April 2021 – Go Retire Psychiatrist

Catatonia: Another Reason to Get the COVID-19 Vaccine

My wife and I have been immunized against COVID-19 and we recognize that people can be hesitant about getting vaccinated. However, I’m remembering my last few months prior to my retirement a year ago working as a general hospital psychiatric consultant and I saw one or two cases of catatonia in the context of COVID-19 infections.

Catatonia is a complex, potentially lethal neuropsychiatric complication of many medical disorders including COVID-19. It can make a person mute and immobile, often making health care professionals mistake it for primary psychiatric illness (for example, catatonic schizophrenia). You can access a fascinating educational module on the National Neuroscience Curriculum Initiative (NNCI) website about catatonia and how it can be associated with COVID-19.

Catatonia can kill people, rendering them unable to move or eat, leading to blood clots and dehydration among a host of other complications. You’ve seen the news stories about blood clots being an extremely rare but deadly side effect of the Johnson & Johnson COVID-19 vaccine. The risk for blood clots is actually higher from COVID-19 infection itself compared with the very low risk from the vaccine.

I made a YouTube video about catatonia and other neuropsychiatric emergencies and that presentation continues to be viewed fairly often. You’ll want to crank up the volume.

I wrote a blog post about catatonia in the setting of delirium a couple of years ago and the information in it is still relevant below.

Catatonic patients may have a fever and muscular rigidity that leads to the release of an enzyme associated with muscle tissue breakdown called creatine kinase (CK). The level of CK can be elevated and detectable on a lab test.

Many patients will have a fast heart rate and fluctuating blood pressure. They may sweat profusely which can lead to a sort of greasy facial appearance. They may have a reduced eye blink rate or seem not to blink at all. They may display facial grimacing.

The patient may exhibit the “psychological pillow” (some call this the “pillow sign”). While lying in bed, the patient holds his head off the pillow with the neck flexed at what looks like an extremely uncomfortable angle. The position, like other odd, awkward postures can be held for hours.

Catatonia can be caused by both psychiatric and medical disorders. It tends to be more common in bipolar disorder than in schizophrenia even though catatonia has historically been associated with schizophrenia as a subtype. You can also see it in encephalitis, liver failure, and in some forms of epilepsy and other medical conditions—to which we can now add COVID-19 infection.

The patient may perseverate or repeat certain words no matter what questions you ask. He may simply echo what you say to him and that’s called “echolalia”.

Although catatonic stupor is what you usually see, less commonly you can see catatonic excitement, which is constant or intermittent purposeless motor activity.

The usual way to assess catatonic stupor in order to distinguish it from hypoactive delirium is to administer Lorazepam intravenously, usually 1 to 2 milligrams. A positive test for catatonic stupor is a quick and sometimes miraculous awakening as the patient returns to more normal animation. The reaction is usually not sustained and the treatment of choice is electroconvulsive therapy (ECT), which can be life-saving because the consequence of untreated catatonia can be death due to such causes as dehydration and pulmonary emboli.

Another less invasive test that doesn’t use medicine is the “telephone effect” described in the 1980s by a neurologist, C. Miller Fisher. It was used to temporarily reverse abulia or akinetic mutism, which in a subset of cases of stupor are probably the neurologist’s terms for catatonia. Sometimes the mute patient suffering from abulia can be tricked into talking by calling him on the telephone. It’s pretty impressive when a patient who is mute in person answers questions by simply calling him up on the telephone just outside his hospital room.

So that, in my opinion, is yet another reason to get the COVID-19 vaccine.

Hey, How About Them Nielsen Surveys?

Hey, how ‘bout them Nielsen’s surveys? I can’t remember getting any Nielsen media rating surveys before I retired and I’ve gotten two of them since then. They send you a crisp, new dollar bill in the mail to entice participation. More likely, it elicits guilt. You’d return the dollar bill but not in the mail, would you? Is this some kind of rite of passage or what?

Technically, you’re not supposed to talk about whether or not you participated in the survey, but I saw one blogger’s post about his radio diary survey. Is there a penalty for admitting you’re a part of “Nielsen Family”? Are there Nielsen Enforcers who come to your house and break your kneecaps while listening to the Godfather soundtrack through their earbuds if you don’t obey the rule?

One white commenter thought Nielsen just targets old white guys for some reason. Then a black commenter pointed out that Nielsen mails the surveys to old black guys too, so it didn’t have anything to do with skin color—and he did it with a sense of humor. He speculated that Nielsen might just target grouchy old retired guys with strong opinions because we remember what the value of a dollar bill was back in the day.

It reminded me of what I used to listen to on the radio in my younger days. Back then, the radio was what you had to use to listen to music. Well, there was a TV music show called American Bandstand, hosted by Dick Clark. The format was pretty much young couples dancing to the latest tunes while the camera panned over the dancers randomly. I remember watching it one day and noticing the camera was moving a lot less randomly and kept focusing on a young blonde woman in the crowd in the middle of the dance floor. That is, it did until she made a very lewd gesture which immediately led to a return to very random camera meandering—and possibly higher Nielsen ratings.

I listened to the radio a lot when I was a kid. One of the local radio stations was KRIB, which the announcer always pronounced “K-OW-I-B because he talked so fast. Many of the songs were bad, so bad that a humorist named Dave Barry published a book about it in 1997, Dave Barry’s Book of Bad Songs. He’s a Miami Herald newspaper columnist who has written a lot of funny books. I had nearly all of them at one time, including the bad songs book. I have only a few now, including an autographed copy of one about getting older, Lessons from Lucy (2019).

One of the worst songs in my opinion was a 1976 tune “Blinded by the Light” by Manfred Mann’s Earth Band. It’s actually a cover of a song by Bruce Springsteen. I kept hearing a lyric I definitely thought was “wrapped up like a douche,” which I swear I never shared with anybody nor looked up on the web (or as Dave Barry would say, “I swear I am not making this up.”) until just today to discover I’m far from the only person to hear that. I also found out that kind of error is called a “mondegreen” (a mishearing of a phrase in a way that gives it a new meaning). The actual lyric was “revved up like a deuce.” That was the kind of bad song Dave Barry wrote about—although I don’t remember that specific song being in his book.

Nowadays I listen to KCCK (88.3 FM) for blues and jazz. Years ago, I used to listen to Da Friday Blues show starting at 6:00 p.m. every Friday. It was hosted by John Heim, who is still doing the show, even after a devastating accidental neck injury which left him paralyzed from the neck down a few years ago. He was hospitalized at The University of Iowa and his family and friends donated a lot of money to help him get to a rehab center in Omaha, Nebraska. John actually retired from teaching in 2004, but has been a DJ at KCCK for years because music means so much to him. He’s a brilliant example to retirees everywhere.

There’s a lot more to radio than Nielsen ratings, no disrespect to Nielsen Families everywhere—and just a reminder, I have no kneecaps worth breaking.

Busy as a Beaver

I’m probably busy as a beaver, especially now that I’ve read a short description of how a beaver builds a dam. The article is short on references; in fact, there are none to back up the unidentified author’s remarks. In fact, I suspect the article is fact-free, the only apparent purpose to create test questions for grade-school children.

The author says that, while beavers are busy when engaged in tree felling and dam building, they are disorganized, poor at planning the activities and often mess them up—even accidentally getting killed by falling timber.

By analogy then, since I retired last year, I’ve been about as busy as a beaver. When my frame of reference was working at the hospital as a consulting psychiatrist, I was extremely busy. I put on 3 to 4 miles and about 30 floors a day chasing consults all over an 800-bed hospital with 8 floors.

Now my typical day is very different. Staying physically fit is challenging. I exercise daily, but it’s hardly as demanding as when I was working. I start off with floor yoga to warm up. I hop on the stationary bike, which is not a Peloton or anything like it. There’s nobody in the display exhorting me to crush that Peloton. The digital mileage counter display doesn’t even work.

Next, I do bodyweight squats. My ankle and knee joints crackle and pop loudly, but as long as they don’t hurt, I imagine I’m fine. Next, I do curl and press exercises with a pair of 10-pound dumbbells. Then I do planks. After 3 sets of squats, etc., I get back on the bike. Following the exercises, I sit for mindfulness meditation. That whole business takes about an hour.

As far as beaver busyness, the only time I felled any timber was last summer, when I flirted with danger using a power pole saw trying to clear dead tree limbs left over from the derecho. That actually was a poorly planned activity and was certainly dangerous. I guess I was busy as a beaver then.

Is there such as a thing as being mentally busy as a beaver? Apparently not. Sena and I play cribbage now and then. Other than that, there’s always TV. I listen to music on the Music Choice Channel on TV. I like the Easy Listening and Light Classical stations. Each musical artist featured has several short biographical notes appear while the music plays. I practice doing mental subtractions when the artist’s birthdate appears. It’s the old borrowing method of subtraction you learn in grade school—unless nobody teaches that anymore. There are usually several grammatical and usage problems (worse than mine) with the information about artists and I practice recasting sentences. Sometimes they’ll mention a musician’s nickname, such as BullyboysquatlowjoocedewdliosityBrahms. Several of the classical musicians composed symphonies before they were potty-trained.

On the practical side, I watch the Weather Channel, following which are shows like Highway Thru Hell and Heavy Rescue 401. Those guys are really busy, dragging semi-trucks out of ditches in snowstorms in British Columbia. They operate 75-ton wreckers with rotating booms and winches which regularly spit their cables at anyone nearby.

I alternate the heavy wrecker shows with the Men in Black (MIB) movies, which poke fun at the UFO and alien themes (a welcome counterpoint to Ancient Aliens which takes itself too seriously). I was sure I was watching MIB movies way too much until I found all of the fans’ contributions to websites which list the many errors in the movies. Just google “MIB goofs.” You’ll see the triumphant announcement from those who somehow know what color scheme New York City streets signs had in 1969 and point out how wrong the movie is. On the other hand, I know what kinds of pies young Agent K and Agent J had in MIB 3 (apple with a “nasty piece of cheddar” and strawberry rhubarb, respectively).

I guess all this makes me busy as a beaver.

Updated CDC Guidelines: When You’re Fully Vaccinated

See today’s updated guidelines from the CDC about what activities are safer once you’ve been fully vaccinated.

Reflection on James Alan McPherson’s “A Solo Song: For Doc”

I’ve been reading the short story collection Hue and Cry by James Alan McPherson with the idea that the entire book was new to me. So, I was stunned when I remembered the story, “A Solo Song: For Doc.” It has more than one layer of meaning, but on one level it’s about a Black railroad train waiter named Doc Craft who is forced into retirement. The narrator tries to teach a young waiter he calls youngblood learning the ropes about how the old school waiters made their work not just a job but a way of life. I was surprised to learn there was a television adaptation of the story made in 1982.

I must have read it in an anthology when I was a youngblood myself. It’s about racism but it’s also about aging, retirement, and change itself. It makes sense that I would feel differently about the story now that I’m older and retired.

I’m about a year into my retirement now and it has not been easy to adjust. Boredom and the search for a new meaning and purpose in my life still challenge me. While racism did not play a part in my decision to leave my profession, there is no doubt that things changed over my three-year phased retirement starting in 2017, dramatically so since the COVID-19 pandemic in 2020.

I thought I was still maintaining my skills as a psychiatric consultant in the general hospital. I was physically fit, in many cases better able to run up and down the stairs for 8 flights than the youngbloods. When they asked me why I became a consulting psychiatrist, I often told them that I “did it for the juice.” I guess that’s why Doc Craft did it.

Maybe I retired because I didn’t want to be pushed out. Doc Craft didn’t retire because he just wasn’t made for it. Sometimes this doc wonders….

Virtual Information Sessions On Covid-19 Vaccines Update

Just some quick thoughts on the Virtual Information Session on COVID-19 Vaccines, Session 2 on 4/19/2021. This was another enlightening presentation. I just noticed that you’ll have to scrub forward to about 10 minutes and 30 seconds to start playback on the YouTube recording. This gap might be edited out in the near future.

It’s worth noting that the risk for getting blood clots from COVID-19 infection is greater than the risk for getting them from the vaccines, according to Dr. Pat Winokur, University of Iowa and Dr. Caitlin Pedati, IDPH. There were other educational answers to very good questions from the audience.

Don’t forget the third session on Saturday, 4/24/2021 at 10:00 a.m. in Spanish only for the YouTube event while the WebEx event will be a bilingual event. See this link for full details.

Virtual Information Sessions on Covid-19 Vaccines

There will be three live, free, virtual information sessions on the COVID-19 vaccines starting today at 10:00 a.m. Guest speakers include Pat Winokur, MD, Executive Dean, Carver College of Medicine; Institute for Clinical and Translational Science (ICTS); Professor of Internal Medicine–Infectious Disease. The third session will be available in Spanish. The sessions are scheduled for April 17, 19, 24.

Addendum: The first presentation this morning was very informative and a recording of it will be available at the link above.

Addendum: The video recording of today’s event doesn’t start until about 8 minutes and 27 seconds after you click on the start play button, so you can scrub ahead to that point to avoid the wait.

Addendum: This afternoon around 3:00 PM when I looked at the video recording the lag time problem on startup had been fixed.

Imagination Lives in Oakland Cemetery

We don’t usually make trips to Oakland Cemetery (or any cemetery for that matter), but today we made an exception to find the grave of James Alan McPherson, the first African American to win a Pulitzer Prize for fiction and longtime Iowa Writers’ Workshop faculty who died in 2016 and for whom an Iowa City park was renamed a month ago.

We never met McPherson, although we are reading a couple of his books (Elbow Room, the Pulitzer Park winning work, and Hue and Cry) and just visited the James Alan McPherson Park on Monday this week.

This trip brought back happy memories right away. It’s not the first time we’ve been to Oakland Cemetery. In 2015 and 2016 we took the same route, parking at Happy Hollow Park on Brown Street and walking east to find the Black Angel. The main reason for going to Happy Hollow Park back then was not so much to see the Black Angel, but for two Psychiatry Department Faculty vs Resident Matball games at Happy Hollow Park. Matball is an imaginative combination of kickball and baseball using large mats for bases and a kickball for pitching, which the hitter actually kicks and runs the bases.

I was on faculty but didn’t play, which I thought would help them win. It was very hot both years. Faculty lost both years. There was another match in 2017 which I didn’t attend, and which I think faculty also lost.

But it was great fun. I don’t remember who put the 2015 trophy won by the residents in a bowl of red (possibly strawberry, I didn’t eat any) Jell-O. That took imagination. It was a stroke of genius, but was not repeated after the following two losses. There have been no Matball games since then.

Anyway, we visited the Black Angel. I think I left some loose change at the foot of the sculpture, which is traditional I think, for good luck. The Black Angel has a very complicated story, which is in many cases, fueled by superhuman imagination. The stories get more complicated every year and the legends have been developing since the 9-foot statue with 4-foot pedestal was created in 1912.

Actually, the Black Angel is often used as a point of reference for the rest of the cemetery. That’s how we used it today to find McPherson’s grave, which is said to be in a place called the poets’ corner where many other artists, including Writers’ Workshop faculty, are buried.

The easiest way to find the Black Angel is probably to approach the cemetery from the west and head east to the intersection of Brown and Governor Streets, where there’s a big sign for Oakland Cemetery. There’s a map next to the cemetery office. We could not find any place marked “poets’ corner.” But the Black Angel is clearly marked.

You’ll notice you can drive through the cemetery, but the paved road is about the width of a car. It’s actually more like a service road, just right for riding mowers, but a little narrow for cars. There is no parking lot we could find, which is why we parked at Happy Hollow Park.

As you reach the Black Angel, you’ll notice one of her wings is raised at a right angle from her body. It points roughly North. You need to go in the opposite direction to find poets’ corner. As you pass the Black Angel, take the second path to the right and simply follow it around, moving south past the University of Iowa Deeded Body Program monument to a section marked with a narrow post labeled “Oak Green.” That’s where you’ll find McPherson’s headstone.

The headstone is easy to pick out; it’s an imaginative work of art. The black rectangular stone is decorated with clever sculptures including his signature car cap, two roses, and even a cigarette in an ashtray. He was a smoker. I don’t know what the characters on the pedestal mean.

On the back of the stone are many carved envelopes indicating McPherson’s mail correspondence with many loving friends and family—and beyond. There is a sense of humor and imagination here too. One of the envelopes is from “Publisher’s Clearinghouse” and the recipient section says “ATTENTION: You may have already won $1,000,000!” I can just picture Ed McMahon! Another is from “Fabian’s Seafood Truck” to “Our Loyal Customer.” I didn’t realize it while we were there, but when we got home, it occurred to me that as we were driving home from James Alan McPherson Park, we saw a big refrigerated truck where seafood was being sold; it was next to the Dairy Queen on Riverside Street. I searched Fabian Seafood on the web and found a picture that exactly matched what we saw.

Around the edge of the headstone was an inscription that to read in its entirety you have to walk all the way around the monument because the words are carved in the front, sides and back:

“I think love must be the ability to suspend one’s intelligence for the sake of something. At the basis of love therefore must live imagination.” This is a quote from McPherson. He also wrote in his essay “Pursuit of the Pneuma” about “an ancient bit of spiritual wisdom” which denies that God rested on the seventh day after creating all existence. Instead, God created imagination and gave this gift to his human creations, enabling us to wield an integrative kind of power—which is what love can do.

Imagination therefore lives in Oakland Cemetery.