Monthly Archives: October 2015

My Grandmother’s Gift

Patchwork Quilt

While cleaning out my attic many years ago, I found a dusty old box marked “special.” It looked like my handwriting, but a much younger redaction. I opened the carton with genuine excitement, having literally forgotten the contents it held.

It was a patchwork quilt, a birthday gift from my grandmother on my twenty-first birthday. There was a card in the box, with an image of a beautiful yellow rose.  I opened the card and the sadness I felt took my breath away.  I couldn’t bear to read her words and closed my tear filled eyes, and tried to remember her, as she was that day.

The memory was so loud, I could actually hear the excitement in her voice as she chattered on in her thick French accent, while I ripped apart the meticulously wrapped package. I could almost smell the sweet aroma of the fresh baked cookies she was making for me that day.

My beloved grandmother, my surrogate mother, was a seamstress. And although we had very little money, I always wore gorgeous and elegant clothes.  We would pour through the pages of the latest fashion magazines and together picked out the most beautiful designs. “This is made for you,” she would proudly exclaim, tearing page after page out of the magazines.  She needed no pattern—every measurement of my body had been devotedly memorized in inches and yards.

She had a job boxing bullets on an assembly line all day—but at night, while others were sleeping, there she was, hunched over her sewing machine, working feverishly to complete something special for me—a dress, coat, suit. Her way of saying “I love you.”

The memories, in flashing snapshots kept coming—one after the other. The sound of her sewing machine, and the gentle humming of her favorite tune. The puppy we picked out when I was five. The clownish self-portrait I painted for her, that she hung so proudly over her bed. The multi-colored sweater coat, I still wear to this day. Her mother’s treasured cameo pin, worn near and dear to my heart. Her fear as she lay dying in my arms.

And now, better late than never, the flashback of the day she proudly presented me with my birthday gift. I struggled to recall my younger self, opening the beautiful card with the single yellow rose and reading the message inside. “A patchwork quilt for your 21 years,” it said.

The quilt was truly magnificent. Handcrafted, full of vibrant colors, large enough for a king size bed.  And yes, I recollected thinking that while I thought it was beautiful, I was slightly disappointed in her choice of gifts. At twenty-one, I was moving around a lot and didn’t even have a bed large enough for this patchwork of remnant material.

Remnant material?

A sharp pain spread across the center of my chest. I frantically pulled the quilt from the musty, old box, laid it on the floor, and caressed the hundreds of squares of material lovingly.  Why, this was no patchwork quilt of remnant material.  This was a pastiche of every dress, suit and article of clothing my grandmother had so laboriously made for me during my first twenty-one years.

A patchwork quilt of me.

The red dotted swiss I wore at a surprise party for my ninth birthday, the hunter green velvet I wore for my sweet sixteen, the lavender satin from my prom dress, the yellow silk jacquard worn on my first job interview.

Overwhelmed, I wrapped myself with her labor of love and cocooned myself in the yards of memories, shivering from the realization of what I had just discovered.

How could I have missed her sentimental intention? How shallow had I been, to think this patchwork of my life was merely remnants of old material?

I cried then for the lost opportunity to embrace her tightly and to express my reverential sense of gratitude to her for preserving my life in this way.

As my tears stained my grandmother’s masterpiece, I spoke out loud, apologizing to my selfless and lonely grandmother for all the time lost, asking her forgiveness for not understanding or appreciating the powerfulness of my heirloom.

Swaddled in my precious gift, still clinging to my birthday card, I was consumed by the heart-wrenching memories that are but a patchwork quilt now.


A Proposal to Solve China’s Gender Imbalance: Share Wives

China Gender Imbalance
Translation: “Marry me!” (Cartoon:

In 2011, I wrote an article for titled “China’s Gender Imbalance” in which I described the possible long-term consequences of China’s one-child policy introduced in 1979.

The result of such draconian family planning? The selective abortion of girls, pressure to abort a pregnancy, and even forced hysterectomies.

I predicted that the large numbers of single Chinese men combined with the scarcity of available women would have future negative ramifications. My forebodings included damage to the mental and physical well-being of men who fail to marry, trafficking of girls to become prostitutes or brides in rural areas, an increase in sexually transmitted diseases, and overall social instability.

The Chinese Academy of Social Science estimates that by 2020, 30 million bachelors will be unable to find a wife in their own country. There are already “bachelor villages,” inhabited primarily by men, scattered across many of China’s poorer regions. The situation has gotten so bad that in some villages men are marrying their first cousins and even their sisters through deals made with relatives. The practice has become so common that some communities are referred to as “incest villages.”

Bottom line is that China’s overpowering preference for boys has put them in a real bind.

In order to negate the ticking bachelor bomb, China has decided to end its decades-long one-child policy. According to a recent statement from the Communist Party, couples will now be allowed to have two children. But that doesn’t solve China’s current  gender imbalance.

I would imagine that the wealthy Chinese man can just buy a spouse. Pay the “bride price” and obtain a wife. She’s chattel, and just another commodity like a car, land, or house.

But what’s a poor Chinese man to do?

Seems that Xie Zuoshi, an economics professor at the Zhejing University of Finance and Economics, has the solution—polyandry. One woman, multiple husbands.

Yes, Xie Zuoshi was quoted as saying poor men who cannot find wives should “bundle up to get one to share between themselves.”

Bundling up? Ew. Like, one husband isn’t enough? Sounds like one dysfunctional mess nest to me.

And why do men continue to prey on the poor, uneducated women?

Because they can.

Ms. New York Senior America–Wait, Me?

Beauty Pageant Winner Brunette
I recently received a call from a colleague asking me if it would be okay if she nominated me as a Ms. New York Senior America contestant.

Me? Ms. New York Senior America? Oh, puleeze.

I mean I’m all for world peace, but this was a stretch, even for me. I wasn’t sure how to respond. So I said nothing. Which is highly unusual for moi.

I guess my pregnant pause caused my colleague to assume that I was interested, or, at the very least mulling it over.

So she enthusiastically jumped right in assuring me that I had an excellent chance of winning because I exemplify what a senior woman is all about. Geez, thanks.

My response was to tell my overly zealous colleague that I was honored she thought of me while simultaneously trying to drum up a way to say NO CHANCE IN HELL diplomatically.

But before I could muster up the words she gushed away: “I’m e-mailing you the information right now. Don’t move.”

A few minutes later I had the lowdown in my e-mail folder.


Hmmm. My competitive self couldn’t help but read on…

The 60 years or older contestants, are judged in 4 categories:

1. The Interview: Private meeting to analyze personality, poise and ability to effectively communicate. Ms. New York Senior America needs to be able to wow the public-at-large as well as the media.

I could like, sooo do that.  

2. The Evening Gown: A runway look-see for judges to establish the presence of elegance, poise, and grace.

No brainer, duh.

3. Life Philosophy: A brief statement limited to 35 seconds.

Hmmm, since I am the queen of verbiage, I like, literally can’t even. But I could try.

4. Talent: Music, the arts, or any other activity appropriate for an elegant, senior woman.

I take this to mean that pole dancing is probably off the table.

Oh and the talent presentation is limited to a maximum of two minutes and 45 seconds.

Since I am basically talentless, this category was the deal breaker. Plus, sorry people, but two minutes and 45 seconds seems like eons.

I responsibly called my colleague back to explain to her that I had no talent whatsoever. I left out the eon part.

“I’m sure you can come up with something,” she cajoled and asked me to get back to her.

Now I’m supposed to get back to her?

Okay, maybe I do have some talent.

Let’s see: I could write a poem or read a snippet from one of my blogs. Snoring.

I could whip out a George Foreman grill and create a killer egg-in-a-hole. But could I debut egg-in-a-hole in 2 minutes 45?

I consulted my husband, who had a brilliant idea: I could take a computer and a screen on stage, and create an Excel pivot table from scratch!

OMG! I got so excited about the genius of his suggestion that I started to imagine all sorts of possibilities and scenarios.

Me, in an interview wowing the judges with my bada bing bada boom.

Me, in a ball gown, strutting and sashaying my creaky self.

Me, and my philosophy and mission of world peace and my game plan for obliterating ISIS in 35 secs.

Me, formulating and titillating the audience with my Excel spreadsheet brilliance.

The more I thought about it, the more invigorated I became. And the more sense it made.

I admittedly give a mean Queen of England wave, and I love to travel.

I could be the face of dignity, glamor, maturity, and inner beauty, to all old people.

I could share my spreadsheet talent with AARP chapters, nursing homes, senior Expos, and the elderly like.

As Ms. New York Senior America 2016, I could be the touchstone for the geriatric masses.

I could be a contender!




Teri Schure, a peppy 62-year-old, grew up on the wrong side of Bridgeport Connecticut, and has been a fairly reputable Long Island resident for the past 32 years. She never graduated from Brevard College in Brevard, North Carolina, and wasted precious time majoring in music theory and minoring in piano. She never obtained a degree of any kind, nor did she earn any certifications. Her passionate and fascinating working career consisted of Excel spreadsheets and calculators. Since she doesn’t have enough money to retire, she continues to eke out a living doing a plethora of grunt work and continues to bust her butt every day to improve her skills.

Since Teri does nothing but slog and toil, she has yet to devote her time and skills to charity, volunteering for various non-profits, or any other causes in her community. Since she is a slave to the almighty dollar, she does not actively support any organizations at all.

Her interests include cleaning the house, paying bills, grocery shopping, laundry, and making sure there is dinner on the table every night.

Since she is still trudging and grinding away, she has no interest in art, dance, horseback riding, gardening, travel, piano, or theater.

Teri is thrilled and honored to be Ms. New York Senior America 2016. She looks forward to proudly promoting a positive image of oldness, while simultaneously extolling the importance of graceful perseverance and acceptance of the inevitable, to all women past their prime.

Her dream is to pageant beyond New York and become Ms. Senior America of 2017.


Bully Bosses–You Know Who You Are


Since it is Freedom from Workplace Bullies Week (October 18-24, 2015), I thought I would blog about those obnoxious, sadistic bully bosses, who would use an elephant gun to shoot a mosquito.

Everyone deserves a safe, healthy workplace, and yet according to the Workplace Bullying Institute, a staggering 35% of the U.S. workforce (approximately 53.5 million Americans) report being bullied at work. And an additional 15% have witnessed workplace bullying, which means that 50% of all Americans have directly experienced bosses who bully.

Unlike schoolyard bullying, the workplace target is not bullied because they are small, weak, shy, or without friends to stand up to their perpetrator. Bully bosses target those who they perceive pose a threat to them. Bosses bully because they are insecure and lack self-confidence and self-esteem.

There is a common perception that bosses who bully see themselves as better than others. But this is a misnomer. Bully bosses target workers who are more successful or brighter than they are. For the most part, targets are more technically skilled than their boss bullies. The targets are more often than not, the seasoned professionals to whom other staff members turn to for guidance because they are patient, empathetic, better liked, and easier to approach.

Targets are likely to have more social skills, are kinder, are better respected, and are more helpful than their bully bosses. Targets are ethical and honest. And unlike their nasty bully bosses, they play by the rules and exhibit exceptional qualities, like a desire to assist, heal, teach, develop and nurture others.

Bully bosses thrive in small companies, which means that if you work for an organization with few employees, your probable only choice is to find another job.

Most bully bosses can’t stand to share credit for the recognition of talent and they often steal credit from skilled targets. Bully bosses abhor those diligent employees who are popular and bring warmth to the workplace. In summary, bully bosses don’t play well with others—just like in the schoolyard.

And how about those wimpy HR people who will confide to you (orally) that your bully boss is a jerk, but there’s nothing they can do about it. After all, it’s not against the law to be a jerk.

Yes, to put it mildly, bosses who bully are jerks. And make no mistake about it HR “experts,” bully bosses can wreak havoc on an organization, and severely hinder a company’s ability to generate a positive and innovative work environment.

Here’s what I’d like to say to all you bully bosses out there:

Your tactics of humiliating, shaming, and embarrassing your subordinates, serve only to expose YOU as the pitiful person you truly are—a coward, ignorant, repulsive, unlikable, and downright detestable.

The only person you embarrass, humiliate and shame is yourself.

Book Marketing Flyer for Dummies

Anyone with Word can create this easy do-it-yourself sell sheet.

As a member of the National Association of Book Entrepreneurs (NABE), my novel Our Romantic Getaway was recently included in their marketing efforts at the 2015 Pacific Northwest Booksellers Show in Portland, Oregon.

As a follow-up, I wanted to send a marketing flyer to all of the potential buyers who visited their booth and/or had expressed interest in my book.

I went online and researched how to put together an effective sell sheet, but was unable to find anything that I could tailor for my personal use. I am a fan of for printing postcards, business cards, and other advertising materials, but they had no templates available that appropriately fit my marketing needs.

So I did a little cut and paste job in Word and voila, I came up with an attractive, cogent marketing tool.

I purchased white 8.5 x 11 card stock (65 lb) and fed the paper through my printer feeder—the front page first, and then placed the completed front page back into the feeder for the back section.

You can download this PDF to see the final product. Our Romantic Getaway Book Flyer

Below is a quick and easy guide to a DIY marketing flyer:

Keep your sell sheet clean and simple. It’s better to include detailed information about a couple of things than to have bits of partial information about a lot of things.

Include a quote, excerpt of a review, blurb, or endorsement from a well-known person or well-respected authority. Including any awards, your book has received will give you credibility as an author.

Flyers with color will almost always stand out from plain black and white flyers. You don’t have to spend a lot of money on the flyer, and if you have a color printer you can print them yourself. If you don’t have a color printer and don’t want to spend the money to have your flyer professionally printed, you can use brightly colored printing paper with bold black text to make sure your flyer stands out.

You don’t want to risk producing a flyer with sub-standard print quality, so while it may be cost-effective to use your own printer, Kinkos, Staples, Office Max, or any similar retail printing establishment can provide affordable flyer printing services. You want your final product to look as professional as possible, so make sure your printer can provide the quality you need.

And don’t forget to make sure your contact information is easy to locate. Offer clear instructions on how to reach you or how to take advantage of your promotion.

If you set up your flyer in Word, your first side should highlight your book cover only. That’s what you’re trying to sell right? The second side of the flyer will include all the other information.

Here is what I included on my flyer:

    • A photo of the book cover (I copied a jpeg of my cover and pasted it into Word)
    • Title of the book (I also placed an award sticker on my front page)
    • Author name
    • Brief description (See my article Write the Perfect Book Blurb for tips)
    • Publisher
    • Category
    • Format
    • ISBN#
    • Pages
    • Retail Price 
    • Contact Information (Mailing address, e-mail, website, blog, telephone)
    • Author Photo (I printed out a photo, using double-sided tape to added it to the flyer)
    • About the Author
    • If you are available for book signing events, add a line saying so
    • A quote, excerpt of a review, blurb, or endorsement from a well-known person or well-respected authority.
    • Relevant PR or marketing plans) (only if you have room)

If you are mailing the flyer, try to call ahead and get the name of the manager. If you don’t know the name of the manager you can address it as “Attention: Book Buyer.”

If you are visiting the local bookstores in your surrounding area, ask to speak to the manager of the store. If the manager is not available, leave the flyer anyway. But make sure to ask for the manager’s name so you can contact or mail them at a later date.

Introduce yourself as a local author, and encourage them to order your book and stock it in their store. Emphasize the fact that you plan on promoting your book extensively in the area and would like to tell people where they can find it for purchase, i.e. recommending their store. You may also decide to leave a copy of your book for their review.

If the bookstore enjoys lots of traffic, etc. and you wish to conduct a book signing there, ask the manager if he or she is interested in hosting a book signing. Most bookstore managers love hosting events, particularly with a local author that will encourage patrons to buy books from their store.

If your flyer is more of a marketing tool for readers, let them know where to purchase your book. If the book is carried by only one or two wholesalers, list them. If handled by a distributor, make sure to include the distributor’s name and 800#.

Sometimes it takes more than one mailing to interest a potential buyer so don’t give up too quickly.  And don’t expect miracles. Marketing is a process. It takes time. Look how long it took you to write your book!

Health Care and Gun Control



April 20, 1999-Columbine High School: 13 dead and 21 wounded

April 16, 2007-Virginia Tech: 32 dead and 17 wounded

July 20, 2012-Aurora Century 16 Theater: 12 dead and 70 wounded

December 14, 2012-Sandy Hook Elementary School: 26 dead

October 1, 2015-Umpqua Community College: 9 dead and 7 wounded


That’s just BS Jeb Bush, aka Mr. Wanna-be-the-President-of-the-United-States. And you know it.

But without the NRA on your side, your political goose is cooked. And after your insensitive and unpresidential comment about “stuff,” I hope your political goose is decimated.

And make no mistake about it: Our elected officials don’t control the NRA. The NRA controls our elected officials.

These officials, whom we voted into office, need to stop kowtowing to the NRA and do something bold and courageous. And we need to put pressure on those officials and force them to effect change and take charge of getting us on the right path. It is up to us to force our elected officials to curb gun violence in America and protect the safety of the public.

I have always felt that we need stricter gun laws. But I also think that our elected officials need to significantly reform our mental health system. Guns and mental health issues are a cataclysmic combination.

And until we as Americans take the necessary steps to ensure that our representatives in Washington, D.C. are looking for solutions, “stuff” is going to continue to happen. BAD STUFF. DEVASTATING STUFF. HEARTBREAKING STUFF.

The U.S. loses 90 people every day from gun violence. And since our elected officials are incapable or plain old afraid to do anything about it, it’s time for the entire country to stand up and take charge.

And sorry to inform you Jeb, your simpleminded opinion that “stuff happens” just doesn’t cut it.

Baa Baa Black Sheep

Black Sheep
Out to dinner with a friend a few weeks ago, she gloomily confided in me that she was the “black sheep” of her family. Her sorrowful declaration raised the hair on my arms and gave me the chilly willies for two reasons:

1. She is beautiful, successful, generous, compassionate, considerate, well-grounded, strong, selfless, and a loving and nurturing mother and wife. The type of woman that anyone would aspire to be.

2. Over the years, I’ve heard this expression more often than I would like to admit. And worse, I’ve heard it used to refer to me. Many times. So many times, that I developed “Black Sheep Syndrome,” if there is such a thing.

So the two of us bitterly asked each other what I have been asking myself for close to fifty years:

Why and how does a child become the black sheep of their family?

When I got home from dinner that night, I looked up the Baa Baa Black Sheep nursery rhyme. Baa Baa Black Sheep is an English poem, dating back to sometime around 1731. But very little is actually known about its origins. While I found several interpretations of the words, there was little to no evidence to support any of them.

I also found several variations of the rhyme, although the one that I prefer is the Mother Goose Melody published sometime in 1765. This version is usually sung to the tune of “Twinkle Twinkle Little Star,” and the “Alphabet Song.” The last couplet is printed as “But none for the little boy who cries in the lane,” as opposed to “One for the little boy who lives down the lane.”

Mother Goose’s version:

Baa, baa, black sheep,
Have you any wool?
Yes, marry, have I,
Three bags full;
One for my master,
One for my dame,
But none for the little boy
Who cries in the lane.

A common interpretation is that the rhyme was against Medieval English taxes on the wool industry.

But I don’t really understand the black sheep part. It doesn’t take a genius to know that white wool is more desirable in the commercial marketplace because it can be dyed any color. Black sheep in a flock, are useless in terms of wool production as it is impossible to dye its fleece. A fleece with even a few black fibers is considered less than desirable.

So if the wool from a black sheep is impossible to dye, rendering it useless, and undesirable, it would be unsaleable, thus no need to tax it at all.

Whatever the reason the rhyme depicts black instead of white, it’s obvious that the undesirable and uselessness of the black sheep is what gives us the term “the black sheep of the family.”

And okay, I can see a sheep farmer who makes a living from wool, considering the black sheep a wastrel. But a family?

Black sheep is a phrase used to describe a pariah, a reject, and a ne’er-do-well, especially within a family unit. Someone who is ostracized and treated differently from the rest. A distasteful outcast, who just doesn’t belong.

Nothing for the little boy who cries in the lane.

Yes, I’m called the black sheep in my family. And I’m finally proud of it.

There I said it. And the best realization and revelation for me is that I actually do feel pride.

And here is my take on the whole “black sheep” defamation:

The family black sheep don’t get picked randomly or by accident. The black sheep are sensitive, unhappy, vulnerable, and usually the outspoken child. The one who refuses to stay silent and just can’t and won’t pretend to be one big happy family.

The designated black sheep is made to carry the hidden blame and shame of relatives who refuse to acknowledge their own flaws and weaknesses.

Toxic and dysfunctional family members tend to project their own jealousies and sense of inferiority onto the shunned and disfavored black sheep.

And even if the black sheep eventually leaves (or is thrown out of) the familial flock, it doesn’t end there. The hated black sheep is more than likely still considered the cause and reason for the family’s difficulties and unhappiness, no matter how much time has passed.

Because the family’s need to place blame and project shame onto the black sheep is the only way, they can live with themselves.
Black Sheep Nursery Photo Cropped

American Express Small Business Saturday Statement Credits Are Canceled for 2015

American Express Cards

The first Small Business Saturday took place on 11/27/10 and American Express encouraged people across the country to support small, local businesses by offering a generous statement credit of $25 off $25. The event was hugely successful, with people coming out in droves to shop and use their Amex cards.

For the past five years, small business owners have relied on the American Express statement credit program on the Saturday after Thanksgiving. The program has helped to counter balance lagging traffic and sales during Black Friday weekend for thousands of small business owners.

My question to Amex: You didn’t think your decision to effectively cancel Small Business Saturday didn’t warrant an announcement on the home page of your Small Business Saturday website?

Shame on American Express for not making sure that small business owners were given a heads up that, for the most part, Small Business Saturday has gone bust.

When I went online today to find out what kind of credit incentive Amex was going to offer for the 2015 Small Business Saturday, I saw nothing on their website. But I did find several articles claiming that an American Express announcement that no statement credits would be offered this year, was buried somewhere in their FAQ section. I looked around on the Amex Small Business Saturday website for quite some time and found no such announcement in their FAQ section or anywhere else.

I ultimately sent an e-mail to Amex directly, asking them if they were in fact canceling statement credits. I received the following e-mail reply back from them:

As in years past, American Express will continue to drive awareness of Small Business Saturday and encourage consumers to shop small through local and national advertising.

This year we are not offering a statement credit offer for Card Members on Small Business Saturday, but are instead increasing the support and resources we provide to help small business owners market the day within their communities and truly make it their own.  Learn about the materials we make available at

  • Customizable marketing materials
  • Free online ads
  • Shop Small merchandise kits (while supplies last)
  • Educational event guides

We are also significantly expanding our grassroots advocacy efforts, such as the Neighborhood Champion program, to facilitate more community events and activities to engage local communities to shop small on Small Business Saturday.

Why would Amex have a Small Business Saturday and not have statement credits? What would motivate people to shop on that day vs. any other day?

Sorry, Amex but your offer to increase support and supply materials isn’t going to bring the store traffic to small businesses that your statement credit program did. It won’t even come close.

The popularity of Black Friday Weekend has lessened in recent years, as e-commerce has completely changed the scope of holiday shopping. And now Amex has decided to quietly cancel their statement credit program?

As the Executive Director of my local Chamber of Commerce, I have seen firsthand how successful stores have been on Small Business Saturday, thanks in large part to the American Express statement credit incentives.

I also witnessed hundreds of shoppers who swarmed the stores that day with loads of Amex cards. And I mean loads—per person. I saw one shopper with at least 50 credit cards. And I witnessed store after store printing out sales receipts that were eight feet long nonstop until they closed at midnight.

A little-known rule regarding American Express cards, is that you can have up to 99 authorized users on any one card—each with their own card, and more importantly, their own individual statement credits.

So I am assuming that American Express was tired of shoppers abusing the program. But they could have easily limited the promotion to one card per person, and that would have been the end of the abuse.

Instead, they canceled the program entirely, with no formal announcement. Not yet, anyway.

Below is a history of incentives going back to the 2010 launch year:

2010: $25 off $25 offer announced on 11/08. Registration opened 11/08. Spending valid 11/27-12/31/10.

2011: $25 off $25 offer announced on 10/06. Registration opened 11/01. Spending valid 11/26/11.

2012: $25 off $25 offer announced on 09/24. Registration opened 11/17. Spending valid 11/24/12.

2013: $10 off $10 offer announced on 10/01. Registration opened 11/24. Spending valid 11/30/13.

2014: $10 off $10 valid 3 times per card announced on 09/27. Registration opened 11/16. Spending valid 11/29/14.

2015:  No formal announcement made yet, that Small Business Saturday statement credits are canceled for 2015.

I get that American Express is trying to cut costs, but in my opinion they should have canceled Small Business Saturday altogether. Let’s get real, without a financial incentive, people won’t pay attention. Wasn’t a financial incentive the whole point of the program?

Incentives or no incentives. At least let small business owners know.

Addiction, Depression, Suicide, Chronic Pain and Their Symbiotic Link


National Suicide Prevention Awareness month came to a close this past Wednesday.

When I sat down to research and blog about the topic earlier this month, I couldn’t write about suicide without also discussing depression, addiction, and chronic pain.

This country has a serious epidemic on our hands and mental health issues need to be addressed year round—not just in September.

While reading this blog, if you think I’ve made a mishmash out of addiction, depression, suicide and chronic pain, it’s because they are all linked and related in so many unfortunate ways. A heartbreaking and devastating mishmash.

Depression and other mood disorders are the number-one risk factor for suicide. Drug abuse and alcohol (with no diagnosis of depression) are a close second.

Suicide is the third leading cause of death among young people with mental health disorders. Statistics show that nearly 40,000 people die from suicide in the United States every year. And suicide also shares a dangerous and undeniable link with the disease of addiction.

According to the National Alliance on Mental Illness, 1 in every 3 people who die from suicide are under the influence of oxycodone, heroin or alcohol. One of the most shocking facts about suicide for me, is that most people who attempt suicide never seek professional help or care.

When a loved one is addicted to drugs or alcohol, the situation creates a life cycle full of anxiety and fear. The possibility of a loved one overdosing, being involved in a serious accident, or suicide, becomes a full-time concern.

Numerous drugs are all-too-commonly, and in my opinion, all-too-too quickly, prescribed by health care practitioners to treat depression, attention deficit hyperactivity disorder, bipolar, anxiety disorders and really, whatever else ails.

Depending on the diagnosis, the prescribed medications can include Xanax, Klonopin, Valium, Seroquel, Ambien, Adderall, Ritalin, and Concerta.

And then there are the commonly prescribed pain relievers associated with conditions such as migraines, musculoskeletal pain, arthritis, sleep deprivation, bodily injuries, surgical procedures and dental work, to name a few. The list of maladies is a long one.

The pain relievers may include Humira, Celebrex, Ambien, Codeine, OxyContin, Vicodin, Roxicodone, Oxecta, Percodan or Percocet. The list of pain killers is also a long one. But make no mistake about it, every malady has its analgesic.

Combine these commonly prescribed medications with insufficient oversight to curb inappropriate prescribing, and it could be a recipe for addiction, depression, suicide, and even chronic pain.

And add into the scenario, addicts who doctor shop for prescription medications, complaining of symptoms that may or may not be real. And doctors that are all-to-willing to prescribe medications for them.

Any one of the examples of medications I mentioned above, alone, or in combination with other drugs, can produce sedation, euphoria, psychosis, depression, suicidal thoughts, joint and other pain, seizures, paranoia, aggressive behavior, addiction, and cardiovascular complications.

The nonmedical misuse and abuse, and the medically prescribed overuse of prescription drugs for depression and other mental health issues is a serious and growing national public health problem in the United States.

Millions of people struggle with depression and contrary to belief they can’t just “get over it.” Yet far too many psychiatrists and other physicians regularly over-prescribe antidepressants and use medication as their first option. This is especially dangerous for children and adolescents. Depression is a leading cause of illness for teenagers. But no matter how old a patient is, medication without weekly psychotherapy is a mere band aid.

The use of antidepressants has increased 400% since 1988, making them the most frequently used drug by those between 18 and 44 years of age. Many are seen in primary care settings and never referred for mental health consultations.

Depression and mental illness are a huge problem and our country is failing those in need of mental health services. So many people out there just can’t get the help they need. Insurance plans are confusing, with spotty mental health care coverage, and many psychologists and psychiatrists don’t even take insurance.

And let’s be honest: Even without insurance worries, mental health care is outrageously pricey and there aren’t enough health care practitioners and professionals to counsel and monitor all of the needy. And there are more out-of-pocket costs associated with mental health conditions than with most other medical conditions.

Over 42 million adults suffer from a mental health problem, with over eight million reporting suicidal thoughts. Over 19 million adults have a substance abuse problem.

Over eight million adults suffer from a mental illness and are uninsured, and one out of every three adults with a mental disability, are unable to see a doctor due to costs.

Additionally, over six million children suffer from an Emotional, Behavioral, or Developmental (EBD) problem, and more than eight percent of youth have attempted suicide. For most youth, symptoms start to present themselves at an early age. When services are provided early, youth are less likely to drop out of school, turn to substances or engage in risky self-injurious behaviors.

Early intervention and screening can help to reduce the negative impact of mental illness for individuals and their families. Yet, so often mental illness is ignored and services aren’t available until an individual proves harmful to him/herself or others.

The United States has a long way to go to adequately address critical mental health care needs. There are too few psychiatrists and psychologists, individuals face huge out-of-pocket costs, and many patients having to wait months for an appointment.

Let me set up two medical scenarios:

Scenario 1: I’ve had a bad earache for a couple of days now, so I can go to an urgent care facility for immediate treatment. Or I can call and make an appointment to see my doctor on an emergency basis, and he will see me asap. Either way, the visit and the prescription will be mostly or completely covered, and I’ll be on the mend in a couple of days.

Scenario 2: I’ve been severely depressed for several months now so I go online to see which professionals are covered on my insurance plan. I then contact all of them to see if they take my insurance (many don’t take insurance at all). Once I find a doctor who either has the time to take me on as a new patient, or takes my insurance, I am warned that the out of pocket expense for the visit is ridiculously high. I decide to make an appointment regardless of the cost, because I’m basically catatonic, but I’m told that I can’t be seen for four weeks. If it’s an emergency, I should go to my local hospital and commit myself into the psychiatric ward.  

Now I’ve heard a lot of negative talk about “Obamacare.“

But here is the truth: The Affordable Care Act makes health insurance coverage more affordable for individuals, families, and small business owners. But more importantly, this health care law includes prevention, early intervention, and treatment of mental and/or substance use disorders as an “essential health benefit” (EHB) that must be covered by health plans that are offered through the Health Insurance Marketplace.

Health insurance plans available in the Marketplace must cover 10 categories of essential health benefits. One of these categories is mental health and substance abuse services. These services include behavioral health treatment, such as psychotherapy and counseling. They also include mental and behavioral health inpatient services and substance use disorder treatment.

Under the Affordable Care Act, most health plans must also cover certain preventative services without a copayment, co-insurance, or deductible. And marketplace plans can’t deny you coverage or charge you more just because you have a pre-existing condition. This includes mental health and substance use disorder conditions. Coverage for treatment of pre-existing conditions begins as soon as your Marketplace coverage starts. There’s no waiting period for coverage of these services.

The war on drugs has now become a war on legal drugs, on patients who take them, and on doctors who so cavalierly prescribe them. According to the U.S. Drug Enforcement Administration (DEA), oxycodone has been abused for more than 30 years. But with the introduction of OxyContin in 1996, there has been a marked escalation of abuse.

Take a look at some of these staggering statistics:

  • According to the National Institute on Drug Abuse (NIDA), approximately 1.1 million people abused prescription medication.
  • NIDA also found that 1 in every 12 high school seniors reported nonmedical use of the prescription pain reliever Vicodin in 2010, and 1 in 20 reported abusing OxyContin, making these medications among the most commonly abused drugs by adolescents.
  • Results from the 2013 National Survey on Drug Use and Health (NSDUH) indicate that approximately 15.3 million people aged 12 or older used prescription drugs non-medically in the past year, and 6.5 million did so in the past month.
  • An estimated 52 million people have used prescription drugs for nonmedical reasons at least once in their lifetimes. Young people are strongly represented in this group.
  • Unintentional overdose deaths involving opioids have quadrupled since 1999 and now outnumber those from heroin and cocaine combined. Use of opioids analgesics exposes users to risks of addiction, abuse and misuse, which can lead to overdose and death.
  • Those who abuse opioids sometimes alter the route of administration by crushing the tablets and swallow or snort them for a fuller effect. Others dilute the tablets in water and injecting them to further intensify the high. Users compare the high to the euphoria of heroin.
  • The abuse of opioids, alone or with alcohol or other drugs, can depress respiration and lead to overdose and subsequent death.
  • Adverse outcomes that may result from prescription drug misuse and abuse can also include falls and fractures, and other seemingly unrelated accidents.
  • According to the 2013 National Survey on Drug Use and Health report, 12.5% of new illegal drug users began with their LEGAL use of prescribed pain relievers.

A friend recently told me that after she had back surgery at the Hospital for Special Surgery in Manhattan, she was given a script for Percocet. She told the health care practitioner she did not need pain medication and thought Advil would be sufficient, but was advised to fill the prescription “just in case.” When her husband brought the bottle home from the pharmacy it contained 100 pills.

I am no medical professional, so I have a question for all you “experts” out there: if my friend took all 100 pills every 4 to 6 hours as prescribed, could she have become addicted? And excuse my ignorance, but what is the difference between becoming addicted vs. dependent to a drug?

And as an aside, no one ever called my friend to check up on her, to make sure she was okay. BTW, all 100 Percocets are still sitting in her medicine cabinet. THROW THEM AWAY GIRLFRIEND.

According to the American Pain Foundation, more than half of the patients who complain of pain to their doctors are depressed. Plus depression can magnify pain. Are they depressed because they are in pain or are they in pain because they are depressed?

Some of the overlaps between depression and chronic pain can be explained by biology. From the research I did, I found that depression and chronic pain share some of the same neurotransmitters—the chemical messengers traveling between nerves. They also share some of the same nerve pathways.

So how can a medical expert know if their patient has chronic pain or depression? And drugs will relieve the pain and/or the depression, but will also help feed a possible addiction.

When I fill out forms for many of my yearly check-ups, I’m always asked about my family history.

As a medical professional, when a patient comes forward with pain, and before prescribing medication, shouldn’t they be asked if they or another family member have a history of alcoholism or addiction?

How does a health care professional know who may have had in the past, or has  an addiction or dependence, and/or is genetically predisposed to addiction? From what I have researched, predisposition can go back three generations.

Addiction, depression, suicide, and chronic pain are not new issues. But the severity and rapid growth of the problem, and the ultimate consequences for us as a Nation, warrants our serious attention.