I'm a retired consult-liaison psychiatrist. I navigated the path in a phased retirement program through the hospital where I was employed. I was fully retired as of June 30, 2020. This blog chronicles my journey.
This is just my presentation on eating disorders vs disordered eating for a Gastrointestinal Disease Department grand rounds several years ago. What’s also helpful is an eating disorder section on the National Neuroscience Curriculum Initiative (NNCI) web site. I left comments and questions there, which the presenter answered.
In addition, the Academy of Consultation-Liaison Psychiatry (ACLP) has an excellent web site and here is the link to a couple of fascinating presentations from the ACLP 2017 annual meeting on management of severe eating disorders, including a report on successful treatment using collaboration between internal medicine and psychiatry.
If you can’t find it from the link, navigate to the Live Learning Center from the ACLP home page and type “eating disorder” in the search field. One of the presentations is entitled “Has She Reached the End of Her Illness Process.” The other is entitled “Creating Inter-Institutional Collaborative Care Models.”
This is a very complex area of medicine and psychiatry. There are no simple solutions, although many experts across the country are hard at work on finding practical solutions.
The caveat is that the information here is not updated for recent changes in the literature.
Taken from the CDC ACIP meeting on 9/01/2022, here is the link to the CDC Interim Clinical Considerations for the Covid-19 Vaccines: Bivalent Boosters.
The University of Iowa Hospital & Clinics has information on the facts and expected availability of the new bivalent Omicron Covid-19 vaccine boosters.
Okay, the update on the Mayo vs Miracle Whip thing is not going as planned so far. A couple of days ago, we had tuna fish sandwiches using Miracle Whip.
This was not the Miracle Whip I knew growing up. Neither of us could appreciate much of a taste at all. It’s a crisis.
Even the label on the jar looks strange. Since when does Kraft call it “Creamy Mayo & Tangy Dressing?” Why do they need to use the word “Mayo?” And it didn’t have the tangy flavor I remember.
This is all because of aliens. I’m pretty sure this is a violation of the Intergalactic Federation for Preservation of Tanginess Standards (IFFPOTS). Look it up.
I never made Miracle Whip sandwiches with just Miracle Whip on two slices of bread. I also had a slice of lunch meat on them. In fact, I ate one Miracle Whip nitrate-rich lunch meat sandwich a day for lunch for years. Its’ a good thing scientists discovered that nitrates aren’t bad for you.
But the point is the Miracle Whip tasted tangy back in those days. What happened?
Maybe it’s because my taste buds are older. More likely it’s because aliens kidnapped me and altered my taste buds. Or maybe they altered the Miracle Whip itself.
We’re not done yet. There are other recipes to try.
I just read Dr. George Dawson’s post “Happy Labor Day” published August 31, 2022. As usual, he’s right on the mark about what makes it very difficult to enjoy psychiatric practice.
And then, I looked on the web for anything on Roger Kathol, MD, FACLP. There’s a YouTube video of my old teacher on the Academy of Consultation-Liaison Psychiatry (ACLP) YouTube site. I gave up my membership a few years ago in anticipation of my retirement.
I think one of my best memories about my psychiatric training was the rotation through the Medical-Psychiatry Unit (MPU). I remember at one time he wanted to call it the Complexity Intervention Unit (CIU)—which I resisted but which made perfect sense. Medical, behavioral, social, and other factors all played roles in the patient presentations we commonly encountered with out patients on that unit where we all worked so hard.
Dr. Kathol made work fun. In fact, he used to read selections from a book about Galen, the Greek physician, writer and philosopher while rounding on the MPU. One day, after I had been up all night on call on the unit, I realized I was supposed to give a short presentation on the evaluation of sodium abnormalities.
I think Roger let me off the hook when he saw me nodding off during a reading from the Galen tome.
Dr. Dawson is right about the need to bring back interest, fun and a sense of humor as well as a sense of being a part of what Roger calls the “House of Medicine.” He outlines what that means in the video.
What made medicine interesting to me and other trainees who had the privilege of working with Roger was his background of training in both internal medicine and psychiatry. He also had a great deal of energy, dedication, and knew how to have fun. He is a great teacher and the House of Medicine needs to remember how valuable an asset a great teacher is.
The CDC ACIP will meet today and tomorrow about the Covid-19 Vaccine Omicron Bivalent Booster candidates from Pfizer and Moderna. A vote is expected this afternoon.
Update: The committee voted by a majority to upvote the approval of the Pfizer and Moderna bivalent boosters this afternoon. There was one dissenting vote because there was no clinical data to present. There was a clinical study using the bivalent vaccine booster, but results would not have been available until November or December.
However, there was a complicated statistical predication model which showed that if the boosters were rolled out this month, many thousands of hospitalizations and deaths could be prevented as opposed to waiting a few more months. That got prioritized in order to approve the boosters now rather than wait for the clinical study results.
There was a lot of concern about the packaging of the boosters resembling other boosters which might lead to mistakes in administration. Pfizer has a booster vial that looks very similar to that of their bivalent Omicron booster, unless you closely read the tiny print on the vial which says it’s BA.4/BA.5.
The committee voted to cancel tomorrow’s meeting since they completed the goal today.
Dr. H. Steven Moffic discussed the issue with psychiatric polypharmacy in his August 29, 2022 entry on Psychiatric Views on the Daily News. The patient who had been getting 10 psychotropic drugs was found to have a medical problem ultimately, which led to simplification of the complex regimen.
This is a great opportunity to again mention the value of what was a regular part of the teaching component of the University of Iowa Hospital Consultation-Liaison Psychiatry service, at least until my retirement. This was the Clinical Problems in Consultation Psychiatry (CPCP) seminar. Once a week or so, when I was staffing the service, I and the trainees, which included medical students, and psychiatry residents as well as Pharmacy, Neurology, and/or Family Medicine residents.
Whenever we encountered a difficult and interesting case, which was almost every rotation, the trainees did a literature search to bone up on the clinical issue and gave a short presentation about it before consultation rounds. Often the case had both medical and psychiatric features.
I looked through my collection of student presentations and found one that might fit Dr. Moffic’s example in a general way. Medical problems can often look like psychiatric problems, which can include thyroid and other diseases. A very important one is autoimmune encephalitis, one example of which is anti-N-methyl-d-aspartate (NMDA) receptor encephalitis. There is an excellent summary of it in the August issue of Current Psychiatry entitled Is it psychosis, or an autoimmune encephalitis? (Current Psychiatry. 2022 August;21(8):31-38,44 | doi: 10.12788/cp.0273).
Several years ago, three medical students tag-teamed this topic and delivered a top-notch CPCP seminar summarizing the pertinent points. I hope the CPCP is still part of the educational curriculum.
The CDC ACIP have an agenda posted indicating that the advisory committee will discuss Covid-19 Bivalent Omicron vaccine candidates on September 1-2, 2022. A vote is scheduled on September 1, 2022.
Historically Black Colleges and Universities (HBCU) are in the news lately. It reminds me of the short time I spent at Huston-Tillotson College. It was renamed Huston-Tillotson University (H-TU) in 2005. I was there in the mid-1970s.
A new President and CEO was just named this month, Dr. Melva K. Williams. And H-TU was recently added to the National Register of Historic Places last month. It has been renovated and modernized. Pictures show a well-kept campus pretty much as I remember it over 40 years ago. I didn’t graduate from H-TU, but instead transferred credits to Iowa State University where I graduated in 1985.
My favorite teacher was Dr. Jenny Lind Porter-Scott, who was white, taught English Literature. Another very influential teacher was Reverend Hector Grant who was black. He taught philosophy and religion. He was instrumental in recruiting me to matriculate at H-TU. He helped me to process my loss on the debating team when the question was whether or not the death penalty played any role in the reduction of crime.
My opponent won the debate mainly because he talked so much, I couldn’t get a word in edgewise. I can’t remember which side of the question I argued, but I thought I could have done better if he had just shut up for a few minutes and let me speak. Reverend Grant used the word “bombastic” in describing the approach my opponent used. On the other hand, he also gently pointed out that sometimes this can be how debates are won.
There’s this “On the other hand” tactic in debating and in reflective thought that my debating opponent managed to repeatedly deflect.
I don’t know what ever happened to Reverend Grant. We spoke on the telephone years ago. He sounded much older and a hint of frailty was in his voice.
I could find only a photo on eBay of a man who closely resembles the teacher I knew and the name on the picture is Reverend Hector Grant. The only other artifact is a funeral program for someone I never knew, which lists Reverend Hector Grant as being the pastor and some of the pallbearers were members of one of the Huston-Tillotson College fraternities.
I think it’s unusual for people to disappear like that, especially nowadays when we have the world wide web. Reverend Hector Grant was an important influence for me. He was one of the few black men of professional stature I encountered in my early life.
On the other hand, contrast that with Reverend Glen Bandel, another clergyman who was a white man and another important influence starting in my early childhood. Reverend Bandel persuaded me to be baptized at Christ’s Church in Mason City, Iowa. He radiated mercy, generosity, and kindness. He died in June of this year. I can find out more about him on the web just from his obituary than I can ever find on Reverend Grant, who apparently disappeared from the face of the earth.
Both of these men were leaders for whom skin color didn’t matter when it came to treating others with respect and civility.
My path in life was largely paved by these two clergymen. Reverend Bandel sat up with our family one night when my mother was very sick. His family took me and my little brother into their home when she was in the hospital.
On the other hand, Reverend Grant was instrumental in guiding me to an HBCU where I saw more black people in a couple of years than I ever saw in my entire life. The First Congregational Church in Mason City was instrumental in making that possible because they helped fund the drive to support H-TU (one of six small HBCUs) by the national 17/76 Achievement Fund of the United Church of Christ.
The news is replete with stories, some of them tragic, about how Greek fraternities haze their pledges. On the other hand, H-TU was pretty rough on pledges too. Upper classmen would make the pledges roll down the steep hills around the campus. They looked exhausted, wearing towels around their necks, running in place when they weren’t running somewhere in the Texas heat.
One H-TU professor said that H-TU was “small enough to know you, but big enough to grow you.” Although I can’t remember ever seeing him on campus because he was traveling most of the time, I at least knew the name of the President was John Q. Taylor (1965-1988). On the other hand, when I transferred credit to Iowa State University, I never knew the name of the President of the university.
Habari Gani is Swahili for “What’s the news?” or as it translated in the context I’m about to set, “What’s going on?” Habari Gani was the name for the annually published book of poetry by the H-TU students. Dr. Porter supported the project. I submitted a poem for the 1975 edition, which didn’t make the cut. When I transferred to Iowa State University, I left without getting a copy.
On the other hand, years later, I got a digital copy of that edition. I tracked it down to the H-TU library in 2016. The librarian was gracious.
Habari Gani has always been a reminder of the reason why I went to H-TU in the first place. I grew up in Iowa and was always the only black student in school. I grew up in mostly white neighborhoods.
On the other hand, when I finally got to H-TU, one of the students asked me, “Why do you talk so hard?” That referred to my Northern accent, which was not the only cultural factor that made social life challenging.
Once I tried to play a pickup game of basketball in the gymnasium. I’m the clumsiest person for any sport you’ll ever see. I was terrible. But the other players didn’t give me a bad time about it. They softly encouraged me. This was in stark contrast to the time I played a pickup game with all white men years before in Iowa. When I heard one of them yell, “Don’t worry about the nigger!” I just sat down on the bleachers.
On the other hand, when I was a kid and our family was hit by hardship, Reverend Bandel was the kindest person on earth to us—it didn’t matter that he was white. And my 2nd grade teacher, who was black (the only black teacher I ever had before going to H-TU), slapped me in the face so hard it made my ears ring—because I was rambunctious and accidentally bumped into her. It’s far too easy to polarize people as good or bad based on the color of their skin, especially when you’re young and impressionable.
It takes practice and experience to learn how to say and think, “On the other hand….”
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