Telemedicine

heipauli · 02-15-09 4:48 pm

Telemedicine, an interesting hobby of some physicians. Many cases have been published in medical periodicals. "Tele" meaning in this connection distance, either geographical or in time. The 'victims' of the post mortem autopsies have usually been world-renowned writers or painters. And the diagnosis has usually been based on the works (i.e. books or paintings) of those deceased 'patients'. As an easy introduction to the subject I present myself, a more or less known figure to you. Admittedly I do not belong to the category of world-renowned persons, but one cannot be sure beforehand ;-) As many of you have been able to discern, I am prone to depressive moods. As causative factors IMHO there must be some wartime experiences, too. Like time spent in bomb shelters, a near hit or miss bomb exploding in the next building lot, time spent in isolation in the hospital for contagious diseases (for how long, I do not know, but before era of antibiotics scarlet fever and diphtheria in succession, the time must have been about one month. So it seems to me that in the hospital I must have developed a conviction that it is quite posssible that there can arise another situation, in which I'll never see my parents. I remember clearly two cases, when I was quite sure that now such a situation had occured. First one was when I was perhaps 5 years old. My father went to some distant city and took me with him. He left me to the custody of an Adventist (?) lady I had never seen before and promised that he will come back in some hours. I had no watch in my possession and I doubt, would that device been of any help. At any rate, I had a very hazy idea, how long an hour actually was. Time went, and went, and went, but agonizingly slowly. Then I realized: I had been had! There had to be a reason, why my mother was left in Helsinki. And the reason obviously was that she as a supposedly more softhearted person could not see, how I was forsaken ultimately. So it was vain to expect father come back. That elderly lady obviously would act as my mother, but how long, that could be only guessed, because she seemed to be old and frail. Maybe to orphanage after her funeral? It took no long time when I began to scream. And I screamed until my father finally came back. The next time of similar nature was in Stockholm, Sweden. I was left alone in a hotel room and my parents went to sightseeing or whatever. I was about 6 years. And when very many hours had went by, I realized that now my parents had concocted a perfect plan for abandoning their firstborn child for a reason I could only guess. My stituation was desperate. I had no passport, no identity papers, no money. I could not read or write even in Finnish and I did not understand Swedish. In addition to that, I had no idea, how many Finnish-speaking people there actually were in the whole country. I knew that somewhere in Sweden lived my aunt, but I had not her address nor her telephone number. I was screaming and weeping when the parents finally came back. Understandably my father was irritated and decided that something must be done. His unfortunate idea was to "harden" me to endure situations in which I could feel myself left alone. His favorite trick was performed when we travelled by train. In a station he could step out of train and keep walking on the platform, even when the train started to move. When the last coach was going by him, he started to run and barely succeeded in catching the train. And in every case he had the tickets and all the money. I has only my anguish. But even the religion had a plentiful supply of horrors of its own. (to be cont. - namely on telemedicine)

maggie · 02-15-09 5:30 pm

Don't mean to interrupt, Pauli - but very interesting! Oh! I have things I wanna say, but I'll wait for you to finish! Glad you came back and are telling these stories!

maggie · 02-15-09 5:32 pm

In my excitement, I neglected to say that the stories are very sad, and I'm sorry you experienced such horrible, horrible abandonment! Just shocking, but instructive, in the bigger picture, I'm just sure! And ultimately healable too! Brain plasticity!!!

elaine · 02-15-09 8:55 pm

Early childhood impressions are never eliminated, as Pauli demonstrates. Although his father intended only to "harden" and help Pauli understand, it was, nevertheless, a very cruel attempt to give a lesson that was entirely inappropriate to the situation.

maggie · 02-15-09 10:05 pm

Early childhood impressions are never eliminated, as Pauli demonstrates. Under ordinary circumstances, that's true, and the earlier the traumatic experience, the more global the damage. I have to say, if Pauli's parents (and I'm sure they were doing the best they knew how) treated him in that cold, insensitive and cruel way at five and six, I truly shudder to think what his pre-verbal experiences might have been at their hands. I would expect a person to not only be depressive, but actively suicidal, given a childhood in that kind of environment, but no need to respond to that, Pauli, of course. And that's leaving off what Pauli added: But even the religion had a plentiful supply of horrors of its own. Pauli, as luck would have it, I had just read the following this morning, before I read your new thread:<blockquote><hr size=0><!-quote-!>quote:Early Relational Trauma Chap. 3, by <a href="http://www.allanschore.com/" target="_blank">Allan N. Schore</a> In this Chapter, I focus on the events in the nursery, not metaphorically, but through the lenses of developmental neuroscience, attachment theory, and infant psychiatry. In recent contributions I have modeled how severe traumatic attachments result in structural limitations of the early developing right brain, expressed in a number of enduring functional deficits, including a fundamental inability to regulate emotional states under stress. It is well established that the loss of the ability to regulate the intensity of affects is the most far-reaching effect of early traumatic abuse and neglect. Theoretical and clinical studies are now focusing on the direct connections between early traumatic attachment experiences and the inability of certain personalities to regulate fear-terror states, leading to developing a high risk for posttraumatic stress disorders. (...) Relational Trauma and Right Brain Development My own work in developmental affective neuroscience and developmental neuropsychiatry integrates recent psychological data of attachment theory and the current data of developmental neurobiology. This psychoneurobiological perspective focuses on the first two years of life, when the human brain grows faster than at any other stage of the life cycle. This period exactly overlaps the period of attachment so intensely studied by contemporary developmental psychology. A fundamental tenet of Bowlby's (1969) model is that, for better or worse, the infant's "capacity to cope with stress" is correlated with certain maternal behaviors. The central thesis of my work is that the early social environment, mediated by the primary caregiver, directly influences the final wiring of the circuits in the infant brain that are responsible for the future social and emotional coping capacities of the individual. The attachment relationship thus directly shapes the maturation of the infant's right brain, which comes to perform adaptive functions in both assessment of visual and auditory socio-emotional communicative signals and the human stress response. The ultimate product of this social-emotional development is a particular system in the prefrontal areas of the right brain that is capable of regulating emotions, including positive emotions, such as joy and interest, as well as negative emotions such as fear and agression. --Healing Trauma: Attachment, Mind, Body, and Brain, ed. Marion F. Solomon & Daniel J. Siegel<!-/quote-!><hr size=0></blockquote>Hope I wasn't interrupting what you wanted to continue saying, Pauli.

maggie · 02-15-09 10:58 pm

Understandably my father was irritated and decided that something must be done. His unfortunate idea was to "harden" me to endure situations in which I could feel myself left alone. <blockquote><hr size=0><!-quote-!>quote:Peggy O'Mara: It is the nature of the child to be dependent, and it is the nature of dependence to be outgrown. Begrudging dependency because it is not independence is like begrudging winter because it is not yet spring. Dependency blossoms into independence in its own time.<!-/quote-!><hr size=0></blockquote>

heipauli · 02-16-09 8:40 am

Dear Ladies, I'm grateful to you for your sympathy!

maggie · 02-16-09 10:41 am

I'm grateful you shared those stories, Pauli! As I said, there's more I could say, but I don't want to interrupt the train of thought you were on, so I'll wait until you get the rest of your thoughts down.

heipauli · 02-17-09 6:28 am

In order to let you, too, to participate in the joys of telemedicine, I've chosen an example for us to analyze. And as most of you live in U.S.A. or Canada, this person has close ties to Northern America. I even suppose that he/she lives there. And there are reasons, why everyone of you knows her/him. I do not reveal his/her gender. In Finnish this hiding were easily done, as one of the marvels of Finnish language is it's gender neutrality. One can write a novel with 500 pages without revealing the gender of the persons appearing in the book, as long as the writer sticks to gender-neutral first names like Kaino (meaning shy, bashful, coy). And the 3rd person singular ("hän") is similar for both genders. In order to avoid unnecessary typing, from this point on I'll use the term "he" instead of "she" or "the person in question", but when I chose "he" instead of "she", the choice was done purely by shortness sake. So for the time being you cannot know the gender of the person in question. Actually even I cannot know it for sure, as I do not know, whether any chromosome tests have been performed in order to reveal his true gender. As I do not know, when I'm able to continue this miniseries, I'll comfort those of you interested in political partisanship: The person in question is not and has never been POTUS, or vice-president, or even a candidate for presidency.

heipauli · 02-17-09 9:22 am

Once upon a time I collided with the writings of a person we together will try to analyze. The first thing I noticed that he was VERY prolific writer. Being very productive is not a sin or fault in se. If we order people according to their quantitative literary output, in the other end are the illiterates and in the other end are people like EGW or Kalle Päätalo. Some of you think that all was O.K. with EGW, both psychologically and neurologically. I do not belong to those people, but let it not disturb you. Many have tried analyze EGW by using writings ascribed to her as a point of departure. Some ideas derived from those studies have been published, some are not. Supposedly even in the future such attempts will be made. But IMHO Kalle Päätalo suffered from Asperger's syndrome. That does not diminish his value as a writer, on the contrary. But although EGW wrote of very many topics, she never - as far as I know - pretended to be THE expert of all possible areas of science. But when reading the writings of the person in question, one got - at least I got - an impression that he is in his own opinion jack of all trades. He knows everything between Earth and Heaven, even IN Heaven.

heipauli · 02-17-09 10:47 am

BTW, the person in question is still living, at least I've not read of his death. And as he has never been my patient and I've never been his physician and all the info about him at my disposal is available to all of you, maybe more to you than for me (some of you may have met him even face to face), I'll do not violate any Finnish law known to me, when I'll continue describing, how I arrived to a diagnosis.

heipauli · 02-17-09 11:06 am

I started to feel something to be amiss, when I noticed, how rapidly his interests changed; I felt that he was not able to think one issue longer than one hour or so. His thoughts changed direction like particles in Brownian motion. Quote from Wiki: "Brownian motion (named after the Scottish botanist Robert Brown) is the seemingly random movement of particles suspended in a liquid or gas or the mathematical model used to describe such random movements, often called a particle theory. The mathematical model of Brownian motion has several real-world applications. An often quoted example is stock market fluctuations." Source: <a href="http://en.wikipedia.org/wiki/Brownian_mothion" target=_top>http://en.wikipedia.org/wiki/Brownian_mothion</a> In addition to that, his spelling errors were curious, when one supposes that he has an academic background (at least so he maintains). As there are numerous top-quality universities in North America, as an European I'm prone to assume that there must be even lousy universities, too. Particularly if they are connected with some fundamentalist denomination. Later on I'll dwell on that university topic, but assuming that he has a degree or degrees, and assuming that English is his first or second language, those errors cannot be disregarded. I, too, make spelling errors, but maybe they are not so remarkable, as English is my fourth language.

heipauli · 02-17-09 12:37 pm

Because common diseases are common and rare diseases are rare - a fact which is hammered even into the thickest skull of doctors-to-be, my search for a diagnosis started with common disorders. At first the disorder called hypomania catched my attention. Quotes: "Hypomania (literally, below mania) is a mood state characterized by persistent and pervasive elevated or irritable mood, and thoughts and behaviors that are consistent with such a mood state. People experiencing hypomanic symptoms typically have a flood of ideas, and sometimes mildly grandiose thoughts and visions. It is distinguished from mania by the absence of psychotic symptoms and by its lower degree of impact on functioning. Hypomania is a feature of two mood disorders: bipolar II disorder and cyclothymia. Hypomania can also have a benefit in creativity and productive energy. Many have cited it as a gateway to their success, and a large number of people with creative talents have experienced hypomania or other symptoms of bipolar disorder. Classic symptoms of hypomania include mild euphoria, a flood of ideas, endless energy, and a desire and drive for success ..." .......... .......... "According to the DSM-IV-TR, a hypomanic episode includes, over the course of at least 4 days, elevated mood plus three of the following symptoms OR irritable mood plus four of the following symptoms: pressured speech; rapid talking inflated self-esteem or grandiosity; decreased need for sleep; flight of ideas or the subjective experience that thoughts are racing; easy distractibility and attention-deficit (superficially similar to attention deficit hyperactivity disorder); increase in psychomotor agitation; and steep involvement in pleasurable activities that may have a high potential for negative psycho-social or physical consequences (e.g., the person engages in unrestrained buying sprees, sexual indiscretions, or foolish business investments). [2] In the hypomanic state, people may feel like they can't slow their mind down, and that the speeding thoughts are crafted exceptionally well. Some examples are speaking or writing in rhyme or alliteration without planning it first; quick responses to people talking; or the ability to improvise easily on the spot. Another type of behavioral response sometimes included as a symptom is emotional flattening or blunted affect. A person may seem unusually cold, uncaring, or arrogant, showing little or no emotional responsiveness." Source: <a href="http://en.wikipedia.org/wiki/Hypomania" target=_top>http://en.wikipedia.org/wiki/Hypomania</a> As you read, there are some common behavioral traits between hypomania and ADHD. But, as time went by, I began to notice something that could not be due to either hypomania or ADHD.

maggie · 02-17-09 9:18 pm

Oohhh...this is not gonna be pretty....<img src="http://www.atomorrow.net/discus/messages/89/584.gif" alt="outtahere">

elaine · 02-17-09 9:58 pm

Maggie, I'm also sensing not a pretty story.

maggie · 02-17-09 10:00 pm

Maybe stop while you're ahead, Pauli, or at least before it gets worse. Just a suggestion....

neal · 02-17-09 10:32 pm

Maggie, I'm also sensing not a pretty story. Depends on the point of view. Seems like a real page-turner to me! I can hardly wait for the next episode.

maggie · 02-17-09 10:36 pm

I can't look.... <img src="http://www.atomorrow.net/discus/messages/89/586.jpg" alt="nooooo">

maggie · 02-17-09 10:40 pm

Pauli, I think you should not take this any farther. Someone's name is not in the title, but it may as well be. OK?

maggie · 02-17-09 10:48 pm

This makes me just as nervous when it happens to someone else as when it happens to me. (Message edited by maggie on February 17, 2009)

maggie · 02-17-09 10:50 pm

Halp. <a href="http://icanhascheezburger.com/" target="_blank">http://icanhascheezburger.com/</a>

heipauli · 02-18-09 1:33 am

Dear Ladies, I appreciate your tender feelings and consequently will make this series shorter than I planned, but at least one story is so delicious that it must be told!

heipauli · 02-18-09 1:59 am

Hypomania is a more dangerous situation than generally thought. It can be a hazard to one's purse, health, reputation and life. How many dictators during the written history have felt that his army is invincible, his ships cannot be sunken, his generals are geniuses and his race superior to the neighboring nations! And how many CEOs of great banks and other financial institutions have felt that "this investment scheme cannot fail". Or think of religious leaders, what they can do when hypomaniac! Even ordinary people can do things they later on regret after the hypomania is over. As far as I can remember correctly, an old acquaintance of mine bought during one month or so 10 wristwatches, several cellular phones and two cars. No one of those purchases was necessary. So, although the peculiarities of "the person in question" cannot be explained solely by resorting to the label "hypomania", it is possible that he suffers from hypomania, too. And if that is the case, he needs some sort of help IMO. In this context I'll take up the WinCapita pyramid scheme. As far as I know, of those 10.000 swindled, less than 1500 have contacted police. Namely those in the middle layers in the pyramid are according Finnish law both victims and perps, at the same time! They are in danger of losing their winnings - if any - and getting some punishment, probably fines, but not losing their losses. As the pyramid is broadest in its base, there are more than 1000 people who have nothing to fear if they go to police and tell their story. But the problem is that very many of them are still hypomaniac due to the great expectations they still harbor. They refuse to believe on any deceit and have held at least two meetings in which they tried to convince each other that the promised huge sums will materialize in due time, as soon as the organizers of the scheme are at large again!

heipauli · 02-18-09 2:14 am

What next aroused my curiosity was the frequent occurrence of neglects. When we speak of neglect in medicine, most of it appears in seeing/not seeing. I wish that many of you would read very thoroughly what can be found when you click the link <a href="http://en.wikipedia.org/wiki/Hemispatial_neglect" target=_top>http://en.wikipedia.org/wiki/Hemispatial_neglect</a> As you can see, the neglect can be in any of the customary five senses. But in addition to that, it can apply to memories, ideas etc. Usually it's axis is horizontal, but if it is vertical, a person suffering from it can read a title of an article and understand it more or less clearly, but ignore what should be visible at the lower part of a page or screen. So he is prone to totally erroneous conclusions after having "read" an article, a book or even 10 lines of text.

heipauli · 02-18-09 2:40 am

And now the story: I have once experienced a neglect-situation sometimes in 90's. The exact date is not an important detail, so I do not tell it although I know it. It happened in my appointment room, i.e. in the room I met the patients. When one patient left the room, I laid my stethoscope on the desk in front of me, walked to a wash-basin, washed my hands and rubbed on some antibacterial agent. Then it occured to me that it were a good idea to rub the stethoscope too. But to my horror, the stethoscope was no more visible on the desk. I knew that it had to be there, but the problem was that I could not see it anymore. I searched 5 - 10 minutes the desk and an instrument table on the left side of my chair, but in vain. As the appointed time for the next patient was due any minute, I walked to another room and loaned another stethoscope for the rest of the day. But the workday was not finished, when I suddenly and unexpectedly saw my own stethoscope! Understandably I was worried because of that neglect I'd experienced and told of the incident to a neurologist. He arranged a series of examinations, cardiovascular and neurological, but in vain. Nothing could be found. So he guessed that maybe I had had an atypical phenomen sometimes connected with migraine (and really very odd - luckily rare - things can be caused by migraine.) But the question remains: Why could I see all the other medical items on my desk (otoscope, reflex hammer, blood pressure meter, etc etc etc. Only the stethoscope was missing! Not until two days ago I arrived to the right answer. Because you ladies (names Elaine, Maggie and Sirje listed in alphabetical order) are much more perceptive than I, I expect that someone of you will tell the right answer during this day.

Adventists for Tomorrow

Announcement

#1 02-15-09 4:48 pm

Telemedicine

#2 02-15-09 5:30 pm

Re: Telemedicine

#3 02-15-09 5:32 pm

Re: Telemedicine

#4 02-15-09 8:55 pm

Re: Telemedicine

#5 02-15-09 10:05 pm

Re: Telemedicine

#6 02-15-09 10:58 pm

Re: Telemedicine

#7 02-16-09 8:40 am

Re: Telemedicine

#8 02-16-09 10:41 am

Re: Telemedicine

#9 02-17-09 6:28 am

Re: Telemedicine

#10 02-17-09 9:22 am

Re: Telemedicine

#11 02-17-09 10:47 am

Re: Telemedicine

#12 02-17-09 11:06 am

Re: Telemedicine

#13 02-17-09 12:37 pm

Re: Telemedicine

#14 02-17-09 9:18 pm

Re: Telemedicine

#15 02-17-09 9:58 pm

Re: Telemedicine

#16 02-17-09 10:00 pm

Re: Telemedicine

#17 02-17-09 10:32 pm

Re: Telemedicine

#18 02-17-09 10:36 pm

Re: Telemedicine

#19 02-17-09 10:40 pm

Re: Telemedicine

#20 02-17-09 10:48 pm

Re: Telemedicine

#21 02-17-09 10:50 pm

Re: Telemedicine

#22 02-18-09 1:33 am

Re: Telemedicine

#23 02-18-09 1:59 am

Re: Telemedicine

#24 02-18-09 2:14 am

Re: Telemedicine

#25 02-18-09 2:40 am

Re: Telemedicine

Board footer