Recently, on my way to a very important breast cancer follow-up appointment that I anxiously drove to while phone-negotiating to keep–20 minutes after the arrival time–I had the revelation that perhaps I was not the “loser-late-guy” I had come to see myself as; rather, it occurred to me that a deeper issue brewed all these years over that has lead to me to do everything but be on time to my appointments.

While on the way back home (I was informed I had to reschedule again) just a few minutes of doing something I call *symptom “source-searching” (trudging through feelings and thoughts to back-travel to the real reasons I think or do things) helped to reveal what was causing my avoidance of being on time.

To my surprise and some grief in acknowledging it, the answer was a trauma response.

I “saw” that I had been operating in flight (not fight) mode to something I saw as a threat to my personal autonomy and voice–adhering to others’ demand for me to be somewhere when they told me to be there–I was vaguely aware that I felt this way, but not cognizant of why and how deeply I felt the need to protect myself from the feeling of extreme vulnerability I felt when attempting to “conform” to society’s definition of punctuality.

To others, this may sound silly or dismissive of ‘character-related’ habitual tardiness, until you consider how autonomy, choice, and identity are removed in abuse experiences.

Being late had been the endeavor of one of my protective selves (IFC) to put a “distance” between me and those who expected punctuality from me in a misguided effort to establish personal dominance and openly exert my freedom in personal choice.

For many years I have had no idea that I was trying to preserve my self by not conforming (as I saw it, unconsciously) to the requirement of being relied upon in this way, seemingly because I felt generally that I could not rely on myself in this way (or many others)–a testament to the extreme self-doubt that occurs with sexual abuse and other types of trauma.

The need to self-preserve and protect one’s body, decisions, and sense of safety in every social situation is a constant, simmering issue for survivors of sexual abuse. Most often we are not aware that many decisions. behaviors, responses, and attitudes are at work in us to achieve this.

The discoveries I made after delving into my heart about my chronic tardiness issue have really changed me, although the results are definitely a work in progress.

I am more purposeful in ensuring I am aware of appointment dates and times-historically, I have also been lackadaisical about even trying to remember them all (and there are plenteous between me and the grandson I raise) and I am consciously working to schedule appointments in less of a chaotic fashion–no double-booking-which has occurred often due to the overwhelming volume of appointments.

I have finally begun making a positive stride in punctuality regarding both in-person and online appointments without feeling like I am losing something of myself in the process. I have been on time to half of my appointments!

I am learning to take the lead in this area of my life rather than letting the past dictate it.

This is a hard-won, small personal victory that I hope encourages others to feel safer in examining their own challenges stemming from trauma of any kind and perhaps offer someone the example to work on trauma issues we so often have to tuck away without attention in order to survive.

I still challenge “The Man”, raised by hippie missionaries, and being a non-conformist woman, but I can now feel comfortable in letting myself picture and realize being on time to anywhere I need to be without feeling like my personal safety is threatened or at risk.

The post Could Chronic Tardiness Signal Unresolved Past Trauma? appeared first on Medika Life.

In the year and a half I worked in that department, I learned more about medicine, human rights, patients’ responses to loss, and the ambivalent relationships of medical personnel than throughout my entire medical work history and career as a nurse.

Although I later moved on to direct care positions in multiple departments (OB and surgery, Mother/Baby/PP, Med-Surg, Trauma), the emergency room experience was my formal introduction to many foundational aspects of the medical environment, especially regarding the unaddressed conflict in the relationships between the differing roles of providers in medicine.

The main concerning dynamic I observed was that nurses were generally dismissed and disregarded by many physicians, as both professionals and as necessary components in the practise of medicine.

In my experience as a professional, this aspect has still not changed over time and spans throughout all specialties in medicine.

When I became a nurse in the year 2000, I was no longer just the observer of adverse or lack of communication toward nurses from physicians or the frequent poor treatment of physicians toward nurses. I became the receiver of both.

Nursing Expertise Is Still Mostly Misunderstood

Many physicians do not see the nursing staff as an imperative extension of their own care and knowledge. Many are unaware of what most nurses do and how much they know. They do, in fact, just expect their orders to be carried out and quite often neglect to understand the gap that nurses must close from orders of care to implementation of care and then to continued follow-up of care. The latter two skills are what create and sustain patient health and wellness.

Nursing responsibilities, experience and skills remain a neglected and misunderstood facet of healthcare. Most lay people see nurses as the medical personnel carrying out their doctor’s orders, making the necessary calls to patients and hopefully, effectively understanding the medical reasoning and intricacies behind the care and information they are delivering.

However, true nursing goes beyond this.

Learning to regurgitate orders and instructions is not what gets a good nurse through school or what keeps his/her patients alive. Critical thinking, research, and observation while responding appropriately in and to emergent, acute, and chronic situations, listening when no one thinks we are listening, and knowing when the wrong medicine or treatment has been ordered or recommended are.

The doctor will not go to jail if the nurse gives an inaccurately ordered medication, resulting in an adverse event or fatality; it is the nurse.

We are, first and foremost, the buffer between a physician and his patient.

And both patients and physicians need this.

What Effective Nursing Offers To Physicians’ Care of Their Patients

Good nurses listen to their patients and have a knack, not just the training for, for excellent triage. Body language tells more than a patient’s report. Patients’ verbal reports must be delicately and discreetly screened for hidden information that is critical in many cases, to appropriate safe care and orders. Nurses hone in on things not said, or that are mis/underrepresented, which often results in a totally different approach to treatment than at first written.

Nurses’ bedside experience yields a wealth of information and patient history that frequently change the initially documented needs and treatment of the patient’s condition. The following are some common examples: (Note that global and national MyChart EMR records now give access to patient medical information and have greatly improved providers’ knowledge of documented patient information.)

1. A patient comes into the emergency room or the clinic reporting a “terrible headache” and is nauseated and dizzy but denies a history of hypertension. Vital signs reveal a dangerously high pressure, but the patient defines themselves as non-hypertensive because they are normally prescribed hypertensive medications, so they consider themselves “cured.” This is a much more common thought process than is understood, especially for elders.

Further nursing triage reveals that the patient is “between” PCPs (very often this is code for the patient’s dislike for their previous one and so they just quit going to visits) and the patient has been out of their medication for two months (due to an inability to cover changing Medicare/other insurance costs). This knowledge prevents the ordering of further hypertensive medications (for perceived acute/undiagnosed episodes) by the ER physician or urgent care clinic doctor which could cause a dangerous drug interaction and/or overdose because the patient is very likely to refill the original medication as well at a later date. This is another common problem among elderly patients, especially. Gaining a full picture of the patient’s circumstances in this situation will also predicate running lab tests which may have not been ordered otherwise or ordered differently. This would offer additional insight to the patient’s current cardiac and renal status/risk in association with current signs and symptoms.

Nursing also contacts the inhouse social worker to assist the patient in funding available to cover the cost of medications and to elicit a list of PCP’s in the immediate area that take patient’s insurance (this is providing SW is as thorough as expected.) Nursing also provides a follow up call a few days after the visit to ensure that patient has had their needs addressed.

2. Patient presents with guarded abdominal pain. Their eyes are dark, their pupils pinpoint, and they are jittery and talking fast. The nurse notices skin irritations and sores and a “slack jaw” appearance in the patient. Many physicians immediately write this patient off as an addict, document “drug-seeking behaviour” as cause for visit and stop there. This has been both my personal and professional experience. Given the patient’s appearance which concurs with heroin/meth addiction, this may be a correct standing diagnosis. However, there is always more to know and investigate. This patient is a human being in need of care and thorough assessment. The pain the patient complains they have often has another root source besides withdrawal. The nurse notices after the doctor leaves the exam room that the patient winces when standing and limps on the right side. An astute nurse will pull the physician back in and subsequent due diligence medically reveals appendicitis. A life is saved.

*A more frequent finding with patients in addiction is bodily injury due to violence perpetrated against them from the population they associate with. Since shame is a huge factor in this group, the patient will often not divulge a criminal act against them and associated injury is easily missed in assessment.

3. Patient complains of generalized dizziness and imbalance. She mentions that she notices one side of her body seems to be “lagging.’ The neurological “tug” test is performed along with the routine balance test. No present abnormalities are observed, yet the patient insists she is experiencing increasing episodes. Although labs are ordered to check for abnormalities in hydration, glucose, and possible tell-tale results of a recent stroke or myocardial infarction (cardiac enzymes and CRP), they come back normal. As the physician is writing discharge orders for PCP follow-up recommendations, the nurse checks in with the patient.

The patient is sitting with her head down. Her off-handed mumbled comment catches the nurse’s attention. “I feel like I’m literally living in darkness and am scared most of the time.” This comment strongly hints at mental health issues. Adverse mental health conditions that are left untreated will absolutely affect the body (altered stature, weight balance, gait, eye movement, posture, cognitive word halt/jumble.) Upon further assessment, the patient also reveals long-term anxiety-related insomnia, one hallmark (though not entirely definitive) of compromised mental health.

A discussion with the doctor now adds a psych evaluation, a mental health consult to her PCP follow up and community referrals. The patient’s time is not wasted reaching out to the medical community because a nurse made the decision to follow the cornerstone of his/her medical training to observe/listen to the patient. Nurses are taught to observe both the presence and absence of information and body language and many other factors. The picture presented when first meeting a patient is most often just the tip of the iceberg.

The Benefits Of Honoring and Respecting One Another as Providers

When physician and nursing roles support and complement each other’s expertise and knowledge, and each respects the other’s insight and practice, great results occur for patients:

• a much more in-depth picture of the patient’s overall physical and mental health is revealed.
• potential risks and needs that often go unidentified are exposed.
• the patient receives a much more comprehensive, relative treatment plan.
• patient trust in the medical community increases

Better patient health is achieved, and a much-needed deeper level of patient trust in their care team begins to be restored.

Unified medical forces create reliability and safety for all involved.

Patient compliance is directly related to patient trust for their provider.

When physicians respect the nurses they work with and understand that good nursing staff are an immeasurable source of support and diverse medical knowledge, the target of healthcare, patients, benefit the most.

They are why there are doctors and nurses in the first place.

The post How Physicians Benefit From The Experience and Knowledge of Nurses appeared first on Medika Life.

It encouraged me to not only accept, but to normalize, and even embrace a cancer diagnosis. I counted how many times the word cancer was repeated as I waited.

Twenty. The words “your cancer” was repeated so many times, my head was swirling.

For cancer treatment to get an ok with the patient, it must first get the patient to be ok with the presence and word cancer; to even give it a home in the thoughts, body, and present awareness.

There is nothing about an adverse health condition that merits giving it permission to take up residence in your body. Disease comes and goes in our lives, but to remain healthy and to stay in perspective of the value and length of life we want, even with the worst physical diagnosis, never do we simply accept a diagnosis and NEVER do we call it our own.

Whether chronic or acute, sickness is not a natural state of the body and does not belong in it.

I have read many a breast cancer patient post on “supportive” websites vehemently owning a breast cancer diagnosis, at the behest and example of their medical providers.

Breast cancer patients are not taught by and large that breast cancer is an unwelcome enemy.

Rather, it is inundated into society for women to expect a diagnosis of breast cancer and then accept it and “fight” it. This is a propaganda technique designed to perpetuate an illness mindset.

Truthfully, there is only ONE fight to be had when it comes to illness, terminal or not and that is the fight to convince your mind that that disease process does not belong in you.

Disease is a separate, dangerous enemy from your body.

As a woman who is still feeling the effects of subsequent treatments and undergoing surgeries post treatment for breast cancer, I can say firsthand that I have lived this truth since diagnosis. I have refused to allow myself to call this attack on my life and purpose my own. It is not from God, so it is not mine.

Our healing is in the unseen, supernatural realm, not in the unseen physical, natural realm. Complete healing is brought into the natural realm through our realizing and believing in the Unseen. The Unseen truths are materialized in the Seen realm through our holding firm to that faith that we possess cancer-free, pain-free and complication-free bodies, spirits and souls (mind, thoughts, emotions, will and all things) in this realm where God our Father lives and has manifested this miraculous freedom from (all) earthly symptoms and diagnoses. Healing is every one of our’s destiny, through faith in His powerful healing desires for us.

No one was destined to be born to die from cancer, addiction, chronic illness, sudden tragedy or ANYTHING else. The Lord, our God, designed us to live long, beautiful lives.

His gentle, but firm command is for us to align ourselves, our thinking and beliefs, with HIS diagnosis of LIFE…not with the enemy’s of Death.

Let every ache and pain be crushed under your feet, under the weight of His promise of complete healing, but stand as a reminder that what we feel (fear, fright, apprehension, ruminations, death visions) is not what we are or where we are going.

Believe this moment that you will live. Looking over your shoulder only in expectation to see great Love running toward you, not to cringe with fear. See your long and healthy life in front of you and begin planning for it.

He has you. He has us.

Believe HIS prescription for health, not Oncology’s for death.❤️

The post Stop Owning a Cancer Diagnosis appeared first on Medika Life.

I primarily worked with Medicaid and Medicare patients because they are the forgotten and most destitute of patients. There were many reasons for the depth of hopelessness and despair evident in the faces and home environment of my patients.

Lack of effectual and compassionate care in the home health situation remains one reason.

Many factors made this job a difficult one, but the patient was the one who suffered the most when home health did not perform as they should.

Problems With the Home Health Situation

The task of assessing all previous diagnoses, intervening to find newer ones, and then beginning the process of teaching those diagnoses is a necessary component of the proper care of each patient.

Discovering that these crucial initial steps were usually not taken by either the admitting nurse or the previously assigned home health nurse of one of my patients was daunting and frustrating.

The heartbreak and difficulty in this nursing position was watching the majority of these patients (whose primary morbid diagnosis was longstanding, at least 10 years) neglect to follow through on their care plan and instructions, second to their loss of faith in their healthcare providers.

Unfortunately, one of the biggest barriers I experienced as the patient’s advocate (the number one job of a nurse) was disassembling the negative and discriminatory attitudes and perceptions that the patient’s medical providers had toward the patient.

Too many physicians and colleagues would give me reports of “combative and noncompliant” statuses for these patients, citing that they “just don’t take their medicine” or “they won’t keep their doctor’s appointments.”

Each report made me think differently of the messenger as my experience in many medical environments taught me early on that no one wants to be or stay sick. I understood that there is always an excess of conflicts and obstacles to the patient obtaining the necessities required to follow instructions or make it to their appointments.

Prescribers and providers often never address, investigate, or consider these important factors.

There are still only a handful of reputable providers who recognize this reality and attempt to bring some resolution to it by rightfully requiring their nursing staff to assist the patient in acquiring necessities, such as medical transportation covered by their insurance, or assistance in finding prescription programs to cover medicine copays.

Meeting just those needs goes a huge distance in increasing compliance of care instructions and appointment keeping. I have worked for just a few home health companies whose own creed to its patients was to liaise for them in this manner and those were the most fulfilling positions I had.

Miscommunication or lack of communication regarding the patient’s need for proper resources would result in the patient’s distrust of the home health company and the medical providers involved in meeting their needs. This perpetuated most “noncompliance.”

The home health nurse new to a patient should consider that a patient who has not had any previous home health or any positive previous home health experience may be slower to respond to recommendations and compliance-based instructions (medication regimen as an example.)

Purpose of Home Health Is To Improve and Stabilize A Patient’s Health, Not To Line Pockets.

The home health field originated to end repetitive emergency room visits and “unnecessary” multiple office visits. It soon became a tool for the medical community to monitor better higher-risk patients’ daily compliance and decisions in diet, medication management, new onset of disease and progression, or reversal of co-morbidities (secondary diagnoses that complicate the primary diagnosis) among other issues.

It is a fantastic idea if implemented with honest intentions, intentions void of the notion to use this vulnerable population to glean as much revenue as possible from Medicaid and Medicare without providing the excellent care documented as performed.

In other words, be very aware of the pervasive cheats and frauds when searching for a home health company or in assessing the one a patient may already have.

They are everywhere and many times, hard to discern.

Extravagant agency offices seem to elicit false confidence in a “successful” company and smooth-talking Case Managers who promise the world usually deliver absolutely nothing.

If something feels wrong upon meeting with staff from a new company, or promises are not delivered, or visits are infrequent, and the patient is not getting better or fully supported, you need a new home healthcare provider.

Most of the home situations I walked into included the patients’ lamenting how a prior nurse had visited only once that month, yet they were supposed to have been seen once or twice a week. When investigated, it was documented (and meticulously, I might add) that there had been several visits that month that had already been billed to the insurance.

This dishonesty and unethical behavior left the patient without their medication refills, without the necessary medical oversight for their conditions and without advocacy between them and their providers, which, incidentally placed each one on the brink of an ER visit-the very situation that home health is there to prevent.

Much of the time I sent patients to the ER for very high blood pressure, infected wounds that had not been treated or dressed, or for the latent symptoms from a heart attack suffered at home. They had not gone to the ER and could not get a hold of their home health nurse to report the incidents.

These are real and frequent occurrences.

Professionally, I experienced the disregard for patient safety that some medical providers showed at times for their patients due to their refusal to provide proper basic care. These kind of providers often had signed contracts with local hospitals to divert patient emergencies away from the emergency room for “cost-effective” measures for those hospitals, in lieu of that physician taking steps to treat an emergency themselves. The intent on paper was to divert non-emergency situations from the ER, not true emergencies: however, this is not the situation I experienced in home health with some providers.

Heart attacks, strokes, extreme hypertension, and other serious conditions cannot be treated outside of the emergency room effectively. Patients lose their lives due to corporate contracts to “divert ER visits.”

Medicaid and Medicare patients were the only patients I knew of who were coaxed into signing these contracts with their physicians, as the providers had to have a patient’s signature to ensure their compliance in such situations.

Many patients relayed to me that they were informed they would have to find another doctor if they refused to sign these “call me first, do not go to the ER” contracts.

This flagrantly discriminatory tactic was and is incomprehensible and is not discussed openly with most nurses. My superiors had heard about it but did not have the details of the nuances of the contracts.

One physician, whom I called to report my patient having had two strokes between doctor’s visits, told me to send this patient (who was currently having stroke signs and symptoms) to his office, not the ER, because “My patients don’t go to the ER. They go through me, first.”

To clarify, this is medical negligence.

This particular patient had sat in the doctor’s office twice in the previous months while suffering active strokes and was now blind due to those incidents. Even after this physician saw the patient on those days, he declined for her to go to the ER for care and sent her home only with a higher dose of medication for her blood pressure.

This patient was not too interested in taking her medication as she didn’t trust her provider. After reporting the incidents and the situation to my supervisor, I assisted her in finding another medical provider. And, yes, I sent her to the ER.

Empower Yourself: Taking A Stand To Demand The Care You Deserve.

To determine if the home care services you are currently receiving are deserving of your insurance dollars and time, ask these 7 questions:

1. From the time your MD ordered home health, how long did it take to receive a call from a home health company? (Ideally, the patient would want to investigate local home health agencies in the area and choose one for the MD to fax the order to, but not all patients have this capability or assistance to do so.)

Two weeks is a normal timeframe. Past that, call your MD and ask which company was faxed the order, call that company, or have the office nurse do this, and inquire about any holdups. Sometimes, insurance is the holdup. Other times, the chosen home health agency did not receive the order, lost the order, or was so disorganized that they themselves don’t know why they hadn’t called you.

2. When you do receive the initial call from a Case Manager to schedule your admission to home health, are they respectful of your time and schedule? If they communicate to you that they “only have this date and time available” to interview for admission (not all patients ordered home health will be admitted to any home health agency,) be wary. As nurses, we are being invited into your home to offer our services to you. You are not at our mercy. Your time and schedule should be considered for each agency appointment to visit you.

3. When a nurse comes to your home, do they respect your home environment? We need to know if you have animals or annoying/intrusive family members that would complicate a visit. Still, we certainly do not pass judgement regarding those or any other issues/situations in the home, barring criminal acts including drug use or abuse of the patient, which would have to be reported and reconciled through proper law and state enforcement.

4. Was your initial admission assessment thorough? This can last up to 2 hours. Use this guideline:

a) Full medical, social, and environmental (complete list of diagnoses and medical issues, family history and current status and issues, risks to your safety in the home) assessment taken?

b) Full assessment /inquiry as to any needs you may have?

c) Complete physical assessment including all body systems check, vital signs, blood sugar checked, equipment needs and checks, and oxygen saturation levels for oxygen-dependent patients. Needed equipment should be ordered immediately and delivered within a week at most.

d) Have all your questions answered to your satisfaction?

e) Explanation of the process of home health visits, documenting in the home (tablet or laptop usually) and how and when to reach either your nurse or the agency or the ER for health issues or questions you may have.

You should be provided with a working number answered by a nurse or knowledgeable agency staff at all times, day or night.

5. Have all of your medications been documented and all have recent refills and correct counts per the nurse? This is imperative to effectively managing your health and improving its status. This must be addressed and handled at EVERY home health visit.

6. After discussing your care plan (which includes the frequency of your visits, the diagnoses nursing will address and individual interventions, teaching and nursing tasks to be provided) do you understand it and agree to it?

7. Has an Emergency Plan been created and discussed with you? This includes exact instructions for the patient and family for handling weather emergencies, local, national disasters, and personal health crises.

In addition to the above, as a patient or family member of the home health patient, make sure that changes in health or problems with any delivery of care (such as not receiving ordered medical equipment) are reported to the home health nurse preferably at the time of occurrence but certainly at the very next visit.

Additional Tips To Maximizing Your Home Health Visits: Be Active In the Improved Health Outcome You Seek

As a combination strategy, medication refills are to be called in per the nurse and the patient/family member. However, ensure that refills are in the home before a home visit so that the nurse can properly dispense medication in a medbox if ordered.

When home visits are scheduled the patient must be educated on the fact that their nurse should arrive within an hour before or after the scheduled time due to several factors: length of time of the nurse’s previous home visit, possible emergencies or other patient needs, and the time to travel to the next patient.

Reporting the names of new doctors and any upcoming scheduled provider visit is imperative at each home health visit as there is usually a need during that home visit to include calls to the PCP or specialist.

In revisiting the original reason for home health, remember that the patient is to be properly and successfully cared for and should expect an outcome of improved health and stability, which helps reduce excessive in-clinic appointments, emergency room visits, and hospitalizations.

If these necessary benefits are absent from your home health care, determine your part in that, if any, and take action to change either your assigned nurse or the healthcare company immediately.

Yes, your life does depend on it.

References:

Expected standards of nursing care in the home:https://bmcnurs.biomedcentral.com/articles/10.1186/s12912-017-0264-9

This article shows how contracts should be handled in relation to reducing ER visits and NON-emergent health issues. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4038086/

The requirements in this article are to be expected of nurses, as well. https://www.homecaremag.com/february-2019/chart-homecare-career

The post What You Need To Know About Home Health Services appeared first on Medika Life.

The perpetual fear of being re-harmed or fear of harming others in any way, stemming from child abuse and violence, or any other trauma or issue, can exist either consciously or unconsciously. These particular type of symptoms occur from the compromise or loss of the sense of the goodness/stability of our self and loss of personal and human identity. 

Christina Vaughn

Harm OCD is a common subtype of OCD that causes intrusive, unwanted thoughts, images or urges to harm oneself or others.

My Experience of The Results Of Early Trauma

A Breeding Ground For OCD

After experiencing sexual abuse in 1983 at age 14, I began having symptoms of panic in my everyday life, fight or flight responses that worked to keep me in a constant state of terror and an urgency to try to control my environment.

A few weeks after being sexually abused by a fellow (adult, age 19) student in my high school, I became acutely aware that I had begun aggressively shaking my knee as I sat in each class, distracting myself from the chaos I felt inside. I began to recognize that I felt on edge all the time. I then began making decisions that put me further in harm’s way, such as hanging out with the girls I had met who had also been abused by the same person. Other boys I met in this crowd began to prey on me as well, as the unaddressed vulnerability from trauma often attracted the attention of other abusers.

The most detrimental, long-lasting effect of the abuse that I still struggle with today was the overwhelming feelings of “foreboding” and heaviness (guilt). I had no words or definition for the blanket of dark and suffocating terror that would creep over me.

Upon revealing to my parents what had happened to me, I was guided to my high school counselor for “talking” about the incident and subsequent harmful occurrences in my life.

Tragically, this man had the habit of taking advantage of vulnerable students and further traumatized me and my situation by asking overtly inappropriate sexual questions and making lewd suggestions to me regarding the abuse. This was all said after he got up and locked his office door in that first and only appointment before executing these violations against me.

I received no other help for the abuse nor sought help until recently, 40 years after the original incident of abuse. Manifestations of abuse will erupt sometime, somewhere in life and more so erratic and abstract without therapy.

Symptoms Begin To Manifest

I first experienced a year-long bout with OCD symptoms in 1989 at age 20 during my first pregnancy and for the first year of my newborn son’s life. I can say with confidence that the symptoms evolved with a definition of Postpartum Syndrome. Still, I believe the issue was more related to an initial acute presentation of Harm OCD.

Because of the urgent nature of harmful thoughts, sensations, and impulses toward my newborn, I believed I was a murderer and only told my father what was happening a year after the experience began because I thought I was going to lose control, commit a violent act, and be sent to prison. To me, the threat was very real. The impact remains with me. The overwhelming vulnerability and incredible sense of loss of self-control were tormentous and paralyzing.

Today, I still have strong memories of several other random thought processes related to my children’s safety that occurred in the past 33 years and provoked life-long terror, guilt, and shame.

The ever-present foreboding feelings caused me to almost completely shy away from intimate playtime with my children as they were growing up. I did not know that these feelings I was having were defined as anything except scary. I was terrified of committing a criminal act involuntarily so I just distanced myself in that way.

I saw and felt that it confused and hurt them. I did not know what to do and deeply grieved the loss we were all experiencing and felt such deep sorrow and shame that subsequently drove most of my life decisions forward.

I experienced a second extended bout of intrusive thought processes and symptomatic Harm OCD several years later:

One Thanksgiving holiday, I made plans to travel from our home in Austin, Texas to Dallas to be with family. After many setbacks in the plans, including having the brakes on our car suddenly go out and finagling repairs near a Holiday, we set out. Just before we reached the highway, a commercial truck hit us head-on. My 8-year-old daughter smashed her face into the back of my seat. Everyone was crying and upset, especially me.

All the frustrations of single-parenting and years of being alone in our needs as humans and family void of any support just seemed to capitalize that day emotionally.

Our car was towed, and we went home. I pressed the insurance company for a rental and we went on to Dallas the next day, but not without experiencing a terrifying incident the night of the crash at the kids’ bedtime.

While putting my two youngest children to bed, I turned my head to speak to them and distinctly heard the words with overpowering impulse “Kill them, kill them, now!”

I was startled and terrified. My body had a neuro-receptive response and I felt “shaky” inside and felt the urgent need for immediate cover or safety, but there was none. Again, because I had no reference point or explanation for any of these feelings, I just condemned myself as crazy and innately murderous.

From that point on, I continued to suffer from harmful thoughts, sensations, and impulses for almost 3 years. One particular day, I had enough and as I was driving somewhere I finally verbally “evicted” what I perceived as demons (and there is truth to this) from my life and thoughts. What changed was that I actually shifted my thought processes and decided to “stop believing the problem was character-related” and to “pay them no attention.”

These two belief mindsets are the bedrock of OCD therapy, as I have learned in my extensive research during the last couple of years.

This thought process is challenged constantly in my life with the symptoms and various nuances of OCD and I do not always have victory over it in the moment, but I am aware of its incongruencies, now, at least.

In employing these changes in my attitude toward the thoughts at the time, the intensity of the symptoms was relieved. Although I experienced relapses of them, they were very brief in comparison.

I endured a few more intense encounters over the following years. Notably, it has only been the last year that I have gained any understanding of and even the definition for OCD and how it is intricately connected to the root origins of C-PTSD I see my therapist.

How Can Sexual Abuse show up as (Harm) OCD Symptoms?

The correlation between childhood abuse (and other traumas) and OCD are noted as often congruent occurrences. Although psychotherapy does not directly source the two at this time, it is well-documented that the sudden and invasive loss of one’s personal boundaries works immediately to compromise an individual’s trust of themselves, others, their surroundings, the perception of their safety, and that of others in their world.

These and many other dysregulated responses create an environment of uncertainty in the mind that seeks from conception to reassure itself. Fear becomes a leading emotion, one from which most of life’s subsequent choices are made, including reactions, responses, and emotional states of being. Autonomic body responses (sensations, impulses, unexplained physical symptoms — the feeling that your response to the symptoms is involuntary.) occur and can cause a great deal of confusion concerning one’s personal “desires” vs. OCD symptoms.

The perpetual fear of being re-harmed or fear of harming others in any way, stemming from child abuse and violence, or any other trauma or issue, can exist either consciously or unconsciously. These particular type of symptoms occur from the compromise or loss of the sense of the goodness/stability of our self and loss of personal and human identity.

Unconsciously, there is the question sometimes asked of oneself “If someone could do those things to me, what stops me from doing the same to others?”

This begins a tormentous, scrupulous investigation into one’s innate morals and decency, true intentions in interactions with others, and a condemning defamation of our person.

Convoluted thought processes that occur as the mind tries to make sense of both the trauma experienced and what to do and how to be afterward can produce thoughts focusing on potential similar threats to those we love and others we value, as OCD capitulates many times on the themes and values we hold dearest to us: such as children, family, certain populations (children, parents) reputation, body functions and perception and others.

Feeling like you could harm someone you love or others physically, sexually, or otherwise (this includes children, which is deeply distressing to experience) detaches a person from healthy physical and emotional interactions with those around us.

As we focus on the horror of those type of thoughts we seclude ourselves further emotionally and physically second to the tormenting shame and guilt associated with those thoughts. One can begin to question every physical or emotional encounter, ruminating relentlessly on one’s “true intentions” for touch, especially any response to normal human interactions.

This is crippling and debilitating.

What To Do:

The primary route to wellness in and from Harm OCD is obtaining help. Therapy for Harm OCD and any other OCD theme includes many methods, with ERP showing the most positive and effective treatment.

Obtaining proper intervention prevents and treats the resultant state of mind that can evolve from initial concerning symptoms to the absolute terror, panic, and dark, chaotic existence that can happen from isolation. Trying to “figure it out” on your own will not bring success, the same way a heart attack or a broken leg will not fix itself without proper intervention.

Many people suffer in silence as guilt, shame, and humiliation prevent them from speaking about their OCD experiences. Being human with a creative mind means we are going to encounter bizarre and sometimes problematic mind processes.

You are not crazy, murderous, pedophilic, or losing your sanity. You have OCD and you need help right now.

Disclaimer: This article focuses on the relationship between Harm OCD and (child) sexual abuse. This type of OCD is not specific to an abuse victim of any particular violence and can occur in anyone for many reasons other than abuse. There is always a core fear(s) that needs to be addressed in any subtype of OCD to treat it effectively.

The post How Past Sexual Abuse Can Show Up As (Harm) OCD appeared first on Medika Life.

I am a breast cancer survivor, a medical professional, and a fierce advocate for ongoing post-treatment diagnostics for the prevention and timely detection of recurrence.

During the active phases of my treatment for breast cancer (ILC right) and DCIS left) and now in my recovery, my nursing experience led me to compare and contrast, through research, the contradicting information given by my medical providers regarding my diagnosis and treatment options, clinically proven alternatives, and managing my health to subsequently prevent recurrence.

Unfortunately, my oncology team provided no information on the latter subject and very little else otherwise that would lead me to restoring my energy, health, cognitive function and more.

My goal forward is to make exceptionally educated, not fear-based, decisions and choices for my life and health. I want to live to at least 100 years old and do so with strength, style, grace and confidence.

And cancer-free.

Understanding The True Risk Of Recurrence

A breast cancer survivor needs adequate, regimented post-treatment diagnostics throughout their life to monitor for recurrence.

This does save lives, and otherwise, substantial length of days.

In my research, I discovered a very intriguing and concerning characteristic of cancer cells observed both during and after chemotherapy and radiation which is not routinely discussed with breast cancer patients: that is that fragmented lingering DNA particles from (treated) and dying cancer cells move into the bloodstream and lymphatic system and lie dormant in the body, with great potential to become activated anytime later from diverse sources of persistent and excess inflammation such as stress, dehydration, cell starvation (not enough nutrients), lack of oxygen to organs and organ systems, and other internal states that hinder or halt the body in regenerating and restoring itself. I do not address external factors in this article.

This information alone begs the need for drastic changes in the current standard of care for recurrence prevention for breast cancer survivors.

The Main Deterrence To Cancer-Free Recovery

The National Cancer Care Network, (NCCN) which steers current oncology guidelines, recommends against routine and continuous monitoring for breast cancer recurrence. Under the influence of this entity’s stance on women’s health, many lives globally have been and continue to be lost.

This is a major failure of the oncological community treating breast cancer.

Conversely, NCCN propagates the idea that “the stress of undergoing ‘unnecessary scans’ and (other diagnostics)” for post-treatment breast cancer patients outweighs the benefit of recurrence-detection focused testing and promotes the idea that “surveillance does not increase survival time.” I disagree. Read here.

If this were actually the case, why are we inundated with the idea that a recurrence is inevitable and expected, but not then followed up on to judiciously detect? (this mindset guides the primary diagnosis and our care plans). Again, if so, why are we led to believe that such aggressive treatments such as chemotherapy, radiation, and aromatase inhibitors are actually as widely clinically successful as touted, if we are left with possible residual disease that will not be monitored until it has progressed significantly, despite treatments?

2023 NCCN Guidelines for Breast Cancer (pg. 23)
On screening for metastases:
“In the absence of clinical signs and symptoms suggestive of recurrent disease, there is no indication for laboratory or imaging studies for metastases screening.”

See this podcast giving NCCN guideline recommendation reasoning for not monitoring most survivors for recurrence. Please note that the statement “there is no clinical evidence for” means that little to no purposeful actions have been taken by NCCN, ASCO or other major oncological entities to aggressively pilot widespread clinical trials in which large, diverse groups of survivors are monitored for recurrence through systematic, long-term monitoring using diagnostic imaging and labs.

This is the problem. The medical community focuses primarily on using clinical data to create treatment plans, but if there is not enough stable and trustworthy clinical data (obtained through extensive research/trials and unbiased, non profit-minded clinicians who are not associated with Big Pharma), then a solid “recommendation” to not routinely follow clinically after treatment periods cannot be made.

This action was first necessary beginning in the early 1970’s (investigate further to see the 1950’s time period where cases began to markedly increase) when breast cancer cases began to substantially rise, according to researched data. Large scale global trials must be commissioned today, to make real strides in saving women’s lives.

The result would unequivocally catapult change, but inevitably also come with the pervasive argument of cost and loss of revenue from halting and preventing the mass cases of metastases we are seeing in most of the world. More on the issue of cost here.

Here are two statements (my third article on recurrence prevention will relay more) from a 2015 PubMed article addressing the concerns for the need for post-treatment diagnostics to catch early metastasis: (the first paragraph states the current standard).

“Current post-treatment surveillance guidelines for patients with treated breast cancer do not recommend intensive surveillance, such as routine chest radiography, bone scans, or laboratory tests, to evaluate distant recurrence or metastatic diseases.”

“Because isolated recurrences are associated with distant metastasis and/or poor outcome, early detection and targeted treatment for recurrences are critical to improve patient outcome.”

This article written in 2004 published in The Journal Of the National Cancer Institute, (focusing for that piece on mammograms) notes even then that the “absence of screening was associated with a markedly increased risk of late-stage disease among women with invasive breast cancer” and that “problems in detection account for 40% of the late-stage cases.”

This information sounds very scary and elicits a feeling of powerlessness in our ability to take control of our health and the quality and length of our lives, however, we can take charge of our lives and health through consciously employing even just a few tools available to us.

Effective, Natural Ways To Prevent Recurrence

Breast cancer post-treatment plans and teaching are almost non-existent. Survivors are left to investigate the realities of and alternatives for their diagnoses independent of clinical guidance. We need concrete information that will help us advocate for ourselves and know our options in preventing recurrence.

Powerful supplements are available, healing mindsets (new conscious way of living and thinking which actually produce hormone functions and neurotransmitter synapses that heal disease states in the body), and many other potent, successful ways of living and being that achieve renewed health and wellness. More importantly, that work to prevent (breast) cancer recurrence.

A first priority, and the most profound route to wellness and healing (which also create an marked absence of disease) is obtaining adequate sleep and rest. Read my associated article here on this topic.

Below is an easy to read list of simple tools to employ highlighting most of the options available in post-treatment scans and labs to ensure the following:

• a) that the treatment(s) you endured show drastic reduction or eradication of disease.
• b) you are educated on your alternatives to prevention and prevention of recurrence.
• c) that your providers continue to order everything available and appropriate for you (3D mammogram, MRI, PET should be a yearly standard) in your years of recovery to monitor your progressive healing and early detection of any regrowth.

Arm Yourself Against Breast Cancer Recurrence

1. Vital diagnostics available

• Thorough hands on exam (clinical breast exam). Every follow up visit. Educate yourself on the expected thorough details of this exam.
• 3D Mammogram (if you did not receive a bilateral mastectomy) every 6 months first year after treatment ends, at least yearly, thereafter. Read here on the newest 3D/4D mammograms.
• Metabolic PET/CT-fdg (yearly) (see here) or
• MRI with contrast (detects cancerous tissue vs. normal tissue, but overall results, in most cases, inferior to PET) or
• CT with contrast (particularly highlights bone structure/changes and some soft tissue but, overall results, in most cases, inferior to PET, alone. MPET/CT is most-efficient.)
• liquid biopsies (ct-dna) yearly or upon the presence of new symptoms. (Because this is just emerging as a (soundly proven) diagnostic tool, few clinical studies recommending timeline protocols (how often to test) are available, but given the nature of discreet cancer cells, it is prudent to request yearly. See here to learn how to pay out of pocket for this test. This company is now contracted with MD Anderson for clinical trials for this powerful diagnostic tool.
• tumor markers and hormone levels (estradiol, FSH/LH etc.) best is every 3–4 months after treatment ends (and in some cases, some labs will be required during chemotherapy). These likely will migrate to every 6 months in the second to third year after treatment ends.
• Bone density (every 2 years)
• Bone scan with contrast (yearly is best preventative, but this is not standard, nor encouraged at all, without symptoms that confirm metastasis, even prior to scan.)

A “wait and see” attitude is fatal to many women. Allowing late symptoms to occur before scheduling diagnostics to confirm extensive or uncontrollable regrowth is never prudent or conducive to preservation of life. In reality, not judiciously monitoring the body and care with scans and labs in the recovery years can inevitably result in any regrowth of cancer taking control.

Breast cancer survivors must stay vehemently pro-active in reporting every new symptom or pain that cannot be explained by short term illness (viruses, colds, the flu etc.) or injury. Even in the presence of these incidents, any persistent pain or symptom needs to be addressed and investigated with thorough and effective diagnostics.

Be tenacious about your survival.

Supplements (in high levels) that act as aromatase inhibitors or have potent anti-cancer properties

2. Each of the following supplements has extensive research supporting their individual powerful anti-tumor functions.

• Melatonin; and read here.
• CoQ10; and read here and here
• Tumeric and read here
• Ashwaganda and read here
• DIM and read here and here
• Vitamin C and here
• Vitamin D and here
• Vitamin E and here
• Whole plant CBD: media has taken over in avidly suppressing the truth of the miraculous effects of taking CBD, and especially with CBG, and using RSO (contains THC). Researching this phenomenal plant is well worth your time. See Charlotte’s Web.
• European mistletoe and here; this article shows how to obtain it in supplements.

3. Mindsets (redirected thought patterns) that establish healing

You are created to live a long, healthy, life.

• No weapon formed against you will prosper. You have armour at your disposal.
• Your body is capable of healing itself and can be spoken to do so, each organ and organ system
• You can think yourself well, whole and fulfilled. Life begins and ends with the mind.
• Expect healing, because it is yours to begin with. We must take this action of expectation with utmost seriousness and implement ferociously.
• Keep a vibrant, open mind. This is the beginning step to changing your cells and disease processes in the body. See podcasts such as this one to acclimate to a new way of thinking about living to old age, despite your diagnosis.
• Deuteronomy 30:19 I call heaven and earth to witness against you today, that I have set before you life and death, blessing and curse. Therefore choose life, that you and your offspring may live.

4. Deep breathing exercises: adequate oxygen causes cancer cell death. This topic needs more research on the writer’s part and in clinical studies, but it’s also common sense to note that increased regular oxygenation in the body increases health and healing.

5. Fasting either weekly or just from dinner to breakfast shows a significant improvement in insulin levels, which increases the body’s resistance to disease. It is linked strongly to preventing cancer, both primary and secondary (recurrence).

Grounding: This is a simple, profound way of promoting healing and preventing (breast) cancer recurrence. Note, that to receive best advantage of this technique, 30–60 minutes daily is recommended. It is also a wonderful way to renew peace to the mind and the body.

To summarize, the majority of breast cancer survivors are not adequately educated by their oncology team of the real risks for recurrence and are not informed of what tests can and should be ordered routinely to monitor for recurrence, which ultimately would save many lives. The oncology field’s gross neglect and resistance toward monitoring breast cancer recurrence has been and continues to be fundamental in creating an environment of that recurrence through neglecting to prioritize our lives with necessary preventative diagnostics.

In closing, I suggest that breast cancer patients be prepared to face strong resistance from their oncology team in introducing any demand for post-treatment diagnostics and especially alternative (non-Western medicine) treatment choices. The cancer care system is not set up to efficiently observe, monitor and track disease recurrence. We must be be our own advocates in obtaining and implementing safer, Big Pharma-free alternatives to our health and especially in standing firm in our right to have thorough, routine scans and labs that will preserve our health and lives.

We need more answers and follow through if we are to effectively fight against recurrence-related deaths.

If this information is helpful to you, please see my first article on preventing breast cancer recurrence.

The post Preventing Breast Cancer Recurrence appeared first on Medika Life.

As a 20 plus year veteran nurse, I understand the body’s processes and potential to truly heal and fully restore optimal health, and I employ the following information myself to help with insomnia, but foremost to prevent recurrence.

Preventing Breast Cancer Recurrence is Achievable

My observations and medical and personal experience lead me to propose that it can take up to five years after treatment ends for restoration of health after breast cancer (due to the intense stress of physical, mental and emotional turmoil associated with a cancer diagnosis and treatment) provided there is no recurrence in that interval. Even if there is, sufficient sleep and rest will combat cancer growth as a primary defense.

Breast cancer patients can absolutely achieve a greater level of health that is above pre-diagnosis and combat /prevent recurrence with simple, intentional life changes.

Two foundationally important interventions which are dynamic inhibitors of disease (cancer, particularly) and deterrences to breast cancer recurrence are full nocturnal sleep and mindful daily rest.

Medical interventions such as surgery, chemotherapy and radiation result in the primordial need for eight or more hours of sleep to effectively heal from the results of those interventions. Daily rest periods in our ongoing recovery are equally crucial.

Breast cancer treatment follow up in most cases is primarily a series of appointments, over the subsequent 5 years past treatment, dotted with some labs and scans, usually sparse in comparison with what feels safe or comfortable to the recovering breast cancer patient.

Most cancer patients will relay that they received no information in their post treatment plans that include either the teaching of the preventative power of full sleep cycles to prevention of recurrence, nor any other clinically proven (natural) actions to take which arm them against recurrence.

Rather, these plans universally focus on highlighting the fear of the “likely possibility” of recurrence. The patient is left looking over their shoulder (as my oncologist advised was my expectation) for the rest of their life and are unsure at best what to do to live confidant and cancer-free.

Most often, we are offered only the option of taking brutal medications that seriously inhibit our quality of life and mental health.

Refusing to live in hopelessness, I have researched many natural defenses which can tangibly be employed to combat insidious cancer regrowth, the most important of which is sleep.

How Does Lack of Sleep Cause a Risk Of Recurrence?

Most women do not get enough sleep to begin with, which predisposes the body to disease states and especially breast cancer, as it is commonly linked to adverse, imbalanced hormonal states, which occur with lack of REM sleeps.

The few studies done since 1976 on the results of poor sleep vs long sleep in post treatment breast cancer survivors reveal a correlation between recurrence and long sleep times (nine or more hours consistently, which is suspected to include fragmented, interrupted sleep), but document that the inconsistency across the board is whether or not these women had undiagnosed underlying conditions (such as depression, sleep apnea or heart disease) predisposing them to excess cancer-friendly cytokines caused by (disease-related) increased stress states. It is important to note that “long sleep times” did not necessarily mean actual uninterrupted sleep of nine hours duration, but rather, nine hours of being in bed attempting to sleep. What was confirmed was that persistently interrupted sleep, fragmented sleep, and short sleep times correlate positively with breast cancer recurrence.

Hormone restoration and distribution occur during sleep, but do not occur adequately in less than 8 hours of sleep. Aldosterone (regulates sodium and potassium) and renin (manages blood pressure) are two important renal (kidney) hormones necessary to help distribute cortisol (the fat and fluid retention stress hormone) and remove excess fat, toxins and fluid from the body, among other important anti-inflammatory and immune functions.

Reduced sleep and inconsistent sleep patterns distort the circadian rhythm of the body, altering the ways these and other hormones perform within the body’s natural defense against inflammation and disease. The end result is altered cell function, which produces disease states, profoundly, cancer.

A little known fact rarely discussed with breast cancer patients is that lingering DNA particles from (treated) and dying cancer cells move into the bloodstream and can lie dormant in the body. They become activated anytime later from diverse sources of persistent and excess inflammation such as stress, dehydration, cell starvation (not enough nutrients), lack of oxygen to organs and organ systems, and other internal states that hinder or halt the body in regenerating and restoring itself. (See this company’s information on ctDNA and end of article for more information. Ask your oncologist or PCP to order this for you. To pay out of pocket, if your insurance will not cover it requires just the doctor’s order and costs in the range of $80)

Chronic stress can cause insomnia and vice versa. In turn, vulnerable internal body regions (ex: mastectomy sites and lymph node(s) (function) restricted by excess, blocked lymphatic fluid) become rich environments for tumor growth. The lymphatic system is how displaced DNA from cancer cells get from one place to another in the body; in addition, body systems that are not consistently restored and regenerated during adequate sleep times are also highly vulnerable to altered cell division, which ultimately leads to abnormal cell growth. This abnormal cell growth if not checked or caught has a strong potential to become cancerous.This is what can cause a secondary or separate cancer state in the body.

What Happens During Sleep That Works To Prevent Recurrence?

The regeneration and restoration of cells and organ systems which occur during optimal sleep duration are imperative to health and especially in preventing cancer in the first place, as well as recurrence.

During sleep, the brain sends signals to the entire body, calling for a slowdown in most functions, elicits the release of necessary hormones that cause growth and repair to skin, muscles and tissues and more. Blood flow is increased to problematic areas for healing.

The brain also regenerates new brain cells, forms myelin (which protects the neural pathways) processes problems and thoughts through dreams and chemical reactions. These reactions reduce a constant of the negative stress-related “fight or flight response” states during the day as the body and mind has been “worked on” to create a more calm state. A body that stays in this FOF mode predominantly or frequently is incredibly strained and at risk for illness and overall system-wide decreased function.

Daily rest breaks, even in 5 minute intervals during the day, allow the body to stop demanding of itself to perform for a bit, giving itself a momentary reboot. This is necessary for mental and physical health.

Real Solutions To Insomnia and Jagged Sleep Patterns:

The insomnia related to (breast) cancer can be long-lasting, induced by several factors both inside and outside our control.

Our mental health is adversely affected by a diagnosis of cancer, the fear of dying, treatment modalities, (processes, techniques) the fear of the unknown, and many other deeply individual idiosyncrasies that, many times, breast cancer patients have no words to verbalize.

So, how in the world do we obtain enough adequate sleep to benefit from it?

1. Obtain Trauma Therapy. Getting professional help as soon as, but preferably before, you notice any changes in your mental and emotional health after diagnosis will go a long way in creating a calmer self and more peaceful life perspective. This will do wonders in restoring rest and sleep, especially if your mental and emotional health were compromised to begin with. This decision is a catalyst to our healing.

Therapy teaches us to reframe our thoughts (which are paramount to our health and healing) and experiences and arms us with new thought processes that highlight the importance of being compassionate to ourselves and focusing on the fact that “we are doing the best we can” in any given life situation. We must learn to stop living in guilt-producing self-condemnation. That will keep you up at night, by itself.

Effective therapy guides us to creating a peaceful mind, and teaches us positive times to focus on problems and form effectual solutions, rather than at bedtime, which we all naturally do. These changes positively produce optimal functions in the brain’s synapses causing less inflammation, irritation and unpleasant feelings, which inhibit falling and/or staying asleep.

2. Get a prescription. When lack of sleep is fostered or caused by menopause, chemotherapy effects, or the formidable radiation process, medicinal approaches appear to be imperative to successfully achieving restful sleep. I am 18 months post treatment and must take both Ambien and low dose Trazodone to sleep. I am not addicted. I need to sleep.

Here are some options: (Read this article about medications in the aforementioned link on sleep.)

• Ambien
• Wellamoon (this is new to me, but as a nurse, I see no problem with it and am going to try it!) Read the positives on the product, but also read the reviews on distribution.
• Trazodone
• Lunesta
• CBD, full spectrum hemp, and here (Important hint: for breast cancer treatment and prevention of recurrence, you will need higher, concentrated doses, including CBG and ThC. Yes, you can get an actual prescription or do your own rogue research to purchase.
• Restoril

3. Reboot your mind after a no sleep jag (and to prevent a long one). I realized recently during one of the 1–2 week episodes of (absolutely) no sleep I experience sometimes, that I was stressing so much at night to fall asleep, that I was actually keeping myself awake trying (I am sure you can relate). I expected to stay awake, so I did. Here are the simple things I do that help me break that cycle and begin returning to regular sleep:

• Move my pillow to the opposite end of the bed. (Why? I don’t know. It works a lot of the time.)
• Sleep in another bed (my child’s. I move him.)
• Not being the last one to go to bed. ( I am weirded out being the only one awake in the house after my diagnosis.)
• Invest at least $40 in a sound machine. Both my mother and I swear by them.
• Journal writing: getting feelings, frustrations and fears out on paper restores my inner center and I sleep every time.
• Purposely change my thought process each day after I experience no sleep, from a helpless outlook to one that reminds me I can still accomplish things and have a good day. This entails checking my feelings about the lack of sleep the night before (or the previous 5) which are usually a regalia of fearful responses (what if I never sleep?, what if brain metastasis is causing this?, I must have done something wrong and my conscience is pressing on me?, I’m so frustrated, I can’t do anything I want or need to after no sleep. This is hopeless.) Just a few pages into this book helped me dramatically change my perspective in dealing with bouts of insomnia.

Cancer cells thrive on strain and stress, so reducing daily stress and inflammation that occur from the hectic nature of life is an attainable goal we all have the power to work toward through rest and sleep.

Breast cancer patients do have many tangible options to create a hostile environment for breast cancer recurrence. We can survive and live out our lives healthy and confident in our ability to do so. Knowledge and education on our options always better our outcomes.

It’s difficult as a female many times to stand firm in self-care when we spend most of our waking time planning and executing the care of so many others in our lives. However, prioritizing our rest and sleep, is not debatable and cannot be compromised. We literally need it to survive our diagnosis.

Further Reading

See my other associated on Prevention of Recurrence:

The post Preventing Breast Cancer Recurrence appeared first on Medika Life.

Part of society deems it honorary, while another views it as workhorse. Still another sector, physicians, oftentimes respond to nursing personnel as though they are invisible, inconsequential creatures. The reality is that the expertise, knowledge, training, and intuition that constitute a good nurse, create an absolutely invaluable, supportive role in medicine and in society. This fact is the focus in this essay.

Nursing credentials come in two forms, the LVN and the RN. Both are licensed. Both have the opportunity to engage and join in one or more of several affiliations that support nursing roles and create opportunities for advancing knowledge and certifications in specific nursing specialties. The LVN requires two years of pre-requisites and 3 following semesters of nursing school. The RN requires two years of prerequisites and 4 following semesters of nursing school. Either profession may continue to BSN or MSN status.

The Unique Qualifications of Nursing

The LVN and RN learn and utilize life-preserving and life-saving skills that progress and sharpen with daily use. Each patient interaction requires moment by moment professional medical judgment to exercise consistent patient care that fosters both health and safety, optimally. No patient, case or shift is ever the same. This reality requires the nurse to be vigilant and up to date in the practise of medical knowledge and skills, such as medication administration/knowledge or the knowledge/practical execution of appropriate interventions and/or triage assessment of/for health-compromising insidious symptoms easily misunderstood, ignored or missed.

Professional positions in a society must meet some important needs of the members of that society. Nursing supplies human beings with preventative healthcare, emergent healthcare and supportive healthcare, which is a most basic biological need of humankind. Most lifelong nurses will agree that to enter the nursing profession is indeed a life purpose and calling. Those who do leave the field usually do not do so without much brooding and conflict, as caring for people is usually interwoven into a nurse’s physical and emotional makeup and is very difficult to break from, professionally and personally.

To be successful in the nursing field, the nurse must always be open to learning about the co-disciplines involved in patient care and in cross-training in new specialties. This gives the nurse opportunity for a deeper understanding of patient perspective and experience, provides the mastering of all skills required to care for and treat diverse patient groups/needs and also increases flexibility for advancement in their career.

The resources available for nurses to continue in and to support their professionalism are Continuing Education Credits, medical seminars, and opportunities to educate patients through pop-up clinics/speaking engagements.

As a nurse hones his/her specialties, they are able to have increased autonomy over their schedules, which provides the freedom and time to focus on their own expression and direction of the profession (such as online courses/blogs/teaching materials), which they have personally designed.

Professionalism Is Actually A State of Mind.

Although not every job is a profession, every employee has the capability to be a professional in moral and in integrity.

Nurses are absolutely required to have the highest integrity and moral values and to carry out those characteristics with every patient they encounter, without a trace of judgmentalism.

Not every person faces a job with conviction or investment in the counterparts, but most nurses do, as the counterparts are people and people are why we do what we do.

I enjoy my profession as a nurse because I have had daily opportunities over the past thirty years to love and care for the precious human beings on this planet.

Professional, committed nurses make the medical world go ‘round.

The post Nursing: Defining A Profession appeared first on Medika Life.

As a fetus, Charlie endured hearing his mother gasp for life during three heroin overdoses, heard the constant fighting and screaming between his birth mother and my son, endured severe malnutrition second to his parents’ homelessness, felt the poisonous effects of multiple substance abuse, and was the victim of the subsequent, injurious, powerful negative stress hormones pulsing through his mother’s veins.

The Origin Of A New Trauma-related Diagnosis

Addiction and overdose result in deep shame, guilt, and fear for persons suffering from addiction.

Most addicts report a heavy burden of anger and disgust for themselves for their addicted state. Subsequently, they acknowledge an absence of self-worth, which perpetuates hopelessness, low initiative for self-care, and an outward disregard for their lives and health as a way to offset dealing with the deep trauma roots of addiction.

A drug-addicted lifestyle is harder on the soul and body of an addict than on the people who love them, although family and friends suffer inexplicably living with and observing a loved one’s addiction.

However, there is a significant other victim of addiction who is most often never even acknowledged until the damage done to them is permanent. This person receives every spiritual, psychological, and physical impairment that the person in addiction experiences in active addiction and overdoses, but is incapable of processing or recovering from the events.

These lives helplessly experience repetitive, excessive drug use, and very often, overdose, in their body and mind. They can not escape the experiences or the source of those experiences and are unable to tell anyone or ask for protection from the effects of another’s drug abuse.

This is because they are not yet born.

How Excessive Prenatal Exposure To Drugs and Overdose Physiologically Affect A Newborn:

An addict’s excessive drug use is an overt sign of self-rejection. The user may not perceive initially that this is an originating factor of their addiction because there are many other valid facets to addiction.

However, a tragic consequence of addiction-related self-rejection is the destruction of innocence, both of the using individual and of any child growing in the womb of a pregnant addict.

A fetus has every capability to perceive love, affection, and its hopeful birth as it does to receive the innate rejection, disregard, and neglectful abuse occurring in substance abuse overdoses and drug abuse during its womb experience.

What transpires physically to the child through the onslaught of poisonous substances in-utero creates the intrinsic knowledge or perception that it is unwanted, alienable, and dismissible as being worthy of concern and love.

This is how addictive drug use causes any addict to feel. This deep trauma belief is transferred to the unborn through brain synapses, hormones, and the connective spirituality between mother and child.

My own grandson has been born from a severely multi-substance exposed pregnancy. Once home from the NICU, this tiny human being wore the look of the sadness and devastation of his intra-uterine experience in his countenance. I had never seen anything like it. It scared me to the core.

My experience with the result of a loved one’s addiction leads me to educate readers on the tragedies of prenatal opioid and substance abuse.

In my work as a NICU nurse, what always struck me about our “drug babies” was their direct inability to readily accept the human touch. I recognized that although sensory and neurological issues were a major component of that born trait, the inability to want or accept human touch was also resultant of the prenatal rejection occurring through pregnancy drug use and overdose.

They would grimace from touch first, as it appeared to hurt. Watching a new child recoil from another human being’s affection is heartbreaking.

An initial diagnosis of NAS or NOWS is not the separative long-term condition that these children go home with. Most NAS symptoms, some of which initially coincide with PORS symptoms, dissipate after several few weeks.

Most times, these babies were discharged home screaming, red-faced, uncomfortable, and heavily medicated. Their parent(s) would never have the patience and wherewithal to care for them, while still in active addiction or early recovery.

These children begin their fragile lives with both a biological and physical understanding/belief that life is pain, an intrinsic search to end that pain (which becomes a future central focus of existence), an inability to independently stop the physical and emotional pain of rejection (which creates a subhuman existence) and a disconnect from intimacy and self that permanently alters their perspective on self-worth, purpose, and trust for humanity.

Why Medical Intervention is Imperative in PORS and Active Parental Addiction

There are now new trauma classes for foster families accepting children from homes of drug use and other abuses, but few are well versed, if at all, on the subject of prenatal exposure to excessive substance use and overdose-related PTSD or the resultant rejection component in the newborn.

This is because the conditions in this delicate population are not yet medically recognized, documented, and treatable pediatric diagnoses.

It is especially not yet widely recognized that these brand new lives have severe PTSD.

Few professionals have or seek research on this.

Even with today’s recent increased trauma research, both the medical community and society seem to pull a sheet over both the inevitable and unexplainable realities occurring to a human being from prenatal drug exposure.

When medical professionals happen to note both the discord in the addict’s parental dynamics and in how prenatal and postnatal drug addiction (at home) affects those babies conceived in addiction, it is common to see the multitudinous signs and symptoms in a child who is suffering from PORS, dismissed as non-related diagnoses.

CPS can and will not intervene in most cases where a mother does not show up positive for substances at birth or just before. Addicts know to circumvent the system. Who confirms that she is sober a few days prior to the test and several days or weeks after discharge?

For the most part, no one.

An addict traditionally does not get sober during pregnancy just because an innocent life is at stake during or after childbirth.

Overall, there is little intervention from the medical community to acknowledge the delicate situation these children are born into or to actually protect their vulnerable and damaged lives from further damage.

Many times, it seems that this lack of response may stem from willful and/or fearful ignorance to address addiction and an age-old stigma that since an “addict begats an addict,” why intervene?

Few medical providers understand the devastating and insidious nature of the addicted mind. Many do not comprehend the further and continuing damage that occurs to a child who goes home to addiction in a post-exposure crisis medically, emotionally, and physically.

As a result, the formation of special parenting techniques is not addressed through counseling/therapy and things such as specialist referrals are not made or followed through with, compromising the child’s health and safety further.

Persons with an addiction can get better and someday give good care to and parent their child well but, in my experience and opinion as a nurse and observant custodial grandmother, the formative years of the child should not be under the care of addicts (even “functioning” ones) or newly recovered ones.

When an addict is in recovery, they learn that they must focus on themselves and their sobriety first and always to keep themselves in check to stay sober. Decisions must be made that leave out other members of that addict’s family and other life priorities in lieu of the priority of sobriety.

Only time, maturity, and experience weaving the recovery program’s requirements into all aspects of the addict’s life will eventually allow for that addict to be able to properly care for others, and achieve the self-awareness and discipline to do so while maintaining sobriety.

My professional and personal experience so far is the observation of the passive omission of the medical community to take initiative to reach out and engage these parents in any appropriate discussion or intervention of the care of their PORS-affected newborn, or the desperate need for addiction services.

Addressing Latent Effects of PORS and An Addicted Parental Response

A healthy baby whose pregnancy is free of substance abuse requires full-time, attentive, round-the-clock care.

A newborn who is riddled with the physical, mental, and emotional after-effects of prenatal substance abuse requires scrutiny and intervention in every aspect of care and an intimate understanding that their responses to everything around them are woven with distrust, fear, and disconnect.

In most cases, the obvious emotional and physical problems cannot be handled safely or appropriately either by addicts who remain in their addiction or by recovering addicts who are less than 1–2 years stable into their sobriety.

Beginning in the early months after birth, it takes a gentle hand, a calm demeanor, an overly attentive approach, and an excess of undistracted care to settle and restructure these children’s spirit after their womb trauma.

Keep in mind, rejection is a foundational component of their physical, mental, and emotional makeup.

The latent effects of this condition pose further danger to a child as they grow and age as most parents in recovery or in active addiction, will not recognize or understand prevailing and insidious symptoms such as the presence of sensory deprivation/overload, general sensorial problems, neurological delays, night terrors, processing disorders, speech/choking swallowing disorders and other serious maladaptations resulting from prenatal drug use and overdose.

Some of these diagnoses could take months or a few years to become visibly evident, although many are present right after birth.

This places the child in yet another traumatic situation because the uneducated, (uneducated to the problems associated with the diagnosis) addicted or sober parent is again, not traditionally sought out by the baby’s or mother’s medical professionals as an interventional risk or for the teaching of the probable issues to come.

Addicted or recovering parents are prone to getting angry easily (which is a result of their complicated mental and emotional condition in addiction) at the distracting crying, incessant need to eat and be soothed, or the refusal to eat and be held, as well as frequent illnesses.

What commonly happens in the manifestation of symptoms, is the parent(s) will react to the “irrational,” confusing behavior and excessive needs of the child and not to the cause of either. Subsequently, several types of abuse are common to occur, as the baby or older child’s behavior is intrinsically misunderstood.

Parents in active addiction or early recovery will usually misunderstand telltale signs that the baby is in need of a different kind of intense and patient parenting. The parents also do not have the ability in their current state to process or act on the needs of their child.

In one particular NICU environment I was employed in, the staff would read the city’s newspaper weekly on the unit to note which of our discharged babies had died by abuse or neglect. It was that common.

Others ended up in our emergency room completely malnourished and in active severe dehydration. Some made it, some did not.

The medical community as a whole must urgently re-examine the entire and intricate phenom of addiction. We must seriously re-examine sending a drug and overdose-exposed infant home to the people who had damaged them in utero, despite their “cleaned up” appearance and promises, and even despite any recent positive recovery status.

The menace that is relapse is an overshadowing, lurking danger, historically, and must be monitored very closely for a newly sober parent.

Self-coined Prenatal Overdose Rejection Syndrome Diagnosis.

Separate from my extensive nursing experience, I have gathered an immense amount of professional and personal expertise in managing, caring for, and in raising a child born into a heroin and meth addiction.

I noticed the symptoms of PORS in my professional career, but it was not until Charlie, my own grandson, was born from severe addiction that I could pen an actual name for the postnatal (and beyond) symptoms that I was seeing.

I have had legal custody of him since his fifth month of life. Charlie grew in-utero in my home from 28 weeks, was born at 38 weeks, and subsequently endured a month-long NICU stay and then was discharged to my home under the care of his birth mother and my youngest son, his father.

Both Charlie’s parents continue to struggle today with their recovery from heroin and meth, but for all their positive efforts (five years later) neither are in any kind of emotional or physical condition to parent Charlie and will not be for a long time, if ever.

During the pregnancy, in a rescue attempt to get help for her and for Charlie, I insisted that my grandson’s birth mother inform all her doctors and prenatal specialists of her heroin and meth addiction.

However, her specialists were not concerned.

They did not intervene and did not question her or even address her obvious positive drug screens occurring before her 28th week.

Not only was she not flagged as a risk to the baby at and after the birth, but the delivering ob/gyn actually told her that heroin and meth were not known to hurt a baby, so he “should be fine.”

This ridiculous and irresponsible line of thinking and under-education on this doctor’s part is reprehensible and did prove to be tragically wrong. Charlie was born with Gastroschisis, requiring immediate surgery after birth, and was subsequently diagnosed with 12 independent diagnoses.

Now, Prenatal Overdose Rejection Syndrome is an additional, undocumented and unrecognized problem I manage in his care and a focal point of intervention in his life.

Symptoms:

Charlie displays a constant need for reassurance of each family member’s role and connection with each other and to secure the idea that he and everyone “go together.” He continually looks for his proper place in the family, as it is clear he feels “out of place,” in general.

He is now almost five years old. Until very recently, he was inconsolable if I was not within sight and behaved as though he believed I was gone for good. This fear of abandonment began at birth. The few months his parents cared for him only cemented his fears as they did not know how and were not focused on meeting his needs…and they had both secretly returned to using just after he came home.

Charlie additionally had sudden, unexplained fevers, frequent illnesses (every 3 weeks almost on the dot) including pneumonia, RSV, strep, and other general maladies. He woke six to seven times a night, screaming inconsolably much of the time.

When a little older, he would hit himself when even gently corrected or if any situation seemed to place him in the spotlight for any reason. These issues are still present but improved now.

Charlie screams and talks angrily in his sleep often, now and seems to have dreams in which he is being threatened or attacked, as evidenced by this sleep speech and cries.

I sincerely believe this has to do with his prenatal and post-birth experiences with substance abuse, overdose, and the irresponsible, incomplete care he received from his parents in the first few months of his life.

For all the physical, neurological, and emotional difficulties (there are many more diagnoses), the most noted after effect of his prenatal exposure and trauma is his noticeable sense of rejection.

I am very careful in my one on one handling of his body when he walks and moves, as any accidental brush, scrape, or slight knock (think of getting a child into a car seat, dressing, or just moving about in general in the home) to his person sends him into a screaming fit, hitting himself.

The expectation of rejection and mistreatment is in his eyes, despite all my expressed care and love for him. I have also seen the same look in the eyes of other special needs children, both in my pediatric career and presently in other children attending therapy appointments at our therapy clinic.

Many things in a human being’s life can cause the rooted belief of unworthiness. It is incomprehensible that a developing fetus can be so poorly treated in the womb that this kind of root would begin before a first breath in the world, but it is an unfortunate reality.

Signs of PORS: (some can be characterized under other diagnoses as well)

If the caregiver/parent/grandparent of a child who suffered prenatal drug abuse and overdoses recognizes some or any of the following signs, immediate PCP’s therapy and developmental delay referrals needs to be made:

• excessive separation anxiety
• frequent night terrors
• social distancing from peers (can be observed as early as 12–18 months)
• delayed or difficult speech and conversation
• frequent, unexplained illnesses
• any purposeful self-injury
• the appearance of being persistently sad, aloof, disengaged or if they appear overexcited, excessively talkative ie: like the Energizer bunny and they are in a noticeable state of stress)
• anything else that appears to be “odd” or out of sorts with their communication methods, thought processes, and reactions to everyday activities and stressors.
• subtle and overt signs of problems processing daily communication and information, discipline, and social expectations. *
• Congenital mobility problems: weaknesses in various parts of the body showing as imbalance, toe-walking, odd gait, frequent falls, weak extremities, etc.

As a fetus, Charlie endured hearing his mother gasp for life during three heroin overdoses, heard the constant fighting and screaming between his birth mother and my son, endured severe malnutrition, felt the effects of multiple substance abuse, and was the victim of the negative stress hormones pulsing through his mother’s veins caused by the distinct chaos of another’s addiction.

Again, I continue to observe that the PORS phenomenon with all its nuances is not considered even when clinicians do work with addicts and their children. The effect of an addict’s life and abuse on the fetus is not addressed head-on.

Medical providers are bound to the search and research of best care and we are trained to unturn every stone for solutions and resolutions. If this is not accomplished, there are dire consequences for a patient who has experienced prenatal exposure to drugs, and especially, severe cases.

This type of unborn life, this type of prenatal rejection, affects the child’s whole physical, mental, emotional and spiritual makeup.

It is a permanent, invisible disfigurement.

Suggesting Further Solutions:

As with any health problem in our world, one effective and necessary solution is education, which is the purpose for my piece on this under-recognized and hugely epidemic medical and social problem.

Active and sober addicts, the parents and caregivers of the affected babies and children, and other involved (and medical) parties affected by Prenatal Overdose Rejection Syndrome need to be educated on the signs and symptoms of this not-yet-diagnosed condition.

Immediate, compassionate and consistent intervention should unequivocally begin at the positive test for pregnancy in an addict. As much as we, the medical community, can do to help that mother obtain permanent sobriety, we should do.

All parties affected by and involved in the care of Prenatal Overdose Rejection Syndrome also need a voice as a way to heal, educate, and be educated to implement treatments and cares and advocate for new research into this devastating issue. This begins by assessing, triaging, monitoring, and providing the utmost, loving and creative care are for these populations, as we are capable of.

This happens through the willful and purposeful engagement of physicians and other medical providers to swiftly address the symptoms of addiction in the parent and those of the child born out of that addiction. Researching and documenting these mental health and physical conditions and presentations is most imperative.

To summarize

Unborn babies in the womb of an active addict are the most at-risk type of patients in society and the medical community due to the inability of this type of patient to advocate for themselves and the inability of the addicted parent (s) to advocate appropriately for either of them.

The lives and health of these babies are severely compromised before birth. They are discarded and rejected prior to life outside the womb through the use and overdosing of substances, whether intentionally or neglectfully done.

Until research on the full psychosocial, psychological, and coinciding physical and emotional prenatal effects of drug use and overdose is addressed thoroughly, and protective measures for the unborn experiencing this abuse are put into effect, many an unborn child in the womb of an active addict will be plagued with a consciousness of intrinsic and lasting rejection before they are even seen or held.

This is unacceptable for our children and grandchildren and for any new human being.

The post Prenatal Overdose Rejection Syndrome appeared first on Medika Life.

Even as a clinician, my Breast Cancer Medicaid status has drastically altered my healthcare delivery and outcome, and I am not the only one.

On January 7th of this year, I had a 3D Mammogram to rule out breast cancer based on its strong history on my mother’s side.

On January 14th, I received a very apprehensive call from my nurse practitioner giving me the diagnosis of Invasive Lobular Carcinoma of the right breast. She was trite and not forthcoming with me concerning my questions regarding the diagnosis. Normally, this provider was exceedingly kind and communicated openly. I had no idea what transpired to change her attitude.

During this short, life-changing conversation, something from my provider’s tone resonated within my spirit that the common human experience with illness and disease that I was about to encounter would include an unexpected dark component.

I realize now, that the tone and hesitancy in her voice most likely conveyed her own understanding that my insurance status would compromise/complicate my outcome.

Subsequently, I have witnessed the passive, but very present, veiled negligence of the medical field to initiate timely treatment for a life-threatening illness in a Medicaid patient.

This is to a depth I had never seen as a medical professional, nor as a patient, and is illuminated in the story of the reprehensible mismanagement of my own health and life by my breast cancer providers.

Incomprehensible Delays In Treatment

Since January of this year, I’ve stood both stage-side and center stage in my experience with the struggle to have my practitioners determine exact diagnosis, proper (or lack thereof) staging, and have endured extreme delays in care, follow up appointments, and in receiving adequate and reliable test results, including the imperative-to-treatment Oncotype.

My initial appointment dates for follow-up procedures and cancer care after diagnosis were not in a timeframe supporting health and timely intervention.

Weeks went by between appointments and most diagnostics, which prevented the swift interventions needed and expected for the concentrated care and attention that newly (or any) diagnosed breast cancer patients require.

After searching for alternative care, I consulted with the breast oncology team at MD Anderson on March 9th to gain a clearer picture of my risk and staging before actually being diagnosed “enough” to decide on a double mastectomy. This was because subsequent recent results showed I had bilateral breast cancer much larger and more involved than originally suspected.

Due to the life-threatening bumbling and delays of my Austin providers explained later in this story, my surgery date was not scheduled until March 23rd, which was 74 days after the original January 14th date of confirmation of breast cancer.

Prior to having the double mastectomy on March 23rd, I investigated what the longest period recommended was between cancer diagnosis and the beginning date of treatment. It is a standard two weeks. If a woman must or chooses to wait any longer, the most time that can pass from diagnosis to beginning of treatment without survival rates greatly declining is 31 days.

This was a concern I had voiced with my providers consistently, but one that did not seem to facilitate any corrective action.

In speaking to many women I know personally who have undergone diagnosis and treatment for breast cancer, I have been informed that not one can parallel their experiences to mine as their treatments were scheduled immediately and their procedures and test results were timely.

None of those women had Medicaid for insurance coverage.

Why do I share all of this?

It is because the tragic reality of my negative experiences, and that of many others on Medicaid, is directly tied to my insurance coverage.

The Real Story: The Alarming and Life-threatening Gaps In (Cancer) Care for The Poor

Just after diagnosis, I began my cancer care as a MAP patient with the Cancer Care Collaborative at Ascension Seton hospital here in Austin, Texas.

If I had to have remained a patient there, I would be looking at a very grim outcome void of any real hope. I stood in shock after walking into the CCC office for the first time, seeing several minority women who were obviously ill, laying or hunched over the chairs. Not a one had their head up. I felt the air of hopelessness and resolution to sickness and death. I wanted out of there, immediately.

This was the place that local providers (my soon-to-be MBCC provider also) worked pro bono.

I soon learned one major source of that hopelessness. It was at the end of my appointment for that day when I went to schedule my next appointment and discovered that my next available appointment would not be for 2 more weeks and would not be with the same provider I saw that day.

Immediately, I felt unimportant and at risk for getting lost in the system. Having to stay in that position with a breast cancer diagnosis that I was informed was “most likely worse than initially thought” would have dramatically reduced my initiative and hope to live. This fateful concession is what I saw in the patients sprawled helplessly in the waiting room of the CCC.

Continuity of care is a foundational principle in healthcare. The lack of it leaves any patient, especially an oncology patient, feeling extremely disconnected, anxious, and forgotten. The truth of the matter is that vital information is missed when several providers work separately on a case and cares are not synergetic. This places the health and life of a cancer patient in danger, as there is no one regular provider to remember a particular patient’s needs and particular situation. Just reading the chart does not suffice, for any medical need, let alone that of a cancer patient.

In contrast to many women at the CCC, who waiver in the gap between Medicaid and MAP eligibility, I was approved for Medicaid. This coverage placed me just one step up from the other reality, from a completely invisible status to the status of “Medicaid recipient.”

I knew I would receive better care than that offered to the CCC patients, but I was genuinely concerned that such a serious diagnosis as breast cancer would be under-treated due to my Medicaid status.

I did not anticipate, even as an experienced nurse, how profoundly that fear would come to fruition.

The Dark Veil of “Healthcare Delivery” to The Poor

Much of the medical community leaves poor patients to infer the un-importance of their health and lives from the subpar care taken in their cases, such as the following:

• a common lack of ordered diagnostics that are normally appropriate for a diagnosis
• dangerous delays in the ordering of any diagnostics
• the nonexistence of the introduction of alternative treatments and preventative medicine to patients (ie: natural, effectual alternatives/additions to chemo, radiation for cancer care such as European Mistletoe, CBD with terpenes or just the suggestion of a keto (friendly) diet
• the pervasive lack of the followup and relaying of test results
• lack of appropriate and effective medications to manage conditions such as pain, insomnia and especially mental health diagnoses.
• dismissal of symptoms by providers resulting in chronic and irreversible conditions in patients (this now seems to a common problem for many patients)
• lack of timely referrals, if a patient is even referred out for specialty care
• the pervasive occurrence of any specialty appointments to yield any appropriate care at all, regardless of diagnosis/symptoms

My personal experiences shadow these instances:

A) Post-surgically, as I wrestled with severe pain from the double mastectomy, I was told by my plastic surgeon’s nurse, that Tylenol and a very small handful of 5mg oxycodone to last weeks, were sufficient for the pain that I was experiencing. In one of the telephone conversations I had with her, she labeled me an “outlier,” in reference to this unrelieved, incomprehensible pain that was causing severe insomnia and upper body immobility for me.

This situation then and now has prevented the natural and necessary process of rest and recovery for me.

I have since learned from several women in my community who have regular private insurance, who also underwent mastectomies, that they alternatively were given appropriate post-mastectomy pain medications such as Hydrocodone and even Dilaudid to manage their post-mastectomy pain.

B) Severe and persistent insomnia plagued me from the date of my surgery. I addressed this problem for four months before getting a referral. None of the medications I was given to “relieve” the insomnia in between were first action medications for insomnia and did not work at all. After I waited almost two more weeks for this referral (still not sleeping) I was told by the new provider I saw that I needed yet another referral to actually get to the MD who ordered effective medication for insomnia.

This was another month’s wait, without more than 20 hours, at best, of sleep, per week.

C) After surgery for breast cancer, medical protocol includes the formation of a treatment plan based on the final results of surgery, risk assessment assays, and lab results.

The Oncotype result must be in hand post-surgically, as it determines the risk factors for metastasis and recurrence of breast cancer, indicating whether chemotherapy, radiation, and hormone therapy are appropriate, or if all three are required.

By May 5th, I still had no Oncotype result and still did not have a confirmed treatment method, after surgery.

Three separate times from the original diagnosis and biopsies in early January 2021 to my surgical follow-up appointment end of March 2021, this test was “ordered,” but never done.

My breast surgeon first discovered in April that the original biopsy tissue taken by another practitioner in January was “insufficient” for processing. This important information was obviously lost in transition and not previously sought after by any of my providers, which certainly raises an eyebrow, as this information is imperative to understanding a patient’s risk of disease recurrence and the benefit of chemotherapy/radiation.

Most concerning is that the breast surgeon “forgot” to order the Oncotype from her own biopsies in February and again from the post-surgical mastectomy tissue retrieved from surgery on March 23rd. The test was neglected a third time, as outlined further in this story.

Before and after surgery, appointments with the breast cancer surgeon left me wondering after each visit what it was in her eyes, and in the hesitant way she slowly and carefully worded things, that I was not being told. She appeared to lack confidence in much of what she relayed to me regarding my original biopsies and scans. Although deemed the best breast surgeon here in Austin, I just could not shake the uneasiness in the air and the unsure nature of my changing diagnoses in our conversations.

I have conceded that my cancer care providers are indeed grossly aware of and understand that the delays in diagnosis, staging and surgery scheduling I have experienced are not normal occurrences and cannot remotely be defined as “best practice.” They know I knew to expect better as a medical professional.

However, I was continually assured that I was getting the “best care possible,” despite the staggered visit conversations containing an ever-present air of disregard, mystery, and even one of concealment.

I have long cared for Medicaid patients in all my nursing specialties. I have been a Medicaid patient before now on and off in my 30-year medical career, second to being a single mom most of my adult life.

I know how poorly Medicaid patients are treated, but this experience opened my eyes to something about the medical field that has changed my perception of care and treatment in healthcare across the board.

I have seen for the first time the concrete evidence of purposeful, pervading medical neglect, particularly in the field of oncology, towards patients with no or lesser insurance. I have witnessed and experienced for myself the total and willful lack of concern for life, my life, as opposed to others who have money and adequate insurance.

Every confusing interaction with my providers indirectly left me feeling worthless and invisible. I knew, they knew, that as a Medicaid patient, I was not getting appropriate care. Treating patients so poorly that the patients themselves resolve that they are not worth the same life-saving treatment that others receive is inconceivable.

This is how and why poor people die from the same diseases and conditions that non-poor people recover from exponentially more often than those with low incomes.

How The Poor are Socially Treated

I had a double mastectomy with 14 right side lymph nodes removed and the left side sentinel node removed in late March.

I rightfully had the expectation to receive compassion in my care, as every patient should expect, especially after major surgery.

This was not my experience.

My breast surgeon did not come to see me in the hospital after the initial procedure. She did not explain postoperatively in any detail at all what she saw in surgery. I was scheduled to leave the hospital 23 hours after surgery, with 4 drains and incomprehensible pain…pain that 5 mg Oxycodone, 300mg Gabapentin, and 1000mg Tylenol alternately do NOT manage. I forced the issue of staying three nights as I knew that was the very least amount of hospital time I could have and go home in any condition not threatening my wellbeing.

The caseworker who saw me just after my surgery encouraged the longer hospital stay until she discovered I was a Medicaid recipient. She then returned to my room and informed me if I stayed a third night, I would “have to pay for it myself.” She was no longer smiling and never came back to check on me after that statement.

Her services had been requested to help me navigate resources and counseling for the amount of personal stress I was going home to. My youngest son was admitted to drug rehab with a coinciding total mental breakdown occurring just two days prior to my surgery and I would be returning home after the mastectomy to care for my 4-year-old grandson with special needs.

I was left to manage these issues and the recovery alone.

The plastic surgeon came on my second day stay, gruff and annoyed. He also focused on informing me I was going to have to pay for the third-night stay. Following this statement, without any other information or report from his work in surgery, he turned on his heels and began walking out the door. Just as he did, he turned his head back at me and dryly stated, “Well, I think you’ll like where we’re going with this…” as if I should be excited about having to re-create my chest? Since he had informed me of nothing else regarding my care, I am only concluding that was the reference he was making.

I was stunned, insulted, and deeply hurt. I no longer cared if I ever got breasts again.

I had consistently been asking about the results of the surgery and lymph node removal from the moment I regained clarity from anesthesia.

The nurses could not tell me anything, and finally, I was informed that my two-week follow-up with the breast surgeon would give me my answers.

Apparently, I was to accept waiting another two weeks before getting any answers to my cancer status.

Upon asking about my results at the two-week post-op visit, specifically the Oncotype, my breast surgeon stared blankly at me, turned from me to her computer, and stated she would “order it immediately.”

Having lost all faith in my Austin breast team, I began preparing to transfer some of my care to MD Anderson in Houston. When requesting my records for the MDA team evaluation two weeks later, it was discovered again that the Oncotype was indeed not ordered.

To clarify for anyone who does not understand the importance of this testing, an Oncotype determines with great precision, a person’s risk of breast cancer recurrence and so is vital to treatment planning post-surgically. The lack of this test post-procedurally results in further delays in treatment for cancer, which further risks a patient’s life. I needed to know whether or not chemotherapy, radiation, and/or hormone therapy were the appropriate courses of action.

Now, four weeks post-op I had no idea what my treatment is and no idea what my risk of further disease is. This has been torment from start to finish. My staging was changed four times from January to mid-March. My prospective treatment plans were therefore changed four times and, although I received a “surgically-free of cancer” report, my visit to the associated oncologist in the same group as my breast surgeon squashed that hope with repeated vague sentences including, “Well, we can’t see everything, so we don’t really know the risk.”

A competent practitioner whose professional goal is to see all patients benefit from valid treatment options would recommend additional testing be performed (like CEA and Signatera Assay) after chemotherapy, if indicated, or after surgery to check for residual cancer DNA in the blood. These test results would further enhance proper treatment planning after adjuvant treatment methods, most often, chemotherapy.

However, the oncologist was not forthcoming with information on this life-saving diagnostic testing until I mentioned it. She hesitated, stumbled over her explanation of the tests, and seemed extremely uncomfortable. She ended the sentence with, “I’ll have to see if this testing is favorable to you and if the insurance will cover it.”

There is NO cancer patient for whom CEA and Signatera assays are not favorable.

These options should be offered to all cancer patients, regardless of insurance status, and are offered, per my research, to many other cancer patients. These diagnostics give cancer patients their cancer status (metastasis, risk of recurrence, previously undetected cancer) with almost 100% accuracy.

My providers know I am a veteran nurse, yet my years of experience and knowledge are not respected or recognized and are even contested many times because I am a patient on Medicaid.

I am eligible for Medicaid today due to having to stop my nursing career, leaving the workforce entirely, to raise my special needs grandson.

A shameful, pervasive neglect of the poor

If I were not a medical professional, I believe I would not be in any place of health right now (and I struggle daily with the ongoing effects of chemo, awaiting radiation) because I have had to fight for everything I have had done and my medical knowledge led this.

The blank stares greeting me every time over the last few months when addressing my concerns over the delays in diagnosis and treatment as a cause for my concern for metastasis, still haunt me.

With my eyes further opened to the grim reality of the outright malpractice and medical neglect shown to patients who are not wealthy or do not have “good” insurance or the ability to self-pay, I am forced to accept, indeed, that the lives of anyone who does not have either are unimportant to many providers and are not considered worthy of many providers’ time.

This truth is one I have long fought against in my own career as I advocated for my own patients, but the depth of the apathy and disregard for my life and the lives that sit in those seats at the Cancer Care Collaborative is outright criminal and inhumane.

Life itself, humanity, is not valuable second to wealth, education, or social status. We are valuable as human beings because we are so greatly valued by our Creator.

We are valued by our loved ones who do not want us to die untimely deaths or due to another’s negligence and apathy. No one wants to die or have a loved one die because medical providers do not value the patient’s life because they are a Medicaid recipient or have no insurance.

Is There A True Resolution?

What is the resolve to this profoundly serious mindset in the medical community…not just in Oncology, but in all areas of the medical field?

Can you teach another human being who does not hold value for every life that all life is valuable? Should doctors, on the very premise of their calling and job description, value one set of lives over another?

Where did the alternate idea of providing more and advanced care to fully insured/wealthy originate? Providers do not make much from Medicaid, so most recipients of Medicaid will not be a priority to these providers at all.

Does the lure or lack of exorbitant money-making really taint providers’ decisions and treatment of patients?

Corporate America mandated in the very late 80’s that patients no longer be noted as “patients,” but “clients.” This swept in a permanent era making the medical field a for-profit “business” rather than a public servant.

Despite the many years I worked to respect and advocate for my poor patients, I am still flabbergasted at the permeating negative attitude in healthcare toward the poor.

As a nurse, I have had many patients on Medicaid who were war veterans, college professors, travelling dance instructors, former nurses, scientists, teachers, and many other professions as well as many others with no profession. They were all valuable lives.

The only solution I advocate for that will change the profit-driven, discrimination-based lack of care in the American healthcare field is nationalized healthcare, a system in which all human beings are treated equally, which would eliminate insurance companies making the decisions for medical diagnosis and treatment. I would not ask my car insurance salesman to dictate my automobile repair, as he is not a mechanic.

I experienced nationalized healthcare in England as a child when my family lived there in the 1970s. We had no problems obtaining care nor did we have to wait for care.

The privatization of our American healthcare system has created and fostered much illness, both acute and chronic, lack of access to medications, treatment modalities, and procedures based on patient income.

If lucrative money-making is at the helm and priority of providers’ decisions, and not the preservation of health and life, then, at one time or another, every person who seeks healthcare will have their health and life compromised as we are all numbers, specifically if we are poor, but when the combination of money, Big Pharma and profit is the driver…none of our lives are really safe.

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