Motif

Author: Cathren Housley

  • Advice From The Trenches: Help

    Advice From The Trenches: Help

    Advice from the Trenches

    Dear C,

    I recently had surgery, and oddly enough, the hardest part of recovery is that I can’t do things for myself that I normally do. I need help — and I really have a hard time asking for help. I was raised back when women were supposed to make everyone else happy, and they thought nothing of sacrificing themselves and going without so that their family could have whatever they needed.

    The upside of this way of thinking is that I really am quite self-sufficient. The downside is that when I can’t be self-sufficient I haven’t really cultivated the types of friendships where I feel like I can ask for help. My job requires me to work with a lot of people, so I have many work friends and multiple social acquaintances. But when it comes to a situation like this, I don’t really have anyone I can turn to. I’d feel like I was asking a relative stranger for help.

    Got any ideas how I can overcome this? I realize now that it was probably a mistake not to develop any close friends, but honestly, I haven’t had time for it for many years and I am so exposed to the public that I never felt isolated. It’s too late to develop any deeper friendships at the moment — but I am really gonna need help for at least another month and a half and if I don’t figure out how to do it, I’ll be in trouble. – Nurse Betty

    C says:

    I realize that you have the best of intentions and you most likely feel like you’re bugging people by asking. It probably never occurred to you that you could actually be depriving other people by not allowing them to help you. 

    The medical explanation for this might make you feel a little better about reaching out. 

    Human brains seem to be wired for kindness. When we give, the reward circuitry in our gray matter is triggered much the same as if we’d been given a bonus at work. That sense of well being you get from kindness to others comes from an increase in the output of the dopamine receptors in our brains. Endogenous opioids and serotonin give us a natural high. At the same time, there can be an increase in oxytocin levels throughout the body, bringing a sense of well being and in turn releasing nitric oxide, a chemical that expands the blood vessels and reduces blood pressure. Kindness not only warms hearts, it’s good for the heart. An added plus is that oxytocin reduces free radicals and inflammation, major culprits in both disease and aging.

    So don’t think about asking for help as burdening other people — it might actually be something that benefits them too. Kindness can be even better when shared — and when two people help each other difficult recoveries can become doable. 

    A study at Brown University showed that recovering alcoholics who helped each other maintained a 40% sobriety rate over time, compared to a rate of only 22% for those who struggled on their own. Anyone who has managed to maintain sobriety through AA can tell you how important shared support was to their recovery.

    As far as your new goal to develop deeper friendships in the future, volunteering might be a good place to meet good people. There are benefits regardless, as you continue to recover –  studies have also shown that people who volunteer have better health and a lower mortality rate. All it takes is 2-4 hours a week, probably far less time than you spend browsing your devices. 

    Kindness improves relationships of all kinds, and people who feel considered are more likely to consider back. As a compulsive giver though, you might want to read this article from Time  that covers both the pros and cons of giving: https://time.com/collection/guide-to-happiness/4070299/secret-to-happiness/

    There can be a fine line between being a giver, and being a sap, a doormat, or a chronic martyr.

    I hope you feel better soon.

  • Vitamin O

    Over 40% of Americans are obese and despite the fact that weight loss clinics and diet fads abound, these statistics continue to rise. The experts have been helpless to stop these burgeoning numbers so it is no wonder that the pharmaceuticals Ozempic, Wegovy, and other semaglutide medications seem like the miracle drugs Americans have been praying for.

    “With just the first dose [of Ozempic?], your body starts burning body fat all on its own without annoying diet or exercise! Speed up your metabolism, increase energy levels, and improve the quality of your sleep all while being actually approved by the FDA – and we can get you this prescription by connecting you to a doctor online in seconds!”

    But is this miracle drug all that it’s cracked up to be? 

    The answer is both yes, and an emphatic NO. For a medical perspective, I consulted my friend, Dr. E.

    Dr. E: Initially, I was extremely skeptical. Endocrinologists had been using these drugs for years to get sugar levels down, but they were very expensive and did not reduce sugar levels that much, so I didn’t prescribe them. When reports of weight loss first came out, I was still unconvinced because it was coming from the pharmaceutical companies. However, when  reports of “clinically significant” weight loss came out about one to two years ago I began to prescribe it.

    What does not get as much press are the side effects – maybe 75% of people get at least some nausea when they start the drug, and some experience a lot of nausea. And, every time patients increase the dose there’s more nausea. This makes it difficult to increase the dose to the target dose or even keep patients on the medication. I needed to educate patients to tough it out until the nausea improved, usually after a few weeks. 

    In my own experience many people do not get up to the so-called “target dose,” but many of these people can lose weight by taking less than the target dose. I keep patients on whatever dose they can tolerate and that also makes them lose weight. Most people do lose weight, but it varies; some lose 5 –10 pounds and others lose 30 pounds and more.  

    A big unanswered question is the long term. Any long-term drug use has side effects and people are going to have to stay on the drug for the rest of their lives. However, a morbidly obese person who loses 60 pounds has so many benefits, from heart health to decreased joint pain, that people are willing to tolerate some side effects. “A well-regarded magazine” did report that Ozempic caused permanent stomach dysfunction/nausea in some people (known as gastroparesis) even after it was stopped, so I have my ears up, but most people say they are happy.  

    Obesity is so prevalent, and the bad health effects of obesity are so severe and well-established, that anything that can cause a significant weight loss — if it works —, is worth the risk. It doesn’t really have to be 100% safe or easy to take because the potential benefits are so big. Before these drugs became available, people were resorting to bariatric surgery to lose weight – so taking a self administered shot once a week approaches being a no brainer.  

    For some reason, the insurance companies themselves are promoting these drugs, even though they cost about $15,000 a year to take and, at the current time, the drug is only approved for people with obesity and diabetes. If patients are obese and without diabetes, insurance companies won’t cover it, so it’s too expensive for most people. But if people meet the qualifications the insurance coverage is there.  

    The medical evidence is pretty clear that the lighter you are, the fewer health issues you have. Until these drugs came out, pretty much nothing else worked, so you can understand why they are getting all this attention and use. Bariatric surgery is almost not a thought any more.  

    New drugs will be coming out, but at the moment the drug companies are having a hard time manufacturing enough to meet the demand, and short-term shortages and unavailability are not uncommon in RI and the rest of the US.

                                                                    *****************

    And there you have the rational side of Ozempic, Wegovy, and other semaglutide weight loss drugs.

    Unfortunately, the distribution of these new drugs is not proceeding according to medical wisdom. Right now you can go online and find at least 20 different sites that will hook you up with an online physician and get you a prescription without going through either your insurance or the medical network.

    America leads the world in obesity. I don’t blame the doctors. Doctors advise their patients all the time to lose weight. But people just can’t do it. The result is that they are willing to pay $15,000 a year for medication that will at best probably make them lose 30 pounds that they’re going to regain as soon as they stop taking the medication.

    Losing weight is not a simple problem and keeping it off is even harder. But this move to pharmaceuticals as the ultimate solution seems to say that we’ve just given up; and I would hate to think that is true.

  • Advice from the Trenches: Lawn and learn

    Advice from the Trenches: Lawn and learn

    Dear C,

    I’m a single homeowner with a creatively rewarding albeit low-paying career. I was married for 12 years, so I don’t feel like I missed out on anything. Honestly? I like living alone.

    I have been very independent in the last 30 years of my life but now that I am starting to get a little older – OK, I admit it, I am over 55 now – I am starting to have a hard time keeping up with taking care of my house, taking care of business, and finding time to take care of myself. I need help. The problem is that I really can’t afford to pay someone to take care of the stuff for me.

    Everyone my own age now hires a lawn crew. I’ve asked some of them for recommendations but every time they quote what to them is a “super cheap”  price all I can think of is geez they must be in a higher income bracket than I am because I can’t pay $150 a month for someone to mow my lawn.  

    I’d ask a neighborhood kid but none of the neighbors I know have teenage kids – most of their children have grown up and moved away by now. Got any ideas how can I find affordable help?

    C says:

    There are a lot of licensed lawn care sites you can turn to, such as Angie’s List and NextDoor.com, but you will pay extra for their advertising and overhead. Craigslist is a possibility, but it wouldn’t be my first choice. Why take chances on anonymous posts? This is RI. We may be a small state, but we do take care of our own. There are a huge number of safer and thriftier resources available for people just like you.

    You didn’t mention your neighborhood or community or I would send you in a more personalized direction, but wherever you are, help is not far from hand.

    First – lucky you! Your age qualifies you for membership and aid from most of the senior centers in RI. For example: the doors of the East Providence Senior Center are open to anyone over 55 and persons of any age who are disabled. They can provide or make arrangements for services and information that covers everything from health services to meals and transportation, and they have community partnerships with more than 25 different local agencies.

    The City of Providence has a collection of offices and agencies that will link you to every service imaginable at oha.ri.gov/what-we-do/connect/senior-resource-centers. They also have a Search By Town feature that allows you to see what is available nearest you.

    But you don’t have to be old to find help. One resource that a lot of people forget about are our community churches. These are often hubs of support which rival any government sponsored organization and they bring people together who have a genuine desire to support each other. 

    I discovered the Chinese Christian Church of Rhode Island through my friend Cathie Ho Nadeau who is originally from Hong Kong. I am not a church goer myself, but Cathie said so many positive things about this open-minded group that I had to see for myself. I discovered a friendly and non-judgemental network that welcomes everyone, whatever their beliefs or country of origin. And talk about support – I mentioned I wanted to learn Mandarin and immediately got three offers for lessons. I suspect that if I had mentioned that my lawn needs mowing it could have been arranged within minutes. Check out all their programs at cccri.org.

    And don’t forget the libraries! They were the best thing Benjamin Franklin ever invented and I owe the only sanity and stability I knew as a child entirely to my local branch. The Community Libraries of PVD has a community support specialist who can assist with finding everything from housing services to substance abuse programs. If they can’t connect you with cheap lawn care, I don’t know who can. clpvd.org/learn/spotlight/community-support/

    The bulletin boards at many supermarkets are another good place to look for workers – everyone from teens to retirees look for opportunities there because it is free, and whoever answers is likely to live nearby with references from people you know. That’s what you want. You could try posting a flier yourself. 

    There is literally an entire state full of possibilities. If you have your own mower, you are already ahead of the game.

  • Breaking Barriers: Providence’s pioneer in death influence

    Breaking Barriers: Providence’s pioneer in death influence

    Photos by Jay Davani.

    Death Café. The name itself evokes a visceral response in each of us. From the moment we are born, we have a sense of what this unknowable event means, and as we grow, the culture and circumstances that surround us influence our perception of death. It is generally a grim view.

    I spoke with Jay Davani, the facilitator of Death Café in Providence. She offers a very different perspective on what the name, and her own work as a pioneer in Death Activism, is all about.

    Davani was born in Iran, a country where the subject of mortality is shrouded in tradition and secrecy. “Death has always been a big part of my life but it’s always been in the background, hidden. I’m Persian and in our culture it is forbidden to speak about death. It’s a bad omen. Even when someone’s dying you don’t say that they’re dying out loud.” Her sole experience at a cemetery as a child left her confused and unsettled. “It was really upsetting to see my father so devastated when I didn’t understand what was going on.”

    It was through art that Davani finally reached her own understanding of death.

    “When I went to college in Atlanta, I picked up my first camera and started teaching myself how to use it.” After she moved to New England to continue her work in graphic design at Brown University, she chose a digital photography class at RISD as her elective. “One of the assignments with that class was to shoot something that we were really uncomfortable with. The first thing that came right to me were cemeteries.” It was a pivotal decision that would launch her journey as an artist and Death Influencer.

    She shot the project at a cemetery in Portsmouth, NH. As she moved amid the rows of quiet stones, the visual nature of photography itself had a magical effect; she saw her surroundings in a new and very different way. “I started to feel more comfortable looking at all the details, the shadows and the light… I felt at home. I remember the moment.” Ever since then she has been walking through and within cemeteries, taking pictures.

    New opportunities came as her work progressed. North Burial Ground, Providence’s oldest municipal cemetery, noticed Davani’s photographs and asked her to do an artist talk. This virtual event held during COVID drew the largest crowd that the organization had ever had. Among the attendees was a Death Doula from Canada who invited Davani to apply to an exclusive two-week program at the Mortem Death School, based in Ontario. This global virtual residency admits only six artists for each session; Davani was one of those chosen.

    “During the program we learned from different death workers in the industry. A Death Doula who worked with us talked about gatherings called Death Cafés. They even have an artspecific Death Café with artists for whom death is a central theme.” After attending those events online for a year, she was inspired to bring the idea to the US.

    Davani wrote a proposal for the Providence City Parks Department and immediately convinced them: “Trust me, this is necessary and people are going to want to come.” The initial contract was for three events, but after the first two maxed out less than an hour after the post went up, the program was extended. Davani is currently in the process of negotiating a contract with the Community Libraries of Providence to host future sessions.

    So what exactly goes on at a Death Café?

    “I am creating and cultivating space for people to face, talk about, and deal with their own mortality and that of their loved ones,” Davani told me. She is also planning a seminar on endof-life paperwork, with an attorney present to help people get started and to understand how to have these conversations.

    “My goal through all of this work is that people suffer less at the end of life.” Davani has had the privilege of witnessing the dying process several times. “The thing that upset me and hurt my heart is that the people who suffer the most are the ones who have the greatest fear of death. Fear does not actually allow the body to die, so they end up feeling the torture of death as a painful and long experience. It’s a survival instinct that is meant to protect us, but in death, it actually ends up hurting us more.”

    What does Davani hope to accomplish?

    “My ultimate goal is that people are more alive, that they feel more aware and more mindful, more in tune with the finite nature of life.” She has seen this at every Death Café. The energy in the room goes from fear, to curiosity, to an explosion. “After each event we’ve held a postmortem afterparty because an hour and a half is just not enough time.” •

    For updates on Death Café visit thejaydavani.com/mortem or follow  @thejaydavani on Instagram.

  • Advice From The Trenches: Everyone’s Business

    Advice From The Trenches: Everyone’s Business

    Advice From The Trenches


    Dear C,

    My friend Lou lives one state away. His dad is 82 now, with no family left but Lou, and for the last few months all I’ve heard about is how stubborn dad is, how his recliner has to be fixed every week, etc, etc – and the sheer amount of time it is taking up. 

    I had to look after my own elderly father until he died, so I understood his frustrations. At first, I just listened; after all, people need to vent. But this summer the situation became more serious. Lou’s father lives alone and has fallen more than once. The last time, he was found unconscious on the floor with all the windows in the house shut and no AC – on a 90 degree day!

    This was the point where I started to make suggestions and tell Lou that his dad needed more help. He kept making excuses like: “Well, I keep telling him but he ignores me” and “He’ll do what he wants no matter what anyone says.” 

    The one thing that I learned while caring for my elderly father before he died is that you can’t let an aging parent who is clearly becoming incapacitated make their own essential health decisions. At a certain age, it is time for the child to step up and become the parent. But when I told him this, Lou just dug his heels in and said, “I can’t worry about it. I’m not going to be there 24/7 and if I put him in a home he’ll kill himself – believe me he will. I’m staying out of it.” Then he made some jokes and changed the subject.

    This was when I begged Lou to contact Medicare, telling him that there were plenty of  services covered by insurance for home care. I apologized for being annoying but said that it really was a matter of life or death if another heat wave hit. That’s when Lou stopped writing.

    After a month, I finally sent an email asking what was going on. I got back a nasty letter telling me that he didn’t want to hear it and it was none of my business. Then he blocked my emails and unfriended me on Facebook.

    What the hell! Am I really just being a pushy asshole who sticks her nose where it doesn’t belong? I still feel like there’s something I should do!       

    Nosey Nora


    C says:

    I find Lou’s response interesting – mostly because it echoes the response that every abusive parent or spouse gives when an outsider steps in and raises questions: “Stay out of this, it’s none of your business!”

    Lou would be right to tell you to mind your own business if there was nothing but the usual family/relationship drama going on – that really IS nobody’s business. But when the drama escalates and lives are in danger, that is a game changer. What Lou is doing has crossed the line. It borders on elder abuse, and when abuse is happening to those in someone’s care, it becomes everyone’s business. That is precisely why laws against abuse exist. 

    Unfortunately, it sounds to me like Lou is as stubborn as his dad. Telling him again and again that he needs to do something won’t help. If Lou lives in another state, about the only recourse you have now is asking his other friends to keep an eye on his dad. You could also notify social services of suspected elder abuse. I wouldn’t worry about pissing off Lou. If he has cut off communications, it’s a clear indication that he has shut the door on your friendship as well.

    Lou is what a therapist would call a “help-rejecting clinger.” He enjoys complaining about problems but he doesn’t want to fix them. I feel badly for his dad. But as far as friendships go, I’d say that this one has become toxic. You did everything you could. Stop beating yourself up. You can’t help people who don’t want to be helped. It’s time to walk away.

  • Advice From the Trenches: The Ozempic Games

    Advice From the Trenches: The Ozempic Games

    Dear C;

    I really want to lose about 15 lbs before my high school reunion. I know this sounds vain and stupid, but I would really feel like crap if I showed up looking like I had a baby when I didn’t. 

    The event is in a couple of weeks and I need something to work fast so I thought of Ozempic. I’ve heard so much about this new drug and so many people seem to be using it that seems like a miracle solution. Not only does it make people lose weight, it reduces their risk of heart attack too.  

    What’s not to like?        

    Pam Pound

    C says:

    Well, I guess that depends on your idea of a good time. But from the testimonials I’ve been reading I suspect that Ozempic may not be quite the miracle miracle solution you were hoping for before your reunion.

    First, take the medical benefits off the table – the weight loss from Ozempic and other semaglutide drugs will only help in the prevention of heart disease if the patient is dangerously obese. For someone like you, Pam, there are no such protective benefits.  

    My favorite honest account by an actual Ozempic user comes from Sharon Osbourne, a woman who will unabashedly admit to every cosmetic or surgical procedure she’s ever had done. During a TV interview with Bill Maher in August of this year, Osbourne, age 70, had this to say about her own experience: “The first few weeks were fucking shit because I just threw up all the time.”

    But let’s look at a full list of common side effects and you can decide for yourself if this what you were hoping for at your highly anticipated HS reunion:

    1. Stomach side effects 

    These are users’ biggest complaints and the symptoms are many. The most common side effect is nausea. Others include vomiting, diarrhea, stomach-area pain, and constipation. High levels of flatulence have also been reported. Some patients receiving Ozempic discontinue treatment due to the GI side effects.

    2. Diabetic Retinopathy 

    This is a serious eye disease that can lead to blindness.Surprisingly, it is the rapid improvement in blood sugar control that may be the underlying cause of a worsening of diabetic retinopathy in some patients. People with type 2 diabetes and long-term, uncontrolled blood sugar levels are at higher risk, as are smokers and those with high blood pressure, high cholesterol, or kidney disease. The complications that may result after long-term use have not been studied.

    3. Thyroid tumors or cancer

    It’s rare, but warnings for Ozempic include a risk for thyroid tumors or cancer. To be fair, this was discovered in studies with rats not humans, but despite the fact that there isn’t enough data to draw a final conclusion, the FDA requires the drug to carry a prominent Boxed Warning. They do not flash this alarm lightly, so if you or anyone in your family has ever had thyroid cancer, I would take the warning seriously.

    4. Low blood sugar (hypoglycemia)

    This can be a pretty serious side effect with Ozempic. In patients who have diabetes, Ozempic can interact with insulin or Metformin, but non-diabetics who are on the 1 mg dose have reported severe low blood sugar as well. Symptoms include disorientation, vertigo, weakness and fatigue, headache and a major case of the shakes. Be careful when standing up too quickly – you could easily faint.

     So if you want to show up at your reunion feeling nauseous, dizzy, anxious, and on the verge of vomiting as you greet old friends, I guess this could be the miracle drug for you. 

    But honestly? I doubt very much that anyone at your reunion is going to be as quick to judge you as you seem to fear. The average American woman today is 5’ 3” and weighs about 170 lbs. Unless every other female in your class has the genetics of Heidi Klum along with a personal trainer and plastic surgeon on call, no one is going to give your extra 15 lbs a second look unless it is to admire your curves.

  • Air and Silk: A Chapbook of Poetry

    Air and Silk: A Chapbook of Poetry

    Air and Silk is a family trio of circus artists based in Providence, RI. Once a year, they bring the circus into their own backyard. 

    The idea began in 2020 during the COVID pandemic lockdown. Simone Jogl and her daughters Skye and Anneken, created a story in movement as a gift for a friend who had become isolated in NYC. It was so well received that they decided to develop the idea into a gift for a much larger audience.

    Their productions involve intricate aerial rigging and magical effects – the first invitational show, Rise Like A Phoenix, began at dusk and as it continued into the dark, twinkling lights on the performer’s costumes spun into their aerial dances. The most amazing part is that they do everything themselves; talent runs in the family. You might even say it soars.

    Simone and her husband, Gerwald, were both competitive amateur ballroom dancers in Austria. Their daughter Anneken began aerial silks when she was nine, then added training in contortion to the mix. Two years ago, she started as a Trouper at Circus Smirkus camp in Vermont, with a dream to make it her professional career someday. This year that dream is coming true – Anneken, now 19, is in full-time circus school and she has completed her first year in the ProTrack program at New England Center for Circus Arts.

    In Rise Like A Phoenix, Skye, then 14, played a mischievous barking puppy. Today, at 16, she is a Circus Smirkus Trouper and just returned from a 10-week tour.

    For their newest performance, A Chapbook of Poetry, the trio has created a series of skits that promise to play with poems old and new, funny and serious. The stage scenery includes a very unusual large prop built especially for the occasion. Air and Silk has been creating impressive multi-act circus shows for four years now as Lafayette Backyard Productions and will perform for parties and site specific events. 

    Weather permitting, there will be two performances this year – Thursday, August 31 at 6pm and Friday, September 1 at 5:30pm. A Chapbook of Poetry was created for friends, neighbors and invited guests. To receive your invitation, please email simone@rolfing-providence.com and visit simone0023.wixsite.com/website/blog to see pics from previous shows.

  • Advice From The Trenches: Is there a Bonehead School?

    Advice From The Trenches: Is there a Bonehead School?

    Dear C and Dr. J,

    I have a theory and I wonder if you can support it. I am convinced that every man in the world secretly goes to Bonehead School before they start dating. There, they learn how to:
    • pretend they don’t know how to use the washing machine
    • leave food crusted on the back of plates so no one will ask them to wash the dishes again
    • always come home from the grocery store with the wrong thing
    • pretend not to understand you say so that you are forced to repeat everything four times
    • forget to do ANYTHING until nagged a minimum of eighty times etc, etc, etc…

    Don’t try to play dumb, Dr. J. You’re a guy; you have to know where the school is.
    Will you come clean and validate tortured wives and girlfriends everywhere?
    – Medea U.

    Dr. J says:

    Damn! You found us out! But from my experience, just about everyone will get away with whatever they can. Women can be even worse. Maybe you can tell me where the Bonehead School for women is, so I can figure out how to avoid the graduates.

    But the time to talk about what you expect and what you really don’t want is at the beginning of a relationship. Most of us try to make whatever impression that we think will get us to that first date and don’t consider the long run. If you try to pretend that you’re super self-sufficient because you think that will get you a brownie point, watch out – the guy will expect you to carry the groceries in every time. Let him know you expect an equal relationship and that responsibility has to work for both of you.   

    Men are like horses – they function best with clear direction and expectations. We can’t read minds, we don’t pay attention to hints, and if you don’t ask, we will assume you don’t need anything. We get confused easily about what you want, and frustrated when we don’t get it right the first time. We are task oriented and like to feel manly and use tools and gadgets. We play games to get out of “women’s work.” If you ask us to do it, we’ll evade you until you give up and do it yourself.  

    So if you want men to do chores eagerly, find a cool tool or toy we can use to do it. 

    So what school do you women go to, to become nagging wives? 

    C says:

    Women go to the school of The Holy Suffering Patron of Saints if we make the mistake of partnering up with guys like you, Dr. J.  I actually enjoyed your explanations, but at the same time, you pretty much admitted that Madea’s accusation is true. The evasion of unwanted tasks is a game that a lot of guys play because they never really grew up. Hopefully, they also know some games that they get paid good money to play. 

    The truth is, Madea, there is no “husband school.” We all learn more from our own parents than anyone else, and they generally present us with the same working model of marriage their own parents taught them. When we as individuals choose our mates, we also choose according to the model passed down from generation to generation. It isn’t conscious as much as a reflex set on automatic pilot.

    You seem to have chosen a partner who likes to play. This isn’t a deal breaker, because it’s tough to find one who doesn’t, but if you don’t plan to leave him, you’d better learn to play the game too. J gave you a good clue – men are more like horses, or dogs, than people. If you want to get any reasonable behavior out of them, you have to train them. They respond well to treats, pats on the head and long rides in the car with the windows down. If you don’t provide them with the admiration and sexual services they feel they deserve, they will go suck up to somebody else. It’s just in their nature. 

    We all have genetic prompts that can be traced to primitive conditions that sometimes don’t exist anymore. For example: the world population has reached 8 billion, so infidelity can no longer be justified as a man’s God-given task in order to insure the survival of humankind. 

    Your husband’s behavior seems, at this point, to be more irritating than damaging. But if it ever becomes abusive, don’t let him explain it away. That’s a game no one should play. 

  • Advice from the Trenches: Psychedelics 

    Advice from the Trenches: Psychedelics 

    Dear C,

    I couldn’t believe it when my daughter told me, but I looked it up online and it’s true – scientists are actually using psychedelic drugs to treat patients with psychiatric disorders!

    I did acid twice back in the 60s as a teen, but from what I experienced, it seems like tripping would drive someone who already had mental problems over the edge! How is it supposed to make traumatized or depressed people better?       

    – Thor Azine

    C says:

    I don’t think scientists are talking about dropping acid at a rock concert, Thor. There’s years of solid research behind the headlines you’re seeing in the media.

    The DEA thinks like you do – they’ve long classified psychedelics as Schedule I controlled substances, which means that they have no therapeutic value whatsoever and a high potential for abuse. But there’s a rather large difference between recreational use and controlled medical use, so when the FDA added their approval for studies, limited and highly controlled research was resumed about 20 years ago. Findings were so promising that in 2017, the FDA designated psychedelics as a “breakthrough therapy” for PTSD, then in 2018 they gave the nod to psilocybin as a breakthrough for treatment-resistant depression. 

    A study published in The New England Journal of Medicine compared psychedelics with SSRIs, the prescription drugs that most doctors prescribe to treat depression. Results showed that psilocybin was as effective, after only two doses, as antidepressants, which have to be taken sometimes for weeks before improvement is seen. But keep in mind, patients don’t just trip out – doses are highly controlled and supervision is mandatory.

    I asked my friend, Juan Verde, about his experience with psychedelics. Juan has lived with MS for many years now, and has a first hand grasp of the therapeutic benefits to be gained from responsible use.

    J says: 

    I’ll start off with this –

    1. Don’t do psychedelics unless you are in a safe place. A calm forest or familiar room is a safe setting. A huge crowded event full of out of control energy is not.

    2. If your head isn’t in a good place to begin with, do not ever try psychedelics alone. Do them with a trusted friend, therapist, or guide, and use microdoses only. Know what you’re taking.

    3. Some people should very definitely not do psychedelics. 

    4. If you do psychedelics, it will change you forever, so do not take it lightly.

    5. Don’t do it too often. Remember it’s a powerful life changing drug.

    The founder of AA, Bill Wilson, got sober after taking a guided LSD trip with a psychiatrist. Wilson fought hard as AA was being formed to include having one guided LSD trip as part of the steps in the program, but lost the battle. He believed it could help people see things a little differently.

    Timothy Leary fucked the psychedelic scene up for everybody.  At the time that Leary was telling everyone to drop acid and “turn on and tune out”, there were 10 or 15 research groups around the country conducting studies. Every single one was shut down after Leary, because he brought such negative attention to LSD. They were turning their own PhD students on to acid at Harvard, and that was the end of it.

    Researchers hate Leary. It’s just now that after 40 years of being shut down that research has started up again.

    Even though it’s different, and less mellow than mushrooms, you learn a lot about your brain on acid. Every time I did it, it made me realize new things, inspired me to do more music, reach out to more people. It was a cumulative effect that stayed with me, but I think a person’s ability to hold onto the results varies.

    Psychedelics were a great teacher for having MS. You learn to live with the moment and deal with whatever comes along – Be Here Now. I just went with it when I was diagnosed with MS, it was another thing to deal with. 

    But I don’t think that everyone will have a revelation and mind change. Psychedelics are very much dependent on the person and the presence or absence of a guide. 

    For recent news from Health Law Policy, Biotechnology, and Bioethics at Harvard Law School: https://hls.harvard.edu/today/reassessing-psychedelics/

  • The Family Doctor

    The Family Doctor

    The number of primary care physicians in the US today is dwindling. Nearly a third of the population lacks access to primary care and those numbers are only going to rise – a shortage of more than 52,000 primary care physicians is anticipated by 2025.

    I spoke with Dr. E, a primary care doctor who has been in practice for about 25 years in Rhode Island about the changes he’s seen in adult primary care.

    C: We all tend to think that a family doctor and a PCP (primary care physician) are the same thing. But there’s a difference, isn’t there?

    Dr. E: Family doctors specialize in everything from pediatrics to adult medicine to obstetrics. A PCP for kids is a pediatrician, and for pregnancies/women’s care, OB/GYN. 

    Most adult PCP’s like myself refer to ourselves as general internists. Like family doctors, we have long term relationships with patients, but we only care for adults, no pregnancies or pediatrics. Having a longer-term working relationship with patients is kind of cool.

    PCP is a term the insurance companies invented, or even more degrading, “provider”. Both terms downplay our professionalism, and equate us with widget producers. 

    C: Why did you choose internal medicine as a specialty?

    Dr. E: I liked the variety, and I enjoyed diagnosing. It was something I felt I was good at.

    C: After school, did you open your own office??

    Dr. E: When I started out, I joined a group of about five5 primary care physicians. I’m with a larger group now.

    No one can open their own office anymore. You can join a hospital or clinic or you make zero in your first year and get burned out. Insurance companies pretty much demand that doctors become part of a network.  

    C: How much influence do insurance companies have in shaping the way that medicine is practiced today?

    Dr. E: As far as policies and expectations, doctors are powerless.  The insurance companies and Federal government are telling us to do a few narrow tasks and calling this “quality”, but I see it as more of a marketing tool and a bureaucracy trying to justify its position than anything else.

    To me, being a good doctor has to do with how well you listen and ask questions, and how well you address patients’ problems from their perspective and, more objectively, doing the right thing medically. Think about what you want and expect in a physician.

    C: The pandemic made some pretty drastic changes in health care. Have there been any permanent changes?

    Dr. E: Telehealth and virtual medicine became accepted and reimbursed. That practice has remained. For anyone with respiratory symptoms, I continue to wear an N95 mask and require masks for patients, though now I tend to take care of these patients on the phone.

    C: Let’s talk about the shortage of PCPs in RI. I know people who find it impossible to get appointments, sometimes waiting several months to get in. What’s going on?

    Dr. E: To start with, primary care physicians in RI are underpaid so the groups in RI are unable to find physicians. All you have to do is walk over the border and you’ll make $40K more in starting salary. 

    I’ll put it this way – usually we have grads from RI Hospital apply to join our medical group. For the past ten years no one from RI Hospital has joined our group. They’ve all gone out of state.

    C: Isn’t being underpaid one of the biggest problems behind the general shortage of PCPs?

    Dr. E: It’s one reason. Compared to what specialists make, internal medicine pays half or less.

    But it’s not just that. There are endless bureaucratic hassles. Computers are not user friendly and half our time revolves around that. Computers make our lives miserable. Also, they all too often don’t interact from one system to another, so often I don’t know what happened with a patient outside my office.

    There’s also a shortage of specialists in RI, and that makes everyone’s life difficult. It is very stressful for me to be responsible for a sick patient whose problems are beyond my ability to help them.

    C: I always just assumed that any specialist I saw would send my PCP the results of my tests – but unless you ask, they don’t, and even then it’s not guaranteed. 

    What advice would you give students who have graduated from medical school and are considering specialties? Would you recommend internal medicine in a medical office here?

    Dr. E No.

    C: Have you thought about changing jobs?

    Dr. E: There’s a tremendous amount of red tape in any job change. It takes 4 to 5 months minimum to go through all the paperwork for licensing, registering with the insurance companies, malpractice insurance, etc. Besides – the whole point of primary care is the long term relationship. That can take 5 to 7 years to develop.

    C: RI is fortunate to have you stay. Thanks, Dr. E!