health care – Page 25 – Go Retire Psychiatrist

Why Can’t I Wear Blue After Labor Day?

I have a few thoughts on the upcoming Labor Day weekend. It occurs to me that Labor Day often evokes images of blue-collar workers. On the other hand, I think in a broader view of the holiday, most of us can think of ourselves as working toward improving our society no matter whether our jobs are in the white-collar or blue-collar sector.

Many eons ago, I was a blue-collar worker. I was a surveyor’s assistant and drafter for a consulting engineers’ company in Mason City, Wallace Holland Kastler Schmitz & Co. (WHKS & Co.). I got attached to my job because it was the first real job I ever had.

I was proud of what I did, even though I didn’t make much money. I had to travel around the state a lot. I lived at the YMCA and ate all my meals in cafes because I was often out of town on jobs and when I was not, there was no kitchen in my tiny sleeping room at the Y.

I wore blue jeans and tee shirts, flannel shirts when I wasn’t out in the hot sun. I liked being outside except when the ragweed was out in the late summer. I had bad hay fever. I tried desensitization shots, but all they did was make my arm swell up. Winters were cold, especially if I had to stand in one place for a long time, either holding up the rod or running the gun.

I was mostly a rear chain man and rod man early on, but moved up to “running the gun” which meant operating the level and theodolite, the former for measuring elevations and the latter for measuring angles. I was proud of my job.

It took me a while to transition from blue-collar to white-collar mindset. In college, I often returned to work for WHKS during the summer breaks. That was where I formed my identity.

Some aspects of the job were simple. You hammered a stake, an iron property marker, or a frost pin if the ground was frozen. Measuring distances, angles, and elevations were often repetitive tasks, yet satisfying because they marked progress toward a concrete goal, like building an airport runway, establishing the outline of a tract of farmland, or raising a bridge. As one of my bosses on the survey crew put it, the work helped you see “the lay of the land.”

Land surveying, mapping, and drawing up plans set my perspective on life when I was a young man. At one time, that perspective made me think I wanted to be an engineer. I respected engineers because they built the subdivisions, highways, dams, and other real things from ideas.

I respected my teachers at WHKS, but couldn’t do the math. And they respected my change of heart.

I eventually became a doctor, after a short stint as a medical technologist in clinical laboratory medicine. You’d think, given my hands-on background, I would have become a surgeon, but I wasn’t made for that either.

I learned basic things at WHKS like being steady, reliable, and focused. I had to learn other things to be a doctor, especially a psychiatrist. On the other hand, in this white-collar environment, especially in a research-oriented academic medical center, I often looked and acted more like a blue-collar worker.

One of the Family Medicine residents who rotated on the psychiatry consultation-liaison service left me a gift of a fireman’s helmet. It fit my head and my approach to psychiatry in the general hospital. What I did mostly was put out the fires, metaphorically speaking, of behavioral eruptions related to delirium which were caused by medical problems. Often, I had to apply blue-collar approaches in a white-collar world. So, can I wear blue after Labor Day?

Happy Labor Day.

CDC Update Today on Covid-19 Variant BA.2.86

Today’s update by the CDC on the Covid-19 variant BA.2.86 is at this link.

Highlights:

“The variant has been identified in at least four states in the United States in samples from either people or wastewater.
This variant is currently being studied in the laboratory to help understand how the immune system may interact with this virus.
The current increases in cases and hospitalizations in the United States are likely being driven by infections with XBB lineage viruses, not the new BA.2.86 variant.”

“CDC’s current assessment is that the updated COVID-19 vaccine, which will be available in mid-September, will likely be effective at reducing severe disease and hospitalization. Immune responses generated from prior infection also help protect against severe outcomes of COVID-19. There is currently no evidence that this variant is causing more severe illness. That assessment may change as additional scientific data are developed. CDC remains committed to releasing updates on trends and observations of this variant.”

“Immune Impacts: Approximately 97% of the U.S. population has antibodies to SARS-CoV-2 from vaccination, previous infection, or both (hybrid immunity). Immune responses to vaccines and infections are complex and involve both humoral (antibodies) and cellular immunity. It is likely that the humoral and cellular immune responses will continue to provide protection against severe disease from this variant. Laboratories are currently working on measuring antibody neutralization of BA.2.86 as well as other immune responses. This is an area of ongoing scientific investigation.

Therapeutics: The assessment as to the impact of BA.2.86 on currently approved or authorized therapeutics is unchanged. Examination of the mutation profile of BA.2.86 suggests that currently available treatments like nirmatrelvir-ritonavir (Paxlovid), remdesivir (Veklury), and molnupiravir (Lagevrio) will be effective against this variant. This assessment is from the SARS-CoV-2 Interagency Group (SIG), which comprises experts from multiple United States government agencies. Monitoring is ongoing, and CDC will update this document as additional data on the impact of this variant on therapeutics become available.”

CDC ACIP to Discuss Covid-19 Vaccines on September 12, 2023

The CDC Advisory Committee on Immunization Practices (ACIP) has a scheduled meeting on September 12, 2023 to discuss Covid-19 vaccines. The information about it is a bit difficult to find. It’s announced as a notice on the Federal Register. On the agenda:

Matters To Be Considered: The agenda will include discussion of COVID–19 vaccines. Recommendation votes for COVID–19 vaccines are scheduled. Agenda items are subject to change as priorities dictate. For more information on the meeting agenda, visit https://www.cdc.gov/vaccines/acip/meetings/index.html.

Clicking the link as of August 28, 2023 did not reveal a meeting agenda, but I expect this to be updated in the near future.

Easy Read Flu Shot Guidance from CDC

There is an easy to read guide about the seasonal influenza shot for 2023-24 at this link.

Official CDC Update on New Covid-19 Variant BA.2.86

I’ve been looking for official CDC news about the new Covid-19 variant, BA.2.86 and it looks like it was just posted on their website yesterday.

Highlights:

“Last week, a new variant of SARS-CoV-2 called BA.2.86 was detected in samples from people in Denmark and Israel. At least two cases have been identified in the United States. This variant is notable because it has multiple genetic differences from previous versions of SARS-CoV-2.”

“Based on what CDC knows now, existing tests used to detect and medications used to treat COVID-19 appear to be effective with this variant. BA.2.86 may be more capable of causing infection in people who have previously had COVID-19 or who have received COVID-19 vaccines. Scientists are evaluating the effectiveness of the forthcoming, updated COVID-19 vaccine. CDC’s current assessment is that this updated vaccine will be effective at reducing severe disease and hospitalization. At this point, there is no evidence that this variant is causing more severe illness. That assessment may change as additional scientific data are developed. CDC will share more as we know more.”

Heat Joke Alert Again!

Here’s another heat joke.

Q: How hot is it?

A: It’s so hot, you don’t have to be a liar to set your pants on fire.

All you have to do is step outside. It’s no joke, frankly. Heat index values could be in the 110-115 degree range. The Excessive Heating Warning has been extended to August 23, 2023.

How the Metta Prayer and the Shower Juggle Are Alike

I’ve been practicing mindfulness meditation since 2014, when I became uncomfortably aware of how unpleasant I was becoming on the job and elsewhere. I called this “burnout.” The word still works as an explanation although it was and is sometimes still an excuse.

I learned about the Lovingkindness meditation or the Metta Prayer during the Mindfulness Based Stress Reduction (MBSR) course I took almost a decade ago.

I used to pray when I was a child. I read the Bible and prayed. I viewed the act of prayer as a request to God back then. And I still probably regard the Metta Prayer as a kind of bargain between me and the cosmos or whatever it is I think of as a higher power.

Just because I say the Metta Prayer doesn’t mean that anybody’s going to treat each other differently. It doesn’t make people get up and square dance together. However, the caution about not expecting others to change just because you say the Metta Prayer doesn’t mean that the practice would not enhance a sense of community—if enough people did it.

There are dozens of scripts for the Metta Prayer easily accessible on the web. The part of it that is directed to those with whom I’m having a difficult time is tricky. Often enough, my goal is to use it as a way of somehow changing the person I’m having difficulty with. It’s the same way I used prayers as a child.

That’s a mistake, but at least I’m aware of it. Prayer is not a request for God or the cosmos to intercede on my behalf so that life won’t be so difficult for me sometimes.

I have trouble remembering that I’m not really a role model, especially nowadays. I’m just an old retired guy who was difficult to work with and needed to change, despite my status as a psychiatrist. I tell dad jokes and clown around but I’m still an old guy with problems—like just about every other old guy.

So, I’m still off and on practicing the Metta Prayer. I’ve noticed that practicing mindfulness is a lot like practicing juggling, which I’ve been doing for almost a year now. I still can’t do certain tricks, like the shower juggle. I can do about three or four throws and drop the balls, sometimes on my head (which is why I wear safety goggles!). And I still tend to use prayer like I’m negotiating a deal to get rid of my faults and troubles.

But I haven’t given up practicing the shower juggle. And I haven’t given up on the Metta Prayer.

Remembrance of Dr. William R. Yates MD

I was thinking about the Clinical Problems in Consultation Psychiatry (CPCP) learning sessions which was introduced to me by one of my first teachers in the University of Iowa Dept of Psychiatry, Dr. William R. (Bill) Yates.

I had originally been thinking of posting one of my own CPCPs that I presented in 2015. It was about the psychosocial adjustment of patients to ostomy.

I searched widely and in vain on the web for any recent information about what Dr. Yates was doing now. I was surprised and saddened to discover his obituary. He died on January 19, 2023 in Tulsa, Oklahoma.

As the obituary says:

He served on the faculty at the University of Iowa for Psychiatry and Family Medicine before becoming Professor and Chair of Psychiatry at the University of Oklahoma College of Medicine in Tulsa. After retiring, he continued to dedicate his time as a volunteer research psychiatrist at OU and the Laureate Institute for Brain Research where he also served on the board of directors. He authored over 100 scientific manuscripts that were published in peer-reviewed journals.

He was an energetic, a great teacher, had a great sense of humor, and was easy to get along with. He published in many scientific journals and taught many trainees. He was an avid bird watcher and his blog Brain Posts highlighting neuroscience research findings is still visible on the web.

He published the paper along with a chief resident on problem-based learning used on the psychiatry consult-liaison service in 1996, the year I graduated psychiatry residency and joined the faculty at The University of Iowa Hospitals & Clinics (Yates, W. R. and T. T. Gerdes (1996). “Problem-based learning in consultation psychiatry.” Gen Hosp Psychiatry 18(3): 139-144.) You can read the abstract for it along with a description of the CPCP at the link above which takes you to my April 19, 2019 blog post “Clinical Problems in Consultation Psychiatry.”

When he was the leader of the psychiatry consult service, we were still using paper charts and his staffing comments were always very brief and encapsulated the assessment and plan succinctly without wasted verbiage—contrasting with my long-winded note.

His remarks about his role at Laureate Institute for Brain Research is still accessible:

“I work part-time as a research psychiatrist for the assessment team at the Laureate Institute for Brain Research. We do research diagnostic assessments for a variety of imaging, genetic and biomarkers studies in mood, anxiety and other brain disorders. I also provide review and analysis of neuroscience research on my blog Brain Posts that can be found at www.brainposts.blogspot.com. You can follow me on Twitter @WRY999. I also use my blog and Twitter feed to share my bird photography images.”

I respected and admired Dr. Yates, as I’m sure many learners did. I will always remember Bill as a gifted scientist and teacher.

I think a fitting tribute would be to go ahead and post my CPCP on the psychosocial adjustment of patients with ostomy. One of the most interesting articles in the bibliography is how the mindfulness meditation approach to that adjustment can be very helpful. The website United Ostomy Association of America website is also informative.

The presentation is also limited to a dozen slides. I often encouraged learners to keep the number of slides to a managed number so the presentations wouldn’t run too long. I called my slide sets the Dirty Dozens.

Many thanks to Dr. William R. Yates and my condolences to his family.