in no particular direction. You can't see through the water because there are so many thoughts. If you put the jar down and leave it there for an hour or so, all the dirt falls to the bottom and the water becomes clear. Yoga and meditation helps you slow down the stream of thoughts, let them rest, see clearly the things that are important and pick up the important thoughts and make them happen.

Treasure map

For the last week I worked on my treasure map: a display of pictures that inspire me. I never thought how much pleasure this exercise will bring me. I thought that once again I will think about all those cool things that I'd like to have but never will get around to doing them.

Instead, I had an enormous pleasure putting it together and looking at it. It has pictures with my family and all the time that we are going to spend having fun together. It has my dream house on the beach and a cool kitchen and a swimming pool, my organic vegetable garden, and my athletic endeavors: a triathlon, teaching yoga to kids, and the Appalachian Trail. It also has a picture of a hospital and a hospital dashboard and the verses of The Impossible Dream.

It also felt great to share it with my husband and my baby. It was the first time in my life that I actually dared to accept my dreams. Maybe not all of them will happen, but I have something that I'll see every evening before bed and I know that my priorities should be and what should make me happy. I don't think I ever expressed all these even to my husband.

What a great tool to share. On Saturday I will get it to my last yoga session and we will see each others... that will give us something interesting to talk about! Try it! It will give you a few happy moments, and once it's up you realize that it's not really as impossible as you thought.

Meditation and living in the moment

If you were around for a while you know my hunger for comments. While feeling better over the last couple of months, I (and my blog) survived without many comments for a while now. On Friday I had the great pleasure of finding two very nice comments... Woohoo! I inspired someone to do something about their anxiety.

A new social anxiety blog is out! Please welcome travel.trekker1 and wish her good luck in your journey. She seems like a good buddy for me so I am looking forward to more posts and communication.

And an additional note about the last blog I wrote about: Matt Ambrose at Overcoming Social Anxiety: this is a must read. It is kind and gentle. It is the best writing on social anxiety that I stumbled upon. It makes me feel good about myself when I read it.

The guys at the Mental Health Blog Research Study have their survey up and you can take it if you want to help research anxiety disorders and blogs. Email mhblog@tcnj.edu before July 10, 2008 if you are interested.

In one of the latest comments, a reader talked about how difficult it is to be living in the moment. I've been working on this for the last half an year, so I can tell you what worked for me:

- Some sort of vigorous activity that requires concentration and doesn't leave you time to drift into thinking. Ashtanga yoga does this for me. But it took a while. For weeks I kept just thinking how hard it is, what comes next, this is hard, this is easy, and when is the end of the class, etc. I'm now just concentrating on the current posture and it's great.

- In the beginning, use your senses with strong cues: eat something you really love with great attention and pleasure: enjoy a chocolate truffle for a minute or so, smell a great perfume, listen to the birds singing, or to the ocean waves. Eventually you will start being aware of all the chatter around all the time and you will feel and touch and smell things without judgment, for example smelling something foul will just bring awareness not necessarily disgust.

- Read. You will be surprised how many successful people (like Seth Godin or John Halamka) have some sort of meditative practice and preach living in the moment and utilizing the time while you have it... NOW! to do something rather than think about what you could have done or what you will do.

- When overwhelmed with thoughts, ask yourself if there's anything I can do about this right now (can you write an email, make a call, etc. to make the idea happen)? If yes, just do it, if not, let the thought go. I used to fantasize a lot about spending time with friends and intelligent discussions we would have, etc. Now when I think about this, I just smile, say I love you to my imaginary friends and then think: Hey but you are not really here so Good Bye, I'll see you next time! No beating up, no frustrations, no expectations.

And because my commenter mentioned Eckhart Tolle, here's the list of things that helped me in my journey:

- The yoga teachers training at the Yoga and Healing Center in Scotch Plains, NJ - graduation in two weeks... need go practice and learn
- A Yoga, Chocolate and Wine seminar with Yoga Dave
- A 3 hours seminar with Bijan and reading Effortless Prosperity daily lesson and trying to practice it
- Reading A New Earth - Eckhart Tolle

The wavy line of anxiety

I noticed that with anxiety you can't just relax and let things the way they are. You continuously need to push through and challenge yourself. Any time spent in the comfort zone makes the anxiety take over more and more... You can give yourself a dy off, but that's a bout it, next day just start over and get into challenges again and again.

Of course the ultimate cure is living in the moment and realizing that all these things we so dearly care about (like other people's opinions or what X and Z said) ultimately don't mean anything. So complete relaxation is the cure. But even if you get there, there is a lot of work in continuing to do it and not getting back into your anxious spot.

Here's a visual cue that I'm using to think about this: take a piece of paper and write down any activity that involves interaction with other people grouping them from the ones that cause most anxiety to the ones with least anxiety. I would have an interview on TV on the left side and friendly chatting with my husband or interacting with my happy kid on the right. Now draw a wavy line to separate the activities between comfort zone and anxiety zone.

The aim of every day is to push that line more and more to the left including more and more activities that are uncomfortable. Doing them time and time again will make them shift into the comfort zone.

When you relax and don't push, the line will not be stable: it just moves to the right and you get more and more uncomfortable.

So in order to make any progress or even keep the statu quo, you need to work all the time, every day and every hour and push that line. It's a Sisyphus job, but it's the only way you can live and enjoy life.

No rest for the weary! Good luck and keep pushing that line!

Excellent article

An excellent article in New York Times talking about using meditation in therapy:

http://www.nytimes.com/2008/05/27/health/research/27budd.html?pagewanted=1&_r=2&ref=health

Don't miss it!

Living in the moment

One of my favorite authors, Irvin Yalom, describes the aim of therapy as opening up first to your therapist and then to the world. I loved his comment, lived by it and wrote a post about it a very long time ago.

However, with anxiety, I think you can be open all you want and still be anxious. It eases up some of the attempts to hide the anxiety, but it doesn't resolve the problem.

I think that with anxiety, the aim of therapy is to minimize the time a problem hangs out in your head. It used to be that I had problems that we discussed through multiple sessions: I worried about those things constantly for weeks: bad, very bad. Those are stale thoughts.

Let's say you have a 10 minutes phone conversation. You hang up and then start replaying the phone conversation in your head over and over again for days. You beat yourself up over what you should have said, you are very proud of what you said well, you interpret what you heard in numerous ways, you have emotions that might not have anything to do with the actual call, they are just emotions brought on by your thoughts and your interpretation of the phone call.

I knew that therapy was over when any of the issues I brought up were about one day old at most. The problems would come and go, wash over me, were processed in real time and went away. No stale thoughts, no interpretations. You can think clearly and not reactive with a fresh problem.

I am a project manager, so I do have problems that last days or weeks, but when I get back home, they don't exist and they shouldn't exist. Tomorrow is another day that I can deal with them, and looking at them with fresh eyes is always easier. Bringing my problems home is a sure way to trigger terrible-twos behavior and upset everyone else.

I am now working on really living in the moment and being present at any time, no afterthoughts, no interpretation. Something happens: it causes emotion: let the emotion be there, feel it, enjoy it, express it and move on to something else.

This is the aim of meditation and yoga, and I recommend either or both for social anxiety or just any kind of anxiety.

And another reason to live in the moment from Dr Rob.... And from Dr Rob again a great quote for good laughs. It's short enough that I am including it all to spare you the need to transfer over, but Dr. Rob's blog is a must read!

"Why did God make it that you have teenagers at the same time you are going through menopause?"

Wish me luck! I think I'll be there! I should perfect this living in the moment thing by then!

We are all in the same bucket

One of the first things that my therapist did with me and the most successful for gaining my trust was to explain that everybody has at some level the same anxieties that I have. She used herself and her experiences as an example and it was extremely powerful.

She made sure I understood that I am not crazy and that my thoughts are reasonable and my anxieties not so unusual.

It is tough and very lonely to have social anxiety without knowing what's going on. You feel really really lonely and you think you are some kind of monster that nobody wants to be with. Once you find out that it's not that uncommon, this knowledge comes with a bit of relief that there are other people having the same thing and that there is hope, but on the other side, you have a mental health issue/disease which officially puts you in a I'm at least a bit crazy category. Deciding to do therapy or taking medication is again a step forward, but it comes with the issue of having to admit it to others.

This is why establishing that you are not crazy is a great first step in therapy. Brilliant!

Once we know that we have social anxiety, we tend to identify all our traits that prove that we have social anxiety. Sometimes what is a simple difference between people's behavior becomes in our mind unbreakable proof of our being abnormal. And I think we feel attracted to people that are different and that we desire to be like and don't realize that there are enough people out there just like us.

Just recently I noticed this with me. I considered as a typical social anxiety trait the fact that I only dated two men in my life. I found out that my latest hero, John Halamka, married his first and only date. I don't know that he has social anxiety or not, I suspect not too much, but maybe some people are just more efficient this way. Friends that I stayed with, I liked from the very beginning, so is that so bad? Just like people that start drinking in college because they think that everybody else does. Some people just don't drink and some people don't need to date a lot! Does that make us unusual? Probably, but crazy... no!

So, take heart! You're probably not as weird as you think, and almost everybody has anxieties in one way or another.

Preparing for therapy

So you found out that you have social anxiety. And you read that the best treatment is a combination of drugs and therapy, probably CBT - cognitive behavioral therapy. I'm pretty sure you heard that you probably have a bio-chemical imbalance... oh, that sounds so good: it's not in your head, it's a disease!

Here's my take: forget about drugs... ignore drug advertisements, ignore doctors that insist that you can't do it otherwise, ignore articles. Forget about them. Be strong and work through it for an year. Then you can decide that what you're doing is not enough.

Drug companies and medical insurance companies are not on your side. They are in for making profit, not for keeping/making you healthy. There's a lot of money involved and they are all thrown to convince you that you need expensive drugs. Lots of doctors are biased by the same advertisements. Forget the free samples. They will not last forever and then you'll end up with an expensive drug that you'll probably have a hard time weaning from.

A word on Complementary and alternative medicine: I think it's mostly placebo. I also think placebo is a wonderful thing that you should fully benefit from. But don't spend a fortune on it. Keep an eye on the wallet. Hey, that $2 bottle of homeopathic medicine that makes you feel so good: go ahead and use it! Omega 3s are making you more calm: go for it! But hundreds of $ a month for this stuff, forget about it!

This leaves you with one task: finding a good therapist - the right therapist. Psychologists are OK, but don't necessarily insist on a doctor. My therapist is a psychiatric nurse and she's excellent. Ask around: ask doctors, friends, family. If you can afford it, a therapist that does not accept any insurance is a good sign: probably successful enough to not need it, and less hassled by insurance companies (and more willing to give that time and attention to you, not your co-payment). Insurance companies are not your friends. Forget their referrals, they will send you to the cheapest guy in town.

Two books you need to read before starting therapy:

• Health and Suffering in America: The Context and Content of Mental Health Care
  by Robert Fancher
• The Gift of Therapy: An Open Letter to a New Generation of Therapists and Their Patients
  by Irvin Yalom

The first is a very down-to earth book about mental health care and will give you some food for thought. The second one is more practical, and will clarify some of the things that will happen in therapy - patterns of interaction that we all go through.

I love Yalom. His books followed me on each therapy session and I always ended up admitting that he was right about this too.

It's not easy to go through therapy. There will be rough spots. There will be challenges. You need to find someone that will be there for you all the way. And you need to have the strength to go back again and again. Each step up will be preceded by a very difficult breakthrough. Don't give up because it's hard. Always know that this will be over and it will be better soon.

I imagined that in therapy you talk and talk and then you discover one thing that caused it all and then you talk about it and you cry and that's it... it never happened to me. I had a few moments of "this is it", here's the problem, but a week after that the problem was still there. So there are no rules.

And last advice: if a therapist does not work, just move on without judgment. It just isn't the right person at the right time: it's not you, nor the therapist, just grist for the mill. Forget about it and find someone else. The CBT therapist that I kept bitching about in my blog ended up being really helpful more recently. I just wasn't ready when I saw him. But somehow what he said in those first 5 weeks of therapy stuck with me and I'm remembering and appreciating it now. I guess I am now ready for cognitive-behavior therapy. Only I don't need someone to help.

More to come... I'm enjoying writing this.

New Blog

Check this new very interesting blog about social anxiety: - Overcoming Social Anxiety. Mat Ambrose is a freelance writer. The first articles are very well written... duh!

I'm very honored to be in his blogroll.

Starting therapy - my story

In 2004 I was not sleeping well and not feeling well. I visited my doctor and she diagnosed anxiety, prescribed Clonazepam and suggested that I start seeing a therapist.

I felt great on Clonazepam, but I hated that i needed more and more to sleep better. I took it for 3-4 months while I was under a lot of stress at work and then got off of it. The weaning was scary. My anxiety shot up very bad. I didn't sleep for a night or two. I resisted starting it over and after a week I was fine but I started being scared of medication.

I looked for a therapist and it looks like there's one at every street corner. I had the sense that I shouldn't just pick one, but I had no clue how to find the right one. At that time I had no idea that social anxiety was even defined. I had no idea what was wrong with me in the first place. I called a couple of therapists and found out they are really busy. I finally found one near my house that reluctantly found a time for me. I went there for 4 weeks and left disgusted. The therapist seemed to be more interested in my $10 copayment than my well-being. It did not go well.

I had the idea to search the web for extremely shy or something along these lines. I found books and I found that a disorder exists and it has a name. I ordered the books and started reading. I was not alone anymore... there were people that knew what I felt.

I got pregnant and momentarily dropped the idea of "fixing" the social anxiety. In April 2006, I decided it's time to attack it and get it over with. It took me two years. I am not over with it, I just accept myself and my social anxiety as part of myself. It's there, but it doesn't stop me from important things in my life.

I first went to a CBT (cognitive-behavior therapy) specialist. He was teaching at a big New York university, so I figured he must be good. I went there for 5 weeks. I didn't feel we were doing enough, and he felt he can't help me. He suggested that I see someone else, but did not offer any help with a name or anything. I failed again.

A month or two later I called a number that my new doctor gave me. It was supposed to be my last effort with therapy before giving up and asking for medication to help me cope. I was not optimistic. On the phone, this new therapist mentioned all the reasons why I shouldn't see her: too far away, no time, etc. but I said I don't know what else to do and that I need to talk to someone.

I went in once and was hooked. She had a few soundbites that I loved, among others "oh, men, my dear...". But the most important one was: "Ileana, no matter what will happen, I will be here for you." And she was there for me, even if it was difficult at time for me and her.

Next post will be about what I'd suggest that someone does before starting therapy... we all live to give advice, don't we?

What's up?

I had an offer to write an anxiety blog for a health web site. I just turned it down. I will continue to be my own boss.

But it made me think some and I had a few ideas for blog posts that I would like to write. Two years ago in April I seriously decided to attack my anxiety. Now, two years later, I just finished a long round of therapy and I think I won, at least for the time being. Two or three weeks went by and I didn't need to run back to my therapist for help. I can deal with life on my own! Woohoo!

So my posts will concentrate on what helped me in therapy. I'm pretty sure this might help someone.

As I mentioned before, I started a yoga teacher's training. I love it and it helps me immensely. My articles might sound esoteric and funny in respect to this, but you'll have to live with me.

It's good to be back to my own forgotten blog.

Call for research

I was asked to participate in a research about mental health and blogging habits. Sounds interesting. If you want to join the details are below.

I will get back soon with more posts!


Hello,
I am part of a research group from The College of New Jersey interested in gaining information on the views of authors of mental health blogs. This study is part of a research project of Dr. Yifeng Hu, a professor in the Communication Studies department at TCNJ. You have been contacted because you are the author of such a blog. Participation will involve responding to surveys about your mental health and blogging habits. The results are completely confidential. No respondent's personal identity will be requested or associated with any set of answers. We appreciate your time and help with our study and as a thank you for participating you will receive a $5 gift card (or you can choose to donate your amount to Mental Health America). If you are interested, please send an email to mhblog@tcnj.edu and be sure to include a link to the home page of your blog as well as your preferred contact email address. The survey will be sent to you via email within the next few weeks. Thank you in advance for your participation!
--
Mental Health Blog Research Group
The College of New Jersey
mhblog@tcnj.edu

Hi guys!

I've been up with a lot lately. Lots of work and taking care of my kid, but also lots of thinking and crystallizing my thoughts.

I started a yoga teacher's training. It's wonderful. I knew that the exercise and mediation is going to help with anxiety, but this is so much more than that.

Wendy, the teacher is insisting on being positive: no gossiping is allowed, no push backs... What can a bunch of people (mostly women) do when exercising a lot and being positive and open? A lot! So I keep going on my way to openness full speed.


This being said, I'm not sure I want to delve on the anxiety side so much. It helped me go through a phase and open up, but now I don't feel like throwing in everyone's face that I am an emotional mess... probably because I a not that much of a mess anymore. I'm not much into venting anymore. My new blog is Cool Yoga Mama. It might be a bit too sweet for some. I will strive to keep it all positive. Feel free to visit! I'd love to see you there!

And thanks for the support during this last year. It helped me immensely.

Quote

A quote from The Winter of our Discontent - John Steinbeck that the ones of you that have social anxiety might find helpful:

My sudden fear that I might be showing through was very great. I had made myself believe that the eyes are not the mirror of the soul. Some of the deadliest little female contraptions I ever saw had the faces and the eyes of angels. There is a breed that can read through skin and through bone right into the center, but they are rare. For the most part people are not curious except about themselves. Once a Canadian girl of Scottish blood told me a story that had bitten her and the telling bit me. She said that in the age of growing up when she felt that all eyes were on her and not favorably, so that she went from blushes to tears and back again, her Highland grandfather, observing her pain, said sharply: "Ye wouldna be sae worrit wi' what folk think about ye if ye kenned how seldom they do." It cured her and the telling reassured me of privacy, because it's true.

The whole book is wonderful and you should read it!

The things I love

It's almost two weeks since my father died and I am realizing that I mostly like to do things that I did with him: logic, math, thinking out of the box, hiking, skying. I just re-read the book I love most: The Winter of our Discontent - John Steinbeck and I realized he suggested it. He was reading books and underlining the parts he loved most... and I loved those parts too. I am glad I asked for books he liked this summer when I last saw him and I got a couple of books.

He was the utmost authority in my life. When he approved of something I did, it made me feel very good and accomplished. He was also very critical (did anyone doubt that with my social anxiety?) and I sometimes felt anxiety talking to him.

On a funny note, one thing he was critical about was my French... He was very good at it, and I wasn't that good. I found it ironical that I flew in an Air France flight to Romania to attend his funeral... thus one more time realizing how poor my French is.

When I left for US seven years ago, he had to learn English and to use a PC and do email and he did... at 75 years old. He had a dictionary and taught himself to use the PC and navigate the Internet without previously speaking English. He was pretty amazing and a great guy.

Models

I had this post already written, so I will publish it, but the next few days/posts will take a different turn, as my father unexpectedly (he was 82 and had a heart condition, so as unexpected as this can be) died yesterday. I am on the way to visit my family.

My first and best model was my father.
__________________________________


All my life I was in search of a model, someone that I can shape my life on. Someone that I can learn from. I kept looking and when I found someone that almost matched my dreams, I would put them on a pedestal and keep them on my Olympus mountain. I honored and feared them.

This might have been an important part in my social anxiety. I was shy with mostly everyone, but with my models, I was frozen. I couldn't say anything in fear of saying the wrong thing and making them reject me.

I must have lost a few friendships in my need that my friends are the perfect models, and in not accepting them to be in any way wrong or faulty, or just think differently. I would put them very high in my expectations, and when reality set in and I would see they are just human being, I left unsatisfied.

In this respect, I thing blogging has been a great help, not necessary me blogging as much as reading other blogs. As opposed to the rest of my life where I had one model that had to live up to my expectations, I found lots of models. I can enjoy and learn from each of them, but the pressure on them being perfect is not there... plus what do you know about a person from their blog?

So, who am I learning from these days?

Paul Levy - Last year I called Paul my hero... he's still my hero. He just recently got the awards for The Best Medical Blog and The Best Ethics/Policy Blog for 2007. Well deserved! I agree with the rest of the voters. Paul is cool.

John Halamka, MD - the CIO at Paul Levy's hospital, BIDMC, and a bunch of other places (like that insignificant Harvard Medical School). John successfully embodies the saying: accept what you can't change and do the most out of what you can change. He makes things seem simple, but acknowledges the complexity of each situation. He couldn't have done all the things he did with a different attitude. I think I will be raving about him a lot in future posts.

Jolie Bookspan-The Fitness Fixer - I met Jolie in person, the only blogger I have actually met. We liked each other and I hope we'll get to meet again and do things together. She's strong enough to do anything she wants to do. I love her ambition and what she does with her life.

Seth Godin - I think he has the most popular blog... and it is worth! I just subscribed and hung out for a month or two... this is the best that blogging has to offer. One short post after another, one small idea after another, he made me understand where I can go from here. I will talk about him some more as well, but I highly recommend his blog!

All my social anxiety friends and their progress: SA Dave, Drew at Shy and quiet, Leila as the Perfect Hypochondriac and "the Guy from Successfully Shy". Guys, you're all doing great! It is so good to see how much we've accomplished against our common enemy! I'm reading you all and keeping in touch with your progress. Keep going!

Anger

I ran into an article that explains that expressing anger might be helpful for your health and that couples that express anger are happier.

My father had a heart attack when I was 9. We were told it is not healthy for him to get angry. I hope they don't tell families things like this anymore these days. It really put too much pressure on us. Ever since anyone's anger made me very uncomfortable. I don't know what to say, what to do, where to hide and how to make it stop.

Over the last year, I had a different take on that. It's anger expressed in blog posts. Some of my favorites are the angry guys - The Angry Pharmacist, The Angry Doctor (not writing much lately - I suspect he's not that angry anymore), and Panda Bear, MD in hid good angry days.

Their anger is obviously not making me that uncomfortable because I am not expected to do anything, instead, I can appreciate that they might be right most of the time. The article mentions that as well... In anger you forget who you need to be nice to and just cut to the chase and say things as you really see them.

When people are angry, you can really find out what they are thinking.

Memory and anxiety

I keep wondering whether there is a link between my lifelong dealing with anxiety and my excellent memory for details.

I think it's partially an exercise thing... I kept being very attentive to any communication of any sort with anyone and kept rehashing it in my mind forever, that I think my memory got worked a lot. Now that I am not that anxious any more I find myself remembering details that nobody should remember. I know details from blog posts that were written an year ago. When Paul Levy's blog was the only one I read, it maybe made sense, but now I am reading a lot and still feel like I remember too many details.

This might make someone that cares about their privacy very wary, but I think there is a chance to meet people like me on the blogosphere. I pretty much read these things once, maybe twice if they are very interesting or have interesting comments. And I also keep track of a million details in the project I'm managing.

I think I should just be happy about it!

The good, the wonderful and the rest

I noticed a few positive things this week. First, I was doing a user training. I did not have enough time to prepare and I didn't do a spectacular job. I did trainings with brand new computer users and I know what it takes to get them up to speed, but this time I just didn't have the time. One of the people at the course gave me an article from New York Times on how to teach computer skills. In the past this would have embarrassed me terribly. I would have been upset for days.

I'm not happy that I was criticized, and I wish I did a better job, but I recognize that the problem is not me not trying enough or not being able to do it, but the fact that you need time to prepare a training course. I am unhappy, but not paralyzed... this is new!

Along the same lines, the other day we had a few friends for brunch and we were talking about the American students not being culturally savvy enough to recognize a well-known Marx quote. I didn't recognize it either and that got me a bunch of sarcastic comments. I would have died from embarrassment. After the initial shock, I thought about why I don't know that... and I came up with an explanation that I think was instructive for everyone.

I grew up in the 70s-80s Romania. At that time Romania was a socialist country, but we weren't very close to Russia. Romania did not want to participate in invading Czechoslovakia in 1968. So I actually did not learn Russian, nor did I study Marx or Lenin. I pretty much kept up with what we learned in school: basically no foreign literature, dry and boring history and geography lessons, very little musical education and no other art education. I learned French and German in school and English in private lessons with my favorite teacher. I read all the books that I found in the house, but without much guidance from anyone. My parents were trying to keep sane at the those insane times by talking to each other and getting feedback from each other on the very crazy things that went on with their jobs.

I don't believe this is my fault. I am able now to round my education, and I'd like to, but, again, I recognize that there is a compromise between all that you want to do and what you can do... and I am choosing having a job, spending time with my child and family, reading other stuff and sleeping 7 hours a night or more. I hope I will be able to read and learn more with my child or when I retire. Until then, whatever culture I have is good enough.

And the third good thing, and the best, is my husband. When I started therapy we were both a bit nervous about it. It opened the possibilities that we will both discover things that we might not like; it is not uncommon for women to discover their power and "free" themselves of the evil men, etc.

Last year, whenever we had friends over or met other people, I would ask my husband to reassure me: Was I OK? Did I do well? How did I come out?

Now, when we go to bed, he cuddles and hugs me and says: I like you, I really like you. I like what kind of person you are, what kind of mother. I like that you are witty and smart and nice. I like the person you are... He used to reassure me to make me feel good about myself, but this is different. I think it's wonderful that I turned out into someone he likes and that I am now coming out of my shell enough for people to see that.

On the uncomfortable note, I am changing my gastro-enterologist and I feel very uncomfortable to face the old one. I called to ask for a test result and the nurse asked me to make an appointment. I got very anxious... There's more work to do. I am very uncomfortable confronting anyone. Bad news are difficult to give, I guess!

Oh, the Places You'll Go

Those of you that have been around last year might remember that I had a bad brush with a disease called preeclampsia and I lost a baby 5 years ago. It's anniversary time again and this year I'd like to do something special in preparation for this.

While I was pregnant, I was happy to get ready for the baby and one of the things I did was to buy children's books. Among others, Dr. Seuss's "Oh, the Places You'll Go!"

To give you an idea of how clueless we were, the day before I was 3 hours away from home installing an application in Production. I drove home that evening and in the car, I happily sang "On top of the world" with Karen Carpenter. I fast forwarded through the "This is Good Bye my love" song that was right after. On Friday, Valentine's day, I went for an Ob visit and told the doctor that my blood pressure was high due to a Pepsi I drank the day before. Next I know I am in the best hospital around with an IV, a catheter and discussing how very sick I was with a bunch of High-risk Obs.

To make it short, I was very sick, the baby was very early and very small, and I had to be induced so I won't die. The baby was stillborn. It was a very dramatic night, also in the mid of the Big Snowstorm of 2003, with nurses and doctors being stuck in the hospital for days.

After this nightmare, my husband got home the evening his baby died and finds a box. He opens it and inside was a book: "Oh, the Places You'll Go". Since then he can't stand the book. He has a difficult time having it in the house and just yesterday told me that it will at least be another 5 years before he will be able to read it.

I start crying each time I see it as well, and could not read it to the end without crying. It must have been so difficult for him... this year I had the power to read the book and it is an incredible book. I would hate to not have my son read it and learn it.

For this year's anniversary of our son's death I am going to quote a paragraph of this book each day and find meaning in it. Enjoy! Do read it if you haven't already! It is wonderful!

Tips

Giving tips: to whom, how much, when, how, etc. was a big issue for me. I had an idea what was customary back in Romania, but when I got to US I realized that's a completely different culture likely with different tipping rules. The envelopes in the hotel rooms and movies sort of give you an idea. I looked at my husband's habits figuring this will help me. I read Internet advice... things didn't match. I was confused and panicked whenever I was in a situation where tips were likely expected.

I think I got it now: there are no rules - each person does whatever they feel like: some tip more and everybody, others don't tip at all. You can get excellent service without tipping and people don't necessarily remember you even when tipping. So I am just listening to my heart and do what feels right at the moment.

I decided that during Christmas with the daycare center teachers. They are really nice to the kid, and while he has a teacher in a small group, she's there only 3 hours a day, and he is there 8 hours a day, so obviously there are lots of people taking care of him... so who would I give money and how much? Last minute, I decided: I'll get a bunch of nice chocolate gifts, enough for everyone. I got a small baby gift for one of the teachers that was pregnant. I put them all in a bag and wrote a nice note about thanking them for being his second family.

It went well... they are nice to the kid no matter what... and what they think or say behind my back... I don't care anymore. Nice words mean more to me than money and I think I made some people's life better when I said nice and heartfelt stuff.

Yesterday I got gas. It was really cold out here. And I thought about the poor guy that was in the frost all day filling up gas tanks, and I gave him two bucks. It felt the right thing to do.

Now I can relax about my tipping habits and find something else to worry about. So long!

Happy New Year!

Everybody is looking back at the past year and making resolutions for the new one, so here are mine. As achievements for 2007, I did well and I prepared myself for doing more this year:

• My first and best achievement is getting my son through his second year of life, healthy and happy. He turned from an eating, pooping, sleeping, crying and laughing blob into a little person that can get anywhere, communicate wishes and needs, be a social creature (just a bit shy, but very nice and friendly, making friends everywhere he goes) and a very loving and lovable part of the family. We can't imagine life without him.
  
• Family life and work had their challenges, but went well. It is a learning process and we're getting better at it.
• My health has not been spectacular. I dealt with a month long flare of ulcerative colitis, most of it during my vacation... that much for a relaxing vacation. But this has been bothering me for many years and I had no idea what was happening, so finding out what it is was a relief. It is easier to deal with something that has a name. I've also had a lot of colds during the last six months and I have no idea how to make this stop.
  
• As for social anxiety, I went from being afraid to tell anyone, to shouting out loud to everyone, and finally to a more rational position of being able to share it in appropriate contexts, being casual about it, but not blowing it into everyone's face. I have worked a lot on accepting myself.

What about 2008:

• Bracing up for the terrible twos... I'm sure my son will provide enough challenge and opportunity to learn... his emotional development especially is particularly interesting for me in understanding my own emotional issues.
• I need to get my health under control
• I'd like to build a support network of friends and family and work on balancing my life: add more fun and exercise to my current work and family only schedule.
  
• I want to become a better listener and I want to work on explaining what I am thinking so that people will understand where I am coming from.

Medication for SA

There was an article in New York times last week written by Dr. Carlat about being paid by a drug company to present a drug to other doctors. It has raised huge waves over the Internet and got me thinking at various levels. The aspect I would like to comment on now is the personal one - do you medicate for social anxiety or not?

My long time readers probably know already where I stand. I do not take any medicine for this and I am very happy with this decision... actually more and more happy the more I learn about it.


The problem is that therapy is not cheap. Insurance companies will not encourage therapy vs. medication because it is not cost-efficient for them. My insurance company has estimated the average annual cost for an anxiety disorder at around $1900. This includes doctor, medication and tests. Depending on the type of anxiety (low or medium) the doctor costs are between $600-$800. I am not sure how they calculated this, but they reimburse a therapist at $90/session for 20 sessions a year. This makes $1800, more than they plan to pay for both the doctor and medication.

So doctors are assaulted by both insurance companies to recommend medication and by drug companies to recommend their product (insurance might be more interested in cheaper drugs). Read that article in NYT... the push by drug companies can go beyong the short skirted girls with free samples and lunches and the ads we patients see on TV... it can go with respected doctors and researchers supporting one or another drug, with studies paid by drug companies. How can you not be influenced by all this?

So what are we patients left to do... I think I would resist as much as possible and do anything possible to avoid getting on meds. Happiness does not come in a bottle.

I am thrilled at the series of events that made me not take meds and try anything else: it basically had to do with the baby: I wanted to breastfeed at any cost. The baby was thriving and very healthy when breastfed and it kept me going and trying new things until it worked: a new therapist, exercise, meditation... anything to make it get better.

If this didn't convince you, read this article about someone trying to quit taking Effexor.

Just like everybody else

My kid is 2 and I just lost my illusion that I am somehow different than all the other mothers. I imagined that I am not as crazy and obsessed about him as all the others about their kids... I actually am, I can talk for hours about him, I have tons of pictures (I had a friend ask me today if the Internet is too small to hold all his pictures), I even think it's really cool to talk to him on the phone so I put him on with anyone (hmmm, anyone sees some social anxiety here?).

No comment

http://www.revolutionhealth.com/blogs/valjonesmd/vintage-dr-val-the--9305

I'm closing shop

I think that I will abandon my social anxiety blog. I love blogging, but I am so bored about blogging about my emotions and vents. I want to blog about computer systems and project management and databases and I feel confined in the title. I might get back one day and I will continue to read the blogs of my socially anxious friends.

I think I had some good posts and I hope I helped a person or two to at least not feel so lonely in their condition. I definitely learned a lot and found a lot of comfort in blogging and reading about others.

Here are my highlights for those that will get to my blog in the future:

1. Diagnosing social anxiety - how to tell your doctor
2. First step - therapy - find the right person, not the right therapy school
3. For spouses, friends and family of people with social anxiety: Dealing with emotional people I and II, and helping them.
4. How bad can it be. Also check my poll results.
5. Keep in touch with family and friends from college and school because it will be more difficult to find new ones later in life
6. A very popular post on emotional immaturity... My more recent opinion on this is that it is emotionally mature to occasionally be immature, just accept it, forgive yourself and apologize if needed and move on.
7. About openness
8. My big revelation
9. ... and snippets for people with social anxiety to not feel like they are the only ones feeling this emotional: dreading the publicity, blogging anxiety, doctor's offices

Thank you all for reading my blog, and commenting every now and then! Thank you for joining me in this journey. I will post a link to my new blog as soon as I will have something there.

Another doctor story - part II

I have a development going on about my previous doctor rant. I am not sure I can describe it as being successful in beating social anxiety, but it surely is an important step toward it. Some moments were awkward, but I made my point and I was listened to.

On a subsequent appointment, I gave the doctor the book "If Disney Ran your Hospital" (see this post for more details on this book). He was very happy to read it. A week later he called and asked what exactly made ,e give him the book, what needs to be improved in his practice. We talked a lot, but my main points were that I wasn't clearly told what I have to pay and given options to accept or not and that the office was not as family-like as advertised. The doctor found something that I apparently was overcharged for and promissed a refund and then told me that they will try to improve by the time I go there again.

I was supposed to go today and on Saturday, I got a hand-written card from the doctor thanking me for the book, with the refund, and a gift certificate for a restaurant. Also, when I called today to cancel the appointment, the person answering the phone was very energetic and helpful.

I think this is "mission accompli". Maybe the right way was to tell the doctor what was wrong from the very beginning without venting on the blog, but one way or another, I helped a medical office give better service. I feel bad about my previous post now... It was great to talk to the doctor and realize that he really really wanted to do things better.

Alternative medicine

I'm alone at home, fighting a cold and drinking some wine to help with it... This has nothing to do with alternative medicine (hmmm, maybe a little ;) ). I got the idea from Paul Levy's blog, so go blame him and his daughter.

A number of medblogers posted lately about alternative medicine (Dr. Rob has a post with links, and Panda Bear had a number of posts over the last couple of weeks). I had an first hand experience with this earlier this year. I must agree with them on everything they wrote. Here's my story.

Earlier this year I decided that I need to fight the mild hypertension that I had after my first pregnancy and through my second pregnancy. I studied the DASH diet, made plans to start exercising and read about the subject. From a book on the DASH diet, I found a book - What your Doctor doesn't tell you about hypertension. It had great reviews and was written my an MD. He hypothesized that there are lots of studies that show how XYZ vitamin or supplement is lowering the blood pressure a little bit and that if you actually take all of them at once, you can significantly lower the blood pressure. He also recommends a modified and even more aggressive form of DASH.

I got that book to my doctor and he politely noticed that the author does not correctly quote the studies he's referring to, that he doesn't believe in nutraceuticals and that probably the die from all those supplements will cause an allergic reaction. This last argument actually won the fight. The book landed in the trash along with some bottles of supplements that I had. I saved any money on additional supplements and instead started to seriously exercise. Within 6 months my blood pressure decreased from hypertensive levels to normal (not even pre-hypertensive). I'm now not even exercising that much and the blood pressure is still low. Some of it might have to do with lower anxiety levels.

The irony is that if I actually followed the advice in the book and had the same result, I would say that it was that that did it. I would be a strong supporter of alternative medicine and would shout loud and clear that those supplements did it for me.

My doctor's argument that the author didn't correctly quote the studies seemed like he was stumbling on a technicality, but it is important though because if someone actually knows how to read a research study, they would quote them appropriately.

And it's scary that I think I did the right thing with the information I had at the time: this was an MD. And had great reviews on Amazon. This is scary... How are we supposed to find correct and reliable information?

Makes me also wonder about trusting any of the doctor rating engines out there. I am a great believer in reading the Amazon.com reviews for books... but I don't buy any more books with medical information based on their reviews.

It's new poll time again

My October poll was How much does social anxiety affect your life?

The answers were:

• I don't have social anxiety 0 (0%)
• It actually helps me to have a better life 0 (0%)
• It doesn't affect me at all 0 (0%)
• It affects me somewhat, but not in major ways 5 (12%)
• It seriously affects me, but I still go on with my life 22 (56%)
• I don't have a life, it affects me that much 12 (30%)

My heart is with you, people that responded that they don't have a life and that their life is seriously affected by social anxiety, which makes 86% of respondents. I wish I could do something, anything for you... I guess that as long as you came and visited my blog, all I can do is to keep writing about social anxiety and dealing with it, and encouraging you to participate in any way that you feel almost comfortable participating.

Thank you so much for answering my poll.

November's poll has to do with the form of communication and interaction that you find most comfortable and uncomfortable.

I prefer one on one interactions: having someone pay 100% attention to me, I like speaking to a group in a formal prepared presentation, but not in an informal one (being asked a question in class), I tend to lead in a group, or try to be really invisible. I hate speaking on the telephone. I am OK with email and IM, but I hate when the answer to an email never comes back (I never know if the other person is just busy, never got the email, had no time and forgot about it, or just didn't care or want to answer). I don't like i-chat, but I think that's just because it's so hard to communicate anything. I guess in the same category, I absolutely can't do small talk. I need to talk important stuff 8-p)

What about you? Feel free to answer the poll and comment anonymously or not if you need to say more. Here's a task of the month for the don't have a lifers out there: post anonymously! I will try to be supportive!

What I was told and noticed myself is that with anxiety you have no easy way, you need to face it and challenge yourself... always. If not, it gets worse. It only gets better if you challenge it. It's like exercise: you need to keep doing it, otherwise it takes you over.

Grand Rounds and grand managers

Make sure you check Grand Rounds this week. Paul Levy is hosting it and the theme is a personal experience in a hospital that changed beliefs. What a wonderful idea! The change of perspective from medical professional to being in the patient's shoes. Brilliant as always!

And another blog that I recently started reading - Seth Godin's blog . Great marketing ideas and just plain good sense for websites and life. Here's a post that reminded me of Paul and his management style.

That's how most CEOs and top managers make decisions. Not based on unemotional data, but on emotion-rich, experience-based stories. And if management isn't permeable to the outside world, the whole organization is going to suffer, isn't it?

Bloggers, back pain and embarassment

Back in May, I had a post with a link to the Fitness Fixer. I am reading Jolie's blog since then and I like it very much. she had a Neck and Backpain Workshop for the last two week-ends relatively close to me and I went there. I also went to a yoga class with her. It was great! She's so different and challenging and seeing and doing this so different than everybody else (hmmm, just like me?). So if any of you live in Philadelphia, go meet her!

Jolie is very nice and very smart. I liked her a lot and I hope I will use what she taught us to never get backpain and to help some of my friends that do. Visit her blog! There is something to be learned from there.

I enjoy meeting people through blogging. It's easier and feels safer for us. I prefer this environment to anything else to getting to know others.

And now the funny part: I sent Jolie the comment I had in May about her blog, so she knew that I have social anxiety. She went out of her way to make me feel good. (Jolie, if you read this, you are great, and I love you very much and you did just fine, so please don't get upset with the rest of this) . Jolie challenged me more than physically...

I had to laugh at all the nice things she did for me that embarrassed the hell out of me: all we want is to be lost in the crowd, don't single us out. She hugged me and noticed how nice I am. She got me a ride for two blocks so I can get to the yoga class - Oh, the horror of riding in a car with 4 perfect strangers... I would have happily walked in the rain than try to make conversation. Good thing that it was really close.

My husband joked about the similarity of my feelings and my 2 years old's feelings when he sees a big dog or some other scary animal (we went to the zoo and he saw a big pig at the petting farm - he declared - nooo pig, no pig, no pig and clutched on tightly to my husband). The same with me: nooo people, please, no new people!

Thank you Jolie for challenging me in all sorts of ways! Now that the danger is gone, I am very amused at the whole situation, really!

Joke on social anxiety

My husband made up a brilliant joke:

"You are arguing with yourself and you are too shy to answer. Now that's social anxiety!"

About copying and feeding from this blog

I have noticed a website feeding off my and SA Dave's blogs. While that website seems to be in work, it makes us uncomfortable to see our posts copied somewhere else. This is not Technorati or Bloglines or some other common RSS feed, it has our blogs under headings with social anxiety, suggesting that we are somehow doing SA therapy. Please appreciate that we are not feeling good about this and stop feeding on our blogs.

They say that copying is a sign of flattery, but I don't feel flattered. I am feeling way more shy to write anything. I'm no expert. I have no medical degree. I can speak for what I feel about my anxiety and maybe that is what some of you feel, but I'm sure there are just as many people with social anxiety that do not find themselves in what I am saying and for which this is much worse.

Thank you for your understanding. I deleted my email from my blog, but I'm allowing anonymous comments, and will not post a comment if you mention it. So if you want to contact me just send a comment.

(BTW one other reason I'm shy about posting more is not getting any comments. I must be a bad writer lately... oh, we are so dependent on other people's feedback!)

Preeclampsia awareness

This is a post for those of you that are interested in pregnancy and preeclampsia issues.

My very good friend and founder of the Preeclampsia Foundation, Anne Garrett Addison (gosh, Anne, there are so many double consonants in your name!) was nominated as a Woman of Worth by L'Oreal

She just had an interview on NPR. It is worth listening to. It is a story of the need to empower patients in being active in their own care, in understanding their conditions and partnering with their doctors for their care. Anne has been my and hundreds of other women's mentor in becoming empowered patients. It was my brush with preeclampsia that made possible my researching more about social anxiety and about being able to live (pretty well) with it.

It is late at night and I really need to go to bed, but I will update this post with more relevant links about preeclampsia awareness and patient empowerment. I am very grateful that I had preeclampsia and that made me meet Anne. Thank you Anne for all that you did and are still doing for us and for me!

Growing pains

I think I'm growing a bit these days.

My first revelation is that it's unfair to judge anyone because you can never know everything that is going on with that other person. Unless you know all the factors how can you say whether someone is doing or not the right thing. This has to do with my last post and with my previous rants mainly about doctors. I got to understand a bit more about a couple of doctors that I complained about in the past. I got to see how one of them is really trying to do things better and I think this is what is important: continuous improvement rather than perfection.

My second growing point and the answer to all the people that get to my blog by searching for "is social anxiety ever going away" and "emotional immaturity" is that I will live with social anxiety for the rest of my life. It will not get better. I might lose jobs, opportunities, friends, relationships, etc. over this and this is OK. Other people are losing jobs, opportunities, friends, relationships, etc. over other things. I will have to accept it, live with myself, get over it as fast as possible and move on. Emotional waves will come and go, some will be stronger and more painful than others. I just need to know that they all will go away eventually.

I met someone that might be useful in achieving my impossible dream. I was breathless, speechless, said the wrong things, had the wrong attitude. It will not go away. I might fix it by sending an email or going back, or maybe not, but the only way to get that job is to continue to do this over and over again until it becomes so normal that I can do it without overwhelming emotions or until someone will be able to see through the emotional content. Either way the emotional maturity and the social anxiety won't matter anymore. The only person that this is a big deal for is myself.

It was painful to see someone interested in what I had to say and seeing me running away from talking about what I want to talk about most.

I will try to work on a marketing speech to help me get through easier, but I will expect even this to fail. I cannot win if I will always run away.

Malpractice

I read this article in Medical Economics and I got offended.... big time offended. You advise doctors to write notes that detailed to avoid a malpractice suit? This mean doctors spend more time writing notes than they spend talking to patients? And this for the 1% or less patients that would sue them?

Can't they come up with something more economic? Can they record the conversations during appointments - that would embarrass us a lot, but how is it different anyway? It can only be used if you sue them.

Can we come up with some promise that we are not set to sue them? Like marriage? In sickness and in health... We're not all after you! Shouldn't the lawyers work on doing something like that than on suing doctors... I guess that wouldn't bring enough money.

When I had a breast lump, I had two doctors give me breast exams without a chaperon. I very much appreciated their ability to see me for what I was - a scared woman - rather than a malpractice suit waiting to happen. These doctors gained my full respect. Of course I wouldn't blame anyone that uses a chaperon (you need to do what you need to do), but having the guts to do otherwise needs to be appreciated.

What a mess!

Piglet

I added my avatar on Social Anxiety Friends. I am Piglet... If you didn't read Winnie the Pooh lately, do so. It's really fun reading. Here's a description of the characters:


http://www.femail.com.au/learningthroughdisney.htm

Other books that we read to our kid that were fun:

- The Princess Bride

- Grimm's Fairy Tales - I got the complete works volume... they are not as fairy tales as you'd think! Lots of real life lessons!

- Mary Poppins - she's not that nice

- The Jungle Book

- The Wizard of Oz

New poll and old poll results

Here are the results of my latest poll:

Out of 29 voters

2 do not have social anxiety

The other 27 use the following to help with social anxiety (options are not exclusive, more than one item could be selected):

• 10 (34%) - Read books, blogs, etc.
• 9 (31%) - Do individual therapy
• 6 (20%) - Do nothing
• 5 (17%) - Take medication
• 5 (17%) - Exercise
• 4 (13%) - Blog, diary, other writings
• 2 (6%) - Meditate
• 2 (6%) - Other
• 0 - Group therapy (I guess I am not popular with the Phoenix group ;) )

I was impressed with the large number of people that do nothing and the small number of people that meditate... I guess you guys felt just like me when you tried to meditate. It never works well at home.

This inspired me for my October poll: how much does social anxiety affect your life. It affects my life a little, but not to a level that it stops me from doing things: I would avoid a party or talking to someone, but I still see people, work, do new stuff, etc. How about you? How bad is it?

Ending relationships

I just figured another SA quirk of mine. Another bulb was lit. What's nice about figuring these out is that once you realize what's going on, it becomes easy to recognize and easier to handle and it eventually goes away.

I mentioned that my doctor is leaving and I won't be seeing him. We had a very special relationship and it is sad.

However, when I first found out, I was thrilled. Whenever I am in a relationship, I am terrified by its ending. I don't enjoy what I have because I am scared of losing it. It was my nightmare that I will call to go see him with who knows what awful problem and I will find out that he's gone. Or that he will tell me that he doesn't want to see me anymore.

And this was so perfect. I am in a good place now, not many health-related issues lurking, nothing major going on, enough time to look for someone else, etc. What perfect timing! What opportunity to end a good relationship on good terms and put it on the shelf as a trophy and a proof that I can actually have a relationship.

So I am pretty good at starting a relationship, but then I am terrified that it will eventually end.

Even with my husband, I got confident enough lately that I am no longer scared of a divorce, I am pretty sure that we will separate by death, but I am often thinking about it. I don't wish it, but I am thinking at any moment what would I do if it happened. I need to be prepared for it at any time.

It's worse with friends. I am scared of commitment because I know that it will end. I'm afraid to start anything because I don't know how it will end and that I would lose everything I have.

Still around

I'm still around, but it's been some awful weeks. My whole family and I were sick for the last three weeks or so. Somewhere in the middle of this nightmare, I found out that my doctor is going to another hospital too far away from me. It seemed that there will be no end to the nightmare.

And today, the sun came out. I am on antibiotics and starting to smell things and feel good again, the baby gained enough weight and his cold is getting better too without antibiotics, and I am finally getting to a resolution to what I want in a new doctor. I even got a plan.

And to top it off nicely, my wonderful husband cooked dinner AND cleaned the kitchen this evening. Ladies, go away, he's taken!

Now, Dr. Rob is hosting the Ground Rounds next week, so I have until Sunday morning to come up with a good post.... so I need to get serious writing going!

Social Anxiety Friends

Another reader sent me a link for my commenter Jay P. Check this out

http://www.socialanxietyfriends.com/

I registered yesterday and navigated a bit around. I got more hugs and welcome's than I am comfortable with, but it's a nice place. Does that prove that I have social anxiety or what?

A new friend

I have a new friend. I haven't had a "real" friend in a lot of years. I had friends that I wrote to, that I emailed or instant messaged with. I had friends that I met for a weekly event, like going to yoga twice a week, but that's about all. I had family friends that I could foist all the inviting/talking part to my husband.

I haven't had a "real" friend since college. And I am very confused and very shy about this role. All these problems that I never encountered: how will my husband react, how will her husband react, how will the world react? I should call... but when? what time is best? is it better to call when I am happy, unhappy or just when I am neither.

It's funny how I found the getting friends part really easy and entertaining. I did great and acted as if I had no anxiety at all. I had nothing to lose, but now that I won... I have so much to lose. And I feel stuck and scared.

Feels like listening to Beatles' Yesterday: "Yesterday, love was such an easy game to play!"

Marriage to a person with SA - comment

In response to my post below, Jay P commented that for some people with social anxiety getting married is only a dream. I will add the comment in its entirety, because it is very moving.

I will also change my profile to adress the fact that I only have mild social anxiety and that I apparently could quite easily overcome lots of problems. Even so, I made immense progress in the last year and I hope that this will encourage each of you SA sufferers to try to get to a point where social anxiety is affecting you less.

Many thanks, Jay, for your comment!

Jay P. said...
"Can you have a successful marriage with someone that has social anxiety? Apparently the most difficult thing is getting there - the whole socialising, dating thing." Exactly.Getting 'there' requires all the sorts of things that someone with social anxiety has difficulty facing. Such as those rather mundane, trivial things to everyone else like speaking, eye contact, and god forbid, being in a social context, anywhere!

Personally I've recently stooped to a new social anxiety low. I have more or less stopped speaking. I've begun to carry a small notebook around with me wherever I must go and if I am asked a question or even worst if I must ask a question, out it comes with pen in hand. Not surprisingly I've found that it limits conversation. Yes, thankfully shortens it.

I'm amazed that a relationship can develop when you're plagued with social anxiety. But don't get me wrong, I envy anyone that has.

It's not for a lack of good looks or intelligence that forbids me-likely anyone with social anxiety-from anything meaningful with the opposite sex. No, it's an apparent lack of personality under the guise of rudeness, insensitivity, even stupidity.

Of course my being is neither part nor sum of those things at all. It's all about being shy and how a sufferer is robbed of so many things in life because of it. A relationship, even marriage? Who'd even dare hope of such things?

Marriage with a person with SA

I occasionally see search strings about "husband with social anxiety" or the like. Can you have a successful marriage with someone that has social anxiety? After all, they might kill your own social life.

Apparently the most difficult thing is getting there - the whole socialising, dating thing. The two men that I ever dated I also married... I'm very efficient this way. Once married, people with social anxiety are apparently doing pretty well.

I think the key to making it is openness and communication. In my first marriage, we didn't communicate all that well and I think this is where it broke. It wasn't social anxiety that caused the break.

I told my current husband about social anxiety almost as soon as I knew what it was, and had him read a book about it. He got it and understood some of what was going on. Since then we both keep evolving and trying to understand what's going on. We talk a lot about my anxiety and find ways to help me.

It was important to realize that I need to be told ahead of time about plans for socializing and that I can refuse them. The simple fact that I can accept or refuse something made me comfortable enough that I hardly say no to anything these days.

Keep talking and being accepting of your social anxious friends or spouses and it will all be OK. Help them overcome their shyness, but be supportive when they can't and make sure you tell them when they are doing well in a social situation.

Grand Rounds and Polls

Susan at Rickety Contrivances of Doing Good put up this week's Grand Rounds. It is an interesting edition and it's subject is Narrative Medicine.

Pioneered by Rita Charon, an internist and professor at Columbia's College of Physicians and Surgeons, Narrative Medicine trains doctors and other caregivers to use careful listening and reflective writing to forge deeper connections with their
patients, resulting in better care.

Susan included my post on helping people with social anxiety in the first cut. Many thanks, Susan!

Go check the whole story. It sounds very interesting:

http://improbableoptimisms.blogspot.com/2007/08/grand-rounds-volume-3-number-49.html

__________

Second news is that I put up a new poll with questions on what are you using to help with your social anxiety. I think we are all curious what percentage of us uses medication vs. what else is used. I will leave this poll up through the whole month of September.

How to tell your doctor that you have social anxiety

This is a question that comes up quite often in the search strings on my blog...

So how do you tell your doctor? First thing to try is to just say it, prepare your "speech" in advance, repeat it, and then when at the doctor just take a deep breath and say it: I have social anxiety. For them it's not really as much of a big deal as it is for us. It's just another disease and another diagnostic code.

The thing is, each of us is different, my social anxiety mostly kicks in when I really like someone and want to be closer to them. So for me it worked quite well with a new doctor. I said it when I saw him the second time and it wasn't such a big deal. I had to repeat it again after I've been through a pregnancy with him and respected him much more. That time it was hell for both him and me; it came at the expense of his lunch break. It was very difficult but also very relieving. I felt very light coming out of that room... also emotionally drained.

So, again, try to say it, as difficult as it seems. If this doesn't work, write it down and send a letter and an email a week or so before your appointment. You might be embarrassed that the office staff might read it. I was very embarrassed to see my emails in my medical record. At the end of the day, for the medical office staff, you are just another patient with another diagnostic code, they don't really care that much. If anything, they will be nicer to you. The general idea of what social anxiety is that you're cutely shy and easily teasable. Few people really understand the emotional turmoil we go through.

Another idea is to say that you have anxiety. The doctor should not jump in with medication, they should send you to a therapist, psychiatrist or the like... Then the only person you need to give details to is the therapist. I recommend that you don't start dealing with social anxiety by taking medication. There's always the chance that you can do without and the medicine for SA are not innocent.

So good luck! and feel free to comment (anonymously or not) on how YOU told your doctor about it.

Rebuild your back

The other blog that I recently started reading is Dean Moyer's Rebuild Your Back. I love the way Dean is teaching others to deal with back pain. It seems to me like the right way to resolve it. Doctors and pain medicine can only do that much, chiropractors and other alternative medicine options seem to mainly work on "if you believe it, it will happen".

If you have back pain, visiting the site and the forum is a must. It just happened that about three of my closest friends had back pain since I started reading his blog... so I keep telling them: See, I told you!

The blog has other topics that I found both interesting and controversial, and the links to the Skeptic's Circle opened a different world to me.

Check it out! And thank you Dean for discovering me on the Grand Rounds and commenting on my blog.

I love my kid's pediatrician

I have a good positive post for you guys!

I love the pediatrician office. I am very proud that I found them and stayed with them. It's a small practice with 3 doctors. I think this is the best because it's small enough that you know each doctor , but big enough to cover all the hours, so you don't get to talk to some other doctor on call. It's always one of the three. Less than that and you would end up meeting a complete stranger for on-call. For more than that, it would be difficult to know each doctor and have unfragmented care.

I can ask for one of the doctors or just rotate through them as I wish. They are a bit far away from us, but they work with two of the best hospitals around and I think that is important. They are out of network for my insurance and I am actually happy about that because I know that they get paid a fair amount and don't have to reduce quality to cut costs.

They have evening hours, they get you in the same day for a sick child and they even come on the week-ends if needed. They are usually on time and I never had any issues with them.

At one of my first appointments, I felt attacked when the old doctor asked the usual questions about not leaving the baby alone on the adult bed, baby-proofing the house, fire arms, etc. I then realized they have to always ask these questions and it's not personal, so I relaxed.

Initially I rotated through each doctor to get to know them, but for 9 months or so, I just stayed with the youngest one. He has a kid about the same age as my kid and it's really cool to share the experience. He's fun: "Oh, I worry unnecessary about my kid as well." I love that he takes the time to talk to me and that listens to my concerns and reassures me. It's also cool that if I think he's missing something, I can go to the "old doctor" and ask about it.

____

I wonder what is it that makes this relationship so good and why am I so critical towards other doctors. I'm pretty sure it's something internal with me and how I react or come across to other people, but I can't figure out what it is.

I think this is more like a partnership for making sure the kid is fine. I think that doctor-patient relationships that are based on mutual respect are successful. If the doctor feels threatened, or if the patient feels unheard, the relationship just fails.

My view on Electronic Medical Records - EMR

I have read a lot about EMR systems, but I never really saw one. I imagine they handle appointments and allows staff to maintain a patient database. Maybe the more advanced ones electronically transmit data to insurance agencies and pharmacies and get lab results.

But I wonder if they actually help the doctors at all. I suspect they are just electronic notebooks for doctors having them enter notes electronically instead of dictating them.

I wonder if the lab results and other documents are stored in the database as searcheable numbers or they are simply pictures of the other documents.

I imagine that a good EMR should allow the doctor to select options from lists of values and then generate codes and reports. I looked at my doctor's notes once. He started by dividing the sheet in 3 areas and labeled each with the subject he needed to cover. It could have been Chronic hypertension, right upper quadrant pain and heart (I'm making it up, I don't remember the details). Anyway, it would be nice to have a program where you just enter a few letters and it fills out the rest. If you have a category that is not in the list, you can enter it in a separate field and the program should be smart enough to "learn" it and use it next time.

Then, because hypertension was selected, it would open up a history of that and give the doctor options. The computer should suggest a billing code, but allow the doctor to modify it. It should give medication options and allow the doctor to pick one.

When done, it should generate any report that is needed: referrals, letters to other doctors, insurance papers, etc. and allow the doctor or staff to review it one more time before sending it electronically.

Is this what EMRs are about? I doubt it. I am building database software systems and I am very aware how difficult it is to build something with such high level of artificial intelligence, but if they don't do all that, why would we be surprised that doctors are slow to adopt them? What do they bring the doctors? I think that the existing systems are more about keeping the office lean (less staff) than actually helping the doctor.

Why am I writing all this? What a good question... I guess because I am dreaming to build such a system, but I see few chances to get there.

Another doctor story

My dear and beloved readers, I promise, I tried my best to not be critical, I wanted this to be my happy post and everything to be good. It is not. I am not unhappy, just sad with the way the world is. So here goes another doctor story.

I have this mild but annoying foot pain since I was pregnant - 20 months ago. It is only annoying when I walk for a long time (like our 10 miles hike from a month ago). It's not that bad, but I figured if I can make it go away why not try.

My doctor very warmly recommends this podiatrist and tells me that all the doctors he recommends are his friends, but his patients actually like this guy. This is big for my doctor.

I call and get a 7PM appointment - hey, appointment at a convenient time, amazing! They send me directions, they call me twice to confirm my appointment with an automatic message. This guy obviously has an EMR system... I am grounded. I loved him even before I met him.

When I get there, it turns out that he doesn't take my insurance, but the first appointment is free. I quit caring about my insurance a while back. The doctors I have the best relationship with are out of network anyway. So this doesn't put me off.

The doctor comes in with a laptop, examines my foot, asks the questions, etc. He finds a spot that hurts and explains what he thinks is wrong. I listen and then tell him: oh, so if I just wear wide shoes it should go away. He says that's not enough and sets me up for a X-ray and U/S. I am presented with a U/S paper where I promise that I pay $50 if my insurance doesn't. Hey $50 is not the end of the world.

The X-ray is perfect, On the U/S he shows me a black area that is supposed to be my infection. Before I know, I get a hydrocortizone injection, a pad on my foot and I am armed with a cream and pads ($24.5). I shyly ask if it might not just go away just by wearing wider shoes. Doctor becomes uncomfortable and hurries out the room. I am set up to have another appointment in a week.

Will my pain go away? Likely. Would it just go away if I wore wider shoes anyway? Probably. Would I go back to the doctor if he just told me that? Likely not, but just because I would feel better.

Why are we so hungry for intervention? Why is this doctor basically a vendor? A very good and courteous one, but at the end of the day just a vendor. That EMR system that he has needs to be paid for...

And BTW, I had to peek at the EMR system and saw his notes: they started with "This 37 yo female patient..." He typed that in... shouldn't that be automatic, generated by the system?

I lost any hope that I am not the most critical freak that ever existed.... Everybody likes this guy, even my doctor, and I don't? What's wrong with me? Can I just be happy?

ETA: Check out the development of this story.

Poll results

OK, so my poll results are:

11 - have social anxiety (SA)

3 - don't have social anxiety but want to find out more about it

1 - is here for other reasons than social anxiety

This result was very surprising to me. I did not expect the SA people to come out and participate. Many many thanks for participating and for reading. I realize that for some of you even taking this anonymous poll might have been difficult. I also realize that you are coming here again and again because you find yourselves in what I am writing, realizing that you are not alone or finding hope that your issues have chances to be resolved or at least become acceptable. I now feel responsible to keep writing and letting the world know about us.

I was hoping that more people don't have SA, but are interested in it. I was secretly dreaming that there are SA researchers out there that would try to learn more about SA and find ways to help us... I guess research money is not much and it's mainly given by drug companies, so research in this area will have something to do with medication.

Thank you again for participating. I will keep writing about SA and I will try to attract people that don't know much about it so we can increase awareness. The first step will be to edit my post on helping SA people and submitting it to the Grand Rounds this week. Wish me luck! Feel free to offer suggestions, anonymous comments are allowed!

Dr. Rob

I have a few blogs I started to read recently. One of them is Dr. Rob. He is on the list of the best 100 medblogs and pretty much everyone on the medical blogs world has a link to his blog. I am so happy that so many people like him. This alone makes the world a better place. He has a lot of common sense, is smart (hey a doctor building his own EMR... - I am in IT after all, this has to impress me) and very very sweet.

He surprised me this morning with a post on children's fears... as you'll see it's not just children's fears and it matches very well the subject of this blog. Make sure to read it.

Thank you Dr. Rob for writing... and if you ever get stuck in Newark, let me know. I'll be happy to offer a place to lay down, a dinner and an ear eager to learn about your IT achievements and not only...

Edited to add: Two more Dr. Rob posts that you should not miss

Read To My Patients and give it to your doctor to share with their patients.
http://distractiblemind.ambulatorycomputing.com/2007/07/23/to-my-patients/
It's wonderful. I especially like this part:

You are not crazy. I have a lot of people who are really anxious about
things in their life and they are worried that they are “going crazy.”
There is a huge difference between being “crazy” (psychosis) and struggling
in life. Everyone is struggling in life (no matter how “together” they
appear on the outside). One of the best parts of sitting in my seat is
that I have a whole bunch of people opening up to me with their insecurities
and anxiety. I have realized that everyone is just as insecure as I am
- and this really makes me feel better in my own struggles. If you
can’t share your anxieties with me, then who can you share them with?
I promise not to make you feel that you are feeling the wrong emotions.

Also check Perfect words ... how nice is that? http://distractiblemind.ambulatorycomputing.com/2007/07/25/perfect-words/

Please take my poll

Please fill in my poll on the righthand side of the main screen. I am so curious what attracts people to my blog, and especially what brings them back... I'm looking forward to seeing your answers.

Many thanks!

Helping socially anxious people

I love to check the search strings on my blog. A quite common thread is people that ask how can they help a socially anxious person. Of course there's the conventional path that they need to be encouraged to take and that I recommend: tell their doctor, find a therapist, read tons of books on the subject, read blogs and try to hook up with people that have the same issue, read blogs and try to hook up with people that don't have this issue, write a blog or keep a journal for their feelings, symptoms, etc.

In this post though, I'd like to talk about how to interact with them on a daily basis. The simple answer is just be there for them and let them know you are there for them. When I was pregnant I had a cyber-friend that emailed me each time I posted an update on the Preeclampsia Forum. Each and every time, I would get an email saying she's thinking about me, she's glad I'm doing well or sorry that I'm not doing so well. There were months when I didn't even get myself to answer those emails, but they kept coming. Thank you so much for those emails, N! They really helped.

So the long term solution is to reach out to them occasionally even if they don't answer back. But I think an even more interesting question is how to react to the emotional roller coaster they go through and they sometimes drag the other ones around into.

I stand by my previous posts ( see Dealing with Emotional People and Dealing with Emotional People - Part II) that when upset, you need to listen to their vent and empathise. Don't try to rationalize (it will just demonstrate to them they are irrational) and don't tell them it's all in their head. After they relax, make sure to reassure them that you still love them, you think they are fine, that this kind of meltdowns happen to everyone (an example of when this happened to you is great).

What about when they are overcome with shyness, obviously not being able to get over it: blushing, nervous, trying to say something, but can't, wringing hands, looking down, etc. I think you need to do the same: break the silence with a question, ask what are they thinking, say it's OK, they are fine, that you have time to listen. Don't go away trying to relieve them of their obvious discomfort, just help them go through it.

Sometimes the silence becomes so awkward for the socially anxious that they wouldn't start talking because the issue is too small and they made too big of a deal of it. This will extend the silence even more and make it even more awkward. All they want is to run away and hide. Don't let them run away. It will make them feel good for a short time, but will hate themselves later. Again, after the episode, make sure to let them know they are fine and you still love them. Don't laugh at how small their issues are.

The question that comes up in our heads time and time again after these episodes is: what is he/she going to think about me? He/she will run away and never want to see me again.

Happy Anniversary to Paul Levy's blog

Paul Levy's blog is 1 year old today. Happy anniversary!

Paul's blog was my inspiration to start my own blog. I read his for about a month and then decided I need to talk to Paul. As it seemed practically impossible, I decided to write a blog instead and invite him over.

Paul was more open than I ever expected. He emailed me back, welcomed me on the blogosphere, read and commented on my posts and generally encouraged me on my road. He created the Personal stories group on his blog roll and I am always proud to see my link the first one there.

More than anything, his posts are like an vacation island to me and a window on a part of the world that I never had access to before. I learned the power of openness, and the freedom that comes with it.

Thank you so much Paul for opening up to us and for helping me grow. Here's to many more years of great blogging.

Where does the medical interest come from?

I got a new reader (Hi C and welcome!) and she asked me a good question: why the medical interest.

I always wanted to be a doctor. My grandfather was a surgeon, family physician and ob-gyn. In his 90s, his hands were so precise that he would walk with a cup full of coffee from the kitchen to his room without spilling a drop. At 80 years old, he was doing a spinal taps, one of them right when a big earthquake happened. He was very respected and everybody was wishing that someone will follow his steps. I would have liked it, but when time came, the status of health care in Romania was pretty bad and doctors were not seen as having a bright future (he he, talk about the American healthcare being in bad shape...). On top of that the admission exam was extremely difficult and i never thought I would ever make it. Right now, I think I had good chances anyway, but at that time my self esteem was very low and no one around me told me otherwise.

Life seemed to take me farther away from medicine, until I got hit with preeclampsia. After the initial shock with this not well understood disease, I got every book I could find on the subject and some of the books were medical textbooks. I found the Preeclampsia Foundation and a group of people that were just as nuts about finding answers and learning more (even if that meant housewives reading medical textbooks).

I learned and understood a lot in those years: I learned how little is known about pregnancy, I learned that doctors are not Gods, I learned that we need to take responsibilities and to accept a degree of risk. After the initial: "you doctors are all idiots" phase, I learned to respect doctors and medical professionals and I tried as hard as possible to communicate effectively and help them help me. It was a long road with lots of bumps, but I ended up feeling very comfortable with the doctors I sticked around and I feel I have a good grip on navigating through the health system.

After my second pregnancy, when it looked like preeclampsia was out of sight for a while or maybe forever, I attacked the anxiety with a new set of health care system challenges: finding the right therapist, deciding on meds vs. therapy or both, etc.

While working on the anxiety, I realized that I had the freedom to have dreams and that no matter how unlikely these dreams are, I can still have them. There is no shame in dreaming. I found Paul Levy. Paul is not a doctor, but he does a great job being the CEO of a large hospital... so maybe my dream is not that impossible either. Add to that that I am working in a field (IT, database software development) that is needed like air in healthcare today, and the dream seems just around the corner.

Grand Rounds

For those of you interested in medical-related writings, be sure to check the Grand Rounds - the best of the medical blogosphere. Each week it is hosted by another blogger.

As a personal challenge, I submitted one of my posts this week and it was accepted. Check the rest of it

http://blog.vitummedicinus.com/2007/07/official-grand-rounds-volume-3-number.html

Many thanks to Vitum Medicinus for including me.

6 months update

There are 6 months since I started this blog and 1 year of therapy (no anxiety-related medication) and I see major improvements.

Anxiety is still here, but it has no steam. It really is like a roller coaster ride: gets me up or down quickly, a bit dizzy and nauseated at times, but 5 minutes later (or an hour... or a day), the ride stops and things are fine again. I am still shy around new people, avoiding to make phone calls, not sleeping when something good or bad happens, etc. but it lasts only one night, or a finite amount of time, I know exactly what it is, and I have the luxury of rationing through it. Whenever I get too angry, overly upset or too happy, I just question what caused this and I talk myself through being rational about it.

I am even more thrilled with my physical health. Everyday I am amazed at how well I am doing. Last year I used to have high blood pressure (mild, but still, without medication it would get into 130/100). I now take no medication and my blood pressure is around 115/75. I get spikes into the 80s when I am anxious or excited (like posting comments on other people's blogs ;o) ).

My recent diagnosis with ulcerative colitis has been an immense relief for me. Yes, it is a chronic disease, but it is manageable. I didn't feel really well for a very long time, and I always thought it was the anxiety that was causing it. Isolating the real problem made me me feel better (with medication) and relax about the anxiety messing up my life.

So I am very much OK with where I am... I did very well, I got very far. What is the miracle? What did I do? I did therapy, exercise regularly (aerobics for 45 minutes 3-5 times a week and yoga 2-3 times a week) and blogged. I also read a lot (LOL - I knew I was doing better when I put all my psych books back on the shelf and swore that I will not read another one for another year at least).

I hope that over the next couple of weeks I will be able to describe how each of these was beneficial for me, but all in all, I just attacked the anxiety with as many weapons as I could (other than medication) and I eventually won. I guess that how everything can be resolved in life.

Are you ready to use props?

When you are very fresh in a yoga class, you are usually told that you can use blocks and straps to help you through the poses. Unfortunately, when really new to it, there's no way you could do that without help: you try so hard to do some of the stuff, that you can't even breathe and much less scoot around for your block. If you go out of the pose, you feel that you would never go back in again. As you gain more experience and strength, you are able to breathe, move easier and figure where you need some help, and get your blocks and straps to help.

By reading medblogs, I found out that the new year just started for medical interns and residents and likely they are in completely new and scary roles and can't hardly manage to go through the day. Therefore I completely understand the poor resident that I am going to trash in the rest of this post.

OK, here's the story:

I'm going for my appointment to find out the results of the colonoscopy. I was very happy to finally get to talk to a gastroenterologist so I could put into perspective all the various complaints that I had during my life.

I get to do the vital signs part quickly and I am planted in an exam room. I wait there until about 1 hour after my appointment was scheduled. A resident and a medical student eventually come in. The resident states his name and starts asking me about my symptoms. Asks me to sit on the table and does an exam. I politely and slightly joking ask him what the results of the colonoscopy are. He pompously tells me that the doctor is going to talk to me about my results and the treatment and starts writing in the chart. I am amused and amazed at how little interest he has in me as a person. For this guy, I am just a set of interesting bowels... if even interesting (maybe GI is not his desired specialty and he just wants this over with).

The med student figured the awkwardness of the situation. She introduces herself. She asks me what other symptoms I had. I say a few things and then get frustrated with the resident's incapacity to treat me as a person. I stop talking. The med student asks me if this was my first colonoscopy. I answer yes. (what a great prop she handed the resident - first colonoscopy... she must have questions, right) The resident keeps ignoring us both. I am a bit frustrated, but things are still OK as I know that I will eventually see the doctor.

After another 15 minutes, the doctor and the rest of the guys come in. The doctor is quite young, but he looked bright and cute when he did the colonoscopy. He's telling me that I indeed have ulcerative colitis, and explains the treatment. I ask how long will the treatment take: he says he has no idea, it's a wait and see. He hurries toward the door. As all three of them almost head out, the med student asks if I had any questions. My frustration bursts out, and the doctor figures that something is wrong with this picture. He sends the resident and med student away and insists that I ask my questions. I get to ask my questions and understand a bit more about my condition. I am relieved and happy. I stopped being a set of bowels.

I am told that most patients are very happy with this kind of treatment.. as long as they have their prescription and their pain can go away. When I complain about the delay, I get apologies and I am told that's because he takes time with his patients. I had to laugh out loud at this one. Come on guys, do you still expect us to believe that? It's just bad management, not all that wonderful quality time that you give to your patients.

Many thanks to the med student that saved the day and I hope the poor resident will be able to get the props soon as he gets used to his new role. As for the young doctor, what are we turning these guys into? All in all, I think it was a learning experience for all of us.

My anxiety: I got very frustrated and I had my moment of emotional immaturity: I insisted that I leave upset and that I don't want to talk. Fortunately, I got over it and after taking a few breaths, I could concentrate on my questions. The whole experience was so emotionally intense for me that I cried as I got into the car, but I was OK with this and the whole event. I could have been more mature, but I don't feel that I needed to. I am happy with myself. I still have social anxiety, but I am not viewing it as a disaster, just living with it. I guess I got to the point where I can use props if I need to :)

We are not broken TV sets and you are not TV repairmen

I was planning to write a mini-series dedicated to computers and IT in general, but I just had another (rich in anxiety) healthcare experience and I neeeeeed to talk about it.

As I see it, having colitis is pretty straightforward for doctors these days in US. You have the symptoms, they have the luxury of seeing what's going on with a colonoscopy, they figure what's up. They give you ASA first, if it doesn't work, they give you steroids and so on. Just like fixing a TV: the image is flickering, so you get a flashlight, open the back cover, peek inside, find a burned something, replace it, still doesn't work, you go up the stream until you find something broken and the TV now works.

Just that we are not TVs, we are humans. And even though you have tons of pressures with administration, too many patients, too little time, and who knows what else I'm pretty sure you didn't go to medical school to find out how to peek in assholes and write prescriptions. I bet you went there to help people in need, and to have human contact. So where in the process did you lose this? Why did you become insensitive machines?

I realized today why would someone like to do Gastro/Enterology. I think you have the opportunity to offer more relief and be in more intimate human contact than almost any other specialty. Even more than gynecology, pretty much at the same level as obstetrics.

I don't know details about all the gastric/intestinal diseases, but in our culture, we put so much emotional content in our digestive system... think of all the bathroom jokes, of the big laughs on burps and farts. So, here you have someone that is scared enough to come see a doctor, after a lot of embarrassment at work or in public places, after avoiding to be too far away from a clean toilet because the bathroom becomes a very common place. Oh the growling stomach and the rushed trips to the bathroom, and the horror of checking what's coming out and the daily cramps.

Maybe you indeed do not need to know all the details of our symptoms, because you have your solutions, but we need to finally tell someone and there's a big trust that we put in you. Yes, we too are embarrassed to talk about our bloody poops and our smelly farts, but you are the only ones we can talk to about it; when we are finally ready to talk about this, please listen to us and try to empathise. And maybe, if you do listen carefully, you will eventually be able to tell us more than you tell us these days, one day you will be able to make connections between all that ails us and can suggest ways to prevent it in the future without drugs.

I ended up being listened to and I asked my questions and I got a few answers. And all is well if it ends well.

I will comment on the other aspects of my adventure in later posts, but, if you are a doctor, other medical professional or a medical professional to be, please always remember: we are not broken TVs, and you are not just repairmen.

More along the same lines in a post from new blog I added to my to read list: Surgeonsblog. Check it out:

http://surgeonsblog.blogspot.com/2007/06/shoefoot-other.html

And another one :)

http://www.memag.com/memag/article/articleDetail.jsp?id=438103&ref=25

Doctors don't need admins to show them how to do their job....

First of all, I need to say that I have no business or knowledge to comment on the stuff below, but this is my blog, so I'll do it anyway. I am just a software developer and a health care administrator wannabe... I will likely find other ways to fill my life before I'll ever get there anyway.

I mentioned a few weeks or months back that I like Dr. Wes's blog. I love his posts and I also learn new things about hearts (real ones). As with other people that I like, I find it very disturbing to read that there are things that we do not agree on. I need to work on this, but this post is a commentary on one of his posts that I don't agree with.

http://drwes.blogspot.com/2007/06/clipboards-or-care.html

I don't know enough about the exact details of the deal to be able to disagree with the entire post, but here's what I didn't like

Once again, it appears that hospital administrators would rather turn to
non-medical auto-industry "efficiency" and "safety" experts, rather than asking
health care professionals to recommend the best way to improve care.
...
Do we really need yet another company or administrator to tell us how to do
our job? Is it all about safety and efficacy? Or might providing a better
nurse-to-patient ratio be far better at improving care?

I am sure we are all frustrated with the health care status: patients, doctors, nurses, etc. But I think that a big part of the problem is the administration. If administration is telling doctors and nurses what to do, it is wrong, administration should empower them to do their jobs and take care of all the non-medical stuff so that they can do their jobs.

In software development, we say that the modern project manager is no longer a supervisor, but a partner that helps developers to do their jobs without needing to care about budget, time constraints, getting approvals, having the right hardware or software to do their jobs, etc. They just tell us what to do in what order and when and ask us what we need to get this accomplished in terms of time, and resources. Then they make that happen: they supply the resources and let us do our job.

That's what hospital administration should do, no more, no less. From my perspective as a patient, it's not the doctors or nurses that I am complaining about, it is the administration. I think that medical office staff is shortsighted, I think they don't get it, I think they perpetuate the idea of doctors as "Minor deities" (BTW, wonderful post, Paul! Yes, I too love my doctor but hate the system). They act as if they don't care about our time or our pains. Customer service is so poor. I doubt that I am the only one that is more annoyed about trying to get an appointment or try to get a doctor to call back then it is to actually talk to the doctor. In Romanian we have an expression: "on the way to God you get eaten by the angels"... I can't think of a better metaphor for what's going on.

So why not let the administration learn more from other industries? They do need to learn. They can't do it from their peers, most of them seem stuck in the same hole.

Just this week I went to the hospital to have a procedure. I love to look around and see what's good and what's bad. So while looking around I see a chart: customers satisfaction surveys for nurses: 100% ... my, my, these guys are already perfect, there's nothing better to be done.
(I think that the book "If Disney Ran your Hospital" - by Fred Lee is wonderful and right on target on this). And, of course, the poster with: if you can't give us a 5 just call the nurse manager and she'll fix it for you - guiltying us into giving them only 5s. Oh, well!

The hospital is wonderful and the nurses and doctors were great. It was a good experience, not a memorable one, but good enough. I don't have complaints about doctors or nurses.

But they call the patients one hour and a half before the procedure is scheduled... Why? Why not 30 minutes, maybe even 15 minutes? After all, all there is to do is to sign a bunch of papers, and get undressed. They take a medical history and they put in an IV, but all this stuff is done in L&D in less than 15 minutes.

I didn't get the impression that there were too few nurses... maybe they are overworked, I don't know. They do plan the same number of patients, so what difference does it make to them that we stay there an additional hour? All I can think of is that if someone cancels or comes late they want to be sure that the doctors and nurses stay occupied. But is it worth? Shouldn't administration ask and find a solution to this particular scenario without inconveniencing the patients? Maybe this is what "lean" should mean?

Next Disney ride: colonoscopy

Here's synchronicity in action: I have been in high anxiety for months: March, April, May. And I worried myself sick. Yes, you can get yourself sick by worrying.

So here I was feeling anxious and sick, away from home and having no clue what's wrong with me. One day, while reading a Grand Rounds post, I read about The Midwife with a Knife (a perinatologist ;) ) having a colonoscopy. The diagnostic was ulcerative colitis. I look it up and I figured: that's me, that's what I have. The post was very reassuring about both the procedure and curing the disease and it calmed down my fears.

The conclusion is: if you need a colonoscopy, go get it. It's not such a big deal. Yes, the prep is disgusting, but as far as the procedure goes, these days in the US they put you to sleep and you won't remember or feel anything. Fasting for 36 hours is pretty bad, but after the first missed lunch you get used to it. If I had to do it again, I would skip work during the prep, so plan for two free days for this: get a good book. My doctors also timed the medicine so that the worst of the cleaning happened before bed, so I could have a good night sleep. It's useful to make sure this happens. And make sure you have some disper rash cream handy... hey, isn't it grand to have a baby at home?

I indeed have colitis... why did I need a colonoscopy? I could have told them that because "I read about it in a blog" LOL ;) See how I'm using the taxpayers dollars and increasing the insurance rates unnecessarily!

Anxiety was under control and I feel like after another day at Disneyland.

A post on comments about the hospital to follow soon, this was just a if you're sick get thee to the doctor and don't complain about the colonoscopy.

Synchronicity

My therapist recommended a book about synchronicity about a month ago: The Tao of Psychology by Jean Shinoda Bolen.

I read a few chapters and I was bored. It wasn't such great writing. Then, one day, I got it. I read a chapter in that one day in which it was important to read it, in which lots of important stuff apparently unrelated came together.

Synchronicity is about events that happen and that we find connections between. The author suggests that noticing them as well as being more open to intuitive and/or emotional or artistic thinking uses a different part of the brain than the rational thinking.

I am an engineer, in a family of engineers, married to an engineer... so rational thinking was always big in my life. I started noticing synchronic events as a game, but it soon became a very important part of my growth and much of it has helped me crack the nut.

What happens to me, things people say, things I read in blogs that seem to have no connection whatsoever become very powerful nudges , eye openers or food for thought.

I wanted to talk about this in a separate thread because I will mention it a lot. It's been part of my thinking lately. If you're looking for something interesting to read give this book a try.

I hate anxiety

I hate to be anxious. When I am anxious I can't achieve anything. All I am able to do or think is to beat myself up and criticise others. A lot of procrastination too. I need to force myself to do anything: exercise, cook, eat.

These days I achieved a lot. I started a few projects around the house, made progress at work.

The only thought that worries me now is that this feeling good won't last. I think though that this was a bigger than normal threshold and I will feel better than before.

I cracked the nut!

It's been hovering around for the couple of weeks, but I only figured the whole thing sometimes this week. I cracked the nut. I understand the cycle of my anxiety. I know how to stop it. And it worked just fine for the last couple of days. Is this all? Will I be happy forever? I am sure not, but I got a new threshold and it is higher.

So what is it? It's me! It's all about me being unhappy with myself. It's all about me wanting to do or be something else than I am. That's the cycle:

• I want to be able to do something or be someone else
• I get frustrated when I don't get it
• I try harder and I say I can do it
• When I fail, I get angry
• I project my anger on someone else or I find a scapegoat
• I get very critical about someone else
• I either say what I feel - and I am smart, have good intuition and good memory - when I am critical, I am in general right on target and it hurts... badly
• I don't say what I feel and I accumulate so much anger that it explodes at inappropriate times and in inappropriate places
• I feel very bad about it
• I start beating myself up and I find lots of situations when I was inadequate
• I am unhappy for days and I hurt someone I care about.

That's it! Whenever I got angry or frustrated these past few days, I asked myself: what is it that I am unhappy with myself about? Do I really need to do this thing? And anger and frustration went away.

I wanted to communicate better with my mother. Because I didn't get there fast enough, I was annoyed and angry at her and me. I am OK now, but I had to let our relationship go where it will go without forcing it.

I got upset with my husband this morning because he was watching TV while we exercised. I realized that I was unhappy with me because I think I should encourage him to exercise more intense and I think the TV stops him from doing that.

I got upset when he asked whether we had spaghetti sauce... because I thought it was my duty to have the spaghetti sauce handy.

Is it really that simple? And why did it take so long to discover this? I have made so much discovery lately. There's so much to write, there's so much I understood! I hope I will be able to write it down these days and maybe help the next person visiting this blog.

I hope it lasts because the victory is so sweet and the long trip is all worth.

People go to Disneyland for this kind of excitement

You like Disneyland, don't you? All the fun unexpected cool stuff that you see and feel, the fear and excitement of roller coasters, waiting in line discussing about the next experience, the different atmosphere and environment then in real life.

I don't need to go to Disneyland for this. Roller coasters make me dizzy and I'm not easily getting into the it's fun time mood. All I need to do is go to a medical facility. I am strange, very strange, extremely strange.

I find it fun to notice what's good and what's not, I like to see good changes, I get all upset if something is not good. I find interacting with medical personnel as exciting as a roller coaster: the anxiety over meeting someone new, the possibility of an interesting conversation, the possibility of discovering or learning something new about me, the pleasure of learning new words that I can Google at home. I can then make new connections about my body and feed the hypochondriac in me. Then the failure of connecting, the things they don't get, the fear that i didn't express it the right way. There's always the challenge of saying everything concise enough to not waste their time and the satisfaction that it was the right way to do it.

After my pregnancy loss I got to visit quite a bunch of medical offices and had all sorts of procedures done. I had good experiences and bad ones, excellent interactions and not so good ones. I got to feel listened and understood and I got to feel frustrated.

I am having fun profiling them: I like places where they display anatomy charts and calls for research studies rather then places where they display notices over notices about what they won't do: they don't make medical records copies for free, they don't accept x insurance, they don't fill in x form more than once a year, they don't accept checks, or credit, or cash, etc.

I saw places where they get you right away, where the doctor apologizes if they run late, where the doctor says he/she won't apologize for being late because he/she is taking his time with patients, where they know your medical history details, and where they don't even know basic facts about you or don't bother to look at the previous page in your chart to see when you were there last time or when you got blood work done. I saw places where they tell you what they are thinking, planning to do, and places where they wouldn't tell you almost anything but would then ask a million times if you are OK.

I think that they are all only humans trying to do their best in a pretty bad system. They could of course do better, but they are trying and progress is made despite all hardship.

I get to anticipate what's going on: I like to know the diagnostic beforehand, know what's next, know what the speech of the day will be about. The downside to this is the blood pressure monitor and the stethoscope: they get to measure my excitement without understanding the reason. My heart rate and my blood pressure run too high over there. Oh, all the fun I would have if they didn't have a blood pressure monitor!!!

For whatever it's worth, for me you are like Disneyland! So when's my next appointment?

Don't miss Paul Levy's post

Please read Paul Levy's post from today. It is a very interesting comment about how girls/women act. I found myself in some of these comnments. Very interesting.

http://runningahospital.blogspot.com/2007/06/advice-to-referees-and-managers.html

As always, thank you Paul.

Dealing with emotional people - part II

In a post below, I was commenting that reasoning when talking to people in a highly emotional state is the wrong way to go. Empathising and trying to understand the emotion is so much better.

I need to add something that one should never ever say, especially not to emotional people: "It's all in your head." Fortunately doctors quit saying this or at least I haven't heard it lately.

If you feel the need to say it, stop and think for a minute. Maybe that emotional person is exaggerating, maybe her/his perception is way distorted, but there must be something that got the person so upset. And telling her/him that it's all in her head will not help at all. Clarifying the issue will help everyone.

Changing environments

We're visiting my home country - Romania. We also visited Turkey for a week. It is an interesting and revealing trip anxiety wise.

I am now relaxed enough that I can observe things. One of the things I noticed is that people's temperament is different from country to country. People in Romania are much more reserved than the typical ones in US. The people in Turkey are much more open than both. I am even more reserved than the typical Romanian, but I want to be as open as a Turk. LOL how's that for high expectations.

But this explains why coming to US I felt more out of line than I felt at home in Romania. I was never comfortable here either and I have my issues anyway, but at least I can feel I am not as abnormal as I think I am.