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Monday, December 29, 2014

Making Resolutions That Last

2:06 PM Posted by Tiffany Taft , , ,
It’s that time again. An entire year has come and gone and we are left with an opportunity to examine what we have done and how far we have come this year. After some investigation, it appears that only 30% of individuals will actually set New Year Resolutions - meaning less than half of Americans will set healthy and obtainable goals for the new year. People may vow to eat better, lose weight, improve relationships, and even learn to cook; possibilities are endless.
Currently, the diet industry worth is over $60 billion and the fitness industry is a $25 billion dollar industry. With so many options and “fixes” promised by some organizations, it can be even more challenging for those wanting to change poor habits for healthier ones.

Here are some ideas for you this new year to achieve those resolutions you desire to change.

First, create a resolution that you really want. If you are creating a goal that others want for you, but you do not want for yourself, it is not going to work. Trying to change for the sake of others is not the best option for lifelong results. You have to want the change. So make sure your resolution is for YOU. Also, too much is not always a good thing.

Your resolutions should be limited. If you find yourself writing more than five big goals, consider the top three you would like to see different this year. Part of setting goals is to make sure they are obtainable, so be specific. If you set several larger resolutions, its common for people to “give up” when they do not see positive results across all of their goals. Be realistic and specific with these changes.

When you set goals, they should be measurable. The action plan you design should include how you will measure your success both small and large. Sometimes it’s hard to see the whole picture and reviewing small pieces of success you accomplished throughout the week is extremely helpful.

 Next, create a plan of action. Change is never easy and sometimes you may need the help of others. If getting more exercise or eating right are your resolutions, perhaps you may need to find a friend or a group of likeminded individuals who can encourage you and your goals.
Be prepared that your goals mean you will have to change your habits. Habits can be difficult to change and/or break. Knowing which habits are the hardest to reduce or change will also be helpful when setting your action plan. Support systems including your friends and family will be extremely beneficial during your initial engagement of changing habits.

Additionally, you should consider writing down your goal and sharing it with others. Seeing a visual reminder of your long-term desire for change in addition to friends or family getting positive reminders can all assist positive change. Please keep in mind that those you share your goals with should be supportive for you. Lifestyle changes are difficult by themselves, try and limit negative feedback that some individuals may offer.

Finally, if you feel like you missed the mark or failed at your goal, forgive yourself and move forward. The first of the year is not the only time you can set New Year resolutions. Your new year starts when you want; 365 days from day one. If you make a mistake, eat the wrong food, miss a workout – whatever the case may be – you can always start again. You create your own refresh button. Remember: It’s not how you fall, it’s how you get back up.

Happy New Years everyone. Keep your goals strong!

Sunday, December 28, 2014

Holidays, Relatives, and Keeping Our Sanity

5:12 AM Posted by Tiffany Taft , , , ,
It’s that time of year where family and friends gather for festivities and holiday cheer. But sometimes, cheer is in short supply, especially when relationships experience conflicts. Turmoil within our closest relationships can sometimes make or break our holiday spirit. It does not matter how old you are, get-togethers can be challenging. So as the holidays progress, here are some helpful reminders of improving and maintaining healthy relationships with friends and family to enjoy the most of this season and the end of 2014.
First off, believe and understand that you are not the only one having a difficult time. By acknowledging that others may be experiencing similar difficulties, it may help reduce feelings of inadequacy or self-criticism when you engage with friends and family.

Next, consider your current emotional state and ask yourself if you typically feel frustrated or aggravated with those around you. It’s a difficult task, but if you are reacting and responding to others differently than you usually do, it’s beneficial to return to your typical emotional state.

When you find yourself stressed, frustrated or aggravated, take a moment for yourself. Taking a break and even removing yourself from challenging situations can reduce conflict and internal turmoil. For example, you can leave the room for a few moments or even go for a walk to reduce negative emotional experiences.
Also, when friends or family say something less appealing, try not to take it to heart. If you do not take comments personally, you will have a greater ability to exhibit conscious choices and responses. If you can limit feeling personally attacked by others, you may find it easier to observe the dynamics of relationships around you (both friends and family).

It’s surprising how much you can learn by simply observing those around you.

You may identify individuals who are quick to attack and criticize, seek attention and even avoid conflicts. Additionally, showing compassion to those closest to you can greatly reduce negative interactions with others. Showing compassion and even empathy to friends and family experiencing a difficult time of year is likely to reduce unnecessary conflict during holiday get-togethers.

So remember, as the year draws closer to an end, try to prevent holiday blues associated with poor interactions of those closest to you. When holiday cheer is lacking because relationships have become more challenging, take a moment and reflect on these helpful reminders. If your relationships flourish during these holidays, it is likely your mental health will as well. Be prepared to use your positive coping strategies and be mindful of your own responses around others. Positive relationships and interactions with others begins with you.

Sunday, December 21, 2014

The challenge of sitting with our thoughts

7:36 PM Posted by Stephanie Horgan , , , ,

One of my favorite authors, Anne Lamott, once said, "My mind is a bad neighborhood I try not to go into alone." It seems that more and more of us are finding that being alone with our thoughts can be a truly terrifying activity. When was the last time you spent time doing nothing? Take out the social media and electronic distractions, and what do you have left when you are alone? Where does your mind go?

I came across a study recently that was too fascinating not to share. Many of you may have already read about it, but it got me thinking about how our minds work. The article was published in Science magazine, and the title was "Just think: The challenges of the disengaged mind." In this article, authors looked at 11 different scientific studies, and found that participants typically did not enjoy spending 6 to 15 minutes in a room by themselves with nothing to do but think. They found that the participants enjoyed doing mundane external activities much more, and that many preferred to administer electric shocks to themselves instead of being left alone with their thoughts. The conclusion that was drawn was that most people seem to prefer to be doing something rather than nothing, even if that something is negative. I notice this tendency in myself and how difficult it is to just sit and be, rather than do. 

The set up of most of the studies was using college-student participants and having them spend time by themselves in an unadorned room (for 6 to 15 min, depending on the study) after storing all of their belongings, including cell phones and writing implements. The participants were typically asked to spend the time entertaining themselves with their thoughts, with the only rules being that they should remain in their seats and stay awake. After this thinking period, participants answered questions about how enjoyable the experience was and how hard it was to concentrate. Next the researchers wanted to find out if participants would enjoy themselves more if they have something to do. In this study, researchers randomly assigned participants to entertain themselves with their own thoughts or to engage in external activities (such as reading a book, listening to music, or surfing the Web). They asked the latter participants not to communicate with others (ex via texting or emailing), so that they could compare nonsocial external activities (such as reading) with a nonsocial internal activity (thinking). The results were that participants enjoyed the external activities much more than just thinking, found it easier to concentrate, and reported that their minds wandered less. The scientists then repeated these experiments again with non-college students and found similar results. 
This finding especially fascinated me: Many participants elected to receive negative stimulation over no stimulation—especially men. Sixty-seven percent of men (12 of 18) gave themselves at least one shock during the thinking period, not including one outlier who administered 190 shocks to himself! But what is striking is that simply being alone with their own thoughts for 15 min was apparently so aversive that it drove many participants to self-administer an electric shock that they had earlier said they would pay to avoid. What does that say about how much fear we as humans have of being alone with our thoughts?! 

This was a beautifully written quote at the end of the article: Research has shown that minds are difficult to control however, and it may be particularly hard to steer our thoughts in pleasant directions and keep them there. This may be why many people seek to gain better control of their thoughts with meditation and other techniques, with clear benefits. Without such training, people prefer doing to thinking, even if what they are doing is so unpleasant that they would normally pay to avoid it. The untutored mind does not like to be alone with itself.

As a therapist who gets to journey into many peoples thought processes, I can testify that minds are can be very tricky things to change. More often than not, I use CBT (cognitive behavioral therapy) to challenge client's thoughts and help them have more control over what script is running in their head. I also enjoy using the principles of mindfulness to help clients notice where their minds typically go, let go of the anxiety or depression, and just be still. It is much easier on paper than it is in reality, but the hard work of looking at your thoughts in therapy is completely worth it.

Monday, December 8, 2014

Handling Holiday Weight Gain

9:03 AM Posted by Tiffany Taft , , , ,
In the midst of the holiday season, food is heavy topic. Between cookie exchanges, holiday parties and family dinners, many people find themselves eating more. Over 35% of Americans report family celebrations and feasts are a source of weight gain. On average, between Thanksgiving and New Years, Americans will gain anywhere from five to ten pounds (that’s one dress size!). Typically, people consume 32% more during holiday dinners and even more if holidays fall on the weekend.
For this season, limiting overall consumption of unhealthy or unnecessary foods will be key. Surrounded by increased choices of food and desserts, it can be challenging and difficult to say no. In an effort to keep those holiday pounds off and maintain healthy lifestyles, here are several suggestions to consider. Planning ahead will be a simple and effective tool for you.

Know what types of food will be available and what you can eat. If several of your favorite dishes will be offered, choose beforehand which one you want over the others. Self-monitoring is an effective tool to maintain your current weight and reduce the likelihood of holiday weight gain. Self-monitoring uses personal observation and recording your target behaviors. However, you will have to be honest about what you are eating and how much. Using self-monitoring and documenting your foods can help you identify specific food groups that are challenging to refrain from eating to as well as patterns when you are likely to eat more.

Even with reviewing your food choices, you still need to eat; so don’t deprive yourself altogether. Consider having a bite or two instead of the whole piece. If you get to cook this year, use new recipes that are low in calories. Even if you have to bring food places, at least you know there will be a healthy alternative and you can still enjoy meals with others. If you are headed to a holiday dinner or party, you may consider eating a healthy snack beforehand.

Curbing your appetite can reduce overeating and unnecessary calorie consumption. Another suggestion is not to skip regular meals. Maintaining consistent blood sugar levels by eating regular meals can reduce weight gain. If you plan to starve yourself and gorge out on holiday dinners, that is not an effective plan.

During meals and festivities, remember to drink water. There will be several opportunities for you to consume empty calories through liquids. Having a water bottle on hand can help curb your appetite and decrease hunger.

Finally, make sure you are getting rest (7 to 8 hours of sleep) and exercise. Research has shown that limited sleep increases hunger up to 18% in adults. You need to get your rest. Increasing your exercise time by 10 to 15 minutes also can help shed those extra holiday calories.

 Gaining weight by consuming sugary drinks and desserts is not difficult to do this time of year. Challenging yourself to refrain from holiday cookie platters and unhealthy eating patterns is much harder. So remember, before you fill your plate, consider food options and choices in front of you. There’s no reason you cannot start the New Years off right before the end of the 2014.

It’s all about moderation.

Friday, December 5, 2014

In the Spotlight: Sjogren's Syndrome

10:50 AM Posted by Stephanie Horgan ,
Dr. Taft's blog entry yesterday on surviving the holidays could not be more timely. This is the month of December, and I am just now writing the November post for our Rare Disease of the Month blog. This month we're discussing Sjogren's Syndrome. Although you may have never heard of it, the disease currently affects over 4 million Americans. In case you're wondering (like I was), it is pronounced "SHOW-grins." It was named after the man who discovered it in 1933, Dr. Henrik Sjogren. One well-known celebrity with Sjogren's Syndrome is the tennis player Venus Williams.   

Photo credit: What If Gourmet

Snapshot:  Sjogren's Syndrome is an autoimmune disease where the person's white cells are attacking the body's moisture-producing glands. Nine out of ten patients are women, and half of the time it occurs  in the presence of another autoimmune disease such as lupus or arthritis. The hallmark symptoms are dry eyes and dry mouth, but since this diseases is systemic, it can affect many other areas of the body. Some of the parts of the body that can be affected are kidneys, lungs, liver, pancreas, the GI system, and the central nervous system. Some patients experience joint pain and extreme fatigue.  If you want to see a great snapshot of Sjogren's, check out this video clip put out by the Sjogren's Syndrome Foundation. 

Photo credit: US Pharmacist

What About Diagnosis and Treatment?
Because the symptoms patients may experience are similar to other diseases, the average length of time to receive a diagnosis of Sjogren's is 3.9 years. Often time it can be overlooked or misdiagnosed. There is no single test that confirms Sjogren's Syndrome. Ophthalmologists typically are the doctors who diagnose this. After doing a physical exam and listening to your symptoms, they use a variety of tests to make a diagnosis. The tests include blood tests to look for abnormal antibodies or inflammation, as well as eye tests that measure tear production and dryness. Dental exams looking for salivary abnormalities help as well. 

There is no cure for Sjogren's and different patients report different levels of severity of symptoms. Treatments can include over-the-counter as well as prescription medications. Some patients require immuno-suppressive drugs to treat their systemic disease. 

Photo credit: Tufts University

What About the Social and Emotional Impact?
There are few research studies on the social and emotional impact of Sjogren's Syndrome.  Some of the symptoms of the illness are invisible like extreme fatigue, joint pain, and vaginal dryness. That does not mean that symptoms are not life-altering though. On top of this, other symptoms like red eyes, tooth decay, swollen parotid glands and skin rashes may be more visible and present more challenges to a patient's social life and body image.  Social withdrawl, depression, anxiety can happen, as they can for other patients with chronic illness. 

Helpful Resources:

Sjogren's Syndrome Foundation
Search for local Support Groups
Celebrate World Sjogren's Day on July 23
Sjogren's National Patient Conference 
Clinical Trials for Sjogren's Syndrome

Thursday, December 4, 2014

Dealing with the Holiday Blues

1:52 PM Posted by Tiffany Taft , , ,
It’s December and ‘tis the season to be jolly. Thanksgiving has passed with Christmas and Hanukah quickly approaching. You cannot leave home without being reminded of holiday spirit. Radio stations are filled with holiday carols and business fronts show support of holiday celebrations. However, anticipation of holiday cheer leave many feeling anything but jolly. 

The “holiday blues” create feelings of sadness, anxiety, stress and loneliness for many people. So let’s look at some of the reasons holiday blues develop. 

A leading cause to holiday blues begins with feeling pressured to be “merry.” Everywhere you go there are holiday reminders, decorations and greetings filled with cheer and positive regard. But if you’re not feeling cheerful, internal pressure begins to stir. Many feel forced to “be merry” which can create increased feelings of sadness or guilt and lead to isolation.

Also, some individuals reflect on past gatherings with friends and family. Whether it’s consciously or unconsciously, everyone has a mental record of their previous holidays. Your current mood may be impacted by previous disappointing or sad holiday experiences. Additionally, many people experience reminders of being alone or that a loved one will not be present. 

Negative emotions are likely to develop when holiday celebrations are a sharp reminder of pain, grief and loss. Separation of family and friends, whether emotionally or geographically, can also be painful this time of year. And let’s not forget financial burdens and hardships. Anxiety and stress are often checked off with gift lifts. 

Even more, if financial resources are low, many feel as though they are on the outside looking in while others experience joy through gift giving. 

So how do we fight these holiday blues? 

Don’t despair and know that it is ok to feel what you feel. Forcing feelings during holiday celebrations tend to make circumstances worse. 

Give a hand to someone in need. When we are helping others it’s difficult to focus on our own feelings of sadness. 

Create a new tradition for yourself or your family. If you have unpleasant or unhappy memories of holidays passed, it’s time to start making your own. A new tradition may be just what this holiday needs for you. 

Stay active and busy as much as possible. If you are able to fill your schedule with FUN holiday celebrations, you fight isolation and depression. Also being physically active during these winter months can combat your holiday funk. 

Finally, give yourself a gift of positive regard. This time of year, we spend a lot of time going places and doing things for the holiday season. So stop, give pause and offer yourself some positive encouragement. You deserve it! Beat the “bah humbug” mood and make a change for positive health this year. You can beat those holiday blues.

Tuesday, November 25, 2014

Mental Health After Bariatric Surgery

7:37 AM Posted by Tiffany Taft , ,
Today's blog entry is by Erin Schuyler, an advanced doctoral student in clinical psychology working in our practice for the year.

When a person elects for bariatric surgery, several changes are likely to occur in their life. Physical attributes associated with unwanted weight will reduce as well as eating habits and food selections are adjusted.
What about a person’s emotional and psychological experience? How are these factors impacted and what emotional changes can those pursuing bariatric surgery expect?

Exploring these factors will hopefully provide further insight to persons considering bariatric surgery in addition to candidates who have already pursued this option. Research has shown many bariatric surgery candidates (BSC) have a history of depression, anxiety, binge eating and other mood disorders. In particular, BSC are five times more likely to have suffered from a major depressive episode in the past year.

Following weight-loss surgery, more than one-third of patients experience positive changes in their mental health, but not all BSC report psychological benefits. More commonly than expected, mental health conditions can develop post-surgery. Some BSC continue to struggle with weight loss, maintenance and regain. This experience results in body image dissatisfaction which heavily impacts their psychopathology.

In some cases, basic expectations that life will dramatically change and mental health status will improve, can also negatively impact psychological health post-surgery. Dissatisfaction with weight loss amount, body image (sagging or loose skin) and social status post-surgery are likely factors to perpetuate depressive symptoms.

In a recent study published by Obesity Surgery, BSC reported normal or improved moods after weight-loss surgery; however some persons suggested negative mood changes. More specifically, Ivezaj and Grilo (2014) discovered between 6 and 12 months, about 13% of patients experienced an increase in depressive symptoms.

Twelve months post-surgery, almost 4% of patients reported feeling more depressed than before the procedure.

Negative mood changes were also correlated to lower self-esteem and a person’s social functioning. The findings suggest that between 6 and 12 months after surgery, depressive symptoms and negative mood changes began to creep in. This timeline is a critical period for early detection and treatment of depression in BSC. Bariatric surgery is a lifestyle change; both mind and body.

Physical and mental health transitions following bariatric procedures are inevitable. Understanding your mental health pre- and post-surgery is extremely important to combat undesired negative emotional experiences. Depression is an illness that impacts the body, mood and thoughts as well as affects the way you eat, sleep, think and feel. Addressing mood changes and developing coping strategies to alleviate negative emotions are up to you. Your emotional health goes hand in hand with physical health. Lifestyle improvements and changes, combined with counseling, can be very helpful in improving mental health following bariatric surgery.

Tuesday, November 11, 2014

Psychosocial aspects of having an ostomy

8:49 AM Posted by Stephanie Horgan , , , , ,
This past Saturday, Tiffany and I had the honor of speaking at the United Ostomy Associations of America's Regional Midwest conference. I was assigned the task of speaking to the patients, and Tiffany addressed the partners or caregivers. I wanted to share with you some of the highlights from my talk. I only had an hour for my session, and with about 100 people in the room, it was not nearly enough time. I love bullet points, so here you go:

We are all different! Every ostomate is different and not one size fits all for the emotional/mental aspect either.
Who had months to talk about an ostomy and weigh pros/cons? Who was this a more sudden decision for?
Who had cancer? Who had IBD? Something else?
Who had an ileostomy? colostomy? urostomy?
Who has a temporary? Permanent? Multiple temporaries?
What age where you when you got your ostomy? Under 20, 20s, 30s, 40s, 50s, 60+
Who was single when they got their ostomy? With a serious partner when they had it?
Some find a stoma life-saving, others it is devastating.
Some people have strong social supports and some people are isolated.

The goal is to be true to your own experience and not compare yourself and acknowledge that it takes time to heal physically and emotionally. As author Brene Brown says, "“Owning our story and loving ourselves through that process is the bravest thing that we will ever do.” 

· Think back to when you first got your stoma. Do you remember how you explained it to people? Everyone is different in the level of disclosure they feel comfortable with, and that is ok.
·However much you choose to disclose is up to you, but it can be harder to hold it in and have anxiety about keeping a secret from others.
·When you are ready to disclose, start small, and potentially share it with other ostomates and close family or friends
·Rehearse explanation for acquaintances or colleagues. Have a way to deflect intrusive questions like "I don't really like talking about it a lot, I just wanted you to know the general idea."
·It is sometimes helpful to start by asking whoever you are telling if they've ever heard of an ostomy.
·Your ostomy does not have to define you, and its your choice of who you tell.

Photo Credit: People Skills Decoded
Social life
· It is very common for ostomates to have anxiety about accidents, odor, or noise. Although there are some pieces outside of your control, there are very concrete ways of decreasing this anxiety.
-Be prepared with an extra set of clothes and spare supplies.
-Control the pieces you can like diet, odor-reducing products, finding the right pouching system, and clothing you feel confident in
·Activities and sports should not be impacted. According to most experts, patients should be able to resume normal activities, and in the case of high contact sports there are protective products and belts for extra support. Also, emptying the bag before activities and locating bathrooms around the activity decreases anxiety.
· Eating and diet can be tricky. Everyone is different so ask your doctor or ostomy nurse about their recommendations. In general, there are foods that are easy or hard to digest and can cause blockages, but most ostomates can eat almost anything. Add new foods in gradually. For specific advice, meet with a nutritionist. 
 Photo credit: Dr. Oz

 Mental health
·Statistics: a diagnosis of anxiety happens in up to 45% of ostomates and depression in up to 33% of ostomates
·There is a strong mind body connection- when your health is affected, your mental health is impacted.
·There are many different phases of grief and adjustment to having an ostomy. There is a very real loss of a natural body function of being able to control when you poop. This loss is not minimized even if the ostomy saved your life. When we were kids, we learned how to control this function, and used the toilet privately and appropriately. Now we have to learn all over how to manage this bodily function and it can feel out of control and make us feel dependent and anxious.
·This loss is sudden and significant and makes ostomates feel different or separate from others.
·Some studies draw parallels to amputees, except ours is a hidden amputation.
·All sorts of emotional reactions can come up:  Shock- unable to process, lots of fear/tears, denial/retreating/minimizing, anger/fear,  Denial, Anger, bargaining, depression, acceptance, apathy, bitterness. All these reactions are normal.
·Ultimately, its normal to have the thoughts of "Why Me?" but those can get patients stuck. Once you are ready to move forward, instead of focusing on things you cannot control, focus your energy on steps you can take to improve your quality of life. It is important to recognize what is in your control and be proactive in managing your illness and your stress. The focus should be on moving forward and what can you do from this point on.
·Important thing is to have places to express your feelings such as a support system, therapist, journal, or online community.
·Don't underestimate the mental and emotional impact. Be open to getting help and receiving support and acceptance from others.
·Support groups are a wonderful way for patients to share experiences and gain encouragement about their situation. It is also a place to feel normal and to swap ideas.
·Tell your story. Talk to others, write a blog, journal it. 
Photo credit: Career Rocketeer
·Appearance changes can cause feelings of inferiority, disfigurement, loss of femininity, feeling alienated from your body, or feeling angry at your body.
·Losing a function like being able to control pooping or passing gas can change your self-concept.
·What messages do you believe about your body or tell yourself when you look at your stoma- write a few down? Look at this list and identify any negative messages you tell yourself.  It is important to challenge unhelpful messages. Some questions you can ask are: Is it true? What evidence do you have to believe it or not believe it? How do you react when you believe that thought? Who would you be without the thought? What else can you replace that thought with? What would you tell a friend who is struggling with that thought? 
·Reframe your perspective- What did you lose by getting a stoma? What did you gain? Realize the lack of options you had and how severe the illness was that you had to do this. Appreciate that you get another chance at life and reconsider your life priorities.
·Change your view of yourself as a victim to a fighter/survivor
·Define yourself and live out your purpose. An ostomy is just one small part of you- it doesn't define you.
·Embrace your scars, they tell your story of what you have overcome and are your battle wounds, so be proud!
·Buy clothes that you feel confident in.·Stop believing in the media's version of beauty and look for beauty all around you. Cut out media that is clouding you with unhelpful messages (like TV, magazines, music). Check out Awestomy's "You have a right to remain sexy" campaign.
·Write messages of affirmation and put them around house or in your phone as reminders.

Photo credit: Biola University
·One thing I hear a lot with ostomy patients is the stress about when to disclose your ostomy if you are single and dating. In my opinion, the earlier the better, but definitely once you are approaching intimate moments, you need to bring it up. Honestly, its a good test- a good partner will truly be with you for you, not for how you poop, and will be happy you are healthy enough to date because of your life-saving ostomy.
·Disclose using simple language and don't get too technical. Emphasize why you chose it and what it did positively for you. Your partner will most likely take their cues from you. If you portray it as a devastating and sad, they may be concerned. If you portray it as positive and life-saving, they may not think twice about it.
·It is important to have an ongoing open dialogue with your partner as they may have questions or concerns. Also, talk through expectations for sex and make sure to ask for what you want and need. It can be helpful to talk about your fears and hopes regarding sexuality.
·Control pieces you can to decrease anxiety such as emptying your pouch before intimate moments, and also there is wonderful linergie that can make people feel more comfortable.
·Check in with yourself about your sexual desire. Low self-esteem, medications, or mood disorders can decrease this so its good to talk about this with your doctor or therapist.
·Experiment with different sexual positions, and have patience and humor as you do this.
·Allow yourself to be touched and held as is comfortable, even if you don't feel sexy.
·Your biggest sex organ is your brain! Identify thought patterns that are not helpful during your intimate moments.

·This is an inventory that is used in research to see how ostmates are adjusting to their ostomy. It’s a helpful tool when looking to see if you have accepted your body with your stoma, or if you still are struggling and may need some help. If you decide you would like to accept your stoma more, please reach out!

Sunday, October 19, 2014

In the Spotlight: Pica

6:18 AM Posted by Tiffany Taft ,
This month for our Rare Disease of the Month blog we're discussing Pica, which is a condition that often appears in conjunction with other conditions.  The word Pica is from the latin for Magpie, which is a bird associated with odd eating habits.  It was first documented in medicine in 1563. Pica has the potential to be dangerous, even fatal, depending on the substances the person is eating.

Snapshot:  Pica is when a person repeatedly eats substances with no nutritional value such as dirt, ice, paint, stones, or even glass.  Eating these substances must occur for at least 1 month and at an age where it's developmentally appropriate to not engage in this behavior (aka a 3 month old eating a piece of dirt is not Pica). The most common substance eaten is ice, which may seem benign, and can lead to cracked teeth, slowed digestion, and weight gain.  There are several subtypes of Pica, depending on the preferred substance to eat. Complications may occur. For example, lead poisoning may result from the ingestion of paint or paint-soaked plaster, hairballs may cause intestinal obstruction, and infections may follow ingestion of feces or dirt. Pica can also be a cultural practice not associated with a deficiency or disorder.

How Common is It?
Pica is more common in women (often during pregnancy), small children, and people living with developmental disabilities such as Autism.  Pica often occurs when the person has some type of vitamin or mineral deficiency, most commonly iron or zinc, which can drive cravings. Pica cravings are most commonly seen in children and occur in approximately 25-30% of all children.

What About Diagnosis and Treatment?
There is no single test that confirms pica. However, because pica can occur in people who have lower than normal nutrient levels and poor nutrition, blood levels of iron and zinc should be tested.   Anemia should also be ruled out. Pica may also be a behavioral response to stress. People living with certain chronic illnesses are more susceptible to developing pica including celiac disease and sickle cell anemia, as well as people who have undergone gastric bypass surgery.

Treatment should first address any missing nutrients or other medical problems, such as lead poisoning. Treating pica involves behaviors, the environment, and family education. One form of treatment associates the pica behavior with negative consequences or punishment (mild aversion therapy). Then the person gets positive reinforcement for eating normal foods. Medications may help reduce the abnormal eating behavior if pica is part of a developmental disorder such as intellectual disability. There is some evidence that a simple multivitamin supplement could be an effective treatment in some cases.  In many cases, the disorder lasts several months, then disappears on its own.

What About the Social and Emotional Impact?
There are few research studies on the social and emotional impact of pica.  A major issue can be stigma. We teach children not to eat dirt even before they can talk; conversely, telling someone to eat dirt is a powerful expression of contempt, a way of demoting them from human to animal.  Pica even has its own reality TV show - "My Strange Addiction" where, unfortunately, they are often the subject of ridicule and being thought of as "weird" or "crazy."  The stress from pica-related stigma can add fuel to the stress-pica cycle, making the urge to engage in pica-behavior stronger and more frequent.  Social withdrawal, feelings of isolation, depression, and anxiety can result.

Helpful Resources:

Yahoo! Pica Support Group
Medscape Information About Pica

Saturday, October 18, 2014

How To Fail at Awareness

7:11 AM Posted by Tiffany Taft , ,
I don't need to make anyone aware that October is Breast Cancer Awareness month.  Our annual descent into all things pink to remind the populace that women (and men, although this is usually lost in the messages) get breast cancer.  And we should get our mammograms, do our monthly breast exams, and support women who have been diagnosed with this awful disease.

It's a great idea, and whoever thought it up gets a major high five.  Unfortunately, we've turned this idea on its head and the message is often upsetting, distasteful, and demeaning to women living with breast cancer, or who are survivors.

I don't claim to speak for anyone who lives with this diagnosis, but I have listened to several of them who actually hate October, the color pink, and most of the "awareness" campaigns.  I use quotes around that word because the aim to truly raise awareness of what breast cancer is has been lost in a sea of pink merchandise and marketing gimmicks.  Take the pink drill bit:

I completely understand that these ad campaigns produce revenue for various breast cancer organizations, like Susan G Komen, who, in turn, invest millions of dollars in breast cancer research and patient support programs.  But how does this help people understand what living with breast cancer is really like?  I guess the pain that is often endured may be something like being drilled by a device designed to cut through layers of limestone?

We've sugar coated breast cancer in a layer of pink bullshit, I mean icing:

The fact of the matter is breast cancer isn't cute, or sweet, or, for the love of all things holy, sexual.

Breast cancer is painful, and messy, and can be really depressing.  Up to a third of women living with breast cancer develop anxiety or depression.  It's devastating for spouses, family, and friends when a loved one is diagnosed.

It's a really uncomfortable topic if you get into the weeds.  Which is what all of these "awareness" campaigns try to buffer the general population from.  The message is "Look I totally want to support breast cancer awareness...but I really don't want to know the details.  So let's keep it light, okay?"

I'm not saying that we need to plaster images of cancerous breasts, people vomiting into buckets from chemotherapy, or radiation burns at the 50 yard line.  But we shouldn't shy away from these realities, either.  The message to those going through the diagnosis, treatments, and prognoses is a lack of respect.  Not everyone survives with their breasts in tact, so having a 30 foot bra in the middle of Daley Plaza in Chicago is a lovely reminder for those who've had mastectomies that they've somehow failed, or are less of a woman:

Not everyone survives, either.  Yet discussions about metastatic breast cancer are non-existent for the most part.

So what can we do to truly be more aware of what breast cancer is?  If you know someone who has breast cancer, talk to them and listen to their stories.  Even the uncomfortable stuff, if they're willing to share it with you.  If you don't have this relationship, read blogs of people who live with it.  Follow them on Twitter (@annmarieg4@AdamsLisa, and @ReneeCancerLand are good ones).

Do a Google image search of breast cancer; mixed among the pink ribbons are real images of what breast cancer does.

Update your Facebook status with a breast cancer statistic, a link to self-exams, or a blog entry that really hits home rather than the color of your underwear or whatever the hell this year's offensive campaign is.  Donate money to the American Cancer Society, Avon Walk, or Gilda's Club.

Get outside of the comfort zone of the pink crap.  People living with breast cancer will thank you for it.

Thursday, October 9, 2014

How to have an allergy-free Halloween

1:11 PM Posted by Stephanie Horgan ,
Happy autumn, everyone! The air is crisp, the leaves are turning, and pumpkins abound. Many families celebrate Halloween and I wanted to dedicate this blog entry to our patients who have food allergies or restrictions. A few years ago, Dr. Taft and I traveled to Cincinnati, Ohio, to speak at the Cured Foundation conference. There we met with families who have children with with Eosinophilic esophagitis (EoE) or Eosinophilic Gastrointestinal Disorders (EGIDs), and saw some of the most severe food allergies we have ever seen. Although you may not know children with as severe of food allergies as those diagnoses, there are currently 15 million Americans dealing with food allergies. Our friends over at Food Allergy Research and Education (FARE) have a wonderful idea for families who celebrate Halloween that I wanted to share.

What it is:
Their project is called the Teal Pumpkin Project. The basic idea of this initiative is to have houses provide non-edible treats for those trick-or-treaters who may have illnesses such as food allergies, diabetes. Houses who choose to do this are encouraged to put out a Teal Pumpkin sign or paint a pumpkin teal, in order to show they are doing this. While most families hand out treats that contain peanuts, tree nuts, coconut, milk ingredients, and gluten, a teal pumpkin is a symbol to show that there are alternatives available that are non-edible.

What could I hand out instead of candy?
 FARE suggests glow bracelets or necklaces, pencils, markers, boxes of crayons, erasers, bubbles, mini Slinkies, whistles or noisemakers, bouncy balls, coins, spider rings, vampire teeth, mini notepads, playing cards, bookmarks, stickers, play-dough, and stencils. You can purchase these items inexpensively at dollar stores, or online at Amazon and Oriental Trading. The best part is that they’ll easily keep until next Halloween if you have extras, so there’s no waste — unlike those mini candy bars that go stale.

FARE is also offering a free printable poster that you can stick in your window — or right on your front door — to make sure trick-or-treaters and their parents understand you have non-food treats available. Some people may feel comfortable offering both edible and non-edible treats, which is fine, as long as they are kept seperate so that there isn't contamination. Let us know what you end up getting and how it goes!

Thursday, October 2, 2014

National Mental Illness Awareness Week (Oct 5-11, 2014)

12:18 PM Posted by Stephanie Horgan ,

Next week begins the 24th anniversary of having Congress recognize and establish a National Mental Illness Awareness Week. It starts Monday October 5th and continues until October 11th. As a therapist, I have the opportunity to meet many different types of clients, some with physical illness, some with mental illness, and often these two overlap. There is still such a long ways to go with decreasing the stigma around mental illness. There are wonderful organizations doing great work to empower those who suffer to share their stories, in order for others to truly understand what mental illness is about. If you haven’t already, check out these three: National Alliance on Mental Illness, Bring Change to Mind, and StrengthofUs. 
One of the best ways to decrease the stigma around mental illness is to know the facts and educate yourself and others. I was shocked to know that 1 in 4 American adults have a mental illness as well as 1 in 5 American kids. That number is astounding, and yet how many people actually talk about their experience openly? I am truly lucky to get to walk along so many of those managing their illness, and I encourage anyone reading this who is struggling to reach out for help. You are not alone. And now I’ll let the statistics speak for themselves: (courtesy of NAMI)

One in four adults−approximately 61.5 million Americans−experiences mental illness in a given year.
Approximately 20 percent of youth ages 13 to 18 experience severe mental disorders in a given year. For ages 8 to 15, the estimate is 13 percent.
Approximately 6.7 percent of American adults−about 14.8 million people−live with major depression.
Approximately 18.1 percent of American adults−about 42 million people−live with anxiety disorders, such as panic disorder, obsessive-compulsive disorder (OCD), posttraumatic stress disorder (PTSD), generalized anxiety disorder and phobias.
About 9.2 million adults have co-occurring mental health and addiction disorders.
Approximately 26 percent of homeless adults staying in shelters live with serious mental illness and an estimated 46 percent live with severe mental illness and/or substance use disorders.
Approximately 60 percent of adults12, and almost one-half of youth ages 8 to 15 with a mental illness received no mental health services in the previous year.
African American and Hispanic Americans used mental health services at about one-half the rate of whites in the past year and Asian Americans at about one-third the rate.
Individuals living with serious mental illness face an increased risk of having chronic medical conditions.
Adults living with serious mental illness die on average 25 years earlier than other Americans, largely due to treatable medical conditions.
Suicide is the tenth leading cause of death in the U.S. (more common than homicide) and the third leading cause of death for ages 15 to 24 years.
Although military members comprise less than 1 percent of the U.S. population, veterans represent 20 percent of suicides nationally. Each day, about 22 veterans die from suicide.