Recovery Michigan

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This box room of despair, where the walls are like sponges, soak up the desperate wails of fellow prisoners. The relentless injustices recounted reverberate like violent echoes through the corridors, bleak despite the bright glib platitudes screaming wellness and recovery behind plastic-glass noticeboards. Domed mirrors track our moves; the panoptical arrangement empty of watchers except for those enclosed in their fish-bowl office, attached to phones and computers, hammering out notes about that which they cannot know. For they never ask and wait. They ask, of course, of course they ask: how are you? But they do not wait for the answer before moving onto the next room, rattling keys and shouting “checks” as they pound on doors. There is one window in my box-room and that is in the door. No air circulates only recycled distress.

They do not enquire, as a dear friend does, “how is your heart, soldier?”. For we are all soldiers here — battling or training or mediating with entities that others may not see. That they may not witness as anything but sickness. Meaning is not chased down, meaning is irrelevant, shoved to the bottom of the pile under British National Formularies, and badly written reports of behaviours and misdemeanours. Such as absconding from the place you are being held against your will, as if that is anything but the epitome of sanity. There is no Stockholm Syndrome in me.

I sit, tight as a bud clasping a bee, looking gentle, asking for as little as possible, hoping to go unmarked, unseen, to give nothing away. I am trying to hold on to the core of my being without submitting to psychiatric biddings. There are undoing’s, unravelling’s, outbursts, because you can only hold your breath for so long. There may have been a chair thrown at a wall, a leg broken clean off, but no one hurt. They forgave me that. But I am hoop-jumping, playing the game, ticking boxes, though not fully engaging. I don’t talk to my fellow patients, I am porous, you see. I feel things deeply and without fences I am penetrated, invaded upon, colonised, hijacked from the inside. And then where do I have to go but out of my skin, or to sear my skin so that it thickens enough to contain me like a fortress? No, I don’t mix.

http://bit.ly/2HUnoh6

The fact that the study used real-life information makes it unique. Pietilä and colleagues examined data from 4,098 men and women aged between 18 and 65, whose heart rate variability (HRV) was recorded in uncontrolled, real-world conditions using a special device.

As the authors write, "The association between acute alcohol intake and physiological changes has not yet been studied in noncontrolled real-world settings."

The scientists had access to sleep HRV recordings from a minimum of 2 nights: one where the participants had consumed alcohol and one where they hadn't.

HRV measures the variations in time between heartbeats, variations which are regulated by the autonomic nervous system.

The autonomic nervous system comprises the sympathetic nervous system and the parasympathetic nervous system. The former controls the fight-or-flight response, whereas the latter is responsible for the "rest-and-digest" state.

Therefore, HRV measurements enabled the researchers to assess the quality of the participants' restful state. The scientists examined the participants' first 3 hours of sleep after drinking alcohol.

Alcohol intake was broken down into "low," "moderate," and "high," — categories that were calculated based on the participants' body weight.

The Dietary Guidelines for Americans define moderate drinking as up to one drink per day for women, and up to two daily drinks for men.

http://bit.ly/2Iqr89w

In 1994, Christine Jackson, MD, noticed that when victims of sexual assault were brought into area hospitals in Baltimore City, neither the physicians nor the nurses had been trained in how to collect evidence or detect injuries for these patients. Police, though, expected that the staff was trained. As a result, the outcomes of the kit collections were terrible.

Jackson wanted the hospitals to do better for the patients, so she founded the Mercy Medical Center Forensic Nursing Program. Back then, said Debra S. Holbrook, MSN, RN, SANE A, FNE A/P, specially trained nurses, who were called Sexual Assault Nurse Examiners (SANE) or Sexual Assault Forensic Examiners (SAFE), were trained and educated in comprehensive care of victims of sexual assault. Mercy Medical Center, in Baltimore City, was designated the point center for this kind of medical forensic care.

"The Mercy Medical Center Forensic Nursing Program now cares for almost 1,000 patients each year, and sees all forms of interpersonal violence, including sexual assault; domestic, dating, and stalking violence; elder and vulnerable population abuse, neglect, and maltreatment; human trafficking; strangulation; trauma; chronic abuse of foreign nationals seeking asylum and T/U visas [related to human trafficking]; and suspects of all person's crimes," explained Holbrook, director of Forensic Nursing at Mercy Medical Center.

She said the program is also one of the only mobile ones in the United States -- meaning that the nurses involved are able to travel to various hospitals and institutions throughout the area. "For 25 years, the Mercy Forensic Nurse Examiner (FNE) Program has been the only mobile program of its kind in Maryland, seeing patients in all surrounding hospitals including Johns Hopkins Hospital, the University of Maryland Medical System, Shock Trauma, and all emergency departments, nursing homes, and prison systems. The Program has also created Memorandum of Understandings with all branches of the military, seeing victims from the U.S. Naval Academy, Fort Meade, Fort McHenry and Reserves, and Kimbrough Army Hospital."

https://ti.me/2JIoqZY

Playing football professionally has been linked to chronic traumatic encephalopathy (CTE), a degenerative brain disease. But what happens to children who start the sport early, before they even turn 12?

That’s the question neuropathologist Dr. Ann McKee, whose groundbreaking work on CTE has uncovered the neurological risks of playing football, set out to answer in a new study published in the Annals of Neurology. In her team’s analysis of the brains of 211 deceased football players who had been diagnosed with CTE, along with detailed behavioral questionnaires filled out by their relatives and interviews with family members, McKee expected to find more severe signs of the condition in people who started the game young. These would be visible in more pronounced deposits of tau protein, which kills brain cells, in the brains of men who sustained hundreds — if not thousands — of extra head impacts as children.

To McKee’s great surprise, however, early exposure to tackle football was not associated with more severe signs of CTE, or other brain diseases like Alzheimer’s. Instead, she found something perhaps even more disturbing. Football players who played tackle football as children suffered the devastating symptoms of brain disease, like cognitive impairment and mood swings, earlier in their lives.

http://bit.ly/2jjpUz1

In the largest study of its kind, a three-minute version of a brain stimulation treatment was shown to be just as effective as the standard 37-minute version for hard-to-treat depression.

These results were published in a new Canadian study in The Lancet co-led by the Centre for Addiction and Mental Health (CAMH) and the University Health Network’s Krembil Research Institute, in collaboration with the University of British Columbia.

The treatment is called repetitive transcranial magnetic stimulation (rTMS), which is a form of treatment that uses magnetic field pulses to non-invasively stimulate a part of the brain called the dorsolateral prefrontal cortex, which is associated with mood regulation. The study compared standard rTMS treatment, which uses high frequency (10 Hz) brain stimulation for 37.5 minutes per session, with a newer form of rTMS called intermittent theta burst stimulation (iTBS), that mimics the brain’s natural rhythms and takes just over three minutes per treatment.

“The main impact of this study is that the number of people who are able to be treated using theta burst stimulation compared to the standard form of rTMS can be increased by three to four fold,” says lead author Dr. Daniel Blumberger, Co-Director of the Temerty Centre for Therapeutic Brain Intervention at CAMH.

“These findings will have a significant impact on our ability to treat patients,” says Dr. Jonathan Downar, Co-Director, University Health Network’s rTMS Clinic; Scientist, Krembil Research Institute and senior author of the study. “This will allow every device in Canada to treat several times more people per day, meaning shorter wait lists and better access to this treatment.”

The study, conducted with Dr. Fidel Vila-Rodriguez, Assistant Professor, University of British Columbia, focused on people with treatment-resistant depression, defined as a condition whereby people do not experience a sufficient improvement in their symptoms after trying antidepressant medications. Up to 40 per cent of people with depression may experience treatment resistance.

http://bit.ly/2jgkGnE

After a marathon mark-up session that stretched into late evening Wednesday, a House Energy and Commerce subcommittee advanced dozens of bills related to the opioid crisis, which now go to the full committee.

"Taken together, the bills before us today will improve access to care for individuals suffering from substance use disorder, provide our healthcare system with the tools and resources it needs to care for patients, and help prevent future misuse of opioids," said Subcommittee Chair Michael Burgess (R-Texas) in a press statement.

Many of the bills looked to expand quality treatment for substance use disorders and to prevent inappropriate prescribing or access to opioids.

The Senate Health Education Labor and Pensions (HELP) Committee also advanced a raft of proposals as part of the Opioid Crisis Response Act of 2018 earlier this week.

Among the bills advanced by the subcommittee:

• Requirement that Medicaid providers check prescription drug monitoring programs
• Mandate for states to operate drug management programs, a.k.a "lock-ins"(which limit the number of pharmacies from which at-risk beneficiaries can receive prescriptions)
• Partial repeal of the Institutions for Mental Diseases exclusion that bars Medicaid from reimbursing treatment for mental health or substance use disorder treatment in facilities with 16 or more beds

Stakeholders React

Corey Waller, MD, an addiction specialist based in the Greater Philadelphia area, applauded the House for its "comprehensive" approach to addressing the opioid epidemic.

Only Dark Chocolate, remember......

http://bit.ly/2jcsIxD

Eating a whole bar of dark chocolate appeared to give some people better vision within 2 hours, researchers said.

As shown by Jeff Rabin, OD, MS, PhD, of the University of the Incarnate Word Rosenberg School of Optometry in San Antonio, and colleagues in the study online in JAMA Ophthalmology, when 30 participants without pathologic eye disease each consumed dark and milk chocolate in separate sessions, they tended to have better small-letter contrast sensitivity right after eating the dark chocolate (1.45 log of the inverse of the minimum detectable contrast [logCS] units versus 1.30 logCS units after milk chocolate consumption, P<0.001).

"These results show that high- and low-contrast vision can be improved within 2 hours after consumption of a commercially available dark chocolate bar. Although the specific mechanism for visual improvement awaits further study, an increase in retinal, visual pathway, and/or cerebral blood flow could be contributory, enhancing bioavailability of oxygen and nutrients to metabolically active sites," the authors suggested.

http://bit.ly/2JwgVFF

Jiyoung Ahn and other researchers from the New York University School of Medicine in New York City have recently focused on how alcohol impacts the bacterial microbiome of the mouth.

Their findings, now published in the journal Microbiome, indicate that although a nightly drink may delight the palate, it will likely promote the growth of harmful bacteria in the mouth while at the same time stunting the development of helpful, probiotic bacteria.

"Our study offers clear evidence that drinking is bad for maintaining a healthy balance of microbes in the mouth and could help explain why drinking, like smoking, leads to bacterial changes already tied to cancer and chronic disease."

Jiyoung Ahn

The researchers then analyzed the biological samples and combined these results with the data on the participants' drinking habits in order to understand which bacteria thrived in the oral microbiota of people who don't drink and those who do. They also explored which bacteria were prevented from developing.

Ahn and team found that alcohol consumption led to more consistent development of certain harmful bacteria in the mouth — namely, those belonging to the species Bacteroidales, Actinomyces, and Neisseria.

At the same time, healthy bacteria — such as those from the species Lactobacillales — that can help to prevent the certain diseases from taking hold could not develop properly in the oral microbiomes of drinkers.

"Drinkers," the study authors write, "had decreased abundance of order Lactobacillales [...] Other taxa [bacterial species], some of which are potentially pathogenic, were enriched with higher alcohol consumption."

http://bit.ly/2jfnPUJ

Everyone knows medical care in the US is expensive even with insurance and prohibitively expensive without it. I have a lot of patients who are uninsured, or who bounce on and off insurance, or who have trouble affording their co-pays. This is a collection of tricks I’ve learned (mostly from them) to help deal with these situations. They are US-based and may not apply to other countries. Within the US, they are a combination of legal and probably-legal; I’ve tried to mark which is which but I am not a lawyer and can’t make promises. None of this is medical advice; use at your own risk.

This is intended for people who already know they do not qualify for government assistance. If you’re not sure, check HealthCare.gov and look into the particular patchwork of assistance programs in your state and county.

I. Prescription Medication

II. Therapy

III. Supplement Analogues

Back in the 70's, we tried a treatment to reduce withdrawal symptoms in heroin addicts that used sodium bicarf, calcium carbonate and some magnesium salt, and it did a very good job of reducing the physical symptoms of withdrawal. I know there are other versions of this idea for both opiate and nicotine withdrawal out there. Interesting to find that baking soda works not through biochemistry but through a signaling mechanism that alters the body's ongoing response to inflammation....

http://bit.ly/2rc690H

That little box you put in the refrigerator and freezer to prevent odoriferous gases from tainting your food may hold the key to reducing the destructive inflammation of autoimmune diseases like rheumatoid arthritis. New evidence from investigators at the Medical College of Georgia (MCG) shows how a cheap, over-the-counter antacid solution of sodium bicarbonate (commonly referred to as baking soda) can encourage the spleen to promote an anti-inflammatory environment that could be therapeutic in the face of inflammatory disease. Findings from the new study were published recently in the Journal of Immunology, in an article entitled “Oral NaHCO3 Activates a Splenic Anti-Inflammatory Pathway: Evidence That Cholinergic Signals Are Transmitted via Mesothelial Cells.”

Previous studies have shown that when rats or healthy people drink a solution of sodium bicarbonate, it becomes a trigger for the stomach to make more acid to digest the next meal and for little-studied mesothelial cells sitting on the spleen to tell the fist-sized organ that there's no need to mount a protective immune response.

The splenic response to pH shift is that “it's most likely a hamburger, not a bacterial infection," noted senior study investigator Paul O'Connor, Ph.D., a renal physiologist in the MCG department of physiology.

Mesothelial cells line body cavities, like the digestive tract, and they also cover the exterior of organs to quite literally keep them from rubbing together. About a decade ago, it was found that these cells also provide another level of protection—microvilli that sense the environment and warn the organs they cover that there is an invader and an immune response is needed.

The MCG researchers believe that drinking baking soda tells the spleen—which is part of the immune system where some white blood cells, like macrophages, are stored—to go easy on the immune response. "Certainly, drinking bicarbonate affects the spleen, and we think it's through the mesothelial cells," Dr. O'Connor noted.

Interestingly, the research team found that after drinking water with baking soda for two weeks, the population of macrophages in the spleen, kidneys, and blood shifted from primarily those that promote inflammation, called M1, to those that reduce it, called M2. Macrophages, perhaps best known for their ability to consume garbage in the body, like debris from injured or dead cells, are often the immune systems first responders to a call for assistance.