A Breasty Situation

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“You will need to return for a sonogram” were words strung together and thrown at me. Me. Clearly she didn’t know who I was. I’m a doctor. I’m a warrior mom. And our type don’t get … nevermind.

Secretly, I’ve always thought that those multiple breast jabs and elbow stabs that I’ve endured from my dual-diagnoses, Autism/ADHD, son was bound to show up on a scan somewhere. He is relentless.

But true to my profession, I’ve ignored “self-care” and the phone call. Not to mention, it took nearly an act of Congress to get me to the Mammogram. My doctor sent me that prescription in all forms but a telegram. It eventually got done. And again, true to my profession, I strongly recommend you getting one.

But now they want me back. Oh for heaven’s. What for?

Alright. Let’s run the possibilities.

1)It’s fake. The results are fake news. Aka, artifact, aka scars (thank you, Nolan), aka plain-ole tissue density. Yea. Yipeee! All because I paid the extra $75 for 3-D imaging in search of every spec. And … thinking deeply … paying for that kind of test kinda means that I do want to know. Doesn’t it? Moving on.

2)It’s real. The results are truly news. Aka, not artifact. Aka, not scars. Aka not plain-ole breast tissue density. Alright. I’m breathing. Then what the heck is it?

Let me ask you a question? Have you ever taken a photo of a pond, through a screen door and then converted it to a black and white photo and then tried to determine what kind of bug was flying by as you snapped the shot? Neither have I.

But you would be close in saying that it was a flying insect as opposed to a leaping frog. I’m also sure that it would be challenging to say that it was a yellow jacket and not a bee.

To be certain, you would have had to be by the pond and notice the bee and the hive up close in person. In medicine – we would akin that to a tissue biopsy.

But the nice thing about imaging, whether it be a picture or a mammogram, is that it gives you a very good idea of what you are looking at. Aka, it’s a flying bug or it’s a mass that does not look like the surrounding tissue. The limitations, however, are such that it cannot be specific.

Yet, here I sit, tooled with knowledge, having not made that phone call.

Is it because 2 years ago, I went through the same and the follow-up sonogram was negative and now I’m complacent? Or is it because I’m a dual-diagnoses autism/ADHD mom and I have a plethora of annoyances that leaves me too drained to drive? Or is it that I’m using my love of blogging to procrastinate?


Seated with you, in the office, hearing you rattle off the above, I would level with you and say “Stop making excuses.”

And would likely have gone on to saying something like “The sick you is of no good to the busy you or to your life’s priorities. So, make the call. Get your screening done. Complete your follow-up.”

Pausing for effect. And my own thoughts.

What’s my final action? Thanks for the talk. I’m ready now. My booth is waiting. I’m off to make that call. Cue the soundtrack to Super-Doctor-Mommy!

5 Steps To Overcoming Depression In 24 Hours

overcoming depression
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Have you been feeling sad for a while now? Are plates piling up at bedside and showers a necessity? Has it sickened you, deeply, that you haven’t phoned a friend in weeks but you just cannot seem to snap out of it. Well, seeing as there is no such switch, here are 5 easy steps to changing your life. On your own. In just 24 hours.

But first. Over the next 24 hours, you have my permission to ignore the laundry climbing your walls. Then feel free to apply that concept to all things unsanitary in your surroundings, such as the kids bathroom and possibly your hair. That’s thoughts for another day.

Second. Let go of all nagging thoughts. None of it matters today. Hakuna Matata. Namaste. No problem, Mon. Pick your favorite phrase and let your worries die down. Because you are ready for your 5 easy steps?

Here goes …

Step 1. Set your alarm for a time in the morning that you are likely to awaken. You wont need a clock for this step because your mental timing and cracked circadian rhythm will do. So set your mind to waking in 8- 12 hours. This will give you something to look forward to … or be afraid of. And these, by golly, are emotions that studies have shown, strike that, life and common sense have shown are new emotions that replace sadness.

Step 2. Mentally locate your most comfortable shoe and clothing. You may even set them aside at this time. Searching for apparel is a known morning frustration that leads to returning to bed so skip the morning drama. Plan ahead your comfy wear because tomorrow is very near. No shopping required.

Step 3. Take your night pills. Those vitamins that you bought won’t take themselves. So whether it be your SamE, sleeping pill or SSRI, set yourself up for morning success by prepping your body. Rest is coming up as one of the 5 steps so be ready for a rejuvenating rest. In this step, you may also benefit from a soothing cup of chamomile or lemon balm tea. And in case you were wondering, now is not the time to take a stimulant. So no caffeine, nootropics or those pills you purchased online for energy boosting for at least 8 hours prior to resting. Additionally, skip any over the counter medications that may make you feel drowsy in the morning.

Step 4. Go to bed. Those words are music to my ears and to many who suffer from depression. This recommendation however is a means to an end. The end of depression. But more than likely, this is where that nagging feeling returns. What if I can’t sleep? What if I wake up too late? What if there’s a spider in my room? Scroll back to the top of this post where I said Hakuna Matata. We do want this first 24 hours to work. But if it doesn’t. You’ll get another one. So get some rest.

Step 5. The big finale. The one you’ve been waiting for. The cure of all cures. The mother of all … ok, I will get on with it.

Step 5. Simply go outside. Put on those comfortable shoes (Flip flops. Florsheims. Fubu. It doesn’t matter) and those comfy clothes and march your unbrushed teeth and need-a-bath body out the front door. We need no deterant to getting out the door, at this step, aside from getting dressed. Why? Because there’s nothing quite like the dread of brushing your teeth when in the grips of depression. So forgataboutit! Do it later. Tomorrow. Soon.

Be it winter or warm weather, studies have shown (seriously this time) that sunshine and fresh air does a mind and body good. So take this step seriously and plan your outing!

What will you do outside? My favorite is nothing by the beach. But you can go crazy and walk all the way around the block or better yet, a stroll in the park or just sit on your front door steps. Next thing you know, you will be signed up for country line dancing and running a half marathon. Hey, it’s been known to happen.

So there you have it. 5 easy steps to overcoming depression in 24 hours.

Want more easy steps, try the 8 laws of health: the NEWSTART principles. This website can tell you more: https://www.heavenpreparation.org/the-8-laws-of-health

I would love to hear how you did. Leave me a comment. Drop me a line. Follow my blog. Just be sure to take care of yourself. And remember. Rome wasn’t built in … 24 hours. It took a lot of persistent work over a long time period. So just stick with it and improve on every 24 hours that you are given. Call your doctor or mental health professional for additional care.

Exposure Conquered The Beast

We did not yet have a date to close but we knew that one thing was for sure: moving with Nolan was going to be a monster tamed only by exposure.

“Nolan” I said. “Do you want to see our new home?” I was scared to make ownership statements not having ownership status but it was a necessary evil. He didn’t respond and he didnt really have to because we were already on our way.

Nothing about the drive sparked excitement. Left turn out the driveway and down streets reminiscent of a school bus ride. He didn’t bat an eye. We were only moving a few towns over.

Crayons and markers were everywhere. In the crevices, carved into the cream leather seats, chewed and sprinkled onto the carpet with a few scattered marking on actual paper. Those all evidenced his freedom to stim and the nearby I-gave-up-years-ago expression on my face. So it was in keeping with keeping him comfortable, in his own skin, that we took off to the nearby town.

“This is the house, Noly.” I said as I bumped the curb, my eye catching the In-Contract sign. “Would you like to live here? We can move all your things here. And play in the yard.”

On and on we spoke. Not so much for the sake of dreaming but for the sake of being onsite. For the sake of touching the door handle. For the sake of feeling the newness. For the sake of seeing the physical property and hearing the sounds of his new world. All his 5 senses were present such that where one layed dificient, another would take its place.

We knew the stats. It drove us into action. Moving to a new home is listed as a life’s major stressor. It skips hand in hand with death and divorce. So, tacking on a special needs kid to those dynamics, you then understand our need to nip a melt-down in the bud months in advance.

The day came. The papers were signed. The house was ours. The shrubs, the windows, the rooms. Ours! But wait, the room. THE room. HIS room. Time stood still. It has to be duplicated, and identically, to his current room. Afterall we are risking no new behavioral outbreaks people! So off to buy paint we were. Yankees gray and Yankees blue. Brushes, pans and rollers all new. It was like we didn’t have another kid named … aaaahhhhh, as we braced for the Nolan new home horrors.

Then … Nothing.

Well, not nothing nothing. We didn’t cure his autism or anything. He still rammed us with his head and grunted like a wildhog as his pre-ram alert. And he still stims a crayon like Michael Angelo himself, but we were already all over that. #sawthedentist.

But, the dude took to the his new home so naturally, and dare I say, so excitedly, that it was as if we over did the whole exposure, exposure and identical room plan thing. Seriously. We even return to the old house, with him in the car, to retrieve more items and little-hyper-man not only remained seated in the car, he requested to go back home. Ya! “New home, please” said he – because he is quite the verbal gentleman despite having bulldozed you earlier.

It was then that we realized our transplantation success. We overdid it and it was okay. Hi Five Hon! Bring it in.

As for our daughter, #autismsibling, should you find her, drop us a note below.

Jk. Shes around here. Somewhere. Lol.

Do You Wanna Marry Juanna?

Juanna is a popular girl? You sure you wanna marry her?

Breath-taking as she is, she will leave you dry and high. And though it’s true that she’s no digger, moolah goes up in smokes around her.

She tells pretty little lies like “you’re hungry” and “you smell nice.” 

But to your doctor, you’ll come a runin’.  Outta breath and barely breathn’. ‘Cause you thought that I was foolin’ when I said “Don’t Marry Juana”

Right now, she’s with a politician. Soon there’ll be some dirt-a-dish’n. But they’ll say they were researchin’ for a bill they’ll soon be passin’.

She promised you a nice death bed as a perk to get you all wed ’cause you’re in pain and enough said.

But she cheats with thoroughbreds. Strong and healthy lives instead. Making waste of minds in head. Not just those who hurt in bed.

That wed license shouldn’t be legal. She’ll fly away with your cerebral. Empty lives that should have been full must now see a doc to get an air-full.

What do you think of little Ms. Juanna? Should we keep her or make her a goner!

By: Dr Anthonette Desire.

All rights reserved. Previously blogged on http://www.nadmedicalservices.com on Saturday, April 19, 2014  Stock photo from godaddy.com

The Home Run

In a world beyond my right now but within my hands reach, I energetically scribbled across the page. Pearls of wisdom poured from the podium and flooded my brain. A headache. I felt it coming on.  Clutching my coffee cup tighter than I need to, I settled in to becoming a #Harvardwriter.

The next 3 days delivered as promised.

I drank from its thunderous downpour of power-packed content. I learned of the wonders of deadlines, of the secrets to maintaining motivation and of the magic of the couch.

But should I say hello? The density of genius that packed the room was at infinitum. The Harvard Medical School Course on Writing, Publishing and Social Media for Healthcare Professionals attracted physicians, psychologist and healthcare professionals world-wide. And there I sat, one of them, yet, in awe.

Then someone approached and said “Hello.”

Staying in the moment and connecting with thought-leaders had fueled my pre-conference decision to ditch the laptop from my things-to-pack list. But regret gnawed at the grey matter of brain until it was jolted by that in-the-moment MOMENT.

Did I just hear that? Did Dr. Julie Silver, Director of the course and author extraordinaire, just offer up a momentous opportunity, on a larger than life podium, at the Fairmont Plaza, for a #HarvardWriter inductee, to pitch a book idea, on the fly, in front of an accomplished panel of authors, editors, agents, coaches, publishers and social media judges while in a packed ball room? What the what?

Catapulted by my initiates, I stood before giants. And seized the day. My book is coming out tomorrow.

Okay, no it’s not.

But unknowingly,  being consciously present as the audience of pitch-practiced authors, as they braved the ice-cold world of engaging the publishers, had taught me how to land the 70-second elevator pitch.

I had 23 out of 23 judges at “No! Don’t pee there!”

Ok. You had to be there. But that laptop-free session became my pitch-on-the-fly prep and I was ready to change my world.

Magnetic people interactions were my destiny. A midnight dinner with the author of the book, “I’m not a Princess, I’m a complete fairytale”. A reminiscing stroll with the author of “Hindsight: Coming of age on the streets of Hollywood”- a book worthy of Netflix, Energizing conversations with Blogger and Twitter Top-Voice, Dr. Melissa Welby,  group selfies on a backdrop fit for social media rounded my stay as I  watched starry eyed writers, published professionals and accomplished doctors dream.

Slouched in exhaustion and dizzy from the weekend’s speed, I sought refuge on seating tucked deep into the lobby.  The bustling noises had faded and I now dreamt of home. I listened as steps pattered close behind me and heard someone say “I’m so glad that we met.” Uncurled from the cough, barefoot on the floor, I stood and smiled widely. The last person to wish me good bye that weekend was none other that Dr. Nilsy Rapalo. The same someone who started my weekend with “Hello.”

It was magical. It must have been the couch.

The Needle Is Out!

You sat there and you wondered if the needle was still in. After all, it was a needle that punctured your vein. And the evidence is left strapped to your arm.

But little do you know of the magics of medicine delivered daily. The slight-of-hand tricks-of-the-trade that we pull off on a regular bases.

Because, shazam! The needle IS out. Did you see it?

But what is in? What is that residual poking feeling that remains? It’s not all in your head. It’s right there. You can feel it.

And something IS there. It is called a catheter. A fancy term for a straw. And it is left behind after the needle is retracted. Yes! Retracted. Pulled out. Gone. Removed. Usually manually but often with a spring-action, click-of-a-button, snap-back into a safety cover.

But why is the catheter there? Well, that’s there because we, your doctors, would like direct access to your blood stream. Yes. Full, unfettered, direct access right to your heart! Or Lung, or toe or belly button. You get it. For the administration of treatment.

So next time you swear that there is still something poking you. It’s not in your brain. It’s in your vein. It’s a venous catheter.

Restraints In The Hospital

Recently, I was met with a very angry family member. “Why is my brother tied to the bed?” He asked. “I’m usually a very reasonable man but he cannot speak for himself. So I sure will. And I’m very upset about this!” were his next words.

Surely, I should have been offended. After all, I just saved his life. You’re welcome.

But the realities of restraints in the hospital setting are heart breaking. And usually occur in the most fragile of patients – the critically ill and the cognitively impaired. So, how does one decide when it is ok to tie a patient’s wrists to the bedrails? And how often does this occur? What are the patient’s thoughts on this practice? And why is this practice even allowed by the hospital governing bodies?

I will tell you this. I know, that as a hospitalist physician, I get those calls. You know the one. “Doc, Mr X has removed his IV access and is streaking naked down the hall screaming ‘They’re not gonna getting me.” And I will have to respond to that escalating situation with an overhead announcement of “Code Manpower Needed.”

And I also know that I will get the call that little Ms. Y is hosing down her toes with her running IV antibiotics while planting new flowers in the brown soil of her diapers.

And that Little Jonny, physically all grown up, is still mentally challenged and giving the staff a hard time by not staying put.

Or that Joey Shmoey has extubated himself and is now a pale shade of grey.

So what do we do?

We restrain.

Now of course, you should be rightfully up in arms! Repeat after me… “What? That’s your answer? Aren’t there other modalities that can be attempted prior to resorting to HANDCUFFS? exclamation! Exclamation! EXXCLAMMATIONS !!!!

And the answer is … yes of course. Who do you think we are? savages? Wait. don’t answer that. But serious, “not staying-put” is not a valid reason for restraints. So keep reading.

The PSQH website on Patient Safety and Quality Healthcare recently published an article on just this public concern. They entitled it “The Correct Use of Physical Restraints in the Inpatient Setting”, a titles that begs one to wonder of the incorrect uses. And they have pointed out that it is a slippery slope.

So when my angry family member voiced his advocating rights, I have no choice but to nodded and validated. And when alternative therapeutic modalities were suggested, I considered them and offered a few of my own. Until we all come to a consensus. In this case, given this situation, at this current time, in this current state, restraints was the safest modality to offer 1st line treatment.

The truth is, however, that the optics of restraints aren’t easily reconciled with its necessity. Nor are its adverse effects.

So although this case resulted in a mutual agreement, the next case may be you or your family. Or maybe it’s me. On a slippery slope.

So what do you do? You ask questions. You say something. You advocate. You wait for the rational. And you help to make the treatment process safe and effective.

What can you do? You can stay at bedside. Because we will respect your wishes to remove restraints while patient is under your supervision.

What are your views? I’d like to hear from you.


*Featured hand photo taken from free photo library