Aging Gracefully

Studies at Duke University’s Center of Aging and Human Development have clearly shown that people who devote their lives to thinking of others first instead of living for themselves will renew their strength and retard wasting away spiritually and physically. Here are some examples of people whose giving to others first produced a robust life:

v    At 93, George Bernard Shaw wrote the play, Farfetched Fables

v    At 90, Pablo Picasso was producing drawings and engravings

v    At 89, Mary Baker Eddy directed the Christian Science Church

v    At 89, Bob Hope finished a world tour for the USO

v    At 89, Albert Schweitzer headed a hospital in Africa

v    At 82, Winston Churchill wrote A History of the English Speaking Peoples

v    At 81, Goethe finished his play, Faust

No Excuses

VERSE FOR TODAY: Command them to do good, to be rich in good deeds and to be generous and willing to share.                                                                        1 Timothy 6:18

Dr. Baker, a medical missionary to Sierra Leone, was fishing in the Jong River when a canoe approached carrying a severely ill woman. A quick examination of the woman revealed that she was bleeding internally. Dr. Baker paddled two miles up-river, the canoe with the distressed woman following closely behind. After disembarking, passengers from both canoes drove in Dr. Baker’s jeep to the hospital, a mile from the river. A universal donor, Dr. Baker quickly gave a unit of his own blood to the patient. He then surgically removed an ectopic pregnancy that without emergency surgery would have led to the patient’s death. 

Those who, after reading about Dr. Baker, feel compelled to convert their Cadillac into a Congo canoe can consider this caveat: All of us don’t have to be missionaries to serve others. Most of us, destined to realize our potential for service in unnoticed ways, can provide generous acts of kindness as meaningful as those who paddle canoes upstream, give their own blood, and perform life-saving surgery.

Whether in the jungle or in a cozy suburban neighborhood, those who serve must consider giving to others more important than personal accomplishments and individual security. The standards for service are “How much can I give?” not,” How much can I get?” “What is right thing to do?” not, “What is the safe thing?” “What is the maximum possible?” not, “What is the minimum possible?”

From TimesOnline

When prolonging life becomes prolonging death

The case of one doctor this week illustrates an agonising dilemma

Melanie Reid

 

A hundred or so years ago the birth of a premature baby was just one small, visceral moment of everyday suffering.

Nature swiftly took its course; the doctor uttered grey, commonplace words; the mother turned her face to the wall.

Today the same event makes a deep ethical and economic imprint upon our society. The baby hovers between life and death, dependent on machines and drugs. Its mother and father spend months in limbo; its doctors inhabit a prison created by technology and parental expectation.

I wonder if modern doctors ever envy the less complex lives of their antecedents, men who never had to face the intellectual battle about prolonging life: that tyranny of “when”. When to switch off the machine, when to withdraw one drug, when to administer another, when to acknowledge that all that is left to do is to alleviate suffering.

Actually, it’s worse than that. Modern medicine is not just about prolonging life, it’s increasingly about prolonging death. The plight of Dr Michael Munro, 41, a consultant neonatologist accused of hastening the deaths of two terminally ill babies, goes directly to the heart of what is, I believe, the most pressing issue this ageing, baby-sparse society of ours faces.

We possess immense medical technology, but have not studied the moral consequences of having it. We are incapable of addressing the concept of a good death. And we are failing disastrously to nurture doctors who, to those ends, seek only to reduce the suffering of dying patients.

The case of Dr Munro, whose hearing before the General Medical Council’s fitness to practise panel runs all this week in Manchester, has big implications both for the profession and for the terminally ill: a condition that, as far as I aware, is universal enough to make the need for some compassionate pragmatism all the more pressing.

The consultant was caring for two very premature babies. Both Baby Y and Baby X were unable to breathe independently. One suffered significant heart problems, the other had a big brain haemorrhage. In both, separate, cases at Aberdeen Maternity Hospital the difficult decision was made, with the parents, to withdraw treatment.

The breathing tube was removed and a course of morphine was begun. The babies began to struggle to breathe, a normal part of the dying process known as agonal gasping. Were we Victorians, we would know this.

These days, however, how many of us are well versed in the dying process?

And how many of us imagine we could calmly nurse our child as it gasped its way to death, without crying out for succour?

Baby X’s parents asked Dr Munro to alleviate his suffering. The GMC was told that the doctor administered a drug that he told the parents “was on the verge of what society finds acceptable”.

In Baby Y’s case, Dr Munro did the same, injecting 23 times the normal dose of a muscle relaxant called pancuronium. Both babies died soon afterwards.

So was this “tantamount to euthanasia”, as the GMC’s lawyer has alleged? Or was Dr Munro merely a good man acting from the very highest motives to spare distress at the inevitable end of life?

What is very telling is that the mothers and fathers of babies X and Y “fully supported the doctor’s actions and were grateful to him”. The whistle-blower, significantly, seems to have been the nursing staff.

Within individual members of the medical profession, there is said to be considerable sympathy for Dr Munro. But the GMC, once aware that he stepped over the ethical line that divides the withdrawal of treatment from that of active intervention to hasten death, had to be seen to act. This is the harsh reality in postShipman times, where a vocal minority lurks, ever ready to portray doctors as potential murderers.

Among some in the profession, there is a feeling that Dr Munro made the mistake of treating the parents’ distress, rather than the child’s condition. He should, in an ideal world, have worked harder to prepare the parents for the process of dying.

Which may be true, but doctors do not live in an ideal world. They live in frantic, demanding real time.

The silent majority, past polls suggest, would not punish a doctor for reducing the suffering of someone who was going to die anyway. Most of us support some kind of compassionate euthanasia for terminally ill people who have made clear their wishes. Or – in the case of infants, who cannot make their wishes know – then we support the authority of their parents.

Very few people take the view that life, any sort of life, is always better than death, yet the latter approach is what is institutionalised in medical ethics, largely as a result of the blame society.

Doctors should, in general, conform to society’s wishes; I’m not at all certain they do so over the concept of not prolonging death. This is a divergence that will grow as the babyboomer generation faces up to decrepitude and dementia; and realises that undignified, lingering dying is far more terrifying than death itself.

We may detect some moves in the right direction. Fifteen years ago Dr Nigel Cox was convicted of attempting to murder a terminally ill patient who was howling in distress. He was reprimanded by the GMC and allowed to return to work. Today, significantly, Dr Munro’s case was not dealt with by police in the first instance, but by the GMC. We must hope that he too is allowed to continue his invaluable work.

More importantly though, we must start a debate, with the GMC and many others, to pin down the meaning of a good death.

PROLONGING LIFE, NOT DEATH

The 3.8 million United States seniors who celebrated their 85^th birthday before the year 2000 constituted the fastest growing segment of the population. By 2030, this group will number 9 million, and will swell to 19 million by 2050. The new focus on aging must go beyond extending the life span. Rather than delaying death, medical science must work toward prolonging a fully lived life.

Knowledge, knowing what to do in a certain situation, is the wisdom of God put into action.

v    Two types of knowledge

o      The physical, the intellectual, the worldly, the material, the temporal

o      The spiritual, the Godly, the eternal

§       For we fix our eyes not on what is seen but what is unseen. For what is seen is temporary, but what is unseen is eternal.

                                                                                       II Corinthians 4:18

v    Modern medicine—and in particular psychiatric medicine—has the opportunity to bridge the gap between intellectual knowledge and spiritual understanding--and in doing so encourage a dialogue between life and death decisions.

Created to Become Like Christ

God knew what he was doing from the very beginning. He decided from the outset to shape the lives of those who love him along the same lines as the life of his Son. The Son stands first in the line of humanity he restored. We see the original and intended shape of our lives there in him.

Romans 8:29 (THE MESSAGE)

MODERN WARS OF ISRAEL

v   The assassination of Tsar Alexander II in Russia in 1881 was blamed on the Jews

v   Some Jews fled to Palestine

v   1897 the First Zionist Congress advocated the establishment of a separate country for the Jewish people in Palestine

v   1917 Arthur Balfour, the British Foreign Secretary, issued the Balfour Declaration promising British support for the Jewish homeland

v   WW II, to win Arab support in fighting Germany, the British issued a White Paper limiting Jewish immigration to Palestine to 20,000 a year

v   After WW II Britain fought against Israeli immigration to Palestine

v   May 14 1948 Israeli Declaration of independence

v   May 15 1948 five Arab states—Egypt, Jordan, Iraq, Lebanon, and Syria attacked Israel and were eventually defeated

 v   1964 Palestine Liberation organization (PLO) was founded

v   May 1967 Six Day War Israel destroyed the attacking Arab forces wining the Golan Heights, the Sinai peninsula, Gaza Strip, and the West Bank

v   1972 PLO killed 11 Israeli athletes during the Munich Olympic Games

v   1973 Yom Kippur War—a surprise assault by the Egyptians won back some land that Israel had taken earlier

 

The first practical application for electricity

Benjamin Franklin, in 1749, experimented with using electricity to stun turkeys. Rather than stunning the turkeys, the turkeys were given too much electricity and were electrocuted. Franklin found that the meat from these turkeys was more tender. A quote from "The Private Franklin" by Lopez and Herbert, stated that, "Killing turkeys electrically, with the pleasant side effect that it made them uncommonly tender, was the first practical application for electricity."

Electrical stimulation is the application of low (50 to 100 volts) to high (400 to 550 volts) voltage of electricity to freshly slaughtered livestock (applied immediately after slaughter to up to 30 minutes after slaughter) to improve the tenderness of the meat and to cause the color, firmness, and marbling of the meat to be enhanced.

For more information check out:

Spiritual Growth

Spiritual growth is the process of replacing self-absorption with Christ-absorption. To become like Jesus we must fill our lives with his Word.

• All scripture is God-breathed and useful for teaching, rebuking, correcting, and training in righteousness. I Timothy 3:16
• Do not let this Book of the Law depart from your mouth but meditate on it day and night, so that you will be careful to do everything written in it. Joshuah 1: 8
• Blessed is the man who does not walk in the counsel of the wicked or stand in the way of sinners or sit in the seat of mockers; but his delight in in the law of the Lord and on this law he meditates day and night. He is like a tree planted by streams of water, which yields its fruit in season and whose leaf does not wither. Psalm 1:1-3
• Jesus said, "The words I have spoken to you are spirit and life." John 6:63

A New Treatment for Back Pain: The Proadjuster

When Chiropractors palpate your spine, they are checking for joint fluidity, motion and or rigidity. Improper motion effecting the nerve function is called a subluxation. In a similar fashion to palpation, the ProAdjuster can determine whether the vertebra's motion is too rigid or too fluid. 

     A light force is introduced into the vertebra to check motion, it is reflected back to the piezoelectric sensor, which measures the reflective force, sending it to the computer for interpretation. The ProAdjuster utilizes a precise oscillating force with uninterrupted motion. It is able to increase the mobility of the spinal segments by reducing or enabling motion in the abnormal areas. In other words, the ProAdjuster reduces subluxation by “unsticking” the joint.

By applying the ProAdjuster's resonant force impulses precisely to the affected areas, you will receive gentle, effective treatment to that specific area. This will relieve the pressure on the nerve, allowing the nerve to heal and restore the nerve's ability to transmit signals to and from the brain more freely--and, most important, relieve the pain!  For more information goggle: proadjuster lifestyle

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ECLAMPSIA

Preeclampsia is the development of high blood pressure and edema between the 20th week of pregnancy and a week after the birth of a child. Eclampsia consists of convulsive seizures or coma without any other cause for these symptoms. The cause is unknown. Treatment consists of control of blood pressure, magnesium sulfate, restoration of proper body fluids via IV infusion, and anti-seizure medication.

WOULD YOU LIKE TO ASK A QUESTION ABOUT ECLAMPSIA OR POST A COMMENT? 

ABANDONMENT

A girl was abandoned by her parents. The neighbors reported the parents gone. When to police found the child she was reduced to skin-and-bones (literally). She had a protuberant abdomen and looked like the starving kids you see pictured in National Geographic. She was subsequently adopted by a man and woman who sexually abused her. Despite these traumas she developed her musical talents, was popular in school, graduated from a major university, and was happily married for 23 years until her husband abandoned her for a younger women. She began drinking heavily and became addicted to prescription drugs.

WOULD YOU LIKE TO DISCUSS ABANDONMENT AND ITS CONSEQUENCES?

Self Mutilating Behavior

• An example  self-mutilating behavior is cutting the skin until blood has been drawn.
• Self-mutilating behavior is a symptom seen in both men and women with various psychiatric disorders, but the majority of those who self-mutilate are women with borderline personality disorder.

The most extreme case seen by this scribe was a man with insulin dependent diabes mellitus and end-stage renal disease requiring dialysis to maintain proper body fluids and salts, bit his fingers off.  

 WOULD YOU LIKE TO ASK A QUESTION OR MAKE A COMMENT ABOUT SELF-MUTILATING BEHAVIOR?

One-handed Division-I Basketbal Player

CEDAR CITY, Utah - It was a conversation with which Dax Crum was all too familiar.

Southern Utah University coach Roger Reid had called Crum into his office. And Crum knew exactly what was coming.

"I told him he could come out for the team, but the chances of playing were very, very slim," Reid said. "In my mind, I didn't think there was any chance he'd ever play. No way."

	Meet Dax Crum
Southern Utah provided us with team footage of the Thunderbirds' game with the University of Missouri-Kansas City, in which Dax Crum played 16 minutes, hit a 3-pointer and managed to make the opposition forget he was born without a right hand.

However, a half season into Reid's tenure at the school, Crum, who was born without a right hand, has forced his coach into playing him significant minutes.

The 6-foot-2 senior guard logged a career-high 16 minutes, made a 3-pointer and slowed down Missouri-Kansas City's leading scorer, Dane Brumagin, for much of the second half in a 63-60 loss earlier in the month.

"I've coached this game for a long time and they ought to build a monument of him," Reid said. "Dax is all about defying the odds and playing for the right reasons."

Crum was born without nearly his entire right hand. Just a tiny finger sticks out of his nub and is barely noticeable. Crum's parents were given the option of transplanting a toe to act as another finger, but they declined due to concerns with post-surgical rejection.

It's crazy, but many opposing players, coaches and fans are often shocked when told of Crum's handicap after watching him play or practice. UMKC sports information director James Allen was completely unaware throughout the entire game. Southern Utah assistant Ron Carling's wife had no idea after watching Crum play for nearly three weeks.

"Honestly, you can't even really tell he has a disability," said Brumagin, who is averaging 18.6 points per game. "You've got to treat him like everyone else. He's playing Division I basketball and he's a good player. He was right up there with anyone else who has guarded me this year, but he's pretty inspirational. It's amazing."

Crum, 23, was nudged into playing sports by his father, Richard, a former star at Kirtland Central in New Mexico.

"Honestly, when Dax was born, I was angry with God," Richard Crum said. "How can you send me a one-handed boy when you know my sons are going to be athletes?

"But he's taught me that you can do anything," he said. "He's changed my life in so many ways."

Richard and Valerie, who died of cancer a little more than three years ago, decided to go with shoelaces instead of taking the easy way out and buying Velcro sneakers for their son. Four-year-old Dax wasn't allowed to go to school until he was able to tie them on his own.

Once Dax figured it out, his two grandfathers were called into the room.

"Dax sat down in the middle of the floor and at the end, two old grandfathers had tears streaming down their eyes," Richard Crum said. "One of them, a World War II Navy veteran, said, 'You're my hero.'"

Dax Crum could have taken a Division I soccer scholarship, but he was determined to play D-I basketball. And he is. (Deb Hill / Special to FOXSports.com)

Not everyone was as supportive. Richard remembers one woman asking him to take his son away because Dax was scaring her daughter. Another wanted him to have Dax put his arm in his pocket. Little boys stared. Little girls squealed.

Richard and Valerie resisted hiding his handicap.

"It was an awkward situation," Richard said. "But for me to do it would have sent the wrong message."

Crum persevered, especially with his passion on the basketball court, where he earned all-star honors at BYU's camp when he was 12. However, the coach the following year hardly played Crum.

"They treated me like I was 3 years old," Crum said.

His father made certain that wasn't going to happen again. He took a teaching position at Kirtland Central and was also an assistant on the basketball team. When Dax wasn't in the high-school gym with his father, the two of them were in the nearby church working on his game.

Crum became a first-team all-state player at Kirtland Central, winning three state titles, and also starred in soccer, baseball and track. After either the second or third state crown, father and son just smirked at each other when the public address announcer asked everyone to give Crum a hand.

"The irony of it was huge," Richard Crum said. "I just nodded at Dax and he winked back at me."

Despite his success on the hardwood, there were no Division I suitors coming out of high school. He played two sports at Arizona Western Junior College while on a soccer scholarship.

Crum started the second half of his sophomore season for an Arizona Western team that was ranked No. 1 in the country and finished 31-3.

"When I first got there, it was 'good for him,'" Crum said. "Then I started taking some of their playing time and some of them weren't so happy. Nobody likes being beaten by the one-handed kid.

"There were some guys who loved me and others didn't think I deserved to be on the court," he said. "I heard guys saying, 'How good can you be? Dax took your spot.' I just let it go. I just go out and play."

After his two-year stint at Arizona Western, Crum turned down a D-I soccer scholarship at Dayton for an opportunity to play basketball as a walk-on at Southern Utah.

"I wanted to be a Division I basketball player," Crum said. "I wanted to do something that no one has done."

Crum played sparingly two seasons ago under former coach Bill Evans. He redshirted last season and wound up on the football team — as a kicker/punter who also played some cornerback.

Shortly after Reid, who spent seven seasons as the head coach at BYU from 1989-97, took the reigns, Crum decided he wanted to give it another try in his final season of eligibility.

 

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That's when Reid did everything in his power to shoot down the idea.

"I don't blame him. Every coach I've ever had worries about the same thing," Crum said. "If I put him on the floor, are they going to take advantage of him? I wonder if I was coaching me, would I put myself in the game?"

Then Reid watched Crum outwork all of his teammates in practice.

It's a remarkable sight, how much passion and energy he displays when he's on the court. His nickname at Arizona Western was "The Pest." At Southern Utah, they've dubbed him the "Dax-inator" because of his unwavering defensive prowess.

"It's a good thing now," said Southern Utah assistant Austin Ainge, who played against Crum when he was a player at BYU. "I like it as a coach, but I hated it when he was guarding me.

"The amazing thing is he can still go right," said Ainge. "He finds a way. He's clever."

In addition to his pestering defense, Crum is somehow able to make shots with consistency. He rests the ball on his nub, uses his left hand to shoot and is a legitimate 3-point threat with a quick release. He rarely drops a pass and his teammates are unable to take the ball away from him in practice despite only having one hand to dribble the ball.

"To tell you the truth, I didn't know he had one hand for the first three days," said Southern Utah senior forward Tate Sorenson. "He handles himself pretty good and it's not just a charity case. He can play."

"He's the best perimeter defender we have," Carling said.

Crum is also extremely open and light-hearted. One time prior to a soccer game, he walked out for rock-paper-scissors, which would determine what team started the game with the ball. When both players threw out their hands, Crum tossed out his right hand and chuckled.

At times when he's dribbling the ball up the court, he'll hold up his hand with the one finger, smile and yell "Four" to call a play. Crum still gets a kick out of opposing players' reactions in the postgame handshake line.

"It's funny," Crum said.

"He's the first one to make a joke about it," Sorenson said.

The letters have come in from young children and adults. One man lost his arm in a farm accident and wanted to know how Crum does everything. Others want to know how he cuts steak or ties his shoes.

"It just takes me a little time to figure it out my way," Crum said.

Crum is married, has a 3.7 GPA and is working on his MBA. The plan is for him to go into the financial world for a while — at least long enough to support wife Ashley's medical schools bills — before he goes into coaching.

Crum, who worked three jobs until he was given a scholarship by Reid for the second semester, didn't get off the bench in eight of the team's first 13 games.

"The past three years have been rough," Crum said. "I haven't really played. I'll go into a game for one or two minutes, have a turnover and say, "Why am I doing this?'"

Crum knows the answer.

"You work for a couple years just to get a chance," Crum said. "Once you get a chance, it's like, 'Wow.' Just those 16 minutes against UMKC were worth it all to me. That's how much fun it is."

Sunday Rounds

To hospital at o600. Patients still asleep. Woke them to find out how they were doing. Made notes quickly. Finished rounds in one hour. Usually Sunday rounds are perfunctory unless admissions or problem patients. Want to get to church and worship on Sunday. Great nurses. Can trust them to watch over patients and notify me of problems.

Sunday School lesson on hypocrisy. One cause of sin, not hypocrisy, is caused by wanting to follow the rules and having no contact with spirit. 

Read in National Geographic about Black Pharaohs, descendants of Ham via Cush.

W. called to report on back treatment. She is getting Proadjuster treatment from chiropractor. Going well. She believes in the spinal nerve maldistribution as cause of many illnesses. So does recorder. Much truth to acupuncture points and Chukkas. Not spiritual truth, but physiologic truth.

B. called excited that his BB team of 12 year-old boys won close game.

Happiness versus Joy

Happiness	Unhappiness	Joy
Red Lamborghini	Totaled Corvette with a $15,000 unpaid note	A walk in the park
Corner office in Petronas Towers	Windowless basement office	Contentment in all things
Night with a desperate housewife	Sexually transmitted disease	A wife of noble character
Executive power	Servitude	A willing and obedient heart
Fully funded 401-K	Bear market at retirement	Generosity
Fame and fortune	Harassed and helpless	Humble and grateful service
Tequila Sunrise	Hangover	A fruitful vine
Intelligent and knowledgeable	Ignorant and apathetic	Wise and discerning
Superiority	Inferiority	Selflessness
Possessing worldly things	Craving, lusting, boasting	A virtuous life
Pride in accomplishments	Arrogance and hubris	Warm-hearted appreciation

Noncompliance

Two admissions today. One was discharged yesterday. Went home to find she had been robbed of TV, Stereo, and money. Decompensated began to devil was inside her. This lady so washed out on drugs she has a vacuous appearance. Very flat and no life. Discharged her yesterday because we felt nothing else could be done. Thought that she might immediately return to drugs because cocaine is only substance that can bring life to her attitude. Sadly, every time she uses cocaine she depletes more dopamine from brain which only increases her apathy and craving. Had no money for drugs and decompensated. When go to hospital delusional and hallucinating with downcast gaze and no life in eyes.

Second admission was discharged about nine months ago. Said discharge meds helped a great deal, but never returned to MHMR to get a refill of meds and slowly developed delusions, suicidal thoughts, and voices telling her to kill self.

LYRICA IN THE TREATMENT OF FIBROMYALGIA

Lyrica, the first treatment for neuropathic pain associated with Diabetic Peripheral Neuropathy, is indicated for the management of Fibromyalgia, Postherpetic Neuralgia, and as adjunctive therapy for adults with Partial Onset Seizures.

CHARACTERISTICS OF FIBROMYALGIA

v    Core symptom of fibromyalgia is chronic widespread pain, associated with diffuse tenderness

v    Patients demonstrate pain on palpation in at least 11 of 18 tender points

v    Fibromyalgia is believed to be a dysfunctional hyperexcitability in pain processing

MECHANISM OF ACTION OF LYRICA

v    Although the exact mechanism of action is unknown, results from animal models indicate that the analgesic effects of Lyrica may be associated with the following functions:

ü     Lyrica crosses the blood-brain barrier to bind to the 2-delta subunit to close presynaptic calcium channels diminishing excessive neuronal activity.

ü     Decreases the release of the excitatory neurotransmitter glutamate

ü     Decreases substance P

ü     May work in the central nervous system to reduce the level of perceived pain

ONSET OF ACTION

v    Can reduce neuropathic pain and anxiety in one week.  

METABOLISM

v    No liver metabolism

v    Hepatic impairment mandates no dose adjustment

v    Lyrica is excreted renally 

v    Can be removed by hemodialysis.

Dosing recommendations

v    Initial dose = 75 mg. twice daily 

v    At week one as needed increase to 150 mg. twice daily

v    Maximum dose = 225 mg twice daily (450 mg daily)

v    Discontinue gradually over minimum of one week

o      Flat pricing across dosage strengths

SIDE EFFECTS

v    Dizziness

v    Somnolence

v    Cognitive slowing, difficulty concentrating, or poor attention span

v    Fatigue

v    Dry mouth

v    Blurred vision

v    Weight gain

v    Edema

v    Patients with a creatinine clearance of 30 to 60 mL/min had a greater incidence of discontinuation due to adverse reactions than patients with normal creatinine clearance

Consults

Called for consult at SJRMC. BHU, in Navasota is about 35 miles from SJRMC making consults difficult. About the only thing dreadful about the recorders job. Lady had complications from gastric stapling surgery June 2007. Has been in hospital taking care of multiple surgical complications for 6 1/2 months so far. Was depressed and crying when seen a couple of days before. Placed her on Geodon 20 mg IM feeling better, but can't keep giving injections. Having trouble sleeping. Discontinued IM Geodon and started on Seroquel 20 mg--very low dose to improve sleep and also workup to therapeutic dose for depression. Placed on Remeron for depressing which will also help with sleep. Meds had to be given via GI tube.

SMART GOALS

Goal directed planning provides a guideline for helping others. Goals can be achieved by following the SMART acronym:

o      Smart goals. The eternal question is this: Will we live to achieve our personal goals, comfort and pleasure, or will we establish goals that direct us toward serving God and others? The eternal way, the smart way, enables us to establish goals designed to use our talents, gifts, skills and abilities to serve others and honor God.

o      Measurable—Goals must be specific as “I will write from 6-7 AM Monday-Saturday.”

o      Achievable—Goals must be sensible. Anyone can write an hour daily if they are motivated.  

o      Realistic—Establishing a goal to write 8 hours daily is impossible unless you are Stephen King who writes from 8 AM to 5 PM each day.

o      Time oriented—An absence of a specific time to accomplish your goals makes measuring your progress impossible.

ANXIETY AND WORRY CAUSING PHYSICAL SYMPTOMS

Disorder	Symptoms	Examples
Somatoform Disorder	Physical complaints with no physical findings	·      Fibromyalgia ·      Hypochondriasis ·      Somatization disorder
Conversion Disorder	Anxiety/Anger converted into one symptom that cannot be explained by a medical condition	·      Paralysis of an extremity with normal reflexes ·      Pseudoseizures (false seizures) ·      Vomiting with no physical causes ·      Pain without physical findings ·      Blindness with pupils that dilate when exposed to light
Psychosomatic Illness	Physical illness in which emotional factors contribute	·      Ulcers ·      Most headaches ·      High blood pressure ·      Irritable bowel syndrome ·      Heart attack ·      Asthma