Podcasts about ativan

In this episode of the Inside EMS podcast, hosts Chris Cebollero and Kelly Grayson dig deep into one of EMS's most overlooked (and often forgotten) topics — toxidromes. You might remember the word from paramedic class, but today's street calls demand more than a vague memory. With patients taking everything from grandma's Ativan to street-made speed, understanding toxidromes is crucial for making quick, accurate clinical calls. The crew breaks down the five major toxidromes every medic should know: anticholinergic, cholinergic, opioid, sympathomimetic and sedative-hypnotic. From classic mnemonics like “mad as a hatter” to real-life stories of fire ant poisonings, this episode serves up practical knowledge with EMS-grade humor. Chris and Kelly cover telltale signs (sweaty vs. dry skin, pinpoint vs. dilated pupils), treatment pearls of wisdom (easy on that naloxone, folks), and the real-world complications of polypharmacy. Plus, they touch on lesser-known players like serotonin syndrome and hallucinogens. This one's a refresher you didn't know you needed — but you'll be grateful when you respond to your next overdose call. Memorable quotes “Antidotes are overrated. Supportive care will take care of most of the toxidromes out there.” — Kelly Grayson “If they're pleasantly stuporous but breathing effectively, it's not an overdose. It's just a dose.” — Kelly Grayson “Narcan is not a punishment, it's a treatment. You don't slam it, you bump it just a little bit, just enough to get them breathing again.” — Kelly Grayson Enjoying the show? Email the Inside EMS team at theshow@ems1.com to share ideas, suggestions and feedback, or let us know if you'd like to join us as a guest.

This week I am joined by another Breaking Up With Anxiety Program client... Ashley!! Ashley's struggles with anxiety seemed to come out of nowhere, leading to terrifying panic attacks during simple tasks like running errands at Walmart. Her body would go numb, she'd get extremely dizzy, and feel like she was about to pass out. Despite living what appeared to be a healthy lifestyle - working out regularly and eating clean - she found herself spiraling into an anxiety disorder and struggling with severe insomnia, eventually leading her to rely on a combination of medications including Ativan, sleeping pills, and escitalopram just to get through each day. She couldn't understand why this was happening to her when her life didn't seem particularly stressful and, as a former fitness competitor, she thought she had some really good habits. Through our work together, we discovered that despite her background in fitness competitions, her "healthy" diet wasn't providing all the nutrients her body needed. We made some targeted dietary adjustments and worked on optimizing her gut health and supporting her adrenals. Now, Ashley sleeps a full 8 hours every night without any medication, has completely overcome her panic attacks, and has developed a daily toolkit of specific habits that keep anxiety far away. Most importantly, breaking up with anxiety has allowed her to show up as the present, patient mother she always wanted to be for her little boy. I hope this episode gives you the hope and encouragement that freedom from anxiety is absolutely possible! As always, I'd love to hear your thoughts! Send me a message on Instagram after you've listened @tay.gendron The Yoga Nidra Ashley mentioned on this call is Ally Boothroyd Yoga Nidra on YouTube Register for my free "How to Break Up with Your Anxiety Without Medication" class: https://courses.taygendron.com/january25-class For more information on my 4-month Breaking Up With Anxiety Program: https://www.taygendron.com/breaking-up-with-anxiety And don't forget to subscribe so you never miss an episode! Website: www.taygendron.com

Matt Walker welcomes Dr. Ranji Varghese to the podcast this week for an in-depth conversation about sleep and prescription sleeping pills. A psychiatrist specializing in sleep medicine, Dr. Varghese begins by discussing his entry into the field which was sparked by a fascination with sleep and wake circadian rhythms. He goes on to highlight the Minnesota Regional Sleep Disorder Center's focus on parasomnias, particularly REM Sleep Behavior Disorder, emphasizing the intersection of neuroscience, physiology, and psychology in sleep medicine.As you will hear, sleeping pills, prescribed to initiate or maintain sleep, are typically used as a last resort for insomnia after other treatments fail. Dr. Varghese explains they work by modulating brain activity, often targeting neurotransmitters like GABA or melatonin receptors. He details two main classes: benzodiazepines (like Restoril and Ativan) and non-benzodiazepines (Z-drugs like Ambien and Lunesta), outlining their mechanisms, benefits, and risks. His powerful personal anecdote and the discussion of complex sleep-related behaviors underscore the critical need for careful consideration and informed decision-making when using these medications.Please note that Matt is not a medical doctor, and none of the content in this podcast should be considered medical advice in any way, shape, or form, nor prescriptive in any way.Long-time show sponsor LMNT is Matt Walker's go-to for a sugar-free electrolyte mix. With the perfect electrolyte balance and science-backed formulation, LMNT is a product Matt trusts daily, adding it to his workouts and protein shakes. And now, for a seasonal twist, their Chocolate Medley range is back with flavors like Chocolate Mint and Matt's favorite, Chocolate Raspberry. Get a free sample pack with any purchase at drinklmnt.com/mattwalker—just use his link to try it yourself!Another great sponsor of the show is AG1, a comprehensive nutritional drink trusted by thousands worldwide, including Matt! For nearly four years and counting, he has relied on AG1 to fuel his post-workout routine with its powerhouse blend of over 75 essential minerals, vitamins, probiotics, and prebiotics, meticulously crafted to support your daily nutritional needs. AG1 is registered and approved by the Therapeutic Goods Administration, boasting GMP badges for quality assurance. As a special offer for our listeners, when you try AG1, you'll receive a complimentary one-year supply of both Vitamin D and K2, and with your first subscription, you'll also receive five free AG1 travel packs! Visit AG1 to explore AG1's range of offerings and claim your exclusive offer.As always, if you have thoughts or feedback you'd like to share, please reach out to Matt on Instagram.Matt: Instagram @drmattwalker or on X @sleepdiplomatConnect with Dr. Varghese:Instagram: @docvargheseX: @docvargheseMinnesota Regional Sleep Disorders Center:https://www.hennepinhealthcare.org/specialty/minnesota-regional-sleep-disorders-center/IIT-MN: https://iit-mn.com/

Ask David: Getting Off Benzos How Does Music Stir Our Emotions? Combatting Negative Thoughts about the World Treating Schizophrenia with TEAM The Four Feared Fantasy Techniques and more! Questions for today: Mamunur asks: What's the best way to withdraw from benzodiazepines? Gray asks: How does music evoke such powerful emotional reactions? Josh thanks David for techniques that have helped in his personal and professional life. Harold asks: How do you respond to negative thoughts about the world, as opposed to self-criticisms? For example, “The world is filled with so little joy and so much suffering.” Moritz asks: How do you help people with bipolar, schizophrenia, etc.? John expresses gratitude for our answer to his question on Positive Reframing, which triggered an “ah ha moment.” Rhonda asks: What are the four Feared Fantasy Techniques? The answers below were written prior to the podcast. Listen to the podcast for the dialogue among Rhonda, Matt, and David, as much more emerges from the discussions! Mamunur asks: What's the best way to withdraw from benzodiazepines? Ask David, Bangladesh question Dear Sir, I am writing to you from Bangladesh. Your book Feeling Good is a phenomenal work, and it has greatly helped in promoting the development of a healthy mind through logic and reason. Sir, I have a question regarding benzodiazepine withdrawal, which is often prescribed for mental health disorders. Is there a specific CBT (Cognitive Behavioral Therapy) approach that can help in withdrawing from benzodiazepines? Your guidance on this would be invaluable, as many people have been taking it for years, either knowingly or unknowingly, without being fully aware of its severe withdrawal effects. Thank you, sir, for your kind contributions to humanity. Sincerely, Mamunur Rahman Senior Lecturer David's reply Dear Mamunur, Thank you for your important question! I am so glad you like my book, Feeling Good, and appreciate your kind comments! As a general rule, slow taper off of benzodiazepines is recommended. This might involve slowly decreasing the dose over a period of several weeks. When I was younger I used to take 0.25 mg of Xanax for sleep, because it was initially promoted as being non-addictive, which was wrong. It is highly addictive. The dose I used was the smallest dose. When I realized that I was “hooked,” I tapered off of it over about a week, and simply put up with the side effects of withdrawal, primarily an increase of anxiety and difficulty sleeping. These disappeared after several weeks. Abrupt withdrawal from high doses of any benzodiazepine can trigger seizures, as I'm sure you know. That is the biggest danger, perhaps. I do recall a published study from years ago conducted at Harvard, I believe at McClean Hospital. The divided two groups of people hooked on Xanax into two groups. Both groups were switched to Klonopin which has a longer “half-life” in the blood and is supposedly a bit easier to withdraw from than Xanax, which goes out of the blood rapidly, causing more sudden and intense withdrawal effects. After this initial phase, both groups continued with slowly tapering off the Klonopin under the guidance of medical experts. However, one of the groups also attended weekly cognitive therapy groups, learning about how to combat the distorted thoughts that trigger negative feelings like anxiety and depression. My memory of the study is that the group receiving cognitive therapy plus drug management did much better. As I recall, 80% of them were able to withdraw successfully. However, the group receiving drug management alone did poorly, with only about 20% achieving withdrawal. My memory of the details may be somewhat faulty, but the main conclusion was clear that the support of the group cognitive therapy greatly enhanced the success of withdrawal from benzodiazepines. I decided early in my career not to prescribe benzodiazepines like Ativan, Valium, Librium, Xanax, and Klonopin for depression or anxiety, because the drug-free methods I and others have developed are very powerful, and the use of benzos can actually make the outcomes worse. Years back, a research colleague from Canada, Henny Westra, PhD, reviewed the world literature on treatment of anxiety with CBT plus benzos and concluded that the benzos did not enhance outcomes. Here is the link: https://pubmed.ncbi.nlm.nih.gov/12214810/. I hope this information is useful and I will include this in a future Feeling Good Podcast.   Gray asks: How does music evoke such powerful emotional reactions? Subject: Re: Podcast question: love songs Hi David, That's a really tough question. Music has a unique way of cutting straight to emotions for me, and it makes it especially hard to identify the thoughts behind them. My best way of explaining is with these two thoughts, which have to be viewed as a pair to get that emotional reaction: My life would be perfect if I had that I'm so far away from that These thoughts don't resonate quite right for me, but it's something like that, going from imagining bliss to crashing to hopelessness within the space of a moment. Thank you so much for your response. Gray David's reply You're right. Music can be so beautiful, especially of course, the songs we love, that it is magical and emotional to listen to! It seems more like a sensory experience, than something mediated by thoughts, but we certainly have perceptions of beauty, etc. Similar with some incredibly delicious food. Creates incredible delight and satisfaction, and no words are necessary other than “delicious!” Sorry I can't give you a better answer to your outstanding question! Best, david   Josh thanks David for techniques that have helped in his personal and professional life. Dear Dr. Burns, I am sure you are swamped with substantive emails and fan mail, but I just wanted to express appreciation to you for all I have gained from your publicly available content. I have learned so much that I have applied in my personal life. I have also benefited tremendously in my work with clients. So much of what you say about anxiety, and especially the hidden emotion technique, has allowed clients to have in almost every session an aha moment. I have not yet been able to see a complete removal of symptoms in one session yet, but as a therapist, I too have many skills yet to improve and much work to do. So, in short, thank you so much for making your experience and wisdom available for free, and thank you for doing it in such an engaging manner. Sincerely, Josh Farkas   David's Reply Thanks, Josh. You are welcome to join our weekly virtual free training group I offer as part of my volunteer work for Stanford, if interested. For more complete change within sessions, a double session (two hours) in my experience is vastly more effective. Is it okay to read your kind note on a podcast? Warmly, david   Harold asks: How do you respond to negative thoughts about the world, as opposed to self-criticisms? For example, “The world is filled with so little joy and so much suffering.” Dear Dr. Burns, First of all, I would like to thank you for all your work and your outreach. Your books have profoundly influenced my thinking and value system. I really admire how you exemplify both scientific rigor and human warmth. Finally, I want to thank you for promoting the idea of “Rejection Practice! I haven't had a breakthrough yet, but some unexpected, very encouraging experiences. I first came across Feeling Good 12 years ago when I developed moderate depression in the context of living with my ex-partner, who probably had borderline personality disorder. I tried the techniques in Feeling Good and also psychotherapy, but unfortunately without much success. I only started feeling a lot better when I began to rebuild my social life and leisure time activities (ballroom dancing, getting involved with a church, ...). Several months later, I also broke up with my ex-girlfriend. Since then, I've had ongoing mild depression. I recently tried the techniques in Feeling Great but wanted to ask you for your opinion on a couple of negative thoughts I'm particularly stuck with. My issue is that I'm normally not attacking myself, but life in general. I keep on telling myself things like "Life is just one crisis after the other," "Life is for the lucky ones," "Really good things just don't want to happen," "Life is so much suffering and so little joy," and the depression itself makes these statements all the more convincing. (Triggering events can be rainy holidays, romantic rejections, grant interview rejections, etc.) I think it could be helpful if in a podcast you could give more examples on resolving negative thoughts attacking life / the world rather than oneself. I also have many more questions for podcasts if you are interested. Thank you for reading this, and thank you so much again for all your work! With very best wishes, Harold   David's Reply Happy to address this on an Ask David, and it would help if you could let me know what negative feelings you have, and how strong they are. I will be answer in a general way, and not engaging you in therapy, which cannot be done in this context. Is that okay? I'm attaching a Daily Mood Log to help organize your thoughts and feelings. Send it back if you can with the Event, Negative Feelings and % Now columns filled out (0-100), and Negative thoughts and belief in each (0-100). You can also fill in the distortion column using abbreviations, like AON for All-or-Nothing, SH for Should Statement or Hidden Should, MF for Mental filtering, DP for Discounting the Positives, and so forth. Thanks! If you were in a session with me, or if we were just friends talking, I would reply to your complaints with the Disarming Technique, Thought and Feeling Empathy, “I Feel” Statements, Stroking, and Inquiry, like this: Harold: “Life is so much suffering and so little joy." David: “I'm sad to hear you say that, but you're right. There's an enormous amount of suffering in the world, like the horrible wars in Ukraine and in the Mid-East. (I feel; Disarming Technique) It makes sense that you'd be upset, and have all kinds of feelings, even anger since there's so much cruelty, too. (Feeling Empathy) And even people who appear positive and joyful often have inner sadness and loneliness that they are hiding. (Disarming Technique) Your comment tells me a great deal about your core values on honesty and compassion for others. (Stroking) Can you tell me more about the suffering that you've seen that has saddened you the most, and how you feel inside? (Inquiry) But I'm mainly interested in you right now. Can you tell me more about YOUR suffering, and especially if there's some problem you might want some help with? (Inquiry; Changing the Focus) I would continue this strategy until you gave me an A on Empathy, and then I would go on to the A of TEAM (Assessing Resistance), and ask what kind of help, if any, you'd be look for in today's session. I might also use a paradox, like the Acid Test. If you wanted to reduce some of your negative feelings, I might try a variety of techniques, such as “How Many Minutes?” I'd also think about the Hidden Emotion Technique. Is there some problem in your life right now that you're not dealing with, so you instead obsess about the problems in the world to distract yourself? I would continue this strategy until you gave me an A on Empathy, and then I would go on to the A of TEAM (Assessing Resistance), and ask what kind of help, if any, you'd be look for in today's session. I might also use a paradox, like the Acid Test. If you wanted to reduce some of your negative feelings, I might try a variety of techniques, such as “How Many Minutes?” I'd also think about the Hidden Emotion Technique. Is there some problem in your life right now that you're not dealing with, so you instead obsess about the problems in the world to distract yourself? I ask this because your negative thoughts are very general, but I always focus only on specifics, specific problems and moments. What's has been going on with your parents or in the past or present that you are distressed about? I've found that when I (or my patients) solve one specific problem that's bugging me, everything seems to suddenly brighten up. For example, you wrote : “I asked someone out I like; she surprisingly said yes. After 10 days of not hearing from her, I messaged her, . . . “ I wrote a book about dating, Intimate Connections, because I was a nurd and had a lot to learn about dating. One idea is that waiting 10 days might not be a good idea to arrange the specifics of the date, as that might make her feel uneasy. There's a lot to learn about dating, for example. A tool like the Pleasure Predicting Sheet can sometimes help, too. And finally, a good therapist can also often speed things up. Sometimes two heads are better than one. You seem extremely smart and willing to work hard, so there's all kinds of room for growth, learning, and greater joy. The Feeling Great App is NOT therapy, but the tools there might also be helpful, especially since you are willing to work hard a do a lot. That's super important. Can I use this email in my reply in the show notes if we discuss your excellent questions? And should I change your name to Harold? Warmly, david Best, david     Moritz asks: How do you help people with bipolar, schizophrenia, etc.? Hi David, You have mentioned a few times that there are only a handful of "real" psychological disorders with known causes, as opposed to just a collection of symptoms. Could you please tell a bit about how you would go about helping somebody with one of the "real" disorders (like Schizophrenia or Bipolar) using TEAM therapy? Most of the episodes with personal work seem to fall into the other category (anxiety, depression, compulsive behavior), so I'd be really curious about some examples. Best regards, Moritz Lenz   David's Reply Hi Moritz, Thanks! Good question, and happy to address this on an Ask David. Here's the answer in a nutshell. When working with someone with schizophrenia, the goal is to help them develop greater happiness and interpersonal functioning, exactly the same as with anyone else, using TEAM. The goal is not to cure schizophrenia, because we still do not know the cause and there is no cure. But we can help individuals with schizophrenia with problems that they are having. Bipolar: in the manic phase, usually strong meds are indicated, and often at least one hospitalization. For the rest of their lives, including depression, TEAM works great. Can add more in the podcast. Best, david   John expresses gratitude for answer his question on Positive Reframing, which triggered an “ah ha moment.” Hi David and Rhonda! I have listened to Episode 415 and your response to my positive reframing question! I had a bit of a aha moment! I think I had been approaching it in the cheerleading sense and trying to encourage myself with these positive qualities rather than attaching the positives to the negative thoughts and feelings themselves! This has created a much stronger emotional response during the positive reframing section! The building up of the negative thoughts and feelings is a gamechanger! Thanks so much for the time and attention given to it during the podcast. Thanks so much again, I appreciate you folks way more than you could know! John David's Reply Thanks, Rhonda and John. Yes, you've pointed out a huge error many people make when trying to grasp positive reframing. If it is okay, we can include your comment in a future podcast. Warmly, david   Rhonda asks about the four Feared Fantasy Techniques: David's Reply Here are the four Feared Fantasy Techniques Approval Addiction / Perceived Perfectionism: “I judge you.” Achievement Addiction: “High School Reunion.” Love Addiction: Rejection Feared Fantasy Submissiveness: No Practice There are quite a number of additional role plays, too, as you know. Maybe a question about all the role plays, bc we all have: Self-Critical Thoughts: Paradoxical and Straightforward Double Standard Externalization of Voices Uncovering Techniques Man from Mars Tempting Thoughts Devil's Advocate Technique Tic-Tok Technique Resistance Externalization of Resistance How Many Minutes? Five Secrets / Relationship Conflict Intimacy Exercise One Minute-Drill I'll bet you can think of more, too! This is one of the unique features of TEAM, but for whatever reason it seems like few therapists use them. As you know, on average they tend to be way more potent and emotional, and of course fast impact. Warmly, david

I am thrilled to have Dr. Olivera Bogunovic and Holly Hardman with me on the show today. Dr. Bogunovic is an assistant professor of psychiatry at Harvard Medical School and the medical director of the alcohol, drug, and addiction outpatient program at the McLean Hospital, and Holly directed the documentary As Prescribed. In today's discussion, we dive into the ongoing benzodiazepine crisis in the United States, with over 92 million prescriptions written each year for medications like Ativan, Valium, Xanax, and Klonopin. We discuss the origin of those drugs in the 1970s as treatments for anxiety and how they lead to tremendous physical dependency. Holly shares her experience with the neurological effects she suffered after long-term use of Klonopin, and we examine challenges in psychiatric care, the need for informed consent, and the impact of social media. We also cover the role of lifestyle, the need for psychotherapy and psychosocial support, and the significance of hope. This conversation is truly invaluable! Given how frequently benzodiazepines get prescribed, everyone must understand their associated risks and considerations. IN THIS EPISODE YOU WILL LEARN: How prescribing practices have evolved over the last two decades The significant consequences older adults face when they suddenly stop using benzodiazepines  Holly shares how doctors misinformed her when she began taking Klonopin.  Holly describes the benzodiazepine-induced symptoms and cognitive issues she experienced Why people must get informed about the long-term effects of benzodiazepines when consenting to take them How benzodiazepines work in the body and impact the brain Why benzodiazepines are ineffective when used long-term for insomnia The challenges certain people face when accessing psychiatric care What is BIND, and what are its symptoms? The significance of diet and holistic approaches for managing mental health and why community support is essential in the recovery process Why As Prescribed is an educational documentary for everyone Connect with Cynthia Thurlow   Follow on Twitter Instagram LinkedIn Check out Cynthia's website Submit your questions to support@cynthiathurlow.com Connect with Dr. Olivera Bogunovic The McLean Hospital (in Boston) The documentary, As Prescribed, is available in the United States and Canada on Prime Video, Apple, Kanopy, Tubi, and Google.

We were joined by Heidi Shertok, a novelist and author of Unorthodox Love to talk all about our collective anxiety and the need to take Ativan in order to get through a Shabbat dinner. Julia and J discussed how Americans seem to always have the need to yell and talk over each other, strange nicknames and how a privileged childhood can be very damaging.

Episode 175: Alcohol Use Disorder Basics   Future Dr. Sangha explains the clinical presentation, diagnosis, and fundamentals of the treatment of alcohol use disorder (AUD). Dr. Arreaza offers insights about the human aspect of the treatment of AUD.    Written by Darshpreet Sangha, MS4, Ross University School of Medicine. Editing and comments by Hector Arreaza, MD.You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.What is Alcohol Use Disorder?AUD is characterized as the inability to stop or control alcohol use despite adverse physical, social and occupational consequences. According to DSM-5, it is a pattern of alcohol use that, over 12 months, results in at least two of the following symptoms, indicating clinically substantial impairment or distress: Alcohol is frequently used in higher quantities or for longer periods than planned.There is a persistent desire or unsuccessful attempt to reduce or manage alcohol use.Activities that are required to get alcohol, consume alcohol, or recuperate from its effects take up a lot of time.A strong need or desire to consume alcohol—a craving.A pattern of drinking alcohol that prevents one from carrying out important responsibilities at work, school, or home.Sustained alcohol consumption despite ongoing or recurring interpersonal or social issues brought on by or made worse by alcohol's effects.Alcohol usage results in the reduction or cessation of important social, professional, or leisure activities.Frequent consumption of alcohol under risky physical circumstances.Continuing to drink even when one is aware of a chronic or recurrent health or psychological issue that may have been brought on by or made worse by alcoholTolerance: requiring significantly higher alcohol intake to produce the same intended effect. Withdrawal: Characterized by the typical withdrawal symptoms or a noticing relief after taking alcohol or a closely related substance, such as benzodiazepine.How can we determine the severity of AUD? Mild: 2–3 symptomsModerate: 4–5 symptomsSevere: >/= 6 symptomsWho is at risk for AUD?Note: Ancestry offers a DNA analysis to find out about your heritage. You can also send that DNA to a third party to learn about your risks for diseases and conditions (for example, Prometheus.) Anyone can find out about their risk for alcoholism by doing a DNA test. The risk factors for AUD are: Male genderAges 18-29Native American and White ethnicitiesHaving Significant disabilityHaving other substance use disorderMood disorder (MDD, Bipolar)Personality disorder (borderline, antisocial personality)What is heavy drinking?According to the National Institute of Alcohol Abuse and Alcoholism (NIAAA), heavy alcohol use is characterized as: Males who drink > 4 drinks daily or > 14 drinks per week Females who drink > 3 drinks on any given day or > 7 drinks per weekPathophysiology of AUD.The pathogenesis of AUD is not well understood, but factors that may play a role are genetics, environmental influences, personality traits, and cognitive functioning. Also, genetic factors may decrease the risk of AUD, i.e., the flushing reaction, seen in individuals who are homozygous for the gene that encodes for aldehyde dehydrogenase, which breaks down acetaldehyde. Who should be screened?A person with AUD may not be easy to diagnose in a simple office visit, but some clues may point you in that direction. First of all, patients with AUD may present to you during their sober state, that´s why ALL adults (including pregnant patients) must be screened for AUD in primary care )Grade B recommendation). The frequency has not been determined but as a general rule, at least in Clinica Sierra Vista, we screen once a year. The USPSTF has concluded that there is insufficient evidence to recommend screening adolescents between 12-17 years old. What are the clinical manifestations of AUD?Some symptoms may be subtle, including sleep disturbance, GERD, HTN, but some may be obvious, such as signs of advanced liver disease (ascites, jaundice, bleeding disorders, etc.)If you draw routine labs, you may find abnormal LFTs (AST:ALT ratio >2:1), macrocytic anemia (MCV >100 fL), and elevated Gamma-glutamyl transferase (GGT). All these findings are highly suggestive of AUD. Patients with AUD may present in either an intoxication or withdrawal state. Signs and symptoms of acute intoxication may include “slurred speech, nystagmus, disinhibited behavior, incoordination, unsteady gait, hypotension, tachycardia, memory impairment, stupor, or coma.” Signs and symptoms of withdrawal range from tremulousness to hallucinations, seizures, and death. They are seen between 4 and 72 hours after the last drink, peaking at 48 hours, and can last up to 5 days. Alcohol withdrawal is one of the few fatal withdrawal syndromes that we know in medicine, and the symptoms can be assessed using a CIWA assessment. Treatment of AUD.There are factors to consider before starting treatment: Evaluating the severity of AUD Establishing clear treatment goals is associated with better treatment outcomesAssessing readiness to change: It can be done by motivational interviewing and using the stages of change model, which are, Pre-contemplation, contemplation, preparation, action, maintenance, and relapse.Discussing treatment of withdrawal.Treatment may be done as outpatient or it may require hospitalization. Dr. Beare sent an email with this information: “The approach to treating patients with AUD can be broken into two parts - the first is withdrawal management and the second is the long-term maintenance part. You MUST have a good plan for withdrawal treatment as it can be fatal if it's not addressed properly.” “Patients with any history of seizures due to withdrawal or a history of delirium tremens need inpatient management. If their withdrawal symptoms are typically mild (agitation, tremors, sleeplessness, anxiety) then outpatient management may be appropriate, typically with a long-acting benzodiazepine such as Librium or Ativan.”According to Dr. Beare, “the human aspect isa key element in treating alcohol use disorder. These patients arrive with tremendous amounts of suffering, shame, guilt, and fear. The relationship between the patient and provider needs to be built with compassion and understanding that this disease is horrible from the patient's perspective and using an algorithmic and calculated approach can cause significant harm to the rapport-building process, leading to lower success rates.”Treatment requires a lot of motivation and willpower. Hopefully, we can use some tools to assist our patients to be successful.-For mild disorder, Psychosocial interventions like motivational interviewing and mutual help groups like AA meetings may be enough to help our patient quit drinking.-For moderate or severe disorder: 1st line treatment is Meditation and structured, evidence-based psychosocial interventions (CBT, 12-step facilitation); which leads to better outcomesFor patients who lack motivation, motivational interviewing can be a useful initial interventionFor motivated patients: medical management, combined behavioral intervention, or a combination of both can be utilizedFor patients with limited cognitive abilities, 12-step facilitation, or contingency management can be helpful For patients who have an involved partner: Behavioral couples therapy can be utilizedMedications for AUD.The first-line pharmacological treatment is Naltrexone. It is given as a daily single dose and can be started while the patient is still actively drinking. There is a monthly dose of long-acting injectable naltrexone as well. Naltrexone is contraindicated in individuals taking opioids, and patients with acute hepatitis or hepatic failure. Alternative 1st line treatment is Acamprosate which can be used in people with contraindications to Naltrexone.AUD is a chronic problem and requires a close follow-up to evaluate response to treatment and complications. Medications need to be used along with psychotherapy and support, and medications may need to be changed or adjusted depending on the patient. It is an individualized therapy that requires full engagement of the doctor, the patient, and their families or social support. In conclusion, I would just like to add that, be compassionate because AUD is not a choice. AUD is a chronic problem like diabetes and HTN and may require a long road to recovery. Treatment includes psychotherapy, medications, and regular follow-up.Thank you for listening!Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:Risky drinking and alcohol use disorder: Epidemiology, clinical features, adverse consequences, screening, and assessment, https://www.uptodate.com/contents/risky-drinking-and-alcohol-use-disorder-epidemiology-clinical-features-adverse-consequences-screening-and-assessment, accessed on August 18, 2024.Hasin DS, Stinson FS, Ogburn E, Grant BF. Prevalence, correlates, disability, and comorbidity of DSM-IV alcohol abuse and dependence in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Arch Gen Psychiatry, Accessed on August 18, 2024.Alcohol use disorder: Treatment overview, https://www.uptodate.com/contents/alcohol-use-disorder-treatment-overview, assessed on August 18, 2024. Royalty-free music used for this episode, Grande Hip-Hop by Gushito, downloaded on Nov 06, 2023, from https://www.videvo.net

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Join Joe McDonald as he reads from the Big Book of Alcoholics Anonymous, diving into the raw and emotional experiences outlined in the early pages of the book. Reflecting on the challenges many face, Joe discusses the difficulty in finding solutions and the natural tendency towards doubt, especially among agnostics.“How many of you have tried solving your problem with the mind that created it? Many of you know what that means. How many of you solved your alcohol problem with a methamphetamine solution or perhaps an opiate solution of some type or a benzo? Maybe you just compounded your problem because you thought you had an Ativan deficiency. Okay, so that means we've written a book which we believe to be spiritual as well as moral and it means of course that we're gonna talk about God. Here difficulty arises with agnostics. So long before we got there, we acknowledged that we all are doubters by nature, so we want to focus you on the experience. Does that make sense?”Joe's discussion sheds light on the common struggles in finding effective solutions while offering a message of hope and the possibility of transformation through the 12-step recovery process. This session emphasizes the importance of reaching out for help and the power of the support found within recovery communities.For more content, please like, comment, and share. Also, join us live every Thursday night at 7 p.m. Arizona time for the full step experience on our YouTube channel.Join us for more inspiring recovery stories and transformative insights.Check out our website at: www.positionofneutrality.orgYouTube:http://www.youtube.com/@positionofneutrality721Facebook: https://www.facebook.com/PositionOfNeutralitySpotify: https://open.spotify.com/show/3mGbAbcacTs83RhMsv6FmY?si=6531e7adfdbb480eRSS: Position of Neutrality | RSS.comTikTok: https://www.tiktok.com/@interactivestepexp?is_from_webapp=1&sender_device=pc#PositionOfNeutrality, #JoeMcDonald, #BrianReinhart, #WayneGiles, #EricReinhart, #DeniseMcDonald, #JoeTeaches, #Step2AA, #BigBookAA, #RecoveryJourney, #AddictionRecovery, #12Steps, #SpiritualAwakening, #InnerPeace, #Healing, #PersonalGrowth, #RecoveryCommunity, #Mindfulness, #Resilience, #OvercomingAddiction, #SpiritualPath, #RecoverySupport, #SobrietyJourney, #HelpingOthers, #AddictsRecovery, #FaithInRecovery, #NewBeginnings

In this insightful exploration of Step 1 from the Alcoholics Anonymous Big Book, Joe McDonald delves into the perils of self-medication. Reflecting on the passage, Joe highlights how easily individuals can be caught in the cycle of addiction, often exacerbated by attempts to manage symptoms with other substances like Valium or Ativan.Joe humorously recounts, “The doctor thought you may have had a little Valium deficiency. If you're a serious enough drinker, they'll treat your Valium deficiency every once in a while.” He points out how this approach, rather than alleviating the problem, often leads to quicker and more severe health declines, encapsulated in the phrase, “Better living through chemistry.”Joe's discussion sheds light on the broader issue within recovery communities where the focus sometimes shifts too narrowly, leading to debates about whether to talk about drugs or alcohol specifically. He emphasizes the importance of understanding that addiction, regardless of the substance, leads to the same destructive path.“We admitted we were powerless over alcohol—that our lives had become unmanageable.” This first step is crucial in recognizing the need for change and the dangers of self-medication.Join us as Joe McDonald reads and expands on the Big Book of Alcoholics Anonymous, offering deeper understanding and practical advice for those on their recovery journey. Tune in every Thursday at 7:00 p.m. Arizona time on our YouTube channel for more comprehensive discussions and spiritual insights.For more content, please like, comment, and share. Also, make sure to join us live every Thursday night at 7 p.m. Arizona time for the full step experience on our YouTube channel. Join us for more inspiring recovery stories and transformative insights.Check out our website at: www.positionofneutrality.orgYouTube: http://www.youtube.com/@positionofneutrality721Facebook: https://www.facebook.com/PositionOfNeutralitySpotify: https://open.spotify.com/show/3mGbAbcacTs83RhMsv6FmY?si=6531e7adfdbb480eRSS: Position of Neutrality | RSS.comTikTok: https://www.tiktok.com/@interactivestepexp?is_from_webapp=1&sender_device=pc#PositionOfNeutrality, #JoeMcDonald, #BrianReinhart, #WayneGiles, #EricReinhart, #DeniseMcDonald, #JoeTeaches, #Step1, #BigBookAA, #SelfMedication, #RecoveryJourney, #AddictionRecovery, #12Steps, #SpiritualAwakening, #InnerPeace, #Healing, #PersonalGrowth, #RecoveryCommunity, #Mindfulness, #Resilience, #OvercomingAddiction, #SpiritualPath, #RecoverySupport, #SobrietyJourney, #HelpingOthers, #AddictsRecovery, #HopelessVariety

Listen to ASCO's Journal of Clinical Oncology essay, “Three Days was Enough” by Dr. Teresa Thomas, Associate Professor at the University of Pittsburgh School of Nursing. The essay is followed by an interview with Thomas and host Dr. Lidia Schapira. Having medically adjacent experience, Thomas shares her personal story of helping her family come to terms with hospice care for her father. TRANSCRIPT Narrator: Three Days Was Enough, by Teresa Hagan Thomas, PhD, BA, RN  My dad agreed to receive hospice on a technicality. It happened after weeks of trying to get him home oxygen. My brother drove him to the oncologist's office, and I helped him get into the wheelchair. He did not complain, but just asked me to hold his coffee mug, smiling because I snuck him a fresh donut. Three months before, dad was well-maintained on treatment for a neuroendocrine tumor. It was not until two separate, non–cancer-related hospital admissions kept him off treatment that the cancer saw a chance to hijack his body, take over his organs, and lead to a precipitous decline. As we waited for the oncologist, I told dad not to downplay his shortness of breath. But he wanted to look good enough to get chemotherapy the following week, the only way he saw to resolve his lymphedema and keep the cancer at bay. He failed the oxygen saturation test by one point, and having not qualified for home oxygen, we drove home disappointed without further recommendations or support. The sense of defeat was maddening. We were batting down an escalating onslaught of health issues at home only to be turned away from the professional caregivers when we most needed their advocacy. I was enraged that all the work arranging the appointment led to nothing and disappointed for my dad as he sat consumed in his pain and shortness of breath. His oncology team was supportive when his health was stable but did not have the skills or systems to proactively help us manage the dying process. I channeled my disillusionment with the health care system by calling in favors for a palliative care consult, both aware of my privilege but also stopping at nothing to give relief to my dad. A few days later, my dad and mom were willing to accept hospice care for the singular purpose of getting oxygen. I was sitting next to my dad in his home office, amix of posters from his travels abroad and family wedding photos surrounding us. When he asked for my thoughts about hospice, I carefully laid out what I saw as the benefits—namely, he would immediately qualify for home oxygen and get a level of care beyond what his oncologist could offer. But as I tried to give him all the words I knew from my professional life, I just saw the man who raised me staring back at me hoping for a way out of the painful, weak state he was in. He was not giving up on treatment or controlling the cancer. I was not going to change that. I wanted that, too. Now his eyes were sunken, all the fat gone from his face, and his entire body working to breathe. His belly was large, the tumor taking over, and his legs swollen with lymphedema. I felt the boniness of his shoulders and back. There was no coming back from this. I was in disbelief that he was dying so quickly, selfishly wanting him to stay but also knowing he deserved a pain free death. He agreed to enroll in hospice, with the plan that he would unenroll and try to get more treatment. I wanted to be right there with him, treating this as a temporary detour and not the end. I looked him directly in the eyes, searching to see any recognition that he would never get treatment again and that this was it. Not seeing anything, I tried to open the door to discussing death, reminding him how tenaciously he had fought to keep this cancer controlled and acknowledging the need to focus on his quality of life. I desperately wanted to have an open discussion about dying, but his stoic Irish mentality kept us from having that heart-to-heart. Initially, I was disappointed that my attempt had failed, but now I recognize that achieving a good death did not depend on verbalizing that he was dying. He was living and dying, hoping and accepting, trusting and doing his own thing. Our plan was logical and irrational. I remember thinking people in these situations needed to face reality. Here with my father, being so direct would be counterproductive. He very likely recognized what was likely to unfold, and hospice allowed him the unstated permission to let go. I called his oncologist, and together dad and I asked to enroll in hospice. The oncologist responded, “We are so glad you finally made this decision.” By that night, the hospice nurse was sitting at my parent's kitchen table preparing us. Dad was sitting in the front room, finally relaxing in the plush leather lift chair we impulsively bought for him, with the oxygen machine humming at this side. We grilled the hospice nurse with questions. She kept saying how fast patients with cancer seem to go downhill. She told us without telling us. She gave us breadcrumbs, just enough information to get us through each step of the dying process, giving morphine, getting a hospital bed, giving Ativan, and finally seeing him pass. Three days after enrolling in hospice, he died at home withmany of our family at his side. Just like the hospice nurse said he would, he died on his own terms: after he had said goodbye to all his siblings, after the infant he and my mom were fostering was placed with his adoptive parents, and after all five of his children were at home with him. He died with dignity, mentally capable until the last hours, and surrounded by love. His exact terms. I am not sure what conversations were had between my dad, my mom, and his oncology team in the weeks before he died. I do not know if they openly discussed the need for palliative care or hospice. Dad's providers might have, and my parents willfully or naively missed the clues. I can imagine for the oncology team, discussing hospice meant admitting that the treatment plan had not worked as intended and that they could not meet my dad's needs. I know for my parents, discussing hospice would give air to the idea of death and therefore was not only avoided but actively discounted. As a researcher focused on palliative care, these dynamics were not new to me. I recognize how the stigma surrounding hospice and palliative care prevents earlier provision of quality end-of-life care. That knowledge did not prepare me when it was my dad dying. Awakening to the reality of dad dying was incredibly difficult when every hour we were managing his frenzy of health issues.  Three days is used as an indicator of poor end-of-life care since people are eligible for hospice when they have a 6-month life expectancy.1 My dad did not openly discuss hospice until days before he died, but the number of days did not matter for my dad. What he was now able to do—because of hospice—during those days mattered more. During his last 3 days, dad meticulously rewrote his will, had it notarized by a hospice social worker, visited with his siblings, and made amends for long-past transgressions, enjoyed his favorite foods—fresh Boston cream donuts and black French press coffee—and spent quality one-on-one time with each of his kids and most of his grandkids. Although death was never directly discussed, neither was the idea of unenrolling in hospice. Hospice was what was allowing him to maximize the mental and physical capacity he had left. Those 3 days took my family from being stressed to our limit trying to manage dad's disintegrating health to feeling like we were being led by competent, caring hospice nurses who picked up our phone calls and responded within minutes. Now a year since he passed, I have a newfound appreciation for the complexity of discussing death with families and an even greater desire to advocate for improved end-of-life care for patients with serious illness. Despite his dramatic decline in health, my dad had a good death thanks to his hospice team. Three days was all it took.  Dr. Lidia Schapira: Hello, and welcome to JCO's Cancer Stories: The Art of Oncology, which features essays and personal reflections from authors exploring their experience in the field of oncology. I'm your host, Dr. Lidia Schapira, Professor of Medicine at Stanford University. Today we're joined by Dr. Teresa Thomas, Associate Professor at the University of Pittsburgh School of Nursing. In this episode, we will be discussing her Art of Oncology article “Three Days Was Enough.”  Our guest's disclosures will be linked in the transcript.  Teresa, welcome to our podcast and thank you for joining us. Dr. Teresa Thomas: Thank you. It's great to be here. Dr. Lidia Schapira: It's great to have you. So let's talk about your beautiful piece, which is very personal. Thank you so much for writing and sending this and sharing this. In your piece, you say that you waited about a year before you thought about writing. Can you tell us a little bit about why you waited and why perhaps for you it was important to take some time to process the experience and then decide to share it? Dr. Teresa Thomas: Absolutely. Well, I think it would be false to say that I waited a year to write it. I think I was writing it for a year. And like a lot of researchers, I really process things through writing, trying to make sense of the passing of my father, of course, but also what this means for me professionally. It's very ironic that everything that I study in my research, things that we encounter clinically, unfolded right there extremely poignantly with my father. And like anyone, I'm just trying to make sense of it and trying to find lessons learned where we as nurses, healthcare providers, researchers, can push things forward a little bit, which I think is what I was trying to do with the piece because it did raise a lot of questions for me and is making me rethink my research questions and how I conduct myself and what the important areas of our field really are.  Dr. Lidia Schapira: So let's talk a little bit and go deeper into that. First, I wanted to talk a little bit about your vulnerability, personal vulnerability. It's your father we're talking about, and you clearly adored this man who is your father. Can you talk a little bit about the emotional aspect of dealing with the family's acceptance finally, or the family's readiness to call hospice in? Dr. Teresa Thomas: Absolutely. I mean, it's all of the emotions. When I think about it, it was this very awkward place of being one of the few medically adjacent people. I'm not a practicing clinician. I am a researcher who has a nurse training. So it was this ‘I know enough and the family's relying on me and I'm going to the appointments.' And being that in between, between the oncology team, my father, my mother, my siblings, people asking questions. And at the same time, I know this story. So it was personal and distant. I knew what was happening, that he was dying. I didn't want to know that he was dying. And it was just a crazy time too. Every day there were a thousand things going on. I didn't put this in the piece, but I was also extremely pregnant at the time, so had hormones going. My mom was getting sick herself with cancer, ironically, right as my father was dying. It was just absolutely insane. And now we're trying to unpack all of that. But to be that person that people are relying on to understand what's going on, to shepherd them, and also not really wanting to know, it was a hard juxtaposition. I knew what should be happening, right? I knew that we should be having these discussions about palliative care. I knew that he was eligible for hospice, I knew he should be on hospice, but I wasn't ready. And professionally, I wear that hat of a nurse and a researcher very reluctantly. When I'm dealing with my health care, and especially someone else's healthcare, I do not disclose, I do not try to interfere. And for Dad, I had to step up and push and interfere a little bit, which is extremely awkward and not comfortable. Dr. Lidia Schapira: Let's talk a little bit about readiness, because readiness means so many things, but it's such an important theme here, and it's often such an important theme when we look at the literature about end of life communication. Can you talk a little bit about how this experience has informed the way you think about readiness, readiness to accept that it is indeed time for that call to hospice? Dr. Teresa Thomas: Absolutely. So I think as a researcher and as a clinician, you want that discussion, you want the documentation, you want all the ducks in a row. You need to understand, do they get it? Is their head in that space where they're making plans? Can you think about what you want your death to look like? We need it said, we need it laid out so that we can check that box. And obviously, there's a lot more than checking boxes when this is done correctly and in a patient centered way. We didn't have time for that to happen, and yet everything still laid out. Now, I write in the piece, my dad was just very stoic and had a history of not talking about emotions. And I don't think it's all too different than his generation. And maybe men in general or there are patients that are just like that. There were never those deep conversations with the oncology team. There basically wasn't that conversation even with me.  So beyond that, I mean, beyond just saying we had that conversation, what the piece is trying to say, or what I was trying to say was that it was the things that he did that were more important, he literally rewrote his will in his last days. In his few moments of clarity, he was sitting there. He was a wills and estates attorney. So, I mean, he was fully equipped to do this, but this is what he was doing. He knew that he was dying. He never voiced it. He never made a specific plan. But we had a care team in his oncology team, and absolutely in his hospice team, who just shepherded us and allowed him to do everything that he would have done even if he had had six months in hospice. And that's what was more important. He got what he wanted, and he was allowed to do what he wanted. And that's now how I'm thinking about end of life care and where our field in research and in executing that needs to go. Dr. Lidia Schapira: I think that's incredibly profound. I think one of the lines that I enjoyed the most in reading and rereading your essay is when you just describe what actually happened and how he relaxed into the chair. He relaxed when he had oxygen. I mean, it wasn't so much what he said, but what you saw there was even the physical signs of somebody who says, “Well, you know, something else is happening here.” There was a transition that you actually appreciated there and captured. Am I right? And did I read that right?  Dr. Teresa Thomas: Absolutely. That was the turning point. I mean, we are a big family. We never make impulse purchases. But my sister and I, we just drove out. We didn't care about the cost. I think my mom gave us her credit card. She never gives us a credit card. And we just said, “We don't care. This is our dad. We're buying this.” And to see him after this, just extremely precipitous decline where every breath in and out and that searching for air and all of those signs, even to take away a little bit of that, absolutely felt so good. And he wasn't totally pain free, but he had oxygen. I mean, the most basic thing you need. So, yes, that was a very good feeling. Dr. Lidia Schapira: So the labor of breathing can be overwhelming and in a way distressing. Whether we call that painful or not is maybe just a matter of the language that we use.  There's another theme that emerged in your writing, and again, I wanted to hear your reaction to this, and that is failure. You use the term in terms of, in so many different ways, perhaps the failure of the oncology team to develop or deliver or propose a treatment that was really good. They were done. So they- in some ways, there was a sense of failure. It was a bit of a failure of capturing the right moment to make the hospice referral. It wasn't quite what the books say we should be doing. There's a lot of that in the essay. Can you talk a little bit about how you understand failure and how that concept may in some way interfere with our ability to act or appreciate things? Dr. Teresa Thomas: There were no specific failures as more of a secondary caregiver at the end who stepped in to assist my mom. There were likely things going on that were under-recognized, unappreciated, or because nothing was said directly that there could have been soft leeways into. “Let's talk about hospice.” That, I think, my parents did not want to hear, and that door was closed. That's where additional layers of support in how do we talk about this as a family? How do we introduce, well, hospice isn't end of life care necessarily, but there are additional supports that hospice allows that your typical oncology practice can't provide.  I remember one conversation when my mom called me up and she was telling me that she had just met with Dad's team, and she was saying, the oncologist said, this is the last treatment, that after this, there's nothing left. She was going on and on, and I wanted to basically rip the band aid off for her. And I said, “Mom, they're telling you that it's time for hospice.” “No, absolutely not, Teresa. Hospice was not brought up. Don't bring up that word to your father. All they were saying was, this was the last treatment.” Now we can talk about that with my mom and say, “Do you see what they may have been laying the groundwork for?” And she says, “Yes, now I understand. But at that time and place, that soft entry, that door was not being opened by them.” And I don't think that's untypical. I think that we did the best that we could with the situation that Dad had. Dr. Lidia Schapira: So, Teresa, I'm struck by the incredibly generous and wise framing that you use to talk about this. You could have said, “Oh, my goodness. It was only three days,” and instead you chose to say, “Three days were enough.” So I wonder how you did this, how you actually looked at it from that perspective, because so much of what happens to us is defined by the lens through which we see it and the words we use to construct the narrative. So tell me how you got to, “Oh, my God. They weren't ready, and there was so much failure,” to, “Hey, three days was enough.” Dr. Teresa Thomas: The three days were important for me because one year ahead of my dad getting sick, I was writing a paper with one of my mentors, Yael Schenker, and one of the wonderful med students that we work with and we used it as an indicator of poor quality end of life care. Did the patient enroll in hospice within the past three days? And we had these wonderful discussions with Yael and Bob Arnold and Doug White and everyone here at the University of Pittsburgh involved in palliative care about what does that mean? And is this just a random quality indicator with no real world value? And I respect all of their opinions because they do see this clinically, whereas as a researcher, “Oh, this is easy for me to analyze and I have a citation that says this is a quality indicator, so let's use it.” And I thought, “Oh, isn't the world ironic? This is exactly what happened with Dad.” And it was. I mean, maybe part of it is to our Catholic faith, and threes are very important so I think that was a little for my family.  But there was nothing else to do. We opened up, we had conversations, we had heart to hearts. We found when dad was mentally with it, we sat down with him. I gave him his coffee. He always had a doughnut, he was pre-diabetic. Who cares? There was ice cream, there were donuts, there was coffee. All of a sudden we went from, “Don't give Dad any pain meds,” to, “Where's the morphine? Give him some more.” And we timed it so that each one of us kids and his wife and his siblings, we got to say the things that, man, if it was any other illness or any other setting where we weren't there, we would have lived our entire lives regretting not having had that. Would I have wanted him to be around when the son that was protruding from my belly was born a couple months later? Absolutely. Would I have wanted more trips, more meals? Yes, yes, and yes. It wasn't going to happen. And it didn't. That's selfish. I mean, that was a selfish desire.  He lived a wonderful life. He closed out everything in those three days. He said his goodbyes. He was ready to go. And our family is a strong family. We carried my mom through it and we carried each other through it. And for him, he deserved to go without the pain, the loss of control, the loss of being himself. When we moved him into the hospital bed, that was it. We had to help him go to the bathroom within the last 12 hours of life. And I thought, this is not my dad he's going to check out because this is just not how he's going to live his life. Is that worth it? No, that wasn't worth it. And that was him. And that's what the hospice nurse told us. Everyone checks out when they're ready. That's Dad. Dr. Lidia Schapira: I can't resist the urge to ask you this question of how you're taking this life lesson, this really important story which you framed and articulated so beautifully here for us into your work.  Dr. Teresa Thomas: So my work has always been in patient centered care, as nebulous as a concept as that is, and promoting patient self-advocacy. How do patients say what they need? Which is the great irony, right? That my work is corresponding exactly with what I experience and see. And I think that's probably why I love this research question. And now I see that not just the cancer experience, but framing that end of life care. And what does hospice mean? I think we had the best hospice team in the world. I don't see how any other hospice team could deliver as great care. And then, of course, I'm looking into, is all hospice like this? What are the hospice outcomes? And I realize, unsurprisingly, that we absolutely are spoiled, and this is not what most people experience. So I'm lucky that I'm in a place here at the University of Pittsburgh and with researchers that we have a palliative research center. This is easy for me to pivot into this place and to think about how do we create teams of clinicians, policies at a local level, at a state and a federal level that allow people access to really good clinicians at the end of life - clinicians that understand absolutely there's a medical management part just as much there's a human part that's happening here with the patient and with the family.  What was it that our hospice team did? It's the easy things. They gave us one sheet of paper, one phone number, “Call this number. We will pick up. You do not need to give us your medical record number. You don't have to tell us a history.” We called that number any time, and someone answered our questions. So basic, patient centered care, so basic. How do we do that? How do we do that at a systems level? How do we prepare patients to work with their clinicians when that's not there? These sort of high touch, but very difficult to innovate in clunky segregated systems. It's given me direction, and it lets me feel like I'm helping my family in retrospect, too. Dr. Lidia Schapira: In some ways, it keeps you connected to your dad. Dr. Teresa Thomas: Absolutely.  Dr. Lidia Schapira: Yeah. Well, thank you so much. It was a really beautiful, beautiful piece. Art of Oncology is about telling a story. But stories can inspire, stories can lead people to find their own path towards advocacy or research so thank you so much. To wrap this up, do you have a final message for our readers and listeners? Dr. Teresa Thomas: Everyone has their experience with end of life and with palliative care, maybe, but definitely cancer care, and I just hope that it strikes a chord and makes people think about how we can make sure that families and patients receive the best care at end of life. Dr. Lidia Schapira: Well, thank you so much, Theresa, for your story and for what you do. And until next time, thank you for listening to JCO's Cancer Stories: The Art of Oncology. Don't forget to give us a rating or review, and be sure to subscribe so you never miss an episode. You can find all of ASCO shows at asco.org/podcasts.  The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions.   Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.     Like, share and subscribe so you never miss an episode and leave a rating or review.    Guest Bio: Dr. Teresa Thomas is an Associate Professor at the University of Pittsburgh School of Nursing.  

Back in the day there was a commercial for a pain reliever called Anacin, which was so psychotically hilarious that its catch phrase instantly became a “viral” meme, way before that term was invented. Even as 10 year olds, we would go around screaming: “Mother, PLEASE, I'd rather do it myself!!” Imitating the emotionally wrecked housewife in the ad. Nowadays, such an outburst would probably result in a Xanax, Valium, Klonopin, or Ativan prescription.Jo Ann Campbell and the folks at Cameo Parkway records wasted no daylight in capitalizing on this phenomenon when they created this winking homage. The singer growls at her mother when the poor parent is only trying to keep her little virgin from getting pregnant. But, the teen has other ideas: She's out to learn about sex the old fashioned way (just like mom did) - and, when you see videos of Ms. Campbell, “The Blonde Bombshell” you'll understand why there was to be no containing that character's animal energy. 

Michelle Keller is an assistant professor of gerontology and the Leonard and Sophie Davis Early Career Chair in Minority Aging at the USC Leonard Davis School. She spoke to us about her research focused on improving patient-clinician communication, medication management, and the identification of dementia in minority older adults. Here are highlights from our conversation. On polypharmacy “When it comes to older adults and medications, it's important to understand that while medications can be incredibly beneficial for treating various conditions, they can also present really unique risks in this population. Older adults often take multiple medications at the same time. This is what we call polypharmacy.” “Older adults can be more sensitive to certain medications, they might experience side effects more intensely or even at lower doses than younger individuals. … This is particularly true for medications that affect our central nervous system, our brain, right? So, thinking about medications that are sedating or that have some sort of psychoactive effect. These medications, especially when they're combined together, can lead to things like confusion, dizziness and an increased risk of falls.” On her study of interventions to address polypharmacy “What we found in this study was that interventions to address polypharmacy can do a great job of reducing medications which are potentially harmful, identifying which medications people should be taking, improving the appropriateness of the medications people are taking, and reducing the total number of medications. So thinking about outcomes related to medications, what we have found is that it is really hard to change more downstream clinical outcomes, things like mortality, falls, hospitalizations, and emergency department visits. We did find that interventions that had multiple components; in other words, where a clinician is meeting face to face with a patient, reviewing their medications, reviewing all the chronic diseases that they have, along with their full patient history of what has happened to them in the past, those interventions tend to have a greater effect on mortality. So in other words, those types of interventions are reducing the risk of that someone actually dies.” “We also found that falls decrease when patients fully stop potentially harmful medications. These may be medications where somebody is feeling very dizzy or that make people feel very dizzy or drowsy, medications that may control somebody's blood sugar a little bit too much… So, their blood pressure's a little too low and they may actually fall as a result of these medications. But what we found was that stopping medications such as benzodiazepines, which are often taken for sleep or anxiety, can take months. These types of medications can have withdrawal effects. And so it's really, really important for somebody to work very closely with a healthcare provider to slowly taper these medications down to try to reduce those withdrawal effects.” “What we have found in working with other researchers and clinicians is that when patients team up with a healthcare provider, such as their primary care physician or clinical pharmacist who's embedded in the healthcare system, they really are able to stop taking some of these medications, and they feel a lot better. They feel much more energy, they're able to do the things that they really enjoy. They have a greater quality of life. But it's something that just takes time.” On the Empower Intervention for benzodiazepines “The typical recommendation for benzodiazepines is that they really should be taken short-term. These are medications that physicians typically recommend somebody take for a maximum of four weeks. What we have found in some of our research is that people are actually taking these for years, if not decades. And so stopping these medications can be quite challenging, and sometimes patients aren't fully convinced about why they should be stopping these medications. So, we took an intervention that started in Canada. It was developed by researchers in Quebec, and this is called the Empower Intervention. And what we did is we tailored it to a health system here in the US. The Empower Intervention is a really great brochure that contains some pretty striking facts about benzodiazepines.” “To give you some examples of benzodiazepine, these are like your Xanax, your Ativan, your Klonopin; these are the medications that we're talking about here. These brochures highlighted some really interesting facts, such as the fact that they can be harmful or linked to hip fractures and car accidents, and they can make people feel very tired and weak. What we did for this intervention is we sent these brochures to about 300 people along with a letter from their primary care physician, emphasizing that these medications can be harmful if taken for too long and especially among older adults. So what we did for this study is we compared patients who had received these brochures to patients who did not receive them. So they're going on usual care. Their physicians may have mentioned something to them, this was our control group, right? We didn't send anything to this particular group.” “We reviewed the medical records for both groups, and we looked at what kinds of medications they had been prescribed. And what we found is that patients who received the brochures were really activated. You know, when they received this messaging they would send messages in the patient portal to their physicians saying, ‘I didn't know that there were these risks of these medications. I would really like to come in and talk to you about them.' They made appointments to start tapering down these medications. What we found was for every 10 brochures that we sent, one person completely stopped taking these medications, which is a really good return on investment. This is a simple intervention. It has now been done in some other health systems in the US, particularly the Veterans Affairs health system.” On challenges in de-prescribing “I think some of the challenges that physicians face in de-prescribing is that de-prescribing takes a lot of time. As we all know, our primary care visits are very short; physicians, particularly in the primary care setting, are really rushed through their visits. And so I think having some of these conversations can just be something that's challenging. I also think they're quite complex conversations to have. They may not have received the training, for example, on how to taper a medication in a safe way so that a patient does not feel withdrawal effects. And I do think that there is something about getting physician buy-in … they are concerned [that] if they bring it up, the patient may be angry with them; they may be upset. And so I think really showing physicians ways in which this can be brought up that are really framed around ‘how do we center the patient's health and quality of life' – I think those are still questions that we as researchers are working on.” On the role of caregivers “It's really important for caregivers to be aware of the medications their loved ones are taking for many reasons. I think they can be amazing advocates in helping bring up potential side effects during doctor's visits. So, for example, if a caregiver is noticing that someone is feeling drowsy or doesn't have that much energy or is feeling dizzy, any sort of cognitive impairments such as those that may be seen in dementia, [they] may actually be a result of medication side effects. So, I think really becoming an advocate for somebody when seeing the doctor is one really important thing that caregivers can do.”  “Another area where caregivers can play a really important role is among people with dementia. People with dementia can have really some challenges in managing their medications. They may miss doses, they may take several medications twice, so they may have an overdose, or they may take the wrong medication altogether. So, caregivers can play really pivotal roles in helping somebody manage medication changes. There have been some early interventions looking at how to engage caregivers and persons with dementia. And some of the challenges that those researchers have seen is that there [is] often more than one person actually caring for somebody with dementia. And so, engaging that whole group of people who may be working with that person has been a real challenge.” On challenges facing patients with language barriers  “There is research showing that patients with language barriers have a greater risk of being hospitalized or re-hospitalized because of some of the communication challenges that come with medication management. So, you can imagine that, for example, older adults and their caregivers with language barriers may have a difficult time understanding medication instructions, which can lead to improper use. So when and how to take medications, recognizing potential side effects, understanding the purpose of each medication. And on top of that, you can layer on things, like if somebody doesn't have a great understanding of the condition. We call that disease literacy, or they may have health literacy issues.” “Right now, a mentee and I are working on this review of interventions that have been done specifically for patients with language barriers focused on improving medication management. And what we found was that interventions that really engaged people from communities with language barriers have been some of the most effective ways to really help people learn about which medications are working really well for them, how to improve medication adherence and other important outcomes. So, for example, an intervention that we found was researchers engaged folks in the community, co-created videos about medications in the community and why it was important to take them. And then when they actually distributed these interventions, they made sure that both in terms of the videos and some of the other educational materials that were handed out to folks that these really were very tailored both language-wise, literacy-wise, and culturally tailored to the communities that they were serving.” On new dementia medications and disparities in the diagnosis of dementia  “We are learning that older Black and Latino adults tend to get diagnosed with dementia once the disease has progressed more. And what that means is that they may not have received some of the kind of services that may help them or their families. So, for example, they may not have received enough support to be able to plan for the rest of their lives, or their families may not necessarily have received caregiving support early on in disease progress.” “I think in regard to these particular dementia medications, for example, if older adults are diagnosed with dementia at a place where they're no longer eligible to receive these medications, I think that'll be a really pretty serious health equity issue. So, I am really interested in how we make sure that people are getting diagnosed in time to make them eligible for really potentially beneficial treatments that may help them down the road.” On effective strategies for de-prescribing  “The most effective strategies that we see de-prescribing these medications is offering something else. So, for example, some of the most evidence for insomnia really exists around the use of using cognitive behavioral therapy. There's also been well-done systematic reviews that have found evidence that music or acupuncture may help people with insomnia. … I think one thing that's very important to think about when we de-prescribe medications is what else can we offer people? We're not just leaving people in the lurch and saying, ‘We're taking this away and we're leaving you with nothing.' We're actually able to offer them some non-pharmacological options as well.” Transcript Speaker 1 (00:02): One thing that's very important to think about when we de-prescribe medications is: what else can we offer people? We're not just leaving people in the lurch and saying, we're taking this away and we're leaving you with nothing. We're actually able to offer them some non-pharmacological options as well Speaker 2 (00:17): From the USC Leonard Davis School of Gerontology, this is Lessons in Lifespan Health, a podcast about the science and scientists improving how we live and age. I'm Orli Belman, Chief Communications Officer. On today's episode: how Professor Michelle Keller is working with older adults, caregivers and clinicians to manage the use and potential overuse of high risk medications. Michelle Keller is an Assistant Professor of Gerontology and the Leonard and Sophie Davis Early Career Chair in Minority Aging at the USC Leonard Davis School. Her research is focused on improving patient-clinician communication, medication management, and the identification of dementia in minority older adults. Hi, Michelle. Welcome and thank you for joining us today. Speaker 1 (01:06): Thank you so much for having me. Speaker 2 (01:08): I wanna start by asking you to talk about older adults and medications. We can all understand why medications are beneficial, but when it comes to older adults, what are some of the ways they can be problematic? Speaker 1 (01:19): Absolutely. So when it comes to older adults and medications, it's important to understand that while medications can be incredibly beneficial for treating various conditions, they can also present really unique risks in this population. So older adults often take multiple medications at the same time. This is what we call polypharmacy. Polypharmacy can increase the risk of drug interactions, right? So I like to think of the example of a suitcase, right? So imagine that you are packing up, getting ready to go to a trip. You start putting one thing into the suitcase, gets a little heavy, but you can manage it, right? You're suddenly adding more and more things and the suitcase is getting heavier and heavier to the point where you actually throw out your back at the airport, right? This is really what I think of when our bodies are kind of processing multiple medications at once with the additional challenge that some of these drugs may actually interact with one another. Speaker 1 (02:15): This is why it's so important for patients to talk to their doctors about the medications they're taking and the potential risks of each medication as people get older. I think one thing that people don't often think about is that when clinical trials are being done, often many clinical trials have excluded older adults. So we don't always have a great sense of how these medications work in older adult populations. And on top of that, they may exclude people with chronic conditions who are already taking a variety of other medications. And so as a result, what is happening now is that we have many people who are taking these medications, and it hasn't been well tested in these populations. It hasn't really been, you know, we don't have a clear sense of what is happening when all of these medications are being taken together. So polypharmacy can really increase the risk of drug interactions. Speaker 1 (03:09): As I was saying, when one medication affects another, and this can lead to a variety of adverse effects. So for example, if someone is taking multiple medications that make you feel drowsy or sleepy when you stack them on top of each other–thinking again about that suitcase, that can lead someone to have an increased risk of falls, potentially a fracture resulting from those falls, car accidents if they're feeling very drowsy or dizzy and other medications can increase our risk of internal bleeding. Another thing that's really important to think about for older adults is that as we get older, our bodies undergo various changes that can alter how our medications are absorbed, distributed, and actually excreted from the body. So for example, kidney and liver function can really decline with age. And so that can actually affect how well we process the drugs through our body. Speaker 1 (04:05): What that means is that drugs may stay in our bodies for longer periods of time leading to more side effects or adverse effects. The last thing I really wanted to bring up is this idea of how things change as we get older. So we maybe have been taking a medication for many years, but as we get older because of the changes that are happening within our body, some medications, which were fine for us when we were younger, are now gonna lead to more serious adverse effects now that we're older. So older adults can be more sensitive to certain medications, so they might experience side effects more intensely or even at lower doses than younger individuals. They might feel the effects. So this is particularly true for medications that affect our central nervous system, our brain, right? So thinking about medications that are sedating or that have some sort of psychoactive effect. Speaker 1 (05:04): These medications, especially when they're combined together, can lead to things like confusion, dizziness, and an increased risk of falls. One medication which people often take to help them sleep is Benadryl or Tylenol PM. This medication is actually a drug that's really recommended to avoid in older adults because it can be very sedating, making people feel very drowsy throughout the day. And it actually also has the effects on the brain and has been associated with a higher increased risk of dementia. So these are medications that again, we don't think of as generally harmful, but again, in an older person might really be an issue. Speaker 2 (05:46): That's a really helpful example 'cause that's just an over the counter medication that anyone can get, even without a doctor. You recently published two papers looking at interventions for addressing polypharmacy. The first one was a review of several studies. What did you learn in that review about the effectiveness or not of programs that are designed to reduce harmful polypharmacy? Speaker 1 (06:08): So we reviewed several systematic reviews. These are collections, as you mentioned, of numerous studies to understand how well interventions to address polypharmacy are working. Many of these interventions include a process called de-prescribing, which is the process of systematically reducing or stopping medications that may no longer be beneficial or might be causing harm, particularly in older adults. The goal of deprescribing is to optimize an individual's medication regimen to improve their overall health and quality of life. What we found in this study was that interventions to address polypharmacy can do a great job of reducing medications which are potentially harmful, identifying which medications people should be taking, improving the appropriateness of the medications people are taking, and reducing the total number of medications. So thinking about outcomes related to medications, what we have found is that it is really hard to change more downstream clinical outcomes. Speaker 1 (07:11): Things like mortality falls, hospitalizations, and emergency department visits. We did find that interventions that had multiple components, in other words where a clinician is meeting face-to-face with a patient, reviewing their medications, reviewing all the chronic diseases that they have along with their full patient history of what has happened to them in the past, those interventions tend to have a greater effect on mortality. So in other words, those types of interventions are reducing the risk that someone actually dies. We also found that falls decrease when patients fully stop potentially harmful medications. So these may be medications that make people feel very dizzy or drowsy medications that may control somebody's blood sugar a little bit too much and so they're actually feeling very low blood sugar or medications where their blood pressure is overly controlled. So their blood pressure's a little too low, and they may actually fall as a result of these medications. Speaker 1 (08:12): But what we found was that stopping medications such as benzodiazepines, which are often taken for sleep or anxiety, can take months. These types of medications can have withdrawal effects. And so it's really, really important for somebody to work very closely with a healthcare provider to slowly taper these medications down, to try to reduce those withdrawal effects. And because it takes so long to fully stop these medications, it's hard for studies to really find an effect unless they're following that person for a long period of time, which studies often don't. And so that's one of the challenges that we've seen in the research is that studies haven't followed people for enough time. Or at the time that they're measuring some of these clinical outcomes, not enough time has gone by to really see the full effects. So what we have found in working with other researchers and clinicians is that when patients team up with a healthcare provider such as their primary care physician or clinical pharmacist who's embedded in the healthcare system, they really are able to stop taking some of these medications and they feel a lot better. They feel much more energy, they're able to do the things that they really enjoy. They have a greater quality of life, but it's something that just takes time. Speaker 2 (09:28): And I imagine it's something you have to balance when someone really might need a medication to treat something and then managing the side effects. That's really interesting. I know the second study looked at a particular intervention and this was the use of educational materials for benzodiazepines. What led you to explore this area and what did you find? Speaker 1 (09:49): Great question. So benzodiazepines are, as I mentioned earlier, medications that are often used for sleep or anxiety. The typical recommendation for benzodiazepines is that they really should be taken short term. These are medications that, you know, physicians typically recommend somebody take for a maximum of four weeks. What we have found in some of our research is that people are actually taking these for years, if not decades. And so stopping these medications can be quite challenging and sometimes patients aren't fully convinced about why they should be stopping these medications. So we took an intervention that started in Canada. It was developed by researchers in Canada, in Quebec, and this is called the Empower Intervention. And what we did is we tailored it to a health system here in the US. The Empower Intervention is a really great brochure that contains some pretty striking facts about benzodiazepines. Speaker 1 (10:45): To give you some examples of benzodiazepine, these are like your Xanax, your Ativan, your Klonopin. These are the medications that we're talking about here. These brochures highlighted some really interesting facts such as the fact that they can be harmful or linked to hip fractures and car accidents and they can make people feel very tired and weak. What we did for this intervention is we sent these brochures to about 300 people along with a letter from their primary care physician, emphasizing that these medications can be harmful if taken for too long and especially among older adults. So what we did for this study is we compared patients who had received these brochures to patients who did not receive them. So kind of they're going on their usual care, their physicians may have mentioned something to them. This was our control group, right? We didn't send anything to this particular group. Speaker 1 (11:40): We reviewed the medical records for both groups and we looked at what kinds of medications they had been prescribed. And what we found is that patients who received the brochures were really activated. You know, when they received this messaging, they would send messages in the patient portal to their physicians saying, I didn't know that there were these risks of these medications. I would really like to come in and talk to you about them. They made appointments to start tapering down these medications. What we found was for every 10 brochures that we sent, one person completely stopped taking these medications, which is a really good return on investment. This is a simple intervention. It has now been done in some other health systems in the US, particularly the Veterans Affairs health system. And you know, groups have found similar effects. We also found that the probability that someone in the intervention group completely stopped their medications was about 10% greater compared to the group that did not get the brochure. Speaker 1 (12:41): So again, you know, for a cheap simple intervention, we were pretty excited about these results. What's been really interesting is I just came back from two conferences, the US De-Prescribing Research Network and the Society for General Internal Medicine Annual Meeting. And we find that other researchers are also finding that engaging patients in reducing these potentially harmful medications is actually one of the most effective forms of deprescribing. There have been plenty of studies where researchers have actually engaged physicians and those have not been as successful. So what I'm really excited about in terms of thinking about future interventions is, how do we really engage patients in learning about what are the best options for them to manage their health? Speaker 2 (13:28): So you just said that physicians, it's been a little harder to see change in their prescribing behaviors. What do we know about ways they can introduce the idea of reducing or stopping a medication? Speaker 1 (13:39): Yeah, I think it's a great question. I think communicating when, how and why a medication should be reduced or stopped can be really challenging. What researchers have found is that when physicians focus on improving a patient's quality of life, that is what is most effective. So for example, thinking about stopping or reducing certain medications can give somebody more energy, help them move around better, they're not feeling as unsteady on their feet or dizzy. They can think more clearly because they're no longer feeling feelings of brain fog or sleepiness or drowsiness. I think these can be some really effective messages. I think some of the challenges that physicians face in de-prescribing is that de-prescribing takes a lot of time. As we all know, our primary care visits are very short. Physicians, particularly in the primary care setting, are really rushed through their visits. And so I think having some of these conversations can just be something that's challenging. Speaker 1 (14:41): I also think they're quite complex conversations to have. They may not have received the training, for example, on how to taper a medication in a safe way so that a patient does not feel withdrawal effects. And I do think that there is something about getting physician buy-in, in terms of, they are concerned about, you know, if they bring it up, the patient may be angry with them, they may be upset. And so I think really showing physicians ways in which this can be brought up that's really framed around, how do we center the patient's health and quality of life? I think those are are still questions that we as researchers are working on. Speaker 2 (15:17): We've talked about physicians and obviously patients themselves. How about caregivers? What role can they play in helping address some of these issues? And are there interventions that especially aim to include them? Speaker 1 (15:28): Yeah, great question. I think it's really important for caregivers to be aware of the medications their loved ones are taking. For many reasons. I think they can be amazing advocates in helping bring up potential side effects during doctor's visits. So for example, if a caregiver is noticing that someone is feeling drowsy or doesn't have that much energy or is feeling dizzy, any sort of cognitive impairments, right? So, such as those that may be seen in dementia, may actually be a result of medication side effects. So I think really becoming an advocate for somebody when seeing the doctor is one really important thing that caregivers can do. Another area where caregivers can play a really important role is among people with dementia. People with dementia can have some challenges in managing their medications. They may miss doses, they may take several medications twice, so they may have an overdose or they may take the wrong medication altogether. So caregivers can play really pivotal roles in helping somebody manage medication changes. There have been some early interventions looking at how to engage caregivers and persons with dementia. And some of the challenges that those researchers have seen is that there are often more than one person actually caring for somebody with dementia. And so engaging that whole group of people who may be working with that person has been a real challenge. Speaker 2 (16:54): Are there particular challenges faciing under-resourced communities or populations with language barriers? I imagine some of this communication is even harder in these cases. What do you think needs to be done in these areas? Speaker 1 (17:09): Absolutely. There is research showing that patients with language barriers have a greater risk of being hospitalized or rehospitalized because of some of the communication challenges that come with medication management. So you can imagine that for example, you know, older adults and their caregivers with language barriers may have a difficult time understanding medication instructions, which can lead to improper use. So when and how to take medications, recognizing potential side effects, understanding the purpose of each medication. And on top of that, you can layer on things like, you know, if somebody doesn't have a great understanding of the condition, right? So we call that disease literacy. Or they may have health literacy issues, or on top of that, we may even have literacy concerns where the person does not know how to read or has a limited ability to read. So layering on all these challenges can really make it difficult to both manage your medications and communicate with physicians about their concerns or side effects regarding medications. Speaker 1 (18:14): Right now, mentee and I are working on this review of interventions that have been done specifically for patients with language barriers focused on improving medication management. And what we found was that interventions that really engaged people from communities with language barriers have been some of the most effective ways to really help people learn about which medications are working really well for them, how to improve medication adherence and other important outcomes. So for example, an intervention that we found was researchers engaged folks in the community. They co-created videos about medications in the community and why it was important to take them. And then when they actually distributed these interventions, they made sure that both in terms of the videos and some of the other educational materials that were handed out to folks, that these really were very tailored both language wise, literacy wise, and culturally tailored to the communities that they were serving. Speaker 2 (19:16): Another area I wanna touch on is your work improving doctor patient communication. And I'm curious if your background as a newspaper reporter has informed your research in this area, and what are some of the ways that patients lose out when communication is not clear? Speaker 1 (19:32): So I think a lot about how we can help clinicians communicate complex information about medications and other treatments in simple, accessible ways. Which is really something that I aimed to do as a reporter, right? When I worked as a reporter, oftentimes I would take studies from medical journals and I would break them down in a way that was really easy and accessible for the public to read. And so that is really something that I'm very interested in. How do we help clinicians do the same thing? Or if we're designing interventions for patients, how do we do something similar? How do we make the risks and benefits of medications very clear to people so that they're able to make the best decisions about those for their health? So one area that I'm really interested in is these new medications for dementia that have come out, which are the anti amyloid medications. These medications have some pretty potentially serious side effects such as brain bleeding and swelling. And I'm working on a research proposal thinking about, how do we best present these medications to patients in a way that they feel like they're able to make the best decisions for themselves and their loved ones? I think it'd be really critical, particularly in terms of health equity for people to have a very good sense of how these medications can potentially help but also understand the serious risks associated with the new dementia medications. Speaker 2 (21:02): And speaking of dementia, I think you've also looked at the diagnosis of dementia and whether or not there's differences in minority populations. Is that something you can tell us a little bit about? Speaker 1 (21:14): Absolutely. So that is an area of research that I'm actually just starting to get into because what we are learning is that older black and Latino adults tend to get diagnosed with dementia once the disease has progressed more. And what that means is that they may not have received some of the services that may help them or their families. So for example, they may not have received enough support to be able to plan for the rest of their lives, or their families may not necessarily have received caregiving support early on in disease progress. I think in regards to these particular dementia medications, for example, if older adults are diagnosed with dementia at a place where they're no longer eligible to receive these medications, I think that'll be a really pretty serious health equity issue. So I am really interested in, how do we make sure that people are getting diagnosed in time to make them eligible for really potentially beneficial treatments that may help them down the road? So I'm thinking about how do we train physicians who are working in under-resourced settings, which may serve large proportions of black and Latino older adults, how to diagnose dementia in a primary care setting, and working with some colleagues in the Los Angeles Department of Health Services on how we can think about making physicians feel more confident, their diagnosis of dementia among older adults. Speaker 2 (22:40): And I wanna go back to sleep and anxiety because I know that's something that affects so many people at all ages. If these interventions are successful and people are able to stop taking some of these medications, are there strategies or interventions that we know might work for helping them with the initial conditions they were struggling with to begin with? Speaker 1 (23:01): Yeah, absolutely. I think that's a really good question because sleep and anxiety are things that can really affect somebody's quality of life and functioning, right? The most effective strategies that we see de-prescribing these medications is offering something else. So for example, some of the most evidence for insomnia really exists around using cognitive behavioral therapy. There's also been really well done systematic reviews that have found evidence that music or acupuncture may help people with insomnia. So I think one thing that's very important to think about when we de-prescribe medications is what else can we offer people? We're not just leaving people in the lurch and saying, we're taking this away and we're leaving you with nothing. We're actually able to offer them some non-pharmacological options as well. Speaker 2 (23:48): That's a really helpful note to end on. Thank you for joining us, and I know that people are really gonna benefit from learning about all you've been working on and all your work that's gonna continue in the future. Speaker 1 (23:59): Thank you so much for having me today. It's been a real pleasure. Speaker 2 (24:02): That wraps up this lesson in Lifespan Health. Thanks to Professor Michelle Keller for her time and expertise and to all of you for choosing to listen. Join us next time for another Lesson in Lifespan Health, and please subscribe to our podcast@lifespanhealth.usc.edu. Lessons in Lifespan Health is supported by the Ney Center for Healthspan Science.

In this episode of Talking Insomnia, Lorene shares her journey from struggling with Ativan withdrawal and chronic insomnia to finding a path to recovery and peace. She discusses her initial struggles with insomnia, beginning in 2020, her experiences with various medications, and her ultimate discovery of effective self-care and healing strategies. Would you like your copy of our FREE 'Off-to-Dreamland' kickoff booklet? If you said "Duh" then simply head over to https://www.thesleepcoachschool.com and click the link at the tippy top. Happy reading!  Would you like to work with one of our certified sleep coach? Awesome! Here are some great options:  The Insomnia Immunity Group Coaching Program.  BedTyme, a sleep coaching app for iOS and Android offering 1:1 text based coaching.  Zoom based 1:1 coaching with Coach Michelle or Coach Daniel. The Insomnia Immunity program is perfect if you like learning through video and want to join a group on your journey towards sleeping well. BedTyme is ideal if you like to learn via text and have a sleep coach in your pocket. The 1:1 Zoom based program is for you if you like to connect one on one with someone who has been where you are now. Find out more about these programs here: https://www.thesleepcoachschool.com/ Do you like learning by reading? If so, here are two books that offer breakthroughs! Tales of Courage by Daniel Erichsen https://www.amazon.com/Tales-Courage-... Set it & Forget it by Daniel Erichsen https://www.amazon.com/Set-Forget-rea... Would you like to become a Sleep Hero by supporting the Natto movement on Patreon? If so, that's incredibly nice of you

Welcome to Episode 12 of the Parasite Doc Podcast!

The puzzling deaths of three Kansas City Chiefs fans, Clayton McGeeney, David Harrington, and Ricky Johnson, have left the community in shock and raised questions about what could have led to their bizarre demise. On January 9, their lifeless bodies were discovered frozen in the backyard of their friend Jordan Willis' home, two days after they had gathered to watch a football game.    The grim discovery was made after McGeeney's fiancée became concerned when he failed to return home on that Sunday, and attempts to reach Willis, the homeowner, went unanswered. When police arrived at the scene, Willis was reportedly found with a wine glass in hand, seemingly unaware of the tragedy unfolding in his backyard. His claim of being asleep with noise-canceling headphones for two days has raised eyebrows.    Despite the eerie circumstances, authorities have ruled out foul play, and Willis is not considered a suspect. However, the deaths remain shrouded in mystery, leaving the community seeking answers.    Dr. Caleb Alexander, an epidemiologist from Johns Hopkins University, has weighed in on the case, suggesting that the deaths could be linked to a dangerous combination of opioid-like drugs and alcohol. He emphasized that the involvement of three individuals intensifies the curiosity and tragedy surrounding the incident, indicating that more than just moderate alcohol consumption may have played a role.    Dr. Alexander explained that various prescription drugs, when combined with alcohol, can lead to a heightened level of sedation, potentially resulting in the victims succumbing to the freezing weather. Common drugs such as Xanax, Ativan, Valium, and carisoprodol were cited as potential culprits.    Illicit opioids like fentanyl also remain a possibility, with Dr. Alexander considering it "a very plausible scenario." He noted the recent tragedy of musician Jose Vasquez and his wife succumbing to a fentanyl overdose, emphasizing the risk even in group settings.    The weather conditions on January 7 and 8, with temperatures in the 30s, could have contributed to their deaths. Dr. Alexander explained that sitting outdoors without movement in such weather could pose serious danger, as individuals would not generate enough body heat to stay warm.  As the Kansas City Police Department awaits the results of autopsies and toxicology reports, the true cause of this tragic incident remains uncertain. Dr. Alexander stressed the importance of these reports in unraveling the mystery.    The community and the families of the deceased are left in grief and confusion, with many hoping for clarity and closure regarding the deaths of three friends whose lives ended so tragically and unexpectedly. Want to listen to ALL of our podcasts AD-FREE? Subscribe through APPLE PODCASTS, and try it for three days free: https://tinyurl.com/ycw626tj Follow Our Other Cases: https://www.truecrimetodaypod.com The latest on Catching the Long Island Serial Killer, Awaiting Admission: BTK's Unconfessed Crimes, Delphi Murders: Inside the Crime, Chad & Lori Daybell, The Murder of Ana Walshe, Alex Murdaugh, Bryan Kohberger, Lucy Letby, Kouri Richins, Malevolent Mormon Mommys, Justice for Harmony Montgomery, The Murder of Stephen Smith, The Murder of Madeline Kingsbury, and much more! Listen at https://www.truecrimetodaypod.com

The puzzling deaths of three Kansas City Chiefs fans, Clayton McGeeney, David Harrington, and Ricky Johnson, have left the community in shock and raised questions about what could have led to their bizarre demise. On January 9, their lifeless bodies were discovered frozen in the backyard of their friend Jordan Willis' home, two days after they had gathered to watch a football game.    The grim discovery was made after McGeeney's fiancée became concerned when he failed to return home on that Sunday, and attempts to reach Willis, the homeowner, went unanswered. When police arrived at the scene, Willis was reportedly found with a wine glass in hand, seemingly unaware of the tragedy unfolding in his backyard. His claim of being asleep with noise-canceling headphones for two days has raised eyebrows.    Despite the eerie circumstances, authorities have ruled out foul play, and Willis is not considered a suspect. However, the deaths remain shrouded in mystery, leaving the community seeking answers.    Dr. Caleb Alexander, an epidemiologist from Johns Hopkins University, has weighed in on the case, suggesting that the deaths could be linked to a dangerous combination of opioid-like drugs and alcohol. He emphasized that the involvement of three individuals intensifies the curiosity and tragedy surrounding the incident, indicating that more than just moderate alcohol consumption may have played a role.    Dr. Alexander explained that various prescription drugs, when combined with alcohol, can lead to a heightened level of sedation, potentially resulting in the victims succumbing to the freezing weather. Common drugs such as Xanax, Ativan, Valium, and carisoprodol were cited as potential culprits.    Illicit opioids like fentanyl also remain a possibility, with Dr. Alexander considering it "a very plausible scenario." He noted the recent tragedy of musician Jose Vasquez and his wife succumbing to a fentanyl overdose, emphasizing the risk even in group settings.    The weather conditions on January 7 and 8, with temperatures in the 30s, could have contributed to their deaths. Dr. Alexander explained that sitting outdoors without movement in such weather could pose serious danger, as individuals would not generate enough body heat to stay warm.  As the Kansas City Police Department awaits the results of autopsies and toxicology reports, the true cause of this tragic incident remains uncertain. Dr. Alexander stressed the importance of these reports in unraveling the mystery.    The community and the families of the deceased are left in grief and confusion, with many hoping for clarity and closure regarding the deaths of three friends whose lives ended so tragically and unexpectedly. Want to listen to ALL of our podcasts AD-FREE? Subscribe through APPLE PODCASTS, and try it for three days free: https://tinyurl.com/ycw626tj Follow Our Other Cases: https://www.truecrimetodaypod.com The latest on Catching the Long Island Serial Killer, Awaiting Admission: BTK's Unconfessed Crimes, Delphi Murders: Inside the Crime, Chad & Lori Daybell, The Murder of Ana Walshe, Alex Murdaugh, Bryan Kohberger, Lucy Letby, Kouri Richins, Malevolent Mormon Mommys, Justice for Harmony Montgomery, The Murder of Stephen Smith, The Murder of Madeline Kingsbury, and much more! Listen at https://www.truecrimetodaypod.com

The puzzling deaths of three Kansas City Chiefs fans, Clayton McGeeney, David Harrington, and Ricky Johnson, have left the community in shock and raised questions about what could have led to their bizarre demise. On January 9, their lifeless bodies were discovered frozen in the backyard of their friend Jordan Willis' home, two days after they had gathered to watch a football game.    The grim discovery was made after McGeeney's fiancée became concerned when he failed to return home on that Sunday, and attempts to reach Willis, the homeowner, went unanswered. When police arrived at the scene, Willis was reportedly found with a wine glass in hand, seemingly unaware of the tragedy unfolding in his backyard. His claim of being asleep with noise-canceling headphones for two days has raised eyebrows.    Despite the eerie circumstances, authorities have ruled out foul play, and Willis is not considered a suspect. However, the deaths remain shrouded in mystery, leaving the community seeking answers.    Dr. Caleb Alexander, an epidemiologist from Johns Hopkins University, has weighed in on the case, suggesting that the deaths could be linked to a dangerous combination of opioid-like drugs and alcohol. He emphasized that the involvement of three individuals intensifies the curiosity and tragedy surrounding the incident, indicating that more than just moderate alcohol consumption may have played a role.    Dr. Alexander explained that various prescription drugs, when combined with alcohol, can lead to a heightened level of sedation, potentially resulting in the victims succumbing to the freezing weather. Common drugs such as Xanax, Ativan, Valium, and carisoprodol were cited as potential culprits.    Illicit opioids like fentanyl also remain a possibility, with Dr. Alexander considering it "a very plausible scenario." He noted the recent tragedy of musician Jose Vasquez and his wife succumbing to a fentanyl overdose, emphasizing the risk even in group settings.    The weather conditions on January 7 and 8, with temperatures in the 30s, could have contributed to their deaths. Dr. Alexander explained that sitting outdoors without movement in such weather could pose serious danger, as individuals would not generate enough body heat to stay warm.  As the Kansas City Police Department awaits the results of autopsies and toxicology reports, the true cause of this tragic incident remains uncertain. Dr. Alexander stressed the importance of these reports in unraveling the mystery.    The community and the families of the deceased are left in grief and confusion, with many hoping for clarity and closure regarding the deaths of three friends whose lives ended so tragically and unexpectedly. Want to listen to ALL of our podcasts AD-FREE? Subscribe through APPLE PODCASTS, and try it for three days free: https://tinyurl.com/ycw626tj Follow Our Other Cases: https://www.truecrimetodaypod.com The latest on Catching the Long Island Serial Killer, Awaiting Admission: BTK's Unconfessed Crimes, Delphi Murders: Inside the Crime, Chad & Lori Daybell, The Murder of Ana Walshe, Alex Murdaugh, Bryan Kohberger, Lucy Letby, Kouri Richins, Malevolent Mormon Mommys, Justice for Harmony Montgomery, The Murder of Stephen Smith, The Murder of Madeline Kingsbury, and much more! Listen at https://www.truecrimetodaypod.com

In this edition of Talking Insomnia, we get to hear Michael's story in conversation with Coach Michelle. A journey of hospital visits, medication like Ativan and Clonazepam, and feeling better than even before the sleep troubles began. If you'd like to get in touch with Mike, this is where you can do just that: Email: me@hearsay.tech Website: https://www.hearsay.tech  Would you like a roadmap from Insomnia to immunity? Download using below link. https://www.thesleepcoachschool.com/h... Would you like to work with one of our certified sleep coach? Awesome! Here are some great options: The Insomnia Immunity Group Coaching Program.  BedTyme, a sleep coaching app for iOS and Android offering 1:1 text based coaching.  Zoom based 1:1 coaching with Coach Michelle or Coach Daniel. The Insomnia Immunity program is perfect if you like learning through video and want to join a group on your journey towards sleeping well. BedTyme is ideal if you like to learn via text and have a sleep coach in your pocket. The 1:1 Zoom based program is for you if you like to connect one on one with someone who has been where you are now. Find out more about these programs here: https://www.thesleepcoachschool.com/  Do you like learning by reading? If so, here are two books that offer breakthroughs! Tales of Courage by Daniel Erichsen https://www.amazon.com/Tales-Courage-... Set it & Forget it by Daniel Erichsen https://www.amazon.com/Set-Forget-rea... Would you like to become a Sleep Hero by supporting the Natto movement on Patreon? If so, that's incredibly nice of you

What are the benzodiazepines used for anti anxiety? What's the difference between them? Are benzodiazepines ever safe? Ativan, Xanax and Klonopin are some of the most prescribed medications in America for anti anxiety.. What's the difference between them? Tune in to this week's episode of All Things Substance.

A benzo peer support training class can be quite educational — especially for the instructor. In early November, I had the pleasure of teaching a sold-out course to individuals with a wide mix of backgrounds. It was quite illuminating. In today's episode, I share some insights from teaching peer support training. I also discuss my response to some constructive criticism, look at our focus here at Easing Anxiety, and wish everyone a very happy holiday season. Video ID: BFP129 CHAPTERS00:00 INTRODUCTION00:16 Thanksgiving & Family03:11 Feedback Form Fixed04:18 Constructive Criticism06:33 Our Direction / Indecision07:22 Anxiety Management & BIND10:43 Our Focus on Mental Health13:52 Connecting with You15:55 Not Medical Advice16:33 How Ya Doin'?19:48 FEATURE 21:28 About the Course24:52 Benzos & Recovery (SUD)30:06 Learning from Recovery (SUD)31:20 Interaction & Discussion33:08 Teaching BIND36:10 Boundaries37:16 Patient Boundaries39:43 Caregiver Boundaries41:31 Categories of Symptoms48:37 Benzos and Alcohol52:21 Active Benzo Community54:25 You Got This!56:02 CLOSING  REFERENCESFeedback—    What Do You Want to See at Easing Anxiety? — https://easinganxiety.com/feedbackResources—    Benzo Peer Training — https://benzopeertraining.org —    BIND Symptoms (14 Categoreies) — https://easinganxiety.com/symptoms  SITE LINKSVISIT US ONLINE — Website: https://www.easinganxiety.com — YouTube: https://youtube.com/@easinganx — Twitter: https://twitter.com/@easinganx — Facebook: https://facebook.com/easinganxfb — Instagram: https://instagram.com/easinganx SUBSCRIBE / SUPPORT US — Join Our Mailing List: https://easinganxiety.com/subscribe — Make a Donation: https://easinganxiety.com/donate  PODCAST SUMMARYThis podcast is dedicated to those who struggle with side effects, dependence, and withdrawal from benzos, a group of drugs from the benzodiazepine and nonbenzodiazepine classes, better known as anti-anxiety drugs, sleeping pills, sedatives, and minor tranquilizers. Their common brand names include Ambien, Ativan, Klonopin, Lunesta, Valium, and Xanax. DISCLAIMERAll content provided on this YouTube channel is for general informational purposes only and should never be considered medical or health advice. The author of the content provided on this channel is not engaged in rendering medical, health, psychological, or any other kind of personal or professional services. Health-related information provided is not a substitute for medical advice and should not be used to diagnose or treat health problems or to prescribe any medical devices or other remedies. Never disregard medical advice or delay in seeking it.Please visit our website for our complete disclaimer at https://www.easinganxiety.com/disclaimer.  MUSIC CREDITS— All music provided / licensed through Storyblocks (https://www.storyblocks.com)  Benzo Free Theme— Title: "Walk in the Park" — Artist: Neil Cross PRODUCTION CREDITSEasing Anxiety is produced by…Denim Mountain Press https://www.denimmountainpress.com

Meet Dr. Doryn Chervin. Hear her benzo story. Her background in public health. Her take on benzos, BIND, setbacks, research, doctors, healing, the benzo community, and what has been going on behind the scenes at Easing Anxiety. Doryn Chervin holds a doctorate in public health and spent 40 years as a public health program strategist and evaluator. She is also on the board at the Alliance for Benzodiazepine Best Practices. Doryn took clonazepam for over 25 years, is now benzo-free, and works tirelessly helping those still struggling with dependence and BIND.Video ID: BFP128 CHAPTERS00:00 INTRODUCTION02:10 Welcome Doryn02:38 Doryn's Background04:38 Suicide Prevention Leadership06:15 Doryn's Benzo Story09:13 It's Really Possible to Heal 09:42 How Are You Feeling Now? 11:01 BIND Setbacks12:38 Journey to Learn / FDA 13:33 Doryn and the Alliance 14:57 FDA / Kaiser Research Study17:43 Working Together at EA 19:38  Partnering with the Community 21:42 Anxiety and Instability 22:59 There's No One Way25:32 Murphy Says Hi26:28 Upcoming Podcast on EA Plan27:10 Financial Sustainability 30:53 Getting to Know Doryn 31:55 Content & Services 34:56 An Information Resource35:55 A Strong Research Background39:26 The Human Connection43:03 We Want to Hear from You46:57 Sub Group Peer Support49:21 Live / In-Person Events51:00 Falling Asleep to the Podcast52:04 Burnout in Benzo Community54:02 EA Updates / Next Podcast55:25 Doryn's Struggle with Anxiety57:04 CLOSING    REFERENCESFeedback—    What Do You Want to See at Easing Anxiety? — https://easinganxiety.com/feedbackResources—    Doryn's Introductory Blog Post — https://www.easinganxiety.com/post/introducing-dr-doryn-chervin —    The Alliance for Benzodiazepine Best Practices — https://benzoreform.org  —    The National Action Alliance for Suicide Prevention — https://theactionalliance.org —    FDA 2020 Boxed Warning on Benzodiazepines https://www.easinganxiety.com/post/new-fda-warning-on-benzodiazepines-what-does-it-really-mean —    The Ashton Manual — https://easinganxiety.com/ashton —    BOOK: Benzo Free: The World of Anti-Anxiety Drugs and the Reality of Withdrawal — https://easinganxiety.com/book  —    Benzodiazepine Action Work Group — https://benzoaction.org—    A Peacock Consulting (Angela Peacock) — https://apeacockconsulting.com  SITE LINKSVISIT US ONLINE — Website: https://www.easinganxiety.com — YouTube: https://youtube.com/@easinganx — Twitter: https://twitter.com/@easinganx — Facebook: https://facebook.com/easinganxfb — Instagram: https://instagram.com/easinganx SUBSCRIBE / SUPPORT US — Join Our Mailing List: https://easinganxiety.com/subscribe — Make a Donation: https://easinganxiety.com/donate  PODCAST SUMMARYThis podcast is dedicated to those who struggle with side effects, dependence, and withdrawal from benzos, a group of drugs from the benzodiazepine and nonbenzodiazepine classes, better known as anti-anxiety drugs, sleeping pills, sedatives, and minor tranquilizers. Their common brand names include Ambien, Ativan, Klonopin, Lunesta, Valium, and Xanax. DISCLAIMERAll content provided on this YouTube channel is for general informational purposes only and should never be considered medical or health advice. The author of the content provided on this channel is not engaged in rendering medical, health, psychological, or any other kind of personal or professional services. Health-related information provided is not a substitute for medical advice and should not be used to diagnose or treat health problems or to prescribe any medical devices or other remedies. Never disregard medical advice or delay in seeking it.Please visit our website for our complete disclaimer at https://www.easinganxiety.com/disclaimer.  MUSIC CREDITS— All music provided / licensed through Storyblocks (https://www.storyblocks.com)  Benzo Free Theme— Title: "Walk in the Park" — Artist: Neil Cross PRODUCTION CREDITSEasing Anxiety is produced by…Denim Mountain Press https://www.denimmountainpress.com

It's 3:00am. Sleep is elusive. Collective thoughts converge on the manic mind. So, why not record a podcast? Join D as he ponders benzos and BIND, fatigue and fear, motivation, meditation, gratitude, and grace. All from the comfort of his own bed. Video ID: BFP127 CHAPTERS0:00:00 It's 3:14 am0:02:21 Struggling Lately0:05:30 Podcast Delays 0:07:08 Benzo Peer Training0:07:51 Overwhelm & Fatigue0:09:02 New Content Coming… 0:10:35 Coping with Insomnia0:13:38 Missed Y'all 0:14:34 Ruminations in a Dark Room0:16:23 Finding Life Balance0:19:10 Motivation to Change 0:24:00 Discipline As We Heal0:26:00 Moving Forward0:28:38 It Does Get Better0:29:52 Advice for the Younger You?0:32:54 Being OK with Yourself 0:38:35 Trying to Belong0:40:14 A Calming Voice0:42:26 BIND Frustration / Emotion0:47:40 Talking in the Bathroom0:48:56 Podcasts & Authenticity0:51:24 Meditation & Perfectionism 0:53:53 Five Minute Meditation0:54:38 Yin Yoga & BIND0:56:19 Changing for the Better0:58:56 Benefits of Gratitude1:04:27 Three Gratitudes1:06:08 Being Grateful for Others1:13:27 CLOSING SITE LINKSVISIT US ONLINE — Website: https://www.easinganxiety.com — YouTube: https://youtube.com/@easinganx — Twitter: https://twitter.com/@easinganx — Facebook: https://facebook.com/easinganxfb — Instagram: https://instagram.com/easinganx SUBSCRIBE / SUPPORT US — Join Our Mailing List: https://easinganxiety.com/subscribe — Make a Donation: https://easinganxiety.com/donate  PODCAST SUMMARYThis podcast is dedicated to those who struggle with side effects, dependence, and withdrawal from benzos, a group of drugs from the benzodiazepine and nonbenzodiazepine classes, better known as anti-anxiety drugs, sleeping pills, sedatives, and minor tranquilizers. Their common brand names include Ambien, Ativan, Klonopin, Lunesta, Valium, and Xanax. DISCLAIMERAll content provided on this YouTube channel is for general informational purposes only and should never be considered medical or health advice. The author of the content provided on this channel is not engaged in rendering medical, health, psychological, or any other kind of personal or professional services. Health-related information provided is not a substitute for medical advice and should not be used to diagnose or treat health problems or to prescribe any medical devices or other remedies. Never disregard medical advice or delay in seeking it.Please visit our website for our complete disclaimer at https://www.easinganxiety.com/disclaimer.  MUSIC CREDITS— All music provided / licensed through Storyblocks (https://www.storyblocks.com)  Benzo Free Theme— Title: "Walk in the Park" — Artist: Neil Cross PRODUCTION CREDITSEasing Anxiety is produced by…Denim Mountain Press https://www.denimmountainpress.com

Benzos and grief, diet, and distension. Benzos and pets, laughter, and levity. Benzos and indecision and lack of memory. Benzos and research, internet, and advocacy. So many topics, so much to discuss. In today's episode, we dive into our mailbag again to hear from you. D shares some comments, answers some questions, and even reads some critical feedback. Join us for a few insights and friendly discussion.  Video ID: BFP126 CHAPTERS00:00 INTRODUCTION02:25 The Gift of Caregiving04:13 Our New Puppy05:48 The Social Benefit of Dogs07:50 Recent Blog Posts at EA09:41 1,000 YouTube Subscribers11:53 Graham, Jimmy, & Robin 17:07  Lightening the Load 21:45 A.I. and Being Genuine24:20 MAILBAG24:33 Indecision and  Control28:11 Five Stages of Grief29:25 No One Path31:11 Connection So Important32:45 Benzo Belly35:58 What Is a Healthy Diet?38:00 Way Too Much About Me39:04 Angie at Burning Man42:00  Internet for Awareness43:38 Research Is Important45:19 Internet Limitations46:09 Content Vying for Coverage47:27 Has My Memory Improved?50:51 Thanks for the Comments52:12 MOMENT OF PEACE REFERENCES INTRODUCTION — Easing Anxiety Blog Posts: https://www.easinganxiety.com/posts/categories/blog — Our New Puppy Blog Post: https://www.easinganxiety.com/post/meet-murphy-our-new-mascot MAILBAG — Indecision — https://www.easinganxiety.com/post/anxiety-and-indecision-6-tips-to-help-you-decide — 5 Stages of Grief — https://www.easinganxiety.com/post/benzos-bind-and-the-5-stages-of-grief — Who Am I Now? — https://www.easinganxiety.com/post/who-am-i-now-confidence-and-self-esteem-in-benzo-withdrawal-bind-bfp122 — Benzo Belly (Take 2) — https://www.easinganxiety.com/post/benzo-belly-our-gut-in-withdrawal-take-2-bfp060 — Lazy Morning on the Patio — https://www.easinganxiety.com/post/lazy-morning-on-the-patio-updates-community-compassion-and-coaching  — Angela Peacock — https://apeacockconsulting.com — BIND Roundtable — https://www.easinganxiety.com/post/the-bind-roundtable-benzodiazepine-survey-research-team — Benzo Brain — https://www.easinganxiety.com/post/benzo-brain-cognitive-symptoms-in-withdrawal-bfp073 SITE LINKSVISIT US ONLINE — Website: https://www.easinganxiety.com — YouTube: https://youtube.com/@easinganx — Twitter: https://twitter.com/@easinganx — Facebook: https://facebook.com/easinganxfb SUBSCRIBE / SUPPORT US — Join Our Mailing List: https://easinganxiety.com/subscribe — Make a Donation: https://easinganxiety.com/donate  PODCAST SUMMARYThis podcast is dedicated to those who struggle with side effects, dependence, and withdrawal from benzos, a group of drugs from the benzodiazepine and nonbenzodiazepine classes, better known as anti-anxiety drugs, sleeping pills, sedatives, and minor tranquilizers. Their common brand names include Ambien, Ativan, Klonopin, Lunesta, Valium, and Xanax. DISCLAIMERAll content provided on this YouTube channel is for general informational purposes only and should never be considered medical or health advice. The author of the content provided on this channel is not engaged in rendering medical, health, psychological, or any other kind of personal or professional services. Health-related information provided is not a substitute for medical advice and should not be used to diagnose or treat health problems or to prescribe any medical devices or other remedies. Never disregard medical advice or delay in seeking it.Please visit our website for our complete disclaimer at https://www.easinganxiety.com/disclaimer. MUSIC CREDITS— All music provided / licensed through Storyblocks (https://www.storyblocks.com) Benzo Free Theme— Title: "Walk in the Park" — Artist: Neil Cross PRODUCTION CREDITSEasing Anxiety is produced by…Denim Mountain Press https://www.denimmountainpress.com

Nick tried to watch the queer love parade of Heartstopper and Red, White and Royal Blue, but fought some familiar neuroses instead. He also got to watch Venus Williams irl and listened to Emma talk about Only Murders season 3. Plenty of giggles and a fun new game, let's go! Show Notes: @1:00 - Hot takes |  Ativan attack, Heartstopper (sort of), Lyft worship,  @27:45 - |  Only Murders in the Building, tennis - Western & Southern Open @37:30 - Game | 5 Second Rule Want to support us and get fun extras? Join our Patreon!  At takespod.com or Patreon.com/takespod  Like 30 Rock? Like Nick and Julie? Listen to them on their 30 Rock rewatch podcast: Blerg! (@blergpodcast) wherever you listen to Takes. 

What's new at Easing Anxiety? What's new in the benzo community? What's new in the world of BIND? And what should someone new to benzos do if they're just getting started? Join D for an off-script conversation this lazy Sunday morning.In today's episode, D records the podcast live on his back patio enjoying the sights and sounds of nature. He discusses the EA Community, a new team member, lingering symptoms, coaching, training, surviving, and a few tips for those just getting started.Video ID: BFP125 CHAPTERS00:00 Introduction02:41 Sunday on the Porch05:05 Replying to Your Emails08:41 EA Community Update09:56 Welcome Doryn Chervin11:41 How to Be Notified12:37 Podcast Update13:59 My Health Status15:39 9 Years Benzo Free16:21 Managing the Crazy17:26 Starting Out Afraid18:48 Why I Still Have Symptoms21:40 More Benzo Support Today24:19 Advice for Beginners25:37 Amazing Benzo Support Orgs30:55 You Got This31:38 Love Doing the Podcast33:23 Blog, Subscribe, and Log In35:08 Coaching and Training40:46 We Heal41:30 BIND and BIND Coverage43:54 Our Approach at EA46:20 Compassionate Responsibility51:03 D Unscripted52:04 Wish You Were Here55:58 Thank You57:03 ClosingBIND RESOURCES— Easing Anxiety — https://easinganxiety.com— Benzodiazepine Information Coalition (BIC) — https://benzoinfo.com— The Alliance for Benzodiazepine Best Practices — https://benzoreform.org— Benzo Action Work Group — https://benzoaction.org— Benzo Peer Training — https://benzopeertraining.org— Baylissa Frederick — https://mccare.org— Jennifer Leigh — https://benzowithdrawalhelp.com— Benzo Warrior — https://benzowarrior.com— Geraldine Burns — https://podcasts.apple.com/us/podcast/benzodiazepine-awareness-with-geraldine-burns/id1358022441— Angela Peacock — https://apeacockconsulting.comSITE LINKSVISIT US ONLINE— Website: https://www.easinganxiety.com— YouTube: https://youtube.com/@easinganx— Twitter: https://twitter.com/@easinganx— Facebook: https://facebook.com/easinganxfbSUBSCRIBE / SUPPORT US— Join Our Mailing List: https://easinganxiety.com/subscribe— Make a Donation: https://easinganxiety.com/donate PODCAST SUMMARYThis podcast is dedicated to those who struggle with side effects, dependence, and withdrawal from benzos, a group of drugs from the benzodiazepine and nonbenzodiazepine classes, better known as anti-anxiety drugs, sleeping pills, sedatives, and minor tranquilizers. Their common brand names include Ambien, Ativan, Klonopin, Lunesta, Valium, and Xanax. DISCLAIMERAll content provided on this YouTube channel is for general informational purposes only and should never be considered medical or health advice. The author of the content provided on this channel is not engaged in rendering medical, health, psychological, or any other kind of personal or professional services. Health-related information provided is not a substitute for medical advice and should not be used to diagnose or treat health problems or to prescribe any medical devices or other remedies.Never disregard medical advice or delay in seeking it.Please visit our website for our complete disclaimer at https://www.easinganxiety.com/disclaimer. MUSIC CREDITS— All music provided / licensed through Storyblocks (https://www.storyblocks.com)Benzo Free Theme— Title: "Walk in the Park"— Artist: Neil Cross PRODUCTION CREDITSEasing Anxiety is produced by…Denim Mountain Presshttps://www.denimmountainpress.com

Chris, Chey, and Danii are back at 565 Live for another episode of Poor Man's Podcast. This week we're joined by guest comedian Addy Petschke-Haas.  The gang each taste and review ”Surf Breaker” from Ever Grain Brewing and rate it on the Guy Fieri Flavor Richter Scale.  Courtney of @steelingpittsburgh tells you about some of the best events happening around Pittsburgh this (and every) weekend in her Weekend Update PGH.  And as always, The New News with Danii Kaufman.Some of the topics discussed during the show are: •  Rhythm and Brews 2023 •  Worst day of Danii's life •  Ativan shopping •  Addy's throwing knives •  The sport of "Jugger" •  Choose your Jugger weapon •  Danii is meant for a fur vest •  Issue with Addy's open mic  •  Which former Poor Man's Podcast guest would be your first pick in Jugger? •  Pittsburgh comedy Jugger league •  Danii sees the Barbie movie •  13 other Mattel toys becoming movies (including Barney, Hot Wheels, and more) •  Man spends $14K for a "hyper-realistic collie suit •  And The New News with Danii KaufmanTune in next week for guests Brandon Johnson and Michelle Koper of Pittsburgh Foodie Girls"Thanks for listening!"All things Poor Man's Podcast:https://linktr.ee/PoormanspodcastRhythm & Brews:https://www.bonafidebellevue.org/rhythm-brews-festival/Steeling Pittsburgh:https://www.instagram.com/steelingpittsburgh/

Recorded June 9, 2023 Book Talk Starts at 26.03 Our annual Mother Bear KAL began June 1, 2023, but any bears you have knit or crocheted in 2023 are eligible as entries for prizes.  To find out all about this wonderful charity, please go to Mother Bear Project website.  Talk bears with us in the Mother Bear Chatter thread and post your finished bears in the FOs thread. We have a listener who has come up with 3 incentive prizes for increasing your bear count!  For more info, please check out the Mother Bear Incentive Prizes thread.   Virtual Knitting Group via Zoom EVENTS Tracie and Barb will be at: Lambtown - October 7-8, 2023 at the Dixon May Fairgrounds in Dixon, CA The TKGA Retreat 2023 - November 2-5, 2023 at the Hilton Charlotte University Place Hotel in Charlotte, North Carolina   Tracie will be in New Zealand and Sydney, Australia this summer!  If you are near Auckland, National Park, Wellington, or the Marlborough region in NZ, or Sydney, and you'd like to try to meet up, please message Tracie at 2knitlitchicks@gmail.com or alittleposy on Ravelry.   KNITTING Barb finished 3 bears (272, 273, 274)   Tracie finished: Summer Sorrel by Wood & Pine in Despondent Dyes OMG Glitter! in the Even My Attorney Says “Let It Go” colorway 4 Mother Bears - 307-310 Gnome 26 - Never Not Gnoming by Sarah Schira in Neighborhood Fiber Co Rustic Fingering in Rock Creek Park and Psych Ward Yarns Hecka Fingering in Cable Car Red   Barb is working on: Rock It Tee by Tanis Lavalee, using Anzula Breeze in the Fern and Gravity colorways WYS Vanilla Socks, using West Yorkshire Spinners Signature 4-ply Self-Striping in the Peacock colorway Razzle Dazzle Scarf in Leading Men Fiber Arts Show Stopper Gradient Set in the Razzle Dazzle #22 colorway 6600K (Striped Hoodie) by Barry Klein, using 4 colors of Lana Grossa Ecopuna Degradé   Barb has Cast On Mother Bear 275   Cast On: Rift by Jacqueline Cieslak in Juniper Moon Farm Zooey Experimental sweater - all mini skeins! Mother Bear 311   Working On: Marklee DK by Elizabeth Doherty in Knit Picks Comfy in Planetarium Socks in Tosh Merino Light Glitter in T'Challa colorway   BOOKS Barb and Tracie both enthusiastically recommend:  Demon Copperhead by Barbara Kingsolver - 5 stars   Barb read: The Liar's Club by Mary Karr - 4 stars The Year of Less : How I Stopped Shopping, Gave Away My Belongings, and Discovered Life is Worth More than Anything You can Buy in a Store by Cait Flanders - 3 stars   Tracie read: The Night She Disappeared by Lisa Jewell - 4.5 stars Tracie recommends Onyx Professional Hard as Hoof Nail Strengthening Cream

Naftal Benisty is the creator and host of the podcast, “Benzo Tired.” A social worker by trade, Naftal's personal experience with kindling, seizures, and multiple prescriptions for benzodiazepines steered him into the world of benzo advocacy.In our conversation, Naftal shares his benzo story and the reasons he decided to start a podcast. We also talk about seizures, the indefinite hold, BIND, deprescribing guidelines, medical education, remaining positive, and so much more.Video ID: BFP123CHAPTERS0:00:00 INTRODUCTION0:01:06 Feeling Good / Taking a Break0:02:54 Peer Support Training0:04:34 Checking in with You0:08:54 FEATURE: Naftal Benisty0:13:51 Welcome0:14:36 A Bit About Naftal0:16:15 Naftal's Benzo Story0:26:32 Benzos and Seizures0:29:20 Tapering & the Indefinite Hold0:35:18 How Are You Now?0:36:18 Starting His Podcast0:38:29 Making the Podcast Is a Gift0:41:04 Benefits of Lived Experience0:43:44 BIND Discovery0:44:59 Consortium's Deprescribing Guidelines0:46:28 U.S. vs. International Benzo Support0:50:31 Educating Medical Professionals0:52:08 Are There Good Benzo Uses?0:53:48 Haeley & Tom Episode0:56:22 Our Caregivers0:59:16 Future for Naftal / Podcast1:00:47 Long COVID and Benzos1:01:16 How Podcasts Help1:03:48 Balancing Honesty and Positivity1:06:09 Doing Great Work1:06:58 One Piece of Advice1:07:17 Deprescribing Guidelines1:08:57 Shane Kenny's Movie1:09:20 Final Words1:10:50 CLOSING RESOURCES— Benzo Tired on Spotify: https://open.spotify.com/show/7HHdbrsbTpMMmlrL9TCWfi— Benzo Tired: Haely & Tom Episode: https://open.spotify.com/episode/1VTFkXLVDrMVrHdHiaoMaV?si=P5_pecyKSyap3iSweKPwsg— BAWG Documentation (scroll down to see “projects”): https://benzoaction.org— Deprescribing Guidelines from BAWG: https://corxconsortium.org/wp-content/uploads/Benzo-Deprescribing.pdf— BIND Description: https://easinganxiety.com/BIND SITE LINKSVISIT US ONLINE— Website: https://www.easinganxiety.com— YouTube: https://youtube.com/@easinganx— Twitter: https://twitter.com/@easinganx— Facebook: https://facebook.com/easinganxfb— Instagram: https://instagram.com/easinganxSUBSCRIBE / SUPPORT US— Join Our Mailing List: https://easinganxiety.com/subscribe— Make a Donation: https://easinganxiety.com/donate PODCAST SUMMARYThis podcast is dedicated to those who struggle with side effects, dependence, and withdrawal from benzos, a group of drugs from the benzodiazepine and nonbenzodiazepine classes, better known as anti-anxiety drugs, sleeping pills, sedatives, and minor tranquilizers. Their common brand names include Ambien, Ativan, Klonopin, Lunesta, Valium, and Xanax. DISCLAIMERAll content provided on this YouTube channel is for general informational purposes only and should never be considered medical or health advice. The author of the content provided on this channel is not engaged in rendering medical, health, psychological, or any other kind of personal or professional services. Health-related information provided is not a substitute for medical advice and should not be used to diagnose or treat health problems or to prescribe any medical devices or other remedies.Never disregard medical advice or delay in seeking it.Please visit our website for our complete disclaimer at https://www.easinganxiety.com/disclaimer. MUSIC CREDITS— All music provided / licensed through Storyblocks (https://www.storyblocks.com) Benzo Free Theme— Title: "Walk in the Park"— Artist: Neil Cross PRODUCTION CREDITSEasing Anxiety is produced by…Denim Mountain Presshttps://www.denimmountainpress.com

Who are the most famous people for showing their bits on OnlyFans? Raven wants to be a script doctor; Rich has a fear of needles and prefers sedation dentistry; Ativan vs. Xanax; Odd medical fears; Black Rock and Members Only jackets; How many laughs a show does Feeney average? What in the world is Snax the Sloth? Raven names the funniest comedians he's met; Blue balls, fact or fiction? The best way to get over someone you dated; The story of Rich and his wife; Family Guy "What would you rather do?" Strange sights at concerts and sporting events; Sabu arrives in AEW for the Adam Cole/Chris Jericho feud. immediate online backlash ensues; Fanmail and of course, all the usual perversions. Follow the guys on Twitter!Raven - @theRavenEffectRich - @RichBocchiniFeeney - @jffeeney3rdAthletic Greens, the best way to reclaim your health and boost your immune system. Visit athleticgreens.com/Raven to take ownership of your health and get a one year supply of vitamin D and five travel packs.Get Raven trading cards by going to beaujay.com - buy early and oftenAsk Danna on ebay is selling a bunch of Raven's old comics and other goods, go buy Raven's stuff. Check out the store at https://www.ebay.com/str/askdannaHave Raven say things that you want him to say, either for yourself or for someone you want to talk big-game shit to by going to www.cameo.com/ravenprime1If you want all the uncensored goodness AND watch The Raven Effect, sign up for Patreon by going to www.patreon.com/TheRavenEffect it's only $5 a monthThis show is part of the Spreaker Prime Network, if you are interested in advertising on this podcast, contact us at https://www.spreaker.com/show/5166640/advertisement

Personality changes. Loss of ability. Loss of confidence. Loss of self. These are common in benzo withdrawal and BIND, and yet we rarely talk about them. What does this look like? What are its causes? And most of all, what can we do about it?In today's episode, we explore the loss of self during benzo withdrawal. We also respond to a question on tinnitus, share a comment on the benefits of nature, and hear a benzo story from New Zealand.https://www.easinganxiety.com/post/who-am-i-now-confidence-and-self-esteem-in-benzo-withdrawal-bind-bfp122Video ID: BFP122Chapters00:00 INTRODUCTION01:28 Back from Vacation03:36 Benzo Work Updates04:57 Still Have Some Symptoms07:00 Today's Format08:11 MAILBAG08:17 Benzos and Tinnitus12:58 Nature and Connection15:39 BENZO STORY16:29 Eta's Mum's Story / New Zealand22:04 Medical Communication Failures25:40 FEATURE26:59 BIND Refresher27:43 Our Lives Have Changed28:29 Benzo Life Effects Data30:41 Loss of Confidence35:00 Humility vs. Egoism35:54 Symptoms that Affect Confidence38:23 What Can We Do?38:42 Making Use of the Extra Time40:35 Finding Acceptance42:59 Six Tips for Improving Self-Esteem47:22 MOMENT OF PEACE ResourcesThe following resource links are provided as a courtesy to our listeners. They do not constitute an endorsement by Easing Anxiety of the resource or any recommendations or advice provided therein.— Ackerman, Courtney E. “What Is Self-Confidence? (+9 Proven Ways to Increase It).” Positive Psychology. July 9, 2018. Accessed May 11, 2023. https://positivepsychology.com/self-confidence/.— Ashton, C. Heather. Benzodiazepines: How They Work and How to Withdraw (aka The Ashton Manual). 2002. Accessed April 13, 2016. https://easinganxiety.com/ashton.— Finlayson, AJ Reid, Macoubrie J, Huff C, Foster DE, Martin PR. Experiences with benzodiazepine use, tapering, and discontinuation: an Internet survey. Therapeutic Advances in Psychopharmacology. 2022;12. doi:10.1177/20451253221082386. https://journals.sagepub.com/doi/full/10.1177/20451253221082386.— Foster, D E. Benzo Free: The World of Anti-Anxiety Drugs and the Reality of Withdrawal. Erie, CO: Denim Mountain Press, 2018. https://www.benzofree.org/book.— Huff C, Finlayson AJR, Foster DE, Martin PR. Enduring neurological sequelae of benzodiazepine use: an Internet survey. Therapeutic Advances in Psychopharmacology. 2023;13. doi:10.1177/20451253221145561. https://journals.sagepub.com/doi/10.1177/20451253221145561.— Ravenscraft, Eric. “Practical Ways to Improve Your Confidence (and Why You Should).” New York Times. June 3, 2019. Accessed May 11, 2023. https://www.nytimes.com/2019/06/03/smarter-living/how-to-improve-self-confidence.html.— Tinnitus. Mayo Clinic Patient Care & Health Information. Accessed May 11, 2023. https://www.mayoclinic.org/diseases-conditions/tinnitus/symptoms-causes/syc-20350156.— “Top 10 Tips for Overcoming Low Self-Esteem.” Ditch the Label. September 26, 2022. Accessed May 11, 2023. https://www.ditchthelabel.org/overcoming-low-self-esteem/. The PodcastThe Benzo Free Podcast provides information, support, and community to those who struggle with the long-term effects of anxiety medications such as benzodiazepines (Xanax, Ativan, Klonopin, Valium) and Z-drugs (Ambien, Lunesta, Sonata).WEBSITE: https://www.easinganxiety.comMAILING LIST: https://www.easinganxiety.com/subscribeYOUTUBE: https://youtube.com/@easinganxDISCLAIMERAll content provided by Easing Anxiety is for general informational purposes only and should never be considered medical advice. Any health-related information provided is not a substitute for medical advice and should not be used to diagnose or treat health problems, or to prescribe any medical devices or other remedies. Never disregard medical advice or delay in seeking it. Please visit our website for our complete disclaimer at https://www.easinganxiety.com/disclaimer.CREDITSMusic provided / licensed by Storyblocks Audio— https://www.storyblocks.comBenzo Free Theme — Title: “Walk in the Park”— Artist: Neil CrossPRODUCTIONEasing Anxiety is produced by…Denim Mountain Presshttps://www.denimmountainpress.com©2023 Denim Mountain Press – All Rights Reserved

In this week's podcast episode, we talked with Dr. Katherine Unverferth on Menopause, anxiety, and mental health. We covered the below topics: How do we define peri-menopause and menopause?  What causes menopause?  Why do some have more menopausal symptoms than others?  Why do some people report rapid rises in anxiety (and even panic disorder) during menopause.  Is the increase in anxiety with menopause biological, physiological, or psychological?  Why do some people experience mood differences or report the onset of depression during menopause?  What treatments are avaialble to help those who are suffering from menopause (or perimenopause) and anxiety and depression? Welcome back, everybody. I am so happy to have you here. We are doing another deep dive into sexual health and anxiety as a part of our Sexual Health and Anxiety Series. We first did an episode on sexual anxiety or sexual performance anxiety. Then we did an episode on arousal and anxiety. That was by me. Then we did an amazing episode on sexual side effects of antidepressants with Dr. Aziz. And then last week, we did another episode by me basically going through all of the sexual intrusive thoughts that often people will have, particularly those who have OCD.  This week, we are deep diving into menopause and anxiety. This is an incredibly important episode specifically for those who are going through menopause or want to be trained to understand what it is like to go through menopause and how menopause impacts our mental health in terms of sometimes people will have an increase in anxiety or depression. This week, we have an amazing guest coming on because this is not my specialty. I try not to speak on things that I don't feel confident talking about. This week, we have the amazing Dr. Katherine Unverferth. She is an Assistant Clinical Professor at The David Geffen School of Medicine and she also serves as the Director of the Women's Life Center and Medical Director of the Maternal Mental Health Program. She is an expert in reproductive psychiatry, which is why we got her on the show. She specializes in treating women during periods of hormonal transitions in her private practice in Santa Monica. She lectures and researches and studies areas on postpartum depression, antenatal depression, postpartum psychosis, premenstrual dysphoric disorder—which we will cover next week, I promise; we have an amazing guest talking about that—and perimenopausal mood and anxiety disorders. I am so excited to have Dr. Unverferth on the show to talk about menopause and the collision between menopause and anxiety. You are going to get so much amazing information on this show, so I'm just going to head straight over there. Again, thank you so much to our guest. Let's get over to the show. Kimberley: Welcome. I am so honored to have Dr. Katherine Unverferth with us talking today about menopause and anxiety. Thank you for coming on the show. Dr. Katie: Of course. Thanks for having me. HOW DO WE DEFINE PERI-MENOPAUSE AND MENOPAUSE?  Kimberley: Okay. I have a ton of questions for you. A lot of these questions were asked from the community, from our crew of people who are really wanting more information about this. We've titled it Menopause and Anxiety, but I want to get really clear, first of all, in terms of the terms and whether we're using them correctly. Can you first define what is menopause, and then we can go from there? Dr. Katie: Definitely. I think when you're talking about menopause, you also have to think about perimenopause. Menopause is defined as the time after the final menstrual period. Meaning, the last menstrual period somebody has. It can only be defined retrospectively, so you typically only know you're in menopause a year after you've had your final menstrual period. But that's the technical definition—after the final menstrual period, it's usually defined one year after. Perimenopause is the time leading up to that where people have hormonal changes. Sometimes they have vasomotor symptoms, they can have mood changes, and that period typically lasts about four years but varies. I think that people often know that they're getting close to menopause because of the perimenopausal symptoms they might be experiencing. Kimberley: Okay. How might somebody know they're going into perimenopause? I think that's how you would say you go into it. Is that right?  Dr. Katie: Yeah. You start experiencing it there. I don't know if there's a specific term.  Kimberley: Sure. How would one know they're moving in that direction?  Dr. Katie: Typically, we look for a few different things. One of the earliest signs is menstrual cycle changes. As someone enters perimenopause, their menstrual cycle starts to lengthen, whereas before, it might have been a normal 28-day cycle. Once it lengthens to greater than seven days, over 35 days, we would start to think of someone might be in perimenopause because it's lengthened significantly from their baseline before.  Other symptoms that are really consistent with perimenopause are vasomotor symptoms. Most women who go through perimenopause will have these. These are hot flashes or hot flushes—those are synonyms for the same experience—and night sweats. Hot flashes, as the name describes what it is, they last about two to four minutes. It's a feeling of warmth that typically begins in the chest or the head and spreads outward, often associated with flushing, with sweating that's followed by a period of chills and sometimes anxiety. The night sweats are hot flashes but in the middle of the night when someone is sleeping, so it can be very disruptive to sleep. That combination of the menstrual cycle changes plus these vasomotor symptoms is typically how we define perimenopause or how we diagnose perimenopause. Once someone is later in perimenopause, when they're getting closer to their final menstrual period, often they'll skip menstrual cycles altogether, so it might be 60 days in between having bleeding. Whereas before, it was a more regular period of time. I think one of the defining features too is hormonal fluctuations during those times. But interestingly, there's not much clinical utility to getting the blood test to check hormone levels because they can vary wildly from cycle to cycle. Overall, what we do see is that certain hormones increase, others decrease, and that probably contributes to some of the symptoms that we see around that time as well. Kimberley: Right, which is so interesting because I think that's why a lot of people come to me and I try to only answer questions I'm skilled to answer. Those symptoms can very much mimic anxiety. I know we'll get into that very soon, but that's really interesting—this idea of hot flashes. I always remember coming home to my mom from school and she was actually in the freezer, except for her feet. It was one of those door freezers. So, I understand the heat that they're feeling, this hot flash, it's a full body hot flash stimulant like someone may have if they're having a panic attack maybe.  Dr. Katie: Exactly. There are lots of interesting studies really looking at the overlap of menopausal panic attacks and hot flashes too. There's a lot of this research that's really trying to suss out what comes first in perimenopause because we know that anxiety predisposes someone to hot flashes and it can predispose someone to panic attacks, which is interesting. It seems like there's this common denominator there. But I think that that's a really interesting thing that hopefully we'll get into this overlap between the two. WHAT AGE DOES SOMEONE GET PERIMENOPAUSE AND MENOPAUSE? Kimberley: I'm guessing this is something I'm moving towards as well. What age groups, what ages does this usually start? What's the demographics for someone going into perimenopause and menopause? Dr. Katie: The average age of menopause is 51, and then people spend about four years in perimenopause. Late 40s would be a typical time to start perimenopause. Basically, any age after 40, when someone's having these symptoms, they're likely in perimenopause. If it happens before the age of 40 where someone's having menstrual cycle abnormalities and they're having these vasomotor symptoms, that might be a sign of primary ovarian insufficiency. It used to be called premature ovarian failure, but that would be a sign that they should probably go see a doctor and get checked out. If it's after 40, it's very likely that they're having perimenopausal symptoms. Kimberley: Okay. What causes this to happen? What are the shifts that happen in people's bodies that lead someone into this period of their life? Dr. Katie: I think there are a lot of things that are going on. I think it's really important to emphasize that menopause is a natural part of aging. That this isn't some abnormal process. Nothing is wrong. It's a natural part of aging. It can still be very uncomfortable, I think. But basically, over time, a woman's eggs decline and the follicles that help these eggs develop also develop less. There's this decline in the functioning of the ovaries. There are a few reasons this might be. There are some studies that show that blood flow to the ovaries is reduced as a result of aging, so maybe that makes them function a little bit less. The follicles that remain in the ovaries are probably aging, and then the follicles, which are still there, also might not be the healthiest of follicles, which is why they weren't used earlier.  There's this combination of things that leads to these very significant hormonal changes that start around perimenopause. The first of these is an increase in follicle-stimulating hormone. Follicle-stimulating hormone is released by the pituitary and encourages the ovaries to develop follicles. That increases over time because the follicles aren't developing in the same way. It's like the pituitary is trying harder and harder to get them to work. At the same time as these, as the follicles and ovaries are aging, what we see is that the ovaries produce less estrogen and progesterone overall. But there's still these wild fluctuations that are happening. FSH is going up, but it's fluctuating up; estrogen and progesterone are going down, but they're fluctuating down. It's these really big shifts that seem to cause a lot of the symptoms that we associate with this time. WHY DO SOME HAVE MORE MENOPAUSAL SYMPTOMS THAN OTHERS?  Kimberley: Is there a reason why some people have more symptoms than others? Is it your genetic component or is there a hormonal component? What's your experience? Dr. Katie: I think there are lots of different reasons and we probably need more research in this area. There are definitely genetic components that influence it. For example, we know that women who have family members who went through menopause earlier are likely to go through menopause themselves earlier. There's some genetic thing that's influencing the interplay of factors. I think we know that there are certain lifestyles. There are certain behaviors, like certain behaviors in someone's life that can influence, I think, their symptoms. We know that smoking, obesity, having a more sedentary lifestyle can impact vasomotor symptoms. I think some really interesting research looks at the psychological influences here. We know that women who have higher levels of neuroticism, when they go through perimenopause, have more anxiety and mood changes associated with it. People who have higher levels of somatic anxiety, coming into this perimenopausal transition, can also have a tougher time. I think that makes sense when we think about someone with somatic anxiety. They're going to be very, very attuned to these small changes in their body. During perimenopause, there are these huge changes that are happening in your body. That can trigger, I think, a lot of anxiety and a focus on the symptoms.  I think with vasomotor symptoms specifically, like hot flashes and hot flashes specifically, night sweats, not quite as much, we know that there are these psychological characteristics that probably perpetuate and worsen hot flashes. When someone has a hot flash, it's certainly uncomfortable for most people. But the level of distress can be very different. They've looked at the cognitions that occur when people have hot flashes and at some point, people believe like, “Oh, this is very embarrassing, this is very shameful.” That doesn't help them process it. They might believe, “This is never going to go away. I can't cope with it.” That's also not going to help. I think that's really a target for cognitive behavioral therapy to help people during this time. Kimberley: It just makes me think too, as somebody who has friends going through this, and you can please correct me, what I've noticed is there's also a grief process that goes along with it too, like it's another flag in terms of being flown, in terms of I'm aging. I've also heard, but maybe you have more to say about people feeling like it makes them less feminine. Is that your experience too, or is that just my experience of what I've heard? Dr. Katie: No, I agree. I think in my clinical experience, people go through it in a lot of different ways. I think that there is this grief. I think it can bring out a lot of existential anxiety. It is a sign that you are getting older. This can bring up a lot of these questions like, who am I? What's my purpose? Where am I going? But I think it's really important to remind women that we're not defined by our reproductive functioning. I think that that's something that people forget. Were you less of a woman when you were 15 or when you were 10 maybe and you hadn't gone through puberty? You're still the same person. But I do think that there's a lot of cultural stress around this, and I think there are a lot of complexities around the way society sees aging women. I think that those are cultural issues that need to be fixed, but not necessarily a problem within the woman themselves. WHAT CAUSES MENOPAUSE AND ANXIETY SYMPTOMS?  Kimberley: That's really helpful to know and understand. Okay, let's talk about if I could get a little more understanding of this relationship with anxiety. Maybe you can be clearer with me so that I understand it. Is it more of what we're saying in terms of like, it's the chicken and the egg? Is that what you mean in terms of people who have anxiety tend to have more symptoms, but then those symptoms can create more anxiety and it's like a snowball? Or is that not true for everybody? Can you explain how that works? Dr. Katie: With regard to the perimenopausal period, what I think researchers are trying to figure out is, do vasomotor symptoms, like hot flashes, lead to anxiety and panic, or do anxiety and panic worsen the vasomotor symptoms? We don't have a lot of information there. Part of it is because it's difficult to study. Because when you're doing symptom checklists, there's a lot of overlap between a hot flash and a panic attack. It's just been difficult, I think, to suss out in research. I think what we do know is there was one study that showed that people who have higher levels of anxiety are five times more likely to report hot flashes than women with anxiety in the normal range. Whether or not the anxiety is necessarily causing it, I do think that there's probably some perpetuation of like, I think that the anxiety is perpetuating the hot flashes, which perpetuates the anxiety. We just don't know exactly where it starts.  MENOPAUSE & PANIC ATTACKS  But I mean, if we just think about it for a second, if we think about what's common between them, I think that both panic attacks and hot flashes have a quick onset. They have a spontaneous onset, a rapid peak, they can be provoked by anxiety, they can include changes in temperature, like feelings of heat and sweating. They can have these palpitations, they can have this shortness of breath, nausea. And then it's very common that panic is reported during hot flashes, and hot flashes can be reported during panic. I think there's this interplay that we're trying to figure out. I think what's interesting too is that common antidepressants can treat both panic and hot flashes, which is not something that probably everybody knows. There are probably different reasons that they're treating each of them, but it is still just this other place where there is this overlap.  Kimberley: Okay. That's really interesting. One thing that really strikes me is I actually have a medical condition called postural orthostatic tachycardic syndrome (POTS), and you get really dizzy. I'm an Anxiety Specialist, so I can be good at pulling apart what is what, but it is very hard. You have to really be mindful to know the difference in the moment because let's say I have this whoosh of dizziness. My mind immediately first says I'm having a panic attack, which makes you panic. I'm assuming someone with that whoosh of maybe a hot flash has that same thing where your amygdala, I'm guessing, is immediately going to be like, “Yeah, we're having a panic attack. This is where we're going.” That makes a lot of sense to me. Now, some people also have reported to me that their anxiety has made them-- and again we have to understand what causes what, and we don't understand it, but how does that spread into their daily life? What I've heard is people say, “I don't feel like I can leave the house because what if I have a hot flash, which creates then a panic attack,” or “It's embarrassing to have a hot flash. You sweat and your clothes are all wet and so forth.” Do you have a common example of how that also shows up for people?  Dr. Katie: Yeah. I think that what you were alluding to is this behavioral avoidance that can happen. We can see that with panic attacks where people sometimes develop agoraphobia, fear of being in certain places. Sometimes they don't want to leave their home. I think with hot flashes, we do also see this behavioral avoidance when people especially tend to find them very distressing. They catastrophize it when they happen. They worry about social shaming. That avoidance, I think, the way that we understand anxiety is that if you have an anxiety and then you change your behaviors as a result of that anxiety, that tends to perpetuate the anxiety. That's one of the targets of cognitive behavioral therapy for hot flashes, is really trying to unwind some of this behavioral avoidance. Also, we know that temperature changes can trigger hot flashes. Unfortunately, it looks like strong positive and strong negative emotion can trigger hot flashes, just feeling any end of the spectrum. There are certain other triggers that can trigger hot flashes. I think that it's just this discomfort and this fear of having a hot flash that I think really generalizes the anxiety during this time.  HORMONES, ANXIETY, & MENOPAUSE There's also this interesting hormonal component too that's being studied as well. We've talked a little bit about progesterone. But in reproductive psychiatry, we really focus on this metabolite of progesterone called allopregnanolone. I think this is interesting because allopregnanolone is a metabolite of progesterone. We know that progesterone is going like this, up and up and down during this time. Allopregnanolone works on this receptor that tends to have very calming effects. Other things that work at this receptor are benzodiazepines like Xanax and Ativan or alcohol. It has this calming effect. But when it's going like this, it's calming and then it's not, and then it's calming and then it's not, up and down rollercoaster. There's some thought that that specifically might contribute to anxiety during this time. It can be more generalized. It's not always just related to hot flashes, even though we've been more specific on that. It can be the same as anxiety at any point in anyone else's life, like ruminative thoughts, worry, intrusive thoughts, just this general discomfort. I think this is a really exciting area of research where we're looking at ways to modulate this pathway to help women cope better. There are studies looking at progesterone metabolites to see if they can be helpful with mood changes during this time. Kimberley: Interesting. Let's work through it. As a clinician, if someone presents with anxiety, what I would usually do is do an inventory of the behaviors that they do in effort to reduce or remove that anxiety or uncertainty that they feel. And then we practice purposely returning to those behaviors. Exposure and so forth. From what you understand, would you be doing the same with the hot flashes or is there a balance between, there will be sometimes where you will go in purposely or go out and live your life whether you have a hot flash or not? How do we balance that from a clinical standpoint? Even as a clinician, I'm curious to know. As a clinician, what would I encourage my client to do? Would it be like our normal response of, “Come on, let's just do it, let's face all of our fears,” or is there a bit of a balance here that we move towards? Dr. Katie: It's more of a balance. I think one of the important things is that what you want to do-- I think the focus is on the cognition here a little bit. I'm not familiar and I don't think that exposure to hot flashes is intentionally triggering hot flashes repeatedly, like sometimes we do in panic disorders is part of this. What I understand from the protocol is that it's really looking at the unhelpful cognitions that relate to menopause, aging, and vasomotor symptoms. This idea of like, everybody is looking at me when I'm having a hot flash, this is so shameful. Or maybe it goes further, like no one will like me anymore. Who knows exactly where it can go? We know that when people have cognitive distortions, it's not really based on rational thinking. I think other part is you work on monitoring and modifying hot flash triggers, so it feels more in your control like temperature changes and doing those things. I think other things that you do is there's some evidence for diaphragmatic breathing to help with the management of hot flashes. You teach someone those skills. I think your idea is you want to get them back out there and living their life despite the hot flashes, and also just education. This isn't going to last forever. Yes, this is uncomfortable, but everybody goes through this. This is a normal part of aging. Also encouraging them to seek treatment if they need it. In addition to therapy, we know that there are medications that can help with this. If the hot flashes are impacting their life in a significant way or very distressing to them, go see a reproductive psychiatrist or go see an OB-GYN who can talk to you about the different options to really treat what's coming up. Kimberley: Right. That's helpful. I want to quickly just add on to that with your advice. I think what you're saying is when we come from an anxiety treatment model, we are looking at exposure, but when it comes to someone who's going through this real life, like their actual symptoms aren't imagined, they're there, it's okay for them to modify to not be going to hot saunas and so forth that we know that they're going to be triggered, but just to do the things that get them back to their daily functioning, but it is still okay for them. I think what I'm trying to say is it's still okay for them to be doing some accommodation of the symptoms of perimenopause, but not accommodation of the anxiety. Is that where we draw the line? Dr. Katie: I think that's a really good way of explaining it. DEPRESSION AND MENOPAUSE Kimberley: All right. The other piece of this is as important, which is how depression impacted here. Can you share a little bit how mood changes can be impacted by perimenopause?  Dr. Katie: Definitely. We know that there's a significant increase in not only the onset of a new depression, but also recurrence of prior depressive episodes during perimenopause. It's probably related to the changing levels of hormones, but also, I think what we've alluded to and what we have to acknowledge is there are big life changes that are happening around this time as well. I think cultural views of aging, I think a lot of times people have changes in their relationships, their partners. Their libido can change. There's so many moving parts that they think that also contributes to it.  But specifically with regard to perimenopausal depression, we categorize this in the reproductive subtype of depression. At these different periods of hormonal transition, certain women are prone to have a depressive episode. We know that that's true during normal cycling. For example, premenstrual dysphoric disorder or PMDD is a reproductive subtype of depression. People sometimes get depressed in those two weeks before their period and then feel fine during the week of their period or the week after. During the luteal phase, they experience depression. We know that that group of women also is at increased risk for perinatal depression, so depression during pregnancy and postpartum. And then that same group is also at risk for perimenopausal depression. What we know is that a subset of women is probably sensitive to normal levels of changing hormones, and that for them, it triggers a depressive episode.  One of the biggest risk factors for depression during perimenopause is a prior history of depression. Unfortunately, the way depression works is that once you have it, you're more likely to have it in the future. For people who have had depression in their life or have specifically had depression around these times of hormonal transition, it's probably just important to keep an eye on how they're doing, make sure they have appropriate support, whether that's from a therapist or a psychiatrist, and monitor themselves closely. Kimberley: Okay. This is really helpful to know. We know that people with anxiety tend to have depression as well. Have you found those who've had previous depression or previous anxiety also have coexisting in terms of having those panic attacks and depression at the same time? Dr. Katie: That's interesting. I haven't read any research on that. It wouldn't surprise me. But I think at least for research purposes, they're separating it. I think clinically, of course, we can see it being all mixed together. But for research, it's depression or panic and they keep those separate. Kimberley: Right. One thing that just came to me in terms of just clarifying too is, I'm assuming a lot of people who have health anxiety are incredibly triggered during perimenopause as well, these symptoms that are unexplained but explained. But I'm wondering, is that also something that you commonly see in terms of they're having these symptoms and questioning whether it means something serious is happening? Has that been something that you see a lot of? Dr. Katie: Definitely. I think the first time someone has a hot flash, it can be extremely distressing. It's a very uncomfortable sensation. I think there are other changes that happen during perimenopause that, of course, I think, raise concern. We know that in addition to night sweats, people can just have general aches and pains. They can have headaches. Cognitive complaints can be very common during this time. Just this feeling of brain fog, not feeling as sharp as one used to be. They can have sleep disturbances, which can of course worsen the anxiety and the cognitive complaints, and the depression. I think there can be a myriad of symptoms. Other distressing symptoms, I'm not sure if they necessarily-- I think if you know what's going on, it's not quite as distressing, but there can be these urogenital symptoms, like vaginal dryness, vaginal burning. There can be recurrent UTIs, there can be difficulty with urination. There are this constellation of symptoms that I'm sure could trigger health anxiety in people, especially if they have preexisting health anxiety. WHAT TREATMENTS ARE AVAIALBLE TO HELP THOSE WHO ARE SUFFERING FROM MENOPAUSE (OR PERIMENOPAUSE) AND ANXIETY AND DEPRESSION?  Kimberley: Yeah, absolutely. Someone's listened to this episode so they're at least informed, which is wonderful. They start to see enough evidence that this may be what is going on for them. What would be the steps following that? Is it something that you just go through and like a fever, you just ride it out kind of thing? Or are there medications or treatments? What would you suggest someone do in the order as they go through it? Dr. Katie: I think it depends on what's going on and how they're experiencing it. If this is distressing, life interfering, if they're having trouble functioning, they should absolutely seek treatment. I think there are a few different things they can do depending on what's going on. For depression and anxiety, medications are the first line. Antidepressants would still be the first-line therapy there. There's some evidence for menopausal hormone therapy, but there's not really enough. There is evidence for menopausal hormone therapy, but it's not currently first line for depression or anxiety. If someone had treatment-resistant depression that came up in the perimenopausal transition, I think it's reasonable to consider menopausal hormone therapy. But currently, menopausal hormone therapy isn't really recommended for that.  If someone is having distressing vasomotor symptoms with night sweats and recurrent hot flashes or hot flushes during the day, menopausal hormone therapy is a very good option. That is something to consider. They could go talk to their OB-GYN about it. Certain people will be candidates for it and other people might not. If you think it might be something you're interested in, I recommend going and speaking to your OB-GYN sooner rather than later.  Antidepressants themselves can also help with vasomotor symptoms as well. They can specifically help with hot flashes and night sweats. If someone has depression and anxiety and hot flashes and night sweats, antidepressant can be a really good choice because it can help with both of those. There was a really interesting study that compared Lexapro to menopausal hormone therapy for hot flashes, for quality of life, for sleep, and for depression. Essentially, both of them helped sleep quality of life in vasomotor symptoms, but only the Lexapro helped the depression. It really just depends on what's going on.  I think another thing that we've also talked about is therapy. This can be a big life transition. I think really no woman going through menopause is the same. Some people have toddlers. Some people have grown children who have just left their home. Some people are just starting their career. Some people are about to retire. Relationships can change. I think that it's really important to take what's going on in the context of a woman's life. I think therapy can be really helpful to help them process and understand what they're going through. Kimberley: Right. You had mentioned before, and I just wanted to touch on this, vaginal drying and stuff like that, which I'm sure, again, a reason for this series is just how much sexual intimacy and so forth can impact somebody's satisfaction in life or functioning or in relationships. Is that something that is also treatable with these different treatment models or is there a different treatment for that?  Dr. Katie: With menopausal hormone therapy, when someone has hot flashes or these other symptoms that we were talking about, not the urogenital ones, they need to take systemic menopausal hormone therapy. They basically need estrogen and progesterone to go throughout their body. When someone is just having these urogenital symptoms, they can often use topical vaginal estrogen. It's applied vaginally. That can be really helpful for those symptoms as well. I think if that's something that someone is struggling with that they want treatment for, it's very reasonable to go talk to their OB-GYN about it because there are therapies that can be-- Kimberley: Right, that's like a cream or lotion kind of thing.  Dr. Katie: Exactly.  Kimberley: Interesting. Oh wow. All right. That is so helpful. We've talked about the medical piece, the medication piece. A lot of people also I see on social media mostly talk about these more-- I don't want to use the word “natural” because I don't like that word “natural.” I don't even know what word I would use, but non-medical-- Dr. Katie: Like supplements or-- Kimberley: Yeah. I know it's different for everyone and everyone listening should please seek a doctor for medical advice, but is that something that you talk about with patients or do you stick more just to the things that have been researched? What are your thoughts? Dr. Katie: I think that supplements can be helpful for some people. I don't always find that they're as effective as medications. If someone is really struggling on a day-to-day basis, I do think that using treatments that have more evidence behind them is better. I think that there are some supplements that have a little bit of evidence, but I do think that they come with their own risks. Because supplements aren't regulated by the FDA and things like that, I don't typically recommend them. I think if someone is interested in finding a more naturopathic doctor who might be able to talk to them about those things is reasonable.  Kimberley: Super helpful. Is there anything that you feel like we haven't covered or that would be important for us to really drill home and make sure we point out here at the end before we finish up? Dr. Katie: I think we've covered a lot. I think that the most important thing that I really want to stress is this is a normal part of aging. This is not a disease; this is not a disease state. Also, there are treatments that can be so effective. You don't have to struggle in silence. It is not something shameful. There are clinicians who are trained, who are able to help if these symptoms are coming up. Just not being afraid to go and talk about it and go reach out for help. I think that that can be so helpful and really life-changing for some people when they get the right treatment. Kimberley: Right. Thank you. Where can we hear about you, get in touch with you, maybe seek out your services? Dr. Katie: You can find me online. I have a website. It's just www.drkatiemd.com. It's D-R-K-A-T-I-E-M-D.com. You can follow me on Instagram on the same. If you're interested to see more of my talks and lectures, I often post those on my LinkedIn page. You can follow me on LinkedIn. I think if you are personally interested in learning more about menopause, there's a really great book by an OB-GYN, her name is Dr. Jen Gunter, and it's called The Menopause Manifesto. For anybody who really wants to educate themselves about menopause and understand more about what's going on in their body and their treatments, I really recommend that book. Kimberley: Amazing. That's so good to have that resource as well. Thank you. I'm really, really honored. I know you're doing so many amazing things and running so many amazing programs. I'm so grateful for your time and your expertise on this. Dr. Katie: Of course. I'm so glad that you're doing a podcast on this. I think this is a topic that we really need more information and education out there. Kimberley: Yeah. Thank you.

Share this post with others: Road Trip to the Rx Summit in Atlanta (Final) / Presentation Cancellation, Vacation Reschedule, Benzo Community Activity, Social Media Effects, and Rollin' with the Changes Podcast ID: BFP121 Chapters 00:00  Which Day Is It?00:19  Presentation / Vacation04:59  What to Talk About?05:48  Benzo Community Activity06:15  Social Media Effects08:30  Promoting Others' Sites10:12  Rollin' with the Changes12:23  Closing References The following resource links are provided as a courtesy to our listeners. They do not constitute an endorsement by Benzo Free of the resource or any recommendations or advice provided therein. Rx Summit: https://rx-summit.com Rx Summit Agenda (Benzo Presentation Tuesday 8:00am): https://www.eventscribe.net/2023/RxSummit/agenda.asp?startdate=4/11/2023&enddate=4/11/2023&BCFO=&pfp=FullSchedule&mode=&fa=&fb=&fc=&fd= Site Links VISIT US ONLINE— Website: https://www.easinganxiety.com— YouTube: https://youtube.com/@easinganx Podcast Summary This podcast is dedicated to those who struggle with side effects, dependence, and withdrawal from benzos, a group of drugs from the benzodiazepine and nonbenzodiazepine classes, better known as anti-anxiety drugs, sleeping pills, sedatives, and minor tranquilizers. Their common brand names include Ambien, Ativan, Klonopin, Lunesta, Valium, and Xanax. Feedback We'd love to hear from you! The Benzo Free Podcast is a community podcast and we need your input to help it grow and improve. You can tell us what you think in the following ways: Fill out our Feedback Form at https://www.easinganxiety.com/feedback Email us at feedback@easinganxiety.com Comment on one of our videos or posts. Disclaimer All content provided on this YouTube channel is for general informational purposes only and should never be considered medical or health advice. The author of the content provided on this channel is not engaged in rendering medical, health, psychological, or any other kind of personal or professional services. Health-related information provided is not a substitute for medical advice and should not be used to diagnose or treat health problems or to prescribe any medical devices or other remedies. Never disregard medical advice or delay in seeking it. Please visit our website for our complete disclaimer at https://www.easinganxiety.com/disclaimer. Music Credits All music is provided by and licensed through Storyblocks (https://storyblocks.com). Benzo Free Theme— Title: "Walk in the Park"— Artist: Neil Cross Production Credits Easing Anxiety is produced by…Denim Mountain Presshttps://www.denimmountainpress.com

***AUDIO ISSUE AT 20 MIN MARK CORRECTED, SORRY :)***Xanax. Valium. Ativan. Chances are, you've heard of these medications, and you may have even been prescribed them before. The opioid crisis has dominated headlines for the past few years, but over that same time, another drug crisis has been hiding in plain sight. Benzodiazepines (the drug class of the brands mentioned above) are an underrecognized and important contributor to the public health crisis of drug morbidity and mortality. Benzodiazepines first came on the scene in the late 50s/early 60s to treat a variety of mental health conditions, as they are quite effective in providing calming and sedative effects. Representation in current culture, such as in the Netflix documentary “Take Your Pills: Xanax” , and the popular memoir by Melissa Bond, “Blood Orange Night,” shed light on the use and misuse of these meds.Needless to say, with long term use comes increased risk for addiction and physiologic dependence and we are currently seeing serious harms to people from these drugs. Thankfully, we have our lovely friend and expert, Gail Basch, MD, FASAM here to educate!Dr. Gail Basch is a Psychiatrist and Addiction Medicine specialist and director of the Outpatient Addiction Clinic at Rush University Medical Center and fellowship director for the Addiction Medicine fellowship at Rush. Dr. Basch helps us understand the history and future of benzodiazepine use (and abuse), and offers wonderful educational insights into this "overlooked drug epidemic".Topics covered in this episode include:The origin of benzos and their mechanism of action.How did they get so popular?Why/how are they prescribed?Are they effective? For what indications? Are there "better" medications out there to treat these same indications?When should you stop taking them? What are the concerns for long-term use?What are the side effects?What is meant by "addiction" vs "psychological dependence'?How can someone wean off of these medications?What are some resources for patients and providers who want more information about benzo use and withdrawal?Dr. Basch recommends the Ashton Manual, a wonderful resources pioneered by the incomparable Dr. Heather Ashton. A British physician and psychopharmacologist, Dr. Ashton literally "wrote the book" about benzodiazepines and our complicated relationships with this class of drugs. Check it out!Dr. Basch's professional profileFor more episodes, limited edition merch, or to become a Friend of Your Doctor Friends (and more), follow this link!Also, CHECK OUT AMAZING HEALTH PODCASTS on The Health Podcast Network(For real, this network is AMAZING and has fantastic, evidence-based, honest health information, and we are so happy to partner with them!) Find us at:Website: yourdoctorfriendspodcast.com Email: yourdoctorfriendspodcast@gmail.com Call the DOCLINE on 312-380-5005 and leave us a message. We will listen and maybe even respond/play it on the show! (Disclaimer: we will not answer specific medical questions or offer medical advice. Consult your healthcare professional with any and all personal health questions.) Connect with us:@your_doctor_friends (

Share this post with others: Road Trip to the Rx Summit in Atlanta (Day 5-6) / 1st Day of Rx Summit, Small Victories, Managing Benzo Limitations, BIND, Pelvic Floor Dysfunction and Urinary Difficulties, Fear of Heights, and Finding Ways to Do Things Podcast ID: BFP120 Chapters 00:00  Welcome to Days 5-600:28  Day 5 Recap01:31  First Day of Conference04:15  Benzo Morning Obsessions06:50  Small Victories07:13  Managing Limitations07:47  Pelvic Floor Dysfunction10:45  Managing PFD14:57  Symptom Management15:50  Fear of Heights17:40  Finding Ways to Do Things19:06  Thought Train Derailment 220:30  Closing References The following resource links are provided as a courtesy to our listeners. They do not constitute an endorsement by Benzo Free of the resource or any recommendations or advice provided therein. Rx Summit: https://rx-summit.com Rx Summit Agenda (Benzo Presentation Tuesday 8:00am): https://www.eventscribe.net/2023/RxSummit/agenda.asp?startdate=4/11/2023&enddate=4/11/2023&BCFO=&pfp=FullSchedule&mode=&fa=&fb=&fc=&fd= Site Links VISIT US ONLINE— Website: https://www.easinganxiety.com— YouTube: https://youtube.com/@easinganx Podcast Summary This podcast is dedicated to those who struggle with side effects, dependence, and withdrawal from benzos, a group of drugs from the benzodiazepine and nonbenzodiazepine classes, better known as anti-anxiety drugs, sleeping pills, sedatives, and minor tranquilizers. Their common brand names include Ambien, Ativan, Klonopin, Lunesta, Valium, and Xanax. Feedback We'd love to hear from you! The Benzo Free Podcast is a community podcast and we need your input to help it grow and improve. You can tell us what you think in the following ways: Fill out our Feedback Form at https://www.easinganxiety.com/feedback Email us at feedback@easinganxiety.com Comment on one of our videos or posts. Disclaimer All content provided on this YouTube channel is for general informational purposes only and should never be considered medical or health advice. The author of the content provided on this channel is not engaged in rendering medical, health, psychological, or any other kind of personal or professional services. Health-related information provided is not a substitute for medical advice and should not be used to diagnose or treat health problems or to prescribe any medical devices or other remedies. Never disregard medical advice or delay in seeking it. Please visit our website for our complete disclaimer at https://www.easinganxiety.com/disclaimer. Music Credits All music is provided by and licensed through Storyblocks (https://storyblocks.com). Benzo Free Theme— Title: "Walk in the Park"— Artist: Neil Cross Production Credits Easing Anxiety is produced by…Denim Mountain Presshttps://www.denimmountainpress.com

Share this post with others: Road Trip to the Rx Summit in Atlanta (Day 4) / Nashville, TN to Alpharetta, GA / Driving and Flying Working Around Limitations, Emotions and Social Media, Setting Boundaries Podcast ID: BFP119 Chapters 00:00 Welcome to Georgia02:16 Managing My Symptoms 102:46 Hotel Room Tour04:51 Driving in the Rain05:42 Managing My Symptoms 206:24 Driving and Flying07:47 Work Around Limitations08:48 Emotions and Social Media11:59 Setting Boundaries12:52 Train of Thought Derailment13:20 Back to Boundaries14:53 Care for Our Caregivers15:37 Closing References The following resource links are provided as a courtesy to our listeners. They do not constitute an endorsement by Benzo Free of the resource or any recommendations or advice provided therein. Rx Summit: https://rx-summit.com Rx Summit Agenda (Benzo Presentation Tuesday 8:00am): https://www.eventscribe.net/2023/RxSummit/agenda.asp?startdate=4/11/2023&enddate=4/11/2023&BCFO=&pfp=FullSchedule&mode=&fa=&fb=&fc=&fd= Site Links VISIT US ONLINE— Website: https://www.easinganxiety.com— YouTube: https://youtube.com/@easinganx Podcast Summary This podcast is dedicated to those who struggle with side effects, dependence, and withdrawal from benzos, a group of drugs from the benzodiazepine and nonbenzodiazepine classes, better known as anti-anxiety drugs, sleeping pills, sedatives, and minor tranquilizers. Their common brand names include Ambien, Ativan, Klonopin, Lunesta, Valium, and Xanax. Feedback We'd love to hear from you! The Benzo Free Podcast is a community podcast and we need your input to help it grow and improve. You can tell us what you think in the following ways: Fill out our Feedback Form at https://www.easinganxiety.com/feedback Email us at feedback@easinganxiety.com Comment on one of our videos or posts. Disclaimer All content provided on this YouTube channel is for general informational purposes only and should never be considered medical or health advice. The author of the content provided on this channel is not engaged in rendering medical, health, psychological, or any other kind of personal or professional services. Health-related information provided is not a substitute for medical advice and should not be used to diagnose or treat health problems or to prescribe any medical devices or other remedies. Never disregard medical advice or delay in seeking it. Please visit our website for our complete disclaimer at https://www.easinganxiety.com/disclaimer. Music Credits All music is provided by and licensed through Storyblocks (https://storyblocks.com). Benzo Free Theme— Title: "Walk in the Park"— Artist: Neil Cross Production Credits Easing Anxiety is produced by…Denim Mountain Presshttps://www.denimmountainpress.com

Share this post with others: Road Trip to the Rx Summit in Atlanta (Day 3) / Branson, MO to Nashville, TN / Back Home in Missouri, People with Crosses on the Roadside, Getting Out There and Doing Things Podcast ID: BFP118 Chapters 00:00  Welcome to Opryland01:11  Back Home in Missouri03:27  Roadside Crosses: Preface07:29  Roadside Crosses: Interview09:24  Roadside Crosses: Follow Up12:54  Getting Out There and Doing Things14:31  Closing References The following resource links are provided as a courtesy to our listeners. They do not constitute an endorsement by Benzo Free of the resource or any recommendations or advice provided therein. Rx Summit: https://rx-summit.com Rx Summit Agenda (Benzo Presentation Tuesday 8:00am): https://www.eventscribe.net/2023/RxSummit/agenda.asp?startdate=4/11/2023&enddate=4/11/2023&BCFO=&pfp=FullSchedule&mode=&fa=&fb=&fc=&fd= Site Links VISIT US ONLINE— Website: https://www.easinganxiety.com— YouTube: https://youtube.com/@easinganx Podcast Summary This podcast is dedicated to those who struggle with side effects, dependence, and withdrawal from benzos, a group of drugs from the benzodiazepine and nonbenzodiazepine classes, better known as anti-anxiety drugs, sleeping pills, sedatives, and minor tranquilizers. Their common brand names include Ambien, Ativan, Klonopin, Lunesta, Valium, and Xanax. Feedback We'd love to hear from you! The Benzo Free Podcast is a community podcast and we need your input to help it grow and improve. You can tell us what you think in the following ways: Fill out our Feedback Form at https://www.easinganxiety.com/feedback Email us at feedback@easinganxiety.com Comment on one of our videos or posts. Disclaimer All content provided on this YouTube channel is for general informational purposes only and should never be considered medical or health advice. The author of the content provided on this channel is not engaged in rendering medical, health, psychological, or any other kind of personal or professional services. Health-related information provided is not a substitute for medical advice and should not be used to diagnose or treat health problems or to prescribe any medical devices or other remedies. Never disregard medical advice or delay in seeking it. Please visit our website for our complete disclaimer at https://www.easinganxiety.com/disclaimer. Music Credits All music is provided by and licensed through Storyblocks (https://storyblocks.com). Benzo Free Theme— Title: "Walk in the Park"— Artist: Neil Cross Production Credits Easing Anxiety is produced by…Denim Mountain Presshttps://www.denimmountainpress.com

Share this post with others: Road Trip to the Rx Summit in Atlanta (Day 1) / Denver to Salina, Kansas / Series introduction, why I like road trips, a friendly voice. Podcast ID: BFP116 Chapters 00:00  Welcome to Day 100:47  About the Road Trip02:45  Why I Like Road Trips03:33  Our New Social Feeds04:31  Human Connection07:33  A Friendly Voice 09:11  I Hope You'll Join Me References The following resource links are provided as a courtesy to our listeners. They do not constitute an endorsement by Benzo Free of the resource or any recommendations or advice provided therein. Rx Summit: https://rx-summit.com Rx Summit Agenda (Benzo Presentation Tuesday 8:00am): https://www.eventscribe.net/2023/RxSummit/agenda.asp?startdate=4/11/2023&enddate=4/11/2023&BCFO=&pfp=FullSchedule&mode=&fa=&fb=&fc=&fd= Site Links VISIT US ONLINE— Website: https://www.easinganxiety.com— YouTube: https://youtube.com/@easinganx Podcast Summary This podcast is dedicated to those who struggle with side effects, dependence, and withdrawal from benzos, a group of drugs from the benzodiazepine and nonbenzodiazepine classes, better known as anti-anxiety drugs, sleeping pills, sedatives, and minor tranquilizers. Their common brand names include Ambien, Ativan, Klonopin, Lunesta, Valium, and Xanax. Feedback We'd love to hear from you! The Benzo Free Podcast is a community podcast and we need your input to help it grow and improve. You can tell us what you think in the following ways: Fill out our Feedback Form at https://www.easinganxiety.com/feedback Email us at feedback@easinganxiety.com Comment on one of our videos or posts. Disclaimer All content provided on this YouTube channel is for general informational purposes only and should never be considered medical or health advice. The author of the content provided on this channel is not engaged in rendering medical, health, psychological, or any other kind of personal or professional services. Health-related information provided is not a substitute for medical advice and should not be used to diagnose or treat health problems or to prescribe any medical devices or other remedies. Never disregard medical advice or delay in seeking it. Please visit our website for our complete disclaimer at https://www.easinganxiety.com/disclaimer. Music Credits All music is provided by and licensed through Storyblocks (https://storyblocks.com). Benzo Free Theme— Title: "Walk in the Park"— Artist: Neil Cross Production Credits Easing Anxiety is produced by…Denim Mountain Presshttps://www.denimmountainpress.com

Share this post with others: Road Trip to the Rx Summit in Atlanta (Day 2) / Salina, KS to Branson, MO / Benzos and indecision, the loss of confidence, life becoming small, and appreciation of the little things. Podcast ID: BFP117 Chapters 00:00  Welcome to Branson01:24  Drive Status01:58  Confidence, Indecision, and Benzos07:10  Life Becoming Small09:06  Appreciating the Little Things11:50  What's Next?12:55  Thanks for Joining Me13:08  Finding Beauty in Everything14:13  Closing References The following resource links are provided as a courtesy to our listeners. They do not constitute an endorsement by Benzo Free of the resource or any recommendations or advice provided therein. Rx Summit: https://rx-summit.com Rx Summit Agenda (Benzo Presentation Tuesday 8:00am): https://www.eventscribe.net/2023/RxSummit/agenda.asp?startdate=4/11/2023&enddate=4/11/2023&BCFO=&pfp=FullSchedule&mode=&fa=&fb=&fc=&fd= Site Links VISIT US ONLINE— Website: https://www.easinganxiety.com— YouTube: https://youtube.com/@easinganx Podcast Summary This podcast is dedicated to those who struggle with side effects, dependence, and withdrawal from benzos, a group of drugs from the benzodiazepine and nonbenzodiazepine classes, better known as anti-anxiety drugs, sleeping pills, sedatives, and minor tranquilizers. Their common brand names include Ambien, Ativan, Klonopin, Lunesta, Valium, and Xanax. Feedback We'd love to hear from you! The Benzo Free Podcast is a community podcast and we need your input to help it grow and improve. You can tell us what you think in the following ways: Fill out our Feedback Form at https://www.easinganxiety.com/feedback Email us at feedback@easinganxiety.com Comment on one of our videos or posts. Disclaimer All content provided on this YouTube channel is for general informational purposes only and should never be considered medical or health advice. The author of the content provided on this channel is not engaged in rendering medical, health, psychological, or any other kind of personal or professional services. Health-related information provided is not a substitute for medical advice and should not be used to diagnose or treat health problems or to prescribe any medical devices or other remedies. Never disregard medical advice or delay in seeking it. Please visit our website for our complete disclaimer at https://www.easinganxiety.com/disclaimer. Music Credits All music is provided by and licensed through Storyblocks (https://storyblocks.com). Benzo Free Theme— Title: "Walk in the Park"— Artist: Neil Cross Production Credits Easing Anxiety is produced by…Denim Mountain Presshttps://www.denimmountainpress.com

Share this post with others: David Powers is an artist, filmmaker, PhD candidate in psychology, and founder of Powers Benzo Recovery Coaching. After a severe car accident, David became dependent on diazepam. Now benzo-free, he helps others through his films, videos, and coaching. In Part II of our conversation, we learn about support, coaching, and membership sites. We also discuss psychology, overprescribing, gratitude, burnout, healing, society, culture, and much more. Please join us for this relaxed and informative conversation. Podcast ID: BFP115 Chapters 00:00  INTRODUCTION02:04  Benzo Recovery School07:13  Benzo Collaboration13:09  Shooting Short Films14:25  Feature Benzo Film20:11  Support, Burnout, and Fees28:38  Benzo Clinic / Commune30:53  Structured Healing33:34  Opportunity for Positive Change37:07  Gratitude in Withdrawal37:37  Jungian Approach40:38  Not the Ideal Situation41:09  Benzo Overprescribing44:21  Benzo Revolution44:58  America, Society, and Unity47:43  Bruce Lee, a Chinese Hero48:22  Humanity and Positivity51:34  Age, Wisdom, and Reality56:43  Wrapping Up58:47  CLOSING References The following resource links are provided as a courtesy to our listeners. They do not constitute an endorsement by Benzo Free of the resource or any recommendations or advice provided therein. POWERS BENZO RECOVERY COACHING Website — https://www.powersbenzocoaching.com/ YouTube — https://www.youtube.com/channel/UC18DrdP18DuSxoi2dxuSYUg Benzo Recovery School — https://www.powersbenzocoaching.com/benzoschool Site Links VISIT US ONLINE— WEBSITE: https://www.easinganxiety.com— YOUTUBE: https://youtube.com/@easinganx Podcast Summary This podcast is dedicated to those who struggle with side effects, dependence, and withdrawal from benzos, a group of drugs from the benzodiazepine and nonbenzodiazepine classes, better known as anti-anxiety drugs, sleeping pills, sedatives, and minor tranquilizers. Their common brand names include Ambien, Ativan, Klonopin, Lunesta, Valium, and Xanax. Feedback We'd love to hear from you! The Benzo Free Podcast is a community podcast and we need your input to help it grow and improve. You can tell us what you think in the following ways: Fill out our Feedback Form at https://www.easinganxiety.com/feedback Email us at feedback@easinganxiety.com Comment on one of our videos or posts. Disclaimer All content provided on this YouTube channel is for general informational purposes only and should never be considered medical or health advice. The author of the content provided on this channel is not engaged in rendering medical, health, psychological, or any other kind of personal or professional services. Health-related information provided is not a substitute for medical advice and should not be used to diagnose or treat health problems or to prescribe any medical devices or other remedies. Never disregard medical advice or delay in seeking it. Please visit our website for our complete disclaimer at https://www.easinganxiety.com/disclaimer. Music Credits All music is provided by and licensed through Storyblocks (https://storyblocks.com). Benzo Free Theme— Title: "Walk in the Park"— Artist: Neil Cross Production Credits Easing Anxiety is produced by…Denim Mountain Presshttps://www.denimmountainpress.com

Share this post with others: David Powers is an artist, filmmaker, PhD candidate in psychology, and founder of Powers Benzo Recovery Coaching. After a severe car accident, David became dependent on diazepam. Now benzo-free, he helps others through his films, videos, and coaching. In Part I of our conversation, we hear about David's personal struggle with benzodiazepines. We also discuss research and funding, the limbic system, GABA, fear, hope, symptoms, and even chat a bit about film. Please join us for this relaxed and informative conversation. Podcast ID: BFP114 Chapters 0:00:00  INTRODUCTION0:02:35  Rx Summit0:03:46  Upcoming Vacation0:06:02  INTERVIEW: Intro0:07:28  Filmmakers Chat0:11:38  Welcome to the Podcast0:12:34  David's Benzo Story0:25:38  Benzo Advocacy0:27:29  Are You Fully Healed?0:28:39  Giving Hope0:30:36 Audience-Led Podcasts0:33:14  Publishing His Book0:34:47  Moving into Coaching0:38:22  Benzo Recovery School0:44:56  Wrapping Up PhD0:46:26  Research and Funding0:50:35  Forums and Fear0:53:35  GABA and the Limbic System0:56:08  Responding to Fear0:58:15  Nerves, Symptoms, and Focus1:02:24  CLOSING References The following resource links are provided as a courtesy to our listeners. They do not constitute an endorsement by Benzo Free of the resource or any recommendations or advice provided therein. RESOURCES (Powers Benzo Recovery Coaching) Website — https://www.powersbenzocoaching.com/ YouTube — https://www.youtube.com/channel/UC18DrdP18DuSxoi2dxuSYUg Benzo Recovery School — https://www.powersbenzocoaching.com/benzoschool Site Links VISIT US ONLINE— WEBSITE: https://www.easinganxiety.com— YOUTUBE: https://youtube.com/@easinganx Podcast Summary This podcast is dedicated to those who struggle with side effects, dependence, and withdrawal from benzos, a group of drugs from the benzodiazepine and nonbenzodiazepine classes, better known as anti-anxiety drugs, sleeping pills, sedatives, and minor tranquilizers. Their common brand names include Ambien, Ativan, Klonopin, Lunesta, Valium, and Xanax. Feedback We'd love to hear from you! The Benzo Free Podcast is a community podcast and we need your input to help it grow and improve. You can tell us what you think in the following ways: Fill out our Feedback Form at https://www.easinganxiety.com/feedback Email us at feedback@easinganxiety.com Comment on one of our videos or posts. Disclaimer All content provided on this YouTube channel is for general informational purposes only and should never be considered medical or health advice. The author of the content provided on this channel is not engaged in rendering medical, health, psychological, or any other kind of personal or professional services. Health-related information provided is not a substitute for medical advice and should not be used to diagnose or treat health problems or to prescribe any medical devices or other remedies. Never disregard medical advice or delay in seeking it. Please visit our website for our complete disclaimer at https://www.easinganxiety.com/disclaimer. Music Credits All music is provided by and licensed through Storyblocks (https://storyblocks.com). Benzo Free Theme— Title: "Walk in the Park"— Artist: Neil Cross Production Credits Easing Anxiety is produced by…Denim Mountain Presshttps://www.denimmountainpress.com

“As nurses, we care for a lot of patients with anxiety, right? We have to fight not to get jaded and write off our patient's symptoms. It would've been easy for this nurse to just administer some Xanax or Ativan and gone on with her shift. It's not like the patient's vitals were super high or super low, but this nurse tapped into two things: her intuition and critical thinking skills.”You may recall this quote from an earlier episode, but we're revisiting it today because discerning between a heart attack and anxiety can sometimes be tricky. There's a lot to learn from this story of a patient that was experiencing a huge myocardial infarction but downplayed her symptoms as "just anxiety."Listen in for a lesson in intuition, critical thinking skills, and MORE!Topics discussed in this episode:Sarah's patient's initial complaint and symptomsWhat concerns the primary Nurse had about the patient's presentationPathophysiology and treatment of inferior wall myocardial infarctionRevisiting the components of “M.O.N.A.”Applying MONA to inferior wall MINursing considerations for managing patients with a STEMIHow the nurse saved the patient's lifeHow you should respond to a patient with chest painIf you would like to check out Sarah's 1hr, 1 CE course, go to: http://www.rapidresponseandrescue.comTo get the FREE Rapid Response RN Assessment Guide and the coupon code for $10 off the cost of the course, message Sarah on Instagram @TheRapidResponseRN and type the word PODCAST!This episode was produced by Podcast Boutique http://www.podcastboutique.comMentioned in this episode:AND If you are planning to sit for your CCRN and would like to take the Critical Care Academy CCRN prep course you can visit https://www.ccrnacademy.com and use coupon code RAPID10 to get 10% off the cost of the course!

We have another thrilling and exciting interview for you today around recovery. Melissa Bond joins me to discuss her story of addiction and recovery from benzodiazepines, more specifically, Ativan. Melissa is a narrative journalist and poet. In the years of her dependence on benzodiazepines, she has blogged and become a regular contributor for Mad in America. She is also the author of the memoir Blood Orange Night where she writes about becoming dependent upon and then withdrawing from benzodiazepines.   Some of the topics we discussed include:   Melissa shares her story of addiction to benzodiazepines and how it affected her life with her family (5:53)   “Benzos are the thieves that take everything.” (21:29)   How Melissa decided to withdraw from benzos and took it upon herself to do it (24:19)   Identifying as an addict and why as a culture we must ask, “What is addiction?” (38:12) Learn more about your ad choices. Visit megaphone.fm/adchoices

***TW/CW*** suicide, murder and harm to children will be discussed.We are diving back into the Lindsay Clancy case - she has been accused of strangling and killing her children. If you aren't familiar with this case please listen to it here: (https://open.spotify.com/episode/6wU3SpiZxeaMwcmrKWWHVB) and then come back to this episode. ***Lindsay was prescribed 13 different psychiatric medications:zolpidem (sold under the brand name Ambien); clonazepam (sold under the brand name Klonopin); diazepam (sold under the brand name Valium); fluoxetine (sold under the brand name Prozac); lamotrigine (sold under the brand name Lamictil); lorazepam (sold under the brand name Ativan); mirtazapine (sold under the brand name Remeron); quetiapine fumarate (sold under the brand name Seroquel); sertaline (sold under the brand name Zoloft); trazodone, hydroxyzine, amitriptyline, and buspirone.Nonprofit ‘The Blue Dot Project': https://www.thebluedotproject.orgRustic Marlin: https://rusticmarlin.com/blogs/influencer-round-up/the-blue-dot-projectPatrick Clancy's Statement/GoFundMe: https://www.gofundme.com/f/patrick-clancy-donationsFollow me: @manicandmedicated_If you or someone you know is struggling with suicidal thoughts please call the Suicide & Crisis Lifeline at 988 or 800-273-8255 to connect with a trained counselor, or visit 988lifeline.org.

Share this post with others: What can we do about tinnitus? What about brain lock? What about insomnia? Does alcohol help? Can flumazenil fix this? What about overwhelm and isolation? These and other questions are discussed as we dive deep into the mailbag. In today's episode, we explore the mailbag — in particular, your YouTube comments. We also catch up on D's health, progress with the workgroup, some exciting conference news, and much more. It's good to be back and we're so glad you tuned in. Podcast ID: BFP112 Chapters 00:00  INTRODUCTION01:29  A Hopeful New Year03:13  My Health Update06:39  Reminder of Acute W/D08:56  Website Update09:59  Peer Support Training Update11:46  Rx Summit Presentation 14:39  Hope and Overwhelm16:58  It's Good to Be Back19:00  MAILBAG19:08  Benzos in the ER21:34  Flumazenil Treatment25:47  Where Did BIND Come From?28:52  Suicidality, Brain Lock, and Isolation35:37  Insomnia37:19  Alcohol and Withdrawal40:48  Sleep Hygiene Tips43:23  Tinnitus45:34  Coping, BIND, and Kind Words47:36  Anecdote About BIND48:52  We Make a Difference50:22  Thank You for Everything52:09  MOMENT OF PEACE References The following resource links are provided as a courtesy to our listeners. They do not constitute an endorsement by Benzo Free of the resource or any recommendations or advice provided therein. Work Group Projects— Benzodiazepine Action Work Group (BAWG) — https://www.benzoaction.org— BAWG Peer Support Training Information — https://www.benzopeertraining.orgBIND Information— Easing Anxiety: Basics of BIND — https://easinganxiety.com/blog/basics-of-bind/ Video Presentation— A New You: Life After Benzos — https://easinganxiety.com/blog/a-new-you-life-aftter-benzo-withdrawal-bwpres2022 Conferences— Rx and Illicit Drug Summit — https://www.rx-summit.com/ — ASAM Annual Conference — https://annualconference.asam.org/2023/asam/index.aspSuicide Prevention— Easing Anxiety: Suicide Prevention Resources — https://easinganxiety.com/blog/category/resources/resources-suicide/resources-suicide-us/ Site Links VISIT US ONLINE— WEBSITE: https://www.easinganxiety.com— YOUTUBE (Easing Anxiety): https://www.youtube.com/easinganxiety— YOUTUBE (Benzo Free): https://www.youtube.com/benzofree PLEASE LET US KNOW WHAT YOU THINK— COMMENT: On this video in YouTube— COMMENT: On the blog post on our website— FEEDBACK FORM: https://www.easinganxiety.com/feedback— EMAIL: feedback@easinganxiety.com SUPPORT US— Make a Donation: https://www.easinganxiety.com/donate Podcast Summary This podcast is dedicated to those who struggle with side effects, dependence, and withdrawal from benzos, a group of drugs from the benzodiazepine and nonbenzodiazepine classes, better known as anti-anxiety drugs, sleeping pills, sedatives, and minor tranquilizers. Their common brand names include Ambien, Ativan, Klonopin, Lunesta, Valium, and Xanax. Feedback We'd love to hear from you! The Benzo Free Podcast is a community podcast and we need your input to help it grow and improve. You can tell us what you think in the following ways: Fill out our Feedback Form at https://www.easinganxiety.com/feedback Email us at feedback@easinganxiety.com Comment on one of our videos or posts. Disclaimer All content provided on this YouTube channel is for general informational purposes only and should never be considered medical or health advice. The author of the content provided on this channel is not engaged in rendering medical, health, psychological, or any other kind of personal or professional services. Health-related information provided is not a substitute for medical advice and should not be used to diagnose or treat health problems or to prescribe any medical devices or other remedies. Never disregard medical advice or delay in seeking it. Please visit our website for our complete disclaimer at https://www.easinganxiety.com/disclaimer. Music Credits

The Z-drugs: Ambien. Lunesta. Sonata. What are these? Are they benzos? Hypnotics? When did they hit the market? Can they cause dependence? Withdrawal? BIND? These questions and more will be discussed in our feature today. In today's episode, we focus on nonbenzodiazepines, or Z-drugs. How are they like benzodiazepines, and how are they different? We also answer some questions about dosage, duration, and rebounding and we hear a story of struggle from Tulsa, Oklahoma. https://www.easinganxiety.com/post/z-drugs-the-other-benzos-an-in-depth-look-at-ambien-lunesta-and-sonata-bfp111Video ID: BFP111Chapters 00:00 INTRODUCTION02:09 My Podcast Voice05:33 Progress on Website06:33 Peer Support Training Update09:10 Struggles, Symptoms, and the Podcast14:47 A reason why, or just coincidence? 18:16 MAILBAG18:58 Does dosage or duration matter? 21:24 Rebound from medical procedures?24:31 BENZO STORY32:28 FEATURE: Z-drugs34:38 What are Z-drugs?36:00 When did Z-drugs hit the market?36:36 Do Z-drugs act like BZDs on the body?37:54 Z-drugs often partnered with BZDs39:46 What are Z-drugs prescribed for?40:07 The Quest for the Magic Pill42:04 Are Z-drugs less likely to cause symptoms?45:06 What are the Z-drug side effects?47:02 Are Z-drug symptoms different?48:20 How to taper from Z-drugs?49:05 BZD and Z-drug Terminology51:48 MOMENT OF PEACE Resources The following resource links are provided as a courtesy to our listeners. They do not constitute an endorsement by Easing Anxiety of the resource or any recommendations or advice provided therein. FEATURE: Z-drugsAshton, C. Heather. Benzodiazepines: How They Work and How to Withdraw (aka The Ashton Manual). 2002. Accessed April 13, 2016. https://easinganxiety.com/ashton Brandt J, Leong C. Benzodiazepines and Z-Drugs: An Updated Review of Major Adverse Outcomes Reported on in Epidemiologic Research. Drugs R D. 2017 Dec;17(4):493-507. doi: 10.1007/s40268-017-0207-7. PMID: 28865038; PMCID: PMC5694420. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5694420/. Foster, D E. Benzo Free: The World of Anti-Anxiety Drugs and the Reality of Withdrawal. Erie, CO: Denim Mountain Press, 2018. https://easinganxiety.com/book Kay, Abigail L. et al. Drug Abuse, Dependency, and Withdrawal. Therapy in Sleep Medicine. 2012. https://doi.org/10.1016/C2009-0-40426-4. Schifano F, Chiappini S, Corkery JM, Guirguis A. An Insight into Z-Drug Abuse and Dependence: An Examination of Reports to the European Medicines Agency Database of Suspected Adverse Drug Reactions. Int J Neuropsychopharmacol. 2019 Apr 1;22(4):270-277. doi: 10.1093/ijnp/pyz007. PMID: 30722037; PMCID: PMC6441128. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6441128/. U.S. Food & Drug Administration. Taking Z-drugs for Insomnia? Know the Risks. Last Updated April 30, 2019. Accessed November 30, 2022. https://www.fda.gov/consumers/consumer-updates/taking-z-drugs-insomnia-know-risks. Waller, Derek G., Anthony P. Sampson. Anxiety, obsessive-compulsive disorder and insomnia. Medical Pharmacology and Therapeutics. Fifth Edition. 2018. https://www.sciencedirect.com/science/article/pii/B9780702071676000208. Wikipedia. Nonbenzodiazepine. Accessed November 30, 2022. https://en.wikipedia.org/wiki/Nonbenzodiazepine. Z-Drug. ScienceDirect. 2022. Accessed November 30, 2022. https://www.sciencedirect.com/topics/neuroscience/z-drug.  The PodcastThe Benzo Free Podcast provides information, support, and community to those who struggle with the long-term effects of anxiety medications such as benzodiazepines (Xanax, Ativan, Klonopin, Valium) and Z-drugs (Ambien, Lunesta, Sonata). WEBSITE: https://www.easinganxiety.comMAILING LIST: https://www.easinganxiety.com/subscribe YOUTUBE: https://youtube.com/@easinganx DISCLAIMERAll content provided by Easing Anxiety is for general informational purposes only and should never be considered medical advice. Any health-related information provided is not a substitute for medical advice and should not be used to diagnose or treat health problems, or to prescribe any medical devices or other remedies. Never disregard medical advice or delay in seeking it. Please visit our website for our complete disclaimer at https://www.easinganxiety.com/disclaimer. CREDITSMusic provided / licensed by Storyblocks Audio — https://www.storyblocks.com Benzo Free Theme — Title: “Walk in the Park” — Artist: Neil Cross PRODUCTIONEasing Anxiety is produced by…Denim Mountain Presshttps://www.denimmountainpress.com ©2022 Denim Mountain Press – All Rights Reserved

Amy LeClair grew up as a Junior Olympic Gymnast. At 11 she had her first interaction with Obsessive Compulsive Disorder while on a trip with her class. Suddenly she was bombarded by intrusive thoughts that made her wonder if she would hurt them even though she had no desire to do so. She was able to find tools to help with her OCD until Amy went to college. As a Division 1 gymnast at San Jose State, she experienced extreme verbal and emotional abuse from her coaches and was sexually assaulted by her head trainer. The trauma from that was buried, but came out in the form of anxiety which she treated with copious amounts of Ativan, eventually becoming addicted while pregnant with her daughter. Amy experienced a severe depressive episode just before giving birth and delivered her child while hospitalized on a psych hold. Things had hit a complete bottom and she eventually sought help in the form of an Intensive Outpatient Program that led to an OCD recovery program that changed her life. After finally finding help that worked, she went on to participate in an FBI investigation of San Jose State and entered into litigation against the Cal State University system eventually reaching a settlement agreement this past July. Amy now publicly advocates for athlete safety while focusing on the adverse effects of verbal abuse and sexual assault on mental health. Currently, she works with a nonprofit advocacy association who has assisted over a dozen states in adopting laws to protect the basic freedoms and protections of NCAA athletes.Episode ResourcesNOCD | treatmyocd.comConnect with AmyInstagram | @amyleclair_Connect with The Courage to ChangePodcast Website | lionrock.life/couragetochangepodcastPodcast Instagram | @couragetochange_podcastYouTube | The Courage to Change PodcastTikTok | @ashleyloebblassingamePodcast Email | podcast@lionrock.lifePodcast Facebook | @thecouragetochangepodcastLionrock ResourcesLionrock Life Mobile App | lionrock.life/mobile-appSupport Group Meeting Schedule | lionrock.life/meetings

Dr. Anna Lembke is our guest today — and trust me — you don't want to miss this one! We discuss benzodiazepine tapering, substitution, the dopamine cycle, flumazenil, anxiety, social media, finding a doctor and so much more.Anna Lembke, MD is a professor of psychiatry at Stanford University School of Medicine, chief of the Stanford Addiction Medicine Dual Diagnosis Clinic, and an internationally recognized leader in addiction medicine, treatment, and education. A best-selling author, she has also testified before both the U.S. House and Senate and appeared in the Netflix documentary, “The Social Dilemma.”https://www.easinganxiety.com/post/conversation-with-stanford-psychiatris-anna-lembke-md-bfp110Video ID: BFP110Chapters 0:00:00 INTRODUCTION0:01:55 Benzos & Surgery Update0:03:25 PROTECT Study0:04:35 FEATURE: Dr. Anna Lembke0:05:28 Dr. Lembke's Bio0:06:54 Welcome / About Dr. Lembke0:09:32 Deprescribing Clinics0:10:53 Learning from Addiction Medicine0:12:17 The Bravo Protocol0:13:37 The Ashton Manual0:14:59 Benzo Horror Stories0:15:50 The Dopamine Cycle0:19:45 Addiction vs. Dependence0:21:59 Is Benzo Withdrawal Unique?0:24:52 When Did You Become Concerned?0:26:40 Changes in Prescribing Practices0:29:15 Increasing Rates of Anxiety0:30:24 Drugifying Human Behaviors0:31:28 Digital Device Addiction0:34:59 Reinforcing Negative Experiences0:38:37 Mindfulness / Expectations0:41:49 Finding Acceptance0:43:48 How Do You Taper Your Patients?0:46:48 Substitution vs. Direct Taper0:49:57 Dosing Schedule / Flexibility0:52:06 Stabilizing Before Tapering0:54:31 Finding a Doctor You Can Trust0:56:04 You Make a Difference as a Patient0:56:53 Flumazenil and Other Treatments1:00:33 Benzos and the Elderly1:02:24 The Danger of Designer Benzos1:03:59 What are Benzos Good For?1:05:31 Benzos for Medical Procedures1:07:32 Final Words for the Patient1:09:10 CLOSING BIO for Dr. Anna LembkeAnna Lembke, MD is professor of psychiatry at Stanford University School of Medicine and chief of the Stanford Addiction Medicine Dual Diagnosis Clinic. A clinician scholar, she is the author of more than a hundred peer-reviewed publications, has testified before the United States House of Representatives and Senate, has served as an expert witness in federal and state opioid litigation, and is an internationally recognized leader in addiction medicine treatment and education.In 2016, Anna published “Drug Dealer, MD – How Doctors Were Duped, Patients Got Hooked, and Why It's So Hard to Stop” (Johns Hopkins University Press, 2016), highlighted in the New York Times as one of the top five books to read to understand the opioid epidemic (Zuger, 2018). Dr. Lembke appeared in the Netflix documentary “The Social Dilemma,” an unvarnished look at the impact of social media on our lives. Her latest book, “Dopamine Nation: Finding Balance in the Age of Indulgence” (Dutton/Penguin Random House, August 2021) was an instant New York Times and Los Angeles Times bestseller and explores how to moderate compulsive overconsumption in a dopamine-overloaded world. Resources The following resource links are provided as a courtesy to our listeners. They do not constitute an endorsement by Easing Anxiety of the resource or any recommendations or advice provided therein. RESOURCES for Anna Lembke, MD— WEBSITE — https://www.annalembke.com/— PROFILE: Stanford University — https://profiles.stanford.edu/anna-lembke— BOOK: “Drug Dealer, MD” — https://www.annalembke.com/drug-dealer-md— BOOK: “Dopamine Nation” — https://www.annalembke.com/drug-dealer-md — VIDEO: “Benzodiazepines: The Hidden Epidemic” — https://www.youtube.com/watch?v=Ln1F2oANexw— VIDEO: “Benzodiazepines: Dependence and Withdrawal” — https://www.youtube.com/watch?v=-W9EEI2ZXKU— VIDEO: “Benzodiazepine Tolerance: An Adverse Medical Event” — https://www.youtube.com/watch?v=R7r_94vyOL4— BRAVO! A Collaborative Approach to Opioid Tapering — https://www.oregonpainguidance.org/guideline/tapering/— The Ashton Manual — https://easinganxiety.com/blog/ashton-manual/ The PodcastThe Benzo Free Podcast provides information, support, and community to those who struggle with the long-term effects of anxiety medications such as benzodiazepines (Xanax, Ativan, Klonopin, Valium) and Z-drugs (Ambien, Lunesta, Sonata). WEBSITE: https://www.easinganxiety.comMAILING LIST: https://www.easinganxiety.com/subscribe YOUTUBE: https://youtube.com/@easinganx DISCLAIMERAll content provided by Easing Anxiety is for general informational purposes only and should never be considered medical advice. Any health-related information provided is not a substitute for medical advice and should not be used to diagnose or treat health problems, or to prescribe any medical devices or other remedies. Never disregard medical advice or delay in seeking it. Please visit our website for our complete disclaimer at https://www.easinganxiety.com/disclaimer. CREDITSMusic provided / licensed by Storyblocks Audio — https://www.storyblocks.com Benzo Free Theme — Title: “Walk in the Park” — Artist: Neil Cross PRODUCTIONEasing Anxiety is produced by…Denim Mountain Presshttps://www.denimmountainpress.com ©2022 Denim Mountain Press – All Rights Reserved

On this podcast episode, I discuss lorazepam (Ativan) pharmacology, adverse effects, and common drug interactions. Lorazepam has numerous dosage forms and the IV formulation does contain propylene glycol which can accumulate if it is used for longer periods of time. There is a boxed warning for lorazepam when it is used with opioids. The risk for opioid overdose, coma, and death increases significantly. Lorazepam is an intermediate acting benzodiazpine. It's half-life for most adult patients is in the 12-18 hour range.

The poet and journalist Melissa Bond had terrible insomnia. Her doctor prescribed Ativan, a benzodiazepine. Then her life fell apart.