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.

Right and wrong decisions

Did you notice that there are very few big decisions? Decisions that could change your life, decisions that are absolutely right or absolutely wrong. It seems that life gets you where it wants to no matter what decisions you make.


You can almost always turn around and try again another option. And no matter what decision you make there are opportunities and risks along the way. A decision might look perfect today and disastrous tomorrow due to some event that could not even be thought of.

So what's the right way to make decisions? I think you just need to figure what's good about each option, what's bad, then just make the decision and realize that either way it's about the same. An informed decision is occasionally better. So reading and asking around people who know is good.

A lot of people think though that there is a right way and a wrong way to do things. I am one of them. If things end up badly, I agonize over which one was the wrong decision. I also agonize while making the decision. And any person that expresses an opinion about what is right makes me cringe and doubt myself.

If I could only understand that most of the time it does not matter: any decision is good enough.

Backpain anyone?

I can't live without blogging... all of a sudden I have so many things to say. I guess I must be feeling better. After all a vacation is coming up soon.

In the spirit of more exercising that I wrote about earlier, I subscribed to a blog for fitness - The Fitness Fixer. It's a great blog with simple solutions that don't require gyms and equipment.

It explains one cool way to avoid backpain: tuck the hips under and straighten the back. This is using the abs some, thus resolving two problems in one. Check it out!

http://www.healthline.com/blogs/exercise_fitness/

And I came up with a trick. I straightened my back and set the rearview mirror in my car to that height. Now each time I try to use it it reminds me to keep a straight back. Very neat!

We've been working out some 30-45 minutes every morning this week - aerobics. And I went to yoga 3 times.... hmmm this looks like it's working, doesn't it?

Trip anxiety

I will soon take a trip. Any trip is anxiety provoking for me, but this in particular involves a lot of social contacts and is particularly difficult. I am back to waking up early in the mornings and being on the edge most of the time.

I exercised a bit more this week and that was good and I will wait until I come back to really step up on that project.

Until about two days ago the idea of the trip was so terrifying for me that I was paralyzed about doing anything. When anyone asked me what was I scared of, I couldn't even think what... I guess I made progress because now I am preparing some (getting little gifts, etc.) and thinking what got me so scared.

Amblyopia

This is in no way medical information, it's just a story that I made up to make sense of what goes on with me. As I read or hear more either from a doctor or some article or friend, I twist my story so it will fit that new information.

I have amblyopia - lazy eye - in my left eye. It runs in my family. This is not an eye defect, but a brain interpretation defect, the brain just doesn't want to "see". There is nothing physically wrong with my eye.

There are two ways that this is treated: an older idea was to abandon the lazy eye, so that it got lazier and lazier and you would expect to lose sight in that eye by the time you're old. This is the way I was treated for about 20 years. The lazy eye got worse and worse, but what was worse was that the good right eye would get tired by the end of the day. No nights spent learning for me, and quite commonly I would skip reading that page before bed. This is very painful for me because I love reading. Computer reading is much better than paper... woohoo for now having enough to read in blogs.

A more recent approach is to force the lazy eye to help. So they would increase the dioptries until the lazy eye is forced to contribute. This is what my current doctor is trying to do with me. I have a new pair of glasses and right now it's pretty difficult to read, but it gets better every day as the left eye is forced to do something.

I think there is a connection between the way my eyes work and my social anxiety. On one side I am so successful professionally and within my family, on another I am so unable to deal with new people and make friends. One part works so hard, the other needs serious pushing to do anything. So what is the right dioptry that I need to add to my lazy part to make it contribute to my well-being? And how do you apply this?

I went to a yoga class yesterday. At a certain point I noticed my neighbour's wedding ring: it looked like a plain wide white gold simple band. I went on with the class and 10-15 minutes later I notice that her ring was actually encrusted with little diamonds. So what made my eyes see much better this time? Was it the breathing, the exercise, the blood flow to the eyes? I think so. And I decided what my next step will be in trying to deal with my social anxiety: I am going to exercise... a lot. I will see where that goes, but it can't go wrong.

I exercised regularly since summer of last year, not much, but at least two hours a week. In February, I couldn't do much and since March I am in a maze anxiety-wise. It's time to get it back and do more of it.

That being said, I won't have much time left for blogging :( I will try to update weekly though! And I will keep reading my favorite blogs... while my left eye hopefully gets better ;)

Parenting joys and challenges

In our longer than normal journey to have a baby, lots of people told us how this is going to be the best experience of our lives. I knew that I will love it, but I never realized what it really means. You hear: my baby started crawling at x months and walking at y months. It feels like precise milestones that you need to get to. Instead there's a long journey for each of these milestones. The baby doesn't just start walking. There are so many little steps, you can see a tiny bit of advance every day. Sometimes you think it's never going to happen, and then one day it does.

Last week we heard the baby say a word in the right context for the first time: hot, hot. What intense happiness and joy. It gets even better because he understands that we talk about him and that we are happy and he looks so proud of himself. He looks at us with the hugest smile ever.

And the challenges... I think I am a better mother because of my struggles with anxiety. I understand how he feels and I think I react appropriately and help him go through it. When he cries without any apparent reason, I usually feel and understand where his pain came from.

Two weeks ago the baby got sick, then I got sick, then his father got sick. We struggled for a while and finally a week ago we all were well. However in the struggle the baby felt neglected and we had a period of fussiness and clinging. Once again we had to let him cry himself to sleep because it felt like we never spent enough time with him. I had such a hard time deciding where the right line is between being there for him when he needs me and taking some much needed time for myself and letting him soothe himself.

When I was sick and staying in bed one morning, he first enjoyed his new found freedom and played around for five minutes or so, then he came over, looked at me in bed and started crying. I could not calm him no matter what. His babysitter came half an hour later and all of a sudden he was happy again. I think he was saying: "Now my mother is sick and there's no one to take care of me so what am I going to do?"

For the last two weekends I have been very close to him, almost always there when he wanted me, and finally this evening we won: he went to bed without crying. Did I find the right balance? I will never know, but my heart isn't shattered this evening after a long time.

Acknowledgements

I've been posting for a while now and I'd like to take the time to acknowledge the blogs/Internet resources that I'm enjoying the most at the time.

Of course I need to start with Paul Levy. Paul is my mentor into blogging and I probably would have stopped doing this a long time ago if it weren't for his kindness when I started this blog. Paul's posts on Running a Hospital are always interesting and thought provoking. I am so glad that he is read so much and that he gets tons of comments on some of his posts. I am learning about hospitals and managing people and how different people have different opinions. It's always interesting to see that the other side has a valid point too. The link on his blog keeps bringing over readers on my blog. Paul, you are the best!

Maria at intueri is always fun to read. In the morning, when I open my news on bloglines, I read Maria's posts the last... I'm keeping them for desert, like a piece of chocolate. Maria is nice and kind and fun. She's a psychiatrist and I think she must be a darn good one.

I think everyone is reading Kevin, M.D., but just in case anyone missed it, if you want an idea about what's going on in the medical blogging world, or if you want to find interesting blogs, this is the place to go. Short messages, but with witty comments and very useful excerpts.

Other health care blogs that I find interesting and fun:

• The Angry Pharmacist -
• Pediatrics Now - Dr. Gwenn is in
• Dr. Wes - a cardiologist

Hospital Impact had a big impact on me by recommending the book "If Disney Ran your Hospital" - by Fred Lee

I'm also reading the Medical Economics magazine online. It is free and I think it has stuff that is readable by normal human beings.

And I need to add my dearest social anxious friends out there:

- SA Dave
- Shy and quiet Drew
- Successfully Shy

For news and fun reading, there are free RSS feeds to the New Yorker, the New York Times. The Wall Street Journal requires a subscription to see the whole articles, but their Health Care Blog is interesting and free.

And finally for those of you that check every day your favorite blogs, I am using bloglines to store my favorites and see when anything is new or updated. It saves a lot of time and it's fun.

Many thanks to all my new acquaintances mentioned here and to all my readers!

Emotional immaturity

When I got my driver's license, a new test was recently introduced: the psychological test. The result for me was "emotional immaturity". I keep remembering those two words anytime my anxiety spikes. What a good way to put it.

It feels like for me anything either doesn't matter or matters more than life itself. When I do something I am all in it, when I like someone I love them, when I hate I really hate. The smallest encounter consumes me.

How did I get here? Early on I start noticing that my reactions are different than those of other people, so I started controlling them: I don't show that I am happy or sad until I decide what amount of that emotion is appropriate to show. Excitement, anger, joy, pain... it's all under control. Now I need to smile, now I need to be nice, now I should show that I'm upset. It's a lot of pressure and work. It's hard work and the results are not very encouraging: people think you don't care, when you burst out they get surprised and become uncomfortable with the emotional overflow. Then there's always the lag: something happens and I don't show any emotion until I decide what the appropriate emotion is. So everything looks good 5 minutes after it happens, but the next day a storm comes out: quite confusing for everyone around, isn't it?

I'm pretty sure this is not only me: I see it on the other blogs: someone tries to increase their likeability, we all think about how we reacted to something and try to control it.

And it infuriates me. It infuriates me that we shouldn't have to do this. It's unfair that we need to make so many conscious decisions about everything. Can we just not do it? Just let it go? It gets you on things you care about the most: you lose friends, relationships over it... maybe those friendships and relationships never had the chance and you're blaming yourself for it, but you will never know and you swear that the next time you meet someone you will not let it happen again.