Monday, April 29, 2013

Boston Marathon Runner & Psychiatrist Shares Personal Story of Patriots' Day 2013

Special guest post by psychiatrist Brent Forester, M.D.
"People here need to talk about what they have been through,” says Dr. Forester. “I spoke with my medical students after the race, and they all wanted to do something to help. I told them that the injured, their families, and first responders all need a lot of emotional support.”
Monday, April 15, 2013 began as a sunny, chilly early spring day...a perfect respite to our long, dark, cold winter that brought challenges to the months of training required to run a marathon. My wife, Kim, was giving me a hard time for the training schedule I was keeping, perhaps secretly knowing what I did not yet realize: I was destined to run Boston in 2013.

What began as a challenge from Kim to run a half marathon in 1999 had morphed into a full blown passion and time consuming avocation: running long distance races to fundraise for the Alzheimer’s Association and this year, a mentoring program for future geriatric psychiatry clinicians. But after a personal best in the Chicago Marathon in October 2012, I had decided to spend 2013 focusing on a more “normal” distance of 13.1 miles, setting a goal of running 50 half marathons by my 50th birthday (35 down with three years to go!).

Perhaps by fate, one of my running buddies was felled by a foot injury and offered me his number for Boston in late February, with only six weeks to go until race day. Luckily, I had been training with this most incredible group of friends, all neighbors and fellow runners, meeting five days a week at 5:40 a.m. (or earlier!) at the corner of Ledge and Mossman in Sudbury. Sadly, a year of brainstorming had yet to generate a team name.

On Saturday before the marathon, our families and friends gathered for a festive night of pasta to celebrate all the hours and miles of running, lack of sleep, painful legs, and cross-training efforts that included early morning TRX and spin classes and a Tuesday night yoga group for runners (minus the see-through Lululemon wear). Anticipation and excitement for Monday, Patriots’ Day, was at a peak.

The Boston Marathon is known for Heartbreak Hill, the cheering Wellesley women, the rowdy and inebriated Boston College students, the biker bar patrons on the Hopkinton/Ashland line yelling in their black leather outfits drinking beers on a Monday Morning. Where else does this happen? The Boston Marathon is all about the crowds. They are loud, deep, diverse, and hysterically funny with signs and outrageous costumes. The same fans cheering on the world’s elite, yell even louder for the “normal” charity and barely qualified runners, distributing beer, oranges, pretzels, and even Vaseline on a stick to reduce the inevitable burning and blistering skin.

Monday, April 15th was a tough run for me. It was warmer in the sun than expected, and a pacing problem during the first half of the race left me weary climbing Heartbreak Hill. But a running buddy neighbor of mine ran a mile with me through the Newton Hills, and then I took off, determined to complete this race in less than four hours. It would be very close. The Red Sox crowd had just spilled into Kenmore Square when I arrived, and they were loud…but I stayed focused, down and up Commonwealth Ave. crossing beneath Massachusetts Ave., then a right on Hereford, a surprisingly tough hill up to Boylston, and a left hand turn down the long, endless 800 meters to the finish line near Dartmouth.

3:58:46. I did it! Exhausted. About to break out into tears reflecting my emotional sense of accomplishment and relief, when I heard behind me a massive explosion. I ducked. We shook. And then I looked behind me at a cloud of smoke and debris. “Oh my God,” I thought immediately of the many lives that had instantaneously ended or changed forever. But it was all very confusing: Where were my wife and daughter? I’ve got to get out of here. Where were the water and the silver warming cape? Was that a terrible accident or… And then the second bomb, panic; we were under attack.

Where was the next bomb going to strike? I borrowed a cell phone, “Kim, there was a bomb at the finish line; I am fine. Where are you?” She was driving on Huntington and Dartmouth, a block away…oh no. “Stay away from the Westin, do not park; drive to the corner of Boylston and the Commons.” How come everyone was so calm? The volunteers handed out our water, the silver cape, food, and the precious finisher’s medal, and then I left on Berkeley to the buses for my yellow bag and the port-o-potties, but were they even safe?

I do not recall well the four block walk to that meeting spot; it seemed endless, and there was no Kim when I arrived. And no cell phone service. Then, three of our psychiatry residents came walking across the street, calmly and not sure of what was happening. They are a godsend of emotional support with cell phones. I am shivering. I have not eaten or even sipped any water. An hour passes; finally Kim and my daughter arrive, unscathed. We were safe.

And then the “what ifs” race through your mind: What if I had taken my usual port-o-potty break or not pushed through those last few miles to break the four hour mark? I cannot really think about these realities.

Will the marathon, Patriots’ Day, Boston, Fenway Park, and all the stadiums hosting our beloved local sports teams ever be the same again?

The timing of the bombs was such that the charity runners were crossing the finish line, the four hour gang, not the elites or the sub-three hour athletes, but the everyday guy and gal who train though ice and snow for this moment, to cross the finish line in Boston cheered on by hundreds of thousands of loud supporters, strangers who seem to care about you and want to see you reach your goals whatever they may be. They were the targets of the Boston bombers.

Boston strong, the theme that has risen from the ashes of this tragedy, carries us forward and brings us closer together as a community of runners, spectators, first responders, healthcare professionals, firefighters, and police. We are all together now as one, culminating in the heroic 24 hour siege and Boston area lockdown, another surreal event capturing the intensity, exhaustion, and ultimately relief of a region.

Finally, at 8:42 p.m. on April 19th, it is over. In a boat on Franklin Street, five blocks from my old Watertown apartment. The local hero is a regular guy who spies the blood and then the suspect.

It’s now time to go to sleep. I'll be up in five hours to meet my running crew for a slow six miles around our neighborhood, running for the first time since Hopkinton and sharing our stories, our grief, our anger, and our triumphs. This is the way we process our emotions and move forward. We still need a name for our crew; Sudbury Strong may work.

The American Psychiatric Association's website has resources for coping with traumatic events and how to help children.

Tuesday, April 23, 2013

Depression in People with Parkinson’s Disease

By Dr Mizrab Khan MRCPsych Member of the Royal College of Psychiatrists, United Kingdom

Arshya Vahabzadeh, M.D. Resident Psychiatrist, Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine Follow @VahabzadehMD

Since April is Parkinson’s Awareness Month, we wanted to discuss its connection to clinical depression.
Parkinson’s and Mental Health
Parkinson’s disease is a chronic and progressive neuropsychiatric condition that affects more than one million Americans, with over 60,000 people being diagnosed every year. People with Parkinson’s often develop physical symptoms such as tremors at rest, stiffness, and a general slowing of movement.
Today, there’s a better understanding of the psychiatric and mental health concerns of people with Parkinson’s disease. Parkinson’s disease affects several parts of the brain connected to control of mood. This may cause depression and other mental illnesses that harm the quality of life of people with Parkinson’s disease.
Depression in People with Parkinson’s
People with Parkinson’s disease often suffer from clinical depression (more than one third of individuals). Depressive symptoms include apathy as well as changes in sleep, appetite, and self-esteem. It’s far more than feeling sad or “blue” after being diagnosed with Parkinson’s. Studies show that clinical depression may even come before the development of physical symptoms of Parkinson’s. Becoming depressed is also thought to be independent of the physical symptoms, with some people with mild Parkinson’s developing severe mood symptoms. Detecting the depression may be more difficult in Parkinson’s disease because there’s an overlap between the signs of depression and the physical symptoms of Parkinson’s.
If someone with Parkinson’s disease is increasingly apathetic with changes in mood, sleep, appetite, or low self-esteem, then he or she should see a doctor for a psychiatric assessment. People with Parkinson’s are at a higher risk of suicidal thoughts and actions, so it’s important to pay close attention to these warning signs and seek a mental health evaluation.
Can Depression in Parkinson’s Disease be Treated?
Yes, just as depression can be treated for those without Parkinson’s, depression in people with Parkinson’s disease can be improved using both psychological and medication treatments. However, a personalized treatment plan should be created, and any antidepressant medication should be prescribed by a physician who is aware of the other medications that are commonly used in Parkinson’s disease. Ongoing research will help determine the best method to treat this depression.  

Friday, April 19, 2013

Part 2: What I wish I knew when my daughter was first diagnosed with autism

Guest post by Carolyn Chambers

As the mother of a 9-year old daughter with autism (Kellie was diagnosed with autism in January of 2008 at the age of 4), I’ve learned some things through networking and making friends with other parents who have kids with autism. Now I want to share more tips with you.

Just because a school district (or Early Intervention) says that a certain program is most appropriate for your child doesn’t mean that it is. As I mentioned in the first part of my blog post, doing your own research is key. Here’s a helpful website about special education law and advocacy for children with disabilities: If you don’t agree with your child’s school recommendations, request independent evaluations to help determine what is most appropriate. 
Treat each professional (school and medical) who works with your child with respect and as an integral part of your child’s “team.” If you feel that someone is challenging, find someone more appropriate to join the team.

As you are proactively communicating with your child’s team of doctors and teachers, make sure they are communicating with each other about treatment. Is everyone aware of what the other one is doing? This is especially important if your child responds to something particularly well in a session. Share that information with every team member. This will make your child’s programming much more effective! And, if something isn’t working for your child, be sure to let everyone know that as well.

Use your child’s “quirks” or obsessions as motivators for therapy sessions. My daughter went through a Super Mario phase, so we incorporated Super Mario into her sessions as much as possible which was successful.

Another tip for parents who are married: don’t forget your marriage! You and your spouse need quality alone time whenever possible. Autism can be extremely stressful on a marriage. Often parents get overwhelmed; there is simply too much going on in their day-to-day lives, and “date night” loses priority. This is another reason why connecting with parents who have children with autism is essential. They can recommend child care providers and share their advice for focusing on marriage while raising a child with autism.

While you make time for your marriage, you also need to carve out some “me time.” Time to go out with friends or do something you enjoy by yourself that isn’t autism OR child-related. Maybe that means going to Starbucks with a good book.

Families of children with autism need to budget for out-of-pocket expenses for therapies and treatments, so speaking to other, more experienced parents helped me. Unfortunately, many of the therapies are not covered by insurance. I still have a hard time getting health care benefits for my daughter’s speech therapy, which is what she needs the most. However, there are some creative, legitimate ways to get needed therapies covered and/or reduce your out-of-pocket expenses. Here are excellent resources: and my all-time favorite:

Friday, April 5, 2013

What I wish I knew when my daughter was first diagnosed with autism

Guest post by Carolyn Chambers

Greetings! My name is Carolyn, and I’m the mother of two daughters, Kirsten (10 years old) and Kellie (9 years old). Kellie was diagnosed with autism in January of 2008 at the age of 4. My first marriage ended shortly after my daughter got her diagnosis. I ventured into single mom-hood while navigating through the often overwhelming unknowns of what to do when you have a child with autism. There was no “Autism for Dummies” book back then, though after doing a quick Google search, I see there’s one available now. I ultimately had to figure out how to best help my daughter mostly on my own and began researching, reading, networking, and engaging with other parents as well as picking the brains of the many professionals who I had the honor to work with thanks to autism.

The best parent connection that I made was with a former friend from high school who later became my wonderful and supportive husband! One of our mutual friends advocated that we “reconnect” through Facebook since we both have daughters on the autism spectrum.
Which brings me to one of the top tips I can offer to parents who have recently gone through having a child diagnosed with autism: get connected with other parents, so you can learn from their experiences.

Join a parent support group like TACA (Talk About Curing Autism). Personally, this has been my #1 and what helped my daughter the most. I learned so much from other parents’ advice on best therapy providers, doctors, school districts, behavioral-type of programs, treatments, interventions, problem solving, etc. And, as a bonus, I made some life-long friends through the support groups.

You should also attend autism conferences; that’s where you’re going to discover the newest cutting edge treatments and therapies as well as learn about the latest research in development. It’s your chance to be immersed with experts and professionals (and another opportunity to network with parents!).

But be prepared to be confused with all of the conflicting information and advice that’s out there. Researching and consulting with experienced parents and doctors will prove priceless.
Paying close attention to your child’s diet is another helpful tip I’ve received and wanted to share with you. You are what you eat! Learn about all of the special diets out there that are said to benefit children with autism and ADHD. At the very least, cut out the junk food, processed, and artificial ingredients. This is something all parents and caregivers should do for their kids regardless of an autism diagnosis. Understand how the digestive system is connected to what goes on in the brain. There’s plenty of science-based knowledge out there supporting the importance of nutrition. Be sure to ask other parents about what diets have been most successful for their children with autism.

Be wary of “miracle cures.” The curse of being proactive when it comes to researching possible interventions for your child is being exposed to all the countless “treatments” that make too good to be true promises and drain your wallet. Me being an information junkie, I don’t mind reading about some of these “treatments” with a grain of salt. But before considering any treatment, even the ones that are less “out there,” remember to research them thoroughly and speak with as many parents as possible who have tried that sort of treatment. Any treatment you proceed with should be done under an experienced doctor’s guidance.
I have more tips to share, so, please come back next week to read the second part of my post.