Treatment Options

In addressing any illness, physical or psychological, we know that different treatments work for different people. This begs the question, if a safe, low-cost treatment exists for a life-threatening condition, shouldn’t it be an option?

Left Breathless

According to the American Academy of Allergy, Asthma & Immunology, approximately 250,000 people die prematurely each year from asthma.

I don’t consider myself an anxious person, but I’m anxious about keeping track of my prescription asthma rescue inhaler. If I lost it, I would have to return to the pharmacy where my prescription was filled to replace it. This wasn’t always the case.

For most of my life, I could walk into any drugstore, buy an over-the-counter rescue inhaler for under $20, and quell an asthma attack in less than a minute. In 2012 the only OTC rescue inhaler was taken off the market not because it wasn’t effective (its active ingredient is the same used in emergency rooms) but because the propellant that spritzed it into the lungs contributed to ozone depletion.

The company that made the OTC inhaler sought FDC approval for a revised version with the ecologically sound propellant (the same one that the current prescription inhalers used). Their application was denied. The FDC claimed that cleaning the unit (exactly the same instructions as the prescription inhaler) was too complicated.

Since my only other non-prescription option was an emergency room, I made an appointment to see a doctor. He gave me a 10-day sample of an inhaler to prevent attacks (co-pay $220 a month) and a prescription for a rescue inhaler (co-pay $44).

The sample asthma prevention inhaler that the doctor gave me triggered the worst asthma attack I’ve suffered in decades. The active ingredient in the prescription rescue inhaler didn’t stop it for more than a few minutes, and if I hadn’t found a nebulizer version of the active ingredient of my old OTC inhaler (cost $60) at the local drug store, my only other option was the emergency room.

That event made me wonder how many people died each year and how many health care dollars spent because a proven OTC treatment was no longer available.

A Painful Addiction

The American Society of Addiction Medicine states Opioids led to 20,101 prescription pain reliever and 12,990 heroin overdose deaths 2015.

In the NPR news story, “Breakthrough Pain Treatment Or Snake Oil? You Decide,” Joe Palca illustrates the financial obstacle of bringing a non-addictive pain reliever to market. A researcher at the University of Texas has developed an effective topical pain cream, but since it doesn’t employ a patented molecule (its key ingredient, resveratrol, is found in red wine and numerous other wellness products already on the market) no drug company could recoup enough of a profit through a patent monopoly to invest in clinical trials.

Resveratrol is harmless, so the researcher decided to make the cream available online. But, since it’s not marketed by a major pharmaceutical company as a pain treatment, you won’t hear about it from a doctor.

Traumatic Stress

The Veterans Stress Project states Post Traumatic Stress Disorder (PTSD) is responsible for 22 veteran suicides a day.

Congressman Tim Ryan makes the case to the head of the Veterans Administration (VA) to offer a non-drug PTSD treatment, Emotional Freedom Technique (EFT).

“A randomized controlled trial showed significant improvement in 86% of veterans with clinical PTSD after just six EFT acupressure treatment sessions. A number of peer-reviewed studies, such as one randomized controlled trial by Britain’s National Health Service (NHS), published in the Journal of Nervous and Mental Disease, found that EFT effectively remediated PTSD. Another trial showed that compared to talk therapy, EFT significantly lowers cortisol levels. Other research found normalization of stress-related EEG frequencies in the brain following EFT. In fact, a review in an American Psychological Association (APA) journal identified 51 peer-reviewed papers analyzing the tapping of acupuncture points to address psychological issues.

“A recent report found the lifetime cost of treating PTSD in a single veteran to be $1.4 million dollars. Multiply that by an estimated 500,000 Iraq and Afghanistan veterans with PTSD and you get $700 billion. That’s the potential cost of not doing more to remediate PTSD in our veterans.”

I attended a local Meetup.com group to learn about how EFT compared to the more established non-drug treatment Mindfulness-Based Stress Reduction (MBSR).

It took about five minutes for Helen McConnell to demonstrate the technique, which combines tapping acupressure points with simple self-acceptance cognitive techniques that both EFT and MBSR use. Two people who had specific pains to work on (one physical, one emotional) both claimed that the EFT session helped a lot. I don’t know enough about acupressure to assess the tapping part, but I know that many forms of touch therapy (from massage to good long hugs) can lower cortisol levels. Focusing attention on the part of the body that is stressed or in pain is a focus of MBSR and other pain management practices.

A Psychology Today blog post explains how EFT works through the experience of a Marine Corps vet who had been traumatized by being forced to shoot a child. “That came back to me night after night for years,” he said. “After tapping, you still have the emotion, but it doesn’t own you. It’s not overwhelming. It’s just a memory.”

Ten Minute Exercise

Here are a couple of possible treatment options. If your depression stems from chronic pain, take 3:30 min. to listen to the Joe Palca piece and decide whether Ted’s Pain Cream sounds like it’s worth a try.

If your depression is related to post-traumatic stress, check out the 5:35 video at the Veterans Stress Project for more information about EFT.

The Case of Unintentional Weight Gain and the Killed Off Chips

Early Sunday morning, I discovered a killed off bag of Trader Joe’s Cornbread Crisps Sweet and Salty Cornbread Snack in the kitchen garbage pail. Using Judson Brewer’s work on addiction as a basis, I set out to investigate the chain of events that led to this crime of unintentional weight gain and snackicide.

The bag was killed off Saturday between the hours of 11:00 PM and Midnight. The guilty party, E. (who confessed on the condition that her name be withheld), had devoured the last of the chips after returning from a post-concert happy hour with a friend where the food options had failed to entice.

E. was not ignorant of the crime. She knew that the habit of late night snacking came with a sentence of bloated belly, unintentional weight gain, and clothes feeling snug around the waste. Unfortunately, the law-abiding, calorie conscious part of the brain tends to go off line when the the chips are down. In addiction acronym lingo, it’s advisable to HALT when Hungry-Angry-Lonely-or-Tired. As a crime prevention strategy, E. had placed a restraining order on having sweet and salty snack items in the home. So how did this bag sneak into the house and harm’s way?

At about 8:30 PM, Bruce, E.’s co-defendant, who didn’t attend the concert, opted to have a beer and watch the movie Kansas City Bomber instead. Bruce had had a light dinner, so he decided to eat some of the Cornbread Crisps, whose sweet saltiness complemented the beverage.

At 5:00 PM, Bruce had had a “dinner” consisting of Cornbread Crisps, a jalapeño cheddar roll, and an apple. Anticipating a happy hour menu later that evening, E. tried to avoid unintentional weight gain by eating a light supper of Cornbread Crisps, curried carrot and cashew dip, and a jalapeño cheddar roll.

At roughly 3:30 PM, after completing her 10,000 step walk, a hungry E. was shopping at Trader Joe’s, when she was entrapped by this copy. “Enjoy the flavor of freshly baked cornbread wherever you are–without turning on the oven. Made with fragrant cornmeal and a touch of sea salt, these slightly sweet, take-anywhere snacks are baked to a gold crisp. Crumble them into soup or salad for added crunch, serve them alongside warm chili & cream cheese dip, or simply eat by the handful.”

Though not admissible as evidence in this case, E. had been sentenced to unintentional weight gain for a prior conviction involving toast addiction. Her defense attorney at the time had pleaded clemency on the basis that when E. made toast to stave off hunger during her work day, her brain had formed a secondary habit, seeing toast as a relief from one or more job-related stressors. An expert witness testified that it’s this craving, seeing food as a pleasant way to relieve (or at least stop thinking about) some stressor other than hunger that turns eating into addiction.

At about 2:30 PM, E. paid a visit to Helen Bernhard Bakery, reinforcing the craving trigger for the crisps. She didn’t want to buy something that she’d have around for late night snacking, but committed a minor parole violation by purchasing the aforementioned jalapeño cheddar rolls. At this point, she stipulates that she was hungry. She had completed roughly half of her intended 10,000-step walk.

Aiding and abetting her entering Helen Bernhard Bakery was October’s  photo scavenger hunt. One of the prompts was “baked,” which further reinforced the craving for bread. Once inside the bakery to take a photo, the chances were slimmer that she’d escape without buying something. She could rationalize that it would be a misdemeanor to go into the store and take a photo of a “baked” good without buying it.

The piece of circumstantial evidence in the case of the killed off bag was a book E. checked out from the Staff Picks shelf of the library entitled The Rye Baker: Classic Breads from Europe and America.

Even if E. had been able to resist the prompting from the photo scavenger hunt cue, the memory of past bread pleasures reinforced by this book’s food porn photos and recipes would have likely enticed her to her criminal act.

In the end, we both plead guilty for knocking off that bag of Cornbread Crisps Sweet and Salty Cornbread Snack in less than a day. We know that it won’t bring it back to say that it was simply in the wrong place at the wrong time, but are repentant none-the-less. We both plead temporary insanity and throw ourselves on the mercy of the court.

Ten Minute Verdict

As punishment, we were sentenced to watch Justin Brewer’s Ted Talk: A Simple Way to Break a Bad Habit.

Mindfulness of Trauma

When it comes to post traumatic stress, the brain’s ability to reinvent itself can be a double-edged sword.

At 5:00 AM Saturday morning I was unloading my computer monitor and some other equipment from the back of my hatchback when I noticed a brawny dude in shabby clothing standing nearby.

He said, “I’m gonna need that.”

For a moment I was unclear about his meaning. Then I noticed he was looking at the things I was unloading from the car.

The man seemed out of it so I assumed he was on drugs. I assumed he intended to take the computer equipment to sell it to buy more drugs. My mind raced as I totaled up the cost of replacing the equipment. I didn’t want to fight him for it. I didn’t know if the guy had a weapon, but as I looked at his face, I noticed his nose had been broken. He had been in more fights than I had.

“This isn’t worth much,” I said.

There was more anger in his voice when he repeated, “I’m gonna need that!”

I didn’t like where this was going so I stepped away from the equipment and said, “Okay.”

Instead of calming down, the man seemed more agitated. He looked around to see if anyone was watching us.

There was a gun in my face. My heart raced. He pulled the trigger.

It was over.


I woke up. It had all been a nightmare.

I’m no stranger to nightmares, anxiety dreams. It’s always a relief to wake up and shake them off.

I would have shaken this one off, too, because I can’t think of a form of fiction more interesting to the creator and mind-numbingly boring for everybody else than dreams.

But later that Saturday morning, during a conversation about mindfulness and anxiety, the topic of post traumatic stress disorder (PTSD) arose. Out of curiosity, I read an article entitled “The Science of Trauma, Mindfulness, and PTSD,” by Jennifer Wolkin, which contained the following quote: “I believe that there’s nothing truly disordered about having a reaction to seeing atrocities and tragedies beyond our mind’s ability to fathom.”

This makes perfect sense when we recognize that almost all of the brain’s activity, including the tiny sliver that we can consciously control, is geared to keeping the body alive. Memories of life threatening moments will naturally receive the highest priority. Associations that trigger those memories will naturally create stress. And, thanks to neuroplasticity (the way the brain subtly rewires itself every time we repeat a certain thought process) the more often these memories come to mind, the more we increase the likelihood that they’ll come to mind in the future.

This mental activity becomes a “disorder” only because the physical stress it produces is more harmful than the associations that trigger it.

Virtual Atrocities and Tragedies

Let me briefly recount the “atrocities and tragedies” I witnessed in the hours before my nightmare.

I tour a quadruple murder scene in a hotel suite where bloody hand prints stain a carpet at a dead man’s feet, a second man’s corpse has been sliced at the skull and jawline. A severed arm on the floor. The corpse of the armless man has been thrown against a grand piano with such force that the piano has broken in half. Everything in the room has been smashed. There is blood everywhere. Another dead man’s legs lead to an unseen room.

A young man wakes up in his apartment to the sound of his landlord outside destroying his car with a hammer, he runs outside to stop him but the landlord continued his destruction, demands his $600 rent, and threatens to kill him with the hammer if he doesn’t pay up today.

A woman lay handcuffed to a bed when a stray bullet from a sniper’s rifle kills the man who has apparently abducted her.

Another young man is trying to use his computer hacking skills to break into a secure, remote building, guarded by a skinhead with a shotgun. A woman drives up and hacks the skinhead to death with a machete. She then comes for the hacker.

The first young man is taken on a reckless, life-threatening ride by an oblivious driver.

The machete woman drives the hacker to a gas station where she discovers the attendant has been murdered. When a man with a gun pops up from behind the counter, she shoots him. When a second man with a shotgun emerges from the gas station, she shoots him, too.

The first young man visits his sister. They play music together, he on the guitar, she on the drums. She looks down at her hand and sees that instead of holding a drum stick, she’s holding a carving knife that is cutting into her hand.

A band of destructive marauders with baseball bats and crow bars emerge from a van and start destroying everything in their path to the first young man’s apartment. He cowers behind his guitar as the marauders destroy everything he owns. Seeing he’s lost everything, he smashes his guitar against the wall as well.

The landlord bursts into the destroyed apartment with a gun and threatens to kill the young man. He shoots, and the bullet ricochets off a microwave, several other things, and lodges in his skull. He drops dead.

Another pair of men murder a hotel manager with an electrified crossbow.

All of this stuff is, of course, run of the mill for a dramatic, hour-long TV show these days. What caught me off guard is that this graphic violence and destruction had all occurred during the first episode of a comedy series based on the work of Douglas Adams, best known for the mostly harmless “Hitchhiker’s Guide to the Galaxy.”

Prior to this, “Breaking Bad” and “Homeland” were probably the most violent TV shows I’d watched. It’s likely not the violence that affected me, but the way the violence caught me off guard.

The intention was to watch a light and funny diversion at the end of a more-stressful-than-usual work week. Not exactly what you’d call trauma. Not exactly what you’d call stress.

Genuine Threats

On two occasions, I’ve been hit by drunk drivers while behind the wheel of a car. After those accidents, I noticed a mild trepidation when approaching the intersections where they had occurred. When I recognized the trepidation arising, I made a mental note that there was nothing special about the intersections (like their proximity to a bar) that made them more susceptible to drunk driving. My brain gradually reconfigured itself so that I could pass through them without undue stress.

I recognize that if someone had been injured or killed in either of those accidents, each time I approached those intersections, the strength of the unpleasant memories might well have reinforced the trepidation.

And it’s much easier to use mindful awareness to supplant a stressful event when you can anticipate a trigger (as you can when approaching a physical location) than when it comes out of nowhere (like unexpectedly graphic violence in a silly comedy).

Ten Minute Exercise

Some of the instructions from the mindfulness literature on building a more stress-resistant mind that are well worth ten minutes before bedtime include:

1. Recognizing the kinds of thoughts and emotions that lead to stress in yourself and others.

2. Recognizing the situations where these thoughts and emotions arise.

(Apparently watching graphic violence in comedy shows is stressful for me.)

3. Either avoiding those situations when optional or being vigilant about proactively supplanting stressful thoughts and emotions by cultivating beneficial thoughts and emotions if the situation is not optional.

(It’s easy for me to avoid watching violent comedies. I try to maintain vigilance while driving.)

 

Climate of Change

When faced with changes in our environment, our internal climate can be shaped by grief or gratitude.

Over the past week I got the opportunity to witness man-made climate change up close.

The Eagle Creek forest fire spread to 33,000 acres and counting, the smoke was so thick that it transformed the sun into a weak red orb so weak that I had to remind myself not to stare at it, the temperature fell far short of forecast highs, and the area was covered with more ash than it’s seen since Mt. St. Helen’s blew its top in 1980.

The fire affected many people’s internal climate, too. It was allegedly started by a teenage boy from Vancouver, Washington carelessly tossing firecrackers around on the popular trail. Those who have hiked that beautiful waterfall-lined trail faced the challenge of coming to grips with the destruction and the insult that it didn’t have to happen.

Maybe it did have to happen.

The young man who sparked the destruction was simply combining two things that he loved. I can’t blame him for loving Eagle Creek. I love Eagle Creek. I can’t blame him for loving fireworks. I was disappointed by the cancellation of the Oregon Symphony’s annual Waterfront Concert, which usually culminates in a performance of the 1812 Overture and a big, bombastic fireworks display. I know that fireworks are bad for the environment. I always keep my asthma inhaler handy in case wheezing is triggered by the air pollution the fireworks create.

What’s more fun than setting off firecrackers? How about setting off firecrackers and listening to them echo through Eagle Creek?

It’s not something I would do. But, I’m glad that I didn’t have the opportunity to do it when I was a teenager, before the judgment center in my frontal lobe developed.

When it comes to facing change in our environment, we can choose grief or gratitude. We grieve when we think of the good things we’ll miss. We’re grateful when we think of the good things we’ve had. I’m grateful that I knew Eagle Creek as it was before the fire, and I hope I’ll have a chance to return.

I’m also grateful for the ongoing efforts of the firefighters to preserve what remains. I’m grateful that folks will still be able to visit the Multnomah Falls Lodge. I know many homeowners are grateful that their houses were saved.

And, when the fire finally burns out, as it will, I’m grateful that the fire scar will be there as a reminder that we mustn’t take such precious gifts as the Columbia River Gorge National Scenic Area for granted. Maybe the lasting impression of one moment of carelessness will cause others to think twice before accidentally sparking fires of their own.

This weekend I hiked the Heart of the Park loop of Forest Park and added a little extra gratitude to my forest bathing. I try never to take Forest Park for granted. But I’m grateful for what destruction has taught me.

The first time I took an awe walk by Mt. St. Helen’s, sixteen years after the blast, my jaw dropped at the scope of the blast zone. Yet the ranger on the tour by Johnston Ridge kept pointing out signs of how new life was taking hold where the old had been obliterated.

On the drive back home, I marveled as I walked along the Hummocks Trail at the miniature forest taking root in the wake of the one that had been decimated. On a subsequent visit, ten years later, I marveled again at how fast the trees had grown.