It was a shock to learn that yesterday’s tragic death of Mary Richardson Kennedy, the separated wife of Robert F. Kennedy Jr., was due to suicide. While many of the details are still unclear and undisclosed, apparently the 52-year-old was found dead in her home in Westchester County, N.Y. after she had hanged herself. It’s disturbing, to say the least. And it makes us wonder if her drug and alcohol problems were to blame.
According to the National Institute of Mental Health, over 34,000 people commit suicide each year. Of those, more than 90% have depression and other mental disorders, or a substance-abuse disorder (often in combination with other mental disorders).
The Psychiatric Times also states that these mental health disorders can be especially dangerous:
Although it is difficult to compare the relative impact among different mental health problems with the risk of suicide, alcohol and drug use disorders have been found to be strongly related to suicide risk.3,5 Individuals with a substance use disorder (ie, either a diagnosis of abuse or dependence on alcohol or drugs) are almost 6 times more likely to report a lifetime suicide attempt than those without a substance use disorder.
No one knows if Kennedy was still battling these problems, but the mother of four, was reportedly battling depression along with drug and alcohol addictions two years ago when she separated from her husband. She was also arrested for a DUI in May 2010 with a blood alcohol level of 0.11 percent.
Months later, she was arrested for driving under the influence of drugs. But the judge dismissed that charge, saying that there wasn’t evidence Kennedy was aware her prescription drugs would impair her ability to drive.
According to what a neighbor told the Daily News, Kennedy seemed “lost and alone” recently:
She always seems lost these days, whenever she came into the village. Lost and alone and sort of out of it.
It’s especially sad when someone cannot get the mental help they need for depression and drug or alcohol addictions. It may seem like an easily treated disorder, but we all know that it’s not.
Our hearts go out to the entire Kennedy family.
Photo: politico.com
Related posts:
- ‘Almost Alcoholic’: The Blurry Line Between Wine With Dinner and Being Alcoholic
- Group Wants To Sterilize Drug-Addicted Women…Like Spaying Dogs
Post from: Blisstree
There is a lot of controversy and difference of opinion surrounding Type 2 Diabetes. There are differing opinions on what we should be eating, what we shouldn’t be eating and what types of medications/supplements would be best for us to use. There is one area where I’ve yet to read any opposing ideas: the need for regular exercise.
It is widely thought that regular exercise is beneficial to people with Type 2 Diabetes (and everyone else, of course). Whether we are obese, overweight or thin, we can all benefit from regular exercise. Phew! Well that sounds easy, right? If only….
If you’re like me, the idea of exercising is about as exciting as a trip to the dentist, without Novocain. What a pain! I was somewhat athletic in my teens but never enjoyed running. In my twenties I was a busy working mom and never took the time to exercise on a regular basis.
Over the next 30 years the weight slowly snuck up on me and, voila!, I was overweight. I bet this sounds familiar to a lot of you. In my 50’s a diagnosis of diabetes put the idea of regular exercise in my face. That, along with the realization that I needed to change my eating habits, felt daunting and impossible.
I’ve excelled over the years at taking a stab at exercising. There was that unfortunate green polyester running suit in the 70’s, a pact with friends that we’d walk together every day in the 80’s, the brilliant idea that I would ride that bike up and down the hills in the 90’s, you get the idea. The problem wasn’t with the activities I chose, (they were all excellent forms of exercise) it was a problem with my dedication and commitment. It was just too easy to quit.
I’m here to tell you folks, we can’t quit. Somehow we have to find the drive and motivation to do this often. You can do it! You know the drill. You’ve all read those articles about how to fit exercise into your day. Walk the mall, park on the far end of the lot, take the stairs, walk the dog. I’m not here to tell you how to exercise; I’m here to tell you that you are worth the effort.
It is a proven fact that regular exercise will help us to control our glucose. It will help us to lose weight. It will strengthen our hearts. It will improve neuropathy and hopefully keep it at bay. So you tell me; what about those things aren’t motivating? Find an exercise program that you can do and stick with, then find what motivates you to keep doing it.
Make sure your goals are reasonable; don’t plan to run a marathon right off the bat. It doesn’t matter what you do or how you look while you do it, it just matters that you make the effort. Hey, if I can exercise regularly, so can you! You will feel great, I promise. So what’s stopping you?
sweettype2
Her name is Kate. She happens to be a PWD, Type 2. Does that define her? Yes and no. She’s so much more.
- Website - More Posts
Here in North America, many moms I know have hired a midwife or doula for the same reason – many find doctors to be too clinical or simply too busy to give them the attention they crave – and so they’re dishing out thousands of dollars to have someone support them through labor and delivery (and everything that follows). More »
Post from: Blisstree
Extra virgin coconut butter – it’s one of the trendier nutritional ingredients. Coconut oil is advanced for its ability deliver fast energy without affecting blood sugar. Its use is touted as a way to speed up the metabolism making weight loss easier. It is being sold as essential oil for addressing certain forms of cognitive decline and dementia.
Coconut oil also is a saturated fat that does cause an increase in cholesterol levels. For 4-6 hours after a meal, it also has been shown to hinder our arteries’ ability to relax and dilate. It may contribute to insulin insensitivity, and – despite the antioxidant levels of extra virgin coconut oil – is likely somewhat inflammatory.
Health aside, extra virgin coconut oil/butter is a great for baking! Flaky and crusty cakes, pies and other baked goods without out the animal products.
The good, the bad, and the delicious.
We have long known that some fats are healthier and some are harmful—with saturated fats (SFAs) generally falling into the harmful category. Coconut butter is substantially a saturated fat, but……
….The saturated fat in coconut is different from that of most other fats and oils, not only saturated kinds, but also the polyunsaturated and monounsaturated fats. While most dietary fats are composed of long-chain fatty acids, coconut butter is composed largely of lauric acid, a medium-chain fatty acid.
Without going into the chemistry, the key point to understand is that lauric acid can be absorbed directly into the body and even directly into the cells, undigested. Other fats and oils must first be broken down. The lauric acid thus can serve as quick, no-sugar source of energy.
For some time, coconut oil has been known to be a useful source of energy for selected groups. Coconut butter has been shown beneficial for infants, individuals with difficulty digesting fats, and possibly for athletes requiring a quick burst of energy.
And Cholesterol
Coconut oil, like other saturated fats and trans fats, does increase cholesterol levels.
Adding 10 percent or 20 percent coconut oil in the diet for one to two weeks increased cholesterol levels, including LDL cholesterol levels, as well as total triglycerides in the blood.[i]
In India, coconut butter has been used widely by much of the population. Heart disease in India is among the highest in the world. Indian researchers sought to determine the effects of blending a polyunsaturated fat (PUFA), like those found in vegetable oils, with the coconut butter. Cholesterol levels were reduced between 5 percent and 21 percent, when the amount of coconut oil was reduced by blending in PUFAs. The authors of the Indian study concluded that the atherogenic (the artery blocking build of plaque) potentials of a coconut oil can be significantly decreased by reducing this oils intake by blending it with the polyunsaturated vegetable oils.[ii]
And Arterial Dilation
Another study also found that coconut oil compromised how the arteries functioned for four to six hours after a meal when compared with polyunsaturated fats.[iii] The coconut oils adversely impacted the arteries ability to relax and dilate. These results are the similar to those found for any saturated fats
And Blood Sugar Regulation
High-fat diets, particularly those rich in SFAs, also have been shown to reduce the body’s ability to regulate blood sugars. These diets are associated with a decline in the body’s ability to use insulin effectively. One study compared three types of diets: a diet high in medium-chain fats like the lauric acid found in coconut oil, a diet high in long-chain fats, and a low-fat diet.[iv]
Both high-fat diets led to the less effective use of insulin compared to the low-fat diet. The effect, however, was less significant with the high medium-chain fats.[v], [vi]
In another study, however, only the long-chain SFAs affected insulin levels. The medium-chain fats did not.[vii]
And Weight Loss
What about increasing metabolic rate? There may be some science here – but here is the trick. Coconut oil is still high in calories. Whatever the increase metabolic rate, it will be overwhelmed by the additional calories. Cut back on another source of calories for any potential benefit. Figure a teaspoon of coconut oil is about 45 calories.
Using Coconut Butter: Summary
While the research continues, coconut butter falls somewhere between a healthful and a harmful fat. For some specific groups, though, notably infants and adults with difficulty digesting fats, coconut butter may have a very useful nutritional role. Some also suggest that coconut butter helps improve certain types of dementia, but the data again is far from conclusive.
What about the antioxidant and anti-inflammatory compounds in extra-virgin coconut oil? Personally, I see no reason to seek out a high calories source of these compounds – and the lauric fatty acid may have some inflammatory effects itself. Look to high nutrient, higher fiber vegetables, fruits, nuts, and fish for these compounds.
Looking beyond the health benefits though, coconut butter has some great culinary benefits. For the baker, coconut butter offers a somewhat better alternative to the standard dairy butter. For the vegan baker, coconut butter may be an essential ingredient for making delicious desserts.
For most of us, however, more research is needed before we take steps to add a lot more coconut butter to our diets. It may be healthier than other types of SFAs, but the evidence does not seem to suggest it would qualify as a healthy fat, and remember, even healthier fat should be used smartly.
Learn more about how you can keep you arteries young and healthy, and beat back diabetes, dementia and heart disease – and still love food every day – in the Kardea Heart Smart Solution (affiliate link).
——————————————————————————–
[i] M. Castillo, J. H. Hortal “García Coconut Oil Affects Lipoprotein Composition and Structure of Neonatal Chicks,” Biochemistry 119, no. 4 (1996).
[ii] Preeti Chandrashekar, B. R. Lokesh, et al. “Hypolipidemic Effect of Blends of Coconut Oil with Soybean Oil or Sunflower Oil in Experimental Rats,” Food Chemistry Vol, 123, December 2010, pp. 728-733.
[iii] Stephen J Nicholls, Pia Lundman, et al “Consumption of Saturated Fat Impairs the Anti-Inflammatory Properties of High Density Lipoproteins and Endothelial Function” Journal of the American College of Cardiology Vol 48, Issue 4, August 16, 2006, pp. 715-720.
[iv] Johan De Vogel-van den Boscha, Sjoerd A. A. van den Berga, et al. “High-Fat Diets Rich in Medium- versus Long-Chain Fatty Acids Induce Distinct Patterns of Tissue-Specific Insulin Resistance,” The Journal of Nutritional Biochemistry 22, no. 4 (2011): 366–71.
[v] Ibid.
[vi] Joris Hoeks, Marco Mens ink, et al. “Long- and Medium-Chain Fatty Acids Induce Insulin Resistance to a Similar Extent in Humans Despite Marked Differences in Muscle Fat Accumulation,” The Journal of Clinical Endocrinology & Metabolism Volume 7 No.2 January 2012: pp., 208-216.
[vii]Silvia Wein, Siegfried Wolffram, et al. “Medium-Chain Fatty Acids Ameliorate Insulin Resistance Caused by High-Fat Diets in Rats,” Diabetes/Metabolism Research and Reviews25, no. 2 (2009): 185–94.
Rob Leighton
Rob Leighton is founder of Kardea Nutrition, a company focused on advancing cardiometabolic health with information, education and enabling products. With Dr. Richard Collins, The Cooking Cardiologist, and Susan Buckley, registered dietitian, Rob authored The Kardea Gourmet: Smart & Delicious Eating for a Healthy Heart.
- 
- Website - More Posts
From Cambridge University YouTube channel: “At Cambridge, we offer two medicine courses - the Standard Course and the Graduate Course. With both, our aim is to educate students to become compassionate, thoughtful, skilled members - and leaders - of the medical profession.
Success in medicine requires application and hard work, both while studying and when in practice. However, it brings great rewards in terms of job satisfaction, involving as it does a combination of science and human interactions, and numerous career opportunities.”
To find out more about Medicine at Cambridge, see http://study.cam.ac.uk/undergraduate/courses/medicine
Posted at Clinical Cases and Images. Stay updated and subscribe, follow us on Twitter and connect on Facebook.
The “Best of Medical Blogs - BMB weekly review and blog carnival” is a weekly summary of the best posts from medical blogs. Feel free to send your suggestions to my email at clinicalcases@gmail.com. Best of Medical Blogs (BMB) is published every Tuesday, just like the old Grand Rounds.
A Medical Educator Joins Social Media: One Year Later
Dr. Djuricich, Program Director in Medicine-Pediatrics at the Indiana University, shares what he has learned in one short year: If physicians and other health care professionals are not becoming involved in social media, they are missing out on a “place” where many of the patients already are. There is a lot of misinformation floating around on the internet. It is a duty of physicians to combat this and provide correct information. Do not let social media take over your life. The important things (family, friends, etc.) are still the important things, so don’t lose the priorities. http://goo.gl/zNfpe
What explains blogging longevity? It’s easy: blog for yourself, and share with others
Dr. Centor explains his blogging longevity after 10-years of blogging. I’ve been blogging for 8 years, and I agreee with him: Why you should write a blog for yourself rather than for a shifting audience http://goo.gl/P8xtz
Here’s Dr. Centor again: Explaining longevity is subjective. Mostly, I like blogging. Basically I blog with myself in mind, and am gratified that others find my comments interesting. Blogging is never a chore. One cannot last 10 years doing a chore. http://goo.gl/Jyl2o
Cardiologist Dr. Wes nominates the hardest to read Abstract of the Year at 2012 Heart Rhythm Society
What is the abstract that contributes the smallest amount to our field while demonstrating the worst grammar, the most bureaucratic lingo and, of course, verbosity. The sentence that clinched it? “Conclusions: The harmonization of endpoint definitions, terminology, and clinical trial design paradigms provides consistency across clinical trial studies that can facility (sic) clinician acceptance of results and the evaluation of safety and effectiveness of devices and medicines for atrial fibrillation.” http://goo.gl/ZstA0
Harvard Medical School Q&A blog doctor reflects on his readers’ feedback
Dr. Komaroff from the blog Ask Doctor K.: “Since I began this column last September, I’ve received a lot of mail — both emails and “snail mail.” Mostly it’s been health questions. I can’t answer them all, but I try to answer as many as I can. However, I’ve also received complaints. Sometimes they represent an honest difference of perspective. On occasion, they reflect the fact that I’m a man.” http://goo.gl/XK3O1
A complete list of all academic medical journals available for the iPad
The omnipresent blog iMedicalApps makes a good use of Google Docs spreadsheet to list the apps of many academic medical journals available for the iPad. I still have personal preference for the open web rather than apps but that’s just me. http://goo.gl/13Gjz
What is postinfectious cough and how to treat it?
From Dr. Matthew Mintz’ blog: While the cause of the postinfectious cough is not known, it has been thought to be due to the extensive damage of cells lining the lung and widespread airway inflammation of the upper and/or lower airways. The good news is that this usually goes away by itself, the bad news is that it can take weeks or even months, and can be quite disruptive to patients lives. Since symptoms are caused primarily by inflammation and hyperresponsiveness/bronchoconstriction in the lungs (which is what we see in asthma), then treatment is likely best with something that treats both inflammation and bronchoconstriction in the lungs, such as an inhaled corticosteroid/long-acting beta agonist like Advair (which is commonly used in asthma). Use of Advair for postinfectious cough may be the single most common off-label use of any prescription product. Since inflammation can persist for weeks, it is important that Advair be used for at least 4 weeks. If symptoms return, the patient should be brought back for pulmonary function testing as this may be a new presentation of asthma. http://goo.gl/RgxLb
Reality Social Media: Live Tweeting Brain Surgery. What is the downside of this marketing push? Dr. Wes explains: http://goo.gl/XbKwv
“Healthcare Going To The Dogs” - a video for training hospital administrators http://goo.gl/hv40a and http://goo.gl/xsW4J
Science blogging and self-promotion? http://goo.gl/yGUqS
Posted at Clinical Cases and Images. Stay updated and subscribe, follow us on Twitter and connect on Facebook.
GINGER: What’s your diabetes diagnosis story?
I was diagnosed with Type 1 diabetes started using insulin and I began feeling better, really better.
GINGER: The training for ballet is rigorous! What is your training like?
CATHERINE: Each ballet dancer will have a different training regimen because no two people are alike. We try to focus on what challenges us so that we can present ourselves to choreographers as the whole package and be able to perform many different types of movement. I always have been a big fan of Pilates and Zena Rommett’s floor barre technique for correcting alignment and improving posture. It always helps put “everything in the right place” so that when I am in ballet class I can work on expression.
Cardio training is very important too. Running is my favorite as I can listen to music and release any stress I had built up over the day. I don’t run very fast but it’s a goal of mine not to be the slowest runner on the track. Of course ballet class is the gold standard as well as other types of dance like modern or arial dance. A dance class is a combination of progressive exercises that include balance, strength, turns and jumps. I try to get in an equal amount of each type of exercise as if you do too much of one type then you can get injured in another. Cross training is very important.
Ginger Vieira
Ginger Vieira has lived with Type 1 diabetes and Celiac disease since 1999. She is a writer, health coach, video blogger, speaker and diabetes advocate at Living in Progress. Ginger wrote and self-published the book: Your Diabetes Science Experiment.
- 
- - 
- Website - More Posts
The “Best of Medical Blogs - BMB weekly review and blog carnival” is a weekly summary of the best posts from medical blogs. Feel free to send your suggestions to my email at clinicalcases@gmail.com. Best of Medical Blogs (BMB) is published every Tuesday, just like the old Grand Rounds.
A Medical Educator Joins Social Media: One Year Later
Dr. Djuricich, Program Director in Medicine-Pediatrics at the Indiana University, shares what he has learned in one short year: If physicians and other health care professionals are not becoming involved in social media, they are missing out on a “place” where many of the patients already are. There is a lot of misinformation floating around on the internet. It is a duty of physicians to combat this and provide correct information. Do not let social media take over your life. The important things (family, friends, etc.) are still the important things, so don’t lose the priorities. http://goo.gl/zNfpe
What explains blogging longevity? It’s easy: blog for yourself, and share with others
Dr. Centor explains his blogging longevity after 10-years of blogging. I’ve been blogging for 8 years, and I agreee with him: Why you should write a blog for yourself rather than for a shifting audience http://goo.gl/P8xtz
Here’s Dr. Centor again: Explaining longevity is subjective. Mostly, I like blogging. Basically I blog with myself in mind, and am gratified that others find my comments interesting. Blogging is never a chore. One cannot last 10 years doing a chore. http://goo.gl/Jyl2o
Cardiologist Dr. Wes nominates the hardest to read Abstract of the Year at 2012 Heart Rhythm Society
What is the abstract that contributes the smallest amount to our field while demonstrating the worst grammar, the most bureaucratic lingo and, of course, verbosity. The sentence that clinched it? “Conclusions: The harmonization of endpoint definitions, terminology, and clinical trial design paradigms provides consistency across clinical trial studies that can facility (sic) clinician acceptance of results and the evaluation of safety and effectiveness of devices and medicines for atrial fibrillation.” http://goo.gl/ZstA0
Harvard Medical School Q&A blog doctor reflects on his readers’ feedback
Dr. Komaroff from the blog Ask Doctor K.: “Since I began this column last September, I’ve received a lot of mail — both emails and “snail mail.” Mostly it’s been health questions. I can’t answer them all, but I try to answer as many as I can. However, I’ve also received complaints. Sometimes they represent an honest difference of perspective. On occasion, they reflect the fact that I’m a man.” http://goo.gl/XK3O1
A complete list of all academic medical journals available for the iPad
The omnipresent blog iMedicalApps makes a good use of Google Docs spreadsheet to list the apps of many academic medical journals available for the iPad. I still have personal preference for the open web rather than apps but that’s just me. http://goo.gl/13Gjz
What is postinfectious cough and how to treat it?
From Dr. Matthew Mintz’ blog: While the cause of the postinfectious cough is not known, it has been thought to be due to the extensive damage of cells lining the lung and widespread airway inflammation of the upper and/or lower airways. The good news is that this usually goes away by itself, the bad news is that it can take weeks or even months, and can be quite disruptive to patients lives. Since symptoms are caused primarily by inflammation and hyperresponsiveness/bronchoconstriction in the lungs (which is what we see in asthma), then treatment is likely best with something that treats both inflammation and bronchoconstriction in the lungs, such as an inhaled corticosteroid/long-acting beta agonist like Advair (which is commonly used in asthma). Use of Advair for postinfectious cough may be the single most common off-label use of any prescription product. Since inflammation can persist for weeks, it is important that Advair be used for at least 4 weeks. If symptoms return, the patient should be brought back for pulmonary function testing as this may be a new presentation of asthma. http://goo.gl/RgxLb
Reality Social Media: Live Tweeting Brain Surgery. What is the downside of this marketing push? Dr. Wes explains: http://goo.gl/XbKwv
“Healthcare Going To The Dogs” - a video for training hospital administrators http://goo.gl/hv40a and http://goo.gl/xsW4J
Science blogging and self-promotion? http://goo.gl/yGUqS
Posted at Clinical Cases and Images. Stay updated and subscribe, follow us on Twitter and connect on Facebook.
Let’s look at the two most common habits so many people make when they begin a new diet that are bound (I mean, guaranteed) to make your goals in weight loss practically impossible.
1. Your diet is too strict!
Sure, eliminating practically every carbohydrate, all sweets, everything that comes from a cow, and your beloved peanut butter is bound to help you lose weight. The only problem, though, is that you probably can’t maintain a diet of chicken, fish, spinach, and almonds for very long. You’re human. You get cravings…and hey, you actually need calories.The alternative? Make sure your diet is realistic. For example, I know I have an immensely powerful sweet-tooth. I also know, though, that if I give myself plenty of freedom to have sweets once a day, then that is enough for me. The freedom alone of being able to make that choice actually leads me to going several days without even thinking about candy! Seriously. Lately, I even keep a container of Sour Patch Kids on my kitchen counter. There are no rules about those Sour Patch Kids; therefore, I don’t feel any emotional drive to eat them. Having them there reminds me that I can choose to eat whatever I want, but I choose to make good choices for at least 90 percent of my day.If 90 percent of my day consists of good choices (eggs, fruit, natural peanut butter, chicken, fish, lean beef, broccoli, etc.), then I know that a yummy sweet a few times a week isn’t going to derail my success in maintaining or losing weight.
Think about creating a diet that actually includes some of the foods you love, in moderation. Whether you have one cheat-day for the whole week or 3 cheat-meals throughout the week, it’s important to give yourself the freedom to be human.
2. You aren’t eating enough!
Okay, let’s face it: your body needs calories. Life would surely be much easier if we didn’t need food, I know, but it’s a fact of life. Therefore, when you decide to lose weight and you cut your calorie intake down to 1,000 calories a day, with these itty-bitty meals spread hours apart throughout the day…you’re on your way to the diet graveyard.
Your metabolism is fueled by the food you eat. I’m sure you’ve heard Jennifer Lopez rattling about how she eats 6 meals a day, right? Well, she is onto something there. When you eat every 2-3 hours, your metabolism is very happy. It’s like adding wood to a burning fire. You have to tend to it, take care of it. It you neglect that fire for 7 or 8 hours, it’s going to go out. Your metabolism is the same thing!
And on top of all that, when you don’t get enough calories in general, even if you’re eating every 2-3 hours, your body is going to think you’re starving it. Literally, “Oh my gosh, Ginger is starving me! I have to slow my metabolism down so I don’t burn all this good back-up fuel!”
That back-up fuel is body fat. Your metabolism will slow down if you don’t get in enough calories, and it will actually try to preserve that body fat that you are desperately trying to get rid of. For most women, 1,500 to 1,800 calories is a good start. If you’re an incredibly active woman, then you could need anywhere from 2,000 to 3,000 calories. Intense athletes need more.
Most men can start with 1,800 to 2,200 calories. The more active you are, the more that calorie intake can aim towards 3,000 calories.
If your diet leaves your stomach aching with hunger…don’t ignore it! Eat! Eat when you’re hungry. I’m sure you know that moment when you find yourself bingeing on everything in sight because you just went five days of eating 1,000 calories. That isn’t good.
In the end, instead of thinking about your new plan as a “diet,” think about it as though you are building an entirely new habit of eating. For the rest of your life. Whatever “new habit” you create ought to be something that will keep you happy, satisfied, and alive for a long, long time. For me, that “habit” has to include a little Ben & Jerry’s Pistachio Pistachio ice cream every now and then.
Ginger Vieira
Ginger Vieira has lived with Type 1 diabetes and Celiac disease since 1999. She is a writer, health coach, video blogger, speaker and diabetes advocate at Living in Progress. Ginger wrote and self-published the book: Your Diabetes Science Experiment.
- - - - Website - More Posts
From American Family Physician:
Depression affects up to 9% of U.S. population.
The U.S. Preventive Services Task Force recommends screening in adolescents and adults but it does not recommend screening for depression in children 7-11 years of age, or screening for suicide risk in the general population.
The Patient Health Questionnaire (PHQ)-2 and PHQ-9 are commonly used and validated screening tools.
The PHQ-2 has a 97% sensitivity and 67% specificity in adults. The PHQ-2 inquires about the frequency of depressed mood and anhedonia over the past 2 weeks, scoring each as 0 (”not at all”) to 3 (”nearly every day”).
PHQ-9 has a 61% sensitivity and 94% specificity in adults. The PHQ-9 depression module scores each of the 9 DSM-IV criteria as “0” (not at all) to “3” (nearly every day).
If the PHQ-2 is positive for depression, the PHQ-9 should be administered.
In older adults, the 15-item Geriatric Depression Scale is an appropriate follow-up test.
If these screening tests are positive for depression, further evaluation is needed to confirm that the patient’s symptoms meet the Diagnostic and Statistical Manual of Mental Disorders’ (DSM) criteria for diagnosis.
References:
Screening for depression. Maurer DM. Am Fam Physician. 2012 Jan 15;85(2):139-44.
Image source: Vincent van Gogh’s 1890 painting At Eternity’s Gate. Wikipedia, public domain.
Posted at Clinical Cases and Images. Stay updated and subscribe, follow us on Twitter and connect on Facebook.
What’s my own diabetes story? Well, I’ve lived with Type 1 diabetes and Celiac disease since 1999, after diagnosing myself at age 13 during a 7th grade health fair. I know, that sounds pretty crazy, but it happened.
This kid in my class was doing his health fair project on diabetes, and I had all of the symptoms listed on his poster. I told my mom I thought I had that ‘diabetes thing’ but she said that was impossible! None of us knew what diabetes was at the time.
A week later, I stayed home sick from school, and I burst into tears for no reason. I grew up in a house of brothers, so I rarely cried (ya know, you’re not allowed to cry in a house of big brothers). Anyways, my mom took one look at my tears, brought me to the hospital, and sure enough: type 1 diabetes.
While completing my Bachelor’s of Science in Professional Writing during 2008 at Champlain College, I started working out with a personal trainer, and fell in love with exercise and powerlifting. I obtained my certification as an ISSA personal trainer, and the National Yoga Alliance certification as an Ashtanga yoga instructor. Today, I’m an active member of the Diabetes Advocates, I’m known in the Diabetes Online Community for my various work as health coach, video blogger, and author:
- Diabetes Health Coaching & Advocacy: Living-in-Progress
- Diabetes video blogs at my YouTube Channel
- My book: “Your Diabetes Science Experiment”
- 15 Powerlifting records in 2009 & 2010, including: 190 lb. bench press, 265 lb. squat, and a 308 lb. deadlift
- Mental Skills Coach at TeamWILD - which teaches people with diabetes to be endurance athletes
- Columnist at Diabetes Social Media Advocacy: “Ask Coach G” - Q&A about exercise, nutrition, and emotional well-being in life with diabetes.
As an avid presenter and panel member at health-focused conferences across the country, my passion for motivating and creating change in the lives of people with diabetes has led me to being accepted as a presenter at this year’s Medicine 2.0 conference in Boston to speak on the power of “eCoaching,” and selected as the keynote speaker at the annual American Association of Diabetes Educators of Utah this coming fall to speak on how to motivate and empower patients living with diabetes.
- Visit this link for my complete list of public speaking events.
- Visit this link for press and interviews on my work within diabetes and health.
I’m looking forward to bringing you engaging, sometimes humorous, sometimes educational and always inspiring new content!
Ginger Vieira
Ginger Vieira has lived with Type 1 diabetes and Celiac disease since 1999. She is a writer, health coach, video blogger, speaker and diabetes advocate at Living in Progress. Ginger wrote and self-published the book: Your Diabetes Science Experiment.
- - - - Website - More Posts
Managing diabetes around exercise is not simple. Being able to achieve the best performance for a 30 minute run, a Zumba class, a 3 hour bike ride or a brisk walk requires those of us with diabetes to have at least a basic understanding of some complex information. Because without controlled blood sugars during exercise, you might be interfering with your body’s ability to burn fat, build muscle and progress in your overall fitness. And most certainly, uncontrolled blood sugars hamper performance.
I know for me, on more than 30 year journey with diabetes, learning rudimentary exercise physiology and basic nutrition as a lay person has made all the difference in my health, my happiness and my relationship with my body and my diabetes. BI know what a difference it has made to learn from experts on HOW to successfully exercise and manage my diabetes for performance. I want to share with the Diabetes Daily community some of the wisdom and guidance that the TeamWILD staff gives me and regular everyday people with diabetes, like you!
Here are 5 tips from TeamWILD’s Marcey Robinson , MS, RD, CDE, BC-ADM, on the most important things you need to know about diabetes and exercise. To your fitness and health! GO WILD!
1. The goal is blood sugar control and performance. Ideally you will be fueling your exercise and maintaining blood sugars within a range of 80-180 mg/dl, but it’s really important for you to evaluate where your own target is and where you feel safe and strong.
2. Know how your medications work and how they will impact your exercise performance. If you are on insulin, know your insulin action and before each and every exercise session, ask yourself, “How much insulin do I have on board and how will that impact my blood sugars during my exercise?”
3. Pay attention to your insulin, for both type 1 and type 2. Aerobic exercise, like cycling, will lowerblood sugar because the working muscle increases the demand for fuel or sugar. However, for those of you who take insulin, it is important to remember that your body still requires some insulin during exercise to properly utilize carbohydrate/sugar as fuel. Your insulin needs will be reduced, however, please be careful. Decreasing insulin too much can lead to uncontrolled high blood sugars and even ketoacidosis.
4. Be Responsible: Whenever you go out for an exercise session, you must have a blood glucose meter and glucose tabs with you. Especially if you are on medication that could result in a low blood sugar. I recommend that athletes test at least every hour, more often if needed. If you are wearing a continuous glucose monitor and it’s calibrated accurately that particular day, you might be able to test somewhat less frequently. The reason you want to test so often is to track your trends.
5. Track your trends and write down what you do. I know record keeping is no fun but by writing down your insulin/medication, what you eat and at what time, and what your blood sugars were doing, how long you rode, what were the conditions and how did you feel that day, you will be able to identify patterns and know what works and what didn’t. Remember, you are your own best source of information. Review this data with your diabetes team and make adjustments as you go so that when you arrive at your athletic event, you have a really good Ride Day Plan. At TeamWILD we insist that all our athletes write down their Ride/Race Plan and review it frequently!
If you like what you learned here, and you want to spend a few days with Marcey and the TeamWILD staff, including Diabetes Daily’s Ginger Vieira, come to CampWILD in Boulder Colorado June 20 – 24. To learn more about CampWILD and TeamWILD and to gain access to special pricing, visit our site here!
Mari Ruddy is Director of TeamWILD Athletics and Found of the Red Rider Recognition Program for Cyclists with Diabetes at the Tour de Cure.
marir
Here are my suggestions for some of the top articles in medicine in May 2012 so far:
Is Geriatric Medicine Terminally Ill? asks Annals of Internal Medicine http://goo.gl/J4jMU
Low vitamin D (below 50 nmol/L (20 ng/mL) increases risk for clinical disease among older adults http://goo.gl/tBXS4
Senior physicians keep working, putting off the R-word - 20% of U.S. physicians are older than 65 http://goo.gl/Dxgip
Many young doctors worried about future of medicine - amednews http://goo.gl/r61lW
“One of the greatest risks of social media is ignoring social media” says chief integrity officer of Cleveland Clinic. Patients want to use social media tools to manage health care http://goo.gl/9SAry
Doctors can risk lawsuits when writing about patients - amednews points to books about patients as examples http://goo.gl/QhqFS
Coffee is the most complex food known to man. It has 1200 flavor components. The nearest comparison is red wine with 450 chemical compounds in the flavor make-up. In most commercial blends there are 10 to 12 different coffees, from different farms. http://goo.gl/m2LwD
Guidelines for social media use by Federation of State Medical Boards (FSMB) describe in detail what NOT to do: http://goo.gl/Raq2e
Prevention of acute knee injuries in adolescent female football (soccer) players: warm-up could help http://goo.gl/dBgSS
Is It Possible To Walk And Work At The Same Time? Kaiser Permanente tries walking meetings http://goo.gl/cRu8l
Corneal transplantation - 2012 state of the art review in The Lancet http://goo.gl/JBAag
Towards an optimum strategy in rheumatoid arthritis: For RA patients who fail initial methotrexate treatment, add-on disease-modifying antirheumatic drugs are appropriate http://goo.gl/ONq6u
Time Spent Behind the Wheel May Increase Heart Health Risks, linked to less time spent exercising http://goo.gl/NUYX7
Recipe For Safer Drinking Water (from bacteria)? Add Sun, Salt And Lime http://goo.gl/kU2ZK
The articles were selected from my Twitter and Google Reader streams.
Posted at Clinical Cases and Images. Stay updated and subscribe, follow us on Twitter and connect on Facebook.
(Actually curing diabetes is beyond Tony’s capabilities at this time…*ahem*)
If the Iron Man had diabetes…
- He could program his voice-activated office to sense his blood sugar for him. He would say, “Computer, what’s my blood sugar?” and the computer would reply, “Mr. Stark, your blood sugar is 88 mg/dL.” Or it might say, “Time for a juice box, Mr. Stark, your blood sugar is 75 mg/dL and dropping.”
- One of the buttons on the arm of his suit would launch a juice box and a straw from his forearm. His hands would still be free to continue driving, or launching missiles at bad guys–whatever–while he drank juice from the box located securely in his forearm. When he was done, the juice box would automatically flatten itself and be stored in the “recycling” area of his suit.
- He’d invent a type of insulin that would be stored and secreted in a container placed safely behind the unibeam that protects his heart. His body will secrete the insulin at his command. It will need be refilled, though, every 30 days…because most insulin expires after 30 days…even in Tony Stark’s suit.
When Tony is about to eat a meal, his suit will calculate how many calories his body needs in that very moment for adequate energy. His suit will then scan the food Tony is about to eat, and show him a picture image of how much food he ought to consume from his plate. If Tony was trying to lose 5 lbs., his suit would adjust accordingly for his weight loss goals.- Also, before eating a meal, Tony’s suit will tell him, “Mr. Stark, you are about to consume 45 grams of carbohydrates.” The suit would then secrete the appropriate amount of insulin through the container of insulin located safely behind the unibeam that protects his heart.
- If the Iron Man had diabetes, I’m also pretty sure he’d call me up. We’d become great friends, and then we’d eventually start dating.
What kinds of things do you think Tony Stark would invent if he had diabetes?
gingervieira
Ginger Vieira has lived with Type 1 diabetes and Celiac disease since 1999. She is a writer, health coach, video blogger, speaker and diabetes advocate at Living in Progress. Ginger wrote and self-published the book: Your Diabetes Science Experiment.
- - - - Website - More Posts
I know many probably don’t agree with me. I mean, who wouldn’t take the vaccine and just open up to a whole new day and move on? I have had diabetes for (almost) 24 years. It is all I’ve ever known. If given the vaccine, it would be like removing an extra appendage that I’ve always had. It’s always been there. I have learned to adapt and live with it. And I’m scared that it would take almost 24 years to undo all of that. It’s like I’ve been married to it all of these years and the vaccine would be the divorce decree .
I would love to be free from the worry of what more and more years of having this disease will do to my body. I would absolutely with all of my heart LOVE to know that there would be a way to prevent more children and adults from the possibility of having to live with this. To know that if there were ever a diagnosis date for one of my children, that it would be okay, because they would just need to have the vaccine and it could be reversed.
I’m scared that I have become too comfortable with my diabetes. I’m protective of it. It has been my biggest, hugest, most ginormous responsibility since being a child. I’ve learned how, if I put forth the effort, to balance it just right between my shoulders and carry it with me through life. The vaccine would lift that boulder from me, but just as any thing that carries a weight for a long period of time, I would be off-balance for a while and have to relearn how to walk again without it.
While I do not want to give the impression that I’m against the vaccine – because I am 100000% for it – I’m just scared of what life would be like after, because it’s unknown to me… or at least I don’t remember it.
If you were given the opportunity to take the vaccine after years of living with diabetes, how would you “cope”? Would you throw a big “going away” party for it and bid it goodbye and move on easily? Or would it be like the sad-but-not-so-sad death of an old, irritating but faithful friend, who while it leeched off of you and damaged your insides, it taught you more about your body than you would have ever known and how to take care of yourself probably better than anyone ever could?
sugabetic
My name is Sarah and I am a Type 1 diabetic.
I was diagnosed on November 22, 1988, at the ripe ‘ole age of 4. Growing up in a very rural community, there were no other Type 1 diabetics that we knew other than my cousin, who lived in a town sorta far away. Other than doctors, there was no other support system that knew what it was like to live with diabetes. So, my support system was only my mom, dad, sister and brother.
Even though I had this wonderful support system, it still wasn’t enough. They could only truly understand so much. That’s when, after I was married, I started looking for places online to share my stories and connect with other people. There wasn’t much help through things like AIM and the such (the only platforms I knew of at the time), but then I stumbled upon TuDiabetes. It was there that I found my “other” support system. And from there, I met several people who then suggested I sign up for twitter. From there, I started following people who wrote these things called “blogs”. A d-friend from TuDiabetes suggested that I start my own blog. I wasn’t fond of the idea, but after much hesitation, I did. And it was the best thing ever.
That was in April of 2009. I have been blogging ever since because I feel that by reaching out and sharing those stories, I may reach someone else who is in need of a stronger support system like I was. Someone who may need to read a story from someone else who “gets it”.
And it’s my belief that through sharing our stories and being a part of that online support system, we help to bring even more awareness to what living with diabetes is really like. It’s said that “the squeaky wheel gets the grease”, and it’s my thinking that the squeakier we can get, the more aware the general public will be, and hopefully we’ll get what we need in research and funding so that we can find a cure (a.k.a – the “grease”).