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Self-care in Medicine: Physicians Pursuing Other Careers

Recently, I have been focusing on ways to reduce burnout at work and home. In the news and media, we’ve all seemed to be focusing on this topic a lot lately. I’ve had some opportunities to discuss my own thoughts and tips on how to avoid physically and mentally burning out in 2 online articles recently. The first was for a feature in Medical Economics. The article can be found here on their website.
Additionally, the below-mentioned NBC News article that some of my comments are quoted in has been popping up on a lot of folks’ timelines because of the important convo it sparks for all careers. I think it fits right in with what we discuss here, no matter what career you’re in, especially if you work for someone else.
Take a gander. Share the article with others, as well, especially if you have friends in the medical field to continue sparking up the very important conversations.

The doctor is out? Why physicians are leaving their practices to pursue other careers

“After 20 years, I quit medicine and none of my colleagues were surprised. In fact, they all said they wish they could do the same,” said one doctor.
by Nicole Spector /
Image: A man pushes a stretcher in a hospital

The Association of American Medical Colleges projects a shortage of 42,600 to 121,300 physicians by 2030.Getty Images

The news that New York University will offer free tuition to all its medical school students, in the hope of encouraging more doctors to choose lower-paying specialties, offered hope to those wishing to pursue a career in the field.

However, becoming a doctor remains one of the most challenging career paths you can embark upon. It requires extensive (and expensive) schooling followed by intensive residencies before you’re fully on your feet. The idea, generally, is that all the hard work will pay off not only financially, but also in terms of job satisfaction and work-life balance; then there’s the immeasurable personal benefits of helping people, and possibly even saving lives. In terms of both nobility and prestige, few occupations rank as high.

So why is there waning interest in being a physician? A recent report from the Association of American Medical Colleges projected a shortage of 42,600 to 121,300 physicians by 2030, up from its 2017 projected shortage of 40,800 to 104,900 doctors.

There appear to be two main factors driving this anticipated doctor drought: First, young people are becoming less interested in pursuing medical careers with the rise of STEM jobs, a shift that Craig Fowler, regional VP of The Medicus Firm, a national physician search and consulting agency based in Dallas, has noticed.

“There are definitely fewer people going to [med school] and more going into careers like engineering,” Fowler told NBC News.

Fowler also speaks to the desire among millennials to be in hip, urban locations — a luxury you likely won’t get when you’re fresh out of medical school and in need of a residency.

“This is why places in middle America hire firms like ours,” Fowler said. “They’re having a harder time attracting people.”

But perhaps the more interesting story lies not with those deciding to eschew medical degrees; it’s with the people who went through all that training, who became doctors — and then decided to opt for another path.

This drastic career change can be a result of new med school grads being unable to find a residency within a reasonable period of time.

“Graduating med school doesn’t mean you’ll get into a residency,” said Fowler. “There aren’t enough residency slots for medical grads. So you have that population of people who have an MD but didn’t practice for that reason. There is this bottleneck effect.”

The mounting bureaucracy

This “bottleneck effect” doesn’t usually sour grads on staying the course, Fowler finds, but he does see plenty of doctors in the later stages of their careers hang up their stethoscopes earlier than expected. Some cite electronic health records (EHRs) as part of the reason — especially old school doctors who don’t pride themselves on their computer skills. New research by Stanford Medicine, conducted by The Harris Poll, found that 59 percent think EHRs “need a complete overhaul;” while 40 percent see “more challenges with EHRs than benefits.”

And then there are those doctors who left medicine because the cons of the job started to far outweigh the pros.

“After 20 years, I quit medicine and none of my colleagues were surprised. In fact, they all said they wish they could do the same,” Dr. Amy Baxter told NBC News.

“I began to feel like an easily replaceable cog in the health care machine. With the [enforcement] of EHRs, I had to spend more time as a scribe. One night a child I was treating had a seizure and I couldn’t get the medicine to enable them to breathe because their chart wasn’t in the system yet. This kid was fixing to die and I, the doctor, couldn’t get the medicine. It was demoralizing.”

Baxter left pediatric emergency medicine to head a company that develops physiological products for personal pain management.

Dr. Ha-Neul Seo, director of global recruitment at EF Education First in London, was a general practitioner in the U.K. for several years before heading to the U.S. to study health care management and policy. She wound up leaving medicine to focus on education because she felt, to some extent, she’d defaulted into a career that turned out to be more tedious than expected.

“As a patient you want your doctor to love and be passionate about their work — and I realized that wasn’t me,” Seo said. “Some parts were incredible, but the moments when I felt I was making a true difference were too few and far between. And then there was the issue of work-life balance. I had my first child and was barely seeing him. The schedule was relentless.”

Dr. Nicole Swiner, a physician and author, has stuck with being a doctor because she loves it so much, but she deeply empathizes with those who decide to leave.

“It has gotten worse for all of us, unfortunately — whether you work in the hospital or in the outpatient setting,” she told NBC News. “We are burdened more by nonmedical business or insurance professionals without any medical training. It’s disheartening. ​I have transitioned to more part-time clinical work [so as to focus more on] speaking, writing and consulting.”

“Become a full-time consultant, author, speaker, entrepreneur, baker, cheerleader — whatever. Just be happy. Life’s too short,” Swiner said.

#TAQM #TAQMvol2 #doctorpreneurs #physicianburnout #nosuperwoman #docswiner #mediadoc
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Wellness Wednesday: Work Life for the 40 & Over Club

Hey, good people!!! So, if you didn’t know I recently joined the 40 & over club this past April. Since joining I have now gained a new characteristic of not caring much about anything but the things I love. I have also re-created my work schedule where I will be in the clinic for only three days, with doing more tele-work from home. It inspired me to post some ideas and questions on Instragram in my Instastories and received some great feedback.

…and what perfect timing it was when I came across an article titled “People Over 40 Should Only Work 3 Days A Week, Expert Claim“….

Click here to read the article.

But while reading the article, it made me think…

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Life is expensive! So working 3 days a week is taking a financial back step, or a financial cha-cha, depending on how you look at life. Me? I say let’s dance baby…let’s dance.

But okay, I understand. Working 3 days may not be financially feasible. So that leads me to remember some tips that helped me.

tip 1

Planning takes time, organization, and dedication. Set some time aside to prioritize your goals, and write them down.

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Work less and live more! Life is more than work. You have to enjoy your free time; wait…you have to have free time to enjoy! If you feel that you are working too much, then cut back some on some work. Also, just learn how to say no.

So these next two tips are personal boundaries we have to set for ourselves. And although it will be tough, and take some time to master…I know we can do it!

tip 3

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In addition to the article, I wanted to add a quote from two debt burden and financial experts Drs. Nii-Danko and Renee Darko.

“The debt burden for many physicians and other professionals can be a major factor in determining if cutting back hours is financially possible. For us, significantly decreasing our debt burden allowed us to not only cut back on the number hours that we worked, but actually allowed us to live on Nii’s salary so that Renée could primarily stay at home once our baby was born. Without so much debt, your income can really go a long way.”

If the article and above quote aren’t enough encouragement to cut back, then I don’t know what it! Also, find encouragement and inspiration from your tribe; your community. A good friend of mine tweeted this recently:

margo

–right on time as I was writing this blog. Cutting back is required at times to practice healthy self-care.

Now, I don’t want you all to think that I don’t understand how hard it is to step back from our income. It’s easier said than done. However, I have confidence that we (the 40 & Older Boss Group) can cut back some days to enjoy our life! Let’s take control of our time & finances so we can live our BEST LIVES!

As Lil’ Duval says…….

living best life

Healthline Newsletter Feature: Craving Ice

My comments were featured in a recent article in Healthline Newsletter!

If you are “addicted” to eating ice, take a look here or read below to find out one reason why you might be.

Chewing-on-Ice

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Why Do You Crave Ice?

Do you ever get an urge to crunch on a piece of ice? If you do, you’re not alone.

You might think you’re craving for ice has something to do with the hot weather outside. And while a frozen cube of water can quench your thirst in the middle of summer, there are actually a few medical reasons you may be craving the frozen water in your freezer.

What causes you to crave ice?

You can crave ice for a number of reasons. Here are the common reasons people crave ice:

Pica

If you’re experiencing an insatiable craving to eat ice, you may have a condition called pica. “In medical terms, pica is a disorder defined by a desire to eat substances that lack any nutritional value,” explains Dr. Sarina Pasricha, MD, MSCR.

People with pica often crave nonfood items, like dirt, paint chips, clay, hair, ice, or paper. If ice is the substance you crave, then you may have a type of pica called pagophagia.

While there’s no single cause of pica or pagophagia, they can occur if you have iron deficiency anemia. Malnutrition or a mental health disorder may also be the culprit.

Pica is often seen in children and may have a psychological basis, such as obsessive-compulsive disorder or a pediatric developmental disorder. It’s also commonly related to an underlying nutrient deficiency, typically iron. This then results in anemia.

Iron deficiency anemia

You don’t have to receive a diagnosis of pica to crave ice. Some people with anemia may crave ice as a result of an iron deficiency. One study proposed that this is because ice gives people with anemia a mental boost. Anemia is a medical condition in which your blood doesn’t carry enough oxygen to the rest of your body. This results in less energy.

Other symptoms of anemia include:

  • shortness of breath
  • dizziness
  • weakness

Pregnancy

If you’re pregnant, your doctor may discover that you have anemia. “Pregnant women are often anemic due to the demands on the blood supply and circulation, poor nutritional intake, or from abnormal bleeding,” explains Dr. C. Nicole Swiner, MD. Even if you don’t have a history of anemia, you can become iron deficient during pregnancy.

In addition to anemia, Pasricha says there are other reasons you may crave ice during pregnancy:

  • Pregnancy can cause nausea and vomiting, which can lead to dehydration. In this case, eating ice allows you to stay hydrated without worsening the nausea symptoms.
  • Since ice has no odor or taste, many women crave ice during pregnancy.
  • Pregnancy increases a woman’s metabolic rate and causes vasodilation (swelling of the blood vessels). Both of these can lead women to feel increasingly hot and therefore crave cold items such as ice.

Should you see a doctor about your ice cravings?

Pasricha recommends seeing your doctor if your desire to eat or chew ice continues to increase for at least one month. Your doctor will likely perform basic lab work to test for iron deficiency anemia, which needs to be evaluated and treated.

It’s also a good idea to have your teeth evaluated. Chewing ice over time can ruin enamel. Ask your doctor to look at your teeth. They can tell you if a visit to the dentist is necessary.

How can you stop your ice cravings?

Once you visit your doctor, the next step is to come up with a plan to stop, or at least decrease, your ice cravings.

If anemia is the cause of your cravings, your doctor may start you on iron supplements and replacement therapy. After your iron stores are replaced, the ice craving usually resolves.

If anemia isn’t the underlying cause, your doctor may look at psychological reasons for the craving. “Some people may have craved ice due to psychological stressors, in which case, cognitive behavioral therapy has been shown to be helpful,” says Pasricha.

The bottom line

Compulsive ice chewing for a period of longer than one month is a sign of a more significant medical or psychological issue that needs to be checked out.

If you’re craving and chewing on ice for reasons other than thirst, make an appointment to see your healthcare provider.

Mental Health in Black Children: BlackDoctor.org

Thanks to blackdoctor.org for featuring my comments in this recent article.

Click here for the official article, or read below. Enjoy!

Depression in Black Children: What Does It Look Like?

What could a child possibly be depressed about? They don’t have bills or responsibilities, so what is there to really be sad about? Unfortunately, that is the misguided thinking in a lot of our homes. While a concerted effort to address mental health needs in the Black community is growing. There’s still a great need to address our little Black boys and girls who are suffering in the dark.

Childhood depression is often overlooked because kids, at the time, don’t have the language or perspective to understand what they’re feeling. Kids like Rhylan Thai Hagan and Stormiyah Denson-Jackson left this world without an explanation of their unspoken pain.

Across the nation suicides amongst Black children under 18 are up 71 percent in the past decade. Researchers are perplexed as to the reason why, but many indicate that factors such as perceived racism might explain the rise. Rheeda Walker, a professor at the University of Houston, believes that the perception that suicide isn’t a Black thing can also explain why it’s hard to detect the warning signs

“If there is a belief that black children do not kill themselves, there’s no reason to use tools to talk about suicide prevention,” she said.

The National Institute of Mental Health defines depression as “a common but serious mood disorder. It causes severe symptoms that affect how you feel, think, and handle daily activities, such as sleeping, eating, or working. To be diagnosed with depression, the symptoms must be present for at least two weeks.”

Depression is not to be confused with anxiety. People suffering from depression often have delayed or slower reactions. While people with anxiety are often hyper and have racing thoughts. Oftentimes the two get intertwined because of the similarity in symptoms.

If you feel that your child suffers from either you’re strongly encouraged to see a doctor or therapist.

Dr. C. Nicole Swiner and therapist Dr. Alisha Powell provide our readers with an in-depth look at childhood depression in the Black community.

BlackDoctor: How does childhood depression differ from adult depression?

Dr. Swiner: I believe many symptoms and factors may be similar, however, more symptoms are more related to decreased attention, increased irritability and agitation and acting out than low mood and sadness.

Dr. Powell: Child depression looks different from adult depression because children may not be able to tell you what’s wrong. They may become more isolated and less social with their peers.

BlackDoctor: What factors lead to childhood depression?

Dr. Swiner: Genetics, hormonal changes, emotional trauma, abuse or increased stress are factors that contribute to childhood depression.

Dr. Powell: Childhood depression can stem from stressors at home or school. It can also be caused by unhealthy interpersonal relationships or it can be a chemical imbalance in the brain.

BlackDoctor: How can you support your child through depression?

Dr. Swiner: Open communication, counseling, and therapy. Last resort would be medications, natural and pharmaceutical, with the help of physicians.

Dr. Powell: You can support your child with depression by not attempting to fix it on your own. Don’t shame them because of how they feel or tell them to snap out of it. Take them to talk to a licensed mental health professional and be open to different treatment options.

BlackDoctor: Is medicine always necessary?

Dr. Swiner: As a last resort and with the help of a physician, possibly.

Dr. Powell: Medication isn’t always necessary. However, in cases where there’s no identified stressor or trigger, medication can help with the chemical imbalance in the brain. Medication can also be helpful if there is a dramatic decrease in functioning—like if your child is not sleeping or eating and has started to self-harm.

Listen to the recommendations of mental health providers on whether or not medication is a good option for your child.

BlackDoctor: What are free or cost-effective ways to support your child’s mental health needs?

Dr. Swiner: Encouraging exercise, rest, hobbies, journaling, counseling with in-school therapists and ministers through a church.

Dr. Powell: Talk to your child’s school counselor about low-cost counseling clinics in the community and other resources. Call your insurance company and find out what behavioral health benefits are available. Many times, counseling graduate programs offer low-cost counseling as their students work with people in the community in order to get the hours that they need to graduate.

I also want to add: Depression should be taken seriously—especially in Black kids. Keep the lines of communication open but also understand that your child may also need to speak to someone else that isn’t you. Support your child by letting them know that there isn’t anything wrong with seeking help.

Essence Magazine: My Recent Features on Mental Health

I’ve had 2 wonderful opportunities this month to be in Essence Magazine! One on their #snapchat format, and the other online. Of course, I am beyond excited and would love for you all to check out the articles here or below!

You can also find the snapchat posts through my IG posts.

 

Enjoy!

Written by: Michelle Darrisaw, Essence Mag

May, 30, 2018

The Many Different Types Of Anxiety And Depression

Depressed Woman

“Nowadays, everyone from celebrities and social media influencers to teens is being more open about their struggles with mental health and giving a face to issues such as social anxiety and depression.

According to a recent study released by JAMA Pediatrics, from 2001 to 2015, the suicide rate for Black children ages 5 to 12 doubled that of their white counterparts in the same age range.

Dr. Marissa Long, a California-based clinical psychologist, who is also the founder of mental health and wellness subscription box, Thrive WISE, attributed the increase in anxiety and depression to societal issues such as school shootings, cyberbullying and economic instability.

“Anxiety is the most common of mental health issues in the U.S., but depression is not far behind as the leading cause of disability in the U.S. for teens and young adults,” stated Dr. Long. “It’s important to differentiate between normal moodiness and serious signs of disorders so that appropriate treatment can be secured.”

With these alarming numbers and the fact that it’s Mental Health Awareness Month, we decided to enlist the help of Dr. Long and other medical experts to break down the many different types of anxiety and depression, as well as things you should do if you’ve started noticing the following and symptoms. But first you should know that we all get nervous, sad or anxious from time to time, but it’s when these feelings persist that we should pay close attention.

“I like to say that anxiety is stress and worry shaken and heated up, which ultimately impacts our body as well,” stated Dr. Long. “It changes the flavor of our experience by diluting the reality of the situation in front of us, and adding in unwarranted and rigid thoughts that support our fear. There are FIVE major anxiety disorderseach with their own symptom presentation.”

Dr. Long summarizes the five disorders, associated symptoms, and treatment options as follows:

1. Generalized Anxiety Disorder (GAD)

With GAD, the name says it all. It can show up as persistent negative thoughts or negative assessments of one’s self, situations and the world around them as being scary, resulting in avoidance and efforts to mitigate the anticipated anxiety.

Physical Symptoms: Muscle tension, poor sleep, upset stomach, and jaw pain.

2. Social Anxiety/Social Phobia

Social anxiety or social phobia is an intense fear of social situations due to concerns about being criticized, embarrassed or humiliated. Something as seemingly simple as making a phone call, sitting in a waiting room, speaking publicly, eating with others, sharing an opinion or even talking with friends can prompt serious anxiety. For some, social phobia can also be experienced relate to specific people or situations such as talking to your boss or parties. There are many different types of phobias but the main thing to keep in mind is that it involves an irrational level of fear about something that is disproportionate to the actual danger. On top of all of this, unfortunately, people can have more than one specific phobia.

Physical Symptoms: Shaking, nausea or diarrhea, sweating, blushing or feeling flushed.

3. Panic Disorder

The experience of a panic attack is a uniquely awful one, but having a panic attack in and of itself does not warrant a diagnosis of panic disorder. Panic attacks involve a gradual build to or sudden experience of intense, and often uncontrollable and racing anxious thoughts combined with physical symptoms. It is when a person has recurrent and disabling panic attacks and/or persistent fears for longer than a month that a diagnosis of panic disorder may be warranted. The occurrence of panic attacks varies from one person to the next, happening as often as several times per day to once every couple of years.

Physical Symptoms: Tightness in the chest, shortness of breath, shakiness, chest pain, dizziness and excessive perspiration.

4. Obsessive Compulsive Disorder (OCD)

OCD is characterized by intrusive and persistent anxious thoughts or behaviors that are carried out with the purpose of relieving the anxiety. The thoughts and behaviors work together as a super team against their host in this disorder, and are quite powerful even when the person is able to identify their thoughts as unrealistic and the compulsions as unnecessary. For teens and young adults, this can result in an inability to attend school, let alone engage in normal social interactions, thus disabling them from engaging with life in a seemingly normal way.

5. Post-Traumatic Stress Disorder (PTSD)

PTSD is a common outcome of a traumatic event that is experienced, witnessed or even heard about in such a way that causes trauma. Symptoms can include difficulty relaxing and feeling on edge; hypervigilance, nightmares or flashbacks related to the experience, avoidance of anything related to the traumatic event, and an emotional numbness. PTSD is diagnosed when symptoms have been present for at least a month, but symptoms may not present until long after the trauma.

 

In recent years, the surviving victims of school shootings have been prime candidates for subsequent PTSD diagnoses, though other events like sexual assault, car accidents or witnessing a death are all examples of traumas that may bring about PTSD.

1. Major Depressive Disorder

Dr. Long also weighed in on six forms of depressive disorders and their overall effects on teens and young adults: She explains that “major depressive disorder is the most common form of depression and is characterized by the occurrence of specific symptoms, over a period of at least two weeks, that impair regular functioning in school or social activities for teens and young adults.”

Far too often, parents and loved ones write off major depressive disorder in their children as hormonal changes or an act of rebellion against authority.

Physical Symptoms: Decrease or increase in appetite, insomnia or hypersomnia, psychomotor agitation or retardation, constant fatigue, feelings of worthlessness or excessive and inappropriate guilt, recurrent thoughts of death and suicidal ideation (with or without specific plans for committing suicide) and cognitive difficulties like the inability to think, concentrate or make decisions.

2. Persistent Depressive Disorder (Dysthymia)

Dysthymia can be quite sneaky, especially among teens and young adults. It is often thought of as the disorder suffered by the beloved cartoon character, Eeyore (from Winnie the Pooh), who moped about his life on a rather consistent basis. The pervasive nature of it often allows people to view it as being the personality of the depressed individual rather than the health issue it actually is.

Persistent depressive disorder commonly goes undiagnosed into later adulthood but presents itself as a consistently low, dark or sad mood. For adolescents, the symptoms need to persist for more than one year, whereas adults require two or more years of persistent symptoms to meet the diagnosis. It’s important to note that symptoms experienced in dysthymia are not as severe as with major depression, and the persistence of symptoms does not mean that those with this disorder would be unable to have happy moments or days. Major depression may co-occur with dysthymia, or precede it, making it that much trickier to catch and diagnose.

Physical Symptoms: Poor appetite or overeating, low self-esteem, poor concentration, difficulty making decisions, low energy or fatigue, feelings of hopelessness, and insomnia or hypersomnia.

3. Premenstrual Dysphoric Disorder (PMDD)

While an extension of premenstrual syndrome (PMS), premenstrual dysphoric disorder (PMDD) should be understood to be much more severe and at times disabling. For teens and young adults, there is a tendency to, again, write the emotional experience off as being moody or “extra” until the heightened physical symptoms bring cause for concern and attention. Symptoms of PMDD usually begin seven to ten days before the start of a menstrual period and continue through the first few days of the period.

Physical Symptoms: Breast tenderness, bloating, fatigue, changes in sleep and eating habits, anxiety or tension, sadness or hopelessness, moodiness, irritability or anger.

4. Depressive Disorder Due to Another Medical Condition

When medical conditions bring about depressive symptoms, it’s called depressive disorder due to another medical condition. This can be tremendously difficult to diagnose because there is generally an assumption that teens and young adults are physically healthy, unless there is a glaringly obvious weight gain or loss. A simple blood panel and urinalysis can determine if a patient is suffering from another medical condition, like hypothyroidism, for example.

Physical Symptoms: Fatigue, weight gain, sleep changes, irritability, memory loss and low mood.

5. Seasonal Affective Disorder (SAD)

Adolescents and young adults with SAD struggle with the symptoms of a major depressive disorder, but it is limited to a specific time of year, specifically winter. The cause of this is related to decreased exposure to sunlight during the shorter days of winter months. For teenagers, this change could cause them to isolate from their friends and avoid participating in physical activities.

6. Bipolar Depression

Bipolar depression is a mixture of depression and manic episodes. It is treated in similar ways as depression, but with more intensive therapy needed.

Physical Symptoms: The feeling of being on a high, but not in a good way, with thoughts of grandiosity. Also, be on the lookout for increased, uncomfortable energy, insomnia and unhealthy hypersexuality.

PREVENTION TREATMENTS

Journaling

“Journaling is highly recommended as a tool that can help relieve the symptoms of depression and anxiety, stated Latonia Francois, a mental health expert and founder of Let’s Write Life, which is a journaling and event company. “It’s a healthier alternative to antidepressants and other forms of harmful self-medication. On a mild level, journaling can be recommended as a form of self-care and a way for mental health professionals to help their clients express themselves, track patterns of progress and spark conversations that clients may not be able to vocalize.”

Self-Care Days and Activities

Family doctor and the best-selling author of How to Avoid the Superwoman Complex, Dr. C. Nicole Swiner (#docswiner), recommended the following forms of self-care to help you focus outwardly, instead of turning your attention inward to your anxiety: exercise, journaling, coloring, listening or producing music, being creative in the arts or volunteering to help others.

“Regular exercise increases endorphins aka the feel-good hormone,” Dr. Swiner stated. “Restful sleep, [maintaining] fulfilling relationships, and [adopting] healthy hobbies outside of school and work can help mild cases of depression. You just have to be aware of when things get out of control.”

Medication and Therapy

“One way to treat depression is, of course, with use of medications,” Dr. Swiner advised. “I’d say the biggest thing in our community that prevents us from seeking help with depression and similar issues is that we’re too proud to talk about it. Or, it’s because we don’t want to be put on a ‘crazy pill’ and have bad side effects (like weight gain or decreased sexual desires). Medicine is not the only way to treat these things, however, so keep an open mind and talk to someone about it in counseling and therapy.””

An Oldie but Goodie for Mental Health Awareness Month: Stress-related Disorders

Here’s an article I penned in 2010 around this time of year. Still very relevant…..

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This month makes a year that I’ve been writing articles for medical education. My first article centered on the issue of depression and being self-aware of the warning signs.

Here are some of the most common stress-related disorders that I see on a daily basis.

  1. Depression and anxiety/panic disorders. This is pretty easy to understand. The more stress a person has, the worse underlying mental health disorders can become. The stress of loss of a loved one, loss of a job or threat of losing your job, or a strained relationship can lead to overwhelming sadness or symptoms of panic. Insomnia and sleep disturbances can occur as racing thoughts and worry increase at night. Alcohol and tobacco abuse can also occur concurrently as ways to self-medicate in the absence of correct ways of treatment such as prayer, counseling, therapy or prescribed medication.
  2. Hypertension and heart disease. Otherwise known as high blood pressure, stress can cause an increase in constriction of blood vessels. Stress has not been proven as a direct cause of high blood pressure, but it can have an overall effect on the release of hormones from the nervous system and circulatory systems, which makes it harder for the heart to pump blood to our vital organs. If blood pressure is chronically high and blood vessels have enough damage or cholesterol buildup, heart disease can be the result. Some chest pain can even be linked to stress.
  3. GERD (acid reflux) and stomach ulcers. Emotional stress can lead to an increased production of acid from proton pumps and H2 receptors in our stomachs. If acidity is prominent, a burning sensation can be felt and pain can extend from the stomach (in the center and to the left of the middle of the stomach) all the way up to the esophagus and throat. Foods that we eat, including caffeinated beverages, spicy ingredients and citrus can make this worse. If left for too long, ulcers, or an eating away of the lining of the stomach, can develop and even worsen to the point of bleeding.
  4. Obesity. Stress can cause an increase of the hormone cortisol to be released from the adrenal glands. Cortisol is linked to increased glucose (blood sugar) and weight gain. Also, while some of us eat less with stress, many of us eat more “comfort foods,” which are generally more sweet and fatty, and have more calories.
  5. Headaches. Migraines are thought to be the most common type of headache, but tension is probably higher on the list of causes of headache. Both types can increase with stress. With tension headaches, a tense pressure or squeeze can be felt in any part of the head, usually with muscle tension and soreness of the neck and even shoulders. Migraines are thought to be associated with signals from the nervous system that relax blood vessels. When vessels relax, blood rushes to them and cause dilation. If too dilated, this can cause pain.
  6. Abnormal menstrual cycles. Skipping a period can be very distressing for a woman, especially if unexplained. Although we don’t know what the certain cause is, it is thought that emotional stress affects release of certain pituitary hormones that can cause irregular periods. If weight is lost or gained due to stress, estrogen or a lack thereof, it can also cause irregular periods.
  7. Viral infections. When we’re stressed or fatigued, our immune system doesn’t work as well to prevent us from infection. We all have antibodies from vaccines or from previous infections that have built up in memory cells and are programmed to increase when we are exposed to infections. Stress reduces this response. Colds can occur more frequently and, even worse, viruses such as herpes and HPV (human papilloma virus can show themselves during these “down” times.
  8. Cancers. This one is controversial, as some studies say one thing and some say another. The conflicting data questions whether stress can be a direct cause of some cancers. In 2002, a study was done on patients who had breast cancer that was treated. The question was asked if stress could be linked to the cancer coming back. The study could not prove it to be true. However, in animal studies, an increase of stress hormones was linked directly to growth of some tumors. Long story short, the evidence is inconsistent, but there may be truth to the claim that stress can lead to certain cancers.

All in all, be self-aware of the signs. If you’re feeling overwhelmed, as we all at some point do, be pro-active by exercising, drinking plenty of water, getting good restful sleep and doing those things that you enjoy doing with those you love. If it still feels like life is crashing down on you or your body is breaking down, please see your doctor.

WeHaveKids Shares My Thoughts on Probiotics

I contributed to an article featured on WeHaveKids.com. I shared my opinions on stomach issues in children. I share my support for using probiotics for an aching tummy. See here or read below!

Thanks,

DocSwiner

When “Mommy, My Stomach Hurts!” Requires Medical Attention

Updated on May 9, 2018

I am a mother who had the ordeal of a daughter with appendicitis.

We’ve all had upset stomachs from time to time. We often don’t worry about it since we chalk it up to something we ate. However, it is always concerning when your child says their stomach hurts. You’re not sure if they had just overindulged from the tub of ice cream or if something serious is going on.

There can be a variety of reasons for their discomfort. Before you panic, keep in mind that most causes for stomach aches are pretty banal and can be resolved with time and possibly an antacid for children. However, you should be aware of more serious causes like appendicitis. I had the experience of my daughter suffering from this. This article is intended to share my story as well as keep you informed for when your child says they have stomach pain.

This CAT scan shows a case of appendicitis. Note that the diameter of the appendix is swelled up to 17 mm in diameter. The normal size is around seven or eight mm.
This CAT scan shows a case of appendicitis. Note that the diameter of the appendix is swelled up to 17 mm in diameter. The normal size is around seven or eight mm. | Source

What Causes Stomach Pain in a Child?

Abdominal pain in a child can be troubling but the cause for it may not be serious. There are a variety of causes that are not life-threatening or do not require a visit to the emergency room.

Constipation

Studies have shown that constipation is responsible for nearly half of all cases of sudden stomach pain in children. It can be assumed constipation is the cause if your child has not gone to the restroom in two days or if their stool is hard. However, according to Dr. Dan Thomas, a pediatric gastroenterologist at Childrens Hospital Los Angeles, a bowel movement may not eliminate everything in their colon. Here are some preventive and relief measures.

  • Make sure your child gets plenty of fiber and fluids.
  • Avoid heavy consumption of processed grains and dairy.
  • Whole-grain cereals and pear juice can help alleviate symptoms.
  • Check with a pediatrician if your child can take any over-the-counter medication that can soften their stool.
  • Do not give your child any laxatives that is intended for adults.
  • Have your child try probiotics. “These natural bacteria, found in most yogurts or as over-the-counter supplements or vitamins, replenish the gut and help balance ph levels,” says Dr. C. Nicole Swiner, a family medicine specialist at Durham Family Medicine in Durham, North Carolina. “They’re a safe, non-pharmaceutical treatment for constipation, diarrhea, and other “below the belt” issues. It’s my go-to for my five and seven-year-old.”

Gas

Gas is naturally produced by food being broken down in the large intestine. Some children can produce more than others, especially if they eat a lot of sugar. Excessive gas can be painful. Dairy foods can create great discomfort if your child is lactose intolerant. The best solution for this is to identify what your child is eating that is causing uncomfortable gas. You can read this useful article that describes which foods causes and prevents gas.

Gastroesophageal Reflux

It can surprising to hear but children can indeed suffer from heartburn. A symptom of gastroesophageal reflux disease (GERD) includes stomach aches. According to Nationwide Children’s, this can occur when a child eats spicy food, fried food, junk food, or acidic food. It is best to implement preventive measures such as ensuring your child eats fruits and vegetables to balance out acid levels. You may check with a pediatrician if any type of medication can be used.

Abdominal Migraine

According to the American Migraine Foundation, this is a condition mostly found in children age five to nine. The symptoms include stomach pain, nausea, and vomiting. The triggers for the pain are similar to those of migraine headaches. Medication may be prescribed if the migraines are frequent. Children with abdominal migraines may go on to develop migraine headaches later in life.

These are gallstones formed from cholesterol. For size reference, each grid is 1 mm.
These are gallstones formed from cholesterol. For size reference, each grid is 1 mm. | Source

When to Worry About Your Child’s Stomach Pain

If your child’s stomach pain does not improve in 24 hours, gets worse, or becomes more frequent, then something serious may be happening. These are some causes that require medical attention.

Gallstones

Gallstones are formed when the bile in your gallbladder hardens into stone-like objects. The can cause blockage in the hepatic ducts, which can lead to infection and organ damage. While not common in children, it does happen. According to Seattle’s Children, the most common symptom is pain in the upper belly, typically on the right side. The pain is recurring and could potentially last for hours. Pain can occur after eating a meal, especially if the food is fatty or greasy. For more information, you can read this in-depth article on problems and treatments related to gallstones.

Stomach Ulcer

This is a lesion in the stomach. According to the University of Rochester Medical Center, they are often caused by an infection of Heliobacter pylori, a bacteria that weakens the protective mucus in the stomach. The most common symptom for this is a burning or gnawing pain in the stomach. Other symptoms include anemia and fatigue. Treatment may include a variety of medicines and even surgery if needed. You can read this article which covers more complications and treatments of stomach ulcers.

Inflammatory Bowel Disease

This is a chronic disease where the stomach, small intestine, or colon are inflamed or irritated. According to the American College of Gastroenterology, this condition is relatively rare in children, although it is slightly more common with teens around ages 15 to 19. The most common symptom is abdominal pain along with diarrhea and the presence of blood in bowel movements. Medication will be needed to treat this disease.

Intussusception

This is a life-threatening condition where a part of the intestine folds into another segment. This obstructs food from passing through the intestine. This can lead to infections such as peritonitis. According to the Children’s Hospital of Philadelphia, there is no known cause, although viral infections and abnormalities like polyps may play a role. Abdominal pain is the most common symptom. Vomiting may occur as well as bloody stool. Treatment is done with an enema or with surgery in more dire cases.

A CAT scan showing a case of intussusception. The circular target sign indicates where one part of the bowel folded into another.
A CAT scan showing a case of intussusception. The circular target sign indicates where one part of the bowel folded into another. | Source

Appendicitis

This is a condition where the appendix suffers from inflammation. If an infected appendix is not removed, it can burst and spread bacteria. This can lead to serious infections and can cause peritonitis.

What causes appendicitis in children?

According to KidsHealth, appendicitis is the result of the appendix being blocked. This blockage is typically caused by hard stool (called fecolith), lymphadenopathy (the inflammation of lymph nodes), or even infections from parasites. A ruptured appendix can release bacteria throughout the abdomen, which can cause further complications. Appendicitis usually affects children and teens between the age of 10 and 20. It is the most common reason for emergency abdominal surgery in children.

What are the symptoms of appendicitis?

You should call a doctor if your child is experiencing any of the following symptoms.

  • Strong stomach pain near the belly button or around the lower right side of the abdomen. The pain can begin infrequently before becoming more constant.
  • The presence of a low fever.
  • A decrease in appetite.
  • Nausea and vomiting.
  • Diarrhea, particularly if mucus is present.
  • An infant with appendicitis may have their abdomen appear swollen or bloated.

My Personal Experience

One of the main reasons I am writing this is to potentially help save a child’s life. Here is my story!

A few years ago my daughter complained of a stomach ache. Being the typical mom, I dismissed it as something she ate or she needed to have a bowel movement. The next morning, she said her stomach still hurt, but I got her dressed, fed her crackers, and sent her off to school. Since I work at the school, I told the teacher if her stomach continues to hurt, allow her to put her head down and I would pick her up immediately following school. My daughter rested all day in class but nothing major happened. I checked with the teacher who said she seemed fine by the end of the day. I checked with my daughter who said she felt better, so I decided to stay at work and send her to extended care to play for a while.

About an hour after arriving home, she said her stomach pain had returned. At this point I was wondering if she was faking this whole thing—but then again, after raising three other kids, I have learned to never accuse them of faking because you never know. So I called her doctor and explained the problem: stomach pain, vomiting on the first day, no fever, no diarrhea, no appetite. The doctor felt it was maybe the flu coming on. I did not believe it was the flu. She was not coughing, sniffling, or had a sore throat. So I did what every typical mother does. I jumped on the Internet and researched the flu.

My little sunshine felt better the next morning, so off to school we went. But later that day she ate and vomited and also developed a sore throat, so I decided to keep her home and keep an eye on her. She started to run a fever and get the sniffles so I figured that it was the flu. I took her to the doctor and they gave her an antibiotic for her throat. I ran out to get all the typical cough medicine and fill her with fluids. By Monday she felt better and we were off to another week at school. No stomach pain, no fever, nothing. Great!

The following week she developed a bizarre rash, so I took her to the doctor because I figured that she had been sick for two weeks now and this was not normal. I have watched enough House to know this was not normal. The doctor told me it was just a rash and gave her a steroid and discontinued the antibiotic. A few days later she felt better.

The following week she began to complain of stomach pain again. I told her to rest and see if it goes away. She played with her siblings so I dismissed the problem. In the middle of the night she came to get into bed with us, which is not abnormal. The next morning she complained of her stomach hurting but this time, she was rocking with the pain. I went to the Internet to research stomach pain in children. I wrote down her bowel movements and charted the past 2 ½ weeks. I went to the store to get something to help with her stomach ache. When I returned home she was in tears. I rushed to her side, trying to remain calm as I determined what was wrong. I took her temperature; low grade! I asked the typical questions. Where does it hurt? How bad is the pain? Are you hungry? Are you thirsty? Can you get up? Did you go potty since mommy left?

I gave her a painkiller and some plum juice to move the crowd inside. A few moments later, she cries louder. I go back to her room and she is rocking even more, this time holding her stomach. I stretch her legs out and lay my hand on her stomach. She tells me that doesn’t hurt. I press down and she cries louder. I tell the other children to get dressed because we are leaving. I call her pediatrician to let her know I am going to the emergency room. She concurs and off we go!

I will spare you the emergency room nightmare. Let’s just say that after a five hour wait we finally get blood test and a CT scan. The doctor came in to give us the bad news. Our daughter had to have surgery because she had appendicitis. Then another doctor entered the room and asked me to explain what happened. I told him how the pain started weeks ago, and how I called the doctor, took her to the doctor twice, and how this morning she was crying in pain but now she felt better. She was talking, laughing, and having a good time. She was her old self again. Were they sure this was appendicitis?

The head physician stated (and I quote), “This is not good.” Now I am scared. He tells us the pain leaving is the calm before the storm, how sometimes right before your appendix ruptures, you don’t feel pain. He explained how the pain with appendicitis comes and goes and that she needed surgery immediately!

Within minutes, a surgeon entered the room and explained everything, how fecal matter gets into your appendix and it gets infected and requires removal. He explained why my five-year-old needed surgery within the hour, as soon as they assembled a team. I was on the phone with all my prayer warriors, asking them to get the lines of prayer open. My husband and I prayed over our daughter and for the healing of her little body.

What Happened?

My daughter came home and recovered—praise God. The surgeons stated her appendix was nasty and they were sure they caught it just before it ruptured. The surgeon said my daughter must posses a high pain tolerance because she should have been screaming in agony—it was really bad. I know God was watching over my daughter because this could have turned out much worse. I pray this article and my story will help you.

Sources

  • Appendicitis. (2015, May). From KidsHealth.
  • Abdominal Migraine. From American Migraine Foundation.
  • Eller, D. (2015, July 15). “My Stomach Hurts”: Common Causes and Cures for Tummy Trouble. From Parents.
  • Gallstones. From Seattle Children’s.
  • Inflammatory Bowel Disease in Children. From American College of Gastroenterology.
  • Intussusception. (2014, March 31). From Children’s Hospital of Philadelphia.
  • Stomach and Duodenal Ulcers in Children. From University of Rochester Medical Center.
  • What to Do If Your Child Complains of Heartburn. From Nationwide Children’s.