Most Recent Blog Posts

• Girl Power: The Importance of Girl Power: The Importance of Good Friends

  • From: SaralynMarkMD
  • Description:

    In our busy lives filled with work responsibilities and caring for children, family, and even the planet, it's difficult to find the time to be with girlfriends. As we know, friends are often the first group that we call when the world becomes a bit chaotic but can be the last group we connect to when there are not enough hours in a day to do all that we 'should' do to be responsible adults. I would argue that it is exactly through our relationships with our girlfriends that we have the energy and power to take on the world.

    Girlfriends are different from sisters. Now I am not competing these groups against each other; they are very different. Each comes with its own set of joy, camaraderie, and history, but family can also be laden with personal interactions starting with the pecking order of birth, parent favoritism, and good old-fashioned sibling rivalry (stuff that is sometimes hard to change and never easy to forget). Girlfriends come with a freedom from all of that: we choose our friends and decide how we want to interact and play.

    As we go through marriages and divorces, births and deaths, promotions and resignations, weight loss and gain, short and long hair, fitness and illness -- all the dichotomy that life offers -- girl friends can provide the foundation for women to stand on and take it all in. This perch gives a vantage point that can provide clarity and a vision for the future. Take away that pedestal and the view can be dark and narrow. That is how I see the power from a girlfriend relationship.

    Sharing news and giving each other a hug or smile can make a difference in our lives. All of us have seen and felt the loneliness of being abandoned by a girlfriend in a time of need. I recall that after I lost my mom, a girlfriend whom had been close to me basically disappeared. I don't think that she meant to be unkind, but perhaps the pain of this loss was too much for her too and she did not know how to cope or to provide comfort. It was painful nonetheless. Everyone has limits and I found hers. It made me evaluate the relationship and realize the limitations that some have and perhaps that I could have in a similar situation. I would hope that I would not be like that, but I realize now that the dynamic nature of any relationship could be like that -- not out of a lack of love or caring, but out of internal fears.

    I believe in the balance of nature, so with that loss I also found that another girlfriend from childhood was there with an open heart. She had lost a parent and had faced her own medical crisis, for which I had been there for her. Although we don't live in the same location, share the same professional background, or have same family responsibilities, we have a history that goes back to the time we were little girls playing in a backyard. This gift is priceless and fills my life with gratitude and strength.

    There is something about girlfriend power -- it is the light that makes our days brighter.

     

  • Blog post
  • 2 weeks ago
  • Views: 97
  • Not yet rated

• Dad's Day Thoughts: Men's Heal Dad's Day Thoughts: Men's Health & the Father-Daughter Bond

  • From: SaralynMarkMD
  • Description:

    As Father's Day nears, it's a good time to focus on men's health and how fathers can also impact the health of their daughters. 

    Historically, American medicine has focused on men's health. But over the past 10 to 20 years, women's health has gained more attention. Now, in some ways, there is a gender bias, as men's health has been moved more into the traditional realm of reproductive health -- focusing on the prostate gland and impotency. Women's health had a reproductive leaning as well initially. This does a disservice to men as it once did for women. There are many other health issues that need our attention: Heart disease is still the number one killer for men (and for women), osteoporosis affects men, and mental health issues are important too.

    (Editor's Note: Click here to see Dr. Saralyn Mark discussing men's health on Good Morning America.)

    We also know that men tend to minimize symptoms and do not like going to their doctors, which have a hugely negative impact on the health of our fathers and sons. They're also prone to poor compliance with medications, which happens to be an issue across both sexes. High blood pressure, smoking, high cholesterol, and high blood sugars and diabetes are risk factors for heart attacks, stokes and some cancers. Smoking can also have a bad impact on bones -- damaging bone cells and sometimes leading to osteoporosis. It's critical for the men in our lives to have their annual checkups and to monitor these conditions. And for the women in their lives and for themselves, Father's Day is a great day to quit smoking.

    So how does all of this impact the health of the daughter? 

    For starters, one's family medical history is very important. All too often physicians ask women chiefly for the maternal history -- asking if one's mother or sister had breast cancer, for example, to determine if a woman is high risk. It's important to remember that we inherit genes from both our parents. So even in the case of breast cancer, it's important to know your father's personal (men can get breast cancer too, though it's more rare) and family history. 

    Similarly, osteoporosis can impact both men and women, and 70% of your risk for this disease is inherited. Men tend to get osteoporosis later in life than do women, but it is more deadly for men, especially in the first year after a hip fracture. Yet, we rarely ask men about their risk factors for this disease. It's helpful for doctors to know how much calcium and vitamin D they get from food and the sun, or whether they have secondary causes for it, such as being on certain medications, smoking, or diseases like thyroid disease. All too often, men are not even offered the chance to get a bone density test, which measures bone mass, so they can be diagnosed and treated if necessary. A daughter may notice that her father is getting shorter. Well it is not due to natural aging, but probably due to osteoporosis. So if her dad has it, she too is at higher risk and needs to think about ways to protect her bones from fracturing.
    Family history for heart disease is important too. If you have a father who has had a heart attack before the age of 55, your risk increases. Keep in mind: your risk increases also if your mom had a heart attack before the age of 65. 

    When it comes to conception, the age of the father also plays a role in the pregnancy and developing fetus. We used to only be concerned about the age of the mom, but now we see that dad's age is important too. For example, children born to men over the age of 40 may be at higher risk for developing autism. We are starting to learn what we need to do regarding screening for diseases for offspring with older fathers.
    
    Mental health issues, including substance abuse, can have genetic component too. All too often, men are not diagnosed with depression, which is more common in women. But studies have shown that men who are depressed and attempt suicide are more likely to succeed. A recent study showed that men, like women, can get postpartum depression, generally in the first 3 to 6 months after the baby is born. We are used to hearing about the 'baby blues' for new moms but since dads can get it too, we need to focus more attention to it. A father's mental and emotional health impacts the health of the child. If not treated, these problems in the parents can lead to issues in the child down the road.

    In honor of Father's Day, I want to focus for a moment on our troops who have fought in Afghanistan and Iraq. We are seeing increased rates of depression, post-traumatic stress disorder, and traumatic brain injury in those who serve. New research is showing that men with TBI and PTSD may be at higher risk for dementia as they get older. The impact on families is significant. As we honor their service to protect us, we need to ensure that we protect them too.

    So what can a daughter do to help celebrate Father's Day and improve their dad's health?

    You may want to sit down and talk to your father about his health. Find out how he is doing and if he is having any problems with daily activities, including sleeping, eating, and remembering things. Encourage him to see his physician for a checkup, which can be a good time to talk about risk factors for some of the diseases we discussed today. Prepare a nutritious meal to celebrate the day. Moderation is the key regarding meal portions, alcohol, and desserts. Ask your father to do something healthy for the day: go for a walk or a hike or play a game of golf or tennis. If that is more challenging, do something that reduces stress such as listening to music.

    Give him a present that has a positive health message. I remember I once was given a gift by a family member who knew that I liked to garden and was into physical fitness. The gift was a lawnmower. It was a bit unusual but really thoughtful. So consider giving him something that he can use. A rake, shovel, or set of golf clubs will go much further towards improving the quality of his life than will another tie!

    Happy Father's Day!

  • Blog post
  • 1 month ago
  • Views: 127
  • Not yet rated

• What a Blast! What a Blast!

  • From: SaralynMarkMD
  • Description:

    What a way to celebrate a birthday! On May 14, I saw the launch of the space shuttle Atlantis lift off to the International Space Station for the last time. I had been invited by NASA to see this magnificent vehicle blast off into space -- surrounded by those who built it, serviced it, and had loved ones on board it. This was my third launch and it still filled my heart with awe. At the two minute mark, we all stood and faced the flag and sang the National Anthem. It was a poignant moment knowing that soon we will be dependent on the Russian Soyuz to get us to the space station. I loved hearing all the different space operations say "Go" for launch -- each knowing that a "No" would stop the whole process. A few minutes before there was discussion about a 1/6 of an inch ball bearing that was found. Engineers determined that it was part of a space camera, but that could have scrubbed the mission. It just reflected the meticulous safety checks on the multiple millions of pieces that make up a shuttle.

    During the 10 second countdown, everyone screamed out the numbers as if it were New Year's Eve! As the clock struck zero, a giant plume of smoke and a brilliant light emanated from the base of the shuttle...lift off!

    People cheered, applauded and some cried. As we got near to the two minute mark from launch, there was a moment of quiet from the crowd. We all remembered the Challenger, which exploded when the solid rocket boosters separated at that moment. As soon as we heard confirmation from Misson Control that all was well, a giant roar erupted from the crowd.

    By 8 minutes, the shuttle was in the zero gravity environment of space: if the astronauts were not strapped to their seats, they would float around. They are now traveling at 17,500 miles per hour around this beautiful and fragile planet. I wondered if they could see the brown sheen of an oil slick in the Gulf of Mexico, the fires burning down the trees in the Amazon or the smog surrounding the Great Wall of China.

    I hope that we all will have an opportunity to blast off into space someday if we want. The space program has revolutionized how we live our lives, how we protect our health and how we understand our environment.

    There will be many discussions about what we need to do with space exploration -- to go to the moon or not or to venture to Mars or even to asteroids, where we have recently discovered water and the organic materials for life. I just wish that whatever we decide, we remember that humans were designed to explore and to learn. We all felt like excited children on May 14, watching the shuttle. Imagine how we could feel as we suit up to view the earth from space. It would be a blast!

  • Blog post
  • 2 months ago
  • Views: 153
  • Not yet rated

• A Civilized Bill A Civilized Bill

  • From: SaralynMarkMD
  • Description:

    After 14 months of debate, town halls, protests, and fear mongering, the nation finally has a bill to provide health insurance to over 32 million Americans and new laws to protect those who all ready have it. It only took over 60 years to successfully fight for it. This issue has polarized the nation for decades--perhaps because so many fundamental issues are at stake including constitutional rights, states rights, abortion rights, and the right to pursue happiness. Some have even said that it is through good health that true happiness can be found. 

    As a doctor, I always found it frustrating to have to argue with insurance company reps to get the appropriate tests or medications for my patients. I was the physician, but the person on the other end of the phone line had the power to make the decision which would impact the well being of my patient. As a consumer, I was frustrated and angry that my own private insurance went up each year. In fact, it increased this year by over 30%, and yet I was healthy and rarely used it except for preventive screenings. As a daughter, I was devastated when my mother was shipped out of an university hospital emergency room in the middle of the night because she had "maxed" out her insurance. The next day she "crashed and burned" in medical jargon and thus begun her 3 weeks of torture and suffering in a futile attempt to fix horrific medical missteps.

    Initially, I strongly supported health care reform. I worked on the presidential campaign with the hope that we would achieve this goal --believing that health care was not a privilege but a right for all Americans. As the bill developed and it appeared that individuals with more income as well as device companies would have to pay extra taxes, I became less enthusiastic. Perhaps it is human behavior to not want to pay for others' bad behavior such as for the diseases associated with obesity, smoking and drinking. I also provided scientific policy advice to a device company that is so fully committed to ensuring the promotion of good health that it directs many of its profits into research and development as well as providing Americans with stable, good jobs. I became concerned that these new taxes would impinge on these opportunities which have helped the public tremendously.

    But, I became a believer again that we needed reform and we needed it now. We all learn from our experiences if we are just open to receiving the messages. Sometimes they have to hit you on the head and even in your heart. I began to remember the last week of my mother's life when I had to meet with the Chief Financial Officer of the hospital that she was in to discuss her medical bills and to remind him why she was there. I would have rather met with the Chief Resident to discuss medical therapies to save her life. The sod was not even placed on my mother's grave when the hospital began sending menacing letters to my father. His fear of losing his home compounded his grief over his loss of his beloved wife of 56 years. 

    I finally remembered a lesson that I received at Columbia University. I had taken an anthropology course taught by Professor Rose Solecki. Her husband had excavated a cave in Shanidar, Iraq and unearthed skeletons of Neanderthals. They found one man who had been clearly infirmed with injuries to his limbs -some of which could have been congenital or from childhood. This demonstrated that his clan had taken care of him which allowed him to live a relatively long life. Dr. Solecki stated that this was one of the first examples of compassion and care for others indicative of civilization. Prior to this, it was assumed that those who were ill or injured would be left behind because it would negatively impact the clan.

    So, perhaps we can look at the passage of health care reform legislation in a brighter light--that it is not indicative of socialism or communism or the fall of democracy, but rather as a milestone of a civilized society. It may have taken us a long time to get here, but we have finally evolved.

  • Blog post
  • 4 months ago
  • Views: 240
  • Not yet rated

• Snowbound! Snowbound!

  • From: SaralynMarkMD
  • Description:

    

    What a winter! I remember hearing that the Farmer's Almanac said this would be a tough season, but I had no idea that it meant it would be the worst winter on record in Washington, D.C. history. I flew back early from a conference in Texas last Friday, trying to get home to the nation's capital before the blizzard hit. I was hearing reports from my neighbors that the store shelves were already bare, so I asked them to get me some milk, water and bananas. (Funny what you think you need or want in a storm.) 

    I grew up in Colorado so blizzards are not that new to me. I recall that we never even had a snow day for school. But then again, we could get three feet of snow in the morning and the sun would come out that afternoon. During our late spring storms, we could even go out and snow bathe -- better to get the full tan with all the rays beaming off the snow banks. Ignorance about skin cancer was stupid bliss at the time. 

    Yet, this was going to be a big storm in DC, and I couldn't wait to get outside and play in it. I woke up early last Saturday -- memories of my childhood rushing through my mind. As soon as the sun came up, I got my equipment ready: not my shovel, but my cross-country skis. They had been packed away for just this moment. With determination, I made my way through the two feet of snow that was waiting for me outside my door and then basically body surfed down my steps to make my way to the street. I strapped my skis on and made it to the main thoroughfare, Wisconsin Avenue. There were no cars around except for a few snowplows. I had not done this since the blizzard of 1997! Gliding down near empty avenues that would have been teeming with cars and people on a normal day filled me with sheer delight. Some hearty souls who were out shoveling or trying to walk, smiled and shouted out words of encouragement. I felt like I had come back to my Colorado roots.

    After an hour of exploring my city on skis, I returned home and shoveled and shoveled and shoveled. One of my neighbors and I decided to do this for our other neighbors as well. I know that sounds strange, but I have always loved to shovel. It's great exercise, it's fun to be outside, and it's fulfilling to accomplish something -- a positive spin on something that could be more than tedious. I joked with my neighbors that I would work for food and they actually took me up on that -- feeding me breakfast and dinner. Not a bad deal for a few hours of work. But the spirit of helping others was the best reward.  

    We are now coming into the next big snowstorm and some of the novelty of watching the snowflakes fall has worn off. The hassles of trying to just walk down a street, finding a way to get through the backyard to throw out bags of trash, watching helplessly the weight of all this white stuff on the roof, and canceling meetings and travel plans are increasing. Yet, we are so blessed. We have shelter and most of us still have electricity, heat and people around to help us out. It has been said that people plan and Mother Nature laughs. All we can do now is smile with her.

     

  • Blog post
  • 5 months ago
  • Views: 414
  • Not yet rated

• Help for Haiti Help for Haiti

  • From: SaralynMarkMD
  • Description:

    Another disaster has struck the planet -- a natural disaster worsened by a manmade calamity. A 7.0 earthquake struck Haiti yesterday, January 12. Thousands or perhaps even hundreds of thousands of people may have been killed, millions displaced and a capital destroyed. We have, in some ways, become immune to seeing or reading about these events -- from the tsunami in Indonesia, the hurricanes and floods in the American South, and to the earthquakes in Asia. Each year brings more names to a growing list that the planet is turbulent and volatile, and we are just temporary residents often living under conditions that are not conducive to surviving these events. We live too close to fault lines or shores, we build homes and buildings of cheap and flimsy materials, we have stripped the land of trees to hold back the mud, and have separated ourselves by race, economics, and even gender.
    
    These types of disasters of epic proportions illustrate vividly that we are really only a moment's step from oblivion. I know that it sounds nihilistic and bleak, and that is not my intention. For most of us in the developed world, especially western nations, we try to protect ourselves from the wrath of nature. We build to code, we chart fault lines, we buy flood insurance, waterproof our homes, and take many other steps to shield ourselves from the tragedy and disaster that our sister countries around the world experience annually. We are fortunate to have been born or to live in a world with these opportunities. What the earthquake in Haiti illustrates is that we are all connected, even if not by geography, but by the human spirit of joy and now extreme suffering.
    
    For most of us, we will never know what it is to feel as if the world has disappeared -- to not be able to find loved ones, to find shelter or food, to not have medical care for those who are injured, or to bury those who have died. What has happened on this poor island called Haiti is the next chapter in a history marked by violence, abuse, slavery, rape, illiteracy, starvation, and fear -- not by just one country but many -- many that are the leaders of the free world today.
    
    Perhaps to rewrite this chapter, the world can unify to send aid, to send troops who will come to protect and not kill, and to send money to rebuild. In the biblical sense could this be the next Great Flood, which wiped out the misery of the past in order to build anew? Instead of animals on that ark, each one of us can play a part by contributing money and resources to a country -- to a people -- who have mainly known terror. It can start with each one of us providing that human connection to care.
    
    Click here for a list of ways you can contribute and help.

  • Blog post
  • 6 months ago
  • Views: 110
  • Not yet rated

• A Time for Reflection A Time for Reflection

  • From: SaralynMarkMD
  • Description:

    What a year! To say it was a roller coaster does not do it justice. I know that for many of us, the journey was filled with love, excitement and adventure but to balance it out add a touch of sadness, grief, and pain.  Perhaps that is the path that we all need to take to appreciate what we have, to grow, and to fully feel the emotions of life. As I finish the last of my travel for the year, I now have a few minutes up in the air to look down on our beautiful planet and take stock of what has just happened. The promise of a new year provides us this ideal incentive to reflect.

    There is a new movie called “Up in the Air” -- the acting is superb but the story line is disturbing to me on so many fronts.  I recently saw this movie and it made me think long and hard about my life.  Some of the similarities to the main characters hit home -- always on the move and planning my life around the next flight or train ride or even bus ride. Trying to balance home, family, work and self time -- the simple things like getting some exercise or having food in my refrigerator or watering my plants always a challenge to accomplish. It is the most basic of activities that we all take for granted until we have to be organized to get them done.  It makes me laugh when I hear my voice mail messages and friends have been trained to say “Wherever you are, when you get this message, give me a call.”

    I had a year that never slowed down nor provided many moments of peace and quiet.  I lost my mom this year and I was with her throughout her battle to live. She cherished every minute. One of my favorite “moments of tranquility” was when I took her outside the medical facility and we sat in the sun for a few minutes -- her face looking up, her eyes closed, her mouth in a smile -- just savoring the warmth on her skin and the joy of being with her daughter.  Yes this was quite a year -- I was in Berlin for the fall of the Wall celebration, in New York to see an award winning play, on the Mall in Washington, DC to witness the inauguration of our new President, on Capitol Hill to speak about veterans’ health and many other extraordinary events, but it was that moment with my mom that I treasure the most.

    Next year, I promise to close my eyes and smile while the sun warms my skin and my heart.  And it will be for more than one moment in time.

  • Blog post
  • 7 months ago
  • Views: 167

• Must-See TV: Inaugural Veteran Must-See TV: Inaugural Veterans Day National Broadcast

  • From: SaralynMarkMD
  • Description:
    Editor's Note: Don't miss Dr. Saralyn Mark on the Inaugural Veterans Day National Multimedia 24-Hour Broadcast on November 11, 2009. Dr. Mark will be speaking about the tragedy at Ft. Hood in Texas. Click here for more information.
  • Blog post
  • 8 months ago
  • Views: 130
  • Not yet rated

• A Safe Place A Safe Place

  • From: SaralynMarkMD
  • Description:

    I’ve been awake for about 40 hours, catching just two hours of sleep the night before while on a plane to Berlin. I arrived in Berlin yesterday to give a speech at a medical conference that started today. When I got to the hotel last night, I was so excited I was finally going to get some rest. But at 9:30 p.m. Berlin time life changed for all of us with any military connection. As I was getting ready for bed, I turned on the television and tuned into the only English-speaking station: CNN. My heart froze as I saw the special news bulletin that soldiers had been killed and many injured at Ft. Hood in Texas. I awaited more news and could not believe what I was hearing. When I learned that the suspect was a doctor soldier, I was both shocked and angry. Here was a person that our troops trusted with their lives and he betrayed them, killing his own comrades…brothers and sisters who would give their lives for him.

    I ended up staying awake all night again, transfixed by every news story and trying to get any extra piece of information. In the morning I headed to my medical conference in a slight daze fueled by adrenalin and dismay. I kept thinking that I was also on the road when a soldier killed his fellow troop’s overseas back in May and now I was on the road again during this tragedy. I had the urge to be home, safe, and with people who would understand how I felt. Even if I hadn’t had a military connection, I would have wanted to have connected with other folks who were feeling the same sense of sadness over this tragedy.
     
    I cannot imagine how the families of those killed and wounded feel. For a moment, I thought about my own military family member and was relieved that Ft. Hood was not in the plan at the moment. So many of our nation´s troops have been on this military base before and after deployments. I imagine Ft. Hood used to feel like safe ground to them. Our homes are our sanctuary -- our sacred sites where we feel safe and protected. To have this happen on our home turf violates this belief and undermines the founding belief that we can be protected somewhere. To have this destroyed by a fellow soldier who understood the stress of war makes it even more horrific.
     
    I know that it sounds like an oxymoron: a strange concept to think that a military base should not be affected by violence. Perhaps it is our way of coping with what a military life entails. We are not immune from the trauma of war. We face it every day in the missing limbs or souls of our loved ones. We just did not think that it would happen at home. This just further highlights the need for better mental healthcare for not only those who defend and protect, but also those who care for them at home and in a clinic. The doctor needs to heal thy self but not alone.
     
    Yesterday, FT. Hood exploded in a hail of bullets and bloodshed. Like Ajax, the Greek warrior that I blogged about recently about in “Theater of War,” who wanted to kill his comrades, this soldier unfortunately succeeded. This soldier had given clues that something was wrong. Clues cannot be ignored because we need people to fight wars overseas. The war has come home to our shores. I urge our leaders to make sure that families are included in the assessments of our troops; we know when things are wrong even when soldiers are still able to do their jobs. We can help protect our loved ones so they can protect us.

  • Blog post
  • 8 months ago
  • Views: 121
  • Not yet rated

• Theater of War Theater of War

  • From: SaralynMarkMD
  • Description:

    On October 26, 2009, the Theater of War came to Washington, D.C. at the Shakespeare Theater. This event was sponsored by the Department of Veterans Affairs and the Department of Defense as part of their Mental Health Summit. I was invited to participate on the panel as a member of the Blue Star Families. During the year, Theater of War has presented readings of Sophocles' Ajax and Pilocetetes to military communities.

    Bryan Doerries is the translator and director of this performance. He stated that 'These ancient plays timelessly and universally depict the psychological and physical wounds inflicted upon warriors by war.' It is his hope that by presenting these plays, 'it will demystify and destigmatize psychological injury and to facilitate open dialogue with members of the military family.' The panel that follows the reading serves an important purpose. It is a frank discussion about the challenges that service members, their families, and those who care for them face each day.

    Bryan Doerries told me that he has performed this play to audiences on military bases, hospitals, homeless shelters, and theaters. Generally, the audience participates by sharing their experiences with the panel. It was suggested that Greek drama was a form of story telling and tool for therapy for veterans thousands of years ago. It is a creative method to engage the audience to feel safe and comfortable to open up about their personal journeys -- perhaps a form of group therapy.

    Ajax tells the story of warrior who becomes depressed near the end of the Trojan War. He attempts to murder his commanding officers but fails and eventually commits suicide. Philoctetes is the story of a Greek warrior who is marooned on a deserted island after sustaining an injury. Both tales reveal poignant aspects to the trauma of war and its impact on family and fellow troops. The actors in the readings included Adam Driver, Terrence Howard, Elizabeth Marvel, and David Strathairn. They all did a brilliant job. It was a simple set -- a table with microphones and no costumes. Their emotion and turmoil were reflected in their voice inflections and movements of their heads and eyes. We all sat transfixed throughout the readings.

    I sat in the front row with other members of the panel which included two members of the military, a doctor from the Uniformed Services, and a chaplain. Each provided their own reflections of how the war impacted their lives. Sitting on the panel from center stage, I could see several generals sitting in the front row with many seats taken in the auditorium by other members of the military and participants from the Mental Health Summit. We each had a few minutes to speak followed by questions from the audience. I had a chance to share my experience as a member of the military family who has faced the challenges of loved ones coming back from war. I must admit that it is easier to do a formal medical presentation as a doctor, but I felt that it was important to share and connect with others who faced similar situations. As we know, feeling isolated and alone in our journeys can be difficult. I could see many heads nod while I spoke, which indicated to me that I was perhaps a voice for those who could not speak.

    This setting in Washington led to more questions that had a legal or a scientific basis which is indicative of life in D.C. Apparently, in other performances, more members of the audience tell about their war injuries and challenges of adapting to life back home. There was interest in the Blue Star Families mission which was an honor to share with others.  I hope that the Theater of War continues to be performed across this country and to eventually be open to the general public. It may be a wonderful method to share with the public what the impact of war can be on those who serve and those who love them.

    Editor's comment:

    After months of hard work, The Post Deployment Health Assessment Act (originally S.711) that Dr. Mark testified on Capitol Hill to support was signed into law as an amendment to the FY 2010 Defense Reauthorization Act on 10/28/2009. http://baucus.senate.gov/?p=press_release&id=57

  • Blog post
  • 8 months ago
  • Views: 119
  • Not yet rated

• What Does It Mean To Be a Canc What Does It Mean To Be a Cancer Survivor?

  • From: SaralynMarkMD
  • Description:

    Last October I gave a series of lectures in Panama City, which was completely adorned with pink ribbons. The former First Lady of Panama was a patron for the breast cancer community, and through her support every major landmark and building was wrapped in pink. There was literally a pink ribbon everywhere you looked, adorning the airport, the shopping centers, the presidential palace, and even the Panama Canal. It was a wonderful way to raise awareness of a disease that affects over one in eight women over their lifetime.

    Every October, we see this same level of enthusiasm in cities across America, which hopefully translates into more women getting their mammograms and feeling connected to their bodies and their medical communities. A disease that for so long had been silent and associated with stigma has finally found its voice and its power base.

    With more women surviving breast cancer than ever before, we now have an “army” of women to help raise funds for research and education. Often the best salve or medication for one who has experienced a life altering or life threatening illness is the ability to help others facing a similar situation. But how does one define being a survivor? Is a survivor someone who has gone through chemotherapy, surgery, and/or radiation and is still able to get up in the morning and face the new day? Is a survivor someone who has been disease free for a year, five years, or 10 or more years? Or is a survivor someone who has faced multiple bouts of cancer and yet still has a hope and indefatigable desire to live?

    I never really thought much about these questions until a few months ago when I went cross-country skiing with my friend. She was diagnosed with breast cancer five years ago and endured the ordeal of chemotherapy. This past winter, she was diagnosed with metastatic breast cancer after doctors found tiny spots on her lungs. As we were gliding along a winding trail, she said she was sad that she could no longer call herself a survivor. While she doesn’t feel ill and is able to do all the activities she did before this new diagnosis, she now fell into a new category: “a patient with incurable cancer.” My friend still feels like a survivor, though, and has found joy and peace in her life. She has a desire to help the world through her spiritual training and doesn’t want to be thought of as a terminal case...someone who was not a survivor.

    Watching my friend and others navigate the challenging path of incurable cancer got me thinking about what it means to be a survivor. Like many, I followed Senator Ted Kennedy’s valiant struggle to continue serving his country until the very end of his life despite having a brain tumor. (I will always be grateful to him for his support of an important piece of legislation to provide mental healthcare for our troops this past June 2009). We all watched in awe as Patrick Swayze, battling Stage 4 pancreatic cancer, not only starred in a television series, but wrote a book and spoke publicly about pancreatic cancer. My mother, who also fought pancreatic cancer, felt like she had a brother in him during her journey to combat the disease. (She did not die from pancreatic cancer, but from medical errors leading to a hospital-acquired infection). She also never gave up hope and continued to care for her family and community with her audacious sense of humor and honesty. She served as my editor for some of my articles and even for my new book, which will be published this coming year.

    All of these men and women are survivors! They lived their lives fully and with a sense of purpose. They never gave up and they never gave in. Although they may always be associated with the cancer that infiltrated their lives, they survived it to be champions for those they loved and served. Their legacies live on.

  • Blog post
  • 9 months ago
  • Views: 126
  • Not yet rated

• Hope & Change Hope & Change

  • From: SaralynMarkMD
  • Description:
    I was surprised to learn that President Obama received a Nobel Peace Prize, but was delighted to hear the news for America! The world can see what we may offer -- just wish we could get through partisan politics to accomplish it. Perhaps my Letter to the Editor from the Washington Post last November was a bit prescient -- hope we can do what we are capable of achieving!
  • Blog post
  • 9 months ago
  • Views: 100
  • Not yet rated

• A New Year of "Firsts" A New Year of "Firsts"

  • From: SaralynMarkMD
  • Description:

    I came back to Denver this week to be home with my family for the first Rosh Hashanah or the jewish New Year without my mom. It has been a week filled with sadness, tears, occasional laughter as we remembered stories from the past, and a desire to continue the traditions that my mom instilled within all of us. The first night of the holiday was sober and difficult. It was hard to believe that she was not there conducting the orchestra, which included all my siblings, to ensure that the dinner was served properly and in the style to which my father had grown accustomed.

    We failed, even though we thought we had it all planned out, we could not get the dinner right. It started out with my sister asking who was going to sit in my mom’s chair. You see, I had set the table and until my sister asked that question, I did not realize that I set a place setting for my mom. When she mentioned it, it dawned on me what I had done. I was in charge of setting the dining table for decades of holiday dinners and I always made sure that I set my mom’s chair in the right place...nearest to the kitchen. I unconsciously did it again. Next, the chicken soup was cold, the matzah balls were cold, the glass holding the Sabbath candle cracked during the middle of the dinner and my sister’s dog kept running around the house looking for her favorite person, my mom. Finally, she settled down when we put her on my mom’s blanket on the carpet next to the table. The dinner was saved many times that night by the microwave oven.

    I have been told by many folks that this will be a year of “firsts.” My mom loved holidays and we centered our lives around them. Now, I wish that they would disappear because they make our loss more monumental, more quiet and more lonely. I know this feeling will eventually disappear and we will have a year of new memories and, hopefully, a year filled with old traditions. My mom would love that.

  • Blog post
  • 10 months ago
  • Views: 117
  • Not yet rated

• A Tribute to My Mother A Tribute to My Mother

  • From: SaralynMarkMD
  • Description:

    Editor's Note: For those of you who have been following Dr. Saralyn Mark's blog -- and her regular updates on her mother's experience with the health care system -- we're saddened to share the news that Dr. Mark's mother recently passed away. Below are the remarks Dr. Mark delivered at her mother's funeral on August 18, 2009. Please join us in sharing your condolences with Saralyn.

    Our beautiful mother and devoted wife passed away at sunset near the end of Shabbos, our Sabbath, with her loving family at her side. She left with the grace and dignity that she shared with everyone she met throughout her life. Her courage and bravery helped all of us to understand the beauty of life, family and faith. She fought with her last breath and let us know with her gentle smiles throughout that we were very much loved. It was an honor to be her daughter.

    My mother was our matriarch, our role model. She never gave up and she never showed fear except one time. Last Tuesday, I asked her after she had been through so many procedures and pain if she still wanted to continue the fight. She told me 'yes' because she was 'afraid' to leave us because she loved us so much. She was willing to endure anything -- and endure she did. She welcomed the opportunity to find any way to live and be with her family and her Jewish community.

    I was in awe of my mom. Every week and then every 2 weeks for 17 months she would actually look forward to her chemo treatments. She put on her best outfit with matching lipstick, ate a hamburger before she started, and never complained. Even when she was in the ICU during the past 3 weeks, she wanted her chemo because she felt that it would help her to stay with us. I will never forget watching my mom eat a steak and a salad while on a ventilator because she knew she needed nutrition to win her battle, which she did. She beat pancreatic cancer -- an amazing feat.

    I would like to share with you a few stories about my mom. She took me to college in New York City. When she saw my dorm room and that it had one window facing a wall in an air shaft with the furnace below so I could keep the window open all year round and be in a sauna, she smiled and promised me that she would never tell my dad about my lodging which would upset him since all my siblings had gone to college in Colorado with scenic settings. I will never forget the care packages that she sent me. It was not just simple cookies and mandelbrot, I had seasoned veal chops and stuffed cabbage in my bags. I remember hoping my flights were on time so they wouldn't defrost in my luggage.

    But one of the best stories that so captures the extraordinary spirit of my mom took place about 3 1/2 years ago. My mother was sent to hospice because no one wanted to operate on her fractured hip; she was considered too high of a risk. After about 10 days of no food and little water, she opened her eyes and told my sisters and me that she could not be buried next Sunday because the Denver Broncos would be in the playoffs and no one would come to her funeral. Needless-to-say, we kidnapped her from hospice, found a surgeon, and she walked again.

    My mom was a brilliant woman with a wicked sense of humor -- truly a force of nature. She taught me to never abandon my dreams, to never be silent when I could speak for those who did not have a voice, and to never forget my roots and the community that nurtured me. When she had something serious to say to me, it usually began with 'little girl' and I knew I was in for an interesting discussion. She taught me that the inner spirit and love that surround a person can influence their health and well-being. And in my darkest hour of my life last Saturday, she put her arms around me as I put my head to her chest and she helped me to begin to heal.

    My mother loved this synagogue and the stained glass windows. It reminded her of the Chagall windows at Hadassah Hospital in Israel. Being here, I recall a poem by Elizabeth Kubler-Ross:

    'People are like stained glass windows.
    They sparkle and shine when the sun is out,
    but when the darkness sets in,
    their true beauty is revealed only if there is light from within.'

    On Saturday, when we left the hospital for the last time, I looked up at the night sky and saw the brightest heavenly object-the planet Venus, the planet of love. It illuminated my path all the way back to my parents' home. And I knew that my mother's spirit was there-brilliantly shining to provide courage and strength for my wonderful siblings and phenomenal father and for me, my mother's shayna madela, her little girl.

  • Blog post
  • 11 months ago
  • Views: 103
  • Not yet rated

• Updates from the Field: The La Updates from the Field: The Latest on H1N1

  • From: SaralynMarkMD
  • Description:

    I want to share with you some updates I’ve provided to the various organizations and agencies I advise regarding novel H1N1 flu, commonly known as swine flu. Keep in mind that this is an evolving situation and what we know now may change.

    
    

    1) Federal supervision of the novel H1N1 vaccine will be administered by public health departments to ensure strict oversight of the vaccine and its possible side effects. During a recent White House Summit, there was an announcement from the Centers for Disease Control and Prevention (CDC) about using other facilities, like health clinics, community centers, and schools as vaccination sites. Essentially, schools will try to stay open. The decision to close schools will take place at a local level where officials can weigh all the factors, including how many students and teachers are ill or whether or not certain schools have special issues, like a large population of students with special health needs. Private providers and clinics will be able to administer the vaccine so long as the clinics sign and comply with the provider pre-registration process/agreements, ensuring that the vaccine will be stored properly and administered according to standards and priorities. The VARS -- an electronic system monitored by the CDC and state public health departments which tracks side effects -- will be used. Additionally, there will be an electronic registry to monitor doses given. It is estimated that schools may get the H1N1 vaccine for their students by the end of September.

    
    

    2) The CDC will be conducting prospective studies to evaluate post-vaccine side effects and efficacy. For example, four sites around the nation will do comprehensive review, including evaluating at least 900 pregnant women and their use of over-the-counter medicines.

    
    

    3) There are new treatment and prevention guidelines for pregnant women, who are four times more likely to have complications from H1N1 infection compared to the general population. It is recommended that Tamiflu (5 days) be given for treatment or Relenza (10 days) be used preventatively to treat expectant moms. Relenza is inhaled and results in decreased systemic absorption, which may have a lesser impact on the fetus. (For those with asthma, caution is necessary when taking Relenza.)

    
    

    4) If one presents with flu-like symptoms during the summer season, it is assumed to be novel H1N1 infection and should be treated. It is unusual for the seasonal flu to appear during the summer, but the H1N1 virus has done just that throughout the world. Studies now show that the rapid detection tests used to diagnose H1N1 infection are not accurate. The nasopharyngeal swabs using PCR-Polymerase Chain Reaction technology are recommended if there is concern about diagnosing and treating the infection.

    
    

    5) New studies coming out of the United Kingdom indicate that children may experience more side effects to Tamiflu than adults, including vomiting, nausea, diarrhea, dehydration, and neuropsychiatric complications (nightmares, insomnia, and poor concentration). These side effects may outweigh the benefits, so more investigation is needed.

    
    

    6) It is highly recommended that health clinics use separate rooms to isolate those suspected with H1N1 infection. Many believe it may even be wise to have patients with flu-like symptoms call in advance of arriving at health facilities, so steps can be taken to limit their exposure to non-infected patients. Those suspected to be infected with novel H1N1 should wear facemasks to prevent spread to others. Emergency rooms and even clinics may end up being the new incubators of this disease.

    
    

    7) There is much debate over the strategy of removing pregnant women from working with suspected or infected patients. There are challenges to this approach, including an already limited workforce supply and the fact that some women don't even know when they are pregnant. Some have even suggested that this tactic may also be appropriate for other high risk groups, such as those who are obese. This is not a very practical solution, but the need for it should be considered over time.

    
    

    8) Seasonal flu vaccines are being shipped to the U.S. market and novel H1N1 studies are now ongoing at eight sites. I have some concerns about the H1N1 vaccines and their impact on the immune system. Some of my concerns, which may not be fully evaluated during these studies due to a lack of time, include:

    
    
    
    
    • Impact of one’s sex on response to the vaccine, as well as the use of adjuvant therapies on dosage. It’s believed that the female immune and inflammatory response may be more robust, so perhaps women may need a smaller dosage. Might a smaller dosage decrease the side effects that some women experienced when vaccinated? 
      
    • Is there a higher risk for complications if one receives the seasonal flu vaccine and then is exposed to pandemic flu or given the first shot of pandemic flu vaccine? Will there be a cytokine storm (a serious immune reaction), since there is some cross over in the antigenic determinants and the immune and inflammatory systems will be activated? 
      
    • Is there a higher risk for complications due to cytokine storm if one gets the pandemic flu vaccine and then is exposed to seasonal flu or the seasonal flu vaccine?
      
    • Will there be populations were the pandemic flu vaccine may not be effective?
      
    • Will there be any impact if one gets one pandemic flu vaccine from one drug maker than another -- such as those who travel overseas and get vaccinated?
    
    

     

    
    

    Tight surveillance for side effects and efficacy will be essential as the immunization effort gets underway. Public service announcements have been funded and will appear now and throughout the year to help educate the public.

    
    

    While the novel H1N1 presents serious concerns, it’s good to keep in mind that the U.S. has developed a robust public health system over the years, which will help to protect our health and wellbeing. For most of us, what’s key to remember is that if you do not feel well and have flu-like symptoms, stay home! There is simply no need to risk infecting others or to worsen your own recovery. A tincture of time, rest, and fluids is often the best medicine. If you’re not doing well, call your doctor immediately. Keep in mind that your local emergency room may not necessarily be the best place to spend time.

    
    

    Always stay informed and never hesitate to ask questions!
    

  • Blog post
  • 11 months ago
  • Views: 99
  • Not yet rated

• Nothing to Fear But the Flu It Nothing to Fear But the Flu Itself

  • From: SaralynMarkMD
  • Description:

    I remember the moment when I first heard about the H1N1 pandemic flu, formerly known as Swine Flu. It was a quiet Saturday morning near the near the end of April when news began to break about cases of people dying of a new infection in Mexico. This infection had all the hallmarks of a serious public health crisis: a new 'bug,' young people dying, and an infection spreading quickly through the population. After working on the public health response to SARS in 2003 and for a potential avian influenza or bird flu pandemic in 2005, I had a feeling we were in for a wild ride.

    Within days, shelves in stores were wiped clean of hand sanitizers, gloves, and face masks. Tamiflu, an anti-viral medication which can decrease the severity of infection, was becoming hard to find. The media began reporting on cases of H1N1 infection in the United States. The Centers for Disease Control and Prevention (CDC) started holding news conferences and teleconferences with doctors around the nation. We knew that we were in the midst of a potential pandemic, and the severity and impact was hard to predict.

    With each new case, the level of fear began to grow. Talk about the 1918 “Spanish flu” increased. The first wave from that flu was mild and then it came back with a vengeance. Millions of people died around the world. Stories of how healthy people dropped dead within hours with blood oozing from their eyes and mouth just escalated our anxiety of what could be around the corner for all of us today.

    The funny or perhaps odd thing was that I never placed the nation's pandemic plan in my bookcase in my office at NASA; instead I kept the giant binder next to my desk. Perhaps it gave me a sense of confidence that we were ready for anything. The interesting thing was that the plan was designed for an infection that occurred overseas such as in Asia-we were expecting bird flu not a home grown variety from our own continent. The Vice President took a bit of flak for suggesting that it may not be a good thing to take public transportation and to fly. He was actually correct according to our pandemic plan but the challenge was that the bug had originated over here. Social distancing which is what the Vice President was suggesting would have potentially worked if the virus had not yet spread widely-it would have helped to slow down the infection.

    Over the past few weeks, I have been giving briefings on the H1N1 flu to NASA and its occupational health clinics. NASA has always done an outstanding job tackling health emergencies which impact their employees -- from the devastation of Katrina in 2005 to the anthrax scare. I recently attended the White House Summit on Flu which was held at the National Institutes of Health (NIH). Leaders from the Department of Health and Human Services, Department of Homeland Security, and the Department of Education, as well several governors and public health officials from every state, were in attendance. Even the President participated from his meetings in Italy. Discussion about a new vaccine and who would get top priority was discussed -- namely health care workers, children, pregnant women, and adults with underlying conditions. We hope to have a vaccine ready for mid-October. There are concerns that folks will need two shots to be effectively immunized since our immune systems have not been exposed to this virus before.

    I have been concerned that women, especially pregnant women, are at high risk for complications. Animal studies have shown that females may be more resistant to H1N1 infection compared to males, but once they are infected, they mount a very vigorous inflammatory response which can cause more secretions, leading to pneumonia in the lungs. Pregnant women may lose that resistance because their immune systems have changed so that they do not reject the fetus, yet they still have a strong inflammatory response. It may also be harder to ventilate a woman who is pregnant because of the increased resistance and pressure on the lungs from her pregnancy. The positive side to this may be that women may only require one shot or a smaller dosage to be immunized. Studies are now underway to assess what is needed. We know that women can have more side effects to vaccinations and that women are more likely to develop auto-immune diseases compared to men in general. So this is an important area to investigate.

    I am concerned that the fall will be a difficult time. Kids are coming back to school and, if summer camp infections are any indication, schools may be another hot bed for infections. We will just have to see what happens and be ready. Closing schools can slow down infection rates, but it is also challenging for families, as parents need to work and some children get many meals at schools. In the meantime, schools are preparing for distance learning just in case.

    We will also have the seasonal flu vaccine available, probably starting in September. Keep in mind that this will not protect you from pandemic flu. Pandemic vaccines will be given through public health departments. Surveillance or checking for side effects will be closely followed, especially since this is a new vaccine. We learned some important lessons from the 1976 swine flu vaccine program. More people died from the vaccine than they did from the swine flu in 1976.

    I have found that with information and with honest communication, we can keep the fear level down. Fear can cause bad decisions and keep people from living their best life possible. We will learn a great deal as we move forward. There may be times of confusion, but this is understandable. As long as we keep an open mind and ask good questions, we will get through this new pandemic -- the first one of this century.

  • Blog post
  • 1 year ago
  • Views: 72
  • Not yet rated

• No Time to Wait: Tackling the No Time to Wait: Tackling the Physician Shortage

  • From: SaralynMarkMD
  • Description:

    Have you ever had to wait to see a doctor? Perhaps it took you a few months to get an appointment or maybe you had to sit for a long time in a waiting room? When you are ill or not feeling well, minutes can feel like hours and months can feel like years.

    Now imagine this: toss in another 46 million additional Americans wanting appointments with the same number of doctors currently in practice. That is just one scenario that could play out if we do not make dramatic changes to our medical workforce.

    The American Academy of Family Practice predicts there may be a shortage of 40,000 family doctors in just 10 years if medical schools continue to graduate only half the needed numbers into primary care. It is estimated that by 2025, we will be short 124,000 doctors. There are already over 215 million primary care visits scheduled each year. Just think how many more will occur as the population swells and ages.

    It is not just the patients who feel frustrated by the physician shortage; doctors feel the strain, too. Consider the doctors working in underserved urban poor and rural communities who want to retire or reduce their hours to part time and cannot without leaving a further hole in local care. We've all heard reports of some communities without any medical care whatsoever and patients who have to drive for hours to get it. I remember when I was a resident at the VA Hospital in San Francisco and saw patients who had driven five hours from Redding, California, to visit our clinics, including one patient who had just had a heart attack!

    I always like to believe that by facing big challenges, we can grow and create exciting opportunities. Now is such a time if we dare to be bold and innovative. It's up to us to change the healthcare landscape in our nation. I want to share one solution with you...

    At the turn of this century, I chaired the National Task Force on Physician Reentry when I was with the Office on Women's Health within the Department of Health and Human Services. At the time I wanted to examine reentry issues because I was contacted by so many fellow female doctors eager to return to practice after having raised their children. Initially I thought this was really just a women's issue. I was surprised to learn that men wanted the ability to have periods of clinical inactivity and then return to the workforce, too. Talk about an equal opportunity issue! The task force met for over a year and we published our recommendations in 2002 (Mark, S., Gupta, J.  Reentry Into Clinical Practice. JAMA. 2002; 1091-1096).

    We all know that with the aging of the population the prospect of vastly expanded medical coverage and the potential need for increased numbers of doctors during public health emergencies such as pandemics, natural disasters, and bio-terrorism, immediate action is needed. For example, we see in Argentina that they have declared a public health emergency because their medical system is overwhelmed with the number of H1N1 (Swine) flu cases that have occurred during their winter flu season. This could happen in the U.S., as well. Even though we are planning for it, we still need doctors -- and lots of them -- if the pandemic continues in waves over many months or years.

    One potential solution is the development and support of physician reentry programs. Physician reentry is defined as returning to professional activity/clinical practice for which one has been trained or certified after an extended period of time. The Physician Reentry into Workforce project, established in 2006 and building upon the work of my original task force, is a collaboration of over 20 physician membership organizations, regulatory groups, and educators.

    Under the leadership of the American Academy of Pediatrics and the American Medical Association, significant progress has been made by this project to address competency assessment, educational, licensing, and credentialing requirement, along with strategies to encourage physicians to reenter clinical practice.

    Although it is important to ensure that new physicians enter primary care, it would be a waste to not utilize the vast talent and rich experience of doctors who have left clinical practice but now wish to return to serve the public. We cannot afford to wait to build the pipeline of new talent.

    If you believe that this is a good idea, please contact me or the White House (www.whitehouse.gov). It is through public support that we can change our healthcare system. There is 'no time to wait.' Our lives depend on it.

  • Blog post
  • 1 year ago
  • Views: 95
  • Not yet rated

• The Invisible Wounds of War The Invisible Wounds of War

  • From: SaralynMarkMD
  • Description:

    Editor's Update: After hearing Dr. Mark's below briefing, the U.S. Senate Armed Services Committee voted unanimously to adopt the Montana model for assessing returning combat vets for post-traumatic stress disorder. Read the story here.

    Last Wednesday, I had an opportunity to present to Congress my thoughts on the 'invisible wounds' of war. According to a 2008 RAND report, nearly 20% of veterans who have returned from Iraq and Afghanistan suffer from post traumatic stress disorder (PTSD) or major depression. I think that these numbers are actually low, since the report was based on extrapolated data from a survey of less than 2,000 troops. We now know that the number of Army suicides has increased every year since the Iraq War began, and this is the first time since the Vietnam War that the Army suicide rate has surpassed the civilian suicide rate. 

    The briefing was in the Dirksen Senate Office Building and was sponsored by Senators Max Baucus (D-Montana), Mike Johanns (R-Nebraska), and Jon Tester (D-Montana). The Senate hearing room, with its elegant wood paneling and high ceilings, was filled to the brim and every seat was taken. People were even standing near the windows and out in the doorway. I was seated in the middle of a very long table and was flanked by two colonels: Colonel Jeff Ireland, Director of the Montana National Guard, and Colonel Peter Duffy (retired), Deputy Director of the National Guard Association. We were joined by three others including two psychologists and Mr. Patrick Campbell, Chief Legislative Counsel for Iraq and Afghanistan Veterans of America. Mr. Campbell shared his experiences of how difficult it was to get mental healthcare while on active duty and how he was inappropriately questioned about his symptoms and needs when he returned home to the U.S.

    During the briefing, staffers took copious notes and the audience remained completely silent. I don't think I’ve ever spoken to a more attentive group of people. I usually don't like to use prepared remarks, but we had tight time limits and I wanted to be sure I conveyed all my points. I’ve included my remarks here in this blog (see previous two entries); many passages were actually taken from my prior BeWell blogs ('A Nation of Ghosts' and 'Shock and AWE'), which focused on these issues. Congress is considering legislation to help veterans suffering from PTSD and other mental health issues. This was a chance to raise the level of awareness for other Senate offices to support this legislation. (I’ve since learned that other Senators signed on to support S.711-The Post Deployment Health Assessment Act of 2009 after hearing the briefing).

    I must admit that it was cathartic to be able to formally share my viewpoints. I was having my own flashbacks to March of this year when I was on Capitol Hill to speak to congressional offices about pancreatic cancer. In some ways, talking about the mental health needs of the military was harder. Both touch my life very closely and I feel a need and a responsibility to make a difference and help others, as well as my own family. But talking about PTSD -- or as I would like to call it 'AWE' (Adaptation to the Extreme Environment of War) -- was a more delicate topic for me.

    Perhaps because I think that there is an understanding that military wives are not to speak out, especially to tell Congress that 'it is not ethically nor morally acceptable to send our loved ones off to war without the resources that they need to protect themselves.' I can only guess that other spouses might feel that they cannot talk about the painful changes they are seeing in their partners. It is a taboo topic filled with stigma, as if our loved ones are weak and not made of the 'right stuff' for the military. I wonder if this silence is like a cancer that eats away at our loved ones and our families.

    After the briefing, I stayed in the room for an extra 45 minutes taking questions from the audience, including Senate staffers who were officers in the military. Their stories were so poignant and courageous. I felt like we were their voices and I hope that we did them justice.

    My three points that I wanted to make in that briefing room were the following: 1) War changes everyone and people adapt. Those changes (AWE) are a normal reaction to an abnormal situation with PTSD at the other end of the continuum, where the adaptation process has progressed to a dysfunctional state; 2) We should offer mandatory surveillance and rehabilitation before, during and post-deployment; 3) Family members need to be involved. Currently we have no where to go to confidentially report changes that we see in our loved ones without causing potential damage to their careers.

    After the briefing I left the hearing room with Colonel Ireland we walked together to the train station. I felt a sense of sadness and exhaustion as I entered the Metro. It was an honor to have had the opportunity to speak and share ideas, but the weight of what we still need to accomplish is huge. I know that I am but one voice representing many. I hope that my message encourages others to speak out, as well, and to demand action. We are blessed to have a First Lady who is committed to the well-being of military families and her advocacy can make a big difference. 

    If we can afford to go to war, we have to afford to take care of the mental health of our troops. We must stop viewing mental health care as a luxury. It is a necessity to ensure that our troops, our loved ones, can defend our nation and come back and be productive members of our society and our families.

  • Blog post
  • 1 year ago
  • Views: 95
  • Not yet rated

• Remarks to Congress: Part 1 Remarks to Congress: Part 1

  • From: SaralynMarkMD
  • Description:

    Editor’s Note: These are Part 1 of prepared remarks that Dr. Mark delivered on June 17, 2009 to members of Congress.

    Good Afternoon, Ladies and Gentlemen:

    I would like to thank Senator Baucus, Senator Johanns, and Senator Tester and their staff members for the opportunity to speak to you today on the psychological health issues that our military and veterans face. These issues touch my life, both professionally as a physician who trained and practiced in veteran’s hospitals, and personally as a wife of a soldier who has served overseas, including in Afghanistan. As a doctor, I feel quite comfortable discussing statistics with you, but I want to first put a face and a heart to the issues that we, as a nation, are facing.

    For so many with loved ones in the military, the years since September 11, 2001 have been a series of time together, trying to recapture the promise of marriages, the joys of caring for children, the bliss of simple gifts such as taking a walk and vast time apart when are fears are magnified by news reports of bombings and death. The public can understand that finality, but there is another side to this war that is finally being exposed-the psychological and cognitive impairment which can be hard to measure and visualize. It has been stated that cognitive brain injury and post traumatic stress disorder are the signature injuries of these conflicts.

    Even when our loved ones return, some with physical injuries as well, it is these invisible wounds that damage the fabric of lives. They may come home, but emotionally they have disappeared. Family members, holding on to these precious spirits, disparately search for health care which could bring back their loved ones. We can no longer deny that we are a nation haunted by ghosts -- veterans of wars -- that we have not had the capacity to help.

    Military families across this country can share tales of how our loved ones cannot sit in crowded rooms or outdoors for fear of an explosive device being detonated. How the nights are filled with terror as images shatter dreams. Perhaps, these are normal reactions to abnormal situations. Yet, these reactions create chaos in the world back home which is not bombarded with enemy fire or bombs.

    On September 5, 2008, the Army stated that the suicide rate among returning veterans was higher than the general population and even among Vietnam warriors and these casualties continue to climb -- shocking numbers which should have alarmed the American public and created a public outcry.

    The years of planning and leading missions, evading or stalking an enemy, always being on guard have taken a massive toll on our loved ones' psyches and their health as well as their families. Then to navigate health care systems that don't acknowledge these injuries for concern over disability payments or ineptitude only compound a tragic situation. I recall speaking to one Vet Center health provider who told me that their goal was to keep our troops off the streets and out of jail-lofty goals for our citizens who have defended our nation.

    Fighting this war has rested on the shoulders of over 1.6 million Americans and their families. But the responsibility needs to be shared by all. I have often thought that if there had been a draft, millions would march in the streets to demand that we provide what is needed to support those who have sacrificed so much in the name of freedom. I have heard that we do not have the finances to provide the mental health care that is needed. It is not ethically or morally acceptable for our nation to send our loved ones off to war without the resources that they need to protect themselves. In my second presentation, I will discuss with you solutions to address the stigma and challenges of providing this critical component of health care.

    We must stop viewing mental health care as a luxury. It is a necessity to ensure that our troops, our loved ones, can defend our nation and come back and be productive members of our society and our families.

    Thank you.

  • Blog post
  • 1 year ago
  • Views: 75
  • Not yet rated

• Remarks to Congress: Part 2 Remarks to Congress: Part 2

  • From: SaralynMarkMD
  • Description:

    Editor’s Note: These are Part 2 of prepared remarks that Dr. Mark delivered on June 17, 2009 to members of Congress.

    'Shock and Awe' is a phrase that was introduced and quickly woven into our conversations during March 2003. We knew that it conveyed our military's strength and superiority fighting the enemy in Iraq.  We were transfixed by the fireworks illuminating the night's sky over Baghdad. Six years have gone by since 'shock and awe' transformed our lexicon and eight years since our troops landed in Afghanistan. Battles have been fought in distant lands to protect our freedom and security.

    Now, we are finally acknowledging that this war is coming home…it has reached our shores. For years we knew that this was coming, but it was difficult to face. 'Shock and AWE.” Perhaps it is time for our nation to accept and understand a new version of this concept -- one still grounded in military strength but now associated with a benevolent action rather than destruction.

    Military jargon is filled with acronyms. So to continue that long-standing tradition, AWE can be an acronym for 'Adaptation to the War Environment.' AWE is a normal process that the body and psyche experiences to adapt to the extreme environment of battle in order for a person to survive. By just changing the nomenclature, we can begin to change a climate filled with stigma, fear and humiliation.

    Instead of saying post traumatic stress disorder or PTSD to describe all the signs and symptoms that our troops experience, which sometimes can imply victimization, weakness, disability or disease, we can describe it as AWE -- a normal reaction to an abnormal situation with PTSD at the other end of the continuum, where the adaptation process has progressed to a dysfunctional state.

    We need to not only provide the superficial modification of wording from PTSD to AWE, but also dispel the notion that only a few are affected by war. Everyone comes back changed. We are fighting an unconventional war that will continue for years. It is now time to take an unconventional approach to prevention and treatment of this issue. Otherwise, we will continue to be a nation haunted by ghosts.

    It is time that we come forward and state that we expect all our troops will return with reactions to the extreme environment of war. It is the norm rather than the abnormality. It then becomes a shared experience and not associated with shame or dishonor.

    This approach has worked in other settings such as within NASA where I have served as a Senior Medical Advisor for over a decade. For example, it is expected that all astronauts will experience bone loss secondary to the microgravity environment in space. Astronauts undergo training to achieve maximum fitness before they fly, utilize counter-measures such as physical activity during flight to mitigate loss and all go through extensive rehabilitation programs upon return. The severity of the bone loss and recovery varies by astronaut, but they know that they will all lose bone and will require assistance to protect their health at home and 'flight readiness' for their missions.

    This model could work for our military. We can help our troops better prepare in advance for the stresses of war through mandatory surveillance and counseling, have countermeasures in the field such as well trained mental health personnel and mandatory surveillance and rehabilitation upon return to a non-hostile environment. The Post Deployment Health Assessment Act of 2009 is one critical step in this process.

    If we assume that everyone will have adapted to the war environment (AWE) and will require mental health care, it removes the stigma associated with it. We also need to ensure that family members are part of this approach. Right now, we have no where to go to confidentially report changes that we see in our loved ones without causing potential damage to their careers which creates further mistrust and chaos in our families.

    This novel approach can help to protect the 'fight readiness' of our troops for the battlefield and for their adjustment to the home front. Imagine the day when it will be a badge of courage and honor to say 'I'm in AWE'. 

    Thank you for your time and attention this afternoon. I look forward to answering your questions.

  • Blog post
  • 1 year ago
  • Views: 83
  • Not yet rated