Feb 23

Red Dress Gala for Womens Heart Health

WexlerPsychRedDressGalaby Dr. Micaela Wexler

This past weekend, I once again had the privilege of speaking at the Alpha Phi Foundation Red Dress Gala to raise awareness of women’s heart health. I was on a panel with Dr. Lee McKinley, a pulmonary critical care specialist who confronts severe heart disease on a daily basis. He gave us some harsh facts about heart disease. It is the number one killer of women each year in the United States.

The following factors contribute to this: obesity, sedentary lifestyle, fatty diet, smoking and hypertension. Only 3% of Americans adhere to ALL four of the following healthy habits which have been found to prevent heart disease: 150 minutes of exercise per week; 5 fruits and vegetables per day; normal weight; no smoking.
While I acknowledge that it is important to hear these hard facts, as a psychiatrist, I opt for a more light hearted approach to motivate people to adopt healthy habits. So, here is a fun filled day of cardiac health.

Upon waking up, while you’re still in bed, take a few cleansing breaths. Deep breathing lowers blood pressure. Try a breath now: breathe in slowly, into your stomach, hold and then slowly let your breath out. Do this a few times.

When you get to the bathroom, read the post it note you left on your mirror last night telling you something wonderful about yourself. If all it says is “you’re awesome!” That’s enough. WexlerPsychToilet

Then, as you sit on the toilet with your phone in your hand, read a joke or look at a funny video.
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Laughter really is the best medicine. A 2006 study in Maryland showed that laughing 15 minutes a day dilates your vessels 22 percent. This lowers your blood pressure, and putts less strain on your heart.

Now it’s time to crank up your favorite dance song, or two. Something with a beat, and start dancing. Dancing improves heart health. Listening to rhythmic music 30 minutes a day lowers blood pressure and heart rate. I recommend Grenade by Bruno Mars. Played 10 times in a row.

When you get to work, hug your boss.

A study in North Carolina showed that hugs reduce heart disease, and women benefit more than men. And it doesn’t matter if the person is close to you or a casual acquaintance. You still get the benefit. So hug someone every day, several times a day.
WexlerPsychHug

If you have to sit for your job, get up and walk around at least once an hour. I take a big container of water and take a huge drink right when I get to work. An hour later, I go to a bathroom far away from the clinic. Fewer people use it, which means fewer germs. And, more movement.

While you’re in the bathroom, think about your beautiful body. This beautiful body that brought you here today. Women, we are COMPLICATED! We don’t have typical symptoms of heart attacks. If you feel anything funny from your neck to your pelvis, call your doctor. WexlerPsychMirror

Walk during lunch. It doesn’t have to be a long walk. Walking 10 minutes a day twice a day every day significantly reduces heart disease.

Middle of the afternoon: time for some more cleansing breaths. Check out your mood. Are you stressed out? Taking those deep breaths will relax you.

If you find you have trouble relaxing, or that your mood is depressed, think about getting help. Untreated depression carries a high risk of a heart attack, especially for women. You have to be happy: you heart depends on it.

Don’t forget to hug people during the day! Every day during Womens heart month.
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After work, treat yourself to some more dancing while you change out of your work clothes. You earned it!

Then, it’s time for a glass of red wine. Studies have shown that a daily glass of red wine is good for your heart.
After dinner, treat yourself to some dark chocolate for dessert. Again, you’re doing this for your heart. Chocolate with 65% cacao is good for your heart. WexlerPsychRedWine

Then just before bed, grab that blank post it, and write something awesome about yourself and put it on your bathroom mirror.
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Dr. Micaela Wexler provides child, adolescent and adult pscyhiatric services in Kansas City.

Please visit Wexler Family Psychiatry to schedule an appointment.

Appointment information for Dr. Wexler: wexlerpsych.com

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Logo Copyright Debby Bloom

Nov 02

Is Dr. Lisa Tseng a murderer?

DrLisaTsengWexlerPsychiatryby Dr. Micaela Wexler

On February 5, 2016, Dr. Lisa Tseng, a Los Angeles area physician, was sentenced to 30 years to life for killing three patients who overdosed on pain pills she prescribed.

Prosecutors charged Tseng with murder for the deaths of Vu Nguyen, 28, of Lake Forest; Steven Ogle, 25, of Palm Desert; and Joey Rovero, 21, an Arizona State University student who prosecutors say traveled more than 300 miles with friends from Tempe, Arizona, to obtain prescriptions from Tseng at her California clinic. The prosecution made the case that she recklessly prescribed large amounts of narcotic pain killers to people who did not need them, and the jury agreed.

Her defense team has made the claim that this was a case of malpractice, not murder, that Dr. Tseng was deceived by her patients, and that physicians should not be held responsible if their patients abuse their medications, and that her patients should have known not to take large amounts of narcotics, and not to mix them with alcohol or benzodiazepines.

It’s difficult to make a case for malpractice given these facts. Malpractice is generally reserved when great harm is caused by a physician’s mistake. But, Dr. Tseng’s actions do not fall under the definition of an error. She did not accidentally prescribe the wrong medications; she intentionally prescribed opioids, Soma, and Xanax. Habitually. Approximately 25 times a day.

On her very first meeting with this out of state patient, she allegedly quickly prescribed Rovero more than 200 pills, including nearly a hundred 30-milligram doses of Roxycodone, a potent and addictive painkiller. Nine days later, he was dead, joining the approximately 100 Americans per day who die from a drug overdose. The investigation showed that in addition to the three deaths for which she was convicted, eight other patients died from overdosing on her prescriptions. Numerous others overdosed, including one in the clinic bathroom shortly after his appointment. Her staff and patients testified she spent just minutes with each patient, did not perform physical exams, and did not verify they had a true need for these medications.

I believe responsible prescribing is the duty of every physician. Having said that, what exactly does this mean?
How is one physician guilty of malpractice while yet another is guilty of manslaughter, while Dr. Tseng is the first physician to be convicted of murder for the death of patients to whom she prescribed medications?

Losing patients is the reality of being a physician. Patients routinely die even when physicians do everything possible; death can result even when a patient has been prescribed a medication that is not controlled and considered low risk, such as a patient with asthma inadvertently prescribed a beta blocker. Then we have the issue of suicide by overdose: we do not hold physicians responsible when a patient decides to ingest the entire bottle.

As a psychiatrist, I have found it extremely challenging to treat patients who request narcotic pain medications. It is difficult to determine which ones have a pain issue and which ones have an addiction. I have learned the hard way that a patient with a true pain disorder can be just as violent as one with a narcotic pain pill addiction.

I have decided that for ME responsible prescribing of narcotic pain medication means VERY limited prescribing. I do not prescribe narcotic pain medications for any patient longer than a few days, for the simple reason that I am not trained in pain management. I prescribe controlled substances such as benzodiazepines and stimulants only to patients who will be under my care long term. I educate patients about this as early as possible.

If a patient enters my care on an acute psychiatric unit while prescribed a narcotic pain medication, I advise the patient the pain medication will be continued overnight and will be discontinued if I am not able to verify that they have a legitimate prescription. To ease their discomfort I will taper rather than abruptly discontinue opioid medications. If a patient presents to an outpatient setting requesting pain medication, I advise that I am not skilled in narcotic pain prescribing, and as such, I am not able to keep them safe, so I will not be writing a prescription for narcotics.

I’ll be the first to admit: this is much more complicated than what I have just described. Most patients requesting opioid pain medications are not content with my limits. The most mild reactions are those in which they try to persuade me to give them a prescription “for a few days worth to get me by until I find a doctor.” They launch into a detailed description of their medical issues, and explain how their pain is contributing to their depression and suicidal behavior. Some will go so far as to say, “if I don’t get my pain meds (or Valium, or Xanax), I’ll go kill myself.” I have hospitalized such patients involuntarily.

These are the “easy” patients. What happens far too often is that patients become aggressive. Their behavior ranges from verbal threats, “I know where you live” is the most common, to physical aggression. I have been spit on, kicked, shoved, had books thrown on me, had my hair pulled and, in one case I was beaten up by a patient who then attempted to strangle me. I have learned I am far from alone in these experiences, so much so that I now teach a class on coping with these types of patient situations.

I have encountered numerous physicians in the rural Midwest who, as Dr. Tseng was known to do, prescribe large amounts of opioids to patients they know little about. The Drug Enforcement Administration says Dr. Tseng wrote more than 27,000 prescriptions in just three years, at an average of 25 a day. By the time Joey Rovero, a college student in Arizona, visited her California office in December 2009, Dr. Tseng had developed a reputation as a “candy doctor,” a name given to doctors who “give you whatever you ask for.”

As a medical student and intern, I delivered approximately 70 newborns. I loved delivering babies. I loved the excitement; I loved holding their slimy bodies, stimulating their faces until they cried, watching their color change from blue to pink. I loved being present as a new family was formed. So great is my love of this, that I have remained active in providing breast feeding support, because of the proximity it affords me to this process.

If I happened to be the only person around, I would certainly deliver a baby if needed. However, I would never consider putting myself in a position where I would routinely be expected to participate in deliveries. It would be horribly irresponsible, and if a baby died under such circumstances, I’m not sure it would be considered malpractice.

This is the analogy from my life which most closely matches Dr. Tseng’s situation. There is no evidence to suggest Dr. Tseng had the proper training or technique to prescribe such large numbers of opioids. Her prescription of opioids in such large amounts would be similar to me running to women’s homes to get there before the midwife, knowing that in her vulnerable state, a woman in labor might actually prefer a physician over a midwife.

While it is true that Joey Rovero was an intelligent young adult, a college student just months away from completing college, unlike Dr. Tseng, he did not have a medical degree. Like Dr. Tseng, I also attended an osteopathic medical school. I was trained that the physical exam is of utmost importance when treating physiologically based medical conditions. In addition, all osteopathic medical students learn osteopathic manipulation technique (OMT). We are encouraged to turn to OMT as much as possible, especially in treating pain.

I don’t know what motivates physicians to run what are known as “pill mills.” Prescribing opioids in such large amounts turned out to be very lucrative, as reports indicate Dr. Tseng made $5 million in three years. A couple of years ago, I discussed this issue with a friend who happens to be a malpractice attorney. He advised me these cases never make it to court because the patients are unsympathetic due to their addictions. “We always find something in their background that will make them look bad in court.”

Joey Rovero was not someone with “something bad” in his background. He grew up as a good student and athlete in a close knit family. Rather than being shamed by the circumstances of their son’s death, his parents filed a complaint against Dr. Tseng. The following year, April Rovero started the National Coalition Against Prescription Drug Abuse. She has worked tirelessly to educate students, parents and lawmakers on the dangers of narcotic prescription drugs.

Dr. Lisa Tseng’s conviction and prison sentence is a wake up call that the manner in which we treat pain, as well as how we address the problem of prescription medication addiction needs to be addressed.

Dr. Micaela Wexler provides child, adolescent and adult pscyhiatric services in Kansas City.

Please visit Wexler Family Psychiatry to schedule an appointment.

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Appointment information for Dr. Wexler: wexlerpsych.com

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Jun 04

Thank you, Caitlyn

by Dr. Micaela WexlerVanity Fair July 2015 Cover

As both a parent and as a psychiatrist, I was filled with hope and joy by the introduction via Vanity Fair of Caitlyn Jenner. I have been involved in advocating for transgender rights for several years. When I was in my psychiatry residency at Kansas University Medical Center, I did my scholarly project on transgenderism. My research involved a review of the literature as well as “field work.” I interviewed transgender individuals in various settings: Navajo Nation, San Francisco, Kansas City, among others.
I learned about embryological gender development, and how this can lead to both intersex disorders and transsexualism. My training as a physician made it quite easy for me to understand how a discrepancy between genital differentiation and brain sexual differentiation can result in transsexualism.

I learned the horrifying statistics with regard to violence against transgender individuals. While the average American has a one in 18,000 chance of being murdered (which to me is a deplorable number), a transgender individual has a one in 12 chance of being murdered. I think of that statistic every time I give one of my elderly patients a clock test for dementia. I learned how Gwen Araujo was brutally murdered on October 4, 2002, just shy of her 18th birthday. The four men who killed her were found innocent due to their “gay panic deception” defense.

The grim statistics with regard to suicide in the transgender community are inescapable to me as a psychiatrist. A staggering 41% of transgender individuals in the United States have attempted suicide. For transgender youth, that statistic jumps to over 50%. When Leelah Alcorn died from suicide in December 2014, I was haunted by her plea left behind in her suicide note: “The only way I will rest in peace is if one day transgender people aren’t treated the way I was.”

How was Leelah Alcorn treated? In a note she wrote prior to her death, she makes it clear she is committing suicide “because life isn’t worth living as a transgender.“ She acknowledges that her peers and school were supportive, but not her parents. Her mother “reacted extremely negatively,” and she urges other parents to be more accepting. Her mother’s lack of acceptance, on many levels, persisted after her death, when she posted on Facebook that her “sweet 16 year old son” was hit by a truck when out for a morning walk.

Given the realities faced by the transgender community, Caitlyn Jenner’s public act of courage, which is accompanied by widespread acceptance, including that of her family, is cause for celebration. It is so refreshing to see the word “transgender” NOT followed by the word “tragedy” or suicide.” While it is true that she comes from a tremendous amount of privilege, with the accumulation of resources made possible by capitalizing on a male persona for several decades, it is wonderful that she is using her celebrity as a vehicle to help others, especially members of an extremely marginalized group.

Research shows that the younger a transgender individual is when she or he transitions, the greater positive effect this will have on his or her mental health. They suffer less bullying, discrimination and isolation the younger they are when they assert their true identity. Treatment with hormone blockers to prevent unwanted physical characteristics allows for a more complete social development.

Given these findings, I can’t help being sad that Caitlyn had to wait until her 60’s to assert her true identity. This is tempered by the fact that by giving a positive public face to transgenderism, more transgender youth will be able to transition and live their lives to their full potential. We are much closer to having Leelah Alcorn rest in peace.
Thank you, Caitlyn.
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Apr 20

Why was Natasha McKenna Tasered?

by Dr. Micaela Wexler

WexlerPsychiatryNatashaMcKenna

On February 3, 2015, Natasha McKenna, a 37 year old woman with a diagnoses of schizophrenia, who was being detained in the Fairfax County, Virginia jail, stopped breathing after a stun gun was used on her. She had been restrained in her cell by six deputies with handcuffs behind her back, leg shackles and a face mask prior to being shocked four (some reports say six) times. She was taken to a hospital, placed on life support, and died several days later, leaving a seven year old daughter.

Why was Natasha McKenna tasered? Tasers are not recommended for use in the mentally ill. McKenna’s mental health challenges were well known to involved parties. She was diagnosed with schizophrenia at the age of 12. She had no history of serious criminal convictions, but was known for her erratic behavior. She had been arrested on January 15, 2015 by Alexandria, Virginia police after creating a disturbance at a Hertz car rental location. She ran from police, resisted arrested, and was combative with officers. That incident resulted in hospitalization at a psychiatric facility. By the time she was restrained at the Fairfax County jail and tasered, she had already spent eight days in the jail’s mental health unit. During that time she had engaged in bizarre behavior indicative of her deteriorating mental state: she had urinated and defecated in her cell and had been combative with deputies.

Why was a felony warrant for assault obtained for a person well-known to have mental health challenges? During her public disturbance on January 15, she punched a cop, bit another cop. She was not arrested, however; she was transferred by the Alexandria, Virginia police to a psychiatric facility where she was hospitalized for several days. Despite this transfer, the police issued a felony warrant for assault. By January 26, she had been released. On that day, she called police to report an assault. Workers at the store where she borrowed the phone reported she was dressed in hospital patient attire. When she was picked up by Fairfax County sheriff deputies, she was taken to jail rather than to a hospital, in large part because of the warrant for her arrest. She was viewed as a criminal rather than a person with mental health challenges.
Treating people with mental health challenges like criminals while denying them care hurts all of us. This was tragically demonstrated in 2007 when Seung-Hui Cho, who had been recognized as being severely mentally ill and briefly hospitalized, was not treated and went on to kill 32 people at Virginia Tech.

While providing CIT training for all law enforcement personnel is a useful goal, more basic steps can be immediately taken, such as not using a taser on a person who is already restrained and not using one on a person who is emotionally unstable. Widespread recognition of mental illness for what it is, a medical condition which renders the person vulnerable, would go a long way to preventing unnecessary tragedies like the death of Natasha McKenna.
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Mar 31

It was NOT the depression

by Dr. Micaela Wexler

As a psychiatrist who treats people with depression on a daily basis it is disheartening to see news story after news story referring to depression in relation to the Lufthansa Germanwings Airbus crash. The latest news story I’ve seen is one titled “Lufthansa’s Deadly Confession,” and it reveals that Lufthansa (gasp) knew Andreas Lubitz was depressed and continued training him.

People do NOT murder because of DEPRESSION. People do not do much of anything because of depression. That’s the problem with depression: it prevents people from taking actions, from accomplishing, from participating. People with depression are unable to do things they could previously do before a depressive episode. They lack interest, energy, concentration. People with depression do not suddenly get an urge to go out and do something evil that takes a great deal of skill and planning.

Perhaps there is confusion about what depression is. If so, then it is up to people like me, a psychiatrist who is intimately acquainted with depression, to educate about what depression is. The mnemonic device DIGSPACES (Depression, loss of Interest, Guilt, Sleep disturbance, Psychomotor agitation/retardation, Appetite changes, loss of Energy, Suicidal thoughts) is a helpful way to remember these key symptoms of Major Depressive Disorder. To be diagnosed, the person has to have had FIVE or more present over the previous two week period, and it has to reflect a change from the previous level of functioning.

Does any of this sound like someone is focused and energetic enough to go plan the murder of 149 people?

It is stigmatizing to the many people I see who courageously struggle with their depression to see the media continuing to relate this tragedy to depression. I am not saying Andreas Lubitz did not suffer from depression at some point. Evidence shows that he did, and that is very sad. What I am simply saying is that the depression is not why he did what he did. Yes, depressed people can be capable of evil things, they are capable of hurting others, of causing damage, of lying, stealing, just like anyone else. But, it isn’t the DEPRESSION that makes them do this. Their motivations would be the same as anyone else committing evil, violent acts.

It’s hard enough to get people who struggle with depression to get help. Let’s not make it worse by stigmatizing them. This will not only serve to further marginalize the mentally ill, but it will do nothing to get to the root of what really caused Andreas Lubitz to crash a plane full of innocent people. And, both of those situations hurt all of us.

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Mar 15

Dementia Treatment Guide

By Dr. Micaela Wexler

One size does not fit all!WexlerPsychiatryDementia1

The treatment of dementia is a skill that is becoming more urgent for the primary care physician. While it is essential to treat dementia early, it is equally important to remember that one size does not fit all. For example, Aricept, a medication ideal for Alzheimer’s Disease (AD) may be detrimental for Frontotemporal Lobar Dementia (FTLD).

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What follows is a Dementia Treatment Guide, a short description of the most common forms of dementia, and their treatments. This is meant to be a quick guide, not all-encompassing. Please read disclaimer before using this guide.

Alzheimer’s Disease (AD) – most common form of dementia, begins with memory loss followed by language difficulties. As AD progresses from mild to moderate, people lose executive function. Severe AD is characterized by imbalance, decreased movement and complete lack of communication.

AD Treatment:

Mild to moderate AD – acetylcholinesterase inhibitors (Aricept, Exelon, Razadyne)

Moderate to severe AD – NamendaWexlerPsychiatryDementia3

Research shows that targeted lifestyle choices can decrease cognitive decline associated with AD: elimination of simple carbohydrates and gluten, increased consumption of fruits and vegetables, fasting for 12 hours between dinner and breakfast, 7-8 hours of sleep each night, exercising 30 minutes a day 6 days a week, yoga, mediation and stress reduction.

Vascular Dementia (VD) – the second most common type of dementia characterized by a step-wise decline in memory and cognitive functioning caused by decreased blood flow to the brain due to strokes.

VD Treatment: stroke prevention to stop progression; lifestyle modifications to target heart disease, hypertension and diabetes; Namenda is both neuroprotective and improves cognition, preferred over Aricept.

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Dementia with Lewy Bodies (DLB) – movement problems EARLY, memory problems LATER (opposite of AD); rapid progression; visual hallucinations; REM sleep disorder; 3-minute test to screen for LBDWexlerPsychiatryDementia6

DLB Tx: very responsive to Aricept and Exelon, for both memory and behavior; Klonopin for REM sleep disorder; extreme caution using anti-psychotics

Frontotemporal Lobar Dementia (FTLD) – strikes YOUNG people; memory normal in early stages, behavior and mood problems prominent, loss of impulse control; misdiagnosed as Bipolar Disorder; rapidly progressiveWexlerPsychiatryDementia7

FTLD Tx: behavior problems – use Depakote, Tegretol; memory – use Namenda, AVOID Aricept and Exelon; speech therapy preserves function, avoid benzodiazepines

Parkinson’s Disease Dementia a (PPD) – 1 of 5 patients with Parkinson’s Disease gets PPD, 4 of 10 patients with PD get AD.

PPD Tx: Namenda or Aricept for memory, Aricept does not affect movement; extreme caution using anti-psychotics; use Seroquel if needed

Wernicke-Korsakoff Dementia - confabulation, often preceded by Wernicke’s encephalopathy which is characterized by confusion, ataxia and nystagmus. Caused by thiamine deficiency, which can result from alcohol dependence, eating disorders, AIDS, malnutrition.

WKD Tx: thiamine, Namenda, Aricept, Exelon. Namenda neuroprotective. Anti-psychotics do NOT decrease confabulation.

This Dementia Treatment Guide was originally created as a supplement for a CME course given at the Missouri Association of Osteopathic Physicians and Surgeons Annual Convention in Branson, Missouri on May 1, 2015.

Note: photos do not represent people with dementia; they are photos of actors and models, go to 123rf.com for information on releases and credits.
References:
10 Warning Signs of Alzheimer’s

Vascular Dementia: Signs, Symptoms and Treatment

Frontotemporal Lobar Dementia

Lewy Body Dementia Association

The value of clock drawing in identifying executive cognitive dysfunction in people with a normal Mini-Mental State Examination score

Toothbrushing, inflammation, and risk of cardiovascular disease: results from Scottish Health Survey

Poor Dental Health May Lead to Alzheimer’s Disease

Treatment of Frontotemporal Dementia

Clock-drawing: is it the ideal cognitive screening test?

Treatment of behavioral and psychological symptoms of AD with Yokukansan

Aricept beneficial in mod-severe AD and comparable to Namenda in mod-severe AD. No improvement in combining both for Mod-severe AD.

Long term use of donepezil in DLB 108 patients enrolled in 52 week study – improvement in cognitive function, reduced caregiver burden lasted 52 weeks with few adverse events

Risperidone Versus Yokukansan in the Treatment of Severe Alzheimer’s Disease

Atypical antipsychotic drugs in the treatment of behavioural and psychological symptoms of dementia: systematic review

ACETYLCHOLINESTERASE INHIBITORS FOR THE TREATMENT OF WERNICKE–KORSAKOFF SYNDROME−THREE FURTHER CASES SHOW RESPONSE TO DONEPEZIL

Consensus guidelines for the clinical and pathologic diagnosis of dementia with Lewy bodies (DLB): report of the consortium on DLB international workshop

Reversal of cognitive decline – a novel therapeutic program

Results of a large, federally funded trial showed that 10 milligrams of donepezil (Aricept) daily reduced the risk of progressing from amnestic MCI to Alzheimer’s disease for about a year, but the benefit disappeared within three years.

Early diagnosis beneficial in AD
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Feb 07

Fun-filled Day of Womens Heart Health

by Dr. Micaela Wexler

On Friday, February 6, 2015, I had the honor of speaking at a fundraiser for Women’s Heart Health Month. I spoke at the Red Dress Gala held by the Alpha Phi Sorority at Indiana University.
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Full disclosure: my daughter, Sarah Raider-Wexler, is a sophomore at IU, and as VP of Marketing for her sorority, she is in charge of the chapter’s two philanthropic projects. I have no financial ties to pharmaceutical or cardiac treatment device companies. I do not prescribe medications for cardiac medical issues, although I do continue them when patients are admitted to my care in the hospital.
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I am very proud my daughter. It was a beautiful event. Everywhere I looked, there were smiling pairs of mothers and daughters in their red dresses. And, this year they raised several thousand dollars more than last year.

When Sarah asked me if I would be the physician speaker, she said, “Mom, heart disease can be pretty grim: it’s the number one killer of women. So, give them some tips, but please, keep it light.”

Women’s cardiac health is near and dear to my heart not only because I am a physician but because both my parents have heart disease. My father survived a heart attack and my mother survived open heart surgery.

I have learned people are much more likely to engage in healthy behavior if it is fun!

A fun-filled day of cardiac health:

Wake up and take a few deep cleansing breaths while you’re still in bed. Deep breathing decreases blood pressure. Let’s try one right now.

When you get to the bathroom, read the post it note you left on your mirror last night telling you something wonderful about yourself. If all it says is “you’re awesome!” That’s enough.

Then, as you sit on the toilet with your phone in your hand, and I know there are people in this room who do that, read a joke or look at a funny video.

Laughter really is the best medicine. A 2006 study in Maryland showed that laughing 15 minutes a day dilates your vessels 22 percent. This lowers your blood pressure, and putts less strain on your heart.

Now it’s time to crank up your favorite dance song, or two. Something with a beat, and start dancing. Dancing improves heart health. Listening to rhythmic music 30 minutes a day lowers blood pressure and heart rate. I recommend Grenade by Bruno Mars.

Played 10 times in a row.

When you get to work, hug your boss.

Hugs save lives.A study in North Carolina showed that hugs reduce heart disease, and women benefit more than men. And it doesn’t matter if the person is close to you or a casual acquaintance. You still get the benefit. So hug someone every day, several times a day.

If you have to sit for your job, get up and walk around at least once an hour. I take a big container of water and take a huge drink right when I get to work. An hour later, I go to a bathroom far away from the clinic. Fewer people use it, which means fewer germs. And, more movement.

While you’re in the bathroom, think about your beautiful body. This beautiful body that brought you here today. Women, we are COMPLICATED! Women don’t have typical symptoms of heart attacks. If you feel anything funny from your jaw to your pelvis, call your doctor.

Walk during lunch. It doesn’t have to be a long walk. Walking 10 minutes a day twice a day every day significantly reduces heart disease.

Middle of the afternoon: time for some more cleansing breaths. Check out your mood. Are you stressed out? Taking those deep breaths will relax you.

If you find you have trouble relaxing, or that your mood is depressed, think about getting help. Untreated depression carries a high risk of a heart attack, especially for women. You have to be happy: you heart depends on it.

Don’t forget to hug people during the day! Do this every day during Womens Heart Month.

After work, treat yourself to some more dancing while you change out of your work clothes, to get rid of the day’s stress. You earned it!

Then, it’s time for a glass of red wine. Studies have shown that ONE daily glass of red wine is good for your heart.

After dinner, treat yourself to some dark chocolate for dessert. Again, you’re doing this for your heart. Chocolate with 65% cacao is the kind that is good for your heart.

Then just before bed, grab that blank post it, and write something awesome about yourself and put it on your bathroom mirror.

Early diagnosis beneficial in AD
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Nov 26

Comparing Ferguson to the OJ Simpson case

by Dr. Micaela Wexler

In the days since the tragic events in Ferguson Monday night, I have seen an appalling number of Facebook posts comparing the Michael Brown case to the OJ Simpson case. Judging by the wording of the posts, the posters consider themselves quite clever as they point out that “white people didn’t riot when OJ Simpson was acquitted.”

First, it is disappointing to see how quick people are to judge when they have not walked in another person’s shoes. I don’t know if Officer Wilson was right or wrong in what he did, I wasn’t there, it is not my place to judge him. It is also not my place to judge how a people responds to deep psychic pain. Second, to compare the Michael Brown case to the OJ Simpson case is irresponsibly ignorant. OJ’s acquittal says more about how we devalue women and over value celebrities then it says about race.

In addition, whether one agrees with what Officer Wilson did or not, what happened in Ferguson is a monumental tragedy. First, an 18 year old man lost his life after doing what I have witnessed countless teenage boys do: shoplifting and walking in the street. His body was left to bake in the hot sun for four hours before it was removed. This loss tore open a deep wound in that community.

What happened in Ferguson Monday night is a large scale of what I see every day as a psychiatrist: people who are so angry and wounded they give up and destroy themselves. That community committed a form of collective suicide. It is as morally repugnant for us to use these events as a form of entertainment as it would be to make an individual who died from suicide an object of derision.

Early diagnosis beneficial in AD
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Oct 14

Talking to your teenager about Ebola

by Dr. Micaela Wexler
wexlerpsychiatryEbola

As the Ebola epidemic continues to grow in West Africa and begins to spread to other countries, it is natural for teenagers to become distressed. One teenager asked me yesterday, “Are we all going to die from this?” Even though I am a psychiatrist who treats teenagers daily, I did not have an immediate answer.

I decided to do some research and share my findings and ideas on this blog.

First, be calm when talking to children of any age about Ebola. Don’t panic. Don’t give in to hysterics. If you harbor fears or conspiracy theories, share them with other ADULTS. There is no need to share ideas not founded in fact with teenagers.

Stick to established facts. After consulting the CDC web site, I not only had some answers, but I was reassured that it is very unlikely, maybe impossible that we are all going to die from Ebola.

Share with your teenager how Ebola is transmitted. According to the CDC web site, Ebola is transmitted through direct contact (through broken skin or mucous membranes in, for example, the eyes, nose, or mouth) with:
- blood or body fluids (including but not limited to urine, saliva, sweat, feces, vomit, breast milk, and semen) of a person who is sick with Ebola
- objects (like needles and syringes) that have been contaminated with the virus
infected animals

Ebola is not spread through the air or by water. In the United States, it is also not spread by contact with food. In West Africa, handling wild animals used for food also poses a risk for Ebola transmission. There is no evidence that mosquitos or other insects can transmit Ebola virus. Only mammals (for example, humans, bats, monkeys, and apes) have shown the ability to become infected with and spread Ebola virus.

Point out to teenagers their low risk for Ebola. People at highest risk are healthcare providers caring for patients with Ebola and close friends and family members of patients with Ebola. So, unless your teenager is a healthcare provider, her or his risk is almost non-existent.

Ebola Symptoms

Teenagers benefit from having concrete facts. It doesn’t hurt to teach your teenager the signs and symptoms of Ebola. Signs and symptoms include: fever, severe headache, muscle pain, weakness, diarrhea, vomiting, abdominal pain, unexplained bleeding or bruising.

Give your teenager a plan for coping with Ebola. I was happy to note that for non-healthcare workers, it is pretty easy to avoid acquiring Ebola. Practice personal hygiene, such as frequent hand washing. Avoid contact with bodily fluids, such as vomit or saliva, of people with signs of infection. Avoid travel to areas of the world, namely West Africa, with Ebola outbreaks. Avoid contact with bats, rodents and non-human primates known to carry the virus.

Ask your teenager to share her or his ideas of how the Ebola outbreak should be controlled. Remember, teenagers will soon be tomorrow’s leaders; let them know we value their ideas.

Finally, point out our healthcare system is one of the best in the world. Yes, tragically, the first person to be diagnosed with Ebola in this country has died and a nurse who cared for him has contracted Ebola. However, we have the capability to learn quickly and implement changes.

The same day a nurse caring for Thomas Duncan was diagnosed with Ebola, the University of Kansas began treating a patient who arrived with a high fever and had been working on a medical boat off the coast of West Africa. KU Medical Center immediately implemented CDC guidelines. The patient called the hospital and was met with staff wearing protective equipment. The patient was immediately isolated in an area of the hospital with its own ventilation system. The staff caring for the patient will not care for any other patients until Ebola is either ruled out, or the patient no longer requires treatment. (Update: initial tests are negative for Ebola.)

As with any crisis, it is important to remain calm, get the facts, and focus on scientifically backed methods to cope with the crisis. There are many other dangers which our teenagers face. For example, it is estimated that every year 2 million adolescents attempt suicide. Teenagers face a great number of risks which do not have easy solutions, such as hand-washing and avoiding vomit. Let’s keep things in perspective as we communicate with our teenagers, and let’s not let hysteria distract us from their very real needs.

Dr. Micaela Wexler provides child, adolescent and adult pscyhiatric services in Kansas City.

Please visit Wexler Family Psychiatry to schedule an appointment.

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Logo Copyright Debby Bloom

Appointment information for Dr. Micaela Wexler: wexlerpsych.com

Aug 29

1-800-273-TALK – every college student should know this number

By Dr. Micaela Wexler

WexlerPsychiatryWinter

34,000 people die from suicide in this country every year; 1100 of them are college students. Suicide is the second leading cause of death for college students.

With these statistics, why isn’t the number to the National Suicide Prevention Lifeline, 1-800-273-TALK, easily accessible to every college student?

For every person who dies from suicide, 6-7 are left behind with deep lasting pain. For college students, that number is much higher, especially for high functioning students “who had everything to live for.” Students who are bright and popular leave a frightening and persistent feeling of confusion in their fellow students, even in those they had never met personally. When Kyle Ambrogi committed suicide at U Penn October 2005, his team mates were unable to focus, and lost four consecutive games, giving U Penn its first 5-loss season in 6 years.

For me as a psychiatrist it is a tragedy that in an environment such as a university, with so many resources and knowledge, the information about mental health treatment and it’s effectiveness remains elusive. My work has brought me into contact with many suicide attempt survivors who emphasize to me the life saving power of treatment. There is a way to make the pain go away. There are therapies and medications that really do work.

Sadly, most college students do not know where to turn for help. Others fall prey to the stigma of mental illness that persists, even at universities where mental health professionals are trained. They are afraid to seek help for fear they will appear weak, or will suffer consequences, such as loss of friendships, or expulsion from organizations, or even expulsion from school.

The pain of suicide is too great for this to continue. The death of a college student to suicide is a tragic loss for our society as a whole. All students should have 1-800-273-TALK, the National Suicide Prevention Lifeline, written on their bathroom mirror. Students and professors should know the warning signs for suicide: IS PATH WARM (Ideation, Substance Abuse, Purposelessness, Anxiety, Trapped, Hopelessness, Withdrawal, Anger, Recklessness, Mood Swings).

The reasons behind suicide are varied and complex. College students should know that this is a preventable cause of death. The American Foundation for Suicide Prevention is a good resource for those who have been affected by suicide and want to know the “why” behind this painful event, as well as steps we can all take to prevent such future tragedies.
Early diagnosis beneficial in AD
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Appointment information for Dr. Micaela Wexler: wexlerpsych.com