Fornits
General Interest => Open Free for All => Topic started by: Anonymous on February 18, 2006, 10:37:00 AM
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http://www.latimes.com/features/health/ ... ome-health (http://www.latimes.com/features/health/la-he-geriatric13feb13,0,2672248.story?coll=la-home-health)
Turmoil in life's final chapter
Drugs can treat dementia-related behaviors. But, families know, there's a price.
By Marianne Szegedy-Maszak
Special to The Times
February 13, 2006
Perhaps the cruelest paradox of dementia both for sufferers and their caregivers is that memory loss is the least horrible of its symptoms.
It's not the grown child's name forgotten or the pill not taken or the suddenly lost sense of place that drives the elderly from homes to institutions, but the unmanageable aggression, the uncontrolled paranoia, the inappropriate sexual behavior that ultimately afflict 90% of those who suffer dementia.
"Many people get pulled out of their homes and put into institutional settings because the caregivers just can't handle all the other symptoms," says Dr. Dilip Jeste, head of geriatric psychiatry at UC San Diego medical school.
Treating these caustic symptoms is heartbreaking and complicated and has only grown more so in the past year.
Last April the U.S. Food and Drug Administration issued a public health advisory about newer drugs used to treat dementia, known as atypical antipsychotic medicines. These medicines, though approved for other conditions, caused far fewer side effects than traditional antipsychotic drugs, so patients and their families were more likely to stick with them. As a result, the drugs were widely viewed as more effective.
But, as the agency alerted caregivers and patients, the drugs can cause unexpected death in a small number of elderly people who take them to treat behavioral symptoms. The result was a "black box" warning describing the risk of using the drugs for the treatment of geriatric dementia.
In the year since these warnings were issued, healthcare providers, families and caregivers have had to weigh the risks and benefits of these medications while coping with the suffering of vulnerable patients who are unable to make decisions on their own.
Many returned to older antipsychotic medications, with their more serious side effects, such as a Parkinson's-like syndrome that makes people's faces contort.
Others, after examining the data, decided to continue with the newer medications, says Dr. Helen Lavretsky, professor of geriatric psychiatry at UCLA's Semel Institute for Neuroscience and Human Behavior.
Subsequently, a large epidemiological study, which appeared in the New England Journal of Medicine in December, found that there was very little difference in terms of mortality rates between the two classes of drugs.
"We have to remember that the risk of dying is still small," says James Ellison, clinical director of geriatric psychiatry at Harvard's McLean Hospital.
And the potential benefits of the newer drugs are huge getting out of the hospital, moving into a nursing home or assisted living facility, not being agitated or aggressive.
To help determine who is most at risk from the newer drugs' most dangerous side effects, experts say, a diagnosis may be crucial. Although many symptoms of Alzheimer's and dementia look very much alike memory loss, agitation, behavioral changes there are important differences.
Dementia is typically caused by small strokes that cut off blood flow in the brain and inevitably impair function. Over the course of a lifetime, the likelihood of suffering from the disorder increases. It affects one person in 20 over age 65 and one person in five older than 80, according to the Alzheimer's Assn.
An early study of the atypical antipsychotics established a connection between the drugs and subsequent strokes, heart attacks or pneumonia. But in trying to determine which patients were the most vulnerable to these catastrophic events, researchers found that a number of the patients in the studies had other risk factors for stroke, such as diabetes or high blood pressure.
"Can you prove that the drug caused the stroke or death with these patients?" Jeste asks. "It is really hard to prove the connection; nonetheless, you can't dismiss it."
In Alzheimer's disease, which accounts for 55% of all cases of dementia, the deterioration comes not from strokes but from the accumulation of layers of plaques in the brain that smother neuronal function. The Alzheimer's Assn. estimates that 4.5 million people have the disease today, but it anticipates that by 2050, 16 million will be affected.
Regardless of the diagnosis, or the resulting therapies, the effective treatment of such behavioral symptoms is a public health problem.
"This is a big issue," says Dr. Dan Blazer, the president of the American Assn. for Geriatric Psychiatry. "It affects an enormous number of people, and for the individuals who suffer, life is miserable."
Dueling medications
Treatment of dementia and its related behaviors is further complicated by other drugs and drug interactions.
According to a 2003 report by Families USA, a Washington, D.C.-based consumer health organization, although seniors make up only 13% of the total population, they account for about 34% of all prescriptions dispensed and 42% of all prescription drug spending.
Lavretsky says her typical patient is taking 15 prescription medications.
Conditions such as hypertension, osteoporosis, diabetes, arthritis, heart disease, perhaps cancer or mental illness, each require a formulary of sometimes two or three different drugs. Many patients also take over-the-counter medications and herbs and teas, which pose still more complications as their side effects, drug interactions or simply the way they metabolize in the liver have not been studied.
"The use of any medication in the elderly is associated with an increased risk of side effects," Lavretsky says. "The risks of each medicine have to be assessed very carefully in the context of complex management with other drugs."
Could a particular blood pressure medicine, in a particular person who is, for example, diabetic, dangerously interact with an antipsychotic? It is impossible to accurately predict each individual case, but after years of trial and error, the most judicious strategy, she says, is to use "one drug instead of many, and the lowest dose of that drug."
The drugs themselves create even more challenges for the clinician.
As in the case of the antipsychotics, some of the medications used to treat behavior have serious physical side effects. But some of the drugs used to treat physical problems can have what McLean's Ellison calls "behavioral toxicity."
For example, it is very common for older people to be on anticholinergics medications that block a neurotransmitter that is important in the brain for memory. Some of the medicines that help people sleep, even over-the-counter medications, or others that help patients cope with incontinence are anticholinergics.
An incontinent patient with dementia, who requires procholinergic medication for cognitive function and anticholinergic medication for the incontinence, presents a problem doctors encounter infrequently with other groups of patients.
"That is the problem with the aging body," Ellison says. "You solve one problem and you create another."
Simi Valley resident Lowell Dreyfus saw the truth of this observation during his father's illness.
His father suffered from Alzheimer's in the early 1990s, before atypical antipsychotics were available. At one point, his father's confusion and agitation became unmanageable for his mother, and his slow decline seemed to spin out of control.
After weeks of rages and incontinence, he tried to climb out on the balcony and jump off. His wife was able to restrain him long enough for a neighbor to call the police.
It took six officers to subdue the 80-year-old man before they took him to the emergency room in handcuffs. He was then taken to a downtown Los Angeles mental health facility, where he remained for three days and was given a large dose of the older antipsychotic medication Haldol.
Dreyfus' father reacted badly to the medication. "He was unable to wake up and completely bloated, like someone pumped him full of steroids," his son recalls. "I said to them, 'What have you done to my father? He was lucid yesterday morning, and today he is a vegetable.' "
His father eventually recovered from the episode and was given a cognitive enhancer a drug that addresses specific memory problems, not behavioral ones. He responded miraculously to it.
After another two years of relative health and even clarity, he eventually succumbed to the disease.
As terrifying as the Haldol episode was, however, Dreyfus still believes in the importance of drugs whether antipsychotics or other medications.
"Unless a person really firsthand lives with this type of disease, it is very difficult to understand," Dreyfus says. "And I believe that whatever drug is out there that can lessen the pain and make it easier for everyone to deal with the situation has to be tried."
Complicated decisions
Eventually the progression of time makes old age fatal for everyone. But researchers point out that even for the most frail and vulnerable among us, there are ways to make the final chapter of life a gentle one.
With a growing number of people living well into their 80s, and leaving spouses and children to weigh complicated choices, the question of how best to make these decisions lingers.
The possibility of antipsychotic medication was always in the back of Laurel DuBeck's mind as she confronted her father's deterioration from Alzheimer's four years ago. At 81, he had a mass of complicating conditions Parkinson's disease, diabetes, heart disease but they didn't compromise his strength or his rages when she tried to awaken him in the morning and help him out of bed.
"He would yell at me and swat at me because I was doing it 'wrong,' " recalls DuBeck, a nurse from Zanesville, Ohio. She didn't try to persuade him to change his mind, however. Rather, she distracted him with a conversation about the weather or their plans for the day, and his rages would subside. He was "unable to deal with two things at the same time," so distraction worked, she says.
DuBeck understood that the atypical antipsychotic drugs can sometimes be the only way to calm a patient, especially when the paranoia gets out of control. But the enormous quantity of medications that her father took for his other illnesses dissuaded her from adding another one. "I just didn't want to give him anything that I didn't have to," she says.
Geriatric psychiatrists agree that other health risks and realities, such as illnesses or medications, must be considered. Sometimes antipsychotics will be an option. Sometimes they won't. Regardless, Lavretsky says: "We just have to be very careful with everything that we do."
Copyright 2006 Los Angeles Times
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Dear lord,
Skip the risks associated with drugs and
1) eliminate hydrogenated oils, trans fats and high fat meat and dairy.
2) replace 'bad' fats with 'good' fats- olive and grapeseed oil
3) increase their intake of Omegas (salmon, etc), vegetables (particularly green- kale, collards, brocolli, etc)
4) give them a glass or two of good red wine every night- which according to my mom's DO is the best 'trankelizer' to be found
5) give them CoQ10, cal/mag, fish oil, hawthorn, grapeseed extract, folic acid, and B Vits
It'll clean that cholesterol right out of their brain veins.
Everything doesn't have to be a "WAR ON". Most times it just takes some working with nature. Give your body what it needs to works right... and guess what, short of a physical abnormality, it will!!! What a fucking concept.
Eat the Standard American Diet (highly profitable for our capitalist culture) and you're gonna risk cholesterol clogged veins in your heart and brain as well as gallstones.
Oh, but they can remove the gallbladder. Yep, and then you're a prime candidate for heart disease or attack.
Work with nature. The only WAR should be against the advice of the majority of ignorant practitioners in the medical industry who haven't a fucking clue how to help people prevent disease.
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On 2006-02-18 13:25:00, Deborah wrote:
"
4) give them a glass or two of good red wine every night- which according to my mom's DO is the best 'trankelizer' to be found
5) give them CoQ10, cal/mag, fish oil, hawthorn, grapeseed extract, folic acid, and B Vits
This was the norm long before processed foods became dominant. Same with the trans fat, etc.
Now science is identifying Alzheimers.
Prior to that it was called hardening of the arteries.
Dementia has been a symptom of old age since biblical times.
The health food industry promises alot, and makes
it sound simple ... but are the claims every scientifically proven, or is it just a slam against western medicine and modern cooking?
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On 2006-02-18 13:25:00, Deborah wrote:
medical industry who haven't a fucking clue how to help people prevent disease."
It is puzzling to watch your posts that are so angry at the pharmaceuticals and physicians.
Then you quote a book written by two doctors ...?
Who just give out menu's and state in a different kind of presentation what the American Heart Association has been teaching for many years.
When in most cases it comes down to people making their own choices. When they don't make the choices that agree with you, down comes your wrath.
Why are you so angry?
BTW - That darn life expectancy just keeps going up, and up, and up! Hate when that happens to torpedo those anti free choice activists.
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These two doctors are exceptions to the rule, and challenge the main stream treatment model. Had I not read their book, my mother would have stints, if she survived the highly risky procedure, and be taking drugs that could have equally damaging effects.
I visited the AHA website and didn?t find anything about ?reversing? heart disease. While they make some good general recommendations (may have even adopted some from the Framingham study), the information is not specific enough to accomplish that. Now, if I missed the section on reversing heart disease, let me know.
What I found most useful to come out of the study was how to assess your risk. Get a full panel done. Divide the LDL (bad) by the HDL (good) and if the ratio is 4 or greater, then you should make significant changes to your diet/lifestyle.
100/20 = 5 At risk, even with a ?low? LDL. 250/80 = 3 Not at risk, even with a ?high? LDL.
They recommend, among other things, 10g of fat per day if one is at risk.
Hydrogenated oils appear to be one of the biggest culprits. Totally unnatural and the body can?t process it so it ends up in the heart, brain, gallbladder as stones. Try to find a product in the store that doesn?t contain hydro or partially hydro oil. Good for shelf life, bad for human life.
The life expectancy thing is interesting. What is the ?quality? of life? All the studies I've read indicate the quality of life in American has decreased. We are 6th, in terms of quality of life, world wide.
My mom is 69 and can outwork me. Her twin has stints and alzheimer?s- basically incapacitated- doesn?t even travel to family events.
My wrath? Do you feel an attack on the medical/pharm industry is an attack on you personally?
It really is about choice. We all (or most of us) get to choose how we live? and die.
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On 2006-02-20 20:54:00, Deborah wrote:
My wrath? Do you feel an attack on the medical/pharm industry is an attack on you personally?
It really is about choice. We all (or most of us) get to choose how we live? and die.
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Thanks for the detailed answer.
Regarding does an attack on the medical, pharmaceutical industry affect me personally?
No.
I went through my "absolute" angst against the AMA, Psych Meds, and through all my energy to alternative choices.
What I found out the hard way was that 1/3 of all medical expenditures are cash for the alternative methods.
The amount of criticism the alternative practicioners, health food employees, and advocates had against western medicine was so consistant, and similiar, that as I deteriorated I had the chance to step back and look at my past decade.
At the same time I got involved in mental health advocacy. I observed that the alternative dogma was extremely negative, consistantly smashmouth that a vulnerable patient would often be afraid of western medicine, and then feel guilty that they where not doing well with alternative methodes. As they where going further and further downhill.
Then I noticed that the big bad western medicine was not practicing smashmout against alternative medicine.
To do poorly for the mentally ill usually means disasterous outcomes in their personal lives. With the reinstitutionalization of the mentally ill into jails, it was imperative that a patients free choice be accompanied by unbiased information.
I was involve, what more can I say.
Manipulation is horrible to a sick, vulnerable person. Asking for unbiased information should not produce an argument. Just the facts, sources and citations.
That is not what happens. Check out your posts, and the consistancy of your smashmouth towards anyone who disagrees with your dogma.
Then re-read it, and the disagreements are not that at all. Just ordinary people either practicing their free will and choices and try to tell you that your smashmouth doesn't apply to them. And you respond harshly.
Why would those that you chased off of Fornits have such bad posts against you? Because you offend them.
Anyway, my quest for unbiased information for any health problem is not against you, it is the higher ground, seeking to find the unbiased in biased statements and providing the other side, if necessary, so that the reader can make an decision for themselves, with no verbal coercion.
If you, and others, could change your wording ever so slightly then you would have policy statements that an individual could follow, if they choose.
If the attacks on any type of practice, other than your choice, continues then it is not unbiased and those that are informed know that you are not experienced but rather spewing out items that you can cut and paste.
When this happens and you are critical of another form of treatment then a person might buy into your dogma not because of the treatment but rather to be against something.
Being against pharma, or physicians, is myopic.
Just like being agains anything alternative is myopic.
Having the ability to read what is available regarding any illness and to make one's decision is what it is all about.
Yes, people should have the right to choose however they want to live.
You are practicing this right, yes?
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> My mom is 69 and can outwork me.
> Her twin has stints and alzheimer?s -
> basically incapacitated- doesn?t
> even travel to family events.
When growing up was your mothers twin
sister always the sicker, more frail
of the two?
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> The life expectancy thing is interesting.
> What is the ?quality? of life? All the
> studies I've read indicate the quality
> of life in American has decreased. We
> are 6th, in terms of quality of life,
> world wide.
Yes, quality of life is key!
Could you post the links to these studies?
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I personally feel that if at all possible it is better to keep the elderly family members at home and with people they know. I think that keeps the mind active and they feel safer. I take care of my 102 yr old grandfather. Up until just last year, he was very active, very coherent, and didn't have any significant health problems. But after a bout of Pneumonia in December, he became confused and hallucinated and became upset and agitated and paranoid. After 2 weeks in the hospital and many tests, they determined no particular cause other than lowered circulation in the brain. They put him on Seroquel, which, at first didnt seem to help. But the last 2 weeks have been relatively episode free. He is still 102, so every day is a bonus, but I feel that if drugs help keep the patient at home, then it should be used. He still needs assistance, and supervision, but he is at least sleeping at night and not trying to fight things that aren't there. I think a good diet helps prevent many health problems down the line in the elderly, but in my grandfather's case, at this point he should be able to eat what he wants.
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It must be such an honor to help out
your grandfather. He being 102 is
quite the bonus.
What was his "secret" to longevity?
How has his quality of life been
over 11 decades?
In our family we had a women live
to 104. She was funny, when Willard
Scott NBC, called her on the air to
say happy birthday. He said this
is Willard Scott, do you know who
I am? She said yes, and if you
are calling it must mean that I
am a hundred years old, oh my!
Her "secret" she used to tell folks
when they asked was to be happy, try
to make everything funny, and don't
dwell on negatives. Help people,
don't influence to accept your belief's
because life will be much easier!
I don't recall her worried about her
diet or what medication, or alternative
items she took.
To me, as a little kid, she was always
fun to visit!
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You said:
What I found out the hard way was that 1/3 of all medical expenditures are cash for the alternative methods.
And then:
Then I noticed that the big bad western medicine was not practicing smashmout against alternative medicine.
Do you see a contradiction there? I would think that it is more than 1/3 that?s not covered. What were the 2/3 of your expenditures for, that were covered? Why shouldn?t any ?treatment? be covered by insurance if it is ?working? and/or rx?d by a health professional? Why don't more docs prescribe herbs/supplements? Are they unaware of the benefits?
I don't know who you think your kidding with the comment that WM doesn't smashmouth alternatives.
The AMA didn?t smashmouth Chiropractic? Fortunately their efforts were unsuccessful.
It's often covert. But, all they need do to prevent the average person from having access to ?alternatives? is maintain the status quo- ensure they aren?t covered by insurance. Put out bogus studies, and continue to train docs as they currently do. That could change in the next decade or two as Dr Andrew Weil turns out more alternative MDs. We shall see.
BTW, that?s about the third time you?ve claimed I?ve chased people off. Who? Do you have names or this delusional talk?
And this?
Manipulation is horrible to a sick, vulnerable person. Asking for unbiased information should not produce an argument. Just the facts, sources and citations.
And in numerous posts (including this one), you ?smashmouth? me for copying and pasting.
I shouldn't post my experience or cited work or 'experts'. What's left? Let you 'chase me off' so you have full control? That IS what this is about.
I know you didn?t do all the ?research? that supports your beliefs and opinions and frequently don?t cite them.
You continually accuse me of doing precisely what you are/have done, right down to the name calling. I haven?t coerced one person on this forum to take my ?cited? advice. You on the other hand have repeatedly made claims that are not scientifically proven. That qualifies as deception/coercion.
This is your greatest fear:
When this happens and you are critical of another form of treatment then a person might buy into your dogma not because of the treatment but rather to be against something.
I guess you're just going to have to live with that. People will either depend solely on their doc or do some research and participate in their own 'treatment'. Neither here nor there for me. But I will continue to post what I feel in useful for those who may want to investigate less risky or intrusive treatment.
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You know who you chased off. One in particular
was very upset that you used her name while
she was on hiatus.
Your the link master, find it.
Regarding my agenda, unbiased information, let the patient decide for themselves, and support free choice.
Re-read all my posts.
I know you ignore what I say, and only hear what you want.
Perhaps you could take an English class, learn how to state your posts without the hate, and then there would be no one getting upset with the tone and obvious bias of your posts.
Hint: there is also available these treatments.
Herbs and the such. Some do prescribe. When meds are derived from herbs it is a little reduntant, correct. Most of the time the herb content is not what is stated on the bottle.
The alternative folks have plenty of money to do their own double blind studies.
Finally, check out the type of statements you make regarding me, and others. If you can't figure it out your English teacher will explain.
I know you are not involved with the mentally ill on a daily basis because you posted it.
Got it. Read my posts. I support unbiased information. Being misquoted is annoying, coming from you it is now expected. That is sad.
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I could guess. Paul?
Whose name did I use?
And who are all the folks I chased off?
If you are Paul, I'll pass on re-reading your posts. Didn't enjoy them the first time around.
Perhaps we speak different languages, cause I rarely read one of your post and understand it the first time through. Usually pretty incoherent.
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Feel free to speak about what's important to you and how your values and beliefs affect your situation.
But please be careful and don't assume that everyone else is the same.
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"Personally, I'd rather hear your personal experience with the drug than a broad generalization."
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On 2006-02-21 18:18:00, Deborah wrote:
"
Whose name did I use?
"
Deborah? Respectfully, fuck you.
You have no idea what it's like to have one of the two most serious mental illnesses in existence, and you have no idea how *high function* I am for having that illness *at all*.
Am I perfectly normal? NO. And until they have a cure, I never will be.
Do you call people in wheelchairs "gimpy" for an encore? Bitch them out for using their wheelchair as an "excuse" for taking all the *good* parking spaces?
Not just for me, but for everyone out there living with a major mental illness, or any of the other "silent" disabilities, fuck you you ignorant, idiotic, fool of a bitch.
There. *Now* I've insulted you. And you've never deserved it more.
(Name withheld by request)
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Out of context, that sounds pretty bad Paul. Was that your intention? Why not post the link so the entire thread can be read?
http://fornits.com/wwf/viewtopic.php?to ... 270#114008 (http://fornits.com/wwf/viewtopic.php?topic=3515&forum=9&start=270#114008)
Preceeded by this lovely thread.
http://fornits.com/wwf/viewtopic.php?topic=9138&forum=9 (http://fornits.com/wwf/viewtopic.php?topic=9138&forum=9)
And then your one man polls and attacks against me personally for my opinions:
http://fornits.com/wwf/viewtopic.php?to ... 11&forum=9 (http://fornits.com/wwf/viewtopic.php?topic=10711&forum=9)
If you're implying that I chased Tim away, you are dead wrong. She continues to post here, just as you do. Was there anyone else?
Paul, I think you are a very distressed man.
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BEING JUDGMENTAL: When people post, you are seeing a "snapshot" of what is happening with their lives and emotions. You are NOT seeing the "whole movie." We all have different situations, and we all have different considerations and backgrounds. Please do not be judgmental about how another person lives their life--if you do, you will make it harder for others to post for fear of being judged. It takes some people a lot of courage to speak up, and a Dr. Laura-type "don't be so stupid" approach can do a lot of harm. Be gentle. And people will be gentle with you.
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"Personally, I'd rather hear your personal experience with the drug than a broad generalization."
Who wrote this?
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On 2006-02-21 18:18:00, Deborah wrote:
"
I could guess. Paul?
I thought Anons and those who request their names
not to be used are respected around here.
I think the reason why is that if names are used then these discussion quickly break down to name calling rather than the content of the thread -
in this case it was about Geriatric Care - I don't
think so anymore.
I didn't see Paul's name on this thread, and now
it is being attacked. Is this about Paul now. Is Paul even involved? Who knows for sure. But now this thread seems to be about him.
No wonder why there is seldom an attempt at intelligent debate on this forum. It just opens one up to personal attacks.
Perhaps moderating these forums is in order.
Or maybe attacking the poster is what people want?
Now you have brought in this other person, who Anon said did not want her name mentioned. No wonder why she left the Forum, or not.
Regardless, I don't think she will be please that her name is being printed over and over again in this thread.
Who is responsible for not respecting her right either? And why couldn't she have remained nameless.
I guess it is obvious. It is more important to attack the person, not the content of the thread.
Bummer.
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http://www.latimes.com/news/local/la-me ... california (http://www.latimes.com/news/local/la-me-lopez22feb22,0,6772038.column?coll=la-headlines-california)
STEVE LOPEZ / POINTS WEST
Friends May Be the Best Medicine
Steve Lopez
Points West
February 22, 2006
"They give you sodium pentothal. I remember that they strap you down, so when you come to, you don't fall off the table."
That's Nathaniel Anthony Ayers talking about shock therapy, which he had at the Woodruff Psychiatric Hospital in Cleveland some time after his first psychotic break several decades ago.
We were talking in his new apartment on skid row in downtown Los Angeles, where he was supposed to be giving me a cello lesson. But Nathaniel was in a chatty mood, reflecting on a life of great ambition and greater disappointment. I reached for a pen instead of a bow, and over the next 2 1/2 hours, he revealed aspects of his life he had never talked about before.
"I guess they don't like quitters," Nathaniel said. "I'd quit Juilliard, so they gave me shock therapy."
I interrupted him. You didn't quit Juilliard, I said. You had a nervous breakdown before completing your final year and ended up in a mental hospital.
Nathaniel had been living on the streets of downtown Los Angeles for years when I saw him playing a two-string violin in Pershing Square. In the year since I got to know him, he has never said more than a few words about his schizophrenia or the treatment he received many years ago. The man is seriously ill and I'm no doctor, so, as usual, I had no idea where we were headed as we began exploring the mysteries of his mind.
But I wondered if this was yet another step on his road to some form of recovery and a more honest assessment of his illness. He's been sleeping in his apartment more and more, growing comfortable with the idea of running water and warm blankets. He's been talking about working toward a recital with his cello teacher. And now he seemed to be frankly assessing his mental state.
I decided to plunge in. Sometimes, I told him, he seems to talk to people who aren't there.
"Do I do that?" he asked with a look of dread. "That's socially embarrassing when someone talks to himself rather than relate to a friend and participate in his surroundings."
It sounded like something he'd heard years ago in therapy.
"I don't know if I hear voices or not," Nathaniel said after giving it more consideration. "I don't know if what I'm hearing is abnormal. I think there's an incredible amount of subconscious energy. It emits itself through the brain and into your nervous system."
I'm told that Nathaniel has been closely observing fellow clients at Lamp the skid row center he visits as they act up. He appears to be recognizing his own behavior in theirs, according to Stuart Robinson, one of the agency's directors, who said Nathaniel has been offering words of encouragement to his fellow travelers.
Since the topic was on the table, I asked Nathaniel as delicately as possible to describe the breakdown that landed him in a hospital years ago.
"I could not understand what was going on in New York," he said.
Meaning what?
"I couldn't understand what the constant attack from people was all about."
What attack?
"A person smoking a cigarette in front of you."
As we spoke, he pointed disgustedly to cigarette burns in the carpet, and after compulsively cleaning a window with a squirt bottle of 409, he scrubbed his hands at the bathroom sink. Then he checked the toilet and flushed it for the second time in five minutes.
"Then I had the pressure of my lessons," he said of his days at Juilliard. "I was all alone, no family around, none of my people there."
Your people?
"The black people."
All of which must have made his worsening mental state more devastating and his recovery more daunting. Once his illness kicked in, Nathaniel said, he was prone to fistfights and all manner of abusive behavior, and he recalled the efforts of therapists to rein him in.
"They helped me understand I don't want to behave in a violent way. I don't need to be out of control."
He'd left me an opening here, I thought. Maybe intentionally, maybe not. The few times it had come up in the past, Nathaniel had told me he wasn't interested in doctors or therapy ever again. No way. But his mood sure sounded different now, so I asked if he would consider it.
"I will support any psychiatrist who will support me," he said firmly, telling me that one particular doctor in Cleveland helped straighten him out for a while.
"My mind would not strive to be the best citizen I could be; my mind could not strive to do what's best for Nathaniel. You have no idea what's going on with God, country, yourself. Your relationship with your family erodes, you have no friends, no human desire. You get into fights."
That sounds like a long time ago, I told him, reminding him of all his progress. Nathaniel nodded and said he'd like to make his own contribution to "the psychiatric environment." I asked if he was saying he'd like to one day be a therapist, which isn't as crazy as it sounds. Lots of mental health advocates are former clients.
"I'd want to be a music therapist," Nathaniel answered, saying he'd prescribe music as medicine for the mind and soul. "The real reason for music is to create something to help you understand yourself."
When I later spoke to Dr. Mark Ragins, a psychiatrist who has been one of my sounding boards for Nathaniel's developments over the last year, he said the latest news is all good. He said that sometimes when people come indoors after living on the streets, it can take the edge off and make them less resistant to help. That could be what's happening with Nathaniel. It's the kind of story, he noted, that validates the plan to spend Prop. 63 money on housing and outreach for people who are mentally ill.
I asked if maybe Nathaniel was one of the lucky ones who seem to rebound from schizophrenia in middle age. He might be in the long run, Ragins said, but that type of recovery occurs over a much longer stretch. Instead, he said, he thought Nathaniel's new friendships with me, Stuart Robinson at Lamp and others have driven his recovery.
"Relationship is primary," Ragins said. It doesn't have to be more than once a week, and it doesn't have to be someone with an advanced degree in therapy. "It is possible to cause seemingly biochemical changes through human emotional involvement. You literally have changed his chemicals by being his friend."
I wasn't alone on this, but his point is an important one. Mentally ill people often wear out the patience of friends and family. Unless someone else comes along to take up the slack, they can become completely untethered.
Nathaniel has a long way to go, Ragins reminded me. Acknowledging your mental illness is frightening, he said, and so is coming to grips with the lost years. It takes tremendous courage to get through the day, let alone design a new world for yourself a world of new possibilities also presents new risks.
Don't push him into therapy right away, Ragins suggested. He advised me to remind Nathaniel of the discrepancy between the life he envisions and the hurdles that stand in the way, and gently guide him toward therapy or whatever else might help.
Just before we left his apartment, Nathaniel said it was many months ago that he first considered coming in off the streets.
"When you gave me the Beethoven sonatas," he said, "it gave me the idea of living in a house for the sole purpose of having a piano and learning something from the Beethoven statue" in Pershing Square. "The Beethoven statue encourages me to carry on with the most difficult challenges of my life.
"Professionalism, courtesy and respect. I read that on a police car door."
He never disappoints.
As I began to leave, Nathaniel called me back and gave me a long, firm handshake. He held me in his glance and sealed something there, too.
My smile followed his, and neither of us needed to say a thing.
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Found the source of this quote:
Personally, I'd rather hear your personal experience with the drug than a broad generalization.
Post URL: http://fornits.com/wwf/viewtopic.php?to ... rt=0#15260 (http://fornits.com/wwf/viewtopic.php?topic=2539&forum=9&start=0#15260)
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It is probably more important to make
sure to move to a state that supports
Euthanasia after retirement!
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Hey -- I'm here because of Deborah. She sure didn't drive me away. Deborah is one of only two people on the WWW who picked up on and understood what I was trying to get across about my unwarranted labeling, incarceration, and assault and battery at the hands of the "mental health system:" If it could happen to me, it could happen to anyone! As far as I can see, Deborah doesn't object to anyone's decisions about what they want to do about their own lives. (I've been reading as a "nonmember" for a long time.)
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February 27, 2006
Growing Old Together, in New Kind of Commune
By PATRICIA LEIGH BROWN
DAVIS, Calif., Feb. 23 - They are unlikely revolutionaries. Bearing walkers and canes, a veritable Merck Manual of ailments among them, the 12 old friends - average age 80 - looked as though they should have been sitting down to a game of Scrabble, not pioneering a new kind of commune.
Opting for old age on their own terms, they were starting a new chapter in their lives as residents of Glacier Circle, the country's first self-planned housing development for the elderly - a community they had conceived and designed themselves, right down to its purple gutters.
Over the past five years, the residents of Glacier Circle have found and bought land together, hired an architect together, ironed out insurance together, lobbied for a zoning change together and existentially probed togetherness together.
"Here you get to pick your family instead of being born into it," said Peggy Northup-Dawson, 79, a retired family therapist and mother of six who is legally blind. "We recognized that when you're physically closer to each other, you pay more attention, look in on each other. The idea was to share care."
The four couples, two widows and two who are now living solo live in eight individual town houses, grouped around an inner courtyard. Still under construction is the "common house" with a living room and a large kitchen and dining room for communal dinners; upstairs is a studio apartment they will rent at below market value to a skilled nurse who will provide additional care. It is their own self-styled, potluck utopia.
"It's an acknowledgment that intimacy doesn't happen by chance," said John Jungerman, 84, a retired nuclear physicist and one of several Ph.D.'s in the group, who is perpetually clad in purple socks and sandals.
"At first John said, 'I'm not old enough,' " his wife, Nancy, said of the commune. "I said, 'You're 80 years old. How old do you have to be?' "
There are about a dozen co-operative housing developments for the elderly in development, from Santa Fe, N.M., to St. Petersburg, Fla., a fledgling movement to communally address "the challenge of aging non-institutionally," said Charles Durett, an architect in Nevada City, Calif., who imported the concept he named co-housing - people buying homes in a community they plan and run together - from Denmark in the late 1960's.
Though communal housing for the elderly is new, intergenerational communities have been around since 1991, when the first opened in this politically progressive university town. There are now 82 across the country.
In Abingdon, Va., residents are beginning to move into ElderSpirit, a development founded by a 76-year-old former nun, Dene Peterson. The community of 37, 10 years in the making, includes a "spirit house" for ecumenical prayer and meditation.
"I just thought there had to be a better way for older people to live," said Ms. Peterson, who formed a nonprofit development corporation with three other former Glenmary sisters, a Catholic order, and knit together a variety of private and governmental funds (16 of the 29 units are subsidized affordable housing).
Ms. Peterson says she was haunted and inspired by her work with elderly public housing residents in Chicago in the 1960's.
"The elderly were dying," she recalled, "and they were anonymous."
With millions of baby boomers moving toward retirement, gerontologists and developers are looking to communal housing for the elderly with growing interest, building on a generation's mythology that already includes communes and college dormitories.
In co-operative housing, said Janice Blanchard, a gerontologist and housing consultant in Denver, "the social consciousness of the 1960's can get re-expressed." Baby boomers, she predicted, "are going to want to recreate the peak experience of their lives. Whether a commune or a college dorm, the common denominator was community."
Rich Morrison, 79, a retired psychologist from Sacramento State University and the sole single man at Glacier Circle, only recently gave up his hobby, swimming the major rapids of the Colorado River. "Emotionally, there's no reason why I can't continue to grow until I'm 100, if I'm lucky," he said.
Mr. Morrison is once widowed and twice divorced. Like others in the group who have struggled through every loss, from a child's suicide to the death of a spouse, he speaks about now being able to make "heart choices," hard won.
"I've been lonely," said Lois Grau, 87, whose husband died three years ago. "Little things go wrong that he would have fixed."
Mrs. Grau and her friends have known each other for nearly 40 years, raising children in the same neighborhood. Many residents met through the local Unitarian Universalist Church, and they still begin weekly meetings by pledging to "listen deeply and thoughtfully" to each other. Davis is known for its involved citizenry who dash off to their book groups at 7 p.m. The Glacier Circle 12 even partake of what they call a "dream group," in which they discuss their dreams.
Their talents and resources are by no means typical. They are all accomplished professionals, and the market value of their homes allowed them to purchase land and build their dream at a cost of $3.2 million, or about $400,000 each, plus $350 a month in dues. They expect to collect $850 a month in rental income. Individuals own their own homes but share expenses of common areas.
Stan Dawson, 75, a resident who has a doctorate from the Harvard School of Public Health, retired as chief of air pollution standards for the State of California to navigate the project full time through bureaucratic hurdles.
"It was a wonderful thing my dad played golf every day," he said of his father's retirement. "But I wanted to further my life in old age."
The design-by-democracy may not work for everyone.
The architect, Julie Haney, 49, said tension broke out over the color of gutters and trim on their bungalow-style homes. As Ms. Haney explained, "Ann likes blue, Stan wanted brown, Ann hates brown, everyone liked purple."
Ms. Haney, whose own elderly parents died as the design was nearing completion, said the residents forgot things more often than her younger clients did but made up for it with perspective. "I asked, 'Do you want a 20-year roof or a 40-year roof?" she recalled. "They said, 'If it lasts five years, we'll be happy.' "
To be sure, the challenges are daunting. Sue Saum, 74, for instance, moved in with her husband Jim, 84, a retired professor who, during the course of planning the community, was told he had Alzheimer's disease. Shortly thereafter, Mrs. Saum was operated on for breast cancer, and recently she had back surgery. At some point, she acknowledges, her husband may need care beyond their friends' abilities.
"It's one of those day-at-a-time, figure-it-out-as-you-go things," she said. "But creating a community like this, you learn a lot about the strength of the human spirit."
Twelve friends' buying land at age 80 requires a certain leap of faith. By its nature Glacier Circle will change over time. A homeowners association, consisting of one resident from each unit, has the right of first refusal to buy any home when a vacancy arises, for whatever reason, or what Dr. Jungerman nonchalantly calls a visit from "the great father in the sky."
Glacier Circle is too small to legally mandate age restrictions, but Ray Coppock, 83, a retired editor, thinks that will take care of itself. "They'll take one look at us," he said. "That should reduce the potential buyer situation."
At ElderSpirit in Virginia, which will be fully occupied in late spring, spirituality is the major draw. Ms. Peterson defined spirituality as "people finding meaning in their lives, acknowledging ways to give up the ego and grow the soul."
Six more ElderSpirit communities, in St. Petersburg, Fla., Wichita, Kan., and elsewhere, are in planning stages, with some financing from the Chicago-based Retirement Research Foundation.
Not surprisingly, a streamlined form of community housing may be in the wind, as efforts spring up around the country to speed up the planning process, which normally takes two and a half to three and a half years.
Unlike intergenerational co-operative housing, a niche market of about 5,000 people, communal housing for the elderly has "far more market potential," said Jim Leach, president of the Wonderland Hill Development Company in Denver, which is building Silver Sage, a communal housing development for the elderly scheduled to open in Boulder next year.
Dr. William Thomas, who developed the "Eden Alternative," a widely publicized effort to make nursing homes less institutional, is developing Eldershire in Sherburne, N.Y., south of Syracuse, a hybrid between co-operative housing and a traditional development. The idea is to build first and then attract residents who will run it themselves.
Dr. Thomas compares co-operative housing, and its time-consuming community planning, with "homemade bread - people get together, mix the ingredients, let the dough rise." He's trying to adapt the concept for broader consumption - "100 million people," he says, "buy bread at the store."
Even revolutionaries need to be flexible. At Glacier Circle, where the first tulips of spring are popping up, the group had approved special wall insulation for Mr. Morrison, who has a penchant for playing Mahler's Ninth Symphony at 3 a.m. When the bass and timpani pulse through his subwoofer, his neighbor Dorie Datel, a youthful 80-year-old, just lets it slide. For Ms. Datel, whose husband left her for "the other woman" he met at Elderhostel, this group's wisdom and resolve are embedded in the square footage.
"We've all lived through the Depression and war and the big stuff, so we know that things don't always stay the same," Ms. Datel said. "All of us are interested in living."
Copyright 2006The New York Times Company
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Knoxville (WVLT) - Duke University medical researchers have made a surprising finding among patients with heart disease who take anti- depressant drugs.
http://fornits.com/wwf/viewtopic.php?to ... 350#177620 (http://fornits.com/wwf/viewtopic.php?topic=3515&forum=9&start=350#177620)
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There is probably not a very good solution here.
Depression causes heart disease.
If anti-depressants cause a heart attack, then
I guess those that are depressed with heart
disease are going to die sooner than later.
None of us live forever.
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Deborah,
Are you by any chance a chiropractor?