This blog covers current events, brain injury, general psychology, health psychology, medical psychology, testing, and general issues.
|Posted by Margaret Donohue on April 24, 2016 at 12:40 PM||comments (0)|
Patient shaming. This time it happened to/about my cat. This happens by physicians (or vets) when they don’t know what is going on and all the treatment options they know of have been exhausted. It usually happens to people on the fourth visit either when there isn’t a diagnosis or the treatment is ineffective.
I ‘ve had Tatum since she was just under 2 years old. She was a hot mess. She was in several foster homes. The rescue organization referred to her as medically fragile. She had a couple of common cat conditions, namely cat acne, and bilateral herpes of the eyes. But she was ripping her face and ears open and the go-to diagnosis was some sort of unseen parasite. She was subjected to scrapings, dips, multiple medications and a food diet so extreme that she was only eating one brand of cat food and only turkey pate at that. She still had all the conditions. The rescue person dropped her off, did a cursory look at the house and ran out yelling “Start the car. They took the cat.”
I kept up with all the craziness for a year. Then I stopped the pills. I stopped the drops. I kept her eating out of ceramic or glass dishes. I started varying her food. No change. She ripped her face open and I took her to two vets. No parasites. It’s stress. Cat self-harm. Cat trauma. New people trigger it. Sometimes the other cat triggers it. Sometimes it’s a thunderstorm. She eventually gets over it. She’s been fine for the last several days.
She just turned five and I took her to the vet. New vet. “She should be on L-Lysine twice a day” she said.
“I did that,” I said. “It does nothing.”
“She’s ripping her face open because of the cat acne. It’s painful” she said.
“No,” I said. “She rips her face open when she’s psychotic.”
“We can treat that. There’s medication for it” she said.
“I’ve given her creams and drops for a year. It does nothing. No thank you.”
“So you want your cat to be in pain. I guess you know everything.”
“She’s here for vaccinations. Can you do those?”
“Yes,” she said.
It’s annoying. It happens because doctors are taught in medical school that they have to know everything. For many it hinders later collaborative practice. They blame patients with chronic medical conditions that don’t respond to typical treatment. They blame parents for children not improving. They blame people when they can’t diagnose. They refer to therapy as a last resort rather than as a first line of options. Switching doctors happens with disgruntled patients or being referred out to specialists is the common practice for physicians. It fragments treatment, limits history, and results in poorer medical care. As more physicians integrate psychologists into their practices hopefully this will lessen.
|Posted by Margaret Donohue on April 19, 2016 at 9:20 AM||comments (0)|
Disability is a complex system of insurance companies, state regulations, federal regulations and governmental bodies with competing and differing codes for determination. It’s confusing to a lot of people. Our office can help with all forms of evaluation.
A disabling condition is a physical or emotional illness or collection of symptoms that impairs the ability to function in one or more areas of life. Accommodations are methods to assist someone in performing tasks so they can function better.
Accommodations may include a device such as a computer that recognizes speech, or converts speech to text, or reads text aloud. It may be a wheelchair or a cane. It may be a device that helps to put on socks, or grab items, or button. It may be a device that helps someone hold a spoon, or fork, or pencil. It may be a cell phone or tape recorder. It may be a system of applications that says what color something is, what denomination of money someone has, or a prompting system to help with memory. It may be a medical device to test blood sugar, blood pressure, temperature, pulse. It may be extended time on exams, a private room, natural lighting, a test given on computer or a paper based test. It may be a service animal or emotional support animal. It may be voice activated door bells, light switches, smoke detectors. It’s not an advantage, but it may be an equalizer.
An off work notice. This is a letter to an employer indicating a disabled person is not able to function in their usual and customary job as a result of a temporary disabling condition. This usually needs to come from a physician (psychologists count as physicians in this regard). The person is expected to undergo some form of treatment to return them back to their usual and customary job.
Evaluation of disability by a treating provider. This is a letter or report of the symptoms and a description of functional impairments. This may be requested by an employer or by an insurance company handling a disability claim. This letter does not have to be written by a physician.
Evaluation of disability for the Social Security Administration. This is an evaluation of how an individual is able to function in their ability to perform simple work in the general labor market. The is not an evaluation of their ability to perform their usual and customary job. This is simple work. Examples would be the person who bags groceries at a grocery store and retrieves shopping carts, or the helper that waters plants at the local nursery. It involves some degree of judgment such as not putting the gallon of milk on top of the carton of eggs.
Evaluation of disability for accommodations. This is a complex evaluation involving multiple layers of documenting what is required and what is available. For conditions such as ADHD, or for tests such as licensing board tests these evaluations are lengthy and extensive.
We perform all tyes of evaluaitons on all age groups and write letters as part of those evaluations. Feel free to contact our office.
|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 28, 2016 at 8:50 AM||comments (0)|
In 2006 I and a colleague stood up in an auditorium in San Jose at a California Psychological Association convention and spoke about what it was like to have a head injury, and how the research, done mainly by psychologists working for insurance companies and personal injury attorneys, was flat out wrong.
In 2006 basic information about concussion included the following INCORRECT information:
We’ve come a long way. Here’s what we know now:
It’s 2016. Here’s what we need to know:
Our office evaluates people to provide information on neuropsychological functioning. If you need an evaluation feel free to contact us at 818-389-8384.
|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 (0)|
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.