One Ounce That Does a Lot

The thyroid gland is about two inches long and about one inch wide. It sits at the base of the neck, straddling the windpipe. It weighs about an ounce. When your healthcare provider encircles your neck with her hands and asks you to swallow, she is checking the size of your thyroid.

The thyroid’s main job is to control metabolism by secreting hormones.  If you, an adult, have too much thyroid hormone (hyperthyroidism) you will lose weight. If you have too little (hypothyroidism), you will gain weight. But that’s not all. Thyroid hormones have a strong influence on the nervous system, which influences everything. In turn, a change in the nervous system affects the thyroid.  Together, the thyroid and the pituitary in your brain function like the heating/cooling system in your home. For example, if the temperature in your home falls below a preset minimum on your thermostat, the furnace will start and send heat around your house until the preset temperature is reached. Then, once again responding to the temperature on the thermostat, the furnace will stop sending heat. What does all this mean for the way you feel and behave?

If your thyroid gland isn’t functioning properly it will not respond to the pituitary. The level of thyroid hormone in your blood stream will remain the same or drop further.  You may feel tired or not mentally sharp. If this persists, you may feel depressed or moody. You may have difficulty sleeping, in spite of feeling tired and sleepy. Physically, you may begin gaining weight, no matter how little you eat or how much you exercise. Meanwhile, your pituitary is frantically sending out thyroid stimulating hormone (TSH).  If this goes on long enough – the pituitary in overdrive – it may result in enlargement of the pituitary. But most people never reach this stage.  They generally feel sick enough to consult a healthcare provider.

On the other hand, if your thyroid keeps sending out thyroid hormone no matter how little TSH there is in your blood, your symptoms will be different. Emotionally you may feel anxious for no reason or more anxious for the reasons you do have. There’s some evidence that prolonged stress increases your risk for hyperthyroidism. You may be irritable or have difficulty concentrating. You may have difficulty sleeping, just as with low thyroid.  Physically you will begin to lose weight, no matter how many carbs you pile on. You might notice your heart racing, often greater than 100 beats per minute. Your hands may tremble. Eventually your thyroid will enlarge and you will feel or see the enlargement at the base of your neck. But, once again, most people have consulted a healthcare provider before this occurs.

Bottom line? That little gland in your neck is powerful. It can cause both physical and emotional/mental symptoms. The mind and the body are connected. They are both part of us. It may be only one that is causing your symptoms. But always suspect both, not just one, when you aren’t feeling well.


Memorial Day

Who do you remember? Which war? Which peace action? For me, It’s Vietnam. I can still remember reading the posthumous letters, delayed until after death. I can still remember holding sobbing friends. I can still remember dreaming of peace.
Is it worse today than it was back then? Or during Korea or World War II or World War I? I don’t know. I just don’t know. Loss, grief, pain – they are still the same.

I’m an amateur genealogist. Because I’m bilingual (English/Italian), I’ve been volunteering my time indexing Italian birth and death records. So many children died so young that we index of an age of zero. But I bet those children weren’t zero in their families. Loss, grief, pain – they are still the same.

I’ve done quite a few records from World war I. Young men died in so many ways – bullets, bombs, shrapnel, infection, gangrene, dysentery, gas. Perhaps we can pat ourselves on the back and say, “Well, no one dies of dysentery or gangrene or gas in today’s war.” Perhaps. But Loss, grief, pain – they are still the same.

Take time during your much earned holiday time to think about today as well as about yesterday. Is war any better? Loss, grief, pain – they are still the same.

Depression and the Holidays

A great deal has been written about the topic of depression during the holiday season. I’m not going to rehash that. Today’s blog is more of a personal reflection on my professional experiences with depression among the elderly and individuals needing long-term care.

In one of my positions as a psychologist, I “covered” skilled nursing facilities. That’s the newer term for nursing homes. Today’s skilled nursing facility (SNF) is unlike the nursing home or old people’s home of the past. A SNF has both “patients” in the traditional sense, that is, individuals who are recovering from a medical or surgical illness, and non-patients. The non-patients are long-term residents or clients: the younger physically disabled, the frail elderly, and the mentally disabled. Each SNF is somewhat like a small town without children. There are town officials (registered and licensed practical nurses), town employees (certified nursing assistants, dietary workers, physical, occupational and speech therapists), citizens in no official capacity (clients or patients), county or state officials (owners, physicians), and visiting dignitaries (medical and psychological specialty consultants). What makes the SNF unlike a real small town, however, is that only the citizens actually live in the town. Everyone else is an out-of-towner with lives separate from the townies.

Now for the holidays. The holidays are everywhere: TV, SNF décor, the conversations of the out-of-towners. There are more visiting dignitaries, the ones who come once a year and sing or dance or give out small gender neutral and politically correct gifts. All, absolutely all, of the dignitaries mean well. They want to bring cheer and happiness to the townies. But they, too, go home.

The townies? Well, they are left with their memories and thoughts. Remember that year that Santa left his footprints in the ashes? Oh. No one but me is left to remember. Remember sliding down that big hill behind the school? I remember the feeling. But my body can no longer feel the experience or any, for that matter. Remember – no, I’d rather not. My mom drank and my dad scowled. Remember. No, I can no longer remember. What are the holidays? Where is everyone?

Some townies get out of town to family from out of town. They bring back peace and, best of all, they bring back hope.

Hope – one of the criteria for happiness and a stalwart defense against depression.

So, my blog readers, I wish you hope in this crazy world. Please spare a thought in your busy days for those who have little or none of it.

This day and this month

Wikipedia defines caregiver as an unpaid or paid person who helps another individual with impairment with his or her activities of daily living. Merriam-Webster defines a caregiver as a person who gives help and protection to someone (such as a child, an old person, or someone who is sick). Veterans Day is almost over and perhaps this is a good time to reflect on war injured veterans who require another individual to help them with activities of daily living.

When we think of disabilities the obvious first comes to mind – paraplegia, blindness, single or multiple amputations, maybe severe scarring. When we think further we may think about the invisible disabilities – traumatic brain injuries (blasts are the leading cause of TBI), psychological injuries, internal injuries with lasting effects. For these veterans, their war goes on. It also goes on for their caregivers. November is National Family Caregivers Month.

Family caregivers are unpaid yet they care for many, if not most, of our disabled veterans. Caregivers also care for our elderly who may have one of the dementias, such as Alzheimer’s disease, or are frail due to age. They care for our children and adolescents who may have congenital, traumatic or illness related disabilities. They sometimes care for our dying.

It’s their family responsibility you say? Maybe. But whose responsibility is it when they need care?

Caregiving is grueling work. It is physically, emotionally, and mentally exhausting. Anyone who has been responsible for a toddler for even one day knows this. But a toddler grows into a child and becomes more independent. Imagine having a toddler for all of your life. That is not to say that there aren’t rewards in caregiving. But the rewards don’t come in the form of free time or rest, things that everyone needs. These rewards are intangible and don’t really make up for disturbed sleep, postponed or forgotten social engagements, or disturbed relationships.

So today and this month and all the time, let’s thank our veterans and let’s thank the caregivers. Let’s do something for them. Are you listening Veterans Admiration? Are you listen Federal Government? Are you Listen State Government? Are you listening?

What is dementia? A quick synopsis.

Dementia is the name given to a group of disorders characterized by multiple cognitive deficits. Dementia may have many different causes. Among them are traumatic brain injury, Parkinson’s disease, Lewy bodies (small “lumps” of protein) that form in brain cells, Alzheimer’s disease, nutritional or hormonal deficiencies, infection, and tumor. This is not an exhaustive list. There are many potential causes of dementia. Treatment depends on the cause.

When someone has dementia, what are we saying? Dementia is more than memory loss. Symptoms vary among individuals. There may be personality changes, e.g., inappropriate behavior. There may be changes in mood, e.g., depression. There may be difficulty planning tasks. There may be changes in motor function. Symptoms vary with the location in the brain that is affected.

Diagnosis in the early stages can be difficult because of this variability of symptoms. Is it stress? Depression? A psychosis brought on by exposure to a toxic substance? Or is it one of the progressive dementias, such as Alzheimer’s disease?

Bottom line? Consult a healthcare professional if symptoms persist or seem to be getting worse. Treatment may be as simple as hormone replacement. If it is truly one of the progressive dementias, there is no cure. But medication can slow the process and give many quality years following diagnosis.

Be Aware of COPD

COPD (chronic obstructive pulmonary disease) is the third leading cause of death in the United States, behind heart disease and cancer. Lung cancer is the #1 leading cause of cancer deaths in both men and women. More on that another day.

Smoking is the primary cause of lung cancer and COPD. It is one of the causes of heart disease. This blog is not going to be a diatribe against smoking. You all know it’s bad for you. You all know you should quit or not start. Enough said. Oh, as an aside, smoking marijuana is as bad for your lungs as is tobacco. Think twice before you smoke marijuana recreationally.

Dying from lung disease is very unpleasant. Yes, I’ve seen it. I’ll spare you the graphic details. Instead I’ll tell you what happens to the lungs in COPD and let you think about it.

First, a very brief anatomy lesson (with apologies to my anatomy professors). You have two lungs, one on each side of your heart in your chest cavity. The lung on the left side has two lobes and extends further down that the right lung, in order to make room for the heart, which tilts slightly to the left. The lung on the right has three lobes and does not tilt downward, in order to make room for the liver, which is below the diaphragm. Each lobe of the lungs is further divided into segments.

As you breathe, the air travels from your nose into your trachea, basically a tube in your throat. The trachea branches left and right into the left bronchus and the right bronchus (plural: bronchi), which divide into ever smaller tubes, called bronchioles. Imagine a tree with ever smaller branches. Each bronchiole ends in an air sac called an alveolus (plural: alveoli – I am so glad I took Latin in high school). This is where the air you breathe ends up.

Your blood vessels also get smaller and smaller as they enter the lungs. The smallest blood vessels, which should be full of gaseous waste products, transfer the waste into the alveoli and pick up oxygen from the alveoli. So, if your lungs are healthy, you breathe in oxygen and breathe out waste.

COPD is actually a pair of lung diseases: emphysema and chronic bronchitis. In emphysema, the walls of the alveoli have been damaged and either the alveoli can’t contract enough to expel the waste or the walls are too thick to go through the exchange process. In chronic bronchitis (-itis at the end of a word means inflammation), the irritated bronchial tree secretes mucus, lots of mucus. Eventually there is so much mucus that the individual with chronic bronchitis can’t expel it all. This interferes with breathing.

Both emphysema and chronic bronchitis progress slowly. But the end is an inability to breath, either because oxygen and waste can’t be exchanged or because there is an obstruction preventing breathing. Breathing is not only necessary for life. It is also necessary to perform the everyday tasks of life: eating, standing, dressing, brushing your teeth, even smiling and, of course, laughing.

There is no cure for COPD. The severity of the symptoms can wax and wane. It is not reversible. But life style changes and medications can make you feel better. Consult with your healthcare provider. Don’t smoke.

For more information:

Drug Shortages

#shortages:  Fomepizole Injection (Antizol)
Methylphenidate Hydrochloride ER Capsules/Tablets (Ritalin LA)

Mary Lou Bernardo, PhD, MSN


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