A strengths-based approach to autism

You hear your spouse breathing nearby and you instantly get angry. Your 6-year-old yawns and it triggers a fight-or-flight reaction in you. You avoid restaurants because you can’t stand the sound of chewing. Sounds other people don’t even seem to notice, drive you up a wall. You might have misophonia.
What is misophonia?

People with misophonia are affected emotionally by common sounds — usually those made by others, and usually ones that other people don’t pay attention to. The examples above (breathing, yawning, or chewing) create a fight-or-flight response that triggers anger and a desire to escape. This disorder is little studied and we don’t know how common it is. It affects some worse than others and can lead to isolation, as people suffering from this condition try to avoid these trigger sounds. People who have misophonia often feel embarrassed and don’t mention it to healthcare providers — and often healthcare providers haven’t heard of it anyway. Nonetheless, it is a real disorder and one that seriously compromises functioning, socializing, and ultimately mental health. Misophonia usually appears around age 12, and likely affects more people than we realize.
What causes misophonia?

New research has started to identify causes for misophonia. A British-based research team studied 20 adults with misophonia and 22 without it. They all rated the unpleasantness of different sounds, including common trigger sounds (eating and breathing), universally disturbing sounds (of babies crying and people screaming), and neutral sounds (such as rain). As expected, persons with misophonia rated the trigger sounds of eating and breathing as highly disturbing while those without it did not. Both groups rated the unpleasantness of babies crying and people screaming about the same, as they did the neutral sounds. This confirmed that the misophonic persons were far more affected by specific trigger sounds, but don’t differ much from others regarding other types of sounds.

The researchers also noted that persons with misophonia showed much greater physiological signs of stress (increased sweat and heart rate) to the trigger sounds of eating and breathing than those without it. No significant difference was found between the groups for the neutral sounds or the disturbing sounds of a baby crying or people screaming.
The brain science of misophonia

The team’s important finding was in a part of the brain that plays a role both in anger and in integrating outside inputs (such as sounds) with inputs from organs such as the heart and lungs: the anterior insular cortex (AIC). Using fMRI scans to measure brain activity, the researchers found that the AIC caused much more activity in other parts of the brain during the trigger sounds for those with misophonia than for the control group. Specifically, the parts of the brain responsible for long-term memories, fear, and other emotions were activated. This makes sense, since people with misophonia have strong emotional reactions to common sounds; more importantly, it demonstrates that these parts of the brain are the ones responsible for the experience of misophonia.

The researchers also used whole-brain MRI scans to map participants’ brains and found that people with misophonia have higher amounts of myelination. Myelin is a fatty substance that wraps around nerve cells in the brain to provide electrical insulation, like the insulation on a wire. It’s not known if the extra myelin is a cause or an effect of misophonia and its triggering of other brain areas.
There is some good news

Misophonia clinics exist throughout the US and elsewhere, and treatments such as auditory distraction (with white noise or headphones) and cognitive behavioral therapy have shown some success in improving functioning. For more information, contact the Misophonia Association. We are in the midst of an unprecedented epidemic, with several million people currently addicted to opiates in the United States, including both prescription drugs and heroin. Much discussion has been devoted to the visible tragedy of overdoses, which are killing dozens of people every day. Less attention has been paid to a more subtle, but damaging and painful, component of this epidemic: how a person suffering from opiate addiction affects his or her family members.
The effects of substance use disorder on loved ones

Substance use disorders (SUDs) are brain diseases that can negatively affect a person’s behavior and fundamentally alter one’s personality. It is not uncommon for people suffering from SUDs to act in a way that is alienating and destructive to their friends and families. For example, a common scenario is theft of property or money to purchase drugs. Families can feel hurt and betrayed by this behavior, especially if they don’t understand that addiction is a disease. Family members can feel lied to, cheated, manipulated, and at times even threatened. With any signs of progress, with each stay in rehab, they become hopeful, only to have their hopes dashed again and again.

What can you do if you have a loved one addicted to opiates? This question has no easy answers, but does have several distinct schools of thought.
The “tough love” approach

A common belief is that a “tough love” approach will help family members avoid enabling the addiction. The thinking is that a family member can make an addiction worse by removing or cushioning the natural consequences of the addicted person’s actions, so that they do not have an incentive to recover. For example, if a person spends all his or her money on drugs, and you give them more money for food, you have enabled their addiction. Otherwise, presumably, they would go hungry, and would start to understand the connection between their drug use and their hunger.

In this example, the tough love approach suggests that the thieving offender be forced to “find their bottom,” or become miserable enough to understand the inescapable need to seek treatment. This response would also serve the purposes of protecting the family’s finances and property and setting up physical and psychological boundaries, so that the members of the family can move on with their lives.

Unfortunately, with our current opiate crisis, “finding your bottom” all too commonly can mean death from overdose, especially with our streets being flooded with fentanyl, a deadly opiate that people often mistakenly buy, looking for heroin.
Plain old love as an approach

Gradually, a more nurturing and supportive approach to substance users is supplanting the tough love approach. This is partly in response to the sheer number of overdose deaths. It is also due in part to the increasing awareness of addiction as a disease that needs to be met with empathy, rather than a moral failing that deserves scorn and punishment. Instead of tough love, people are simply using plain old love to try to coax their family member back into the fold, and hopefully encourage them to seek treatment. Each slip or relapse is met with support and patience, as families increasingly understand the chronic and relapsing nature of addiction. Many believe that this is a safer and more humane way to respond to addiction.

A tenet of 12-step ideology is that addiction is a “disease of isolation,” with its hallmarks being secrecy and disconnection. Therefore it makes sense that human connection would be an important component of treating addiction, and that a strategy of loving engagement might be more effective than one that shuns the sufferer or blames the victim. Through engagement and connection, a lifeline to treatment can be offered.
And about the suffering of family and friends…

It is essential to pay attention to the well-being of the family members themselves during all of this, as having a loved one with a substance use disorder can be profoundly stressful and disruptive, even traumatic. Every situation is different, but certain general principles apply. Psychologically, it is critical to be as open with your social community as you feel comfortable being, and to rely on the support of others. Many people find getting involved in a recovery group such as Al-Anon or Nar-Anon to be invaluable. Sometimes suffering alone can be the worst type of suffering. Family therapists and addiction specialists may also be helpful.

On a practical level, one must protect one’s finances, and you may need to change passwords or secure valuables if theft is an issue. If living with your addicted loved one is just too stressful, alternative living arrangements may be necessary. Some families may need to change their locks. Families must decide whether they truly wish to go deeply into debt to fund a second or third stint at rehab.

One of the most difficult situations that families can face is coping with a loved one who is actively abusing opiates. With our current epidemic, it is becoming distressingly common. This situation is always replete with guilt, shame, and stigma for everyone. A frequently used metaphor (borrowed from airline safety videos, yet commonly employed in recovery centers) is that it is critical that you put on your own oxygen mask before trying to help others do the same, so that you are able to remain functional in order to help. This fully pertains to addiction. We suffer alone, but we recover together. At our son’s 18-month checkup five years ago, our pediatrician expressed concern. Gio wasn’t using any words, and would become so frustrated he would bang his head on the ground. Still, my husband and I were in denial. We dragged our feet. Meanwhile, our son grunted and screamed; people said things. Finally we started therapy with early intervention services.

A few months later, after hundreds of pages of behavior questionnaires for us and hours of testing for Gio, we heard the words: “Your son meets criteria for a diagnosis of autism spectrum disorder…”

Our journey has taken us through several behavioral approaches with many different providers. Today, Gio is doing very well, in an integrated first grade in public school. He can speak, read, write, and play. His speech and syntax can be hard to understand, but we are thrilled that we can communicate with him.
The difference between typical and functional

Longtime autism researcher Laurent Mottron wrote a recent scientific editorial in which he points out that the current approach to treating a child with autism is based on changing them, making them conform, suppressing repetitive behaviors, intervening with any “obsessive” interests. Our family experienced this firsthand. Some of our early behavioral therapists would see Gio lie on the ground to play, his face level with the cars and trucks he was rolling into long rows, and they would tell us, “Make him sit up. No lying down. Let’s rearrange the cars. Tell him, they don’t always have to be in a straight line, Gio!”

To me, this approach seemed rigid. We don’t all have to act in the exact same way. These kids need to function, not robotically imitate “normal.”
Why not leverage difference rather than extinguish it?

We naturally gravitated towards Stanley Greenspan’s “DIR/Floortime” approach, in which therapists and parents follow the child’s lead, using the child’s interests to engage them, and then helping the child to progress and develop.

Mottron’s research supports Greenspan’s approach: study the child to identify his or her areas of interest. The more intense the interest the better, because that’s what the child will find stimulating. Let them fully explore that object or theme (shiny things? purple things? wheels?) because these interests help the developing brain to figure out the world.

Then, use that interest as a means to engage with the child, and help them make more connections. Mottron suggests that parents and teachers get on the same level with the child and engage in a similar activity — be it rolling cars and trucks, or lining them up. When the child is comfortable, add in something more. Maybe, make the cars and trucks talk to each other.

But, don’t pressure the child to join the conversation. Let them be exposed to words, conversations, and songs, without forced social interaction. This is how early language skills can be taught in a non-stressful way, acknowledging and aligning with the autistic brain. The ongoing relationship and engagement will foster communication.

Basically, what both Greenspan and Mottron are advocating are methods of teaching autistic children to relate, adapt, and function in the world, without “forcing the autism out of them.”

The concept of accepting autistic kids as they are, and incorporating the natural ways they think into educational and therapeutic techniques, feels right to me. Gio is different from most kids, and really, he’s not interested in most kids. Our attempts to push him to participate in “fun” group activities like soccer, Easter egg hunts, and birthday parties have all been spectacular failures. Maybe the real failure was ours: by pushing him to “fit in,” we deny his true nature. Yes, the way he thinks is sometimes mysterious to us, but he clearly has great strengths: a remarkable ability to focus and persevere, to experiment with his ideas, and to follow his vision.

World-renowned autism expert and animal rights activist Temple Grandin (who is herself autistic, and very open about her preference for animal rather than human companionship!) sums up Mottron’s approach perfectly: “The focus should be on teaching people with autism to adapt to the social world around them while still retaining the essence of who they are, including their autism.”

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Why Does My Diet Not Work?

As a teenager, you may have had constant problems with acne breakouts which had a negative effect on your self-esteem and confidence. Once these hormonally charged years are over and you have found an effective way to reduce the chances of acne flare-ups or recurrences, you may still feel the impact of this skin issue. This is because the scars, spots, and other marks of the acne flare-ups you once had are still noticeable on your face or other parts of your body.

As such, dermatological experts say that curing the condition of acne or preventing their appearance is not enough; acne scars need to be taken care of also so that you won't have to face this problem as well.

For people who are still grappling with acne breakouts and want to minimize and prevent the occurrence of acne scars, below are some useful tips to keep in mind:

Apply Aloe Vera. Aloe Vera sap can be used to treat various conditions including red pimples, burns, and wounds. It is also a natural moisturizer that can help rejuvenate your skin. Applying Aloe Vera sap can effectively hasten the healing process of your acne scars. Simply apply the sap directly on the scars.

Use cold compress. Ice cubes, in particular, will soothe your inflamed skin and reduce the redness. Wrap an ice cube with a clean piece of cloth and hold this right against your acne scars for at least two minutes.

Apply raw honey on acne or pimples. Honey has been effective in treating acne and red pimples. It is a safe, organic antibacterial natural product that can reduce inflammation and soothe the skin at the same time. To get the best results, use raw honey to minimize or get rid of acne scars.

Put lemon juice solution on the affected areas. Lemon juice has bleaching properties and can help to lighten the scars. For the solution, take some fresh lemon juice and combine it with an equal amount of water. Apply this solution directly on these scars. Leave the lemon juice on the scars for about 20 minutes before removing or cleansing it off. Moisturize your skin after washing the juice off to avoid dryness.

Apply cortisone cream. Lastly, if you're looking for an over-the-counter product that can help you minimize and avoid acne scars, start with cortisone creams. This type of cream can help reduce inflammation and at the same time, promote speedy healing of the scars. To make sure that you will buy the right product, particularly one that is safe for your skin, consult your doctor or dermatologist first.
Sunlight is the body's main supply of Vitamin D which is necessary for strong bones and teeth. Vitamin D is in almost every tissue so it is important for the health of the whole body. However, 50% of people over 50 have low levels of this vitamin which is not present in many of our foods. Studies have shown that a lack of it can lead to diabetes, depression, heart disease, hip fractures, muscle spasm and multiple sclerosis.

If we don't get enough Vitamin D our cells can multiply too fast and grow to become malignant tumours increasing risk of breast, colon, prostate, ovary, oesophagus and lymphatic cancers. Lack of vitamin D can also interfere with insulin secretion so it could affect diabetes sufferers It was found in 'Archives of General Psychiatry' that deficiencies lead to depression because it affects the tiny parathyroid glands behind the thyroid and they become overactive producing to much of a hormone which is often associated with depression.

Other studies at Emory University show a link with Parkinson's with patients having more than twice the lowest levels of Vitamin D in their blood. Whilst another study showed that lack of Vitamin D could lead to hip fractures in post-menopausal women due to a deficiency making it harder to absorb calcium and maintaining bone density as well as keeping the muscles strong. It is also believed to play a role in MS, muscle pains and even some types of kidney disease. Studies show the older you get the more you need.

As important it is to get some sun, we still need to cover up and limit sun exposure of 15 to 20 minutes on unprotected skin, at least twice a week is a good idea. You can check if you are deficient in Vitamin D through a blood test just like we test for cholesterol or glucose.

Food wise best sources are salmon, mackerel, eggs, cod liver oil, and milk or dairy foods but avoid dairy if you have sinus or susceptibility to colds and flu. Supplements are also available to help you get Vitamin D into the body and are available at the health food store but this is not as good as a dose of good old sunshine.

Many scientists believe too much sun will cause skin cancer but Marianne Berwick, head of the Epidemiology and Cancer Prevention Program at the University of New Mexico in Albuquerque says that: "Sunscreen is probably effective against a type of skin cancer called squamous cell carcinoma, but there's little evidence that it prevents another type called basal cell carcinoma." There are no data showing that sunscreen protects against malignant melanoma, the most dangerous type of skin cancer.

There are tests being done on how good sunscreen protects against ultraviolet light UVA and UVB, however to be safe I would limit your time in the sun and still wear protective clothing. Also confine yourself to early morning or late afternoon sun. Generally, try to balance your sun exposure and you should do alright.
The provision of health care services is an important proviso in every society and the nation at large. It is against this background that every government in an attempt to safeguard the life of its citizenry ensures that health care services are readily available. What would become of a society or nation with a population of ill health? What becomes of the productive manpower?

There are dire consequences for a nation that relegates healthcare delivery to the background. Productivity is not only affected but such a society or nation stands a greater probability of extinction since mortality rate will increase astronomically.

The people of Afram Plains [an agrarian community] have not been left out of the share of this national cake-health care services. There are hospitals, clinics and CHPS compounds in almost every major town in this part of the countryside.

But what has become of the culture of healthcare delivery by healthcare professionals in these hospitals, clinics and CHPS compounds in Afram Plains? I have been propelled to write this article when I visited the Presbyterian health centre at Tease, the district capital of Afram Plains south constituency.

The fact is incontrovertible and I will not mince with words-the healthcare delivery system at Tease Presbyterian Health Centre is next to nothing, and nothing good to write home about. This is a health centre where human dignity has been rendered as absolute trash. Disrespect for clients has climbed onto a legendary status. I do not intend to, by this article mention any names but want to clearly state my position on the actions and inactions of healthcare professionals at this healthcare centre.

Oh but let me first ask "is healthcare delivery a right or privilege" Well your guess may be as good as mine. Don't these healthcare workers know that "a sound mind lives in a healthy body"?

Let me quickly give you a routine about the wack health delivery system here. This is a true account of what I witnessed when I visited the healthcare centre.

"A parent brings in her sick child at about 10:06 am, pulse and temperature is checked within a matter of five minutes. The sick child is then taken to the lab for test. The laboratory technician after picking the blood sample leaves his post/room [with the lab office opened] only to return after an hour and thirty minutes to attend to a now queuing clients who have gone through the initial stages of pulse and temperature checks. [ Had the microscope been stolen after his return what would be his story to tell?] He then hands the lab report to the parent of the sick child thirty minutes after his return. This sick child is then taken to the consulting room to see the one and only supposed Doctor who reported to work at about 10:30 am. They spend about 10 minutes in the consulting room after which drugs were prescribed to be taken at the dispensary for a fee. At the dispensary again, another drama unfolds. The dispensary attendants are on break enjoying their meals to the full glare of clients. They therefore ask the parent of the sick child to wait patiently while they do justice to their food. And they spent well over 40 minutes on their meal."

All these dramatic scenes are showcased at this health centre without any one to supervise what goes in and out of this health centre. Oh perhaps it's for the government and we all know what government workers do at their places of work. I bet you can't pretend you knoweth not.

Clearly give a picturesque view of the incident. Now assuming without admitting that this sick child is in an emergency and needs urgent medical treatment what would have become of the situation? For the child to die and cry foul afterwards. In fact, the welfare of clients is not at the heart of these so called health professionals. Another mind boggling drama I witnessed was how these officials were moving to and fro from one office to the other and discussing issues best known to them whilst clients were suffering in long queues in wait of treatment.

While I wouldn't like to be seen as overly critical, it is equally important that some of these healthcare workers are cautioned with immediate effect to desist from their "I don't care" attitude displayed at their place of work. The insatiable appetite by health care workers to humiliate and embarrass clients is something way out of health care practice.

It beats my wildest imagination why people dressed in white, green and white, brown etc. mandated to provided health care delivery to the people treat clients as if they are doing them a great service. Aren't they paid for services they render?

The earlier an effortful attempt is geared towards redeeming the image of this healthcare centre, the better it would be for all of us. It has attracted a bad name for itself for far too long.
1. Finding The Right Match

Finding the right place for your medical needs is much like finding the right primary care doctor. Feeling comfortable with your physician is a critical step in choosing the right Maui Urgent Care Center. Before you walk in the door, call and ask if you can speak to an available physician. Ask him or her questions about how they handle medical conditions such as, do they take a more traditional approach, or do they recommend alternative treatment options? Once you feel comfortable with their style of care, you'll feel more confident that you're choosing the right medical provider. In addition to the style of care, you should also ask how long your physician has lived in Hawaii. The islands are home to very unique organisms that visitors can find themselves allergic to, including flowers like protea, foods such as poi, and marine life like Potters Angel fish and sea fan coral. These rare flora and fauna only exist here or in just a few remote areas in the world, so visitors are unlikely to have had any previous contact with them. That's why a local physician who understands what to look for and the right questions to ask is crucial to making the right diagnosis so you can get better faster, and back to enjoying your vacation.

2. Accessibility

Maui, and in particular the east side of the island, has many remote areas that are popular visitor destinations but far from the commercial hubs where most urgent care centers are located. For instance, if you were staying at the Travaasa Hotel in Hana, Maui, and needed to visit your nearest urgent care clinic, you'd have drive 4-5 hours to get there, which would result in you missing an entire day of your vacation in paradise. In many cases finding a Maui-based urgent care center that offers telemedicine visits is the best option for accessing medical care. Having the ability to see your Hawai'i-licensed physician from your computer, tablet, or mobile device can save you time and help you quickly decide whether you need to make a trip into the nearest urgent care center or hospital. In most instances, your doctor can fax or call in a prescription to the nearest pharmacy saving you hours of travel time.

3. Affordability

When searching for the right urgent care center in Maui it's important to ask about payment and coverage options. Many urgent care centers offer only local insurance including HMA, UHA, HMMA or Kaiser Your Choice coverage that can result in a higher out-of-pocket cost for visitors. Calling and asking about coverage before you show up can save you time and money. No insurance? Don't worry, most walk-in clinics offer a rate for people without insurance -- but you'll want to know up front what those costs are so you can make the most informed healthcare decision.

4. Ask The Experts

Your hotel or timeshare concierge provides a great place to start your urgent care search. They deal with hundreds of visitors and are very familiar the activities that can result in injuries for the under or unprepared, like ocean dives, surf schools, and day hikes in more rugged areas. Consequently, they have relationships with the closest urgent care centers. As soon as you determine that you need care, make your concierge the first stop on your journey to feeling better.

5. Dig Deeper

Once you have a few walk-in care locations in mind, go online and read about experiences other visitors have had. Check sites like Yelp, Google Places, Facebook and the urgent care centers' websites for customer testimonials and star ratings. Picking a location that has good reviews and clinic pictures will help reduce your anxiety, make a more informed healthcare decision, and result in a better overall medical care experience.

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