by tyler | May 24, 2023 | CNN, health
Here’s a look at abortion in the United States.
January 22, 1973 – Roe v. Wade – The US Supreme Court, in a 7-2 decision, affirms the legality of a woman’s right to have an abortion under the Fourteenth Amendment to the Constitution.
2003 – President George W. Bush signs a law called the Partial-Birth Abortion Ban Act of 2003. The law uses a non-medical phrase to describe a late-term procedure that involves dilation and extraction of the fetus. The law has been challenged in courts, including the Supreme Court, which upheld the law in a 5-4 ruling in 2007.
May 2, 2022 – Politico publishes what it calls a draft of a majority opinion written by Justice Samuel Alito that would overturn Roe v. Wade’s holding of a federal constitutional right to an abortion. The court confirms the authenticity of the document on May 3, but stresses it is not the final decision. The opinion in the case is not expected to be published until late June.
June 24, 2022 – The Supreme Court overturns Roe v. Wade with a 6-3 decision, holding that there is no longer a federal constitutional right to an abortion. Going forward, abortion rights will be determined by states, unless Congress acts.
The Hyde Amendment prohibits federal funds like Medicaid to be used to obtain or perform an abortion, except in cases of rape, incest or if the mother’s life is in danger.
Some states fund abortion under other circumstances than those mandated by the Hyde Amendment.
State abortion laws and policies from the Guttmacher Institute (As of April 30, 2023).
Number of abortions reported to the Centers for Disease Control and Prevention from selected reporting areas:
2020: 620,327
2019: 629,898
2018: 619,591
2017: 609,095
2016: 623,471
2015: 638,169
2014: 652,639
2013: 644,435
2012: 699,202
2011: 730,322
2010: 765,651
2009: 789,217
2008: 825,564
2007: 827,609
2006: 852,385
2000: 857,475
1995: 1,210,883
1990: 1,429,247
1985: 1,328,570
1980: 1,297,606
* The totals may fluctuate depending on how many states provide numbers in a given year.
2020 is the most recent year for which the CDC has released statistics.
The total number of abortions decreased 2% from 2019 to 2020. There were 11.2 abortions per 1,000 women ages 15-44.
According to the CDC, 80.9% were performed at the ninth week or earlier and 93.1% were performed at or before 13 weeks. About 9.2% were performed later than 13 weeks.
by tyler | May 18, 2023 | CNN, health
Here’s some background information about sarin, a man-made nerve agent developed for chemical warfare.
Sarin is a liquid that is clear, colorless, tasteless and odorless.
Sarin is an extremely volatile nerve agent because of its ability to change from liquid to gas.
If it evaporates into a gas, it can spread into the environment.
Sarin’s designation by NATO is GB.
People are exposed to sarin through skin contact, eye contact or by breathing it in. Sarin can also be mixed with water or food.
Sarin dissipates quickly, presenting an immediate but short-lived threat.
Sarin’s main ingredient is methyl phosphonyl difluoride.
Mild or moderately exposed people usually recover completely. Severely exposed people are not likely to survive.
Runny nose
Watery eyes
Small, pinpoint pupils
Eye pain
Blurred vision
Drooling and excessive sweating
Cough
Chest tightness
Rapid breathing
Diarrhea
Increased urination
Confusion
Drowsiness
Weakness
Headache
Nausea, vomiting, and/or abdominal pain
Slow or fast heart rate
Loss of Consciousness
Convulsions
Paralysis
Respiratory failure possibly leading to death
Leave the area of contamination as quickly as possible. Seek fresh air if exposure occurs indoors. If exposure is outdoors, head to higher ground as sarin is heavier than air and sinks.
Remove contaminated clothing, flush eyes with water, and wash skin with soap and water.
If ingested, do not induce vomiting or flush with fluids.
Medical care should be sought immediately. Antidotes are available in many hospitals.
1938 – Sarin is developed in Germany as a pesticide.
April-May 1967 – The US military secretly tests sarin in the Upper Waiakea Forest Reserve on the island of Hawaii. The testers detonate sarin-filled 155mm artillery shells to study how the nerve agent disperses in a tropical jungle. The Pentagon confirms the “Red Oak” program in November 2002.
March 16, 1988 – The Iraqi air force attacks the northern Iraq town of Halabja with poison gases that were thought to include sarin, VX and other deadly compounds. Reports indicate that 5,000 people died in the attack. Countless others suffer eyesight loss, respiratory ailments and cancers.
June 27, 1994 – In Japan, seven people die and more than 500 are hospitalized when the Aum Supreme Truth (or Aum Shinri Kyo) cult releases sarin from a truck by driving slowly around an apartment complex in Matsumoto, Nagano Prefecture. Another victim dies in 2008.
March 20, 1995 – The Aum Supreme Truth cult, now known as Aleph, places plastic bags of sarin on trains that converge in the Tokyo government district during rush hour. Thirteen people die and more than 5,000 become ill.
May 17, 2004 – A coalition convoy in Baghdad finds sarin gas in an artillery round that had been rigged as an improvised explosive device. The IED detonates as officials attempt to defuse it. Two members of the explosive ordinance team suffer minor exposure.
June 23, 2006 – The US Army releases a report to Congress stating that allied forces have recovered approximately 500 weapons munitions containing degraded mustard or sarin gas since the start of the Iraq War in 2003. The weapons were produced before the 1991 Gulf War. However, according to October 2014 reporting by the New York Times, even at the time of the report’s publication the information was “outdated” and “understated.”
June 15, 2012 – Katsuya Takahashi, 54, the last fugitive suspect in the 1995 sarin attacks on the Tokyo subway, is captured by Japanese police, ending a 17-year manhunt.
April 25, 2013 – US Defense Secretary Chuck Hagel announces that Syria has used sarin on a small scale, killing 150 people in the country.
August 21, 2013 – A new alleged chemical weapons attack kills more than 1,000 people in the Syrian countryside outside its capital, Damascus. Hundreds of those killed are children.
September 1, 2013 – US Secretary of State John Kerry announces that samples of blood and hair taken from eastern Damascus have “tested positive for signatures of sarin.”
September 16, 2013 – UN weapons inspectors return “overwhelming and indisputable” evidence of the use of sarin in Syria, UN Secretary-General Ban Ki-moon says.
January 4, 2016 – The UN releases a report that indicates Syrians may have been exposed to a sarin-type gas in 11 instances. The UN based its report on a publication by the Organization for the Prohibition of Chemical Weapons. Source of the gas and those responsible for its use are being investigated.
April 4, 2017 – An airstrike on a rebel-held town in northwestern Syria leaves 89 civilians dead, including children, from a suspected chemical attack, using sarin gas. The US, Turkey and other Western states blame the regime of Syrian President Bashar al-Assad who vehemently denies the accusation. The following week, UK scientists claim to have evidence that sarin gas, or a similar substance, was used based on samples from victims. Investigations continue to confirm the gas used and those responsible.
April 26, 2017 – French Foreign Minister Jean-Marc Ayrault announces that samples taken from the attack on the rebel-held town of Khan Sheikhoun matched those from a previous incident, and that the evidence provides proof that the Syrian regime is responsible for carrying out the attack on April 4.
July 2018 – Cult leader Shoko Asahara and twelve other members of the Aum Shinrikyo cult are executed for their roles in the 1995 Tokyo sarin attack.
May 11, 2022 – In a study, researchers find that exposure to the nerve gas sarin may be the cause of Gulf War illness, a condition affecting US veterans of the 1990-91 Gulf War.
by tyler | May 17, 2023 | CNN, health
In a veterinary lab in North Carolina, Woofus, a 15-year-old basset hound mix, is allowing researchers to attach an electroencephalogram, or EEG, electrodes to his head before padding off to a dark, cozy room for an afternoon nap.
During his snooze, the study team will analyze Woofus’ brain waves to judge the quality of his sleep. Woofus has canine cognitive dysfunction syndrome, or CCDS, the doggie disorder that’s similar to Alzheimer’s disease in people. The elderly dog’s owners say he is struggling to get enough rest at night.
“Just like humans with Alzheimer’s disease, dogs with CCDS experience sleep disruptions, such as insomnia and sleep fragmentation,” said veterinarian Dr. Natasha Olby, a professor of neurology, neurosurgery and gerontology at North Carolina State College of Veterinary Medicine in Raleigh.
Woofus isn’t the only sleep-deprived dog in this study. On other days in the clinic, Jake, a 13-year-old pointer, and Coco, a 12-year-old dachshund, among others, might be taking a siesta while researchers peer inside their brains.
“Owners of dogs with CCDS report their dogs suffer from difficulty sleeping at night, increased sleeping during the day or both, as well as pacing and vocalizations at night,” Olby said. “This can be very hard on the dog’s owners — not only are they worried for their pet, their sleep is also significantly disrupted.”
To find out whether sleep problems in dogs indicate early signs of dementia as they do in people, Olby and her team turned to a group of senior dogs enrolled in an ongoing study testing antiaging supplements. The dogs visit twice a year “and do all kinds of really fun cognitive testing,” she said. “They really enjoy it and like the handlers they work with.”
To be considered for the antiaging study, the dog must have lived more than 75% of the expected life span for their breed or mix of breeds. A dog also could not be crippled by arthritis or going blind, as the pet needed to be able to perform tasks designed to test their cognitive capabilities.
A dog might be asked, for example, to find a treat hidden under a cup or a snack inside a cylinder in which one end had been closed by a researcher. By repeating the tasks at the clinic every six months, any decline in the dog’s mental agility or performance can be tracked.
For the new study measuring a dog’s brain waves during sleep, researchers used a form of electroencephalogram called polysomnography, used in sleep clinics to diagnose sleep problems in people.
“It’s the gold standard method to look at what the brain is doing during sleep,” Olby said, adding this is the first canine study to apply the same technology used on humans.
“We glue these electrodes on with a really great conductive glue that’s water soluble. Then we just wash it off afterwards,” she said. “We don’t use anywhere near as many electrodes as you see on people in a sleep lab, because dogs have far less cortex and surface area to cover.”
Already at ease with the staff, it wasn’t too difficult to train 28 senior dogs to wear electrodes and walk around with dangling wires without complaint, she said.
To make the dogs more comfortable during their siestas, owners bring their dogs’ beds from home, which are placed in a protected room with white noise.
“Staff sit with them while they nap to make sure that they’re not trying to pull out or eat the electrodes or do anything that might hurt them,” Olby said.
When sleeping brain waves were compared with a dog’s cognitive testing, researchers found that dogs with greater dementia spent less time in deep and REM sleep, just as people do. The study was recently published in the journal Frontiers in Veterinary Science.
“Dogs that did worse on our memory tests had levels of REM sleep which were not as deep as they should be,” Olby said. “We found the same when it came to deep sleep.”
While no one knows the exact mechanism at work — either in people or in dogs — research like this study may help scientists better understand the process and find ways to treat it, Olby said.
“There’s a possibility we might be able to identify an early signature of change on the EEG that can tell us, ‘Hey, things are starting to slide.’ Because with a chronic neurodegenerative process, of course we’d love to be able to intervene sooner rather than later.”
In the meantime, there are medications for anxiety and melatonin for sleep that veterinarians can prescribe as a dog ages, Olby said. And as with people, diet and exercise appears to be a factor.
“There’s been some very nice studies showing diets that are enriched in flavonoids and antioxidants and medium-chain fatty acids could possibly slow the development of dementia in dogs,” she said. “It’s just like people — if you can eat a Mediterranean diet and do your exercise, you’re going to do better.”
Doggie dementia is a worrisome reality for many senior dogs. Research has found that by 11 or 12 years of age, 28% of dogs had mild and 10% had severe cognitive impairment. By the time the dogs reached age 15, the risk had risen to 68% for mild and 35% for severe cognitive impairment. A 2022 study found the odds of canine cognitive dysfunction increased by 52% with each year of age, Olby said.
Pet owners can look for signs that their dog’s mental functions are declining. According to Olby, vets use an acronym called DISHA-AL, which stands for disorientation, interaction changes, sleep/wake cycle alterations, house soiling; activity changes (increased or decreased); and anxiety and learning & memory.
“One of the earliest signs is you’ll start to see a little confusion just like you do with people, they suddenly start to make some mistakes and things you wouldn’t expect them to do. Very similar to us,” Olby said.
Dogs may also lose learned behaviors, or forget their house training and begin to have unintentional accidents around the house, she added.
“A classic problem is wandering around and getting lost under the table or something — they just can’t process the information and figure out where they are. Changes in sleep cycle, increased anxiety, all of these things are classic signs of dementia,” she said.
Don’t assume that is what is wrong with your dog, however. Just like in people, other health problems such as metabolic disease, urinary tract infections or even brain tumors can mimic classic signs of dementia.
“High blood pressure can make dogs anxious, for example,” Olby said, “so a vet needs to thoroughly check the dog to rule out disease.”
by tyler | May 17, 2023 | CNN, health
It was a regrettable mistake. But Kim Sylvester thought she was doing the right thing at the time.
Her 80-year-old mother, Harriet Burkel, had fallen at her home in Raleigh, North Carolina, fractured her pelvis and gone to a rehabilitation center to recover. It was only days after the death of Burkel’s husband, 82, who had moved into a memory care facility three years earlier.
With growing distress, Sylvester had watched her mother, who had emphysema and peripheral artery disease, become increasingly frail and isolated. “I would say, ‘Can I help you?’ And my mother would say, ‘No, I can do this myself. I don’t need anything. I can handle it,’ ” Sylvester told me.
Now, Sylvester had a chance to get some more information. She let herself into her mother’s home and went through all the paperwork she could find. “It was a shambles — completely disorganized, bills everywhere,” she said. “It was clear things were out of control.”
Sylvester sprang into action, terminating her mother’s orders for anti-aging supplements, canceling two car warranty insurance policies (Burkel wasn’t driving at that point), ending a yearlong contract for knee injections with a chiropractor and throwing out donation requests from dozens of organizations. When her mother found out, she was furious.
“I was trying to save my mother, but I became someone she couldn’t trust — the enemy,” Sylvester said. “I really messed up.”
Dealing with an older parent who stubbornly resists offers of help isn’t easy. But the solution isn’t to make an older person feel like you’re steamrolling them and taking over their affairs. What’s needed instead are respect, empathy and appreciation of the older person’s autonomy.
“It’s hard when you see an older person making poor choices and decisions. But if that person is cognitively intact, you can’t force them to do what you think they should do,” said Anne Sansevero, president of the board of directors of the Aging Life Care Association, a national organization of care managers who work with older adults and their families. “They have a right to make choices for themselves.”
That doesn’t mean adult children concerned about an older parent should step aside or agree to everything the parent proposes. Rather, a different set of skills is needed.
Cheryl Woodson, an author and retired physician based in the Chicago area, learned this firsthand when her mother — whom Woodson described as a “very powerful” woman — developed mild cognitive impairment. She started getting lost while driving and would buy things she didn’t need, then give them away.
Chastising her mother wasn’t going to work. “You can’t push people like my mother or try to take control,” Woodson said. “You don’t tell them, ‘No, you’re wrong,’ because they changed your diapers and they’ll always be your mom.”
Instead, Woodson learned to appeal to her mother’s pride in being the family matriarch. “Whenever she got upset, I’d ask her, ‘Mother, what year was it that Aunt Terri got married?’ or ‘Mother, I don’t remember how to make macaroni. How much cheese do you put in?’ And she’d forget what she was worked up about, and we’d just go on from there.”
Woodson, author of “To Survive Caregiving: A Daughter’s Experience, a Doctor’s Advice,” also learned to apply a “does it really matter to safety or health?” standard to her mother’s behavior. It helped Woodson let go of her sometimes unreasonable expectations.
One example she related: “My mother used to shake hot sauce on pancakes. It would drive my brother nuts, but she was eating, and that was good.”
“You don’t want to rub their nose into their incapacity,” said Woodson, whose mother died in 2003.
Barry Jacobs, a clinical psychologist and family therapist, sounded similar themes in describing a psychiatrist in his late 70s who didn’t like to bend to authority. After his wife died, the older man stopped shaving and changing his clothes regularly. Though he had diabetes, he didn’t want to see a physician and instead prescribed medicine for himself. Even after several strokes compromised his vision, he insisted on driving.
Jacobs’ take: “You don’t want to go toe-to-toe with someone like this, because you will lose. They’re almost daring you to tell them what to do so they can show you they won’t follow your advice.”
What’s the alternative? “I would employ empathy and appeal to this person’s pride as a basis for handling adversity or change,” Jacobs said. “I might say something along the lines of, ‘I know you don’t want to stop driving and that this will be very painful for you. But I know you have faced difficult, painful changes before and you’ll find your way through this.’ “
“You’re appealing to their ideal self rather than treating them as if they don’t have the right to make their own decisions anymore,” he said. In the older psychiatrist’s case, conflict with his four children was constant, but he eventually stopped driving.
Another strategy that can be useful: “Show up, but do it in a way that’s face-saving,” Jacobs said. Instead of asking your father if you can check in on him, “Go to his house and say, ‘The kids really wanted to see you. I hope you don’t mind.’ Or ‘We made too much food. I hope you don’t mind my bringing it over.’ Or ‘I wanted to stop by. I hope you can give me some advice about this issue that’s on my mind.’ “
This psychiatrist didn’t have any cognitive problems, though he wasn’t as sharp as he used to be. But encroaching cognitive impairment often colors difficult family interactions.
If you think this might be a factor with your parents, instead of trying to persuade them to accept more help at home, try to get them medically evaluated, said Leslie Kernisan, author of “When Your Aging Parent Needs Help: A Geriatrician’s Step-by-Step Guide to Memory Loss, Resistance, Safety Worries, and More.”
“Decreased brain function can affect an older adult’s insight and judgment and ability to understand the risks of certain actions or situations while also making people suspicious and defensive,” she noted.
This doesn’t mean you should give up on talking to an older parent with mild cognitive impairment or early-stage dementia, however. “You always want to give the older adult a chance to weigh in and talk about what’s important to them and their feelings and concerns,” Kernisan said.
“If you frame your suggestions as a way of helping your parent achieve a goal they’ve said was important, they tend to be much more receptive to it,” she said.
A turning point for Sylvester and her mother came when the older woman, who developed dementia, went to a nursing home at the end of 2021. Her mother, who at first didn’t realize the move was permanent, was furious, and Sylvester waited two months before visiting. When she finally walked into Burkel’s room, bearing a Valentine’s Day wreath, Burkel hugged her and said, “I’m so glad to see you,” before pulling away. “But I’m so mad at my other daughter.”
Sylvester, who doesn’t have a sister, responded, “I know, Mom. She meant well, but she didn’t handle things properly.” She learned the value of what she calls a “therapeutic fiblet” from Kernisan, who ran a family caregiver group Sylvester attended between 2019 and 2021.
After that visit, Sylvester saw her mother often, and all was well between the two women up until Burkel’s death. “If something was upsetting my mother, I would just go, ‘Interesting,’ or ‘That’s a thought.’ You have to give yourself time to remember this is not the person you used to know and create the person you need to be your parent, who’s changed so much.”
by tyler | May 15, 2023 | CNN, health
When someone you love dies, the world as you’ve known it is totally upended.
One way people cope, psychologist Sherry Cormier said, is by trying to find some sort of certainty. This need for structure is probably one factor behind the popularity that latched onto the “five stages of grief” over 50 years ago and hasn’t yet let up, said David Kessler, who founded grief.com, a resource aiming to help people deal with uncharted territory related to grief. Kessler coauthored “On Grief and Grieving” with the late Dr. Elisabeth Kübler-Ross.
A Swiss American psychiatrist and pioneer of studies on dying people, Kübler-Ross wrote “On Death and Dying,” the 1969 book in which she proposed the patient-focused, death-adjustment pattern, the “Five Stages of Grief.” Those stages are denial, anger, bargaining, depression and acceptance.
“In the actual book, she talked about more than five stages,” Kessler said. “Think about the context of 1969 — doctors and hospital personnel were not talking about the end-of-life process. … Elisabeth really hoped ‘On Death and Dying’ would start the conversation.”
Since then, there has been extensive media coverage of the five stages; use in television shows including “Grey’s Anatomy” and “House”; clinician support; and criticism. Those five stages are what people clung to, Kessler said.
Grief and psychology experts and academics have criticized the framework for not being thoroughly supported by research, suggesting that the bereaved move through grief sequentially or implying one correct way to grieve. But these suggestions weren’t Kübler-Ross’ intentions, and she stated these caveats on the first page of the book, Kessler said.
While there’s debate among experts about the stages of grief, “people who are in the pain of grief are just saying, ‘Help me,’ ” Kessler said. Here’s what the five stages of grief are, and how you can consider and process them in whichever order you experience them.
In denial there is grace, in that we can’t fully register the total pain, shock and disbelief over our loss in one moment or day, so the pain is spread over time, Kessler said.
While denial in a literal and dysfunctional sense would be trying to convince yourself your loved one isn’t dead, an inability to comprehend the loss for a while is healthy — not something you need to snap out of quickly, he added.
If you’re struggling with overwhelming denial, you can try to stop fighting the reality you’ve been presented with, said Cormier, who is also a bereavement trauma specialist and consultant.
Anger is another natural reaction to loss, whether it’s anger at the cause of death, the deceased, the god of your religion, yourself or the randomness of the universe, Kessler said.
“Anger is pain’s bodyguard. It’s how we express pain,” he said. “That stage gives people permission to be angry in healthy ways, and to know it’s not bad.”
Anger “can be an anchor, giving temporary structure to the nothingness of loss. At first grief feels like being lost at sea: no connection to anything,” according to Kessler’s website. “Then you get angry at someone, maybe a person who didn’t attend the funeral, maybe a person who isn’t around, maybe a person who is different now that your loved one has died. Suddenly you have a structure — your anger toward them.”
Beneath anger can be feelings of hopelessness or powerlessness, Cormier said, sometimes prompting guilt and blame that some people use to maintain an illusion of control or express frustration.
“Our minds would always rather feel guilty than helpless,” Kessler said.
Depending on how your loved one died, one way to overcome guilt- and blame-related anger is by realizing that as horrific as your loss is, it wasn’t personally done to you, Kessler said.
“The reality is the death rate in families is 100%,” he said. “Everyone is going to die eventually, but our minds just can’t fathom that.”
Allow yourself to express anger in healthy ways, Kessler advised, whether it’s “grief yoga,” screaming in your car, using a punching bag, running or other forms of exercise.
Often also stemming from guilt, bargaining after a loss typically involves “if only” statements, focused on regrets about what you did or didn’t do before the person died, Kessler said.
“We may even bargain with the pain. We will do anything not to feel the pain of this loss,” Kessler’s site says. “People often think of the stages as lasting weeks or months. They forget that the stages are responses to feelings that can last for minutes or hours as we flip in and out of one and then another.”
Remember that we live in a world where sometimes bad things happen despite our best efforts, Kessler said.
Depression, or an acute sadness, is when the great loss begins more deeply affecting your life. Maybe the sadness feels as if it will last forever, or you’ve withdrawn from life or are wondering if life is worth living alone.
Sadness hits people at different times, Cormier said. She has known people who aren’t distraught in the first year after loss, but by year three are consumed with sadness. Why? Because for a time, some can maintain the illusion that a loved one is away on vacation and may be returning, she said.
Often, the eventual, deep sadness “is really an expression of, ‘my loved one is gone and not coming back,’” Cormier said.
But those feelings shouldn’t always be labeled as clinical depression, Kessler said. If you think you’re depressed around a death, see a psychiatrist for an evaluation, he advised.
To cope with sadness, you can also seek support from friends, family or grief support groups, and regularly practice self-care, Cormier suggested.
Acceptance doesn’t mean you’re OK with your loved one being gone. “It just means that I now accept the new reality of my life. I’m a widow, I live alone. I don’t have siblings to call up anymore. I don’t have parents to call up anymore,” said Cormier, who wrote “Sweet Sorrow: Finding Enduring Wholeness After Grief and Loss” after losing her husband and immediate family.
Acceptance isn’t grief’s end, either. You might have many little moments of acceptance over time, Kessler said, such as when you plan and attend the funeral.
“One of the questions I get asked most is, ‘When will this grief be over?’” Kessler added. “Very gently, I’ll ask, ‘How long is the person going to be dead? Because if the person is going to be dead for a long time, you’re going to grieve for a long time. It doesn’t mean you will always grieve with pain. To me, the goal of grief work is to eventually remember the person with more love than pain.”
Arriving at acceptance means you’re healing, Cormier said. But if you can’t get there, you need to seek professional help. Intense and persistent grief that causes problems and interferes with everyday functioning, in a way that typical grief doesn’t after some time has passed, is known as prolonged grief disorder, according to the American Psychiatric Association. The disorder was added to the revised Diagnostic and Statistical Manual of Mental Disorders released in March 2022.
To be diagnosed with prolonged grief disorder, a loved one’s death had to have occurred at least a year prior for adults, and at least six months ago for children and adolescents, according to the association, which publishes the DSM. One symptom is difficulty with reintegration, such as pursuing interests or interacting with friends.
Cormier doesn’t think we ever “get over” grief. Our task is different than moving on — it’s learning to integrate the loss into our lives so that we can move forward with a new reality, she added. “It’s sort of offensive to grievers to say, ‘Oh, you’ve really moved on.’ No, I don’t think grievers move on. We move forward.”
After his son died at age 21 nearly five years ago, Kessler wanted something beyond acceptance. He had studied late neurologist, psychiatrist and philosopher Dr. Viktor Frankl’s work on meaning, and wondered how meaning related to grief — which inspired his book “Finding Meaning: The Sixth Stage of Grief.”
Meaning didn’t eliminate Kessler’s pain, but it did cushion it, he said.
Meaning is in what we later do or realize as the bereaved people, Kessler explained. Maybe you recognize the fragility of life, try to change a law or donate money to research so no one dies the way your loved one did, or make a change in your life.
by tyler | May 15, 2023 | CNN, health
Over the past two years, rural Greene County in northeastern Tennessee has collected more than $2.7 million from regional and national settlements with opioid manufacturers and distributors. But instead of helping people harmed by addiction, county officials are finding other ways to spend it.
They have put $2.4 million toward paying off the county’s debt and have directed another $1 million arriving over more than a decade into a capital projects fund. In March, they appropriated $50,000 from that fund to buy a “litter crew vehicle” — a pickup truck to drive inmates to collect trash along county roads.
“It’s astounding,” said Nancy Schneck, a retired nurse who has seen addiction infiltrate the community, where employers avoid drug testing for fear of losing too many employees and mental health crises and homelessness are rampant. She wants to see the money go toward mental health and addiction treatment. Why can’t county leaders “see treating some people and maybe getting them out of this cycle might be advantageous?” she said.
In 2021, the latest year for which comparable data is available, Greene County’s rate of drug overdose deaths topped state and national figures.
But Mayor Kevin Morrison said the county has borne the costs of the opioid epidemic for years: It has funded a beleaguered sheriff’s office, improved the jail — which is packed with people who’ve committed addiction-related crimes — and supported a drug court to divert some people to treatment. It has also suffered indirect costs of the crisis: people dropping out of the workforce due to addiction, schools and welfare services caring for more children who’ve experienced trauma, and some taxpayers leaving the county altogether. Addiction is not the sole reason for Greene County’s economic woes, but it has contributed to more than $30 million of debt.
“We’ve been dealing with this crisis for quite some time, but nobody wants to pay the bill as it comes,” Morrison said. “So when these funds are made available, then we are paying bills that have been due for quite some time.”
The debate in this Appalachian county is reverberating nationwide as state and local governments receive billions of dollars from companies that made, distributed, or sold opioid painkillers, like Johnson & Johnson, Cardinal Health, and CVS. The companies were accused of fueling the overdose epidemic, and the money is meant to remediate that harm. About $3 billion has already landed in state, county, and city coffers, and about $50 billion more is expected in the coming decade and beyond.
States are required to spend at least 85% of the money on opioid-related programs, but KFF Health News’ ongoing investigation into how the cash is used — and misused — shows there is wide interpretation of that standard and little oversight.
That restriction didn’t apply to the money Greene County moved to its capital projects fund.
In many rural communities, which have been struggling to pay addiction-related costs for decades, local officials justify using the settlement funds to reimburse past expenses. Most of Tennessee’s 95 counties are in significant debt, which can present difficult choices about how to use this money, said Robert Pack, co-director of East Tennessee State University’s Addiction Science Center.
Still, he and many advocates hope the settlement funds are spent on tackling the current crisis. After all, more than 200 people nationwide are dying of overdoses each day. Investing in treatment and prevention can save lives and protect future generations, they say.
“There is no good excuse to sit on the funds or put them into a general fund,” said Tricia Christensen, policy director for the nonprofit Community Education Group. The organization is tracking settlement spending across Appalachia, which Christensen called the epidemic’s ground zero. “These dollars should be used to support people who have been most impacted by the overdose crisis.”
Nationally, there has been little oversight of the settlement dollars. President Joe Biden’s administration pledged to ensure the funds went toward tackling the addiction crisis, but has taken little action. Accountability at the state level varies.
In Tennessee, 15% of the state’s opioid settlement funds are controlled by the legislature and another 15% by local governments. Those two buckets have few restrictions.
The other 70% is controlled by an Opioid Abatement Council, which has more rigorous standards. When the council, which must give 35% of its funds to local governments, recently distributed more than $31 million to counties, it required the funds be spent on a list of approved interventions, such as building recovery housing and increasing addiction treatment for uninsured people.
“I can guarantee we’re going to bird-dog” those funds, said Stephen Loyd, chair of the council and a physician in recovery from opioid addiction. If counties use them for unapproved purposes, the counties will not receive future payouts, he said.
Greene County’s reimbursement of its capital projects fund comes from its own pot — the 15% that is controlled entirely by local governments.
In such cases, the public can hold officials accountable, Loyd said. “If you don’t like the way the money is being spent, you have the ability to vote.”
Local leaders are generally not being “nefarious” with these decisions, he said. They make hundreds of budgetary choices a month and simply don’t have experience with addiction or health policy to guide them in using the money.
Loyd and other local experts are trying to fill that gap. He meets with county officials and recommends they speak with their local anti-drug coalitions or hold listening sessions to hear from community members. Pack, from East Tennessee State, urges them to increase access to medications that have proven effective in treating opioid addiction.
Both men point counties to an online recovery ecosystem index, where leaders can see how their area’s resources for recovery compare with those of others.
In Greene County, for example, the index indicates there are no recovery residences and the number of treatment facilities and mental health providers per 100,000 residents is below state and national averages.
“That’s a great place to get started,” Loyd said.
Some Greene County residents want to see opioid settlement funds go to local initiatives that are already operating on the ground. The Greene County Anti-Drug Coalition, for instance, hosts presentations to educate young people and their parents on the risks of drug use. They meet with convenience store owners to reinforce the importance of not selling alcohol, cigarettes, or vaping devices to minors. In the future, the coalition hopes to offer classes on life skills, such as how to budget and make decisions under pressure.
“If we can do prevention work with kids, we can change the trajectory of their lives as adults,” said Wendy Peay, secretary of the anti-drug coalition and executive director of United Way of Greene County.
The coalition has asked the county for settlement funds but has not received any yet.
Nearby in Carter County, a new residential treatment facility is taking shape at the site of a former prison. At least seven counties, cities, and towns in the region have committed a combined $10 million in opioid settlement funds to support it, said Stacy Street, a criminal court judge who came up with the idea. Greene County is among the few local governments that did not contribute.
The facility, which Street said he expects to open this summer, will initially house 45 people for stays of a year or longer. It will be part of the region’s drug recovery court system, in which people with addiction who have committed crimes are diverted to intensive treatment instead of prison.
Currently there are no long-term residential facilities in the area for such patients, Street said. Too often, people in his court receive treatment during the day but return home at night to “the same sandbox, playing with the same sand-mates,” increasing their risk of relapse.
Street said the new facility will not offer medications to treat opioid addiction — the gold standard of medical care — because of security concerns. But some patients may be taken to receive them off campus.
Morrison, the Greene County mayor, said he worried about contributing to the facility because it is a recurring cost and the settlement funds will stop flowing in 2038.
“There’s been great pressure put on local entities like Greene County to try to solve this problem with this limited amount of funding,” he said, when “the federal government, which has the ability to print money to solve these problems, is not in this business.”
The county is still deciding how to spend nearly $334,000 of settlement funds it recently received from the state’s Opioid Abatement Council. Morrison said they’re considering using it for the anti-drug coalition’s education efforts and the county drug court. Given the guidelines from the abatement council, these funds can’t be used to pay old debts.
