September is Suicide Prevention Awareness Month (SPAM). This spam is good. Here’s a link to the National Alliance on Mental Illness (NAMI) website on SPAM. And see the message below from University of Iowa President Barbara Wilson. We can all use this well-being toolkit as well.
Category: health care
What is the Answer to Automated Answering Machine Recordings?
I’ve been calling local pharmacies in an effort to schedule getting the updated Covid-19 vaccine updated bivalent booster and the flu shot as well. I imagine I’m not the only one encountering the frustrating automated answering machines.
It’s confusing to find out that if I answer the question about how many Covid-19 vaccine shots I’ve gotten (which is 4, including the two initial doses and two boosters), the machine politely sort of congratulates me (“you’re good to go!) and then hangs up. That contrasts with the web-based organization message in large font against a bright red background which assures me that I can schedule a time to get both vaccines—if I set up an on-line account (which always makes me suspicious). It turns out that the old “continue as a guest” alternative puts my personal information at risk. I’m unable to get a live person on the line.
I found a few tactics on the web for bypassing these recordings, but I’m pretty sure they don’t work. Some of them have been around for over 15 years, like pressing zero once or even repeatedly. That can result in the recording automatically hanging up on you.
There are other suggestions for pressing various special characters on your smartphone, which some people swear by.
Speaking of swearing, I even found one suggestion for swearing repeatedly into the phone to get past the automated answering machine. I’m pretty sure that doesn’t work.
I think I’ll just sit tight and wait a while. There’s no rush. But I wish there were some polite and effective way to get a live person on the line when you get the automated answering machine from hell:
Drugs-R-Us Pharmacy: Hello, what would you like to do today? You can say, “vaccine,” “alien abductions,” or “triple fat burger with soggy fries and a cola.”
Customer: Vaccine.
Drugs-R-Us: Thank you! Would you like to do: schedule a new, review a scheduled time, cancel an appointment, or talk about the weather?
Customer: Schedule a new.
Drugs-R-Us: What vaccine would you like to schedule?
Customer: Updated Covid-19 booster.
Drugs-R-Us: Got it! And would you like any other vaccines?
Customer: Flu shot.
Drugs-R-Us: I see; I’ll make a note of that. You can ask the pharmacist at your visit for another vaccine, which would be administered as an intra-ocular injection in the eye of your choice. Now, a booster. I’ll need some more information, including your birthdate, phone number, number of previous vaccinations, distinguishing marks, social security number, all bank account numbers, record of previous arrests, and the name of your first-born child, if any. First, how many vaccines have you received?
Customer: Four.
Drugs-R-Us: You rock! You have all the vaccines you need and that means it’s Beer O’clock for you, dude. Is there anything else?
Customer: But I want the updated Covid-19 booster! Can’t you understand that it’s new and your company says it’s available now?
Drugs-R-Us: Good-bye (click).
Maybe I’ll have better luck next week.
Is Treatment with Antibodies a Substitute for Vaccination for Covid-19?
I read the news article about scientists publishing a study which shows it’s possible to make antibodies that may neutralize most of the Covid-19 variants. I read this after failing to find any local facility in my area that has the updated bivalent Covid-19 vaccine booster available yet. Sena and I plan to get the booster, which would be our 5th shot.
I don’t have a clue how to evaluate the study itself, which was published in an Open Access journal, Communications Biology. I didn’t understand the peer reviewers’ comments and suggestions because I lack the scientific background to make sense of them.
I was under the impression that using antibodies for Covid-19 has to be prompted by getting infected first. In fact, the lead author of the study actually points out in the news article in published in the Jerusalem Post,
“In our view, targeted treatment with antibodies and their delivery to the body in high concentrations can serve as an effective substitute for repeated boosters, especially for at-risk populations and those with weakened immune systems. COVID-19 infection can cause serious illness, and we know that providing antibodies in the first days following infection can stop the spread of the virus.
“It is, therefore, possible that by using effective antibody treatment, we will not have to provide booster doses to the entire population every time there is a new variant,” Freund concluded.
I understand that immunity wanes after vaccination and that’s frustrating because apparently you need another booster every few months.
But I’m not sure I see how the antibody treatment would be a replacement for vaccines, if that’s the implication.
The interventions sound complementary. Wouldn’t it be better to have vaccine-induced immunity and use the antibodies as a backup treatment when you get infected?
I got the impression from reading about monoclonal antibody treatments that they have to be administered by infusions in specialty clinics. And you have to catch it in the first few days. And the indication for it is getting infected with the virus—which I thought could be avoided in the first place by getting vaccinated.
The plan now seems to be to manufacture vaccines annually to target important variants of Covid-19, similar to what we’ve been doing for influenza. We’ve been getting flu shots every year for a long time. Maybe we won’t need to get boosters every few months.
It makes sense to use antibodies for immunocompromised persons, though, because they don’t respond as well to vaccines.
Why would we “substitute” monoclonal antibody infusions administered in clinics to treat infections for vaccines which can prevent severe disease and death?
I’m not knocking the study; I’m just a retired psychiatrist, not an infectious disease scientist. Am I missing something?
A Retired Consultation-Liaison Psychiatrist’s Perspective on Eating Disorders
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.
CDC Interim Clinical Considerations for Covid-19 Vaccine Bivalent Boosters
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.
University of Iowa Hospitals Information on Omicron-Specific Covid-19 Vaccine Booster
The University of Iowa Hospital & Clinics has information on the facts and expected availability of the new bivalent Omicron Covid-19 vaccine boosters.
What Would Make Psychiatry More Fun?
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.
CDC ACIP Meeting Today and Tomorrow: Covid-19 Vaccine Omicron Bivalent Booster Candidates
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.
FDA Authorizes Bivalent Covid-19 Vaccine Booster Dose Today
The FDA announced the EUA authorization this morning of the Moderna and Pfizer-BioNTech Bivalent Omicron Covid-19 Vaccine Booster Dose.
CDC-ACIP meeting starts tomorrow for evaluation of the booster doses.
Psychiatric Polypharmacy: An Opportunity to Teach with CPCP
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.
Go Retire Psychiatrist 