January 4, 2013

‘What can you do if an addict isn’t ready to give up using drugs and alcohol?’

BILL: Dave, did you see that Scott Sterling, son of L.A. Clippers owner, Donald Sterling was found dead alone in his apartment right after New Years Eve?

DR. DAVE: I understand he had a history involving drugs. At any rate, the coroner’s office believes he died of an “apparent drug overdose.”

BILL: It wasn’t the first time I’ve read of someone OD-ing on Christmas, a birthday or like Scott Sterling, on New Years Eve. “Significant dates can indeed very difficult for addicts,” says Dr. Damon Raskin, Cliffside Malibu Treatment Center. “The addict will often use the day as an artificial marker to stop using. This is just a set up for failure and relapse since they haven’t done the necessary psychological work that is required to really quit for good.” Dave, how would you describe that “getting ready to quit” process?

DR. DAVE: In the early days of addiction treatment, the steps in the recovery process were “admitting you had a problem, Accepting the full therapy for recovery, and then Surrendering to the fact that it was a life long process; or the stages of Admission, Acceptance and Surrender.”

BILL: So, unless the addict admitted he had a problem, there was really no starting point for treatment?

DR. DAVE: Exactly the problem Bill. But, the addiction treatment process of the last 10 years has found another stage we can address to get the addict to admission–it is called the Contemplation Stage. If we can get the addict talking and thinking about his use, then we have a bridge to admission.

BILL: It seems to a non-professional like me that this whole “contemplation” process might be saying to my fellow addicts who are still using that “It’s not that bad, you can take your time deciding on whether to stop.” If you believe Amy Winehouse’s father, she was mixing Librium with her booze and died of an OD mixture of both while “contemplating” away.

DR. DAVE: If you are making the point that half-hearted efforts to quit can add to the fatal nature of the disease of addiction, you won’t get any argument with me. In fact, many credible relapse researchers believe there is something called the Abstinence Violation Effect–or A.V.E. for short. If an addict just lets her craving build and build, without reducing the emotional toxicity behind it, when the relapse occurs, the combination of guilt and craving can send the addict off into a binge of even more excessive use than before.

BILL: Another important idea, says Dr. Raskin is that “if an addict stops using for a week or two, and then goes back to using the same dose of drugs they were using before they stopped, they may have lost tolerance to the drug which makes it much easier to overdose.”

DR. DAVE: With all three of us having made the point that anything that delays the addict’s quitting will bring them closer to that fatal overdose, still, we desperately need additional research on how to turn the “contemplation stage” into a bridge to recovery….

BILL: ..including reminding our readers, along with Don Sterling and NFL coach Andy Reid who lost his son to overdose addiction in 2012, that one proven strategy to “cross the bridge” is to enlist a professional from this national list of Intervention Specialists. But Doc, I can’t help but be concerned about the many therapists and counselors who are not specialists but are trying to get their addicted patients who are in the Contemplation stage into addiction treatment.

DR. DAVE: I assume you mean the ones that have ethically confronted the addict, with compassion, and explained they need help and standard addiction treatment has been rejected? I have real ethical concerns about the health practitioners dispensing drugs that might hasten an OD, or the therapist who goes along with the addict’s pretense that addiction is simply a byproduct of depression or anxiety that should be treated INSTEAD of the drug use.

BILL: Of course! I know there has been a whole language game of therapy to avoid the elephant of addiction in the room…my personal favorite is someone tossing out the phrase they are doing “harm reduction” by addressing virtually any other problem than the addiction!

DR. DAVE: The one proven strategy, outside of Intervention, that has been shown to be effective in the Contemplation Stage is what is called Motivational Interviewing.

BILL: That’s what you were teaching the health personnel in the Scripps Emergency Rooms of San Diego County and the physicians dealing with drug using teens in Juneau Alaska?

DR. DAVE: Exactly, it’s a way of talking to addicts that move them farther out of denial and towards an internal motivation for admitting they need treatment. The National Institute of Health has actually taken the research and turned it into very readable strategies and methods that both family members and therapists have found useful. So many parents and spouses have found it helped them that I would recommend it to anyone working with or living with an untreated addict

Original Article

Cliffside Malibu

Dr. Damon Raskin

January 3, 2013

Eight Hospital Employees Fired For Refusing Flu Vaccines

An Indiana hospital has fired eight employees, including at least three veteran nurses, after they refused mandatory flu shots, stirring up controversy over which should come first: employee rights or patient safety. The hospital imposed mandatory vaccines, responding to rising concerns about the spread of influenza.

Ethel Hoover wore all black on her last day of work as a nurse in the critical care unit at Indiana University Health Goshen Hospital. She said she was in “mourning” because she would have been at the hospital 22 years in February, and she’s only called out of work four or five times in her whole career , she said.

“This is my body. I have a right to refuse the flu vaccine,” Hoover, 61, told ABCNews.com. “For 21 years, I have religiously not taken the flu vaccine, and now you’re telling me that I believe in it.”

More than 15,100 flu cases have been reported to the Centers for Disease Control and Prevention since Sept. 30, including 16 pediatric deaths. Indiana’s flu activity level is considered high, according to the CDC, which last month announced that the flu season came a month earlier than usual.

When Hoover first heard about the mandate, she said she didn’t realize officials would take it so seriously. She said she filed two medical exemptions, a religious exemption and two appeals, but they were all denied. The Dec. 15 flu shot deadline came and went. Hoover’s last day of employment was Dec. 21.

Fellow nurse Kacy Davis said she and her colleagues were “horrified” over Hoover’s firing, calling her their “go-to” nurse and a “preceptor.”

“It was a good place to work,” Hoover said. “We’ve worked together all these years. We’re like a family.”

The hospital said in a statement that it implemented the mandate to promote patient safety based on recommendations from the American Medical Association, the American Nurses Association, and the Centers for Disease Control and Prevention. It announced the mandate in September. Of the hospital’s 26,000 employees statewide, 95 percent complied. That means 1,300 employees did not comply, but only eight were fired.

“IU Health’s top priority is the health and wellbeing of our patients,” said hospital spokeswoman Whitney Ertel. “Participation in the annual Influenza Patient Safety Program is a condition of employment with IU Health for the health and safety of the patients that we serve, and is therefore required.”

The CDC recommends flu shots for everyone older than six months of age. Dr. William Schaffner, chair of preventive medicine at Vanderbilt University Medical Center in Nashville, Tenn., said hospital patients are especially vulnerable to flu complications because their bodies are already weakened.

“I cannot think of a reason for any health care professional to decline influenza immunization that’s valid,” said Schaffner, a former president of the National Foundation for Infectious Diseases, adding that people with egg allergies may have to avoid the flu shot to prevent anaphylactic shock, but even that hurdle has been remedied. The Food and Drug Administration approved an egg-free vaccine in November.

Schaffner said invalid excuses to avoid the shot include being afraid of needles and simply promising to stay home when they’re sick. Patients now have the option of a vaccine nasal spray if they want to avoid needles. And since flu victims become contagious before they start to feel sick, they can get patients sick even if they stay home when they have symptoms.

Over the last several years, hospitals have been moving toward mandatory vaccinations because many only have 60 percent vaccination rates, Schaffner said. He is leading an effort for a similar mandate at Vanderbilt University Medical Center.

Nurses in particular tend to be the most reluctant to get vaccinated among health care workers, Schaffner said, citing his opinion.

“There seems to be a persistent myth that you can get flu from a flu vaccine among nurses,” he said. “They subject themselves to more influenza by not being immunized, and they certainly do not participate in putting patient safety first.”

In October 2011, Vanderbilt broke the world record for number of vaccines administered in an eight-hour period in an event called Flulapalooza. From 6:50 a.m. to 2:50 p.m., they vaccinated 12,647 people. By that evening, more than 14,000 people had been vaccinated, and there were no severe adverse reactions, he said.

But still, Hoover’s lawyer, Alan Phillips, says his client had the right to refuse her flu shot under Title VII of the Civil Rights Act of 1964, which prohibits religious discrimination of employees. Religion is legally broad under the First Amendment, so it could include any strongly held belief, he said, adding that the belief flu shots are bad should suffice.

“If your personal beliefs are religious in nature, then they are a protected belief,” Phillips said.

Phillips, who is based out of North Carolina, has made a name for himself fighting for employees’ rights to get out of mandated flu shots, but he has never needed to go to court. Although he usually handles a couple dozen health care workers per year, he had 150 this fall in 25 states.

Dr. Damon Raskin, an internist with his own practice in the Pacific Palisades in Los Angeles, said hospitals should mandate flu vaccines as a matter of public safety. The flu can lead to complications like pneumonia and death, said Raskin, who is also affiliated with the Cliffside Malibu Addiction Rehabilitation Center.

“I think if the health care worker has some problem with religious faith then perhaps during flu season, they shouldn’t do that job,” Raskin said, suggesting that the worker do something administrative instead during flu season. “It’s not fair to the patient. The people who are most at risk are in the hospital.”

Original Article

Cliffside Malibu

Dr. Damon Raskin

January 2, 2013

Son of billionaire Clippers owner Donald Sterling dead, drugs suspected

Sad news this morning as KTLA and CNN are both reporting the son of billionaire Donald Sterling, owner of the Los Angeles Clippers basketball team, was found dead allegedly surrounded by drug paraphernalia.

Police are still investigating the death of Scott Sterling, 32, son of Clippers owner Donald Sterling, whose body was found at a home in Malibu.

Local Los Angeles affiliate KTLA reports that detectives were called to the 22600 block of Pacific Coast Highway at 11:29 p.m. on Tuesday, from information provided by the Los Angeles County Sheriff’s Department. Confirmation on the death came from the L.A. County Coroner’s office.

An autopsy will be performed to determine the cause of death. According to KTLA, it appeared to be an overdose with drug paraphernalia allegedly discovered at the scene.

Scott Sterling made headlines when he was 19 years old, after he shot his childhood friend, Philip Scheid, who he claimed attacked him with a knife, allegedly over an actress’ affections. The incident happened at Donald Sterling’s home on Beverly Drive in Beverly Hills.

More than a year after the shooting, prosecutors dropped file charges, saying the victim wasn’t credible. The conclusion left police frustrated as ballistics reports showed that the victim was shot from behind from at least 15 feet away, yet the young Sterling claimed self-defense.

“No rational person would entertain the possibility of his story being true,” Beverly Hills Det. Sgt. Jack Douglas wrote in a memo to prosecutors.

Dr Damon Raskin, consulting board certified internist at Cliffside Malibu (www.cliffsidemalibu.com) a premiere residential rehabilitation facility, spoke to Monsters and Critics this morning (Jan. 2) on this developing story:

“Although it is still too early to tell, it appears that this may be another tragic tale of a privileged individual who did not seek help for his depression, addiction or both. When there are so many resources available to help, it is a sad day when another young person succumbs in this way.”

Dr Damon Raskin, consulting board certified internist at Cliffside Malibu (www.cliffsidemalibu.com) a premiere residential rehabilitation facility, spoke to Monsters and Critics this morning (Jan. 2) on this developing story:

Original Article

Cliffside Malibu

Dr. Damon Raskin

January 2, 2013

Male Menopause: Is It Ruining Your Marriage?

A few months ago, a 72-year-old judge walked into Dr. Damon Raskin’s Pacific Palisades California internal medicine office with a problem he could barely articulate. The judge, well-known in his community, was fatigued all the time and had lost his passion for life. With a simple blood test, Raskin was able to figure out something else the man had lost: testosterone.

Low testosterone levels were zapping the judge’s zest for living, diminishing his sex drive, reducing the results of gym workouts and even causing him to lose the sharp focus he held for his life’s work. But he was one of the lucky ones. He knew things didn’t have to be this way just because he was 72 and he sought help.

After using a testosterone gel for two weeks, the judge called Raskin and reported he had renewed intimate relations with his wife of 40-plus years, was feeling more like his old self and had basically found his mojo. Huff/Post50 caught up with Raskin, an expert on the subject, to talk about the problem that is popularly known as male menopause. Raskin is the supervising doctor for Ageless Men’s Health, a nationwide facility dealing with men’s health and anti-aging issues.

HP: How common is male menopause?
Raskin: Over the last five to seven years, we are seeing many more patients with male menopause. I think, to some degree, the problem has always existed but now men are starting to come forward realizing that low testosterone levels impact their lives adversely and that needn’t be the case.

HP: Any hard numbers?
Raskin: The leading research on the problem of male menopause is the Hypogonadism in Males study, known as the HIM Study. It found that 38 percent of the men over 45 tested by their doctors have low testosterone. And that doesn’t count the men who aren’t presenting themselves in medical offices seeking care. I believe it is an underdiagnosed condition and is way more prevalent than we think.

HP: But just like female menopause, isn’t this just a fact of biology? You get older, systems fail kind of thing?
Raskin: Female menopause is very different for a number of reasons. For one, we have points that help us define what’s going on — perimenopause, menopause, post-menopause. We use markers that are very obvious to denote where a woman is, when her menstrual cycle stops, when she experiences hot flashes, when she notices a diminished libido. With men, there are no milestones like that. Men’s bodies are changing, but many of them don’t understand that it could be because of hypogonadism — lowered testosterone levels.

HP: What are the symptoms that typically bring a patient to see you?
Raskin: Interestingly, it isn’t only lowered sex drive although that’s certainly one of them. Often, they just feel almost depressed, not like their old selves, they don’t want to do the things that used to bring them pleasure. They have lost their zest for life. Yes, in some cases, there is also erectile dysfunction and diminished sex drive.

HP: So, it’s the husband telling the wife that he “has a headache?”
Raskin: Yes, and he worries about why he’s not in the mood anymore. Sometimes it feels like general fatigue and there may be other conditions going on that we need to rule out.

HP: Like what?
Raskin: Underactive thyroid, anemia, their body composition is changing and they have more belly fat. They are working out but not seeing the results.

HP: So is this something that is confined to older men, guys in their 60s or 70s?
Raskin: Absolutely not. There are men in their 80s who don’t experience lower testosterone levels and men in their 40s who do. Men with Type 2 diabetes are more prone to low testosterone. So are men with high blood pressure and men taking certain medications. Opiate use can lower testosterone. Men who have used — abused — steroids in the pursuit of athletics are also prone to it when the steroid use is stopped. Obesity has also been linked to low testosterone.

HP: What’s the diagnostic process and treatment like?
Raskin: We run a screening blood test and testosterone levels are low, we screen to see what other causes might be present. If those are ruled out, the testosterone replacement therapy is fairly simple. It can be a patch, a gel — that’s the most common — or even shots. These are all prescription medications.

HP: And that’s it?
Raskin: No, there are follow ups to make sure the levels don’t get too high. If testosterone levels are high, it can cause some irritability and aggressiveness. There are some potential links to prostate cancer, although no long-term studies have been done linking testosterone replacement therapy with prostate cancer. In some cases, a woman might complain that before the therapy, her husband wasn’t interested in having sex … and now she says he wants to have it all the time. There are side effects

Original Article

Dr. Damon Raskin at Cliffside Malibu

Dr. Damon Raskin