Wednesday, January 30, 2013

Lunching at Daddypops with Helen Kirschner

Daddypops Diner in Hatboro, PA, is an institution, founded by Ken and Beth Smith. Helen commented on the wishing well as we clumb up the front steps.
I ordered a grilled cheese with tomato and Helen got a bowl of vegetable soup. The food was delicious!

Since it was a balmy day, we decided to walk the streets of Hatboro.

I introduced Helen to Mark Amos and assistant Bev who print our Compass mental health mag.

When we came in, his hundred-million-dollar Xerox machine was whirring. I think of it as akin to the

Atom-smashing machine in Switzerland, the world's largest atom smasher, called the Large Hadron Collider. They're trying to find the Higgs particle.

Mark was in the back on his computer eating delicious greasy bay-seasoning potato chips. I told him we'd have the Compass for him shortly.

Stopped at LeRoy's Flowers, said hello to owner Bob, son of original owner LeRoy LaBold, and of course to say Namaste to the Buddha.

"When are you gonna buy her?" asked Bob.

I'll put her on my wish list.

Heading back to the car, I found a new grocery store called FELUCCA.

"We're just browsing," I told Mike.

Mike is the American name for Palestinian native Ahmed Shaat. An American citizen, he's lived here for 25 years. He has relatives that live in the Gaza Strip, he said.

I told him Helen and I were both Jewish.

Right now, I'm eating a freshly made za'ter

mine has a thin crust and is topped with seasonings, mostly thyme. Quite good.

I'll skip the story about the dog poop outside the post office. I told not-going-postal Sandy about it in case they wanted to send Cinderella out to clean it up.

What I did was grab a stack of junk-mail newspapers and spread it over the poop, which several people had stepped in.

At my Writer's Group on Saturday, I'm gonna write a poem about Sandy. I told Helen that when I bot stamps from him thother day, I felt like a small child speaking up to a grown-up.

Ever felt like that?

Sunday, January 27, 2013

Schmoozing after Dr Shlewiet's Talk at the Giant

Thanks Saul Miller, DDS, for taking the photo.

I always carry my stuff in an old Xerox box lid from when our Compass was printed for free by Janssen Pharmaceutica, makers of Risperdal, which was one of three drugs I took when I got psychotic. Here are the drugs: Haldol, Risperdal, and Navane.

It's always great to see Betsey Kirk, her husband Will and son William Raighne Kirk, who goes by the name Raighne (say "Raney"), a Celtic name for "Little Mighty Powerful One."

When Raighne was born he weighed all of 3 pounds and 12 ounces.

He was in the hospital for 10 days and never missed a beat after being discharged. Go, Mighty One, go!

Here's Saul now with newcomer Mary. Her family calls her "Neen" b/c one of her sibs couldn't pronounce her name correctly. I love nicknames.

Call me "Ruthie."

Will commented that Saul looks a little like Jeff Goldblum, known for his role in the wonderful and frightening film "The Fly."

Saul Miller or Jeff Goldblum?

Gerri and Betsey.

Whatcha eating, Betsey?

I had decaf coffee - into which I always add Cocoa and Cinnamon - which Adryn served me and one Irish Potato.

Margaret and Chang had bought a box and shared it at table.

We discussed books and movies.

The Kirks did not like the movie about FDR at Hyde Park even tho they said DiCaprio did a good job.

They're gonna see Quartet, the first movie directed by Dustin Hoffman, who gave a terrific interview on Charlie Rose which you can watch online.

From the previews shown on Charlie Rose the movie looked like a colossal bore! Totally banal dialogue.

I told them I saw Gregg Allman on the Tavis Smiley Show, giving a book tour for his new book "My Cross to Bear."

Although he's been off substances for many years, the man could barely speak. Maybe he was on Topomax, per Dr Shlewiet's talk.

Wonder what Tavis thought... Gregg gave one-word answers. The book is quite good. I'm not actually all that familiar with their music. Here's their album Eat a Peach (they're from Georgia) on The Tube.

They recorded the album right after Duane's death in 1971. Always reckless and impulsive, Duane was on drugs and died in a motorcycle accident in 1971.

He's been rated the second best guitarist by Rolling Stone magazine. Eric Clapton used to come by to hear him play.

The GREATS always learn from each other.

I told the movie-luvin' fun-lovin' Kirks they MUST SEE Homeland. Told em to rent it from interlibrary loan. Betsey said she used to work in the interlibrary loan department at Delaware Valley College.

They told me about a TV series called "Life" which starred Damian Lewis, who is in Homeland. They said you couldn't tell he was British.

I reserved it from my library.

Beautiful day out today. Forty degrees, says my outdoor thermometer.

Dr Basem Shlewiet speaks to full house at Giant Supermarket

We had the biggest turnout for any program we've held at the Giant Supermarket, as you can see by the above photo.

Before Dr. Shlewiet got there, I addressed the audience and asked how they heard of the event.

As usual, NAMI groups brought most of the folks, but a new resource - the Midweek Wire - brought several people there.

Only a handful of people were from New Directions.

I also told the group that after the talk, we always meet downstairs in the Coffee Shop to schmooze.

We also discussed mental hospitals. Most people had excellent experiences at Horsham Clinic. One person complained about the psych ward of Abington Memorial Hospital. Apparently it's one big unit - Horsham has a variety of different bldgs - and so you'll be in there with people with dementia which is quite unsettling for a depressed person. 

When Dr. Shlewiet came in, I introduced him as Basem Shlewiet and asked the audience, Where dyou think he's from originally?

Then as a hint I said, Think of the most troubled country that's always in the news.

Yes, Syria. (Don't forget that the late Steve Jobs was half-Syrian.)

In the next issue of our Compass mental health magazine, we'll feature Profile of a Psychiatrist and it will be Dr Shlewiet.

Dr Shlewiet gave a brief bio: He received his psychiatric degree in Syria. He and his wife came to the US in 1997. His English is impeccable. When you see one of the numerous psychiatrists from other lands, you must be able to understand them perfectly.

Dr Shlewiet completed his residency training at Einstein Medical Center in Philadelphia, and his Child Fellowship at the Children’s Hospital of Philadelphia. I told him over the phone that Einstein is where I had my kidney transplant in 2011. He was unaware of all the people my age - in our sixties - whose kidneys have been compromised due to lithium use.

This will be one of the themes in the upcoming Compass.

If you're on lithium, and Dr Shlewiet emphasized this, you must get regular lab tests. Lithium may also knock out your thyroid function, which it did mine. I take Synthroid, a synthetic thyroid hormone.

He mentioned that in May the new DSM-V will come out. Read this Times article about it.

This is the Diagnostic & Statistical Manual by which psychiatric diseases are coded. When I had bipolar d/o - it went away 12 years ago - my code was 296.62.

The doctor emphasized the importance of getting a correct diagnosis. Less than half the people in our group know their diagnosis. Not good!

Dr Shlewiet used slides to project information. Super-informative. Wish I could've photographed them.

I remember thinking to myself when the meds appeared on the screen: They are like my friends.

Dr. Shlewiet did emphasize to try psychotherapy first before you go on meds, but only if your depression is mild to moderate.

He also emphasized that research shows that therapy in combination with medications work best.

MONOAMINE OXIDASE INHIBITORS, the earliest antidepressants, were developed in the 1950s but fell out of favor b/c of their eating restrictions and interactions with other meds. Our "Sally," who's on Nardil, has hip pain and her family doc can barely prescribe anything helpful for her. Sally, who I'd been urging for years to seek a consultation with another psychiatrist, will see Dr. Shlewiet.

Look, all I'm interested in doing is referring our people to good psychiatrists that will help them and treat them with respect! We have at least 50 psychiatrists from all over the Philly area on our Top Doc/Top Therapist List. It is only available by speaking with me over the phone. We don't mail it out. 

FROM WIKI: The older MAOIs' heyday was mostly between the years 1957 and 1970.[8] The initial popularity of the 'classic' non-selective irreversible MAO inhibitors began to wane due to their serious interactions with sympathomimetic drugs and tyramine-containing foods that could lead to dangerous hypertensive emergencies. As a result, the use by medical practitioners of these older MAOIs declined. When scientists discovered that there are two different MAO enzymes (MAO-A and MAO-B), they developed selective compounds for MAO-B, (for example, selegiline, which is used for Parkinson's disease), to reduce the side-effects and serious interactions.

Here are some interesting things Dr. S mentioned:

Topomax really doesn't work for bipolar d/o. I remember when I saw my last psychiatrist, Larry Schwartz, from whom I learned a lot, that he told me he had a patient who could not speak after he prescribed her Topomax.

It's often prescribed as an adjunct with psychotropic medications to control weight gain. 

The popular antidepressant Effexor works as an SSRI on lower doses. SSRI's were developed in the 1980s and changed the course of medicine.

The first of the TRICYCLIC DRUGS (named for their three interconnected rings of atoms) was imipramine (brand name Tofranil), discovered in the early 1950s. 

My info comes Dr Shlewiet and from Wikipedia and other online sources.  

Lots of bad side effects with tricyclics, including dry mouth, constipation, weight gain, and cardiac problems, which Dr S noted was the worst problem.

"Tricyclics have a narrow therapeutic window," he said. 

The 1980s saw the advent of the SSRIs such as Prozac, Celexa, Paxil, Luvox and Zoloft. They all have properties that combat OCD.

He mentioned that Paxil got in trouble b/c they hid the suicide rates in their studies. “Glaxo knew as early as 1989 that Paxil increased the risk of suicidal behavior in patients by more than 8-fold compared to patients who received a placebo," he said.

Later all antidepressants got a black box warning relating to increased suicidal thoughts but not completed suicide rates, he said.

Generally patients have to be monitored closely when starting treatment and the first 2-3 months are most crucial.  Patients who are very depressed don’t have the energy sometimes to kill themselves but as they get better, their energy might increase while they are still suicidal and they could end up committing suicide, he said.

SSRI = Selective Serotine Reuptake Inhibitors.  

YOU FIGURE OUT WHAT THIS MEANS, I'm not a doctor:  SSRIs are believed to increase the extracellular level of the neurotransmitter serotonin by inhibiting its reuptake into the presynaptic cell, increasing the level of serotonin in the synaptic cleft available to bind to the postsynaptic receptor

Dr Shlewiet shocked the audience by saying the SSRIs don't work very well for folks with bipolar d/o. 

The most profoundly depressed person with bipolar I know, who isn't getting any better, is on a slew of SSRIs. She feels loyal to her psychiatrist and doesn't wanna switch.

When weaning off the SSRIs, said Dr S, 20 percent of patients get "SSRI Discontinuation Syndrome."  This doesn't happen with Prozac b/c of its long half-life. It also occurs with Effexor. 

Symptoms include flu-like symptoms, nausea, insomnia, and hyper-arousal. Did you see the Ray Charles movie when he tried to withdraw from heroin? Kind of similar. 

I remember one woman in our group who was very sick after discontinuing her SSRI and spent 6 weeks on her couch. Her then-husband had absolutely no sympathy for her.

There's also a condition called "Serotonin Syndrome" that results most from taking two medications that effect Serotonin where your body has too much serotonin."It's potentially life-threatening," said the doctor, "and you must go to the emergency room."

After reading about all these side effects, it's no wonder people don't wanna go on meds. That's why you must have a good psychiatrist you can reach in times of crisis.

Why do people get depressed?

"We don't really know why people get depressed," said Dr Shlewiet, "but we have theories."

Genetics, family history, social and environmental forces.

Two-thirds of depressed people, he said, do not get appropriate treatment.

There are so many reasons for this including stigma toward people with mental illness, which was not helped by the recent mass shootings in Newtown, CT. Here's my article in the Intell about it. There's also an excellent Radio Times program with Joseph Rogers, co-founder of the Mental Health Assn of Southeastern PA, who says the same thing. Joseph has bipolar d/o and said he takes meds including Risperdal. Listen to this excellent 50-minute talk.

Dr Shlewiet said that with proper treatment 80 percent of the people with depression can improve.

Sadly, that's not 100 percent. Other things can be tried including ECT and transcranial magnetic stimulation. Here's one of our Giant programs that featured Dr Boyadjis on TMS

There's also microsurgery by Helen Mayberg, MD. This will be mentioned in our next Compass.

"After we treat for depression," said Dr S, "we often find out a year later that the person has bipolar d/o."

Don't we know it? According to statistics I've read, it takes 9 years for a bipolar individual to get properly diagnosed.

"In some patients with recurrent depression that is not responsive to treatment, we could discover years later that a person has bipolar disorder and not unipolar depression.  The first manic episode might happen later after several depressive episodes." said Dr S.

"THERE IS NO WAY TO DIFFERENTIATE BETWEEN BIPOLAR DEPRESSION (or a Depressive Episode in a Bipolar patient) AND Unipolar REGULAR DEPRESSION," he said.

"Bipolar depression is harder to treat," he said.

"SSRI's don't work," he continued. "Research validates this."

His favorite drugs for bipolar depression are: LAMICTAL, SEROQUEL and ABILIFY.

We have a woman in our group, "LuAnn," who's in her early 80s. She comes from a family rife with mental illness, including suicides. LuAnn wasn't hit until she was 65 years old. She went from psychiatrist to psychiatrist, treatment-resistant, until she found a nurse-practitioner, who prescribed a lo-dose of Seroquel.

LuAnn has been fine ever since. Hallelujah!

Dr S said he finds Abilify - introduced 7 years ago - to be one of the better drugs. He said he tends to wait before prescribing a new drug. In drug trials, only a small sample of people have taken the drug. After its release, thousands of people will take it, showing how it works in the general population.

Abilify tissue box. Larry Schwartz gave me one. I finally threw it away. I prefer hankies, which I cut out from old shirts.

Question about the new antidepressant Prestiq: "It's very similar to Effexor with easier dosing."

He also discussed benzodiazepines. I volunteered that I'm president of the Klonopin fan club, having taken it for 16 years. I was lucky to wean off it in only five weeks. To prepare for this, I weaned off coffee. When I drink coffee, I only drink decaf.

Klonopin, he said, is sometimes used as an adjunct in acute mania and should only be used for a short time. 

He also said, which I hadn't known, that the benzos may contribute to depression, which does make sense if they're antimanic.

He spoke about the unmedicated bipolar individual. 25 percent of these individuals, he said, will end up with an early death. This may result from self-medicating with drugs and alcohol, they might die from an overdose or car accident, they may become homeless, or die from other impulsive behavior including suicide.  


Although they're decidedly cheaper, they should have the same active ingredients as their brand name counterparts (as well as the same the mg amount,) although that is not always the case.

One of the manufacturers of Wellbutrin generic did not have the correct dosing rendering the medication ineffective and it was recalled. 

For carbamazepine (generic Tegretol)  it is much easier to monitor it since you can measure the blood levels and therefore it does not really matter if you take a brand name or generic.

We always give our speakers a nice gift.

I baked Dr S a whole-wheat loaf that morning and also gave him some crocus flowers in a porcelain Dutch shoe.

Here's his contact info:

Basem K. Shlewiet, M.D.
16 N Franklin St
Doylestown, PA 18901

Click on his website here. 

Be sure to read about schmoozing in the downstairs coffeeshop.

Thursday, January 24, 2013

I finally boogie with Jacques Pepin - my Scallop dish

Just my opinion, but I find Jacques incredibly sexy! In fact, I'd say most of the male chefs on the cooking shows on PBS are inrresistibly attractive. Jacques, born in 1935, is 10 years older than me, so, happily, we'll grow old together.

Here's the great Chinese chef...

Ming Tsai, born 1965

Rick Bayless, Mexican cuisine

The same is true with orchestra conductors, such as

Seiji Ozawa, who, according to Wiki, became famous not only for his conducting mannerisms, but also his sartorial style: he wore the traditional formal dress with a white turtleneck rather than the usual starched shirt, waistcoat, and white tie.

Born in 1935, he has major health problems today. 

Here's the scallop dish I made with Pepin's help. I was bicycling while watching him but knew I wanted to try this unusual recipe.

I bought 5-6 scallops at the Giant this afternoon, after our morning meeting. Debbie, the fish monger, told me to saute them just until they were tender or else they'd get hard.

I cut them in half and also sauteed my crimini mushrooms and a segment of a shallot, which you'll see on the right. Its pungent smell is like a combination of garlic and onion. I forgot to add the red-wine vinegar.

I also had steamed buttered brussels sprouts and 6 rice crackers as my starch. Mary Ann Moylen is my nutrition boss.

Am getting excited about our next Compass mag.

Carl Yeager, who we profiled years ago, will once again do the back cover as well as have one or two of his digitally enhanced photos inside.

Carl Yeager
Just cribbed this off FB. Hard to see. I'm guessing he's at a recent art show at Moss Rehab.

Okay, you have a good night. I've got an hour worth of writing to go before hitting the books.

Tuesday, January 22, 2013

On a cold January day I go with State Farm

Thru the window I saw the Mini-Cooper pull up. Look at the dusting of snow we got last nite. It was cold this morning - 14 degrees!

Mark Armstrong and I sat down in the kitchen to do business. He took one indoor photo - the electric box down in the basement bathroom. It was freezing down there! Also took photos of the front and back of my house.

Here I am in my warm PJs. I ain't going anywhere today. Worked for hours on the Compass mag. What a great issue it'll be.

They sure like the color RED. I'll save about $400 a year by switching to State Farm from Ohio Casualty, even tho I'm from Ohio - Why-o-why-o-WHY-o, why did I ever leave Ohio? Lyrics from musical Wonderful Town, lyrics by Betty Comden and Adolph Green, music by Leonard Bernstein.

As a kid, I listened to every musical that came to B'way. Dad bought them all. When he was dying, we played them in his bedroom. His favorite was The Pajama Game.

I told Mark Armstrong I'm not planning to die in a car crash. But if I do, SAVE MY GODDAM KIDNEY and give it to someone. It's currently only 38 years old.

Flowers on the windowsill in the drab winter is important.

Yesterday, at the Willow Grove Giant Pharmacy, I ran into a problem. With the new year, my Prograf - immunosuppressant - was not covered by insurance.

Pharmacist Bobby called me and said he spent hours on the phone figuring out how to get me coverage. He told me to see pharmacist Hannah yesterday so I could pick up my drugs at a lower price than $117 per bottle. I take two a day and run out fast.

Went to the Giant in the afternoon, reluctantly putting on a pair of jeans over my PJs. Hannah told me to have a seat, it would take awhile.

I selected a book from the sale books.

I was engrossed in the tale of the Utah disappearance of a wife and mother, when suddenly Hannah came running over.....

"We did it," she shouted. "We did it!"

She'd been talking to Bobby over the phone - it was his day off - and they figured out how to charge it to part of my Highmark card.

In appreciation, I bought three daffodils - one for Hannah, one for her assistant Donna and one for me.

And, in an unusual splurge.... I BOUGHT THE BOOK.

Monday, January 21, 2013

Inauguration Day - Jan 21, 2013: "Our Journey is not Complete"

Obama took the oath of office a day early before the official swearing-in today. Here's Justice Roberts doing the honors. My photos are from the Times, ABC News and NBC News.

The family attends church services before the official swearing in. 600,000 people are expected to attend. If it's 36 degrees outside in suburban Philly, l'd guess it's the same temp in DC.  Yep, says "Weather Underground."

Scott and I watched the inaug and parade on NBC news, which I thot had the best coverage. A fashion correspondent from the Washington Post said Michelle wore "high end" clothing plus this J.Crew belt. Her kids - 14 and 12 - apparently wore J.Crew outfits.

And, yes, she's wearing bangs for the first time. To hide her worry lines? So did Mamie Eisenhower.

Parade down Presidential Ave. Scott and I were thrilled b/c we'd recently been there and saw lots of bldgs like The Old Post Office.
Luncheon is served!

Chuck Schumer waves too. Never knew what he looked like. Faces uphill battle as nominee for Defense Secretary.

Great they invited the widow of slain activist Medgar Evers.

 I favorited the first lady and Obama on FB.

Always a pleasure to see you, Bill aka William Jefferson Clinton.

Here's Jimmy and Rosalynn Carter. Carter said he just talked to George Bush Sr who's been in the hospital quite a while. They're old friends.

Altho we saw Congressman Paul Ryan Jr, we all wondered where Mitt was and if he were watching the inauguration. What dyou think?

Jay-Z and Beyonce

Tres cool when the Obamas got outa their Cadillac limo and walked. I noticed an ambulance was a few cars back in case any shots rang out. Dyou think Dr Marcus Welby was on board?

Good ole Joe! I guess he's what LBJ was to JFK, a dealmaker. And irrepressibly happy. A super-obnoxious NBC on/ground reporter, caught Biden's attention and Obama's too. No one was making contact with either the prez or VP until the weatherman Roker yelled out several times and asked them how they liked the weather.

The Secret Service weren't too pleased. We could see the Secret Service scanning in all directions throughout the entire gig.

Justice Roberts swears them in. I really enjoyed the poet.
PHOTO: Richard Blanco, 44, was chosen as President Obama's inaugural poet. In addition to being the youngest of the five inaugural poets in history, he becomes the first Latino and gay man to serve the role.
Poet Richard Blanco, 44. Read more about him AND read his poem "One Today."

What's for dinner Mom? My friend Ellen is making chicken parm. I'm eating a luscious salad with added broiled cauliflower.

Broiled caulflower. Place cauli in baking sheet. Pour olive oil across florets and sprinkle with black pepper. Incredibly delicious!

Quiet honestly, these are FAB-U-LUSS!!!