PTSD after car crash

I just moved from one office to another in my building and ran across an article that was brought to my attention a while ago, but I never got around to writing about it.

Many of us are aware of the potential for death and injury in motor vehicle crashes (we had quite the confluence of them locally last week end):

“…traffic injury remains the leading health threat to children in the United States. In 1996, 938,000 children under 21 years of age were injured as passengers in cars, 39,000 pedestrians and 33,000 bicyclists.”

What isn’t often noted, looked at or realized is the psychic trauma that accompanies being in a crash, even if you are minimally injured. The study the article referred to found that after involvement in a motor vehicular crash, even with minimal injury:

“25 percent of these children and 15 percent of their parents suffered PTSD”

The lack of recognition of this problem leads to those folks not seeking or receiving care and treatment for their symptoms and problems. Only a minority of these folks even talked their symptoms over with others, so they were getting no support through their difficulties. PTSD (post-traumatic stress disorder) can lead to long term difficulties and even suicide, so it should not be ignored. It needs to be made clear to folks that these psychic injuries are no less real than the physical ones, and no less worthy of treatment than the physical ones (both can lead to chronic problems).

Mycobacterium vaccae is your friend

Talk about natural health treatments, Earth one of the ancient "elements". I came across an article about the health benefits of dirt and Mycobacterium vaccae.

It seems that exposure to M vaccae, i.e. getting it “under your skin”, boosts your immune system and improves your brain chemistry. So now there is a scientific “reason” for feeling good after you’ve worked in your garden or out in the yard, beyond the fresh air and sunshine. These bacteria get into your system and one result of the immune cascade is that serotonin production in your brain increases. More serotonin elevates your mood and has a few other positive mental effects that I recall studying some years ago.

So if you are feeling a bit down, grieving, or otherwise in a "funk”, get down and dirty. Get your hands in some dirt (soil for those that don’t like to play in the dirt). Breathe in that great aroma of fresh, moist soil. Welcome Mycobacterium vaccae into your system, into your body’s milieu. Germs can be your friends (and often are).

I've said it before

I've said it before (but it does seem to have universal applicability):

Think

Don't take chances

Make good choices

Too many kids die

I was talking a reporter (one of many today and over the weekend) and he was asking if I thought there was any common threads among several recent incidents or if there was something in common that could be used in prevention.

He was not so much thinking of the 16 and 17 year old girls who died in a crash in the middle of the day on Saturday, but more of the 15 year old who died in a crash at 3:45 am. That 15 year old was in a car driven by a 14 year who was quite intoxicated. There have also been some other cases of death or injury in the region that occurred late at night, or early in the morning, depending on your perspective, that beg the question are “we” doing something wrong or not doing something right.

I told him that they should be at the very least wake-up calls for people to pay attention to what is happening to their kids or kids close to their kids. I told him I re-evaluated (again) curfew and other issues pertaining to my teen. I also discussed with him my feeling that at the root of at least some of this is that we parents make mistakes of commission and omission. Parents try too often to be their kids’ friend instead of their parent and are therefore too lenient and put fewer restrictions on them then they really ought.

Teens still need control and direction, even if it means you have a shouting match or 2. While they may seem pretty mature, their brains really aren’t developed to that point When stressed or when peers are around or something else happens their “second guessing” or reconsidering fails. They don’t think a second time through something to realize that it really isn’t a good choice or a good idea. They plunge ahead, often making wrong choices and taking chances to their detriment.

That’s what goes through my head when these things happen in my county or I read about them elsewhere. I hope that we can stop the next one.

Death prevetnion via pre-prom event

I have not been so affected by a pre-prom event as I was today. I may have been in a more emotional state with other stuff that is going on, but it really hit me today.

A pre-prom event (at least most of them around here) consists of a crash enactment with bashed cars and teens with make-up and mikes or a recorded dialog played for a large group of students on the football field, followed by a couple of speakers (very often including the Coroner). The point is to convince teens not to drink or use other drugs, not to drink (or use drugs) and drive, and not to ride with someone who is intoxicated, with at least the nominal focus on the upcoming prom night.

Today’s event followed that formula. The weather was great. The audience quiet and seemed to pay attention. Differences started fairly early. Through the course of the event about 5 of the seated students passed-out and had to be taken out (I think 2 to the hospital). So it was apparent at that point that there was a fair amount of emotional energy in the “air”. I spoke after the physical part of the presentation and I think I did fairly well (there were positive comments later). I spoke about possible deaths and injuries, loss of potential, the “forever” need to say you’re sorry if you are responsible in any way, and that I don’t want them dead in my office and to have to inform their folks.

What really got me however was the mother who spoke after me of her 2 teens involved in a drunk driving accident. One of her son’s died as a result, her other critically injured. She talked of the ICU and the test that showed “brain death” before his heart stopped. She talked about how they unwrapped his Christmas gift (the crash happened just before and his death just after Christmas), a leather jacket, and had him buried in it. She showed the shirts that were cut off his body when he received emergency care to no avail.

I cried as she talked and hugged that mother when she finished. When will I have to cry and hug another mother?

Food for the forest or cremation, I'd consider it

An Australian scientist called Wednesday for an end to the age-old tradition of cremation, saying the practice contributed to global warming

But to bury the hatchet with environmentalists, he suggested it would not be a bad idea to bequeath one's body as food for a forest.

Grief is about more than death

We grieve many things, not just death. Any loss generates grieving. The amount and degree of grief varies with the amount and degree of the attachment, the amount of energy we have invested or tied to the object of loss. Grief is natural and normal. It doesn’t go away; we do not get over it.

With that loss our life has changed, because our attachment, energy investment, is lost or at least for a time cast adrift. Our self concept and our world view must be altered in view of this loss we are grieving. We can change and, really, will change whether we participate actively in that change or not. Participation is the best option.

We must realize that that energy, previously invested elsewhere, is now available to us. With that realization we can change our relationship (develop a new relationship) with that lost “object” (or deceased loved one if that is the case). That lost “object” may not be the “object” we think it is. It may not be a “thing” at all. The loss may be the loss of the comfort of sameness, a change in status or relationship with another or a loss of what was considered “normal” of “normalcy”.

The change in relationship may be specifically with the person of “object” lost or it may be a new relationship with your “environment” (broadly defined), your surrounds, your community (again broadly defined), your new “you” (based on the changed and reinvested energy), or your new world view.

Grief is normal. You will not get over it, but with the development of new relationship it takes a different place in your life and a different energy investment.

Coroner biz not covered on CSI

“We can’t make everyone happy, and I guess I really don’t want to”, said the Coroner to his Administrative Assistant. [So that I don’t sound so heartless, and example of this would be proof that the perpetrator did it and there are a legion of other examples]

Busy day today: case conferences all morning (our new inquest analog) and a meeting with local DEA folks about cases and working with them on those and others. Also, an undercurrent of unresolved issues: local police department not happy with us despite the fact that they didn’t request an autopsy for nearly 48 hours and we had released the body; another police force elsewhere to whom we had pointed out “the error of their ways”; and other stuff.

There is always “other stuff”. There are no typical days. Doing the coroner's job isn’t nearly as difficult as taking care of the “other stuff”.

Can’t make everyone happy and I probably won’t.

On another note:

I am often asked about “unusual cases/deaths” when I give talks about the coroner’s biz and I ran across one today. In reviewing a case from 1999, it proved to be unusual. It was the case of a woman riding in the backseat of an auto. Another car struck a deer throwing it into the car where the woman was a passenger. The deer kicked the woman in the head, which ultimately resulted in her death.

People die from a variety of causes and there is a different story with each of them.

Tonight's forum presentation

16 y/o dies of hypothermia/exposure after a drinking party
17y/o dies in an auto crash, the driver’s blood alcohol demonstrates intoxication

Headlines, Coroner’s cases
We have to notify the parents of these kids who are dead, kids aren’t supposed to die before their parents
Lives lost, opportunities lost, potential lost

And the deaths are only a small fraction of the serious problems that result from underage drinking, horrible as they are

The adolescent brain is a work in progress; exposure of the developing brain to alcohol and drugs alters its potential
But more important to tonight’s discussion is the fact that the adolescent brain isn’t complete, it lacks the “second guess” ability (the ability to pause and reconsider an action before undertaking it, particularly in the face of "stress” and peer pressure)

I know this despite expecting more from my teen daughter (and from other teens), but always think/remember that adolescents do not have the full capacity to control themselves. We overestimate the adolescent brain's ability to process legal and social standards and to use them as a behavior guide. We adults need to do some of the controlling that they are not capable of.

Parents must help their children make the "right” choices, through “control”, repeated discussions (shouting matches, if necessary), and by example.

Don’t allow teenagers to end up in my office.

Columbia College of Missouri in Waukegan

I gave a lecture last evening (I guess it’s a lecture when you talk, and hopefully teach something, to a group of folks in a class at a college). I really enjoyed doing it. I warned them at the start that they should ask questions and keep me to a time limit (they said there wasn’t any time limit). Being both a physician and a politician, I can talk a long time once I get started. The lecture stretched to 2 hours from the scheduled 1 hour. I probably could have gone on even longer, but I had finished the coffee I brought with me, I needed to get home and these 12 or so hour days do get to me sometimes.

It is interesting talking to the various audiences that I do presentations to. The level of the talk and types/caliber of questions vary, as do the things we talk about and/or of interest to the group to a certain extent. The talk last night was to students in a criminology class, so I did try to gear it to fit with their academic interest, although they did have a fair range of questions and we ended talking about a lot of coroner-related things (worst case, this case, that case, coroner "powers", etc). It does seem that an awful lot of folks in all walks of life and of all ages have a great curiosity for the coroner biz.

The instructor did invite me back next year, though I am not sure what I would do with a second school logo coffee cup (my “stipend” for doing the lecture). Don’t get me wrong, in looks good in my office and I do like to change up my coffee cup from time to time (and I do drink a lot of coffee). I look forward to a repeat of the experience

Cocoa to forestall death and improve your blood pressure

There are reports out on the beneficial health effects of dark chocolate. This study compared the effects of tea vs dark chocolate/cocoa (vs neither) consumption. While both tea and cocoa contained favorable flavonoids, those folks consuming cocoa containing products experienced a improvement in their blood pressure (which would result in decreased risk of related disease and death) due to some additional flavonoids present in the cocoa.

Foods like dark chocolate, which contain plenty of cocoa, may potentially reduce high blood pressure by acting in a manner similar to many blood pressure-lowering drugs, according to an analysis of previous studies by German researchers.

Researchers report a two-week follow-up of these patients after which both systolic and diastolic blood pressure was lowered in the group consuming cocoa.

Researchers also warned the study was not a recommendation to consume large amounts of chocolate since they are still loaded with calories. "Rationally applied, cocoa products might be considered part of dietary approaches to lower hypertension risk," they concluded.

Certainly if you are going to eat chocolate choose the high cocoa containing dark chocolates, but don’t over eat them (all things in moderation). Obesity trumps these BP effects. Dark chocolate is better tasting anyway and certainly is better tasting than BP meds (caveat: only replace your meds with chocolate under the supervision of a physician).

A diet with a goodly amount of fruits and vegetables, exercise, and throw in a spot of tea and cocoa-containing products, that’s the ticket.

Working with the County

I (with my Chief Deputy) had a meeting with 2 folks today.

First was an individual from the County HR Department. We had noticed that our deputies/investigators were making less than investigators in the County Public Defender’s Office. In response to our questioning, the HR folks did a preliminary “study” of Coroner’s Offices in surrounding counties to gauge how our wages compared. According to their preliminary “study” our wages compared favorably. However, they neglected to compare volume of cases (they report that volume really doesn’t “figure in” when they are making those decisions, despite comparing a county with 1100 annual cases to our 3600 caseload) nor differences in job responsibilities, what the deputies/investigators really do on the job. Suffice it to say my deputies do more. Back to the “study” for them and beefing up our job description to better capture what my deputies do for us. Also, seemingly under duress they will look how the wage was calculated for the Public Defender’s Investigator. Looks like an upcoming struggle, the stage likely set by the previous administration not keeping the wages up-to-date. It is a struggle worth engaging in.

The other individual we met with was the new County Communication Director. She seems energetic, engaged and qualified (nice change). She was impressed with what we are doing with public education and related activities. We look forward to working with her to further our goals of public education, forestalling death, and making more information and resources available to the public. The potential is great, but she will be pretty much starting from scratch in a pretty provincial atmosphere. I hope she is up to the challenge, hangs in there and accomplishes what she seems set to accomplish (it will be helpful for us and what we want to accomplish). [It will be interesting to see if and when she reads my blog. She seemed interested in it when I mentioned it, but did not ask for its address.]

The Now and Future Effects of the Iraq War

From yesterday’s Washington Post:

About 1,800 U.S. troops, according to the Department of Veterans Affairs, are now suffering from traumatic brain injuries (TBIs) caused by penetrating wounds. But neurologists worry that hundreds of thousands more -- at least 30 percent of the troops who've engaged in active combat for four months or longer in Iraq and Afghanistan -- are at risk of potentially disabling neurological disorders from the blast waves of IEDs and mortars, all without suffering a scratch.
For the first time, the U.S. military is treating more head injuries than chest or abdominal wounds, and it is ill-equipped to do so. According to a July 2005 estimate from Walter Reed Army Medical Center, two-thirds of all soldiers wounded in Iraq who don't immediately return to duty have traumatic brain injuries…
The lethal blast wave is a two-part assault that rattles the brain against the skull. The initial shock wave of very high pressure is followed closely by the "secondary wind": a huge volume of displaced air flooding back into the area, again under high pressure. No helmet or armor can defend against such a massive wave front…

It is thought that shock waves damage the brain at a microscopic, sub-cellular level…
"When the sound wave moves through the brain, it seems to cause little gas bubbles to form," he said. "When they pop, it leaves a cavity. So you are littering people's brains with these little holes."… Indeed, soldiers walking away from IED blasts have discovered that they often suffer from memory loss, short attention spans, muddled reasoning, headaches, confusion, anxiety, depression and irritability…

Now in its fifth year, the Iraq conflict is not a war of death for U.S. troops nearly so much as it is a war of disabilities. The symbol of this battle is not the cemetery but the orthopedic ward and the neurosurgical unit. The men and women inside those units have come home alive but missing arms and legs, many unable to see or hear or remember who they were before being hit by a roadside bomb.

Martin Luther King, Jr.’s Death Anniversary

Yesterday was the anniversary of Martin Luther King, Jr.’s assassination. As pointed out in an article I came across today, let’s remember him for more than a Civil Rights leader (of which he was a consummate one), but as a Human Rights leader.

"True compassion," King declared, "is more than flinging a coin to a beggar; it comes to see that an edifice which produces beggars needs restructuring."

He spoke out and called the United States "the greatest purveyor of violence in the world today." (in reference to Vietnam and our other world-wide “excursions”)

In his last months, King was organizing the most militant project of his life: the Poor People's Campaign. He crisscrossed the country to assemble "a multiracial army of the poor" that would descend on Washington -- engaging in nonviolent civil disobedience at the Capitol, if need be -- until Congress enacted a poor people's bill of rights.

He was a great man and a great leader. To remember him only for his “I Had a Dream Speech” makes him 1 dimensional and does not recall all he accomplished and the great potential that was snuffed out much too soon.

"Suicide Comedy"

"We just hope they don't cause too many accidents,"

What could a partner in an indie film company that specializes in horror films be talking about?

The suicide comedy "Wristcutters: A Love Story" will be released in August, with a marketing campaign featuring cardboard cutouts of characters jumping off a bridge, electrocuting and hanging themselves. The signage will be placed on telephone poles and trees in major markets beginning next month.

What the “heck”. This “information” from Rueters raises a number of questions in my head. Suicide “comedy”? Yes, I remember Harold and Maude, but they were faux suicides. “Cardboard cutouts” “hanging” around depicting folks dying by suicide. That doesn’t seem like a real cool idea to me.

I am not big on suppressing advertising, I can usually ignore the stuff I choose to, but this is way over the top. In that spirit I pass this along:

Dear friends,
We need your help. AfterDark Films plans to release a Lionsgate Entertainment movie this summer called Wristcutters: A Love Story. The film premiered at the Sundance Film Festival last year to some acclaim. Mental Health America and its national partners have not yet been able to view the film and cannot yet share any detail on the content.
This month, however, AfterDark will launch an alarming “shock and awe” advertising campaign featuring cutouts of the movie characters in the states in which they kill themselves (e.g., jumping off bridges and electrocuting and hanging themselves). These signs will hang from telephone poles and trees in communities nationwide.
Interestingly enough, recent outrage around the advertising campaign of another one of the companies’ films, Captivity, forced AfterDark to remove billboards that showed graphic images of women, being kidnapped, confined, tortured and killed.
On March 12, Mental Health America and 13 of its national colleagues signed a joint letter to AfterDark and Lionsgate, asking the companies to drop Wristcutters’ marketing campaign. Our letters and calls have gone unanswered by AfterDark. Lionsgate claims they have nothing to do with marketing decisions.
You Can Help stop the Wristcutters suicide marketing campaign.
Send a handwritten or typed letter to Lionsgate and AfterDark demanding they pull the marketing campaign. Use the messages and contact information below.
Send a letter to your mayor alerting him of the film’s marketing campaign and asking that he or she not allow the images in your community.
Reach out to video rental stores who will receive the film and its marketing materials shortly after the movie’s theatrical release asking that they not display the film’s marketing materials.
Send this email to your colleagues, friends and family.
Suggested messages:
The planned marketing campaign for Wristcutters, which features graphic depictions of suicide, is both alarming and dangerous.
Suicide is NOT entertainment. With more than 30,000 suicides and 1.4 million suicide attempts in the United States each year, it is a national crisis and tragedy.
AfterDark must modify the planned marketing campaign for Wristcutters before rolling it out.
Scientific evidence shows that portrayals of suicide pose the very real danger of ‘suicide contagion,’ the clinical term for ‘copy cat’ suicides.
Images of suicide are cruel and offensive to people who have contemplated or attempted suicide or to those who have lost family or friends to suicide.
This is not an issue of “political correctness” this is an issue of public health.
Please direct letters to:
Mr. Jon Feltheimer
CEO & Co-Chairman
Lionsgate Entertainment Corporation
2700 Colorado Ave.
Santa Monica, CA 90404
Office: 310- 449-9200
Fax: 310- 255-3870
Email: general-inquiries@lgf.com
Mr. Courtney Solomon
Partner
AfterDark Films
2161 N. Bronson Ave.
Los Angeles, CA 90068
Office: 323-468-9888
Email: info@wristcutters.com
If your email is returned because of the companies’ mailboxes are full, please consider calling, mailing or faxing your letter. It’s important that our voice be heard! And if their mailboxes overflow, that means we are being heard loud and clear.
To read the letter Mental Health America and its national colleagues sent to Lionsgate and AfterDark, visit http://www.mentalhealthamerica.net/go/about-us/pressroom/-wristcutters-letter.
If you have any questions, contact Heather Cobb, senior director of media relations, at (703) 797-2588.
Please remember to forward this message to your friends!

Kids frequently "experience" death

Researching for another project I am working on I came across a couple of interesting facts:

“It is estimated that at any given time in the average classroom, there are at least two students who are grieving from the death of a loved one.”

“1 out of 20 American children under age 15 has lost one or both parents to death.”

While I certainly have known for a long time that death and grieving were ubiquitous experiences, these 2 bits of information really drove it home today. It tells me that schools should do more to educate kids about death. It is a natural and frequent phenomenon. We will all experience it at least once. But there remains a strong taboo around it and any honest discussion of it, particularly before it happens in one’s life.

It should be a part of school curricula from an early age, certainly as much as telling kids not to smoke.

Other questions those “bits” raise would be about school personnel’s (teachers and counselors) preparedness and ability to deal with death and grieving when it occurs in a child’s life. It is something the personnel will be exposed to on a frequent basis.

The article (which has a good general discussion of the topic) makes a good case for both curricula inclusion and training and education of school personnel. It certainly ought to be considered (very strongly).

Balance and health

I recently read: “The world works best in balance”.

Becoming more accepting of that philosophy, I went on vacation (just got back to work). While this may not sound all that interesting or “news-worthy”, if you knew me and my habits, you’d know it was. I seldom take time off and less often go on vacation. My last vacation was about two years ago.

I decided a few weeks ago to accede to my wife’s suggestion that we take a vacation for a variety of reasons, but foremost in my mind was a need for balance in my life.

Balance is important. It is important for physical and mental health. Balance in work and “play”. Balance in energy use and acquisition (and I don’t mean gas and electricity). Balance in energy investment and expenditure. The energy I speak of here is the energy that fuels our soul, our emotions, and our relationships with “all our relatives”. Those “relatives” include our families, our friends, our co-workers, all those we come in contact with and interact with (“relate” with), even those we pass on the street or buy our “venti coffee black” from.

Take a break often and recharge your batteries. Whether that break is long or short. Whether it is a brief meditation, a mindless TV show or movie, or a longer break like a vacation, it is important to re-energize. Pulling back in that energy with balance will allow you to invest in relationships that would otherwise become strained and damaged. Pulling back in that energy with balance will help your physical and mental health. You owe it to all your “relatives”.