Indicators versus triggers - knowing about these can help you control symptom expression

In managing chronic physical health or mental health conditions, it is important to know the difference between indicators and triggers.  Identification of the two allows for increased control of symptom expression.

An indicator is something that often (or always) PRECEDES symptom expression.  A trigger is something that CAUSES symptom expression.

Allow me to provide an example from my life.  I have migraines.  When I am exposed to an allergen such as the chemicals in someone's perfume, that TRIGGERS a migraine.  In other words, I have no migraine symptoms, encounter the chemicals, and develop a migraine.  Often, migraine intensity is linked to how much I was exposed to the allergen.

Once or twice a month, I have a random migraine.  This migraine is not tied to ANY trigger I can identify.  However, each time one of these migraines comes along, I feel really, really happy for 48 hours prior to onset of migraine pain.   While I am typically content and positive, I rarely am happy to the point of giggling.  So, I watch for giggling and out-of-my-ordinary happiness.  When that happiness occurs, I can increase my sleep amounts, make to to be extra careful in avoiding triggers, and start taking preventative medication.

Knowing triggers and indicators can allow you to reduce symptom expression.  Another example, for someone who has bipolar disorder, tracking stimulus for several weeks/a couple of months will often show a pattern of how much stimulus results in mood switching.  When I have worked with people who have tracked stimulus, the people typically find that a certain level of "good stimulus" (eustress) and a much lower level of "bad stimulus" (distress) will result in mood change.  With this information, the person can then plan events to reduce likelihood of mood switching.

Specifically, if John Doe can tolerate 2 eustress activities (like going to dinner with friends, and staying up late to watch a movie), but can only tolerate 1 distress activity (finding out he has work that is past due), John can plan to take care of the work over the weekend.  To avoid mood switching, John will have to change the evening out to another weekend.

Sometimes using mood tracking, the person will be able to link intensity of stimulus to length of mood change.  For example, when I was working with a person who had bipolar disorder, that individual found it was possible to predict the length of depressive episodes by tracking how much stimulus was being experienced.  Using this information, the individual was able to attend a week-long, highly-important-to-the-individual event.  The person planned self-care activities throughout that week to reduce stimulus.  And the individual understood the level of stimulus would likely result in a 3 week depression afterwards.  The depression lasted 2 1/2 weeks.

When processing the entire chain of events, the individual was able to state unlike previous depressive episodes, having an expected time frame for the depression and understanding that the depressive episode was part of how his body and brain worked resulted in the individual being able to resist suicidal impulses.  Prior to understanding how the individual's bipolar disorder worked, the individual would self-harm while depressed.  With the tracking tools and education the individual was able to use planning, self-talk, and understanding to reduce anxiety about depressive episodes.

There are excellent tracking applications, websites, and files on the internet.

• Psychologytools.org has multiple worksheets.  
• PatientsLikeMe.com has some lovely possibilities.  
• Latuda (medication for bipolar disorder depression) has a great mood tracker on its website (http://www.latuda.com/bpd/treating-bipolar-depression.html).    
• SparkPeople.com lets you track food and exercise.
• It is also possible to track triggers and indicators just using pen and paper.  

I would suggest, if you are looking for indicators as well as triggers, to track activity, food intake, weather patterns, and as much detail as you can in your life.  Sometimes it can be a combination of things that result in triggering symptom expression.

Sometimes indicators are subtle and hard to identify without enough information to track down the indicator.  For example, one individual identified moon phases as her trigger for symptom expression,  The day after a full moon, she experiences increase in symptoms, with this increase lasting about 72 hours.  The couple days before the full moon, she feels very tired.  The fatigue is an indicator.  The full moon is a trigger.

MHSS - What it is and what it is not

I work in the field of mental health.  For a year, I was a clinician.  Now, I am a team leader (supervisor to clinicians).  In both roles, I have often explained Mental Health Skill-building Services (MHSS) to community members and those with whom I work.  (Disclaimer:  These are my own opinions and thoughts, not necessarily those of the company for which I work.)

I think this analogy is the best description I have created:

A psychiatrist is the one who prescribes medications to address chemical imbalances in a person's brain.

A counselor is the one who helps a person work through previous trauma, family relationships, and all the other things that lay heavy upon a person's heart.

A MHSS clinician is the one who helps you learn how to do the things you need to develop a healthy life by reducing impact of mental illness.  MHSS clinicians also teach skills which were not otherwise developed - for example, communication skills, social skills, independent living skills like maintenance of hygiene, budgeting, cooking, household maintenance, etc.  MHSS clinicians train your hands how to work.

A Case Manager helps coordinate all other mental health and physical health providers and links people to community resources to meet a person's needs.

A treatment team means all the mental health providers and medical providers work together in order to provide appropriate treatment.


What MHSS is not... based on medicaid requirements and purview of services.

MHSS is not a taxi service or a companionship service - clinicians accompany clients to appointments when there is MHSS justification for doing so.  If the clinician is not needed, then developing independent transportation becomes an skill upon which client and clinician works.

MHSS is not a counseling service.  While many MHSS clinicians have Master's Degrees, not everyone does.  Further, counselors must hold a counseling license.  MHSS clinicians have a different criteria/qualification.  In Virginia, clinicians must be Qualified Mental Health Professional (QMHP) and specified for adults (QMHP-A) or chidren (QMHP-C).

MHSS is not a butler or maid service.  While clinicians often work with a client, it does no good (and often causes harm) if clinicians work harder than the client or "take over" tasks the client is able to complete.  Further, MHSS focuses on teaching skills, which means the client should be doing the work with assistance from the clinician.

MHSS is not a crisis service.  Because MHSS is not a counseling or therapy service, it would be inappropriate to attempt to provide crisis intervention and stabilization services - which have a fairly significant amount of therapeutic components.

MHSS is not a forever service - once goals are accomplished, discharge occurs.  The focus of MHSS is training people to be independent as much as possible.  Progress is tracked on a regular basis and treatment plans are tailored to the needs of each client.

Chicken Frittata

Chicken Frittata

In a glass cake pan, Layer the following

2 cups shredded, cooked chicken mixed with 1 cup sour cream

4 ounces crumbled Feta cheese

8 jumbo or large eggs whisked until smooth

4 ounces mozzarella


Bake uncovered at 350 degrees Fahrenheit for 1 hour until browned on top.

Serve with green veggies (steamed Kale, lima beans, peas, broccoli, etc.) or salad.  Have cherries for dessert.

EpiPen Copay Coupon for 2015 Link

Here is a link to the EpiPen Copay Coupon.  It can save you up to $100.00 per refill for epipens.

https://www.epipen.com/en/copay-offer

Holiday Cooking Marathon - Pumpkin Mascarpone Pie, Pumpkin Soymilk Pie, Broccoli Casserole with cheese sauce

Holiday Cooking Marathon:

Pumpkin Mascarpone Pies –

3 ½ cups cooked, mashed pumpkin

1 ½ cups honey

6 large eggs

2 cups milk/cream mixture

12 ounces mascarpone cheese

8 ounces apricot preserves/jam

1 ½ teaspoon vanilla extract

½ teaspoon sea salt

Mix all until smooth.  Pour into glass or ceramic pie pans (at least 2).  Bake at 350 for 60-90 minutes until dry on top and starting to crack.

Pumpkin Soymilk Pie

8 ounces cooked, mashed pumpkin

1 tablespoon lemon juice

1 ½ teaspoon vanilla extract

1 cup honey

4 eggs

8 ounces vanilla soymilk

Mix all until smooth.  Pour into metal pie pan.  Bake at 350 for 1 hour until dry on top and starting to crack.

Broccoli Casserole with cheese sauce

Broccoli

3 bunches broccoli cut into bite-sized bits.

3 cups thick chicken broth (chicken broth boiled down to at least ½ original amount to concentrate flavors and to make freezer storage easier)

½ onion, finely minced

3 cloves garlic, minced/crushed

1 cup water

Put all ingredients in large stock pot.  Bring to boil.  Cover.  Boil 4 minutes until broccoli starts to soften and turns bright green.  DRAIN – SAVING THE BROTH!!.  Run cold water over broccoli to stop cooking.  Set aside.

Return broth to stock pan to use in cheese sauce.

Cheese sauce

8 ounces Colby cheese, shredded

8 ounces cheddar cheese, shredded

4 ounces feta cheese, shredded/crumbled

4 ounces finely shredded Asiago cheese

4 cups full-flavor broth (ex. Broth from the broccoli, thick chicken broth, chicken broth plus extra bouillon cube, etc.)

1 cup 50/50 bean flour (Besan flour) and starch (I used a blend of tapioca starch and sweet potato starch)

2 cups cold water.

16 ounces sour cream

6 eggs

Bring broth to boil.  While broth comes to boil, mix water and flour/starch until smooth (Important that there are no lumps!!). 

Set cheeses in bowl beside stove.  Set sour cream beside stove. 

Once broth boils, drizzle flour/starch/water mixture into broth STIRRING CONSTANTLY.  It should thicken quickly.  IF too thick add more water.  If too thin add more starch/flour/water mixture.  Target is thick gravy consistency. 

Once thickened, still stirring constantly, start dropping handfuls of cheese into the pot.  Stir until melted.  Add another handful.  Continue until all cheese is added and melted. 

Stir in sour cream.  Bring to simmer.  Remove from heat.

In a large, metal bowl - Whisk eggs until smooth.  Slowly add hot cheese mixture ¼ cup at a time to temper the eggs.  When cheese mixture is completely added, sauce is complete. 

Put cooked broccoli in casserole dish.  Pour over cheese sauce until covered.  Bake in oven at 350 until browned and bubbly on top.

TIPS AND DISCUSSION

I had a ton of extra cheese sauce, so I also cut up a casserole dish worth of baby potatoes and covered those with the cheese sauce.  Still had a quart left, so am going to see if it mixes into mashed potatoes well.

My hands get sore because of fibromyalgia and osteoarthritis – so I did all mixing with a mixer. 

I have allergies, so I used safe for me ingredients.  Because so many of my friends and family have allergies, there are no brands listed here – too much possibility of reactions.

Thick broth – I make my own broth from chickens I stew.  When the bones and skin have had all the wonderful nutrients stewed out, I strain out the solids and then boil the broth down to about 1/6 of what the original volume was.  This creates something like a gel, which has an intense and wonderful flavor.  I use this for my base in lots of things that other people might use bouillon. 

Pies- the pies would probably be more flavorful with cinnamon, nutmeg, ginger, clove, and other sweet spices – however I am now reacting to cinnamon and clove.  L  However, if this is not the case for you, go for it!

There are no crusts on the pies because I am cooking for myself and several family members so I am working around multiple food restrictions.  If I were making this just for myself, I would use ground nuts, honey, bean flour, and butter to make a crust.

Still to make – grain-free bread which will then be made into stuffing.  Roast.  Wild Turkey.  Devilled Eggs.  Sweet Tea.  Mashed potatoes. 

I think the cooking is my favorite part of ANY holiday!

A Holiday Wish

During the Holiday season, I hear so very often people feeling despair due to their family having fractured connections, money being less than needs and nothing near what presents might require, real life not resembling anything close to television glitter or facebook stellar moments.

Please remember you have both family of blood and a family of the heart.  When one is cracked or broken, the other is there to love, sustain, and care.  Holidays, regardless of which religion to which you belong or you abstain, are there to celebrate the miracles of life in all the myriad possibilities it has.  And that which is illusion will never anchor you when challenges arise.  Instead, that which is real will serve as your foundation to build something that echoes through the ages.

You each are real.  You each matter.  And to everyone who breathes - there are connections which bind you into the tapestry that makes life.  Celebrate that which you have, that of which you dream, and the family you have chosen to make within this world.

My Holiday Wish is this:
May each of you find yourself to be enough;
May each of you find the courage to step outside whatever box has been placed around you in order that you find what your potential truly is;
May each of you find peace in your life and love within the connections you have to others.

Be kind to yourselves and to each other.

Roasted taters and cheese. Beeswax lip & Hand balm - 2 recipes

Roasted Taters and Cheese
Last night, I was hungry, but really did not want to do much cooking and DEFINITELY did not want to do many dishes.  So, I thought about some sort of twist on a baked potato.  This is what I ended up with:

2 large (baking) potatoes - scrubbed clean.
8 ounces mozzarella (or any other) cheese
1 tablespoon butter

I sliced the scrubbed baking potatoes into rounds that were 1/4 inch thick.  It is important to get all rounds about the same thickness.

I put down a layer of potato rounds in the bottom of a glass casserole dish.  I then laid out a second layer on top of the first, offsetting the potatoes so the second layer lay over the edges of the potatoes below it.

I dotted the entire top layer with very thin slices of butter.

I put this into a cold oven and turned it onto 400 degrees fahrenheit, let it bake for 20 minutes.

At 20 minutes, I took the potatoes out of the oven and topped with thinly sliced mozzarella cheese (could use shredded cheese, but why bother with the work of shredding it when slices work just as well??).  I put the potatoes back into the oven for another 15-20 minutes.  When the cheese was toasty browned on top and crispy, I took them out of the oven.

It was a lovely meal to eat with salmon and green peas.  And, the amount of dishes - 1 casserole dish and 1 knife (I sliced the cheese in the casserole dish before layering on potatoes so I did not have to dirty a cutting board).

AWESOME!




BEESWAX LIP/HAND BALM

2 ounces of beeswax
1/2 cup castor oil
1/4 cup apricot kernel oil.

Put all ingredients in a double boiler (or if you don't have one as I do not, make one by sticking a smaller pot suspended in a bigger pot and fill the bigger pot so water covers the bottom 1/3 of the smaller pot's depth).

Heat OVER LOW HEAT (takes about 30-45 minutes) to melt the beeswax.  Stir frequently.  Time to completely melt beeswax is reduced if you chop the beeswax into thin chunks/slices prior to heating.

Once completely melted, turn out into glass dish with sides or into containers.  Once cool, use sharp, oiled knife to cut into small squares.  Wrap in waxed paper and then in foil.  Tie a little bow on it.  Give as gifts for hands/lips over winter.