healthcare

practicing mindfulness

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It’s also helpful to realize that this very body that we have, that’s sitting right here right now… with its aches and it pleasures… is exactly what we need to be fully human, fully awake, fully alive.
Ok, maybe it’s also important to have food, clothing, and a roof over our heads for many of us to be fully human, fully awake, and fully alive. Let’s not let that small point take us away from the brilliance of this quote.

What’s so brilliant about it? For reason particularly driven by subtle messages from the media driven into our forming minds, we are a culture driven by a need for “more” in order to feel alive or happy. For other reasons we are also a culture driven to try and eradicate discomfort. Both of these messages are partly driven by business trying to make a buck and spending billions of dollars are marketing to drive this into our minds.
The price?

A constant feeling of dis-ease within us. We’re can’t be content with where we are in any particular moment because our minds are either trying to flee away from some discomfort or toward some comfort.

Pema Chodron is simply trying to remind us that aches and pleasures are part of the human experience. There may not be a catastrophe when a pain is there, it may just be part of being “fully alive.” There may not be a need to get the wheels anxiety or distress to be set in motion. Of course, if you are under extreme distress or have an inkling that something is off physically, it’s important to get it checked out by a medical professional.

However, next time you’re feeling physical or emotional pain, know that this is temporary and say to yourself, “maybe this is exactly what I need to be fully human, fully awake, fully alive.” See if you can bring your attention to it with a sense of compassion and caring. Next time you are feeling pleasure, also know that this is temporary and part of being fully alive… reposted from monday’s mindful quote
wow- what a very uncomfortable week this has been. i started feeling a sort of gurgling discomfort in my sinuses on monday and stayed in bed for 3 days with a fever and runny nose missing both my day job, but also cancelling on a catering gig which did leave a hole in my monthly budget.  when i spoke with my doctor’s office, i was informed that they recommended that i let the infection run its course and would be offered antibiotics after 10 days or so. i felt betrayed by this news which is ironic because i rarely take any meds (, aspirin, cough syrup, cold pills other than my hiv and psych meds for any reason. however i have had a sinus infection a few times before and have found that to be something that i am susceptible to and very weakened by for some reason. back in the late 80’s, my sinuses swelled onto the surface of my forehead giving me a cyclops sort of presentation that caused me to scream when i saw my reflection in the mirror. even that time, i didn’t take medication, i used steam and vapo-rub for about 4 hours. luckily, the channelling of a lon chaney type creature vanished with not much residual affect other than that gorilla i saw in the mirror. 
anyway, a couple of years ago i had another infection and it went on ad nauseum. i couldn’t shake the fever and the nose might as well have been training for a triathlon. the only relief came very late in the game in the form of amoxocillin. and this week i found myself wanting that same order and with the response from my caregivers that i didn’t qualify, my sense of balance seemed to waft away like the scent of a freshly baked pie flows out of the kitchen. 
i had to pull myself up from my bootstraps and visit them in person and plead my case- with several sales pitches in tow. “i can’t lay around for days doing nothing”- ” i feel like i am being punished for being healthy” ” i don’t really want to use up a week’s pto with a crappy fever and box of kleenex. somehow i got my way. 
what also became apparent was that the mercury-in-retrograde stage directions had been put into place. my car wouldn’t start, my dishwasher ran some sort of leak, the order of snacks for my group didn’t get placed, the meal i planned to pick up for another group didn’t get handled because of the car. in spite of all these mishaps ( quite plentiful for one  day) were also met with an answer from my life which caused no real trauma other than to my sense of balance. the early groups survived with no doughnuts- the second group had no attendees so i disappointed no one directly- my friend loaned me a car for a week, and nothing seems damaged by water all over the floor. 
with all the blows to my plans for my life this week, there also has been a net that showed up to catch me from any imminent fall. in other words, i didn’t crumble or suffer- other than in my own mind. actually my life protected me – even from me.

that’s the good news. and it is good. the other side of the story is that i have not been on my best behavior nor in my best frame of mind. i have wallowed in a little pity, played a bit of the victim, been a bit gamey and childish,  and worked it more than i would like to admit.  being human is really damn humbling…

am offering 2 selections with today’s post- 1 with homage to the mindful part of myself and the other with a nod to the diva that walks the catwalk inside my head with repetition…. mercury in retrograde leaves november 10- fingers crossed we make it without too much more destruction and re-creation..the title of this post is practicing mindfulness – the emphasis is on practicing.

ROSC- Recovery Oriented Systems of Care

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c’est moi at African American Health Fair Denver
The following  information was cut and pasted from the SAMHSA website. It is the up-to-date information regarding healthcare reform with regard to substance abuse and mental health treatment. This particular information is of particular interest to me because I work in these fields. And these issues intersect in my life every day in many ways. I believe (through and through) that these issues are worth spending my days around. Some people I know and some people I care about have struggles with these issues that swallow up their lives. So the idea of equal access to treatment is almost worth the national debt. 
But along with parity comes the idea that treatment for both mental health and substance abuse have a mandate to improve their efficacy to coincide with their accessibility. In their current state, these treatment modalities offer stigma, uncertainty, an extremely low percentage of successful outcomes, options that are designed for the providers benefit and not the recipients- i.e. 28 day in-patient- 90 day outpatient- etc,  the focus of substance abuse and mental health will need to expand from treatment to recovery/resilience if it is to be taken seriously. As science moves us forward in understanding, it reveals to us that the brain effects caused by substance and chemical imbalance are lifetime issues for the majority of us and we need to look towards caring for those issues with longterm solutions. Recovery-Oriented Systems of Care are the options that the movers and shakers are looking towards. We might have much better outcomes when we start to treat the whole person for the whole of their lives. ps- if you are inteterested in recovery i recommend you start reading the work of william white at www.williamwhitepapers.com



On October 3rd, 2008, the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 was signed into law. This new Federal law requires group health insurance plans (those with more than 50 insured employees) that offer coverage for mental illness and substance use disorders to provide those benefits in no more restrictive way than all other medical and surgical procedures covered by the plan. The Mental Health Parity and Addiction Equity Act does not require group health plans to cover mental health (MH) and substance use disorder (SUD) benefits but, when plans do cover these benefits, MH and SUD benefits must be covered at levels that are no lower and with treatment limitations that are no more restrictive than would be the case for the other medical and surgical benefits offered by the plan.

The Mental Health Parity and Addiction Equity Act:
Eliminates the practice of unequal health treatment. This practice has kept individuals with untreated substance use and mental health disorders from receiving critically important treatment services. Providing parity provides insurance coverage for substance use and mental health disorders equally to other chronic health conditions like diabetes, asthma, and hypertension.

Improves access to much needed mental health and substance use disorder treatment services through more equitable coverage. Millions of Americans with mental health (MH) and/or substance use disorders (SUD) fail to receive the treatment they need to get and stay well. The lack of health insurance coverage for MH and SUD treatment has contributed to a large gap in treatment services. Improving coverage of MH and SUD services will help more people get the care they need.

Recovery-Oriented Systems of Care (ROSC) is a coordinated network of community-based services and supports that is person-centered and builds on the strengths and resilience of individuals, families, and communities to achieve abstinence and improved health, wellness, and quality of life for those with or at risk of alcohol and drug problems. SAMHSA/CSAT
Note: Prevention Services also play a major role in developing ROSC.
ROSC will require developing supports and services that provide self-directed approaches which respect the role of personal choice and commitment in pursuit of health and wellness. Developing a ROSC also requires helpinging engage people and families in support networks in their communities, to ease their integration back into the community and get their lives back on track. Linking people to services and supports helps sustain long-term recovery. The services and supports may include resources such as:
  • recovery centers in your community;
  • recovery activities and websites;
  • peer support;
  • mutual help groups;
  • faith based supports;
  • housing;
  • transportation;
  • education and vocational;
  • mental health services;
  • medical care, including HIV Services;
  • financial and budget counseling;
  • legal, and advocacy services;
  • alcohol/drug and gambling services;
  • prevention for children and adolescents; and
  • parenting and family services.
Developing a Recovery Oriented System of Care that is built on the strengths and resilience of individuals, families and communities who are actively taking responsibility for their health and wellness drives the continued efforts to build a foundation for recovery in our future .


Summer Newsletter 2011

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Surprisingly, the TEN (Treatment Education Network) newsletter is still going strong. We are halfway through our 4th year and the content gets stronger. I still think it important for PLWH in Colorado to have visible proof that other people live with HIV and lead positive and happy, healthy lives-especially in rural Colorado. It must feel so isolating to be among so few. This was the initial purpose for the creation of this publication- to reassure all the readers that indeed there are everyday folks who have moved past the stun and the stigma and have gone on with their lives.

The 30th anniversary of HIV in America is probably a good time to reflect on all that has changed. If you know someone who may be challenged by their situation, please forward this to them. Maybe it will make a difference. In honor of my own 26 years of knowingly living with HIV, I am posting  a vid of Carol Burnett singing Stephen Sondheim’s “I’m Still Here”. MWAH!

TEN Newsletter Summer 2011(function() { var scribd = document.createElement(“script”); scribd.type = “text/javascript”; scribd.async = true; scribd.src = “http://www.scribd.com/javascripts/embed_code/inject.js”; var s = document.getElementsByTagName(“script”)[0]; s.parentNode.insertBefore(scribd, s); })();

how to save a life

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Step one you say we need to talk
He walks you say sit down it’s just a talk
He smiles politely back at you
You stare politely right on through
Some sort of window to your right
As he goes left and you stay right
Between the lines of fear and blame
And you begin to wonder why you came

Strength Over Speed Colorado

our team has been piecing together some ideas for a newer direction for the hiv positive patients who are (or are struggling with) dealing with substance abuse issues and healthcare adherence lapses. there are several factors which are closely related to many of these individuals challenges.  trauma, stigma, depression, aging, sexual dysfunction, isolation, self-esteem, mental health are the first of many to come to mind.

most of the patients i see live below the poverty level. some by design, but most reside in this strata because this is all they know. insurance is not an issue as it is not a choice. luckily in colorado, there is a state program which is designed to give access to healthcare to every coloradan. so much of the basic and intricate healthcare issues and hiv care issues can be met. but honestly, many of these individuals don’t care about healthcare or hiv care. the avoidance of these as well as avoiding as many of their feelings beyond numb creates a perfect environment for drug and alcohol use to morph into abuse almost invisibly- at least to them. it’s quite a different story to the world around them as out of balance seems quite evident.

one thing that seems to be a reality in our city is that  a sense of community and camaraderie in the world of alcohol and drugs exists and beckons. the bars- especially gay bars are community oriented and geared towards fun while you use. music, emcees, shows, drag shows, comedy, dancing, are all at our fingertips as we begin to cement our relationship with drugs and alcohol. the concept of fun is interlaced with use and as we all know it does feel good to get high. it’s moderation which becomes the issue, or maybe the lack of it.

so when people are conceptualizing themselves changing their use, or stopping their use, the idea of fun and festivity becomes a major factor. “life will be dull without the party” accompanies a belief that there will never be joy in their lives again if they stop using. seems pretty reasonable to me. felt that way myself actually. and if you think about it, the image of sobriety pales with regard to fun-loving. as a matter of fact, even though i believe that being sober has brought an unbelievable sense of calm and peace to my life, i don’t even think my using friends think of me as being very much fun. conversely, i would imagine they see me as a buzz kill.

anyway, we are trying to put together a visual and approachable set of peers who have gone through the changes involved in giving up drug use and drinking and have become conduits of joy. i know that i am much happier than i was before 9/29/04, and if you sit an chat with me for a while, i think you’ll believe it and feel it, and i know it is true of many, many others too! this is the subliminal message we want to disseminate. i am currently looking to seattle’s strength over speed  for some inspiration. that grassroots effort has been in development for a few years and i believe they have affected lives. they mix together men who have stopped using meth with men who are actively using- some of those reformed are involved with 12-step and some are not. this encounter, no doubt, allows people weighing their options to see that life can easily continue successfully without the armor of substance protecting us.

the next offering is a workbook-driven curriculum for meth users that is evidence-based and hails from the Matrix Institute of CA. i worked with a version of it previously when i helped develop a program called  the “mile high meth project” for another agency. the matrix has its strengths and weaknesses, but the structure works well and it is designed to engage user’s right brain in order to address the left. coming down off meth creates so much emotionality, that any process that can grab their attention is worth its weight in gold. this is not specifically for gay men. this is much more universal. this is also not poz-only. it’s not as if people discriminate when they are actively using, and i am trusting that same acceptance tendency can bring educational opportunities as well as personal growth and self-acceptance.

this layer will hopefully work as we extend our efforts here beyond gay men. in colorado, poz persons who are not gay men struggle with isolation and stigma even more intensely. there is a small sense if community among these subsets, but it is not cohesive. at least not at our workplace. thus far, we have started a drop in group for the gay poz patients and it seems to be making an imprint. this week heralds its 1-year anniversary, and i believe we have had almost 100 persons through our doors. and our substance treatment numbers for that population have quadrupled with the onset of this effort. and the work continues.

of course, what we are working towards includes helping people find their way to healthcare adherence and retention. the science has been available for some time to keep this virus manageable and undetectable. the costly and debilitating problems that unaddressed hiv infection brings can be greatly minimized by adherence. honestly, i have seen about 15 persons pass this year and most of them would be categorized in the aforementioned. i know that what i am working towards is how to save a life.

keep your fingers crossed… oh… and, can you see my heart smile?

of course the fray are from colorado turf. their stunning debut album seemed to almost usher in the latest indie music boon that we are now in the midst. i heard an interview with lead singer isaac as he talked about visiting a mountainside drug and alcohol recovery camp for youth and was inspired to write these lyrics. appropriate…. local…… lovely..

and in the mix

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i was up late last night trying to send over some change for the next newsletter. i definitely am excited about this one. many articles by poz women who have traditionally stayed pretty quiet in these parts. and women feel stigmatized just as much (if not more) than any of the men. sexually transmitted viruses somehow have a moral connotation that accompanies them.

i have started the new position at the hospital. i find i am much busier and i like it. i have meetings today around the standards of care for substance abuse within the ryan white system. i am cheering silently that a friend who is back in the throes of IV meth use will go to rehab. i have asked my sponsor and one of my bffs to go to the lunch next weekend for the afr presentation. i am headed to grand lake next thursday for the weekend. and i have been approved to go to chicago in october for the opiate replacement conference- aatod.  i will get to see some old friends and remember once again who i am becoming.

life seems to be opening up. there are many stories running at the same time. i am smiling. the current metaphor for my life may just be the rose of sharon bushes i planted in front of the house. they are small but in full bloom with flouncy purple blossoms caressing the breeze. they remind me of the change that is always in proces in my life and the world around.