James Amos

Shout Out to the European Delirium Association

I just want to give an enthusiastic shout out to the European Delirium Association (EDA). I rediscovered the website. It’s updated and an extremely helpful organization in the study of delirium. It provides excellent education about the disorder.

I met one of the past presidents of the EDA, Alasdair MacLullich back in the early 2010s. In fact, while I was staffing the University of Iowa Hospital consultation-liaison service, he was generous enough to send us one of the pieces of technology which was designed to test for delirium: The Edinburgh Delirium Test Box or Delbox.

I wrote a blog post years ago about the EDA. At that time, the group published a newsletter called the Annals of Delirium. Here’s an excerpt from one of the issues in 2010:

Delirium has a long way to go before it gets the attention it deserves, before it is present in the public consciousness in the way cancer is, or even HIV. Bearing in mind the prevalence of delirium and the impact it has on patients and families we may believe it is only a matter of time, but I believe that the process is going far too slowly. Some countries are doing better than others and some areas of medicine are making greater inroads, which can only benefit us all in the long run. In the UK, however, if you search for delirium on the BBC website you are directed to the music page and the group Delirium Tremens.

I remember thinking that the anecdote reminded me of how that sounded a lot like the way things were going in the United States at that time.

And the EDA announcement about the new delirium organization in the U.S. that was just getting it’s start around that time, in 2011—the American Delirium Society (ADS).

There are educational videos about delirium on the EDA website and I’m excited to learn more about them.

Further, there was a sort of word search game I rediscovered that was made by the EDA. Some of the words are on the diagonal. Give it a shot! I finished it, but it was very challenging. If you need the key, please comment.

Gratitude to Pastor Robert Stone

I came across a couple of items that prompted my renewed gratitude. One of them was an article in Bloomberg on the web, “US Medical Schools Grapple With First Admissions Since End of Affirmative Action” by Richard Abbey, Ilena Peng, and Marie Patino, published on December 14, 2023. It’s about how hard it is for black students to get into and graduate from medical school. Just getting to college is a major hurdle.

The other item is an obituary of one of the most important persons in my life, Pastor Robert Leroy Stone. He authorized scholarships for two years of my undergraduate college education, which were at Huston-Tillotson College (now Huston-Tillotson University, one of the HBCUs) in Austin, Texas. That was back in the 1970s, ancient history now. The issue of Affirmative Action was widely discussed during that time.

As usual, I’m dumbfounded by how often I miss the passing of the critically important people who made my success in life possible. And there is this astonishing connection which followed me even to Iowa City—but of which I was unaware. After he retired, Pastor Stone moved from Mason City to Iowa City in November of 2001. At that time, I had graduated from The University of Iowa College of Medicine, finished my residency in psychiatry in 1996, and was on staff in University of Iowa Dept of Psychiatry. I never knew he was so close. He died in 2002.

Pastor Stone was a Board Member and Chair of the Mason City YMCA, where I lived for a while. He was also a Member of the Board of Chemical Dependency Services of North Iowa as well as the Mental Health Center of North Iowa.

Although I didn’t graduate from Huston-Tillotson College, I was able to transfer credit to Iowa State University. And from there I went to medical school at The University of Iowa.

I’ve read other stories about how hard it is for Black students to get into and finish medical school. My path was indirect and not easy, but Pastor Stone made it possible. And for that, I am grateful.

CDC Issues Health Alert Network Announcement Recommending Vaccinations for Seasonal Respiratory Illnesses

The CDC recently issued a Health Alert Network (HAN) announcement urging physicians to recommend that patients get their influenza, Covid-19, and RSV vaccines.

Time for Another Blast from the Past

I found an interesting blog post from my previous blog, The Practical Psychosomaticist. I wrote it in 2011 and it’s about the patient experience of delirium. I was delirious briefly after a colonoscopy many years ago. I don’t remember much about it. But from what Sena tells me about it, it was similar to other delirium episodes I’ve seen in the hospitalized medically ill. Thankfully, it was not severe.

“Recalling the Experience of Delirium: The Delirium Experience Questionnaire (DEQ)

Have you ever been delirious and recalled the experience? Many patients do and they usually are frightened by the experience which can be marked by delusions and hallucinations that are remembered as fragments of a harrowing nightmare. This has been studied by Breitbart, et al using an instrument they developed called the Delirium Experience Questionnaire (DEQ). In the article there’s a description of the scale:

The DEQ is a face-valid, brief instrument that was developedby the investigators specifically for this survey study andassesses recall of the delirium experience and the degree ofdistress related to the delirium episode in patients, spouses/caregivers,and nurses. The DEQ asks six questions of patients who haverecovered from an episode of delirium including: 1) Do you rememberbeing confused? Yes or No; 2) If no, are you distressed thatyou can’t remember? Yes or No; 3) How distressed? 0–4numerical rating scale (NRS) with 0 = not at all and 4 = extremely;4) If you do remember being confused, was the experience distressing?Yes or No; 5) How distressing? 0–4 NRS; and 6) Can youdescribe the experience? This final question allowed for a qualitativeassessment of the delirium experience through the verbatim transcriptionof patients’ description of the experience (not reported inthis paper). In addition, spouse/caregivers and nurses wereeach asked a single question: 1) Spouse/caregiver: How distressedwere you during the patient’s delirium? 0–4 NRS; 2) Nurse:Your patient was confused, did you find it distressing? 0–4NRS. The DEQ was administered on resolution of delirium[1].

54% of patients recalled their delirium experience. Perceptual disturbances were among the best predictors of recall. Delusions were the most significant predictor of distress. Patients with hypoactive delirium were just as distressed as those with hyperactive delirium. Mean distress levels for patients were rated at around 3 by patients and their nurses and close to 4 by family members.

In another more recent and similar study using the DEQ, the numbers were even more sobering. 74% of patients recalled being delirious and 81% reported the experience as distressing with a median distress level of 3[2].

In my work as a consultant, I’ve interviewed many patients who are delirious and their relatives and friends, who suffer as well from the experience of watching someone they love suffer from delirium. It’s very difficult to watch this kind of mental torture caused by medical disorders and medications.

The 6^th question of the DEQ often produced accounts that sound terrifying. The point of the article was that the subjective report of delirium sufferers confirms that the distress levels are very high indeed and remind us of the major reason for developing systematic methods of preventing it or detecting it early and managing the syndrome—reducing suffering.”

1. Breitbart, W., C. Gibson, and A. Tremblay, The Delirium Experience: Delirium Recall and Delirium-Related Distress in Hospitalized Patients With Cancer, Their Spouses/Caregivers, and Their Nurses. Psychosomatics, 2002. 43(3): p. 183-194.

2. Bruera, E., et al., Impact of delirium and recall on the level of distress in patients with advanced cancer and their family caregivers. Cancer, 2009. 115(9): p. 2004-12.

Whirlpool Care Counts Laundry Program Cleans Up!

Sena and I just recently saw the TV commercial about the Whirlpool Care Counts^TM Laundry Program, which has been providing washers and dryers for schools. It was launched to address school absenteeism, one cause of which is bullying of kids who don’t have clean clothes. They are also more likely to drop out of school.

It turns out this program has been going on since 2015. And there’s an Iowa connection. In 2017, Morris Elementary in Des Moines got a new washer and dryer (Des Moines Register, “Iowa teacher meets New Yorker on Instagram, and needy school gets a big lift” by Laura Rowley, published Oct 7, 2019, accessed 12/13/2023).

According to the Whirlpool’s website about it, there are over 150 programs in schools across 40 states.

The website even lists research studies demonstrating the link between a lack of clean clothes and school attendance rates.

We reminisced about what we did about this issue when we were in grade school. We don’t remember skipping school because of dirty clothes. We managed by washing them by hand, or in my family, using an old hand wringer as well. We hung clothes out to dry on the line in the back yard. Sena did that and also used a fan.

I was sometimes bullied, but it was related to being black rather than having old clothes. I didn’t change my outfit every day because I didn’t have enough clothes for that.

When I got old enough, I delivered the Des Moines Register. Talk about nickel and diming. The rates were pretty low compared to today, but I still had some customers who complained about the price. I walked my route to collect subscription fees. I was not a great salesman but I was a steady worker, delivering papers in any weather, even dragging them in a wagon through knee deep snow.

You could buy things with your money through the paper’s main office. The first thing I bought was an alarm clock with a glass face through which the clockwork was visible. I didn’t really need an alarm clock to get me out of bed to deliver papers. I was a light sleeper even then. I just thought the clock was cool.

I saved enough money (mostly in quarters) to buy my first bicycle. It cost about $20 at Ralph’s Bicycle & Hobby Shop in Mason City. It was used and I think it was a 24 inch. I did not do wheelies.

I don’t remember buying clothes.

I remember collecting from a young couple who were obviously newlyweds. They would often both come to the door wrapped in nothing but big bath towels. I wondered if they even had any clothes. Maybe they didn’t have any laundry facilities.

Anyway, I think the Whirlpool program is a great idea.

Rearranging My Books

The other day, I finally rearranged my bookshelf. I’ve put it off for a long time. While I was doing it, I remembered where I spend the most time in my thoughts. I don’t have a very broad library, which probably illustrates where my mind wanders. It has changed very little over the years. Retirement affected it some, but not a great deal. After I rearranged the books, it was not just better organized. It made me think about the past, the present, and the future.

I have a lot of books by Malcolm Gladwell for some reason. The Tipping Point was published around the time when all of my immediate family members died for one reason for another. They died within a few years of each other. It was a difficult time. I remember hoping I would just get through it. I did.

I’m still a fan of Stephen Covey. The 7 Habits Manual for the Signature Program marks a time when I was contemplating leaving my position at The University for a position in private practice. It didn’t work out, and it’s just as well.

Of course, there are many books about consultation psychiatry, including the one I wrote with my former Dept. of Psychiatry Chair, Robert Robinson. Every once in a while, I search the web to find out what former colleagues and trainees are doing now. I can’t find a few, which makes me wonder. A couple have died. I’m a little less eager to look around each time I find out about those. Finding obituaries is a sad thing—and it makes me a little nervous about my own mortality. One or two have apparently simply dropped off the face of the earth.

I read some books for fun. I’m a fan of humorists, which is no surprise. The most recent is The Little Prince. That book and others like it inspire me.

I like books that make me laugh and give me hope. It’s difficult to sustain hope in humanity, if you read much of the news, which I tend to avoid.

I feel better when we go out for walks. Recently we did that about a week ago when there were a couple of warm days. On one day, we saw a couple of bald eagles and northern shovelers (the latter of which we’ve never seen before), at Terry Trueblood Recreation Area.

On another warm day we saw a couple Harvest Preserve staff members preparing to hang a big Christmas wreath on the side of a barn on the property that faces Scott Boulevard. They’d got some evergreen branches from an “overgrown Christmas tree farm.” It had a big red bow. They were going to decorate it further and hang it. We hoped it would be finished by the time we returned that day, but it wasn’t done.

When we returned a day later, it was very cold but the wreath was on the barn wall and it was festooned with gorgeous decorative balls. It was worth waiting for.

Video music credit:

Canon and Variation by Twin Musicom is licensed under a Creative Commons Attribution 4.0 license. https://creativecommons.org/licenses/by/4.0/

Artist: http://www.twinmusicom.org/

Partners in Juggling Crime Breaking the Internet Again!

We are breaking the internet again as partners in juggling crime. It turns out the 2-person 6 ball juggling pattern has 3 variations:

The 1, 2 Pass: Both partners make two right hand throws, then pass to the partner on the third throw. Always throw from the right side to your partner’s left.

The 1 Pass: You pass after every other throw.

Pass: You pass on every right-hand throw. You could call it pass, pass, fast!

The Pass variation is really difficult, although some jugglers make it look easy. We mainly look funny, but we’re just getting started!

We include a slow-motion clip for each variation.

CDC Weekly Update on Viral Respiratory Illness

As of December 8, 2023, the CDC reports:

“National test positivity, emergency department visits, and hospitalizations for influenza continue to increase. Influenza A(H1N1) is the predominant influenza virus circulating although influenza A(H3N2) and influenza B viruses are also being reported.
RSV-associated hospitalization rates remain elevated among young children and are increasing among older adults; of note, only 15.9% of adults 60+ report having received an RSV vaccine.
National vaccination coverage for COVID-19, influenza, and RSV vaccines increased slightly for children and adults compared to the previous week and remains low for both groups.”

However, the overall respiratory illness rates have gone from “moderate” to “low” in Iowa.

Still Practicing the Shower Juggle!

I’m still practicing the shower juggle pattern. I’m comparing how I did in April with how I’m doing now. No doubt, my form is wonky and I still can do only 3-5 throws.

But I think juggling with the big plastic balls is easier when it comes to the shower. I can’t figure why, unless it’s the more uniform spherical shape and evenly distributed weight.

It’s definitely not my form.

Spoonbills and Bald Eagles at Sand Lake!

The other day it was about 60 degrees and the sun shone brilliantly—not a day to stay indoors! We went out to Terry Trueblood Recreation Area and did some bird-watching.

Out on a sand bar on Sand Lake, we caught sight of two bald eagles. They seemed to be a mated pair. They actually courted by vocalizing and billing. I know about their spectacular cartwheel flying ritual, but I didn’t capture that on camera as they took flight. They mate for life.

We also saw a flock of migrating Northern Shovelers, dabbling in the lake. We’ve been going out to that park for years and this was the first time we’ve ever seen them. They’re also known as spoonbills or spoonies because of their large bills, which they use to sieve the water for food.

We put on about two and a half miles on my step counter, and we worked up an appetite. Climbing up and down the banks of Sand Lake is a lot of work. So, we got the two for one price on the Culver’s butter burger and topped it off with a Wendy’s peppermint frosty.