Tag: relationship

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Do you actually understand what addiction or substance abuse disorder means?

I just had a long term former substance disorder patient turned warrior and full fledged citizen of llife and family and work. She spent years on crack cocaine and it destroyed her life, her job options, her home, her family, and her health. Her once bright appearance became unrecognizable. The good news is that three years ago now, with prompting by her parents who had not yet given up on her, offered her a place to live in exchange for getting help. You know what, she got that help and three years later she is independent, has her own apartment, and her own job and comes into my office smiling with make up on. It is amazing to witness.

it really got me to thinking a lot about addiction and substance abuse disorder. I thought about all the misconceptions that I have heard about it and all the judgement that I have heard about it. Let me take a minute to explain what it really is.

Sadly I have a lot of personal experience with this with patients and I make it a point to listen to their stories in detail, always hoping that I can grab something from one of them that could be used to inspire another patient in trouble.

Let’s first define addiction. The definition of addiction is the fact or conditions of being addicted to a particular substance, thing, or activity. I know, using a word to define itself right? An addiction can also be referred to as a dependence, craving, habit, weakness, compulsion, fixation, or enslavement to a particular substance, thing, or activity. You get the point though, correct? It implies an unhealthy deep attachment to anything.
Now let’s talk about substance abuse disorder. the definition of substance use disorder is the persistent use of drugs despite substantial harm and adverse consequences to oneself and or others. This often described in laymen’s terms as drug or alcohol abuse.

So, you see they both go together. They can’t really exist without each other, but yet they are not the same thing.

Theses are devious bad buddies people. When people often think of addiction, they get either judgy or uncomfortable. They tend to be afraid of or look down on those patients and people, either because they just don’t understand it or they have had some personal bad experience.

I get it, if you have been the victim of a crime perpetrated by someone under the influence of drugs or alcohol, it can be both terrifying and very serious and something that it hard to get. Short of that, most of the judging or condescending toward addiction patients is just a lack of understanding,

This is not me saying that there are basic codes of conduct that should be followed by any human being. No. Not at all. I am just trying to make sure that this particular disease is better understood.

Wait? Did I say disease? Yep I did. Addiction is truly a form of disease with multiple components not unlike diabetes or hypertension. You could tell yourself, there is no way that someone made a choice to be diabetic or hypertensive and an addicted person did! Well, actually, in a way, genetics aside, sometimes people have made choices to gain weight or make other unhealthy decisions that led them to those diagnoses in the first place and once the anatomical changes are in place, serious measures have to be taken to attempt to correct them and ensure a longer life.

Well, whaddya know. The same kind of principles apply to addiction. Addiction has multiple components. There may in fact be a genetic susctibility. There may be environmental factors. There may be stimulating traumas that lead people to try to find a mental way out and they pick the worst one. Last time I checked, no addicts that I have come to know just sat down one day and decided to shoot up heroin out of nowhere. That initial terrible decision came from a variety of different sources and triggers the majority of the time.

Like with any disease, once addiction has rooted itself in the brain, it literally changes the brain anatomy, It literally causes the formation of a whole new shortcut pathway of dopamine to the nucleus accumbens in the brain. This decreases and intensifies the perception of the pleasure response, while also shortening the duration at which it lasts. This is a terrible double-edged sword and even for those who maintain recovery status, there is a risk of that new path always being there, hence the forever fight against cravings and temptation.

Like with any disease, it requires a certain level of readiness before recovery can even become an entertainable option, just like hypertension and diabetes. I have patients every day that are not ready to actualize that they have these conditions and it is incredibly difficult to help them until they are ready. Unfortunately, addiction carries the extra weight of ruining all the patient’s relationships and job opportunities all around them so many people suffer, not just the patient. That is a way that addiction is definitely worse and potentially more powerful.

My whole point and the most important bottom line is to offer a least a slight pause of understanding for the addicted patient. They do need help and hopefully they are willing to receive it. They have to understand going in that it will require a lifetime of strength, resistance and fortitude. It is not a job or a task that is completed in a day. There are multiple steps every single day to keep the train on track so to speak. It is no easy task, but it can potentially save their lives.

Have a great day everyone. There are potential heros at heart everywhere.

Dr. Katz

Look How Far We’ve Come!

My husband and I have just celebrated 31 years together, 25 of them legal! Yes, that means that we just had our 25th wedding anniversary. We got to spend it in New Orleans with all kinds of food, ghost, voodoo, music, and fun. It was a wonderful time. I felt so fortunate that we got to spend it together, just the two of us. It had been several years since one or the other of us were sick and could not enjoy each other on our anniversary for one reason or another. This year was truly a blessing.

I started thinking back about how far we’ve come. I first met my husband in medical school. How he first drew my attention was the fact that he was literally the guy that laughed 30 seconds longer than anyone else in the entire lecture auditorium, loudly and with vigor. To the point that you were kind of shrinking down in your seat and hunching your shoulder with embarrassment, even though you weren’t the one doing the laughing…Oh lord. He also wore leisure suites fresh out the 70s every single day to school. Um what?! I gotta say, that was unique if nothing else.

So, we weren’t actually friends or hung out in any way and then one day, he invites himself to a concert with me and a friend of mine. I am ashamed to say that we actually refused to pick him up at his apartment because he lived in a part of Detroit that we were scared of at at the time (this was back in the 90s, not Detroit as we know it now). Well, he was un-fased and actually drove an hour way to meet us up at a dance club in his broke-ass, bungie cord hatchback attached Sunbird SE to meet us! We ended up dancing the night away. He had the whole club heying and hoing in a matter of 20 minutes! He complimented my absolutely horrible outfit…with sincerity! We ended up going back to my house together and he looked with rapt attention at my ridiculous post card collection and ate my parents terrible food and we talked til dawn, just like a movie. Honest to gosh.

Now, here we are 31 years later. Still happy and thriving. We have mounted the sometimes un-seemingly recoverable obstacles and tragedies and kept on going. We are both independent physicians and take care of people of all ages every day. We laugh until we almost pee our pants. We like the same ridiculous jokes. We watch chick flicks together. We are parents to three beautiful girls, who feel more like 6 any given day. I’m telling ya, we got it going on. You just never know what joy you could end up with if you give things a chance.

Dr. Katz

I am so ready to do even more good in the world.

I have been given multiple gifts lately. I am humbled and fortunate to have survived brain cancer while breaking some records. I have returned to full functioning, besides the need for the occasional brief power nap. My memories are returning. My stamina is approaching normal levels. My business is getting back on track. All of these are such wonderful things.

Even more wonderful lately is that I have had several old acquaintances, students, etcetera reach out again for the first time in a long time. They have heard that I am healthy again and would like to get reacquainted. Some of them have stories of how they have learned from me. Some of them need my help once again. I am so blown away and honored by these remembrances. Yes 100 percent yes! Let’s reach out! Let’s reconnect! Let me help you! It would be my pleasure. I am grateful that you even thought of me. Let’s do this! I am ready to continue my outpouring of good into the world. I am ready to continue to convert my sometimes tough and traumatic experiences into good advice and support for others. I am ready!

Have an amazing and blessed day everyone!

Dr. Katz

How to give bad news ” the right way.”..or what is the patient’s role in their own health care?

Ok what the heck does that mean? I am going to tell you what it means to me. I have had to give a lot of bad news lately. I have also had to receive a lot of bad news myself lately with all my cancer battle stuff.

Most of the news I have had to give has been heartbreaking because the scenario was scarily familiar: women who hadn’t had regular care in many years and finally made their way to me. I had to be the one to drop the verbal bomb on them about something that was probably either preventable or vastly more treatable with earlier detection and treatment that could have come with routine, regular care.

So, what is the best way to go about giving bad news? I feel like this is something that we are never really taught in a meaningful way in medical school. I have not seen any significant study proven data that describe exactly how to do it. Most of the techniques that I use have come from my own experiences as a patient and the experiences that I have with my patients.

The first thing I would like to emphasize is that you really need to put the time in to know your patient. You need to know much more than the details of their history and their diagnosis. You need to take the time to know them as a person. You need to have an appreciation of their life situation and the availability, if any, of any family or friend support. You have to at least have an idea of what they are ready to handle and digest in terms of information about their diagnosis. Not every person is the same. Not every person is ready to hear the complete blunt truth all at once. Some need to hear things in phases and parts. Some need to hear it all at once. You need to figure out which is which.

Please, do not attempt to commiserate with the patient by saying things like ” I totally know how you feel…or I completely understand what you are going through.” There is a 99 percent chance that that is not true, unless you literally have gone through the exact same thing. It almost is kind of an insult to the patient and minimizes what they are going through without you meaning to. It is much better to say something like…”Of course I can’t possibly fully understand what you are going through, but I am going to do my best to help you get through it. or…”.I know this news is hitting you very hard right now, but I want you to take a minute to take it in and let me help you figure out what direction to go next.”

It is essential to get the patient actively involved in their care. This sounds obvious, but you would be amazed at how often a patient gets almost immediately lost in the shuffle of the “team process” without actually being able to be the captain of their own team. This is absolutely crucial. This is the very first stage of empowerment for the patient that has to be initiated as soon as possible. This is the beginning of the way to help them see their way through their diagnosis. I am always puzzled at doctors that are wary of patients that are knowledgeable and want to be involved in their care. I personally feel that this is the ultimate blessing and one of the best probability indicators of success and survival. We physicians should never be unnerved by this. We as physicians need to realize that our roles are as team members and advisors with experience, never patriarchal dictators of patient care regardless of patient input.

Just some food for thought guys.

Dr. Katz

The time that guy sent me a “d k” pic.( One of the many things I just can’t make up.)

Hello everyone. Long time no write. As you know, I have been an obgyn for over twenty years, so I have seen a lot of crap…from the LADIES. I have been the palace of pelvic exams, beauty treatments, intimate secrets and more for many many years. Nothing really surprised me….until the other day.

I was on my social media( because nowadays you can’t seem to be successful in business without using it), and I clicked on one of my many direct messages for one of my companies. I frequently get messages from both male and female clients. That’s right guys, men get beauty treatments in secret too!. For now, let’s call the guy ” Joe.” Well “Joe” sent me a message, after trying to call multiple times. I give him the benefit of the doubt and try to open the message. Lo and behold there was a pic of “Joe” from the waist down in all his naked glory, cradling himself with his hand, as if to accentuate the size difference between the body parts. Whoah “Joe!” What the hell made you think I wanted to see that? I have one at home that I can stare at whenever I want by the way. He included a message to say that he sent it because I am such a sexy doctor….ummm…ok.

Here’s my question “Joe.” What were you hoping to get out of this? Was this flirting, in lieu of flowers or candy? First and last strike for me I’d say. Were you trying to force me to look at your genitals? That’s coercion man.

I decided to do a little research. How did/or since when did sending “D k” pics become so popular? Interestingly, no one knows. GQ did an article about this in August of 2019. It was very interesting. Apparently most men genuinely hope that whoever received the pic will whip themselves into a sexualized frenzy and immediately send back their own nudes. They also noted that most of the time when WOMEN sent nudes, they included their face. Not so with the penises. Just penis only. This tells me that these guys don’t think they have to preconsider at all when sending these little “presents.”

Unfortunately, this primal impulse has somehow lead to validation of the “d k” pic as a valid form of courtship! What?!!! The Journal Of Sex Research says that the thinking is very transaction oriented. ” IF I send this pic, they will send one back.” When we look back in history, the ‘D k” pic goes all the way back to Roman graffitti. I am not kidding you. Initially it had to be drawn or scribbled by hand but now with technology, it can all be potentially anonymous, which leads to a ton of risky sexual behaviors. The same study made the distinction between solicited( did you ask for it?) and unsolicited( no thank you). The only scenario in which unsolicited pics were welcome was for gay men on dating sites. For the rest of folks, it only stimulated shame, anger, and disgust.

So, we’ve studied it. Most people don’t like it.( Yeah right here!) I say cut it out will yah? Know your audience! It’s one thing to send a nude to a person you are in a relationship with ( if they are into that kind of thing). It’s quite another to send anonymous body part pics to someone you don’t even know. The moral of this story is put it back in your pants! I have no desire to look at it! #penisstrangerdanger

Dr. Katz

So, why did you come in to see me?

Just remember. This is supposed to be funny, but with a side of truth.

You know, my life is full and interesting. I get to help people every day and do what I love. That makes me one of the luckiest people I know. I will never forget that. I used to think, before I actually went into medicine, that every patient that would walk in that door wanted to be there and would be ready to be a part of their own healthcare team. Weirdly, that is not the case. This is true for a large portion of my patients, but for some, I am not so sure.

As I reflect over the last 20 plus years, I realize that there are several types of patients in my practice. Let’s review.

There is the patient that you inadvertently become friends with and become attached to. To some extent, this happens to me all the time. I always try to bond with my patients in attempt to care for them better. I try to get insight into their lives to help them through whatever issues they are trying to solve. They always tell you in medical school never to get attached, but sometimes I can’t help it. In my mind, it is a reflection of the depth of my caring. I am always careful to respect doctor patient boundaries though. It’s not like I go party at their houses or anything.

There is the patient that doubts literally everything you say. I mean everything. For every plan you come up with, they have a counter plan or they doubt that it will work. They question your every move. They constantly re ask the same questions to see if they can trap you into giving a different answer. I realize that most of the time, this has nothing to do with me. Often, these are patients that have been bounced from office to office without actually getting the help that they need. Or, worse yet, they have had a bad experience or suffered malpractice and this makes it very difficult for them to trust any doctor. I try to take that into consideration when working with them.

There is the patient who thinks THEY are the doctor. You know the one. They grew up with family members or friends that are physicians and they know just enough to be dangerous….to themselves and your 16 plus years of schooling are not going to change their mind.

There is the entitled patient, who thinks only of themselves and becomes indignant when attention is not focused on them. These are the patients that become irate when their pap smear is interrupted because I have to run to the hospital to save someone who is hemorrhaging. The “big picture” is somewhat lost on them. They want special treatment and have tantrums when things do not go their way, regardless of the reason. I try to set very clear communication and expectations with these folks, but sometimes they get upset nonetheless.

There is the patient that “never goes to the doctor.” This is the patient that hasn’t been to the doctor in years because they haven’t had any symptoms. This is the patient that doesn’t trust doctors and has to make sure you know it by repeating the first two statements multiple times during their visit. However, if this same patient suddenly has an issue that they determine to be urgent, you had better drop everything and address it right away. Never mind that they have neglected their health for years. It is up to you to fix it….and quickly……so they can go back to never coming in for check-ups.

Let’s not forget the self-diagnosing patient. We all know that with the help of Google, our friends, our family and the chiropractor, we can figure anything out on our own, even before reporting to the doctor’s office. Those are the folks that come in convinced they have a rare tropical disease because Doctor Google said so after they typed in their symptoms. It is often very difficult to talk them out of it, but I try. Half the time, they are apologizing for looking stuff up in Google, as they are insisting that it has to be correct!

There is also the patient with overbearing family members. In my case, this most often presents and the teenage patient with the anxious parent. The parent is often on a covert fact-finding mission to discover if the teen is sexually active or not. They talk over the patient, and try to fill in all the details to show how concerned they are, but then don’t really seem to want to hear what the teen has to say. I get that they want to make sure the patient gets what she needs, but this behavior only shuts down any potential successful communication that I was hoping to have the patient.

There is a final category. This is the one we spend our whole careers hoping to encounter: the patient that reminds you why you went into medicine in the first place. This is the patient that appreciates what you do for them and how you care for them. This is the patient that is nice to your hardworking staff. This is the patient that follows through with what you recommend. This is the patient that talks with you not at you at the office.

The bottom line is that my job offers infinite variety. All of these patient types keep me on my toes and my mind fresh and ready for anything. They each have their own advantages and challenges. It’s not exactly how I thought it would be, but I wouldn’t change a thing.

Dr. Katz

Embrace where you are now, but don’t forget where you have been.

closeup photography of pink rose flower

I feel grateful every day just to be above ground and be reasonably physically and mentally healthy. I have a great family. I have rebuilt bridges. I have strengthened old relationships and built new ones. I am attempting to take even better care of myself and make myself a priority. I have made myself a mission of positivity that I attempt to fulfill at least once a day, no matter how small the triumph.

Wow! It seems like a lot of work doesn’t it? Frankly, it is, but so Worth IT! There are days when I get tired and don’t feel like putting in an effort. That’s when I have to stop and remember where I was even a year or two ago: somewhat depressed, frustrated, lonely despite people surrounding me, full of cancer trying to take my life, not able to work like I wanted to help support my family, mentally swirling with guilt and self-induced feelings of failure.

I have come a long way since then, but in order to keep my current path intact, I need to keep in mind where I came from and the lessons it taught me. I learned that no one can fully heal all of me but me. No one can really help assure my future without my help and driving force. I need to be mindful and grateful of the “good days” even if thrybaten’t as frequent as I would like. I learned that there isn’t always a tommorow, so I better make damn sure that today is the best I can muster. Nobody can do that for me. I’ve got to care enough to do it myself.

Dr. Katz

Man! It’s hard to feel sexy when you have cancer.

Picture the scene: Your partner gives you the let’s get frisky look. They start petting you in the way you are normally into. The sexy dance has started. The lights are dimmed aaaaaaand……nothing. You are laying there all bald and post chemo( well it has been a few days but you get the idea), fresh off your latest chemo hot flash, tired, bloated and not the least bit sexy….in your mind. You just aren’t up for it. It’s not you. It definitely isn’t your partner. It’s the freakin absence of sexiness that sometimes comes with cancer and chemo. I tell ya, the changes in appearance alone are a real confidence killer at times. My husband is the most amazing partner and best friend on the planet and regular me can’t get enough of him. But, cancer me is another story.

Cancer and cancer treatment can have a very significant impact on a woman’s sexuality in many ways. Disfiguring surgery may be required that can significantly affect your self esteem and confidence. Treatments can sometimes put you into premature menopause with hot flashes, vaginal dryness, pain with intercourse and decreased libido. Certain pelvic cancers require such extensive surgery, radiation, etc that a woman is left without proper function of her sexual organs permanently.

I get it, this sounds all doom and gloomy. The good news is that not all women are left with permanent sexual dysfunction after cancer. Sometimes the effects are temporary and things go back to normal when treatment is over. I am seriously hoping that I fall into this category.

Fortunately the data shows that if a woman was able to have satisfactory sexual experiences before cancer, she will be able to again. The American Cancer Society has a whole section of helpful tips and information for women who are having sexual issues resulting from cancer treatment. Some of these are in fact very helpful. The bottom line of all of them is that sometimes you have to get creative and you have to reinvest in your own self-love and confidence. Sometimes the same techniques for sexual satisfaction that you used before will not be successful anymore. You might not even have the same parts anymore. You may have to use more lubricant when you didn’t have to before. You may have to explore different things that excite you. You may require a vibrator for extra stimulation. You may need to try different positions. You may need to employ more fantasies into your sexual relationships. You may need dilator therapy to re-stretch the vaginal canal. These are just a couple of examples.

There is an interesting set of exercises recommended by the American Cancer Society for patients feeling anxious about sex and the way that their appearance has changed and adjusting to those changes. They suggest looking in the mirror, dressed at first, and noting the changes in your appearance: your surgical scars, ostomies, missing parts, etc. Then notice what you try to avoid looking at. Then while dressed, try to find three things that you like about your appearance. Once you are comfortable looking at yourself as a stranger might see you, then change the exercise and repeat it with you being dressed “sexy” for your partner. Finally, repeat the exercise nude with the same steps until you are able to look at yourself and adjust to the changes and feel comfortable. Don’t stop until you can give yourself 3 compliments like you did in phase one of the exercises.

The last thing to address regarding the impact of cancer on sexuality is the anxiety that goes along with it. It takes time to realize even when treatment is over that you are actually better and that life can go on, including sex. Clear communication is the absolutely paramount here. Talk openly with your partner about your fears and issues. Don’t leave them in the dark and just reject them. They can’t possibly understand what is going on in your head unless you tell them. Get therapy if you need to. Talk openly with your doctors. You be the one to bring it up. I can tell you right now that most physicians are not comfortable enough to make sure to address sexual issues at any time, much less with their cancer patients. This will be something that you really need to take charge of and advocate for if you want things to change and improve. As much as we try to deny it at time, our sexuality and sexual health are key components to our relationships and overall health. Sex is just as important for cancer patients as it is for every day folks. So, do what you can to preserve it. It’s for your health!

Dr. Katz