Shoulder Dislocations, Separations-Lessons Learned in Hospital Emergency Room.

April 27, 2013, (I Am,Forever Grateful to Jesse and Corin) while on a fishing trip on the Chilliwack, (Vedder) River, I suffered a fall, causing a dislocation and minor fracture (probably the Hill-Sach’s Lesion) of the left shoulder.

 I am not complaining about the doctors or nurses who finally treated me; they were very professional; and that treatment was excellent. I am complaining, however, about my reception at Emergency; I never was actually admitted to the Chilliwack Hospital.

One of the admitting/reception personnel; who apparently could not accept,  comprehend, or even consider, the fact that I might be in extreme pain; unable to easily reach into a back pants pocket to retrieve a wallet; virtually unable to use either arm (my injury was somewhat unusual in that I was unable to bring my left arm in toward my body, as people usually will do after suffering a dislocation, meaning that in order to be able to tolerate the pain at all, I had to support it with my right hand)was extremely obnoxious and accused me of being uncooperative. When I told her that I was presently unable to sign any papers she spoke out loudly enough for several other prospective patients to hear “I can’t get anything out of this guy, maybe one of the nurses can but he’s low priority anyway.” It took seven or eight hours, before I was examined or received treatment of any kind. The thing that is comical about all this: nothing in that wallet was later required and I never did sign any papers  all information was already on their computer system. 
What is not comical or funny-the outside of my upper arm and shoulder still feels numbed, a symptom of probable (unnecessary, had I been treated in an expedient manner) nerve damage.My clothing was all soaking wet from the rain, I mention this only because while I told hospital staff that I had suffered either a broken arm or shoulder injury due to a fall, so had obviously suffered severe trauma, was in severe pain, could quite possibly have suffered a compound fracture, could quite possibly have had severe internal or external bleeding, other unnoticed or unmentioned injuries; I was not given even a quick, cursory physical examination--nothing at all--except "observation"-- for seven or eight hours.

The most common, and probable, ways of a separated, or a dislocated, shoulder injury occurrence are through: falling onto your shoulder, especially on a hard surface, being hit in the shoulder, and  by trying to break a fall with your hand.

The two injuries are easy to confuse; but a dislocated shoulder and a separated shoulder are two separate and distinctly different injuries.
Here's the run-down.  To diagnose a separated  or dislocated shoulder, your doctor will give you a thorough exam. You may need X-rays to rule out broken bones and other conditions.

What's the Treatment for Dislocated Shoulder or Separated Shoulder?

If you strongly suspect you or someone you know has a shoulder dislocation, seek emergency care, IMMEDIATELY. There will generally be a short SHOCK PERIOD-this phenomenon occurs even in sudden death- before your body fully realizes that it has been injured. THIS SHOCK PERIOD IS THE TIME YOU MUST USE, BEFORE YOU ARE FULLY INCAPACITATED, IN ORDER TO SEEK HELP.
Further, waiting several hours before seeking treatment could result in unnecessary suffering, and further, damage, to tendons, muscles, blood vessels, and nerves.
Dislocated shoulders need to be treated right away. Your doctor will need to move the arm bone back into the shoulder socket. Since there will be internal bleeding, and bruising, the joint will get more swollen, and more painful, by the minute, the sooner the better.In my case, there was actually two types of pain. First, an over powering-what is often described as dull numbing-except that there was nothing dull about it; and then with any slight movement-a scorching, searing, flame; threatening to consume my entire body. Once the arm bone is back in the socket, some of the pain will go away- it did in my case; but then, I had also been given six milligrams of morphine during the procedure. 
After the shoulder bone is repositioned, you can use conservative treatment to reduce pain and swelling. The same treatment would also be used for a separated shoulder. The patient should see an orthopaedic doctor for a follow-up examination within a few days. Pain relieving medications may be modified and the joint examined to see that relocation has been maintained. The doctor may re-examine for injury to structures damaged by the original trauma.

People with either of these two injuries appear in the ER in an extreme amount of pain, and pain control is the first priority. The usual sequence of events begins with drugs to help with the pain, a quick exam (first responders or first-aid type)  by the doctor, followed by x-rays to make sure no bones are broken. Only then can the dislocated shoulder can be reduced. Most people prefer to be aggressively sedated for the procedure. After the shoulder is back in place and another x-ray confirms this, the patient is allowed to wake up and go home using a sling or shoulder immobilizer.

Dislocated shoulder: in this injury, a fall or blow causes the top of your arm bone to pop out of the shoulder socket. Unlike a lot of joints in your body-your elbow, for instance-the shoulder is incredibly mobile. You can twist and move your upper arm in almost any direction. But there's a price for this ease of movement. Dislocated or separated shoulders can result from a sharp twisting of the arm. The shoulder joint is inherently unstable, prone to slipping out of place; consequently, the shoulders are the most common joint in the body to dislocate. The arm is moved away from the body (abducted) and externally rotated (turning the forearm, palm side up). The joint gives way, and the humeral head, or the ball of the joint, is ripped out of the socket. The structures that hold the shoulder together are torn, including the joint capsule, cartilage, and the ligaments of the rotator cuff. Most shoulder dislocations happen at the lower front of the shoulder, because of the particular anatomy of the shoulder joint. The bones of the shoulder are the socket of the shoulder blade (scapula) and the ball at the upper end of the arm bone (humerus). The socket on the shoulder blade is fairly shallow, but a lip or rim of cartilage makes it deeper. The joint is supported on all sides by ligaments called the joint capsule, and the whole thing is covered by the rotator cuff. The rotator cuff is made up of four tendons attached to muscles that start on the scapula and end on the upper humerus. They reinforce the shoulder joint from above, in front, and in back, which makes the weakest point in the rotator cuff in the lower front.

In severe cases of dislocated shoulder, the tissue and nerves around the shoulder joint get damaged. If you keep dislocating your shoulder, you could wind up with chronic instability and weakness.

The Separated shoulder: despite the name, this injury doesn't directly affect the shoulder joint. Instead, a fall, blow, or sharp twisting of the arm; tears one of the ligaments that connects the collarbone to shoulder blade. Since it's no longer anchored, the collarbone may move out of position and push against the skin near the top of your shoulder. Although separated shoulders can cause deformity, people usually recover fully with time.

What Does a Dislocated Shoulder or Separated Shoulder Feel Like?

Symptoms of a dislocated shoulder are:

1.     The main symptoms of a shoulder dislocation are severe pain at the shoulder joint and upper arm that hurts more when the area is moved. The patient will have great difficulty moving the arm; even a little bit.

2.     Deformation of the shoulder-a bump in the front or back of the shoulder, depending on how the bone has been dislocated.

3.     If the shoulder is touched from the side, it feels mushy, as if the underlying bone is gone (usually the humeral head - top of the arm bone - is displaced below and toward the front).The deltoid muscle (the round muscle covering the shoulder joint) may appear to be flatter on the injured side when compared to the healthy side.

4.     Any movement of the arm may cause pain in the shoulder.

5.     The pulse at the wrist, touch sensation, and hand movement are usually normal. (Damage to nerves, blood vessels, ligaments, tendons, and muscles can occur. These injuries can be difficult to diagnose because you are incapacitated by the dislocation.)

6.     A set of shoulder x-rays is usually standard in diagnosing a shoulder dislocation. They are used to determine the presence of a dislocation, and also to check for other injuries (such as a fracture of the upper humerus, or tearing of the ligaments connecting the associated Injuries).

7.     A significant minority of shoulder dislocations involve an associated injury, such as fracture, tendon or ligament tear, or neurovascular injury.

8.     Fractures: occur in about 30% of cases. The most commonly seen fractures are the Hill-Sach’s Lesion (hatchet deformity); seen in 54-76% of cases, this is a compression fracture that results in the formation of a groove in the poster lateral aspect of the humeral head. It is best viewed on x-ray with internal rotation of the arm and should be looked for in all post-reduction x-rays-collarbone to the shoulder blade).

Symptoms of a separated shoulder are:

1.       Intense pain as soon as the injury occurs.

2.       Tenderness of the shoulder and collarbone.

3.       Swelling.

4.       Bruising.

5.       Deformed shoulder

First-Aid and/or home treatment for either injury; you should:

·         Ice your shoulder to reduce pain and swelling. Do it for 20-30 minutes every three to four hours, for two to three days or longer.

·         Use a sling or shoulder immobilizer to prevent further injury until you get medical treatment. Then follow the doctor's advice about whether or not to use a sling.

·         Take anti-inflammatory painkillers. Non-steroidal anti-inflammatory drugs, or NSAIDS, like Advil, Aleve, or Motrin, will help with pain and swelling. However, these drugs may have side effects, like an increased risk of bleeding and ulcers. They should be used only occasionally, unless your doctor specifically says otherwise.

·         Practice stretching and strengthening exercises if your doctor recommends them.

Most of the time, these treatments will do the trick. But in rare cases, you may need surgery. Surgery for severe separated shoulders is sometimes needed to repair the torn ligament. Afterwards, you will probably need to keep your arm in a sling for about six weeks.

For a severely dislocated shoulder, surgery is sometimes needed to correctly position the bones. If you keep dislocating your shoulder, surgery to tighten the tendons surrounding the joint may help.

When Will my Dislocated or Separated Shoulder Feel Better?

How quickly you recover depends on how serious your shoulder injury is:

·         Separated shoulders may resolve after six to eight weeks.

·          Dislocated shoulders may take longer- more like three to 12 weeks. But these are just rough estimates. Everyone heals at a different rate.

·          Some symptoms, like stiffness, may linger for a time. A separated shoulder can sometimes leave a permanent, but painless, bump on your shoulder.

·          Once the acute symptoms are gone, your doctor will probably want you to start rehabilitation. This will make your shoulder muscles stronger and more limber. It will both help you recover and reduce the chances of future shoulder injuries.

·          You might start with gentle stretching exercises that become more intense as you get better. But don't start exercising without talking to your doctor first.

·          Whatever you do, don't rush things. For young athletes; ease back into your sport. If you play baseball, start by tossing the ball and work up to throwing at full speed. People who play contact sports need to be especially careful that they are fully healed before playing again.

Don't try to return to your previous level of physical activity until:

1.       You can move your injured shoulder as freely as your uninjured shoulder.

2.       Your injured shoulder feels as strong as your uninjured shoulder.

3.       If you start using your shoulder before it's healed, you could cause permanent damage. Getting back in the game early is not worth the risk of a lifelong disability.

4.       Since the joint has been damaged and is unstable, the sling or shoulder immobilizer will need to be worn for a few weeks. At the same time, the physical therapist and orthopaedic surgeon may decide to do range of motion exercises to balance the achievement of joint stability, while minimizing the loss of function. A solid shoulder that doesn't move can limit an individual's mobility and lifestyle dramatically.

5.       Unfortunately, in young people and athletes, the re-dislocation rate is high (up to 90%), and the non-surgical approach that can work for the older person may not work as well for somebody who wants to use the arm aggressively. The conservative, non-surgical approach can take more than three months until return to full activity can be expected

Progression of treatment, further notes:
May 23, 2013: using range of motion exercises, in order to regain freedom of shoulder movement. Unable to lift and at the same time bring left my left arm across in front of my body, unless assisted with my right. Still experience considerable pain in doing so and there is still some swelling and evidence of bruising.

May 26, 2013: yesterday,which would be the 25th; was very discouraged with the way shoulder was coming along; was unable to bring elbow across in front of body and then lift it at all unassisted. Pain had also increased; to the point that decision was made to started wearing the sling again and keep the arm supported pretty well all day. Today, found that not only can   arm be lifted to about mid-chest level unassisted but the pain is again greatly diminished. Will continue to use the sling to give the arm support for the rest of the day however. Appears that real progress has been made but must be careful not to overdo it on the exercising.
June 3, 2013-still experiencing a feeling of numbness in the back of  arm and shoulder. Also feeling some deep joint pain. Still have difficulty bringing arm to a raised position in front of body and would not be able to toss a ball into the air for say a tennis serve,would not feel safe driving a vehicle,would not trust  joint or shoulder to support body weight. Continue to take 2, 500mgs, extra strength, Acetaminophen, apply Volterin rub-found to be more effective than a heat liniment- and wear sling for support after careful daily range of motion exercise.  

.© Al (Alex-Alexander) D. Girvan. All rights Reserved.

The Psychology of Losing Weight--How to keep those pounds off.

If as most of us have found, it’s hard to lose weight, and it is, it most certainly is, then we’ve also found that when we’ve managed to lose a few pounds, it’s been even harder to keep those lost pounds off.

In fact, in every diet study, nearly all those people who’ve managed to lose significant amounts of weight have put it back on within a few months, some even faster.

So any strategy that can help a dieter keep some of the lost weight off is welcome news, as is this study published in the Journal of Medical Internet Research.

In this study, researchers got a group (348 folks) of overweight people to lose 19 pounds on average over a period of about 6 months, which is a pretty good weight loss.

They then got some of the dieters to enroll in a specially-designed web-based program where they had to chart their progress (or backsliding) and where they could also chat with some of the other study participants.

After 2 ½ years, although all the study participants had gained back some weight, those who use the web site the most gained back the least amount of weight, or looking at it from a more happy perspective, the losers who used the web site most were able to keep 9 pounds off after 30 months, while the non-users had gained it all back.

And there’s nothing magical about this web site, I think: just a place on the web (and there are many such places) to keep you interested, eager, honest, and where you can commiserate with others going through the same thing.
But it does seem to help.

Does "Texting" Lead to Depression and or Risky Behaviour in Teens and Adults?

Research and an extensive new survey both indicate that teens who send 120, one hundred twenty, text messages a day or spend more than 3, three, hours a day, are much more likely to be engaged in abnormal, RISKY BEHAVIOUR. drugs, gangs, fights, and sexual activity. They are also likely to be obese.

Research shows these teens often:

• Claim to be bored or that there is nothing to do.
• May be involved in bullying, fights, or "swarming".
• Show signs of depression.
• Are more likely to be involved with drugs.
• Are much more likely to be involved in gangs.
•  Lack interest--especially in  school work and physical activity.
• Are more susceptible to peer pressure.
• Lack self-esteem.
• Start sexual activity at a very young age.

Our Kids Are Not All-right.

It is doubtful however, that reducing access to these electronic "TOYS"would reduce the risk. It is far more important to determine the "ROOT CAUSE"-- the reasons Why?
How, or if, adults are affected remains uncertain; because it is doubtful that any adult spends near as much time with these devices as does a teen.

Teen Stress Doubles Risk of Depression In Adulthood

Stress as a teenager could double the risk of developing depression in early adulthood, according to new research.

Published: 7:30AM GMT 05 Nov 2010

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Stress as a teenager can lead to depression in later life, scientists said Photo: Alamy

The pressures of modern life may be more hazardous to our mental health than previously believed after scientists found there may be a link between the recent rise in mood disorders and the increase of daily stress.

Professor Mark Ellenbogen, of Concordia University, Montreal, said: "Major depression has become one of the most pressing health issues in both developing and developed countries."

 He believes stress is a major contributour to the rise in depression, a leading cause of disability worldwide. It is a growing public health problem that the World Health Organization identified as affecting about 121 million people.

His team is evaluating the stress of children living in families where at least one parent is affected by a mood disorder. They are measuring the levels of cortisol in their saliva. Children from at-risk families have higher cortisol levels and it seems to persist into adulthood.

Prof Ellenbogen said: "Although there may be many causes to the rise in cortisol, this increase may be in part due to exposure to family stress and parenting style.

"We have not yet confirmed that these children then go on to develop mood disorders of their own. However, we have some exciting preliminary data showing that high cortisol levels in adolescences doubles your risk for developing a serious mood disorder in young adulthood."

He added: "Cortisol is something you secrete when faced with situations that are hard to deal with or challenging situations beyond your ability to cope."

His study is looking at offspring of parents who have a bipolar disorder but who do not have mental health issues themselves. It is already known from previous studies that such offspring are at higher risk of developing depression and bipolar disorders.

He said: "But they dont yet have the disorder. That is the beauty of what we have been doing - we have been doing this research specifically to address this question."

The team has been following 150 children age 4 to 12 for a decade, half with parents without mental health issues, the other half with at least one parent with bipolar disorder.

What Prof Ellenbogen found is a link between high levels of stress and cortisol in the early environment and a correlation with later depression. The research suggests they may have vulnerability for depression.

He said: "They adapt by producing high levels of cortisol, which is a good thing, but it may have a negative side effect down the line. What starts out as adaptive (high levels of cortisol), ends up being maladaptive. That is my suspicion and we have some evidence that is the case."

But parenting style had much to do with reducing the stress of life events and early hormone secretion. Children from homes with lots of stress combined with chaotic parenting - inconsistent eating and sleeping habits, job loss, hospitalisation, single parents, marital distress, or divorce showed higher levels of stress and cortisol.

Children from homes with lower stress, a better parental structure and consistent organisation showed normal hormone levels.

Prof Ellenbogen said: "I would like to highlight the fact that parents who do their best to be consistent parents, that really looks like it makes a huge difference regardless of what mental disorders they have that is what I found astounding.

"It is not a small thing having a bipolar disorder. Its quite a significant handicap in many ways. The flipside is that many of our sample is doing incredibly well."

The Problems of Ageing and the Necessity of Ensuring the Continuance of a Daily Routine..

See Also:

Being Single Can Kill You. Can Your Pet Help Keep You Healthy?

The Problems of Ageing.

When society idealizes "growing old gracefully," it asks a great deal of the ageing person, for the over-sixty-five years often bring the most stressful changes of a persons life. Consider the following changes, at least several of which confront every old man and woman.

Retirement

Many people look forward to the period of their lives when they will be free from the demands of the clock and commuter traffic. And, some do find their retirement  years to be "golden'--particularly those who are healthy, happily married, financially comfortable, and well equipped with interests that they are eager to pursue. However, these people are in the minority. Many others--the majority-- cut off from their, long established, daily routine, from the activity that has lent them an identity for a lifetime, feel bereft. In a society that defines and values people according to their CELEBRITY STATUS or career/work roles, it is easy for the retired to feel FUNCTIONLESS AND USELESS. In addition many miss now independent children, friends from the job , and the camaraderie of the workplace.

Poverty

Again: Those who have no money worries in their old age are a minority. Many, now living in LEGISLATED POVERTY find that their pensions (many of which--eg. union pensions--they may not  know how to even access), Social Security checks, and savings do not all them the comforts or even the basic necessities (often forced to resort to "food banks") they once could afford. Furthermore, what income they have is always depleted by inflation. Seniors are always a deprived group.  The deprivations may be subtle, such as not being able to afford to go on a "trip" or to buy one's granddaughter a graduation present, or they may be starkly obvious, such as cold, hunger, living in vermin infested living quarters, or suffering physical abuse. In any case, they are stressful, to say the least.

Loneliness

Many people in the over-sixty five years  must survive the death of a  child or spouse; two of the most traumatic changes that can occur in the life of a human being. The surviving partner may be ill equipped to lie alone--most of us are, and other choices--such as living with one's children--may be unattractive or unavailable. To compound the problem: The longer people live the more our society wants them to die and get out of the way of progress. The more likely they are to see their friends die one by one, leaving them more and more isolated every year.

Physical Changes

Older people must accept the unpleasant fact that in a society that overvalues the looks and concerns of youth--while much of it is necessitated by the expectations of our society-- they no longer act or look young. They are "old fogies". Both men and women may be chagrined at their deepening wrinkles and sagging bodies. In addition old people may begin to notice that their bodies don't seem to work as well as they used to: eyes and ears are not as keen as they were, their walk is not as spritely. Worse still, more than 80 percent of those over sixty-five suffer from some form of chronic illness: heart disease, arthritis, problems with digestion and sleep, and so on, and so on-- none of which they can adequately afford to confront.

An old man or woman may feel stress from every one of these sources. Add to these circumstances the generally negative attitude of the larger society toward the aged--where even the fact of ageing must be hidden under euphemisms like "senior citizens"--and it is hardly surprising that depression and anxiety are common among old people.

And what becomes of the old person who responds to such stresses with anxiety or depression? The most pernicious result is that he or she may be labelled "demented",or "senile" without showing real signs of organic brain pathology. It is easy for family members, nursing home personnel, and especially doctors and nurses who deal with geriatrics and the ageing to make this mistake. Consider the woman of eighty who seems sad and withdrawn, who complains about the food, her health, and reminisces about her past, who talks to herself because she has no other audience, who begins to neglect her appearance and hygiene because she has nowhere to go and no one to see, and whose memory doesn't seem what it used to be. Our reaction is too often to conclude that "Aunt Jane's mind is wandering" rather than "Aunt Jane is depressed." This error has sinister ramifications. For while depression is something that we have ways of treating, senility is not. Senility eventually kills. The senile are generally put away in nursing homes or in the back wards of general hospitals--a huge huge drain on the health care system--where they continue to deteriorate.

Given the stresses associated with ageing, it is not surprising that some older people experience depression, anxiety, and other psychological problems. Sometimes, of course, psychotherapy may be helpful But greater support from our government--society as a whole--and the recognition that even normal ageing can be stressful in our day and age--would seem to be in order. 

Presently the best advise is: Don't get old.

Being Single Can Kill You. Can Your Pet Help Keep You Healthy?

Psychologists have known for some time that human companionship is a good antidote for stress. Friends and close relatives can ease loneliness and depression, fears and anxieties. We know too, that the benefits of close relationships are not just psychological--they are physiological as well. Married people (not short term sexual relationships), for example have a lower premature death rates than single people--so much for the currently prevailing theory that single people are happier. For every married man under sixty-five who dies of lung cancer, two divorced man under sixty-five succumb to this disease.The same ratio applies to deaths from strokes.
For heart disease, which kills about a million people each year, the data are even more striking. Depending on the age group, the death rate from heart disease is as much as two to five times among the divorced, the single, and the widowed than among the married. Loneliness, it seems, may hurt the heart as much as too many tanning/health spas, steaks or cigarettes. One researcher has noted that the risk of premature mortality for divorced non-smokers is approximately the same as for married people who smoke a pack a day.
And, researchers now know that human companionship isn't the only kind that helps to keep people healthy. Pets too, can improve our psychological and physical health. Most dog or cat owners know that they gain pleasure from their pets, but only recently has that pleasure been connected to stress reduction--a finding that has also proved useful in the treatment of alcohol and other drug dependency. A pet is a tie for someone who may lack supportive, affectionate, human bonds. Pets can also be a source of companionship, acting to relieve negative feelings, such as anxiety and grief. Even for people who have generally satisfying human relationships and do not suffer from loneliness, pets can be beneficial. Unlike people, pets don't criticize, nag, or make judgements. Again, unlike many people, they know what love is and therefore are always loving.
A number of research studies have confirmed the relationship between pets and human stress reduction. English researchers gave cage birds to twelve pensioners and plants to another group. After three months, the health of the pet owners showed more improvement than did that of the plant owners. In another study, researchers studied the effects of animals on human blood pressure. They knew that talking is associated with a sharp rise in blood pressure, and wondered how the presence of a pet would influence cardiovascular response to speech. Thirty-six children aged nine to sixteen participated in the experiment. Each child was asked to read from a book of children's poetry with and without the presence of a unfamiliar (but friendly) dog in the room. The child's blood pressure was taken at various times during the experiment, and results showed that the presence of the dog was associated with lower blood pressure.
A research study in which heart patients were the subjects seems to confirm the healthful effects of pet ownership Ninety-six patients who had been admitted to a hospital for severe coronary problems (either heart attacks or angina pectoris )participated in the experiment. One year after discharge from the hospital, surviving patients were contacted. Fourteen had died within the year. Eleven of those did not own pets. Among the seventy-eight surviving patients, fifty owned pets. In all 28 percent of the patients who did not own  pets had died within the year, compared with only 3 percent of the patients who did own pets. There was no significant survival difference between male and female patients. The researchers who conducted this study raise an important question. What os it about pet ownership that helps people? Perhaps personality differences between pet owners and non-pet owners are really responsible for the higher survival rates of pet owners. Interestingly, though, they could find "no differences in measures of tension, anxiety, depression, confusion, vigour, or fatigue between pet owners and non-owners
We don't know a;; the reasons why pet ownership is healthful, but the research done to date suggests several conclusions: Pets provide companionship that may compensate for inadequate human relationships. By giving people something to  care for, pats add purpose to life and can enhance self-image. Touching pets is a soothing activity and in itself sometimes seems to decrease anxiety Pets keep their owners busy and ENSURE THE CONTINUANCE OF A DAILY ROUTINE. For retired or chronically ill people, this can help prevent feelings of emptiness. Pets provide a focus of attention, which may keep people from dwelling on worries and unpleasant thoughts. Finally, dogs require walking , a healthful exercise for most people (may help to prevent over exertion an a "health" spa); and owning a dog may help feel safer in their homes ar neighbourhoods. 

APPROXIMATELY 99.99%-- PARENTS IN NORTH AMERICA EXHIBIT CRIMINAL IRRESPONSIBILITY, WHEN DEALING WITH ADOLESCENT/TEENAGE CHILDREN

APPROXIMATELY 99.99%-- PARENTS IN NORTH AMERICA EXHIBIT CRIMINAL IRRESPONSIBILITY, WHEN DEALING WITH ADOLESCENT/TEENAGE CHILDREN

I have observed that many of you are still joining “causes” rather than looking for the cause.

The above statistics are a perfect example.

While the exact statistics are somewhat higher; for our purposes, the approximation will do.

There are many reasons, or at least excuses, used to condone this irresponsibility. Many parents claim they: “are too busy to always be around but that they are doing their best to protect their children”, “have a life to live as well”, “are trying to do what is best for their children”, “are doing what is necessary in today’s society to enable their children to FIT IN”, “are providing for their child all the things they never had as a child”, etc. Etc.

In many cases, it is a case of the CHILD parenting the ADULT, and telling the adult what to do and how to live.

These same parents tend to treat the adolescent/teenage child as an adult; who they are not and there are very strict laws confirming that they are not. These same parents tend to forget, or fail to care; that it is illegal for anyone under the age of eighteen: to attend a restricted/adult movie, buy or drink alcohol, enter a bar or cocktail lounge, enter into any legally binding contract (this includes renting an apartment or other place of abode), or remain for any length of time in an unsupervised—without parental guidance-- condition.

Adult supervisors need to understand that teenagers (most beyond the age of 18) have not fully developed the ability to evaluate situations and to make accurate judgments about risks. All teens tend to underestimate risks and overestimate their own abilities. As a result, they are often apt to accept a dare from a friend that can lead to dangerous risk-taking and illegal or self-destructive behaviour. Some may try feats beyond their physical abilities without full appreciation of the danger.

Everybody, especially adolescents, learns and develops at a different rate. Adolescents and many adults can be emotionally unstable. They can act impulsively. They differ from one another and even from themselves from moment to moment. In short, these young people often seem maddeningly unpredictable. The changes, shifts, and unpredictability of adolescence confound parents.

Research now supports that the teenager’s brain is different than the adult brain. The teen brain is not a finished product, but is a “work in progress.” Until recently, parents and most scientists, believed that the major “wiring” of the brain was completed by as early as three years of age, and that the brain was fully mature—and the personality fully developed-- by age10 or 12. New findings show that the GREATEST changes to the parts of the brain that are responsible for functions such as: self-control, judgment, emotions, and organisation occur BETWEEN puberty and adulthood. This explains certain teen-age behaviour such as poor decision making, recklessness, and emotional outbursts.

This research has also confirmed an old belief (an adult was 21 or over) THE BRAIN IS STILL DEVELOPING, DURING TEEN YEARS and teens are not responsible adults—because, they are not adults. Brain, “maturation “does not stop at age 10, but continues through the teen years and into the 20’s. What is most surprising is that you get a second wave of overproduction of gray matter, something that was thought to happen only in the first 18 months of life. Following the overproduction of gray matter, the brain undergoes a process called “pruning” where connections among neurons in the brain that are not used wither away, while those that are used stay—the “use it or lose it” principle. It is thought that this pruning process makes the brain more efficient by strengthening the connections that are used most often, and eliminating the clutter of those that are not used at all. While in most respects, this process is undoubtedly beneficial, on the negative side: an adolescent/teen, that is removed from the biological family home,  will often forget all previous teachings, family values, and traditions—they will often forget, or reject who their parents are and adopt a completely foreign value system, peer group, and standard of life.

Teens also differ from adults in their ability to read and understand emotions in the faces of others. Teens and adults actually use different regions of the brain in responding to certain tasks. In teens the frontal lobes (the seat of goal-oriented rational thinking) are less active and their amygdala (a structure in the temporal lobe that is involved in discriminating fear and other emotions) is more active. Teens often misread facial expressions, with those under the age of 14 more often seeing sadness, or anger, or confusion, instead of fear. “In teens, the judgment, insight and reasoning power of the frontal cortex is not being brought to bear on the task as it is in adults and teens process information differently than adults.

If the choices adolescents make about using drugs, alcohol, engaging in body modification, engaging in or avoiding challenging learning tasks have long-term and irreversible consequences for development of their brains, then discouraging harmful choices and encouraging healthy ones is all the more urgent. And any parent, or legal guardian not doing so is guilty of the CRIMINAL offenses of child abandonment, abuse and neglect.

If, there has been a "normal" dispute between a parent and an adolescent child and you step in to" side"

with the child, offer to take him/her away from the parent, harbour a runaway, or in any way interfere with the rights and responsibilities of the parent, when you are not a legal guardian--you are guilty of contributing to the delinquency of a child.

LINK--

http://al-alex-alexander-girvan.blogspot.com/2010/09/where-are-your-children-what-are-they.html

First Nations and Borderline Personality Disorder

Borderline personality disorder (BPD) is an emotional disorder that causes emotional instability, leading to stress and other problems.

With borderline personality disorder your image of yourself is distorted, making you feel worthless and fundamentally flawed. Your anger, impulsivity and frequent mood swings may push others away, even though you desire loving relationships.

If you have borderline personality disorder, don't get discouraged. Many people with borderline personality disorder get better with treatment and can live happy, peaceful lives.

 Diagnosis

Often young persons who identify as Aboriginal or First Nations experience a repetitive pattern of disorganization and instability in self-image. How can they truly identify as First Nations, if they have a French, Irish, Scottish or other European name? To make matters worse, the term aboriginal originated mainly in Australia. Often their Peer Groups will be facing the exact same dilemma, so that the young person also loses a sense of Community. Assimilation is not a new phenomenon--it has been a reality since the beginning of time but it has never ceased to cause problems.

  A person with a borderline personality disorder often experiences a repetitive pattern of disorganization and instability in self-image, mood, behavior and close personal relationships. This can cause significant distress or impairment in friendships and work. A person with this disorder can often be bright and intelligent, and appear warm, friendly and competent. They sometimes can maintain this appearance for a number of years until their defense structure crumbles, usually around a stressful situation like the breakup of a romantic relationship or the death of a parent.

 Symptoms

Relationships with others are intense but stormy and unstable with marked shifts of feelings and difficulties in maintaining intimate, close connections. The person may manipulate others and often has difficulty with trusting others. There is also emotional instability with marked and frequent shifts to an empty lonely depression or to irritability and anxiety. There may be unpredictable and impulsive behavior which might include excessive spending, promiscuity, gambling, drug or alcohol abuse, shoplifting, overeating or physically self-damaging actions such as suicide gestures. The person may show inappropriate and intense anger or rage with temper tantrums, constant brooding and resentment, feelings of deprivation, and a loss of control or fear of loss of control over angry feelings. There are also identity disturbances with confusion and uncertainty about self-identity, sexuality, life goals and values, career choices, friendships. There is a deep-seated feeling that one is flawed, defective, damaged or bad in some way, with a tendency to go to extremes in thinking, feeling or behavior. Under extreme stress or in severe cases there can be brief psychotic episodes with loss of contact with reality or bizarre behavior or symptoms. Even in less severe instances, there is often significant disruption of relationships and work performance. The depression which accompanies this disorder can cause much suffering and can lead to serious suicide attempts.

 Etiology

It is a common disorder with estimates running as high as 10-14% of the general population. The frequency in women is two to three times greater than men. This may be related to genetic or hormonal influences. An association between this disorder and severe cases of premenstrual tension has been postulated. Women commonly suffer from depression more often than men. The increased frequency of borderline disorders among women may also be a consequence of the greater incidence of incestuous experiences during their childhood. This is believed to occur ten times more often in women than in men, with estimates running to up to one-fourth of all women. This chronic or periodic victimization and sometimes brutalization can later result in impaired relationships and mistrust of men and excessive preoccupation with sexuality, sexual promiscuity, inhibitions, deep-seated depression and a seriously damaged self-image. There may be an innate predisposition to this disorder in some people. Because of this there may ensue subsequent failures in development in the relationship between mother and infant particularly during the separation and identity-forming phases of childhood.

 Treatment

Treatment includes psychotherapy which allows the patient to talk about both present difficulties and past experiences in the presence of an empathetic, accepting and non-judgemental therapist. The therapy needs to be structured, consistent and regular, with the patient encouraged to talk about his or her feelings rather than to discharge them in his or her usual self-defeating ways. Sometimes medications such as antidepressants, lithium carbonate, or antipsychotic medication are useful for certain patients or during certain times in the treatment of individual patients. Treatment of any alcohol or drug abuse problems is often mandatory if the therapy is to be able to continue. Brief hospitalization may sometimes be necessary during acutely stressful episodes or if suicide or other self-destructive behavior threatens to erupt. Hospitalization may provide a a temporary removal from external stress. Outpatient treatment is usually difficult and long-term - sometimes over a number of years. The goals of treatment could include increased self-awareness with greater impulse control and increased stability of relationships. A positive result would be in one's increased tolerance of anxiety. Therapy should help to alleviate psychotic or mood-disturbance symptoms and generally integrate the whole personality. With this increased awareness and capacity for self-observation and introspection, it is hoped the patient will be able to change the rigid patterns tragically set earlier in life and prevent the pattern from repeating itself in the next generational cycle.

Teenage Suicide

Most everyone at some time in his or her life will experience periods of anxiety, sadness, and despair. These are normal reactions to the pain of loss, rejection, or disappointment. Those with serious mental illnesses, however, often experience much more extreme reactions, reactions that can leave them mired in hopelessness. And when all hope is lost, some feel that suicide is the only solution. It isn’t.

According to the National Institute of Mental Health, scientific evidence has shown that almost all people who take their own lives have a diagnosable mental or substance abuse disorder, and the majority have more than one disorder. In other words, the feelings that often lead to suicide are highly treatable. That’s why it is imperative that we better understand the symptoms of the disorders and the behaviors that often accompany thoughts of suicide. With more knowledge, we can often prevent the devastation of losing a loved one.

Now the eighth-leading cause of death overall in the U.S. and the third-leading cause of death for young people between the ages of 15 and 24 years, suicide has become the subject of much recent focus. U.S. Surgeon General David Satcher, for instance, recently announced his Call to Action to Prevent Suicide, 1999, an initiative intended to increase public awareness, promote intervention strategies, and enhance research. The media, too, has been paying very close attention to the subject of suicide, writing articles and books and running news stories. Suicide among our nation’s youth, a population very vulnerable to self-destructive emotions, has perhaps received the most discussion of late. Maybe this is because teenage suicide seems the most tragic—lives lost before they’ve even started. Yet, while all of this recent focus is good, it’s only the beginning. We cannot continue to lose so many lives unnecessarily.

Some Basic Facts

• In 1996, more teenagers and young adults died of suicide than from cancer, heart disease, AIDS, birth defects, stroke, pneumonia and influenza, and chronic lung disease combined.

• In 1996, suicide was the second-leading cause of death among college students, the third-leading cause of death among those aged 15 to 24 years, and the fourth- leading cause of death among those aged 10 to 14 years.

• From 1980 to 1996, the rate of suicide among African-American males aged 15 to 19 years increased by 105 percent.

It is a hopeful sign that while the incidence of suicide among adolescents and young adults nearly tripled from 1965 to 1987, teen suicide rates in the past ten years have actually been declining, possibly due to increased recognition and treatment. (1996 is the most recent year for which suicide statistics are available.)

Suicide "Signs"

There are many behavioral indicators that can help parents or friends recognize the threat of suicide in a loved one. Since mental and substance-related disorders so frequently accompany suicidal behavior, many of the cues to be looked for are

symptoms associated with such disorders as depression, bipolar disorder (manic depression), anxiety disorders, alcohol and drug use, disruptive behavior disorders, borderline personality disorder, and schizophrenia.

Some common symptoms of these disorders include:

• Extreme personality changes
• Loss of interest in activities that used to be enjoyable
• Significant loss or gain in appetite

• Difficulty falling asleep or wanting to sleep all day
• Fatigue or loss of energy
• Feelings of worthlessness or guilt

• Withdrawal from family and friends
• Neglect of personal appearance or hygiene
• Sadness, irritability, or indifference
• Having trouble concentrating
• Extreme anxiety or panic
• Drug or alcohol use or abuse
• Aggressive, destructive, or defiant behavior
• Poor school performance
• Hallucinations or unusual beliefs

Tragically, many of these signs go unrecognized. And while suffering from one of these symptoms certainly does not necessarily mean that one is suicidal, it’s always best to communicate openly with a loved one who has one or more of these behaviors, especially if they are unusual for that person.

There are also some more obvious signs of the potential for committing suicide. Putting one’s affairs in order, such as giving or throwing away favorite belongings, is a strong clue. And it can’t be stressed more strongly that any talk of death or suicide should be taken seriously and paid close attention to. It is a sad fact that while many of those who commit suicide talked about it beforehand, only 33 percent to 50 percent were identified by their doctors as having a mental illness at the time of their death and only 15 percent of suicide victims were in treatment at the time of their death. Any history of previous suicide attempts is also reason for concern and watchfulness. Approximately one-third of teens who die by suicide have made a previous suicide attempt. It should be noted as well that while more females attempt suicide, more males are successful in completing suicide.

Causes

While the reasons that teens commit suicide vary widely, there are some common situations and circumstances that seem to lead to such extreme measures. These include major disappointment, rejection, failure, or loss such as breaking up with a girlfriend or boyfriend, failing a big exam, or witnessing family turmoil. Since the overwhelming majority of those who commit suicide have a mental or substance-related disorder, they often have difficulty coping with such crippling stressors. They are unable to see that their life can turn around, unable to recognize that suicide is a permanent solution to a temporary problem. Usually, the common reasons for suicide listed above are actually not the "causes" of the suicide, but rather triggers for suicide in a person suffering from a mental illness or substance-related disorder.

More recently, scientists have focused on the biology of suicide. Suicide is thought by some to have a genetic component, to run in families. And research has shown strong evidence that mental and substance-related disorders, which commonly affect those who end up committing suicide, do run in families. While the suicide of a relative is obviously not a direct "cause" of suicide, it does, perhaps, put certain individuals at more risk than others. Certainly, the suicide of one’s parent or other close family member could lead to thoughts of such behavior in a teen with a mental or substance-related disorder.

Research has also explored the specific brain chemistry of those who take their own lives. Recent studies indicate that those who have attempted suicide may also have low levels of the brain chemical serotonin. Serotonin helps control impulsivity, and low levels of the brain chemical are thought to cause more impulsive behavior. Suicides are often committed out of impulse. Antidepressant drugs affecting serotonin are used to treat depression, impulsivity, and suicidal thoughts. However, much more research is needed to confirm these hypotheses and, hopefully, eventually lead to more definite indicators of and treatment for those prone to suicide.

How to Help

Since people who are contemplating suicide feel so alone and helpless, the most important thing to do if you think a friend or loved one is suicidal is to communicate with him or her openly and frequently. Make it clear that you care; stress your willingness to listen. Also, be sure to take all talk of suicide seriously. Don’t assume that people who talk about killing themselves won’t really do it. An estimated 80 percent of all those who commit suicide give some warning of their intentions or mention their feelings to a friend or family member. And don’t ignore what may seem like casual threats or remarks. Statements like "You’ll be sorry when I’m dead" and "I can’t see any way out," no matter how off-the-cuff or jokingly said, may indicate serious suicidal feelings.

One of the most common misconceptions about talking with someone who might be contemplating suicide is that bringing up the subject may make things worse. This is not true. There is no danger of "giving someone the idea." Rather, the opposite is correct. Bringing up the question of suicide and discussing it without showing shock or disapproval is one of the most helpful things you can do. This openness shows that you are taking the individual seriously and responding to the severity of his or her distress.

If you do find that your friend or loved one is contemplating suicide, it is essential to help him or her find immediate professional care. (Calling the NAMI HelpLine at 1-800-950-NAMI [6264] for more information or to help you locate your local NAMI for area assistance is one possible resource.) Don’t make the common misjudgment that those contemplating suicide are unwilling to seek help. Studies of suicide victims show that more than half had sought medical help within six months before their deaths. And don’t leave the suicidal person to find help alone—they usually aren’t capable. Also, never assume that someone who is determined to end his or her life can’t be stopped. Even the most severely depressed person has mixed feelings about death, wavering until the very last moment between wanting to live and wanting to die. Most suicidal people do not want death; they want the pain to stop. The impulse to end it all, though, no matter how overpowering, does not last forever.

If the threat is immediate, if your friend or loved one tells you he or she is going to commit suicide, you must act immediately. Don’t leave the person alone, and don’t try to argue. Instead, ask questions like, "Have you thought about how you’d do it?" "Do you have the means?" and "Have you decided when you’ll do it?" If the person has a defined plan, the means are easily available, the method is a lethal one, and the time is set, the risk of suicide is obviously severe. In such an instance, you must take the individual to the nearest psychiatric facility or hospital emergency room. If you are together on the phone, you may even need to call 911 or the police. Remember, under such circumstances no actions on your part should be considered too extreme—you are trying to save a life. An overwhelming majority of young people who hear a suicide threat from a friend or loved one don’t report the threat to an adult. Take all threats seriously—you are not betraying someone’s trust by trying to keep them alive.

Other Serious Considerations

Don’t automatically assume that someone who was considering suicide and is now in treatment or tells you that he or she is feeling better is, in fact, doing better. Some who commit suicide actually do so just as they seem to be improving. One reason for this may be that they did not have enough energy to kill themselves when they were extremely depressed, but now have just enough energy to go through with their plan. Another reason for suicide during a seeming improvement is that resigning oneself to death can release anxiety. While it’s not good to monitor every action of someone who is recovering from suicidal thoughts, it is important to make certain that the lines of communication between you and the individual remain open.

While it may seem a bit obvious, it should also be mentioned that it is extremely advisable to bar teens who are suicidal from access to firearms. Nearly 60 percent of all completed suicides are committed with a firearm. And while having a firearm does not in itself promote suicidal behavior, knowing that one is accessible may help a troubled teen formulate his or her suicidal plans.
LINK--http://thegirvanway.blogspot.com/2010/03/suicide.html