Sunday, July 31, 2005

Symptom Center -

Symptom Center - "Research a particular symptom and get a list of diseases with the symptom or similar symptoms." This clever website offers list of possibilities of what maybe wrong. It's a two-edged sword, and should only be used by a sophisticated and aware patient !

From Web-savvy patient to a cyberchondriac - The Doctor's Office: "As a physician, I'm not troubled by the autonomy of the informed patient. What troubles me is the proliferation of the partially informed patient and, frankly, the misinformed patient -- the patient who crosses the line from Internet-educated patient to cyberchondriac."

Tuesday, July 19, 2005

Stress - Some Basic Definitions by Dr Kamath

In order for the reader to process the information in this guide, he must first understand basic definitions of certain terms used in it. This would ensure that both the reader and the author are “tuned in” with each other. This is important because the reader brings into this learning process his own meaning of certain terms, which might not be consistent with their true meaning. For example, the term “stress” might mean different things to different people. When asked, “What is stress?” the often heard incorrect replies are, “Anxiety?” “worry?” “out of control?” “overwork?”

1. What is a symptom?

A symptom is an uncomfortable sensation in the mind or the body indicative of some problem with one’s health. We experience one symptom or another on a daily basis: headaches, aches and pains in the joints, cough, stomach ache, heartburn, sleeplessness, etc. Vast majority of television advertisements are on drugs meant to help alleviate these common bodily symptoms: sleeping aides; pain medications, constipation medications, etc. Most symptoms we experience on daily basis are transient.
As we read before, when symptoms become persistent, we visit doctors. When the doctors do not find any physical cause for our persistent symptoms they conclude that we now have a stress-related symptom. For example, if I keep feeling exhausted all the time and the doctor can not find anything to explain it, he would tell me it is stress-related.

2. What is stress?

Simply put, stress means getting upset about something. Peace of mind is gone. Sense of tranquility is gone.
This simple definition of stress often baffles people who are already down with a stress-related disorder such as depression or anxiety, as evidenced by their statement, “I am not upset about anything except this disorder itself!” This is because they are not aware of the role of various stressful events and problems that upset them prior to the onset of their disorder. It is the job of the psychiatrist to help them connect the dots.
[By the way, drugs that seemingly bring back our sense of peace and tranquility are called tranquilizers. Almost all psychotropic (“mind-altering”) drugs such as antidepressants, mood stabilizers, anti-anxiety drugs and anti-psychotic drugs have this effect on the mind.]

3. What does “getting upset” mean?

Human beings are endowed with the ability to experience hundreds of emotions. Most of them are negative or painful emotions. Positive emotions are precious few: joy, happiness, contentment, ecstasy, peacefulness, etc. Of the hundreds of negative or painful emotions, I have listed here thirty five as the most important in our understanding of stress. I made up this list after carefully listening to thousands of stressed-out patients. When upset for whatever reason, we experience one or more of these thirty five painful, potentially toxic emotions in our mind:

Fear, hurt, anger, sadness, guilt, shame, disappointment, frustration, helplessness, hopelessness, humiliation, hate, bitterness, resentment, envy, jealousy, terror, horror, disgust, embarrassment, rage, exasperation, insecurity, despair, dejection, remorse, regret, worthlessness, hostility, vengefulness, dread, sorrow, sinfulness, despondency, uselessness.

It is these painful, potentially toxic emotions in the mind and the brain that make us feel and look upset, cause changes in the brain chemicals and make various stress symptoms to appear. If we can make these painful emotions go away from the mind, the brain chemicals go back to their normal state, and stress symptoms disappear. The simplest way to look at this is to imagine the mind as a balloon. When we are calm, the balloon/mind is empty of painful emotions and so it can be seen as “deflated”. When we are upset, the mind/balloon is inflated with painful emotions, and stress symptoms appear immediately. If we can somehow make the painful emotions disappear from the mind/balloon again, it deflates again, the brain chemicals go back to their normal position, and symptoms disappear immediately.

Here is a gross example. As you step into your bathroom, you see a six foot long cobra in the bathtub. Scared, your balloon inflates immediately, your brain chemicals change and you experience many stress symptoms: fast heart beat, shortness of breath, trembling of hands, anxiety, sweating, etc. Your first response is to get away from the bathroom. After mustering some courage (the antidote to fear) you decide to prod the snake with a long stick. It does not move. You get a little closer and discover that it is just a real-looking rubber cobra put in the bathtub by your kids as a prank. You get a good laugh at this innocent prank. Your balloon shrinks, your chemicals go back to normal and your stress symptoms disappear promptly.
This inflating and deflating of the balloon/mind happens continually day in and day out in response to various upsetting events and problems we face in life. Even when we dream in sleep, our balloon could become inflated and we could experience various stress symptoms such as fast heart beat, shortness of breath, sweating, etc., in response to the danger we perceive in it. If you dream of being chased by a ferocious bear, you would feel very stressed. When you wake up and realize it was merely a dream, your balloon would shrink and you would feel calm once again.
Those of us who are able to keep our balloon shrunk on a daily basis live free from stress. Of course, there are appropriate and inappropriate ways of accomplishing this. If for whatever reason one is not able to keep his balloon shrunk, his stress symptoms would become persistent, get worse over time, and he would need a shrink to do the shrinking for him. Now you know why we psychiatrists are called shrinks!
In small to moderate doses these painful emotions are very useful for normal emotional growth and maturation, just as a small dose of fertilizer is essential for plants to grow to their full potential. In large doses, however, these emotions could become toxic and damage normal growth and maturation of people, no different than a large dose of fertilizer ruining the health of plants. This is especially true if one mishandles these emotions. A 16 years old boy involved in a fender-bender car accident could benefit from this scary experience, and learn to be a better driver. A total car wreck with loss of several lives could, on the contrary, leave permanent emotional scars on the same 16 year old, resulting in life-long suffering, especially if he did not deal with this tragedy promptly and in an appropriate manner.

4. Evolutionary roots of stress symptoms

Why do we have stress symptoms? The fundamental function of the mind is self-preservation. At the most primitive level the mind’s basic tasks are to decide what is bad for it (a function of thinking); fear that which is bad for it (a function of feeling), and to flee from it or fight back (a function of action). Fear is the most fundamental painful emotion which we share with all animals. The main purpose of fear was self-preservation as we struggled for survival, and evolved into the socially oriented modern man over hundreds of thousands of years in the wilderness of Africa.
Self-preservation boiled down to one of two responses to threats posed by other animals or fellow beings: either fight back or flee. Either way, the body must be quickly prepared for action when man faced grave threat to his personal safety. That meant rapidly turning on various vital organs of the body: heart, lungs, muscles, etc. to flee or fight back. Bursts of hormones into the blood circulation and chemical messages sent rapidly via a vast network of nerves connecting the brain to the body organs ensured sudden increase in blood supply to these organs for this purpose. These changes in the body organs manifested themselves as stress symptoms: Fast heart beat to ensure increased volume of blood; heavy breathing to increase supply of oxygen; blood pressure rise to increase rate of supply of blood; rushing of blood into to the tense muscles to take action; increased blood supply to the skin to cool the blood by means of sweating, etc. The increased blood supply to the whole body made it feel very hot. Once the threat was over, fear went away, brain chemicals went back to their normal or slightly altered state, and the man calmed down once again. The modern man experiences these very symptoms in panic disorder without any identifiable external threat. We will study later how this could happen.[By the way, we use the term “cold-blooded” to describe those who are not stressed at all when they commit a horrible, violent crime, and the term “hot blooded” to describe those who are quick to temper, meaning, they get stressed easily.]
The degree to which the primitive man became “emotionally charged” depended upon the perception of the level of danger posed by the threat. The primitive man’s stress response was appropriately different when he encountered a mosquito than when he came across a poisonous cobra, or a charging lion. Whereas the mosquito was seen as a nuisance, the cobra was best dealt with through avoidance. The lion, however, was seen as extremely dangerous as it was a predatory animal. The humans of other tribes were also perceived as extremely dangerous.

5. How did emotions come to play greater role in modern man’s life?

Self-preservation forced the primitive man to become a social being. As man evolved into even more complex social being over hundreds of thousands of years, he came to acquire more and more emotions in his new environment: the human society. They served as important tools to communicate good as well as bad feelings in his interaction with his fellow beings, his allies in the struggle for survival. No wonder, absence of social support system makes one vulnerable to serious stress.
As the functions of the primitive man’s mind became increasingly complex, his brain enlarged, and his face became the most important part of communication with others. Long before he learned to communicate verbally, he could express his feelings to fellow beings by facial expressions using dozens of facial muscles, no different than children do before they learn to talk.
Naturally, the blood supply to the brain and face gradually increased enormously to facilitate expression of emotions. That is why when really upset the face turns red, eyes become blood-shot, nose becomes stuffy, veins in the neck engorge and the head feels like it is about to explode. No wonder, headache is one of the commonest symptoms of stress. Blushing, which happens when we are bashful, embarrassed or humiliated, is an example of mildly increased blood flow to the face. We often describe emotional faces with such phrases as “red with rage,” “green with envy,” “ashen white with fright,” “dark with despair” etc. “Poker-faced,” “bald-faced,” “bland-faced,” “mask-faced” are some of the pejorative terms we use to describe people who effectively hide their true emotions.
As millennia after millennia passed, man learned to express his emotions to fellow beings by means of speech, crying, sobbing, sighing, moaning, groaning, squalling, bawling, grunting and other sounds and motions of face and the body. Copious flow of salty tears served the purpose of reducing not only the volume of blood flow into the head but also the inner emotional tension. Shedding tears of sadness is such an important mechanism for reducing inner emotional tension as well as the blood flow into the head that now those who are unable to do so are condemned to suffer from severe headaches and other psychiatric and psychosomatic pain disorders later in their lives.
Even though we have come a long way from the dangerous environment of the African savanna, we are still wired to suffer stress symptoms whenever we experience fear and other painful emotions in our daily dealings with others. We might not be too fearful of losing our lives on a daily basis like the primitive man did, but we do constantly fear losing various other things we have come to believe are essential for our security and self-preservation in the society of people: love, liberty, acceptance, respect of others, relationships, livelihood, money, property, etc. When we lose these, or are threatened with the loss of these, our sense of security is threatened, we get upset or stressed, and we experience stress symptoms no different than our prehistoric ancestors did when they were attacked by a charging lion in the African savanna. The modern man’s brain is still wired like that of primitive man of a million years ago even though he has been “civilized“ for five thousand years. We can see evidence of primitive thinking in our everyday behavior.
As the primitive man became more and more civilized, free expression of painful emotions came to be frowned upon, especially in western societies. To maintain order, decor, peace and harmony in the society, subtle and overt restrictions were put on people as to how they could express their emotions. Normal expression of grief has come to be branded as “creating a scene.” Overt display of sadness nowadays mean being “hysterical.” Crying over something is now called “maudlin.” Complaining about something is now known as “whining.” Gradually, being civilized has come to mean holding a stiff upper lip when the mind is full of swirling emotions. Whenever I attend funerals, I am struck by the jovial mood of the family of the dead person. No moist eyes here. Most are either drunk or drugged. The remaining are busy being strong for others, or celebrating their good fortune!
Inability or unwillingness to deal with painful emotions is the foundation of all stress-related disorders. Unexpressed emotional pain, unshed tears, unresolved grief and conflicts- all have a price to pay in the long run: stress-related disorders. Understanding the nature of our emotions is absolutely essential for healthful life. Emotional Quotient (E. Q.), -savvy in dealing with one’s own emotions and in tuning in with others’- is more important than Intelligence Quotient (I. Q.) -general knowledge about the world- in successful life management. Indeed, it is rare to find both these attributes in the same person. Most of my clients score very low on their E. Q. Explains why they are in the predicament they find themselves in.

6. What is an “emotional cascade” ?

Sometimes, when we experience just one of the above painful emotions in
response to a serious stressful situation, a cascade of painful emotions follows. For example, if I felt hurt or humiliated by someone’s nasty comment, after a while I might begin to experience a cascade of emotions: bitterness, resentment, anger, rage, hate and vengefulness. An angry outburst at the loved one could be followed by guilt, shame, embarrassment, remorse, regret, sorrow, worthlessness, etc. This chain reaction is very common after one has received a serious emotional or physical injury by negligent or deliberate action of another person. Behind every lawsuit there is a cascade of painful emotions with a need to exact revenge or to gain compensation. Do not believe any suing person who says, “It is not revenge or money that made me sue!”

7. What do these emotions mean?

1. Fear means being scared in response to something perceived as dangerous or offensive. Not only do we fear getting hurt physically and emotionally, we also fear losing things that we are attached to emotionally: people, job, money, power, title, love, respect, etc. Fear can be conquered with faith, courage, reassurance and prayer.
2. Hurt means one’s feelings are injured. It is a form of mental pain. Solace is antidote to hurt.
3. Anger means one experiences sudden, very adverse, antagonistic emotions against someone or something. It is an extreme form of displeasure. Anger usually follows hurt. Forgiveness is antidote to anger.
4. Sadness means one is feeling emotionally down or depressed. Sadness is prominent in grief, that is, when you lose someone or something you are very fond of. Happiness cancels-out sadness.
5. Guilt is what one feels when he has done something that is not consistent with his own conscience, or values he learned from his parents or parental figures. Guilt makes us downgrade ourselves in our own eye. People without guilt become antisocial in behavior. Thieves, rapists, murderers, mafia, etc. feel no guilt. Guilt is countered with compensation, repentance, begging forgiveness or offering apology.
6. Shame is what one feels when he thinks others around him, whose opinion he values, disapprove his behavior. In shame we feel downgraded in others’ eyes. This emotion is fast disappearing in the United States. Shame is overcome with public exposure and confession.
7. Disappointment means one feels let down by the turn of events or by the people he trusted. One an overcome this by acceptance of human frailty.
8. Frustration is what one feels when he is not making headway with his goal in spite of his best efforts. Patience might help us to deal with this emotion.
9. Helplessness is what one feels when he is completely at the mercy of a dangerous situation or person. A woman being raped at the point of a loaded gun is a classic example of helplessness. Rage often follows helplessness. Doing something to deal with the situation can counter feelings of helplessness.
10. Hopelessness is what one feels when he faces a situation which is getting steadily worse and he is at a loss what to do. Being told that one has terminal cancer is an example. Faith and prayer often counter this emotion.
11. Humiliation means one is belittled or humbled by another person, usually in the presence of others. Hurt, anger and rage often follow this emotion. Tolerate it with dignity.
12. Hate is an powerful emotion of aversion or extreme dislike directed toward someone or something. Hate makes one avoid the hated person and wish him ill. Hate often hurts the person who harbors it for long. Hate can be overcome with love.
13. Bitterness is an extremely distasteful feeling one has about a particular incident. Counter it by letting go.
14. Resentment is a simmering, low grade anger one feels towards those one dislikes for some hurt suffered from them in the past. Forgive and move on.
15. Envy is a feeling of discontent or resentment over others’ possessions or accomplishments. Be content with what you have.
16. Jealousy is what we feel when we fear being pushed aside by others, or we are made to feel insecure by another person’s accomplishment or possessions. This is a sign of insecurity. Improve your self-esteem to get over this.
17. Terror is what we feel when we face a sudden and serious life threatening event. It is an extreme form of fear. Face it with fortitude.
18. Horror is the shock we feel when we witness a frightening and dreadful event around us. Face it with outrage.
19. Disgust is what we feel when we experience loathing or sickening feeling in response to an offensive event or situation. Deal with this by walking away from it.
20. Embarrassment is what we feel when we are uncomfortable or disconcerted in a situation. Try to see humor in it.
21. Rage is a sudden and extreme form of anger in which we are almost out of control. Control yourself before you hurt someone.
22. Exasperation is what we feel when we feel aggravated, annoyed or infuriated by a difficult situation or person. Do something to change the situation.
23. Insecurity is what we feel when we are in a situation which makes us feel vulnerable to danger of some sort. Actions of others could also make us feel insecure. Listen to your instinct. Do whatever you need to to ensure your safety.
24. Despair is what we feel when we have given up all hope. Find solace in prayer.
25. Dejection is what we feel when we are disheartened by bad news or turn of events. Don’t give up hope.
26. Remorse is what we feel when we admit to doing something bad that was injurious to others. Apologize.
27. Regret is what we feel when we realize that we missed out an opportunity or did something wrong. Forgive yourself and do not make the same mistake again.
28. Worthlessness is an emotion we feel when we have repeatedly failed to accomplish what we set out to. It is an extreme form of low self-esteem. Reexamine your goals and methods.
29. Hostility is the adverse feeling against those we dislike or hate. Give it up and move on. Hostility creates more hostility.
30. Vengefulness is what we do when we feel a need to get back at someone whom we perceive as having done us wrong. Leave it to God to punish those that have hurt us.
31. Dread is what we feel when we are anticipating something terrible to happen. Courage.
32. Sinfulness is what we feel when we have done something that we think is wrong as per our religious or spiritual belief. Renew your Faith; repent; ask for forgiveness.
33. Sorrow is the grief we feel when we have lost someone or something we are emotionally attached to. Express it. Accept the loss. Move on.
34. Despondency is what we feel when we are very discouraged, or when we experience hopelessness about a situation. Seek spiritual strength.
35. Uselessness is what we feel when others around us treat us as though what we think, feel and do does not matter at all. Recognize that there is no such thing as useless person. Only, his time has not come.

8. What factors determine how much upset we get?

How much upset we get is directly related to 1) severity of painful emotions and 2) the number of painful emotions we experience in response to a stressful event. If you were very scared about something, you would be a lot more upset than if you were slightly scared. If you experience several powerful painful emotions all at once, such as fear, hurt, anger, sadness, etc., you would be feeling a lot more upset than if you experienced only
one of these emotions. For example, a woman’s emotional reaction to discovering her spouse’s unfaithfulness would be infinitely greater than her reaction to his forgetting her birthday.
As to exactly what, how many and how severe emotions we experience when upset depends upon the nature of the event or the problem at hand. A close friend’s death might cause one to feel profound sorrow. Betrayal of trust by another close friend could cause him to feel hurt, anger, sadness, disappointment and many other emotions.
Because we are all different from one another in the way we respond to stressors by virtue of our differing genes, innate temperament, emotional sensitivity, past experiences and cultural influences, each of our reaction to a given situation is also different. What upsets one very much might not upset another at all. In fact, what is outrageous to one might be hilarious to another. For that matter, what might upset us today might not upset us a year from now as, by then, our thinking might be quite different. Therefore, it is inappropriate to generalize stress response and designate a severity number to a given stressful event: death of a spouse: 100; divorce: 98, etc. Breakup of a relationship could devastate one and relieve another. Death of a spouse could cause one person’s balloon to pop and make another person open a Champaign bottle. All depends on one’s state of mind at the given moment.
That is why one person might see a glass as half full and another as half empty. One might become very upset when the price of a stock goes down, and another might become ecstatic, because he sees an opportunity to make some money. One might see you as a great person and another might see you as the worst person on earth. One might judge a person as terrorist and another might declare him a freedom fighter. Everything depends on one’s perception. Changing perception is one of many tools in coping with stress as we will study later.

Sunday, July 17, 2005

The Patient's Handbook

The Patient's HandbookAn excellent guide to help patients get the most out of the US Healthcare system.

Stress and the Current State of Affairs - Dr Kamath

1. Why you should know something about stress

While moderate amount of stress is essential for normal growth and maturation, excessive stress combined with poor coping and managing invariably leads to loss of tranquility of mind; emotional disorders such as anxiety and depression; and physical disorders such as obesity, high blood pressure, fibromyalgia, chronic fatigue, irritable bowel syndrome, and many other disorders.
Stressed-out people often resort to drinking alcohol, taking street drugs smoking cigarette and overeating, gambling and promiscuous sex in a futile attempt to cope with their stress, not to mention driving around aimlessly. These bad habits, in turn, often cause, or contribute to, heart disease, liver disease, lung disease, stroke, diabetes, arthritis, high blood pressure, sexually transmitted diseases and other common serious physical disorders, not to mention financial problem.
Long term adverse consequences of these bad habits and complications thereof on family, marriage, children, society, personal finances, healthcare cost and national economy are mind-boggling. Over 50 per cent of my patients grew up in families with at least one alcoholic or drug-addicted parent. Over 75% of emergency room visits and 90% of hospitalization are for disorders directly or indirectly caused by stress.

2. Why are people referred to psychiatrists?

The myth that only so-called crazy people see psychiatrists is deeply ingrained in the minds of many people. “I am not crazy; I don’t know why I am here!” is the defensive statement I often hear from patients when they see me for the very first time. Indeed, a very small percentage of people treated by psychiatrists can be truly branded as “crazy” or “psychotic.” Even psychotic disorders, in which patients experience delusions and hallucinations, are now amenable to treatment if the patient cooperates with the doctor.
These days psychiatrists treat a whole cross section of society: doctors, lawyers, accountants, nurses, contractors, laborers, car dealers....... Almost all of these people are well-functioning, productive people in the society. They consult psychiatrists because they suffer from various persistent or recurrent physical and/or mental symptoms for which their personal physicians have found neither a physical basis nor medical relief. Suspecting underlying psychological factors as the cause of these persistent symptoms, physicians refer them to psychiatrists.
Some common persistent stress symptoms are: sleeplessness, exhaustion, loss of appetite, weight loss, poor concentration, loss of interest in usual activities, tearfulness, pain attack somewhere in the body, anxiety, tension, relentless worrying, panic attack, nervousness, crying, aches and pains all over the body, etc. Some common stress symptoms that appear episodically are: chest pain, stomach ache, flip-flopping of heart, shortness of breath, headache attacks, panic attacks, etc.
When no identifiable physical basis is found for these symptoms, they are referred to as stress-related. Stress-related does not mean one is imagining or faking his symptoms. It simply means that the symptoms are caused by chemical changes in the brain brought on by stress. Yes, what we think or how we feel affects every organ in the body.

3. How do people react when told their physical symptoms are stress-related?

Since most stressed-out people do not know what stress is or how stress could cause various frightening physical symptoms, they often assert that stress has nothing to do with their symptoms. A lot of them, especially the ones with severe physical symptoms, say, severe chest pain, or shortness of breath, are shocked out of their wits when told that there is nothing physically wrong with them. Their common question is, “How can my mind cause this chest pain?” Reassurance that there is nothing physically wrong with them often makes them feel worse instead of better! They would rather be told they had a heart attack! Such is the dread people have about so-called “mental illness.”
Some of these people try to cope with their predicament by indulging in a little bit of self-deception: “I have no more stress than any one else! This can’t be stress! I am not imagining this. I handle my stress just fine. My doctor does not know what he is talking about! He must have missed something!” Baffled and scared, they redouble their efforts to establish a physical basis for their symptoms by going on an expensive medical wild goose chase. They consult various hotshot specialists, undergo expensive tests, and often visit well-known medical center such as Mayo Clinic without getting an iota of benefit. Every year billions of dollars are wasted by stressed-out people on unnecessary medical tests and procedures. Uninformed doctors become their unwitting partners in this medical merry-go-round. Neither the medical community at large nor the health insurance industry has a clue about this major healthcare issue.
When, as it happens on rare occasions, people do admit having stress they insist they handled their stress well. When asked what they meant by stress or how they handled it, however, they are at a loss for words. Because of the ignorance about the phenomenon of stress and the stigma attached to the so-called mental illness people rarely consult psychiatrists before ordinary stress has progressed into a serious stress-related disorder such as depression, panic disorder and the like. Many are forced into treatment by family members, employers or legal authorities as a result of their dysfunctional behavior at home, at work place or in the community respectively. It is the goal of this little guide to remove these two scourges of mankind: Ignorance about stress and stigma of mental illness.

4. What do doctors tell patients with stress-related disorders, and why?

When patients ask their doctors, “Why do I have this depression/anxiety disorder?” the commonest answer given even by some experienced doctors these days is, “You have a chemical imbalance.” The clear-cut message to the patient is: “This is a medical illness, no different than diabetes. We now have medications available to correct your chemical imbalance. This is not caused by a weakness in your personality. You are not responsible for having this problem. There is no need for you to be ashamed of it. So do not be so hard on yourself.”
Until the advent of psychotropic (“mind-altering”) drugs about 50 years ago, our understanding about various psychiatric disorders was based on various complicated theories proposed by psychoanalysts such as Sigmund Freud. To an average doctor, these theories were extremely complicated to understand and even more difficult to apply in the evaluation and treatment of “mental” disorders. Doctors often tried to apply these theories in practice without much success, or with hilarious results. Another common explanation was, “Depression is anger turned inwards.” Psychoanalysis contributed a lot to our understanding of the mind, but it did not have all the answers.
The discovery of antidepressant and antipsychotic medications gave the medical community the much needed evidence to believe that there is a physical/chemical basis for mental illnesses. The simple phrase “chemical imbalance” came in handy in explaining to patients the nature of depression and other stress-related disorders. In the late nineteen eighties, a new group of antidepressant drugs were released by drug companies for public consumption. These drugs known as serotonin specific reuptake inhibitors (SSRI) became very popular in no time due to the alleged ease of administration as well as lack of side-effects. The phrase “serotonin imbalance” is now on everyone’s tongue. The message to the patients was loud and clear: “A pill a day could correct your chemical imbalance and cure your mental disorder. Go for it.” The pendulum had now swung from one extreme of “it is all in your mind” to the other extreme of “it is all your brain chemicals.”
Originally this message was given to patients by the medical community to encourage them to give up stigma of mental illness and seek psychiatric help. Pretty soon, especially after the discovery of newer antidepressants, the drug companies jumped on this “medicalization” bandwagon and began to promote this concept so they could sell their highfalutin drugs to the burgeoning stressed-out population.
Over the past two decades, patients have come to like this new concept of “chemical imbalance” as well because now they do not have to feel ashamed or guilty for their stress disorder; they do not have to dig up all the old, buried traumatic issues in counseling; they do not have to take the trouble of learning new coping skills; they do not have to take any responsibility for all their stupid actions and behaviors which brought on their stress; they do not have to admit to any common human weaknesses which contributed to their behavior, and they do not have to do anything more than just take a pill everyday to alleviate their dreadful stress symptoms. They have little awareness that not wanting to know how they truly felt in their mind is the main reason why they are sick now. Prompt alleviation of their stress symptoms by medication further reinforces their tendency to bury the past and act as if nothing bad ever happened. Ignorance of all this effectively condemns them to repeat their past mistakes.
Doctors like this idea of “chemical imbalance” also because it saves them the time and the trouble to explore and understand patient’s seemingly complicated mind. In the absence of a useful model to explain the functions of the mind, or a simple interview technique to elicit hidden emotions and memories, they are completely at sea when it came to a “mental patient.” Now all they have to do is to make a list of patient’s symptoms and tell the patient, “Bingo! You have seven out of nine symptoms listed here. You have a chemical imbalance! Take this pill daily and in four weeks you will be well!”
To complicate matters further, unaware of the role of stress in sickness, the profit-motivated and short-sighted health insurance industry pays little for healing through introspection and self-awareness. Their simple message to doctors?: “Control symptoms as quickly as possible with drugs. Keep the cost down. Avoid sending patients to psychiatrists and psychologists. Counseling costs a lot more money besides being useless.” What the health insurance industry does not know is that millions of their clients go on expensive medical wild goose chase costing them billions of dollars every year, all because they mistake their stress symptoms for serious physical illness. The insurance industry has no choice but to pay for these unnecessary tests and treatment as they are ordered by lawsuit-phobic doctors to “rule out a serious medical disorder.”
This situation has been further complicated by the dearth of competent counselors who are able to explain to patients in simple words what is wrong with them; how they came to be in their predicament and what they could do to alleviate their symptoms. I have lost count of patients who tried counseling without gaining a penny’s worth of insight into their symptoms. When asked, “Did your counselor know why you suffered from this disorder?” the most common answer was, “I don’t think my counselor had a clue what my problem was. And I had no clue what he was talking about.” Some patients reported feeling totally baffled and horrified by the suggestion of the counselors that the root of their problem was that they were “fixated” or in love with the parent of the opposite sex. Obviously, the counselor was trying to explain the patient’s stress symptoms using outdated Freudian theories of mental illness. Uninformed or baffled counselors often indulge in such nonsensical “therapy” as relaxation therapy; deep breathing; touching fingers with the thumb, etc. as a way to justify the fee they charge them.
To make matters even worse -if that is possible- everyday we are bombarded with television and newspaper advertisements touting various “nerve medication” meant to control chemical imbalance in our brain. We are more or less guaranteed freedom from depression and anxiety if only we took a pill a day. Even the leading psychiatrists in this country, often financially linked to various drug companies, now talk as if medication alone could control all stress-related disorders. Hundreds of leading psychiatrists receive huge honorariums from drug companies to present hour-long lectures to family practitioners all over the country; or to present weekend-long seminars and symposia to fellow psychiatrists on how drugs could solve the “national epidemic” of depression and anxiety disorder. I have heard psychiatrist after psychiatrist exhorting their colleagues, “We must not be satisfied till we have controlled all symptoms of depression and have pushed the disorder into remission even if it means combining several antidepressant drugs!” No mention about any serious psychological, family or social factors that might be fueling patients’ depressive or anxiety symptoms making it hard to control them.
If psychiatrists do acknowledge the role of stress in producing or aggravating various disorders, it is usually in the form of a lip service, and the recommended remedies are invariably superfluous: deep breathing exercises, relaxation techniques, yoga, meditation, and other nonsense. The usual statement goes like this: “I then (after drugging up the patient) refer these patients for “psychosocial intervention” (whatever that means!), and deep breathing exercises and relaxation therapy.” I have never heard one reputable psychiatrist say anything meaningful when it came to coping with stress.
Nowadays, just about every medical doctor or specialist who has license to write a prescription -gynecologist, cardiologist, neurologist, urologist, cardio-thoracic surgeon, oncologist, nurse practitioner - freely writes prescription for antidepressant, anti-anxiety and even anti-psychotic drugs without taking a detailed personal, family and genetic history; without fully understanding and explaining either their benefit or risks; without fully knowing their side-effects, and without fully understanding potential long-term consequences of using these drugs.
Any psychiatrist reluctant to prescribe drugs is doomed. He might even be sued by brainwashed patients and their lawyers for not toeing the cook-book formulas of treatment increasingly promoted for the benefit of seemingly beleaguered psychiatrists who have, it often appears, stopped thinking for themselves. “Evidence-based treatments” proposed by some psychiatrists and promoted by the drug companies have taken the place of personalized treatment based on various highly sensitive patient-related factors (which we will soon study), commonsense, intuition and wisdom of years of practice. Annihilation of independent thinking psychiatrists seems to be T-O-T-A-L. The victory of drug companies appears to be C-O-M-P-L-E-T-E!.

5. What are some possible long term consequences of this trend?

Since the doctors and the patients have both been indoctrinated - should I say brainwashed?- into believing that it is a simple matter of taking a pill to correct a so-called chemical imbalance, they have little incentive to go into the details of various traumatic events and problems that caused the chemical imbalance leading to the onset of patients’ disorder. Nor are they aware of the mental mechanisms causing the disorder. Most patients feel better after a few weeks and so they believe that their problem has been solved. Since they do not have the insight into various factors that brought on their disorder, they continue to make the same mistakes as before, and get sick again later in spite of on-going treatment. Some stay on these medications for the rest of their lives for the sake of maintaining their “quality of life.” To them it is no different than taking a blood pressure pill every day. Still some others, especially with family history of bipolar disorder, develop manic episode, requiring more serious and prolonged treatment with mood stabilizing drugs. In this case, the prescribing doctor neglected to take (“I am too busy for that”) a detailed genetic history on these patients; or he did not know of the fact that antidepressant medications could trigger bipolar disorder in patients who have personal or family history of that disorder.
This problem can be even more serious with children as noted in the recent “suicide risk black box warning” issued by the Food and Drug Administration for all SSRI antidepressant medications. The drug companies have been so thorough in wining and dining doctors and their spouses while raising their awareness about bipolar disorder that now we have hundreds of thousands of people casually diagnosed and treated by family physicians as suffering from bipolar disorder. Even minor mood instability -ups and downs of emotions- caused by everyday stress is nowadays misdiagnosed as bipolar disorder. Why? Because the drug companies now have come up with half a dozen new “mood stabilizers,” known as atypical antipsychotics, costing anywhere from five to ten bucks per pill.
The term “bipolar” is nowadays used as a pejorative term by the lay public. People use this term to put down people they don’t like, as in, “She is impossible to deal with. She is a bipolar!” People dread telling their doctors about their serious mood swings for fear of being told they have a bipolar disorder. Others go around bragging about their bipolar disorder to get welfare or Social Security disability benefits. These days many people talk loosely about, “wild mood swings.” When asked what they meant, they would say that some days they felt a little down and other days they felt normal. Thanks to the drug companies, we are on the verge of becoming a Bipolar Nation, if we are not already one!
This trend is nothing new. Over the past few years, as new drugs came into the market, doctors became busy treating millions of people for diagnoses promoted by drug companies. First they focused on schizophrenia. I remember the times -late sixties and early seventies- when just about every stressed-out patient was diagnosed as schizophrenic. Then they followed successively with depressive disorder; panic disorder; social phobia; attention deficit disorder; obsessive-compulsive disorder; post traumatic stress disorder, erectile dysfunction..... Now it is the turn of bipolar disorder. Future disorders you can expect to be announced soon for the purposes of raising awareness of the public: Chronic fatigue syndrome; fibromyalgia; chronic pain syndrome; restless leg syndrome; sleep apnea; stuffy nose caused by stress; constipation brought on by too little time to go to the bathroom..... You get the idea, right?
As new drugs are introduced to the medical profession, the public is bombarded with information about the targeted malady via T. V. and magazine advertisements. Unable to correctly interpret the information, many patients ask their doctors for specific drugs to treat their self-diagnosed disorder. Doctors are only too eager to oblige them primarily because they do not want to lose them as their clients. There is always another doctor around the corner ready to oblige them with a prescription. Of course there are other not so obvious reasons as well, which the reader could guess for himself. When my seriously ill psychiatric patients visit their personal doctors or other medical specialists for their other health problems, they are often routinely asked by these doctors or nurse practitioners, “Do you want me to write prescriptions for your nerve medications also?” Such is the level of trivialization of psychiatric medicines in this country today.
Thousands of casually treated depressed and anxious people have now become “immune” to the drugs caused by the effect of accumulating stress in their system due to unresolved recent issues; newly emerging issues and resurfacing of old issues. So these patients are now declared as “refractory” cases, or “treatment resistant” cases, or “treatment challenges.” Now they are put on three, four or even five medications to “aggressively control” their symptoms: two or three antidepressant drugs to complement each other, plus an antipsychotic drug for “augmentation” or “mood stabilization,” plus an anti-anxiety medication to control “jitters”, a drug to control aches and pains, another to keep the patient awake during the day time, and of course, sleeping aide at night to get away from it all.
All these developments suit the drug companies just fine. This multiple drug regimen, which was looked down upon until recently by the medical profession, has been given a new spin and a new politically correct title by leading psychiatrists backed by drug companies: creative polypharmacy, which means the art of giving patients multiple medications to treat a wide range of symptoms. The idea is to make all patients completely symptoms-free. We are about create heaven on earth by using prescription drugs.
To the drug companies, this is exactly what the doctor ordered, pun intended. For, they have a whole new list of drugs in the pipeline to treat every conceivable symptom; every new side-effect from drugs, and newer high sounding disorders that they bring to the
attention of the public every year in the garb of “raising awareness.” Recently a reputable drug company released a new antidepressant drug which purportedly targets pain associated with stress-related disorder. They justify such actions by saying, “Look at all these millions of people out there who are enjoying quality life because of the pills they are taking! Without these pills they would be languishing in State Hospitals!”
True enough. There was a time in the recent past when hundreds of thousands of people were “warehoused” in poorly managed state run facilities all over the U. S. I know. I have worked in two of them. Most of these patients have been liberated from the state facilities and are now housed in various non-hospital setting. Drugs have, indeed, reduced human misery to a great extent. But that is not the whole story.
We are yet to take stock of long term adverse effects of various psychiatric medications on physical as well as mental health of people taking these drugs for years. We do know that most of them cause significant weight gain, making the already existing obesity problem still worse. Some of them, known as atypical antipsychotics, could cause metabolic syndromes such as diabetes and high cholesterol levels, or hormonal changes. Diabetes, hypertension, arthritis, heart disease, stroke, and even death are some of the complications from obesity as well as some psychiatric drugs.
Some drugs cause serious sexual dysfunction such as difficulty in reaching orgasm or loss of interest in sex. We do not know how many marriages have broken up due to these common but often unspoken problems. Drug companies would say, “Don’t worry. We now have drugs for these problems also. Shell out just ten bucks per pop.” Our enthusiasm to bring drug treatment to stressed people seems to have blinded us to these and many other as yet undiscovered potentially serious health hazards.
In our zeal to eliminate stigma of mental illness, we have made it even worse. Tell any depressed patient that his malady is caused and aggravated by poor coping with stress, and that education and counseling in expert hands would help a great deal. The reply is predictable. “This is a genetic illness, a chemical imbalance. I am not imagining this. I have never had stress in my life. How could counseling help? You are wrong, mister!”
Because of our increasing reliance on chemicals, both legitimate and illicit, to cope with stress brought on by various life events and problems, we, as people, are gradually losing touch with our true inner self: emotions that rule our lives. We are rapidly degenerating into a pill-popping, quick-fix, blame-something-else-for-our-problem society. If this trend continues, soon phrases such as self-awareness, insight, introspection, soul-searching, search for inner truth, etc. will disappear from our vocabulary. We will soon lose our ability to calm ourselves down using our inner mental and spiritual resources. Instead we will become -if we are already not one- increasingly dependent upon chemicals: alcohol, illicit drugs, antidepressants, mood stabilizers, antipsychotic drugs, tranquilizers, sleeping aids, pain medications and other chemicals yet to be released, just to cope with everyday life events and problems. “Do you have any new drug in the market?” is the question I am frequently asked by my clients as well as non-clients. This degradation of our “personal-responsibility” society into a “drug-dependent” one is gradual and almost imperceptible. That is why no one seems to be alarmed about it.

6. What is the truth?

Uncontrolled stress ultimately leads to chemical imbalance in the brain. No doubt, medications do bring our brain chemicals back to normal to some extent. However, this is just symptomatic treatment to alleviate current misery. It is like trying to control blood sugar with diabetic medications instead of educating and motivating the patient to healthier lifestyle: exercise, weight loss, better eating habits and the like. The patient now has to make a decision: 1) Do I believe that this is a permanent chemical imbalance for which I will need medications forever, like my doctor tells me? Or, 2) Can I learn to cope with stress better and bring brain chemicals back in balance myself so I do not have to take medications forever?
It is my firm belief, having taken care of thousands of stressed-out patients, that anyone with adequate intelligence and capacity for self-awareness; and a mind that is open, uncontaminated with skepticism, and not bogged down by denial, can learn to cope with stress better and thus gradually reverse chemical imbalance in the brain. One might need a little assistance in the beginning with medications to control serious symptoms of their disorder. This is no different than one temporarily needing a plaster cast to fix a broken bone. Patients could gradually learn to keep their brain chemicals in good balance and enjoy good mental health by understanding how the mind works; knowing about stress; learning better methods of coping with stress, and by changing their mental attitudes and behaviors.
The truth is that almost all patients come down with stress-related disorder due to ignorance about stress; stigma of mental illness; poor coping skills; stupid patterns of behavior; cultivated human weaknesses; bad attitudes, and many other factors. If the reader is serious about overcoming his stress-related disorder, he must face these realities and train himself to overcome them rather than hide behind the “chemical imbalance” facade. Understanding stress is the first step in this direction.

Saturday, July 16, 2005

Why patients should share their stories

Traditionally, medical publishing has consisted of books and journals written by doctors for other doctors. The patient, who should be at the center of the medical universe, has always been ignored. Fortunately, this is now quickly changing, as we are recognising that patients are the true experts on their illnesses, and have valuable voices and opinions which should be heard. Many patients are now writing about their experiences, and sharing their stories, so that other patients can benefit from what they have been through. Reading such stories can be enormously helpful to doctors as well - it's very educational to learn what goes on in the mind of the person on the other side of the consultation desk !
I reproduce what one of our patients had to share about his experiences with IVF treatment at our clinic. This is so much more authentic and touching than anything a doctor could have written - and it's much easier for other patients to identify with this point of view. Anjali and I are proud and pleased to be Rajesh's and Bhavana's doctor - and now their friends !

IVF Success Story by Rajesh Jain, [email protected]

This is the story of one couple’s dream to have a baby and another couple’s determination to make that happen.

Bhavana and I had been married six-and-a-half years when we first visited Dr. Aniruddha Malpani in April 2000. I had known him and Dr. Anjali Malpani earlier – through interactions I had with them in 1993-94 when I was trying to do an image processing software and needed to analyse ultrasound scans. That time, I went as an entrepreneur. This time, I went as a patient.

Going to Infertility specialists is not something one can discuss easily with family and friends (however close they may be). It is a difficult decision to make and it means that both husband and wife have to accept reality and make a joint decision to seek advice and help. While the Web can be a helpful resource in understanding problems and possible solutions, there really is no alternative to spending time talking with doctors. Especially, ones who are as warm, friendly and knowledgeable as the Malpanis.

Our first IUI was in November 2001. Everything went well. Even though one knows the statistics (only a 10% success rate), optimism is always high. So it was in our case. Those two weeks after the transfer are long days. When we finally did the pregnancy test and it came as a negative, it was a blow. “But, doctor, everything went well. Why did Bhavana not become pregnant?”

That is a question which is perhaps the hardest to answer for a doctor because there are many possible reasons and yet there isn’t one which will satisfy parents-in-waiting. We were to ask that question four more times over 2002. With each passing IUI, optimism began to get replaced with an acceptance of the reality. Perhaps, a baby was not in our destiny. Bhavana and I also discussed adoption on more than occasion.

We decided to take a break from it in 2003. Even more than the physical pain of all the injections, the emotional stress can be quite unnerving. With each treatment, there is expectation from the family – and that only serves to increases the pressure. And then there is the ticking biological clock.

We did our first ICSI procedure in January 2004. Again, everything went as well as it could have gone. Hopes rose again – what could be better than having an egg and a sperm be mated together! (We also had the “lucky room” at the clinic, we had prayed to all the Gods, and even the astrologers had foreseen a baby!)

I still remember the afternoon I went to collect the blood test report from the lab. As I waited, a number of thoughts flashed before me. While I tried to keep cool, I knew that in the report there lay the magical number that could possibly change our life forever. For a few fleeting moments, I imagined myself as a father.

When the report came, with a bit of trepidation, I opened it. The answer was what I had feared to think about. Bhavana was not pregnant. I made the call home and with a heavy heart made the short long journey home. Bhavana and I sat that afternoon and talked about life beyond. (We had gotten used to living life in one month increments in the hope that the next month would be different.) She was much more accepting of the situation than I was. My scientific mind kept thinking of why a baby could not be created than the eggs and sperms were absolutely fine. Why did we always end up on the wrong side of the probabilities?

Time heals, and so it was this time also. When we went and talked with the Malpanis (who by now had become very close friends), we were willing to call it quits. Going through this tension of the monthly cycles and ensuing disappointments was starting to take its toll. We wanted a finality to it all. We were willing to accept that we’d never have our own baby. We wanted life to move on.

The Malpanis determination was what brought the dream of parenthood back in our eyes. If they were not willing to give up, why were we? They were willing to try all options to help us become parents. This never-say-die attitude on their part was what brought us back to their clinic in July 2004 for our second ICSI procedure.

Like the previous occasions, everything went fine. But this time, I was much more guarded in my optimism. I decided I will not think about it at all. No more of the “what-if-Bhavana-is-pregnant” mindgames. If it happened, I’d think about it later. Else life would go on. Bhavana and I had decided that this would be our last attempt (something we had not told the Malpanis). Life had to go on.

I left for the US on a business trip a couple days after the procedure. The hectic schedule over the next two weeks left me little time to think. But I knew that the blood test was scheduled for August 16. As the date neared, I could not but think about the outcome. I was not very optimistic this time around, but there’s always that glimmer of hope which never ebbs away.

I was at a friend’s home in Atlanta. I knew when my mobile rang early in the morning that it was a call from home. It was Bhavana on the line. The Beta HCG levels indicated pregnancy! In fact, the high levels even suggested there could be twins – we had transferred four embryos. I could not hide my excitement but I was much more measured. After all we had gone through, I was not prepared to think so quickly about a different future. One step at a time.

When I look back, my muted response to Bhavana’s positive test was perhaps an outcome of the business ups and downs I am so used to in my life as an entrepreneur. Failure makes success sweet – but it also teaches equanimity. Success and failure are but two sides of the same coin. We had experienced five previous failures over the past four years. Mentally, I was ready for another one. When the news of the success finally came, I was still hesitant to accept that our long wait was over. After all, waiting was something we had become very used to over the years.

It was another week before I reached back home. Bhavana was doing fine. My parents were delighted with our “good news.” But the story had a few more twists.

The ultrasound scan showed three active foetuses. Triplets! That would be something. Suddenly, from imagining life without a baby, we started thinking how we’d manage with three! Maybe we should have transferred only two of three embryos…

The next ultrasound scan showed only two active foetuses. One had stopped growing. Our ecstasy turned to bit of a shock. But we decided to look at the brighter side of things. We still had twins to look forward to. Only for a week, though.

The next scan showed that another of the foetuses had stopped growing. There was now only one live foetus. Suddenly, the joy of a few weeks ago started to vanish. Each day brought forth its own suspense. The time to the next scan seemed to be the longest of our lives. The Malpanis started Bhavana on painful, intra-muscular injections. Even that was bearable. The emotional stress was more difficult to bear. If God wanted to take away, then why did he give us? What had we done wrong?

The ultrasound scan in the following week showed that the one remaining foetus was growing. A little happiness came back into our life. But now, we just had to take life one scan to the next. What more surprises were in store for us we did not know.

Luckily, there were no more surprises. Even though Bhavana’s vomiting and nausea continued through her nine-month pregnancy, the baby was doing fine and growing well. The weeks passed by slowly. We counted up to 20, and then down. Somehow, pregnancies that go across a calendar year seem so very long!

On April 19, 2005, Abhishek came into the world as a six-and-a-half pound baby after a Caesarian. I could not believe it till I saw him and held him in my own hands. He was a survivor, having seen the death of two of his siblings, and braved the odds to come into this world. Five years after our first meeting with Dr. Aniurddha Malpani and eleven-and-a-half years into our marriage, Bhavana and I were parents.

For me, the lasting memory of April 19 is when both the Malpanis came (separately) and held Abhishek in their hands. He is, after all, their creation. He is a triumph of their determination as much as he is our dream come true.

PS: I wrote a blog post shortly after Abhishek’s birth, followed by a longer letter. Here are also some photos of Abhishek.

Age of Stress - Preface by Dr Kamath

Life is infinitely more stressful today than it was just a decade ago. Every passing year life’s demands are becoming more complex and harder to meet. And it is bound to get worse in the fast-paced twenty first century. Your choices are few: Learn all you can about stress and turn it to your advantage. Or, ignore it and pay a heavy penalty with your emotional, physical and financial health in an era of soaring health care costs.
However, it is not that easy to learn anything new about stress these days. Year after year we have heard from a variety of sources - newspapers, weekly magazines, television shows and how-to-cope books- all kinds of nonsense about stress management. And now the public does not know what to believe any more. The moment we hear or read the word “stress”, words such as exercise, relaxation, meditation, hata-yoga, jogging, walking, hot-tub baths, fishing, massage, deep breathing and the like pop up in the mind. The erroneous belief that these essentially useless activities somehow help us deal with everyday life stress is so ingrained that it is almost impossible to convince most people, including medical professionals, otherwise. Every year more and more so-called experts are adding even more bizarre remedies: Eat a carrot a day; raise dogs; ride bicycle daily; sniff your spouse’s armpit, and the like.
The word “stress” has become quite common in our daily vocabulary. People often glibly use the word in phrases such as, “I feel so stressed-out!” If someone asked them, “what exactly do you mean by stress?” their response probably would be one of complete bafflement: “Oh! Let me think. Um! Uh.... Ah… Stress means.... Ah ... It means ..... Gee! I don’t know! What the heck is it anyway?”
Essential to coping with stress is to understand how the mind works, and that the mind and the body are a highly integrated single unit. This could be made much easier by developing a simple model of the mind. To explain functions of various body organs doctors often compare them to certain commonly used objects: the heart to a four- chambered pump; the kidney to a highly selective filter; the lung to gas exchanging sponge, and the like. What model could we possibly use to explain brain's essential function we call the mind? Extremely complicated as it might seem to us at first blush, the mind and its function could still be easily explained by using some familiar objects that we use everyday. In this booklet I have built, step by step, a simple model of the mind to explain the phenomenon of stress. Where applicable, I have given brief anecdotes to illustrate the point I have tried to make.
All the information given in this book is based on my personal observations of over thirty thousand patients during my thirty-four years in the field of psychiatry. All opinions herein are mine alone. I have not based this guide on any “studies” or “investigations” or “papers.” Commonsense, not convoluted theories, is the basis of this little guide. Welcome to the fascinating world of stress!

All About Stress

All About Stress - A No-Nonsense Guide to Understanding, Managing and Coping with Stress by Dr. K. P. S. Kamath.

For the next few posts, my friend Dr Kamath will be publishing his book, All About Stress, on my blog. Dr Kamath, a board certified psychiatrist, has been in the field of psychiatry since 1971. After serving as medical director of various psychiatric facilities in southeast Missouri, Dr. Kamath went into private practice at Cape Girardeau, Missouri, U. S. A., in 1982. Over the span of thirty four years, he has evaluated and or treated over thirty thousand people with stress-related disorders. This book is about his insight into the human mind. In his dealings with his clients, he gives as much importance to education as counseling and medication treatment.
The first edition of this little guide titled ’Secrets of Stress Management’ was published in 1998 mostly for the benefit of his private clients. The expanded second edition titled ‘All About Stress’ is hereby made available on the Internet to the general public free of cost. The author hopes that it would help millions of stressed-out people who have no access to the right information needed to cope with and manage their everyday stress.
Dr. Kamath has used simple language and terms in this guide so even people with limited education could read and benefit from it. Repetition of certain themes is deliberate keeping in mind the fact that only through repeated impressions could one replace the old and learn the new. This is especially due to the fact that there is a lot of misinformation circulating out there in regards to stress.
Readers are encouraged to freely share the information herein with as many people as possible. They are also welcome to directly communicate with Dr. Kamath via E. mail at [email protected] regarding any questions they might have. This is a free public service offered in the spirit of goodwill to humanity, and I am very proud to be a part of this !

Wednesday, July 13, 2005

Traditional medical practices need to be skeptically examined.

Traditional medical practices need to be skeptically examined.: "To a much greater extent than most people realize, medical practice is determined by adherence to tradition and by reasoning from plausibly related research or personal clinical experience. "

Friday, July 08, 2005

Silence kills and dialogue heals - seven crucial conversations for healthcare

Silence kills and dialogue heals
This study shows how healthcare professionals can master the seven categories of conversations which are essential to
preventing errors in healthcare.
1. Broken rules
2. Lack of support
3. Mistakes
4. Incompetence
5. Poor teamwork
6. Disrespect
7. Micromanagement

Thursday, July 07, 2005

Words Of Wisdom by Dr Hegde

Words Of Wisdom by Dr Hegde: "Clinicians can not afford to avoid uncertainty or pass it off as inherent aspect of the art of medicine. Certainty is a delusion-only uncertainty is certain......this must be acknowledged and addressed explicitly, especially in clinical training, if reason is to be used most effectively to improve the quality and cost effectiveness of clinical practice.'" And the sooner patients realise this, the better. Smart patients have realistic expectations. They know what is in their hands; what's in the doctor's hands - and finally, what is in God's hands ! You can read the entire book, which is a collection of thoughtful essays on health and medicine by Dr Hegde, at this site.

Living Dying by Dr Manu L Kothari and Dr Lopa A Mehta

Living Dying by Dr Manu L Kothari and Dr Lopa A Mehta: "They had not lived enough, never having lived at all. And those who can’t live well, can’t die well, for dying is the last act that the living perform. Life and death are not absolute experiences belonging to separate categories, but are just two sides of the same reality, the seemingly polar opposites that are but parts of a single, larger whole. A good death, a happy one at that, then, is a crowning glory to a good, happy life."
A very wise book on how to accept death by learning to live ! You can read the full book online.

Lessons in Life that Infertility Teaches

Lessons in Life that Infertility Teaches : "Life chooses unusual ways to teach us its lessons – and for many infertile couples, the lessons infertility can teach are priceless. If you can cope with living through infertility, you’ll find it much easier to deal with any of the other “slings and arrows” life can throw at you – and you’ll find that dealing with them is now a peace of cake ! I agree this is hard-earned wisdom, and I wish there was an easier way to learn this, but that’s the way life is – most of us learn only from adversity. Life only teaches us its most important lessons from the difficult times we go through – which is when we discover our inner strengths, tap into our hidden resources, and find out who our real friends are." This is true for most illnesses - we can learn so much from what we go through !

Sunday, July 03, 2005

How to Handle Patient Complaints

How to Handle Patient Complaints Here's an excellent format doctors can use to deal with patient complaints.
It's an easy acronmy - LEAD.
L = Listen
E= Empathise
A= Act
D= Document

Baby Gender Mentor™: At Home Gender Test

Baby Gender Mentor™: At Home Gender Test Who could ever have dreamt that home testing would evolve so rapidly and quickly !

Get A Free IVF Second Opinion

Dr Malpani would be happy to provide a second opinion on your problem.

Consult Now!