Note Bloat Disrupts Utility of Electronic Health Records

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Note Bloat Disrupts Utility of Electronic Health Records
Psychosis Risk High in Refugees
No Paid Sick Leave Means Workers Skip Medical Care
Arrived in the mail today... I'm probably too happy about this. #nerdnurse
Bill and Melinda Gates share their 2016 Annual Letter.
In this touching talk, Ash Beckham offers a fresh approach to empathy and openness. It starts with understanding that everyone, at some point in their life, has experienced hardship. The only way out, says Beckham, is to open the door and step out of your closet
Every 5 years since 1980, a new edition of the Dietary Guidelines for Americans has been published. Its goal is to make recommendations about the components of a healthy and nutritionally adequate diet to help promote health and prevent chronic disease for current and future generations. Although many of its recommendations have remained relatively consistent over time, the Dietary Guidelines has evolved as scientific knowledge has grown. These advancements have provided a greater understanding of, and focus on, the importance of healthy eating patterns as a whole, and how foods and beverages act synergistically to affect health. Therefore, healthy eating patterns is a focus of the 2015-2020 Dietary Guidelines.
NatGeo photo of the day
Over the past decade, the rate of persons aged less than 65 years with health insurance has increased 3.7%, from 83.6% in 2004 to 86.7% in 2014. In 2014, several population groups had higher rates of health insurance coverage than their counterparts, including the white non-Hispanic population and those with an advanced degree.
High blood pressure, or hypertension, has detrimental effects on health, particularly if left uncontrolled for sustained periods of time. High pressure in blood vessels damages major organs, especially the heart, brain, kidneys, and eyes, and is a leading risk factor for heart attacks and strokes. Hypertension in middle age has been linked to steeper rates of cognitive decline later in life. It is often called a “silent killer” because its effects can go unnoticed for years until significant damage has occurred
Helping Americans make healthier food choices, Updating recommendations for physical activity, Measuring progress toward Healthy People 2020 objectives, Improving access to quality health information, Improving patient safety
The CDC provides answers to the 10 most common questions about Zika.
I’ve watched death slowly tear a mother away from her family, steal away a 17-year old who was likely one of the happiest people I’ve ever known, and some days I’ve wrestled with death so intensely that it feels like going 12-rounds with a heavy-weight champion.
Okay. I’m not really allowed to say what I’m about to say. In public, we people who are mentally ill are supposed to hang our heads and only speak of our challenges as things we want “fixed” for fear of folks accusing us of “glamourizing” our condition.
Masochism and The Road Less Taken
The path of least resistance. What an interesting thing. Water, electricity, basically everything takes it… so why can’t I?
From Merriam-Webster: Masochism – enjoyment of pain : pleasure that someone gets from being abused or hurt.
Being diagnosed with Bipolar Disorder has been an interesting ride. Some days I feel like I can manage it better than others (I guess that’s part of the gig, right?). It definitely forced me to reconsider my career choice. I had struggled for years in determining what I wanted to do. I often bounced between being a nurse and working in the IT field. I even considered working in the healthcare IT field, but eventually came to the conclusion that I wanted to be solely in the medical field. As I was working through my pre-nursing classes I had the opportunity to travel to Brazil and spend a week traveling down the Rio Negro on a hospital boat aiding and learning from two surgeons and some nurses in treating various remote villages. It was a life changing experience in so many ways. I knew I didn’t just want to be a nurse, I wanted to be a doctor. But as my history has proven, I was a little indecisive. I continued my pre-nursing classes and when the time came to apply to nursing school I was not accepted (The school I was applying to had a very backwards admissions criteria – on paper I was a solid candidate. It was very backwards). But I took not being accepted as a definitive sign that medical school was where I was supposed to be.
So I transferred to the University of Central Florida and started taking classes in the College of Medicine’s School of Biomedical Sciences. Unfortunately, my bipolar disorder began to really flare up and it caused me to very heavily reconsider my choice to be a doctor – medical school doesn’t play too nice with the inability to get out of bed for days or sleep for days (give or take). So I spun… out of control for a while. I eventually landed on my feet – in the College of Sciences, School of Psychology. The plan – earn my bachelor’s degree in psychology and then go to graduate school to earn my Doctorate of Psychology and practice clinically… practice what you may ask? I don’t know; which isn’t a problem. But there was a nagging. And for a while I didn’t care – I could get my medical fix with the beloved Dr. Gregory House and the worst written show on TV – Grey’s Anatomy (Seriously, the writing is SO FREAKING AWFUL… WHY CAN’T I STOP WATCHING?!?). As it turns out, fictional TV, awesome shows or otherwise, can’t fulfill real life. And after a while I realized that I want to be a doctor… of medicine. Very badly. Even though becoming a doctor will likely be the hardest thing I will ever do, I want it, more than anything. Just being in (or even near) a hospital invigorates me – it’s a rush of life that I can’t describe – it isn’t mania, it’s so much better than that.
But it’s not all sunshine and oranges (I’m a Floridian, it fits). Getting to the point of those two wonderful letters – M.D. – is a long road for even the healthiest of persons. And let’s be honest, Type 1 Bipolar Disorder means I’m a long way from healthy. It reminds me of a poem I once read in high school (my English would be so proud to know I did take something out of those classes – it just looked like I was sleeping). Robert Frost’s “The Road Not Taken.”
I’ll leave you with this thought; what is it that you want most in this life? What are you doing to obtain it? I know what I want most – and I know that to get it, I will hurt; a lot. I will struggle, I will want to quit, I will be pushed to the edge but I know that if I don’t take that road, I will be selling myself short. Funny thing, that road is certainly not the path of least resistance and will certainly cause me massive amounts of pain – and I can’t imagine life any other way.
Inside My Manic Mind
I often think people misconceptialize Bipolar Disorder. They hear it and think of a person who is kind and gentle, and then, out of the blue, they turn into the hulk; almost a Dr. Jekyll / Mr. Hyde scenario. While it's true during a manic episode some may become angry, I don't think it's the typical response. Instead, I think it's much more common for one to become elated, euphoric, almost in a constant high state. They take on a sense of grandiosity, feeling they are invincible. Often they spend money at an alarming pace, sleep less, and make seemingly novel connections to completely unrelated items in life. That's the textbook response for manic episodes, anyone can look up a textbook response, but as I write this, I'm coming off several weeks of mania, which can offer a much more intimate glimpse of what it means to be manic.
It's hard to pin down exactly when my manic episodes start, but a good sign is my sleep schedule. I start going to bed later and later. First 12:30 am, then 1:15 am, 2:00 am, 5:00 am, 7;00 am, and finally, by the time I'm in full-blown mania, I'm not sleeping at night at all. The next sign is I start to think I can pick up old projects that I never finished and accomplish them. I never do restart them though, generally I move to a new idea too quickly. I may start that idea, or maybe I jump to another one. The ideas could be anything from learning some new web framework, or perhaps I decide to create a font (as of this writing I still haven't finished that project) or maybe it's something deeper. One of the biggest struggles my bipolar has caused is a severe inability to decide on a career path.
Next comes the racing thoughts. My mind starts to race and it becomes very hard to put together any serious, coherent thought. This has affected my ability to complete homework, take exams, sit still for long. I've gotten pretty efficient at writing my professors explaining what is going on; something I wish I didn't have to do. I often wonder if my racing thoughts are similar to what those with ADHD experience. If it is, I greatly sympathize for them, because I know that, at some point for me the racing thoughts will fade, I can't imagine living like that all the time. During my manic phases I often will get up to get a drink and by the time I get to the kitchen I forget why I'm there. Or worse, I'll get sidetracked before even going to the kitchen and go there without my glass. In the past, I've actually gone from my room to the kitchen three times just to get a drink, simply because my mind was racing so fast that I couldn't keep my thoughts straight enough, long enough to complete such a meaningless task.
I love to read. When I was younger my head was always buried in a book. In the fourth grade, I chose to do a book report on a Wishbone book. I checked out the book from the library, along with the VHS (before movies were digital downloads we had these things called DVD's, BEFORE THOSE we had these things called VHS tapes. It's hard to believe that I've reached the age where I actually need to explain what a VHS was. Is this what my parents felt like about vinyl!?). When I got in the car, my mom saw both the book and tape and asked about them. I told her it was for a book report - her response was something like, "oh great, you've already figured out that trick." I had no idea what she was talking about, I just loved Wishbone. In fact, I was already nose deep into the book (Admittedly, I totally used that method later in high school). By the time I reached high school I had moved from fiction to legal case studies and legislation. And finally, by my undergraduate years, my reading consisted of (and still does) academic journals, technical white papers, 1000 page textbooks, and that’s what I read for fun. But when I'm manic I can't get through a simple news article. It sucks. I can't take 3 weeks off from my reading and expect to stay ahead, or at least on par in my classes.
I confess, road rage scares me; too often I see stories on the news of needless violence because of it. Because of this, I'm a fairly safe and conservative driver. That all changes when I'm manic. I drive faster, get irritated, curse people who drive slow, question the intelligence of the engineers who programmed the traffic lights, and generally wonder why people don't understand that every road I drive on was built specifically for my needs. This manic mentality is not good.
In my recent bouts of mania I've found myself drawing, sketching, painting. I'm not an artist, the science part of my brain usually outweighs the creative side. I also clean, which falls somewhere on the spectrum from, “My room is now clean and tidy, clothes washed, dried, folded, and put away" to, "I've gone through every box I own, reorganized, shuffled them around, ordered my closet by color and style and completed a head count of my socks." Some may call this productive, others neurotic, regardless, they are definitely obsessive compulsive tendencies (luckily it doesn't interfere with my daily activities yet, thankfully no OCD).
So far everything I've described severely lowers my productivity. However, there is usually a window, sometimes many days, sometimes a few hours, occasionally completely absent, where all previously said things intertwine at the perfect level and I become a person so productive you might wonder if I was on something. It's breathtaking, inspiring, and all around freaking awesome. If I could live in that manic state at all times, I'd change the world in unimaginable ways. Unfortunately, that's not how it works. It's usually clockwork. I'm manic for a time and then, as if I've fallen off a cliff, I become so depressed that hospitalization usually comes up in my inner monologue, but I'll save that for another blog post.
Mania can be a magical, fantastical, inspirational world, but more often it is a place I dread as much as my depression. It's not often that my sleep schedule, ability to focus, and my slightly obsessive cleaning come into perfect alignment to make a Robert capable of anything. No, it's far more likely you'll find me severely impaired as a result of my inability to support a consistent sleep schedule, irrational anger at other drivers, hopelessly attempting to read, and obsessively cleaning. I was once asked if I enjoy the times when I’m manic, and my response was no, I do not enjoy it. Not only do I have to deal with all the issues I've written about, but there is a foreboding shadow of the darkness to come, and no matter what I do, I cannot escape that shadow because, as I've come to learn, that shadow is my own.
When Your Significant Other Has Bipolar Disorder
I was recently asked a question on Twitter about being in a romantic relationship with someone diagnosed with Bipolar Disorder. Below is the original question and my response.
My partner of 11 months was diagnosed with Bipolar Disorder (1) 6 months ago. We have argued quiet a bit recently, but even before the diagnosis we argued a bit about what I thought was trivial stuff and it has just worn me out. I don’t have the love I felt for her or the patience for it anymore. It’s not fair on her either but I feel selfish and guilty. We live together and have been arguing the past few days and I think it’s best that we break up for both our sakes as I don’t have empathy (not just for her) and I’m not a big talker about emotions and that. I just feel really lost.
I think it’s very common to feel lost and confused when someone significant in your life is diagnosed with any mental illness. As a society, we don’t really give mental illness the time of day, so a diagnosis can seem very scary for everyone involved.
First, I think it’s very common to feel lost and confused when someone significant in your life is diagnosed with any mental illness. As a society, we don’t really give mental illness the time of day, so a diagnosis can seem very scary for everyone involved. It’s worth noting that there is a good chance she is feeling many of the same emotions that you are. Because the nature of Bipolar Disorder is so unstable, I spend a lot of time trying to figure out if there was some specific trigger that cause a depressive or manic episode. Honestly, I rarely find a trigger, which leaves me dazed and confused. Bipolar Disorder 1 is far more intense than any other form of the disease and I imagine handling the mood swings can be really challenging and tiring. I fight exhaustion on a regular basis, as I’m sure anyone does who is affected so deeply by Bipolar Disorder; be it the diagnosed or those surrounding them.
A cornerstone to any relationship is communication. Tell your significant other how you feel. It’s always better to put all the cards on the table for both of you to see. Imagine that your emotional state is a radio wave coming from your iPhone, it has peaks and it has valleys. Maybe it looks like this:
small-wave
For a person suffering with Bipolar Disorder it may look like this: big-wave
Now, unless you’re dating Spock, those intense changes in emotion are going to bleed through to every aspect of life and likely cause some tension; even what may seem like trivial things can cause this tension.
Research shows sex cures all “@APA: Sexual intimacy makes couples optimistic even when facing physical, other issues http://t.co/q4QUF9UbhV”
— Aaron Kraus (@Aaron_Kraus) March 4, 2014
For many, empathy does not come naturally or easily. Society has this (in my opinion, irrational) rule that men can’t talk about their emotions. However, you kind of have to talk about emotions to better empathize with someone, there isn’t a way around that; if you want to better understand what someone is going through emotionally, discussing those emotions is inherently necessary. Pushing yourself out of your comfort box generally helps you grow as a person, give it a try, you may find that talking about emotions isn’t as bad as you had once thought.
I stayed in a relationship out of guilt for several months. I felt like it would be selfish of me to end the relationship because she was going through a health issue. I remember a conversation with one of my mentors about it, and he told me to not be a hero, it’s not healthy. Of course, at the time I was convinced that it would be ok, I could be the healthy hero. He was right (mentors generally are). Years later, I was again faced with a situation where I found my significant other facing incredible turbulence. Again, my mentor advised me not to be a hero – things would not end well for either of us. But this time was different, I didn’t feel like I was being a hero; I had real feelings for her and was ready to stand by her and get her through the tough times. Looking back I now acknowledge two vastly different emotional responses. With the first, I wanted to be the hero; I glamorized the idea and thought that it would earn me some brownie points. The second situation, I just wanted to be there for her, out of love, nothing else. Evaluate your feelings; where on the spectrum of those responses do you fall? Regardless of your answer, I’m going to pass on the advice of my mentor; do not be a hero.
Being in a romantic relationship with someone who has a mental illness definitely requires special considerations. In many ways, the good times will be better, but know that when the darkness creeps in, your partner will need an emotional rock to cling to until the storm passes. However, do not count out the regular rules of a relationship. While you may have to be there for the person more or extend more patience or empathy than being with someone who isn’t suffering from a mental illness, generally you know in your heart (or soul, or gut, or stomach, or some magical organ that provides emotional clarity) where you want to be.
This whole response probably could have fit on Twitter by removing a couple of words – Communication is key, push yourself to better understand her, don’t be a hero, follow your gut.
Do you have a question about mental illness?
Tweet me @robertjdown.
Take all of this with a grain of salt, they are just my opinions and may not be right for your situation. I am not a physician or licensed counselor. This blog is not intended as, and is not, a substitute for professional medical advice. If you are having thoughts of suicide or self-harm, contact the National Suicide Prevention online or by phone at 1-800-273-8255.