LAIs

It happens all too often.

 

You have not been taking good care of yourself. You don’t eat, you sleep poorly, and you neglect your medical health. Over a period of months or sometimes years, you begin to isolate yourself from your friends and family. You can’t seem to hold a job. You lose interest in once pleasurable activities. Your thinking becomes odd, your thoughts distorted and fragmented and strange. No one knows about that just yet, because the voices you begin to hear tell you not to mention it, to keep it to yourself. The voices become threatening over time. Sometimes, they tell you to hurt others, or to kill yourself. It becomes harder and harder to tell reality from fantasy. You get depressed, agitated and finally can’t stand it anymore. Someone gets you to a doctor.

 

You or someone you know are diagnosed with a major psychiatric illness such as schizophrenia.

 

The trauma of hearing that kind of diagnosis is bad enough, but then comes the part that most of my patients do not like at all. The part when I talk to them about medications. Now, right off the bat, let me tell you that good treatment of a mental illness is not simply taking meds. It might involve counseling, education, learning new job skills, going to group therapy, talking to your counselor with your family, couples counseling, or getting peer support. That being said, this column will deal with medications, and a specific form of medication, which we will get to shortly. I’m quite sure we will come back to other treatments in this column in the future.

 

So, you have been told you have schizophrenia. Among those many treatment options, your doctor might suggest that you take a medication to treat your psychotic symptoms, one that usually comes in pill form, pills that you must take at least one time per day or maybe more. You discuss how to take them, the possible side effects, how long you might have to take them, and how they should help you recover. You get the prescription filled, begin the course of treatment, and get better! So much better, in fact, that you decide you don’t need these medications any longer, and you stop them. Can you guess what happens then, within a few weeks to a few months? Many patients will relapse, meaning that the same symptoms that got them to come to the doctor in the first place come back, sometimes worse than before.

 

You get so sick during this relapse that you end up in the emergency department and you’re admitted to a psychiatric hospital. You are put back on the same medications you tell the staff you were taking before, since they did work once, and in fairly short order you are discharged home. You see your doctor, you are feeling so much better, things are great, and you are sent home with a new prescription. You may decide, just within the first month home, that you feel so much better, again, that you won’t even get the prescription refilled. Then, those gnawing depressive feelings come back, you can’t sleep at night and you begin to hear voices that tell you that it’s not worth living anymore. Your family starts discussing taking you back to the emergency department, and you know that they are trying to harm you by doing so. You can feel them scheming and plotting against you. The voices agree with you and tell you to “hurt them before they hurt you”.

 

Do you see the pattern here?

 

There is one treatment modality we have which may help you to avoid some of this heartache and misery. If you have a diagnosis such as schizophrenia, and you have trouble taking oral medications or keeping up with your plan of care, including taking medications, then long acting injectables or LAIs, may be right for you.

 

What are LAIs? They are medications that are formulated to be given by injection with a needle into the muscle, from which they are slowly absorbed over weeks or months to treat your psychotic symptoms. They include such medications as Haldol Decanoate, Prolixin Decanoate, Invega Sustenna, Risperdal Consta, Aripiprazole monohydrate, Aristada, and Invega Trinza.

 

Why use them? If you have trouble taking oral medications every day, if you have a substance abuse problem, if you tend to take too many pills at one time, or if you are very sensitive to drug side effects with frequent dosing of pills, then LAIs may be for you. Obvious advantages include not having to remember to take pills every day, not having to come to the drugstore to pick up refills as often, more smooth levels of the medication in your bloodstream leading to fewer side effects, and reduced risk of under or overdosing with your medications.

 

Are there downsides to these medications? Of course. It might take a while to get to the very best dose for you, as you are like no other patient. Dosing guidelines help, but every patient is different. It is not as easy to adjust the ongoing dose of your medication as it might be with pills. You might have some transient pain in the injection site (though a very skillful nurse can inject these medications with little trauma to you!) And of course, there is the always present stigma of having to “go get my shot” every month.

 

Do I think that the advantages outweigh the problems with these medications? If you meet the criteria for receiving this kind of medication therapy, absolutely. If you have the opportunity, speak with your doctor, or make sure your loved one does, to discuss this recovery enhancing opportunity.

 

 

Do You Hear What I Hear?

Did you see the recent Oval Office meeting that included the President, ”Chuck and Nancy”, Mike Pence and a host of live news outlet personnel? Did you watch how the parties in this meeting communicated, or not, with each other?

Listening is an easy thing to do poorly, and a very difficult thing to do well.

One could surmise that the three active talkers wanted to make their points known, over talk and interrupt their counterparts, and make the best impression they could in the reality TV type environment. Stands were made, flags were planted, lines were drawn in the sand. The news media was more than happy to document the sausage being made live.

I don’t think I need to belabor the already made point that this meeting was not very productive.

What does it teach us, or remind us, about listening?

First of all, it must be active. If you really want to listen to someone, and make them feel heard, do these things. Put down everything else for a few minutes. Cell phone in pocket. Newspaper set down on the countertop. Make direct eye contact with the person you want to communicate with and listen to. Did you notice the way the President kept playing to the television cameras? Don’t do that. Look at the person you are talking to.

Listen to the other person’s complete thought before you start talking. Do not interrupt. Sometimes, we are so focused on what we are going to say and how profound it’s going to be that we completely miss the other person’s point!

Seek first to understand, then to be understood. You’ve no doubt heard this before. It works. Get what your companion’s premise is before you try to make them understand yours.

Try to communicate, but not necessarily to persuade. Short of being in a court of law or on a debate team, this is usually the right way to go.

Do not talk over the other person, interrupt the other person, or shout the other person down. I honestly cannot watch some news shows simply because no one on the show has learned to take turns and be polite to others. Sometimes,it really does boil down to what we learned in kindergarten!

Don’t blame.

Take the high road.

Compromise.

Accept responsibility for your own actions and expressed opinions.

That recent Oval Office meeting was a perfect example of how not to communicate effectively.

Learn from it.

Shoulda, Woulda, Coulda

There are some things that are expected of all of us. Some that are expected of most of us. Some that are not really expected at all, but if we do them, we leave a lasting positive impression. Just a few recent thoughts, reflections and musings about some of these in light of the recent days, weeks, months, two years. Not directed at any one person, per se, but maybe applicable to some of us more than others.

If your tie unravels, becomes untacked, or otherwise is in need of repair, sew it up yourself, kindly ask your wife or someone else who is good with a needle to do it for you, or retire the tie. Never, ever tape it.

Walk with your wife. Let her walk beside you. Do not leave her at the car, forget her, let someone else accompany her, or hold the umbrella over her head. Are you proud of her? Do you want everyone to see her at your side, as your equal partner? Then walk with her, not a dozen paces ahead.

When you need to confront someone about a difficult issue, such as the fact that you are firing them, do the right thing and speak with them face to face. Confrontation and dismissal by tweet are for cowards.

Sleep. For the love of God, get some sleep.

When a very simple but profoundly meaningful act is expected, do it gladly. It costs you nothing and may mean everything in terms of positive exposure, compassion and overt patriotism. By the way, those men of The Old Guard walk the same twenty one paces back and forth every day, in blazing heat, drenching rain, swirling snow or under threat of hurricane. Twenty four hours a day, three hundred sixty five days per year. Your worrying about a bad hair day in a little rain is meaningless to them.

Do not shove your peers. Not to jockey for position in a photo op. Not to express discontent with their policies or beliefs. Not in jest. Do not shove.

Calling someone a loser, a week person, slick, a liar, or dumb as a rock is not the way to forge any kind of alliance or even shore up an existing base. Doing so only provokes others, distances, creates rifts in already tenuous relationships, and showcases a profoundly limited descriptive vocabulary.

Watching the events unfold around you is a pretty good way to gauge the temperature of a room, an auditorium, or a church. When people with extensive philosophical, political, and personal differences are chatting amiably with each other, but stare straight ahead in dead silence after you enter the room, that should be your first clue that you are not a welcome member of the club.

Surround yourself with very smart people who you can trust. Then listen to them. Otherwise, they are worthless to you.

Respect history. As we all know, it does not always repeat itself, but it rhymes.

Do not reinvent the wheel. Others have sacrificed personal comfort, honor, blood and treasure to come up with a damn good blueprint of how democracy should and can work. Use it.

Do not consort, cavort, comfort, or collude with the enemy. He is real, and he has nothing but contempt for us.

Even if you are in over your head, act the part. There are people who will coach you. There is usually a script. There are expected duties close to home. Do them. Look the part. Salvage some respect, if not for yourself, then for the office.

Lastly, read. Then, read some more. There is always more to be learned and understood.