Go Retire Psychiatrist

Rounding@Iowa Podcast: “Challenges in Transitioning Seriously Ill Patients from Pediatric to Adult Systems of Care”

I listened to the Rounding@Iowa podcast of February 11, 2025, “Challenges in Transitioning Seriously Ill Patients from Pediatric to Adult Systems of Care.”

88: Modifiable Risk Factors for Breast Cancer – Rounding@IOWA

In this episode of Rounding@IOWA, Dr. Gerry Clancy sits down with breast cancer experts Dr. Katherine Huber‑Keener and Dr. Nicole Fleege for a discussion of modifiable and non‑modifiable risk factors, modern screening tools, and practical strategies clinicians can use to guide prevention and early detection. CME Credit Available: https://uiowa.cloud-cme.com/course/courseoverview?P=0&EID=82146 Host: Gerard Clancy, MD Senior Associate Dean for External Affairs Professor of Psychiatry and Emergency Medicine University of Iowa Carver College of Medicine Guests: Nicole Fleege, MD Clinical Assistant Professor of Internal Medicine-Hematology, Oncology, and Blood and Marrow Transplantation University of Iowa Carver College of Medicine Kathryn Huber-Keener, MD PhD Clinical Associate Professor of Obstetrics and Gynecology – General Obstetrics and Gynecology University of Iowa Carver College of Medicine Financial Disclosures: Dr. Gerard Clancy, his guests, and Rounding@IOWA planning committee members have disclosed no relevant financial relationships. Nurse: The University of Iowa Roy J. and Lucille A. Carver College of Medicine designates this activity for a maximum of 0.75 ANCC contact hour. Pharmacist and Pharmacy Tech: The University of Iowa Roy J. and Lucille A. Carver College of Medicine designates this knowledge-based activity for a maximum of 0.75 ACPE contact hours. Credit will be uploaded to the NABP CPE Monitor within 60 days after the activity completion. Pharmacists must provide their NABP ID and DOB (MMDD) to receive credit. JA0000310-0000-26-035-H99 Physician: The University of Iowa Roy J. and Lucille A. Carver College of Medicine designates this enduring material for a maximum of 0.75 AMA PRA Category 1 CreditTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Other Health Care Providers: A certificate of completion will be available after successful completion of the course. (It is the responsibility of licensees to determine if this continuing education activity meets the requirements of their professional licensure board.)

This was a very interesting presentation about the challenges of helping persons with life-limiting conditions (for example, hemophilia, cystic fibrosis, sickle cell anemia and more) transition from pediatric to adult systems of care. Most of the discussion was about the difficulty in finding doctors who would be willing and able to assume care of patients who had survived to adulthood who had been previously seen in pediatrics throughout childhood.

I listened very carefully to the whole podcast, waiting to hear about what the role of mental health care professionals would be in this kind of transition. There was no mention of it, not even after one of the presenters described a patient who was starting to have hallucinations.

My role as a consulting psychiatrist in a general hospital was mainly to see those with chronic diseases who were being treated by colleagues during a bout of cystic fibrosis or sickle cell crisis. I remember they were young adults, struggling with emotional distress and disruptive behavior.

I was surprised at the lack of discussion about the role of mental health assessments, diagnoses, and treatment including psychotherapy during transitions from pediatric to adult health care. Not that I would have had much to offer other than questions about how mental health professionals could be helpful regarding transitions—but I think they would have not been out of place.

I took a quick look at the resources provided. One of them was a University of Iowa website, the Iowa Center for Disabilities and Development: Transition to Adulthood Clinic For Teens and Young Adult Ages 14-30. Even here, the role of a psychologist was to evaluate learning problems.

One of the discussants mentioned a program called Got Transition, which has a very comprehensive website. There was a section for Special Populations and a list of resources and research when I searched the site using the term “mental health.” It was hard to find a section specific to the population under discussion in the podcast. On the other hand, it was very comprehensive.

In this podcast, discussants talked about the importance of a team approach to transitions. I wonder if there’s a place on the team for psychiatry.

Rife vs Ripe: Which is Right?

I noticed a couple of things about one of the President’s many new Executive Orders, which was “ESTABLISHING THE PRESIDENT’S MAKE AMERICA HEALTHY AGAIN COMMISSION,” or MAHA for short. It was posted on February 13, 2025. One thing it reminded me of is the tax filing season, which is upon us (everything reminds me of the tax filing season around this time of year). The other thing was a short article about the IRS, which is cutting staff sharply in response, probably as a response to the federal government workforce layoffs generally. One sentence in the article read:

“The IRS layoffs, first reported by the New York Times, come as part of a broader effort by President Donald Trump and Elon Musk’s overhaul of the federal government, which they argue is too bloated and inefficient, and ripe with waste and fraud.”

I put the word “ripe” in bold-face type because I sensed that the writer probably meant “rife” instead. I looked up the definitions of both just to make sure: Rife means abundant and ripe means mature (possibly overly mature as in smelly and ready for the garbage can).

I wonder if “rife” or “ripe” could apply to MAHA. I’m all for making us healthy. I agree with promoting health. I’m not sure what is meant by “assess the prevalence of and threat posed by the prescription of selective serotonin reuptake inhibitors, antipsychotics, mood stabilizers, stimulants, and weight-loss drugs.” It sounds like a shot across the bow for psychiatrists and primary care physicians.

Some of the content may be either “rife” (or is it “ripe”?) with potentially misleading innuendo, implying that health care professionals are not doing all we can already to promote health. I agree with promoting research into the “root causes” for mental illness. However, some people need psychiatric medications for “just managing disease.” Reducing the suffering of those who are tortured by depression and delusions and hallucinations makes sense because that’s the humane thing to do.

This reminds me of a very interesting article about what some scientists think about how life began on this planet and how it might start elsewhere in the universe. Some think life evolves mainly by chance, by a cosmic accident. Others think it’s inevitable and occurs when planetary conditions are right. So that might mean there’s a good chance there are extraterrestrials are out there. If they are, what would they think of us?

And this reminds me of a quote from the movie, Men in Black. Agent K is showing Edwards a universal translator, one of the many wonders in the extraterrestrial technology room, which gives us a perspective on how humans rank in the universe:

Agent K: We’re not even supposed to have it. I’ll tell you why. Human thought is so primitive it’s looked upon as an infectious disease in some of the better galaxies.

So is the universe “rife” with life—or is it “ripe”?

FDA Has Yet to Decide on What to Do About the Clozapine REMS Program

I checked on what the FDA is doing about changing or closing down the Clozapine REMS program. It doesn’t look like they’ve taken any action yet. Recall there was a Clozapine REMS Advisory Committee meeting about this on November 19, 2024 that I posted about recently. The upshot was that the committee voted overwhelmingly (14 yes to 1 No) to get rid of the Clozapine REMS program.

What I didn’t realize until today was that a former colleague of mine was a member of the committee. Dr. Jess Fiedorowicz, MD, PhD was on staff at The University of Iowa Health Care in the past and is now head of the Dept of Mental Health at The Ottawa Hospital in Ottawa, Ontario in Canada. I’ve included the YouTube video below of the meeting and you can find Dr. Fiedorowicz’s remarks via Zoom video at around the 8:05 or so mark into the meeting. You can view his vote to shut down the REMS program at around 8:33.

I also found out about a group called The Angry Moms (those who care for family members on clozapine) who are focused on stopping the Clozapine REMS program and one of their web pages makes it pretty clear they’re not happy that the FDA has not made a decision about REMS yet.

They mention Dr. Gil Honigfeld, PhD who I’d never heard of until now. You can tell from his T-shirt how he feels about clozapine. He has been called the “Godfather of Clozapine” and his opinion about the REMS program along with a short history of clozapine can be found at this link.

I don’t know what the FDA will do about the Advisory Committee’s recommendation, but I hope they do it soon.

Sena Double Dog Dared Me to Try the Electric Snow Shovel!

Well, the snow kept coming down. I had to go back out to shovel. I was going to use my plow shovel, but Sena said I was too chicken to try the electric snow shovel.

I couldn’t back down.

So, I had to go out there, after the wind had changed mind you, and use the battery powered shovel. I got snow all over me because no matter what I did to adjust the snow deflectors, the snow just blew back in my face.

I could have been a contender.

Sena Gives the Electric Snow Blower the Real Test!

We got a real snowfall starting last night and into this morning. Sena took the Voltask battery-powered 48V 16-inch snow shovel out and put it through its paces.

We got about 6 inches of snow and it chewed right through it. It threw the snow into the next county! It took her about 30 minutes to make my job a lot easier with the shovel.

Valentine Roses

We’re not forgetting Valentine’s Day coming up on Friday. A dozen roses for us to remember. Dozens of years together to cherish. Countless memories to treasure.

How About Artificial Intelligence for Helping Reduce Delirium in the ICU?

I got the Winter 2025 Hopkins Brain Wise newsletter today and there was a fascinating article, “Using AI to Reduce Delirium in the ICU: Pilot Study will explore AI headset can help reduce delirium and delay post-delirium cognitive decline.”

The article has exciting news about what researchers are doing which will, hopefully, reduce the incidence of delirium in the intensive care unit (ICU). Another Hopkins researcher has published a study that has already used AI algorithms to detect early warning signs of delirium in the ICU;

Gong, Kirby D. M.S.E.1; Lu, Ryan B.S., M.D., Ph.D.2; Bergamaschi, Teya S. M.S.E., Ph.D.3; Sanyal, Akaash M.S.E.4; Guo, Joanna B.S.5; Kim, Han B. M.S.E.6; Nguyen, Hieu T. B.S., Ph.D.7; Greenstein, Joseph L. Ph.D.8; Winslow, Raimond L. Ph.D.9; Stevens, Robert D. M.D.10. Predicting Intensive Care Delirium with Machine Learning: Model Development and External Validation. Anesthesiology 138(3):p 299-311, March 2023. | DOI: 10.1097/ALN.0000000000004478

The list of references for the study of course include those by Dr. E. Wesley Ely, who delivered an internal medicine grand rounds about delirium at the University of Iowa in 2019.

Anybody who reads my blog knows I’ve been knocking AI for a while now. However, anybody who also knows that I’m a retired consultation-liaison psychiatrist knows how interested I am in preventing delirium in the hospital. I worked as a clinical track professor for many years at The University of Iowa Health Care in Iowa City.

It’s fortuitous that I found out about what Johns Hopkins research is doing on this topic because the director of the Johns Hopkins psychiatry department happens to be Dr. Jimmy Potash MD, MPH, who’s identified on the newsletter. He was the head of the psychiatry department at the University of Iowa from 2011-2017.

Besides all the name-dropping I’m doing here, I’m also admitting that I’ll probably soften my position against AI if the research described here does what the investigators and I hope for, which is to reduce delirium in the ICU.

Super Bowl Commercial “Mean Joe Frank” 2025 Looked Familiar!

We watched the Super Bowl last night and one of the many commercials (always a big thing) looked vaguely familiar only after Sena pointed it out. It was the Fareway Frank commercial about Fareway stores. It was a reprise of the famous 1979 Coca-Cola commercial with Mean Joe Green, defensive tackle for the Pittsburg Steelers and a kid. When you compare them, the similarities are obvious. There are two Fareway commercials that are the same, but have different titles, one of them being “Mean Joe Frank.”

The Hey Kid, Catch commercial with Mean Joe Green featured a 9-year-old kid named Tommy Okon. I couldn’t find a name for the kid in the “Mean Joe Frank” version.

But you can find film information on Turner Classic Movies titled “The Steeler and the Pittsburgh Kid” which is based on the commercial. The kid is Henry Martin who later starred in the movie, “E.T. The Extraterrestrial” (1982).

This led to reminiscence of Fareway Store in Mason City, Iowa. I used to walk to Fareway to get groceries and walked back carrying at least two big paper sacks. My arms were always pretty sore when I got home. I used a wagon later on, but had to be careful crossing the railroad tracks on the way back to ensure the eggs didn’t break.

There are Fareway stores all across Iowa and several neighboring states now, but the first one opened in Boone, Iowa in 1938. It popularized the idea of shoppers picking out their own items from the shelves rather than letting a store employee pick them out from the shopper’s list. The store name was inspired by what was sold (“fare”) and treating customers and employees fairly.

The Fareway Frank character was called Forrest Frank in 2024 although it looks like the company has settled on Fareway Frank.

The other Iowa connection worth mentioning is that rookie defensive player for the Philadelphia Eagles (Super Bowl winners), Cooper DeJean, who played for the University of Iowa Hawkeye football team, made a pick-6 interception touchdown in the game.

While the Fareway Frank version of the Super Bowl commercials line-up didn’t make the short list (or any list for that matter) of favorites, it sure did bring back memories for us.

The Big Mo Pod Show: “Variety is the Spice of Life”

We heard the Big Mo Blues Show last night and heard a couple of tunes that were fun. One of them was mentioned on the Big Mo Pod Show today, “Feelin’ Alright” by Stuff. The other was a riot but was not on the podcast, and it was “I Feel So Good (I Wanna Boogie” by Magic Sam.

The one that brought back memories was “Feelin’ Alright” by Stuff. It sounded so familiar and we finally figured out it was a cover of song of the same title and sung by Joe Cocker (the one I remember). However, I guess it was originally written by Dave Mason of the group Traffic in 1968. And there’s even an album “Joe Cocker With Stuff Feelin’ Alright.”

The one Big Mo played last night was from the album Stuff Live at Montreux 1976. It was instrumental and hard to recognize at first. The lyrics are sad, though and it’s about unrequited love, I guess. I associated it years ago with drug and alcohol addiction after seeing the 2012 movie “Flight” on TV. Every scene in which the main character Whip Whitaker (played by Denzel Washington) got high, that song was a part of the scene.

Anyway, moving right along, the song that was not on the podcast and which was a whole lot of fun to listen to was “I Feel So Good (I Wanna Boogie) by Magic Sam. We’ve never heard of him but the way he sang the number made us laugh out loud.

The title of the podcast was right on target: “Variety is the Spice of Life.”