#and I know a lot of mental health professionals are similarly frustrated about the lack of care governments have

[chipped-chimera]

I think the large part of the reason why people get extra pedantic about those with mental illness engaging in self-destructive coping mechanisms (because that's what all of these are! Coping mechanisms! Even for those who are not 'mentally ill') is because it is loudly showing the symptom of a larger problem - that society at large has let this individual down, and badly.

Mental health attitudes have improved a lot over the recent years, but there is a certain kind of bitterness around it for me as someone who has been living with mental health issues 'officially' for 14 years (but arguably might have been my whole life) to see governments (or mine at least) finally sit up and throw more resources into mental health support services post pandemic because they KNOW it's going to have a lasting knock on effect.

Like I am glad it is happening. I am glad there is more support. But at the same time I'm wondering where was this 15 years ago when I was diagnosed with depression which would turn out to be treatment resistant over the years? Where was the care that could have gotten me out of the hole I was in and identified root issues, instead of me largely having to figure out that shit myself at 30? Where is the financial offset for the really expensive treatment I now have to get just as a last ditch effort before literal BRAIN SURGERY just so I can fucking live as someone below the poverty line? Where is recognition of the fact that every medication I have to take to keep myself stable enough to keep going is basically life support and I shouldn't have to PAY just to keep my will to live?

I know my government has launched multiple different programs over the years to try and drive down the suicide rate, but it's never put a dent in it - in fact in recent years it's getting worse. And that's because they only treat the symptom, not the problem.

Highly distressed people show up to hospitals regularly requesting to be admitted for their own safety, and if they aren't turned away (I have read some SHIT let me tell you) or abused within that system that's supposed to help them (... again, I have read some shit) once they're 'recovered' they're turfed out into the world, right back into the same situations that made them so distressed in the first place.

Neurotypical people who are 'mentally well' only get so bent out of shape over those who are highly depressed or distressed engaging in self destructive behaviour because it is in a way showing them that they have failed. They have in some way, let us down. That they did not care enough. While that distressed person is engaging in self-destructive coping mechanisms to try and self soothe or just hold on to their scrap of life by a thread - they tell us to knock it off because they can't sit with the discomfort. We're inconveniencing THEM by just trying to fucking survive.

Any depressed person has the potential to reach that end point, and unless we actually sit the fuck up collectively and get our shit together, address the REASONS people are depressed like discrimination, ableism, racism, poverty etc. nothing is going to change. Telling someone to 'knock it off because you're making me uncomfortable' isn't going to solve shit. It's only going to make it worse.

Because right now when someone has depression? That's sad. But when someone commits suicide? Now it's a tragedy.

Depression was ALWAYS a tragedy of society. And it shouldn't take someone hitting the point of self harm or death for it to be taken seriously.

Some people really hate the idea of mentally ill people fucking up or making choices that damage ourselves and it's so exhausting. So many people talk about how people should be able to make choices about their own body until it's mentally ill people self-harming, or doing drugs/alcohol, not taking meds, doing things generally considered "unhealthy" and then they decide no, actually, people should be able to take control of your right to make decisions about your body because people deemed "mentally ill" just can't be trusted.

Somehow we're not allowed to do things that bother other people, or hurt our bodies, even if other people do shit like that all the time. Somehow people considered "sane" can exercise to the point of making themselves ill, can drink and "occasionally" do drugs, can refuse to take medicine and even self-harm in ways but we're often not allowed to without someone threatening to violate our right to decide about our bodies. Because we don't understand consequences or we "might kill ourselves" but it's so ridiculous.

Like yes, we might kill ourselves. We might fuck ourselves up. We might destroy our entire lives. And? People do that! It happens! It's part of living. People do dangerous shit, people fuck up, people hurt themselves. It's not like we're the only ones who do that but even if we were, you can't puppet other people's lives just because they're living them differently.

Not without violating their right to make decisions about their body. Not without being involved in a violent system that destroys mental health and bodily autonomy. Not without being a part of a violent system that will try to make sure no one is ever free.

[bittermuire]

A (long) analysis of Azriel,

+ a bit of discussion about Gwynriel vs. Elriel at the end.

Lately I’ve seen much discussion surrounding Azriel, and there seems to be a lot of hazy gray area. We know he has a terrible past, carries a lot of trauma, is both mentally and physically scarred, and has disturbingly possessive habits. But why? That’s the question.

I think most of Azriel’s character can be filtered into three sections: his anger, his possessiveness, and his self-loathing. Altogether I believe these form his crippling sense of emotional immaturity, which ultimately shines through most every action he makes in the books.

So yes, I firmly believe Az is a child in the body of a 500 year old Fae. But is he treated as such? No. No, he is not. In fact, he’s treated as the exact opposite, and that can’t be doing wonders for his mental health (which is already in shambles. Off to a cheery start.)

Let’s take a look at his past. He was both mentally and physically abused for the majority of his childhood. Then he was thrown into an unforgiving culture that both mentally and physically abused him as well. Then he was essentially bullied by Cassian and Rhysand for quite a while... until they randomly decided to like him, which is a choice he didn’t seem to play a hand in. And then he became a professional torturer. All the while falling madly in love and becoming obsessed with a female who can’t love him back. Not to mention he’s been ostracized his entire life.

(One big thing though, that I’m going to reference frequently, is Azriel’s constant chase of “happiness.” Kind of like my friends with ADHD. We squeeze all the serotonin we can get out of one thing and then fall into a listless, depressed haze until we find another. I honestly think Azriel does the same thing with people--he latches onto them and lets his mood swings rely on how much attention they do or do not pay him, and whether it is positive or negative.)

So I’m going to go through his relationships with pivotal characters and try to explain what I think is really going on with Azriel.

Regarding Mor:

He was obsessed with her for most of his life. He was incredibly possessive of her and fell instantly in love upon seeing her. Do I think it was love? No. But does Azriel think it was love? Yes, and that is so important. It shows how desperate he was for human connection.

This “love” spiraled into centuries-long obsession that we’ve all seen play out throughout the series. But why is it obsession, and not love? Well, I’m going to go ahead and say that Azriel doesn’t know how to love. He’s never been shown genuine love and so he doesn’t know how to show it to others in the way he intends. He’s basically a baby.

But right after he falls head over heels, Mor sleeps with Cassian, and then Cassian plays the role of the buffer between the two of them all the way up until the events of ACOSF. This is where I think Azriel’s anger comes into play. He can’t get to Mor. His best friend, his brother, is blocking him from her. He can’t touch her, love her, feel her, and he’s so desperate to. But he literally has no way to communicate it because he doesn’t know how, and so he responds in the one way he’s able: anger. And jealousy. And intense protectiveness that eventually begins to translate as possessiveness.

Again, he lets his happiness rely on Mor because he can’t make himself happy, and so his lack of emotional maturity ends up revealing him as desperate and unable to communicate his feelings of inadequacy and frustration. I’m not trying to justify his behavior, not at all. But I think this could be a decent explanation.

Regarding Cassian and Rhysand:

I mean... I kind of hate the way these two have treated Azriel. They all have their fair share of trauma, but Cassian and Rhys also bullied him and ostracized him, and then basically said, “Oh, we like you now.” Which completely leaves Azriel in the dark as to where he stands with them, and strips him of awareness regarding how his friendships with them will operate.

And then he becomes the head of espionage for the Night Court, which involves lots and lots of torture. What kind of message does that send? You’ve seen dirty things, Az, so you don’t mind doing the rest of the dirty things for us, right? That’s the only real message I can get from this. Which then plants the message in Azriel’s head of: Not only do I do dirty things, I myself am a dirty, disgusting thing. Thus, furthering his already deep-seated sense of self-loathing.

Plus, the IC generally operates with a pack-like mindset. One person’s method of healing is everyone’s method of healing. It worked for one person, so it worked for everyone. It’s a very naive mindset, and very toxic as well, so it’s not surprising that literally everyone in the IC is colossally messed up despite preaching themselves as having overcome their demons.

So Azriel never really gets to understand himself and mature as a person. He’s stuck pretending to be perfectly fine underneath Rhysand’s oh-so-benevolent and compassionate hand. Rhysand and Cassian recognize Az as being a little... odd, by seeming to think things like “he’s the quiet one” and “he’s the serious, scary one.” But do they attempt to understand him? No. They leave him to his own devices and let him figure it out himself.

That’s the issue. He’s not ever going to figure it out himself, so long as he’s surrounded by the people who’ve been unwittingly suffocating him for most of his life.

Regarding Elain:

Azriel’s infatuation with Elain, in my opinion, comes as a direct result of his detachment from Mor. Just like one hyperfixation fades quickly from an all-consuming thing to a passing thought, Azriel has shifted from one obsession to the next, in order to keep his spirits on a high.

But I think his feelings for Elain reveal a lot of what Mor did not. Why does he view Elain as so holy compared to him? Why is he so hesitant to touch her? Why does he put her on such a pedestal? That’s his self-loathing coming through again. He hates himself so much that he has to place her above him.

He wants to touch her and love her, just as he did with Mor, but again he is unable. It's a repeating pattern that he can’t get himself out of.

Let’s also look at the way Elain and Azriel’s friendship/relationship began. He had to take care of her, and treat her with utmost respect. She looked at his scars or his siphons, both monstrous looking things, and called them beautiful. Let’s remember that he’s basically a child who’s rarely known genuine love. The minute he gets a glimpse of it, he’s going to grab it by the neck and crush it to his chest. Plus, the fact that she’s the last sister left unattached and he’s the last brother left unattached is probably even more convincing for him that he and Elain are meant for each other. When he’s denied this love that’s come nearly close enough to grab, he responds in the only way he’s able: anger. And jealousy. Just like he did with Mor.

But moving on, that glimpse of potential love comes from Elain. That’s why he’s able to let go of Mor; a relationship with Elain suddenly becomes possible. He’s terrified of ruining this potential love and is incredibly drawn to her all the same. Best of all? She wants him too.

BUT. Azriel knows how fragile Elain is, so he walks on glass around her, coddling her, putting her first like he’s put everyone else first since being a part of the IC. I think he wants to save her from becoming like him. He essentially plays the role of her white knight, entirely losing his sense of self-preservation (not that he ever had one), and thus loses any chance of letting Elain help him mature in return.

Regarding Gwyn:

Now, Gwyn is a different story.

We know Azriel likes her. Maybe not in a consciously romantic way, but he likes her. She makes him smile and laugh, and he finds her amusing. He doesn’t have to walk on eggshells around her.

The big thing, I think, is that he doesn’t have to take care of her. At least, I think that’s what makes him so comfortable around her. With Gwyn, he can relax, and he doesn’t have to watch every move he makes. She treats him like a regular person and he treats her similarly.

Now, is it a bad thing that he doesn’t put her on a saint-like pedestal like he does Elain? No. Definitely not. I think this ordinary friendship signals a much healthier relationship than his festering obsession with Elain. Gwyn simply being his friend and not someone that he feels he has to be perfect for is a good foundation for Azriel growing as a person.

Gwynriel vs. Elriel (the necklace):

Honestly, I’m scared for whatever SJM decides to do, because Azriel has a shitload of trauma to move past and years worth of emotional growth needed before he can be a steady partner in a relationship. Both Gwyn and Elain’s character arcs are definitely not finished and so I think that no matter which way his narrative goes, it’s going to be disappointing in some aspect or another, unfortunately. I don’t think that either one of the females’ arcs really fit well with Azriel’s.

But I’m going to take a closer look at the necklace, because I think it’s a telling narrative point.

For Azriel, the necklace for Elain and Gwyn herself, are both “thing[s] of secret, lovely beauty” to him.

By describing the necklace for Elain as such (instead of Elain herself), Azriel unconsciously reveals his more idealistic view of Elain rather than his love for Elain herself. I kind of get the sense of Azriel giving offerings to a goddess, or something like that. He seems to be more preoccupied with appeasing Elain than actually loving her.

Now, this probably comes from, again, his self-loathing and his emotional immaturity. I’m just repeating myself at this point. He doesn’t know how to love himself and he doesn’t know how to love anyone else.

But then he describes Gwyn as such. Gwyn, the person. In my opinion, this demonstrates a potentially much healthier relationship than what he has with Elain. Azriel, instead of wanting to be perfect for Gwyn and wanting to appease her, is simply made happy by the thought of her. It is Gwyn whom he is taken with, not the idea of Gwyn loving him. And so that takes off so much pressure for him, and introduces the hope that he might be able to mature as a person in a friendship or romantic relationship with Gwyn.

Closing thoughts:

Azriel is a blundering, hormonal child desperate for love with no idea of how to get it, in a 500 year old Fae’s body. He’s also surrounded by people who refuse to address his clear issues... his future’s pretty dim, and I think he realizes it. Which is why whoever SJM chooses to be his romantic interest is going to be very important.

In short, I’m scared for what’s to come. But fingers crossed that his incredibly complex character is done justice.

[mindblindbard]

I saw you mention the hidden intervention stat on the forum, but I thought it would be better to ask here. What would each RO be thinking during the intervention? Or if they themselves found the need for the intervention?(Btw, this is one of my favourite WIPs,and I find myself loving it more with each update)One more questions(if that’s alright)who is your favourite RO?

I’m so happy you’re enjoying it! This ask is from forever ago, because it was kind of tricky for me to answer. Mind Blind deals a lot with mental health issues, but I’m always wary of openly discussing the underlying “message” since it can sometimes make the material come across as moralizing. My number one priority, above all, is that Mind Blind be a fun read.

The intervention (based off a hidden “depression” stat) is pretty hard to trigger. Saying “I wish I were dead” once or twice won’t be enough to make it happen, but if you exclusively choose bleak/suicidal thoughts, then characters will begin to worry. I wanted to give players realistic options on how their character might respond emotionally to their condition. Despair is one of these reactions, especially for an MC already prone to anxiety or depression. But the ROs aren’t the kind of people to let you suffer in silence.

Sally will be the least concerned, because she believes that Button is mentally strong enough to overcome, or at least cope with, their depression. Sally’s own powers wrecked her mental health as a kid (it took her years to overcome the crybaby stage). She’s a self-trained, rather than natural, optimist, and she’d try to share this world view with Button.

Gray similarly feels confident that Button can get to a better place. His biggest concern is probably a fear that he might say the wrong thing and make Button feel worse. He’s been very much raised to have a “stiff upper lip,” so it’s not always natural for him to openly talk about feelings. Being honest about his worry for Button means overcoming a lot of his own trepidation.

Glitch will be the most empathetic, because they’ve struggled with clinical depression in the past. Because Glitch has such a positive and bubbly personality, however, their own issues went unseen by others. They would’ve been relieved had someone intervened and helped them through things in the past—but no one ever noticed. Thus, they somewhat view the chance to help Button as a chance to help their younger self.

Kent/Kenna is more inclined to look at things clinically. They see Button’s depression as a lack of serotonin, a condition exacerbated rather than caused by their Pollard Zero. If Button’s struggling enough to trigger the intervention, Kent/Kenna might be frustrated if they then refuse to seek professional help. Not because they don’t respect Button’s ability to decide for themself, but because Kent/Kenna feels like their ability to help is limited and genuinely wants Button to be happy.

Rosy is a quiet pillar of support—letting Button know “whatever you need, tell me and I’ll provide.” Rather than talk a lot about why Button feels sad/depressed, Rosy believes it better that Button work things out internally and will try not to impose. Not that Rosy doesn’t want to help, but they believe that true change must be self-motivated. Rosy has no delusions that their love can somehow “fix” Button’s issues, and they wouldn’t have fallen in love with someone they didn’t have faith was strong enough to overcome their issues.

I love all the ROs for different reasons, and picking an overall favorite is impossible. Glitch is the most fun to write, whereas K and Rosy require a lot more deliberateness. But if I were a player, I’d probably romance Grayson or Sally first just because I’m a sucker for the whole slow-cooker-crush thing.

[psychologyserviceannoucement]

I've Done Therapy Before and It Didn't Work

Therapy is a hard thing to go through. It’s success is dependent upon both the participation of a professional and the individual. It requires discussing and evaluating a lot of personal information that can be hard to tolerate, let alone put active work into. While therapy is a proven effective treatment for a variety of mental health conditions, the reality is that it often takes people multiple attempts to actually reap the benefit of it. That may seem like an oxymoron, but there are a few reasons why someone’s first go at therapy may not work out and why it’s still worth giving a second shot.

If you’ve ever gone through therapy before then I wanna give you props for putting yourself out there to begin with. It’s uncomfortable and vulnerable, but I appreciate that you gave it a shot. Moreover, I extend my sympathies that your efforts didn’t end up being rewarded. I can understand if that experience has kind of turned you off to the idea of therapy or if it’s made you doubt the effectiveness of it all together. After all, there aren’t many other medical procedures that have this same problem. If you go to a doctor to get a bone set, you generally expect it to work without a second attempt. It’s not a very flattering look to say the least. Even still, despite how negative those experiences may be, I believe it is important to consider why things didn't work out before. Because when I say that people often need more than one attempt at therapy, that doesn’t just mean that it didn’t work. It also means that it did work later on. So it naturally brings us to question about what made the difference between the first try and the third.

One of the biggest reasons people give up on therapy is because of the timing. When people are struggling, they can become desperate for any sort of relief. However, therapy as a treatment takes time. Without going into too much detail about how therapy works (see here for a longer discussion), the process is essentially attempting to work with a part of your health that cannot be observed through traditional methods. Instead of conducting tests or making measurements, therapists have to rely on a far slower way to gather information, talking about symptoms a lot. Even after they are able to identify potential factors contributing to the problem at hand, enacting solutions can also take time. Correcting maladaptive thinking patterns, for instance, can be an extended process of convincing a patient that the pattern exists, that it should be changed, and helping them make that change. That’s already going to take a few sessions to accomplish. Lifestyle changes similarly take some weeks to show the effects of. And that’s assuming the first attempted solution proves correct. As such, the typically recommended period of time suggested before you may start to see results from therapy is 3-4 months or 12-18 sessions. And that’s a long period of time, especially for some more severe conditions. It’s very common for people to get frustrated with the process because they are being asked to do a lot of work even though they aren’t feeling better yet. In fact, a large percentage of patients quit therapy well before it has the chance to show it’s effectiveness. So although the effort you put into treatment before was likely difficult and shouldn’t be diminished, it’s possible that things simply needed more time before they could work. On the other hand, by the second or third attempt people are more likely to stick with therapy longer. They also have the benefit of their previous experiences helping them to progress more quickly. So if you’re willing to try therapy again it might be a little easier than the first time.

Another obstacle people encounter is finding a therapist that fits. I often describe individual therapists as akin to a primary care physician, a general knowledge health professional that’s able to tackle a wide diversity of problems. However, while they may have a surface level understanding on many topics, any specific therapist is not going to have a deep knowledge of all of them. Just like other kinds of doctors, individual therapists specialize in different fields and are going to have gaps in their information. These gaps sometimes prove problematic if a therapist is attempting to treat someone with a condition they are not familiar with or cannot relate to. They have a lot of skills and tools that are universally applicable to any problem, but they may not always use them effectively. And that barrier to understanding can appear for a number of reasons. Sometimes it’s a lack of personal, academic, or professional experience. Sometimes it’s a difference in cultural background: religion, race, sexuality, gender, or so one. Sometimes they have certain core beliefs that are in contrast with yours. Some therapists are very strict and direct. Some prefer a more patient-focused approach where they have a more passive role. Not every therapist is a good fit for everyone. It’s entirely possible that the first person you saw just wasn’t the right person for the job. If you were dissatisfied with your previous therapist, I would encourage you to seek out one that specializes in the specific issues you are struggling with. Alternatively, you can seek someone with a similar background to you. I would go so far as to recommend interviewing them to see if they have views and personality traits that would compliment your treatment.

The last obstacle I would like to discuss is a bit more personal. I’d like not to come across as if I am blaming anyone for their negative experiences or accusing them of not trying hard enough. However, it is sometimes the case that someone may attend therapy sessions without truly giving treatment a shot. The thing about therapy is that it looks silly from the outside and there are still a lot of people who are hesitant to accept it’s validity. That is perfectly understandable. I do not expect everyone to put the same value in therapeutic techniques that I do. Unfortunately though, therapy depends on patient participation. Therapists can help you identify necessary changes in thinking patterns and lifestyle, but only if you allow them access to the information they need to understand you. Moreover, it is entirely up to the individual to actually enact the changes recommended. As such, entering treatment without an open mind that is ready and willing to adhere to the treatment can often become a self-fulfilling prophecy. If you go to treatment, fully believing that it won’t work and letting that belief drive your actions, then it certainly will not. And that’s not to say that everything will work perfectly if you try hard enough. It will still be a process. Sometimes you will put your best effort into something and it still won’t work out. However, the only way to know one way or another is to try it thoroughly. I understand that those who are seeking mental health treatment are oftentimes not in a place where they are able to be very hopeful or optimistic. That’s ok. I’m not asking you to believe with all your heart that you certainly will get better soon. But I am asking you to consider if you really did give it your best shot the first time around.

At least those are some of the bigger reasons why people have trouble with their first attempt at therapy. It’s possible they apply to you, but I don’t know much about your specific experience. I can provide as many explanations as possible, but I can’t account for everything because sometimes things just happen. The truth of recovery is that it’s work, but it’s not like climbing up a mountain. Recovery is more like being lost in a forest. It can take a lot of persistence.  You can’t take three steps in one direction and decide that you’ll never find your way out.. You have to walk pretty far in one direction before you can really find out whether something is there or not. If that attempt didn’t work out, you’ll need to change directions and try a different way. It would be much easier if there was a simple path to follow, but it's simply something you’ll have to work on for a bit. Granted, things aren’t always a struggle. There is a way out. The forest doesn’t go on forever. It does stop eventually and there might be signs to help along the way to point to where that might be. You have your therapist as a guide to help you along and the longer you walk, the better you’ll get at navigating. I’m sorry if you feel stuck, or you’re tired of fighting, or you’re frustrated that nothing seems to be working. But hope is not lost. Statistically, you can still and likely will get better. Perhaps it shouldn’t take this much for you to get to that point, but it is still within your reach. Recovery is very much worth the work that it takes to get to it. So despite the obstacles, I hope that you continue to pursue treatment and put as much as you can into it so that you can find what’s effective and make therapy work for you, even if it takes a few tries.

For more information on mental health topics, check out our Index

[jasoningram]

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Does Circumcision Cause Premature Ejaculation

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[babyconnectingworld]

Can weaning your baby cause maternal depression?

A year into nursing my third son, I went to feed him for the millionth time and the strangest thing happened: I was overcome with the almost nauseatingly strong urge to not. I knew it was time to begin the weaning process, just as I’d done before with my other two babies. It took a few weeks to fully wean him, using the same gradual approach I’d taken with his big brothers, all around the 14-month mark. I expected a smooth transition into toddlerhood and looked forward to a life without another human attached to me. But the onslaught of physical and emotional changes that soon followed was overwhelming and all-consuming. I developed seemingly random symptoms I’d never experienced before: debilitating headaches, mood swings, sadness, anxiety and lethargy—it felt like PMS with a side of the flu. It was more intense than the first months of pregnancy had been. After some passive attempts to google my symptoms and find someone who could relate online, I realized I was dealing with one of the least discussed but more difficult parts of postpartum life: an intense reaction to weaning. I can describe it only as the “weaning fog.” My always reliable social media mom groups, and even some deeper research, produced little advice and very few articles on the weaning fog. Of course, I found information on the basics of weaning: preventing engorgement and finding alternative ways to continue bonding with the baby. But this wasn’t what I was experiencing. I took pregnancy tests (negative), visited my doctor (“It’s a phase”) and talked to other moms (huge variety of experiences). I was frustrated and I needed to know why I was feeling like garbage. My husband and I now refer to what happened to me as the “dark side” of weaning. Let’s start with the facts: Research does not, technically, show that postpartum depression or anxiety surges at this time. But that’s because mothers aren’t specifically screened for depression during weaning, as it’s usually a temporary phase and everyone weans at different times—it could be three months postpartum or three years postpartum. High-quality research simply does not exist yet. However, plenty of women report feeling the effects of the hormonal changes that occur during weaning. Reproductive psychiatrist Alexandra Sacks, author of What No One Tells You: A Guide to Your Emotions from Pregnancy to Motherhood and the host of the Motherhood Sessions podcast, explains it this way: “Some women are more sensitive to hormonal shifts than others; some have more dramatic mood changes around periods, during pregnancy, postpartum and around weaning, but these are individual sensitivities—so some people feel better, and some feel worse.” Others don’t notice any mood changes at all. A decline in oxytocin, the bonding hormone stimulated by breastfeeding, may lead to some women feeling low, says Sacks. She also explains that some women feel better after weaning if they had found breastfeeding to be stressful or disruptive to their own sleep (which may increase stress hormones). When you stop breastfeeding, prolactin (the milk-production hormone) drops off, estrogen shoots back up, and all of it sent me into a PMSing, semi-permanent state of terribleness. Verinder Sharma, a professor of psychiatry with a cross appointment to the Department of Obstetrics and Gynecology at the University of Western Ontario, confirms that the prolactin decrease is the issue, but it’s not the whole story: What matters is how the prolactin affects other changes in the brain and results in depression—or even mania. Sharma says to look for a “clustering of symptoms.” Some women may experience comparatively simple hormone changes with weaning, while others might be plunged into a full-blown postpartum depression. I sure had a cluster of symptoms, but I didn’t feel they were depression-like. It felt more physical for me. “We make a distinction between symptoms and syndromes,” says Sharma. For women, all “reproductive events” related to hormonal changes—this can include pregnancy and postpartum, as well as monthly PMS, menopause, and when you’re getting your period for the very first time—increase the risk of psychiatric problems, he says. For example, bipolar disorder mania is extremely affected by hormonal changes—one in three women with bipolar disorder will experience an onset within a year of starting puberty or getting their first period. It’s also the mental disorder most exacerbated by childbirth, according to Sharma.

How to stop breastfeedingIn the 18th century, doctors and psychiatrists did, in fact, distinguish between postpartum disorders and the “lactational period,” but in contemporary studies, they haven’t done this. Sharma says we are still evaluating men and women too similarly and that a paradigm shift needs to take place for us to more holistically consider a woman’s hormones in relation to her mental health. “That change should reflect the heightened risk around the time of reproductive events,” including during weaning, says Sharma. Due to the lack of research in this area, Sharma says there are no concrete numbers on how many women experience depression or other mental disorders during weaning. He thinks screenings for mood disorders during weaning should be as commonplace as mental health assessments during the early postpartum period. Ideally, doctors should be considering and connecting potential changes at each major hormonal shift in a woman’s life. While my so-called weaning fog was nothing like bipolar mania, I’m certain it was affected by the soup of hormones flowing from my pituitary gland and swirling throughout my body. In addition to this hormonal chaos—or maybe because of it—I was also feeling a little sad that breastfeeding was over, while simultaneously feeling glad that we had stopped. After nursing three babies, I felt a sense of nostalgia and freedom at the same time. It’s that classic push-pull feeling of parenthood: Looking forward yet yearning for the past, too. Mourning the breastfeeding period and feeling a sense of grief or loss is common. Catie Agave*, a 36-year-old mom in Toronto, felt it intensely, since she knew she was most likely going to have only one child. “The journey was ending for us, so that brought on sadness as well,” she says. While she weaned her three-year-old gradually, she started to feel foggy within two weeks of completely weaning. “I wasn’t prepared for the change,” she says. “I didn’t feel like myself. I was more exhausted even though he was finally sleeping more. By week three or four, I had a lack of interest in daily activities, which is difficult when you have a child of that age.” She kept her feelings to herself at first, and then did some googling, but she found very few research-based articles and a lack of support, even in her usual go-tos: her Facebook mom groups and breastfeeding forums. “Nobody talks about it.” “There are a lot of people talking about postpartum depression,” she says. “And reading their symptoms, I thought, yeah, this is what I have—this is depression. But nobody ever said you can have postpartum depression from weaning, too. I was very sad, and it lasted for a long time. I couldn’t find anyone else going through that,” she says. “It was a scary experience.” Agave says she was hesitant to talk to her doctor because she assumed postpartum depression (PPD) was for moms of infants, not moms of toddlers or preschoolers, and she worried she’d be judged for her choice to practise extended breastfeeding. She credits her sister with encouraging her to see a doctor, in spite of her fears. “The doctor was supportive and mentioned postpartum depression can happen up until three years,” she says. Sacks is working to popularize the term “matrescence,” originally coined by an anthropologist in the 1970s, as a better way to describe and fully capture the ongoing transitions of motherhood over time, even if your baby is now growing into a toddler. “It’s a helpful framing of new motherhood as a developmental phase, like ‘adolescence’—it’s not a coincidence that the words sound similar,” she says. “Both matrescence and adolescence describe shifts that are challenging because they involve changes in so many parts of life, ranging from the physical, hormonal, social, emotional and all the rest.” Adolescence is a gradual process—it isn’t instant in the way motherhood can be divided into pre-baby and post-baby life. But we need to be forgiving of ourselves, and to acknowledge that it might take time to adjust to all the shifts and challenges happening at once. Your body, your brain chemistry and your identity are all changing. Whether it’s a few months after birth or three years later, women shouldn’t feel ashamed if they experience the weaning fog, like me, or true depression symptoms, like Agave. We all have our own recovery period. Sacks encourages moms to remember that the end of breastfeeding doesn’t mean your baby needs you any less. Agave, who had struggled with anxiety in the past—but never depression—was ultimately referred to a treatment program where she improved through cognitive behavioural therapy (CBT). She was relieved to know CBT was an option, in addition to taking prescription medications, such as antidepressants. (She was prescribed an SNRI but chose to focus on CBT treatment instead.) “Eventually, my hormones regulated and the feeling of depression significantly decreased, but to this day, the anxiety piece is still there. I think a lot of it is the stress of being a mom.” Around the time I was preparing to pursue professional help, my own symptoms eased up, around two months after they began. I found myself reflecting back on the previous two months, asking, “What just happened?” It had felt like the flu, mixed with mild depression, combined with all those yo-yo-ing feelings about my relationship with my baby. I felt so thankful to feel “normal,” or like myself, again. Batya Grundland, a family physician with an emphasis in obstetrics and women’s health in Toronto, and the former head of maternal care at Women’s College Hospital Family Practice, says gradual versus cold-turkey weaning can play a part in the intensity of hormonal changes. She believes weaning is unlikely to be the sole cause; rather, it’s a complex puzzle with multiple additional factors happening all at once. “The tricky thing is that it would be hard to associate symptoms only with weaning,” she says. For many mothers, reductions to the nursing schedule often coincide with a return to full-time or part-time work. Some women will also experience the return of their period, with ovulation and menstrual cycles beginning to regulate again during the same time frame. “It could make sense that describe feeling pregnant. With the prolactin and estrogen changes, you could feel a whole bunch of things,” says Grundland. Not only are hormones changing drastically during this phase, but women may also be spending long days away from their babies, weaning by necessity (or attempting to pump at work), juggling full-time employment, adjusting to the work/daycare dash, not sleeping enough at night and forgetting to take care of themselves in all of this. “Moms are so busy—they need to be reminded that self-care is important, and we need to figure out ways to better support mothers,” says Sacks. She nudges parents to ask themselves how much they’ve slept and when they ate their last real meal. Do you have time to simply go to the bathroom and brush your teeth alone? Have you had time to yourself not engaged in childcare? Sacks says moms need to reconnect to who they are outside of parenting—like seeing friends, spending time with a romantic partner or pursuing non-child-related interests. “If you cut out the majority of activities that were essential to your routine before having a baby, you may feel disconnected from your identity.” Both Sacks and Grundland also recommend seeking help if temporary feelings of sadness become long-term or interfere with daily activities, but they agree that some sadness can be normal for some individuals. Most women can expect to feel physical and emotional changes for about four to six weeks, says Grundland. My journey through the weaning fog, and my version of self-care during the recovery period, meant seeking out meals with multiple food groups, a simple thing that had fallen off the priority list when I was caring for a colicky baby and keeping my other two toddlers alive and happy. I distinctly recall a three-course lunch I bought for myself, including a rack of ribs, that reminded me how to enjoy other things again, as a separate human from my baby. I had forgotten that I needed to eat real food, too. The end of breastfeeding doesn’t mean your baby needs you any less, emotionally, says Sacks. It’s like every other bittersweet aspect of parenting: “You feel a sense of longing when you see clothes your child no longer fits into, but you’re happy they’re growing. A baby is able to eat foods, but the ‘baby phase’ is now behind you. You can want two things at once.” I wanted to be the selfless, amazing super mom, but to also feel zero guilt treating myself to that rack of ribs—alone—instead of nursing a baby for the fourth time that day. I wanted to feel even-keeled and clear-headed again, yet still bond with my baby in the ways breastfeeding had magically provided. In the end, the months-long weaning fog was just another example of the bizarre and unexpected, yet temporary, phases in my first few years of motherhood.   Read the full article

[stephenmccull]

Abbott’s Fast COVID Test Poses Safety Issues, Lab Workers Say

Lab personnel say worries are mounting over the safety of a rapid coronavirus test by Abbott Laboratories that President Donald Trump has repeatedly lauded ― particularly, the risk of infection to those handling it.

Trump and federal health officials have promoted the ease with which the Abbott test can be given to patients, whether at a drive-thru site or a doctor’s office. Another selling point: The test could “save personal protective equipment (PPE),” according to the Department of Health and Human Services.

Yet medical workers say that there’s a serious danger in the test’s design, one that would require much more protection — not less ― for those who administer it.

Running a test involves swabbing a potentially infected person’s nasal passage and swirling the specimen in an open container with liquid chemicals, raising the potential of releasing the highly contagious virus into the air.

When HHS announced it had bought tens of thousands of Abbott’s point-of-care tests for public labs and others across the country, it noted that “only gloves and a facemask are necessary” to administer it.

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The notion of donning less protection runs contrary to recommendations from the Centers for Disease Control and Prevention, and medical workers fear that they could be infected while testing others.

Abbott says the test can return a positive result in as little as five minutes. And its development was welcome news for governors and hospitals across the nation desperately searching for COVID tests for patients and scarce protective gear for medical workers.

“What makes this test so different is where it can be used: outside the four walls of a traditional hospital such as in the physicians’ office or urgent care clinics,” says Abbott Labs on its website. It has already been deployed in public health labs and several drive-thru sites, where people wait in parking lots normally occupied by casino- and cinema-goers.

We Want To Hear From You

Do you work on the front lines of COVID-19? As a medical specialist, health care manager, or public official or employee?

Tell us what you’re seeing, and help us report on important, untold stories. Contact us at covidtips@kff.org.

Send Us A Tip

But lab officials and medical diagnostic experts say running the Abbott machine — used for years to detect other pathogens, including the flu ― requires a technician to leave patient specimens out in the open. Gloves and a mask alone would not protect them.

Standard precautions for biosafety protection in labs include good hand hygiene and the use of lab coats or gowns, gloves and eye protection to protect medical workers when a specimen is being manipulated, according to the CDC. Health workers collecting specimens should wear an N95 mask and other PPE.

To run the Abbott test, medical workers or patients themselves swab an individual’s naval cavity to collect a specimen. Then, the swab is put back into its original wrapping, potentially exposing workers to contaminated materials when they handle it, according to Michael Pentella, the head of Iowa’s state public health lab who chairs the Association of Public Health Laboratories’ biosafety and biosecurity committee.

Abbott’s instructions direct workers to “vigorously mix” the swab with liquid in an open vessel in the machine for 10 seconds — a kind of open system that Pentella called “unusual.”

“This is the only test I know of where you take the swab and you put it back in the paper wrapping,” said Pentella, who hasn’t used the Abbott rapid tests in his lab but has heard concerns about safety from colleagues. “It’s the contamination that could be associated with the wrapper that has some biosafety professionals concerned.”

The committee he chairs plans to issue safety recommendations for lab workers handling the product.

“It’s not like you shouldn’t use the instrument,” Pentella said. “You just have to use it safely.” While Abbott advises customers to use universal precautions for protecting health care workers, the extent to which that happens is up to each organization, Pentella said. “We don’t want to give this disease to anyone.”

Another longtime medical diagnostics expert expressed shock at the way the Abbott test is performed — that a swab gathered from a potentially infected patient must be openly mixed in liquid.

“The best point-of-care instrument is exactly like an automated pencil sharpener,” said the expert, who like others spoke on the condition of anonymity out of fear of retaliation. “You do nothing else.”

A spokesperson for the New York City Department of Health and Mental Hygiene similarly said officials were worried about biosafety and contamination because of how the test is performed, saying its open structure could contaminate the person performing the test as well as the area around the machine.

Trump has been a reliable pitchman for Abbott’s test, calling it a “whole new ballgame” as he showed off the machine in the Rose Garden. In public remarks from Feb. 29 to April 6 ― the day HHS announced it had purchased thousands of tests — Trump called out Abbott 14 times, according to a review of his remarks during daily White House briefings and related events.

“Now, a lot of people love the Abbott test. So do I. You know, the Abbott test is great because it’s, boom, it’s ― they touch, they put it in, and in five minutes you have [a result],” Trump said this week.

As one former HHS official put it: “He likes showy things that can look good.” A White House spokesperson declined to comment further on Trump’s praise of the company.

Certainly the initial HHS purchase of 30,000 Abbott tests to distribute across the country was supposed to do that. About 13,500 of them went to public health labs plus the CDC’s central lab in Atlanta, according to a department spokeswoman. The Indian Health Service received 10,000 tests, and roughly 5,000 were set aside for the CDC’s International Reagent Resource for states to replenish supplies.

Public health labs appeared to be in line for slightly more tests and devices than indicated in an earlier HHS document, obtained by Kaiser Health News, which showed state and local labs would receive a total 5,500 tests and the CDC lab would get 800.

On April 6, when HHS announced its order, millions of Americans were waiting on COVID tests. Multiple public health labs that received a batch from Abbott said they got 15 devices and supplies to conduct 120 tests. Even calibrating the machine would use up a portion of those — before labs could run patient samples. HHS also ordered 50 Abbott ID Now machines for Alaska because of its remote location, according to agency spokesperson Mia Heck.

When asked why HHS said only gloves and a face mask were necessary to administer the test, Heck said the department deferred to CDC guidelines.

Certain states have offered guidance to those handling patient specimens that is similar to the CDC’s. For example, the Washington state health department advised providers to use “appropriate personal protection” when collecting patient specimens ― at minimum, a gown, gloves, N95 respirator masks and goggles or a face shield, according to emails obtained through a public records request in King County, Washington.

Gary Procop, director of virology at the Cleveland Clinic, said he recommends that personnel either wear appropriate protective gear or use the test in a biological safety cabinet, which protects workers behind a glass shield. The large integrated health system is weighing whether to use the quick test in certain settings, including where there’s a low prevalence of disease, and had concerns about workers handling open swabs.

“What you really want to have is droplet precautions,” he said in an interview.

As safety concerns grow, some state officials are still complaining about a lack of supplies from Abbott — despite its statements that it would manufacture 50,000 tests per day.

“It’s incredibly frustrating because there was a lot of talk about this device, there was a lot of hype on it nationally, and that was wonderful,” New Hampshire Gov. Chris Sununu, a Republican, said at a news conference this month. “And then when they showed up, expectations were set really high as they should be. But to actually have 13 of these devices and have no way to use them, I’m banging my head against the wall.”

Abbott has won considerable publicity for the fast Abbott test since FDA granted emergency authorization on March 27. The company has partnered with CVS Health and Walgreens to set up drive-thru COVID testing sites in multiple states.

As of Monday, nine of 15 planned Walgreens sites in seven states are open with the Abbott tests. Walgreens pharmacists are tasked with overseeing patients and “PPE is used throughout the process,” a spokesperson said, without responding to questions about protocol for handling specimens and which specific items employees wear.

CVS Health is operating five drive-thru sites in five states, with each able to screen 750 to 1,000 people a day, spokesperson Christine Cramer said. Nurse practitioners and physician assistants handling specimens use gloves, gowns, N95 masks and eye shields or goggles.

“We won’t open a site until we are sure we have what we need,” she said.

In Washington, people expected to be in close contact with Trump ― including reporters covering his daily coronavirus briefings — have also been tested on Abbott machines.

Abbott spokesperson Darcy Ross said the company has shipped more than 850,000 rapid tests since April 1, although it’s unclear how many went to private-sector clients versus public health sites.

“We recommend our customers follow the CDC recommendations and guidelines for point-of-care sample handling and PPE. Our product information directly links to CDC guidelines,” she said.

The Abbott tests have had several other hiccups. For example, the Food and Drug Administration this month said Abbott would revise its instructions after one method for preserving specimens ― known as viral transport media — caused inaccurate results because patient samples were too diluted.

Pentella, the Iowa lab official, said, “People are shifting their concern from the viral transport media to, now you have a swab in a wrapper that’s potentially contaminated with nasal secretions from the patient.”

On an April 15 call held by FDA officials on the development and validation of COVID-19 tests, Timothy Stenzel, director of the agency’s Office of In Vitro Diagnostics and Radiological Health, was asked whether the agency has a process to remove authorizations already granted for tests found to be ineffective or dangerous, according to audio obtained by Kaiser Health News. The FDA has granted more than 40 emergency approvals for COVID-19 tests since Feb. 4.

He responded that the FDA’s “traditional way” is for the agency and developer to make decisions together on the best path forward.

“We always first want to engage the developer to understand what the performance issues might be,” he said, “to try to understand what the root cause is.”

“If there are indeed performance issues,” he said, “what is the best way to address that as quickly as possible?”

Abbott’s Fast COVID Test Poses Safety Issues, Lab Workers Say published first on https://smartdrinkingweb.weebly.com/

[gordonwilliamsweb]

Abbott’s Fast COVID Test Poses Safety Issues, Lab Workers Say

Lab personnel say worries are mounting over the safety of a rapid coronavirus test by Abbott Laboratories that President Donald Trump has repeatedly lauded ― particularly, the risk of infection to those handling it.

Trump and federal health officials have promoted the ease with which the Abbott test can be given to patients, whether at a drive-thru site or a doctor’s office. Another selling point: The test could “save personal protective equipment (PPE),” according to the Department of Health and Human Services.

Yet medical workers say that there’s a serious danger in the test’s design, one that would require much more protection — not less ― for those who administer it.

Running a test involves swabbing a potentially infected person’s nasal passage and swirling the specimen in an open container with liquid chemicals, raising the potential of releasing the highly contagious virus into the air.

When HHS announced it had bought tens of thousands of Abbott’s point-of-care tests for public labs and others across the country, it noted that “only gloves and a facemask are necessary” to administer it.

Email Sign-Up

Subscribe to KHN’s free Morning Briefing.

Sign Up

Please confirm your email address below:

Sign Up

The notion of donning less protection runs contrary to recommendations from the Centers for Disease Control and Prevention, and medical workers fear that they could be infected while testing others.

Abbott says the test can return a positive result in as little as five minutes. And its development was welcome news for governors and hospitals across the nation desperately searching for COVID tests for patients and scarce protective gear for medical workers.

“What makes this test so different is where it can be used: outside the four walls of a traditional hospital such as in the physicians’ office or urgent care clinics,” says Abbott Labs on its website. It has already been deployed in public health labs and several drive-thru sites, where people wait in parking lots normally occupied by casino- and cinema-goers.

We Want To Hear From You

Do you work on the front lines of COVID-19? As a medical specialist, health care manager, or public official or employee?

Tell us what you’re seeing, and help us report on important, untold stories. Contact us at covidtips@kff.org.

Send Us A Tip

But lab officials and medical diagnostic experts say running the Abbott machine — used for years to detect other pathogens, including the flu ― requires a technician to leave patient specimens out in the open. Gloves and a mask alone would not protect them.

Standard precautions for biosafety protection in labs include good hand hygiene and the use of lab coats or gowns, gloves and eye protection to protect medical workers when a specimen is being manipulated, according to the CDC. Health workers collecting specimens should wear an N95 mask and other PPE.

To run the Abbott test, medical workers or patients themselves swab an individual’s naval cavity to collect a specimen. Then, the swab is put back into its original wrapping, potentially exposing workers to contaminated materials when they handle it, according to Michael Pentella, the head of Iowa’s state public health lab who chairs the Association of Public Health Laboratories’ biosafety and biosecurity committee.

Abbott’s instructions direct workers to “vigorously mix” the swab with liquid in an open vessel in the machine for 10 seconds — a kind of open system that Pentella called “unusual.”

“This is the only test I know of where you take the swab and you put it back in the paper wrapping,” said Pentella, who hasn’t used the Abbott rapid tests in his lab but has heard concerns about safety from colleagues. “It’s the contamination that could be associated with the wrapper that has some biosafety professionals concerned.”

The committee he chairs plans to issue safety recommendations for lab workers handling the product.

“It’s not like you shouldn’t use the instrument,” Pentella said. “You just have to use it safely.” While Abbott advises customers to use universal precautions for protecting health care workers, the extent to which that happens is up to each organization, Pentella said. “We don’t want to give this disease to anyone.”

Another longtime medical diagnostics expert expressed shock at the way the Abbott test is performed — that a swab gathered from a potentially infected patient must be openly mixed in liquid.

“The best point-of-care instrument is exactly like an automated pencil sharpener,” said the expert, who like others spoke on the condition of anonymity out of fear of retaliation. “You do nothing else.”

A spokesperson for the New York City Department of Health and Mental Hygiene similarly said officials were worried about biosafety and contamination because of how the test is performed, saying its open structure could contaminate the person performing the test as well as the area around the machine.

Trump has been a reliable pitchman for Abbott’s test, calling it a “whole new ballgame” as he showed off the machine in the Rose Garden. In public remarks from Feb. 29 to April 6 ― the day HHS announced it had purchased thousands of tests — Trump called out Abbott 14 times, according to a review of his remarks during daily White House briefings and related events.

“Now, a lot of people love the Abbott test. So do I. You know, the Abbott test is great because it’s, boom, it’s ― they touch, they put it in, and in five minutes you have [a result],” Trump said this week.

As one former HHS official put it: “He likes showy things that can look good.” A White House spokesperson declined to comment further on Trump’s praise of the company.

Certainly the initial HHS purchase of 30,000 Abbott tests to distribute across the country was supposed to do that. About 13,500 of them went to public health labs plus the CDC’s central lab in Atlanta, according to a department spokeswoman. The Indian Health Service received 10,000 tests, and roughly 5,000 were set aside for the CDC’s International Reagent Resource for states to replenish supplies.

Public health labs appeared to be in line for slightly more tests and devices than indicated in an earlier HHS document, obtained by Kaiser Health News, which showed state and local labs would receive a total 5,500 tests and the CDC lab would get 800.

On April 6, when HHS announced its order, millions of Americans were waiting on COVID tests. Multiple public health labs that received a batch from Abbott said they got 15 devices and supplies to conduct 120 tests. Even calibrating the machine would use up a portion of those — before labs could run patient samples. HHS also ordered 50 Abbott ID Now machines for Alaska because of its remote location, according to agency spokesperson Mia Heck.

When asked why HHS said only gloves and a face mask were necessary to administer the test, Heck said the department deferred to CDC guidelines.

Certain states have offered guidance to those handling patient specimens that is similar to the CDC’s. For example, the Washington state health department advised providers to use “appropriate personal protection” when collecting patient specimens ― at minimum, a gown, gloves, N95 respirator masks and goggles or a face shield, according to emails obtained through a public records request in King County, Washington.

Gary Procop, director of virology at the Cleveland Clinic, said he recommends that personnel either wear appropriate protective gear or use the test in a biological safety cabinet, which protects workers behind a glass shield. The large integrated health system is weighing whether to use the quick test in certain settings, including where there’s a low prevalence of disease, and had concerns about workers handling open swabs.

“What you really want to have is droplet precautions,” he said in an interview.

As safety concerns grow, some state officials are still complaining about a lack of supplies from Abbott — despite its statements that it would manufacture 50,000 tests per day.

“It’s incredibly frustrating because there was a lot of talk about this device, there was a lot of hype on it nationally, and that was wonderful,” New Hampshire Gov. Chris Sununu, a Republican, said at a news conference this month. “And then when they showed up, expectations were set really high as they should be. But to actually have 13 of these devices and have no way to use them, I’m banging my head against the wall.”

Abbott has won considerable publicity for the fast Abbott test since FDA granted emergency authorization on March 27. The company has partnered with CVS Health and Walgreens to set up drive-thru COVID testing sites in multiple states.

As of Monday, nine of 15 planned Walgreens sites in seven states are open with the Abbott tests. Walgreens pharmacists are tasked with overseeing patients and “PPE is used throughout the process,” a spokesperson said, without responding to questions about protocol for handling specimens and which specific items employees wear.

CVS Health is operating five drive-thru sites in five states, with each able to screen 750 to 1,000 people a day, spokesperson Christine Cramer said. Nurse practitioners and physician assistants handling specimens use gloves, gowns, N95 masks and eye shields or goggles.

“We won’t open a site until we are sure we have what we need,” she said.

In Washington, people expected to be in close contact with Trump ― including reporters covering his daily coronavirus briefings — have also been tested on Abbott machines.

Abbott spokesperson Darcy Ross said the company has shipped more than 850,000 rapid tests since April 1, although it’s unclear how many went to private-sector clients versus public health sites.

“We recommend our customers follow the CDC recommendations and guidelines for point-of-care sample handling and PPE. Our product information directly links to CDC guidelines,” she said.

The Abbott tests have had several other hiccups. For example, the Food and Drug Administration this month said Abbott would revise its instructions after one method for preserving specimens ― known as viral transport media — caused inaccurate results because patient samples were too diluted.

Pentella, the Iowa lab official, said, “People are shifting their concern from the viral transport media to, now you have a swab in a wrapper that’s potentially contaminated with nasal secretions from the patient.”

On an April 15 call held by FDA officials on the development and validation of COVID-19 tests, Timothy Stenzel, director of the agency’s Office of In Vitro Diagnostics and Radiological Health, was asked whether the agency has a process to remove authorizations already granted for tests found to be ineffective or dangerous, according to audio obtained by Kaiser Health News. The FDA has granted more than 40 emergency approvals for COVID-19 tests since Feb. 4.

He responded that the FDA’s “traditional way” is for the agency and developer to make decisions together on the best path forward.

“We always first want to engage the developer to understand what the performance issues might be,” he said, “to try to understand what the root cause is.”

“If there are indeed performance issues,” he said, “what is the best way to address that as quickly as possible?”

Abbott’s Fast COVID Test Poses Safety Issues, Lab Workers Say published first on https://nootropicspowdersupplier.tumblr.com/

[dinafbrownil]

Abbott’s Fast COVID Test Poses Safety Issues, Lab Workers Say

Lab personnel say worries are mounting over the safety of a rapid coronavirus test by Abbott Laboratories that President Donald Trump has repeatedly lauded ― particularly, the risk of infection to those handling it.

Trump and federal health officials have promoted the ease with which the Abbott test can be given to patients, whether at a drive-thru site or a doctor’s office. Another selling point: The test could “save personal protective equipment (PPE),” according to the Department of Health and Human Services.

Yet medical workers say that there’s a serious danger in the test’s design, one that would require much more protection — not less ― for those who administer it.

Running a test involves swabbing a potentially infected person’s nasal passage and swirling the specimen in an open container with liquid chemicals, raising the potential of releasing the highly contagious virus into the air.

When HHS announced it had bought tens of thousands of Abbott’s point-of-care tests for public labs and others across the country, it noted that “only gloves and a facemask are necessary” to administer it.

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The notion of donning less protection runs contrary to recommendations from the Centers for Disease Control and Prevention, and medical workers fear that they could be infected while testing others.

Abbott says the test can return a positive result in as little as five minutes. And its development was welcome news for governors and hospitals across the nation desperately searching for COVID tests for patients and scarce protective gear for medical workers.

“What makes this test so different is where it can be used: outside the four walls of a traditional hospital such as in the physicians’ office or urgent care clinics,” says Abbott Labs on its website. It has already been deployed in public health labs and several drive-thru sites, where people wait in parking lots normally occupied by casino- and cinema-goers.

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But lab officials and medical diagnostic experts say running the Abbott machine — used for years to detect other pathogens, including the flu ― requires a technician to leave patient specimens out in the open. Gloves and a mask alone would not protect them.

Standard precautions for biosafety protection in labs include good hand hygiene and the use of lab coats or gowns, gloves and eye protection to protect medical workers when a specimen is being manipulated, according to the CDC. Health workers collecting specimens should wear an N95 mask and other PPE.

To run the Abbott test, medical workers or patients themselves swab an individual’s naval cavity to collect a specimen. Then, the swab is put back into its original wrapping, potentially exposing workers to contaminated materials when they handle it, according to Michael Pentella, the head of Iowa’s state public health lab who chairs the Association of Public Health Laboratories’ biosafety and biosecurity committee.

Abbott’s instructions direct workers to “vigorously mix” the swab with liquid in an open vessel in the machine for 10 seconds — a kind of open system that Pentella called “unusual.”

“This is the only test I know of where you take the swab and you put it back in the paper wrapping,” said Pentella, who hasn’t used the Abbott rapid tests in his lab but has heard concerns about safety from colleagues. “It’s the contamination that could be associated with the wrapper that has some biosafety professionals concerned.”

The committee he chairs plans to issue safety recommendations for lab workers handling the product.

“It’s not like you shouldn’t use the instrument,” Pentella said. “You just have to use it safely.” While Abbott advises customers to use universal precautions for protecting health care workers, the extent to which that happens is up to each organization, Pentella said. “We don’t want to give this disease to anyone.”

Another longtime medical diagnostics expert expressed shock at the way the Abbott test is performed — that a swab gathered from a potentially infected patient must be openly mixed in liquid.

“The best point-of-care instrument is exactly like an automated pencil sharpener,” said the expert, who like others spoke on the condition of anonymity out of fear of retaliation. “You do nothing else.”

A spokesperson for the New York City Department of Health and Mental Hygiene similarly said officials were worried about biosafety and contamination because of how the test is performed, saying its open structure could contaminate the person performing the test as well as the area around the machine.

Trump has been a reliable pitchman for Abbott’s test, calling it a “whole new ballgame” as he showed off the machine in the Rose Garden. In public remarks from Feb. 29 to April 6 ― the day HHS announced it had purchased thousands of tests — Trump called out Abbott 14 times, according to a review of his remarks during daily White House briefings and related events.

“Now, a lot of people love the Abbott test. So do I. You know, the Abbott test is great because it’s, boom, it’s ― they touch, they put it in, and in five minutes you have [a result],” Trump said this week.

As one former HHS official put it: “He likes showy things that can look good.” A White House spokesperson declined to comment further on Trump’s praise of the company.

Certainly the initial HHS purchase of 30,000 Abbott tests to distribute across the country was supposed to do that. About 13,500 of them went to public health labs plus the CDC’s central lab in Atlanta, according to a department spokeswoman. The Indian Health Service received 10,000 tests, and roughly 5,000 were set aside for the CDC’s International Reagent Resource for states to replenish supplies.

Public health labs appeared to be in line for slightly more tests and devices than indicated in an earlier HHS document, obtained by Kaiser Health News, which showed state and local labs would receive a total 5,500 tests and the CDC lab would get 800.

On April 6, when HHS announced its order, millions of Americans were waiting on COVID tests. Multiple public health labs that received a batch from Abbott said they got 15 devices and supplies to conduct 120 tests. Even calibrating the machine would use up a portion of those — before labs could run patient samples. HHS also ordered 50 Abbott ID Now machines for Alaska because of its remote location, according to agency spokesperson Mia Heck.

When asked why HHS said only gloves and a face mask were necessary to administer the test, Heck said the department deferred to CDC guidelines.

Certain states have offered guidance to those handling patient specimens that is similar to the CDC’s. For example, the Washington state health department advised providers to use “appropriate personal protection” when collecting patient specimens ― at minimum, a gown, gloves, N95 respirator masks and goggles or a face shield, according to emails obtained through a public records request in King County, Washington.

Gary Procop, director of virology at the Cleveland Clinic, said he recommends that personnel either wear appropriate protective gear or use the test in a biological safety cabinet, which protects workers behind a glass shield. The large integrated health system is weighing whether to use the quick test in certain settings, including where there��s a low prevalence of disease, and had concerns about workers handling open swabs.

“What you really want to have is droplet precautions,” he said in an interview.

As safety concerns grow, some state officials are still complaining about a lack of supplies from Abbott — despite its statements that it would manufacture 50,000 tests per day.

“It’s incredibly frustrating because there was a lot of talk about this device, there was a lot of hype on it nationally, and that was wonderful,” New Hampshire Gov. Chris Sununu, a Republican, said at a news conference this month. “And then when they showed up, expectations were set really high as they should be. But to actually have 13 of these devices and have no way to use them, I’m banging my head against the wall.”

Abbott has won considerable publicity for the fast Abbott test since FDA granted emergency authorization on March 27. The company has partnered with CVS Health and Walgreens to set up drive-thru COVID testing sites in multiple states.

As of Monday, nine of 15 planned Walgreens sites in seven states are open with the Abbott tests. Walgreens pharmacists are tasked with overseeing patients and “PPE is used throughout the process,” a spokesperson said, without responding to questions about protocol for handling specimens and which specific items employees wear.

CVS Health is operating five drive-thru sites in five states, with each able to screen 750 to 1,000 people a day, spokesperson Christine Cramer said. Nurse practitioners and physician assistants handling specimens use gloves, gowns, N95 masks and eye shields or goggles.

“We won’t open a site until we are sure we have what we need,” she said.

In Washington, people expected to be in close contact with Trump ― including reporters covering his daily coronavirus briefings — have also been tested on Abbott machines.

Abbott spokesperson Darcy Ross said the company has shipped more than 850,000 rapid tests since April 1, although it’s unclear how many went to private-sector clients versus public health sites.

“We recommend our customers follow the CDC recommendations and guidelines for point-of-care sample handling and PPE. Our product information directly links to CDC guidelines,” she said.

The Abbott tests have had several other hiccups. For example, the Food and Drug Administration this month said Abbott would revise its instructions after one method for preserving specimens ― known as viral transport media — caused inaccurate results because patient samples were too diluted.

Pentella, the Iowa lab official, said, “People are shifting their concern from the viral transport media to, now you have a swab in a wrapper that’s potentially contaminated with nasal secretions from the patient.”

On an April 15 call held by FDA officials on the development and validation of COVID-19 tests, Timothy Stenzel, director of the agency’s Office of In Vitro Diagnostics and Radiological Health, was asked whether the agency has a process to remove authorizations already granted for tests found to be ineffective or dangerous, according to audio obtained by Kaiser Health News. The FDA has granted more than 40 emergency approvals for COVID-19 tests since Feb. 4.

He responded that the FDA’s “traditional way” is for the agency and developer to make decisions together on the best path forward.

“We always first want to engage the developer to understand what the performance issues might be,” he said, “to try to understand what the root cause is.”

“If there are indeed performance issues,” he said, “what is the best way to address that as quickly as possible?”

from Updates By Dina https://khn.org/news/abbotts-fast-covid-test-poses-safety-issues-lab-workers-say/

[sumukhcomedy]

I’m Moving to a Bigger City to “Follow My Dreams”!

Over the years that I have been a stand-up comedian and people have found out about it, I have heard all the positive general sayings that you can hear: from “it’s great you’re following your dreams!” to “one day I’ll see you on TV” to “you have to move to New York or L.A. to make it.” These are all nice sentiments but they also echo a continued misconstruction of what it means to be in entertainment and a creative person. These misconstructions are seen both inside and outside of comedy and likely in other arts and walks of life as well.

I was as successful as a “local comedian” could possibly get in my first year doing stand-up comedy. I won the “Funniest Person in Columbus” contest at the Columbus Funny Bone and the “Funniest Person in Cincinnati” contest at Go Bananas Comedy Club in Cincinnati. Within nine months, I was hosting a weekend at a comedy club. I was a professional making money being a comedian in less than a year which seems unthinkable now. I knew I loved stand-up comedy and I wanted to make it a career and have some kind of impact in a form of entertainment I always admired.

After a few years of living in Columbus, I wanted to move. I felt that was the best idea for my future in comedy and having a career, the purposes of creativity, and my own personal growth. I had spent my whole life in Ohio and my personality has always wanted to experience more parts of the country and the world and types of people.

After visiting San Francisco, I enjoyed the city and its comedy scene a lot. This is something that usually happens for everyone. It’s not shocking to leave a city you’re accustomed to where you see the same people and go to a bigger city and find it eye-opening as I did with San Francisco. It was a walkable city, I loved its public transportation and its weather, it had a bunch of different shows, a talented group of comedians, and a great comedy history as a city.

I started to put the plans in place to have enough money saved to move in 2011 but then I had a health issue come up. Had I not had health insurance from my employer, I would have had to pay thousands of dollars. The cost would have derailed me. Due to the seriousness of the issue, with both fear and a lack of confidence, I stayed at my job and never made that move.

I continued to live in Columbus. I could have been angry about not being able to move (and perhaps I personally was) but I never expressed that publicly. Each year that I remained in Columbus I saw creative improvement. Even if I was stressed out by trying to handle a job where I was being assigned more responsibility and comedy where I was gaining more responsibility in a scene, I saw the positives to both and tried what I could to focus on being as best as I could be.

I was going on the road. I was performing in comedy clubs. I was starting to do corporate events. I was creating quality shows in the city that I lived in and proud to be a part of a scene with other talented people that are now some of my best friends. I was being a professional comedian and creator even if it meant still having a job unrelated to comedy.

I made a couple visits to Los Angeles and I similarly enjoyed the vibe of comedy in the city. I had a number of friends in comedy doing well there. I had family there. After I recorded my album at the Columbus Funny Bone in Spring 2015, I didn’t feel like there was anything more for me to accomplish in the city that built my comedy. Most of my generation of comedians had left. A new generation of comedians emerged. It was time for me to move on and it was amazingly feasible because my company allowed me to keep working for them even in L.A. The time and hard work in Columbus paid off. I became a better comedian, better show organizer, better business person, and earned enough credibility with the company I work for to keep a job that I also enjoy doing.

Here’s me in some parking lot in Indiana on my way to L.A. waving goodbye to Columbus. 

People equate moving to L.A. with “trying to make it” or becoming famous and, sure, that’s likely why most people are here. I just wanted to continue my path in creativity and in comedy with more challenges and with the same upward trajectory I’ve had since winning those contests in the first year. I feel I’m doing that in the now 2 1/2 years in L.A. If a regular job in comedy or some degree of fame comes with it, that would be nice. If it doesn’t, at least I’m personally satisfied with how I worked at comedy.

When I lived in Columbus, there was such an emphasis on moving away if you had talent. You weren’t truly going to “make it” in Columbus and that may be but that’s also dependent on each individual’s notion of what “making it” is. As a result, this kind of geographical inferiority was stuck in my already self-destructive mind as well. But, as time has passed, I think that idea speaks more to others’ misconceptions that Los Angeles or New York are the only places where entertainment and creativity would be at and to me succumbing to these misconceptions at a young age. In comedy, we make out “moving away” to be some kind of accomplishment and it’s not really. It was a personal accomplishment for me to move to L.A. because I always wanted to live somewhere other than Ohio and it took being 30 years old for me to be able to afford and be mentally prepared for it. But just moving to another city means nothing. It’s nice for people from where you’ve lived to cheer you on, it’s certainly a step towards something else and a life change, but it’s not some “end all, be all” to success in comedy or happiness.

A new city, in fact, just brings about a new load of problems and determining how you get through those. But I liked that. I wanted that challenge. I didn’t mind spending my first 6 months in L.A. weaving through the open mics to figure out which were worth my time. I like the experience of it all. I like the creative progression. And, sure, I’m now in L.A. so hopefully the talent and hard work will lead to more opportunities in comedy so other people will think I’ve “made it.”

So many people have said to me over time that they’re glad I’m “following my dreams.” I appreciate that but the manner in which we perceive dreams can be different. For me, my dream in the first few years relied all on comedy success. Any accomplishment I had in comedy from getting booked by a club to having a newspaper write about me to being on the radio would be what drove my happiness. Then I realized that wasn’t actually how I felt or wanted to feel and wasn’t healthy for me. I recall a few months before moving to L.A. which was at a time when Louis C.K. was the most popular comedian in America, I asked myself, “If you were Louis C.K., would you be happy?” And I realized I wouldn’t be. All that fame, money, and appreciation of that magnitude wasn’t really what I wanted out of comedy and I felt it certainly shouldn’t be the driving force behind my personal happiness. Of course, other people do want that. And, definitely, most people believe that is what every entertainer wants. At least personally, if that level of fame is what drove me, then for me nothing in life would ever be enough and I’d constantly live in misery. Also, there are so many factors involved in and so few people able to reach such an apex.

I realized that my happiness in comedy and how I wanted to do it was the most important thing. That’s one factor in why I stopped drinking alcohol and continue to make certain decisions in life with an emphasis on my happiness. I yearned for the challenges that came with comedy, the expansion of my creativity, an advancement in professionalism, and personal contentment with my work and I wanted to do that on a bigger scale. That’s why I moved to Los Angeles. That’s probably not why most people do or how most people perceive such a move. And, at 30 with where I was in life and in comedy, I also felt if I didn’t try it, I’d regret it. And if I do leave L.A. at some point, it’s not because I “failed” or I didn’t “make it.” Just in the same way, if I had stayed in Columbus, I would not somehow be less of a comedian because I don’t live somewhere bigger or “better.” I’ve put myself into a position where any geographical decision I make is because I want to continue the positive trajectory and happiness of my life and comedy.

Over the years that I wanted to move, I gleaned from the comedians who were friends who I also looked up to about when, how, and if I should move. Not surprisingly, those friends continue to do well in comedy as do I following a certain philosophy. I don’t expect everyone to follow that. But I also think it was worth writing this for those maybe not in the biggest or most recognized cities to glean from someone who has been there if they want to. You’ll know when it’s the right time to move and there’s nothing wrong with where you’re at as long as you’re doing your best to maximize the opportunities and your ability where you’re at. And, perhaps, sometimes you need to take a hard look at the mirror and ask yourself if your frustration with where you’re at is more related to you than your location.

People make a big deal about cities in comedy. Sure, it matters in some ways. In most ways, it doesn’t. It definitely should not affect your personal self-worth or your value as a comedian. You are not the city you live in or the city you want to move to no matter how others perceive it. You are not other people’s definition of “making it” or of “dreams.” Your path in comedy is what you wish to make it with the circumstances you have. Mine led me to Los Angeles after 9 years in Columbus and who knows where it will lead next? But the point here is that, as it turns out, my “making it” or “dreams” in comedy ultimately were personal happiness and inner peace and I am accomplishing that and I definitely have to work my ass off in a variety of ways to continue to accomplish that. That wasn’t dictated by being in Columbus or in L.A. but by what I have done when in those places. And, to me, personal happiness and inner peace are far more valuable than a late night TV credit. Of course, I am still hoping to get a late night TV credit. I mean, I’m still a damn comedian.