|Posted by Margaret Donohue on April 14, 2016 at 8:00 PM||comments (0)|
I explain complex trauma to my students by telling the story of my cat Tatum. I met Tatum through a cat rescue organization. Tatum was described as a fragile medically ill cat. I picked her up in my arms and she jumped out of my grasp. The rescue group had me sign several forms and gave me her medical history. Three foster homes in her six months of life. Countless medical visits. Found in a cardboard box in a McDonald's parking lot in Lancaster, California. She was prescribed multiple medications, creams, pills, a special diet, and she couldn't get along with other animals. She was "slow to warm up." "She's not to go outside. She gets terrified. She responds quickly to being sprayed in the face with water if she's doing something you don't want her to do."
The first time she ripped open her face I assumed what everyone had, that she had mites, or an infection, or some sort of parasite. The first vet didn't find anything but prescribed medication anyway. The second vet didn't prescribe because she was already on medication and nothing was changing. So I asked if it was possible it was just self-injurious behavior. "Oh, we call it delusional parasites" the vet said. So I did research.
Post Traumatic Stress Disorder occurs commonly in animals.
PTSD symptoms in pets can include:
The students will ask what made her get crazy. And I explain that her world was a very scary place when she was a kitten. She was with her litter mates then suddenly put in a cardboard box in a noisy parking lot and separated from them and her mother. She was moved from one house to another. She had lots of painful and annoying medical treatments. Things changed constantly. She went to a noisy rescue with lots of other cats and was terrified. The only thing that seemed to stay the same was her food because she was put on a special diet. So the rescue thought that was what helped.
The same thing happens in people. They get in situations that are frightening, unpredictable and out of their control. They can't self-soothe. They revisit the trauma over and over trying to master it. We have good treatment for people with trauma. But trauma is exceptionally common in rescued pets. The story helps the students understand a bit better.
|Posted by Margaret Donohue on February 2, 2016 at 10:35 PM||comments (0)|
The new information on the Zika virus is that there is a confirmed case of sexual transmission of the virus in Texas. This means that anyone, male or female, traveling to an area where the virus is epidemic, or anyone who has flu like symptoms following being bitten by a mosquito should:
|Posted by Margaret Donohue on January 27, 2016 at 9:25 AM||comments (0)|
For most people the Zika virus is a mild case of flu like symptoms if they notice anything at all. For others, like pregnant women it can result in their children having abnormally small heads and brains, known as microcephally. For others it may produce joint pain, or progressive symptoms of paralysis known as guillain barre syndrome. Fever, rash and runny eyes are common.
Zika virus is a viral infection of the blood carried by mosquitos. Aedes aegypti, the mosquito that carries the virus, lives in tropical and subtropical areas throughout the world. The mosquito strain is in the United States but their aren't enough infected people living in the United States to serve as hosts. It originated in Uganda Africa and was found in a rhesus monkey in 1947. In 2013 it caused significant human outbreaks in French Polynesia. It is likely also able to be sexually transmitted. I say likely because blood borne viruses are usually also sexually transmitted and the virus has been isolated in semen. The disease is most prevalent in South America, but it's also present in other countries. If it's not already in the United States, it will likely be here soon. There is no cure. Prevention measures are to avoid pregnancy in countries where the infection is in epidemic proportions and to avoid mosquitos. Treatment with antiviral medications have limited impact. Several pharmaceutical companies are working on a treatment or preventative medication.
In the meantime, if you can avoid traveling to tropical areas, especially if you are pregnant, then do that. Preventative treatment will likely be available within the next 2 to 5 years.
If you ever have any questions about illness, disability or clinical trials, feel free to contact me. 818-389-8384.
|Posted by Margaret Donohue on January 1, 2016 at 9:10 AM||comments (1521)|
Headaches are a common phenomena. It's one of the most common problem I treat in clinical practice with exceptionally good outcomes. The first step in treatment involves identifying the type of headache somone has.
There are multiple types of headaches.
|Posted by Margaret Donohue on December 24, 2015 at 1:30 PM||comments (0)|
Autoimmune disorders and viral infections are strongly linked together. There are more than 80 identified autoimmune diseases. Viruses, bacteria and other types of infections are recognized as major environmental triggers for the body starting to attack itself.
Chronic cytomegalovirus (CMV) one of a type of herpes virus that causes mild flu-like symptoms has been linked to the development of Sjogren’s syndrome. Sjogren’s syndrome is the second most common autoimmune disease in humans impacting more than 4 million people in the United States. Sjogren's syndrome causes dry eyes, a dry mouth, and can cause joint pain, increased dental decay, swollen salivary glands, vaginal dryness, persistent cough and fatigue.
The research showing some of the mechanisms for the linkage may help with future treatments.
Research: Anne Halenius and Hartmut Hengel, “Human Cytomegalovirus and Autoimmune Disease,” BioMed Research International, vol. 2014, Article ID 472978, 15 pages, 2014. doi:10.1155/2014/472978
|Posted by Margaret Donohue on December 20, 2015 at 11:15 AM||comments (0)|
You don't know me and as a result my medical history will not be believed until it is. My tests tend to come back normal in spite of obvious symptoms of illness. I have a number of unusual medical conditions going back to birth, literally. Many of these are genetic and rare. They run in my family so I'm familiar with some of them, but the presentations never seem to match text book descriptions. So I'm not believed. I know that. I understand that. That doesn't make it correct. I'm part of a large number of patients with unusual, rare or atypical medical conditions. I am not alone.
So let me explain some things.
There are millions of people with rare or unusual medical conditions. I'm not alone. Women with these conditions are more likely to seek treatment than men with these conditions. Women report more trauma as a result of these interactions. Men tend to be more avoidant of treatment and there is a resulting higher mortality rate.
|Posted by Margaret Donohue on December 13, 2015 at 11:55 PM||comments (0)|
Migraines are a type of vascular headache causing a variety of responses to inflammatory pain in and around the lining of the brain with symptoms of acute nausea, vomiting and severe pain. They are different from tension headaches, cluster headaches, rebound headaches, post-concussive headaches, sinus headaches, headaches from hypertension, headaches based on changes in blood sugar, abdominal migraines, hormone related headaches, chronic progressive headaches, and mixed headaches in addition to rarer forms of headaches.
Migraines cause the hands and feet to be cold. They may cause a wide variety of neurological symptoms such as loss of speech, problems with vision, visual and auditory hallucinations including hearing music, and olfactory hallucinations. They can be triggered from a variety of foods, medications, hormonal conditions, stress, genetic predisposition, and environmental conditions. It's important to differentiate migraines from other types of headaches and other medical conditions.
There are a wide variety of treatments for migraines. These include lifestyle changes to reduce stress, adding meditation or yoga, physical therapy, massage and ensuring adequate sleep and exercise. There are lifestyle changes to eliminate triggers for migraine such as eliminating caffiene or other migraine triggering foods or drinks, changing diet to a less inflammatory diet, and changing sleep and wake patterns. There are medications taken at the start of a migraine to lessen the intensity and severity of migraine, and medications taken to prevent migraines from occurring. In chronic migraine botox can be used.
If you are having chronic headaches feel free to contact me for evaluation. 818-389-8384.
|Posted by Margaret Donohue on November 19, 2015 at 7:55 PM||comments (0)|
Many people think their insurance covers psychological or neuropsychological testing. Insurance will stipulate that psychological or neuropsychological testing if it meets criteria for medical necessity. That doesn't mean that a physician or a school or a teacher thought the testing would be necessary. It means that psychological or neuropsychological testing meets the strict criteria set forth by the insurance company.
Medical necessity means that there is no other agency or organization that can provide testing at state or federal expense. So that eliminates testing for:
It means that psychological or neuropsychological testing will produce a change in diagnosis or treatment plan and is the most cost efficient method of obtaining that information. So an MRI or CT scan may be able to rule out memory problems related to brain disease or defect.
If you are interested in obtaining insurance benefits to cover psychological or neuropsychological testing GET AN AUTHORIZATION NUMBER from the insurance company.
If you are interested in having psychological or neuropsychological testing feel free to contact our office. We have access to a large number of psychological and neuropsychological tests at reasonable fees. If you are eligible to use a free service we will advise you of that. Feel free to contact us. Our main office number is 818-223-4116. My cell phone is 818-389-8384 Margaret Donohue, PhD.
|Posted by Margaret Donohue on October 25, 2015 at 11:15 AM||comments (0)|
I listened carefully as psychologist Anthony Zamudio, Ph.D. spoke at the 27th annual Convention of the Los Angeles County Psychological Association about his clinical practice within a primary care clinic. He sees 30 to 50 patients a week in 30 minute intervals. Not what I do. He has patients he treats for psychological factors that impact physical conditions. I see no more than 15 people a week. I spend 50 minutes to 2.5 hours getting a history.
When I first started in practice in a medical office, my clients were depressed and anxious with some weird medical symptom that defied diagnosis. They were frustrated as was the physician. It was my job to assit the patient in describing their symptoms adequately so the medical condition could be illuminated. Cancer, endocrine disiorders, rare medical conditions, and heart disease were the commonly missed diagnoses. The idea was that by taking an adequate history in addition to noting physical symptoms the physician could cut down on unneeded tests and avoid litigation for failure to diagnose. Most people talk about medical symptoms in non-medical terms. There is then a problem with the translation of patient language to doctor language. So a woman comes in saying her neck hurts. The physician gives her a prescription for ibuprophen. She comes back saying her neck is worse. I would then see her. She's been cleaning her shower on her hands and knees. She's been moving furniture. Her son is coming for a visit. She cleans the shower for a bit then her neck hurts. She can no longer clean her shower. After 20 to 30 minutes of lying down covered in sweat, the pain subsides. When she goes back to clean the shower it starts back up. She's nausous from the pain. I tell the physician she needs an EKG a way to check the electrical activity of her heart. The heart attack has already occurred and she's at risk for another one. She has an 99% occluded blood vessel found on angiography at the hospital. At the end of the day I review the case with the physician. So he can see what I saw for the future. Her coloring is ashen. There's some mild bluing as an undertone. She's laboring to breathe. Her jaw is tight. She never mentioned sweating or nausea so the physician wasn't cued to look for heart problems. She talks about neck pain, but holds her hand up to her throat first before reaching around to the back of her neck. She arches her neck slightly to take a deep breath. Physician's still think of chest pain, which is a common presentation in men with heart attacks. Women are more likely to complain of feeling sick and maybe having the flu, or neck pain, or feeling weak or tired. But symptoms increase on exertion and lessen on rest. If the information isn't provided the physician can't know what's going on.
If you are having a problem getting diagnosed for your recurrent symptoms, contact our office. 818-223-4116.
|Posted by Margaret Donohue on October 21, 2015 at 9:00 AM||comments (0)|
Breast cancer in women has a population spike between the ages of 30 and 70.
Percent of U.S. Women Who Develop Breast Cancer over 10-, 20-, and 30-Year Intervals According to Their Current Age, 2009–2011
Current Age 10 Years 20 Years 30 Years
30 0.44 1.88 4.07
40 1.45 3.67 6.83
50 2.29 5.56 8.76
60 3.48 6.89 8.90
70 3.88 6.16 N/A
Source: Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975–2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/browse_csr.php?sectionSEL=23&pageSEL=sect_23_table.10.html, based on November 2013 SEER data submission, posted to the SEER Web site, April 2014.
So the American Cancer Society has recommended that cancer screenings should start at age 45. That breast exams not be done by physicians due to time constraints, and that women over 50 with a negative screening should get evaluated every two years.
If these recommendations are followed, the rate of cancer in African American women between age 30 and 45 will increase and cancers will be found at later stages when they are harder to treat. This is a population most at risk for breat cancer between age 30 and 45.
Global statistics to inform health policy should be a thing of the past. More individualized treatment recommendations should be being made based on a woman's history, genetics, racial background and life expectancy. The more someone knows about their history, the better they can be informed about health care decisions.
A young woman with a history of breast cancer in her family who is positive for the BCRA (breast cancer gene muttion) may want to be screened early. A Caucasian woman with no family history can wait to age 45 for an initial screening. An African American woman with a family history of breast cancer may want to get an initial screening at 30 depending on the age at which relatives developed the disease.
If you want help with health related decision making, assistance in developing a medical genogram to evaluate risk factors, or assistance with treatment planning, feel free to contact us. 818-223-4116 our main office is in Glendale.