If you have never had a knee replacement, then DON'T. OK, maybe taking advice from me is not in your best interests. I have had 4 done since 2001 and now I am paying for it with Chronic Arthritis.
I can hardly walk and when I do it zaps my energy. I do have a walker but it really doesn't help alleviate the pain, just gives me some stability (if I actually use it that is).
I get one good walk in and that is the end of me for the day, although I force myself to walk more but it kills me and then at night I am off to bed at 9,only place I can get a little bit of relief.
My hip has also been extremely painful lately, my orthopedic surgeon is not quite sure at this point if I need my hip replaced first or my knee redone. He will be doing a test to pinpoint where the pain is actually coming from before he decides which to do.
My wife has laughingly suggested I order a "scooter" for scooting around in! (Although she says I should hang tight til after my next operation to see if it helps or not, but I may be scooting around sooner rather than later!)
Tuesday 28 June 2011
Thursday 23 June 2011
Journal Entry
People with deep depression often do not realize how we hurt people who care for us greatly.
Often we think we are the only ones that we hurt, we change who we were without realizing it.
I am not the same person I was, I have no motivation, no memory of what I do sometimes, no energy to do much of anything. We are doing our basement over, well mostly my son and my wife are doing the renovations, as I have little or no energy to do things. Normally I would want to have it done by now(I was always the one to get things done rather than wait for someone to help me).
Often we think we are the only ones that we hurt, we change who we were without realizing it.
I am not the same person I was, I have no motivation, no memory of what I do sometimes, no energy to do much of anything. We are doing our basement over, well mostly my son and my wife are doing the renovations, as I have little or no energy to do things. Normally I would want to have it done by now(I was always the one to get things done rather than wait for someone to help me).
Physician urges collaboration over fee-for-service model
Big changes are needed to fix our ailing mental health-care system, a Halifax family doctor says.
For example, the way doctors are paid doesn’t allow them to take time with people, said Ajantha Jayabarathan, better known as Dr. A.J.
She and other general practitioners are paid for every patient they see, a system called fee-forservice. That may work for simple problems, but the complexity of treating mental illness is another matter.
The collaboration of many practitioners, from social workers to psychiatrists, is needed, Jayabarathan said in an interview Wednesday.
“Already they (the province and Doctors Nova Scotia) are looking at a different way to pay people," she said.
“For instance . . . I meet with a social worker, psychologist or a psychiatrist for an hour to discuss patients, or let’s say they came to my clinic once a month and we all work together. The whole system has been turned around."
Collaborative care is at the heart of a national conference that starts today in Halifax.
Jayabarathan, who will cochair the 12th Canadian Collaborative Mental Health Care Conference, is passionate about the concept.
“I think what it will take is willingness, interest and people stepping forward to say, ‘I think we’re ready to do something like this.’ " A lack of health-care providers or resources isn’t the problem. It’s a matter of using those resources more effectively.
“We’re drowning in a sea of plenty," said Jayabarathan, who has practised in Halifax for 25 years.
“Family doctors don’t work enough with psychologists and vice versa to really understand each other’s expertise. You are unlikely to use a resource that you don’t know much or anything about, even if they work down the hall from you."
The collaborative effort must go beyond the people providing the care, said Dr. Ian Slayter, director of psychiatric services for the Capital district health authority.
For the patient’s privacy and other reasons, the family or other people close to the patient are often shut out, Slayter said Wednesday. Patient confidentiality is important, but addressing that issue can be as simple as asking for consent.
“The patient benefits because they will get better support from their family or whoever supports them," said Slayter, who will co-chair the conference with Jayabarathan.
“Their practitioners and clinicians will be better informed about what’s actually going on with the patient. Because what I see in the office and what the family sees at home can be different."
And family members benefit because they’re included in the process.
“They not only feel more effective but they get help in dealing with their own anxieties and the difficulties they have dealing with a person with a serious illness," Slayter said.
Next week, Capital Health is expected to approve treatment guidelines that include a duty of care to the family, Slayter said.
These guidelines will be distributed to practitioners and health centres.
A group from the Meriden Family Programme in Birmingham, England, has been training a Capital Health team in its collaborative family approach, Slayter said.
The Collaborative Mental Health Care Conference runs from today to Saturday at the World Trade and Convention Centre in Halifax. Speakers and workshops will include officials from the Mental Health Commission of Canada, local practitioners and people who have used the mental health system.
The conference is open to the public, but registration and fees apply, although efforts will be made to make the event as accessible as possible. About 350 people were registered by Wednesday, Jayabarathan said. For more information, go to www.sharedcare. ca.
For example, the way doctors are paid doesn’t allow them to take time with people, said Ajantha Jayabarathan, better known as Dr. A.J.
She and other general practitioners are paid for every patient they see, a system called fee-forservice. That may work for simple problems, but the complexity of treating mental illness is another matter.
The collaboration of many practitioners, from social workers to psychiatrists, is needed, Jayabarathan said in an interview Wednesday.
“Already they (the province and Doctors Nova Scotia) are looking at a different way to pay people," she said.
“For instance . . . I meet with a social worker, psychologist or a psychiatrist for an hour to discuss patients, or let’s say they came to my clinic once a month and we all work together. The whole system has been turned around."
Collaborative care is at the heart of a national conference that starts today in Halifax.
Jayabarathan, who will cochair the 12th Canadian Collaborative Mental Health Care Conference, is passionate about the concept.
“I think what it will take is willingness, interest and people stepping forward to say, ‘I think we’re ready to do something like this.’ " A lack of health-care providers or resources isn’t the problem. It’s a matter of using those resources more effectively.
“We’re drowning in a sea of plenty," said Jayabarathan, who has practised in Halifax for 25 years.
“Family doctors don’t work enough with psychologists and vice versa to really understand each other’s expertise. You are unlikely to use a resource that you don’t know much or anything about, even if they work down the hall from you."
The collaborative effort must go beyond the people providing the care, said Dr. Ian Slayter, director of psychiatric services for the Capital district health authority.
For the patient’s privacy and other reasons, the family or other people close to the patient are often shut out, Slayter said Wednesday. Patient confidentiality is important, but addressing that issue can be as simple as asking for consent.
“The patient benefits because they will get better support from their family or whoever supports them," said Slayter, who will co-chair the conference with Jayabarathan.
“Their practitioners and clinicians will be better informed about what’s actually going on with the patient. Because what I see in the office and what the family sees at home can be different."
And family members benefit because they’re included in the process.
“They not only feel more effective but they get help in dealing with their own anxieties and the difficulties they have dealing with a person with a serious illness," Slayter said.
Next week, Capital Health is expected to approve treatment guidelines that include a duty of care to the family, Slayter said.
These guidelines will be distributed to practitioners and health centres.
A group from the Meriden Family Programme in Birmingham, England, has been training a Capital Health team in its collaborative family approach, Slayter said.
The Collaborative Mental Health Care Conference runs from today to Saturday at the World Trade and Convention Centre in Halifax. Speakers and workshops will include officials from the Mental Health Commission of Canada, local practitioners and people who have used the mental health system.
The conference is open to the public, but registration and fees apply, although efforts will be made to make the event as accessible as possible. About 350 people were registered by Wednesday, Jayabarathan said. For more information, go to www.sharedcare. ca.
Saturday 18 June 2011
coping with long-term depression
If you're coping with long-term depression, you may wonder why you can't feel better. Other people you know may have recovered from their depression more easily -- a few months of therapy or antidepressants and they were back to normal. But it hasn't been like that for you. No matter what treatment you try, you're still suffering.
There is no one reason for treatment-resistant depression. For most people, it's probably a combination of different factors. Some of it is beyond your control, such as the genes you were born with. But there are factors that you can control.
According to experts, here are the reasons why depression can sometimes be hard to treat.- Not staying on a medicine long enough. Antidepressants can take as long as six to eight weeks before they fully take effect. Unfortunately, many people -- and sometimes even doctors -- give up on a depression medicine too early, before it's had a chance to help.
- Skipping doses. If you don't take your antidepressant, it can't help you. You'll never really know if a depression medicine is working unless you take it exactly as prescribed.
- Unpleasant side effects. Many people who have side effects just stop taking their antidepressants. That isn't a good idea. Instead, talk to your doctor and get some help. You might be able to eliminate or ease the side effects and still get relief from your depression. Also, keep in mind that side effects tend to decrease over time.
- Drug interactions. Some other medicines don't mix well with antidepressants. When taken at the same time, neither one may work normally. In some cases, interactions could even be dangerous.
- The wrong medicine or the wrong dose. Antidepressant drugs work very differently in different people. Unfortunately, there's no way to predict how well a depression medicine will work without trying it. So finding the right medicine, at the right dose, takes trial and error -- and occasionally, some time. Many people give up before they find the right one.
- Your genes. Researchers have found a gene that they believe may make depression harder to treat in some people.
- Other medical conditions. Some medical conditions -- like heart disease, cancer, or thyroid problems -- can contribute to depression. Other conditions, like anorexia, can too. It's important that you treat any underlying medical problems in addition to your depression.
- Alcohol or drug abuse. Substance abuse often goes hand-in-hand with depression. It can trigger depression or make it worse. If you have a substance abuse problem, you need to get help.
- The wrong diagnosis. Some people are simply misdiagnosed with treatment-resistant depression. They might actually have another condition, like bipolar disorder or an anxiety disorder. This is why it's so important to work with an expert.
Thursday 16 June 2011
HOWIE MANDEL
BANFF, Alta. — Canadian funnyman Howie Mandel had them rolling in the aisles in Banff this week, even though the subject was really no laughing matter.
The actor, comic and game show host received the award of distinction at a ceremony at the Banff World Media Festival — an annual gathering of TV writers, producers, broadcasters and stars.
“I have mental health issues as it is and as I sit and talk to you I am medicated so the highs and the lows aren’t really bothering me. I’m just floating in the middle," acknowledged Mandel, 55, in a question and answer session before a large audience.
“I am tortured but I came to this game pretty tortured," he said, then smiled and asked: “Why are you laughing at me when I said I’m tortured?"
Mandel has both obsessive compulsive disorder (OCD) and attention deficit hyperactivity disorder (ADHD) and has written about both in his autobiography Here’s the Deal: Don’t Touch Me.
But Mandel finds it therapeutic to talk about his upbringing in the Toronto area where he says he was always a loner and had no friends.
“I weighed 89 pounds and my voice didn’t change and I didn’t shave and I looked like a girl. I could stand in the ladies room and brush my hair. That’s how I met my wife. Second date she found out I was a guy," he said with his trademark laugh. “I don’t want to touch things. I was always nervous and neurotic and afraid."
“I wouldn’t tie my shoelaces at school.
If mine came undone, I wouldn’t pick them up to retie them because the laces were on the floor," Mandel said.
“I’d be angry. I would be anxious and angry and then I’d go home and take a shower until my Mom would say it was dinner time. I would be in the shower for hours and I’d use every towel."
His mental health issues don’t appear to have held him back in his career. He did gigs at Yuk Yuk’s comedy club and spent six seasons on St. Elsewhere. He also began hosting Deal or No Deal which was difficult for a man who doesn’t want to shake hands for fear of germs.
“I always felt rejected. Even today you feel you just always want to keep working. You think tomorrow is going to be your last day," he said.
“I have dark times. It inhibits everything I do on a day-to-day basis. Every waking moment it’s part of who I am," Mandel added.
“How does it affect my work? It affects every day and I think about it. Right now I’m hoping you don’t have any viruses," he said with a chuckle.
Mandel credits the support of Terry, his wife of 35 years, for helping him deal with his problems.
“It’s hard to go through that with anybody who has mental health issues. It’s hard to live with somebody like me."
It was Terry who told him he should become the host of Deal or No Deal, something he thought would end his career.
The actor, comic and game show host received the award of distinction at a ceremony at the Banff World Media Festival — an annual gathering of TV writers, producers, broadcasters and stars.
“I have mental health issues as it is and as I sit and talk to you I am medicated so the highs and the lows aren’t really bothering me. I’m just floating in the middle," acknowledged Mandel, 55, in a question and answer session before a large audience.
“I am tortured but I came to this game pretty tortured," he said, then smiled and asked: “Why are you laughing at me when I said I’m tortured?"
Mandel has both obsessive compulsive disorder (OCD) and attention deficit hyperactivity disorder (ADHD) and has written about both in his autobiography Here’s the Deal: Don’t Touch Me.
But Mandel finds it therapeutic to talk about his upbringing in the Toronto area where he says he was always a loner and had no friends.
“I weighed 89 pounds and my voice didn’t change and I didn’t shave and I looked like a girl. I could stand in the ladies room and brush my hair. That’s how I met my wife. Second date she found out I was a guy," he said with his trademark laugh. “I don’t want to touch things. I was always nervous and neurotic and afraid."
“I wouldn’t tie my shoelaces at school.
If mine came undone, I wouldn’t pick them up to retie them because the laces were on the floor," Mandel said.
“I’d be angry. I would be anxious and angry and then I’d go home and take a shower until my Mom would say it was dinner time. I would be in the shower for hours and I’d use every towel."
His mental health issues don’t appear to have held him back in his career. He did gigs at Yuk Yuk’s comedy club and spent six seasons on St. Elsewhere. He also began hosting Deal or No Deal which was difficult for a man who doesn’t want to shake hands for fear of germs.
“I always felt rejected. Even today you feel you just always want to keep working. You think tomorrow is going to be your last day," he said.
“I have dark times. It inhibits everything I do on a day-to-day basis. Every waking moment it’s part of who I am," Mandel added.
“How does it affect my work? It affects every day and I think about it. Right now I’m hoping you don’t have any viruses," he said with a chuckle.
Mandel credits the support of Terry, his wife of 35 years, for helping him deal with his problems.
“It’s hard to go through that with anybody who has mental health issues. It’s hard to live with somebody like me."
It was Terry who told him he should become the host of Deal or No Deal, something he thought would end his career.
Wednesday 15 June 2011
Support
Support can come from groups or family.
Helping someone with depression can be a challenge. If someone in your life has depression, you may feel helpless and you may wonder what to do. Learn how to offer support and understanding and how to help your loved one get the resources to cope with depression. With the right approach, depression usually gets better. People with depression may not recognize or acknowledge that they're depressed. They may not be aware of signs and symptoms of depression, or they may feel too hopeless to address the issue. People with depression may think that how they feel is normal and not the result of a mental health condition. All too often, people feel ashamed about their depression and mistakenly believe they should be able to overcome it with willpower alone. But depression seldom gets better without treatment and may get worse. Help the person you care about recognize the symptoms of depression and get treatment:
Talk to the person about what you've noticed and why you're concerned.
Explain that depression is a medical condition, not a personal flaw or weakness — and that it usually gets better with treatment.
Suggest that the person see a professional — a medical doctor or a mental health provider such as a licensed counselor or psychologist.
Offer to help prepare a list of questions for the person to discuss in an initial appointment with a doctor or mental health provider.
Express your willingness to help by setting up appointments, going with the person to appointments and attending family therapy sessions.
Helping someone with depression can be a challenge. If someone in your life has depression, you may feel helpless and you may wonder what to do. Learn how to offer support and understanding and how to help your loved one get the resources to cope with depression. With the right approach, depression usually gets better. People with depression may not recognize or acknowledge that they're depressed. They may not be aware of signs and symptoms of depression, or they may feel too hopeless to address the issue. People with depression may think that how they feel is normal and not the result of a mental health condition. All too often, people feel ashamed about their depression and mistakenly believe they should be able to overcome it with willpower alone. But depression seldom gets better without treatment and may get worse. Help the person you care about recognize the symptoms of depression and get treatment:
Friday 10 June 2011
Journal Entry
Last Tuesday night at our group meeting most of the people there said they had a good week, all was well (as pertains to them) although a few had a difficult time. As we went over their week it seemed to be a medication problem they were having instead of a "feeling" problem.
Some people say energy is key to helping with depression, (but for me you must have energy to do something in the first place).
- they do go hand in hand as once one breaks down so does the other and some were on new meds others the old ones seemed not to be working
Some people say energy is key to helping with depression, (but for me you must have energy to do something in the first place).
Monday 6 June 2011
Train the Trainor Course- "Your Way to Wellness"
For the past four days I was attending a "Trainer course on "Your way to wellness" that I had been invited to attend by Capital Health.
It is the Canadian version from Stanford University. The course is a "Trainers" course, so once you take the course you can then teach it to others. It is Licenced by Capital Health.
The course talks to people with chronic diseases, as with depression, people with chronic conditions have similar concerns and problems, their diseases have the same impact on there lives and emotions.
So now I wait for requests to go and teach!
It is the Canadian version from Stanford University. The course is a "Trainers" course, so once you take the course you can then teach it to others. It is Licenced by Capital Health.
The course talks to people with chronic diseases, as with depression, people with chronic conditions have similar concerns and problems, their diseases have the same impact on there lives and emotions.
So now I wait for requests to go and teach!
Wednesday 1 June 2011
Mental health patients waiting in vain for help
I am writing in regard to the May 26 article “Capital Health prepares for strike." In anticipation of a nursing strike, Kathy Mac-Neil, a vice-president with Capital District Health Authority, was quoted as saying that “life and limb" emergencies would not be turned away, but in areas such as mental health, the authority would “probably restrict those to emergency admissions only." What a joke!
Ms. MacNeil has obviously never tried to access mental health services for a friend or family member in Nova Scotia.
As everyone who has ever tried to do so is painfully aware, there is no way to get timely access to mental health services in our province other than in an emergency situation. In order to access even remotely timely services, people have to be considered an immediate danger to themselves or others.
Even if a mental health professional thinks someone may become a danger to self or others if their condition deteriorates, that is not reason enough to be provided with immediate help, according to the provincial Mental Health Standards adopted by the province in 2009. According to these standards, there are four levels of urgency to be considered in the acceptable wait times. Level 0 is classified as “emergent." In those cases, a person must be an “immediate and significant risk of harm to self or others" or have “acute psychosis or mania which cannot be managed in the community." The examples given in the standards are “acute suicidal thoughts with intent," “acute psychosis" or “acute mania." In these cases, the referral process is to send the person to a local emergency department if it’s open.
Level 1 is classified as “urgent." In this category, the target wait time is a week. In this case, the person should be a current risk to self or others, but judged “safe" provided treatment is made available within the next seven days. This person should have “escalating psychosis or mania with a risk of rapid deterioration and need for hospitalization within a week or two."
Examples are “acute suicidal thoughts," “mania," “hypo-mania" or “psychosis."
The Level 2 classification is considered “semi-urgent" with acceptable wait times of a month. These people can be “unstable with risk of acute decompensation due to unstable illness, personality or circumstances." They can be “engaging in new or increased risk behaviours due to mental illness," and there can be “acute deterioration in functioning and role performance due to mental illness." According to the Mental Health Standards of Nova Scotia, it’s totally acceptable to let these people wait 30 days for help.
Also deemed to not require treatment for up to 30 days are people who have “acute clinical depression." They can be “depressed with suicidal thoughts but no intent, plan or history of suicidal behaviour." They can be “single parents with no supports and unable to care for children due to depression." For these people, a month’s wait is acceptable, but according to the standards, a referral to Child Protection Services should be made.
Also falling into this category are parents with mental illnesses suspected of neglecting their children. According to the standards, it is appropriate to leave these people waiting for help up to 30 days!
Finally, we have Level 3, which is considered “regular."
These people are left waiting for services for up to three months or more. People who fall into this category are “chronic but stable patients where rapid deterioration is not imminent in the short term." These are people who are suffering from “depression, anxiety, anger problems, coping problems or personality disorders." They are expected to wait up to 90 days for help if the standards were being met. However, they are not!
In June of 2010, the Nova Scotia auditor general released his report of an investigation into the province’s mental health services system. He found that these standards, as lax as they are, are not being met more than 85 per cent of the time. He also said there was no plan by the Department of Health and Wellness to fix this situation.
I contend, and I expect most Nova Scotians would agree with me, that this is a completely unacceptable situation.
In its 2010-2011 Statement of Mandate, the Department of Health and Wellness made a commitment to “develop a plan to measure wait times." The “strategies to achieve (this) target" were to “continue to implement collaborative primary health teams providing services to mental health patients" and to “host an Atlantic Mental Health Summit to consider collaborative policy initiatives among key stakeholders." While the department is developing “a plan to measure wait times," people who are waiting for mental health services are committing suicide, suffering with their illnesses, creating untold hardship for themselves and their families, and giving up hope.
I am not talking about one or two per cent of the population here, but approximately 180,000 Nova Scotians. Whether or not Capital Health District nurses strike, while professionals sip coffee and listen to keynote speakers at the Atlantic Mental Health Summit, people suffering with mental illnesses will be waiting in vain for help.
John Roswell is program co-ordinator, Digby Clare Mental Health Volunteers (dcmhv@hotmail.com).
Ms. MacNeil has obviously never tried to access mental health services for a friend or family member in Nova Scotia.
As everyone who has ever tried to do so is painfully aware, there is no way to get timely access to mental health services in our province other than in an emergency situation. In order to access even remotely timely services, people have to be considered an immediate danger to themselves or others.
Even if a mental health professional thinks someone may become a danger to self or others if their condition deteriorates, that is not reason enough to be provided with immediate help, according to the provincial Mental Health Standards adopted by the province in 2009. According to these standards, there are four levels of urgency to be considered in the acceptable wait times. Level 0 is classified as “emergent." In those cases, a person must be an “immediate and significant risk of harm to self or others" or have “acute psychosis or mania which cannot be managed in the community." The examples given in the standards are “acute suicidal thoughts with intent," “acute psychosis" or “acute mania." In these cases, the referral process is to send the person to a local emergency department if it’s open.
Level 1 is classified as “urgent." In this category, the target wait time is a week. In this case, the person should be a current risk to self or others, but judged “safe" provided treatment is made available within the next seven days. This person should have “escalating psychosis or mania with a risk of rapid deterioration and need for hospitalization within a week or two."
Examples are “acute suicidal thoughts," “mania," “hypo-mania" or “psychosis."
The Level 2 classification is considered “semi-urgent" with acceptable wait times of a month. These people can be “unstable with risk of acute decompensation due to unstable illness, personality or circumstances." They can be “engaging in new or increased risk behaviours due to mental illness," and there can be “acute deterioration in functioning and role performance due to mental illness." According to the Mental Health Standards of Nova Scotia, it’s totally acceptable to let these people wait 30 days for help.
Also deemed to not require treatment for up to 30 days are people who have “acute clinical depression." They can be “depressed with suicidal thoughts but no intent, plan or history of suicidal behaviour." They can be “single parents with no supports and unable to care for children due to depression." For these people, a month’s wait is acceptable, but according to the standards, a referral to Child Protection Services should be made.
Also falling into this category are parents with mental illnesses suspected of neglecting their children. According to the standards, it is appropriate to leave these people waiting for help up to 30 days!
Finally, we have Level 3, which is considered “regular."
These people are left waiting for services for up to three months or more. People who fall into this category are “chronic but stable patients where rapid deterioration is not imminent in the short term." These are people who are suffering from “depression, anxiety, anger problems, coping problems or personality disorders." They are expected to wait up to 90 days for help if the standards were being met. However, they are not!
In June of 2010, the Nova Scotia auditor general released his report of an investigation into the province’s mental health services system. He found that these standards, as lax as they are, are not being met more than 85 per cent of the time. He also said there was no plan by the Department of Health and Wellness to fix this situation.
I contend, and I expect most Nova Scotians would agree with me, that this is a completely unacceptable situation.
In its 2010-2011 Statement of Mandate, the Department of Health and Wellness made a commitment to “develop a plan to measure wait times." The “strategies to achieve (this) target" were to “continue to implement collaborative primary health teams providing services to mental health patients" and to “host an Atlantic Mental Health Summit to consider collaborative policy initiatives among key stakeholders." While the department is developing “a plan to measure wait times," people who are waiting for mental health services are committing suicide, suffering with their illnesses, creating untold hardship for themselves and their families, and giving up hope.
I am not talking about one or two per cent of the population here, but approximately 180,000 Nova Scotians. Whether or not Capital Health District nurses strike, while professionals sip coffee and listen to keynote speakers at the Atlantic Mental Health Summit, people suffering with mental illnesses will be waiting in vain for help.
John Roswell is program co-ordinator, Digby Clare Mental Health Volunteers (dcmhv@hotmail.com).
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