Bias in illness

RE: Bias in illness

Kate Richardson — Fri, 25 May 2018 10:12:11 GMT

[quote user="Aine Seavers"]

Yes, re forums-I have to limit myself!. I think the FB feline group must be what I call the CVE one-it used to be only for feline distance ed groups but now open to all vets-I thought I saw you post yesterday-unless there is another Kate Richardson-not possible:-).

[/quote]

Yes that would have been me, so if that's the CVE one, then I am on it!

weirdly enough though there is another Kate Richardson and she works in a practice 20 minutes away......

RE: Bias in illness

Aine Seavers — Fri, 25 May 2018 01:20:30 GMT

RE: Bias in illness

Aine Seavers — Fri, 25 May 2018 01:13:38 GMT

I am no shrinking violet as you correctly say but I don't play the person and nor do I back off if attacked but at the end of the day you want to be surrounded by people who allow you to be the best version of yourself to have a happy positive day. That didn't happen on Vetsurg as just pedantically combative and negative so when there was so much support and information to have and share effortlessly elsewhere so folks went-and I suspect I am not alone in doing/saying that. That said I did miss being able to run some things past you and Kate and Alex/Ales etc so nice to be back in touch.

RE: Bias in illness

Kate Richardson — Thu, 24 May 2018 13:31:38 GMT

[quote user="Aine Seavers"]

Excellent comment Kate!. I thought I would see you pop up on the Feline only Forum by CVE but never saw you and now suddenly up you are there. Something Martin should join as well

[/quote]

Hi Aine, I use the ISFM forum a lot and dip my toe in the FB feline group as well, didn't know about the CVE one, but can't cope with anymore forums!!! Spend too much time on them as it is

Welcome back

RE: Bias in illness

Martin Atkinson — Thu, 24 May 2018 13:04:47 GMT

[quote user="Aine Seavers"] I am glad one of the list did check in on you-we are learning from Wynne even in her absence. warm hugs Aine[/quote]Thanks for your hugs! I think you will find the forum a friendlier place so welcome back. But then you were never a shrinking violet yourself.

RE: Bias in illness

Julie Innes — Thu, 24 May 2018 11:33:59 GMT

Re the UTI thing- yes, definitely! When my gran was in and out of hospital , having urinary catheters in I could walk in to her room, have her tell me "There was a fire here today and they left me to burn, than bathed me in the street in front of everyone!" and go find as nurse to tell her gran had another UTI.

When my uncle was in hospital they were trying to tell us he had drug or alcohol or mental health issues, because he kept trying to escape (made it to the train station in his hospital gown!) but it turned out it was a UTI (which we asked them to check for but they wouldn't, initially.)

RE: Bias in illness

Aine Seavers — Thu, 24 May 2018 11:33:28 GMT

I am sorry to hear you had struggles- I logged in a couple of times quietly recently on this forum and found you absent alongside same old same old insult trading posts so I left again but I did half register it was odd nothing from you so now I feel slack at not checking more. I am glad one of the list did check in on you-we are learning from Wynne even in her absence. warm hugs Aine

RE: Bias in illness

Aine Seavers — Thu, 24 May 2018 11:29:04 GMT

Excellent comment Kate!. I thought I would see you pop up on the Feline only Forum by CVE but never saw you and now suddenly up you are there. Something Martin should join as well

RE: Bias in illness

Martin Atkinson — Thu, 24 May 2018 10:11:48 GMT

[quote user="Jo Dyer"]Hahaha, the number of online Asperger's tests I've done! All negative so far....[/quote]Not done those, but the TV documentary on Chris Packham a while ago made me realise I had much in common and its not just because I'm a miserable b*****d! However, I did do an online test for being a Psycopath and only the fact that I have never deliberately hurt anything or anyone stopped me from being full-blown!

While the above is amusing, there is a danger with this self-analysis. The truth is none of us fit a simple diagnosis, mental illness is multi-faceted as are the ways we personally deal with it and the factors which trigger it.

RE: Bias in illness

Bob Russell — Thu, 24 May 2018 09:49:40 GMT

The trouble is that we work in a profession where there is often very little control. We don't know what is going to come through the door next, we don't know how much money will go into the till (especially business owners) and diagnosis is often educated guesswork.

Stress is therefore a normal part of the job for many or most.

We expect so much more of ourselves than is realistic and much of the time we deliver.

I have struggled with a bank that went from 'supportively' leaving me alone to nit-picking and problem creating last summer. The old manager was sacked and replaced by an obnoxious oik that wanted to know how much I spent on groceries each month!

We are changing bank for that reason but so far not much has happened in nearly six months so like wading through treacle! I have a small mortgage and a number of tiny loans so the borrowing is small! Perhaps you have to owe a lot of money to be treated with respect these days.

Frustrating and ridiculously stressful for no purpose at all.

We have to decide what is 'normal' pressure and what is 'abnormal'. Sometimes not that easy to decide at which point it is necessary to ask for help.

I have to admit that I wish I had been introduced to beta-blockers long ago!!

RE: Bias in illness

Liz Barton — Thu, 24 May 2018 09:31:24 GMT

[quote user="Aine Seavers"]I left Vetsurgeon as it was just too toften just a toxic place to log into. Hopefully the new format will work better.[/quote]

Absolutely! And please flag to us if it doesn't feel like the supportive environment we intend it to be. We just need happier places to be online! Especially in light of vet bashing, trolling etc.

RE: Bias in illness

bevs2251 — Thu, 24 May 2018 07:30:34 GMT

Interesting that infections in other parts of the body can cause/predispose to depression/mania etc. Wonder if this happens in animals also ?

Phenergan helps me sleep when I have a hay fever attack but use the 25mg which can make me a bit dopey the next day ! Will order 10mg next time. Unfortunately Piriton taken off market in Oz years ago. Tend to use Zolpidem (Stilnox) 1-2x/week when working the next day but still only get 4-5 hours sleep with that.

Suffered a few bouts of depression over the years (on Zoloft/Sertraline anti-depressants a couple of times) - work and personal issues build-up to a point where chemical help was required. Have avoided using for the last few years but always not far from the drain-hole ! Would be on them if I still worked full-time !

RE: Bias in illness

Aine Seavers — Thu, 24 May 2018 02:24:47 GMT

Undiagnosed UTI can be a cause of mania and in the elderly misdiagnosed as part of the dementia spectrum when clearly not. I had an episode of mania many years ago-induced by the Vit B supplement the doctors put me on-apparently not unknown and clearly reported in the compendium as a side effect. I had a great time, lost 3kg, ate with delicious taste, could speed read and lock to memory tonnes of journals and laughed at life. My mother hallucinates badly on Klacid and both my daughter and husband get personality changes on fluroquinolones. Apparently Baytril Vet med itself misused in humans is known for mania and dissociation. So there can be drug and infectious causes for the mania so make sure they check that out.

Re stress-Wynne's death was a wake up call to me and I left Vetsurgeon as it was just too toften just a toxic place to log into. Hopefully the new format will work better.

Re being human-I recently had to reach for the phenergan (which is also a great analgesic and dries up middle ear secretions so double pain relief) for a night's sleep following horrendous stress where a lawyer client not seen for 6 months presented me with a case that I referred almost asap to specialist centre. when there the young specialist intern big noted themselves to the client without reading my history, announced the drug I had used for the dog's skin( the first drug after 8 vets which fixed the skin) was now the cause of the elevated liver enzymens and told the client my choice of stabilization therapy before sending the dog on the 2 hr journey to them was inappropriate-all of which client then emailed me midnight onwards about in very nice language but obviously blaming me and dirt digging. I have never been so thrown in all my life. The fact that over next 4 days my drug choice was exonerated and proven not to be the cause (but rather the cause being something I had to highlight to the specialist centre!) and my therapy perfect given the presenting parameters measured by them when dog arrived and thrived is beside the point- those days were horrendous. I wrote and complained to the management on the basis that treatment like that is how young vets kill themselves and it was only because I was a battled hardened person with a strong supportive family that I pulled through. I have insisted they take all their front line staff in for a seminar on how to handle clients and shut up before you get all your information in. Until then I am never referred to that site again. It was a classic example of a young specialist not knowing everything being presented with some thing new a general practitioner did and going for the-it must be wrong or out of date cos I Ms Specialist don't know about it-when in fact its actually cutting edge and the egg is then on the specialist face to back track and unsay/do their error. There is just no need for any of it esp now as vets we face the stress of the 'cheap cacophony of voices' that is ignorant social media trolls and keyboard bullies sniping away at people trying to live and work a good life.

RE: Bias in illness

Liz Barton — Wed, 23 May 2018 23:23:11 GMT

[quote user="David Mills"]The problem I think is determining what is disease and what is normal. [/quote]

I doubt we will ever be able to do this as the mind is such a complex beast, therefore it will always be difficult to judge if we do/don't have the necessary definable features. It's about framing the terminology in a way which makes it okay to talk about without stigma.

[quote user="David Mills"]People misreport all the time, so if this is your only (or main) source of information, the diagnosis and outcomes are inevitably going to be more vague.[/quote]

As true for physical as it is for mental disease!

[quote user="David Mills"]Increases awareness is good, but let us not push advancement at the expense of accuracy. And let us not make the normal abnormal.[/quote]

Nor the abnormal 'weakness'! Accuracy will always be difficult when it comes to mental illness - and often lacking. This doesn't sit well with our analytical minds, but is it not better to err on the side of medicalising than risk trivialising?

RE: Bias in illness

David Mills — Wed, 23 May 2018 22:33:28 GMT

[quote user="Liz Barton"]

[quote user="Kate Richardson"]don’t refer to it as a moment of weakness. It is not. [/quote]

We wouldn't call renal disease or pneumonia a moment of weakness. We'd call it an illness. Whether it's happening in the brain or another organ, it's an imbalance in the body - be it chemical or inflammatory. We need to get used to discussing mental illness in the terms we use for physical illness.

[/quote]

The problem I think is determining what is disease and what is normal.

Physical diseases have more definable features.

Mental disease suffer from the accesibility of the mind. For instance, look at the studies on description of seizures by owners, compared to analysis by vets (seeing a video). People misreport all the time, so if this is your only (or main) source of information, the diagnosis and outcomes are inevitably going to be more vague.

Then add in questionable diseases e. g. Female sexual dysfunction. Arguably, ADHD. Etc.

This is not a criticism of mental health disease. But, to me, to say they instantly are the same as "physical disease" somewhat, if anything, does them a disservice. Increases awareness is good, but let us not push advancement at the expense of accuracy. And let us not make the normal abnormal. Whilst humans are hedonistic, life is not, to a greater or lesser extent.

RE: Bias in illness

Liz Barton — Wed, 23 May 2018 22:27:02 GMT

[quote user="Kate Richardson"]don’t refer to it as a moment of weakness. It is not. [/quote]

RE: Bias in illness

Kate Richardson — Wed, 23 May 2018 22:13:55 GMT

Thank you both for sharing your experiences. I experienced a period of depression several years ago (not work induced) and have had low level anxiety since managed well with medication which fortunately has no side effects. But please Martin, don’t refer to it as a moment of weakness. It is not.

RE: Bias in illness

Liz Barton — Wed, 23 May 2018 21:30:58 GMT

[quote user="Jill Butterworth"]I could write a book. Given that I’m suddenly not now able to practice clinically for the time being, that might become a viable option.[/quote]

Hi Jill!

Thank you for your honesty and openness. My mum had episodes of mania and psychosis this time last year and it was a frightening time for all of us - it was linked to an untreated UTI.

If you did want to write then opening these conversations is so helpful for others going through related experiences, and I could share/post on the Vetsnets support hub - just PM me!

Best wishes for a full, speedy recovery!

RE: Bias in illness

Jo Dyer — Wed, 23 May 2018 17:25:06 GMT

[quote user="Martin Atkinson"]I'm always happier on my own. I realise now that this probably means I'm borderline Asbergers.[/quote]

Hahaha, the number of online Asperger's tests I've done! All negative so far....

Have you read the book 'Quiet' by Susan Cain? It's very enlightening for introverts and it sounds as if you are probably one Martin. Of course we are all a collection of traits, it's only when one or more of those traits affects our day-to-day functioning or causes us to suffer that it becomes a disorder.

We humans are so complicated. That's one of the reasons I love dogs so much!

RE: Bias in illness

Jill Butterworth — Wed, 23 May 2018 09:33:43 GMT

[quote user="Jo Dyer"] are they giving you any treatment for the hypomania? Or is it a case that when the pneumonia settles, that will go away as well?[/quote]

I'm just taking Zopiclone 7.5mg SID to induce sleep, which has probably mildly sedated me the rest of the time, to bring my brain down into second gear from fourth. Sleep deprivation is a compounding factor, which as a a vet, I hadn't considered much, except to know that it is used as war torture. I had 4 days straight of the hypomanic symptoms, with barely any sleep, but of course, 9 days of poor sleep, from the onset of pneumonia proper. The psychiatric consultant is hoping that all I need is actual sleep, normal to gradually take over from induced, and my brain will right itself. It's premature to diagnose any underlying conditions at the moment.

You are right, I'm getting an insider's guide to a totally new subject, and I think, becoming what is know in the trade as an 'expert patient'. I have to make sure they can keep up, when taking my history, as I throw in a bit of self diagnosis and excessively detailed observation, just in case it's significant...

One amusing moment came, when I could barely stand up, at the desk at A&E (again) trying to explain what I needed, a nurse came up and gently pressed a leaflet into my hand asking 'Would you recommend our service to Friends and Family?'

WTF?

It turns out there is no space on this form to properly comment on your clinical care. This so called Friends and Family Test is designed by managers to secure NHS funding, mired in targets and changing political policies.

Plenty for me to write about...

RE: Bias in illness

Martin Atkinson — Wed, 23 May 2018 09:28:56 GMT

[quote user="Jill Butterworth"]The consultant psychiatrist thinks it was hypomania, [/quote]

As I said earlier, my younger daughter has been diagnosed with bipolar syndrome. Being bipolar means she is often depressed and has anxiety attacks but manages to cope with her hobbies and music, then becomes hyperactive and almost embarrassingly loud at other times.

It is interesting all the confessions that are coming forth in this thread and it reinforces Jill's assertion that we never quite have our brains under control. Maybe when we were hunter gatherers we were too busy just surviving from day to day to have time for inward, potentially destructive thoughts.

[quote user="Jill Butterworth"]Martin's unexpected confession underlines the silent nature of mental illness, and his usual brashness confirms the Shakespearean observation: 'the lady doth protest too much'.[/quote]I've never thought of it that way, I've always felt that I could look dispassionately look at other people's problems and analyse them from a logical point of view. But as we've discussed, if we're in a comfort zone of relative normality and day to day stability we may be deluding ourselves everything is alright and it takes very little to knock us off line.

However, I have often swung from being somewhere with people I don't know well and almost depressively wishing I was not there, to being the life and sole of the party if I'm confident, but I'm always happier on my own. I realise now that this probably means I'm borderline Asbergers.

To make a more modern quotation - Freddie Mercury: 'I am the great pretender, pretend that I'm doing well', or 'It's finally happened, I've gone slightly mad'!

RE: Bias in illness

Jo Dyer — Wed, 23 May 2018 08:41:05 GMT

[quote user="Jill Butterworth"]My whole life made sense, I could see clearly what I need to do to put things right, for example, who was safe to be around, which of my well meaning friends were too troubled themselves, to be helpful. All my senses were/are heightened (I could tell my friend's female cat had peed in their lounge, about 15 feet away!). I remember remarking to myself distinctly, that it is a shame that most physical illnesses are accompanied by the polar opposite, depression, which makes it difficult to even visualise how to fix something trivial. [/quote]

That is so interesting to hear 'from the horse's mouth' as it were, thank you so much for sharing. I think the brain is endlessly fascinating, soooo complicated, it's only surprising that it doesn't get a bit disrupted more often.

I remember having a cold virus which made me suffer from symptoms of depression, and talking to other people they had it as well. You are right, physical and mental disorders are often interconnected. I also agree with you about navigating the health system. Having tried to get my son diagnosed when he first developed symptoms of Crohn's, I could see that dealing with the NHS could be ok if you were physically fit but vey difficult if you were actually ill. Even so it gave me suicidal thoughts. It made me concerned for the really sick people, frail and old perhaps, who don't have anyone to advocate for them.

You don't have to answer this question, but, are they giving you any treatment for the hypomania? Or is it a case that when the pneumonia settles, that will go away as well?

Wishing you a speedy recovery.

RE: Bias in illness

Jill Butterworth — Wed, 23 May 2018 06:44:09 GMT

[quote user="Jo Dyer"]It sounds as if the mania was not a totally negative experience? I'm doing an MSc in the psychology and neuroscience of mental health, with the current module being Affective (mood) disorders. We were told that hypomania (slightly less serious version of mania) is the only psychiatric disorder which can actually improve functioning.[/quote]

The consultant psychiatrist thinks it was hypomania, and what you say is fascinating because, yes, it was euphoric, apart from the fact that it wouldn't stop, it was really insightful (diagnostic compared to true mania where the sufferer is deluded about their condition). My whole life made sense, I could see clearly what I need to do to put things right, for example, who was safe to be around, which of my well meaning friends were too troubled themselves, to be helpful. All my senses were/are heightened (I could tell my friend's female cat had peed in their lounge, about 15 feet away!). I remember remarking to myself distinctly, that it is a shame that most physical illnesses are accompanied by the polar opposite, depression, which makes it difficult to even visualise how to fix something trivial.

The comments about acute on chronic stress are pertinent to Martin's and my own situation: I felt straddled between a physical and mental illness, perhaps this is not universally acknowledged, but actually normal.

Martin's unexpected confession underlines the silent nature of mental illness, and his usual brashness confirms the Shakespearean observation: 'the lady doth protest too much'.

We've all got a brain, so we've all got a mind, and it's never under our complete control...

RE: Bias in illness

Clive Ansell — Tue, 22 May 2018 20:49:12 GMT

[quote user="Martin Atkinson"]I went to the doctor for a chat and to get something to help me sleep. She gave me some Phenergan. 'What the **** I thought' but it actually works very well with no hangover.[/quote]

I was prescribed Piriton (along with Cetirizine) for Chronic idiopathic Urticaria by a consultant dermatologist. She went on to explain that it also has (Off label) antidepressant and anti anxiety properties too, given that a very closely related molecule was the precursor for some of the early SSRI anti depressant drugs. It certainly does make me sleep really well, although I now rarely need it.

RE: Bias in illness

Jo Dyer — Tue, 22 May 2018 19:52:47 GMT

[quote user="Jill Butterworth"]....have developed my first ever episode of mania during my recovery. It wasn’t and still isn’t, clear if it was a drug reaction, due to the infection or just a spontaneous episode triggered by severe stress. [/quote]

Really interested to hear that, and of course it could have been due to any of the above. I hope you are recovering now from both disorders. It sounds as if the mania was not a totally negative experience? I'm doing an MSc in the psychology and neuroscience of mental health, with the current module being Affective (mood) disorders. We were told that hypomania (slightly less serious version of mania) is the only psychiatric disorder which can actually improve functioning.

[quote user="Martin Atkinson"]I feel a large part of Jill's and my problem is that we're so used to being the strong ones who can cope with what is thrown at us that when something happens apparently quite suddenly our coping mechanisms, which have been struggling under the strain without us often realising it, are suddenly overwhelmed like the dam that finally burst under pressure from the water that has been building slowly. [/quote]

I think you are absolutely right Martin. I'm sorry to hear you have had a bad start to the year and glad to hear things are picking up. I'm currently learning about HPA axis disruption and glucocorticoid resistance in depression which of course fits with the 'acute on chronic' stress scenario you describe.

Stigma is such a big thing with mental health but the thing is I bet we have all suffered to a greater or lesser extent in our lifetimes. It's great to hear people in all walks of life talking about it and making others realise that it is nothing to be ashamed of. I'm not sure why it ever was felt to be shameful, seems ridiculous to blame someone for being ill!