Grand Rounds is Up at Chronic Babe Today

This week's Grand Rounds posts are about women's health issues.

And so is the January Pain Blog Carnival.

MBTI: Personality Differences in Couples

The Myers-Briggs Type Indicator (MBTI) assessment is a psychometric questionnaire designed to measure psychological preferences in how people perceive the world and make decisions.

There are four dimensions of measurement. We each have qualities of all dimensions. But just as some of us have a dominant right or left hand, even though we use both hands all the time; we tend to have preferences for certain MBTI types.

THE FOUR MBTI DIMENSIONS

Extroverting <---> Introverting
Which has to do with where you get your energy. Extroverts recharge when they're around people and they tend to think out loud. Introverts need alone time to recharge and they tend to process internally before speaking.

Intuiting <---> Sensing
Which has to do with how you take in information. Intuitive look for the big picture and patterns (the forest). Sensors look for the details (the trees).

Thinking <---> Feeling
Which has to do with how you make decisions. Thinkers use data to analyze situations. Feelers look to their intuitive gut responses.

Judging <---> Perceiving
Which has to do with your basic orientation to the world. Judgers like to narrow options, make the choice, act on it, and move on. Perceivers like to keep options open and add more possibilities.

I have heard it said that when couples have different preferences on more than two dimensions, relationships are more of a struggle. Richard, my partner, and I differ on two dimensions, and they bite us all the time. I have preferences for Feeling and Judging. He has preferences for Thinking and Perceiving.

How does this play out?

Feeling - Thinking Scenario

B. (Feeler): Today is not a good day. I'm having some pain.
R. (Thinker): Why not try a warm bath, or doing some yoga stretches. That often helps. Or we could watch reruns of the Twilight Zone. That might distract you.

When all I (the Feeler) really want to hear him say is:
"Oh sweetie. I'm so sorry you're hurting. I'm by your side."

Judging - Perceiving Scenario

B. (Judging): I don't know what to do? Should I try myo-fascial physical therapy or acupuncture or different meds? I can't stand this confusion. I want to find the one thing that will work!"

R. (Perceiving): You can try them all! And if something doesn't work once, you can try it again later. It might help then. The good news is that there is always something more to try that might help.

B. (Judging): Groan...I just want to figure out what will work!

We are different. I recently wrote a post about how Richard's Thinking preference and my Feeling preference trip us up. I am Deanna Troi to his Mr. Data (for the Trekkies among you).

When you think about your own relationships in an MBTI context - what do you notice about how the differences between you and your partner show up?

Are you both Extroverts, or is one an Introvert? Do you both like to dive into the details (Sensing) or does that make you crazy because all you want is the big picture (Intuiting)? Is one of you a Thinker and the other a Feeler, like Richard and me? Is one of you a Judger who likes to make a choice and move on, while the other, the Perceiver, likes to add more possibilities into the mix and postpone making a final decision (again, like Richard and me)?

And for those of you who seem to be similar to your partner across all four dimensions -- what is that like? I can only imagine.


more to come about MBTI and couples and illness

Strife at Home Can Make You Sick

From an article on Little About
Strife at Home Can Make You Sick

Disagreements between feuding spouses that continue without satisfying resolution could take a significant toll on one’s health, researchers at Ohio State University conclude. Among those who argued with ineffective conflict management skills, immune systems can be weakened and stress hormones increased.

In two trials involving 120 couples, psychologists found that partners involved in relationship disputes were at risk for sickness. The findings were similar across the marriage spectrum of participants, whether a couple was newly married or wed for many years.

One study focused on newlyweds, the other on husbands and wives married an average of 42 years. Clinicians involved with the study conclude that, with proper conflict resolution, marriage partners can enjoy less stress through real listening and honest sharing of feelings and attitudes. The men studied were more likely to withdraw from or tune out during arguments, while the women were more likely to be distressed about the argument well after a heated dispute.

With the study, mental health practitioners who try to save marriages–counselors, social workers, psychiatrists, psychologists, clergy–now have the science to prove that arguments between couples can lead to battles inside the body. Long term health effects are not yet known.

Ohio State researchers studied many couples, both newlyweds and couples who have been married for decades. They measured the stress hormones in their blood. Couples were brought in for joint counselling sessions on current disputes. Blood was analyzed intermittently.

The presence of the hormones are found to be linked not to the disagreements themselves, but to the way couples fight and resolve (or don’t resolve) conflicts. “They all had a problem that they were talking about, but those who talked about it in a hostile and negative way are the ones who had the negative immune effects,” reports Dr. George Solomon, MD, professor of psychiatry at University of California Los Angeles.

Solomon studies the way in which mind and the immune system interact. He says it’s important for couples to learn how to deal with the conflicts and stress that are inevitable in any committed relationship. In the study of the older couples, abrasive arguments were tied to a weakening of certain aspects of immune response.

Dr. Janice Kiecolt-Glaser, PhD of OSU’s new Institute for Behavioral Medicine Research who was involved in both studies, says that the findings from those headed toward golden anniversaries were more unexpected than the findings from the newlyweds. “You might expect that arguments would have less impact on older couples because they’ve gone through these disagreements many times before and have learned to deal with them,” says Kiecolt-Glaser. “But that’s not the case.”

Besides raised stress hormone levels, the older couples with weaker immune measures also described their usual marital disagreements as more negative.

In the study of newlyweds, researchers concluded that one key to lowering the stress during a couple’s arguments is to concentrate on the issues at hand and reduce the amount of negative responses that result. The style of the fighting is most important. “The sarcasm, name-calling and back-biting are the problems,” says Dr. Ronald Glaser, PhD, another researcher involved in the OSU study.

Of particular interest was the continued elevated stress hormone levels of the women having husbands who withdrew from the arguments. “We’re probably seeing the results of the women thinking about and reliving the argument throughout the day,” Kiecolt-Glaser says.

According to the researchers, while changes in immune response were seen in both newlywed and older couples, the effects may have greater consequences in older people as their immune systems are already waning. “Older adults have greater rates of illness and death due to infectious diseases compared to younger people,” Kiecolt-Glaser says. “Additional stress, such as from marital arguments, may put them at greater risk.”

President Barack Obama

"On this day, we gather because we have chosen hope over fear, unity of purpose over conflict and discord. On this day, we come to proclaim an end to the petty grievances and false promises, the recriminations and worn out dogmas, that for far too long have strangled our politics."

Let us hope.

Divorce and Illness

from The Daily News

Sunday, January 18th 2009, 11:34 PM

"Dawnwell Batista is in the middle of what will forever be known as the Kidney Divorce, and she is an amazing woman who’s been betrayed both by her body and her husband.

Her split from Dr. Richard Batista has been painful enough, dragging on for four years, and mostly, she’s been worried about the children.

But just as their trial was about to begin, the surgeon upped the ante. His lawyer announced that Dr. Batista had donated a kidney to her, and now he wants it back - or its supposed $1.5 million value"

-----------------------------------------------------------------------------------
Speculations

Sometimes love can become a Steven King novel - you know the ones, about a killer car or a killer prom queen or a killer caretaker at a snowed-in, isolated moutain retreat.

How does this happen? How does a couple go from "I do" to "Gimme my kidney back?" From "love and honor" to "wound and maim?" Demanding a kidney refund is so much more mutilating and vampirish than taking back the diamond engagement ring. It's hateful.

And how does love become hate? Does that happen when such a critical mass of disappointment has accumulated that the pile starts to fester and breed hate bacteria? Does it happen when two people have been so blinded by their own illusions for rescue that they enshroud their partner with expectations no mortal could meet? Does it happen in the day to day, inch by inch annoyances that eventually crescendo into an unscalable wall of misery? Does a moment arrive when all murmurings of tenderness disappear leaving only a banshee shriek of hate?

How can you take back the kidney you once gave as some form of loving sacrifice?

And what role does the illlness that required the kidney in the first place play? (Dawn has supposedly had 3 kidney transplants and a double mastectomy). I can imagine illness as an amplifier. Whatever strains existed in this couple's relationship perhaps got overloaded by the extra burdens illness brings. Many of us have struggled with this.

But how many of us have demanded a body part be returned?

And finally, a woman's body is never, never to be used as a field of negotiation. This is the fundamental women's health right.

MBTI: Thinkers and Feelers

The Myers-Briggs Type Indicator (MBTI) assessment is a psychometric questionnaire designed to measure psychological preferences in how people perceive the world and make decisions.

But it's so much more than that. It's a relationship emancipator. It's the knife that slices the Gordian knot that keeps partners entwined in endless, repeating patterns of point and counterpoint, argument and escalation of argument. It can take a world of communication trouble, and if you let it, pare it down to its benign and manageable essence.

What do I mean? Here's a light example.

One of the dimensions the MBTI assesses is the way people make decisions. In general, people either have a preference for what MBTI calls Thinking or Feeling. Thinkers like facts, practicalities, data, and analysis. They decide based on what is logical. Feelers like intuition, gut sense, fairness, and harmony. They decide based on what feels right.

I was having a very good, pain-free day and Richard and I decided to do one of the things we love best - go for a hike. The weather was California perfect. One part of the trail took us through a large redwood forest. For miles, we were encircled by these ancient mother trees. One tree in particular had had its lower trunk hollowed out by fire. What remained was the outer trunk and a cavity that was about 4 feet wide and 8 feet high. The space could easily fit three adults.

I entered into this sanctuary and stood silently for a few minutes, feeling part of something primordial and dignified. When I emerged I said to Richard, "Well that was a little bit of the sacred."

Richard entered in to the chamber, turned around a few times, came back out into the sunlight and said, "That place would be a good shelter from the rain if you needed one."

I am a Feeler. Richard is a Thinker.

---------------------------------------------------------------------------

Before we had this language, it was easy for me to experience his responses to my needs as insensitive. It was easy for him to just not understand what I was asking for and to try harder to parse the situation rationally.

"I'm so miserable," I would moan. "I hate taking pills. And I hate having pain if I don't take them."

"What if you tried cutting back on one of the pills and see what happens," he would offer.

"You just don't understand. I hate all this!" I would moan with a little more volume.

"Well," he would suggest a bit more tentatively not sure of what he wasn't understanding, "what if you sliced one pill in half and tried tapering in smaller increments."

You can see where this conversation would be headed.

What MBTI gives us is a decryption key for this kind of interaction. I can now say to Richard, "You're doing that T-thing. I'd like you to try to be more of an F right now."

He can then filter that through his rational mind and say,"Ahh. You need me to say something like, 'Oh sweetie, I know this is so hard for you. You hate everything about having a pain condition. How can I help?'"

I say in a very succinct, practical, data laden way "Yup. That's what I'm looking for." (we Feelers can be logical when we need to).

He searches inside to find his empathy (Thinkers have feelings - it's just not what they lead with). He repeats what he just practiced, but lets it float on that empathy. "'Oh sweetie, I know this is so hard for you. You hate everything about having a pain condition. How can I help?"

It works. I feel soothed. I feel like we are now both inside the redwood together, sheltering each other.


(more to come on this topic...............)

Tarra and Bella - The Video

I wrote about this unique relationship in a previous post. It is a remarkable example of how love can bridge differences and disabilities. In this video clip, you can see for yourself.

(The clip is preceded by a brief commercial - sorry about that)


Watch CBS Videos Online

Grand Rounds: Vol. 5 No. 17

The (optional) theme I suggested for this Grand Rounds was connections -- connections among people, groups, ideas, opinions, facts, devices, places, events, just about anything. I am interested in how the connection between things led to an outcome that was in some way beyond what could have happened had those things remained apart. It has been intriguing to read what our fellow bloggers chose to connect.

One area of connection that has fascinated me for decades is the realm of science fiction films. Sci-fi films connect the past, the present, and the future; our darkest fears and loftiest hopes; the devastation humans cause and the healing we bring; the divine and the utterly outrageous.

Here's a confession. For the past twenty seven years I have attended the annual 24 hour science fiction film festival. I bring my pillow and my ray gun and sit in the dark with my crew watching the sublime( Blade Runner), the drek (Plan 9 from Outer Space), the naughty (Invasion of the Bee Girls) the forgotten ( A Boy and His Dog), the political (Aelita - Queen of Mars), and the Sean Connery (Zardoz)

So the organizing theme for this Grand Rounds is sci-fi films.



Dr Strangelove or How I Learned to Stop Worrying and Love the Bomb -- A Kubrick masterpiece. A subversive anti-war film that is wonderfully satirical with Peter Sellers in three bizarro roles. It shows us how the collision of perspectives can result in Armageddon, but in a really funny way.

Bongi from Other Things Amanzi writes in his post, Quagmire, about the confusion and tragedy that can result when you move across hospital units to treat a patient and crash up against different practices and attitudes.

Dr Deb introduces us to a new Showtime show, The United States of Tara, about a woman with dissociative identity disorder (formerly known as multiple personality disorder) - although Dr. Deb's withholding her judgment about their depiction of mental illness until more shows air.

No Nurses in the Unemployment Lines on Colorado Heath Insurance Insider points out the sadly ironic gap between the shortage of nurses and the dollars spent, not on better salaries and education grants, but on prizes, spas, and art work.

The Adventures of Buckaroo Banzai Across the 8th Dimension -- deserves its status as a cult classic. Buckaroo is a rock star, a surgeon, a car racer, a planet saver, a real sensitive guy, and a bona fide hero. He's also a servant leader and a humble warrior who knows the value of a good relationship and always speaks the truth (and may perhaps be the originator of the aphorism, "Wherever you go there you are.").

Anesthesioboist, in See One, Do One, Teach One, writes about how meaningful teaching of medical trainees requires more than providing rote instructions and observation. It requires a relationship, a real connection between teacher and student, which can be tough to find in medical education.

Kim from Emergiblog in an alliteratively titled post, Pain, Potty, and Position Protocol for the Professional Peon, brings to our attention a group of unsung heroes who get little recognition from the powers that be, the ER technicians.

Dr. Val in What To Do When Mistakes Happen reminds us that medical errors do occur, and some have tragic consequences. What we do about the error and how we communicate, with truth, to the victims make a world of difference.

2001: A Space Odyssey -- Kubrick's genre busting epic of metaphysical and intergalactic exploration. Stretching the bounds of the familiar to the mind altering vastness of time, space, imagination, and technology. Will we ever forget supercomputer HAL's attempted coup and his ultimate demise?

How to Cope With Pain helps us stretch our thinking to consider that chronic pain, a condition no one asks for, may actually have some positive benefits in her post, Are There Some Benefits To Your Chronic Pain?

Duncan Cross boldly tries new technology to help manage his own upcoming surgery - with some frustrating, useless, and enlightening results. Have a look at The Adventure Begins.

Sharp Brains offers us a way to stretch our thinking capacity with the The Ten Most Popular Brain Fitness and Cognitive Health Books.

The Day the Earth Stood Still (only the original version, please) -- Klatu, a dreamy alien, comes in peace to warn humankind of the path it is on to self destruction. He brings his indestructible robot buddy Gort along as added persuasion. Klatu speaks the truth, we humans ignore it, and as an extra bonus, we try to kill the messenger.

Dr. Siadat from Receiving writes in No Love in the Time of Cholera about the devastating cholera outbreak in Zimbabwe. The solutions are known. The obstacle is implementing them. So what can we do before it's too late?

Scalpel's Edge illuminates some of the harder truths about heath maintenance and understanding your doctor in Expecting Illness Helps Improve Your Health. He writes, "One of the most common obstacles to receiving good health care is the expectation that medicine is magic and that it is normal to be healthy."

Mudphudder shares with us, with a retrospective sense of humor, My Worst Day in the O.R. as a medical student.

Soylent Green -- Overpopulation, environmental degradation, urban paranoia at its juiciest and gun toting Charlton Heston trying to find a murderer and fight a corrupt corporation. Our Chuck uncovers the pernicious secret (stop reading here if you don't want to know) - that the food the corporation produces and the government distributes to the masses, soylent green, is ground up people. We are what we eat, literally.

Dr. Mintz asks us to think about The Problem With Insulin. The new guidelines for managing type 2 diabetes push more patients towards insulin, which might not be such a good idea. These guidelines, he conjectures, are connected to the biases of the authors who write them.

ACP Internist in the post Let Them Eat Drugs informs us that chain groceries, in an attempt to be more competitive, are offering free antibiotics to customers. Won't this just drive overprescribing and antibiotic resistance?

Dr. Rich from The Covert Rationing Blog, in the post Maintaining Plausible Deniability, tells us the story of nurse Dewitt who was allegedly fired because of her husband's high medical bills. Dr. Rich conjectures that the firing managers were placed in an intentional untenable position -- where their only recourse was to take an action that is officially forbidden, but also unofficially invited. He likens this to what health insurance companies do to patients every day.

Invasion of the Body Snatchers (again, only the original, please) -- this red menace tale is about small town residents who begin to lose their personalities about the same time alien pods start hatching everywhere. The pods are evil wombs that absorb humans when they sleep and spit out alien reproductions. Paranoia prevails, no one believes the truth speaking hero, and America is ultimately taken over. The chilling questions that linger are: Who controls your body and can you really tell who the pod people are (just think about the recent presidential and vice presidential campaigns)?

In a thought provoking piece, Pregnancy, Children, and Chronic Illness: Can versus Should?, Laurie of A Chronic Dose asks -- Just because you can get pregnant, should you? and - How can we be the parents we want to be with bodies that don't cooperate?

The Humours blog in its post La Greffe, reviews the French film Un Conte de Noel which connects medical themes to the holiday season. The film is about a family that discovers its shared genetic history of physical and mental illness. The genetic fates of family members cross forbidden relationship lines and create unusual connections.

Insureblog, in a post about Hair Transplant Insurance, makes a provocative connection between hair plugs and in-vitro fertilization and discusses how insurance coverage for either (or both) can drive up costs, affecting the entire health care financing system.

The Back Pain Blog gives us a wealth of excellent tips (accompanied by LOL pictures) on How to Prevent Back Pain with an Ergonomic Workstation.

Forbidden Planet -- a knock-off of Shakespeare's The Tempest, a spaceship crew is on its way to Altair-4 to find out what happened to an earlier crew that hasn't been heard from in 20 years. A strange voice warns the crew to land only at their own peril. They soon discover (along with Robby the Robot, the whacked Dr. Morbius, and his nubile daughter) the destructive force that murdered the previous crew and threatens them -- a force powered by human fear and hate. The only salvation is love.

Keith from Digital Doorway, in Reaching Out to the Margins, with his usual eloquence and compassion reminds us that reaching out and connecting with the vulnerable and disconnected members of our community is a public health concern.

Doc Gurley in Week Two - How Are You Doing? helps us approach the changes we resolve to make not burdened with shame and despair but with a sense of wholeness and practicality. We need to see the connection between who we are now and who we will be in a year, including the bumps and digressions that we'll encounter. She offers science-based behavior change tips.

The Semmelweiss Mystery described on Providentia is a (web) page turner. It's a story about the mysterious death of Dr. Semmelweiss (who is now considered a heroic medical pioneer for advocating hand washing) who died in a lunatic asylum because of the jealousy, prejudice, and fear of his medical colleagues.


Strange Days -- as the millennium approaches and the world hovers between resurrection and annihilation, people peddle "clips," full-sensory pieces of memory from other people's lives. Once inserted into your brain, the lines between present and past and between me and other blur. Our memories become collective and we're all to be tested in the big final countdown.

A story about the FDA spending on morale boosting brought back some high school memories for David of Health Business Blog in his post, FDA Staff: Damned If They Do and If They Don't.

Nancy offers us a collection of memories of the top ten, most read posts on Teen Health 411, including topics such as - can my partner spend the night and a global perspective on teen sex habits. Have a look at Most Read Posts In 2008 From Teen Health 411.

The Fitness Fixer offers us a rich compilation of her readers' stories about how they used her approaches to achieve a stronger, healthier, pain free, active life in the post, New Years Resolutions for Fitness Success -- Readers Hall of Fame.


Thanks to all who submitted posts. And thank you for your encouragement to a first time host. Next week Dr. Val will be hosting Grand Rounds at Get Better Health.

And finally:

May we all have wonderful adventures, never panic, and always know where our towels are.

When Pain Goes Away

For the past three days, Richard has had a smirk on his face. In general, he is a gentle soul, compassionate beyond the point where most people would be showing impatience, usually able to leap over fear and ego in a single bound. He does show moderate smugness -- especially when he is proven right about the time it takes to get to the airport during rush hour. But he rarely smirks.

This current smirk, is a combination of "I told you so" and "I am happy for you, and us." It's a smirk that follows the ending of a pain episode.

He knew, based on many similar episodes of past pain experiences, that getting to the right medication titration would eliminate the pain. I only knew the anxiety of all the untested "what ifs." What if this time is different? What if something else is wrong? What if it takes months or years, again? What if I can't work or write? What if we run out of rice cakes and almond butter (funnily the only thing I can eat when I have pain)?

He goes to Whole Foods and comes back with shopping bags overflowing with rice cakes and almond butter and reminds me, again, that this pain will stop. And it does.

The smirk of love.

Grand Rounds Vol. 5 No. 17 Will Be Hosted Here on January 13

Long time reader and admirer of Grand Rounds (a weekly rotating collection of the best posts from the health care blogosphere). First time host.

I am delighted to have this blog be home base for the upcoming January 13 Grand Rounds. I hope I am overwhelmed with your wonderful and eclectic submissions.

I'd like to offer as a suggested - but optional - theme the topic of: Connections.

I often blog about the connection between two partners and how that connection affects the experience of illness and how illness affects that relationship.

Connections can be between people, groups, ideas, opinions, facts, devices, places, events, etc. The connection can be positive or negative, predictable or surprising. The connection can involve you directly, or you may be a witness. I am interested in your stories, experiences, and thoughts about how the connection between things led (or could lead) to an outcome that was in some way beyond what could have happened had those things remained apart.

You are also welcome to submit a post on any other topic that's of interest to you.

Please send your submission by Sunday, January 11, 2:00pm EST. You can email it to: bkivowitz at gmail dot com

Please use the following format in your email:

Subject Line: Grand Rounds Submission

E-mail Body:

1. Post title
2. Post url
3. Short description of the post
4. Blog title
5. Blog url
   

I look forward to reading all of your submissions. Thank you.

Making Pain Go Away

Here's a word I never used in the before time -- titration. I knew its meaning, but it had no function in my pre-illness life. I didn't titrate how many eggs to put in a cheese omlette or how many gallons of gas I needed to make the drive from San Francisco to Mt. View. I just broke eggs and filled the tank.

For the past three weeks my attention has been riveted on titration. Determining how much to go up on which meds at what time intervals to get my pain back in control has been my mission. In the ole days, my mission might have included helping others. But pain makes its own decisions, and I become its loyal soldier. I follow where it leads, head down, tail tucked.

So I make an adjustment to the medication regimen and like a hawk scanning for prey, I scrutinize the meridians of my body for any evidence that this new combination of meds is reducing the ripples of pain. The outside world ceases to exist.

My pain specialist does guide me. But she also reminds me that pain is individual, and I just have to keep titrating until the cocktail works.

There's that word again. Titration. It has come to have a mythic quality about it.

I just want a recipe.

Richard, my voice of reason, reminds me that I will keep trying and I will get better - in a few days, maybe weeks - but not years, not like before. I try to hear him, but often I just can't. Pain is louder.

But I keep titrating. Two pills twice a day. Then three pills two times a day. Scan for a reduction in pain blips. No. OK then. Three pills three times a day. That's my limit. Not because I get impaired by side effects. Luckliy, I have none. But more meds than that and I cross some arbitrary line that exists only in my mind. The too-many-pills line.

Pain and I eventually come to an agreement. This level of medication for my life back.

I take the deal. Gratefully