Holistic Health Includes the Whole Family

“The whole is more than the sum of its parts.”  -Aristotle, Metaphysica
In holistic health, we speak about treating the whole person. It makes sense.  We are complex beings with emotions, thoughts, and body parts. Each choice we make affects the whole of our being. We have made multiple choices to be who we are at this very moment. In the same vein, whatever health concerns we have, we’ve made many choices to reach our current state of health or ill health. Multiple things come together to make us who we are today.
Holistic health can reach beyond our individual selves. It can also speak of our environment and our communities. Our closest community is our family. Individual families are little communities with their own special rules, needs and values. Each family member fulfills a role. When one family member has health concerns, the whole family experiences changes. Illness can cause stress on the whole family, changing the dynamic of our most tight-knit community.With Community Acupuncture (CA), multiple people are treated in a common room, creating a space of peace and healing. The CA center also becomes it’s own community where people are invested in getting well and staying that way. As parents, grandparents, sisters, brothers and children, CA is a wonderful opportunity to share this healing with our whole families.When whole families are treated together in CA, individuals are able to focus on their specific needs, while all family members benefit from stress reduction. Self-care is modeled to the youngest members, setting them up for a proactive, empowered approach to their health. The experience allows for positive bonding through relaxation and mindfulness.

 

This broader view of holistic health encourages healthy change at a deep and dynamic level, not only affecting a piece of the whole, but in fact, affecting change for the whole family and community.

What better gift can you give your family?

Community Acupuncture now offered at MV Pediatrics in Quincy, MA. Call (617) 745-0050 to set up an appointment for your whole family.Image

Dr. Vonnegut’s response to the Behavioral Health Questionnaire allegedly designed to uncover ADHD.

Dr. Vonnegut does not work to potential, has a short attention span, a family history of learning problems is easily distracted, lacks attention to detail, frequently forgets or misplaces things, concentrates better when moving or fidgeting, sometimes says the first thing that comes to mind, worries needlessly, has low frustration tolerance … And doesn’t believe in diagnosing ADHD or other ‘behavioral issues’ by questionnaire and does believe, that medications can be part of the answer but are never the whole story.

Mushrooms

Since I always do what I always do I must be doing it again.

I started hunting wild mushrooms when I was allowed to get up and move around after an operation to save my left eye.  The retina detached in protest sometime during the Bow Wow Boogie when I was in my fifties, probably dehydrated, running around and crashing into people like I was twenty.  That was the year after I shattered two bones in my hand.  It was like I couldn’t take a hint.   A week after the operation I was allowed up and could walk but was supposed to only look down.  So I became a hunter of wild mushrooms.

*

When they were drawing up the medicines to keep me quiet for the operation, twelve years without a drink or a drug, I knew the little syringe was Fentanyl, a very pure highly addictive narcotic.

“How much do you weigh?”

“Three hundred twenty-seven pounds.”

“You carry it well.”

I was surprised that I didn’t enjoy the drug.  It was sort of bright and giggly but it was like being made to stay inside and watch cartoons on a sunny day when I wanted to go out and play.  It didn’t help being in a hospital and knowing they were poking and cutting my eye and I had just signed that piece of paper that said I might go blind.

When I needed operations on my knees the orthopedist offered me the option of doing it under local.

“You’re kidding, right?  I’m looking forward to being unconscious for a bit.”

*

There’s a moment right after you swallow the first bite of a new mushroom that you are 99+% sure is OK when the less than 1% chance that it’s not, looms large.  There’s a halo of attention around eating a new mushroom that can last for several days.

On a Spring walk with my dog I noticed a dozen or so Black Morel mushrooms under a tree in the yard of a house about a mile from ours.  There was a car in the driveway and a light on.  Before I know what I’m doing, I’m gathering up the mushrooms and stuffing them into my pockets and the dog poop bag I usually bring along.  My dog is whining and looking around nervously.  Like she doesn’t cause me plenty of embarrassment pooping wherever she likes, chasing after other dogs.

I could have come back at night.  What if the person at home looked out and maybe even recognized me.  Maybe I was even their pediatrician.  Knowing the people or not, knocking on their door to ask if you can take mushrooms they probably didn’t know were there seems too strange.  I grab the mushrooms, take off quickly but not so quickly as to attract attention and find several more morels on my way home.  They are delicious.

Once you’ve risked death by eating something and it actually tastes good it’s a very rewarding stimulus and strongly reinforces all the steps that went before so that time place shape color weather all acquire richness and meaning.

“It is much more important to not eat a poisonous mushroom than it is to eat an edible one.”

I read the sentence over and over.  I know it’s wrong but I can’t figure out exactly where the error lies.

“I think I’m getting the hang of it.” said my wife picking up another mushroom.  This was prior to the unfortunate incident.   I was gratified she was taking an interest in my hobby.  You can spend a lifetime not seeing mushrooms but once you see them you will always see them.  It’s not something you can just stop.  Seeing mushrooms takes place somewhere between the brain stem and the cortex.  My head will snap around sometimes when I’m driving and I’ll realize that I must have seen something that looked like a mushroom.

Once you notice mushrooms it’s hard to not want to do something about them, even if it’s only to know what their name is. But eventually the thing that knowing about them is leading to is eating them.  I was surprised to read descriptions of the smell, texture and taste of some of the most thoroughly unappealing, unappetizing and even deadly poisonous mushrooms.  There are some very dedicated people a good deal crazierthan I walking around the woods.  If I was going to put my life and bodily organs at risk, it was only going to be for something that tasted really good.

The Porcini or Cep mushroom, Boletus Edulis, is at or very near the top of everyone’s list. They can be up to a foot across, weigh over 2 lbs and are virtually impossible to confuse with any poisonous mushrooms.  Prior to the incident, I found cooked and ate many very good tasting mushrooms, some of them rated as almost as good as Boletus Edulis and I found a few that might have been the Porcini.  I couldn’t be sure because they were well past their prime and most of the way back to being dust.

There’s a house in my neighborhood with surveillance cameras and warning signs and big black Lincolns that come and go.  The house is set way back and the lawn is huge.  What if there were Porcini mushrooms growing on that lawn.  Would I black my face and come back in the wee hours?  Could I train my dog to fetch mushrooms?  Were those cameras real?  Did the people in the house have a sense of humor?  Did they like mushrooms?  If it was a Mafia guy maybe he remembered Porcini mushrooms from his childhood and I’d be in the position of having to be damn sure of being right and cooking them just right, hoping against hope they weren’t the ‘bitter bolletes’.  Bitter bolletesaren’t poisonous but they do taste horrible.  The Mafia guy would be trying to spit this bitter taste out of his mouth. “Porcini, my ass.” And I’d be going for a ride somewhere.

Collecting mushrooms sounds so gentlemanly.

Wild mushrooms spring up over night and are fit for eating for a day or two, three at the most.

While they say there are no sure fire ways to tell poisonous mushrooms, avoiding the ones that glow in the dark and smell like death seems like a safe practice. There are mushrooms that smell like rotting fish that cook up nicely.  The fact that some of the very poisonous Amanitas taste good goes against much of what I hoped to be true about life.  I  imagine some poor irrevocably fatally poisoned S.O.B talking to fellow mushroom collectors on his deathbed.

“At first I didn’t think it tasted like much but then…”

Ever since taking me to have my stomach pumped, Barb has had a negative attitude towards my fascination with mushrooms.  I’ve explained to her that the mushroom I ingested only rarely caused fatalities and then it is usually in older debilitated people with liver failure.  Debilitated older people with kidney or liver failure have no business eating wild mushrooms unless they are utterly and completely sure of their identification.

In the interest of being helpful I tried to give a neighbor some information about some edible mushrooms growing in his yard.  “Sautéed in butter and a little garlic salt,” I offered.  He was polite enough but didn’t seem likely to take personal advantage of his good luck.  Nor did he offer to let me pick them.

The mushroom growing out of my neighbor’s stump was the Armillaria Mellea or honey mushroom, so called because of it’s honey color rather than a sweet honey taste.  Armillaria is in many ways the most successful organism on the planet.  While most mushrooms are recyclers that breakdown dead or dying plants and return the raw materials to the earth, the Honey Mushroom will take down perfectly healthy trees and sometimes an entire forest.  Most of the organism consists of small black cords that travel miles and miles and miles. The mushrooms you see are the flower of a much much bigger organism.  There’s a single Armillaria that covers most of Oregon, and some of Northern California.  In Europe there’s an Armarilla that stretches from Tuscany to just outside of Barcelona.

When you walk through the woods, how much of the living matter there is animal including bugs and birds and all?  2-3%.   Plants trees bushes moss grass flowers, most of what you see and think off when you think of a walk in the woods make up 15-20% depending.  The rest is all a very quiet world of fungi.  The mushrooms you see aren’t so much the tip of the iceberg as dew drops on top of the ocean.

I don’t want to make people worry and it seems on the face of it wrong to conceive of a mushroom having intent, but it makes basic good sense to be careful about being too sure what a thousand mile long, 3 billion ton, contiguous, ten thousand year old organism that eats forests and can cross mountains and rivers, is and isn’t up to.

Mushrooms have six genders, one that is sort of male two that are sort of female and three that are something else.

Straight out without a lot of qualifiers, I should admit that I am not a careful person.  The reasons don’t matter.  The fact that I have managed to achieve certain things doesn’t matter.  That I am aware of my un-carefulness isn’t as helpful as you might think.  My parents were told that I was a bright boy whose spelling was in the retarded range and whose handwriting was the worst they’d ever seen.  I find it embarrassing that I spell so badly.  I will do almost anything to avoid being embarrassed but no effort either on my part or the part of any teacher has ever dented my utter bafflement when it comes to choosing which, how many and in what order to put letters down.

Somewhere in high school I came across Mark Twain’s statement that it shouldn’t be held against someone if they knew more than one way to spell a word.  Years later, at a conference on ADHD a colleague said that Huck Finn had ADHD and would be treated today and have a better life.  I said that the best that treatment could achieve would be to make him into a second rate Becky Thatcher, and we should worry, at least a little, about that.

I had actually hoped that wild mushrooms might be helpful with my un-carefulness, that the stakes involved might have an alerting focusing effect.

First you have to be scanning for mushrooms as you walk along.  If you’re not looking for anything maybe you won’t see anything.  If you look for mushrooms maybe you’ll see other things but at least you’re looking…  I think that’s what I thought…  And then you find something mushroom like.  And here’s where I thought the carefulness would come in:  I would be picking and maybe eating something that would either taste incredibly good or would poison me.

When I was gnawing on this rubbery non-descript piece of crap that was supposed to be sweet and delicate it didn’t occur to me that I had made a mistaken identification.  I was going to write the authors in question to tell them that the Sweetbread mushroom had an indifferent taste and a disagreeable rubbery texture,

Fifteen minutes or so after eating dinner during which I served the new mushroom dish to myself and not to my wife, my heart starts to race, there are painful muscle spasms in the back of my throat and sweat starts pouring off me.  I remembered seeing a mushroom with a skull and crossbones under it that was called the Sweating Mushroom.  Funny name, I had thought.

“I think I might have made a mistake with the mushrooms.” Said softly.

“What’s that, Dear”?

“I think I made a mistake with the mushrooms,” I said too loudly and clearly, an octave above where I usually speak.  Had I been sure I had ingested a less than fatal dose I would have just gone quietly to bed, turned out the lights and hoped for the best.

It doesn’t help that I’m on the staff of the hospital where I went to get my stomach pumped.  Had I been thinking more clearly I would have gone elsewhere and maybe used another name.

“Doctor,…  what are you doing here?”

“I was hoping maybe you could start an IV, run some saline, and pump out my stomach.”

“Why are you dripping sweat?”

“Funny you should notice that.”

 

There are six separate ways mushrooms can be toxic.  I would have thought one or two would have been plenty.  The less toxic ones make you very sick right away.  With the ones that kill you, you feel fine for several days and then your liver dies and you follow shortly thereafter.  Feeling sick as a dog and with sweat pouring off me so soon after my mushroom snack was a good sign.

“At least it’s not an Amanita,” I comforted myself.

What I had was Muscarine poisoning that shuts down the sympathetic nervous system causing nausea, vomiting, diarrhea, painful constriction of the pharyngeal muscles, intense sweating, profuse tearing and salivation;  a relative bargain.

“I have a piece of the mushroom I ate and the Audubon guide to mushrooms open to the Sweating mushroom right here.”  The Sweetbread Mushroom was right under it. “They look a lot alike don’t you think?”

My mind is like a lynch mob.  If you know that about yourself, why on earth would you collect cook and eat wild mushrooms?

I was so pleased with myself when I found what I thought were sweetbread mushrooms.  They weren’t chewed up by insects the way so many of the edibles were.  There were so many of them, maybe I’d be able to make wild mushrooms for a big group.

So now, a few days after the unfortunate incident, for the first time in many months I’m taking a walk without a basket or paper bag.  I’ve promised my wife in a solemn manner that I will never ever collect or eat wild mushrooms again.

On my return from my walk, walking into my own driveway, I can’t believe it and don’t blame anyone who has trouble believing it and still can’t believe it myself, right behind the wall under the Ash tree is a small modest patch of what can only be the sweetbread mushroom. Really.

My wife isn’t home.  I take one to make a spore print, hiding it behind some books in my study.  It’s pink, confirming that it is indeed the sweetbread mushroom.  I didn’t go back and pick them or eat the one I had picked but I plan to be back waiting at that spot next year when my wife will be in a better mood.

I like to think of it not so much as a lack of carefulness as a wish to move forward.

*

 

What is Your Parenting Style? by Dr. Hub Mathewson

Which parenting style do you have? Does it matter? Probably not.
Numerous studies show that socioeconomic, demographic, and other factors have much more influence overall on your child’s future abilities and success than your parenting style.

That is comforting news today.  During my training as a pediatrician in the 60’s and 70’s there were really only two identified parenting styles; “authoritarian” and “permissive.”  Subcategories were quickly developed like “authoritative” (more democratic than authoritarian), “indulgent” (permissive to the max), and finally “uninvolved” (close to but not quite neglectful)  Dr. Brazelton then superseded Dr. Spock and focused more attention on the baby’s style (“average”, “active”, or “quiet”) which probably helped take some pressure off of the parents who thought baby’s behvior was all up to them..

Newer parenting style labels include “helicopter style” (a protective parent hovering over a toddler aborting any mistakes or mishaps before they happen, and NOT referring to all the shuttling between the child’s organized activities as I thought originally), “drill sergeant” (a self-explanatory variation of  “authoritarian”), and the newly minted “consultant” (appears to be a short hand label for “loving and logical” parenting) (3) A bizarre example illustrating the “consultant” style in this book is the story of the neurosurgeon telling his son that a patient that he operated on had his brains “flow out like thin cottage cheese because he had watched TV four hours a day for six weeks.” Just add something like “masturbation causes blindness” and you’ll have a great recipe for either moral paralysis or potential Post Traumatic Stress Syndrome.

Discussion of “attachment parenting” (think family bed), “emotion coaching”, “concerted cultivation” (think organized leisure activities to better build strengths for competing ), “nurturant”, “Christian positivity”, “tough love”, etc. is just too much for this brief blog, but you get the idea. Wikipedia lists 20 different dysfunctional parenting styles alone.

As in other areas of health care, the sheer number of possibilities and the increased emphasis on “patient choice” have resulted in greater parents’ anxiety about making the “right choice”.  By the way, “choice” is the wrong verb here. Parenting style is a product of your own experiences and upbringing and can probably be modified  just a little by magazine reading, TV viewing, and Google surfing. You “have” a parenting style; you don’t really “choose” one.

To help currently confused and worried parents there is now, of course, many online courses. One offers 8 weeks of multi-media instruction on parenting styles for $97.97 or the “rapid certificate” of just online text for $49.97. Interestingly that online service’s boldest selling point is that their “certificate is guaranteed to be accepted by the courts.”

So, what prompted this reflection on the contemporary complexity around parenting styles? Well, the youngest of my grandchildren (all 6 are “above average”, of course, and their mothers are “all good looking”) was entertaining several of us adults one morning around the kitchen table . We marveled at the antics of this one year old and his deliberate and appropriate responses to ours. His aunt suggested that his good karma, his flow of energy, and his sensitivity to her energy field was the reason. She pointed to the middle of his forehead and said, “He has a very sensitive third eye.” His mother remarked that that is the spot where she made the sign of the cross in his first day as a small infant, and where she repeats that gesture almost every day. I, on the other hand, remain amazed,even after 40 years of pediatric practice, by the rapid development of problem-solving abilities and responsive social behavior that infants and toddlers exhibit.

What explains this phenomenon; astrology, theology, or neurobiology? Take your pick. We have less than perfect understanding of all three, so each, or all, could be the right answer. Likewise for the different, but consistent and loving parenting styles.

References:
1. The Influence of Parenting Styles on Children’s Cognitive Development Amy E. Tiller, B.S., *M. E. Betsy Garrison, Ph.D., *Elizabeth Benchea Block, MPH, Kathryn Cramer, M.S., and Vicky Tiller, M.S. Louisiana State University
2. Wikipedia/Parenting Styles referenced August 30, 2011
3. Parenting with Love & Logic, Foster Cline MD & Jim Fay (a psychiatrist and a school principal) 2006

How We the Adults Should Treat Children and Their Creativity

Adults do not need to direct the sparks of children’s inspiration.  Knowledge thrust upon the children without taking into account their level or when they are absorbed by something else, is perceived by the children as an intrusion into their world and provokes unwillingness and misbehavior.  If we want to look at children’s drawings with enjoyment and see their usefulness, we must first silence our wishes and demends in regard to form as well as content and expectantly accept what they can offer.

Our demands originate for the most part from false ideas about the child himself and what he communicates.  They originate from preferences and prejudices of higher or less high aesthetic values, with parents’ judgments originating from ambition and some vanity or fear in difficult phases of development that they view as final and anxiously cut off prematurely.  The demands of the grown-ups, even where they are justified, belong in realms other than those in which they originated.  For example, cleanliness, exactness, and ability to reproduce a certain content have to do with geometry, ornamental drawing, fashion drawing, and illustration, but nothing at all with creative drawing.

When we prescribe the path to children who, incidentally, develop extremely unevenly in their abilities, we at the same time cut them off from their creative possibilities and ourselves from insight into these possibilities.  Why do adults wan to make the children so quickly, or at all, similar to themselves?  Are we so happy and content with ourselves?

The child is not (or not only) the unfinished, unusable preliminary stage of the adults.  Rithenau seems to have formulated the following exactly for that: “The allegro is not the purpose of the adagio, and the finale is not the purpose of the introduction.  They follow each other because of their own beauty.”

From “Through a Narrow Window, Frieldl Dicker-Brandeis and Her Terezin Students”

The Problem with Being Told what to do

The Problem with Being Told what to do

In 1961 local hospitals and community based doctors were saving lives, taking care of patients with heart attacks and appendicitis, casting fractures and sewing lacerations and doing it all for about 1/100th of what it costs today, not perfectly but not so bad.

In 1981, fresh out of residency, I was able to make a living and start paying down my loans charging $10-$20/visit to tell you whether or not your child had an ear infection or pneumonia or leukemia.   These visits now cost $200 and up which is almost entirely because I have to work through for profit third party insurance.  If you come into my office and I don’t do much, I have to charge you the same $200 I would have had to charge someone with BCBS, because of a contact I had to sign to be able to stay in business.

The stories currently being pushed are that medical care costs so much because of all the scientific and technical advances we’ve made, or because of the fee for service model, which encourages quantity of care rather than quality of care, or because the profession hasn’t fully adopted electronic medical records, or  because patients are too fat and the baby boomers are getting old and patients are demanding too much.  The truth is that medical care, the patients, the providers, Medicare, Medicaid, the VA and the economy as a whole are all dying the death of Ten Thousand Cuts, nine thousand nine hundred and ninety nine of which have come in the form of someone somewhere telling me or local hospitals or other providers how to do a job we were doing perfectly well.  Healthcare providers are rarely in it for the money.  Anyone who goes into pediatrics for the money probably isn’t smart enough to do the job.

The usual justification for HMO’s, Managed Care, DRG, LOS regulations, Copayments, Deductibles, HSA’s, QI initiatives, PFP’s, Patient Safety initiatives, Medical Home initiatives, and now ACO’s, is that they will save money.  They never have and they never will because:

1.    These programs cost money, usually many millions to develop and implement.

2.    When they save money, which they often do, the money saved comes from money the insurers would have otherwise had to pay to providers.  These savings never have been and never will be passed onto consumers in the form of decreased premiums because that’s not what for-profit corporations do.  It’s their money and they are not going to give it back without a reasonable expectation of a ~10% return.

3.    Hospitals and other providers have for sometime now been operating pretty close to the bone in a financial environment created by and run by insurers.  If they are forced to decrease the LOS for healthy newborns or utilization of CT scans and that effectively decreases revenues, they will have to do something to increase revenues or be that much closer to going out of business.  When a hospital or other care provider goes out of business, it works out well for the payer.  No care, no pay.

4.    Having the cost of medical care rise 16000% over the past 50 years has worked out very well for the insurance industry because we now need insurance to protect us from the cost of what we used to be able to pay for out of pocket.  Health care costs are now the leading cause of bankruptcy.  The allowable administration and overhead costs an insurer is allowed under the pathetic few regulatory guidelines are calculated as a percentage of total costs.

5.    For the past 50 years and for the next 50 years, the only way to make money in health care insurance is over insure people who don’t need care and to under insure those who do need care.  Putting lots of lipstick and mascara on this simple truth costs millions and millions of dollars and will ultimately bankrupt our economy and destroy medical care.  HMO’s, Managed Care, Copayments, high deductibles, and QI initiatives, when they work do so by roping in as much money as they can from young healthy people who will cost nothing or close to because they don’t need care and by denying or making care unavailable to those who do need it.  Whether or not a child and their parents are malingering or really need a wheelchair, it’s in the insurers best interest to make paying for it as complicated as possible and to make sure this child is insured by someone else next year.

The problem is not going to be fixed by the government or insurers or the JOHA, or the Academy of Zippy d’ DoDah dictating the content of care to me or Newton Wellesley Hospital or any other provider who isn’t feeling the need for their advice.  Whether or not I ask about guns in the home or smoke detectors or sexual orientation should be up to me.  My patients and I were doing fine before all these other players got into the act.  We didn’t have trouble thinking up things to do or talk about.  I wasn’t missing or mishandling behavioral issues.

The problem with adding a lot more boilerplate to any given clinical encounter is that by the time I see them they’ve had to verify insurance, check balances, pay copayments, check deductibles, sign HIPAA releases, financial policy information sheets and do behavioral health inventories and people have sometimes forgotten what it was they wanted to ask me about and if I hit them with a bunch of questions that are at best irrelevant to their situation and sometimes intrusive or insulting, (like they don’t know about seat belts and car seats and brushing their teeth),  they might reasonably decide they don’t want to talk to me after all.

The ostensible reason I’m given so much guidance about the content of care is that there are very real problems with gun safety and domestic violence but what all this guidance and hospital regulations really do is increase the cost of care that the well don’t need and the unwell do.  Any hospital or practice that is taking care mostly of well, well-insured patients will negotiate any series of hoops better than one burdened by taking care of people who are sick and not so well insured.  Failure to score as well on Patient Safety or Medical Home initiatives then justifies putting a hospital or provider in a higher Tier with higher copayments forcing them either out of business or to find ways to make a living that doesn’t cost insurers any of the $16K per family they’ve come to depend on.

It’s not obesity, it’s not greedy unethical providers, it’s not illegal immigrants.  It’s us and our pathetic attempts to get a few bucks ahead by paying insurers too well to shift costs and protect us from ourselves.  I have very little hope we’re smart enough to find a way out of the trap we’ve made for ourselves especially if we have as a precondition to any change that the Insurance and the Pharmaceutical industries not take a hit.  But what if we had a way to evaluate the net effects of the many programs and features we adopted in part or whole because they were supposed to control costs.  What if copayments and managed care and HMO’s could be shown to have increased costs and decreased access to care? Maybe a plan to undo some of what we did in the past would be a reasonable way to decrease overall costs for everyone.

There should be a firewall between payers and the content of care.  We can’t afford for there not to be.

We are about to spend millions on ACO’s which will fail to contain overall costs for exactly the same reasons Managed Care and HMO’s failed.  They assume there’s money to be saved by having payers dictate the content of care but there isn’t unless you allow some combination of a terrific hit born by patients and providers and an increase in the overall cost of medical care because there’s one thing for sure which is that insurers can’t and won’t get by with less than 10% more than whatever it was they made last year.