drmargaret

I might as well jump into the fray about the contention between Scientology and Psychiatry. Last week Tom Cruz went on the Today show to promote his movie The War of the Worlds and got into an argument with Matt Lauer about the use of psychotropic medications. Lots of news stations covered the argument. I saw it rebroadcast on CNN. I then saw a panel discussion on the Today show the next day with the strangest collection of “experts” about medication. These included a psychiatrist who is opposed to psychotropic medication, a psychologist, and Marie Osmond who had suffered from post partum depression. I’m not sure what anyone could reasonably get out of those “experts.”

There’s a long history of several hundred years of problems with psychiatry. Psychiatrists were making guesses at what was working and what wasn’t for very serious mental illness. These were the people who were confined in insane asylums. These were people with illnesses like dementia, serious organic disorders, the criminally insane, schizophrenia, and bipolar disorder. Occasionally a major depression would slip in, but that was rare. The big break through happened when someone noticed that some schizophrenics with high blood pressure got better on a blood pressure medication known as reserpine. (Schizophrenics see things, and hear things and have delusions and strange thinking, they don’t have split personalities.) So some researchers started looking at why people got better on reserpine and made the hypothesis that chemicals in the brain caused people to be psychotic. So a whole variety of chemicals were developed by drug companies to try to normalize these abnormal brains. If you take pictures of schizophrenics brains on MRI they look different than people with normal brains. They also look different on autopsy. The same is true with dementia also known as Alzheimer’s disease where the entire cortex of the brain shrinks. This starts after age 45 and no one knows why it happens in some people. It produces memory loss. Memory loss isn’t the only symptom but it’s the most obvious. Bipolar disorder used to be known as manic depressive illness. The name was changed a few years ago but the disease is the same. There are periods of grandiosity and severe sleep disturbance and possible delusions with a frank manic episode, and periods of depression. Every single one of these conditions can be improved with medication. In many cases, medication takes these people from institutional care to functional ability. If it is possible for any of these people to live independently without medication outside of an institution then they should absolutely make an attempt at that prior to attempting medication.

Medication is used as a last resort. Hospitalization is used as a last resort. Institutional care on a permanent basis is used when all methods of treatment fail and the person can not live safely in society. Right now people get psychiatrically hospitalized because they are either dangerous to themselves, dangerous to others or gravely disabled and not able to adequately care for themselves. Medications are used on an urgent basis to prevent hospitalization. With correct supervision sometimes they work and are life saving. Sometimes they are given out like candy with little supervision and little direction. They can be harmful when used in that fashion.

Medications are also used because they are faster. They can be problematic when used like this. A child is bouncing off the walls at home. The child isn’t sleeping at all for days on end. The family is staying awake in shifts to watch the child to try to prevent the child from injuring himself. They have relatives coming in to help. There is a family history of bipolar disorder. There are clear parenting issues. The child is getting injured and has been breaking things in the home and climbing on things like bookcases and pulling them over on himself. The kid is running the home. He’s not socialized, is becoming hyperactive, inattentive, isn’t listening, and is getting aggressive. He’s been kicked out of preschool. The place to start with this isn’t medication, but I see lots of these kids coming in for evaluation on very strong medications, some not even approved for use in children. This is a poor practice and is simply done to be faster. Medication alone won’t solve all the problems and may create new ones. Medication may not even be indicated.

In contrast is the case where a teen is showing some episodes of brief delusions. Occasionally he reports everyone is against him. Sometimes he thinks things have been crawling on him. It’s only happened a couple of times so it’s not a big deal and no one is prescribing any medication. He’s being monitored closely. There’s a family history of schizophrenia. There’s been a suicide and a homicide in the family so the stakes are high here. The family is working closely on parenting issues. He’s had normal teen conflicts. Every once in awhile something seems to go awry. The thinking process is disordered. So far he doesn’t need any medication. He functions at home, with peers and at school with just some unusual episodes. The family members all understand the stakes. He can stay the way he is and be a productive member of society. He may not need medication. With stress he may become paranoid and delusional but not need medication. Some members of the family have been able to do that. Others have gone on to develop the full paranoid schizophrenic syndrome and have not been functional even with medication requiring episodes of hospitalization or institutional care. Others have decided to discontinue medication after being released from institutions or hospitals and have either killed someone or killed themselves while in a delusional state.

Now I talk to people who aren’t taking medication, or who are struggling with violence frequently. I think that before someone decides that taking medication is so appalling as Tom Cruz suggests, that they need to recognize that for some the alternative is suicide, homicide–with the attendant prison term, or a life in unspeakable torment by internal demons rendering them unable to function in society.

I don’t think medication is a choice to be made in a flip or glib manner. I don’t think it’s to be made on the basis of what’s easier. I do think it should be the last option. I certainly wish the drug manufactures would test medications on children so we knew the effects. I wish parents were advised when drugs for their children were being provided off-label so they could have informed consent that we don’t have a clue what the medications are doing to their children. But I think psychiatric medications allow people to live full and productive lives outside of State run institutions. Psychotropic medications have saved lives.

The dogs have been out harvesting. There was a bumper crop of blackberries this year. I didn’t plant the blackberries. My neighbor planted them about 15 years ago. They grow along a 75 foot stretch of wall on the north side of my property. I also didn’t plant the apples that hang over the wall or the pomegranets in the back corner. They are all from my neighbor’s yard.

Now in some areas these would be issues of contention. To have someone intrude into your property with invasive planting might be a problem. I see it as fruit gifts. I am not required to water, fertilize, or do anything with an entire side wall of my property. My neighbor has taken it on for me.

I do go out in the fall and tie up the plants after the berries have been harvested. I do pick up the spent fruit. I used to come up with ideas for how to use all the fruit that always seemed to ripen within a few days. That was before the dogs.

The dogs are eating machines. They stand up on the side wall and gingerly pick the berries off the vines. They jump up into the trees and either eat the dried pomegranets or come down with fresh ones. they often wait until later in the summer when they start to split open then eat the seeds out on the deck.

The dogs now seem to have company. There are roof rats and possoms and raccoons which feed off the fruits. They are also raiding my garden which the dogs can’t get into. If the dogs are quick they might catch some of the critters early in the morning or late at dusk when they are forraging. My garden is 25 x 25 feet cut into a traditional cross and is fenced off so I can have an undisturbed crop of onions, garlic and potatoes. Otherwise the dogs would eat them. There are all the traditional summer vegetables of squash, beans, chard and the less traditional bok choy and the tomatoes. There are lots of herbs. More than 75% of the garden is devoted to herbs. There are flowers as well, scattered throughout and some grapes growing for the first time up trellises connecting the squares.

The dogs get to run around the outside and chase things into and catch things running out of the garden. I can tell by what’s knocked over the size of animals coming inside. Some things are about 30 pounds. Which means racoons. Most are small and eating everything, which means rats. The housing is near a ravine which goes up to the mountains. We get wildlife. There’s more than enough in the garden for two people. Plenty for the few rats, racoons and anything the dogs can pull through the fence.

I know the neighbor called an exterminator for the roof rats. I can see that if they get into the house, but not when they are outside running around. There are tons of them in the ravine four doors down. She’ll keep the exterminator company busy most of the year. I’ll just let the dogs have them if they want them and do something if they are in the house. I’ll just plant more stuff or use more screening if I want more stuff kept alone.

In the past week or so, there were two earthquakes in Southern California, one in Northern California which triggered a tsunami warning, one in Alaska, and one in Japan. While most people at the office knew about the two in California they didn’t know about the others or many other smaller earthquakes that occur around the globe. I follow earthquakes as a hobby. The link provides a map to the US Geological Survey.

Now it's important to do some basic planning if you live in California for earthquakes. Having an earthquake kit in your car is a great idea. The old idea of standing in a doorway is a great way of getting your fingers smashed and the better idea is to stand in a hallway or to get under some sturdy furniture. Running out of a house is a bad thing and you get hit by debris. Most of the time you can just ride out the shaking and cover your head. When the shaking stops put on shoes and watch out for glass. Be careful when opening up cabinets because everything shifts. It may not be where you left it. The more you can plan the better things will be. The less you scurry around running around in circles the less likely you will get hurt. People up in Santa Clarita who took off after the Northridge earthquake in 1994 got hurt as freeways and roads were collapsing. Wait until everything stops shaking and there is some light if it is dark. Get a first aid kit and a manual. If you live in an area where there are some major disasters, have camping gear. Have a plan. You may not know when the next earthquake is coming even if your goldfish and puppy is acting weird and everyone around you is crazy, but you can certainly get everyone calm, have extra fish food and puppy food on hand and get everyone settled down while sanity resumes.

The email told me of an airline crash in Africa killing people I was related to. Because of some technicality, there was more than $1 million dollars I could get if only I’d contact them and put up some earnest money of my own to help them help me. I know all of my living relatives and they aren’t in Africa.

The other email was from PayPal asking me for my account number and password because there were some irregularities on my account. I don’t have a PayPal account.

These scams, and others like them, are part of internet fraud. It’s a growth industry. Some, like the first, involve people’s desire to get rich quick. In the old days this was played with a winning lottery ticket by someone who couldn’t cash it. They needed the money fast, were in the country illegally, had a greedy partner, or were a criminal. I liked the criminal one, at least they were truthful. So they offered to let you keep the winning ticket if you gave them some cash up front. You got left with a worthless piece of paper, they made off with your money. The second involves asking for information or “phishing.” It can also be played on the phone or in person. A phoney web site is set up to look like a real web site. It asks for information you are never supposed to give out–like a password. The thief can then use the information to access your account.

The problem is that people start thinking they can’t trust anyone. That no one ever does anything good or kind or helpful. They become paranoid.

Paranoid people act different. They never saw a good intention they weren’t suspicious of. There never was a gift horse they didn’t look in the mouth. They get worried before there is anything to worry about.

Gullible people fail to worry about things. They think there is nothing but goodness in others. They think no one intends to harm them. They place themselves at risk and then are surprised.

My neighbor and I have different world views about the nature of people. She is basically suspicious of others. I have suspicions of some people, but most people do not cause me to be suspicious automatically. She lives in a world populated by evil, frightening people she worries about. She plots ways to ensure they don’t take advantage of her or harm her or those she knows. Although we live in the same neighborhood, I live in a world populated by very different people. Most people are kind and helpful. They will stop and give you directions and will lend you a hand. The actual crime rate is low in a city with a fairly high crime rate. I don’t worry much about the people who live around me. Oh there’s the guy up the street who gives everyone pause, as does the guy down the block, but the police are at their homes every other day checking on them. As long as they keep to themselves, and they do, it’s fine.

I ran into some guys loading up their truck with gardening supplies at the local home improvement place. So I asked them if they could come over and help with some yard work some Saturday. I mentioned that to my neighbor. You would have thought I had just asked to be assasinated. She thought I was crazy. In her world you don’t just ask people. You get references from people who know people, who know people. These were nice, clean cut men, who were doing work for a living. They were doing work on their own home. They might be able to give me an estimate and do some work on my house as well. They weren’t crazy, drunk, hung over, and were up at the crack of dawn on a Saturday. Now if someone has a lawnmower here there might be a deal. If they do a good job I might ask them to come back. Now I do tell people if I’m calling workers to come over to the house. That way someone knows who was over and what was intended. It’s a safe thing. There’s a before and after call. There may be a during call if there’s someone in the house and I’m alone. That increases my safety. Most workers do the same thing. They call at the job site and call when they leave. They may even call when there. It’s the same thing; it’s for their safety. It’s a nice rule to follow and it limits liability in this litigious society.

So there needs to be a balance so someone isn’t too gullible or too paranoid. So the view of most people about others is that they are decent unless they prove otherwise.

There’s something about doing things within moderation that often seems to escape us. Not just me, although certainly me. We bite off more than we can chew.

I decided I was going to do some painting yesturday. No big deal. Just a couple of walls. In fact just one wall and one partial wall. But it’s a big deal for me and I know that. And I decided to top it off with planting two plants. Not good. Very not good. But it seems like such a little amount of stuff, doesn’t it?

I should have had a clue when the guy at Lowe’s said it was quick when I returned to get the second pint of paint. Normally it covers in one coat but it was needing two coats of “Delightful Moon.” I should have had a clue at the store when my arm was going numb, before I ever put the roller into the paint. But I was determined. Determination gets you to push through pain. So I did the first wall, all the way through the second coat, and into the store for the second can, back home and completed the second coat and started the second partial wall first coat before I knew I needed to lie down.

I talked with a guy on Friday. He had neuropathy for 7 or 8 years prior to the development of diabetes. He had 7 or 8 years to get his diet under control while he just had the pins and needles feeling in his feet. But he didn’t do that. He didn’t do that and the pins and needles of neuropathy migrated to his hands. He didn’t do that despite the familt history of diabetes. He didn’t do that because although he knew his diet was insane regarding sugar and carbohydrates, his blood sugar readings weren’t completely stupid so he continued. Now he takes insulin. I understand that.

There are a bunch of MDs who would scream at me about yesturday if they knew. Something on the order of “You did WHAT? On a ladder? Painting? Whatever for?” For the sense of being normal. In the past the diabetic guy could eat sugar. In the past I could paint four walls without pain, maybe even six. In the past we were healthy people.

There are lots of people like that. The people who can’t drink, who can’t gample, who can’t walk far, who can’t breathe well. The people who are at the wake up points of their illnesses. The you better take care of this or else points. The moderation points. The points where you have to cut back seriously or face the dire consequences and some of them may be fatal points.

Psychologists call what I did yesturday denial. It’s a fancy word meaning you hold your middle finger up to whatever is wrong with you and make the challenge. Sooner or later it holds up it’s own middle finger and challenges back victorious. Neener neener. It’s part of figuring it out. People toy with illnesses that can be life threatening. They come in to their SSDI evaluations not taking their medications for several days to make their conditions seem much worse and to let themselves think that maybe they don’t really need to take them. It’s a dance. I don’t dance with my medications. I dance with my activity level.

I was told to be sedentary. Not much more than stretching. A little bit of exercise is good, more than that and there would be hell to pay. I was told that in the 1990’s. That was long before there was quite so much wrong. Occasionally I would try more than stretching. Not good. I could do some stuff but not a lot. Yesturday was a lot. Not good. So I get to spend most of the day in pain and resting. The pain is my own fault. You live you learn and you hopefully do less next time.

I’ve given presentations on head injury. Presentations have been given by others on head injury. There’s some basic information out there. Psychology and neuropsychology devoted an entire decade to research on the brain. My husband asked me why it takes scientists so long to accept information. It’s part of the nature of science. It takes a long time to change thinking.

Most people recover from mild head injury just fine. You bang your head you get over it. The more often you bang your head, the less well you get over it. The harder you bang it and the more damage you do to your brain, the less well you get over it. Head injuries aren’t additive, they are multiplicative. It’s not head injury 1 plus head inury 2. It’s head injury 1 times head injury 2. Further the effects of head injury, like the onset of seizures, can be delayed as long as 18 months post injury. So, you fall and bang your head and think it’s nothing but a pain. You get up and are nauseous, maybe you even vomit. Nothing happens. 12 to 18 months later all of a sudden you fall on the floor and flop around like a fish. You end up in an emergency room. An MD asks you if you have hit your head and you don’t remember that fall a year ago almost 2 years ago and it seems completely unrelated. So the MD decides there’s no cause for the seizure. But there was. You have a 400% greater risk for more seizures and should be on medication or should be followed closely, but no one has a clue. No one can tell you there are activities you should avoid and should have been avoiding for the past year. Instead you get told it was a one time event, it’s no big deal and not to worry.

Head injuries are so common and so mild most of the time they are ignored. You get hit in the head with a softball from your kid. You stand up suddenly and bang your head on the bottom of a cabinet. You slip and fall and hit the back of your head. You suddenly change position and get sick to your stomach. You go on a ride at an amusement park or at a carnaval and it bounces you or spins you around and you get sick or get a headache. You are in a car accident at 20 to 50 mph and snap your neck when the car is rear ended. The dog head butts you in the face or jaw. You’ve got some pain, but you think you are fine. Eight times out of 10 you probably are. It’s those other two times that are the mess. You might know when you throw up or get dizzy. You might know when the strange migraine-like headaches start that let you know you’ve had a minor concussion. You might just never know and think you got sick and got the flu.

Post-concussive headaches follow mild head injuries often. They get labelled as migraines. Real migraines cause your havds to get cold. They are caused by vascular changes. Post-concussive headaches are caused by your brain bouncing into your skull. Your hands don’t get cold. The rest of the migraine-like symptoms are the same. Sensitivity to light, sound, and movement, and feeling better with vomitting. The nerves in the brain have been sheared and need to reconnect. The pain frequency and intensity decreases over time. Over 2 to 5 years the pain diminishes almost completely. In some cases it continues at a low level.

The entire room can be spinning. Dizziness can come with head injury. It comes from damage to the inner ear. It causes vertigo–the sensation that the room spins. It causes loss of balance. It increases the likelihood of more falls.

The more often you bang your head the more problems there will be with thinking. Where you bang your head will determine what kinds of problems with thinking you will have. Remember these are only the 2 out of 10 cases. Most people are right handed. Most people have the right side of their brain involved in recognition, math calculation, drawing things, organizing and synthesis of some types of tasks. The left side of the brain is involved in speaking, paying attention, thinking and explaining things. This is overly simplified but gives an idea. Some left handed people have this organization, others have the sides reversed.

There are even more problems if there is bleeding and swelling. The brain is in an enclosed space. There isn’t much place for expansion in closed head injuries. As the damage expands, structures deeper into the brain are impacted. Problems with regulation of the body’s organs and the endocrine system show up in a small percentage of people following head injury. Some people develop heart problems or go on to develop diabetes, thyroid, or other endocrine disorders.

Now what I have been telling people is that with closed head injury with the 2 of 10 people who have symptoms that they are at risk for significant complications. They are already in an unusual population. If they have not had a seizure, they are at risk for seizures for 18 months post head injury. I advise people not to do any activities that can further injure their brains. No contact sports, no motorcycle riding, no horse back riding, no rollerskating, no roller coaster riding for 5 years post head injury. After that time period, the risk of significant “unexplained” brain bleed, sudden death, or sudden unexplained seizures decreases dramatically and the risk should be the same as anyone.

I saw a child with a history of an unexplained seizure last year. One grand mal seizure where she fell on the floor and flopped around like a fish. No history of any head injury. Except she had a bad stomachache right before she flopped. So I had an idea. My idea was that she had a head injury, probably several. So I started asking. The head injuries started a full 2 years before at a carnaval where she was on a bouncy ride and was bounced all over and got really dizzy and then wanted to go home. Before that there was the time she hit her head and cut it and got a bump. You can still see the scar. Then there were all the times she was hit in the head on the playground with bounce balls or hand balls. I lost count after we got to the fouth head injury before that “unexplained seizure.” Now it’s no longer 1 seizure, it’s more likely her 3rd, but the first that was grand mal. The rest were smaller, petit mal seizures and are ongoing. It’s why she was having those accidents at school and never quite made it to the bathroom in time. Now she can get treatment. Now everyone knows the history. It’s not “unexplained.”

When people make mistakes in psychology it impacts peoples lives. I hear about mistakes all the time. I get to read charts and notes from other clinicians as part of my work. It’s not that I don’t make my own mistakes, I’m human.

Case 1. I treated a guy for depression for 6 months. He wasn’t getting bettter. He was on medication. He was taking it religiously. He wasn’t getting better. Something was wrong. It turned out, he had a knee infection. The infection was causing his depression. Once he was treated with 10 days of antibiotics his depression disappeared. Sometimes depression isn’t depression.

Case 2. A man saw his doctor because he wasn’t sleeping well and started hallucinating. He was hearing his name called. Sometimes he would see things and sometimes he couldn’t move just as he was falling asleep or waking up. His doctor referred him to a psychiatrist. He was misdiagnosed as schizophrenic and put on antipsychotic medications. These worsened his sleep problems and made him so he couldn’t stay awake during the day. He lost his job. It was several years before he was diagnosed and taken off his medications.

Case 3. A woman was having very bad mood swings. Sometimes she was starting to faint. She was diagnosed with a personality disorder and anxiety. She got so desperate she attempted suicide. Although the nodules on her thyroid were noted on her medical chart at the hospital, no one did a complete thyroid work up. She continued to be treated for a personality disorder and anxiety and they added depression to the increasing list of diagnoses. Eventually she was diagnosed with Hasimoto’s thyroiditis, treated for the thyroid disorder and taken off the psychiatric medication.

Case 4. I was treated for depression with Paxil. Paxil should take at least 4 to 8 weeks to work. It worked in 3 days. Clearly Paxil was treating something other than depression. It took awhile to find the gastrointestinal disorder of Hartnup which the Paxil was masking temporarily. It can be controlled by diet.

Case 5. A man brought in his 11 year old son who was being treated for hyperactivity (ADHD). He was also being treated for asthma. The child was on several stimulating medications for asthma. The side effects of the asthma medications were explained to the man. The child didn’t start getting symptoms of hyperactivity (ADHD) until after starting medications for asthma. The diagnosis of hyperactivity must start prior to age 7. He was advised to discuss the asthma medications and their side effects with his prescribing MD.

Case 6. Steroids like prednisone are great medications for serious allergic reactions. An unusual reaction to them is steroid psychosis. It doesn’t happen every time the medications are given, so people doesn’t associate the onset of irritability, delusions, or hallucinations with a medication they have taken in the past. When the medication is stopped the symptoms go away. Usually a family member brings in the person complaining they are irritable and are screaming at everyone. A review of medication finds the steroid which has been started recently.

People report hallucinations as one of the most common reasons why they seek treatment by a psychologist or psychiatrist. Hallucinations can actually involve any of the senses. The most commonly reported hallucinations are auditory hallucinations and visual hallucinations. Medical conditions can cause hallucinations as can psychiatric/psychological disorders.

When people are trying to fake being disabled, hallucinations are frequently what they report are going on. The most commonly faked hallucinations are reports of seeing dead people or hearing dead people.

Real hallucinations may indeed involve seeing former family members, but hallucinations are accompanied by more symptoms than just hallucinations alone. What people miss when they attempt to fake the hallucination is the package of symptoms.

Visual hallucinations often involve seeing dream images when not dreaming. These are the result of impaired rapid eye movement stage of sleep. It takes place over a period of weeks to months, although in some cases can occur in as little as 5 to 10 days with a medication like an antibiotic. In fact, it’s often a side effect of a medication like an antibiotic. It goes away after the medication has been completed and is no longer in the system. People may often have periods during the hallucination where they can’t seem to move. They may have a falling sensation or a flying sensation. These hallucinations often occur just as sleep is starting or ending and the person is already in bed. They are a sleep disturbance.

Another type of visual disturbance misconstrued as a hallucination is a floater. This is a sediment from the aquious humor of the eye which has been dislodged and now floats. Although it’s behind and within the eye. The person sees it as outside themselves. It’s often described as spiders or roaches on the walls. It’s frequently a sequella of head injury.

Auditory hallucinations range from actual conversations between people to sounds in the environment. The most common one is someone’s name being called when no one is there. As an occasional event, it has little meaning. As it increases in frequency it may signal hearing difficulty, sleep disturbance, or psychiatric problems. Noises are the same. Buzzing noises, known as tinitis, can be extremely irritating. Some are due to hearing loss produced as side effects of medications which are toxic to the hair cells in the inner ear. They signal eventual hearing loss. Depending on age, other noises may represent other toxic body states such as kidney disorders or liver disorders and the body’s difficulty with filtering out the wastes in the system.

More unusual hallucinations come from illegal drug use. As brain cells are killed off, visual, auditory and, in some cases, tactile hallucinations develop. Even when the drugs are discontinued the chemical effects can last for some time which the brain heals. This is especially true with the designer drugs, with methamphetamine, and with some of the natural hallucinagenics which can be fatal. It’s not pleasant to watch someone attempting to rip their skin off because they think there are bugs or snakes burrowing under it. Tactile hallucinations do not appear to be pleasant in the least.

I’ve had visual, auditory, olfactory, and gustatory hallucinations. So I can discuss those experiences personally and know what those experiences are like. My family has some rare medical problems. If they are not correctly treated we develop severe sleep problems and depression. Medication for depression or psychotherapy will not fix the underlying medical condition which is a gastrointestinal disorder which disturbes the neurotransmitters in the brain. It causes vitamin deficiencies, oral lesions, skin lesions, and lots of changes throughout the body. It causes scary dream images, auditory command hallucinations, and hallucinations of my name being called. It causes depression and insomnia. Knowing the events weren’t real and were hallucinations didn’t make them any less frightening. There were times when the visual hallucinations were pleasant, bunnies hopping all over the walls, and the voice was positive not negative, but still vague in quality. There were other times when I could see shadows or could see things moving that were stationary. Knowing what these things are like helps me when someone comes in and tells me they are hallucinating. I know all about hallucinations. I come from an entire family that has them. It’s not like we don’t talk about it. We compare notes. I know the difference between my hallucinations and those of people who are depressed or schizophrenic. There are differences in the quality, and the substance of the hallucinations.

My olfactory and gustatory hallucinations are related. In 1985 I was assaulted when I came home one evening from work. A man hit me in the face breaking my glasses into my face and I fell backwards. He stole my purse. He got all of $10. In the process of breaking my glasses into my face my olfactory nerve was partially severed. The olfactory nerve controls your sense of smell. I have a significant loss of sense of smell. Smell is significantly connected to the sense of taste by 85%. When I lost my sense of smell I lost most of my sense of taste. What I got instead were hallucinations. In the presense of strong odors I have a smell. It isn’t the smell that’s there, it’s a different smell. It’s a hallucination. When I taste a strong taste, it’s not the taste that it’s supposed to be, it’s a different taste. It’s a hallucination. Now it’s been 20 years and I’m used to the changes, but my diet tends to be rather bland tasting foods as a result. The good news is that if someone hasn’t taken a shower in a couple of weeks and has been sleeping outside I really can’t get how bad it is, just a minute fraction. So there are some benefits.

I took my dogs for a drive. We drove to Las Vegas. The dogs were in the back seat of my Ford Mustang. There is something about seeing dogs in cars that inspires people to attempt to communicate with them. On the 4 1/2 hour drive several people attempted this communication. Waving was the most common method made to communicate with the dogs.

Neither Cinnamon nor Baxter can wave. Baxter slept for most of the trip, but occasionally he would pop up and look around. This prompted people not only to wave, but to point and in once case to hollar. Several people made floppy dog ear motions at the dogs. Cinnamon just looked at these people. Baxter just looked at these people. If you aren’t giving them a verbal command, a hand signal command, food, or you aren’t encroaching on their space, they aren’t going to notice you all that much. I worry about these people driving who are waving at my dogs. Watch the road not my dogs, please.

Now when we had Zoey it was a different matter. Zoey noticed people waving at her and she played gamed with the people waving. She would play her dog version of peek-a-boo. She would duck down with her head down below the wiindow and wait until she could see the outline of a car next to ours. Then she would pop up and bark at the car. Gotcha! Great fun in parking lots too. She would wait ducked down until someone was next to the car and then she would back at them and scare them. Gotcha! If she thought someone was waving at her, she would get very excited and she’d put her head out the window.

Baxter and Cinnamon only get excited if they see another dog. Then they go crazy. Especially if it’s another dalmation. Baxter will start making talking noises. Cinnamon will whine. Usually the other car or truck with dalmation(s) on board will go crazy back.

The only other time when Baxter and Cinnamon get that excited is at halloween. That’s when kids get dresssed up in dalmation costumes and come to our house. We get at least 2 a year. Cinnamon is always really friendly with these fake dogs. She’s very gentle with them. She generally doesn’t like little children, but the little kids in dalmation costumes just seem to touch her heart and she’s very sweet with them. She stands next to them and gets her picture taken by their parents.

Baxter is a different story. We have to warn kids about Baxter’s tendency to pet people back. There was this child who pet Baxter at PetCo. Nice kid. Baxter pet the kid back. Right in the groin. The kid doubled over and explained in graphic detail to his mother where Baxter had pet him. His mother told him not to use that language. He told her that Baxter had nailed him. So now we warn people that Baxter pets back and to be careful. He sits back like “Yeah, who wants to pet the dog next? Bring it on.” Pet with extreme caution.

Driving a Mustang with two 74 pound dalmations in the back seat causes some commotion especially when I’m getting the dogs into or out of the car. In the neighborhood everyone is used to them and no one pays attention. In places where they aren’t a familiar sight, lots of people stop and stare. They do seem to enjoy car rides and seem to look forward to the trips.

People get prescribed medications for a variety of things. One of my neighbors was given an antibiotic and we were having a conversation about it. I was a pharmacy clerk for a couple of decades so I know a bit about medications.

Medications are labeled very specifically by the pharmacist in accordance with the prescription given to them by the doctor. The prescription has the name of the person to take the medication, the date the medication is filled by the pharmacist, the number of tablets in the container, how the medication is to be taken, the name of the doctor, and the phone number of the pharmacy, and the number of the prescription for reference. These things are all required by prescribing laws. The pharmacist isn’t allowed to pour medications back into old containers. Sometimes if there is a shortage of medications there can be an amendment made to the number of pills made in the container but that’s about it.

Now how people take medications is a completely different story. The person asking me about her antibiotic was asking me if the three times a day label was a suggestion or if she really should take it that much or if she felt worse to take more and if she felt better to take less. So for all of those people out there who are unsure let me answer this once and for all. Think of it as a commandment from God. You take it exactly as it says on the bottle. You don’t take too much. In the case of the antibiotic, if you take too much you will get the runs. You don’t take too little. In the case of the antibiotic, if you take too little the bacteria in your system ir was killing off will start to grow and multiply again. So you take it exactly as directed.

So the big question for a lot of people is what does three times a day mean. For some people you might want to ask your pharmacist. For most medications, three times a day means morning, afternoon and evening. For some medications it means every eight hours exactly, set your clock to wake you up if you need to.

This adherence to labeling is very important in using psychiatric medications. A lot of psychiatric medications take time to work. In many cases a couple of months before they start to become effective. Then they require a constant amount of medication to be in the blood stream to maintain that effectiveness. If someone only takes medications when they feel depressed, or anxious or psychotic then the medications will not work at all they will only produce side effects.

All medications have side effects. Side effects are things that are not the general intended effects of the medications. Not all side effects are bad, in fact some medications are specifically prescribed for their side effects!

It’s also important that you read all the stickers that come on the container that your medication comes in. They tell you important things about your medication. Some medications need to be taken with food. Some medications need to be taken on an empty stomach. Some make driving hazardous.

Make sure you tell the doctor who is writing the prescription about every single other medication you are taking. Make sure in the list of medications you include all the herbal medications and vitamins and over the counter remedies and all that stuff that you “borrow” from other people. If you are using illegal drugs, make sure your doctor knows about it.

Now for those of you that go “doctor shopping” to obtain illegal drugs, it’s not that hard for someone to figure it out. I’m frequently amazed how long it seems to take an MD or series of MDs to catch on. I’m not allowed to report stupid things people do to themselves. When someone comes into an evaluation with four bottles of medication and two of them have someone else’s name on them I get to ask about the other person for whom the medication was intended. When the medication is a narcotic I start getting suspicious. When I see four bottles of a narcotic for the same person filled within a week by four different physicians I’m not suspicious of anything except if the MDs know each other is filling the same medication for the same person. It’s bad practice. Ultimately it’s going to hurt someone.

At least once a week I see someone with long term effects of illegal drug use. Some of these are young people. Some of the effects contine long after the drugs stop. There’s a recent practice of mixing pharmaceutical medications with illegal drugs. Some of these combinations are fatal. There are tremendous spikes in blood pressure and the areas which regulate temperature and the the midbrain fail to work correctly and nothing can fix it. In some cases the heart goes into an arrythymia and beats wrong. It’s a mess.

Some medications interact with things like food. Sometimes you might see a label saying don’t take this medication with grapefruit juice or some other food. The food will either reduce the effectiveness of the medication or will make it too strong.

Finally there’s a book I want to mention. It’s called the Physician’s Desk Reference. It’s published every single year on all of the medications. It’s put out by the manufacturers of the medications. It tells what the medications do, the chemical properties they have and the side effects, their effective dose, and they have pictures of what common medications look like. It’s a collection of all those little pamphlets that come with the medications. The book is either red or blue in color and most libraries have a copy at their reference desk.

For professionals, there’s a book which is updated by researchers on medications. It’s called Facts and Comparisons. It’s available at Medical Libraries. It lists the research on the medications done by researchers, not just the research done by the drug companies. It compares the medications across classes. There are monthly supplements. Check with your local Medical Library to see if they have a copy.