New Moms at Risk for Depression

I read an article a while back in which pediatricians recommended depression screenings for new moms. After you have a baby, your OBGYN may ask you some questions about post-partum depression. However, in this article, Canadian doctors recommended that pediatricians screen for depression in new moms.

This is a good idea because as you moms know, you are at the pediatrician every 5 minutes, it seems, especially with your first baby. There are all these developmental milestones and issues to worry about and vaccines and lectures and that constant weighing. New babies must constantly be weighed to make sure they are gaining weight, but not too much weight. You probably also visit the pediatrician a lot because as a new mom, you are terrified every time the baby coughs, sneezes, spits up, sleeps through a feeding, poops something weird or does anything new. It’s so stressful because you’re new to the game and convinced that you are doing something wrong. My mom called the pediatrician the first time my brother sneezed. She was in a panic only a new first-time mom can appreciate.

If you don’t have children, you might wonder why a new mom might be depressed. You might be especially confused if the baby was planned. Isn’t this what the mother wanted? Why on earth would the mother of a healthy baby be depressed? Sure, the baby looks more like a hairless rat than a Gerber baby, but she must have known that babies don’t start out very good looking.
Well, for starters, newborns provide feedback vigorously. Sometimes, they scream all the damn time. It’s very easy to anger a newborn. Here are some of the things that anger newborns:

  • Feedings
  • Lack of feeding
  • Gas
  • Noise
  • Quiet
  • Swaddling
  • Rocking
  • Lack of rocking
  • Not being held by Mom
  • Being held by Mom
  • Clothing
  • Nudity
  • Dirty diaper
  • Clean diaper
  • You are breathing too loud
  • Fluctuations in the Dow
  • Changes in atmospheric pressure
  • Changes in formula
  • Changes in the mother’s diet if breastfeeding
  • Changes in the return policy at Target

There are some things about being a new mom that no one can really prepare you for. One is the sensation of a healing episiotomy scar. It’s a feeling like no other. Another is a healing c-section scar which has the added bonus of the judgment you may receive for not having a natural birth. Then there’s the fact that it’s next to impossible to get a shower because your baby, who you thought would be a super-cute baby but looks more like crib larvae, will not stop screaming or pooping.

Other reasons for depression include being trapped in the house, not being able to finish a sentence because you are so unbelievably exhausted, sheer tiredness the likes of which you have never known, and the feeling of betrayal you get when you realize you still need to wear maternity clothes. That put together with the hormone cocktail a new mother receives could spiral anyone into a depression. I know that I, personally, spent 45 minutes in the bathroom crying because someone sent my son a windup toy that play “Hush Little Baby” and it was just the saddest song I had ever heard. Hormones can play mind tricks on you.

I think all new moms should be alerted to how real the possibility of this depression can be because it can be difficult. Even moms who don’t struggle with depression aren’t likely caught up in the state of bliss the media leads you to expect. The first six weeks of motherhood can be brutal. You’re sort of removed from real life and it can make it difficult to see things clearly.

I also, selfishly, wanted to post this because I am dying to hear post-partum stories from other Crasstalkers. I know there are some good ones out there. I’ll even help by embarrassing myself some more:

  • I burst into tears at Thanksgiving dinner and asked my husband if he would ever want to have sex with me again (the baby was 2 weeks old). I’m pretty sure my mother overheard me.
  • I nearly tackled a woman who asked me when I was due. I was holding the baby. I knew I wasn’t losing the weight very quickly but she didn’t have to rub it in.

 

Top image here.

Tuesday Morning Open Thread

Morning gang. Shake it off and let’s get moving.

Still not awake? Try this.

Have a great day and don’t let the man keep you down.

City Guide: Detroit

The D, The Dirty, The 313, Hockeytown, Detroit Rock City, Motown, Motor City. Call it anything you want; just don’t call it Hell. Hell’s 60 miles to the west. I have a love/hate with the city, almost as much as my love/hate for New York, but, even if you don’t want to live amongst the urban decay (but, really, why wouldn’t you? One of my friends lives next to a goat slaughterhouse and she sees goats killed e’ry day!), it’s a stellar place to visit, because then people will look at you and say,

“You went on vacation…in Detroit? Why?”

And you can tell them its because you’re a hardcore badass and you saw, like, five shootings and had your rental car stolen (good thing you got that insurance!) and everyone will believe you. That’s the beauty of Detroit. There’s so much awesome crap, but everyone stays away because of the crime, which, to be honest, is bad, but more in some parts than others and I wouldn’t send you to the bad side of Mexicantown. That’d just be reckless.

Now, I by no means claim to be an expert on Detroit. I grew up in the suburbs, but we’d go down into the city for games or theater and then we’d get a bite to eat somewhere nearby. My first long-term exposure to Detroit was my first two years of college when I went to school in midtown. Then I left for 18 months to be in New York. I’m going to do my best to give you a rundown of what to do in and out of the city because Detroit, as special as it is, is also a city that thrives off its suburbs. Detroit, never just means Detroit. It almost always means (in my head) the area west of Telegraph, East of the River, North of Detroit city limits and South of 26 Mile Road (yes, there’s not just 8 Mile). The best stuff, though, is in the city proper.

Before I begin, I’d like to say something controversial. New York pizza sucks. It’s awful. Just terrible. The true king of pizza is Detroit and I will be covering the top three, two of which are in suburbia.

Michigan Central Station

Eat:

Detroit Proper

Mudgie’s: 1300 Porter at Brooklyn 313.961.2000. OMFG MUDGIE’S. If there was one place I’d like to lift to New York City via helicopter, it would be Mudgie’s. I talked about Mudgie’s briefly in the last The Detroiter column, but, OMFG, it’s so good. I finally went down there last week for the first time since I’ve been back in Detroit and I had a total foodgasm. All of the sandwiches are made with fresh ingredients, most of them local and organic and the meats are all ethically sourced. Their mustard supply alone is worth the trip. Best sandwich?

Madill – house roasted turkey, Nueski applewood smoked bacon, avocado, tomato, romaine lettuce, Mudgie-made garlic mayo and melted pepper Jack cheese on an 8 “ sub bun served warm – voted into Detroit’s Top 21 Sandwiches List, Detroit Free Press, March 2008 – $9.50 lg / $7.50 sm

Also amazing is their famed dessert, the fudgie mudgie. It’s a ghiradelli brownie waffle, topped with Calder’s vanilla ice cream, hot fudge and walnuts. This is what it looks like. Disclaimer: I am not responsible if you buy a ticket to Detroit after seeing this photo.

Walnuts cost extra and this person evidently doesn't like walnuts which makes them awful because walnuts are amazing

Union Street: 4145 Woodward Avenue at Willis Street. 313.831.3965. Reservations recommended. Union Street has awesome burgers, awesome fries, awesome Spanish coffees and is right across the street from Garden Bowl

Cass Corridor

Cass Cafe: 4620 Cass Avenue at Forest. 313.831.1400. Cass Cafe isn’t just a restaurant, it’s a complete state of mind, a great place to go drinking between classes, and one of my favorite galleries in the city. Cass has amazing food. It’s thrilling.  The best burger I’ve ever had in my life that I haven’t made myself is from Cass Cafe and that’s their pub style angus steak burger ($7). Well, actually, it’s tied with the Good Stuff Burger at Good Stuff Diner on 14th and 6th in NYC. Besides the point! PBR’s are $2, but it seems like every time I’m there it’s dollar PBR night, which, let’s face it, is swell. The art is hit or miss, but that’s what makes it so great. It’s all local artists just putting themselves out there. My favorite was a charcoal drawing of a brisket I saw a few months back.

Le Petit Zinc: 1055 Trumbull Street. 313.963.2805. There’s a bit of a rivalry amongst those who like their crepes from Le Petit Zinc and those who like them from Good Girls Go To Paris, but the fact of the matter is, they’re equally good. Le Petit Zinc wins out though for smelling like French cheese all day long. The stench is so strong, in fact, that you too are bound to smell like French cheeses for the rest of the day. I think that’s a plus. Others don’t, and those people get their crepes from Good Girls.

Lafayette Coney Island: 118 W Lafayette Blvd. 313.964.8198. Do not, I repeat do not be tricked by American Coney Island’s glitz and glamor. Its shady, gross-looking next door neighbor is the best Coney Island in the city. Dirt cheap food, bad service and weak coffee are the hallmarks of all Coneys, but there’s something special, something, well, right about Lafayette.

 

Yummy Heart Attacks Are Yummy: Coney Islands from Lafayette Coney Island

Traffic Jam and Snug: 511 West Canfield at Second. 313.831.9470. Splendorinda said it best:

I wish I could order the waiters off the menu

Traffic Jam is not a place you go to for food, it’s a place to go to for the eye candy. Yes, the food is good, but it’s a little on the pricey side. The best thing about it is the dairy and bakery in the Snug portion, but it seems like everyone who works at Traffic Jam is impossibly gorgeous (I haven’t been in a while, so this may have changed, but I doubt it). They mix their drinks on the strong side and, being a brewery, have a great selection of beers, the best being the amazingly named “Don’t Touch My Junk”

Pizza from Niki's

Niki’s: 734 Beaubien at Lafayette 313.961.4303. Yes, I just threw a fit the other day about how I quit Niki’s, but the point stands: This is the best pizza in Detroit proper and third best in Metro Detroit. Detroit pizza, if you will, is a miraculous blend of Chicago and New York that just works. Traditionally, it’s a square pizza, what New Yorkers call “Sicilian Style” with a good amount of cheese and sauce. It’s nice and crunchy, and when in pie form, it’s just a little thicker than New York slices. The only pizza in New York that I’ve found can compare is a Sicilian pizza from Rizzo’s in Astoria. Yes, I have to go to Queens for pizza. Queens, people.

Greektown

Astoria Bakery: 541 Monroe at Beaubien 313.963.9603. Best damn bakery in the whole wide world. Get your dessert there after pizza at Niki’s and before gambling your life savings away at Greektown Casino.

Slows BBQ: 2138 Michigan Avenue at Wabash. 313.962.9828.  A little on the pricey side, but, sooooo good. Ribs and Mac. Make it happen, yo.

Suburbia:

Alibi Pizza: 6700 Rochester Road at South Blvd in Troy, Michigan. 248.879.0014: Best pizza in all of Metro Detroit and, therefore, the world. Granted, I grew up on this stuff, but it’s totally true.

Como’s: 22812 Woodward Avenue at Nine Mile in Ferndale, Michigan. 248.548.5005. Second best pizza in Metro Detroit. Get it with feta and pepperoni because that’s the way to do it, yo. With a great atmosphere and location in the heart of Fabulous Ferndale, its no wonder that the restaurant is hugely popular and a great meeting place during Motor City Pride. I broke up with someone here once, but it didn’t taint my love for their pizza! Seriously, it’s real good.

A variety of pizzas from Como's. Como's pizza is more similar to NY pizza than Chicago on the Detroit pizza scale.

Original Pancake House: 33703 Woodward Avenue at 14 Mile Road in Birmingham, Michigan. 248.642.5775. They don’t take reservations and if you plan on showing up after 9am, you better be ready for at least a half hour wait and ten minutes waiting outside. That’s how good this place is. The coffee’s whatever, but their pancakes and crepes are just the bees knees. The best thing on the menu though (It’s awful as takeout. Come with an appetite big enough to eat it in one sitting) is the famed Big Apple. It’s basically a deep fried apple pancake in, like, a million layers. It’s guhmazing.

The Big Apple

Drink:

Oslo: 1456 Woodward Avenue at John R. 313.962.7200. What’s cool about this unassuming sushi bar is its kinda trendy looking mini-club downstairs. The drinks are great, and the  best night to go is First Friday’s for Adriel Thornton’s Fierce Hot Mess party, a little retro gay hipster bacchanal. Michael Trombley throws a similar party, but with a disco theme at the R&R Saloon on the last Saturday of every month. They can be a little hit or miss on the crowd, but the music is simply grand at both parties.

FHM @ Oslo

 

Atlas: 3111 Woodward Avenue at Charlotte. 313.831.2241. Great little unassuming bar with decently priced, strong drinks. That’s all. Nice place to go with friends at the end of the day.

d’Mongos Speakeasy: 1439 Griswold at Clifford. No phone number. Same as Atlas, but only open on Fridays. D’Mongos stays afloat though by being absolutely insane on Friday nights and you’re always bound to meet someone interesting.

d'Mongos

Menjos: 928 McNichols at Pontchartrain Blvd. 313.863.3934. Menjo’s is a terrible, terrible club that I sort of am in love with. It’s like Splash in Chelsea, but so much worse. So much worse. The crowd? Whatever. Not my kind of gays, the drinks are cheap, though. Two dollar wells on Thursdays which is the best night to go anyway, and a house drag queen whose schtick is boring after you’ve seen it so many times. I don’t know why I love such an awful place, but I do and, yet, I find myself cringing every time I’m dragged by a friend to Splash or, even worse, Rush, ugh.

Los Galanes: 3362 Bagley at 23rd. 313.863.3934: Great Mexican food, but this is in Drink for a reason. Las Galanes’ happy hour is the best thing in the whole wide world. Three dollar margaritas from 3-6 and boy are they strong! You’ll need a designated driver after two, for sure.

 

Do:

Great Hall @ The DIA. Photo by Tom Pidgeon for the NYTimes

 

Detroit Institute of Arts: 5200 Woodward Avenue. 313.833.7900. Detroit’s preeminent art museum is also one of the nation’s best. I like to call it the Mini-Met because it has everything, but is  a lot smaller than the Met and a lot easier to navigate. Admission is eight bucks and the best time to go is Friday night’s for free concerts (free with admission) and a variety of activities around the museum.

Museum of Contemporary Art Detroit: 4454 Woodward at Garfield. 313.832.6622. The DIA may be the big boy in the Detroit Art World, but MoCaD is the scrappy little upstart that’s got all the buzz. MoCAD (nobody calls it by its full name) is a graffiti marked cube blocks away from the DIA with some of the best curation of a museum in the city. From Rei Kawakubo to the current exhibition of work by Edgar Arceneaux, the museum caters to everything now.

Michigan Central Station: 2001 15th Street @ Roosevelt Park. No phone number. This abandoned Beaux Arts train station designed by the same team who did Grand Central isn’t open to the public, but that doesn’t mean people don’t get in. A huge pastime is sneaking in and exploring the ruin before heading up to the roof to get a great view of the city. A great idea for a self-made tour would be to scout out a series of abandoned buildings and sneak into them all. There’s a lot of them in Detroit!

Inside Michigan Central Station

Theater District: Basically all of Woodward south of Warren. Fun fact! Did you know that Detroit has the largest theater district in the country after Broadway! I bet you didn’t, and we too get lots of Broadway shows. The Fisher just ended In The Heights and starts Les Miserables later this month and you can catch, like, any concert at Saint Andrews, The Majestic, The Filmore and The Masonic amongst other places because everyone stops in Detroit because Detroit is known for two things: Cars and music. There’s also a lot of great independent theaters like Magic Giraffe and The Abreact. The Fox is pretty hit or miss with their material and tends to do a lot of family friendly stuff, but the space is just gorgeous. Seriously:

Lobby @ The Fox
View from balcony @ The Fox

The Fox is also known for being the first theater in the country to get the equipment to play talkies! Seriously though, there are so many performance spaces, it’s no wonder a lot of artists are flocking to Detroit. It’s essentially a hyper-cheap Brooklyn.

Heidelberg Projects: 3680 Heidelberg @ Mount Elliot. 313.537.8037. OMFG HEIDELBERG! Tyree Guyton’s open air installation piece with a storied history (the city spent a good deal of time in the 80 and 90s trying to destroy it) is probably the quirkiest place in all of Detroit. Seriously. It’s in a bad neighborhood, so it’s not as popular as it otherwise would be, but it’s just a really colorful, happy place that highlights the downfall of the city (at least, that was my takeaway).

Heidelberg Projects. Photo by Gerry Visco

Eastern Market: Alfred and Riopelle. This is actually a bit of a lie since Eastern Market is a neighborhood, not a strict place. I’m just choosing the center of it as its address. Anyways, Eastern Market is popping in the spring with an amazing flower market as well as other little doodads. It’s just a swell place to be. Its NYC corollary would be the Union Square Farmers Market.

Eastern Market

Other Cool Things in Detroit Proper There’s Just Not Time For

  • Penobscot Building
The Penobscot Building is one of Detroit's many fine art deco buildings
  • Detroit Artist’s Market
  • Garden Bowl
  • CityClub
CityClub, Detroit's best bisexual industrial goth nightclub is in the Leland Hotel, pictured, which also has another club in its basement called Labyrinth
  • Renaissance Center (a study in how not to design a building!)
  • Meeting me for karaoke at Soho Bar in Ferndale on Wednesdays!
  • Lots of other great stuff too! Go buy a book about the city!

Special Events of Interest

  • January: North American International Auto Show
  • May: Detroit Electronic Music Festival (DEMF)
  • June: Motor City Pride
  • August: Woodward Dream Cruise
The Woodward Dream Cruise is when everyone brings out their classic cars and cruises down Woodward Avenue
  • September: Tour de Troit Bicycle Race
  • November: Turkey Trot 5k/10k Run Through Downtown
  • Winter: Ice Skating in Campus Martius

 

It’s a super town with a lot of super things and a lot of super people, but you’re going to need a car and you’re going to need to be okay with the fact that you can’t change your mind on a whim because everything is really spread out, but, seriously, give it a chance. It’s just like Brooklyn, only with more cars and better music (I said it). Beware during winter. It gets cold. So cold.

Monday Slumber Party Open Thread

Good evening kids. Hope you had a great day, and are settling down for a nice rest.

 

Stockard Channing is so awesome. Let’s do another.

Not that The Grand Inquisitor can relate or anything.

Have a wonderful night.

Gay Marriage Bans: Why Everyone Should Have the Right to Tie the Knot

This commentary was written by the lovely and talented Lady_E

So, the Indiana legislature passed a resolution amending the constitution to ban gay marriage and civil unions. More bluntly, they passed a resolution to insert discrimination and hate into the state constitution.

Reactions to the hate resolution have run the gamut from sadness to seething anger. Some are making plans to leave Indiana behind for less backwards jurisdictions while others have pledged to stay and fight. In the coming week, Antinickname and I will be debating the cri de guerre issued by the founder of the LGBT blog bilerico.com, Bil Browning, threatening to expose the moral failings, sins, and even covered up criminal activity of the ‘yea’ voting legislators.

But, before that, I want to comment on Indiana’s proposed amendment. The text would read, “Only a marriage between one man and one woman shall be valid or recognized as a marriage in Indiana.”

Supporters of this point to the Bible and “traditional” values. We’ve all seen the bumper stickers “Marriage = one man + one woman.” But, is that really all that marriage equals, from a religious or “traditional” viewpoint? I don’t think so. I would say that traditionally, and certainly religiously, “marriage” is defined by 3 parts: 1) between a man and a woman, 2) a life long commitment that 3) is entered into under the eyes of God.

Let’s use my family as an example. My parents are of different faiths, Jewish and Catholic. They were “married” in a civil ceremony because, even though they are one man/one woman, their marriage violates Part 3. According to the Catholic Church (and in God’s eyes as they say), my mother has never been married. After 35 years of marriage, if my father passed away, my mother could marry in a Catholic ceremony as if my father had never even existed. However, if my parents had been married in the Church and got divorced, any remarriage (and the divorce itself) would not be recognized (unless they got an annulment) because it would violate part 2.

Now, let’s look at my brother and his partner. They are both Jewish. They could get married in a reform temple regardless of the fact that they are both men. Why? Because what matters the most in this particular equation is again Part 3- they are both Jews. Were one of them not Jewish, they would be in the same boat as my parents, regardless of their sexual orientation.

Now think about what this means. My parents receive all the government benefits of being in a recognized marriage even though their marriage is considered harmful and illegitimate by both of their faiths. My brother and his partner, on the other hand, could be married in a temple by a rabbi before their congregation and before God, but would receive none of these same government benefits.

So, here’s what I think. If you want to define “marriage” as it is traditionally and religiously understood, then it shouldn’t be limited to just one of the three parts. Why should a second marriage be rewarded with tax benefits if one of the couple has already violated the “sanctity” of marriage- the life long commitment part? Isn’t that encouraging bad behavior that is harmful to traditional values? And, if we really want to get right down to it, the greatest sin of all from a Christian perspective, well above homosexuality, is to deny Christ the Savior. Well, guess who does that every single day? My dad (love ya, pops!). So, why should a union considered invalid and one that undermines the very purpose of a Christian marriage be recognized and rewarded by the State?

Of course, this will never happen (and I wouldn’t support such a proposal). It won’t happen because the gay marriage debate isn’t about the definition of “marriage.” It isn’t about traditional values or what the Bible says. It’s not even about what kind of relationships are harmful to society. To me, the gay marriage debate is very simple. A hate-filled majority is targeting a minority of fellow citizens for one simple reason- because they know they can do it with impunity. Because they know the same degree of scrutiny will never be applied to their relationships.

Koch Brothers: The HPV of Republican Politics

Man! Those Koch Brothers infect everything Republicans touch!

Wart #1 and Wart #2

Speaker Boehner recently replaced Nancy Pelosi’s “Green the Capital” program that transitioned the congressional food services into using only biodegradable food and drink containers in the congressional eateries.

Science makes him sad.

What did he replace the biodegradable materials with? Expandable polystyrene foam. A.K.A. Styrofoam. You know, that stuff never, ever, ever biodegrades. Ever.

Who is supplying Congress with their coffee cups and to-go boxes that will be poisoning landfills long after human stupidity has resulted in our ejection from this planet?

WinCup, a company owned by former Koch Industries executive George

Koch Industries, the cancer causing wart that continues to taint the Republican agenda.

Do they make Styrofoam knee pads?

Link: Wurtz.

Masterpiece Twitter: Ice-T and Coco

By Danzig and Dancing Queen

During its nearly five-year storied history, Twitter has remained steadfast in its commitment to bringing the best…or just bringing 140 character expressions from individuals around the world. The Twitterverse is filled with eclectic characters and contemporary celebrities who have filled the ether with their random thoughts on life, love and luxury.

In this weekly series, Danzing and Dancing Queen will risk brain cells and credibility scouring the Twitterscape to bring you the best of Twitter. We will then perform dramatic recitations of these tweets for your listening pleasure. Please, enjoy.

This week we feature Ice-T and his wife, Coco.

WARNING: Pictures and language are NSFW (Not safe for work, for the uninitiated)

Ice-T, as performed by Danzig: 

Coco, as performed by Dancing Queen: 

*Danzing and Dancing Queen are not professional actors, but do play actors on Crasstalk.

No One Here Gets Out Alive Part 2: DNR and Artificial Nutrition

In Part One of our series, we all accepted the inevitable and subsequently gave serious thought to who we would choose to make decisions for us were we unable to do so.   Nah.  I know we’re all still in denial.  That’s why I plan to keep nagging you all by talking about this with some frequency.  Today we will talk a bit about some of the actual decisions you need to make for yourself, and possibly for a loved one.  Because I would like to not overwhelm you with information and give you enough information, I will break this down a couple of issues at a time.  Today we will discuss the two biggies:  Do Not Resuscitate orders and artificial nutrition.

DNR stands for ‘Do Not Resuscitate’.  What this means is that if your heart stops beating and you stop breathing, your medical and nursing providers will not attempt CPR or any other means of restarting your heart or breathing.  When making this decision it is important to be realistic about the limits and success of CPR.  TV representations of CPR are very unrealistic, with survival rates over double that of real life.  Also, contrary to what you may see on TV, people don’t get up and walk around after being resuscitated.  They spend days, maybe weeks, in an Intensive Care Unit on ventilation and, if they survive long enough to be discharged, a rate that has been described as being close to zero,  there is often residual physical and cognitive damage and months of rehabilitation that follows.

CPR survival rates range wildly and are affected by how sick you were in the first place.  Generally speaking, 3-37% of people outside of a hospital who get CPR survive the initial resuscitation.  It’s 3-15% for in hospital attempts, reflecting the poor outcomes for people who are already sick or elderly.  Again, this is ‘survival’ of the resuscitation attempt only.  As an historical side note, it has been noted that CPR survival rates have gone down since its introduction because it is used so often on people who are not appropriate candidates (people too sick or of an advanced age to survive)

The best candidates for CPR are younger, generally healthy, victims of trauma or who have a sudden cardiac arrest caused by an arrhythmia.

If you are making this decision for an elderly family member, the simple, honest truth is that they will not survive the attempt.  And even if they do, they will never get out of the ICU.  That is the blunt and honest truth.  Even more ‘Dr. House’:  we will do nothing but crack their ribs into pieces and disrespect their death by attempting it.

DNI: Do not intubate.  This generally goes along with a DNR.  I have seem some orders that are DNI only which is utterly nonsensical as you will need to be intubated if you stop breathing and your heart stops.  Why do CPR with all its intendant risks if you’re not going to follow it up with respiratory support?

Artificial Nutrition:  Artificial nutrition most often takes the form of tube feedings.  This is a tube that is surgically inserted into your stomach or intestine and a liquid supplement is infused directly in.  There are several indications for this, and it is not necessarily an end of life procedure.  For example, Roger Ebert has a gastric tube as a result of his cancer and surgery.  Anyone who loses their ability to swallow is a candidate.  People with esophageal or gastric cancer or people who have neurological swallowing issues because of a stroke are just a couple of examples.  Most of these people live perfectly fine lives with a feeding tube.  However, if you are in a persistent vegetative state or end stage dementia or end stage neurological disease, it is a different kind of decision.  You will have to think about how you would feel having this is there was no hope of recovery or returning to your previous mental state.   Many people with dementia lose their appetite as well as the ability to coordinate their chewing and swallowing which puts them at risk for aspiration and pneumonia.  A feeding tube is often recommended in this situation.  A feeding tube will only provide nutrition.  It will not cure or reverse the natural processes that are occurring.  The same is true of IV hydration.  As people lose the ability to swallow, they become dehydrated and the kidneys and body shuts down.  Fluids may be administered, but will only delay the inevitable.

It is important to note that it is not ‘starving’ someone if artificial nutrition or hydration is declined.  Any pain at end of life would be managed aggressively and comfort and dignity are the paramount goals.  In addition, the dehydration that naturally occurs results in electrolyte imbalances that cloud pain and cognition and provide a natural pain killer and release of endorphins.

I think that’s enough for today, kids.  If you want some help thinking about these decisions, there is an excellent resource called 5 Wishes that helps you think through these end of life decisions.  In the next installment, I will discuss dialysis, Do Not Hospitalize orders and organ donation – and the exciting unveiling of my own advance directives – Spoiler Alert! – Don’t keep me alive.

The awesome story behind the thumbnail pic.

Monday Afternoon Open Thread

Hope you are making it through the day. Hopefully your work day isn’t going like this:

Or this:

Or this:

Let’s all take a moment to read that poster in the back about workplace violence. Have a great day.